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

**Top 12 Things You Should Know For Your Fieldwork**

A list of things to help occupational therapy students prepare or get through their fieldworks/internships in preparation for becoming an independent practitioner.

1. BE PROACTIVE AND REACTIVE. If you have a patient with fragile X syndrome tomorrow, research it in advance. If you see a patient with fragile X syndrome and realize you would benefit from more knowledge or have questions, research it after. Maybe you can present your supervisor with some helpful resources you found, or be better prepared for next time.

2. ASK QUESTIONS, AND KNOW WHEN TO ASK THEM. Supervisors and practitioners of any field are hopefully happy to answer your questions. It’s a great sign that you are processing and synthesizing information. But when you are both with a patient, use your best judgment as to whether it’s an appropriate time to ask it. If in doubt, don’t ask it then. Write it down so you don’t forget or at least scribble a “trigger word” reminder down for later. Bombarding your supervisor with questions at the last second of the day while they hurriedly try to get their act together, isn’t appreciated either. Collaborate on finding a good time to ask the questions.

3. YOU WILL MAKE STUPID MISTAKES AND IT’S OKAY. I’m not talking about safety ones here, I’m talking about basics. Forgetting where you put your pen, or being unable to open a simple container, or bumping into something. You are nervous and on your best behavior and you are trying soooo hard to impress your supervisor. That means you will make the stupidest mistakes of all, and we get it. We were there too. We (likely) aren’t judging you harshly for mistakes that we know are from nervousness.

4. SAFETY COMES FIRST. Stupid mistakes with opening a container are fine, dropping a patient is not. If you don’t feel safe with a patient for any reason (whether it’s for a physical impairment or mental health/cognitive reason), you need to ask for guidance. You may hesitate because you don’t want your supervisor to realize you don’t know how to do something you probably should by now, or to cause them trouble. Guess what? It causes them FAR more trouble, and FAR less confidence in your abilities, if you make a mistake that hurts a patient because you were more concerned about yourself than the patient.

5. HAVE A “CHEAT SHEET”. Common abbreviations, alarm codes, locations, phone numbers, little tidbits of information, whatever. Jot it all down. Keep an index card on your clipboard or in your pocket. When you’re stressed, and you likely will be, you are going to have trouble remembering all the little things you usually don’t have issues with. It’s appreciated when you don’t have to ask your supervisor every 5 minutes for a code they’ve given you twice now.

6. BE EXTRA HELPFUL . Your supervisor will eventually (hopefully) be helped by your presence, but at first, you are an awful lot of extra work, no matter how amazing you are. See something that you can easily put back in place, or clean off, or make more efficient? See a little errand you could run? Offer to do it, or ask permission. You may want to do it without permission but just ensure it’s not something being done deliberately. For example, don’t put away a 100-piece jigsaw puzzle that is laid out, with 6 pieces still undone, unless you are positive it’s not being saved for some reason. Don’t try to organize a drawer of equipment unless you understand its purpose, usage patterns, and knew that someone jumbled it up yesterday but that it looked a specific way the day before.

7. FOCUS ON LEARNING EVEN DURING DOWNTIME AT WORK. If you have any downtime in your work day beyond your legitimate break (haha, good luck) or lunch, you should be actively learning. This is your chance. It’s so tempting to get on your phone a while and veg out during a gap. Maybe sometimes you need it for your mental health or to deal with something. But ideally should be researching, or cleaning, or formulating questions, or updating your cheat sheet, or something that shows determination and drive. Don’t be too zealous and don’t bug your supervisor too much if it’s clear they need a break. But at the very least, ask if there is anything they would like you to do or anything you can do to help, during the downtime.

