29 Jul 2011

Mind mapping OT competition :)

This was sent to me by Tommy Carr:
I wanted to get in touch with you again about my website – www.otstudent.info – as I am now starting a competition in which someone could win mind mapping software worth £199. Basically, in an effort to stimulate collaboration on the website and also creativity among OTs and OT students, I have started a competition for people to send in their mind maps on a subject related to OT. Any mind maps sent will be uploaded to the site (where appropriate!) and the best one will win the prize – closing date is 1st October 2011. The competition page is at:
Category: Occupational Therapy | Comments: 1

26 Jul 2011

Pinterest + OT ideas

I'm starting to obsess over wanting to do more crafts this upcoming year with my school OT kids. I started using Pinterest today http://pinterest.com/funkist/pins/ to keep track of the crafts that may be promising in some way. Like for example, cutting pool noodles into slices to make giant beads!

Category: Occupational Therapy | Comments: 4

21 Jul 2011

contracts/social story on what OT is

Anybody have a social story written on what OT is for? And/or a contract? For use in the school system? I only work with K-6 and this year I am thinking about starting the year with both a social story and a contract for each child, where we review what OT is, who I am, what goals they have, etc. The contract would be to work on those goals/work hard/work together or something along those lines. I think a lot of kids getting OT have no idea what they are doing (including some of mine) so I would like to address that immediately this upcoming year. I think I'm also going to make sure to e-mail the teachers at the beginning of the year (after the craziness of the first week or so subsides for them), telling them what goals OT is working on specifically for the particular child(ren) in their class….and perhaps send home a note with the kids reminding the parents of my e-mail address.

That sounds like a lot of work. But I think it would be good to do. Does anyone out there already have a contract and/or social story for OT aimed at younger ages?

Category: Occupational Therapy | Comments: 2

21 Jul 2011

Young people in nursing homes

http://www.huffingtonpost.com/2011/01/07/assisted-living-more-young-people_n_805772.html

My friend sent this article to me (a long time ago :x) with the enclosed commentary:

I thought you'd be interested in the link below.  It's an article about the increasing number of people under 65 who are in nursing homes. It really is a tragedy.  We have an institutional bias when it comes to long term care funding.  It needs to be shifted so that most of the money is spent on community based care.
Category: Occupational Therapy | Comments: none

21 Jul 2011

school OT crafts I want to try!

 One of my goals for this upcoming school year is to try more crafts. Here is a couple that look interesting that someone does with her home-schooled children. 🙂 I especially like the first and third link, all from Angry Chicken!

http://angrychicken.typepad.com/angry_chicken/2011/06/on-a-rainy-day.html
Making a cloud with rainbows

maybe this one too…
http://angrychicken.typepad.com/angry_chicken/2010/10/bone-digger.html

and I think this one is beautiful….rose petal drawings
http://angrychicken.typepad.com/angry_chicken/2010/10/rose-petal-drawings.html

and this one for Halloween…
http://angrychicken.typepad.com/angry_chicken/2009/10/that-silly-pumpkin-head.html

Category: Occupational Therapy | Comments: none

20 Jul 2011

old OT reminders

I spend a lot of time while working trying to make sure I get the lingo down and know what I am talking about. I write myself a lot of cheat sheets with things I observe/read that I want to use in the future. I don't do a great job of organizing it though. But here is an example cheat sheet from when I worked in adult physical dysfunction last year. Now it's all alien to me since school OT is a whole other area! But when I read some of this stuff it reminds me how complex OT can be. :0

PS: None of this should be taken as advice down below – it could be wrong for all I know, and it's certainly all out of context. Just showing all the complex terminology and thought processes etc. I do notice when I read through this the lack of occupation-based terminology. Oops. 😉

PS2: I am down to under 100 new mails. That's why so many new OT blog posts lately, I'm getting close to everything being cleaned out. 🙂

Stroke:

PROM/AROM

Isometrics

Cocontractions

Rhythmic stabilizations

Scapular muscles

Weight bearing

PNF patterns

Abduction on sidelying

Regressive resistance

Short arc

 

Actaboski?

