Tuesday, June 30, 2009

School buses and safety belts: Not a simple issue

I was pleased to see the article in the recent OT Practice entitled "School Buses + Safety Belts = Good Idea." (Loveland, 2009). I think it is important for OTs to have a good discussion about ways to promote safety and prevention of child injuries.

There are some additional facts to consider so I wanted to list them here:

1. In the studies cited in the Loveland article, there was an annual average of 17,000 children seen for emergency treatment for school-bus related injuries. However, that number is a little misleading. The study reports that only 42% of those injuries were crash related, so by extrapolation, it is arguable that seat belts would not have made a difference in many of those injuries. In fact, the 17,000 number includes slips and falls outside of the bus, getting on/off the bus, etc (McGeehan, 2006).

2. The National Highway Traffic Safety Administration (NHTSA) reports detailed research on their website about school-transportation related injuries and deaths. School buses remain the safest mode of transportation for children. The actual incidence of injury and death is strikingly low and pales in comparison to data on injuries and deaths from other forms of transportation.

3. Study after study shows that compartmentalization works - but it is true that studies also tend to measure the impact of front impact crashes. There is a reason for this - and that is because there has to be some standard for determining safety. It is not reasonable to study every possible rear and side impact configuration because it is impossible to reliably report the result of those impacts. There are just too many variables - size of other vehicle, point of impact, speed of collision, locations of children related to injury distribution within the bus, and many others. People don't like to say it out loud - but the issue may very well relate to diminishing safety benefit in relation to dollars spent, which leads me to the next point.

4. Of course any child injury or any child fatality is one too many - BUT - if we are going to expend resources (money, time, energy, etc.) into injury prevention will our efforts be better served by focusing on causes where there is a MUCH GREATER NEED and where our efforts will HAVE A GREATER IMPACT on reducing injury and fatality? This is a very difficult conversation, and I expect people might get upset about discussing it this way - but it is just a reality. If we spend millions of dollars to save 20 lives a year, could we have saved hundreds of lives by distributing those resources and efforts in a different direction? This is not to diminish the importance of school bus transportation safety - but rather is an important policy question about allocation of resources.

I have made a few entries on child passenger safety in this blog. I don't have the answer to the question of 'how do we best spend our resources,' but I think it is something that we all have to think deeply about.

Loveland, J (2009, June 29). School buses + safety belts = good idea. OT Practice.

McGeehan J et al. (2006). School bus-related injuries among children and teenagers in the United States, 2001-2003, Pediatrics 118, 1978-1984.

Friday, June 12, 2009

NY Times article is demeaning to elderly people who have Alzheimer's

Here is the offending/offensive article: All-Night Care for Dementia’s Restless Minds

I will be the first one to admit that it gets a little boring to listen to people have complaints about political correctness and terminology - everyone is offended by everything these days... but this article went so far beyond any semblance of acceptability that it has to be pointed out.

I am not criticizing the program - because I have no direct knowledge of what actually happens there. In concept I think that offering night time respite care for caregivers is a great idea. Unfortunately, the authors of this article portrayed the program in a very negative way - and I don't think that they really intended to do so.

Throughout the article the authors repetitively compare elderly program participants to children. For example:

1. The participants were "chattering and giggling like children sneaking out of camp."

2. A caregiver reports relief by stating, "It was like when your baby first sleeps through the night."

3. Another sad comparison about a program participant: "...like a kindergartner acclimating to school she made new friends, and blossomed."

4. Some of the activities presented to the participants do not seem to be age appropriate: "A children's pool with soapy water was set on a table, and a few people sat around it, playing with the suds, squeezing the soft toys."

5. The authors continued the theme of comparing the elderly participants to children, stating that the therapist is like "a really cool counselor at night."

6. There were also several sexual references - among the worst – “the place suddenly felt like a girlish slumber party: Mrs. XXX was talking, again, about men and sex, causing Ms. YYYY to dissolve into giggles.”

It was horrifying to see that the authors actually posted the names of these program participants. Could they provide informed consent?

In my opinion this whole article was simply disgusting. If you are so inclined, please write a letter to the NY Times and tell them that the article was demeaning, inappropriate, and a very poor example of journalism. Elderly people who have Alzheimer's Disease deserve much more dignity and respect than what was written in this article.

Monday, June 08, 2009

How I became an occupational therapist

Or perhaps more appropriately titled: Too much information. Oh well.

I wrote a blog entry once about 'the things I do.' It has been lost to time - I am not sure where I have the entry stored but I recall that it received many comments and sparked a lot of conversations about the issues of time and time spent - and how one comes to the decisions about the things they do. That entry is decidedly more serious than this one. So, I am not trying to recreate the original - but couldn't think of a more appropriate title for this entry. Maybe I will look for the original sometime.

Today is a hard work day. I am not questioning why I am an occupational therapist but sometimes when I have hard work days I reflect back on what I thought I wanted to do when I grew up.

