Oobleck Recipe

Here's a fun sensory filled way to celebrate Dr. Seuss' birthday on March 2nd. Read Bartholomew and the Oobleck and then create some oobleck of your own!

What you'll need:

• water
• cornstarch
• food coloring (optional)

Oobleck Recipe:
Mix 1 part water with 1.5 to 2 parts cornstarch. Add a few drops of food coloring if you want to make it colored. Stir and stir some more! You will need to stir for about 10 minutes to create oobleck, a weird semi-solid mixture. 


Enjoy!

We used the paintbrush to stir the mixture. For the kids who weren't quite ready to touch the oobleck with their hands, they could participate by stirring or just using the paintbrush to touch the oobleck.

How will the new definition of autism affect occupational therapy?

With the proposed changes to the DSM-IV, I think that this is a question many occupational therapists are asking right now.

AOTA's staff writer, Stephanie Yamkovenko, has written an article, How Will the New Definition of Autism Spectrum Disorder Affect Occupational Therapy?

I don't think anyone can say for sure what the implications will be, but do check out the article for a good overview of how the changes may affect occupational therapy services. 

Loving the Bumble Ball, Junior!

I have a few kiddos on my caseload right now with hemiplegia that are so good at accommodating and doing things with their less affected hand, that it is a challenge to get them to use both hands!

Blocks are not exciting enough, wind-up toys can be too difficult, but the Bumble Ball, Junior is just right! Holding the ball in one hand and pulling the string with the other provides just the right amount challenge. And they love the vibration of the ball, which motivates them to pull the string over and over again, strengthening the more affected arm!

Friday Features

After enjoying a long weekend visiting with family last week, Friday Features are back!

~I know I've mentioned before how much I enjoy the blog, Love That Max. This week Ellen asked pediatric therapists how to get the maximum benefits out of therapy. You can read the tips here. 

~To get your weekend started, check out "Slipping off the fast track to kindergarten", a lighthearted and quick read about kindergarten prep and the role of pediatric occupational therapy.

Handwriting Without Tears Letter Card Adaptation

I feel like I'm on a Handwriting Without Tears kick this week! Today I'd like to share with you how I adapted the Handwriting Without Tears letter cards to help one of my preschool students. 

Due to his limited motor control, when he tried to trace the letter L, it kept looking like this. More of a random line from the beginning to the end, rather than an L.

So I added a few Wikki Stix to the edge of the L. This created a physical boundary, as well as a high contrast visual boundary.

Now he can trace the L more successfully!

Mat Man

I absolutely love the Handwriting Without Tears curriculum! Handwriting Without Tears has so much to offer outside of basic handwriting, including Mat Man to work on body awareness. If you are not familiar with Mat Man, you can visit Mat Man World on the Handwriting Without Tears website or check out the video below. Basically, Mat Man is created using the Handwriting Without Tears mat, wooden pieces, and a few other extras. Mat Man also has a fun song to go along with building Mat Man that kids love.

Here's a picture of Mat Man that some students helped me make:

And here are a few before and after pictures. I asked my students to draw a picture of me prior to building Mat Man. After we built Mat Man, I had them draw a picture of me again.

This student was on the right track until he decided I turned into a drooling zombie (the line down the middle is my drool), with LOTS of legs!

This student still has some areas to work on, but I was happy to see that the after picture has ears and a face, and at least somewhat resembles a person.

Here's a video from Handwriting Without Tears about building Mat Man.

In my therapy bag...a safety pin

As promised yesterday, here is a simple way to promote the use of the more affected arm in a child with hemiplegia. I simply used a safety pin to hold the unaffected arm close to the body. (Caution! This should only be done under CLOSE supervision, as it WILL affect the child's ability to maintain balance! Also, this should only be done for short periods of time, as it does inhibit the use of the unaffected arm, thereby limiting the child's ability to complete tasks that require the use of both arms.)

With that said, it can be a great way to work on grasping items and playing with toys using the affected arm!

What are your favorite ways to promote the use of the affected arm in children with hemiplegia?

Pediatric Constraint Induced Movement Therapy

What is Pediatric Constraint Induced Movement Therapy?
Pediatric constraint induced movement therapy (also known as CIMT) is a form of therapy that encourages children with hemiplegia to use their affected arm by physically constraining the less affected arm. CIMT is offered by many children's hospitals across the country. These programs are intensive and follow a rigorous protocol.

How does CIMT work?
CIMT programs typically involve casting the child's unaffected arm anywhere from 2 hours per day to 24 hours per day for 4-8 weeks. During that time, the child also receives intensive occupational therapy, sometimes up to 6 hours per day!

What are the benefits?

