Orientation: Finding your Peeps

One of the most important things I have ever done was to find MY PEOPLE.  You know, the ones who get me.  The way I sing everything, all of the time, much to their chagrin.  My introverted nature.  My longshoreman mouth.  My sarcastic humor.  Because these people have been my rock of stability during the storms that happen during the school year.

So how does one locate a peep?
1.  Put on a "Hi My Name Is" and replace your name with Inigo Montoyo or Slim Shady
2.  Look for people who get the joke.
3.  Smile, because they are probably your peep

Ok, Ok.  This may not work in all situations and with all types of personalities.  But finding common ground with at least one person in your work environment during orientation can help set the mood for the year.  I personally am not an icebreaker person but the concept makes sense; force the group to split and speak to one another outside the normal clique.  Forced connections.  Meh.  I like to connect organically when I have the time and energy to pop into rooms and speak in a less chaotic environment.  Or maybe for the first few weeks, try to eat lunch in the staff lounge.

Often, I find that therapeeps (OT, PT, and Speech) will sit together because we typically understand each other's backgrounds.  We are healthcare providers who happen to be in the education setting.  We are using our super powers to help children access their school lives.  But that doesn't mean we cannot look beyond our scope of practice for connection.

Branch out.  Find a teacher of visual impairment, or teacher for the deaf and hard of hearing, or social worker, or special educator, or regular educator, or secretary, or teaching assistant, or nursing assistant.   In fact, FIND ALL OF THESE PEOPLE because you will need their expertise to get through your school year.  There will be questions, and these people may have the answer.  It is vital to daily survival to identify with whom you can connect and consult.

Will they necessarily be the people to which I vent and shed a tear? Probably not.  That is only reserved for the sacred circle of peeps.   But these individuals will collectively help you navigate the school year.  And maybe, just maybe you'll find a peep or two that make going to work a little more sugar-coated.

The Grind: EBP Systematic Review of the strength of sensory techniques and modifications

In my day to day practice, I am constantly integrating sensory-based interventions.  Many of the students with whom I directly work are preschoolers on the autism spectrum.  I am lucky enough to have an actual treatment room with a ball pit, a doorway platform swing (linear only), a trampoline, tunnels, stairs, balance beams, and a steamroller.  I even purchased light covers to soften fluorescent lighting.  And I use the heck out of this space.  I love watching my students' motor planning evolve so that they freely move and engage through the obstacle courses, vocalize, socialize, and participate in later tasks.  My practiced-based evidence, the results of my sessions and its impact on my students' functioning, supported the continued use of these sensory-based techniques.  But I wanted to know more: What does the research say?

Back to the Grind

Well, Bodison and Parham (2018) published a systematic review that reviewed over 11,000 studies from 2007 to 2015.  Only 8 (out of 11,000!!!!!!!!!) met the inclusion criteria of studies that were peer reviewed, in English, had pre and post-testing related to sensory functioning, and the outcome measures of the impact of sensory techniques and environmental modification on a child's function and participation in daily activities, not just physiological changes noted in a lab.  The included studies focused on the following intervention:

• Qigong Massage
• Weighted Vests
• Slow Linear Swinging
• Sensory Enriched Preschool
• Sensory Environment Modifications

Nitty Gritty

• Qigong Massage has been effective in infant and preschool-aged development and behavior, ***when the occupational therapist has extensive training
• There is limited evidence for use weighted vests with kiddos ADHD; using weighted vests for children with ASD was not recommended due to the lack of evidence
• Slow linear swinging may or may not improve on-task behaviors for children on the spectrum; it is dependent on arousal level
• There is insufficient evidence that embedding sensory rich activities into the preschool classroom improves development over a typical preschool setting
• Other techniques like Wilbarger Brushing Protocols, therapy ball, sensory diets, and sensory listening systems were excluded because the quality of the studies out there were low on the evidence totem pole
• Reducing lighting and sound, paired with a weighted blanket helped children participate in dental cleanings

What do the findings mean to me?

