too Light pencil pressure

Thanks all for the great ideas on too heavy pencil pressure in a post below. VERY helpful. At the time I should have also asked for help with children who write too lightly!

Here is a hand-out I came up with for children pressing too lightly…if you have ideas you want to add, please comment. This is a combo of things I've seen on the Internet + a few of my own.

Too light pencil pressure:

1)   Before starting to write, provide lots of proprioceptive input to the upper body. Crab walks, animal walks, downward/upward dog yoga poses, straightening elbows and pressing straight down onto desk (weight bearing into arms) 10 times, having him push his hands together, and/or chair pushups where he puts his hands on his chair and lifts up his bottom x 10, are all great ways to do this. The more input the better.

2)   Consider trying a #1 lead pencil rather than a #2 pencil as it requires less pressure.

3)   Practice fine motor activities in general, including cutting, lacing beads, theraputty or play dough activities, using tweezers/tongs, finger puppets, buttoning, zipping, etc.

4)   Consider buying a weighted pencil, or making your own by supergluing or duct-taping some type of weight (perhaps using a nut of a bolt/nut combo, or some heavy washers) to the pencil, higher than his grip would be, of course

5)   Try using tiny golf pencils, and/or if he doesn’t like it, try using thicker/wider pencils.

6)   Get some blank carbon copy paper to put under his writing so that he can send a copy of his writing to a loved one, and it requires a lot of pressure to show up!

7)   Before writing, regularly use his pencil (both of you do this) to show a scale of “too light, just right, too dark” where you use shades of penciling to demonstrate this. Doing it regularly before writing will help remind him.

8)   After he writes, go through and point to each letter. Is this a ghost letter or a just right letter? Let him count the letters that are just right, and that’s how many minutes he gets for free choice time, or how many skittles he gets, or some other reward you want to use. 

caregiving

I spent the weekend babysitting my grandmother (update: got a great comment about not using the term babysitting. I am good about not using condescending language in general and I would never call it babysitting to her face, but it’s true I should use a more respectful term…so….I spent the weekend CAREGIVING for my grandmother) since she lives with my aunt and my aunt had to go out of town. There were all sorts of OT things I did with her in terms of getting her out of her chair, helping her in the shower, etc. All stuff that would have puzzled me pre-OT days. Down side is, I was up almost every hour with her last night, and I was already exhausted, so that certainly didn’t help.

So suffice to say, I have still not gotten to my e-mails. I apologize as I feel like I have quite a few new ones to respond to!

Tonight I bought Speedstack cups on Amazon.com (about 23 dollars and a great OT toy) + a poem book called What’s for Dinner? that are squirmy icky poems that I saw in a child’s 1st grade classroom. Not sure what i’ll do with the poems from an OT perspective but you never know! I have been making “tennis ball friends” – kids love them. The former OT I shadowed had them, plus I saw a thing on them at school-OT.com.

Okay got to get back to paperwork. Just wanted to tell y’all I’m not dead! Just not being a very good blogger lately. Still read every comment/e-mail, just slow (dead snail slow) to respond these days. Good news is, last day is a little over a month away, so I can get through IEP season! I think I can, I think I can!

iep season

So tired I could cry. 🙂 Sounds like a country song. I took a nap from 8 to 9 just to try and survive. I'm semi falling asleep at stop lights! Went to bed at 3 on Sunday night, 12:30 last night…(luckily I napped yesterday too)….it's almost 9:45 and I hopefully can be done with my highest priority stuff by 11:00::crosses fingers:::….today I had 10 minutes to eat lunch and I felt lucky! The day before I didn't get a chance to eat lunch or even go to the bathroom until 4:30pm. It's my own fault, I am new and trying to figure out too much, it was not this grueling when I was shadowing the OT whose caseload I inherited! I just need to speed up and get things under control. In the meantime, utterly exhausted. I've gotten several blog emails lately – it may be at least this weekend (or worse) before I reply, just FYI. Always happy to hear from people though! Just not quick to respond these days.

Let me reiterate that if I wasn't the perfectionistic OT that I try to be, I wouldn't be quite as insane with my schedule. More or less all my own fault. Don't be scared of school OT! (Although IEP season really is rough. My cat agrees, he is trying to help me write this). Okay I had to rant. Back to work.

updates

well I was up until 3am last night working on IEPs so I am worn out! Now it's almost midnight and I want to head to bed soon but I wanted to quickly say I have been getting GREAT ideas in the comments section about kids who use too much pressure while writing! So check them out!

Busy busy busy IEP season for a school OT!

I gotta tell y’all, I am woorrrrrnnn out. I have been working all day, coming home, doing a few chores (ie shower, commute, fix lunch for next day), and otherwise pretty much working all night until midnight or, like Monday night, until 2 am. It’s IEP season in the schools so things are crazy! Seeing as how this is only my second week alone in this new job, I’m having to work hard to keep up with all the paperwork. But everyone I work with is phenomenal and supportive and it’s going to be okay. Don’t be freaked out by how much I work, I’m sure half of it is unnecessary, but it helps me feel more in control. I don’t work well under stress so having the day planned out helps. Of course things change (ie I discover a kid is on a field trip) but at least I have a skeleton in place. I just need to get used to how things work (and figure out how to better organize things). I need to invent a better OT cart to carry around – I got the foldable box one from Office Depot. Not impressed. And it’s not big enough either, haha. I haven’t searched online to see if they have any like hardcore OT rollies that are like double deckers. I would probably be willing to pay a lot of money for a really good one, I carry this sucker around nonstop and it’s about to die after only a few weeks.

