handwriting deja vu

Today I needed to look up some handwriting stuff in preparation for a kid tomorrow so I was googling things like “weight bearing” and handwriting to see if I could get some fresh new ideas, and lo and behold within the first page one of my old blog entries showed up on a handwriting lecture, hahahaha

Reminded me I need to get back into blogging. I just took a course Saturday on postural control of the trunk and so i've been doing trunk dissociation stuff the last few days – also getting back into sensory stuff for kids. Was in Norway for almost 2 weeks and I've had trouble re-adjusting to work life!

I love occupational therapy, just wish it could be a hobby and not a job. Who wants to sponsor me to blog all day every day and live in a fantasy word? Anyone? No? Okay….back to the real world, will try to blog more!!! Still haven't blogged properly about Sae-Bo or most recent course or about what life has been like latey….I am CLOSE to being done with my first year as an OT practitioner, September 1st…..

Fine motor OT bone

Headed to Norway for a few weeks for a wedding/reunion – was an exchange student for a year there in high school from age 15/16 (junior year of HS) – so about 12 years ago now, CRAZY.  Getting to see my host sister get married, my host family and friends, and my best Norwegian friend Ingun's brand new first baby 🙂
By the way, I have roommates and I'm taking my valuables so I hope that deters any robbers who read this 😉  – Anyway, will be slim blogging in that time obviously.

So let me throw out an OT bone – I give you this AWESOME link of gross motor then TONS of fine motor ideas for pediatrics, done by teachers it appears. VERY HELPFUL.

http://www.hummingbirded.com/fine-motor.html

How to make your own Wiki Stix for peds OT…really adults too I guess.

Did I ever share this recipe on how to make your own Wiki Stix? Google them if you don't know what they are. Great pediatric occupational therapy tool. I got it from someone else who got it from some one else…and I have not tried it. SO TRY AT YOUR OWN RISK….I guess use eye protection, burn protection, hand protection etc as needed…I have no idea how toxic toilet sealant wax so maybe its a weird idea…I dunno…..let me know how it goes if you do!!!

Toilet sealant wax
1/2 cup of paraffin wax
Ball of colorful yarn

1. Melt equal amounts of paraffin wax with toilet sealant
2. Melt crayon shavings into wax mixture
3. When mixture is melted, cut lengths of strip and dip into mixture
4. Lay dipped strings on wax paper to cool
5. Bend wiki stix into shapes and reuse just like commercial ones.

PS: I am SO FREAKING BEHIND ON EMAIL I realized I have missed quite a few important ones. That's also how i Rely on getting all my FB messages so if I have not responded I am SORRY. VERY SORRY. Feel free to write me again and/or be patient, I will eventually rspond it may just be a few months late 😡 ugh. I SUCK!

What do you think this is?

I took an 8am to 530pm course Friday and Saturday with a whole bunch of other occupational therapists (and one PTA!) to learn how to use THIS (my hand is the model)…can anyone guess?? If anyone saw my Twitters they should know the answer. More details tomorrow! It’s bed time!!

Monday = tired OT day

Today a frustrated child stabbed his scissors into the paper, narrowly missing my hand [ he wasn't trying to hurt me].

Today I worked with two adults who had strokes, one adult who had a traumatic brain injury, then a row of pediatric clients:  a child with CP, a child with Down syndrome, and a child with a traumatic brain injury. It's set up as an adult clinic for the most part so it takes a lot of creativity to do therapy with the pediatric clients at times…not just filled with kid stuff. Limited options. It worked out though.

Lots of notes to write though, boo…I am very tired. I should work out but I have decided Mondays need to be a no-guilt workout free day as I always am so tired! Need to prep for tomorrow – was over on hours today and will be over hours this week by a lot as I am taking a course that is also Saturday 8 to 530. So I'll try to shave off time here and there when I don't have patients. 

Did I mention I am tired. Stuff to do but too tired. So….bedtime soon.

SO TIRED TODAY

Today, I shattered a mirror, ran over a butterfly, spilled my (expensive!) Chia seeds, and willfully ate gluten (I was dying for Japanese and it is in the soy sauce and possibly other hidden items as well)……I had a semi quiet day at clinic as 3 people cancelled last minute and I got to eat out twice, which is a very rare occurrence these days, so in some days it was good, but I AM SO FREAKING TIRED right now….its 10pm and I should go to sleep but I dont waaaanntttt tooooooo but I am tirrrrreddddddd sooooo I musssstttt……..things I've been pondering lately include bilateral activities for kids with mild hemiplegia, strengthening of hand muscles for weak children, when to discharge patients with burns, WHY INSURANCE SUCKS SO MUCH for SO MANY PEOPLE, etc etc 🙂 I always have SO MUCH i want to share, but somehow always it doesn't get blogged about as often as it should. Also pondering writing up another piece to submit to OT Practice about the first year as a practitioner….but who are we kidding ahahaa.

