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ADVANCE Outlook: OT

Revisiting an ADVANCE Article 20 Years Later
December 22, 2014 3:39 PM by Jon Bassett

The following guest blog was submitted by Mary Bulger, owner of Marusya Inc.

In September 1995, ADVANCE for Occupational Therapy Practitioners ran an article on my company, Marusya Inc.

I launched Marusya Inc. Design in 1994 and some of my best friends were OTs. They contributed much to the success of my first studio, producing universally designed tableware. The founding of the company really began in Boston in 1988, when I began designing privately for friends and colleagues with a variety of hand problems. Looking in the catalogs, I was appalled at the lack of style, grace and choice adaptive tableware displayed. While knowing design, I knew little about disability. Thus began my collaboration with OTs and PTs, nationally and abroad.

I began at Spaulding Rehabilitation Hospital and the Hospital for Special Surgery in NYC. Therapists were very enthusiastic about preserving their patients' dignity and quality of life. Similarly, therapists were equally welcoming in England and Sweden. I met with directors of OT who were very receptive to discussing design issues. I began an ongoing study of the etiology of common hand problems and their application to product design in collaboration with many rheumatologists and hand therapists, and was able to narrow down design options for the tableware pieces I would create.

Our motto has always been "People may not necessarily be disabled, but they can be disabled by design."

Our products are light, well-balanced and easy to grip. They're designed for users with reduced strength, limited mobility and swollen or painful joints associated with various hand conditions. We continue to consult with rheumatologists and hand therapists to test the ergonomic and aesthetic impact of our products on hand function.

I have continued in my role as designer and art director at Marusya and the designs have matured over 20 years. The Easy Grip Cup, once made of ceramic material, is now manufactured in a BPA-free polypropylene in designer colors. The cup has won numerous awards, been showcased in the Smithsonian Design Museum, and selected as Gourmet Insider‘s "Holiday Hot Pick." The 12 oz. cup sells in the medical as well as traditional retail venues. The mark of a truly universal design is to enable independent functioning.

To celebrate our 20 year anniversary, Marusya Inc. would like to extend a heartfelt "thank you" to the myriad OTs who offered their support, encouragement and expertise in bringing these designs to fruition. We have kicked off our celebration year with a launch of the No Slip Easy Grip Cup on Amazon. Additionally, we would like to extend an exclusive discount offer to OTs. Contact sales@marusyainc.com

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Autism & SPDs: Learning From an OT
October 14, 2014 1:27 PM by Danielle Bullen
Editor's Note: This post, written by Darlida Ospina, MS, CCC-SLP, TSSLD, originally appeared in ADVANCE for Speech and Hearing.

For this blog, I consulted an Occupational Therapist (OT) with 21 years of experience in the field. I consulted Mrs. Vargas for her professional expertise on working with children that have Sensory Processing Disorders (SPDs), given her extensive experience. I strongly feel that SLPs working with children that have an Autistic Spectrum Disorder (ASD) comorbid with an SPD should consult an OT on strategies to help meet the child's sensory needs. Mrs. Vargas received her Bachelors at Fordham University and her Masters degree from Columbia University. She has worked with populations ranging from pediatrics to adults with an array of disorders (e.g. Autistic Spectrum Disorder, Cerebral Palsy, Traumatic Brain Injury, etc.). Mrs. Vargas has also worked in a variety of settings including homes, schools and hospitals.

Based on my experience, I think it is extremely important to consider an OT's input in order to help a child with ASD and a co-occurring SPD reach language or communication therapeutic outcomes. When a child has sensory needs that are not met accordingly, it could lead to more sensory disorganization. This could and will have negative implications as you attempt to elicit some form of functional communication, whether gestured or spoken. Mrs. Vargas defined "Sensory Processing" as the following: "It is how we take information in; how we process or put information together in order to respond in a way that allows us to carry out certain functions such as learning new skills or producing language." Mrs. Vargas indicated that children with SPD have difficulty interpreting information the way a typically developing child would. She added that those individuals without sensory difficulties are able to do things without thinking about it. However, they may have "sensory preferences." For example, one person might be able to concentrate in a noisy environment but another might require absolute silence. Mrs. Vargas explained that SPD is an umbrella term for the three following categories:

1. Sensory Modulation Disorder - Difficulty regulating responses to sensory stimuli

Over-Responsiveness -- Children with sensory over-responsivity are very sensitive to stimulation as they feel the sensation too easily or intensely. They might feel as if they are being bombarded with information or over-stimulated. Mrs. Vargas stated that over-responsive children often have a "fight or flight" response to certain stimuli (e.g. being touched unexpectedly, loud noises). This can become a condition called "sensory defensiveness." This could also manifest itself through covering of the ears or withdrawal (SPDstar.org).

