Polar Bear Cookies

A good friend brought us 3 different kinds of cookies yesterday and these were the cutest:

By varying how you place the eyes, you can create all kinds of expressions to talk about:  "He looks surprised."  "She looks happy."  Super easy recipe to make with kids--try 'em!

http://www.tasteofhome.com/recipes/frosty-polar-bears

Christmas Vacation--Time to Think About What is Important

Ah...two weeks off school.  It's not just the kids who get excited about Christmas break!

First priority:  Get over being sick for a week.

Second priority:  Get ready for a big dinner next Sunday.

Third priority:  Catch up on all those things I've let slide since September 1st.

Oh, really?  My first priority is always to make sure my priorities are in the right order.

Here's a little story I wrote yesterday, a random essay that was stirred up in my brain while I was opening the Christmas cards that had been sitting on my kitchen counter for several days.  Hope you enjoy it.

May you all have a joyful Christmas.

Maybe it's the week-long bout of sinus congestion, coughing and minimal sleep that has contributed to my flighty thoughts this morning, but opening Christmas cards from friends and family made me think about the connection between anxiety and keeping too much stuff.

It's my practice to tear off those little return addresses from envelopes when the info looks unfamiliar, then stuff them in a little cup in my stationery drawer. All through the year I'm reminded of those labels when I open the drawer to root for cards and paper, but I usually don't get around to updating my late 70's address book until just before sending out a mass mailing. If you're pondering when was the last time you received an annual mass mailing from me it was about six years ago.

This morning I looked at the return address of a buddy who lives in the now-frozen tundra of Wisconsin. The info looked pretty familiar, but was I sure? Maybe I should save...no, wait, stop...I don't need to keep it. My worries were taking over, the address looked just like the one I recalled from last year and, if it really turned out to be a new address that I toss out, I could send her a friendly e-mail or locate her with the help of Mr. Google.

Keeping too much stuff in my life, even a tiny slip of paper with a return address, starts with the thought, "I might need this." Little scraps of paper don't take up much room, but they foster the mindset of keeping other things in your life that add up to consume much more space--in your home, in your car or in your mind. Anxiety always asks, "Are you sure?"

Handsome Casaera

There are things I never want to lose--the locket my mom gave me in 8th grade that holds a single cat hair from my beloved companion, Cesaera, the rock with lichen that Casserine "picked" for me on Whiskey Mountain, the shell necklace Uncle Grumpy bought for me from a street vendor in Carytown in '76. I want to linger over these bits of my past, hold them and feel their textures so I can re-live the memories they evoke. Books I don't love, photos of my friends not looking their best and recipes I'd cook if I ever became a perfect wife have long since left the house. They didn't enrich my life or memories while I had them around, why would I keep them.

This time of year is a little too busy to take on extra tasks, like organizing or streamlining this or that area of your life, but it sure is a good time to contemplate what's precious to you. Which ornaments and decorations give you a thrill when you put them out? When you read that holiday letter from a friend, what do you wish you had done this year to stay more connected? If you have a rare moment of quietness in the next week, which thoughts bring tears of thankfulness?

Here's to doing more of what brings us joy next year.

Holiday Sensory Book

Oops--almost forgot to post the photos of our group of middle schoolers making Holiday Sensory Books this past week!

I did not have a real gingerbread boy at home so I made a zombie gingerbread boy for my sample.

During the activity we made sure we talked about:

• How the material felt (scratchy evergreen needles)
• What our eyes saw  (shiny wrapped candy canes)
• What we smelled as we worked on the project (ginger, pine)

Many of our students benefit from hand-over-hand assistance, to use the materials safely and to sometimes even reach/grasp the items.

It takes a lot of deep pressure to make sure the gingerbread boy is firmly glued to the page.

Our SLP not only spent loads of time creating the pages for the iPads but also in making the 2" gingerbread cookies.  And, they were equally as tasty as the ones my mom used to make!

Couldn't keep the adults in the group from adding some bling!

After the glue and scribble paint dries, the pages can be cut apart and made into a flip book.

Fidget Bracelet--DIY

Just in case you have a snowy, frigid day over your holiday break and want to stay warm and toasty, here's an idea for a fun project to do indoors--a kind of Sudoku for the fingers.

