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Showing posts from 2007

This message can be for all anthropologists who are thinking about occupational therapy

I have often stated that the inter-activity generated as a result of this blog is endlessly entertaining to me. I just received this wonderful note about my statement on the blog that reads "This product is sold by weight, and not by volume" :

Hi Chris

Is that a little witticism referring to Gregory Bateson and his little metalogue on knowledge “How much do you know”? I’m soon to graduate with a BA in Anthropology. I’m thinking of pursuing a MS in OT I have a very holisitic view of communication and life; they are one and the same in my book. Do you have any advice or recommendations? I’m very interested in communication theory from bio-semiotic-cybernetic perspective. Hope to hear from you soon.+++++++++++++++++++++++++++++++++++++++++
And my response... (slightly edited)
Thank you for your note – although I chuckled at your question and then started thinking about the act of deconstructing my own writing, and then got all tripped up on subject-object perception about what goes…

Intervention for adults who have sensory processing disorders

I received this email today, and I thought it was a great question:

I am an adult who has Sensory Integration problems that were diagnosed three years ago. I also have central auditory processing disorder and was recently diagnosed with Asperger's. I have had some OT in the past for the SI difficulties, and was wondering if you knew of services for adults with these problems.

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Sensory integration refers to an 'unseen' process that has not yet been clinically defined - people have suggested that it may be a neurochemical problem, or perhaps a neuromigrational problem, or perhaps something else entirely. However, occupational therapists are claiming that it is SOMETHING that has to do with neurological processing - a lot of current research is looking at sympathetic and parasympathetic sensory processing of information.

There are also some occupational therapists who claim that the prevalence of SPD can be as high as 5% (in the 'norm…

the genesis of class warfare

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When we see people who need occupational therapy they have to be understood in more than organic terms. That may seem obvious to some but I know it is not obvious to all. I know that it is not obvious to all because so much of clinical practice looks like it is oriented toward the organic or biological level.

People are more than the sum of their parts, of course - and that is why I find it so important to let my anthropologist out for a walk.

I was reviewing these 'field notes' from some time I spent teaching at a college - and I wondered how different the intervention plans would be if they both came to an occupational therapy clinic with similar injuries or needs:

Penny and Natalie are moving in two different directions. I watched their trajectories intersect for a couple months and it provided a lot material to think about.

Let me start by saying that they don't even know each other. But they are the same age - having both just turned 21. Natalie will graduate in a year …

on botany and telling the truth

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I got email from a parent today asking me how to answer some difficult questions from her son. I told her that it was ok for parents to 'make up a story' for the short term if the real issue at question was too developmentally complex for the child to comprehend. Parents have a lifetime to be honest with their children, and sometimes it is ok to hold the truth for just a little while. The truth is hard for children to understand, sometimes.

I admit that I have a long history of 'telling stories' to children. I do this for fun, and to sometimes promote a fantastic world to them. The world is so much more fun when it is also fantastic. So although I 'stretch' the truth I also know that you reap what you sow (in so many ways). I know this intuitively.

This is something that I always keep in mind, hopefully in the forefront, as I go about the daily tasks associated with raising and also in working with young children. But inevitably, kids ask difficult questions and …

ABC Therapeutics pictures

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As promised, here are a few pictures of our new space... this is the desk I am currently sitting at and making this entry. It belongs to the receptionist but I have temporarily taken over until I get my own office out of boxes.












This is one of the gross motor areas. Phase II of our building project will add an additional gross motor gym, as well as an outdoor play area and bike path. With over an acre to develop we are having a lot of fun developing ideas!






















We especially love the interior design that makes it feel so open and fun for swings!


























Here is Danielle Green, a Level II student from Quinnipiac College, working with one of our friends in the fine motor treatment area!
















...and of course we always have time for fun at ABC Therapeutics! Here is a nice picture of our two Halloween ladybugs!

Sensory issues are not really that confusing, if we would only stop confusing them ourselves

People are easily confused whenever someone talks about sensory integration or sensory processing, mostly because of confusing messages that are sent by occupational therapists regarding these issues.