• Improved use of the child's affected arm
• Improved fine motor skills
• Improved spontaneous use of the child's affected arm
• Improved bilateral coordination (using both arms together)

Is there research to support the use of CIMT?
In general, research on the use of CIMT is limited, but growing. The research that has been conducted generally reports positive outcomes.
A quick literature review of the American Journal of Occupational Therapy revealed the following studies, all of which report positive outcomes:

• Case-Smith, J., DeLuca., S. C., Stevenson, R., & Ramey, S. L. (2012). Multicenter randomized controlled trial of pediatric constraint-induced movement therapy: 6-month follow-up. American Journal of Occupational Therapy, 66, 15–23.
• Cope, S. M., Forst, H. C., Bibis, D., & Liu, X.-C. (2008). Modified constraint-induced movement therapy for a 12-month-old child with hemiplegia: A case report. American Journal of Occupational Therapy, 62, 430–437.
• Dickerson, A. E., & Brown, L. E. (2007). Pediatric constraint-induced movement therapy in a young child with minimal active arm movement. American Journal of Occupational Therapy, 61, 563–573.
• Martin, A., Burtner, P. A., Poole, J., & Phillips, J. (2008). Case report: ICF-level changes in a preschooler after constraint induced movement therapy. American Journal of Occupational Therapy, 62, 282–288.

In addition, The CanChild Centre for Childhood Disability Research has written An Update on Constraint Therapy in Children with Hemiplegia. The research in this article is a little outdated, as it has not been updated since 2006. However, it does give a good overview of CIMT, as well as a review of the research completed prior to 2006.

Where can I learn more?
The update written by the CanChild Centre referred to above, provides an excellent overview of CIMT, as well as a review of the research.

Parents, if you think your child could benefit from constraint induced movement therapy, ask your pediatrician, your child's physical or occupational therapist, or check with your local children's hospital to see if they offer a program.

Therapists, Cincinnati Children's Hospital has created an Evidence-Based Care Guideline for Pediatric Constraint Induced Movement Therapy. To download the guidelines, visit their website by clicking here. Scroll to the bottom of the page and click on Constraint-Induced Movement Therapy under the Occupational Therapy and Physical Therapy section.


Check back tomorrow to learn about technique that I use to promote the use of a child's affected arm.

Let your voice be heard!

The 2012 AOTA Elections are now open for voting! AOTA members, be sure to vote before it closes on February 28th!


The 2012 election includes general elections for the following positions:

• President-Elect
• Vice President
• Director to the Board of Directors
• Commission on Education (COE) Chairperson-Elect
• Ethics Committee (EC) Chairperson-Elect

There are also elections for Chairperson of four of the Special Interest Sections:

• Administration & Management
• Early Intervention & School
• Home & Community Health
• Mental Health 

AOTA student members can also vote in the Assembly of Student Delegates election for the following positions:

• Chairperson
• OT Vice-Chairperson
• OTA Vice-Chaiperson
• Secretary
• Communication and Advocacy Chairperson
• Student Representative to Commission on Education
• Student Representative to the Representative Assembly

Click here to read the candidates' biographies and position statements. You MUST be an AOTA member to vote.

Friday Features

~New blog alert! Thank you to Dr. Anne Zachry for bringing Embrace Your Chaos to my attention. Written by a pediatric occupational therapist and mother of a one year old, Embrace Your Chaos provides practical tips and fun activities to develop sensory motor skills in children. (If you are not already a follower, be sure to check out Dr. Zachry's blog too for great OT ideas!) 

~Ruth Morgan, of Chapel Hill Snippets, contributed a great post to PediaStaff titled Danger of Becoming Desensitized on the Job. I think all school-based therapists can relate to this post and it serves as a friendly reminder for us to remain positive on the job! 

~In honor of Valentine's Day next week, and in case you missed it during the holiday rush, the New York Times published an article, Navigating Love and Autism, in December. Kirsten and Jack, the couple with Asperger's featured in the New York Times article, were also recently interviewed on an NPR Talk of the Nation show, Learning to Love, And Be Loved, With Autism. The story included a call in from an OT who leads a social skills groups for students with autism.

How to make an adapted crayon

I was working with a preschooler and he noticed this pencil in my (over-flowing) pencil box and wanted to try it out.

This student has cerebral palsy and since his grasp on a regular crayon is one of those grasps best described as "funky" (see below), this Y-shaped pencil worked fairly well for him.

There were a few problems with the pencil: 1) it was too big for his hand and 2) a crayon would be a more appropriate than a pencil for a 4 year old. I couldn't find any crayons for purchase that are similar to the Y-shaped pencil, so I decided to create my own.

I want to preface this how-to with the disclaimer that I don't typically use any sort of adaptations or pencil grips for children this young. I prefer to give preschoolers very short crayons and develop their fine motor skills, rather than provide adaptations. With that said, each child is unique, and that's why I adapted this crayon for this particular child.

I used Crayola Air-Dry Clay to form the base of the crayon.

I then placed half of a crayon in the tip of the clay to create this crayon (the air-dry clay takes 1-2 days to dry).

