OT Café

This blogspot offers insight into "what to expect in occupational therapy school'. The blogger in charge of this site is a Pediatric OT named Abby. She created this blog to share thoughts and ideas about peds OT, and to share resources with therapists, parents and teachers alike. Policies, the day in the life of an OT, OT approved toys and ipad apps are also links to view on this page.

The current blog, like mentioned previously, describes what OT school is really like from an individual that has been there. The blog describes school as a full time job, full of classes, studying, reading and fieldwork. The coursework includes many group projects, giving lots of presentation, and hands on learning. Abby explains that her blog is to describe OT in the most real form she can so individuals that are looking into it now the details before committing to a program.

Furthermore, she describes fieldwork, both levels and the important fact that this time is for learning, and the experience not for getting paid (you actually pay the school to work in a clinical setting). She also offers an additional link to the fieldwork section of AOTA.

If a prospective student wants even more information about what being a student entails and being an OT as well, Abby's book with co-author Christie (Mama OT) would be a great investment. This blog is actually an excerpt from this book.

Abby also has facebook, pinterest, twitter and IG accounts to follow for additional OT resources, thoughts and ideas. The blog offers an archive of previous posts that Abby has available.

If anyone knows of an individual that is a prospective OT student, this would be a good resource to provide to them, as well as your own insight into the OT school and profession world.

Maybe we'll all have our own OT blog someday and this could just give us the inspiration to do it.

Braton-Chung, A. (2015). What to expect in occupational therapy school. OT Café. Retrieved from http://abbypediatricot.blogspot.com/

Dickerson, A. E., & Fazio, L, (2006). Role competencies for a fieldwork educator. American Journal of Occupational Therapy. 60(6). 651-652. Retrieved from http://gateway.tx.ovid.com.proxy01.shawnee.edu/sp-3.17.0a/ovidweb.cgi?&S=GOKBFPDFDBDDHLGPNCJKEBLBIPPNAA00&Link+Set=jb.search.29%7c1%7csl_10.

Before becoming a fieldwork educator, there are many things that must be taken into consideration in order to be competent in this role. The basic competencies required to become an educator are based from AOTAs Standards for Continuing Competence which describe the typical values, knowledge, skills and responsibilities. This article breaks down each competency and describes them each into detail such as what each fieldwork educator must be able to do for their students, demonstrate, share and etc. The standards included in this article include knowledge, critical reasoning, interpersonal skills, performance skills, and ethical reasoning.

Watling, R., Koenig, K. P., Davies, P. L., & Schaaf, R. C. (2011). Occupational therapy practice guidelines for children and adolescents with challenges in sensory processing and sensory integration. Bethesda, MD: AOTA Press.

This book discusses the OT process for individual with sensory challenges, developmental disabilities and ASD and includes the fundamentals of OT services, evaluations and interventions. It also includes wide-ranging tables that summarize evidence of current and relevant research by evaluating and rating various studies validity and organizing research based on the individuals age and challenge/disability.

This text is intended mainly for professional healthcare providers as a reference of OT students or educators, policymakers and other clinical practitioners who provide care to individuals with challenges in sensory processing and SI. For individuals outside of the healthcare field, this text offers a guideline of the role in which OT provides for individuals with processing challenges and integrating SI.

Within outpatient therapy, it is common to see trigger points in muscles that cause pain, weakness and some restriction in ROM. A trigger point can be defined as "a focus of hyperirritability in a tissue that when compressed, is locally tender, and if sufficiently hypersensitive, gives rise to referred pain and tenderness, and sometimes to referred autonomic phenomena and distortion of proprioception". There are three different types of trigger points to consider when treating include myofascial cutaneous, fascial, ligamentous and periosteal trigger points.

In order to treat trigger points, an individual is able to use the thumbs, fingers, knuckles, elbows or a combination of each to apply pressure by moving inward toward the center and then slowly releasing. The pressure should last from 30 to 45 seconds but no more than 1 minute. During this treatment, the individual should be relaxed with proper breathing techniques.

