Monday, April 27, 2015

A Day in the Life | Pelvic Floor

I am so excited about today's Day in the Life! Lindsey is an OT who specializes in treating pelvic floor disorders. This is such an interesting practice area and I'm so happy that she's here to share what a day in her life looks like!

When in grad school for OT, I remember recognizing a pattern of practice areas that I found the most compelling: psychosocial issues. I gravitated towards these topics whenever we had a guest lecture or read a journal article. And this interest area made sense to me, in fact it’s one of the main reasons I pursed OT over PT. OTs have a fabulous way of looking holistically at dysfunction; we recognize the role that mental health plays on physical injury. In fact, as a profession, we have deep roots in the mental health field. OT had its origin in the 1700's during Europe's "Age of Enlightenment." At this time, radical new ideas were emerging for the mentally ill. During this new era, concern was given to their mental well being. The doctrine of Moral Treatment utilized occupation; goal-directed use of time, interests, energy, and attention; in combination with purposeful daily activity for treatment.

I specifically remember a lightbulb moment for me. The latest copy of OT Practice arrived in the mail and the cover story was “Treating Incontinence and Pelvic Floor Disorders.”  I was sold! Specializing in this practice area had such an opportunity to enhance quality of life by empowering people to continue participating in their daily activities!

I started The Functional Pelvis, a private practice specializing in pelvic floor muscle dysfunction so that I could do just that: empower and enhance quality of life of men and women. 

A day in my life means carefully planning out what areas of Manhattan I am going to be. The reason is this is so important is because I do “house calls.”  I don’t treat in a clinic or busy gym. I find outcomes are greatly enhanced for my clients by treating them where they are the most comfortable. I pick certain days of the week to be at certain neighborhoods. I also spend a certain portion of my week educating both doctors and the community about the role of a pelvic floor therapist. It’s amazing just how little is known about what we actually do and how we can help. We often pick up where other practitioners stop. We see our clients weekly and in my case, for an hour or more. We have the time to talk with them in detail about their habits and behaviors, which plays such a significant role in pelvic health. And certainly a large part of my job is helping them feel comfortable to open up to me about what can be very embarrassing topics. 

What I am referring to are issues of the pelvic area like pelvic pain, pain when you have sex, frequent urges to urinate, incontinence, bladder leakage, and bowel issues.  This is the stuff we used to laugh about as kids, but as we're grown-ups and it's not really so funny anymore. 

I assess my client’s pelvic floor muscles to evaluate for weakness, endurance and range of motion – just like we do for any other part of the body! For manual muscle testing, we use the modified oxford scale.

A big portion of my session is spent in education: ways to take better care of the pelvic floor, discussing the importance of posture, the role of fiber and water on elimination. I find it such a privilege to enable people to talk about topics that can often be challenging to discuss; I enjoy helping them to feel comfortable and at ease. Once they find pelvic rehab, I often hear how comforting is it that someone finally understands the challenges that they have been dealing with for often many years. The topics that I discuss and treat are often overlooked by most practitioners either because they don’t know how to ask the right questions or the patient may be uncomfortable to bring it up. I have heard topics like incontinence described as the “hand on the doorknob” conversation. If a patient actually feels comfortable bringing it up to their gynecologist or general practitioner, it may be as they are leaving. I take great pride in that these same topics are brought up when my patients walk in the door, not when they leave.

About Lindsey:

Lindsey Vestal graduated from NYU with a Masters of Science in Occupational Therapy. She has specialized in functional pelvic health rehabilitation and has worked with a variety of populations and disorders including: Fecal & Urinary Incontinence, Constipation, Dysparunia, Vulvodynia, Prolaspe, Pre- and Post-Partum Women, and Pelvic Pain Patients. She has trained with Herman & Wallace and Maitland on Pelvic Floor therapy as well as specialized biofeedback training for the pelvic floor.

