Tuesday, April 14, 2015

Shout out to OTs in South Korea!

Looking over the blog stats I see that several viewers today are from South Korea--howdy from Virginia!  I had a family member living near Seoul a few years ago and I have a special place in my heart for the country!

Monday, April 13, 2015

UE ROM

How do you address independence with range of motion exercises?



This student has worked with a school-based OT since he was in early childhood special education.  He also has had rounds of outpatient therapy at a pediatric OT department, as well as one surgical procedure to release the wrist contracture.

The school-based OT trained the student and parent in passive range of motion exercises a few years ago and created a home program, with written and video directions.   

With quite a bit of therapeutic handling, the student's thumb can be extended this far from the palm, but the wrist remains slightly flexed.

In schools, we usually use parts of the school environment as convenient stabilizing points for independent exercise.  In this student's case it was difficult to find a suitable spot, due to the limited wrist, elbow and shoulder movement.  Teachers and assistants assist with passive range of motion for students, following training by the therapist, but this student's physical status and need to frequently change between general ed, special ed and resource classes limit the opportunities to perform joint range of motion exercises.

His LUE contractures interfere with ease of donning his coat, manipulation of school materials and participation in PE activities, even though adaptations are in place.


We practiced using a soft traffic cone (in a color the therapist likes...) to allow the student's hand to assume a semi-relaxed position.  In this position he practiced extending his elbow.

Placing the hand higher on the cone allowed for slightly more shoulder flexion.

Working with students, families, teachers and assistants on increasing student independence with ROM exercises becomes more challenging as the students enters later elementary grades.  There is more of a time crunch and the students usually become very self aware of how their bodies move differently from their peers.  They often do not want to be seen performing exercises in school or even leave class to work with the OT. 

My plan for the rest of this school year is to help the student continue to become more independent with the exercises and to add adapted hand-washing to our practice sessions.  This guy needs to know how to thoroughly clean the palmar area, since it is so difficult to open, as well as the ulnar side of his hand, since it is very calloused.

Friday, April 3, 2015

Criss Cross Practice for Shoe Tying

Sometimes it's pretty difficult for students to practice shoe tying with regular laces--they can be so flimsy and just droop all over.  Using different thicknesses of rope or other cording can make it easier to practice the steps.

The student and I sit side by side, with both feet flat on the floor.  We each use lengths of rope I convinced my DH to share with me and the nylon ends were burned (off school premises!!!) so they wouldn't unravel.
We loop the rope around a leg and practice holding the ends up even, then start crisscrossing the ends, followed by that mind-boggling task of sliding one end under the crisscross....


This student is just beginning to be successful with making a half knot.  She actually asks to practice this, although it takes about 10 attempts to create the half knot.  But, she is getting better.....

After a successful attempt we sometimes practice using a regular shoelace.  The flimsiness of it drives us batty!

This year I made an effort to introduce shoe tying early in the school year, since it takes so much practice.  I've bought some inexpensive shoes and left them in a few classrooms when teachers have shown interest in continuing the practice sessions.  For those shoes I've cut two colors of shoelaces in half, knotted two different colors together, and relaced them in the shoes.  That way the students can more easily see the two ends and two loops while they work.

Note the knot connecting the two half laces, near the bottom of the shoe's tongue.
 


Almost Time for Spring Break!

Yep, after work today starts our week of freedom!  This year the time off will be even more enjoyable since my DD is hosting the holiday dinner on Sunday--no hyper-cleaning the house for me!

I hope to catch up with girlfriends, rescue the root-bound plants in my dismal garden, relocate them to better spots around the yard and give my elderly mouse catcher the attention he deserves.  It'll be grand.  Oh, and I get to sleep in!  I can always catch up with the 5:50 a.m. editions of The Writer's Almanac another week.

Easter is my favorite "holiday."  Not the pastel dresses on adorable little girls or nibbling the ears off chocolate bunnies, but the reason for the celebration.  Good Friday is pretty rough, but Sunday morning is amazing.

Here's a story I wrote this year for Good Friday.  I hope everyone has a wonderful Easter.


There is no rest for the weary soul

 at the wonderful church my family attends.  Babies are

 squalling, toddlers are dancing in the aisles and teen guys

 are sitting quietly, like adorable choirboys, all the while

 stealth texting each other.  Packs of girls frantically wave to

 friends, then scoot over to make room for one more.


