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A Pediatric Perspective

Equipment Resource Lists
July 25, 2014 9:56 AM by Wendy Spoor-Hof

One of the most frustrating parts of my job is being able to get the items the families I work with need when insurance won't cover it or the family can't afford it. Sometimes families need pieces of equipment to help their child be more mobile. Other times it could be something as simple as a knob puzzle or a simple shape sorter to work on fine motor and eye/hand coordination skills. When I can I purchase the smaller items.

Occasionally we might have a stander or a walker that a family is no longer using and they have given to us to share with families who may need it. More often than not though we just don't have the resources to help. I'm sure we are not the only ones who face this struggle. 

Here in Connecticut we are lucky that we have a place called NEAT (New England Assisted Technology Resource and Education center) in Hartford.  NEAT offers a service for Birth-to-Three providers that allows them to borrow pieces of equipment families may need. The equipment has been donated to NEAT by families who no longer need it. I have borrowed wheelchairs, standers, bath seats, and even corner chairs. If the family still needs it after they are exited from Birth-to-Three they just need to give NEAT their name, number, and address so NEAT can keep track of where the equipment is. Once the family no longer needs it they are asked to return it to NEAT. NEAT will even send over a van to drop off/pick up the equipment.  I do not know if other states offer something similar. If you have a location like NEAT in your town please let me know so I can share it here.

Another place to look is Facebook. Special Needs Gently Used Medical Equipment For Sale is one group where you can list or look for items ranging from eye glass frames to tumblers to car seats and wheelchair adapted vans. It is a "closed group" so you do have to request to join it. Another similar page for Canadian families is Zachslist Pediatric Equipment Exchange.  Both groups offer a chance for its members to post items they are trying to get rid of or that they are ISO (In Search Of). 

There are also numerous "mom's groups" which are more localized to the area where the mom's live. A simple search using the terms "moms" and where you are located will help you to find a group in your area. These groups will not just offer items for sale or items being searched for but they will often also offer support for families who may need it. 

Outside of Facebook there is always Craigslist and I know quite a few people who have success finding things they need on there but I wouldn't feel right if I didn't tell you to be careful. As useful as Craigslist might be there are numerous stories of people who have been ripped off when responding to an add. If you are going to answer a listing here please use caution and never, ever go alone to pick something up or drop something off. There are good and decent people out there but there are also people who will try to scam you.

Another site I have used frequently is the Backpage.com site. Once again you can search by location and then narrow the search by what it is you are looking for.  I have also heard quite a few families have had success using Freecycle websites. With Freecycle you have to become a member and then you can search for free items that others are giving away. This site is not just limited to pediatric equipment and toys. There are listings for everything and anything on here so it can be overwhelming at times when you are looking for something.  A couple other web sites are:

Rehab Equipment Exchange  - a website that lists programs that are available in each state that loan out rehab equipment or that allow people to buy, sell, exchange rehab equipment. The list may not be complete but it does have a decent amount of programs listed. 

Buy and Sell Used Home Medical Equipment - you can search the site by zip code and look for items within a certain radius of where you live. 

Equipment can be expensive and just like clothing and shoes, children may outgrow the equipment quickly.  Being able to find a place to purchase the equipment at a less expensive price or, better yet, borrow it, can be financially helpful to the families we work with. If you know of any other sites that would be useful to the families we work with please let me know about them and I will share them here. 

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Loan Forgiveness
July 18, 2014 9:26 AM by Wendy Spoor-Hof
As many of you may already know I have decided to return to school and earn my Master's degree. Next Tuesday is my first class. It will be an English class on writing.  I'm actually very excited about it. I love to learn and the fact that my first class is going to be on writing makes it even more exciting. It will just be the one class over the summer and then come October I will start full time with classes on Friday afternoon and all day Saturday. Right now I can't wait to begin - check with me again around the holidays and it might be a different story.

One of the more challenging things I'm up against is finding a way to pay for college. Unfortunately the company I work for does not participate in any type of educational reimbursement or cost matching program. I have applied for financial aid and placed applications in for numerous scholarships. While researching options for payments I did come across the "student loan forgiveness" program that is being offered to many students by the government. AOTA recently succeeded in getting occupational therapists who work with children, teens, and the elderly eligible to receive loan forgiveness.  The National Education website has a list of loan forgiveness programs offered to a variety of occupations.  Another information website with a list of loan forgiveness programs is the FinAid! Website.

The overlying theme for the loan forgiveness is that one is pursuing a career working in a non-profit field, working with children/teens/elderly/veterans, or in a field that provides specific public services or is in a low income area. Most also require you to have made 120 on-time payments before you will even be considered for the program. 

