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Archive for category: Occupational Therapy At Work

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World “Wear Purple Day” For Epilepsy: Explaining Epilepsy to A Child

Traumatic brain injury (TBI) and epilepsy have close ties. Studies show that often epilepsy develops following TBI. When you have children, both brain injury and epilepsy can be hard to both explain and discuss. However, more recently this has been made easier through the use of some newly developed children’s books that help kids to be learn about, and understand, these conditions:

Epilepsy Today: New Brain Injury Books Launched

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Printing Therapy Success Becomes a Letter to Santa

Guest Blogger: Justine Huszczynski, Occupational Therapist

One of the benefits of being an Occupational Therapist is seeing a client reach, and sometimes surpass, their goals.  One of my favorite moments as an OT came this past December, when my paediatric client, Joshua, made my heart melt with how far he had come in therapy.

When I first started seeing Joshua earlier in the year, he was unable to print much more than his first name.  He had a lot of difficulty holding a pencil and his fine motor strength was minimal.  His mother, Connie, and I made a plan for Joshua to receive OT treatment twice a week for six months, with the help of President’s Choice Children’s Charity as the funding source.  Joshua’s goals involved working on underlying fine motor skills that were needed for the skill (or occupation) of printing.  For months we worked on strengthening Joshua’s fingers and hands.  We used a pencil grip to help him learn where his fingers needed to be placed to hold a pencil.  We worked endlessly on learning letter and number formations, through the use of the Handwriting Without Tears programs.  Eventually, by the time Christmas time rolled around, I was seeing Joshua once a week because he had made so many gains.

During one of our sessions leading up to Christmas, I challenged Joshua to write a letter to Santa. He was going to the Santa Claus Parade that weekend and could hand deliver his letter.  Joshua’s face lit up at the thought of this and his little hands got to work.  After 15 minutes of writing, Joshua finished his very first letter to Santa at the age of 10 years old!

santa

Occupational Therapists are taught to break down tasks into components in order to properly assess where difficulties with that task may lie.  Therefore, when assessing a child’s printing skills, we have to look at the whole task from the moment the child sits down in their chair until they put down their pencil and have completed writing.  More specifically, an Occupational Therapist will assess and observe the following aspects during a printing assessment:

  • Workstation (e.g. desk height, chair size, classroom or home environment)
  • Postural control
  • Attention to task
  • Pencil grasp
  • Pressure on pencil
  • Angle of paper
  • Handwriting speed
  • Size of letters
  • Spacing between letters and words
  • Formation of letters
  • Use of punctuation
  • Formation of ideas for written sentences
  • Ability to copy words or sentences from a near and far point position

Treatment for printing difficulties often will target different aspects from the list above, depending on each specific child’s needs.  However, one of the biggest contributors to a child’s success in any printing program is parent and teacher involvement.  Parents and teachers are key support systems that can remind a child of their printing strategies at home and school, which often leads to an increase in generalization of the skills a that the child may have learned in session with their Occupational Therapist.

Here are some basic ideas for parents and teachers for working on printing skills:

  • Make learning to print a multi-sensory experience! Use trays of rice, sand, shaving cream, or cornmeal to write or trace letters with the child’s index finger.
  • Incorporate printing (and drawing) to bath time with bathtub markers.
  • Use various writing utensils such as pencils, markers, crayons, and chalk.
  • Little crayons for little hands – use smaller writing utensils for younger children to promote the use of a more mature grasp.
  • Teach a maximum of two letters per week so that a child can focus on properly learning and printing those letter formations.
  • Hide the eraser! When a child is in the process of learning to print, do not point out every mistake. Instead, have them look at their finished product and ask them what they like about their work, and what they would change. This will keep the learning process a positive one.

If you have concerns about your child’s printing skills, contact our office to discuss these issues with an Occupational Therapist who can guide you through the next steps for your child.