Based on my reading of David Burns' book, Feeling Good, I've been thinking a lot about the benefit of practicing healthy behaviors to promote a positive mood, and a key is to do homework related to the behavior you want to improve--and count the times you practice the new behavior.  So, I needed something to use for counting that was easy to keep handy...well,

Golf stroke counters to the rescue--the watch-style ones looked kinda dorky and were expensive, so I kept hunting for something else...and,

Youtube to the rescue!  Here is a link to making a golf/knitting counter:

https://youtu.be/djuc6sUw2w0

I used some cording, beads and findings I had laying around the house and in about 15 minutes made this first edition of my counter:

Here you are at the start, no counting has yet been done.  There are seven beads arranged for counting, the larger square and oval ones in the front.  The other beads in the background are just for "pretty."

Here, one bead has moved to the right, representing a count of one.  Six beads are left to use.



It's a little frayed around the edges, but it sure feels nice and soft on the wrist.  Plus, it works--the beads stay where you slide them.

So, what would you like to count:  The number of times you tell your kids how kind they are being to their grandparents?  How often you deflect a verbal barb from that feisty cousin?  The number of  cookie dough "tastes" you've had in the last ten minutes???

 

I think my middle schoolers with autism will enjoy making these counter wristbands next January; maybe to use as fidget bracelets?  If we create them in school colors I see a class business project in the making!   

 

 

Portable Device for Pouring Liquids--Switch Access

Leave it to our newest OT on staff, Amanda Beason, to create a portable cup pourer for use by several of her students.  It took her all of 30 minutes from dream to finish--way to go, Amanda!

Cup Pouring Device video

Smooth, Cool Water Beads

My morning elementary students had a wide variety of reactions to handling these water beads, mostly positive.  We submerged different objects in the beads---plastic letters, foam letters, connecting toys--and the students had to dig out the correct letter or shape to use in our activities.

One student only dared to reach in with his fingertips; the rest of the students seemed to enjoy exploring the cool, smooth beads.  Of course, several students squished them until they popped and one tried to taste them.  Even though the packaging states that they are non-toxic they can be a choking hazard.


You know your fingers want to dive in.

The foam letters don't soak up the moisture from the beads.



Using a Paper Cup to Clean Shaving Cream & Fingerpaint Off a Table

Quick tip:  Yesterday after an extremely messy shaving cream/fingerpaint activity the preschool teacher first wiped off the tables with a dry paper towel and then inverted a paper cup and scraped it around the table in a circular fashion.  Why?  It loosened the dried mess, which then collected in the cup.  Who knew? 

Weighted Shoulder "Shawl"

One of my teachers for high school students with autism asked me about a weighted shawl for trial by a student in her class.  The purpose is similar to using any other type of weighted item that is worn on the body's core--increased awareness of trunk position in space, the need to actively maintain postural integrity because now you're resisting the downward force from the added weight, similar to the feeling you get when a person is gently pressing you downward through your shoulders.  Many people find the input comforting and settling.

If a student has skeletal concerns or neuromuscular concerns be sure to rule out any possibility that the weight on the neck and shoulders may cause discomfort or injury.   Also, this is not a safe option for students who throw things.

This weighted shawl totals six pounds, which is not much for a tall teen.  However, you do feel it after wearing it for a few minutes.  Twenty minutes on, max, and then it comes off.   We'll have to experiment with the weight and wearing time.  If the student responds well to the input I'll sew up a long, skinny pillowcase to keep it in.  Or, how about two colorful soccer socks that meet in the middle?

Thx to my trusty, SLP buddy, for modeling!

Keeping Santa in Check

Unearthing holidays decorations from this storage spot and that, I discovered that I had purchased two more santa Pez dispensers than I needed.  One was missing the paint on his eyes and that inspired this idea for a method of reining in his scrutiny over our household:

Who knows--this technique might also work for that pesky elf on your shelf???

Personal Space

Yesterday I saw one of my high school teachers for students with autism wearing a lanyard with several communication symbols attached; this one caught my eye:

I need one of these, desperately, to help me with a Kindergarten student who practically climbs in my lap while we're working together.  That's okay for my personal children (when they were much smaller) but not the students I work with.  From time to time I've noticed that the students who consistently enter my personal space sometimes do so to distract me from noticing that they haven't followed through on the direction I just gave them...

Another great communication tool/behavior helper on her lanyard serves to visually remind students to identify and label their level of emotion (5 Point Scale*):

I could use this all day long, with students and to help my colleagues understand what they're dealing with when interacting with me...

*5 Point Scale:  https://www.5pointscale.com/

Looking Up

On the way to the car this frosty morning I was greeted by this display in the sky:

Even though I live close to an airport I really don't think these were contrails left by precision pilots.

What type of clouds are these???

Reduce Time Spent in Documentation

Interested in spending more work hours face-to-face with the kids you serve?  Looking for ways to spend off-work hours face-to-face with family and friends, or at least a good book?  Let's reduce our time spent in documentation.