Has anyone taken advantage of any of these programs?  I would love to hear how the process went and if you were able to receive a partial or full refund on any of your student loans. If you were not aware of these programs, do you think you will try and apply for one now that you do? 

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The Importance of Recess
July 11, 2014 9:17 AM by Wendy Spoor-Hof
We all know that if we ask a young child what their favorite class in school is most wil say "recess!" I can recall how important recess was when I was growing up. It was a time to meet up with friends and share the latest school news or join in a game of kickball or jump rope. We would race one another up the monkey bars (Yes!  We had monkey bars back then) or see who could swing the highest on the swings and then jump off and land the farthest distance away. Recess was a time to get out all the energy we had stored sitting in classes all morning and prepare for the afternoon of classes that were coming. 

As first a mother and then someone working in the O.T. field I could never understand the concept of taking recess away from the children who misbehaved or the children who needed to be pulled from the classroom for a short amount of time to work on special education needs. It seemed to me that these were the children that needed and would benefit the most from all the recess had to offer. When my son was in grade school and had to be pulled several times during the day for special education instruction I always made it a point during his P.P.T's to stress that I did not want him taken out of gym or recess. These were areas he needed to help him make it through the rest of the day. 

There have been numerous articles about the rise in ADHD in our country. Many doctors and parents feel this is happening because of the chemicals/preservatives we put in our foods and/or the increased amount of sugar the children are ingesting either through candy or sodas. Therapists, on the other hand, have a more simple explanation. Our kids are not getting the opportunity as much as they use to to get up and move around.  Children are not allowed to go outside and play all day as they use to when I was a child. It's just not as safe a world as it used to be and these days the chance of something happening to our child is just too great a risk.  Plus with both parents working and more and more children in preschool/daycare settings our children don't have the opportunity to experience free play as much as they use to. The only opportunity most children have to get out and play is often the time they get for recess. An article in Scholastic even explains how important recess is and how it helps give our children a chance to be more focused and open to learning.

Tim Walker recently wrote a great article about his experience teaching in Finland and how he was skeptical at first about their approach to teaching (45 minute sessions, 15 minute breaks - all day long). He even tried to incorporate the American way of teaching (longer sessions with only 1 or 2 breaks all day) thinking the children would learn more but came to realize that those frequent breaks were not hindering the ability of the children to learn but were actually giving them what they needed to stay seated and focused during the lessons. 

The Washington Post also ran an article sharing how author Angela Hanscom, a pediatric occupational therapist, felt that the increase in ADHD was actually due to our children's lack of opportunity to get out and move around. She feels that the reason our children have such a hard time sitting down and focusing is in part due a decrease in their core strength and balance abilities. She feels that many of our children who are diagnosed with ADHD may in fact have an underdeveloped vestibular system because they no longer have the opportunity to get out and roll down a hill or swing from monkey bars or climb trees. Come to think of it, I can't remember the last time I've seen a child climbing a tree or hanging from one of the lower branches. I can remember my nana often calling my sister and me in for lunch only to find us sitting in the branches of one of our trees or crouching down and crawling around playing hide and seek in the tall grass that often took over the bottom half of our yard.

So as we move into summer I offer all the parents, therapists, and teachers out there to take more time out of the day to allow our children an opportunity to get up and move. Instead of sitting inside and watching the TV - have a race to see who can roll down the hill faster. Instead of a therapy session inside, if allowed, take it outside and build an obstacle course in the grass or swing on a swing on your belly with legs dangling or dragging in the dirt. When school gets back in session stand up and fight for your child's right to participating in recess. Let's help our kids get up and move more!

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Unexpected Help
July 3, 2014 10:16 AM by Wendy Spoor-Hof
Help can sometimes come from the most unlikely place. I have been working with a child who has a "habit" of rocking back and forth before falling asleep at night. Sometimes the rocking will take 10-15 minutes and other times it may take as long as 45-60 minutes. The rocking is usually done as they are sitting in their bed and they will rock and rock and rock. Mom has even padded the crib railings because they have rocked so hard that they cause bruises up and down their spine. Mom has tried other ways to comfort and get the sand man to come but nothing has worked. This little one can be rocked in a rocking chair by mom, fall asleep in another room, have books read to them, take a warm lavender bath ... you name it, they've tried it and the rocking will always be the one thing they do before falling asleep.

We have researched and researched. Suggestions that were offered by other O.T.s and therapist ranged from a vestibular seeking need to not having the right chemicals in the body to be able to fall asleep to having a desire to hit the "fight or flight" center located on the spine up near the neck. We have tried offering sensory input both tactile and vestibular but the rocking has persisted. We have tried no TV, iPads, radio or other electronics before bed but the rocking has persisted. We have tried soft lullaby music and dimmed lights but the rocking has persisted.

