October is Disability Awareness Month. The personal finance website WalletHub conducted an in-depth analysis of 2015's Best and Worst Cities for Americans with Disabilities, and recently released the results.
According to the U.S. Bureau of Labor Statistics, nearly five million people with disabilities were employed in 2014. However, the unemployment rate for those with a disability continues to be almost double the rate for persons without one, WalletHub states.
WalletHub compared the 150 most populated cities in America across 21 key metrics, ranging from the number of physicians per capita, to the rate of employed people with disabilities, to park accessibility.
The best and worst cities are listed below.
Best Cities for People with Disabilities
1 Overland Park, KS
2 Scottsdale, AZ
3 Peoria, AZ
4 Tampa, FL
5 St. Petersburg, FL
6 Huntington Beach, CA
7 Oklahoma City, OK
8 Gilbert, AZ
9 Honolulu, HI
10 Santa Clarita, CA
Worst Cities for People with Disabilities
141 Rochester, NY
142 Birmingham, AL
143 Newark, NJ
144 Winston-Salem, NC
145 Stockton, CA
146 Worcester, MA
147 Moreno Valley, CA
148 San Bernardino, CA
149 Jersey City, NJ
150 Providence, RI
The full results and methodology can be viewed here.
Did your town make either list? How handicap-accessible do you feel your community is? What are the most common barriers you hear from patients? Leave a comment below.
The American Occupational Therapy Association (AOTA) just issued a press release this week declaring that hundreds of OT clinicians, educators, and students from across the United States will meet with elected officials Sept. 28 on Capitol Hill. They intend to discuss key legislative issues affecting the profession and the current state of healthcare such as mental health, home health, and rehabilitation research. Legislation supporting access to occupational therapy could reduce overall healthcare costs by facilitating independence among patients.
Organized by the AOTA, "Hill Day" is an opportunity for healthcare professionals to bring their concerns straight to their state's lawmakers, offer solutions, ask questions, and listen to guest speakers on the topics that affect their work. Last year, more than 550 occupational therapy practitioners and students from across the country visited Capitol Hill to make their voices heard. To date, more than 570 have registered for the 2015 event.
"Occupational therapy is a critical component to healthcare," said Heather Parsons, AOTA's director of legislative advocacy. "Whether the client's goal is to bathe independently after a stroke or as complicated as returning to work after an accident, occupational therapists work to make that goal a reality. Hill Day attendees will focus on creating new policies to provide quality healthcare that should include occupational therapy services. We are excited to have hundreds of occupational therapy practitioners, educators, and students come to Capitol Hill to talk to lawmakers about occupational therapy."
Here are all the Hill Day details:
Where: The Capitol Visitor Center Congressional Auditorium and Atrium, connected to the Capitol Building at First and East Capitol St., Washington, D.C.
When: 8:30 a.m. to 5 p.m., Sept. 28, 2015 (There will be two briefing sessions: 8:30 to 9:30 a.m. and 10 to 11 a.m., followed by Congressional office visits between 11:30 a.m. and 5 p.m.).
Get Connected: For Hill Day updates, search #OTHillDay, follow @AOTAEvents on Twitter, or visit AOTA's Hill Day website.
To Learn More: E-mail firstname.lastname@example.org or go to the AOTA homepage.
While there are many important differences between the physical and occupational therapy fields, it is more often than not found that each profession can learn a lot from the other.
Back in July I went to visit Phoebe Ministries, a non-profit, multi-facility organization specializing in health care, housing, and support services for seniors located in Allentown, Pa., to learn about their newest implemented therapy program, NET (Neurocognitive Engagement Therapy), which focuses on helping individuals with cognitive impairment regain their function and return to their home environment using traditional as well as nontraditional therapy methods.
Although this program seems to be more OT driven, it actually requires an interdisciplinary team, including physical therapists. In fact, the program's founder is a PT. Jennifer Howanitz, MPT and Director of Rehab Services at Phoebe Allentown, said that when she got to Phoebe with a PT background, and saw there was no unit focused solely on dementia care, she wanted to make that happen and give therapists that kind of training that they hadn't had before.
Howanitz told ADVANCE that the physical therapists at Phoebe are learning how to get more in touch with their creative side, instead of always going by the books and doing things only the way they were taught in school. "It has been more of a challenge for PT's to not be so black and white," said Howanitz. "OT's tend to be more creative naturally," she added.
