The importance of sensory play

I brought an apron with me to a client’s house because I knew we would be playing with whipped cream! I chose the whipped cream over shaving cream so that some tasting could take place. I bought the can of cream before the session and we used up the entire thing. We put plastic finger puppets on top of the canister, we drove cars through it, we got some plastic bugs dirty enough to need baths…

The child has a lot of tactile defensiveness and I was determining how it would affect typical play. I wanted to see if he could be coached into participation via modeling, distraction, slow exposure, or what, so that I could educate the family on how to approach this type of play. Children learn a lot – and get a lot of input – via exploring their environments, so if the child doesn’t have a willingness to get near new textures/sensations, it will affect their ability to learn how their hands work in differing situations as well as cause/effect/characteristics of items, and much more.

There are PLENTY of children who have issues with tactile defensiveness regardless of parental intervention.  Yet I’ve  noticed that many of the children who show signs of tactile defensiveness are being raised by parents who also dislike getting their hands dirty or have never thought to do sensory play. Sometimes educating the parents on the importance of sensory play, pointing out the similarities between parent/child, and/or showing them the strategies of exploration for a hesitant child, is enough to make a big difference in a child’s willingness to participate. Also, letting them know that children who are tactilely defensiveness typically do much better with firm pressure rather than light touch.

Does anybody have any favorite types of sensory play? I love water beads.

Started the journey of getting a clinical doctorate in occupational therapy (OTD)!

I started my post-professional clinical doctorate program on September 2nd. It is an OTD (Occupational Therapy Doctorate) through Rocky Mountain University of Health Professions based in Provo, Utah.

It can be confusing to understand how doctorates work. Essentially clinical doctorates are used in actual practice. Doctors of psychology, optometry, dentistry, physical therapy, etc, are NOT actual MDs. They have a clinical doctorate like DDS, OD, PsyD, etc. Which is what I am getting as an OTD. For all of those areas, excepting perhaps psychology, most of them do not have PhDs. If they do have a PhD, it is in addition their clinical doctorate, not instead of.

Even in psychology I believe that most either have Masters or a PsyD (clinical). Many of these doctoral degrees can be entry-level (typically after a Bachelors). Meaning  the student has no actual practitioner experience and is starting from scratch.

However, there are plenty of practitioners who go into a post-professional program, which means we have been in practice for usually at least a year and typically 5+, so we have a lot of experience that guides our doctoral degree.

Most of the post-professional versions, at least in OT and probably most programs now, are primarily online. We all have our Masters (or older practitioners may have been grandfathered in through their Bachelors), and have been in practice for likely many years. In other words, many of us are established full-time practitioners with families. We have a very different level of experience going into this program.

At this point the next step is all of the scholarly work of research, writing, analysis. etc. At this level of schooling the professors are typically providing guided learning, not a typical lecture style where we are taking in basic information.

Getting a doctorate was not in my plans, at least not now, but as I describe later in this post, I had good reasons.

As I went through the orientation modules for this program, I was quickly humbled at how far technology has come for distance learning. I graduated from my Masters in OT program in 2009, and even back then distance education was not nearly as rigorous as it is now. But five years is a LONG time in the technology world. Back then people thought of online learning as the “University of Phoenix” style jokes. And now that I say that I may hear from angry people who had a good experience with that university. I don’t know anything but the stereotype that it was essentially a way to pay money, do a small amount of work, and get a degree. Please let me know if I am wrong (I certainly have not explored the evidence on it, this is completely hearsay!)

All I know is, I think some people still get skeptical when they hear of online programs. But these programs are rigorous, and interactive, and as I said above, humbling. I’m 32 and I was a very early adopter of technology. I started WORKING online when I was 13, way back before child labor laws and child protection laws were in place. (The labor wasn’t an issue – the protection was.)

And yet even with my familiarity with online work, more so than most people my age, I’ve had a lot of technology learning to do for this program! Wow. I am really impressed with a lot of the older professionals in this program, many of whom are NOT very familiar with online learning. To throw in a major tech learning curve on top of trying to do a doctoral degree while working full-time and taking care of a family? Wow. That’s discipline.

I used to think about doing a PhD, but realized that since I don’t have any strong interest in research or academia, it wouldn’t be a particularly enjoyable journey. I do love teaching, but not on the formal level of lectures of theory that students need to know for a test. And I love getting other people to research things, but I don’t want to do it myself.