Then, miracle of miracles, I was on Facebook when a post came up from the Pediatric Occupational Therapy group I am a member of about a sleep disorder called RMD (Rhythmic Movement Disorder.) I read it from beginning to end and found myself nodding my head and thinking of the little one who rocked. I was so excited about it that I even sent the link to one of the other team members and asked them what they thought. She agreed that it sounded like we may have found a reason behind the rocking.     

I had never expected to find an answer to a case that has been puzzling me for so long on Facebook. I enjoyed being a part of the Facebook Pediatric Occupational Therapy group because of the variety of topics that are brought up and discussed. If you haven't had a chance to join them yet I highly recommend you do. You never know when an answer to something that has been puzzling you may unexpectedly show up.  

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Sensory Friendly 4th of July
July 1, 2014 10:38 AM by Wendy Spoor-Hof
This upcoming weekend can be a very difficult one for children who have sensory integration challenges.  Some children love the colorful explosions of the fireworks as they burst open in the air and the loud *bang* that, although they knew it is coming, still scares them. For other children the bright colors hurt their eyes and the loud noises their ears.  The crowds that gather to watch the fireworks are too loud, too close, and too sensory overwhelming for them to enjoy anything about the event. Thankfully there are things that can be done that would allow for a sensory friendly 4th of July experiences.

The first option is to, of course, stay home and enjoy the firework displays that are shown on T.V. You can dim the lights in the room you're watching the television and, depending on your child, turn up or turn down the volume. Several TV stations will usually offer viewing of the firework displays going on in different cities. Check your local TV listings for which ones are being offered in your area. 

If you want your child to experience the fireworks outside of the home be sure to bring along items that will help them to enjoy them. If they are sensitive to loud noise, bring along ear plugs or headphones. You don't need to be too fancy. There are a variety of inexpensive ear plugs to choose from that will help drown out the loud noises. Some kids prefer the bigger headphones. (Disclaimer: I use Amazon in links for no other reason than they offer a variety of options in one screen shot. Doing a Googlesearch will come up with other options for purchasing the particular one you may choose.)

If your child is more sensitive to the light you can bring along a pair of fun sunglasses for them to wear when the firework display starts. If they don't like wearing sunglasses a wide brimmed hat or a baseball cap would work to shield some of the display when worn down lower on their heads. Some of the younger children prefer their favorite blanket to cuddle with so they can bring it up over their eyes during the "scarier" light displays.

In years past several movie theaters have offered a sensory friendly viewing of fireworks in one of their theaters.  Just like when they show their sensory friendly movies the fireworks are offered in a theater that is dimmed slightly and with a lower noise level than typical. I have tried searching to see if I can find any listings for this year but sadly I have not been able to come up with any options to offer here. I would suggest, however, to call your local movie theater and see if they may be offering a sensory friendly fireworks viewing.

Social stories to share what to expect and trying to visit the place where the fireworks will be held before hand are also ways to help children who may have a hard time get more comfortable with the experience. As crowds can vary it is hard to say if getting there first and finding a quiet place to sit will work or if getting there later and finding a spot that isn't already crowded (on the fringe of the crowd) may be more effective. Regardless of where you may end up watching the display please be sure to have a game plan to leave if the experience becomes too much for your child. There is nothing worse than getting stuck somewhere with a child who is overwhelmed and melting down. Thankfully if you take the steps before hand to try and prevent this from happening you may just end up with a lovely evening spent watching the fireworks with your family - whether it is being outside and part of the crowd or being inside in your own home in a dark room and watching the display on the T.V. -

May your 4th of July be a sensory free one of beautiful and colorful fireworks that light up your evening.

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Sensory Friendly Summer-Movies
June 27, 2014 11:10 AM by Wendy Spoor-Hof

I know that going to the movies is something the boys and I look forward to doing at least a couple times over the summer.  We are lucky that here in Connecticut were we live we have access to both movie theatres and a drive-in movie. I have many happy memories of piling in the family station wagon and going to the drive-in as a child. We never missed any of the Disney films that came out. We would sit with our car turned backwards in the spot, the back door of the wagon open, and watch as we laid on our blankets until we either fell asleep or the double feature was over. If we needed to get up and move, we could either walk around the car or go up the hill to where they had a small simple play ground set up with swings and a slide. Talk about being "sensory friendly" back before it was even a term. 

Sadly there are not very many Drive-in movie theatres left in the world today. According to Drive-ins.com there are only 339 left in the U.S. I've taken my sons to the one here in Mansfield and they've loved it. If you go to the link you can use their search feature to see if there is a driven-in still open near where you live. Some still even have playgrounds for the kids to play on when they need a break!