This article also explains indicators of myofascial dysfunction and further treatment such as hot packs, e-stim, laser and etc, as well as additional types of trigger point therapy such as ischemic compression or dry needling, or myofascial stretching.

Kostopoulos, D. & Rizopoulos, K. (1998). Trigger Point and Myofacial Therapy. Advance Healthcare Network. Retrieved from http://occupational-therapy.advanceweb.com/Article/Trigger-Point-\and---Myofacial-Therapy.aspx.

Timocco. (n.d.) http://www.timocco.com/.

Timocco is a cutting-edge virtual motion gaming system that accelerates the development of motor and cognitive skills that include bi-lateral coordination, crossing midline, hand-eye coordination, attention, posture, visual discrimination, early learning, communication, short-term memory and team work. Timocco develops motor, cognitive and communication skills through each of their 50+ games which has a variety of fine-tuning options that isolate and develop specific movements and skills for varying levels of ability. As children pop balloons, zap aliens or try to catch falling fruit, they don't seem to notice how much skill-building practice they're ultimately getting through this play experience.

Timocco even breaks down exactly how motor, cognitive and communication skills are targeted at the following link: http://www.timocco.com/skills-we-develop/. If you're looking for a specific skill to target and wondering what game to use the following link always you to click on each 'game bubble' for a description of each skill it is targeting or even search by skill in the 'search box': http://www.timocco.com/page-games/. Or if you're looking to target a skill within a certain group in your clientele (diagnosis), at the bottom of each screen in the Timocco website offers several diagnoses to choose from and once selected will once again provide a breakdown of each skill targeted for that group and how it is done.

So, as an pediatric OT looking to purchase this item, Timocco has been made claims to be specialized for children who have Learning Disabilities, Developmental Coordination Disorder, Autism, Cerebral Palsy or ADHD.

Lastly, Timocco provides its potential consumers with published research that has been conducted on this product so the readers can get more insight to its reliability and validity at the following link: http://www.timocco.com/research/

This is a PDF file that discusses therapeutic modalities, such as their descriptions, indications, administration techniques, treatment considerations, effective documentation practices, critical assessment parameters, and precautions/contraindications for each. Although this PDF goes into detail about many different modalities, only a few are going to be summarized with their indications/contraindications in order to give an idea of what it discusses. This is a very good resource to have and possible even print off.

Cryotherapy is described as using 'cold' to achieve results therapeutically and typically used for pain management, anti-inflammation, edema control, decrease of muscle guarding/spams and spasticity management. It should not be used on individuals with sensory deficits, circulatory issues, cold hypersensitivity or HTN.

Fluidotherapy uses dry circulating corn husks as a superficial heat on the affected area. This type of therapy is typically used on hands and/or wrists but can also be used for ankles/foot. The conditions it targets include arthritis, chronic tendonitis, postoperative conditions, post fracture management and Raynaud's syndrome. It should not be used with open wounds. If there is an open wound and fluidotherapy is to be utilized, it should be covered by a plastic barrier to prevent the particles from entering the area.

Hydroptherapy/Aquatic therapy is used as heat or cold therapy in order to manage wounds, such as cleansing/healing or pain by using tanks or whirlpool. Specific conditions that utilized this therapy include arthritis MS, muscular dystrophy or other neuro-myopathies, spinal cord injuries or other orthopedic injuries. When being used, health professional should always watch for excessive loss of body heat of overexertion.

Iontophoresis is a continuous and direct current used to transmit ions through the affected skin that is typically used for pain management, anti-inflammation, scar management and enhanced healing. It should not be used within bruised areas, cuts, broken skin, acute injuries, and active hemorrhages. Basic E-stim contraindications apply and should also be cautiously applied to those who have impaired sensation.