The trees outside your office window are calling...

 
These suggestions are based on the documentation requirements often encountered by therapists who work in public school systems.  I hope some of these ideas may work for you.

Ways to ↓ Time Used for Documentation:

 

Big Picture Questions:

--Who are the potential readers of your documentation? excluding IEPs

• Eligibility teams (including families)
• Outside professionals working with student
• Peer OTs who may work with student in future years
• You
• Third-party payers (such as Medicaid)

--Who is most likely to intensely examine and utilize the information in your report/therapy notes?

• Eligibility teams
• You

--What documentation is the most critical to making decisions about the student?

• Initial evaluations
• Subsequent evaluations regarding student’s abilities & ongoing need for OT services
• Your treatment notes in your school system's online software program (or paper-based system), regarding student’s progress on goals and/or use of accommodations.

 

To consider:  If eligibility team members and the individual therapy provider are the most frequent users of documentation then the majority of time spent documenting should be spent addressing the information needs of those individuals.   Documentation should focus on 1) informing school teams, including the families, of the student’s status and 2) creating easy-to-use data for decision making by the therapist.  If outside professionals, peer OTs and/or third-party payers require further clarification or data, the therapist can provide it upon request.

- - - -

In light of the above-listed questions and responses, how can OTs ↓ the amount of time they spend in documentation of reports and online treatment notes?

 

Reports:  

• Adopt use of a streamlined, customized report template that reduces verbiage while emphasizing essential components of the report.  
• Decrease subjective input.

 

Online treatment notes:

Focus effort on documenting sessions related to:

• a significant breakthrough, change in student’s independence with a skill
• critical information gained via parent/teacher consults
• EOY summary of progress and plan for treatment focus following summer break [this is not a EOY report but a bridge to facilitate speedy resumption of services in the fall]

 

Reduce length and detail in documenting sessions by:

--Documenting the key facts in the session, without adding extraneous details.

Example--try writing, “Student put arms through both sleeves of compression vest, without protest, with less adult prompting as compared to 11-17-16 session" instead of, “Student arrived in classroom, sat at assigned chair and ate his ‘Power Donut” with glee, getting crumbs all over the table, as usual.  After washing his hands independently he demonstrated good interpersonal skills by carefully hugging his best friend and then ambulated over to the therapist, with both arms raised and both hands still coated with sticky crumbs, to assist with putting on his blue compression vest that was lost for two weeks but finally found under the seat of the bus #151.”

 

Use telegraphic writing--pack as much information as possible in the fewest # of words.  Use abbreviations that are commonly used in medical settings.

The 1o reader of your documentation = you.

 

Finalize your online note immediately after writing it.  It takes five minutes to fix a mistake in day/time/minor detail in a note once you alert the help desk of your online documentation provider, or correct the error in your paper-based system.  How long does it take you to go back to a large number of unsigned notes via your online site, review each note and then finalize them all? 
 

If you are using an online documentation system, batch your progress notes--write at least two at one sitting, preferably more.

 

Since our online documentation system doesn’t always populate the data fields with required information, such as the diagnostic code for students, I keep a reference sheet of students and their diagnostic codes handy while I write notes.

 

If you feel like you are shortchanging your students by writing fewer words or details in a note, compromise.  For a student you see twice a week, spend your usual amount of documentation time writing the first note of the week.  Then, practice a shortened approach to word usage in the second note of the week.  Purposely make the second note more succinct.  It takes awhile to get accustomed to not laying every thought out on the page; discomfort is a sign of adaptation and growth.

 

About IEPs:

Be concise, eliminate subjective information: “Jimmy is a sweet, second grader who always comes to school with a kind word and cookie for his teacher.”

Add information about the student’s independence and areas of need that are focused on school performance--it’s unusual to write in telegraphic style in an IEP but aim for brevity.  Does your input exceed the special education teacher’s input?  If so, it's time to downsize your words.

 

----------

Additional suggestion:

 

At least two of our therapists dictate their treatment notes into their Google calendars, then cut/paste the info into their online documentation.  They love the time they save. 

Wouldn't you rather be outside right now?  It's fall, and Virginia is too beautiful to miss.

 

Erupting Snowballs--I Think It's Time for a Snow Day

One of my middle school teachers who serves students with mild cognitive disabilities shared this enticing, looking-forward-to-snow-days activity with me today:

http://www.growingajeweledrose.com/2013/01/erupting-snow-recipe.html

Thanksgiving Sensory Flip Book

This post

http://lifeovercs.com/my-christmas-five-senses-book-free-printable/

inspired an activity idea.

