AOTA T H E

AMERICAN

OCC U PAT I O N A L

T H E R A P Y

A S S O C I AT I O N

®

JUNE 4, 2012

Special Focus on Sensory Processing

Sports
Sensory Processing Disorders
ALSO

for Children With

Sensory Processing Challenges in Schools

PLUS

Money Mangement Interventions International Collaboration News, Capital Briefing, & More

SENSORY PROCESSING MEASURE SENSORY PROCESSING MEASURE–PRESCHOOL

THE BEST IN EVERY SENSE!

No More Confusion
Sensory processing can be a bit bewildering to parents, and sometimes teachers, too. So it’s important to choose a test that measures clearly defined functions and produces comprehensible scores.

Information That Parents Understand
SPM and SPM-P scales are described in simple, nontechnical language: • Social Participation • Vision • Hearing • Touch • Body Awareness • Balance and Motion • Planning and Ideas • Total Sensory Systems

Because it’s easy to explain what you’re measuring, it’s also easy to explain results.

Easy Scoring, Interpretation, and Report Writing
The SPM and SPM-P give you a quick visual summary of results—with scores that are easy to understand and genuinely useful in report writing and treatment planning. Home and School Forms are standardized on the same group of children, so you can directly compare teacher and parent ratings.
P-6043

SAVE when you buy both! SPM/SPM-P Combination Kit (W-505): $262.00
Includes both SPM Comprehensive Kit (ages 5 to 12) and SPM-P Kit (ages 2 to 5)

wpspublish.com • 800-648-8857

Chief Operating Officer: Christopher Bluhm Director of Communications: Laura Collins Director of Marketing: Beth Ledford Editor: Ted McKenna Associate Editor: Andrew Waite CE Articles Editor: Maria Elena E. Louch Art Director: Carol Strauch Production Manager: Sarah Ely Director of Sales & Corporate Relations: Jeffrey A. Casper Sales Manager: Tracy Hammond Advertising Assistant: Clark Collins

AOTA • THE AMERICAN OCCUPATIONAL THERAPY ASSOCIATION
VOLUME 17 • ISSUE 10 • JUNE 4, 2012

Focus on Sensory Processing
FEATURES
Sports for Children With Sensory Processing Disorders
A Guide for Occupational Therapy Practitioners
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Ad inquiries: 800-877-1383, ext. 2715, or e-mail sales@aota.org
OT Practice External Advisory Board

Tina Champagne, Chairperson, Mental Health Special Interest Section Donna Costa, Chairperson, Education Special Interest Section Michael J. Gerg: Chairperson, Work & Industry Special Interest Section Tara Glennon, Chairperson, Administration & Management Special Interest Section Kim Hartmann, Chairperson, Special Interest Sections Council Leslie Jackson, Chairperson, Early Intervention & School Special Interest Section Gavin Jenkins, Chairperson, Technology Special Interest Section Tracy Lynn Jirikowic: Chairperson, Developmental Disabilities Special Interest Section Teresa A. May-Benson: Chairperson, Sensory Integration Special Interest Section Lauro A. Munoz: Chairperson, Physical Disabilities Special Interest Section Regula Robnett, Chairperson, Gerontology Special Interest Section Missi Zahoransky, Chairperson, Home & Community Health Special Interest Section
AOTA President: Florence Clark Executive Director: Frederick P. Somers Chief Public Affairs Officer: Christina Metzler Chief Financial Officer: Chuck Partridge Chief Professional Affairs Officer: Maureen Peterson
© 2012 by The American Occupational Therapy Association, Inc. OT Practice (ISSN 1084-4902) is published 22 times a year, semimonthly except only once in January and December, by The American Occupational Therapy Association, Inc., 4720 Montgomery Lane, Bethesda, MD 20814-3425; 301-652-2682. Periodical postage is paid at Bethesda, MD, and at additional mailing offices. U.S. Postmaster: Send address changes to OT Practice, AOTA, PO Box 31220, Bethesda, MD 20824-1220. Canadian Publications Mail Agreement No. 41071009. Return Undeliverable Canadian Addresses to PO Box 503, RPO West Beaver Creek, Richmond Hill ON L4B 4R6. Mission statement: The American Occupational Therapy Association advances the quality, availability, use, and support of occupational therapy through standard-setting, advocacy, education, and research on behalf of its members and the public. Annual membership dues are $225 for OTs, $131 for OTAs, and $75 student members, of which $14 is allocated to the subscription to this publication. Subscriptions in the U.S. are $142.50 for individuals and $216.50 for institutions. Subscriptions in Canada are $205.25 for individuals and $262.50 for institutions. Subscriptions outside the U.S. and Canada are $310 for individuals and $365 for institutions. Allow 4 to 6 weeks for delivery of the first issue. Copyright of OT Practice is held by The American Occupational Therapy Association, Inc. Written permission must be obtained from AOTA to reproduce or photocopy material appearing in OT Practice. A fee of $15 per page, or per table or illustration, including photographs, will be charged and must be paid before written permission is granted. Direct requests to Permissions, Publications Department, AOTA, or through the Publications area of our Web site. Allow 2 weeks for a response.

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DEPARTMENTS
News Capital Briefing
CMS Proposes List of “Off-the-Shelf” Orthotics

Jackie Kirkpatrick provides suggestions on working with children, families, and coaches to choose and participate in the sports—team or individual, competitive or leisure—that best match children’s sensory processing skills.

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Sensory Processing Challenges in the Schools
Learning “High,” “Low,” and “Just Right” Speeds

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In the Clinic

Bringing Money Management Interventions Into the 21st Century

Perspectives

Chai and Biscuits: Strategies to Create a Collaborative International Occupational Therapy Experience

Calendar

Continuing Education Opportunities

23 28 33

Employment Opportunities Questions and Answers
Susan Shutrump

Serena Zeidler reports on results and lessons learned from implementing a 6-week evidence-based self-regulation program to treat sensory modulation disorders at a suburban New York public elementary school.

* PHOTOGRAPH IS FOR ILLUSTRATIVE PURPOSES. CHILD IN PHOTOGRAPH IS A MODEL.