8. EXPECT AND WELCOME CONSTRUCTIVE CRITICISM. You’re a student, you’re interning, you don’t know everything. You will make mistakes you don’t even know you’re making. Maybe you will talk too loud, or be “too” helpful. (One time I was trying to get my kids to advocate that they need a pencil by giving them a writing task, paper but no pencil, and then deliberately turning away to occupy myself. My shadow jumped up to get it before I could – a perfectly valid thing to do, but I had to give her feedback to wait until I asked since it was often a deliberate act on my part.) Maybe you won’t realize you are insulting a patient with your word choices, or that you keep forgetting to teach a certain skill. The whole point of your internship is to grow. You can’t grow if you aren’t aware, and “you don’t know what you don’t know.” It may sting, especially when you are trying your best and had such good intentions. Try to therefore hold the intent of the person giving you feedback, which is only about making you be even better than you already are. Don’t be defensive. Nod and give appreciative for the feedback.

9. YOUR PLACEMENT/THERAPISTS MAY NOT BE YOUR IDEAL, AND YOU CAN STILL LEARN A LOT. Maybe you really, really, really wanted to do pediatrics, but instead you got a hand specialty. Maybe you have a super stern or um, supervisor with a conflicting personality type, versus the warm/fuzzy one you craved. If there is a true moral/ethical/safety/major concern, speak up to your fieldwork advisor at the school for a potential placement change. If it’s a frustrating/annoying experience, get advice, but realize you are likely in it for the three months if it’s a Level II. You will still learn a lot, even if it’s a lot of what NOT to do, or to work in the face of adversity. A lot of employers ask their potential employees about a time they had a conflict with a coworker, and this will be great for that interview question! Lucky you, right????

10. YOU WILL SOMETIMES FEEL LIKE AN IMPOSTER. It’s okay, we get it. We have all been there. Sometimes we’re still there, when we encounter new situations or change areas of practice. You may feel like you have no idea what you’re doing, but if you are doing it safely, and look confident, and your supervisor, colleagues, and patients are not giving you negative feedback, you’re probably just fine. You will think “gosh, they say I’m doing a good job, but if they REALLY knew how little I know, they wouldn’t say that. I’m just hiding it.” Happy to tell you that you’re probably doing better than you think. Give yourself some credit.

The ten above are pretty universal for all fieldwork students, and the two below are more targeted towards people like me, who have had a long struggle with depression and/or anxiety, and found fieldwork even more challenging than normal, because of it.

11. YOU WILL GET IT EVENTUALLY. This is somewhat similar to the fraud piece. You will likely feel overwhelmed at first, that you will never understand it all, that it’s just way too much, and you will fail. That everyone else can do it, that something is wrong with you, that all your schooling was worthless because you won’t get through the fieldwork. You will be scared. You will be SO CONVINCED it won’t click. But guess what, it will and does. It takes at least a week to start to get a picture of anything, and by the end of the second week you’ll have so much more knowledge than you would have guessed, although a lot of it you may not even give yourself credit for. With every week, more and more scaffolding will help you learn. Unfortunately, at the same time, they’re increasing your independence, so it’s somewhat of a balancing act in terms of anxiety. Keep telling yourself out loud, over and over and over again, whether you believe it or not, that you will get through it. Because you will. It’s a miracle, I’m hardly even exaggerating for once, that I made it through. I’m a great masker, nobody at work truly knew the extent of it. But I did it. YOU WILL TOO. AND IT IS WORTH IT. Because once you’re out of fieldwork, you can go into what you WANT to go into. You can do what feels comfortable, you can work without necessarily feeling like someone is watching you intently, you can start to relax. Which leads to…

12. USE YOUR RESOURCES. This may be your exercise/yoga class, a meditation session or church, a good friend, family, a hobby, the Internet/social media, mentors, textbooks, whatever. Something that gives you confidence in your knowledge, or lets you decompress/relax, or gives you support in whatever form you need. This can also include a psychologist and/or a psychiatrist. I would not have gotten through fieldwork, 100% for sure, without many of these resources, and most especially a psychologist and psychiatrist. Not something I should ideally mention to the world, and many of you people over the age of 35 or so will grimace that I admit it publicly (different perceptions of privacy), but IT IS SO IMPORTANT for people to realize how prevalent it is, and that only happens if people admit it. Yep, I struggled a lot in fieldwork, mostly due to the anxiety disorder. And yes, it was all worth it. And I’ve been a practitioner less time than many of my coworkers because of needing breaks, but I’m on my fourth year now of being a practitioner. And I love, love, love, love being an occupational therapist. And I would do the entire process all over in a heartbeat, even though it nearly killed me at times. IT WAS WORTH IT. If you have passion for the field, and you ARE WILLING TO ADMIT YOU NEED HELP in whatever form that takes (yoga, friends, counseling, any of it), you have a high probability of success.