 

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Supporting Autism, One Amazing Mother at a Time

Julie Entwistle, MBA, BHSc (OT), BSc

According to Autism Speaks, Autism now affects 1 in 88 children and 1 in 54 boys. The 2012 numbers reflect a 78% increase in reported prevalence in the last 6 years (www.autismspeaks.ca).  This is a growing problem, impacting more and more families each year.

Autism is a spectrum disorder, meaning that the signs, symptoms and severity can vary, making this difficult to diagnose and sometimes treat.  Yet through therapy, children with Autism can learn to function and communicate as independently as possible at home, school and with their peers.  In April, Entwistle Power is sponsoring the Burlington Autism Gala – a fundraising event being organized by Jessica Langdon – a mom motivated by her son’s journey with autism who has a vision to find answers and to obtain support for families faced with this diagnosis.

In support of the Gala, Occupational Therapist Justine Huszczynski wrote the following about her experiencing working with Jessica’s son Spencer, and in doing so, highlights some of the features of Autism, and the value of occupational therapy for these children:

When I first met Spencer I was introduced to one of the most intelligent little boys that I think I will ever come to know. He impressed me with his ability to read at such a young age.  He could print his name and spell many different words that I had never seen another child his age be able to do.  I think it was this intelligence that could easily cause a child like Spencer to slip under the radar. He was smart. He could print. He could speak. But beyond this lay a child who couldn’t handle loud noises, busy rooms, or being lightly touched.  An extreme meltdown was constantly on the brink of being unleashed at any given moment – triggered by a change in routine, being told “no”, or being overwhelmed by the environment around him.  Spencer didn’t make consistent eye contact, he had difficulties with social cues, taking turns, and coping with losing at a game.  Although he was verbal, he couldn’t express his feelings, which often caused a minor issue to turn into an explosive meltdown – sometimes lasting for over an hour at a time.

And then there was Jessica. A mom who was dedicated to her son and on a mission to get him the help he needed and deserved.  Jessica knew her son’s needs inside and out. She came to me with a wealth of information about Spencer and she just wanted to make sense of it all.

We started Occupational Therapy with Spencer immediately.  Jessica was in attendance for every session. She participated, asked questions, provided me with information, and was involved every step of the way.  We targeted goals based on self-regulation, social skills, and sensory processing.  We helped Spencer explore new sensory experiences and used strategies to help him cope with overwhelming situations.  Along the way, Jessica and I sat through countless meltdowns but we worked through them.  Spencer learned how to tell us when he was feeling overwhelmed and he could eventually choose strategies to help calm himself down.  It became easier for him to cope with changes in routine and he improved on his ability to follow instructions.  He was changing before our eyes.

Autism awareness led Jessica to seek help for Spence and his early intervention is what I believe helped him make so many gains in therapy.  To me, Spencer exemplifies the positive outcome that can occur when a child is given the supports they need and are surrounded by a family and team that works towards common goals.  Spencer is by no means “cured”. There is no “cure”.  But there is love.  There is support.  There is awareness.  But we still need more answers.  Constantly we are searching for answers.

justine

Justine Huszczynski
jhuszczynski@solutionsforliving.ca

For more information about the gala, please contact Gala Founder, Jessica Langdon at jlangdon@live.ca.  We hope to see you there!

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Dog Awesomeness

I have always had dogs.  We had two when I was a kid, and when they died, we had two more.  When I moved to University I bought myself a Golden Retriever and two years later purchased another one.  When they passed away we adopted another Golden, and this December brought home a Golden puppy (Timber – photo above) to join our family.  I will say I am totally in love with this breed, and really with dogs in general (we have an adopted cat too but after owning a cat I can officially say I am a dog person).

Yes dogs are hairy, poop in your yard (lots), lick themselves, have eye goop, and occasionally have accidents or barf in the house.  They can chew stuff too, are expensive to feed and even more expensive to train, groom and keep healthy.  So, why bother?  Because animals are amazing for your health, and are becoming more and more recognized as being able to offer therapeutic and functional benefit.