I wrote another few pages about why I am doing this program now, and then I get hesitant about being so publicly transparent. I go back and forth on how much to share. I cut out those few pages and put them on my computer in case I decide to use them sometime later. I have shared in earlier posts that I have a very long history of depression and anxiety so I guess I can repeat that part. Some of it may be neurochemical, but most of it is based on over a decade of secrets (some of it thanks to that online world), and therefore a lot of pain.

I was relatively functional when I ignored it all, but it took a lot of energy to always wear a mask that made me look fine. It was exhausting and I paid a heavy price. As the years went by and the secrets continued to compress my soul, my weariness grew, and the darkness inside got so dense it felt like I was turning into a black hole. I was walking oh so perilously into Robin William’s world.

I crashed. Sometimes you have to hit rock bottom to get the momentum to (start to) bounce back.

To make this incredibly long story slightly shorter, and to not get too intimate, I had to fight. But even if you have a machete, you have to be in the thick of it to thin it! Wow I think my word play is so clever…hahaha.

So while I’m dealing with the fight, I haven’t been nearly as functional as I was when I ignored it all. But I also wasn’t okay. I’m better off now, with much more limited function, than I ever was before. Because now I at least know there is a light inside of me somewhere, even if I can’t see it. And sometimes I glimpse it, and sometimes I feel it. I’m just starting to feel better, but I struggle with feeling like the sky could fall any day now, where I wake up and the heaviness is back. It’s happened many times before, so it’s a legitimate fear.

Even doing better, I can’t tolerate much these days, and I will likely not be able to do full-time direct service again (or any job with a schedule controlled by others). I am introverted (I can still appear outgoing, but it’s draining), I don’t like unpredictability, typical work schedules are nearly crippling, and I have always had dread every time I’m about to see a client, no matter how much I love them and feel confident in my therapeutic ability. It’s not obvious because I am very, very skilled at wearing a mask when necessary, which has been at least half my life. Only in this last two years did it get increasingly impossible.

I am only working a few hours a week. I spend a lot of my time getting help in kind of a customized outpatient program.  But I’m making progress. I am doing this doctorate as a form of vocational rehabilitation so that I can stay within the field of OT even if I can’t do much direct service. Because it’s online (minus four days a semester), there is wiggle room within the modules to have off days, and the schedule is mine (often I work best late at night).

My goal with this “vocational rehab” clinical doctoral program, which is a lot less stressful (academics are my biggest strength) than direct service, is to find a way to stay firmly entrenched within the field of OT, but in ways that cater to my strengths and do not require a direct service model. I would love to keep a few direct service cases a week no matter what, but I am hoping to build up a curriculum for elementary schools as this doctoral program’s capstone project, or similar types of products, where I can work my own hours and have a lot of time for off hours/off days. I also hope that I will eventually be more up for furthering the Miss Awesomeness business cause of a more mainstream community empowerment model through the developmental knowledge that OT has provided me. Doing a presentation causes me less stress than direct service, weirdly enough.

The point of sharing all of this is that I want to get back to blogging. Some of it will be more typical blogging and pediatric-based, but some of it is going to be the journey of getting a clinical doctoral degree in occupational therapy. A lot of it will just be the “neurotypical” journey of getting an OTD, just like I did with my Master’s program where I rarely said anything about the mental health struggles. But sometimes, when it’s affecting me (which I anticipate being less and less), it will be acknowledged as a factor.

I have thought about doing this as a separate blog called 296.33, OTD, or something similar. (The ICD-9 code for depression for insurance purposes is 296.33 and I liked how it rhymed with OTD!)  I got feedback from many mentors and they varied in their opinion.

I know many, mentors or not, will disagree and feel I’m harming my future with this decision, but I need to do it anyway. I don’t want others to feel as alone as I have felt. I’m keeping it on the Miss Awesomeness blog for now, but may switch it over to  and delete any current entries. But maybe I’ll keep it here, and just show that it’s okay to be un-awesome sometimes. 😉 However, I am going to compromise and not share as much as I would like to, and keep it at a more formalized level (as formalized as you can get with vulnerability and transparency).

The good news is, even when frequently at varying low capacities, I’ve done a lot in the field of OT. It’s just that at full capacity, I can do so much more, and I know my potential. And I know 100% for sure I will be successful, and that I’m healing, and that the light is there. The journey will remain rocky but I’m learning how to anticipate the obstacles and dodge most of them. I still need a lot of support and am not able to do as much as I would like in the real world, but that’s slowly changing.

The singer Ingrid Michaelson has a song called “Keep Breathing” with a lyric in it that says “I want to change the world…instead I sleep.” See the video below.  That’s been me for a long time.  Now I’m ready to change that lyric to “I want to change the world…and I have started the process.”