Howanitz said that because of the program's overwhelming success with both therapists and patients, physical therapists are learning that they can be more creative with their patients. "The PT's are doing well because the program works. They are seeing these approaches work and it is sparking their creativity. Success breeds confidence and creativity."
OTs, how do you feel about PTs taking on more creative roles? Have you ever had an experience working with a PT and helping them spark more creative thinking? Have you learned something from a PT that you never did as an OT?
Editor's Note: This blog was guest-written by Maher Kharma, MHS, OTR/L, CEAS, occupational therapist at Doctors Community Hospital, Lanham, MD
While occupational therapists wear various hats at different times to maximize client independence, they also function well, and are equipped to do so, as the ones who step in to renovate lifestyles.
Recently, a 65-year-old stroke survivor came to our clinic displaying the typical flexor tone in the affected upper and lower extremities, interfering with his mobility and ADLs. The client presented two years post-stroke, and appeared to have more needs than your typical stroke case.
As trust built up between us, with clinical reasoning at the heart of the operations, this client shared that he was living in a house with his daughter and her children, whom he rarely sees or interacts with, consequently receiving no support.
Over the course of therapy, it became clearer that lacking such support was negatively impacting his ability to progress in therapy. The client repeatedly expressed concerns regarding his lack of support, and it eventually became a regular part of the discussion during the session, placing the person-environment-occupation model at the center of his care, reflecting how the environment constitutes a barrier.
In terms of functional mobility, the client was non-ambulatory and used a manual wheelchair, and his limited progress in physical therapy reflected that he would not progress to the point of becoming ambulatory. In exploring his occupational profile, it became more evident that he used to have an outgoing personality, and enjoyed the outdoors.
As OT intervention started, a home exercise program was developed to address his musculoskeletal limitations, and ADL deficits were routinely addressed. Within a few sessions, the client became excited about his improved independence in ADLs. With limited progress in his motor function, he was referred to a physiatrist and received Botox injections that relaxed his affected upper extremity to some extent.
As to the client's environment, he was connected with a social worker who provided him resources for acquiring his own housing through HUD. He was given a list of additional community resources to enroll in adult day care in order to rejuvenate his occupational roles, as well as a list of home health agencies to hire a home health aide, literature regarding subscribing to lifeline services, and resources for getting his groceries delivered.
Finally, the client was evaluated and fitted with a motorized wheelchair to enable him to access the community more independently.
The outcome of this case turned out to be remarkably satisfactory for the client and the treating team. When lifestyle redesign is needed, occupational therapy can assume this role.
Maher Kharma has been an occupational therapist in various settings for over 20 years. He has lectured on stroke rehabilitation, organized a full-day multidisciplinary stroke conference in 2012, founded a stroke support group, and is currently developing an upper-extremity stroke protocol.
With the start of school approaching, the American Occupational Therapy Association (AOTA), Bethesda, Md., issued a press release on July 30 stating, in part:
"Heavy loads carried by more than 79 million students across the U.S. can cause low-back pain that often lasts through adulthood. According to the U.S. Consumer Product Safety Commission, in 2010 nearly 28,000 strains, sprains, dislocations, and fractures from backpacks were treated in hospital emergency rooms, physicians' offices, and clinics.
‘A child wearing a backpack incorrectly or that is too heavy can be contributing risk factors for discomfort, fatigue, muscle soreness, and musculoskeletal pain especially in the lower back,' says Karen Jacobs, EdD, OTR/L, CPE, clinical professor of occupational therapy at Boston University, and an expert on school ergonomics and healthy growth and development of school-age children."
In light of these risks, the AOTA urges parents and caregivers to consider a variety of factors when selecting a backpack, including size, shoulder strap padding, hip belt options, and comfortable fit. Finally, the organization recommends limiting the supplies in a child's backpack so that it weighs no more than 10% of his body weight.
AOTA's National School Backpack Awareness Day will be celebrated on Sept. 16 with backpack weigh-ins and check-ups, as well as activities and special events. Do you think enough attention is paid to backpack safety for kids? What can occupational therapy professionals do to help spread awareness?
I recently took a trip to Allentown, Pa. to visit Phoebe Ministries, a non-profit, multi-facility organization specializing in health care, housing, and support services for seniors, and learn about a breakthrough program that will pave a more sufficient path for patients with Dementia and other cognitive impairments.
The Neurocognitive Engagement Therapy (NET) program is for patients with cognitive impairments who are usually not accepted into assisted living homes because of their behavior issues that nurses often find too challenging. NET uses traditional as well as non-traditional techniques and approaches when working with patients; the goal is engagement, so the staff does whatever they can to find something their patient loves, and turn it into a beneficial activity or exercise.
