Sunday, March 27, 2016

Happy Easter!

Yes, I'm staying up late tonight, because I don't have to get up early for work tomorrow!

You, too, can enjoy more time off if you work in the public schools!  Go for it.

Happy Easter to all!

Friday, March 25, 2016

Dogs on Call

So, I'm thinking about working toward volunteering, along with my grand-dog, with this organization:  Dogs on Call

It entails becoming a hospital volunteer, taking an obedience class with him (and passing...), shadowing a team and being observed to see if we do a good job.

I know Mr. T is adorable, but will he pass obedience class?  Will he keep it together in a busy hospital setting?  Will he restrain himself from chewing on something in the hospital room that looks enticing?

Of course, he does look good in a uniform (or PFD): 

If you've had experience with any type of animal-assisted therapy, send me some encouragement!

Thursday, March 24, 2016

Dinosaur Eggs Make a Good Stand-In For Easter Eggs

Lottsa bunnies and pastel eggs showing up in classrooms and hallway bulletin boards this time of year, at least in the elementary schools.  Cutting out circles, ovals and leaf shapes to create these figures is a wonderful, functional fine motor challenge but there are times when I'm not sure if my student's family is keen on having their child create items that are closely related, in least in the minds of many folks, to a specific, religious holiday.

So, what's not to love about making dinosaur eggs?  I always choose the vegetarian variety--a brontosaurus--but most students head straight for the carnivores.  This little girl was no exception; only a T-Rex baby dinosaur egg would do!

I used the activity as a means of assessing my student's typical grasp of a pencil and scissors.  Many opportunities for tallying up how many times she picked them up with an age-appropriate grasp, as well as measuring her cutting accuracy.
It's important to cut around the egg very smoothly, so the baby dinosaur won't get scratched when he comes out...

Draw a line from one side to the other, where the baby dinosaur is cracking the egg open

Use your scissors to help the baby dinosaur break the egg...

Wait--we forgot to make the baby T-Rex!

Put the egg back together and hide the baby dinosaur underneath...I hear a noise inside the egg...he's trying to get out...EEK!  It's a baby T-Rex--run for your life!

This activity deserves its own take-home bag.

Although I'm careful to respect the preferences of students and their families when it comes to materials used and activity themes, when it comes to a personal comment from me to you, I want to say:  I hope you have a joyful Easter!

Tuesday, March 22, 2016

Making Better How-To Videos

My SLP buddy and I have been going 'round and 'round with recalling the tricky steps to programming an older device we're using to help a young student remember to swallow more often.

Although the device came with a set of directions, they are quite cumbersome!  The student spends most of her time not wearing the device because 1) the battery has run down and the vibration mode has stopped working as a result, 2) the student has pressed too many buttons to stop the vibration alert that goes off every two minutes, resulting in the programming getting out of whack, and/or 3) the device is missing.

Not much we can do about Reason #3, since we're not in the classroom all day with the student, but we certainly can decrease the time lost due to Reasons #1 and #2, even if the battery needs to be replaced on a frequent basis. 

We wrote out a script, making it as simple as possible, pulled out an old Flip camera, and started filming.  The result is a little fuzzy, but we have a video now to use when training the student's instructional assistant.  Whew!  Using an Invisible Clock as a Alert Timer

Of course, we can make it better by using a tripod to stabilize the camera and not worrying about the fact that there's no way possible, given our skill sets and equipment available, that we can make the small display screen readable throughout the video.  So, stay calm, follow the directions, and do exactly what we tell you!

The device is an  Invisible Clock, circa 2000????  Looks like the company is still in business:

If you have used other wearable alerting devices to help students remember to swallow, pay attention or practice a positive behavior, please share your experiences.

Friday, March 18, 2016

Writing Math Equations

Well, I thought the Google Docs Equation tool would help our students in middle and high schools with writing math, and it can, but using those little, tiny drop-down boxes and clicking on the correct teensy-weensy math symbols you wanted to use is quite tricky if you have FM problems.  Well...

there are shortcuts you can use to avoid all that!  If you use the Help feature on the Google Docs toolbar you can find instructions for creating an equation AND using shortcuts.  The shortcuts are the key to saving time. The key you always need to be able to find, is the backslash key, which is right over the Enter key on a PC. When you are working inside an equation box you just type the backslash key first, immediately followed by the shortcut command of the function (example with multiplication, below)

4 \times 5 = 20

and you get  4 x 5 = 20

Although using just the keyboard math symbols is faster, they don't take you past typical elementary school math "writing."  Being familiar with using Google Docs Equation is useful when you frequently need to write math symbols that cannot be found on the standard keyboard, but are using fractions, square roots, exponents and beyond.