• If I were an early intervention or hospital based therapist, I would consider going for training in Qigong Massage.  But it would be at least 50 hours of training, which is a huge commitment.
• Weighted vests.  How many of us have weighted vests in our closets? Evidence is limited.  Though it is in my tool box, I would try other interventions first before implementing one of these.
• Linear swinging.  Know the reason for using the swing before using. Is it for play and language, reward, balance and strength, or regulation?
• Preschool.  Definitely need more thought and research here.  I have seen a lot, working public preschool for nearly 12 years. Each teacher sets up his or her room differently.  They use different materials, different approaches.  The children, usually between 3-5 years old, are mixed in skill and developmental level.  Collaboration levels and comfort with service providers are all cogs in the multifaceted machine of the the day.  I work with the kids in and out of the classroom to see what may work and how it could be incorporated into the daily routine with the goal that the child can learn to self regulate in his or her natural environment.  And with the push for push-in services, consultation, and modifications, more experience and studies are needed to figure out what is best practice.
• Read up on the other techniques before using them!
• Yes, more research is needed to generalize to a classroom, but it is worth educating teachers and staff to environmental modifications that can help students with ASD.

During my EBP courses I had coincidentally gone through quite a few, if not most of the studies highlighted by Bodison and Parham.  For me, I will continue to use sensory-based interventions as part of treatment for children with sensory dysfunction, but I plan on making more of an effort of keeping better data to see if my practice-based evidence is improving function and on-task behaviors.  

Bodison, S. C. & Parham, L. D. (2018). Specific sensory techniques and sensory environmental modification for children and your thaw sensory integration difficulties. A systematic review. American Journal of Occupational Therapy, 72, 7201190040. https://doi.org/10.5014/ajot.2018.029413

Michael Myers in a Mat Man shirt, holding a box of crayons

It’s coming.  The end of summer.  The end of lazidacial mornings of drinking coffee on the porch in my pajamas with the dog at my feet.  Orientation is around the corner.

Whether you are entering the school doors for the first time or the 12th time, first day anxiety is creeping its way into your head like a bad 80s horror character.  

I like to picture my first day anxiety anthropomorphically, like Michael Myers with a Mat Man shirt on holding a box of crayons.  Chi chi chi, wah wah wah. He sits on my shoulder, like DeadPool on the overpass, coloring an IEP calendar. I ask, he answers.

Wonder what the caseload is going to be like this year?

Comparable to planning a trip to the hairy edge of Saturn

From under what hellish mountain of paperwork will I be shoveling this year?

Somewhere in height between K-2 and Everest

How will I get everything done?

By medicating

How many times will my schedule change? 

If a train is traveling at 80 mph and 30 people are walking in the opposite direction, how many cats would it take to fill the Lake Eerie?

Do I need a swear jar at work? 

Probably

When will I have lunch?

Whenever you damn well please, as long as you can eat it under 3.2 seconds

Don’t get me wrong. I love what I do.  I love my students. I love my co-workers.  But I still struggle with making each year manageable.  So now that I have completed my masters, I want to get back to writing.  It helps me process the day to day quirkiness that is school-based therapy.  

The work-wife (I’ll get into that in a later post) and I thought we would do a podcast about topics, trials, and tribulation of how to survive school-based service provision.  But for now, I think I will start here. Any maybe, just maybe you will come for the ride. Check out the scenery, share your experiences, or just nod your head in solidarity.

September SpOT Light Series: Handwriting with Katherine

Handwriting With Katherine is where you can find all things related to handwriting from Occupational Therapist Katherine Collmer's point of view.  With 17 years of therapeutic experience ranging from psychiatric, neurologic, geriatrics and of course pediatrics, it is her expertise in Assessment and Remediation of Children’s Handwriting Development Skills that she shares with parents and therapists alike.

"I have been interested in writing since I was a teenager.  I still have the short stories that I scribed way back then.  Blogging, however, wasn’t even in my vision back in 2009 when this type of writing found a place in my life.  I was getting restless during a transition in my pediatrics career and a friend of mine suggested that with my interest in writing I should look into blogging.  She suggested that I contact the Advance Magazine online blog editor…and that’s where it all began!"

