Tuesday, May 27, 2008

Occupational therapy and the macabre!

This is a blog entry for Halloween, but I just couldn't wait.

My daughter was recently assigned some Edgar Allan Poe to read - and I immediately assumed it would be one of his most famous poems or short stories. I was surprised to find that she was assigned one of his more esoteric stories which of course caused me to launch into a lecture on the state of education today, blah blah blah - you know, the kind of story that makes teenage daughters roll their eyes.

I told her that additionally it was important to read 'classic' Poe and referred her to "The Raven" and "Annabel Lee" and "The Tell Tale Heart" and "The Fall of the House of Usher." Then I thought I better read them all again myself so I can talk to her about what I just asked her to read. It had been years since I picked up Edgar Allan Poe...

I found quite the surprise while reading these old Poe classics! Mandatory reading assignment for today is "The Fall of the House of Usher." Written in 1839, it talks about occupations and sensory processing disorder - all mixed in with a Gothic twist. What a treat!

Let me know what you think!

file under: surprising finds

Thursday, May 22, 2008

Need a project for your occupational therapy master's or doctoral degree?

I don't have time to do it all by myself - I wish I did. Some days the ideas come flying out of my brain so fast I don't know what to do with them.

Anyway, my idea of the day is for someone to complete a qualitative study of occupational therapy student's occupations.

What could make this interesting? Use Twitter. Bring Mihaly Csikszentmihalyi's data collection methods into the 21st century!

So anyone who is interested can email me proposal ideas they are willing to share - I will create a network of interested people via discussion group, and we can establish recruitment and data parameters and create a really large dataset of daily occupational therapy student occupations.

It is a learning tool and a way for us to explore how to use technology for data collection. Maybe someday the model can be applied to other populations, but for now I have a working assumption that a fair number of OT students are Twittering.

Or if you are an educator and want to try this as a class project I am happy to share some ideas.

email me at chris@abctherapeutics.com

Fun!

Background reading:

Twitter.com

Csikszentmihalyi, M. & Larson, R. (1984). Being Adolescent. New York: Basic Books.

Friday, May 09, 2008

Measurement issues in pediatric occupational therapy

We talk here a lot about evidence based practice, the need for better science in our assessments and intervention, and professional responsibility to make sure all these things happen. On a daily basis we work toward a better 'science' of occupational therapy while at the same time maintaining a close connection to our 'art.' After all, we are often talking about our connections with real people and how we can best offer help.

I feel that we are making some changes in the way we think about these issues in our profession, because I hear more and more people talking about real participation and our goals of assuming or resuming normal occupational behaviors. I've been thinking about this topic all week, and now I am kicking myself twice for not going to the national conference this year. Through the grapevine I am hearing about Dr. Wendy Coster's Slagle lecture and how she talked about measurement issues. I wish I was able to hear her lecture now. Instead, I have to wait for the AJOT article...

Anyway, I ran across a little newspaper article in an Australian paper that caught my eye - it seems to encapsulate the issues I am referencing here. I don't know that we can norm the number of birthday parties that kids participate in, but I wonder if we can develop data about degrees of social participation that contribute to culturally-accepted quality of life measures. That's an awful tall order - but maybe we can get there someday. We will be better occupational therapists when we do.

Monday, May 05, 2008

a response from WFOT

I received a response from WFOT regarding an email I sent them about a banner ad on their website. Here is their response:

From: World Federation of Occupational Therapists [mailto:admin@wfot.org.au]
Sent: 03 May 2008 17:25
To: 'chris@abctherapeutics.com'
Cc: Marilyn Pattison
Subject: WFOT: For Info: banner ads on WFOT website


Dear Dr. Alterio

Many thanks for your letter and the concerns you raise.

I would like to draw to your attention to the following statement on the WFOT website:

Placement of advertising either on the WFOT website or in the Bulletin does not imply any endorsement of the advertised products and / or services by the World Federation of Occupational Therapists.

Based on this I would suggest your criticism of WFOT is somewhat unjustified and your disappointment misplaced. WFOT is staffed by volunteers and the organisation depends upon donations, individual membership and revenue from products and advertising to fund its international activities. The placement of a banner ad serves as a sponsored link to another site so it is, I assume, the content of the other site that you object to. If this is the case then I would suggest you take it up with Schoodles directly.

I would also draw your attention to the fact that the WFOT site also has a tabbed link (non sponsored) to OT Evidence.

Please let me know if you require further clarification.

Kind regards

Marilyn Pattison
Registered Occupational Therapist
Dip.C.O.T.(UK), B.App.Sc.(OT), MBA

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I responded to their response:

Dear Marilyn,

Thanks for your response.