 

“composite digit flexion”

 

“Pt also demo intact LUE sensation to SWM 5.07 for protective sensation, however absent 2 point 1.0cm discrimination along L median nerve distribution/medial cutaneous nerve”

 

OT then applied gentle PROM to L digit flex/extend with differential FDP/FDS tendon gliding and pt instructed in joint blocking.

 

Increase facilitation of normal tone, neuro-re ed out of flexor synergy, activation of paraspinals and abdominals, long duration stretch with ext/sup patterning using deep tendon inhibition techniques, RUE through PNF D2 flexion patterns, OT maintaining flexor synergy inhibition points of contact for increased AROM while pt moved through PNF patterns

 

Ironing board/incline

Sliding board with wedges

Partial stands

Straight cane to activate external rotation with ace bandaged hand

Scapular mobilizatios – elevate, me do it, then u try to help

Supine uphill, cocontractions

Do some oscillations on shld while supine, quick approximations as well, externally rotate thumb while trying to do elbow ext

Prone on elbows or table top

Arm skate

Soques

Remiste

Concentric/eccentric

Closed chain/open chain

 

Lumbricals – tend to get clawed?

Intrinsic plus/minus positioning

Transfers to graded height surfaces

Recripocal patterning

 

No proximal activation palpated

Performed closed chain task

Dynamic reaching over weak limbs?

To improve postural stability, stand on variety of unstable surfaces

Try to self-correct and improve postural integrity, perturbations –v estibular

Change velocity, angle, distance

Unilateral UE release to challenge dynamic sitting balance

Air splint for neutral warmth to decrease tone

Max A to find initial placement on L

 

Unilateral UE downward reach and hip flexion needed for LE clothing management

Intermittent hands on assistance to maximize full elbow extension, keep postural integrity

Lowered concentrically with control

Paresthesias

Cross friction massage

Excursion

FPL – same, only move IP of thumb

FDS – same, to move PIP

Isolated FDS, FDP, FPL tendon     FDP – hol down palm up so can only move DIP

Scapulohumeral rythym discoordinated

 

Ulnar nerve paresthesias, 2/7 for 0.5 2 point discrimination

Stereognosis – no vision tactile search

Intrinsic: digit abd/add, interosseous lumbricals, so do pull apart fingers with resistance. Strengthen intrinsic plus position

Straighten elbow, FDP flatter stretch at IPS????????

 

Follow ulnar nerve tract up C8/T1 (brachial plexus)

 

Scaption to decrease impingement

 

Thumb up: coracobrachialis

Supination: biceps bracchi

 

Ulnar nerve glide ex: elbow extend etc

With OT correcting techniquers

CMC joint tightness

 

Resistive L digit extension

Difficulty with voluntary movement of thumb and digit opposite and lumbrical grip

 

Contract – isotonic

Hold – isometric

Agonist – pattern with limited motion

Antagonist – muscle shortened that limits range of agonist

D2 ext: ext add, int rot, flex abd ext rot, seatbelt  side on top, cross on bottom

D1: flex/add/ext, ext/abd/int, cross on top, side on bottom

PNF – proprioceptive neuromuscular facilitation, increase response of nm mechanism by stimulating prioprioceptors, fl/ext, abd/add, int/ext R, rotary component, balance of antagonists, sag, front, horiz

Trophic changes – ie swollen shiny skin and nails with ridges, sign of CRPS

TENS : transcutaneous, sensory to decrease pain, no visible contractions, bipolar 2, quad 4, crisscross pattern, black delivers shock, red grand/receiving. Further apart pads, shallow, close together deep. IFC – inferential current,

 

Ligaments – frozen shoulder, distraction, rythymic stabilization

Facilitate motor return

Respiratory rate – count number of times chest raises

BP manual, valve tight, pump up past 180, slowly release, listen to brachial artery, first and last heartbeat

 

Try to normalize movement patterns

Media positioned to facilitate BUE

For improved proximal stability for ADL tasks

Performed to improve BUE extensor strength

QD – once a day

BID – 2x a day

Cross tendon massage, subscapularis massage from axillary angle

UE assisted pelvic elevation

Shoulder capsular massage

Interosseous mobilization – supination and pronation, go up and down, radius and ulna

 

Neuro – don’t go past pain, ortho- go past pain

Pain increases tone so only go to tolerance

Ribcage elongation

Don’t stretch hypotonic

Manual protraction/retraction

 

Performed eval and pt has potential to increase functional skills, need to redo home program with 2 visits.