• Discuss OT Practice articles at www.OTConnections.org in the OT Practice Magazine Public Forum. • Send e-mail regarding editorial content to otpractice@aota.org. • Go to www.otpractice.org/currentissue to read OT Practice online. • Visit our Web site at www.aota.org for contributor guidelines, and additional news and information.
OT Practice serves as a comprehensive source for practical information to help occupational therapists and occupational therapy assistants to succeed professionally. OT Practice encourages a dialogue among members on professional concerns and views. The opinions and positions expressed by contributors are their own and not necessarily those of OT Practice’s editors or AOTA. Advertising is accepted on the basis of conformity with AOTA standards. AOTA is not responsible for statements made by advertisers, nor does acceptance of advertising imply endorsement, official attitude, or position of OT Practice’s editors, Advisory Board, or The American Occupational Therapy Association, Inc. For inquiries, contact the advertising department at 800-877-1383, ext. 2715. Changes of address need to be reported to AOTA at least 6 weeks in advance. Members and subscribers should notify the Membership department. Copies not delivered because of address changes will not be replaced. Replacements for copies that were damaged in the mail must be requested within 2 months of the date of issue for domestic subscribers and within 4 months of the date of issue for foreign subscribers. Send notice of address change to AOTA, PO Box 31220, Bethesda, MD 20824-1220, e-mail to members@aota.org, or make the change at our Web site at www.aota.org. Back issues are available prepaid from AOTA’s Membership department for $16 each for AOTA members and $24.75 each for nonmembers (U.S. and Canada) while supplies last.

OT PRACTICE • JUNE 4, 2012

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News
AOTA News

Association updates...profession and industry news
Bates Technical College (OTA), Tacoma, Washington— Accreditation Brown Mackie College-Greenville (OTA), Greenville, South Carolina (additional location of Brown Mackie College-Northern Kentucky, Kentucky)—Accreditation EHOVE Adult Career Center/ Lorain County Community College (OTA), Milan, Ohio—Accreditation Herzing University (OTA), Crystal, Minnesota—Accreditation Indian Hills Community College (OTA), Ottumwa, Iowa—Accreditation New England Institute of Technology (OTM), Warwick, Rhode Island—Accreditation Saint Louis College of Health Careers, County Campus (OTA), Fenton, Missouri— Accreditation Stanbridge College (OTA), Irvine, California—Accreditation

Advanced Practice Specialty Conference

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ave the date for AOTA’s Advanced Practice in Traumatic Injuries & PTSD: Lessons for Military, VA, & Civilian Practitioners conference, to be held from September 7 to 8, 2012, in San Antonio. Topics will include upper extremity orthopedic injuries, pain, burns, vision loss, traumatic brain injuries, warrior transition units, amputations, posttraumatic stress disorder, spinal cord injuries, driving and community mobility, technology, and return to work. Early registration opens June 13 and ends August 20. Regular registration ends September 4. For more information, contact specialtyconference@aota.org or visit the AOTA Web site, at www.aota.org.

(OTM), Brooklyn, New York—Accreditation Towson University (OTM), Towson, Maryland—Accreditation University of Puerto Rico (OTM), San Juan, Puerto Rico— Accreditation University of Puget Sound (OTM), Tacoma, Washington— Accreditation Virginia Commonwealth University (OTM), Richmond, Virginia— Accreditation Wallace State Community College (OTA), Hanceville, Alabama—Accreditation Xavier University (OTM), Cincinnati, Ohio—Accreditation Final ACOTE decision subsequent to a review of a Progress Report: Lincoln College of New England (OTA), Southington, Connecticut—Probationary Accreditation Final ACOTE decision subsequent to a request from the program to be placed on inactive status: College of Southern Nevada (OTA), Las Vegas, Nevada— Probationary Accreditation— Inactive (Inactive Status: The status “inactive” does not replace any other current accreditation status. The designation follows the regular accreditation status (e.g., Accreditation—Inactive or Probationary Accreditation—Inactive). Students graduating from a program with Accreditation—Inactive or Probationary Accreditation— Inactive status are considered graduates of an accredited program. A program may remain on inactive status for a maximum of 3 years dependent upon the accreditation term remaining.) Final ACOTE decision subsequent to a request from the program to voluntarily withdraw from accreditation: Wayne County Community College District (OTA), Detroit, Michigan—Accreditation Withdrawn, Voluntary Final ACOTE decisions subsequent to a review of an initial Report of Self-Study (Step 2 of the Initial Accreditation Process): Brown Mackie College–Kansas City (OTA), Lenexa, Kansas (accredited additional loca-

tion of Brown Mackie College, Indianapolis, IN, transitioning to independent accreditation)—Letter of Review Granted Inter American University of Puerto Rico–Ponce Campus (OTA), Mercedita, Puerto Rico— Letter of Review Granted Neosho County Community College, Ottawa Campus (OTA), Ottawa, Kansas—Letter of Review Granted (Letter of Review Granted: The proposed programs would appear to meet the Standards if fully implemented in accordance with the plans of the sponsoring institution. An initial on-site evaluation will be conducted before an accreditation decision is made.) Final ACOTE decisions subsequent to a review of an Application for Developing Program Status (Step 1 of the Initial Accreditation Process): Central Piedmont Community College (OTA), Charlotte, North Carolina—Developing Program Status Granted Cossatot Community College of the University of Arkansas (OTA), Ashdown, Arkansas— Developing Program Status Granted East Arkansas Community College (OTA), Forrest City, Arkansas—Developing Program Status Granted Eastwick College (OTA), Ramsey, New Jersey—Developing Program Status Granted National American University– Denver Campus (OTA), Denver, Colorado—Developing Program Status Granted Salus University (OTM), Elkins Park, Pennsylvania—Developing Program Status Granted Salus University (OTD), Elkins Park, Pennsylvania—Developing Program Status Granted South University–Tampa (OTA), Tampa, Florida—Developing Program Status Granted Trinity Washington University (OTA), Washington, DC— Developing Program Status Granted University of Medicine and Dentistry of New Jersey (OTA), Scotch Plains, New Jersey (consortium includes County College of Morris, Randolph; Mercer
JUNE 4, 2012 • WWW.AOTA.ORG

Virtual Chats

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articipants in upcoming pediatric virtual chats will discuss preparing for college on June 14 at 11 a.m. EST, and sensory integration on July 17 at 1 p.m. EST. To participate in the chats and view archives of previous talks, visit www. talkshoe.com/tc/73733.