Under-Responsiveness -- Children who are under-responsive to sensory stimuli are often quiet and passive. They also tend to disregard or not respond to stimuli. Mrs. Vargas indicated a child that is under-responsive might not respond to spoken language or to touch. Furthermore, the child might appear withdrawn, difficult to engage and/or appear self-absorbed because they do not detect the sensory input from their environment. For example, they may not perceive objects that are too hot or cold, and may not notice pain in response to falls, cuts or scrapes (SPDstar.org).

Mrs. Vargas added that some children may be under-responsive to one sensory system or over-responsive to another.

According to Mrs. Vargas, sensory modulation affects arousal level or level of alertness that is also important for learning. Throughout the day our arousal level is adequate so that we are able to take in information and learn new information. Some children might have a very low arousal level, which could make it difficult for them to learn and take information.

Mrs. Vargas stated that some children have high arousal levels that can trigger "fight or flight." If the child is "too alert" they may not be prepared to learn because they are thinking about safety.

Sensory Craving -- These children constantly seek sensory stimulation. They are constantly moving, crashing, bumping, and/or jumping. These children also have poor spatial awareness. These sensory seeking children are often thought to have Attention Deficit Hyperactivity Disorder (ADHD) and Attention Deficit Disorder (ADD) (SPDstar.org).

2. Sensory Motor Based Disorder: Difficulty with balance/motor coordination

Postural Disorder -- These children have difficulty stabilizing their body during movement or at rest.

Dyspraxia -- A child with dyspraxia has difficulty processing sensory information accordingly, which results in difficulty planning and carrying out motor actions (SPDstar.org).

3. Sensory Discrimination Disorder: This is the process in which specific qualities of sensory stimuli are perceived and meaning is attributed to them. It has to do with understanding precisely what is seen, heard, felt, tasted or smelled. Children with SDD have difficulty determining characteristics of the stimuli. They have a poor ability to interpret or give meaning to the specific qualities of stimuli. In addition, they have difficulty detecting similarities and differences between stimuli (SPDstar.org).

Mrs. Vargas stated it is important for children to be able to organize sensory information so that you as the clinician can get them to a place where they can respond. This is especially true for SLPs because if you can't manage the child's sensory needs you may have a hard time reaching language. She recommends the following, considering the example of a child with a sensory profile of Sensory Modulation Disorder:

Under-responsive child, visual system: Strategy - use bright colors; bright lights; open windows and shades

Over-responsive child, visual system: Strategy - use one color at a time; cover play table if it is colorful; environmental modifications such as darker room; organizing environment such as toys

Heavy work has a calming effect and arouses an under-responsive system. The proprioceptive sense provides information through our joints, muscles, and ligaments about where our body parts are and what they are doing (as cited in http://www.austismspeaks.org).

Mrs. Vargas suggests the following types of heavy work that helps to orient the child: actively pushing/pulling, carrying materials or toys. For example for mealtime prep have the child open the fridge, wipe the table, etc. This helps the child organize the information they are receiving. Furthermore, using language while the child engages in heavy works helps orient them to the task at hand.

With regards to considering the needs of a child with ASD as part of speech and language therapy sessions, Mrs. Vargas said the following:

 "Provide strategies so the child has some foundation in which they can attend and understand. We all need a certain level of arousal in order to attend and to form concepts to communicate."

Mrs. Vargas recommends the book: The Sensory Connection: An OT and SLP Team Approach

References:

S. Vargas, personal communication, October 5. 2014.

Autism Speaks (2007). Tips for working with participants with Autism. Retrieved from http://www.autismspeaks.org/docs/family_services_docs/tips.pdf.

Star Center - Sensory Therapies and Research (2014). What is SPD? Retrieved from http://spdstar.org/what-is-spd/#sor.

 

To read more blogs by Darlinda, visit Speaking of Autism: Across Contexts and Ages

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Errorless Learning for Memory Impairment
August 25, 2014 3:17 PM by Danielle Bullen

Guest post written by Rachel Wynn, MS, CCC-SLP

Let's start with a story that takes place in a SNF where I worked. The tight quarters of a small therapy gym and rehab wing, allowed for easy co-treating and observation of my fellow therapists' treatment, which I found incredibly valuable as a new graduate. I noticed when a very gentle occupational therapist worked with patient (with memory and cognitive impairment) on training safe ADLs, she often corrected with "no", "don't do that", or "uh uh".

Despite the constant correction, this patient was continuing to make the same "mistakes" (or not complete targeted behavior). I had a hunch as to what was holding this patient back from making progress, after all she was physically able to complete the task. I went home and did a little research (since then I have read a lot of research). Sure enough, I found evidence to support my hunch. Because the patient was doing the wrong thing, she was making the undesired pattern stronger. 

What is errorless learning?

Errorless learning is a strategy or philosophy with the goal of reducing errors. We aren't trying to reduce errors for the sake of improved accuracy during therapeutic trials. We are trying to reduce errors, so patients are practicing the desired information or process correctly (even if that means they need more assistance during trials). This in turn results in improved accuracy of task completion.