 

“composite flexure contracture”

 

Viscolas Flexigrip Hand exerciser

 

Vision: contrast, geographical vs spatial, inattention, poor vision, eyes jump/nystagmus, boundaries ie red tape to red tape

 

0—- bp, then 0 seated, standing etc

 

Dissociation of body and limbs

Active assist bow activity, bow positioned to inhibit compensatory R shld abduction and facilitate flexion in slight scaption. Occasional manual assist to inhibit compensatory R trunk lateral flexion.

Media positioned to promote RUE AROM in diagonal patterns and improve standing balance. Min A to maintain dynamic balance during task, ball placed to provide proprioceptive input to RUE and resisted trunk flexion, to improve postural integrity, decrease compensatory movements, improve tone for increased efficiency with ADL and mobility tasks.

 

Stickler’s syndrome: decreased visual acuity, nystagmus, increased risk of retinal detachment and amblyopia

 

Swivel spoon/wrist splint, steering wheel covers, HEP tendon glide, nerve glide, gentle strength, rubber band extension, towel crumble

 

Category: Occupational Therapy | Comments: none

20 Jul 2011

OT rehab ideas

here were some of the ideas I had written down (some more occupation-based than others but just things to prompt my brain) while working in inpatient rehab….

PS: Belly dancing/fencing were two things I was into…belly dancing is GREAT for hip/core work (find just a basic video on youtube and they can work in the parallel bars, if not shy about it of course) and fencing (with foam swords) if you use the proper stance (google that too) is great for balance and strengthening/stabilizing lower body while also incorporating upper body. 🙂

sorting junk mail
sorting laundry
sorting silverware
working on calendar
working with checkbook
working with dayplanner
opening up garbage bag
dusting with weird confetti
vacuuming
wiping down table
watering plants
setting alarm clock or timer
 making microwave meal
inventorying area
scrubbing spots on walls
cleaning a mirror
paint brush rolling on wall
clocks – telling time, drawing clocks
sorting nuts n bolts
pilates, yoga
belly dancing, fencing

Clothespins, racks, washclothes

Dartboard, standing
Lean on wedges to work on stomach
Wedge ramp, roll ball from one to another on wedge
Place paperclips under bottom, raise up and take away
Sit on BSC, raise up place tennis balls from either side
Dowel ladder, put cones on it or use weighted dowel
Lie on back, reach up and back for items
Ball or bolster rolling up and down wall
Partial sit to stand from mat
Pegs on vertical surface, place pegs in, maybe patterned
Theraputty hand exercises
Airsplinting to reduce tone in elbow
Velcro rotators for hand manip
Pick up rice pieces
Stack tiny cubes
Bend knee back, kick ball
Abacus with foot to slide beads
Hit ball with weighted dowel
Basketball
marching in place
UE assisted pelvic elevation
scooting on mat
lateral weight bear for peg shapes on vert surf
sort cards by suit
Category: Occupational Therapy | Comments: none