Confusion is evident in the public but it is also interesting evident among occupational therapists and researchers as well. There have been some recent efforts to address this confusion by initiating conversation about 'fidelity' in sensory integration research. This means that when someone claims that a study is about sensory integration that it REALLY is about sensory integration. I encourage people to look at the Sensory Integration Global Network website; it has a lot of good information that helps to clearly define the concept of sensory integration.

However, it is also important to understand that sensory integration research is not equivalent to occupational therapy research. Evidence supporting or refuting a sensory integration approach is NOT the same as evidence sup…

Is Brain Gym Effective?

I frequently get email from people asking me about Brain Gym, so I thought I would post one of the emails here. Identifying details have been changed but the letter is essentially intact as written:


Dear Chris,

My son is 11 years old and in the 6th grade. He has Neurofibromatosis Type 1 which is a neurological disorder that affects his entire nervous system. He has Apraxia of Speech, ADHD, auditory processing issues and learning disabilities. We took him for a speech eval and they suggested sensory integration therapy. This summer, based on recommendations from our speech therapist who is GREAT and one of the few people who have actually been trained to treat Apraxia, we began OT with couple of therapists who do sensory integration therapy and are very much into Brain Gym.

I’m really starting to question whether Brain Gym is effective for us. We’ve only gone a couple of months, but I really don’t see any improvements. My child is social, independent and making progress…he is in a mainstr…

Time and occupational therapy

Autumn is a point of change. A transition from green to gold. Certain things happen in Autumn; they are the same each year. Thoreau said that 'Time is but the stream I go a-fishing in.' I think that as occupational therapists we need to remember to consider how important time is, and how it is the grounded substance that we all function within.

Things look different when you see the time that they are occuring within.

Today, as I was driving through the winding backroads of the rural countryside on my way to home visits, the world was rotating through time.

Of course it rotates every day, but today the rotation was palpable. I noticed a school bus in back of me and two young children holding purple flowers on the side of the road, peeking around the hedges to see if the bus was coming. It was something that had happened a thousand times before - not just by these children today but by their parents before them. And their children will do the same. They will be running out of fron…

Diana Henry visits ABC Therapeutics

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ABC Therapeutics staff took a break from beginning of the year activities of scheduling, working with children, and even unpacking boxes in the new office to visit with Diana Henry. Diana is in town to present her "Sensory Tools for Pre-Teens & Teens workshop" at the NYSOTA conference. She will also be presenting on the Sensory Processing Measure.
We had a wonderful visit with Diana and her husband Rick. We were all excited to hear their stories and she gave us some wonderful ideas about organizing our new clinic space!From left to right in this photo: Marjorie Deschner, MS, OTR; Grace Kelley, MS, OTR; Diana Henry, MS, OTR; Lucy Pencille, MS, OTR; and Caroline Alterio, COTA, ROH. Somewhat hidden is Jean Luc Pencille, but I wouldn't want to neglect mentioning him!

Exciting changes on the horizon for ABC Therapeutics

I have neglected this poor blog lately, despite my intentions to write more. I apologize to all my fine readers who have sent me emails asking if my computer has died... ;)

My current activity configuration involves project management on a 'Flip this House' magnitude. We purchased a new building that required some substantial renovations, but now we are ready to move at the end of this month.

Soon I hope to have some pictures to post of our new 'home.' Stay tuned - I am hip deep in boxes and packing material, paint and drywall, building inspectors and certificates of occupancy.

Change is on the horizon!

thoughts about teaching clinical reasoning

Teaching someone a skill is not necessarily a difficult thing. Skills are concrete, task-like, discrete, and relatively well defined.

I have always tried to avoid teaching my students skills because it is my opinion that they need so much more than skill (although sadly they clamor for skills more than they clamor for background knowledge and understanding).

Instead, I try to help my students develop some degree of critical reasoning, problem solving ability, analytical capability, and appreciation. I believe that these attributes will carry them farther than will the mere acquisition of skills.