As an OT, she is a passionate promoter of bridging musculoskeletal pelvic floor rehabilitation as well as lifestyle modifications and addressing the physiological impact that pelvic pain and/or incontinence has on the lives of everyday women.

Prior to founding her own practice, Lindsey was an Occupational Therapist at Roosevelt Hospital in Manhattan. Lindsey lives in Manhattan with her husband, 12 year old lab, and two children.

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Thursday, April 23, 2015

A Day in the Life | School-based OT, Part 4

Please welcome Miss Jaime, a pediatric occupational therapist who is sharing a day in her life as a school OT. Jaime has a full day at school, and then she hops in her car and heads to her second job at a clinic. Read on to see what her day is like.

8:00 - Arrive at school. Check my mailbox and email. As the only district employed Occupational Therapist for ten buildings, I am often the go-to person for many of my colleagues. Usually I receive a bunch of emails asking for materials such as weighted vests, sensory diet handouts, or notices of CSE meetings that I need to attend.

9:20 - My first push-in into a self contained kindergarten class. There are six students, a teacher and two assistants. We practice learning the words "horizontal, diagonal, and vertical" by standing up, laying down, and tilting ourselves diagonal. Then we practice writing the diagonal letters of the alphabet. 

10:00 - I have another push-in into a self contained class. This is a 12:1:1 ungraded class of children with Developmental Disabilities (ages 7 to 10). There is a teacher, a teacher's assistant and a one to one aide. We do a yoga session today; focusing on upper extremity and core strengthening.

10:50 - After a quick stop to my room to drop off my yoga mats and CD player, I get to my next push-in. This is another 6:1:1 ungraded class of children with Developmental Disabilities (Ages 5 to 7). There are four students, a teacher, a teacher's assistant and three one to one aides. We make "snow" today by mixing corn starch and shaving cream. Some of the children love it, and some need hand over hand from their aide to stick their hands in it. The teacher's aides work really hard to make sure the impulsive students don't put any of the "snow" in their mouths.

11:30 - One last push-in before lunch. This is 6:1:2 second grade class with four students, a teacher, a teacher's assistant, and two one to one aides. We start off by doing "Head, Shoulders, Knees and Toes". I show the children how to build a person using wiki stix on the table. Then we practice drawing people; making sure to remember all the important parts.

12:15 - Lunch time! I have a full period for lunch but I usually check my email again and do a bit of paperwork before heading to the faculty room. Then I grab my lunch and sit with the rest of the teachers who also have lunch that period. 

1:00 - After lunch I have an individual one to one session with a second grade student who is classified with Autism. She has weak core and upper extremity strength. I put her on her belly over a therapy ball to work on increasing her strength while doing a puzzle. Then we practice shoe-tying. At the end of the session, we walk to the office and she practices making eye contact and socializing with the secretaries as she delivers an envelope for me.  

1:30 - After my individual session, I have another class push-in to a self contained second grade class. I've been working with the children to learn how to write in script using the Handwriting Without Tears program. This class is full of multi-sensory learners, so we practice writing our new group of letters on cookie sheets with ketchup! The kids love anything messy so it's a hit. 

2:00 - Prep period. This is my time to answer more emails and finish writing an evaluation of a student that I tested yesterday. The period goes too quickly!

2:45 - My last student is absent. I go to one of the general education kindergarten rooms because the school psychologist asked me to observe a student who has trouble sitting in his chair. The child seems to have sensory seeking behaviors, so I run to my room to get him a seat cushion and Velcro for under the table. The teacher will keep me posted on how the child responds to these strategies. 

3:15 - It's almost dismissal time. I have some time to put away the ketchup, cookie sheets, and yoga mats. Then I pack up the materials that I will need for tomorrow when I spend the day in another building.

Travel Time! I drive to my second job at a sensory gym, which gives me the opportunity to work with preschool children in individual sessions.