19 Jul 2011

Low Vision in Children

I went to a seminar on August 15th, 2008 hosted by the Hamilton Eye Clinic, called “The Children's Vision Rehabilitation Project: A MultiDisciplinary Approach to Low Vision in Children” with visiting professors Terry Schwartz, MD, and Rebecca Coakley, MEd, from the West VA Eye Clinic.  The seminar was for ophthalmologists, OTs, vision rehab professionals, educators, and more. One of my good friends Orli is a low vision occupational therapist at Hamilton Eye plus I always want to learn more about everything, so it was a very interesting day. I've intended to write this post for over a YEAR now. Finally got around to it. I should have written it the next day as my notes were not great so I'm missing 95% of it I feel. But I'll share what I did get out of it – note this is my own one year later understanding, so take it with grain of salt. 🙂
Low vision equipment: Many times expensive items are recommended to people but then sit unused for whatever reason – its too ugly or inconvenient or too hard to use or whatever. So ideally a clinic will set something up where for example you use something 30 days as a loan then buy from them as used equipment if you like it – win/win for all.
Starting low vision training: The younger the better. Even a 3 year old can get in some good training. For example let a child explore looking out an empty toilet paper roll. If you start young enough the child will see their low vision aid as practically an appendage because it becomes so integral to their quality of life. I thought it was interesting that it was pointed out that kids who are deaf tend to be more socially adept than blind kids, because of all the nonverbal social cues I guess. Also interesting that young children have an egocentric location thing going on – if you give a child that empty toilet paper roll they may put it between their eyes on their forehead, not on their eye as you would expect. 
Technology: It's now pretty cool to have technology so some of the odder looking devices that people use, are actually seen as impressive or neat, rather than negative. 
Large print: There is frequently at least a 4 month delay for reproduction of books into large print. Audiobooks, Braille, or other options may be better.  Many doctors and therapists assume large print is the answer to everything when in fact it can make things worse depending on the type of vision problem. For example if a person has a constricted vision field, large print just makes it HARDER to see as even less is now within their vision field at any one time.

Canes: Sometimes the person with low vision is not quite at the level at really needing the white cane, but use it anyway because it warns other people to be careful/aware around them.

Reading: Many people with low vision can read, however the difficulty may be in sustaining it due to distance from print, nystagmus, general ocular control, etc.

Nystagmus: Sometimes a head tilt/turn helps quiet the jumping of the eyes and maintain optimal sight.

Here are some things I wrote down that I no longer have any idea what I was referring since it's been like three years 😡 If anyone wants to clarify any of this, go right ahead.

Fans – shadows
Grating acuities, teller acuities, etc, “Facile”
Stable or progressive vision issues

“achromats” = not people first language. 

Sensory channels most used – Learning Media Assessment.
======
 
Braille: A lot of kids actually read Braille with their eyes! If a kid has visual sensory preferences (even with low vision), it may mean Braille is not a great choice. A tactile child will benefit from Braille more.
Alright, I'm headed out to a store, so I need to stop writing this post – so it's unfinished from this point down – I'll try to come back and edit it later today. 

all might have same diagnosis but want different choices .

Some kids can see letters but not read due to saccade issues.
Visual function, with rehab, can lead to functional vision
Albinos – 1/2 fibers dessicate at optic chiasm. problems with stereoopsis? Need orientation and mobility – problems iwth depth perception
Nyctalopia – in to out, transitions – ie bright playground to normal classroom
Try and maximize remaining visision

Brain fools us – we think we see all around us but not raeally

Sighted kids rely on visually impaired kids for freeze frame data – complete change from before!

Desire to drive is often incentive. 

timid kids that bruise and fall a lot – key that maybe field loss is problem.
Optical positions for visition, 
visual function plus rehab = functional vision
Learning Media Assessment – which sensory channels?
Kid may feel butons on your shirt or put head on table. Puppet in hand. Good clue as o visual or tactile. Visual – no Braille. Many kids just read the Braille. 
Each kid in fam may have same VA diagnosis but diff choices on which to use. 
Penlight and toy on penlight like a little monster. 
Tactile buttons or giant diagrams of microwave, dryer, etc. 
Contrast and lighting are two huge ones. 
safety pins on clothing or rubber bands around items
liquid level indicators
commercially available products like giant remote, magnifying glasses, etc
marroon blanket over beige couch
yellow towel over white tub

Category: Occupational Therapy | Comments: none

19 Jul 2011

Tips for NBCOT Exam

I wrote this in 2009 and never finished posting it…the new test had just come out, with the CST part to it. So this is relevant to the new test, but I am NOT up to date on whether things have changed in the last few years, so read this with a grain of salt. Or maybe a salt shaker.

I didn't start studying nearly as early as I should have, but I used 3 sources: TherapyEd book & review course, NBCOT book + online practice exams, and friends.