I am going to try hard to do a picture post this weekend of a lot of the stuff I am using/carrying around with me. I tried to do a picture post the other night as I went through all my own personal K-4 papers of childhood, but Picasa misbehaved 🙁 Apparently I used to spell my name backwards, ie starting with the N, e, r, a, K. And look at me, I turned out okay (don’t comment)! So maybe my reversals kids will be alright too. 🙂

Okay so….now that I’ve done a brief update to say I AM REALLY CRAZY BUSY…I am really crazy busy and therefore really crazy to be blogging right now. I need to prep for tomorrow! Starting…NOW!

Copying from the board, exerting too much pressure writing…OT ideas please

Needing ideas for…

A) Child using too much pressure when writing (ie thick dark lines; fatigues easily from the effort of pressing so hard)

B) Giving a 15-minute or so lesson to an entire 1st grade class on copying from the board.

Have got a few ideas that I will share at some point soon, but would love to hear from my readers in the meantime. Going to do a quick Google search now (my brain is fried for the night…proof: I spelled that brian), and then go to bed…my goal was ridiculously early and it's already an hour past that….

Sooo many decisions to make for OT playtime :)

I bought a Staples “Easy” button this weekend so kids could hit the “That was easy!” button after completing a task. 🙂 I also bought stuff in Staples dollar section, like foam alphabet and a foam elephant puzzle. And a bizarre, long twisted eraser. And some gum since some of the kids attend better with it. And some creepy bugs. And then I'm going through old stuff, I found an old magic kit that I am pondering, plus an old road trip book for kids that I might steal some ideas from (like doing the cats cradle or whatever its called, in your hands)….and I have Animalia, and an adult coloring book for some of the more advanced kids….and some poms to use with Zoo sticks….etc etc. And a $1 Pilates ring I got at Target years ago that I use to have the kids put their entire body into and then out, somewhat like putting on/off clothes. (IE put over head, wiggle over body and down to feet, step out of it, then step back in and go bottom-top.) You can also use a tied in a circle theraband to do the same thing.

I need to take pictures of my OT stash which is accumulating daily and share more of it. Or maybe make another video – my last one about my pediatric toolbox is like…3 years old. Unfortunately I think I've spent more on OT toys lately than I've actually made in salary, haha. Most of it is from the dollar store or dollar sections, but it adds up quickly. 🙂 And then I have a lot in my old craft bins I'm grabbing. It's a little overwhelming actually. Too much of a good thing, in a way. I need to figure out just what I want for tommorrow's kids and not go crazy figuring out the rest! 🙂 One day at a time.

I also printed out a bunch of Tonya's TherapyFunZone stuff, like animal shapes and cootie catchers!! (I totally wrote cootchie by accident….that would be inappropriate).

One thing I'd love some feedback on is BEHAVIOR strategies. Like if I have a elementary school aged child who avoids cutting, drawing, writing, etc, how do I encourage them to do it? I am guessing people will say to avoid it for the most part as well and focus on underlying skills that are deficient and causing the difficulties. Or say use rewards. I just read an article on kidsatthought.com about how using reward systems is ultimately not helpful long-term. I think for a while, as the kids get used to me, since I'm new to this job, I will try to focus a little more on fun stuff so they grow to like me…then once they like me and think they're gonna have fun, I bring out the hard stuff and show them how wrong they were. 🙂 KIDDING – I'm very big on making OT fun for them. Magical. But that takes a lot of hard work. So. I'm working on it. And I can't work on it if I am blogging. So. Off to go print stuff and go through my big ol' toolbox to figure out tommorow's games!

One wise OT (Orli I think?) once told me I could use the same activity in a given day with each kid, but modify it accordingly. IE a day where the children make spiders – it could be made easy or hard depending on how much cutting, gluing, coloring, writing about it, etc….and obviously based on what the child is working on in OT. So a kindergardener and 5th grader could do it at varying levels of difficulty and be working on completely different things. (IE one child is doing it for sequencing, another for fine motor). I liked that idea. I wouldn't do it all the time, but I could see how occasionally it would work well. Especially on theme days, like near Halloween.

Notice how I said I was off to do something then wrote another whole paragraph. Not cool, Karen. Okay this time I mean it. 🙂

Treating Private Patients in OT

Jena Casbon contacted me about writing this article – I think it’s interesting. I hadn’t thought about taking a private patient or two on the side. And I probably wouldn’t do it any time soon since I don’t have enough years of experience. But it’s something to think about for the future. 🙂 PS I have no idea how it works from a billing standpoint!