ACOTE® April 2012 Accreditation Actions
he AOTA Accreditation Council for Occupational Therapy Education (ACOTE®) met from April 28 to 29, 2012, and took the following accreditation actions:
Final ACOTE decisions subsequent to an initial on-site evaluation:
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Final ACOTE decisions subsequent to a re-accreditation on-site evaluation: College of St. Scholastica (OTM), Duluth, Minnesota—Accreditation Colorado State University (OTM), Fort Collins, Colorado—Accreditation Delgado Community College (OTA), New Orleans, Louisiana—Accreditation Florida International University (OTM), Miami, Florida— Accreditation Grossmont College (OTA), El Cajon, California— Accreditation Houston Community College (OTA), Houston, Texas— Accreditation Lehigh Carbon Community College (OTA), Schnecksville, Pennsylvania—Accreditation Manchester Community College (OTA), Manchester, Connecticut—Accreditation Middle Georgia College (OTA), Cochran, Georgia— Accreditation New York Institute of Technology (OTM), Old Westbury, New York—Accreditation North Shore Community College (OTA), Danvers, Massachusetts—Accreditation State University of New York Downstate Medical Center

County Community College, West Windsor; Passaic County Community College, Peterson; and Salem Community College, Carneys Point)— Developing Program Status Granted (Developing Program Status Granted: The proposed program may now admit its first class of students according to the approved timeline and proceed to step 2 of the initial accreditation process (the initial review), which will be followed by step 3 (the initial on-site evaluation). Developing Program Status indicates that the program meets the requirements for Developing Program Status and the plans and resource allocations for the proposed program, if fully implemented, appear to demonstrate the ability to comply with the ACOTE Accreditation Standards.)

practice setting and within the profession. This program will assist in meeting the Centennial Vision strategic objective of “building the profession’s capacity to influence and lead.” It is open to occupational therapy practitioners (OTs and OTAs) with more than 5 years of experience who are currently in management positions. Special consideration will be given to practitioners new to their rehabilitation/school-based occupational therapy manager/ director position. For submission requirements and other details, please go to www.aota.org/managers.

A O TA B u l l e T i N B O A r d
OUTSTANDING RESOURCES FROM

Sensory Processing Concepts and Applications in Practice (CEonCD™)
W. Dunn Earn .2 AOTA CEU (2.5 NBCOT PDUs/2 contact hours) articipants will examine the core concepts of sensory processing based on Dunn’s Model of Sensory Processing. The course explores the similarities and differences between this approach and other sensory-based approaches, examines how to implement the occupational therapy process, and reviews evidence to determine how to create best practice assessment and intervention methods. $68 for members, $97 for nonmembers. Order #4834. http://store.aota.org/ view/?SKU=4834

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Occupational Therapy Practice Guidelines for Children and Adolescents With Challenges in Sensory Processing and Sensory Integration
R. Watling, K. Patten Koenig, P. Davies, & R. Schaaf sing an evidence-based perspective and key concepts from the Occupational Therapy Practice Framework: Domain and Process, 2nd Edition, this new AOTA Practice Guideline provides an overview and insight into occupational therapy evaluation and intervention for youth experiencing sensory processing and integration challenges. $69 for members, $98 for nonmembers. Order #2218. http:// store.aota.org/view/?SKU=2218

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As of May 10, 2012, the number of programs in the accreditation process totaled 369.
OT Doctoral OT Master’s OTA Total 306

ACOTE Seeks New Accreditation Evaluators

Accredited Programs 4 145 157 Programs With Developing Program Status 4 3 26 Applicant Programs 3 5 Total 11 153 22 205

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33 30 369

Additional information regarding occupational therapy accreditation may be obtained from the ACOTE Accreditation section of the AOTA Web page (www.acoteonline.org) or from AOTA accreditation staff at 301-652-6611, ext. 2914 or accred@aota.org.

AOTA Reminders

Leaders Wanted

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pplications are being accepted until June 15 for AOTA’s updated Leadership Development Program for occupational therapy managers who want to cultivate their power and influence in their
OT PRACTICE • JUNE 4, 2012

ou have until June 15 to submit your application for the Roster of Accreditation Evaluators (RAE). For the positions to be filled in January 2013, the Accreditation Council for Occupational Therapy Education (ACOTE) aims to recruit a diverse pool of accreditation volunteers. Doctorally prepared occupational therapy practitioners are especially needed and are strongly encouraged to apply. If you or someone you know would be well suited for this exciting and important volunteer position, download the Educator or Practitioner Application for Membership from the “Announcements & Newsletters” section of the ACOTE Web site at www.acoteonline. org or request an application from AOTA Accreditation staff at accred@aota.org or 301-6526611, ext. 2914. Applications should be completed and returned to accred@ aota.org or by mail to the ACOTE Accreditation Program, continued on page 4

Staying Updated in School-Based Practice
(CEonCD™) Y. Swinth & M. Muhlenhaupt Earn .15 AOTA CEU (1.88 NBCOT PDUs/1.5 contact hours) opics include current legislation such as IDEA 2004, NCLB, and Section 504 of the Rehabilitation Act. Ideas and approaches are presented that can be implemented by an individual occupational therapy practitioner or in collaboration with other colleagues or members of a school district team. Strategies are included to help participants find, use, and apply new information in their practice to promote student participation in the curriculum and across school activities. $51 for members, $73 for nonmembers. Order #4835. http://store.aota.org/ view/?SKU=4835

Sensory Integration: A Compendium of Leading Scholarship
C. Royeen & A. Luebben his book collects the latest research on, debates about, and trends for this timely topic and is ideal for occupational therapy practitioners, students, researchers, and health care professionals who seek to better understand this complex and fascinating field. $55 for members, $79 for nonmembers. Order #1248. http://store.aota.org/ view/?SKU=1248

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Bulletin Board is written by Amanda Fogle, AOTA marketing specialist.

Ready to order? Call 877-404-AOTA or go to http://store.aota.org Enter Promo Code BB

Questions? Call 800-SAY-AOTA (members); 301-652-AOTA (nonmembers and local callers); TDD: 800-377-8555

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c/o AOTA, P.O. Box 31220, Bethesda, MD 20824-1220.

Submit Presentation Proposal for AOTA’s 2013 Conference

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Infant/Toddler Sensory Profile®
Birth-3 years Parent/caregiver questionnaire

OTA is accepting presentation proposals for the 2013 Annual Conference & Expo, to be held in San Diego from April 25 to 28. Please share your practice innovations, research, and experience by submitting a proposal to present at the 93rd annual Conference. Papers may be submitted until June 19. For more, log on to the AOTA Web site (www.aota.org) and click on “Call for Papers.”

practice act in order to amend the definition of occupational therapy based in part on AOTA’s model definition of occupational therapy practice. The proposal included language stating, “Occupational therapy services are provided for habilitation, rehabilitation, and the promotion of health and wellness to those who have or are at risk for developing an illness, injury, disease, disorder, condition, impairment, disability, activity limitation, or participation restriction” as well as a provision to specifically mention orthotics and prosthetics within the definition.