If there isn't a drive-in near you there are still some wonderful sensory friendly options to see a movie. One of the newest options is to have a backyard movie.  More and more families are opting to have viewing parties at home so their children can get up and move around when they need to. This does require a one-time purchase of a movie projector which can range from $65.00 for a cheap one up, to a couple houndred for an average one, to a couple thousand to a top of the line one. We purchased a $125.00 one several summers ago and have used it numerous times over the past couple of years. 

We've used the side of our house as a screen and also a sheet draped up on a clothes line or up over an over turned picnic table. There is always the option of purchasing an outdoor portable screen if you so desire.  What's nice about having your own projector is that you can use it inside (on the wall or ceiling of a room in your house) on rainy days or outside on nice evenings. You can also view any movie you have in your collection.

Another option that is becoming more and more common is to go to a "sensory friendly" movie being shown by your local movie theater. At these showings the lights are dinned slightly but not completely off, the sound is not as loud, and the children are welcome to get up and stretch their legs if they need to and/or talk or sing or be noisey without upsetting other movie goers around them who might not understand their special challenges.  AMC has a listing of where they offer sensory friendly "get up and dance, walk, shout or sing!" movies. 

 If there is not a AMC theater near by you can do a "google" search for sensory friendly movies near your location or call the local movie theater and ask them if they offer any sensory friendly viewings. More and more movie theaters are offering these showings.  Some offer weekly viewings and others offer a montly viewing. If they aren't offering any viewings ask if you can talk with the manager and ask them if they would be willing to try a sensory free movie viewing. You could be surprised to see how open to the suggestion they may be. It's offering an option for them to open their doors to new viewers who may otherwise not be able to enjoy the movies. Every child should be able to experience the fun of escaping into a movie for a few hours and it's nice to see that the movie theaters are understanding that some children aren't able to sit still while enjoying their movie escape.

Animation offers a medium of story telling and visual entertainment which can bring pleasure and information to people of all ages everywhere in the world.  ~Walt Disney

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Love to Learn
June 13, 2014 2:16 PM by Wendy Spoor-Hof
I love going to workshops and seminars and picking up strategies that I can use in my daily work life. I also love to learn about different diagnosis and why their symptoms present in certain ways and what, if anything, can be done to help individuals with those diagnosis live life to their fullest possible ability. I think that is one of the reasons I'm so excited about going back to college.  I love to learn. I really enjoying talking and networking with other therapists and hearing about what works and what doesn't work for them in their daily therapy practices. I enjoy sharing strategies as well as learning about resources available to us as therapists and to our parent's and families.

Just recently I stumbled upon a really great O.T. group on Facebook. It started off as just a basic O.T. group to share difficult cases, get help, and share resources.  It branched off to a pediatric specific group. The individuals I've encountered on both of these groups have been knowledgable, helpful, and above all friendly and non-judgemental. I enjoy reading the questions regarding difficult cases some therapists are encountering and suggestions that are offered based on the experience of other therapists. I'm quickly filling my notebook of useful strategies and website links that I've learned about from these groups.

Another great resource is our very own Advance for O.T. website. There are links for jobs, articles, blogs, and events. A wealth of information! 

If you need to find a particular seminar or workshop you can go to the AOTA website where you can look for seminars/workshops/continuing education courses to gain the needed CEUs to remain "certified". You can search the databases they have available without even having to join.  Other websites that offer courses/seminars are:

  • Educational Resources, Inc - offering links specific to your field (pediatrics, acute care, neurology, etc). Once you choose a class you might be interestd in you can click on it's link and then learn what the class will offer you and what days/times and locations are available for the class/seminer.

  • Your Therapy Source - offering resources for Early Intervention, school-based, and pediatric out patient therapists. Once you are on their site there is a side bar to the left that offers breakdown areas for fine motor, visual, sensory motor, etc...

  • Rehab Education - offering continuing education courses for professional development and for certification and license renewals. They offer on-site, Webinar, On-Demand online lectures, and On-Line reading courses.

  • Cross Country Education - offering live seminars, webinars, and on-line courses. Also offers videos and books to help gain CEUs.

  • Summit Professional Education - offering live seminars, online webcasts, on demand and home studies in a variety of areas for therapists to gain skills, knowledge, and CEU credits.

These are a few sites that I have book marked so I can stay up-to-date on the courses I might be interested in taking. What are your go to places for seminars and CEUs? Have you recently attended a course/seminar that you were really impressed with? I'd love to hear about them.

Learning never exhausts the mind. Leonardo da Vinci


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Timing is Everything
June 9, 2014 9:29 AM by Wendy Spoor-Hof
When working with children it is important to remember that when doing an activity that is less than desirable to them we should always set a beginning and ending time.  Children often don't understand the concept of time until they are much older.  Younger children have no concept of a minute or an hour.  It's all the same to them so it's important to be able to help them realize how long something may take to encourage them to participate.  If a child has a definite idea of when something is going to begin and end they will be more than likely to take part in that activity.  There are a couple ways this can be done.