When you are working with a patient with dementia it is easy to set a goal for improved accuracy (e.g. transfers, ambulation with walker, etc.); however, it is much more challenging to obtain improved accuracy. Errorless learning is a well-researched dementia communication strategy.

Errorless versus errorful learning

If focusing on correction of tasks isn't ideal (due to creating an errorful learning situation), then how do we get patients to complete therapy tasks in an errorless environment? The first thing we need to do is separate task training accuracy and independence goals for patients with dementia or cognitive impairment.

An errorless learning environment relies on the patient receiving all the cues (verbal, visual, and tactile) required in order to complete tasks without error. If the goal is learning a task accurately, then we need to remove the independence aspect, until the task has been mastered.

Evidence-based dementia communication strategies, such as spaced-retrieval therapy and vanishing cues, pair nicely in facilitating an errorless learning environment. As tasks are being mastered, these strategies support our goals for patient independence.

Using dementia communication strategies may be the missing component to helping your patients achieve their goals. Co-treatment requires scheduling and extra effort, but disciplines working together have more tools to use. Collaborate with the SLP on your team to design individualized plans using dementia communication strategies, so you and your patients can meet goals even when dementia or other cognitive impairment is a factor.

Rachel Wynn, MS CCC-SLP is speech-language pathologist specializing in elder care. As the owner of Gray Matter Therapy, she provides education to therapists, healthcare professionals, and families regarding dementia and elder care. She is an advocate for ethical elder care and improving workplace environments, including clinical autonomy for therapists. She is presenting at an upcoming webinar "Dementia Communication Strategies to Improve Therapy Outcomes" with Gawenda Seminars.



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An OT Goes to Atlanta
July 29, 2014 3:56 PM by Jon Bassett
There's an occupational therapist in Georgia who's running for a seat in the State Senate.

Bikram Mohanty, OTR/L, who owns Innovative Rehab Solutions, with two outpatient clinics in Waycross and Valdosta, Ga., is the Democratic candidate for Georgia's 8th Senate district, which encompasses six counties in the south central part of the state.

Mohanty ran in the 2012 race for District 8 and captured almost 40% of the vote. While he lost to Republican incumbent Tim Golden, Golden announced in March that he will not be running for re-election, so Mohanty is confident that he can capture the seat come November.

"I came to this country in 1995," Mohanty told me. "I had $50 in my pocket and the clothes on my back." Following his education at the National Institute of Orthopedics in Calcutta, Mohanty pursued the dream of many OTs in that country, making his way west. He settled in South Georgia, and began practicing with Aegis Therapies and then South Georgia Medical Center. In 2002, he opened his own practice, which at one point had more than 50 employees.

"This country has inspired me to reach higher," he said of his decision to open his own business. "I consider every challenge an opportunity."

If elected, Mohanty will split his time between the business and serving his constituents. State legislators must be in the capital from January through April. Mohanty ran unopposed in the Democratic primary; Republican candidate Ellis Black won a runoff primary election against John P. Page July 22 and will face Mohanty in November.

Mohanty decries a severe shortage of rehabilitation professionals in political positions -- which does patients a disservice, he said. It's a mission he hopes to bring to Atlanta. "Imagine having a PT, OT and a speech-language pathologist in every State house," he said. "Think what that would do for our patients. I'm running for their dream."

Mohanty uses the example of a proposed state bill that would prohibit insurance companies to halt coverage for children who have autism when they reach a certain age -- a common policy among insurers. Effectively the bill -- which has passed with universal support in the Senate but is stalled in the House - would ensure lifetime coverage for people with autism.

"OTs see autistic children all the time," said Mohanty. "Imagine what this bill could do for families, and for OT practitioners." Another example is the Medicare therapy cap. "In all practicality, think what would happen to that cap if there were more therapists in Congress. I want to reach out to every OT, PT, and speech-language pathologist and tell them this task is critical."

But Mohanty pledges to bring more than just a therapist's perspective to office. His flagship issue is education. After learning that many teachers in his district pay for school supplies out of their own pockets, Mohanty has pledged to improve school funding, and promises to accept only $1 in Senate salary, donating the rest to his district's teachers.

To accomplish his objectives, Mohanty declares he will sidestep ideological divides and work together to arrive at real solutions for his constituents.

"The principle that I go by is that political opponents can be friends," said Mohanty, alluding to the current atmosphere of deadlocked government in which innovative ideas are not allowed to flourish. "Idealism is fine, but we have to find a way to not pull each other down."

The election will be held November 4.

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AOTA Meeting Named to 'Fastest 50'
May 23, 2014 1:01 PM by Jon Bassett
BETHESDA, MD -- The American Occupational Therapy Association (AOTA) announced May 23 that it has won Trade Show Executive's Fastest 50 Award, recognizing growth in attendance for its 93rd Annual Conference & Expo held in 2013 in San Diego.