Practitioners in the News
n Patty Coker-Bolt, PhD, OTR/L, Courtney Jarrard, OTR/L, C/ NDT, and Paige Merrill, OTR/L, recently published “The Effects of Oral Motor Stimulation on Feeding Behaviors of Infants Born With Univentricle Anatomy” in the Journal of Pediatric Nursing (doi:10.1016/j. pedn.2012.03.024). n Nancy A. Flinn, PhD, OTR/L, director of outcomes and research at Courage Center in Minnesota, recently received the CMS Innovation grant for $1.8 million to expand the facility’s medical home for persons with disabilities and complex health conditions. For more information, visit www.couragecenter.org. n Roger Smith, PhD, OT, FAOTA, RESNA, was selected to serve a 3-year term as a member of the National Advisory Board on Medical Rehabilitation Research, which advises the National Center for Medical Rehabilitation Research. For more on Smith, visit www4. uwm.edu/chs/faculty_staff/r_ smith.cfm. Andrew Waite is the associate editor of OT Practice. He can be reached at awaite@aota.org.
JUNE 4, 2012 • WWW.AOTA.ORG

Sensory Profile

®

Ages 3-10 Parent/caregiver questionnaire

Industry News

Sensory Profile® School Companion
Ages 3-11 Teacher questionnaire

Adolescent/Adult Sensory Profile®
Age 11 and older Self-questionnaire

Iowa to Revise Occupational Therapy Practice Act
owa recently passed legislation to revise the state’s occupational therapy practice act. As a result of advocacy by the Iowa Occupational Therapy Association (IOTA), the Iowa occupational therapy law includes a contemporary definition of occupational therapy, and the law makes clear that occupational therapists may provide orthotics and prosthetic services within the scope of occupational therapy practice. Last year, the state orthotics and prosthetics association introduced a licensure bill that raised concerns for IOTA because the legislation did not specifically mention occupational therapy. A compromise was reached to include a revision to the occupational therapy law rather than to add exemption to the orthotics and prosthetics bill. Unfortunately, the bill failed to pass in 2011. This year, IOTA sought to revise the occupational therapy

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Confidently evaluate sensory-related difficulties in clients of all ages
Rely on the Sensory Profile family to help you assess your client’s sensory processing abilities and the effect of the sensory system on an individual’s performance at home, school, and work. Each of these research-based questionnaires contains items specific to the environment in which the client’s performance is being assessed. These age-specific tools are designed to help you gather information from parents, teachers, and clients—so that you can develop more effective treatment plans, interventions, and everyday remediation strategies.
For more information or to place an order, visit SensoryProfile.com
800.627.7271

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PsychCorp.com

Copyright © 2012 Pearson Education, Inc., or its affiliate(s). All rights reserved. Always Learning, Pearson, design for Psi, and PsychCorp are trademarks, in the U.S. and/or other countries, of Pearson Education, Inc., or its affiliate(s). 6576 06/12 A3G

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CMS Proposes List of “Off-the-Shelf” Orthotics
Jennifer Bogenrief
as orthotics) to their own patients when these items are furnished as part of their professional services under a plan of care. Although occupational therapists do not have to submit bids, occupational therapists providing these items must accept the rates established by competitive bidding. We expect that competitive bid rates will be lower than present rates. Additionally, CMS recently announced that OTS items will not be included in the second round of competitive bidding, although the agency did publish the draft list and requested comments and has not issued a final list of OTS items. The letter expressed concerns about the perception that an item designated as OTS can be safely purchased without professional, therapeutic support. Major issues include efficacy and quality of items and possible additional injury caused by ill-fitting items purchased without occupational therapy oversight and care. AOTA provided a list of factors that create complexities that could cause significant hardship if not comprehensively addressed by a professional and that should eliminate items from being considered OTS, as such items require more than “minimal self-adjustment for appropriate use.” The factors include items with hinges or metal joints and items that provide torques, including turnbuckles and other attachments that must be adjusted over time. In the letter, AOTA recommended that CMS develop a stakeholder process to evaluate new HCPCS codes to determine whether they are appropriate for designation as OTS. AOTA members may access the comment letter and full list of factors with examples of codes on our Web site at www.aota.org/News/Advocacy News/Orthotics-Rates-Provided. aspx. AOTA will continue to monitor developments related to payment for orthotics; the latest information will be available on our Web site at www.aota. org under the Advocacy Highlights section. n

he Centers for Medicare & Medicaid Services (CMS) recently proposed a list of orthotics that identifies specific Healthcare Common Procedure Coding System (HCPCS) codes as “off-the-shelf” (OTS) orthotics. Until now, CMS has not defined OTS orthotics. The identification of OTS orthotics is important because it determines the rates that CMS will pay for items. (Note that splints provided by occupational therapists are considered to be orthotics by CMS and other payers.) If an item is included on the OTS orthotics list, then CMS will pay occupational therapists the competitive bidding rate for the item. Competitive bidding is a program to save money on durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS). Under the program, DMEPOS suppliers compete to become Medicare contract suppliers by submitting bids to furnish certain items in competitive bidding areas, and CMS awards contracts to enough suppliers to meet beneficiary demand for the bid items. The new, lower payment amounts resulting from the competition replace the Medicare DMEPOS fee schedule amounts for the bid items in these areas.

WHICH ITEMS SHOULD BE OTS ORTHOTICS?
Based on member feedback and collaboration with the American Physical Therapy Association and the American Society of Hand Therapists, AOTA submitted written comments to CMS. AOTA’s letter asserted that: As we have stated in the past, AOTA has great concerns about the dispensing and adjustment of some orthotics without professional management of care. While the designation of OTS is meant only in relation to the cost of an item, it conveys a view that all of these items can be safely purchased without professional, therapeutic support. We also have stated that the term “prefabricated” in the definition of a HCPCS Level II orthotic should not be interpreted to mean “OTS.” That is, just because an item is prefabricated does not mean that “one size fits all,” or that adjustments do not need to be made initially or over time.

“I THOUGHT OTS WERE EXEMPT FROM COMPETITIVE BIDDING”
They are! AOTA advocated for several years to achieve occupational therapist exemption from competitive bidding. In 2007, CMS specifically exempted occupational therapists in private practice (OTPPs) from participating in the competitive bidding process to allow OTPPs to continue to furnish certain types of competitively bid items (such
OT PRACTICE • JUNE 4, 2012

Jennifer Bogenrief is the manager of AOTA’s Reimbursement and Regulatory Policy Department. She can be reached at jbogenrief@aota.org.

