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As an OT with a background in SI, I think our sense of smell is often overlooked. Here are some easy suggestions to use olfactory input as a fun way to supplement treatment activities:
- Add dry JELL-O®mix to watercolor or tempera paints. Or mix up the gelatin with only half the amount of water and have the child paint with the mixture. With either method, when the paint dries, it forms a scratch'n sniff picture! Try lime, cherry and orange flavors.
- Cinnamon rolls make a great group baking activity. Check out a baking mix recipe such as found with Bisquick. Great for taking turns with tasks (add, stir, rolling out dough etc.) or for an even easier version, just use the instant variety such as those found in the pop open tubes.
- Grow small pots of simple herbs like lavender and rosemary in a sunny window. One of my sensory smart teachers did this and she would send a sleepy child to the window to cut a snip of rosemary, known for its alerting qualities. For that child that would not calm down after recess, it was a snip of lavender, known for its calming properties.
- Use scented markers or create your own fragrant crayons by melting old/broken fragments in a can on a warming tray. You can add extracts like vanilla, or an essential oil like lavender then pour the fragrant wax mixture into mini muffin trays or candy molds. For a more kid friendly version, Crayola has a product called Crayon Maker that works off a 60 watt light bulb.
Of course, as with any sensory system, keep in mind safety, moderation and individual sensory preferences when using olfactory input. Hope these ideas help make your treatment sessions more "scent-illating"!
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I received an update last evening from the desk of Lucy Jane Miller. Seems the APA (American Psychiatric Association) has announced the third and final opportunity for public feedback on the upcoming DSM- 5 to be published in 2013. In the newsletter, Dr. Miller gives an update on the status of her research on SPD and involvement with the DSM criteria for inclusion to date. Basically SPD will likely not be included as a new separate diagnostic category but the subtype SOR (Sensory Over-Responsivity) will likely be included as one of several criteria for Autism Spectrum Disorder. Please take the time to review this newest SPD Foundation update for more details on the proposed plan. There is a web page on the link that includes instructions and samples suggestion on how to word/submit your comments. Let's continue to support Dr. Miller and the Foundation in getting SPD into the DSM-5! The deadline for commenting is June 15th. Thanks for your support!
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I came across this article on my iPad from USA Today and just had to pass along as this is helpful information! Seems there are several companies popping up around the country that specialize in providing sitter services and much needed respite care for families of children with special needs. In reviewing the article, it looks like many of the staff are special education teachers now assuming the role of babysitter, nanny or caregiver. I can't help but wonder if these are former teachers that got burned out in the special education classroom and/or are moonlighting in this capacity. In either case, they are well qualified for the job! What a much need addition these types of companies must be in the communities they serve. I hope that we will see more services like this offered nationwide in the near future. As peds OT's it seems we would also have the skillset to take on this kind of role.. perhaps as an extension of a private practice or a franchise such as the examples listed in the article. Let me know if you currently offer and/or free- lance in respite care. I would enjoy hearing about your experience!.
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I have long been an advocate of using affirmations for children as part of my therapy sessions. All children, especially the populations we work with, need continual reminders of a positive message to help maintain self-esteem and self-worth which seem to be such fragile concepts in these busy and often bullying times that our kids find themselves in today. For my students or clients with good cognitive and verbal skills, I would encourage them to find their own words that rang true to a sense of self, while for some of the kids with more profound delays I would just recite a simple statement to them periodically during our time together. One of my favorites was a 6 year old named Rachel. She had a Learning Difference and SPD issues. She had that clumsy, disheveled demeanor that is typical of some of the subtypes of a Sensory Processing Disorder and she struggled academically as well. I would usually see her in her classroom just after lunch where she and I would first have some time together in the back of the room to regroup/transition before taking on her afternoon spelling lessons. I brought in a small mirror, a tub of wet wipes and tissue and allowed her to clean up her face (where she usually "wore" a good bit of her lunch!) and wipe down her eyeglasses. She would then look in the mirror and I would ask "Ok Rachel who are YOU?" To which she would proudly answer "I'm pretty, I'm smart and I'm organized!" and I would concur with a "Yes you ARE!" This inevitably brought smiles for both of us. I lost track of Rachel when I left that school system, but hope that this tiny message during her OT sessions gave her the confidence to handle herself with grace and dignity during her formative school years. Let's make affirmations a part of every therapy treatment plan!