4:30 - My first preschooler is a three and half year old boy who has delayed fine motor skills. We do an obstacle course designed to provide sensory input with crawling, climbing, and hopping. This helps him to focus when we go to the easel to practice tracing and copying shapes. At the end of the session, he practices putting his shoes on by himself. We go to the waiting room where I give Mom some tips to work on hand strengthening at home. 

5:00 - My next preschooler is a four year old girl with sensory processing disorder. She is frightened by too much sensory input and is fearful of having her feet off the ground. I adjust the platform swing so it is only an inch off the ground. We sing her favorite songs as I gently swing her back and forth. After a few minutes she is able to sit crisscross applesauce, with her feet off the ground. We go over to the ball pit. She is willing to go in if there are no other kids in there. Otherwise it is too much!

5:30 - My last session of the day is a five year old boy who will be entering Kindergarten in a few months. He has difficulty with visual memory and visual motor skills. He is an active little boy who doesn't like to sit. He climbs up the rock wall to get bean bags with letters on them. After he crashes down into a pile of cushions, he tells me what the letter is and what sound it makes. I write it and he traces it. Then he writes the letter in sand. Finally, he practices writing with a pencil.
6:00 - End of the day! It's been a busy and productive day. 

About Jaime:

Jaime Spencer is a pediatric Occupational Therapist currently working in Long Island, New York. She has 15 years of experience working in the public school based setting and ten years experience working in a sensory gym. She has a Bachelor's Degree in Occupational Therapy from Utica College and a Master's in Special Education from Adelphi University. She was recently certified in Assistve Technology from the California State University Northridge. Jaime Spencer is also the author of the Occupational Therapy blog

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Wednesday, April 22, 2015

A Day in the Life | School-based OT, Part 3

Today, I'd like to welcome my OT social media idol, Cheryl of OT Notes! If you enjoy reading blogs like mine, then you have Cheryl to thank! As one of the original OT bloggers (in fact, I remember when her blog was the only OT blog I read), Cheryl was a big inspiration to me when I was thinking about starting my own blog, and she continues to inspire me today. I'm so honored to have Cheryl here to share a "typical" day as a school-based therapist.

I work as an occupational therapist in the school system, and literally no day and no week are the same! My days can even be wildly different than that of my coworkers, just by the nature of our caseloads.The educational model is different from the medical model in how and why services are provided. OTs in the school system provide direct services and consultation to help students access their Free and Appropriate Public Education. These services are mandated through the Individuals with Disabilities Education Act for students who go through the IEP process, and through Section 504 of the Americans with Disabilities Act for students who do not qualify for special education. You can check out AOTA’s fact sheet on OT in the school system for more details.

My school district employs about 5 full time OTs and 3 COTAs to cover about 45 schools across our county serving about 20,000 students. I have what I consider a fairly large number of schools and students, but the majority of my students are on consultative services, and I do have assistance from the COTAs at some of my schools to help cover direct services. I do my best to keep my schedule similar from week to week. I’m usually at the same school every Monday, for instance. However, if there are meetings, evaluations, or other reasons that services are missed, the schedule will get reworked. I also try to not make multiple trips per week to my farthest away schools, and instead try to sneak in time to see those students if I have to be out at the site for a meeting.

I have a preference for front-loading my day and my week so I have time for paperwork and catch up as the week goes on. The beginning of the year is absolutely CRAZY trying to find all of my kids and find the best time in their schedule to provide their OT. I try avoid all encore/special classes (art/music/PE/band/library), lunch, recess, core classes, scheduled transition times, and other interventions (speech and sped pullouts). I can’t always do it, but I try!

Monday: I head to a local elementary school. This is a Title I school which serves a lower-income population than some of the other city schools. There are two classrooms for students with autism or developmental delays. I absolutely love the staff here and they are really committed to a lot of positive projects to build their school and community. They also treat me well- I have a mailbox, case managers are quick to inform me when there is a change, teachers frequently fill out screening forms when they have a concern, and everyone is friendly.