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Bringing Money Management Interventions Into the 21st Century
Beth Cardell Amy Gneiting Brett Christensen
method of payment for each bill. The first bill states a positive balance, and the second is set up as an automatic withdrawal; therefore, no payment is required. At first glance, the third and fourth bills look identical. Upon further review, the client must determine that the older of the two bills is last month’s and has already been paid, leaving the fourth bill as the only one that requires payment. Bill number four requires payment through our simulated online bill pay Web site, located at www.health. utah.edu/ot/otiadl. The client must then navigate the Web site, refer to the bill for information, enter information (account number, amount due, and credit card details) into the appropriate fields, and select the correct payment method, deciding between two credit cards. Opportunities for error recognition are provided while using the Web site. If the information entered is incorrect, the client will receive an error message much like what a real Web site would create. of money management and technology, we created a Web site mimicking a real world executive function task, online bill pay.

echnology is becoming the norm in everything we do, from daily communication and getting directions to managing our money. Statistics show that in the past 9 years, monthly online bill pay has increased from 8% to 45%, and check use has actually decreased.1 The instrumental activity of daily living of financial management is highly associated with components of executive function such as working memory, attention to detail, sustained attention, novel problem solving, structuring ideas, developing action plans, mental flexibility, and inhibition.2–4 It is commonplace to see occupational therapy sessions that include writing out checks, balancing checkbooks, and looking up items in the phonebook.5–6 But to meet the emerging needs of our clients and to address the performance demands

ONLINE BILL PAY TASK
With this Web site, created as part of a student project at the University of Utah’s Division of Occupational Therapy, the client completes a complex task requiring several cognitive skills, including problem solving, attention to detail, planning, and judgment. The client is asked to review four bills and decide what actions need to take place. Only one bill requires payment, but this information has to be deciphered by reviewing the information provided on each bill. Problem solving and judgment are required to determine specific due dates, amounts due, and the

Some materials available on the University of Utah’s Division of Occupational Therapy Web site, www.health.utah.edu/ot/colleagues
Using the Site

HOW TO BEGIN USING THIS INTERVENTION
This intervention is currently free for therapists to access and use. The documents needed for the task can be printed off by visiting the University of Utah’s Division of Occupational Therapy Web site, at www.health.utah.edu/ot/ colleagues. The documents available include a brief background on the task, therapist instructions, documentation sheets, two credit cards, and four bills. To increase the “real life” appearance of the task, we recommend printing the credit cards in color and using card stock or lamination to give them a sturdy feel. The Web site, www.health. utah.edu/ot/otiadl, can only be used with these specific documents.
JUNE 4, 2012 • WWW.AOTA.ORG

Score Sheet

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PHOTOGRAPH COURTESY OF THE AUTHORS

The original intent of this project was to create a new item for the Performance Assessment of Self Care Skills (PASS)6 using the authors’ protocol. The online bill pay task cannot be used as an assessment at this point because the detailed research process of testing reliability and validity is still incomplete. A research team at the University of Utah is continuing this process, but in the meantime we wanted to make the Web site accessible as an intervention tool. The documentation sheets provided on the site resemble the score sheets used by the PASS, but at this time they are meant only to offer a way of documenting performance, not to assess cognition. The research team hopes that further testing and development of this item will lead to future use as an assessment. We presented this new online bill pay task to a group of community occupational therapists last year at Utah’s state occupational therapy conference and at AOTA’s Annual Conference & Expo in Philadelphia. The audiences provided positive feedback and were clearly excited to use the task as an intervention in practice. Suggestions were made for additional tasks that are

currently under development, including a bill pay task involving multiple bills and an online shopping task. Although this item was developed with executive function deficits in mind, it can also meet the needs of other populations. This tool can be used to educate individuals who may not have online experience—for example, older adults who are unfamiliar with technology, newly arriving refugees who have never used the Internet, and young adults transitioning to independent living. n

Neuropsychological Society, 15, 354–364. 5. Burton, C., Strauss, E., Bunce, D., Hunter, M. A., & Hultsch, D. (2009). Functional abilities in older adults with mild cognitive impairment. Gerontology, 55(5), 1–12. 6. Rogers, J. C., Holm, M. B., Goldstein, G., McCue, M., & Nussbaum, P. D. (1994). Stability and change in functional assessment of patients with geropsychiatric disorders. American Journal of Occupational Therapy, 48, 914–918. doi:10.5014/ ajot.48.10.914 7. Rogers, J. C., & Holm, M. B. (1997, April). Performance assessment of self-care skills, version 3.1 (PASS). Paper presented at the AOTA’s Annual Conference & Expo, Orlando.

Beth Cardell, MS, OTR/L, is an assistant professor

References
1. Fiserv. (2010). Merging payment and remittance information from all sources. Retrieved from http://www.fiserv.com/trends.htm 2. Jefferson, A. L., Paul, R. H., Ozonoff, A., & Cohen, R. A. (2006). Evaluating elements of executive functioning as predictors of instrumental activities of daily living (IADLs). Archives of Clinical Neuropsychology, 21, 311–320. 3. Knox, L., & Douglas, J. (2009). Long-term ability to interpret facial expression after traumatic brain injury and its relation to social integration. Brain and Cognition, 69, 442–449. 4. Possin, K. L., Brambati, S. M., Rosen, H. J., Johnson, J. K., Pa, J., Weiner, M. W.,...Kramer, J. H. (2009). Rule violation errors are associated with right lateral prefrontal cortex atrophy in neurodegenerative disease. Journal of International

(clinical) at the University of Utah, Division of Occupational Therapy. Her research interests include occupation-based interventions for people with cognitive disabilities. Amy Gneiting, MOTR/L, is a recent graduate of the University of Utah, Division of Occupational Therapy, and is currently employed at Aspen Ridge West, a skilled nursing facility in Salt Lake City, Utah. Brett Christensen, MOTR/L, is a recent graduate of the University of Utah, Division of Occupational Therapy, and is currently employed in early intervention at Jordan School District in Salt Lake City.