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Having a pediatric private practice these days is challenging! Networking at the AOTA conference last week as well as an informal polling among my OT friends/colleagues who own their clinics it seems many therapists face tougher reimbursement issues these days. Insurance companies may be paying less for pediatric OT services and Medicaid payments usually fall below the norm for hourly rates and allow only limited treatment frequency (such as 2x/mos. in some states). Most of the therapists I spoke with use ICD-9 coding for billing individual treatment sessions, then often supplement these services by offering enrichment programs that parents pay out of pocket. Handwriting groups, life skills, social skills and even yoga for special needs are some of the ways OT's are expanding their traditional private practice. With the combination of individual therapy and group sessions, many children with special needs can then get the full benefit of therapy services. AOTA has a short but helpful FAQ section for the Pediatric Practitioner as well as information on Reimbursement Resources. Do you own/work in private practice? How do you balance reimbursement with best practice? Drop me a note and share your thoughts.
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This week approximately 4,000 OT's (including me!) are descending on downtown Indianapolis for AOTA's 92nd Annual Conference and Expo. Of course the conference covers all specialty areas, but note there are well over 100 topics on pediatrics that include pre conference institutes, short courses, workshops and poster sessions. I know I have marked a few of my favorite colleagues that are presenting including Diana Henry and the team of Cari Murray-Slutsky and Betty Paris. Roundtable discussions are also a great way to get an overview of current trends/topics such as this one on PBIS (Positive Behavior Intervention and Supports). The conference is such a great place to network, get updates, earn CEU's and get new ideas for therapy solutions and references. In the Expo Hall, make sure you visit the great team at ADVANCE in booth 1429 and please stop by and see me at booth 401 (Abilitations) as well. Attending the conference is a great way to help support our national organization that has remained the cornerstone of our profession. I look forward to seeing you there!
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This past week I attended and lectured at the Council for Exceptional Children Conference (CEC) in Denver CO. Once again I am humbled and awed by the work that our general and special education teachers do on a daily basis for students with special needs. As I met these professionals from around the country and answered questions, I kept thinking how so much of what we know and do as pediatric therapists can be so helpful to all teachers and students, not just those in special education. Also, as a former school therapist, I know that much of my time helping students on my caseload was not during a 1:1 or group therapy, but instead considered "on behalf time" such as adapting a piece of equipment or in-servicing a teacher's aide. Observing the throes of teachers this past week embracing these concepts makes me an avid supporter for the position AOTA has been advocating: That we need to transform the concept of having a caseload to a workload to better serve the needs of our clients...which includes the student, the teacher and the parent. You can read more about AOTA's position here. When implemented correctly, this approach allows us to expand our OT skills and expertise beyond just the individual students we serve as part of an IEP/IFSP. I look forward to the day when school based OT's are used as system wide consultants for all education. Let me know where your school practice stands along this continuum!
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I love finding motivational stories that inspire children (and adults!) to become their very best despite sometimes impossible odds. Retired pitcher Jim Abbott has recently written a book entitled Imperfect: An Improbable Life. Jim tells of his love of sports, his rise to fame in baseball first as a collegiate athlete, then as an Olympic gold medal winner and finally on to a career in the major leagues that culminated with pitching a no hitter for the Yankees in 1993. An improbable life indeed as Jim was born with a congenital right hand deformity! Much of his mission now involves motivational speaking and inspiring children with special needs. Check out his heartwarming story here. Perhaps this is just the message that one of your patients or students needs to hear during OT Month!