According to Web-MD the health benefits of owning animals are immense.  People that own animals tend to have lower blood pressure, less anxiety and depression, better immunity, and less allergies.  Animals in the home are proven to reduce angry outbursts by people with Dementia, prolong the lifespan of seniors, heart-attack patients fare better in their recovery, and dog owners walk an estimated 68% more than the general public.

Then, there are service or guide dogs.  These dogs are professionally trained at a young age to assist persons with disabilities. While service dogs initially began helping the visually impaired, training programs now exist to teach service dogs to assist persons with a variety of conditions including hearing impairments, seizures, physical disability, autism and diabetes. For example, guide dogs can be taught to distinguish sounds, make physical contact with their handlers, and lead them to the source of noise; be it someone at the door, an alarm clock, crying baby, or a ringing telephone. Guide dogs who assist their handlers with a physical disability retrieve objects, flick switches, open and close appliances, and doors. They are also trained to bark or activate an alert system when help is needed.  They can warn of an oncoming seizure, and some are even trained to protect victims of violence from a perpetrator.  Together guide and service dogs can increase someone’s level of independence, safety, security, and reduce the impact of disability on a daily basis.

It is important to highlight, however, that service dogs are not just pets – these are working animals, highly trained that need to be 100% attentive to their owner at all times.  Distractions can lead to mistakes, and this can harm the dog and handler.  This is why people and children are told to not pet service dogs however tempting that may be.  Ultimately, service dogs should be treated by the public as an assistive device – there to help maximize safety and function, but not to be tampered with.

While the cost to raise and train a puppy to be a future service dog is about $25,000, the Lions Foundation of Canada Dog Guides, and Canadian Dog Guides for the Blind, provide guide these for those in need at no cost.  As part of the process, they match the person to their dog, provide training for the handler, including supply of the appropriate equipment, such as the guide dog’s identification harness or collar.

Beyond the health benefits of pet ownership, Occupational Therapists recognize that guide dogs can play a key role in supporting a handlers’ ability to be more independent, mobile in the community, and safe both indoors and out.  For more information about guide dog programs, talk to your occupational therapist, or visit the Lions Foundation website at http://www.dogguides.com/programs.html or the Canadian Dog Guides for the Blind website at http://www.guidedogs.ca/index2.php.

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Improve Your Concentration

Are you easily distracted?  Find it hard to concentrate or focus?  Distractions such as emails, phone calls, co-workers, and thoughts about your home life can reduce your productivity at work.  And this is a vicious cycle where by being inefficient just leads to more work, more anguish, and more inefficiency!  The following from Health.com provides great tips to stay focused, complete tasks in an efficient manner, and essentially be more productive with less stress. 

Health.com: 13 Ways to Improve Your Concentration at Work

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Alzheimer’s Awareness Month: Keep Your Brain Fit

Alzheimer’s Disease International estimates that over 135 million people around the world will suffer from dementia by the year 2050, and are concerned of a looming global epidemic. How can you ensure you are doing the best for your brain in the hopes of preventing dementia? The Alzheimer’s Society of Canada has a fantastic website that outlines the signs and symptoms of dementia, how to care for someone with Alzheimer’s, and how to keep your brain fit through regular brain exercise and a healthy diet.

Alzheimer’s Society Canada: Brain Boosters

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International Day of the Disabled Person

I love the saying that we are all “temporarily able bodied”.  How true.  Each one of us, at any time, are one situation, condition, virus, bacteria, accident, or even random event away from becoming disabled physically, emotionally, behaviorally or cognitively.  Or, really, many of us are already disabled – visibly or invisibly, and I truly believe the saying: “be kind to all you meet as everyone is fighting a hard battle” – Plato.