Younger children tend to love music so one of the ways to help them get through an undesirable activity is to sing a short song to them while you are doing it.  I will often sing "this is the way we wash our hands (or brush our teeth, or kiss a strawberry, etc.), wash our hands, wash our hands.  This is the way we wash our hands so early in the morning."  The first couple of times you do the activity the child may still want to finish it early so it's important to try and get through the song and then stop.  If you are consistent with this the child will quickly come to learn that the activity begins when the song starts and ends when the song ends.  This is why it is important to have a song you can sing faster in the beginning as you are getting the child to learn this strategy and then be able to slow it down a little as you try to prolong the activity later.  Some songs that work well are "Twinkle, Twinkle, Little Star", "Row, Row, Row Your Boat", and the Alphabet Song.  The Teacher's Guide website has a wonderful list of song lyrics listed alphabetically.  What is really nice is that they not only list the lyrics on the website but they also have links to a downloadable PDF lyric sheet and to a YouTube video of the song being sung!  There is just about every song imaginable on there.  This is a great resource as you can print out the lyrics to give to parents or caregivers to help them follow through on the strategy.

When working with feeding I've found that singing a song while working with a child who may be defensive works really well.  I will start the song as I touch their hand and then move up to their arm, shoulder, cheek, and maybe even chin or lips as I sing the song.  As soon as the song stops, I stop.  This way the child begins to be able to tolerate the input more because they come to realize that it will stop and not go on indefinitely.  Any task is a little more bearable if you know it is going to end.  For young children who have no concept of time a minute can feel like an hour when doing something they don't want to do.  If the task is combined with something like a song that has a definite start and finish it helps them to gain a beginning understanding of the concept of time and be able to tolerate the activity better.

Time outs should also work the same way.  The main concept is taking the child out of the situation and placing them in a safe time out space that is void of anything that would interest them (away from sight of TV, etc.).  The rule of thumb is that a child should be placed in time-out no longer than 1 minute for each year of their life.  So a one year old should not be in time-out for longer than 1 minute, a 2 year old for 2 minutes, etc.  Any longer and the time-out won't work.  Parenting.org has a good time-out resource listing other strategies to make time-outs successful.

For older children we can set an actual time limit as in "we will do this for 5 minutes."  It is always good to combine what you say verbally with a visual aid.  In many cases a simple kitchen time will work or a visual timer that shows the passage of time by a red marking disappearing.  Time tracker has a clock with a red, yellow, green light on top to further help with cuing older children how much time is remaining before the activity ends.  I have also heard that for the older kids a home-made "Time Out Glitter Bottle" can work too.

Do you have a time strategy that you use that's been successful?  Is there a particular timer you like to work with when it comes to timing activities?  I would love to hear about the different types of timers and time awareness strategies others use when working with children.  What have you found that works or doesn't work?

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Back to School
May 27, 2014 9:38 AM by Wendy Spoor-Hof
 As some of you may recall back in my January 24 blog I was wondering if I should pursue my Master's Degree in O.T.  After a good deal of weighing the pros and cons I have decided to go for it. I signed up for my summer class yesterday which will start on July 26 and continue Saturday mornings until summers end. I will then begin my full time program in October which will run approximately every other weekend with an on-line component for the next 2 years. After which will come my fieldworks.  I am nervous and excited and nervous again.

The Master's program I have enrolled in is through the New England Institute of Technology in Rhode Island.  It's actually a bridge program for COTAs who have their Associates and want to get their Masters.  So essentially I will be getting my Bachelors and Masters in 2.5 years.  Did I also mention I will be working full time in Birth-to-Three, writing part time, helping my 15 year old who has complex learning disabilities be as successful as possible in his sophomore year of high school, as well as be a mum and wife?  I think that's what has always drawn me to Occupational Therapy - it's an occupation that embraces versatility.

I will continue to write but will also be sharing some of the experiences of being an adult returning to school, how the lessons I'm learning can be applied to my daily work life, how well (or not so well) I'm able to juggle all the roles mentioned above, and what direction I may decide to head off to once I graduate.  I love pediatrics but am curious to see what other areas may open up to me once I get my Masters.  I hope you will continue to stay with me as I begin this wonderful and scary journey to becoming an O.T.

In the meantime for others who may be looking to return to get their Masters - here are a few colleges listed on the AOTA website that offer similar COTA to MOT "bridge" programs.  If you are already in a Master's program I would love to hear which one you are in and how you are doing with it.