8:00 - I meet my COTA buddy in the parking lot and we lug in a variety of tools and activities. We get set up in the case manager office/intervention area. We communicate before the day about which IEP goals we will address in which way. There are a couple of slots of individual kids where the other practitioner will type notes to catch up, screen new students, or observe consult students. We try to plan this out at the beginning of the day. We are trying to do a once monthly push in session to the autism classroom, and we work on ideas for this also.
8:30 - we see a pair of preschoolers with IEPs for speech impairment. They are getting OT as an early intervening service (EIS, also known as Response to Intervention) to address fine motor concerns.
9:00 - we see a kindergarten student working on basic skill acquisition as part of his IEP. Sometimes we will pull a peer from a first grade class for EIS at this time as well.
9:30 - The case manager runs a reading intervention group and we write some notes.
10:30 - The COTA sees a life skills student who is working on basic prewriting and self-help skills. This is also the time we will do a once monthly push in group in the autism classroom. Most recently, we did a Dr. Seuss theme where we made puppets and oobleck. We used the oobleck to trace letters and shapes, and the puppets to promote social interaction.
11:00 - We see a pair of second graders who have made great progress. Both have attention difficulties and one has an orthopedic impairment. These kids always make us smile, so we end the morning on a high note.
11:30 - we take a lunch either with the case managers in their room or in the staff lounge with the first and second grade teachers. Occasionally someone will ask a question about a kid but usually it’s pretty relaxed.
12:00 - after lunch, we move our materials to another room so that we can continue to have a space and not interrupt other services. This is better for seeing individual students with autism who need additional structure of the smaller room.
12:30 - I see a student with autism with a lot of supports in place. We use a visual schedule, tangible rewards, and multisensory activities to try to get his best participation. The COTA and sometimes the speech therapist will join me for sessions on occasion to help facilitate the readiness skills we are addressing.
1:00 - I’ve just started seeing an older student who was referred for EIS. We are working on perceptual skills and improving handwriting spacing and sizing.
1:30 - The COTA sees another student from the autism classroom. She has made great strides in readiness skills since the beginning of the year and responds really well to the COTA’s ebullient personality.
2:00 - We finish with our final pairing of IEP students. Both have an orthopedic impairment and so we have a more intense focus on hand skills- opening containers, completing multi-step activities, and becoming speedier with classroom tasks.
2:30 - I spend this time catching up on documentation for the day. I fill in the times or absences on my lesson plan sheets for each student. I write notes for the individual sessions. If I have time or pressing deadlines, I may work on upcoming IEPs or writing reports.
3:30 - done for the day! I pack up my car and go get my son from daycare. Unlike jobs I’ve had before, I don’t ever worry about email or notes at home.

About Cheryl:
I got my Master in Occupational Therapy degree from West Virginia University in 2007 and have been writing the OTNotes blog since 2008. I have literally worked with clients across the lifespan- Day 1 to 100+ years and love the flexibility of OT. I’m loving the speed and stability of a full time school system job in Maryland. I have presented at 2 state conferences and twice at AOTA conferences on online and social media tools related to OT as well as other topics. I will be hosting #otalk2us this fall on school system issues.

IMG_8382-8.jpgConnect with Cheryl:
Blog: OT Notes
Twitter: @otnotes
OT Connections:

Tuesday, April 21, 2015

A Day in the Life | School-based OT, Part 2

It's day two of getting a peak into the life of a school-based occupational therapist! Today, please welcome Heather Brohm! Heather's caseload is unique in that she works with students of all ages, ranging from kindergarten through high school. Read on to see what a typical day is like for Heather!

I am an occupational therapist, working in the public school setting. In public schools, occupational therapy is provided to children who are benefiting from IEPs, or Individualized Education Plans, or, in some instances, 504 Agreements, which refer to the Americans with Disabilities Act. OT falls under the category “Related Services” and, along with physical therapy, speech and language therapy, visual or hearing therapies, is focused on increasing independence and participation in the child’s role as a student. However, the students are not my only client in the schools. I work with adults in the schools as well, including paraprofessionals, nursing staff, other therapists, and teachers, including regular, special education, and special subjects (art, music, etc). 