The Fastest 50 Award measures highest growth in exhibition space, highest growth in exhibiting companies, and highest growth in attendance.

AOTA is being recognized for attendance growth from its 92nd annual conference held in Indianapolis in 2012, and its 93rd annual conference held in San Diego in 2013. The Indianapolis conference drew 6,473 attendees and exhibitors, and the San Diego conference -- AOTA's third largest conference ever at the time -- drew 7,133 attendees and exhibitors.

Director of Conferences Frank Gainer, MHS, OTR/L, FAOTA, CAE, and Director of Sales and Corporate Relations Jeff Casper, CEM, accepted the award on behalf of AOTA on May 21 in Chicago.

"Each year we ask attendees what we can do to improve their conference experience, and we do everything we can to implement their suggestions," said Gainer. "Based on their feedback we've offered more sessions for advanced level practitioners, made our onsite guide easier to use, added networking lounges for informal discussions, increased social media presence, and revised the system for tracking and obtaining continuing education credits. These changes have helped our attendance numbers grow, which makes AOTA attractive to more cities, which in turn helps us get the best value and experience for our members."

This is the association's third Fastest 50 award; AOTA's Annual Conference & Expo also made the list for its 2010 and 2011 events.

According to Trade Show Executive's website, medical and healthcare trade shows make up 16 percent of the entire Fastest 50 recognized for 2013 events. Additionally, nonprofit groups, including AOTA, organized 42 of the Fastest 50 shows.

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Education as Engine
April 9, 2014 9:00 AM by Danielle Bullen
Every year since 1955, an occupational therapy leader has been honored to give the Eleanor Clark Slagle lecture at the AOTA annual conference and expo. Slagle was a pioneering occupational therapist, co-founding the National Society for the Promotion of Occupational Therapy in 1910, and a dedicated social activist, working with Jane Addams at Chicago's famed Hull House.

This year the honor went to Maryalynne D. Mitcham, PhD, OTR/L, FAOTA, of the Medical University of South Carolina. On Friday, April 4, Mitcham gave attendees-including some vocally supportive MUSC students-her talk: "Education as Engine."

Barbara Hooper, PhD, OTR/L, FAOTA, and a former student of Mitcham's, introduced her, saying "For the better part of her illustrious career, Dr. Mitcham has been steering occupational therapy along various routes. Hooper told of another former student, who wrote to Mitcham. "Each and every day, I strive to engage my students in meaningful ways like you engaged me."

Mitcham explained the genesis of her lecture topic. "An engine creates a great image for an entity that creates power-power to transmit, power to transfer and power to transform."  At its best, occupational therapy education does all three. But first, Mitcham cautioned, "We need to put together the raw materials to encourage common success."

"My goal was to promote the best learning practices." She admitted that graduates need to acquire more than new knowledge, as that is never-ending. To truly serve its students, OT education needs to offer both the cognitive hard skills needed to strive in any digital context, and the soft skills to communicate, collaborate, connect, and create.

Yet educators must be careful of piling on too much, Mitcham cautioned. "We don't know how to save ourselves from the incessant urge to add one more thing to our curriculum," she said to laughter. OT schools need to equip students with better problem-solving skills rather than cram in every possible theory and case study. "The challenge is to do more thinking, more debating, and more discussing." And as the age gap between the OT professors and the OT students widens, the professors must become adroit at crafting learning for different recipients.

"Occupation needs to be at the core of the profession. Nobody does it the way we do," summed up Mitcham.

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Building Capacity
April 8, 2014 12:05 PM by Danielle Bullen
"I am honored and to stand before you as the 29th president of the AOTA." So said Virginia "Ginny" Stoffel, PhD, OT, BCMH, FAOTA to a crowd at the 2014 AOTA Annual Conference and Expo on Friday, April 3rd.  Her presidential address was called, "Attitude, Authenticity and Action: Building Capacity."

"There is no question about the power of attitude," she said. For occupational therapy clients, attitude creates the emotional fortitude to pursue well-being. Clients fill many roles-parent, child, employee, employer, etc.-and need to be clear about what matters the most to them. "We facilitate reflection on what makes life worth living," Stoffel explained.

She went on to define the 6 emotional styles that affect attitudes and by extension, how client's deal with their recoveries.  Resilience is how fast one recovers from adversity. Outlook is the capacity to remain upbeat. Social Interaction is the consideration of non-verbal cues. Self-awareness is being highly conscious of one's inner thoughts. Cultural Sensitivity is being aware of societal expectations. Attention is the ability to screen out distraction.

"Attitude affects perception. We start by offering unconditional support and acceptance of each person."

Occupational therapists must understand each client's lived experiences in order to be authentic.

Authenticity is an important aspect of heartfelt leaderships.  It can be defined as "being true to oneself in spite of outside pressures."