This is a stretch for many of my students - these demands take them places where they have not really been challenged before. As a result I notice that their confidence is dramatically decreased when they are taken beyond the stages of rote memorization. Because certitude is important I do not accept questions when I have asked them for answers. "Are you asking me or are you telling me?"…

Plato's response to the state of 'certificates' and 'certification' for sensory integration

I received my "certification" to administer and interpret the Sensory Integration and Praxis Tests in 1992. I believe that the test battery was published in 1989 so it was still fairly new at the time I was certified. At that time there was a certification examination that you had to pass. I don't know how psychometrically sound the SII program was - but they claimed that it was a certification program. SII never wanted me to 'recertify' though - which is a little scary.

In the past twenty years the Sensory Integration and Praxis Tests have not been updated and there are no new norms. I have never heard of an occupational therapist talking about the Flynn Effect or heterosis so I don't know if anyone believed that there is a useful lifespan of an assessment tool. Some OTs still use the old Bruininks-Oseretsky test that has 25 year old norms - they just got around to updating those norms recently but I still see a lot of reports with the old test given. Persona…

Sensory Integration in NY Science Times

I was surprised to see an article in the NY Times (Science Times) on sensory integration on 6/5/2007. I grew up being addicted to the Science Times section of that paper so I have some long term positive bias for anything that appears in that section of the paper - even though I don't particularly like the NY Times in general any longer.

So I have some bias, because I am like Virginia O'Hanlon reading something that Frank Church wrote just for me... but the article on sensory integration was relatively even handed so I was pleased. I am a critic of the current state of research for sensory integration so I was happy to see the anecdotal reports of parents and the interesting research that people like Patti Davies are doing on neurophysiological underpinnings of sensory processing all in the same article.

The research funding problem is also described well. This is an article that will be good for the general public and for other researchers and professionals to read and consider…

Spring is supposed to be green, not blue...

My apologies for the prolonged absence - and thank you for all the emails wondering if I was still alive!

I began my private practice 7 years ago with the mission/intent to put myself out of business. At that time I was getting phone calls and requests from families to assist them with their IEP process. It seemed that a lot of the difficulties were in communication between educational teams and families - something that could be easily remedied. Since there is a prescribed 'rulebook' on how the process needs to be conducted I believed that helping families learn the rules would enable them to become better team players who could advocate for their children appropriately.

Fast forward 7 years and now I am helping both families and school districts with the rulebook - but the solutions remain elusive. More families who are dissatisfied with their IEP process find me each year. Sometimes the families need to adjust their approach. Sometimes the districts need to adjust their appro…

Update of therapeutic listening

As promised, I wanted to review some of the articles in the current (March/April 2007) issue of the American Journal of Occupational Therapy. Since I have gotten some emails and blog comments asking me about the Hall & Case-Smith study (see reference below) I thought that this would be a good article to begin discussing.

I was excited to see a study on this intervention technique because I have been hesitant in the past to fully embrace 'therapeutic listening.' In my opinion there is not adequate evidence to support promoting this technique so I was interested to see if this new study would change my mind.

I believe that the authors should be commended for initiating this inquiry, but I also believe that their conclusions are far overstated. There are several fundamental flaws in their design that are concerning.

To begin with, they used a convenience sample. This might have been appropriate if the study was truly exploratory, but there have been several other studies already…

Tying some loose ends

About a year ago I posted about the use of passive tactile sensory stimulation and the lack of evidence that we have about the technique. You can find more discussion on this topic by typing in "Wilbarger" as a search term in this blog or by going to this link.

In any event, I wanted to update a statement that I made last year that reads: While surfing around tonight I think I found a potential source of very useful information - and I think we might be able to thank Ruth Segal..." Dr. Segal did publish her article "Integration and application of a home treatment program: A study of parents and occupational therapists" (Segal & Beyer, 2006). This is an excellent article for all pediatric therapists to read. It reviews in detail the perspective of parents regarding home programs and the disconnect that sometimes occurs between the therapist's thinking and reality of normal family lifestyle. This article isn't directly assessing the effectiveness of a…

another apparent failure

I wrote this four years ago, and since I am recording stories with different endings I thought this would be another scenario that deserves to be dusted off and posted here.

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Camille called me tonight, somewhat frantic, with an obvious need to tell me some news about her daughter.