This is the limit of what I know so far.  For more knowledgeable assistance I suggest you ask your tech person at a middle or high school, or the math department lead teacher.

Monday, March 14, 2016

Little Chocolate Bunnies

Oh man, is it a lot of work to make pink-eared chocolate bunnies!

First, you have to gather all your materials--different colors of chocolate for melting, chocolate molds, microwave-able cup and some extra cups, spoons, "lollipop" sticks and a paintbrush or other item for highlighting.
The chocolate is heated at half power in the microwave, in 30-second  bursts.  That takes--
f  o   r   e   v   e   r ....  If you heat it too fast, too high, too long and don't stir it in-between heatings you risk making a glob of stinky, burnt chocolate.

The SLP had students say whole sentences about which color chocolate they wished to use, made them ask for the lollipop sticks and other materials/tools.  I was watching their hand control and motor planning during spoon dipping and pouring plus their ability to use a hot pad to retrieve the measuring cups from the microwave.

Painting in the pink bunny ears before spooning in the white or dark chocolate.

This task was easy, fine motor control-wise, for several students.  They seemed familiar with the idea of not over-filling the spoon and accurately hovering over the mold opening while carefully pouring the chocolate.  For other students there was a little more clean-up to do; what we call a "learning experience" in the schools. 

These students, in a class for high schoolers with autism, spend many hours each week working on cooking tasks with their teachers, as part of their pre-vocational training and self-help practice.  Some students are very adept in their basic cooking skills!

Many thanks to the PTSO (Parent-Teacher-Student-Organization) at Midlo High for generously giving us a gift card to use for funding these activities!

Friday, March 11, 2016

Soapbox Moment--Hey, It's Friday

Clinical Reasoning During/After Conducting an Evaluation:

So, let's say I've just completed an evaluation.  That means:
  • I’ve worked with the student 1-1 to assess his school-based fine motor/self help/sensory regulation abilities,
  • Observed him arriving in homeroom and getting ready for the day,
  • Taken note of who he talks to, where he sits during group time, how he attends to his teacher and the other students,
  • Peeked inside his desk and journals, then compared his organization and classwork to peers,
  • Watched him line up for transitions and walk down the hallway,
  • Studied how he reacts to the noise in physical education, lunch, recess and assemblies,
  • Compared his grasp of a spoon or fork to his grasp of a pencil/paintbrush/percussion stick
  • Interviewed his teacher and delved into his family’s concerns,
  • Read reports from his community-based OT…and,
  • now it’s time to analyze the findings.
So, here's my quandry:

When do we “pick up” students for therapy, when do we provide classroom suggestions and when do we end our involvement with the student  after the eval  is completed and shared with the IEP team?
Of course, deciding whether or not OT services are required for the student to access his/her educational setting is a “team” decision.  However, the team relies heavily on the therapist to give a careful opinion on whether or not the student requires our services to be able to access his/her classroom, school building, needed materials, community-based settings and more.

We have about 15 OTs on our staff and, despite having peer review groups to sift through our reasons for recommending/not recommending services, I think we all have different criterion for making our decisions.  When I began working in schools I used a assessment of neurological screening, along with other factors, to determine which students might benefit from OT services.  There I was, asking students to assume quadruped and passively rotating their heads to see if I could elicit an A-TNR.  If they exhibited the reflex then I did yearlong sensorimotor groups to improve their “intrinsic” motor development, so they would write better, cut better and attend more easily to school matters.   This is how I developed my caseload in schools where there were classes (all self-contained in that era) for students with learning and/or emotional disabilities.  I don’t know about you, but I find myself exhibiting an A-TNR when I yawn and stretch my arms or when I pick up a heavy tote full of my OT stash—and I’ve scooted on scooter boards and propped on forearms alongside kids for 35+ years.  You’d think my sensorimotor skills would be perfect by now.