It's clear that people have better health and quality of life when they are involved in meaningful occupations. Authenticity means understanding the person, environment, and occupation interaction.  Occupational therapy can re-open the door to new possibilities.  "We beget real-life change and authentic working relationships."

Attitude and authenticity lead to great philosophical discussions, but are incomplete without action. "We are a profession that is ready to roll up our sleeves," said Stoffel.  OTs are no longer content to let other disciplines take the lead when it comes time for health policy discussions. "AOTA is building bridges by focusing on the value OT brings to primary care."

At last year's Capitol Hill Day, 750 AOTA members, representing 34 states, came to Washington, D.C. to lobby Congress. Additionally, members sent their Senators and Representatives over 1300 pro-occupational therapy letters in one day alone.

To support finding new directions for occupational therapy, the AOTA and the AOTF partnered together to give 5 researchers $50,000 grants. Those grants will support the Centennial Vision goal to be science-driven and evidence-based. The researchers will focus on autism and healthy aging, areas that have been identified as health priorities.

"We can do together what neither of us could do alone."

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Everyday Hope
April 7, 2014 9:35 AM by Danielle Bullen
Baltimore, April 4, 2014-You may have seen a commercial featuring a bunch of guys playing wheelchair basketball.  At the end of their game--which featured all the good-natured trash-talking typical of the scene--all but one of the guys gets out the wheelchairs. As this is a commercial for Guinness, the next scene shows the group at their local pub, sharing a laugh, a pint, and most of all a common bond. Although it is a beer commercial, Virginia "Ginny" Stoffel, PhD, OT, BCMH, FAOTA, current president of the AOTA pointed out that it could very well be a commercial for occupational therapy.

She showed this commercial at the Welcoming Ceremony and Keynote Address Thursday, April 3 at the 94th Annual AOTA Annual Conference and Expo. Although those men are actors, not soldiers, it exemplified the theme of the address, "The Wounded Warrior and the Art of Independence."

Stoffel said, "Occupational therapy is the key to providing hope for wounded warriors and providing for their reintegration." That message was exemplified by three extraordinary speakers. In front of a packed ballroom at the Baltimore Convention Center, Stoffel hosted a conversation with Sgt. Travis Mills, Sgt. Monte Bernado, and Corp. Tim Donley. All three were severely injured by IEDs in the Iraq and Afghanistan wars. Donley lost both legs below the knees; Bernado also lost both legs and one hand; Mills is one of only 5 Afghanistan soldiers to survive becoming a quadruple amputee.

Also present was Major Eric Johnson, MS, OTR/L, the first occupational therapist to deploy with a combat brigade and noted researcher on the field of combat TBI, who was one of their OTs at Walter Reed National Military Medical Center.

Stoffel asked Mills, Bernado and Donley what was their biggest fear after their injuries? Mills confessed to his fear of not being able to take care of his family. Bernado spoke of the feeling of helplessness. Donley feared never being able to make a contribution to society.

Luckily for them, they had dedicated and skilled OTs. When Stoffel asked what occupational therapy meant to them, Mills said, "OT taught me a new way to do things." He recalled the story of how his OT made a splint and an adaptive spoon, teaching him how to feed himself.

Bernado described himself as independent and mechanically-oriented. "Therapy opened all these doors to the way my life was before. My OT and this hand there (he waved his prosthetic hand) have done that for me. There's nothing I can't do."

Donley echoed the door theme. He remembered feeling humiliated that is family and friends had to take care of him. "Major Johnson opened a new door to make me feel independent again."

Occupational therapy, of course, is all about returning clients to function. Mills said, "I'm not a sob story. I can get through life easier." He's grateful his OTs forced him to do the work and did not feel sorry for him. That tough love was the lesson he wanted other occupational therapists to take from his experience.

Bernado reminded the OTs in attendance, "It's not just a job. You're making our lives, our lives again."

Donley summed up the sentiments of all three wounded warriors and the thousands of OTs, OTAs and OT students at the conference. "OTs, they're changing the world for the better every day."

 

 

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OT's Unique Value
April 4, 2014 3:27 PM by Danielle Bullen

Baltimore--Today's session "Centennial Vision Progress and Issues Facing the Profession," followed a town hall format as  AOTA leaders Virginia C. Stoffel, PhD, OT, BCMH, FAOTA, Amy Lamb, OTD, OTR/L, FAOTA, and Frederick B. Somers answered audience questions. The following are some of the thought-provoking questions and equally thought-provoking answers.

Q: How is  the AOTA going to help people who may have evidence from their clinics but don't know how to present research?

A:  The AOTA is looking to create a national database of research data. They're refining the evidence-based practice section of their website and encourage clinicians to visit. The goal is to have more tools for researchers. As Stoffel said, "We must use the best tools to move forward."

Q:  Is there discussion around changing the entry point for OT education?