I took a Strong-Campbell Interest Inventory in high school, and it said that my career interests were matched to a speech therapist, a college professor, and an actor. The fourth match was 'occupational therapist' but I never noticed that until I went back and looked at the document years later. The career that I was supposedly most poorly matched to was 'agricultural business manager.' I remember that because for years after taking that test I would respond to "What are you going to college for?" with "I really want to be an agricultural business manager." There are probably people out there who believed me and thought that is what I really wanted to do. The truth is that when I was in high school I thought that interest inventories were stupid and I was mostly interested in my girlfriend, hockey, and Rush.

My own career development came through a combination of interest and happenstance. In elementary school I wanted to be a football player. I don't know what I was thinking. I am not very good at football. If I was a football player, people would be able to say, "Wow, he is not very good, but he really tries hard."

In middle school I wanted to be a marine biologist (now somehow demeaned by that Seinfeld episode, oh well). It was never anything more than a fantasy, really. I used to be so excited when National Geographic was sponsoring another Jacques Cousteau special. I wanted to ride on Calypso and learn how to dive... When I used to keep aquariums I don't think anyone knew that my love of marine life was carried through from my childhood. I have never eaten fish in my life, except fish-sticks once or twice when forced to as a child - it has always seemed sacrilegious to me. I remembering reading that a new kind of squid was discovered and that it can grow to over 24 feet in length - and I didn't have anyone to talk to about that. Most people just think I hate fish, and I don't bother to correct them.

In high school I had a lot of ideas about how I wanted to spend my life. First I wanted to be a veterinarian. I read all of the Herriot books and I even got a job in an animal hospital. I loved the lab work and the anatomy and the pharmacology - the science appealed to my sense of order. But now I understand that what originally caught my fancy was Herriot's ability to connect with people. If I was a veterinarian, I would want people to say, "I love the way he handles my pet. It makes me think that he really cares about me too."

In high school I also wanted to be a stage actor. I was in all the plays in high school and also have done some community theater. I always loved the task of immersing myself into a character and experiencing those affective shifts so intensely while playing. Over time, I found out that people were dramatic and histrionic in real life which is always difficult for me to manage, and I stopped enjoying it as much. I don't do well with dramatic people, and now I find my participation in theater rather ironic.

Between high school and college I wanted to be a geneticist. Oddly, some of the coolest things I have done in my life involved fruit flies (drosophila). In my first college biology course I got to mate winged with wingless fruit flies, and I had to count the wingless offspring to see if the Punnett Square models of gene expression were true (and determine the genetic heritage of the parents). In a different class I got to remove the salivary glands of a fruit fly and see the chromosomes under a microscope. I know that some people would consider this very strange stuff to get excited over, but having success at extracting salivary glands from a fruit fly is truly accomplishing something. At least I always thought so.

Once I got into my sophomore year I wanted to be a physical anthropologist. I loved the rigor of the anatomy, and I also enjoyed the classification schemes of new vs. old world monkeys, knuckle walkers vs. brachiators, etc. Once I took a comparative primate anatomy course and had to dissect a macaque, a baboon, and a human all within the same semester. Believe it or not, that crazy semester made me even more certain that I would not mind being a physical anthropologist. I think that I especially liked the idea of disappearing into a tropical forest for months at a time to do observational research.

Along the way in college I transferred schools and had to put an 'intended major' on the transfer application. I had no idea what to write, so I opened up the college catalogue and pointed my finger. It landed squarely on "Nuclear Medicine Technology," which sounded intriguing. Then I looked at the classes I would have to take and I saw that it was heavily oriented to chemistry and math. Since I was struggling with orbital paths of electrons and calculating molarity and molality I decided that I couldn't be a Nuclear Medicine Technologist. I flipped to the next page and it said "Occupational Therapist," so that is what I put on my transfer application. The rest is history.

My daughter is currently considering her future career path - she is seventeen and not sure if she wants to be an occupational therapist, child psychologist, FBI crime scene investigator, or perhaps Broadway starlet. From my perspective her occupational development is essentially on track. She has passed through Ginzberg's stage of fantasy choices (for the most part) and is coming into tentative choices now based on her values and interests. In trying to move her forward into the stage of realistic choices I am encouraging her to spend actual time observing the professions that she has interests in.

The problem is that even under conditions of observation there are many vocational activities that are not apparent to the casual observer. For example, when I have a high school student spend a day 'observing' me I try to find fun and exciting activities for them to participate in. On these days I am more likely to have them observe me completing evaluations, providing therapy services, and in general spending time with clients.

What my young observers never see are the 45 minute conversations with my site supervisors as we pore over details and strategies of how to handle staffing concerns. They don't see me fighting the fax machine or trekking to the post office to see how faint the stamp ink can be for them to still honor my postage meter. They also don't watch me answering emails on what the most effective potty training chair is and they most certainly don't get to watch me sit paralyzed by responsibility and fall back to blog spewing for some odd kind of therapeutic tension release.

Observations may not really do much for people. I am not sure what does - in my immediate circle of high school buddies there were career aspirations including an architect, lawyer, doctor, two engineers and a rock star. None quite worked out that way, but from what I can tell people are doing fairly well. I don't worry too much about my daughter's occupational choice process. It seems to be happening.

This stream of consciousness is starting to run dry. I really need to get back to work - I have many things to do. None are particularly motivating me, so if anyone knows of a job posting for a physical anthropologist intern in the jungles of Borneo, please send it my way.