Once the sermon begins I close my eyes to help me

 concentrate, and it usually works pretty well.  Thanks

 to the youngster sitting behind me who kicks the back of my

 chair every so often, there's no danger of falling too fast

 asleep.  If I eliminate the visual riot going on amongst

 the congregation during the sermon I can follow along much

 better, and it's really worth it to follow along.  Let

 me hear a good sermon and I've got enough material to last

 me through a whole week, with all the changes I need to make

 in my heart and life.


 There is one service during the year that is completely

 different from all others--the Good Friday service.  We

 enter the sanctuary quietly, sing contemplative hymns,

 listen to narratives from the Gospels, pray and leave in

 silence.


 Volunteers sit in a row in front of the rest of us, usually

 about four people, and they take turns reading Bible

 passages beginning with the Lord's Supper and ending with

 Jesus' crucifixion.  One person is the narrator and

 the others take on parts. They probably have a quick

 practice together before the service and they look a little

 nervous; they're folks I scarcely recognize from Sunday

 mornings and I'm interested in getting to know them by

 listening to their voices.


 One year the man reading the words of Judas did not look

 "the part."  When he began reading Judas' words from

 the Lord's Supper narrative he seemed so humble and

 honest.  It didn't match my imagined snapshot of

 Judas.  As he read later passages his voice took on a

 sinister tone and when he finally spoke the words of

 betrayal, I was shivering.


 The effect of hearing the exact text from the Gospels is

 sobering, and saddening.  It makes it easier to imagine

 the emotions of Jesus, knowing that he would be betrayed and

 have to undergo real death.  Later in life I came to

 understand that the worst part of His suffering was to be

 separated from His Father while He voluntarily stayed on the

 cross, for me.


 We all left the service without talking and walked out of

 the building into the warm, spring air.    Once

 outside, we could take a deep breath and say good-bye to

 friends, ending with the familiar line, " See you Sunday."


 The only way to bear the grief of Good Friday is to look for

 the early light on Easter morning, shining on an empty

 tomb. 




 

Thursday, April 2, 2015

Interactive Data Collection for Handwriting Improvement

One of the first graders I see has the best teacher for helping students improve in all kinds of skills--fine motor, organization, self-regulation and self help.  Maybe she's picked up a few tricks from one of her long-time friends who is another OT on our staff???

Today she was telling me how the student has improved, not just with her handwriting legibility, but with the content of her sentences.  This morning the student and I reviewed some of her recent classwork and made special note of particular letters she had written:  1.  Those formed correctly and sitting on the line, 2.  Those formed correctly but "jumping" off the line and 3.  Those that needed a little help.  I tallied them up like this:
As you can see by the totals at the bottom of each column, the student had 17 correctly-formed letters.  We thought that was a lot!  She was especially proud that 3 of her "t's" and 4 of her "o's" were perfect.

Every writing sample will have a different number of words so all I'm looking for is the ratio of great to fair/poor.  At the beginning of the school year this student did not have very many great letters in her work.

I may offer a little guidance, but the student's progress is due to the daily effort of her wonderful teacher, who has been "Teacher of the Year" at this school several times. 

Wednesday, April 1, 2015

Studying Tips for Test-Taking Students

Hey, it's time to spend lots of sweat and tears studying for and taking tests in school!  Here's an interesting article on strategies for studying:

http://www.additudemag.com/adhd/article/10602.html

Monday, March 30, 2015

T-Shirt Bracelet as Fidget Tool

One of my middle schoolers with autism loves to wind and pull on strings.  Since she doesn't put non-food items in her mouth I'm going to share this recycled fidget tool idea with her teacher and see how it works.

Keep in mind that t-shirt material stretches quite a bit over time when it is pulled on, washed, dried, pulled on, washed, dried...  For this reason I didn't plan a static closure on the bracelet; the length will change daily.


Cut 2-3" wide strips from an old t-shirt.


Tie a firm knot at one end.

Attach the knotted end to a stable object and begin braiding.

Finish braiding and tie a knot at the terminal end, then clip off the extra fabric.


Wind band around the wrist and slip the ends under the band to secure.


The knotted ends will get smaller after washing and drying.


Students will require supervision when using this fidget tool.  If they wind it too tightly around their wrist, put it around their necks or chew on the fabric then it's not the right thing for them.  Keep it at school.

Some students will be able to follow directions for making their own bracelets and there are tutorials available via Internet searching for making very attractive bracelets, adding beads...  Think fund raiser.

Be sure to monitor your student's increase in attention to educational activities, decreased anxiety or other benefits from using the bracelet as a fidget tool.  If they choose to slide it in circles around their wrist, take it off to pull apart like therapy band or just run the braid through their fingers that's appropriate use and may help them feel more alert and ready to learn.

Please send me photos of the recycled fidget tools you use with students!