A:  On that matter, there are continuing discussions planned around different people's perspectives. After conference, the AOTA Board of Directors plans to open a dialogue to consider if the OTA  entry point should move from a two-year degree to a bachelors' degree. The speakers asserted that this is a work-in-progress with much to be evaluated.

 Q: How can I bring the centennial vision to my practice?

A:  Develop a network of people you can lean on. Define what aspects of the vision speak to you and match your professional expertise. Then go be powerful and promote it. "As a new practitioner resist the urge to let someone burst your bubble. You know what's right and the best way to practice," said Lamb.

Q: How can we have good quality outcomes when clinician attendance is on documentation and not their patient?

A: AOTA is working to help clinicians understand those mandates. We must move from a problem-centered orientation, asking "What is the matter with you?" to a person-centered orientation, asking, "What matters to you?" Leaders from AOTA met with leaders of APTA and ASHA to discuss current guidelines for therapy practitioners and to consider if they need to be adjusted. No conclusion was made, but more conversations are encouraged.

Stoffel called on audience members to wear their ambassador hats. "We must be purposeful in how we promote occupational therapy." She  reminded the audience, "OT brings a unique value to individuals and organizations.

"The absolute best advertisement for OT and our value is our everyday practice," concluded Lamb.

 

 


 

 

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Proper Preparation
April 4, 2014 8:57 AM by Danielle Bullen

Baltimore--On Thursday, two OTs from Ohio State tackled an area where occupational therapy is under-utilized--transition planning. In "Job Matching for Individuals with Intellectual and Developmental Disabilities," Andrew Persch, MS, OTR/L and Dennis Cleary, OTD, MS, OTR/L talked about how to best prepare people with disabilities so they are prepared for when they reach age 21 and age out of the public school system.

"We haven't done a good job advocating for our place at the transition planning table," said Persch. With federal law mandating transition planning at age 16 and people with disabilities entitled to occupational therapy under IDEA, OT and transition planning should be a good match, considering occupational therapy's goal of helping people across the lifespan. He called transition planning, "A huge opportunity for is to interfere in a meaningful way with those who need our services."

Two ways that opportunity is being met are Project SEARCH and the Vocational Fit Assessment. Both operate on the premise that students' ability to self-determine is the best predictor of a successful adult life. A client's interest in a particular line of work, their willingness to learn, a natural support system, and honest expectations about their abilities are the core of  transition planning.

Project SEARCH is a national internship program that matches businesses with adults with intellectual and developmental disabilities by capitalizing on their unique skills. One client with OCD and autism got a job sterilizing the bassinets in a NICU. His laser-focused attention to detail is ideal for that task.

The Vocational Fit Assessment was developed at Ohio State as a formula to better match up a job's demands with the worker's needs. Researchers create profiles for different job possibilities and profiles of people enrolled in the program. Using a green, yellow, red motif--green meaning the worker his a high ability in a certain area, yellow meaning the worker needs additional training in a certain area, and red meaning the worker has little or no ability in in a certain area--the VFA presents a colorful chart of all possible job matches.

The goal is to improve long-term outcomes for individuals with disabilities. Just like all of us, if they are engaged in their work, they will do well.

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Smooth Moves
April 3, 2014 1:44 PM by Danielle Bullen

Baltimore-- A panel discussion this afternoon at the AOTA annual conference focused on how occupational therapists can help children with disabilities and their parents transition between different parts of their academic lives.

The opening part focused on the transition from early intervention to preschool. One of the major changes is the transition from the family-centered practice of EI, where the family's priorities help set the OT goals for the child, to the school-centered practice, where the classroom needs help set the OT goals. Although EI services formally end at three-years of age, the panelists recommended early intervention therapists have earlier, honest conversations with parents about children's expectations and the options for preschool education. "We look at all developmental domains and help parents make good decisions. Positive working relationships between service providers and family members is the most crucial factor in successful transitions to inclusive environments for children with disabilities," said Christine Myers, PhD, OTR/L, Eastern Kentucky University.

In the second part of the talk, speakers shared that parents of children with disabilities are more nervous than parents of typically developing peers about the transition from preschool to kindergarten. These fears are not unfounded. Unlike the EI to preschool move, which is governed by strict regulations, no laws oversee this big change for five-year-olds. Moving from the informal, learning-by-play environment of pre-K to the formal, structured environment of kindergarten, with larger class sizes, is a challenge for any young child, yet alone one with special needs.

Occupational therapists can ease this transition by seeking the collaboration of everyone the child will come into contact with--general education teachers, paraprofessionals, physical therapists, speech-language pathologists, school administrators, and so on. One school district started a program called Jump Start in which the entering kindergarten class comes to school one week in August. The children meet their teachers and get familiar with the building and school routines in a safe, closed environment. Just as with the early transition, positive communication between OTs and parents is paramount to helping these kids move successfully onto the next phase of their education.