Paraffin is a superficial heat that uses wax and mineral oil for conditions such as chronic arthritis of the hand and foot, as well as various distal extremity conditions to increase ROM or manage pain. Open wounds should be covered when using paraffin and all heat precautions should be followed as well.

Ultrasound is used as a deep healing technique where sound waves are low intensity and high frequency provide thermal or nonthermal effects to the area. Typically it is used in order to increase the extensibility of collagen fibers in tendons and joint capsules, reduce muscle spasm and modulate pain. It should not be used in areas of poor circulation or impaired sensation, over reproductive organs or eyes, pregnant individuals should avoid using it, as well as those with pacemakers or individuals with cancer, as well as total joint replacements or active epiphyseal growth plates.

There are many other therapeutic modalities noted in this pdf, such as ICF, low-level laser therapy, mechanical intermittent compression, mechanical spinal traction, MENS, NMES, and TENS.

Chapter 2. Therapeutic Modalities. (2012) Retrieved from [PDF] https://www.google.com/?gws_rd=ssl#q=contraindications+of+modalities.

As an OT, one may be faced with the decision of what type of referral to make for a wheelchair. Considering the new statistics out about 'sitting is the new smoking', it may make this decision a little easier. The Standing Company is a manufacturer of three different Superstand Standing Wheelchairs that include the manual, half-power and full-power which are completely custom made for each individual. This company even offers free fittings upon visiting their headquarters in central Michigan.

Currently, the smallest child using a Superstand Wheelchair is 4' tall, with the tallest person being 6'11" and the heaviest being 360lbs, therefore if an individual is in need of a chair, it can be customized for them.

The Standing Company also tries to secure funding for their wheelchairs in order for their patrons to be able to utilize their products without worrying about financials, as well as a follow-up program to make sure the chair is working properly and perfect for that individual. The Standing Company is a start to finish company that makes sure their patrons are taken care of, satisfied and healthier (according to the most recent research posted on their website).

The Standing Company is definitely a most check out site for any wheelchair needs, especially for OT's wanting to provide the best for their clients, as well as a way for them to participate in their occupations.

The Standing Company. (2014). Retrieved from http://thestandingcompany.com/.

I recently purchased this 127 page 3rd edition handbook(pun intended) although there is a 4th edition available, for my second fieldwork rotation in order to get a better grasp (getting punnier) on than hand, its anatomy and the various diagnoses that I could potential see within the following 12 weeks and throughout my career. It is a very easy read as it provides information on evaluating common hand diseases and injuries. In particular, this text provides sections on examining the fingertip and nailbed, carpus, and flexor tendon sheath, as well as information for 2-point discrimination testing and circulation examinations. Definitely worth the purchase if interested in hand therapy.
Further, the text is broken into two parts: examination and common clinical problems. These two parts are broken further into separate chapters as follows:
Introduction
Part I: Examination
1. History and General Examination
2. Examination of Specific Systems
Part II: Common Clinical Problems
3. Lacerations
4. Common Fractures and Dislocations
5. Acquired Deformities
6. Congenital Anomalies
7. Tumors
8. Infection
The text also includes 3 appendices, further suggested readings and an index.

Rayan, G. & Akelman, E. (1990) The Hand: Examination and Diagnosis. Churchill Livingstone: New York, NY.

OTs role in SNF. (n.d.) American Occupational Therapy Association (AOTA.org.). Retrieved from https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&ved=0CCQQFjABahUKEwiLuPfn3aLIAhUGaT4KHfLQBmU&url=https%3A%2F%2Fwww.aota.org%2F-%2Fmedia%2FCorporate%2FFiles%2FAboutOT%2FProfessionals%2FWhatIsOT%2FRDP%2FFacts%

If considering working in a Skilled nursing facility (SNF) following graduation, this fact sheet may be helpful in providing information about occupational therapy's role within this setting. SNF's require occupational therapists to have a majority of roles which coincides with the medical care provided during the variable periods of time.