Tomorrow I get to go on a home visit and work with a student, her mom and teacher and we're making a small flip book related to the sensory experiences associated with Thanksgiving.

• Crunchy corn on the cob (a sticky wall cling and bits of horse corn from my DH's feed bin)
• Pilgrim hat (soft black felt pieces to make the hat, and shiny foil trim)
• Pumpkin pie (clip art and lots of cinnamon), and
• Turkey feathers (colorful, tacky feathers glued on to a little turkey.

The hard-working teacher for students with intellectual disabilities will have gobs of pictures of the items we're using and will have set up the student's school-loaned device to give her lots of opportunities to choose which materials will be used.

The cards that will comprise the book are started, but unfinished so the student can complete the project within a short time frame.

Clip art pumpkin pie slice with cinnamon glued on top.  Student will add cloves to make it smell even better.

Gummy window cling, outlined for better viewing since the paper background is light yellow, like the corn.



Extra fall-themed gummies, just for fun.  I ended up outlining them with a black magic marker, like the ear of corn.

Why so shiny?  Well, the gummies stick very well to the background paper.  And, without the layer of clear plastic film on top, they will stick to their neighbors, too!

 

11-21-2016 Update:  The high schoolers with autism made turkeys with feathers, spicy pie and ears of cornthis morning:

 

 

My SLP buddy and I saw a range of approaches to adding the sensory features to the drawn pictures--ease with touching spices vs. avoidance, interest in sniffing the spices vs. turning their faces away, knowledge of how to untwist the tight glue bottles vs. cluelessness.  What a great activity for speech-language as well as fine motor and sensory opportunities.



Holiday Slime Time

One of my plans this school year is to bring a weekly sensory activity into an elementary class for students with autism.  This slime resource is a treasure for the entire year:

http://littlebinsforlittlehands.com/liquid-starch-slime-easy-sensory-play-recipe/


Alert:  Some (all?) liquid starch may have Borax which should not be consumed.  Read the labels and match your activity to your student with care.

Keep a Little Hawaii in Your Heart

One of my close family members visited Hawaii last month and sent me photos of the view from her almost-private beach accommodations.  Ah......

So, when I came across this activity--a creative twist on the classic clothespins for pinch standby--it made me think of how nice it might be, someday, to visit the same spot as my loved one did.  Ocean Cards for Fine Motor Fun

Oh, I guess you might substitute some other theme in place of the seashells & starfishes, but using tropical critters makes me daydream about happy times that might be in my future.  I guess our students daydream about being super heroes, so go ahead and break out the Spiderman stickers, if you must.

OCD Rituals

After speaking with a middle school special ed teacher this morning I needed to look up information on hoarding and other disorders affecting young kids and teens.  This whole website has such wonderful, practical information:

https://www.anxietybc.com/parenting/tools/changing-or-delaying-ocd-rituals

Refining Grasp and Pinch



Yes, picking ticks helps with refining pinch AND is a functional skill.*

More ideas from our September Fine Motor Share Fair:

 

Refining grasp/pinch:

• Placing stickers on a vertical surface to spell a name
• Using strawberry huller to pick up items
• Paperclip activities
• Placing beads on pipe cleaners (one of our therapists created a spider from pompoms and pipe cleaners, then decorated the "legs" with small beads.
• Using craft stamps
• Placing small items into slit in tennis ball
• Dexterity Junior (iPad app)
• Inserting short straws into spice jar openings
• Pool noodle--cut into 2” thick rings and place in baking pan like cinnamon buns.  Insert pom pom or other small object into holes, then use long tweezers to remove the objects.
• Eraser sandwiches (holiday mini erasers are the bread, poster tack is the filling)

*Just be sure to wear gloves or thoroughly wash your hands afterwards!!!

Back to the Tried and True--Oral Fidgets

Oral fidgets for students in middle and high school are pretty difficult to find, I think.  There is the cool jewelry that is commercially available and that works for many students, and it's wonderful when parents purchase it and send it along to school.  However, not many parents can afford to buy it and it's pretty easy to misplace during the busy school day.

Therapist-made fidgets can be chancy--is it safe for oral use?  Will the student possibly swallow the small parts or little sections that they may bite off the main piece?  Some students chomp down so vigorously on any chewy, even ones purchased from reliable therapy product vendors, that replacements are frequently needed.  It all gets pretty expensive for school budgets, kind-hearted teachers and parents who pay, pay, pay out of pocket to get students what they need.