If you can afford it, take the TherapyEd review course. If money is an issue, it's probably still worth it IF YOU HAVE TROUBLE TESTING (the cost of that course is cheaper than re-taking the exam). If you are a strong student, you can probably get by without it.

I liked the TherapyEd review book that came with the course. I basically memorized the vast majority of the book. You need to be able to spout off the information, NOT just “recognize” it. I did flashcards, not so much to actually use, but to help me concentrate so that I learned while making them. There is what, like, thirteen chapters? So depending on how slowly you study, try and give yourself a few days for each chapter if at all possible. DON'T SKIP ANYTHING. I really only glanced briefly at statistics/research/management, and I wished I had looked closer. Everyone's test is different, but everyone's test will most likely include a little bit of everything. The more you know, the more likely you'll pass, obviously, right?

Now, the TherapyEd questions are kind of weird, I admit. Long and oddly worded. Still good practice. And it has lots of CST to practice with.

The NBCOT book was much more like typical NBCOT questions, although oddly enough, the book didn't have any example CSTs…those new clinical simulation questions. (I ALWAYS confuse the words stimulation/simulation).

NEW NOTE: All this may have changed in the last few years with new editions!!

I HIGHLY recommend purchasing the NBCOT online exam that is 100 questions. According to a classmate who researched it, there is like a .9 (ie high) correlation between your score on that exam versus the real thing. I don't have the evidence though. Also, one of my classmates went up FIFTY points from practice to real thing so I guess um, well, ….anyway, it's still helpful to see how you do on that online exam. The other things you can buy I don't necessarily recommend…if you can afford it, great, it helps with confidence …remember you cannot necessarily go back and see the question though…and answers aren't always given I don't think. So examine everything carefully the first time, and jot down notes as needed.

My favorite study questions had to do with psych….here is a (very very) brief psych med overview. Like I said, it may or may not be on one of your tests, but you should know it regardless! It seemed like each study book had this same information in it.

Akathisia = restlessness, urgent need for movement, typically a psych med side effect.
(This is like my favorite word!)

Tardive dyskinesia = almost constant movement, more chronic and serious, does not go away, and is result of years of heavy psych meds. The movements are more writhing with a lot of oral motor involvement.

Make sure you know the difference between the two types of movement. 🙂

MAOIs = drugs used for depression. You have to be on a restricted diet on these medicines because of an amino acid blah blah – so they like to ask diet questions. They can't have like, pickled, smoked, cheesy things…and one of the first signs of toxicity is a headache. Your patients, whether you work in mental health or not, may be on this type of medication, so make sure you know the reasons for the special diet, etc.

Photosensitivity = lots of psych drugs cause people to be more sensitive to sunlight than normal. If you are doing psych activities/groups and it involves being outside, there is a good chance you'll need to remind the clients and/or be prepared to deal with that side effect.

***As far as I can tell after re-reading this repeatedly, I have not said anything inappropriate/proprietary….if anyone disagrees, please let me know. My intent is to share advice, not do anything illegal!! 🙂

Category: Occupational Therapy | Comments: 5

18 Jul 2011

HELP button, staples button hack

 http://www.engadget.com/2006/07/19/hacking-the-staples-easy-button/

http://www.youtube.com/watch?v=6OEFxc3zTls

http://www.springerlink.com/content/v743km042677w8w0/

I found these three things that might help me figure out a Staples button hack. I want it to say “help” instead of “That was easy!”. By the way, kids LOVE the Staples button and consider it a real treat to be able to hit the button after an activity. Even if the activity was actually somewhat frustrating, the kid gets a ghost of a smile on their face after hitting the button. The only problem is they usually try to hit it like six times in a row.

I have a child who doesn't like to ask for help….I wanted to make a Help button so she could hit it for fun. Seemed like a good idea. Only problem is, I'm not exactly handy with a drill so these hacks seem a little challenging for me. But wanted to throw out the idea of hacking out these buttons for basic communication needs or to be silly.

Other alternative….does anybody know of similar buttons you can buy to say whatever you want? I am sure there are OTs and/or SLPs out there working with AC who know way better than I do.

Category: Occupational Therapy | Comments: none

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