Katherine integrates research-based evidence into many of her posts, making them both useful and insightful.  For example, in a recent post titled Handwriting and Learning: A Vital Link to Skilled Writing, she reflects "Learning through the use of our hands continues to be a vital link for educational success throughout life, with handwriting playing a major role;" all the while, she incorporated ten references to support the idea.

Katherine is also a strong advocate for identifying visual deficits issues early since it is such a crucial element of handwriting.

"Sitting Posture Can Indicate Vision Concerns"

 "Every time I connect a child’s parents with a developmental optometrist and they uncover a hidden visual skill deficit, I consider that a memorable therapeutic moment.  However, my most memorable is the little boy who put on glasses for the first time at the age of 5 and said, “Hey, mommy, look at those pictures on the wall!”  His mommy cried because he’d walked down that hospital hallway many, many times in his young life and had never even seen them before.  Priceless."

Now into her sixth year of publishing, Handwriting With Katherine continues to provide teachers, parents and therapists with easy to use tips, from Pre K to Older Students.  Hop on over now to Handwriting with Katherine to discover what the three handwriting performance areas that simply need to be taught and reinforced right from the start.  And if you want to discover more about Katherine, just “Send me a note!”.   You can also check out her newest adventure Go-To-For-OT on which she pairs up with #therabloggers Stacy Turke, Marie Toole, and Molly Shannon as they share insights on pediatric development and the most frequently asked questions from parents and teachers.

           

September SpOT Light Series: The Pocket OT

I'm sure when Occupational Therapist Cara Koscinski began practicing over 18 years ago,  she did not think she would be a successful mom-trepreneur, public speaker, blogger, and the 2015 Parent's Choice Award winner.  But then of course, who would?

Cara's experience runs the gamut, from heart/lung transplant hospital to rehab and hand therapy as well as pediatrics.   But it is her personal experiences raising her two children with special needs that inspires much of her work.  

"They attended hundreds of hours of therapy.  I felt as though I was on a ‘Level 3’ Fieldwork as I watched and learned from some amazing OTs!  I took the good and left the bad to begin my own pediatric private practice.  I specialize in autism, posture, and SPD.  It’s the best when I go to a training that benefits my own sons and my clients!  I’d go to EVERY training out there if I could afford to."

Searching for connections with therapists and other parents dealing with similar issues, Cara began The Pocket OT in 2005.  Originally it was entitled Route2Greatness because her son was fascinated by roads; he could name them all.  But as her blog evolved into what it is today, she changed the name to The Pocket OT to better suit Cara's quick-reference intentions.  

One of her favorite posts hits close to home.  7 Tips for Fear of Loud Noises  highlights the need for patience when working on desensitization.  "So many children are fearful of loud and un-expected noises at school. My own son could not complete his classroom work for weeks after the school year began as he was afraid that the fire alarm would sound.  My sister’s a music therapist and together, we invented a way to help him."  Sound-Eaze and School-Eaze are available for download from her site as well as sold in special needs catalogues.

Now writing content for 10 years, Cara has also expanded her passion for sharing information into two books, “The Pocket Occupational Therapist” and “The Special Needs SCHOOL Survival Guide," both of which were Family Choice Awards winners  She also has two new books coming this fall:  the first is ‘The Weighted Blanket Sensation” and the other is a children’s book called, “Joshua’s Mighty Mitochondrial Disease."

When asked about a memorable therapeutic moment, Cara shared about how goofiness helped to finally break the ice with a teenage client who hated going to OT.   "He spent seven sessions sitting in my clinic- refusing to speak to me……One session, I went through his entire home exercise program making up silly words; we both started laughing.  After he decided I wasn’t so bad, he ended up meeting ALL of his goals!  I hope he’s doing well!"

Not only can you find her working, writing, managing social media and email (ThePocketOT@gmail.com), posting products on Teachers Pay Teachers, this month you can see her in person. Cara will be speaking after Temple Grandin at the Future Horizons Dallas Autism Super Conference this month. Luckily for followers, The Pocket OT is pocket-full of energy, insight and inspiration. 