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Wrights Law Website
May 16, 2014 9:57 AM by Wendy Spoor-Hof
Today I wanted to share a great resource with you.  When I first started to do research looking to find help for my son who has several Executive Function learning disabilities I stumbled upon this website and find myself not only going back to it frequently but sharing it with other families who are looking for help.  That website is http://www.wrightslaw.com/ .

Now don't be confused by the name. Yes, it is a website that shares a great deal of information "law" related when it comes to the special education world but it is so much more than that.  There is a wealth of information and guidance offered to you for free. When you have a few moments please take a look around this website to see all that it has to offer but in the meantime let me share a few pages with you:

The Special Ed Advocate Newsletter - you can subscribe to a free newsletter that shares the latest news and information regarding special education and advocacy issues.

IDEA 2004 - "includes information about IDEA topics such as child find, eligibility, evaluations, reevaluations, high stakes testing, IEPs, IEP teams, IEP meetings, accommodations, alternate assessments, placements, transition, parental rights, and more."

From Emotions to Advocacy - a great page that helps parents, advocates, teachers, therapists how to gain great advocacy skills.  This page offers a wide range of resources.

And my personal favorite page that I go to often to help parents locate advocates, teachers, therapists, tutors, and so much more.  When I needed an advocate to help me when my son was in Middle School - this is where I found his advocate.  I love this page for all it has to offer.

Yellow Pages for Kids - Another "tricky" name because it isn't so much "for kids" as it is for parents to help their kids with finding a good advocate to help them with their PPT meetings, to find good tutors, therapists, etc. 

You can also find training locations and web training programs on the website.  Take a moment and look around.  I would be surprised if you weren't able to find at least one thing that you could use now or go to later for help.

Is there a website that you have found to be particularly helpful?  I would love to hear about it.

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Oral Motor Warm-Up
May 9, 2014 9:36 AM by Wendy Spoor-Hof

It is a well known fact that in order to get the most out of a workout it is important to first warm-up before you begin to exercise. A good warm-up will not just help prepare your body gradually for more strenuous exercise but will help to prevent injuries.  If a good warm-up helps our bodies get the most out of our exercise routines why is it then that we forget the importance of a warm-up when it comes to working with our oral motor delayed kids?

As with any warm-up simple input prior to more demanding input can only help. When working with a child who may be sensory defensive or have decrease oral motor strength a few "warm-up" strategies should be done prior to each oral motor session depending on what it is we are working on with that child. The warm-up should be individual to each child depending on what goals we are working on.

The oral motor "warm-ups" can be as simple as:

  • Offering vibration through an electronic toothbrush, nuk brush, or "jiggler"
  • Gentle pats to cheeks, lips, and chin
  • Offering nuk/tooth brush inside the mouth to encourage the child to move his/her tongue to follow it back/forth and up/down.

I've found it to be helpful if you offer the family you're working with a chart or checklist to help them get into a good "warm-up" routine. Life can get busy especially around mealtime when we are trying to get the meal ready and on the table for our families. A simple check list with a few quick ideas and how often to do each idea (i.e. offer vibration twice along gum lines/inside cheek for a slow count to 10) helps to keep the caregiver on track and to also offer them a visual guideline so they know just what to do and how often to do it during each warm- up session. Superduper Inc. has an easy handout to look at so you get an idea of how to set one up.

It never ceases to amaze me how often I will be working with a child and showing the family different "exercise/warm-up" strategies to do before they begin to work on feeding only to come back the next visit and find them skipping over the warm-up and going right into trying to get their child to eat. The child is, of course, fighting them because they just aren't ready to begin eating yet and the caregiver ends up frustrated and discouraged. A simple quick and playful warm-up session could easily prevent this.  Explaing the warm-up prior to exercising scenario can often help the caregiver to understand why a child's mouth needs to be "warmed-up" before they will be more open to the actual feeding session.

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Clean Mud
May 2, 2014 8:42 AM by Wendy Spoor-Hof
I remember as a child always being outside. It didn't matter if it was raining or if the sun was out. There were four of us in a small house so I have no doubt the only way the adults in the house maintained their sanity was telling us to "go outside and play!" We would climb trees and play hide and seek in the tall grass and bushes.  When we were hungry we would go home to grab lunch or a snack. Often we would meet up with the neighborhood kids and play kickball or some other game we made up that day. It was a great way to spend a childhood. I think it was also the reason "sensory processing" wasn't as prevalent as it is now. We experienced all types of sensory input in the course of our play.

Today kids are not allowed to be "missing" for a few hours let alone a whole day. It's a shame the way the world has become where we have to keep an eye on our children for fear they will be taken. There doesn't seem to be as much opportunity for the free play way to explore and experience sensory input today as there did back then. I can remember being allowed to take out some pots and pans and spoons and a spatula and we sat for hours making mud pies and mud pancakes -with real mud!  In our backyard! 