Camille is an overprotective mom and grandmother who has been disapproving of her daughter's choices. However, as she is ultimately interested in her daughter's well being (and the associated well-being of her grandchild) she mostly keeps her mouth shut for fear of alienating her daughter.

About two months ago Camille had to be hospitalized for gall bladder surgery, and that left all the caregiving responsibilities of the new grandchild to Karen, her daughter, as it should be. Because it had been my job to go to their home and help educate the family on caregiving for this disabled child, I was trying to split my time between Camille and Karen. As I said though, since the surgery I have been spendin…

Not every story has a successful ending

On most days people appreciate the things I do, which is a positive reinforcement for me to continue with those tasks that keep my private practice running. However, the reality is that sometimes people don't appreciate or understand what you are doing, even if you take the time to explain. Today seems to be the right day to talk about an experience I had when someone was not able to appreciate my efforts.

Collin’s mom is single or divorced – I am not sure which. She has two children by two different fellows, neither of whom believes that their presence is important in the lives of the children. The mom does not work outside of the home; her primary role is as a parent.

Their apartment is in a blue-collar town outside of a large metropolitan area. The town is famous for its chemical dumps and environmental toxins. I do not know if it means anything, but I cannot listen to AM radio in their neighborhood – there is just too much RF interference from the high-tension electricity lines.…

Best treatment options for autism

In a recent comment a reader asked my opinion about the best treatment options for autism. This is inherently a loaded topic because there are so many people who have aligned themselves with particular treatment approaches. Also, there are some people who have experienced significant improvement with a single approach.

I form my opinion on this question based on twenty years of clinical experience working with children and families. I don't believe that there is a single approach that works for everyone. Also, just because something works for someone at some point in time has not been an indicator that it will work for everyone else at countless other moments in time.

From an evidence-based perspective it seems that behavioral approaches have the best research to support their efficacy. However, behavioral approaches are not unitary and the concept of 'efficacy' needs to be clearly defined. Certainly, there is no overwhelming evidence that any behavioral approaches will cure…

The perils of mediocrity and the pursuit of a Centennial Vision

By definition, mediocrity implies ordinary or unremarkable quality. For occupational therapy to achieve the centennial vision that is proposed by AOTA I believe that the profession needs to move far beyond mediocrity.

This week I experienced mediocrity in occupational therapy and in educational systems - it was concerning, so I wanted to share it here.

A parent asked me to attend a meeting at school in preparation for a CSE meeting. The parent was informed that occupational therapy services would be discontinued for her daughter. I won't even argue the child's needs here - but rather will point out the process by which this determination was made.

The child has an IEP but there are no statements on the IEP that indicate her present levels of performance as they relate to her occupational therapy needs or her academic functioning. There are also no goals on the IEP that relate to any needs that might be typically associated with occupational therapy as a related service. Still, th…

Occupational therapy and cones

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If a cone fell on the floor, what is the chance that it would land ‘standing up' on its base??

I wonder this because a family member had a total hip replacement and is receiving occupational therapy in a short term rehabilitation facility. In OT they are teaching her how to pick up objects that have fallen on the floor. That seems like a reasonable point of intervention to me: it is important that people avoid placing undue stress on a new hip joint and I am sure that the OT does not want her to bend excessively.

Why, though, does my family member have to pick up cones?

I know a little about cones, more from my experience with geometry than from my experience as an occupational therapist. A cone is a three dimensional geometric shape. It is the locus of all line segments between a base and a point outside the plane. I know that the base of a cone can be any shape as long as it connects to an apex at any point outside the plane of the base. As far as I know there is nothing in her hom…

Cultural awareness and occupational therapy

Here is an excellent email question I got from a gentleman in India who is considering a career change and would like to practice OT in an English-speaking country.

My question is: Even if I got good command over English, would indigenous people prefer a foreign therapist and would I be able enough to know their problems?

I had this exact same question when I was completing my fieldwork in a mental health setting in an inner-city environment. I grew up in a suburban mostly middle-class world and when I came into my new worksite I looked around and could not recognize the culture around me.

I understood that poverty existed in the world, but I had not seen people trying to get admitted into the psychiatric unit until the monthly governmental check came.