September SpOT Light Series: Can Do Kiddo

Today, the SpOT Light shines on an OT committed to capability.

When she became a mother a year ago, Rachel Coley, an Occupational Therapist of now 9 years, noticed people were looking to her for advice.  "I was asked repeatedly to write a book, start a blog, and create a product or business to help parents."  So as an homage for when she was able to ease parents' anxiety about what their child could not do, but focus on the joy of what they CAN, Can Do Kiddo was born.

With her background in infant and toddler development, and having an infant to boot,  Rachel couldn't help but write about things she was doing with her own child.   Her top tip? Less baby gear, more floortime play!  On her page, What Every Parent Should Know, Rachel links to a variety of posts on letting infants explore outside of the baby gear.  

"As a pediatric Occupational Therapist, I see and treat many issues in older babies, toddlers and children that likely started in early infancy - head shape problems, poor upper body and core strength, sensory processing challenges, and more."  

She also has published Begin with A Blanket, a compilation of 45 tips for infant play and development.  Rachel provides her experience and insight with products that she has found useful, therapeutic and developmentally appropriate. 

Visuals are a big part of Rachel's posts.  They help her describe positioning strategies.  She often used her own child as a model.  But as her child grew, she still needed a model for demonstrating poses and techniques.  So...... she used a stand in.   "I have a VERY realistic baby doll that I use for blog photos from time to time when I need a newborn photo. Luckily baby #2 is due in November so I’ll have a new model!"

So keep on the lookout for Rachel's newest addition in upcoming posts when you visit Can Do Kiddo.  Or contact her directly at rachel@candokiddo.com. 

September SpOT Light Series: The Inspired Treehouse

Today, let's climb up the pediatric therapy 'Giving Tree' as I shine the SpOTLight on: The Inspired Treehouse.

When Claire Heffron, Lauren Drobnjak and Pam Braley began The Inspired Treehouse, it was for out of a love of sharing.  

"The Inspired Treehouse as a way to share information about child development and activities to help promote healthy development in kids.  We all had files full of activity ideas that we used in therapy, but unless they were being used at school, they were just gathering dust in our basements!  We knew that blogging would be a great way for us to organize and archive our ideas while also sharing them with a larger audience.  For me, blogging is my dream job.  It is the perfect way for me to use my expertise as a therapist and my experience as a writer to help others learn more about child development and how they can encourage healthy development for kids at home, in the classroom, and beyond!"

With 10 years of experience in pediatric occupational therapy, and a Bachelor's degree in Magazine Journalism, Claire and her team of co-horts have a lot to share.  Informational posts range from the importance of core strengthening  to an index of over 300 activities for the kids.  Two of her favorites include Inclusion and Providing OT Services in the Classroom.  and Couch Cushion Games for Kids.  Who doesn't like a good game of Wreck it Ralph and Fix-It Felix? :) Claire also advocates for free play and movement to help children develop their skills.

"All of my favorite therapy memories have been when I've set aside my data sheets, paperwork, and therapy "agenda" and simply let the kids take the lead.  It's incredible how much more information you can get this way - about what kids really need and what their strengths are.  These are the times I've felt a true connection with my students and have been able to appreciate their personalities and who they really are.

I think the most important thing we can do as parents, teachers, caregivers, and therapists is to give kids constant opportunities for free play and movement.  Being able to run, jump, climb, balance, and even being allowed to fall once in awhile, are all essential for kids to develop strong gross motor, fine motor, and sensory processing skills.  We can be advocates for integrating movement into the classroom, for ensuring that our kids get enough time for recess and [physical education], and for creating an active lifestyle at home that includes lots of unstructured play time."

Since Claire and Lauren are both active moms, balancing kids, work and the business is a challenge.  But they make it work.  "Our business runs on about 1,000 text messages and voicemails a day, along with the odd rushed phone call with kids yelling and screaming in the background."  

Of course I think that is why I appreciate them as a Therablogger.  Most of us have been there. We are all trying to manage the work-life balance. None of us are Linda Carter's Wonder Woman, though we all wear the crown just as well, if not better!

