Monday, November 28, 2011

The role of the occupational therapist in carpet cleaning

Jimmy was especially active and his mom was having a really difficult time keeping him occupied while she filled out his intake paperwork. His mom was a little frazzled as Jimmy darted around the room, jumped onto the chairs, pulled on the curtains (pulling them off the rod!), and banged on the windows. I intervened at the window banging for safety reasons and as I gently redirected Jimmy he lunged for his mom's coffee, and with a spray of cappuchino across the carpeted waiting room he finally paused.

"Oops," he said, as his mom gave him The Stare. Jimmy froze.

Mom froze too, and after surveying the mess she excused herself to the bathroom. I stayed with Jimmy who suddenly realized he was supposed to be sitting quietly.

Mom returned with some paper towels. The unfinished paperwork sat on the chair, and she cried as she dabbed at the rug. Jimmy knew enough to stare straight ahead at the toy on the child sized table and play quietly.

His mom was upset about the rug and worried that it would leave a stain. "I just don't know what to do!" she said between sobs. "I can't even take him somewhere to get help without it being a disaster."

I really didn't care about the rug because it can be cleaned. Also, cappuchino is relatively benign when I think about all the possible things that can get spilled onto a floor. "It's really ok," I said, attempting to reassure Jimmy's mom. She couldn't hear me and asked for some cleanser.

Soap is an emulsifier because it can take a substance like cappuchino and disperse it into another liquid, like water. Soap micelles have long hydrocarbon chains that help isolate oils or grime so they can be 'cleaned' or 'removed.'

I was thinking that maybe the paperwork was more important than the cleanser and that maybe for the short term the water would be enough to provide a diluted mixture to blot up and reabsorb the coffee into the paper towels. That wasn't enough for the mom though. She wanted some cleanser.

I watched the mom scrub and scrub at the floor, and I figured that is what she did with Jimmy too. I imagined her taking Jimmy against a washboard and scrubbing with all of her might. I bet she tried everything she could so that she could remove the behavioral difficulties that interfered with his participation in school.

You can scrub all day sometimes, and it just isn't enough.

Foaming agents are added to detergent products because somewhere along the line of history people started associating soap bubbles with ACTION. The bubbles might help some, but they aren't really required for the emulsification process. That's my very basic understanding of the chemistry of how this stuff works anyway. The mom wanted ACTION. She wanted to see her scrubbing effort make bubbles. Bubbles meant the rug was getting cleaned.

Maybe bubbles would mean that Jimmy's behavior could improve too, if only we were scrubbing hard enough in the right direction and with the right effort.

I found some rug cleaner and dabbed it into the carpet as I knelt next to mom and handed her a scrub brush. I grabbed a second brush and went to work on the carpet.

"I bet we can get that out no problem," I said hopefully as I scrubbed and scrubbed. Jimmy's mom smiled.

Friday, November 18, 2011

Thoughts about use of weighted vests to promote attending behaviors in children

Please reference an entry earlier this year about seat cushions.

I am essentially re-posting that earlier entry but replacing 'seat cushions' with 'weighted vests.' Let me start this post with congratulations for Amy Collins and Rosalind J. Dworkin who wrote an excellent article in this month's American Journal of Occupational Therapy.

Here comes some mildly edited cutting and pasting from the previous entry - and I will take the liberty of copying my own writing because the issue is identical and this entry will likely be searched separately than the seat cushion entry!

I encourage everyone to open up the current American Journal of Occupational Therapy and read 'Pilot Study of the Effectiveness of Weighted Vests.' This is a fantastic article that looks at the issue of whether or not weighted vests were effective at promoting attending behavior.

I think this is a fantastic study because it take a very common OT intervention and puts it to the test. For many years OTs have been dispensing weighted vests to children in classrooms based on the thought that the vests provided calming/organizing sensory stimulation that would promote attention . This has been done for so many years in so many settings that it becomes a common request from teachers who don't know what to do with children who have attending difficulties. How many OTs hear the request "Can we try to see if a weighted vest will help?"

We have precious little evidence that weighted vests do anything at all for children - and the lack of evidence is reflected in the fact that this intervention is barely mentioned in some common pediatric occupational therapy texts. However, given the formulaic and mythical popularity of the intervention you might think there would be more supporting research!! Now we have a series of recently published articles that when considered in total indicate very little evidence for using weighted vests.

For additional background reading please also reference Hodgetts, Magill-Evans, & Misiaszek (2011); Leew, Stein, & Gibbard (2010); and Stephenson & Carter (2009).

In the AJOT study the authors Collins and Dworkin used an intervention and control group in a blinded and randomly assigned design to measure the impact of wearing a weighted vest on attending behaviors. They used a clever model of removing the weights from the vests in the control group and inserting insignificantly weighted Styrofoam that replicated the appearance of the weighted vests for the data collectors.

The authors were unable to find evidence that weighted vests had any effectiveness for improving attending behaviors. The study was limited because of small sample size and a need for ensuring consistency in coding/recording methods. These limitations are significant enough to warrant the label of 'pilot study.'

The findings of this pilot study are consistent with previous studies and although there are some limitations in the research design there are some other strengths of the study and its confirmation of previous studies is compelling.

My analysis of this is that we should probably make attempts to confirm this with a more tightly controlled design and a larger sample, but based on these results and the consistency of these results with previous studies there is very little support for using weighted vests with the expressed purpose of trying to improve attending behaviors.


References:

Collins, A. & Dworkin, R.J. (2011). Pilot Study of the Effectiveness of Weighted Vests. American Journal of Occupational Therapy, 65(6), 688-694.

Hodgetts, S., Magill-Evans, J., & Misiaszek, J. (2011). Weighted vests, stereotyped behaviors and arousal in children with autism. Journal Of Autism And Developmental Disorders, 41(6), 805-814.

Leew, S., Stein, N., & Gibbard, W. (2010). Weighted vests' effect on social attention for toddlers with Autism Spectrum Disorders. Canadian Journal Of Occupational Therapy. Revue Canadienne D'ergothérapie, 77(2), 113-124.

Stephenson, J., & Carter, M. (2009). The use of weighted vests with children with autism spectrum disorders and other disabilities. Journal Of Autism And Developmental Disorders, 39(1), 105-114.