"I knew Phoebe was known for its rehab," said Jeanne Mathias, whose husband, Dave, was a patient at Phoebe. "I worked to get my husband in there because other places would not take him because of his dementia. They said it was too difficult."
Mathias told ADVANCE that she had confidence in them because any time she came to them with a concern, they listened to her. "It wasn't like they just did what they wanted. They addressed my concerns and made an effort to incorporate them into their rehab approach."
Another one of their goals at Phoebe is to establish more relationships with the family of the patients and to work together with them. "It gave me a better peace of mind to know that they were working along with me in order to accomplish a goal for him and myself."
The NET program is actually backed by studies, all with good results. In my short time visiting the facility, I met two patients who were getting ready to soon be released, when just a short time ago they had come in with high levels of impairment and behavioral issues.
You can learn more about Phoebe Ministries, the NET program, and the therapists behind it in our cover story of Advance for Occupational Therapy Practitioners, out August 10! OTs, do you have experience working with patients with Dementia or other cognitive impairments? Do you think there is enough education out there for therapists to be confident in their ability to handle that kind of care? Let us know in the comments section.
The American Occupational Therapy Association (AOTA), Bethesda, Md., recently issued a press release announcing a major achievement for the profession -- inclusion of occupational therapy in newly established criteria for mental health services.
On May 20, the Substance Abuse Mental Health Services Agency (SAMHSA) included licensed occupational therapists in the list of staff to be considered by newly created certified community behavioral health clinics (CCBHCs). The criterion is used by states to certify CCBHCs, established as part of a two-year demonstration program under Sect. 223 of the Protecting Access to Medicare Act.
"This is a huge opportunity for the profession to return to our mental health roots and provide needed services to those who can most benefit from occupational therapy," said AOTA President Virginia Stoffel, PhD, OT, BCMH, FAOTA. "Because the new CCBHCs will be required to provide integrated care, this is a chance for us to show how our broad understanding of both physical health and behavioral health helps bridge these different worlds of service provision."
The press release continued that the purpose of this demonstration program is to "dramatically improve the quality and availability of community behavioral health services by providing access to well-funded, integrated, coordinated, client-centered mental health and substance use services at CCBHCs. The announced CCBHC criteria are part of a larger Request for Applications for Planning Grants to states. These planning grants will allow states to develop their proposals to participate in the two-year CCBHC demonstration program."
Though an unlimited number of states can receive planning grants, only eight will ultimately be selected to participate in the demonstration program and receive increased federal funding for behavioral health services. All CCBHCs participating in the program must meet criteria outlined by SAMHSA. The newly established criteria for mental health services can be found here.
What do you think about this development and how it will impact the occupational therapy profession?
A couple weeks back, I visited the Occupational Therapy department at MossRehab to talk to Steve Whittaker, an OT who also is certified in low vision rehabilitation, and learn about what they're doing in the field for an article coming out in this month's issue.
While learning about the rehab program, I got to speak with one of Steve's patients, Deborah, and learn about her journey with low vision since she was diagnosed with Stargardt's disease when she was in adolescence. Deborah, along with her adorable and even more loyal guide dog, Gypsy, came in for a session with Steve.
"Individuals who are fully sighted take so much for granted," she told me. "Having low vision can really take a toll, but with the help of vision rehab and Steve, I am learning to regain my independence." And it wasn't just the physical improvement that meant the most to her. "It's a mood lifter and a confidence builder. I can dress myself, cook for myself - I really feel like I am in control of my own life."
Steve and MossRehab are one of a kind in the area because the vision rehabilitation program is part of the patient's overall therapy program. It saves them time, and it saves them money since it would be covered by most insurance companies. "I think vision rehab changes lives. It's all about putting that person in a better place. That's the most rewarding part."
Do you think OTs should take on the role of vision rehab in their therapy program? Have you integrated vision therapy into your practice?
You can learn more about Deborah, Steve and the vision rehab program at MossRehab in the June issue of Advance for Occupational Therapy Practitioners!
NASHVILLE -- During her Presidential Address at the American Occupational Therapy Association's 95th Annual Conference & Expo, held April 16-18 in Nashville, AOTA President Virginia "Ginny" Stoffel, PhD, OT, BCMH, FAOTA, took stock of the current state of the profession and set a course for the decades ahead.