So head on over to The Inspired Treehouse.  I am sure you will find something to spark your interest. Their treehouse reaches further than just the site too.  You can also check out other branches on Facebook @inspired.treehouse, Twitter @inspiredtree and Instagram @insptreehouse. 

AT in the Classroom: Supporting Communication for Students with Complex Needs with Switch Access

If you work with children with complex medical backgrounds, then you know supporting communication needs can be daunting at times.  Cognition, vision, hearing, musculature and more can impact the way in which the child is trying to communicate.  Switch access can be a viable option to increase communication, but it takes a team to make it work.

Position, Position, Position
It is always a priority to address positioning for children with significant physical challenges when assessing communication needs for a multitude of reasons.  First, breathing.  If a child's posture is not in best alignment, with or without support, lung capacity is going to be diminished.  It will be more difficult to produce sounds without proper air supply.  Second, if tone, strength or coordination is an issue, it will be difficult to assess an access point for alternative means of communicating.  The old therapeutic statement "Proximal stability before distal mobility" is just as important to communication as it is to ambulation.   Physical Therapists and Occupational Therapists are both educated in positioning.  Sometimes it takes just a few modifications such as a changing to a chair with arm rests or making foot rest adjustments to improve alignment.  Other times, it is more complicated.

There are a variety of seating and standing systems available on the market like Special Tomato Seats, Leckey, or Rifton Seats, but low cost accommodations can be created with many things that can found at the dollar store, like pool noodles to use as bolsters.  But if you are not sure, refer.  Talk with the parent and determine if the child is followed by anyone already for wheelchairs, strollers and other seating systems.  If they are, you may want to consider requesting permission to speak with outside providers to voice concerns or recommendations.

Once a child is successfully positioned in a functional system, then you can look at the switch based options available in specialty markets and even on Amazon.

Switching it Up
Switches can be a good option for children with a combination of physical and cognitive needs.  They come in a variety of styles, shapes, contours, sizes and sensitivities to fit the unique strengths of a student.  Many styles can be easily plugged into a variety of Cause and Effect toys allow children interact with intent and independence.  Others provide alternative and augmentative communication options to generate single or multiple recordable messages.  Single speech generating switches like the BigMack and multiple message generators like the Step by Step, provide a vocal outlet for requests and comments.

The selection available toys are on the market has left much to be desired, which is why battery device switch adapters, like those found on Enablemart, make battery operated toys available to those with limited mobility.  The copper disk insert has an attached outlet to plug in a standard switch.  Sometime you do have to hack the battery cover to make sure everything fits but now the child has access to turn a toy on and off.  Getting a child to understand and use cause and effect is a powerful tool towards communication.

iPad and Switch Access
There are now Bluetooth Switch Interfaces for the iPad.  I have had good luck with the Pretorian APPlicator.  It provides 4 channels, each with a multitudes of modes.  But just because you have a interface AND a switch, doesn't mean you will be able to use it.  Not all apps are switch accessible.  However, developers are becoming more and more aware of complex needs.  Some of my favorites are from Inclusive Tech.  Also, some augmentative alternative communication apps are more accessible, like Go Talk Now.

Mounting Systems
Now that you have an iPad with usable apps, how do you make sure the child has access to it?  Well, there are a variety of mounting systems.  If the child will be primarily in a wheelchair, Mount'N Movers offers systems and support to walk through the assessment.  What I really liked about them was their adjustability.  Some set ups have swing arm action which comes in handy when a child needs to be transferred.  Other options like AbleNet's Goose Neck Mount and Friction Knob Mounts offer different levels of stability and flexibility, and the cost is much less in comparison to the Mount'N Mover.  Loc Line, a modular hose system originally made for piping needs, created non-traditional, but awesome, do-it-yourself mounting kits too.

Looking at the child's strengths and needs from all angles takes many sets of eyes.  Working as a team to best support the student with complex communication needs is the key.  It ensures all areas of  facilitating communication are addressed.  If you are not sure, refer.  Once you have exhausted your expertise and techniques, follow your district's protocol to request for an Assistive Technology Evaluation.  They may be able to provide insight to strategies and tools available to help enable your student to speak what's on their mind.