By the way, I’ve written a little about OT Student fears in the past, and some ways to impress your professors, and if you go to my archives, I wrote roughly a thousand posts in OT school during 2006 to 2009.

Click “Read More” for the rest of the information, which may be helpful to prospective students who have no idea what I am talking about when I reference Level I and Level II fieldworks. 🙂 

(more…)

The Inspired Treehouse – OT/PT blog and misc

I saw that AOTA (the American Occupational Therapy Association) posted a link to one of the blog entries done by the Inspired Treehouse, http://theinspiredtreehouse.com/

I checked it out and I loved it. It’s done by several OTs and a PT. Great quick tips. Go see and revel in their awesomeness. 🙂

In other super obvious news, I’ve been neglecting the blog lately. And Twitter. Mostly active on Facebook at https://www.facebook.com/missawesomenessdotcom lately. We’ve had an interesting topic being discussed over there, about productivity units and ethics and how the two typically don’t mix as it pertains to high quality of care.

I’ve had a lot going on in personal life and unfortunately the blog has been somewhat on back burner. Today I spent over three hours tangled in phone trees (guess i need an inspired treehouse) and I was practically in tears near the end of that time as it was quite a frustrating experience. My favorite phone tree is the one that is a pain to navigate, then tells you when you finally get to the right place, that the maximum number of people are on hold right then and to try again later. Which I did. Four times. And a few times a few days ago as well. Augh. I think I have a better chance of winning the lottery than getting a hold of someone at that business.

I’m looking forward to doing some fun blog posts on some Melissa & Doug items that they sent me to try out and write about, and a few other items such as the Spot It game, Ark items, etc.
As long-term readers know I’ve been in the elementary schools for 3 years…now I’m not, and I have several 2-year-olds and several 4-year-olds I’m seeing. I had forgotten how tiring the littlest ones are!

Monster Cheese – Most Popular OT Toy I've found :)

*Video transcript at bottom.

My cheap “Monster cheese” is my number one most consistently popular toy, hands-down, among kids under the age of 10 or so. This has been true for over three years, since I discovered it. Even my former OT kids with poor memories who run into me  months later will ask about him. He’s most requested as a reward, which I love since he is also a great “work out” for our occupational therapy sessions.

He works on bilateral coordination (using both the hands), motor planning (figuring out how to maneuver the hands/fingers to get items into it and then back out), imagination/creativity, silliness (some kids are scared of monsters, but monster cheese isn’t scary!), fine motor skills, etc.

Sometimes I use it in my evaluation specifically because it is a novelty where I know the child has never encountered anything like it, for a motor planning/attention/direction-following/imagination assessment as I show them technique. It also takes a little strength which is challenging for some of our younger children with weakness.

At the end of his meal, monster cheese gets so full he has to throw up. That’s their favorite part. And he can hold a LOT inside of it, with his “hyperflex” material. So we get all our friends back!

The cheese is made by PlayVisions and it is called “Stretchy Mice and Cheese”. I originally found it on officeplayground.com as a fidget. It comes with two big mice. It’s also at TherapyShoppe.com now as a great texture/sensory fidget. But I quickly discovered it was way more fun when the cheese ate tiny objects, and somehow “monster cheese” was born. You can buy the cheese on multiple sites, and Amazon is definitely not the cheapest, but it is the most convenient. It eventually gets dirty because it picks up flotsam. Try to be kind to it. You can wash it with soap and water, and then talcum powder it after to help it not be so sticky . Mine lasted a few years before they got super dirty looking, although are still useable. I just got some nice fresh ones. I use all my tiniest toys (Safari Good Luck Minis, Zinkies, Squinkies, etc) with him. The picture shows Good Luck Minis.