Short-term SNF rehab includes remediation of IADLs for d/c environment, functional mobility, community reintegration, home modifications, safety equipment recommendations, adaptations/compensatory strategies and assessing current leisure skills.

Long-term SNF rehab includes functional mobility using AD prn, transfer training, remediation of IADLs, compensatory techniques, low vision enhancement recommendations, positioning, environment modification, education of caregivers/patients and engagement in meaningful activities.

OTs are also proficient in implementing and developing programs within the SNF setting that promote health and participation, remediate deficits and address the impact of disability. Programs that are typically implemented include but not limited to falls prevention, dementia management, restraint reduction, contracture management, positioning programs, therapeutic groups and pre-driving evaluations.
It is an OTs role to provide client satisfaction and promote quality of life within the SNF rehabilitation setting.

Currently on our Peds caseload there is an elementary aged boy that has an IEP within his school that requires sensory breaks that he was not getting during the day due to his teachers believing he did not need it and him not asking for them. A phone call was made to his OT at CRSM asking to contact the school with information supporting the need for the boys sensory breaks and why him not getting them was resulting in acting out and certain behaviors.

One of the resources provided to the school was Amber Swearingen's 'Using a "Sensory Diet with Children with Sensory Processing Disorder (SPD)'. This handout provides information as to what a sensory diet is, such as a 'carefully designed, personalized schedule of sensory enriched activities, equipment, and strategies to help a person stay focused and organized throughout the day' as well as additional explanations.

Also provided within the handout is information needed to assist in creating a sensory diet such as the right frequency, duration and intensity of sensory experiences. A sensory diet has to provide the just right amount of input in order to readjust the neurological system so that the child is able to function at their optimal level.

Furthermore, the OT then devises the perfect sensory diet for the child based on activities they like and their personal input, the optimal setting, the time of day in which it would be most beneficial and who will provide implementation such as encouraging classroom and teacher involvement. Not two children are the same, as no two sensory diets are due to the uniqueness of their needs with SPD.

Lastly, the handout provides further resources about sensory processing disorder and sensory diets for those seeking additional information.

Swearingen, A. (2007). Using a Sensory Diet with children with Sensory Processing Disorder (SPD). Super Duper Handy Handouts! www.superduperinc.com

Schaaf, R. C., & Roley, S. S. (2006). Sensory integration: Applying clinical reasoning to practice with diverse populations. Austin, TX: Pro-ed.

This text provides therapists with information of the process of linking SI with clinical practice within homes, schools and communities while also presenting hundreds of sensory-based activities. There are a wide range of diagnoses targeted within this text, such as ASD, CP, Fragile X Syndrome, high risk infants, children from deprived environments, and children with visual impairments. This text not only provides intervention strategies and process, but assessments and evaluation outcomes as well. Throughout the text, the chapters have been based upon works of other great healthcare providers and had their contributions incorporated. These providers include individuals such as Erna Imperatore Blanche, Zoe Mallioux, Janice P. Burke, Marie Anzalone, Colleen Schneck, Sharon A. Cermak, Lois Hickman, Deanna Iris Savas, Elizabeth Haber, Heather Miller, and Heather Schwenk.

With all post-op individuals, they also require scar massage and management with their plan of care for therapy. Many do not realize this is something that many therapists work on during their treatment sessions, as it is billed under manual treatments. This is also something that our course work does not touch much on, so within the clinic, it was a new learning experience.

The following website provides the basic makeup of scars and how to perform scar massage. It is also thought that through massage, scars stay more pliable which causes them to not be as susceptible for re-opening and promotes healing.
This website provides 4 simple steps for scar massage, as well as warnings to avoid and additional tips that a certified massage therapist could be used as a consult.

Personally, I perform step 4 first from this site before beginning scar massage, which is apply lotion or oils, so that the individual is not rubbed raw during the treatment. Other than that, these steps are helpful in beginning scar massage and with practice, more experience will come.