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Many of you may know already that the CDC released new findings last week on the prevalence of Autism Spectrum Disorders (ASD) in the US. Statistics now indicate that 1 in 88 children are now found to be along the spectrum, with the figure higher for boys at (1 in 54) vs. girls (1 in 252). The overall index indicates a significant rise in this group of disorders since the year 2000 when it was estimated that about 1 in 150 children had some type of ASD.
There are numerous theories and speculation about the increase including better/earlier diagnosis, the risk factors and even if the current definition of ASD is too broad. In any case, the release of the findings shed more light and public awareness on this disability.
As peds therapists, we are often the early observers of some of the characteristics that may indicate the child may be on the spectrum and/or pay attention when a parent tells us that "something is just not quite right" with their son/daughter. I think fellow ADVANCE blogger Devon Alley does a wonderful job sharing some key insights to this with early film footage of her daughter at play.
Characteristics of autism can sometimes be so subtle! Here is a great resource for reviewing the 10 Early Warning Signs for Autism which can include poor eye contact, delayed speech, and unusual or repetitive body movements as some of the indicators.
As always, early identification and early intervention make for the best possible outcome for any child with this diagnosis. As April is Autism Awareness Month and today (April 2, 2012) is World Autism Awareness Day, let us know what you are doing in your community for recognition and support.
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This past week I had the great pleasure of attending the VA state Headstart Conference where I presented a workshop entitled 10 Terrific Tips for Great Fine Motor Skills. I had a ballroom full of teachers seemingly enthralled with the concepts of how good sensory integration especially tactile, vestibular and proprioceptive input lay the foundation. We reviewed the importance of why tummy time, crawling and other upper extremity weight bearing activities, visual tracking games and hand strengthening skills can all help fine motor development. In addition, part of my philosophy is always to discuss meaningful praise and individual affirmations for children as part of the therapy/learning process.
Later after the lecture, one teacher remarked that when entering the workshop she had wondered how I was going to speak for 90 minutes on this topic (translate... Boring!) but afterwards she felt energized and empowered to try some of my suggestions with her students when she returned to her class. Another teacher commented that she knew to do some of the things I reviewed but now that she understood the rationale behind the activities, she would be more diligent about implementing them on a regular basis.
It's these types of "Aha! Moments" that make me proud to be an OT. As pediatric therapists we are in a unique position to educate teachers, parents and medical personnel on tools that can make a difference in the life of a child. What is your favorite "Aha! Moment" when you know you made an impact? I look forward to celebrating your stories!
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This week, in case you haven't heard, the Etch a Sketch is making a comeback! It all started a few days ago when an aide to one presidential hopeful used the Etch a Sketch as a metaphor for the change he felt his candidate would bring. In turn, other rival candidates have jumped on the bandwagon to give their own spin on this metaphor and voila, suddenly the Etch A Sketch itself is a hot commodity! The parent company Ohio Art Company saw the stock price more than double in just a few short days!
As peds therapists, doesn't the name Etch a Sketch just make you want to smile? We all know (well those of us over 40 anyway!) and have used Etch a Sketch's as a therapy tool for ages! It was and remains a great activity for working on bilateral motor coordination and motor planning. Remember your young patient with the head injury that worked so hard to get a diagonal line drawn? Or how about that child with CP that could barely use wrist supination to get the dials to turn? In our digital age of fast moving technology, Etch a Sketch got left behind...until now! Whether you are a new or seasoned therapist, you owe it to yourself to spend a few minutes on the Etch A Sketch website and see the updates! As for my earlier blog on What Do You Have in Your Therapy Bag?, I am now adding an Etch A Sketch to the mix! Happy sketching!
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Holding back kindergarten eligible children with late month birthdays delays their school experience until age 6. This process known as "redshirting" is becoming an increasingly common practice in many school systems. Some parents and other advocates feel it may help give their child an advantage and promote leadership qualities while others disagree. See the controversial news piece which recently aired on CBS 60 Minutes for the full story.
I wondered about this concept of redshirting for our typically developing children and the impact it may be having on our kids with special needs that are in inclusive programs. Does it help or hinder a child with SPD issues perhaps to "sit out" a year? What about children with Learning Differences and/or those getting RtI services? Where do you stand on the ideas of redshirting? Let me know what you are hearing from parents and teachers on this trending topic!