Stoffel is associate professor in the department of occupational science and technology at the University of Wisconsin-Milwaukee. The association's 29th president, she is currently in her second year of a three-year term.
The profession's numbers are growing rapidly, reported Stoffel. While a recent AOTA count placed the number of practicing OTs, OTAs and students at 140,000, more recent estimates place the count closer to 185,000. And according to the U.S. Bureau of Labor Statistics, by 2022, there will be a need for 29% more OTs and 43% more OTAs.
"We need to set 100,000 as our next membership target," said Stoffel in relation to the rising ranks of OT practitioners. "Can you imagine how much more we could accomplish." Stoffel acknowledged the commitment of OT professionals worldwide, having made 36 trips so far as president.
"Engagement strategies may well be one of our greatest strengths as a profession," said Stoffel.
And as 2017 approaches -- the 100-year anniversary of the profession -- AOTA must look beyond that milestone and set new objectives, said Stoffel. The association has retained a public relations and branding firm to craft a new vision statement, in addition to member feedback in the form of focus groups, and electronic surveys. The new vision will be unveiled at next year's conference in Chicago.
"It's time to update our vision for the profession, to look carefully and boldly toward the future," announced Stoffel. "I hope that our future holds a clear, lit path to empowerment as a core attitude of all occupational therapy practitioners."
Members of the AOTA Board of Directors held a roundtable discussion at the AOTA Conference April 18 to hear comments and concerns pertaining to the possible transition to a doctorate of occupational therapy (OTD) as the entry-level degree for clinical practice.
In April 2014, the AOTA Board of Directors adopted the following position statement:
“In response to the changing demands of higher education, the health care environment, and within occupational therapy, it is the position of the American Occupational Therapy Association (AOTA) Board of Directors that the profession should take action to transition toward a doctoral-level single point of entry for occupational therapists, with a target date of 2025. Support of high quality entry-level doctoral education for occupational therapists will benefit the profession, consumers, and society. The Board encourages a profession-wide dialogue on this critical issue.”
Possible negatives raised by audience members in the open-dialogue session at the AOTA conference included:
-- Faculty preparedness. Are professors in today’s OT programs academically equipped to deliver an across-the-board doctoral-level education to OT students?
-- Salaries keeping up with student loans. Many audience members raised the point that employers are not reimbursing doctoral-level OTs any higher than their non-doctorate peers, leaving incoming students to face even higher student loan debts.
-- The needs of the community. Because so many areas of the country are already under-served by OT professionals, audience members wondered whether these children and adults will pursue more common, less expensive services, such as therapeutic recreation specialists or music therapists.
-- Practice specialization. Students completing their doctorate in an entry-level program might have to choose a practice specialty before being “in the field” to work with many different patients in multiple practice settings. This could land them in less-satisfactory roles.
-- Life experience. A popular sentiment among those who have already pursued a master's or doctorate degree was the value that shared clinical experiences among a varied student population brought to the classroom.
-- Fewer opportunities for professional advancement. The current tiered system allows truly committed professionals to distinguish themselves by earning higher degrees. This will be diminished if every practitioner begins practice on the same terminal-degree level.
While the majority of audience members were against the move to an entry-level OTD, some spoke in favor of the transition, or were in academic programs already in the process of transitioning. Panel members explained that AOTA membership is only one stakeholder in the decision, and while they weigh membership opinion heavily in the debate, other stakeholders include public consumers of OT services, referring professionals, and the U.S. Department of Education.
At the earliest, implementation of the new OTD mandate would take place in 2019, said Neil Harvison, PhD, OTR/L, FAOTA, chief academic and scientific affairs officer at AOTA.
The American Occupational Therapy Association's 95th Annual Conference & Exposition kicked off southern-style Thursday night April 16 with a rollicking mini-concert from Sixwire, a Nashville-based country music band that had the packed ballroom clapping, dancing and forming conga lines in the aisles.
AOTA President "Ginny" Stoffel, PhD, OT, BCMH, FAOTA, then announced to applause that the Nashville conference is on track to beat all previous attendance records and become the highest-attended conference to date. Significant milestones for the association in recent months include Hawaii becoming the 50th state to achieve licensure for OTs, and "Occupational Therapy" being a category on a recent "Jeopardy" show, demonstrating the progress being made in marketing the profession of occupational therapy to the public.
And while the Senate passed legislation April 15 to repeal Medicare's Sustainable Growth Rate formula, an initiative supported by many physician and allied health organizations, a repeal of Medicare's outpatient therapy cap on rehabilitation services fell just two votes short, Stoffel said.