Griffin, S. (2014). How to massage scars to help heal them. Livestrong.com. Retrieved from http://www.livestrong.com/article/511612-how-to-massage-scars-to-help-heal-them/.

Roley, S. S., Blanche, E. I., & Schaaf, R. C. (2001). Understanding the nature of sensory integration with diverse populations. Austin, TX: Pro-ed.

This text offers continued discussions and developments of therapeutic use of SI and its application of principals in a wide range of populations. In order to show support towards the clinical reasoning process exploration and expansion into SI is completed by researchers, theoreticians and practitioners. There are two sections in this text which are the theoretical section and the clinical section. In the theoretical section, (chapters 1-10) data and literature from OT, psychobiology, psychology, neuroscience, and child development are included in support and extension of theoretical principles of SI and their clinical application for various populations. The second section, known as the clinical section (chapters 11-20) offers qualitative and quantitative data-gathering, clinical-reasoning techniques and intervention principles that direct the influence of SI function/dysfunction in individuals with DD. This section provides additional application of SI and principles of intervention with children who may have visual impairment, CP, ASD, Fragile X syndrome and those who have not been ID'd with DD such as sensory modulation disorders, high-risk infants and children exposed to deprived environments.

The Quick DASH is a condensed version of the Outcome Measure, 11 items instead of 30 that evaluates physical function and symptoms in individuals with any or multiple musculoskeletal disorders of the UE. The Quick DASH (Disabilities of Arm, Shoulder, and Hand) is used regularly within the clinic I am currently in. I have seen it also used in the SNF but not to the extent that outpatient services utilizes it. Upon evaluation, the QuickDASH is introduced to the individual and the purpose is explained. Our purpose is that through therapy the score they receive on the initial form will decrease (become closer to zero). This score they receive is translated into the percentage that inhibits their daily function by their injury/disability/surgery. If this score ever goes up during a re-assessment, the issue needs to be re-evaluated, such as a follow-up with the doctor due to new injury, strain, over activity etc.

The QuickDASH. (n.d.). The DASH Outcome Measure. Retrieved from http://dash.iwh.on.ca/quickdash.

Working in any setting, especially hospital or outpatient, an OT is bound to get referrals for post-op individuals. Before working with these individuals it is important to know and understand some of the main postoperative rehab protocols for their patient, whether it be an ankle, elbow, hand, hip, knee, shoulder or spine. The following link provides protocols for a variety of areas that are typically seen within the clinic. Although this site is PT formulated, it can be a great source for OTs as well. For easy access to protocols listed, this website offers print, email and PDF versions.

OSNC. (n.d.). Postoperative Rehabilitation Protocols. Orthopedic Specialists of North Carolina. Retrieved from http://www.orthonc.com/physical-therapy/physical-therapy-postoperative-rehabilitation-protocols.

By now we have all performed transfers, whether it be from bed to chair/wheelchair or vice versa, chair to chair, wheelchair to toilet, etc. Although we have performed them it is sometimes a good idea to reflect back and look at the mechanics of a transfer to make sure we continue to do them correctly so injuries do not occur to ourselves or patient. Often times we get caught up in our daily work we can forget the proper techniques we were taught, especially if it were years ago.

The following website provides step-by-step instructions for transferring an individual from a bed to a wheelchair, but some of these steps can also be taken into consideration during different types of transfers, as mentioned above. This site breaks the transfer down into a few categories: preparation, getting a patient ready to transfer, and pivot turn. In each category, the steps are described in detail in order for the reader to get the full picture of how the action should take place.

Additional names for this transfer are as follows: pivot turn, transfer from bed to wheelchair pivot turn and transfer from bed to wheelchair.

Ogiela, D. (2015). Moving a patient from bed to a wheelchair. Medline Plus. Retrieved from https://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000428.htm.

OT Tools for Public School. (n.d.) Blogspot. Retrieved from http://otinpublicschools.blogspot.com/search?updated-max=2015-10-08T14:00:00-04:00&max-results=7&reverse-paginate=true.