Will you be my OT for Life? Or better yet, my Wife? Dear Sarah Marie, Will you marry Me?

b

B

P-6046

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Sports

hich sport do you recommend for her?” asked Anna’s mother during an intervention session. Anna already participated competitively in soccer and swimming, and her mother was interested in which sports—those or something else—best matched her sensory processing challenges. Practitioners who are employed in clinics, hospitals, and schools with clients who have sensory processing disorders (SPDs) are often asked what sports clients can or should play, and providing answers can be tricky. Activity and sport involvement for children with SPDs is a topic that combines knowledge from the fields of sensory integration, sport, exercise science, and coaching. Knowledge of how our clients are affected by their sensory sensitivities is just one piece of the puzzle; it is also necessary to understand more about sport science and how sport is seen in our society. To improve the quality of our sport and activity recommendations, we need to understand benefits and challenges of involvement in sport, why people participate in sports, and family expectations about sport involvement.
8

for Children With Sensory Processing Disorders
A GUIDE FOR OCCUPATIONAL THERAPY PRACTITIONERS
JACKIE KIRKPATRICK

W

Working with children, families, and coaches to choose and participate in the sports—team or individual, competitive or leisure—that best match children’s sensory processing skills.

BENEFITS OF EXERCISE
Children across the United States are experiencing a decrease in fitness, and the highest level of childhood obesity has been recorded over the last few years.1 With this rise in obesity, occupational therapists have been encouraged to develop programs for children that increase activity levels and reinforce healthy living strategies throughout their community.2 Researchers and physicians recommend that preschool and school-aged children should participate in at least 1 hour of moderate exercise a day.2–3 Along with the cognitive benefits of exercise,3 participation in sport, as outlined in a National Association for Sport and Physical Education (NASPE) position paper, can promote fitness, social skills, motor skills, enjoyment of activities, sportsmanship, and self-confidence.4 Benefits of such activity for children with attention deficit hyper-

activity disorder (ADHD), for example, include improved strength, motor skills development, friendships, self-esteem, and confidence.5–7 Children with ADHD who played on three or more sport teams were reported to have significantly fewer anxiety or depression levels than those who participated on fewer teams.8 Of course, other benefits of sport and exercise exist beyond just health. Whereas adults reported participating in sports to maintain a sense of achievement, develop skills, relieve stress, and form support groups, children are reported to be motivated mainly by enjoyment and social interaction, and an interest in trying new sports.9 Indeed, children find participation in sports more enjoyable when they are not forced to compete to win.8–9 For teens, body shape, weight management, social opportunities, and family support are motivating reasons for participating in
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PHOTOGRAPH © bLUE jEAN IMAGES / GETTY FOR ILLUSTRATIVE PURPOSES ONLY. CHILD IS A MODEL.

exercise.9 Many of our negative and positive self-perceptions and stereotypes can be reinforced during youth sport experiences.3,9 Therefore, it is important to try to select a sport or an activity that can meet the child’s physical, emotional, and social, as well as therapeutic, needs.

MANAGING EXPECTATIONS
Family reasons for having a child participate in a particular sport are important to acknowledge. Parents may have unrealistic expectations about what sport a child should participate in and how the child needs to perform in that sport. Children with SPDs, for example, may benefit from a less formalized team sport that creates fewer stressors for social interaction and/or performance.7,10 Activities like bowling or marital arts, which still provide exerOT PRACTICE • JUNE 4, 2012

PHOTOGRAPH © STEVEN WIDOFF / ISTOCKPHOTO FOR ILLUSTRATIVE PURPOSES ONLY. CHILD IS A MODEL.

cise and leisure benefits, may be better suited to some children than more traditional sports like football, basketball, or cheerleading.11 It is important to be sensitive to how the parents feel about sport as it may influence how readily they accept some suggestions; they may need to be reminded that children want sports to be fun.4 The NASPE has a comprehensive self-assessment tool to advise parents on their role in developing safe boundaries with sports and their child.12

fatigue resistant and found in prolonged endurance athletes who participate in marathons, swimming, speed skating, and cross country skiing; and fast twitch (FT) muscle fibers, which generate quick actions that are important for stop-and-change sports like basketball, soccer, and lacrosse. Genetically determined, the ratio of FT to ST fibers is different for each person.13–15 Typically, the muscle fibers of both genders are 45% ST and 55% FT. Some children with SPDs, like anyone else, may be genetically predisposed for endurance motor tasks while others may be better suited to explosive, short duration sports. Muscle tone is another area to consider, as the SPD population typically presents with lower-than-average muscle tone, regardless of their percentage of ST-to-FT fibers. Low muscle tone means more work for bodies to recruit muscle fibers for a specific task. Tennis, a sport that requires constant quick muscle responses, would be challenging for children with SPDs who have low tone because of the extra energy the sport requires to stabilize one’s trunk and arm muscles to hold a racquet and hit a ball. Some sports allow the body more time to recruit muscle fibers for movement, such as the warm-up swing in golf or the bouncing of the ball in tennis—an important consideration for many of our SPD clients. In discus, the athlete swings his or her arm back two to three times to increase the force of the throw; this swinging/recoil action allows the child with sensory issues to give the muscle fibers more time to respond to messages for muscle stabilization. In children with lower muscle tone, there may also be a predisposition for joint laxity and, therefore, an increase in some types of injuries, indicating the need for lower impact types of sports such as bowling, canoeing, and swimming.

SPORTS AND ACTIVITIES FOR CHILDREN WITH SPDS
Many of our clients with SPDs have comorbid challenges with ADHD, autism spectrum disorders, learning disabilities, developmental delays, and behavioral and/or emotional issues.10 Any or all of these difficulties affect people’s abilities to function and complete their daily living skills efficiently at home, in
9

EXERCISE SCIENCE FOR CHILDREN WITH SPDS
Occupational therapists recommending sports for children with SPDs must consider a client’s muscle strength, including the relative prevalence of slow twitch (ST) muscle fibers, which are

Table 1. Sport Strength Profile: Anna
Strengths of the Child
(vestibular, visual, tactile, proprioception, and auditory)

Challenges for the Child
• Vestibular sensitivity to rotation • Decreased visual tracking and processing • Weak bilateral coordination • Weak praxis-motor planning, projected action sequences, and feedback • Weak hand–eye coordination

Sensory Needs

• Proprioceptive seeker • Manages auditory input • Mild tactile sensitivities, managed well • Core stabilization good • Low muscle tone— hands/shoulders • Overall strength good • Body awareness good

Motor Coordination Skills
(ease of learning new skills, muscle tone, strength, tendency for injury)

Organizational and Social Skills

(attention, energy level, impulsivity, social abilities, regulation level, motivation, interest in sport)