He loves his new crayon! This is a work in progress, so I'm still trying to figure out an easy way to swap out the crayon, so he can color with more than one color :) Any suggestions?

It's tax time again...

Want to find out if that iPad you bought to use in therapy is tax deductible?

AOTA has written an article, Top 10 Tax Tips for Occupational Therapy Practitioners. The full text of this article is available on the AOTA website to AOTA members only. (If you're not an AOTA member, your membership fee is tax deductible :) Yet another reason to be an AOTA member...hint, hint).

As an independent contractor, I thought I had already learned all of the inns and outs of tax deductions, but I did learn a few new tips that I was not aware of, like health insurance is only deductible if you're not eligible for insurance coverage, such as through your spouse's job. It's definitely worth taking a look at, whether you are an independent contractor or employee.

As for the iPad, it is tax deductible if you use it for therapy, but if you also use it for personal use, you can't deduct the full price. Refer to the article for a better explanation.

Handprint Valentine's Day Card

I can't believe it's February already! This Valentine's Day card is courtesy of my nephew. It looks like he dipped the sides of his little fingers in red paint and then pressed them into a heart shape. Cute idea for Valentine's Day!

Friday Features

~Be sure to check out this post by Starfish Therapies on how to make a DIY weighted lap bag. The use of a dog toy is such a fun idea and I can't wait to try it out myself!

~AOTA's next pediatric virtual chat is on Response to Intervention and will take place on February 13 at 11:00 EST. These chats always provide good information on timely topics. Click here to sign up and click here to check out previous pediatric virtual chats.

~ The Atlantic had an interesting article on the dangers of car seats. They are not dangerous when used in cars, but can be harmful and affect development when used at other times. As an occupational therapist, I always discourage parents from using a car seat as a chair. It's always best to let your little one try to move around on the floor, with supervision, of course.

~The article above led me to a blog on the New York Times website about the dangers of baby walkers. This article discusses the motor and cognitive impairments that can arise from the use of a baby walker. A good read on why the use of baby walkers is not always the best idea for your little one.

Introvert or Asperger Syndrome?

Today I read Benjamin Nugent's wonderful op-ed in the New York Times, I Had Asperger Syndrome. Briefly. His experience gave a voice to my lingering suspicions about incorrectly diagnosing awkward, introverted, smart teens with Asperger's. Being a quirky teen with "poor" social skills doesn't necessarily equal autism. 

Some food for thought from Mr. Nugent's piece:

• "You can be highly perceptive with regard to social interaction, as a child or adolescent, and still be a spectacular social failure. This is particularly true if you’re bad at sports or nervous or weird-looking."
• "I wonder: If I had been born five years later and given the diagnosis at the more impressionable age of 12, what would have happened? I might never have tried to write about social interaction, having been told that I was hard-wired to find social interaction baffling." 
• "...my experience can’t be unique. Under the rules in place today, any nerd, any withdrawn, bookish kid, can have Asperger syndrome." 

With the upcoming changes to the DSM, everyone seems to have an opinion on how the new changes will affect the number of children diagnosed with autism.

What seems to be most concerning to people is that under the new criteria, those currently labeled "high functioning" or with "Asperger's" will no longer meet the criteria.

My first thought when I heard this concern voiced was that maybe it isn't a bad thing. Maybe introverts are being diagnosed as having Asperger's. I'll admit, I haven't been following the discussion very closely, so I've been keeping my opinions to myself and I might be missing something completely. In fact, please let me know if you think I'm missing something major in this discussion.

So I'm finally weighing in with my opinion:
Yes, I think children with autism, even those with high functioning autism, need access to the necessary therapy and supports to reach their full potential.
No, I don't necessarily think the narrower criteria for autism is a bad thing. Let's not inhibit the abilities of kids by handing out unnecessary labels.


What are your thoughts on the upcoming changes to the DSM?

Parent and Teacher Friendly Resources on Sensory Integration

I am always on the lookout for resources about sensory processing that are written in parent (and teacher) friendly language. While at the Autism West Specialty Conference in December, I found what I was looking for!

Pediatric Therapy Network has created four great booklets that explain sensory integration in easy to understand language. The booklets are Sensory Integration: Answers for Parents, Sensory Integration: Answers for Teachers, Sensory Integration: Answers for Mealtime Success, and Sensory Integration: Answers About Autism.

Some of the highlights:

• Answers for Teachers contains a checklist based on teacher observations to help identify students who may be having difficulty processing sensory information.
• Answers for Teachers also contains a page of Tips for Teachers, with suggested activities for the teacher to try based on the student's behavior.
• Answers for Mealtime Success contains a page of suggested sensory activities for parents to try to assist with mealtimes.

At on $4.95 each, I couldn't pass them up! If you would like one for yourself, they can be purchased directly from Pediatric Therapy Network.

What are your favorite parent friendly resources on sensory integration?