For More information about Supporting Communication, check out the amazing insights of more therapy bloggers by clicking on the listing below....

AT in the Classroom: SETTing the Example for using Assistive Technology

Sometimes I take for granted what I have learned about assistive technology, so let me start out by sharing and defining it before diving into examples...

Assistive Technology (AT) is defined in the Individuals with Disabilities Education Act (IDEA) as any item, piece of equipment, or product system, whether acquired commercially off the shelf, modified, or customized, that is used to increase, maintain, or improve functional capabilities of a child with a disability. It does not include medical devices that are implanted, such as cochlear implants.

As part of every Indvidualized Education Plan (IEP), Assistive Technology should be "considered" as part as the child's ability to have access to a Free and Appropriate Public Education (FAPE).

With all that in mind, in this alphabet soup of educational acronyms, how can parents, educators, and therapists search, select, and support children with complex needs?

Using the SETT Model, as developed by Joy Zabala who is a leader in Universal Design for Learning (UDL) concepts, it is recommended to look at four components: Student, Environment, Task and Tool.  First, you look at the Student: what are their strengths, needs, and motivating factors.  Then, look at the Envirnoment: where is the student going to be completing the task?  Third, name the Task: what does the student need to do or learn? Last is the Tools: how is this child going to access the task at hand, as independently as possible?

When I am working with students, I collaborate constantly with a group of amazing therapists and educators.  We try to look at all options from no tech to high tech. You don't want to jump to the iPad with ProLoQuo2Go if it's not going to work to the child's strengths and meet their needs.  Let me give you a few examples:

Example: 

The Student: A preschool student with significant physical and cognitive disabilities. S/he is able to reach, grab and release with both hands.  S/he is motivated by sensory exploration, food and music.  

The Environment: Student will be completing tasks in the OT room, the classroom, and academic specials like gym, art, and music.  

The Task: develop a means of communicating needs and wants.   

The Tools: 
No Tech: Incorporating the use of gestures, eye contact and vocalizations into activities

Low Tech Option- pictures, like Boardmaker, SymbolStix, or downloaded pictures from the internet.  

Mid Tech Option- voice output single switch with a picture indicating what it says or a swtich activated toy (available through specialty vendors such as Enable Mart  or Able Net or potentially Amazon).

High Tech Option- iPad with Cause and Effect music based play apps such as Inclusive Tech, with a switch and Blue tooth switch interface for the iPad such as the Pretorian APPlicator

During therapy sessions, I use them all.  The combination of all approaches supports intent, initiation, persistence, and communication needs through motivating play. This student must request a turn using a picture exchange to then activate the cause and effect switch based toy/app, indicate more wanted time on the swing, or use of the rice box.  Notice, I haven't attempted to start an alternative and augmentative communication (AAC) app.  S/he is not ready for it yet.  Maybe in the future, maybe not.  

Example 2.

The Student: Student with significant physical mobility challenges. S/he is very bright but has difficult time keeping up with his/her peers during class activities. S/he can type on average at the same speed his peers write; s/he can write single letters and numbers recognizably but large.

The Environment: regular education setting

The Task: S/he needs to be able to complete math, reading, and writing worksheets independently.

The Tools: 
No Tech: scribing, however this involves an adult or peer to do the work, and the student is dysarthric. Reliability of answers should be considered.

Low Tech: Use a Slant board, built up pencil, and strategic positioning (and repositioning) of materials

Mid Tech:Lap top already available in the classroom with shortcut to a word processing application and a printer

High Tech: iPad with a PDF translation app that takes a photo, turns it into a PDF on which the student can type or draw on, access to email and/or printer

The student uses a combination of all four, again. Now that the student has access to the tech, the need for the scribing is lessened.   Sometimes the child wants to write. So with strategic positioning and his built up pencil, s/he can fill in the blank or draw the lines. But when the writing is more than a few letters or numbers, he can complete his work on either the iPad or the computer.  Is it perfect? Is it up to UDL? No, because in theory, the means of his expressing his knowledge wasn't explored before creating the lesson.  But does it work and give him improved access right now?  Yes.  