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I travel a good bit with my job these days so am a frequent flyer with the airlines. Typically the in-flight magazines have a feature where they interview some movie star, CEO or savvy world traveler to ask them what they always carry in a flight bag. In the spirit of this theme (minus the celebrity status!) I have put together my favorite list of items that have been a part of my OT bag for many years...as an itinerant school therapist, a private home based practitioner and even during my days of working inpatient services at a busy hospital. Here are 6 things I always have on hand:
1. Wikki Stix: They have universal appeal to most kids and you can gather so much information about sensory processing/tactile and perceptual skills when handling these sticky candle wick like textures to make shapes and letters.
2. Magnetic Wand and Chips: Often called bingo wands these are an immediate attention grabber if you scatter the chips around a table or floor then hand the child the wand. Watch the gross and fine motor movements as they work on getting all the chips back on the wand. Wonderful to work on balance, equilibrium issues on a therapy ball as they reach from side to side.
3. Bubbles: Focus, visual tracking, oral motor skills and an instant ice breaker!
4. Pegboard and Pegs: I like the mushroom shaped versions that offers slight resistance as the child pushes in/pulls out the peg. Helps give a baseline for hand strength skills.
5. Squiggle Wiggle Writer: Guaranteed to get a child to pick it up and at least make contact with paper! Children along the spectrum who avoid engaging in handwriting tasks will usually make an exception if this vibrating pen is used. Runs off one AA battery.
6. A fidget: I like the Tangle® versions. An immediate rapport builder and gives the child something to focus on while you chat briefly with the teacher, parent or nursing staff to get an overview of why therapy services were requested.
So now you know the top 6 in my bag....but as we all need fresh ideas/approaches periodically it is time to update my repertoire. Please share your favorite therapy bag tools!
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I had a nice comment from Andrea, a peds OT in Oceanside CA the other week in response to my blog on Sensory Integration Across the Lifespan. She was stating how important it is we look at the sensory environment of the individuals we are serving and how unsensory friendly hospitals historically have been. This got me reviewing one of my favorite topics...environments for learning...but in this case also for healing. Color is a perfect example of a quick and easy way to change an environment and have an impact on stress/focus and learning. The color blue for example helps create a psychologically safe environment, a calming effect that can help with thinking/concentration and has been shown to lower blood pressure. Green is also relaxing and is one of the easiest colors for the eyes to process. I know a private peds therapy clinic that uses a shade of pink in one of the speech treatment rooms as pinks/reds are conducive for creating thinking/ short term high energy/activity and helps stimulate conversation. It may also help children with SUR (Sensory Under Responsivity) tendencies. Ruth Lande Shuman, an industrial designer had the simple idea that brighter colored schools could help produce brighter students. She created a nonprofit school painting project called Publicolor in NYC schools which has now been shown to reduce dropout rates and lower discipline problems in schools where the color makeovers were implemented. So it begs the question, what color(s) are in YOUR therapy surroundings?
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Ok so last week I know I was on a soapbox about smart technology possibly changing infant and child development milestones as we know it. On the flip side we know technology is here to stay and we all have certainly seen some of the benefits especially for our kiddos along the autism spectrum and/or those with cognitive/motor impairments. So, just making sure you are following Angelia Wood and her App of the Month review. She does a great job screening apps that may be helpful for OT goals and objectives for all ranges of clients that we serve. I find it a helpful resource as it's hard to keep up with the steady influx of apps being released. This week I wanted to add one that I came across as well. Some of you more savvy app users may be familiar with this one already but it was new to me! It is called MadPad and is wonderful way to work on auditory and/or visual discrimination and sequencing and looks like just plain fun! As we discussed last week, let's remember to incorporate other sensory tools with vestibular, tactile and proprioceptive input along with technology as part of an overall treatment plan. Do you have a favorite app to share for your school or clinic practice?