So, let's try using the tried-and-true clear vinyl tubing to create some disposable, light-use chewies.  It's lead free, all vinyl and each roll only costs about $5.  When cut with a heavy-duty scissors the ends feel smooth and I can use a piece of ribbon or even a short section of tubing to secure it in a bracelet shape.  I have a middle school student who likes to feel crayons, pencils, markers on his lips and just inside his mouth and is very aware of not swallowing non-food items--we'll have a go at it and see if the tubing will satisfy his need for oral fidgets.  Close supervision is a must!

 

Fidgets at the Hardware Store

Who knew?  Walking down the home organization aisle at Lowes my gaze was snagged by these Gear Ties:

I'm wearing one of the 12" black ones right now, as a bracelet, to check it out.  If it's durable it will be a great fidget for one of my middle school students.  It does have a rubber coating so it's out of bounds for my students with latex sensitivities.

Making Applesauce--a Mix of the Olde and the New

Two high school classes for students with autism combined this morning to make applesauce--peeling the apples, coring them, combining sugar and spices and putting them in crockpots for a nice, long soak.  Lots of opportunities to practice:

• Hand washing
• Safe use of sharp equipment (apple peeler, pie-shaped apple slicer)
• Reading directions
• Recalling which step the group is currently on
• Using words and even whole sentences to request what you need
• Using voice output devices to request what you need
• Reading the volume description on the measuring cups and spoons
• Feeling skinny apple peels accumulate on your hand while turning the peeling crank
• Sniffing cinnamon, vanilla, brown sugar while adding the ingredients
• Not touching your face while you're working with food (so hard!)
• Coughing, sneezing away from the prep surface (double so hard!)
• Washing everything afterwards

I had never used a mechanical apple peeler before and it wasn't easy to figure out.  Good thing I had some experienced teachers nearby.

This activity was planned and directed by our school's Transition Coordinator and it was such a pleasure to be able to just be a "helper" and work with many different students--some on my OT caseload and some not.  Boy, did I ever see a lot of fine motor skills, sensory preferences (or not...) and hygiene habits.  Some of the students could probably have jobs in the food service industry one day and some, well, maybe not so much. 

A Little Help With ABC Letter Writing

One of my teachers for high school students with autism, who are not heading for a standard diploma, asked me about on-line aids to help students practice letter formation.  Although several of the students have loaned iPads from special education funds, there is no easy way for teachers to purchase apps for the devices and the county-approved, and funded, apps focus primarily on other areas of academics and communication.

Polling my colleagues in our OT Department, here are some on-line sites that can be used with a touch screen or computer mouse:

abcya.com/letter_trace.htm

doorwayonline.org.uk

http://pbskids.org/writerscontest/create-stories  (you can use the story writing screen to create letters/words for the student to trace in a different color, or type in a word and enlarge it for them to trace with the "pencil" or "marker" tool

 

And, if you are purchasing software for your iPad, here are some recommended apps:

 

Little Writer's App (Alligator apps)

Letter School

Touch and Write

TV teacher--apps for lower case  (if you have extra funds you might want to check out the entire TV teacher series about handwriting; several of our OTs love it)

Write My Name

 

Unfortunately, most of the graphics connected with these on-line sites and apps are pretty juvenile, which doesn't match up well with the age of my high-school students.  However, many of my students love animated movies and cartoons on TV so maybe they won't mind seeing the images as much as I think they might.

 

 

Build a Taco for Better Palmar Arches

Say what?  Yep, that's what our creative OT buddy, Ellen G., told us during our Fine Motor Share Fair last week.

Ellen brought in a completed "taco" and demonstrated how it helps students with developing better arches.  We all believed her.

Here's the link to the fun activity:  Arch Builder Tacos

Will be sharing many of the interesting activities our staff contributed during the Share Fair
in-service--what a great way to get motivated right off the bat this school year!

Jig for Stapling Paper

Has anyone used/created a jig for holding paper steady for stapling?  Here's one I found today that might work for a high school student performing pre-vocational tasks:

Paper Stapling Jig

Time to Re-balance

With the information overload from world events, turmoil surrounding US elections, local happenings and the general disarray of my own thoughts I’m taking a little break from blogging for just a little while.  Talk to you on the other side.

Self Regulation Ideas for High School Students

One of my high school teachers for students with autism had a bunch of new materials in place the very first day of school, to aid students with self regulation, and these caught my eye:

My favorite is "I will take five deep breaths." 

The design is found on this site:  https://www.teacherspayteachers.com/

and sold by this Seller:  https://www.teacherspayteachers.com/Product/Calm-Down-Kit-Visual-Behavioral-Management-Tools-for-Students-with-Autism-667244