This definition of disability from Wikipedia speaks to how all-encompassing the word really is:

Disability is the consequence of an impairment that may be physical, cognitive, mental, sensory, emotional, developmental, or some combination of these. A disability may be present from birth, or occur during a person’s lifetime.

Disabilities is an umbrella term, covering impairments, activity limitations, and participation restrictions. An impairment is a problem in body function or structure; an activity limitation is a difficulty encountered by an individual in executing a task or action; while a participation restriction is a problem experienced by an individual in involvement in life situations. Thus, disability is a complex phenomenon, reflecting an interaction between features of a person’s body and features of the society in which he or she lives.

The last sentence is especially true.  A disability is an interaction of the person and their environment.  This is why I love being an Occupational Therapist.  While I do enjoy helping people to function better through therapy that improves physical, cognitive, behavioral or emotional abilities, I also take pride in tackling the environmental aspects of functional problems.  If we can’t change the person, we can try to change the environment in which they live, and the spaces in which they need to function.  This “holistic” view of disability is, in my opinion, one of the key facets of Occupational Therapy.

I wanted to celebrate this important day by listing some of my most favorite quotes about disability:

“The only disability in life is a bad attitude” – Scott Hamilton

“I choose to not place “DIS” in my ability” – Robert M. Hensel

“Just because a man lacks the use of his eyes doesn’t mean he lacks vision” – Stevie Wonder

“One’s dignity may be assaulted, vandalized and cruelly mocked, but cannot be taken away unless surrendered” – Michael J Fox

“We know that equality of individual ability never has existed and never will, but we do insist that equality of opportunity still must be sought” – Franklin D Roosevelt

“I am only one, but still I am one.  I cannot do everything, but still I can do something; and because I cannot do everything, I will not refuse to do something that I can do” – Helen Keller

So, consider that we are all vulnerable and only temporarily able bodied.  We need to celebrate humanity – in all’s its forms, including the form that is “disability”.

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When Children Can’t Communicate Pain

A few years back my daughter (age five at the time) seemed a bit “off” when she came home from school.  She was withdrawn, tired, and “didn’t want to talk about it”.  She is my kid that struggles to communicate her needs, especially when she is upset, so I tried to give her some time and control over when she would be comfortable talking about it.  Eventually, I went over to her and in stroking her hair realized this had blood in it.  I pulled her bangs aside and noticed a bump, large bruise, and blood on her head, in her hair, and around her temple.  When I asked her what happened, she burst into tears.  Through some coaxing, I got her to tell me that she had fallen on the playground, hit her head, and was so embarrassed about this she didn’t want to tell anyone.  Her teacher picked up on the fact that something was wrong and sent her to talk to the principal.  To the principal she reported nausea, a headache, and was visibly upset, but wouldn’t tell the principal what happened, and the bump and blood on her head and hair was not noticed.  After I got her to calm down, and did some basic mommy first aid, I explained to her the importance of telling adults about these things in case they are serious and need immediate attention. 

The ability to communicate pain and discomfort is invaluable – it not only allows a person to express how they are feeling in order to receive medical attention, but also can help them to obtain medication or treatment to make the pain more manageable.  However, many children (and some adults for that matter) are unable to express their pain due to a difficulty with communication, or a developmental or intellectual disability.  This can make it very difficult for health practitioners and family members to decipher their level of pain following an injury, medical procedure, or with illness.

For children that cannot verbally communicate pain, there are other methods that can help.  For example, the Non-communicating Children’s Pain Checklist (NCCPC-R) was designed for children who are unable to speak due to a cognitive disability.  The NCCPC-R can be completed by a caregiver within the child’s home environment, and measures observations of the child’s vocalizations, social interactions, facial expressions, activity level, appearance of body and limbs, physiological signs, eating, and sleeping.  In addition to the home-based version, a postoperative version of the NCCPC-R also exists.