Treating Private Patients: A Great Opportunity for OT’s

Experiences During School Will Prepare You For…
It never ceases to amaze me how rich and diverse the field of Occupational Therapy is. Many incoming and early graduate students tend to think of our field in terms of:

• age range (mostly in terms of “kids or adults”)
• specific impairments such as arm and hand dysfunction, sensory integration, dementia, vision impairments, driving safety, or ADL’s
• areas of practice such as physical health, mental health and community
• treatment settings such as pediatrics, rehabilitation in hospitals, home health, private clinics, work hardening

Throughout your undergraduate/graduate coursework and clinical placements, you will gain exposure to a wide variety of age groups, disorders and practice locations. These experiences will help build your clinical skills, while molding yourself into a competent clinician.

Your Early Career
The first year after graduating from your OT graduate program is a both stressful and liberating time in your career. In many ways, you are on your own now: able to work on the areas where you feel your patient needs the most help. This degree of autonomy can be scary for many new grads, but hopefully your supervisor, colleagues or former graduate school classmates can support and encourage your clinical decision making.

During the first few years of your career as an Occupational Therapist you will continue to learn so much about disorders, how patients can present differently, how to manage patients and family dynamics, etc. At this stage you will likely begin to gravitate to a specific age group, diagnosis, etc. I urge you to take as many continuing education courses (CEU’s) as you can as you build your expertise. You may even opt to change jobs or settings in order to gain more exposure to different aspects of our field. All of these things will help you to grow and provide excellent care for your patients.

I Wonder If I Could Ever Have A Private Practice…?
Almost every OT friend of mine started out dreaming one day of having a private practice- but as they got into the field more and more, the safety of a regular job with consistent pay won out over the risk of going out on their own. To be honest, starting a private practice has a lot of extra work, extra responsibilities and headaches- but the trade off of high-income and more autonomy is very alluring for some people.

Private Patients: A Great Way to Start
Most of us got into this field because we love to help people, not because we wanted to make money. As time goes by though, the reality of car or house payments, wanting to have extra income for our families, vacations, etc. starts to hit and we become frustrated with our regular pay. Another benefit to private patients is flexibility of your schedule and also getting to treat ideal patients. Treating privately is a great way to help more people while making more money by seeing one to several private patients on the side.

How Does Private Therapy Work?
At some point, you will know colleagues that are treating private patients and a patient or family member will ask if you can provide private treatment. Private occupational therapy is often requested as a way to deal with:

• to provide consistent therapy during gaps over the summer for school-aged children
• to supplement therapy already being received (kids or adults)
• to continue therapy if insurance won’t continue to pay for services (kids or adults)

Most private therapy occurs in the patients’ home and OT’s are paid either through cash/check or reimbursed through an insurance company. Therapists need to have their own liability insurance, document their treatment, market their services to obtain more clients and pay taxes on this extra income. Most therapists charge between $75-$125/hour for their services.

Is Private Therapy Right For You?
I recommend that you have at least 2-3 years experience as an OT before you begin treating privately. You need to build up your expertise in a diagnosis or treatment technique so that your services are truly valuable to your private patients. Because you’ll be doing this on your own, you need to develop a level of confidence about both your clinical and business skills before you start. Starting to see private patients is almost like your first year of practicing all over again. Once you have some practice and experience, you’ll feel much stronger. Some clinicians start with private patients and then graduate to starting their own free-standing private practice- others keep their regular job and see private patients on the side.

I hope this has helped open your mind to yet another really cool aspect of the field of Occupational Therapy!

________________________________________________________________________________________________
Jena
H. Casbon, MS CCC-SLP is a Speech-Language Pathologist and founder of The Independent Clinician. After graduating from Emerson College in 2005, she has worked with adult outpatients in a rehabilitation hospital and inpatients in a skilled nursing facility. Three years into practicing as an SLP, she began treating private patients- but the lack of a “how-to guide” bothered her, so she wrote one.
Follow Jena on Twitter @IndClinician and Facebook http://www.facebook.com/independentclinician
Be sure to visit http://www.IndependentClinician.com to learn more about how to treat private patients.

Nurse in haiti, part 2

My cousin is a nurse that recently went to Haiti for a week to help….this was her second e-mail she sent out. Again, I know she is a nurse and not an OT, but it’s healthcare and I think there are a lot of parallels at times!

Blogging blizzard complete

I am sorry if your eyeballs have popped out of your head after like fifty thousand new blog posts. I got through literally hundreds of e-mails. Again, at expenses of taxes, cough. So when the IRS comes knocking at my door, I blame y’all. 🙂

I finally realized what I should have done – is save them all as drafts and then post like, one a day, rather than posting five thousand at once. I didn’t realize this until late in in the process. So now I have like six saved to do over the next few days/weeks as I remember….I don’t know how to automatically post them regularly at a certain time, with blogger.com. Dunno if it’s possible. Don’t care enough to find out.

I look forward to all y’all’s comments!! One thing about catching up on e-mail/blogging is that then you get this whole new deluge of comments/e-mails. A vicious cycle. BUT I LOVE THEM SO PLEASE E-MAIL/COMMENT YOUR HEART OUT. I’m just slow to respond!

So it took me about two hours to do this blog blizzard – my cat is bored. That says a lot. Good night.