OT Tools for Public School

This site provides activities for OTs to use within their pediatric practice that are fine-motor or sensory-based. Although there are already ideas on this site for OT use, other OTs are able to submit their ideas/tools to share on the site as well. If an idea is technology based, both low and high tech ideas are accepted.

Ideas currently on the website include a therapeutic garden, prehension activities, stuff to chew, scheduling, leaf filter glare guard, weighted lap pads, adapted story books and more. This site can be considered a blog for OTs to share their ideas and get some as well, for their practice, home and/or office, as well as boast on what is going on with them personally or clinically (while following HIPAA).

Occupational Therapy TOOLKIT. (2015). Retrieved from http://www.ottoolkit.com/.

The OT Toolkit is currently utilized consistently in clinical practice at CRSM. It has 630 pages of practical resources within the manual targeting individuals with physical disabilities and older adults. The manual is available as an e-book in PDF format or print. The toolkit includes 85 treatment guides based on current and best practice and 283 full-page illustrated exercise, ADL and education handouts for patient printouts. The resources are also available in Spanish. There is a couple differences between the eBook and text of the OT Toolkit which include the text does not have the bibliography that can be also be access online or the Spanish handouts. A sample page is offered on the website that offers sample views, downloads and print examples of the handouts and treatment guides. If there are suggestions for an idea for a handout, they are encouraged due to the author wanting to make the toolkit a complete resource for OTs.

Educators are able to receive a complimentary examination copy of the soft back text if it is being considered for their course material. Other pricing includes Individual e-book $99, individual e-book with Spanish handouts $119, business e-book $249, business e-book with Spanish handouts $299, soft cover print $109+$4.99 S&H or hard cover print $149+$4.99 S&H.

The website for the OT Toolkit also provides archives of additional resources such as videos, websites and articles with relevant research for OT professionals.

This article provides clinical applications of systematic reviews developed in collaboration with AOTA's evidence-based practice project. This article provides OT interventions targeting adults with cerebrovascular accident. It provides specific assessments to use with individuals with CVA and the potential findings from the case. This article also provides descriptions of what each assessment will provide for the OT, such as what will be evaluated and assessed.
It is often times much easier to comprehend how to utilize certain interventions and assessments when there is a case study attached in order to give it a real life meaning as well as results/findings, otherwise it tends to be difficult to differentiate from others.
Although this article is a good starting point for OT practitioners to understand the application of interventions and assessments for CVA, it does not encompass the full scope of OT practice for CVA survivors.
Nilsen, D; Gillen, G; Arbesman, M; & Lieberman, D. (2015). Occupational Therapy interventions for adults with Stroke. American Journal of Occupational Therapy, 69(5). 6905395010p1-6905395010p3.

Medbridge. (2015). Retrieved from https://www.medbridgeeducation.com/.

This website is offered through my FW cite currently, but can also be accessed through an individual's purchase. When purchased for the promo price of $300/year (regularly $425) or a free on-line subscription is requested it includes accredited CEU courses, patient education videos, patient care HEP, certificate program, library of orthopedic tests and library of manual therapy techniques.

Through the CEUs on MedBridge, individuals that subscribe are able to e-mail questions to instructors directly from the interactive video player while watching a course, and also receive answers directly from the instructor.

The HEP (Home Exercise Program) allows rehab professionals to share programs using the patient portal or personalized printouts. The search engine allows for custom filter views and fast sorting that allows healthcare professionals quickly find the exact exercise required for the individual. The exercise library includes 3,000+ high-quality videos is constantly growing, with 100+ new exercises each month. Subscribers can also request exercises to be added to the filming schedule and printout library.

This site provides additional resources such as knowledge tracks, practice management tools and marketing platform for curriculum for the therapy team, clinician CEU activity and creating a public profile for patients to utilize in their searches and be linked to social media pages.