This link goes to the song on Youtube. I couldn’t figure out how to embed it because the code kept showing up rather than the video.

Keep Breathing by Ingrid Michaelson

Imaginative play is cognitively enhancing

I saw this status on my Facebook feed and it made my day. It was written by one of the 3rd grade teachers at a school I previously worked. She had overheard her daughter, a vibrant and enthusiastic elementary schooler, exclaim, “Yay! A free box!” I LOVED THIS. We have so many children now who get exactly the toy they desire, rather than having to use sticks as swords, or use their imagination with empty boxes. Imagination and creativity are vital to a mentally flexible and entrepreneurial, problem-solving mind. Play-based learning, especially with items that require imaginative thinking, is so important, and so many caregivers forget that.

A Stroke of Insight/Choreographer of Life

I recently listened to Jill’s TED talk on her “Stroke of Insight”. The book was intriguing. The part I remember most was how she felt sleep was the most reparative therapy of all, as I agree with that.

I had an ethically hard time with waking up patients for therapy as I often felt they needed the sleep more than anything else. Not of course if it was “depression sleep”, but if it was healing sleep. I know there are plenty of studies that say otherwise and that the mobility is important, blah blah blah. My personal belief is that sleep is often more important than anything else, when in the beginning healing stages. 

She comments that after her stroke, “I was no longer the choreographer of my life.” I love the poetry of that statement.  All of us have felt out of control at times, and to varying degrees of severity, and it’s often for that reason, that loss of ability to choreograph. The carefully constructed dance of life that was ready for primetime and yet had to be discarded, either permanently, temporarily, or partially. What grief must accompany that feeling, that sense of loss and helplessness. One of our jobs as OTs is to empower our clients to get back to their own life choreographies. 

Kid version of ACLS ;)

Make a transparent digital signature online without special software

I really wanted a digital signature with a transparent background and I was searching but most things involved Photoshop etc. I don’t have any special software.

So I finally found Lunapic for image background transparency and took it from there…

Wrote my (clearly example/fake) signature on a blank piece of paper…took a picture on my phone and sent it to myself on the computer. Notice the white background, where if I tried to use it as a digital signature, it would look messed up with all the white around it. I tried that once and the company refused it since it was clearly a copy with all the weird white. It would have been fine if only I had the transparent signature. Such a pain.

Now to make the signature have the ransparent background.


http://www170.lunapic.com/editor/

Menu > Edit > Transparent

or go straight here:


http://www170.lunapic.com/editor/?action=transparent

I uploaded the pic, and then clicked on the "make transparent". Slide the transparency bar until your signature looks good (clearly seen) but the background is basically just the white and gray checker pattern. It will be obvious. Save to your computer. It will still have a background when you open it randomly on your computer as an image. But when you go into Word, for example, to copy/paste it, it will have the transparency. YAY! Nobody will know it’s any different than a typical scan.

Also, FYI, on at least Mavericks for Mac…you can edit the PDF and it has its own signature capacity built in for you…pretty awesome and has saved me a lot of time since no more printing or scanning! Or PDFescape.com 🙂

Hope this works for you!! I’m posting here as a "lifehack" because it seems ridiculous it was so hard to figure out/find any information.

Long time no see, blog

My hope is that within the next few days I can devote some much needed TLC to this blog and hopefully eventually the rest of the website as well. I’ve been living in paperwork land so it’s been somewhat neglected lately. It’s been around roughly 8!!!! years now, and if you look at the archives, there were a few years where I did around 60 posts, and other years where I did over three hundred, because apparently, I’m certifiably insane. 🙂 Right now I have quite literally hundreds of pictures and partial posts where I just need to tweak some of them for about 5 minutes before posting.

My style isn’t the super awesomely perfect articles of OTs like Mama OT. Guess that’s why she’s Mama! Very admirable. So my drafts are more like pictures with quick ideas or thoughts, and then others are drafts with topics I find very profound and really want to process. For example, how hope is so important and yet can also be, at times, a four letter word. That deserves a lovingly written essay. Which I will one day get to. 🙂

I post more often on the Miss Awesomeness Facebook than anywhere else, lately, which has its own feed on the side. Need to get back onto Twitter too!! There’s been a lot going on this year in my personal life, so I haven’t devoted as much time to this blog as I would like. However, I never stop loving OT and I never stop applying OT to every inch of my life. I never stop taking pictures to share or jotting down notes of things I want to talk about. It’s all hanging out and it doesn’t get old, so I think my goal for the upcoming week will be to get out a few and schedule a few more, as I should easily have 20+ that I could finish in a heartbeat. 🙂

I changed my settings and realized a minute ago that I don’t get the comments sent to my email anymore. I better change that!