Buy at Amazon for convenience http://www.amazon.com/Play-Visions-Stretchy-Mice-Cheese/dp/B0018KJTBC/ref=sr_1_1?ie=UTF8&qid=1402117896&sr=8-1&keywords=stretchy+mice+and+cheese

or buy at TherapyShoppe to support a smaller store! https://www.therapyshoppe.com/category/P559-stretchy-mice-cheese-special-needs-calming-sensory-fidget-toy

Good Luck Minis https://safariltd.com/products/view/gl-mini-wild-america-fun-pack-349922

In this video, I’m working with four year old Michael, who has now met Monster Cheese several times. He really struggled to feed it the first few times but now he has it down. 

K: Okay. These people probably haven’t seen monster cheese before. 

M: Hey, ninja’s going to be eaten.
K: Nooo not the ninja.
M: He got eaten. The car’s going to be eaten.
K: Noooo.
M: The car is trying to go in this spot.. the car got eaten. Now more’s stuff going to be ate. This balls are going to be ate. Hey the balls got ate.
K: Poor balls.
M: Nader [cars character] is going to be ate…soon…he going to eat all the sticks.
K: I feel like this is a not good day for most of our friends.
M:. Look at these guys….he just ate the ninja….because monster cheese is a bully.
K: Monster cheese is a bully.
M: He’s kind of eating stuff that doesn’t taste good for him, and he tries to eat stuff that’s not good for him.
K: You know monster cheese, we have to have a talk with you about nutrition.
M: No he doesn’t want to.
K: I don’t doubt that.
M: He’s trying to go right through the holes. But he eats sticks all up. He ate a stick.
K: Oh that could be painful.
M: He’s very interesting.
K: I found some cookies. Do you think he would like some cookies?
M: He will. But he can eat this cookie.
K: Can he?
M: Yes.
K: Be careful with that stick
M: He has a stick right in his mouth.
K: Yeah. That probably hurts.
M: That doesn’t hurt for monster cheese. Because he eats every stick he likes…he pokes his whole body up.

K: That’s true, I guess that’s how he had to get holes, huh.
M: He’s trying to get more holes. Oh he’s going to eat this turtle.
K: Not my turtle. Anything but the turtle.
M: He ate his turtle.
K: Rude.
M: He’s a rude guy.
K: He is rude.

M: He eats ….he’s going to eat the dinosaur.
K: Don’t eat my robot friend.
M: He’s going to eat his robot friend.
K: Nooooo
M: Yeah he can.
K: Well luckily I have another one, he can’t eat them both right?
M: Yes he can. He’s eating the robot.
K: Oh no. Maybe we’ll save him later. You think we’ll be able to save them later?

M: He’ll eat all the eyeballs.
K: But I need them to see.
M: No.
K: How are we going to make our eyeballs if we don’t have eyeballs?
M: He’s eating all the eyeballs.
K: This is a very sad day for us, isn’t it.
M: He’s trying to eat all the guys, and now he’s just a ninja pokey.
K: A ninja pokey?
M: He’s a monster cheese pokey.
K: I wonder if the ninja will be able to help everyone else get out.
M:But the ninja’s stuck in the belly.
K: But maybe he can like kick his way out.
M: But he has to tell all the people to get out.
K: That’s true. He has to help them.

M: But he’s eating all the eyeballs so all the persons will get smooshed by eyeballs.
K: (Laughs)
M: That would be funny?
K: That would be very funny. I like that idea. Although it’s a little sad too.
M: But he’s going to eat all your friends.
K: (gasps)This is going to be a rough day, I can tell.

M: He’s getting stuffed. Monster cheese is going to throw up.
K: I hope he does, because I want my friends back.
M: But he won’t throw up, forever.
K: Oh I think I have a trick we can play on him in a minute. Maybe that will help.
M: He will….(indecipherable)….this thing.
K: He looks like he has a toothpick in his mouth, like he’s just cleaning his teeth.
M: He’s just cleaning his teeth with a stick.
K: :(laughs)
M: That’s funny?

*Parents gave verbal/written permission for this video to be shared.
*Youtube gave the suggestion of “Munster Cheese” as a tag AHAHAHAHAA love it.