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Research Roundup
April 3, 2014 10:33 AM by Danielle Bullen

Baltimore--At the Baltimore convention center this morning, occupational therapists and occupational therapy students presented on a variety of research topics spanning the gamut of patient ages and conditions.

Long the purview of speech-language pathologists, augmentative and alternative communication devices have begun to infiltrate OT's practice. Maura Regan, BS, OTS of the University of Scranton looked at whether High-Tech or Low-Tech AAC does a better job at improving communication among non-verbal children with autism or PDD-NOS. Regan's poster presentation consisted of literature reviews of existing studies on the topic. She found, when applied to the overall population, there is no discernible benefit to using a low-tech option, like a picture board, versus a high-tech, computerized model. Regan concluded that child preference is the best way to select the appropriate device, adding sometimes the child will use one kind at home and another kind at school. For her part, she would like to work with children with autism after graduation, so this research project played into that goal nicely.

In another presentation, Maneshka Perera, MS, OTR/L and Nandita A. Singh, MPH, OTR/L discussed a collaborative rehab program they have with physical therapy at Rusk Rehabilitation at NYU Langone Medical Center. An OT and a PT co-treated spinal cord injury patients that were not as functional as they could be. Using low-tech methods of gait belts and exercise balls, Perera, Singh, and their colleagues where able to re-engage muscles with manual techniques. In just 8 visits, some patients saw extreme functional outcomes. One patient cited being able to transfer from his bed to his wheelchair without assistance--an improvement both physically and for his self-esteem. As occupational therapists, they are able to translate this research into setting new, functional goals to help these and other SCI patients with their ADL's.

Deirdre R. Dawson, PhD, OT Reg and her colleagues at the University of Toronto researched an elemental aspect of all our lives--music. In a currently ongoing study, they are observing unilateral, first-time stroke victims to see if making music can improve their recovery. Over the course of 15 visits, the patients play the drums for gross-motor skills, play the keyboards for fine-motor skills, play the bongos for a more complex mental and physical coordination task, and listen to popular songs to engage their memories. So far, the researchers have seen an improvement in executive functioning, motor skills, and mood. One patient observed that his stroke had less of a negative effect on his life since his participation in the music group.

Thus were just a sampling of the innovative research being done by OTs. Be sure to stop by CC Ballrooms I and II if you're at the AOTA annual meeting and learn more about the cutting edge of the profession,

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A Charming Good Time
March 26, 2014 11:16 AM by Danielle Bullen

It's that time of year again! From April 3-6, over 5,000 OTs, OTAs and OT students will descend on Baltimore for the 94th AOTA Annual Conference and Expo. "Charm City" promises to be a gracious host for those rehab professionals.

After a day of intense pre-conference workshops on April 2, the event kicks into full swing. The schedule is packed with short courses, long courses, research presentations, and poster presentations. From children and youth to mental health to work and industry, there is sure to be a category of event that fits your professional goals.

On April 3, at the opening keynote, "The Wounded Warrior and the Art of Independence," three wounded service members will share their personal occupational therapy success stories.  Newly elected AOTA president Virginia Stoffel will present the annual Presidential Address on April 4: "Attitude, Authenticity, and Action: Building Capacity for Occupational Therapy."

Each year, a highlight of the AOTA conference is the Eleanor Clarke Slagle lecture.  The award honors an occupational therapist who has contributed to the body of knowledge of the profession. This time, Maralynne D. Mitcham, PhD, OTR/L, FAOTA, of the Medical University of South Carolina, will speak on "Education as Engine."

The annual meeting is a time for occupational therapy professionals to honor their own. The awards ceremony on Saturday, April 5 will highlight the best and the brightest from both the AOTA and the American Occupational Therapy Foundation. Who will win the Award of Merit, the Writers' Awards, the Roster of Honor Award, and the AOTF Meritorious Service Award?

Yet it's not all lectures and classes. OT students can mingle at Students Unconferenced on Thursday night. Early birds can partake in a free Friday morning Pilates session or a Saturday morning 5K around the Inner Harbor. And put on your dancing shoes and raise a glass Friday night at the AOTA gala at the American Visionary Art Museum.

And of course, the exhibit hall is a major part of the conference. Approximately 350 exhibitors will be presenting their products and services, so be sure to carve out some time to walk through. ADVANCE will be in booth 218, so stop by to renew your magazine subscription, pick up the latest issue and purchase one-of-a-kind OT gear from the ADVANCE Healthcare Shop. You might even run into staffer Danielle Bullen.

Yes, ADVANCE for Occupational Therapy Practitioners will be on site in Charm City. Be sure to return to the ADVANCE Outlook blog during and after the conference and keep up with us on Facebook and Twitter to get the latest news from the Inner Harbor.

See you there!

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'Tis the Season!
December 12, 2013 2:23 PM by Brian Ferrie

In this season of giving thanks, ADVANCE has so much to be grateful for. Besides the rewarding response we continue to receive for our dedicated print reporting on the rehabilitation profession, our efforts to expand web and social media coverage have engaged record numbers of readers and fans.