Quick, easy, creative activity: Visual-motor rubber band play

Quick, Easy, Creative OT.

Use rubber bands to work on visual-motor skills! This can be fun and imaginative and a great idea when your options are limited. You can have the child “create” something such as the dog paw seen above on the right, or you can have the child “copy” something! You can focus on figure-ground, spatial orientation, creativity, spatial language (is the blue band under or on top of the red band?), etc! Try to keep this activity play-based. Maybe the bands are actually “bubbles” or you’re giving the dog paw a high-five by placing another dog paw directly on top, whatever. The task can be the same, but the language/drama surrounding it can turn it into play!

Starting your own business as an entrepreneurial occupational therapist

I was asked to contribute to one of AOTA’s (our national OT association) Late Night with New Practitioners posts on OT Connection, specifically geared at entrepreneurism. Here is what I contributed to their July post (OT Connection is for AOTA members only so I am pasting it here).

1. Let passion be your guide. It’s never too early or too late to start building up your own company.
2. Jump into the shallow end. Keep your job, do the basic legal paperwork (not that hard or expensive), and test the water in your spare time.
3. Actively accumulate entrepreneurial resources. Books, mentors, podcasts, interdisciplinary role modeling, observation, inspirational Pinterest quotes, casual discussions, anything and everything.
4. Save all your ideas and plans in a spot outside of your own head. Think of it as your brain back-up.
5. Time is money. Frustration is money. Outsource accordingly.
6. Learn how to spell the word “entrepreneurial”!

Below are the steps I had to take to start my business in San Diego County in the state of CA, so they may be different for yours. This was for me being independent though, no employees, no office location, and private pay only.

I also want to note that I am NOT saying this is an exhaustive list and that in all cases you should double-check for yourself that you are on the right track. This is a generic guide only.

Also, this is with the assumption that you have determined you have a feasible business plan, and now just need to execute the basic legalities/safeties.

STEPS TO START BUSINESS AS AN OT ENTREPRENEUR:

1. Apply for a business license/tax certificate through your county government site, a .gov address. Very simple online process with small fee.

1a. Decide whether you are going to be a LLC or Sole proprietorship or what, and the business .gov website you go to will explain if you are even eligible for an LLC. In California, licensed professionals can’t do LLC, so I went with sole proprietorship. It’s pretty simple to look at the options and decide, or run it by a trusted friend/mentor/business person if you’re nervous. It shouldn’t make a big difference at this point, in my possibly ignorant opinion. 🙂 You need to decide so that you check the right box on the business tax certificate/other forms.

2. If you have a fictitious business name, meaning that your own name is not in the title, then you have to register that with your county. You’d contact the county and you get the form, very basic form and small fee, to register it. For my county, once I submitted the form, they gave me another small task or so, very straight forward, from there.

3. Sign up for an EIN, or taxpayer ID number, through irs.gov. Very quick and easy. This basically just means that as a business, you can use that number versus your social security number.

4. Get a business banking account. For mine, because I had a fictitious business name, they had to wait until I could show them I had applied for the fictitious name, so don’t try this too soon, or find out what they will need.

5. Get both umbrella/general AND professional liability insurance. I used HPSO for professional liability, and I was able to do umbrella/general with my current go-to company for financial/insurance needs, USAA. It will up your insurance just a little bit for some pretty significant coverage, so a good deal.

6. I have no idea what to tell you if you are wanting to apply to be part of insurance companies, hopefully someone else can chime in. Nor do I know all the details if you are wanting to have your own office/employees etc. This is for me going to people’s homes or local places or doing consultation. Just me, and no office, and private pay only.

7. Business cards! Marketing! Etc! Ideally, find a mentor, someone who is already doing this type of practice, to ensure you have done everything you need to do for your own county.

8. Get an accountant BEFORE YOU NEED THEM FOR TAXES. To ensure you are doing the right things so that when tax season comes along, you A) have someone you trust, B) have an established relationship, and C) know you have done the correct things.

9. OUTSOURCE/RESOURCE. Need help with a website? Help with marketing/business card design? Yes, you can do it all yourself, but your time and frustration both count as money. Ten hours of frustration to do something someone else could do in an hour? You’ve lost at least $400 dollars of your own time and mental health, and could have paid someone far less. Network and find out who other people are using.

Beautiful article about a child with cancer and the support she receives

Thanks AOTA for posting this article in the NY Daily News on Facebook. Re-posting.

http://www.nydailynews.com/life-style/health/best-children-hospitals-fighting-cancer-article-1.1818289