I look for different markers now when I do assessments and most of them relate to what the student needs to do at school.  Can he retrieve what he needs in his pencil box or book bag at the same rate as other students?  If yes, then he’s organized “enough” in class.   Does she know to sit on the edge of the group, next to a peer who is calm and friendly?  That’s a good indication of a young student’s early self-advocacy and emerging interpersonal skills.  Does he write legibly enough that his teachers can read his answers on a worksheet, yet independently use his school-issued laptop for the majority of his other writing?  That counts as being able to appropriately manage writing tasks at school.
What I’m looking for, when it comes to recommending direct OT services, is what does the student need to do that only OT can help him achieve?  Does a 4th grader write legibly, and comfortably, with an immature grasp?  He doesn’t need OT as a related service so he can switch over to a perfect, tripod grasp; it's time away from class that is not critical to his school success.  But, if he can’t sustain a steady grasp on the paintbrush in art because of muscle fatigue then I know how to adapt the paintbrush, the activity, the position of the easel and the knowledge base of the teacher so the student can be independent.  My services are needed.

If we were to assess primitive reflexes, fine motor skills, coordination, sensory-sensitivity and other measurable components that make up a child, many students in special ed and general ed would fall below the average range.  If I had to score within the 1st standard deviation from the norm in all of those areas to pass my employment physical I’d never get the job.
When we consider whether or not a student needs our services to access the school environment, to their highest level of independence, let’s remember that we’re here to provide services that are unique to our professional training and experience.  Although we certainly are useful as intuitive and skilled classroom helpers our mission is not to provide services that are within the scope of other professionals—teachers, instructional assistants, physical education teachers, art teachers and many others.  We deliver the skills and knowledge that we have been educated and trained to provide when it comes to meeting the needs of the student, and then we work ourselves out of a job by training other team members to help that one, specific student, become independent in school.   This may take a semester or much longer, but my goal is independence—on the part of the student and the people he may need for support.

I see my job as figuring out why a student is having difficulties with a critical task at school, trying out and practicing easier or adapted methods for the student to master the skills needed to perform the task and then training the teacher and/or parents on how they can keep the skill moving along.  How do you see your job at school? 

Tuesday, March 8, 2016

Adult Hemiplegia--Treatment Strategies

Searching for another phys dis topic I came across this so-wonderful-I'm-tearing-up handout that accompanies a video by Jan Davis MS, OTR/L.  Reviewing the content makes me remember why I first wanted to work in adult rehab.

When I work with kids with hemiplegia I want to keep Jan's treatment ideas and strategies in mind.

Friday, March 4, 2016

Embossed Paper for Fidgeting

Yesterday I asked the technician for our Vision Department if she had any embossed paper handy I could check out for interesting textures & patterns. She had some thick, white sheets from the geometry handouts, filled with all kinds of triangles, squares and circles and I thought that would be interesting for some of my texture-hungry students to keep at their desks for quiet fidgeting.
in one of my autism classes this morning I found another source of embossed paper.  The high school student who volunteers in the classroom on Friday mornings offered to teach me how to use the embossing machine and helped me get over my fear that I might break it.
It took about 60 seconds to make these 4" x 6" embossed papers, using the donated paper and tools on hand.  The textures are irrestible.
I can hardly keep my fingertips from exploring the dotted swiss paper and clustered teardrops in the chrysanthemum pattern--imagine how that might be oh-so-fascinating for some students.

Update:  I started thinking about my target student; she will probably finger the textured paper so much that it will quickly tear apart.  What to do?

Frame 'em.  The lightweight, embossed paper is now surrounded by cardboard "frames," made from recycled cardboard and leftover duct tape from another project.
The student does not pick at tape or enjoy taking things apart.  This just might work for her.

Why two colors of duct tape?  Why not--it increases the visual appeal, don't ya think?

Thanks to Ms. C and Ms. R who shared their "stash" of paper with me, and to the student volunteer who is headed out of the country to do more volunteer work during her school break.  I should tell her more about occupational therapy as a career...

Wednesday, March 2, 2016

The Magic of Glue Dots

Breaking news!  One of my teachers for middle schoolers with moderate mental disabilities just sent me this message about a student who would rather pick at things more than anything else in the world:

I just wanted to let you know I found something great for Leora.  She is using glue dots (Strips cut into individual squares) with her assignments... and they are working AWESOME for her!  She seems to love the peeling and picking aspect of it, and it saves so much glue!!

Doesn't that make your heart happy?

And, I just found this video for making them yourself:

Tuesday, March 1, 2016

Jack Hartmann's Alphabet Workout

My OT buddy, Lauren Swedenborg, just made my morning by sharing this link!  This video is another great tool for helping kids dynamically understand the alphabet's spatial twists-and-turns:

Jack Hartmann's Alphabet Workout