However, she was proud to announce that AOTA members sent 20,000 letters to their representatives and AOTA earned floor time as the Senate debated the issue.
"We weren't successful this time, but we'll continue to fight for repeal," said Stoffel.
Following Stoffel's remarks, keynote speaker Rosalind Wiseman, well-known expert on bullying and author whose book "Queen Bees and Wannabes" inspired the movie "Mean Girls," explained to her audience that occupational therapists are in a unique position to interrupt the cycle of bullying and exclusion often experienced by -- and originating from -- young people with social challenges.
"For the best of intentions, schools across the country have jumped on the issue of bullying," said Wiseman, but often with less-than-ideal results. Well-meaning teachers and administrators often speak in meaningless sound bytes such as "be kind" and "how would you feel if it was you," or try to force the bully and the victim to spend time together to become friends -- none of which get at the complex root causes of social dynamics, said Wiseman.
Also, we often view bullying in extremes, with one person "bad" all the time, and one person completely without fault, she added. Finally, not everything is bullying -- being excluded from an Instagram photo of friends at a movie isn't bullying. True bullying, said Wiseman, is stripping someone of their right to be treated with dignity, and attacking someone based on race, gender, disability, sexual orientation or other differences.
"Entertaining people by humiliating others is unacceptable," Wiseman said.
Distinct Value Statement
In other conference news, on Thursday afternoon April 16, presenters of "AOTA Centennial Vision in Action" discussed the association's "OT Distinct Value Statement," a component of the AOTA's Centennial Vision.
An ad hoc committee of OTs from a variety of backgrounds convened to develop a consensus statement outlining the value that occupational therapists bring to patient's lives.
In 2014, AOTA's board of directors realized that the value statement was closely related to the association's Centennial Vision -- a guiding statement setting the goals of the profession for its centennial anniversary in 2017 -- and adopted it as a component of the vision.
The value statement is as follows:
"Occupational therapy's distinct value is to improve health and quality of life through facilitating participation and engagement in occupations, the meaningful, necessary and familiar activities of everyday life. Occupational therapy is client-centered, achieves positive outcomes and is cost-effective."
Five members of the value statement committee provided practical examples of the values occupational therapy brings to patients in their individual practice settings -- acute care, pediatrics, rehabilitation, long-term care and school settings.
The association plans to promote the value statement through its marketing channels, including a 3-minute video currently live on YouTube.
"You are going to be seeing a lot of this statement in the coming months," said committee member and AOTA Vice President Amy Lamb, OTD, OTR/L, FAOTA.
April is always a busy month for OTs. On April 16-19, the American Occupational Therapy Association’s Annual Conference & Expo will be held at the Music City Center in downtown Nashville. This year’s keynote speaker, Rosalind Wiseman, whose book Queen Bees and Masterminds was the inspiration for the movie Mean Girls, will educate OTs on how they can help their young patients negotiate the many social challenges of childhood and adolescence.
Other conference highlights will include the AOTA Town Hall Meeting, a check-in on the progress of AOTA’s Centennial Vision; the Eleanor Clarke Slagle Lecture, this year delivered by Helen S. Cohen, EdD, OTR, FAOTA; and the Presidential Address from Virginia “Ginny” Stoffel, PhD, OT, BCMH, FAOTA.
Not to mention the annual Awards and Recognition Ceremony, AOTPAC Night, an OTD Dialogue with the AOTA Board of Directors, leadership and networking events, and a variety of fundraising opportunities benefiting the American Occupational Therapy Foundation (AOTF). There’s a lot to see and do.
Stay tuned to www.advanceweb.com/ot as we bring you up-to-the-minute coverage in the form of blogs, photos, news, and feature articles from the heart of the action.
April is also Occupational Therapy Month -- a time to celebrate all that OTs do and to promote the difference they make in lives. OT Month dates back to 1980 and is celebrated in conjunction with the AOTA Conference. Hospitals, private practices, school districts, assisted living residences, home care agencies and universities find their own ways to commemorate the occasion.
ADVANCE has compiled online resources to observe OT Month, including ways to celebrate, a shareable certificate of appreciation, reflections from practicing OTs and more. And for that special colleague or employee, you can choose from a wide selection of OT-themed accessories, apparel, promotional décor and more at www.advanceweb.com/shop. Click “OT Month” on the right margin.
Happy OT Month to all our readers.
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 email@example.com
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
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
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.