• Regulation level varies • Good social skills • Previous team experiences— widely throughout day soccer, swimming • Good attention to task • Energy level good • Interested in sport

school, and within the community. In one study, children with SPDs preferred less structured play and were found to participate less in team sports (50%) than their peers (92%).10 But children who tended to be sensation seeking showed higher preference for participating in sports.16 Children who had sensitivities to smell, auditory input, and vision, and/or low energy, had low preference for social activities. Individual sports are recommended for children with ADHD because these activities allow the child to maximize focus.11 An individual sport like swimming uses repetitive movements that facilitate the child’s concentration level and encourage calmness.11 Some individual sports, such as bowling, swimming, track and field, and martial arts, allow the athlete to be part of a larger team, giving the child the benefit of a group experience without the stresses of being a player on a team.11 Sports that provide immediate feedback, as when striking a golf ball, can help children with ADHD to focus their attention.11 Research by Vickers suggested that children with ADHD work on activities like swimming or golf that develop sustained visual attention skills.17

DOCUMENTING STRENGTHS AND CHALLENGES
In helping select sports for children with SPDs, occupational therapists

Table 2. Sensory Profile Example: Soccer
Characteristics/Environment:
• Played outside primarily • Unpredictable environment • Speed of game is not controllable. Mostly fast paced • Team sport—competitiveness varies • Can be played at all ages • Can be recreational or competitive • Need to be able to follow directions of coach in practice and games • Equipment to wear: shin guards, cleats, and socks • Uniform shirts • Body contact with other players—pushing and shoving to get to ball • Feel of the ball, can get dirty/muddy • Feel of ground/grass if player falls • Goalie—wears extra shirt and gloves • Weather variability—could be hot, cold, windy, rainy, etc. • Tracking ball on field • Constant activity/unpredictable movement of people and ball • Many kids on field at same time • Need to know where to be on field • Safety awareness while running and kicking

Tactile:

Vestibular-Proprioceptive/Motor Coordination:

• Requires fair–good coordination • Change motor plan in middle of action • Skills—kick and dribble ball with feet • Need to determine light vs. hard pushing of other players • Ball hitting kids while playing • Force to kick ball when ball is moving • Lots of linear movement and jumping

Olfactory/Gustatory:

• Outdoor smells, grass • Sunscreen and bug spray • Cold water kids drink while playing • Chewing on clothes

Visual:

• Whistle blowing • Parents/kids/coach/referee yelling • Sound of running on field • Environmental noise—insects and airplanes; some playing fields have many games going on at one time—very noisy

Auditory:

10

JUNE 4, 2012 • WWW.AOTA.ORG

PHOTOGRAPH © HéLèNE VALLéE / ISTOCKPHOTO FOR ILLUSTRATIVE PURPOSES ONLY. PEOPLE ARE MODELS.

should review the child’s sensory needs, motor coordination/praxis, and organizational and social skills, based on results from standardized assessments like the Sensory Integration and Praxis Tests,18 Sensory Processing Measure,19 and Bruininks-Oskersky Test of Motor Proficiency20 as well as clinical observation. Review and determine which areas affect their involvement in a sport—for example, is the child a sensory seeker who loves vestibular and proprioceptive input? The child’s preferences for certain sports, in terms of motivation to play a particular sport, should also be considered. Understanding the child’s motor coordination and praxis level is crucial in sport selection; if a sport’s motor organization requirements are too complex, the child will not want to participate. Consider muscle tone: Does the child have the postural skills to run over an uneven field or hold a racquet or stick? Is he or she able to throw and catch a ball consistently? Follow twostep directions more than half the time? Analyze the child’s organizational and social abilities in the areas of energy level, impulsivity, attention to task, and ability to follow directions. The child’s regulation level, social interaction skills, previous sport experience, and motivation to participate in sports should also be documented. What is the child’s overall energy level and how well does the child self-regulate in different environments? A high energy level is a definite strength when selecting sports like cross country running or skiing. Children with relatively low energy levels may not have the stamina to play a running game like basketball. See Table 1 on p. 10 for a sample sport strength profile. In addition to understanding the child’s sensory strengths and challenges, the sensory aspects of each sport needs to be appreciated. Every sport has its own sensory profile, too—the visual, auditory, olfactory, tactile, vestibular-proprioceptive, and gustatory aspects. The environment in which a sport is played can also affect how well a child performs—a noisy and smelly gym can be a challenging environment for children with auditory and spatial difficulties, for example. See Table 2 on p. 10 for a sample sensory profile of soccer. Most sports
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Table 3. Characteristics of Sports for Children With Sensory Issues
Static Sports Bowling Fishing Diving Swimming Hiking Archery Rock climbing Trampoline Martial arts Track and field Yoga Dynamic Sports Less dynamic Skiing Skating Fencing Volleyball Cycling Wrestling Racquet sports Horseback riding Baseball More dynamic Ultimate Frisbee Basketball Soccer Lacrosse Football Field hockey Dance Lower Energy Sports Bowling Fishing Archery Hiking Recreational cycling Baseball Martial arts Horseback riding Golf Table tennis Yoga High Energy Sports Basketball Track and field Cheerleading Cross country Dance Rock climbing Hockey Mountain cycling BMX bike racing Extreme sports Skiing Tennis Soccer Lacrosse Vestibular Sports Track and field Football Gymnastics Trampoline Basketball Wrestling Lacrosse Cheerleading Hockey—ice or field Cycling Skating—ice or roller Sky diving, hang gliding Tennis & other racquet sports Dance Tactile Sports Wrestling Soccer Basketball Swimming/Diving Hockey Canoeing/kayaking Hiking Fishing Trampoline Gymnastics Auditory Sports Higher Basketball Soccer Bowling Soccer Volleyball Sports in A gym Dance Cheerleading Lower Swimming Archery Skating Hiking Fishing Sailing Canoe Kayak Martial arts Proprioceptive Sports Football Water polo/ Swimming Soccer Basketball Lacrosse Hockey—ice or field Wrestling Visual Higher Baseball Basketball Cycling Racquet sports Most team sports Lower Fishing Bowling Swimming Individual Sports Swimming* Wrestling* Bowling* Rock Climbing* Archery* Track and field* Cycling* Sailing* Fencing* Hiking Martial arts* Tumbling* Horseback riding Fishing Tennis* Table tennis Badminton* Canoeing Yoga Kayaking Skiing* Geocaching *Can also be part of a team

Motor Coordination (varies with task and sports level)
Dog paddle Jogging

Low

Front crawl Running in gym Fencing Golf Bike riding Canoeing Sky Diving

Breast stroke Running on trail Cheerleading Basketball Soccer Lacrosse Floor Hockey

High

can be organized within the following five categories in addition to their sensory characteristics. See Table 3 for categories of sports based on these five characteristics as well as their most prominent sensory features. Energy requirements. High energy sports include basketball, tennis, and ice hockey, which all require continuous movements. Lower energy sports, including bowling and fishing, are less