Interestingly, studies have shown that the expression of pain by children with Autism Spectrum Disorder is not significantly different from typically developing children or even from children with intellectual disabilities. However, what does seem to be different is the length of the behavioral reactions of children with Autism, after the source of pain has been removed. This information may be surprising to some, as it is often thought that children with Autism are insensitive or have a high tolerance to pain.  Therefore, caregivers and healthcare professionals need to be aware that although a child with Autism (or any developmental disability for that matter) may be unable to verbally communicate their level of pain, we cannot assume that they are not in pain.  We need to be able to look beyond verbal communication.  One method, using observation, is the FLACC scale (Face, Legs, Activity, Cry, Consolability).  With this, pain in children and adults who are unable to communicate are observed through are range of symptoms that are scored from 0 to 2.

So while my daughter is capable of communicating verbally, emotional upset and embarrassment prevented her from taking the important step of telling an adult about what happened.  Through her behavior and presentation, her teacher, the principal and I were able to see that something was wrong, and eventually, when she was comfortable talking about it, I figured out what happened.  Thus, behavior, verbal or not, is a key indication of how a child is feeling.  It is important for parents and healthcare providers to be aware of the signs of pain in children, verbal or non-verbal, as their bodies can very well communicate their level of pain when they cannot do so through words.

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National Child Day

Written by Justine Huszczynski, Occupational Therapist

 

Today marks the date when Canada adopted the United Nations Convention on the Rights of the Child (UNCRC).  Simply put, the UNCRC is a treaty that outlines the basic human rights for children and youth.

                                             

Among other rights, the UNCRC outlines “survival and development rights” which are explained as “the basic rights to life, survival and development of one’s full potential”.  Looking into this a little deeper, Article 23 under the “survival and development rights” states:

 

“Children who have any kind of disability have the right to special care and support, as well as all the rights in the Convention, so that they can live full and independent lives.”

           

So, how is Canada ensuring that the rights of children with disabilities are being fulfilled?  Of course, we have public healthcare which provides children prompt access to medical attention.  But Article 23 goes beyond this.  It also includes the right to services – therapy services perhaps – that children with “any kind of disability” should be able to access such that they can become independent adults and experience a fulfilling life.

 

While Ontario offers plenty of publicly funded early intervention services for children with disabilities (based on the availability of twenty government-funded children’s treatment centres across the province), how are the outrageous waitlists for some of the most valuable services offered in these centres acceptable?  For example, last year the Toronto Star surveyed nine of the government-funded treatment centres and found average waitlist times ranging from one to FOUR years for a child to receive intensive behavioural intervention (IBI) therapy.

 

So how does this follow the guidelines of the UNCRC? Honestly, it doesn’t.  Simply having a service available to a child with a disability is not enough.  The service needs to be provided.  Long waitlists do not allow children to “live full and independent lives” but in fact can stifle a child’s development by denying access to programs that are most effective as “early intervention”.

 

Therefore, while we celebrate how far we have come to secure the rights of children, we need to look ahead and aim for a brighter future for those children that may need some extra support – sooner rather than later.  An example of striving for a brighter future comes from the parents of one of my clients who devoted their time to being their child’s advocate when “he didn’t have a voice”.  After this young client was denied services by one of the government-funded children’s treatment centres in Ontario, his parents scheduled a meeting with their local Member of Provincial Parliament (MPP) to advocate for their son’s dire need for early intervention services.  As a result of the advocacy skills of my client’s parents, the MPP ordered the treatment centre to complete a reassessment and the child was granted the early intervention services that he absolutely deserved and required.  During a conversation with the mother of this client, she stated, “It is my job to be make my child’s life better”.   This statement is heartwarming, and perhaps we should view it as a challenge.  A challenge for all of us – therapists, health professionals, teachers, citizens, governments– to truly make it our “job” to ensure children are given the best life possible.  So take the challenge and advocate for our children – ask more questions, get second opinions, research the available charitable funding, schedule meetings with your MPP, school board trustee, and don’t take no for an answer.