Joan, In the context of his school environment he is able to successfully manipulate all materials. When I completed the assessment (about 45 min of writing activities), he did not appear to fatigue and I even asked him if his hands were tired, to which he responded they were not. He is able to keep up with taking notes in class, and other than some issues with spacing between words, his writing is 100% legible. With these things in mind, I provided the recommendations of modified paper and keyboarding. My job is to assist him in meeting his needs to promote success in his educational setting through acc/mods, not provide 'treatment' to address decreased strength. I also work in a pediatric clinic and often have difficulty separating the two models. The challenge is to provide the appropriate services in each individual setting per regulations and scope of practice. I think sometimes it's hard for parents to understand the difference between the two models. It doesn't help that not all districts provide services in the same way, making it more difficult for parents to understand.
Thanks so much for your input!! -----Original Message----- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com] On Behalf Of Joan Riches Sent: Friday, February 19, 2010 1:38 PM To: OTlist@OTnow.com Subject: Re: [OTlist] Evidence? Renee What did you suss out regarding the reason that he grips his pen or pencil so hard that his hand gets tired?-or was that your conclusion? In my experience and this is not research evidence or even particularly large handwriting problems can go back to atypical development of the shoulder girdle in infancy so that the child was unable to hold up his hands to explore the movements of his fingers. This can be a result of treatment for congenitally dislocated hips among other things - anything that prevents pushing up from the prone position. By the time the shoulder girdle strengthens there are more interesting things to do than be fascinated with fingers so they remain undifferentiated. I'm sure your recommendations are designed to remedy this. It might help the mother to understand if she thinks back and realizes that this developmental step was skipped for one reason or another and that meaningful activities will be more effective than exercises. How does he do with activities that require him to manipulate very small pieces - Lego model building etc? Joan Riches B.Sc.O.T., OT(C) Specialist in Cognitive Disability High River, Alberta, Canada -----Original Message----- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com] On Behalf Of Renee Lowrey Sent: February 19, 2010 5:19 AM To: otlist@otnow.com Subject: [OTlist] Evidence? I am working in a school district where we provide hands-on consultation. I work with a student to see which intervention strategies (accommodations/modifications) will work best and then education teachers on how to use and follow through with the recommendations. I recently completed an eval on a student for handwriting legibility (per mom). I recommended acc/mods for home & school and provided some strengthening activities that could be incorporated into the natural context of his school day. Unfortunately, but mom was not satisfied with these recommendations. She wants us to work on hand strengthening (like in the a clinic) setting so his hand doesnt get tired when he writes (Hes in 3rd grade now). No matter how I explain how services are better provided in the context of the classroom and how the acc/mods will allow him to participate in his education, she is not satisfied. She doesnt want him to depend on the acc/mods, which she thinks will result in decreased hand strength and therefore illegible handwriting. Does anyone know of any research regarding the efficacy, or lack thereof, of hand strengthening exercises and improved hand writing; or of the benefits of a consultation model rather than an direct, pull-out model in school systems? Any info will be most appreciated. Thanks, Renée L., OTR/L -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com No virus found in this incoming message. Checked by AVG - www.avg.com Version: 8.5.435 / Virus Database: 271.1.1/2691 - Release Date: 02/19/10 07:34:00 No virus found in this outgoing message. Checked by AVG - www.avg.com Version: 8.5.435 / Virus Database: 271.1.1/2691 - Release Date: 02/19/10 07:34:00 -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