bedtime. thanks all for the really kind and/or helpful comments y'all have been leaving. always makes my heart glow!!
loooooooooooooooooooove
me

hmmm, amazing parkour ….new OT ? jk

http://www.todaysbigthing.com/2010/05/20

This is an amazing parkour video….basically street ninjas. Incredible things they do with their bodies. Some gyms
offer parkour classes now. If I had higher-level patients and was doing more athletic rehab kinda stuff, I'd totally
try to incorporate elements of this. 🙂

I am feeling a bloggy urge…I have to go to store and do some errands but maybe later i'll blog/catch up!!

busy busy

Preparing for a pediatric eval, a pediatric treatment, and other treatments including strokes and peripheral neuropathy. Need to finish writing up some goals. More in next few days, I've been a poor poster lately!! It's almost 11pm….hope to be in bed by midnight so hope I can get prepped and finish the goals up for an eval by then, and then I'm gonna get to work early to prepare for my first Peabody! And then it's a long day with a hyper pt at the end of the day so let's hope my energy stays up! 🙂

Evidence-based practice, practitioner versus student, smack-down.

I recently received a comment with constructive criticism regarding how I present OT to the masses. I wanted to write about my perspective regarding how I share OT. First I'll start by addressing Anita's comments, then go into further detail.

I could see after Anita pointed it out, how what I wrote looked as if I was saying “I have no idea, let's try this”. That's one of the down-sides of blogging, it rarely occurs to me people will read things in a spirit quite differently than intended. In reality, I have taken a special course in physical agent modalities that included the use of TENS [transcutaneous electrical nerve stimulation] for multiple uses, including pain reduction, based on the gate theory of pain. It is appropriate for the use of pain reduction in a post-burns pt as long as I'm not directly covering the burns with the electrodes. TENS units, to the best of my knowledge, do have supportive evidence to back their use as a common physical agent modality. Anecdotally, using the TENS units on specific acupuncture points (such as Li3 and Li10 which are located on the upper extremities), helps more than just using the TENS in random locations. A very experienced physical therapist I work with has used the TENS units specifically on acupuncture points with great success in pain reduction. When I used the question marks in “Li3 and Li10 I think it is??”, I was referring to not remembering the NAMES of the two specific acupuncture points – I knew exactly where to place them, just wasn't positive I had properly remembered their names. Regarding evidence-based practice, using the TENS was warranted, and whether it was on an acupuncture point or not may HELP but would not harm. I should check to see if any evidence-based articles exist regarding the use of TENS on acupuncture points.

As a new practitioner with somewhat limited local resources due to my geographic area, I try hard to be evidence-based when approaching new areas of practice (new to me). For example, I recently had a pt with chemotherapy-induced peripheral neuropathy, and I found three different articles in medical journals that I had the library get for me. I read those to get a better understanding of what to expect/know about this specific issue, and that is where I learned about pseudo-athetosis and severe sensory ataxia, both of which were relevant to what I was handling. I've also researched and gotten multiple (I think SIX?) articles on shoulder subluxation after stroke, to better grasp best treatment protocols. For basic treatment, I often rely heavily on what I have seen other therapists perform, or what I have received advice about, or learned while in school, or observed in fieldwork, etc….I do not approach each treatment with “I didn't find an article on this so I have no idea if it's evidence-based”….I rely on clinical judgment and the professional expertise of others, my research/resources from schooling, fieldwork, and recent experiences, to determine whether I am providing basic appropriate treatment. When I get into more new issues or want to explore alternate routes, I start researching.There are times when I want to explore what would happen if I took a common treatment protocol in one area and applied it to another – for example, taking the surgical brushing of the Wilibarger protocols of sensory integration, and determining whether it would be a feasible or appropriate treatment for the peripheral neuropathy….hard to know in cases like that. I definitely never experiment on my pts in harmful ways.

Anita also commented that when I blog I often do not act as if I have solid evidence-based foundations to draw from, and am rather just experimenting. She suggested I approach blogging in a more professional manner in regards to presenting questions about interventions.

When it comes to my blogging as a new practitioner, I do tend to have a very student-like approach of trying to “learn out loud', pondering my options, looking through my books, asking questions of others. I do tend to be very informal in my presentation, and I guess it can appear that OT is an easy/simple profession where we just use common sense. It's not my intention to make it sound like OT is not a skilled profession (you have to have at least a Master's degree now) – but it is my intention to make OT seem like a possible and fascinating career for perspective OTs. I'm not always so great (okay, NEVER great) about using a lot of professional terminology and acting very professional in my blogging presentations.

