Hi, I am going to be the devils advocate, and say that this child may very well have skipped a few crucial developmental stages most possibly contributing to the problem. We are trained in dissecting these problems and intervening at these levels to re mediate the problem. In a school based model, we are asked to create adaptations, or when possible treat children using school related functional strategies that may serve to best support their academics in or out of class. I have seen kids receive years of therapy with little gains for various reasons. Poor follow through, limited family involvement, limited intensity and the list goes on. My dilemma rests with Renee. The restrictions we are up against in the schools often limits our ability to make real progress. This child's true underlying issues are thereafter never met, yet services continue for years. If in fact, this child has true shoulder girdle instability, and probably postural instability, among other issues, can one time weekly help re mediate these issues or consultation + a home exercise program? I recently took a course with Mary Kawar "Eye Sight To Insight" It was a wonderful course with a wealth of strategies backed up with theory and some research. She did respond to a question related to frequency and intensity of services in her school based practice. She recommended 1x weekly with parent involvement and a strong home exercise program to be completed 2x daily. Her Research and theory was not backed by any evidence, however the vision therapy literature is beginning to demonstrate some strong evidence when coupled with occupational therapy.
Andrea Houtras MSOTR/L-Hamilton Pediatric Therapy LLC -----Origi From: Joan Riches <jric...@telusplanet.net> To: OTlist@OTnow.com Sent: Fri, Feb 19, 2010 2:37 pm 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 doesn’t get tired when he writes (He’s 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 doesn’t 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