I am aware of the WFOT statement about not endorsing advertisors - but I still fail to understand why WFOT would accept advertisements from a company that sells a product that some occupational therapy professionals might object to.

There are always a diversity of opinions on any given topic - and then a corresponding opportunity for dialogue. I believe that a discussion about evidence-based practice is legitimate and comment or opinion about products that might not meet those standards that many occupational therapists embrace is not misplaced.

In fact, the presence of the WFOT section on evidence based practice is what caused me to voice my concerns. It is difficult to understand why WFOT would promote evidence based practice on one hand and take advertising money for that product with the other hand.

Anyway, that is just my opinion. WFOT is your organization and you all are certainly very free to do whatever you want. I just wanted to share my opinion.

Regards,

Christopher J. Alterio, Dr.OT, OTR

Saturday, May 03, 2008

new sensory research for children who have autism

Below is a feed I picked off of ScienceDaily - reporting on a study that was presented at the recent AOTA conference. I wish that more information was available - and I was unable to attend conference this year.

I'll have to reserve most of my comments because I just need more information. I am encouraged by the apparent rigor of a double blind design - but wondering if they just used the Sensory Profile as a pre-post measurement. I'll try to find out and post more...

Here is the newsfeed:

Autistic Mannerisms Reduced By Sensory Treatment

ScienceDaily (2008-04-27) -- Children with autistic spectrum disorders who underwent sensory integration therapy exhibited fewer autistic mannerisms compared to children who received standard treatments. Such mannerisms, including repetitive hand movements or actions, making noises, jumping or having highly restricted interests, often interfere with paying attention and learning. ...; read full article

Thursday, May 01, 2008

An attack on evidence-based assessment in occupational therapy

In the past I have blogged about evidence based practice so I don't really feel the need to revisit the topic at length. The use of evidence is not a passing fad but rather represents a real shift in the sophistication of our science. This shift was not just restricted to occupational therapy but occupational therapy was caught up in it. That was a good thing.

I am revisiting this tonight because I was visiting the WFOT website and I saw one of their banner ads. The ad was for Schoodles, and the ad said "Changing the way therapists around the world assess children." Kudos to the advertising people at Schoodles because I almost never click on banner ads but I never heard of this assessment tool and was intrigued by the claim.

Perhaps the Schoodles people will be sorry that I clicked because I don't really have anything flattering to say about their statements or philosophy.

This Schoodles product is antithetical to evidence based practice. Although I understand and appreciate the uses of qualitative and informal assessment methods, I was disturbed by the statements made on the website. Here is a sample of what I found that was particularly objectionable:

  1. "Standardized test scores can be valuable, but don't give enough information about classroom problems or starting points for intervention."
  2. "Most of the time occupational therapists don't need numbers and standardized scores to 'qualify' children for services or show continued need. Deciding which children could benefit from our services is really an art, not a science."
  3. "What do I do when teachers and parents want numbers? Give them numbers! You can give approximate age ranges for most of the skills on the tool. Parents typically understand terms such as '1-2 years below age level' much better than 1.5 standard deviations below the mean or 5th%ile. We have found that approximate age ranges satisfy most recipients of our information. You can also draw the focus away from numbers and instead stress classroom function, which is really what we need to look at for any student."

I suppose that their banner ad is correct, and that their assessment system would change the way that therapists assess children. In my opinion, it sets us back around 20 years or so in the sophistication of our assessments. That is a real change - unfortunately, in a negative direction.

The Schoodles approach is unfortunate. Even in the absence of norm-referenced assessments there are many wonderful criterion referenced tools that can be used. Why would anyone abandon these in favor of non-standardized methods???? Even worse, why be so flippant about using standardized methods? If someone asks for numbers the Schoodles people tell us to just 'Give them numbers!' Precision in measurement is not something that is important to the Schoodles people, apparently.

I do not know about the world that the Schoodles people operate in, but in my world school districts want to have norm referenced testing to determine eligibility for services. The same is true for early intervention and preschool services. Insurance companies also like to know where a child is functioning in relationship to a norm or established age criteria.

Most importantly, when parents want to know about the functioning of their children I don't blow smoke at them. Instead, I educate them about what statistics mean.

++++++++++++++++++++++++++++++++++++++

I wouldn't mind if this was marketed as 'an informal functional assessment tool to supplement your standardized measurements.' Instead I am disappointed with the grandiose claim of 'changing the way therapists evaluate children.' I am disappointed with the attack on evidence-based practice. I am disappointed with the flippant perspective on the value of standardized tools.

And IF WFOT has any control over the banner ads on their site, I am kind of wondering who is asleep at the wheel over there. In some ways, that is the most disappointing.