I very much like the idea of performing evidence-based research then coming on here and asking for more specific thoughts from other therapists, but realistically it's unlikely. When I do have specific questions of practitioners, I tend to use the OT Connections blog which i know is read almost exclusively by therapists. I tend to use this blog for getting out my jumbled thoughts and for giving the general public an idea of what sorts of things OT might see – it's less for other OTs than for prospective OTs or OT students. I guess some could argue I do the profession injustice/harm by my haphazard blogging as an occupational therapist, but based on the e-mails/comments I've received over the last few years, I've helped many people with making their final decisions to enter the profession or not, and/or to help them determine whether it's potentially a pathway to follow. 

I do believe overall it's important to aim for evidence-based practice – evidence of the highest power when possible, such as meta-analysis and systematic review and not just case studies. When I have the time and energy or need to research myself, I do. I also do believe in the anecdotal evidence of more experienced therapists who have used interventions with great success – in those cases there probably is evidence to back up the interventions that I just haven't yet taken the time to research. When I have specific questions I tend to ask on OT Connections, and when I am just sharing my thoughts and letting them flow out my fingers, I tend to come here. If some OTs read this blog and are horrified at my informality and how it may appear that I'm not really sure of what I am doing, then I am sorry because it's not my intention to appear clueless – just learning, the same as I did when I was a student. Even as a new practitioner, I don't see a reason to blog differently than I did as a student, as the learning process is the same – it's just that how I use the information is different as it will be applied to real clients.

So in conclusion I appreciated Anita's comment (which can be found on the post 2 below on the pediatric SI post), and also appreciated Donna's comment on criticism being necessary for growth (see one post below). I'm going to try harder to not sound quite so hesitant or questioning when blogging, and to possibly take her advice and occasionally do my research then ask specific questions. But I'm also still going to write my crazy jumbled rambling posts where I'm pondering what to do wi
th clients – but may try to be better about clarifying I do know my basic practice standards/interventions, and am just trying to decide how to best apply them.

Some days I cringe regarding my blogging jumbles, other days I am proud of them. I do occasionally get critical comments that I can grow from, and then I get a lot of comments that make me happy regarding people realizing how much they love the profession of OT after following my blogs. I'm Facebook friends with several now-OT students who I first met as prospective students through this blog. I love watching their journey, and I love introducing people to OT, and I still need to work on increasing professionalism, but I'm always going to be crazy as well. 🙂 I may not be a very experienced occupational therapist, and I sometimes have fewer local resources than I'd like, but overall I have great relationships with my patients and I work INCREDIBLY HARD to do research and read and prepare for my clients so that they get the best possible treatment.

I got a text the other day from a friend who reads my blog who said he would be horrified if I did in fact use proper grammar in a blog post (like I threatened in this previous post), so hopefully he won't have a heart attack. Not used to GRAMMAR! I'm a txter! Srsly. Anyway – enough being serious….Anita, hope I addressed your comments….I'm going to try to be better, but probably not as good as you hope, as if I have to start behaving myself, it will take too long to write up! Haha.

Now it's time to go cuddle with my hideously ugly cat Lester! I gave him a partial haircut today, it's very ripply. Maybe I'll write again tomorrow with new thoughts on things (I want to do some more research on hand and trunk dysfunction from a hand dysfunction book I found, plus I found an OT goals book that had great goals in it I want to use for pediatric pts!)

Critical comments…ouchful yet necessary on my OT journey!!

Part of the fun of having a blog is all the sweet comments. Part of the yuckiness is the critical comments – some deserved, some not. I choose whether to allow comments and sometimes its tempting to not allow people to see the ones criticizing me, but I also think it's really important to grow from the criticism and share the struggle/journey with readers.

 In this case, one of my blog readers Anita wrote a very thoughtful comment on a recent post criticizing some of the way I present information and it was very valid, although for some of it I do have legitimate reasons and/or things get misunderstood, I think……

I reallllly want to write a long blog post explaining but as it is I'm getting ready for work so no time. But this weekend, get prepared for an evidence based practice vs anecdotal vs experience vs student/practitioner vs blog, kinda post! Who knows, I may actually use proper grammar, so get excited. So go read her comment, think about it, and come back soon for a discussion. If you do agree with Anita and want to join on the criticism bandwagon, please maybe wait until my next post, as if I get a whole ton of posts telling me I suck I'm going to be really sad! Not that Anita said I suck and she also said I didn't have to post it – I REALLY appreciate her comments so I can think about it and grow.

Now I better get to work!!