So as the East Coast seems to have no shortage of mud this week I thought I would share a couple of clean mud recipes to help families engage in mud play without making too much of a mess.

This first one we have used numerous times both during playgroups and one-on-one in families homes. If you have a child who may be averse to getting too messy the best way to work into this play is to have them participate in making the mud. Have them rip the paper, place the paper into the container, and stir it - first with a spoon and then with their hands. I worked with one little boy who really enjoyed putting the paper into the water so much he didn't realize he was wrist deep in the clean mud until we were almost done with the session. 

Clean Mud #1:  All that is needed is 3 items.  1) Ivory soap (though I have used other brands with equal success). 2) toilet paper  and 3) water.  If you plan on keeping the mud around for a few days you can add some borax to it which will keep it from getting moldy.  

Clean Mud #2:  I have not made this one yet but another therapist I worked with has with good success...  This one requires only 2 items. 1) Water and 2) Baking soda

Clean Mud #3:  Same type as #1 but with this one you add sparkles!  Truthfully you can add pretty much anything you want to ... some washable paint for colored mud, different glitters, etc. - it's only as limited as your imagination.

We have hidden things in the mud to encourage kids to touch it. We've used spoons, cups, bowls and measuring cups to work on scooping and pouring.  We've even smeared it onto thick paper or cardboard to make designs and then placed them in the sun to dry. So have some clean fun and let me know what you thought. How receptive were the kids to it?  What did you do to make the mud unique? Fun?  

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The Spit Cup for Picky Eaters
April 25, 2014 3:27 PM by Wendy Spoor-Hof

I realize I may have spoken about the "spit cup" before when discussing Picky Eaters but I feel it is worth repeating. It is a strategy that works very well when you have a child who is a picky eater with the ability to understand consequences and cause/effect type strategies. It does not work as well for children who are low or mid-level functioning on the spectrum though.  It also doesn't work well if there is a preexisting medical issue causing the child not to be able to swallow safely - or to hurt when they swallow.

The premise is this - if a child who is a picky eater does not have to swallow the new foods we are introducing to them they will be more likely to interact with them. There are only a few basic steps to getting the "spit cup" to work.

1) Find a cup that you can use at each meal and even take with you when you go out for meals. This can be a Dixie type cup or a reusable plastic cup. Both my boys had plastic cups that were different colors so they whose was who. Have this cup with them at each meal. You can call it a "spit cup" or a "no-no cup" or "no thank you cup" - whatever you want to use so they will come to know what it is.

2) Start as you would with any picky eater depending on where they are in their food progression:

- Touch - As soon as they are willing to touch and pick up the food they don't want to eat you will have them pick it up and place it in the cup.  As soon as they are comfortable with picking up a variety of new foods and placing them in the cup with no-minimal hesitation move on to ...

- Kiss - You will have them KISS the food and then you (or they) will place it in the cup.  As soon as they continuously KISS a variety of new foods and place them into the cup with no-minimal hesitation you move onto...

- LICKING - You will have them stick out their tongue and LICK the food (or at the least having their tongue touch it) and then you (or they) will place the food into the cup.  Once they are continuously LICKING a variety of new foods and placing them into the cup with no-minimal hesitation you will move onto...

- BITING - You will have them take a small BITE at first (moving up to bigger bites as they gain confidence) of the new food and then spit it out into the cup.  They should NEVER be made to swallow it unless it is their choice and their choice only.  Once they will take bites out of a variety of foods and spit what they don't want into the cup with no-minimal hesitation you move onto...

- HOLD - You will have them hold (and chew if they want) the food in their mouths to a count of 3 or 5 or 10 - depending on how they are doing.  As soon as you stop counting you have them spit the food into the cup.  There may be times at this point where there is actually no food left in their mouths.  Depending on the child you can make a big deal of how great they did taking a bit and eating the food or you can ignore and move onto the next bite.

More often than not a child will be more willing to try new things if they know that they do not have to swallow it.  The thing that causes a lot of picky eaters to be so picky is the fear that the food they see and think they don't like because it looks, smells, feels or tastes different will be forced into their mouths and they will have to swallow it.  I always tell parents to think of the one food that they absolutely would hate to have to eat - the one food that just thinking of may turn their stomach or make them inwardly gag.  Now think about how you would feel if you were forced to take a bite of that food and swallow it.  This is how a picky eater feels every day.  BUT once they gain the confidence that they will not have to swallow it but just "taste" it they will be much more willing to try new foods.