I understood that some people were on drugs, and I had even seen some of my friends try drugs, but I never saw anyone needing to be strapped down to a gurney after a bad PCP trip because they thought that they could see the devil if they lo…

Sensory integration: warning to parents and insurance companies

In a recent entry I talked about the issues of pseudoscience and the problems with sensory integration theory from an academic and theory-based perspective. Today I got an email from a parent that illustrates the problem from the street:

QUESTION:

My child has just been diagnosed with sensory integration difficulties. I must admit the evaluation results are scary and seem overwhelming. I can only imagine what my child is feeling.

I am very anxious to get my child help. We had my child tested at A PROMINENT AND WELL KNOWN SENSORY INTEGRATION CLINIC (name redacted). They are excellent - but the treatment is very expensive and not covered by insurance.

Do you have any experience with how to get the insurance company to make an exception?

It has been recommended that we get 1 hour of weekly therapy for about 18 months and if possible a 3 week summer camp. The hourly sessions cost $165.00

Your response would be appreciated.

Thank you
NAME REDACTED

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Insurance companies se…

Is a doctoral degree necessary for entry level Occupational Therapy practice?

I entered my profession in 1987 and at that time a bachelor’s degree was required to practice as an occupational therapist. At the American Occupational Therapy Association's Annual Conference in 1999, the Representative Assembly passed Resolution J, mandating post-baccalaureate education for entry into the profession.

I still have not seen any study that indicates that baccalaureate-trained professionals are in any way less effective than people who enter the profession at the master’s level. The marketplace also never acknowledged the alleged benefit of the master’s degree, as people with advanced credentials did not make any more money than people with bachelor’s degrees.

I summarize from this set of facts that the move to post-baccalaureate education served the needs of educational institutions who were able to get more tuition from students who were trying to enter the profession. Students stay in school longer and educational institutions benefit by collecting more tuition. I …

pseudoscience and sensory integration theory

Pseudoscience is defined by characteristics including the use of vague, exaggerated or untestable claims, over-reliance on confirmation rather than refutation, lack of openness to testing by other experts, lack of progress, and personalization of issues (see Wikipedia article which is a nice summary). As the article notes, however, it is important to distinguish protoscience with pseudoscience.

At this point in time, 35 years after Jean Ayres wrote Sensory Integration and Learning Disorders, I am willing to consider that this concept of sensory integration theory is no longer 'nascent' and that we have not made appropriate progress toward researching and validating the theory as it is now constituted. For perspective, in 1972 when that book was published, the first hand-held calculator was marketed. Has science not moved forward since that time?

This is not to say that children don't have learning problems, or that they don't have problems in processing sensory informati…

another look at child passenger safety

Earlier this week Consumer Reports reported on the performance of certain child restraints in side impact crashes. That generated a few calls and emails to me from concerned parents.

Now I see that they are retracting the article because of new data they are considering. It seems that the crash velocities used in the Consumer Reports testing far exceeded the 35-38 mph standard that is typically used. Go check out their retraction statement HERE.

I like to highlight this information because any pediatric OTs out there who have young children on their caseloads should be sharing this information with parents. When parents hear about these reports they begin to lose confidence in their car seats - it is critical that parents continue to place their children in their car seats.

This is particularly true for parents of children who have disabilities. Many of these parents already lack confidence in child restraints. Traditional child restraint devices do not address the unique positioning nee…

answers to questions

(I intended to post this over a week ago; life got in the way).

Here are some recent questions that I will answer here:


Hi Chris, I'm an occupational therapist working in a child development clinic in Israel. I am looking into the validity of the Wilbarger brushing technique. I've come across very little that validates the intervention. I thought I read on your blog some sort of critique of the lack of evidence. It might have been on a different blog, but would appreciate your feedback nonetheless especially after reading your thoughts on evidence based practice. Thanks and have a happy new year!-dena


Hi Dena!

Happy New Year to you too! I have blogged about the Wilbarger protocol here (http://abctherapeutics.blogspot.com/2006/04/wilbarger-approach-how-patient-should.html). Nothing has really changed since I wrote that last April. There has been nothing new published that I have seen.

People use the search terms ‘Wilbarger protocol’ frequently, based on hits to this blog. I believe …