My days are busy and long! I work with both secondary students – grades 9 to post-graduate, and elementary – Kindergarten to 5th. I can see both 5 year olds and 21 year olds in the same morning. In both of my schools, I see students in the Life Skills classroom, a self-contained room for children who have moderate to severe disabilities. I also see students who benefit from Learning Support, who need less intensive supports and may be included in regular education for all or part of the day. A typical day for me looks something like this:

7:30 – A whole class group with a Life Skills classroom at the secondary level. We do yoga together 1-2 times a month. I have observed benefits in self-care skills – donning and doffing shoes, vocational skills – wiping down mats, moving furniture, relaxation and self regulation, following directions, as well as the opportunities to stretch and move functionally.
8:00 – Pack up my stuff and move on to the elementary school, as I have an IEP meeting at 8:20. The student’s mother is attendance, as well as the special education and regular education teachers, principal, and speech and language therapist. We review the student’s progress made since the previous meeting, and discuss any concerns, changes in programming/placement, and new goals.
9:00 – An individual session with an older elementary student. We practice a strategy to support self-regulation and self- control, and trial a new, simplified method for recording homework assignments, to increase his self-efficacy and independence.
9:30 – Another older elementary student, this time working on keyboarding and improving his knowledge of basic computer skills.
10:00 – A group of younger elementary students – working on bilateral coordination, visual perception, and visual motor coordination. Today we practice tying shoe laces – what a way to address all 3!
10:30 – A pair of older students from the Life Skills classroom. They are making great progress in OT this year, improving self care skills to button small buttons independently.
11:00 – A younger student from the same classroom. He attends with his 1:1 aide, and we work on his emerging skills – zipping a jacket, writing his name, with lots of positive reinforcement and yoga poses in between.
11:30 – Kindergartner this time – addressing motor planning and bilateral coordination difficulties that impact his independence opening lunch containers.
12:00 – Making sure that I am incorporating suggestions from the vision therapist when designing this second grader’s therapy activities.
12:30 – I grab a quick snack while I finally jump on email. I may have invitations for IEP meetings, notifications of evaluations/permissions returned, questions from parents or teachers, or all of the above.
1:00 – I pop into another student’s speech and language session to check in. She uses AAC (Augmentative and Alternative Communication) and I use this opportunity to consult with her support staff and problem solve as necessary.
1:15 – I run down the hall to consult and check in on other students in Learning Support classrooms.
1:30 – I pick up another student from the Life Skills classroom – beginning our session with sensory input, moving on to practicing clothing fasteners and prewriting practice.
2:00 – Another short break – this time I’m writing my weekly notes home for the children in the self-contained classroom.
2:30 – Another pair of students and a classroom aide from Life Skills for yoga poses and finger plays!
3:00 – Last kiddo of the day, and we are working on a “How to Draw” activity of a popular cartoon to support motor planning, and fine and visual motor skills.
3:30 – I don’t have another IEP this afternoon, so I pack up and wipe down the table and mats. Some weeks I check in with the teachers I work with to see if there is anything they need or if there are successes to share.

It’s a long day, but full of little accomplishments and successes. I usually spend time each night, or on a lighter day, writing notes, IEPs, progress reports, and evaluations. I really enjoy being able to see my students take pride in their work and gain confidence, and working with such a wide range of students, in both ages and abilities, helps keep me on my toes and the big picture in mind. I love OT because it lets me be creative and a problem solver.

About Heather:
Heather Brohm, OTR/L, has been an occupational therapist for 6 year, working in the school setting with children from ages 4 to 21. She creates products for school OTs in her Teachers Pay Teachers store, The Organizing OT. Heather is interested in furthering the occupational therapy profession through a strong evidence base, and is the founder of, a website designed just for occupational therapists. A Valid Occupation is a database of OT resources and references, enhanced with a professional social network of therapists from around the world.

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