This is a great resource providing links to articles and other sites that promote evidence based practice in pediatric occupational therapy. I used the resources listed under the school-based section frequently during this rotation because I was in a school. I think this is a great resource for anyone looking to go into pediatrics, I know it was very helpful to me for coming up with treatment ideas as well as developing a better understanding of my students diagnoses and subsequent needs.

This is a fact sheet that talks about the roles that OTs can play in a community mental health setting. This is a setting that would allow OTs to work primarily with the psychosocial needs of clients. Settings that fall into this category include: community mental health centers, assertiveness community treatment teams, psychosocial clubhouses, homeless and women's shelters, correctional facilities, senior centers, after-school programs, as well as homes and workplaces. OTRs and COTAs in these settings focus on providing services that promote physical and mental health and wellness, habilitation and rehabilitation, and approaches that are recovery-oriented. Research suggests that OT services and interventions can have a positive impact on those with mental illnesses living in the community.

This is a website that outlines the laws and regulations regarding supervision in occupational therapy, physical therapy, and athletic training in Ohio. The section pertaining to OT is section 4755-7-04 starting at the bottom of page 21. Supervision guidelines were put into place to ensure that OT consumers are protected. OTRs are ultimately responsible for all clients, as well as actions of COTAs, students (both MOT and COTA), as well as unlicensed staff. If an OTR is responsible for administering evaluations, directly treating, and supervising COTAs, the ratio should be no more than 1 OTR per 4 COTAs. However, if the OTR is only administering evaluations and supervising COTAs, the ratio increases to 1 OTR per 6 COTAs.

This study is a qualitative study that looks at how first and second year OT students perceive the concept of professionalism. They found 3 general themes in these students perceptions: searching for explicit examples, responsibility to the profession, and building and fulfilling societal responsibility. I liked this article because the authors state that this is an important concept to understand so that OT programs, OT managers, and OT practitioners can more easily identify research and education priorities when it comes to professionalism.

This article gives guideline for OT practitioners on how to define and set their professional boundaries so that they do not find themselves in a scenario in which they may violate the code of ethics. I really like this article because it provides a lot of scenarios in which an ethical violation could occur and provides information regarding what our code of ethics dictate we do.

This article from AOTA talks about what exactly clinical reasoning is, and offers up a different definition from what has been the traditional one in OT. They state that clinical reasoning is not only being able to give specific reasons to justify decisions, but is also understanding and knowledge that we gain through experience. It is more than just applying theory, it is something that we must work to incorporate into our every day routines as OTs.

This article looks at the efficacy of a technique called tapping facilitation for CVA patients with hemiplegic UEs. I got to learn about this technique with an inpatient who had a massive CVA when she went in for open heart surgery. Her right arm and hand were completely flaccid. We used this to work on regaining elbow flexion & extension, as well as wrist flexion and extension. This technique involves putting the targeted muscle group on a stretch (i.e. elbow/wrist flexors or extensors) and firmly tapping the muscle bellies until there was a palpable to visually noticeable "twitch" in those muscles. After this twitch was felt or observed we would passively take the elbow or wrist through the ROM we were working on so that the brain could reform the connections.

Although this article is written in regards to HVPCs effect on ankle sprain, I used HVPC, concurrently with pulsed ultrasound in quite a few of my patients (carpal tunnel, tennis elbow, s/p elbow surgery, Dequervains, extensor tenosynovitis, etc). It proved to be very useful for cell/tissue healing and pain reduction in many of my patients. This modality involves the typical electrode placement of 4 pads crossing the affected area with a dispersive pad on the back or thigh, and we would use it in combination with therapeutic ultrasound. We also had two combo units we used, which did not require the use of electrode pads, rather the electric current came from the same sound head that the ultrasound was coming from, and we still used the dispersive pad on the back or thigh

This article talks about a stress-loading, also known as the "Scrub & Carry Program," beneficial for patients with Complex Regional Pain Syndrome/Reflex Sympathetic Dystrophy. This program entails stressing the body part, typically a hand in hopes of the nervous system regulating the pain signals it is sending to the brain. Patients using this program will "scrub" using a brush or the Dystrophile and scrubbing foreward/backward & side-to-side, initially starting for 3 minutes at a time and gradually increasing. Then patients are to carry a weighted object, to their tolerance, in the affected hand for as much of the day as possible. We used this with a patient who had a traumatic work place amputation to his ring finger, and deep laceration (down to the bone) to his middle finger and was starting to show signs of RSD. Though he has poor compliance with this program at home, we did see some benefit from it in the clinic.

This article talks about the positive effect lavender essential oils can have on the nervous system. While at my site I got to use essential oils quite often with my peds patients as another for of sensory stimulation. The most interesting way I got to use it was providing my extreme sensory-seeking ped with an essential oil charm, which we use peppermint oil in, for when she returns to school so that she is better able to attend to her classroom work. It was incredible to see the positive effect it has on her, and how excited she was to use it. Kristy, my FE, also used essential oils in a "smelling game" for peds, in which she would put a few drops of an essential oil on a tissue in a cup, do this with a few different oils, peds patients were then placed prone in the net swing and asked to spin around and either find their favorite scent, or to smell each cup and identify the scent. This works both for sensory seekers & sensory avoiders.

I used this article in my EBP presentation for my site, as I dealt with a lot of patients that had carpal tunnel, and quite a few of them had it bilaterally. This was really helpful in breaking down each of the options for nonsurgical management, as well as providing research studies that had shown each interventions efficacy. Iontophoresis was the modality I found most interesting, however I only got to use it twice with a patient before finding out his insurance did not cover it.