My boys are now 15 and 20 and to this day they will try any new food that is offered to them as long as there is a napkin nearby (as the child gets older they can be transitioned from spitting into a cup to spitting into a napkin).  They have never hesitated to not just try new foods but to try old foods they know they didn't like before but maybe might like now because I've made them differently.  The other day my son, who hates green beans, had two helpings of them because I tried a new recipe.  He did not hesitate to try them because he knew if he didn't like them he didn't have to eat them.  One of my families even used this strategy on their older son (11 years old) who would only eat a handful of foods and within 2 weeks of consistently working with him (they could skip right to the take a bite and spit it out because he was older and not delayed in any way) he greeted me at the door with "guess what my new favorite food is?  Meatloaf!!"  And this was coming from a kid that gagged at the sight of any type of "mashed up meat" (hamburgers, meatloaf, meatballs, etc.).  By the time I had finished working with his younger brother the older brother's acceptable food list had grown to that of a typical kid his age.

I urge all therapists, teachers, parents who work with picky eaters to just try the "spit cup" strategy out.  I have used it on many, many of my picky eaters and have found great success with it.  The hardest part of this strategy is getting the care givers/parents to allow their child to spit out the food.  Once they understand how and why the strategy will work in the end they come around to trying it and they are amazed at how well it works.  Give it a try and please let me know how it works for you.  If you have any questions or concerns please message me. 

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Early Intervention – What Does it Mean and Who Can it Help?
April 18, 2014 11:29 AM by Wendy Spoor-Hof
I have been working in Early Intervention for the past 10 years but I'm still surprised how many families have never heard that there is assistance for families whose children are experiencing developmental delays before they reach preschool. For those who may not know early Intervention is a part of the Individuals with Disabilities Education Improvement Act (IDEA). Part C of IDEA requires that each state has a comprehensive and multidisciplinary system in place to help families with infants and toddlers who may be experiencing, or at risk for experiencing, developmental delays in one or more of their skill areas (gross motor, fine motor, speech/language, cognitive, self-help/adaptive and social/emotional.) The Wrightslaw website  has a wonderful explanation of what "Early Intervention" is and how Part C of IDEA has been set up to help infants and toddlers who are/may be at risk. 

Numerous studies and research has shown that early intervention is important for several reasons:

  • From birth to three years of age the brain is more "flexible" and the neural pathways/circuits in the brain can strengthened by working on different strategies to help develop the skill areas that are showing delays. In some cases it is believed that the brain can even "rewire" its neural pathways with the help of early intervention.

  • Learning you have a child with developmental delays can be overwhelming at first. Families who may be struggling with not knowing what to do or who to turn to can receive guidance and support from early intervention services.

  • Having a child with special needs often means learning different strategies to help your child meet their developmental milestones. Early intervention services include occupational therapists, physical therapists, speech therapists, teachers, early intervention assistants/associates, Autism specialists, and nutritionists - all who will come to the family in their home environment and help them to better understand their child's needs and teach them the strategies needed for their child to learn to the best of their ability.

So how can you find the Early Intervention provider in your state? The Raising a Sensory Smart Child website has a wonderful list of who to contact in each state.  The National Dissemination Center for Children with Disabilities also has a page that where you can find other state organizations that will help families who have children with delays and/or disabilities.

If you know of a good resource I would love to hear about it. 



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April is Occupational Therapy Month – Celebrate!
April 11, 2014 9:32 AM by Wendy Spoor-Hof
I never set out to be part of the occupational therapy world. I started out in travel but as much as I loved traveling and helping others with their travel needs there was just something missing. The local community college offered a "Healthcare Career Awareness" night and since I knew I wanted to do something in the healthcare field I attended to see what careers were out there. It was on that night that I first learned about "Occupational Therapy" and realized that was where I belonged. It took several more years before I could pursue that dream and I haven't looked back since. As a matter of fact, as some may already know, after being a COTA/L for 10 years I've decided to return to school at the young age of 52 to pursue my OT master's degree. 

I work in birth-to-three and there are still so many people out there who don't understand what "Occupational Therapy" is. I enjoy sharing what I do and what other opportunities there are out there for OTs and COTAs. One of the moms whose son I worked with just graduated with her COTA degree. She went into the field after she became aware of what we do and how big a difference we can make in someone's life. I have another mom who wanted to go back to school now that her kids are in school and is also looking into pursuing a career in the occupational therapy field. 

So, as April is the month to spread the word and celebrate all that occupational therapy can offer I thought it would be fun to share some links on ways to celebrate OT this month:

So from me to you ... THANK YOU!!!! for all that you do as an OT or a COTA and for sharing with those you work with and come in contact with how important and what a difference Occupational Therapy can make in someone's life. 

I would love to hear how OT has made a difference in your life or in the life of someone you have worked with.  What have you or will you be doing to celebrate in April? 

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