Example 3.
The Student: Elementary student with decreased strength and endurance to upper extremities and absent lower body sesnsation.  Also wears glasses.  Enjoys reading and music, but has a hard time comprehending and expressing what she knows.  S/he hunts and pecks on the keyboard.
The Environment: The inclusion classroom
The Task: Reading assignments, comprehension
The Tools:
No Tech: Provide modified educational materials like multiple choice questions
Low Tech: Highlighting strips to visually narrow the area the student needs to which s/he needs to attend. Access to read-aloud accommodations on the ePublished version of the reading program
Mid Tech: Access to laptop with a text to speech app/extension (Read and Write for Google, Readability, etc)
High Tech: iPad with PDF translation app to enlarge the print on the screen and limit visual clutter.  If student has a print disability, may qualify for Bookshare account and could use Voice Dream app on the iPad as well.

Combination of all four.

Notice the trend?  There is no end-all, be-all answer to access needs because depending on the strengths, needs, environment, and task, the tools required will be different.  And it is always a work in progress as the demands of the schoolwork change.  The important thing to take out of this is that you need to ask the right WH questions.  Who? Where? What? and How? Because if you don't know the answer, you can consult with your team or request an Assistive Technology Evaluation from your local AT group, in accordance with your district policies and procedures.  If you're not sure, refer!  

If you want to learn more about SETT, UDL, CAST, AIM, or any of the other Assistive Technology acronyms, there are amazing free and at cost webinars available on-line through AbleNet University, CDT Institute, and AOTA .  And don't forget to make friends with your local AT program!  They can be an amazing resource.

Adventures in Assistive Technology: Adapting the Power Wheels

I had been dying to do this project for over a year, since I had first heard about the Go Baby Go through the University of Delaware.  It was an AH HA moment.  I could totally do that. Adapting a powered toy car so my kiddos could have access to play with their peers as well as build other skills such as switch use, or head and trunk strength, or language, upper extremity strength... you name it, I could justify it.  It is my magic, as an OT, ya know to justify ANYTHING!

So a few weeks ago I finally resparked the flame of innovation and started asking for donations of used power toys.  And to my joy, my nieces and nephews donated their John Deer truck because they weren't using it anymore and they wanted to help my kids.  There I was, John Deer in hand. Now to get the rest of the supplies.

Ratcheting PVC cutter
Cuts through pipe like buttah'

Switch. Check.  (ablenet.com)
PVC piping. Check.  (local neighborhood hardware store)
Nuts and Bolts. Check.  (local neighborhood hardware store)
Kill Switch. Check.  (amazon.com)
A husband to help me rewire. Check.

Once my Mr. Fix-It helped to rewire and solder the gas pedal to the switch, I got my Ratcheting PVC cutters out.  These are a necessary tool if you work with PVC.  Worth every penny.  I also got to steal Mr. Fix-Its Dremel tool and new Milwaukee Power Drill to perforate the holes in the piping and the truck to install the support frame.

Finishing touches included good ole pipe insulation,  duct tape to provide a softer support to the bracing, and industrial Velcro for a lap belt and shoulder support.  And voila, Pimp My Ride: John Deer Power Wheels edition was complete.

My son testing it out

When I envisioned the outcome, I primarily had my students with significant physical disabilities in mind, but the benefits of the project spread beyond that group.  Students with autism found it quite intriguing and motivating.  Those that were non-verbal, vocalized and expressed words such as "Cool!" "Go!" "4 by 4" and "Deer".  It gave others a chance for parallel play and structured communicative play by incorporating voice out put switches with phrases like "Do you want to go for a ride with me?" and "GO!"  Driving also encouraged bilateral hand use and intrinsic hand strengthening, as the children have to use push the switch while holding the steering wheel as they drive.  For my more involved students, I steer while they activate the switch.


Though not 100% complete, I still need to set a secondary switch for a right cheek activation site, this project is well on its way to fulfilling its purpose: increasing participation amongst children with multiple disabilities during free time play.  I actually wish that I had considered completing a research study on its effects on social participation.  Maybe next year....