Just as the rehab profession is constantly evolving and reacting to new developments, so too is the journalism profession. We at ADVANCE take pride in our ability to push the cutting edge, offering our community of rehab professionals vital information about the profession you love, while providing opportunities to share your thoughts on these developments through our various interactive platforms.

On our website this month, keep an eye out for Top 10 lists of the most popular blogs and app reviews from 2013 -- which continue to build followers as two of the most popular departments ever offered by ADVANCE. We'll also be showcasing Top 10 lists of the year's best features, multimedia and Student Center articles.

Finally, we want to thank you. Without our tens of thousands of dedicated print readers, hundreds of thousands of web fans and talented contributors too numerous to name, none of this would be possible. We rely on you for interviews and freelance contributions, guest editorials and reader comments.

Your feedback and participation are what enable ADVANCE to keep our fingers on the pulse of the rehab profession. Your passion for that profession inspires us every day. So to all of our readers and fans across the country and around the world, cheers to a great 2013 and here's hoping for an even better 2014!

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December 2013 Web Focus: Physical Rehabilitation

Learn how occupational therapy can benefit physical ailments.

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Mission Accomplished!
September 20, 2013 2:52 PM by Brian Ferrie

I did it. On Sept. 15, I attempted and completed my first-ever 13.1-mile race -- the Philadelphia Rock ‘n' Roll Half-Marathon. Although I've been running since I was 13, this particular accomplishment meant a lot to me because my ability to run has been hampered for about 15 years by recurring iliotibial (IT) band tendonitis in my right knee.

I wrote a guest blog post for Philly.com last week about the origins of my injury and how I've tried to manage it. In a nutshell, for most of the past 15 years my efforts to combat the inflammation have consisted of rest, ice, protective knee straps, Ibuprofen, not running on consecutive days and generally limiting myself to about 3 miles when I did run. That was all well and good if the only races I ever wanted to run were 5Ks. But over the past couple years, I became determined to push my limits and stop letting my knee hold me back.

So after doing some research, I incorporated two new key elements into my training. The first was a shortened stride, because I read that keeping it more underneath my center of gravity would decrease stress on my knee and help soften stride impact. The second was regularly using a foam roller to loosen up my hamstrings, quads and IT bands.

Armed with these supplemental tactics, I've been gradually increasing my training mileage and race distances since the spring of 2012. I capped off last year's running season in November with an 8.4-mile loop race along the Schuylkill River in Philadelphia, the first time I had run that far since high school. Then I challenged myself early this running season by taking on a 10-mile race in ADVANCE's hometown, King of Prussia, PA. But all the while, I knew my ultimate goal was to complete a half-marathon -- and that judgment day finally arrived this week.

So how did it go? Well, I can truly say it was the most physically grueling challenge I've ever faced. But not because of my knee, which held up great. The course was beautiful and the weather perfect (about 60 degrees with clear skies). Music bands and cheer squads along the way definitely helped keep me going.

My goal was to not only finish the half-marathon, but run it at 8-minute-mile pace. I actually impressed myself with how consistent a pace I was able to keep -- almost exactly 8 minutes a mile for each of the first 11 miles. At that point, I found myself staring at 2 miles to go and about 30 seconds overall ahead of goal pace. Mentally I felt very good about the position I had put myself in. Physically, I felt like every muscle in my legs was about to seize up. "Just hold on!" I told myself. "You can do it. You don't have to run any faster -- just maintain." Easier said than done, but I willed myself forward.

By the 13-mile mark, I knew I had lost some seconds and it would come down to the wire whether I reached my time goal or not. So I steeled myself to give every last bit of energy I had for the final 0.1 miles, which turned out to be... uphill. My legs felt like lead weights but I forced them to surge ahead and actually started passing other competitors in the straightaway. As the end loomed, I coaxed one last burst of speed out of my spent body and shot through the finish line. Struggling to walk on wobbly legs in the post-race area, I felt overwhelming relief and satisfaction from having passed such a daunting test. 

But did I reach my time goal? I wasn't sure -- and actually thought I might have missed it by a few seconds. Later that day, I pulled out my smartphone and went to the race website in search of posted results. To run at exactly 8-minute-mile pace or better, I needed to finish with a time of 1 hour, 44 minutes and 52 seconds. So I inputted my name, took a deep breath and hoped for the best. My time? 1:44:51! Incredibly, over the course of 13.1094 miles, I had beaten my goal by a single, solitary second. It was an amazing cap to what I already felt was a terrific accomplishment.

Who knows if I'll ever run another half-marathon again? But finishing this one, especially considering the challenges I had to overcome to even reach the starting line, has to rank as one of the greatest moments of my life.

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Blog: Run a Half Marathon? Check.

ADVANCE staffer Rebecca Mayer Knutsen checks an item off her bucket list.

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