Overall, I would consider this an advanced project due to the nature of adaptation and tools needed.  If I didn't have my husband's support, I don't think it would have made it out of my basement.  Also, there are a significant amount of obstacles.  First, logistics.  The size of the vehicle is big.  It's a two-seater.  And even though we removed the dump bed from the truck, it is still large to store (ask my co workers).  So if you are considering doing a project like this, you need to examine your storage capacity.  You also have to respect administration for your building.  I am lucky to work with educators and facility managers that don't mind my therapeutic antics.  Second, cost.  Though the power wheels was donated, I purchased most of the materials.  PVC is cheap; foam insulation is cheap; switches can be costly.  I completed this for under $50 but I had a lot of materials and tools already.  Third, overall understanding of positioning and access sites.  Position of the body is key to accessing life, including switches.  If a child is not supported appropriately and safely, the participation in motorized play will not be successful.

Sea Choice Universal Kill Switch
Available through amazon.com

So if you are interested in researching a project like this, check out Cole Galloway and his team at the University of Delaware.  I downloaded their instructions, and then modified it to fit my needs.  For example, the kill switch they used is a single throw switch; my Mr. Fix It recommended the coil based like ones used on boats. Since it attaches to me while the children are driving, I don't have to worry about them driving off.  Go Baby Go project developers recently published new directions which are clearer and more organized.  And if you want to help me make another adapted car, you can visit my Donor's Choose site.

Special Thanks to Maddie and Patrick for donating their toy! Without it, my students would not be having nearly as much fun!

OT's Role in a Zombie Apocalypse

It dawned on me the other day, with the impending doom and end-of-days, occupational therapists have the untapped potential to address the needs of a new population: Zombies.

With the unique training and ability to look at the whole person, an occupational therapist should remember to address all occupational areas when providing treatment during the Zombie Apocalypse:

Environmental Modifications:
A zombie's ataxic gait and poor safety awareness puts it at greater risks for falls in the home and community.  Recommending the removal of scatter rugs, improved lighting in hallways, and instructing them in the correct use of adaptive mobility equipment such as a walker or cane (in coordination with a Zombie-Certified Physical Therapist of course), can help decrease the risks of a fall in the home.

Self Help Skills:
Having observed functional deficits in Zombie eating habits such as open mouth posture,  poor tool use and hygiene issues, an OT practitioner should consider meal time adaptations. A Nosey Cup or weighted utensils could provide the difference between certain messiness and spillage to a more socially acceptable behavior.  Pacing eating by encouraging small amounts at a time can hamper pocketing or stuffing.

Social Skills- Supporting Functional Communication:
If only the Zombie could tell you, "I WANT BRAINS PLEASE."  But it appears from countless Zombie observations that oral communication is limited.  Incorporating a picture support system, gestures and sign (in coordination with a Zombie-Certified Speech and Language Pathologist) may mean the difference from an impulsive and frustrating attack on you or a loved one and the happy exchange of pleasantries.  And if the Zombie client demonstrates efficiency with low-tech supports, then an assistive technology assessment should be completed to identify other high-tech options that may be indicated.

Workforce Reentry:
Even a Zombie needs to participate to the best of his or her ability in a vocational outlet.  Looking at interests and skills with a Zombie-Certified Vocational Counsellor and an occupational interest inventory, your Zombie client may find a meaningful position.  Don't forget to evaluate the needs for  assistive technology or environmental modifications such as work from home, standing stations, a quiet brain-free office versus a cubicle to inhibit any distractions.

Leisure Balance:
When looking at the Work-Leisure balance of your Zombie client, it may be clearly out of whack.  Exploring creative outlets including music, exercise and arts and crafts could mean the difference between an overstressed Zombie to one with meaningful play.  And if reading is something your Zombie client is interested in but the visual attention and perception has caused a print disability, Screen reader software or audio books are a great option.

So if you are an entrepreneur or enjoy a challenge, the Zombie Apocalypse may be a great opportunity for you to put the step back into the walking dead.