Trampoline bounce Archery Hiking Bowling Jogging

_______________ Sports examples ________________

physically demanding. Pick a sport or activity that matches the energy needs of the child.11 This is especially important with a child’s first experience with a sport. Dynamics. With dynamic sports, such as soccer, basketball, and lacrosse, the players and their positions on the field change constantly. Individual
11

Sensory Processing Challenges in the Schools
Learning “High,” “Low,” and “Just Right” Speeds
SERENA ZEIDLER

N

ina is a 9-year-old girl with a diagnosis of Asperger’s syndrome. She receives special education instruction within an integrated (inclusion) fourth-grade class model. Nina is easily distracted and has trouble attending to classroom lessons. She is very sensitive to loud noises and becomes anxious and loses focus in anticipation of fire drill alarms and assemblies. Nina needs an adult to stay close by, as any sensory issue that she is experiencing must be addressed immediately or her behavior usually escalates and becomes difficult to control. Given the issues that Nina has, how can occupational therapy help? Schoolbased occupational therapy practitioners often provide services to students like Nina, whose sensory processing difficulties affect their school participation and performance. Sensory processing disorders are “impairments in detecting, modulating, interpreting, or responding to sensory stimuli” (p. 229).1 Students with this type of disorder may experience difficulty paying attention in the classroom. Sensory modulation disorder is a type of sensory processing disorder that occurs when there is impairment in the

Implementing a 6-week evidence-based self-regulation program to treat sensory modulation disorders at a suburban New York public elementary school.
ability to regulate the degree, intensity, and nature of responses to sensory input.1 Occupational therapy practitioners can apply sensory integration theory to treat sensory modulation disorders through programs that implement selfregulation strategies.2 Self-regulation has been described as “the ability to modulate the intensity, frequency, and duration of verbal and motor acts in social and educational settings” (p. 5).3 The Alert Program (How Does your Engine Run? Alert Program for Self-Regulation), was founded by occupational therapists Williams and Shellenberger to teach children to change how alert they feel to facilitate learning, attending, and positive behaviors.4 The Alert Program consists of lessons that use sensorimotor activities and strategies based on sensory integration theory. Children learn how to regulate their own arousal states so they can respond efficiently to the demands of a situation or task.4 This article describes the implementation of a 6-week evidence-based self-regulation program at a suburban New York public elementary school, with particular emphasis on the effect of self-regulation on students’ ability to attend to task. School-based occupational therapists often receive referrals for children with sensory-based attentional issues and use a variety of strategies to improve on-task behaviors and participation. This intervention explored whether the Alert Program, a comprehensive self-regulation program based on sensory integration theory, was an effective school-based intervention to improve attention to task in 7- to-10year-old students with sensory processing difficulties. Seven students participated in the intervention. Six of the students had conditions on the autism spectrum, and one student was diagnosed with attention deficit hyperactivity disorder. The program was designed to promote awareness to students, teachers, and parents of how arousal states can be regulated through using sensory
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14

PHOTOGRAPH COURTESY OF THE AUTHOR

strategies both in school and at home. As the occupational therapist conducting the evidence-based intervention, I introduced the program to students, teachers, and parents, and provided all training and follow up.

SUPPORT FROM THE LITERATURE
The literature provided supporting evidence for the intervention. When using a sensory-based approach, specific sensory stimulation is provided. The key assumption in sensory-based approaches is that targeted sensory input leads to the remediation of impaired sensory processes.5 Various sensory-based strategies are used by occupational therapy practitioners to address sensory processing difficulties. Multiple studies have reported an improvement in attention to task and behaviors using sensory-based approaches and interventions.6–11 Post et al. provided evidence to support self-regulated learning.3 The authors recommended that researchers identify the skills needed for self-regulation and find ways to help children learn to organize, modify, and regulate responses in order to improve their conscious control. Cohn, Miller, and Tickle-Degnen identified self-regulation as one of the three main child-focused areas about which parents of children with sensory modulation disorder were most concerned.12 The Alert Program is a group intervention commonly used by occupational therapy practitioners to address sensory modulation needs.13 Barnes, Vogel, Beck, Schoenfeld, and Owen evaluated the use of the Alert Program in a public school classroom to increase self-regulation behaviors in children with emotional disturbances.14 Such children can often experience problems with learning and sensory processing, and studies have shown that these children frequently show deficits in processing sensory environmental information.14 The results of the study suggested that the Alert Program may have contributed to improved sensory processing skills in the classroom. Salls and Bucey used the Alert Program to teach self-regulation strategies to middle school students in a classroom-based setting.15 Although results were not analyzed statistically, the collaborative-based program was found to be effective in strengthening
OT PRACTICE • JUNE 4, 2012

Engine Speedometer Hand Presses

Wall Push-ups

self-awareness, creative problem solving, and sensory regulation. The program fostered greater awareness of occupational therapy in the middle school environment, and it provided a costeffective model for best practice in the school setting.

STEPS OF THE INTERVENTION
My first step in conducting the intervention was to obtain written consent from the administration of the school district. I then established inclusion and exclusion criteria. The Sensory Profile School Companion was completed by classroom teachers and used to identify students from my caseload who demonstrated sensory processing difficulties that affected their school performance.16 Inclusion criteria also required that students be ages 7 to 10 years, which reflected the needs and availability of

students in the elementary school, and to have reported difficulties with on-task behavior in the school environment. Students who had previously completed a formal program in self-regulation were excluded. Institutional Review Board approval was received, and then parent consent and child assent was obtained. When identifying students for the intervention, the views of the classroom teacher and speech therapist were taken into consideration. I developed a list of students who were being considered for the planned intervention and then met with the classroom teacher of each of these students. I provided a brief overview of the Alert Program, and I discussed the possibility of the student’s inclusion in the intervention. Teachers had the opportunity to share their thoughts on whether the student could understand the basic concepts of the Alert Program, and if they felt that the student could benefit from the program. For students who were receiving speech-language services, I also sought input from the speech therapist to determine whether the student’s verbal comprehension skills were sufficient to understand the underlying concept of the Alert Program: “If your body is like a car engine, sometimes it runs on high, sometimes it runs on low, and sometimes it runs just right” (p. 2-1).4 I carefully considered the input received from the classroom teacher and speech therapist when identifying appropriate students for the program. The 6-week Alert Program intervention was included in each student’s individualized education program (IEP). Each student’s IEP documented the presence of attention difficulties within the school setting. The Physical Development section of the IEP included a statement documenting sensory processing difficulties that impact classroom/school performance, and the IEP included an occupational therapy goal reflecting the need to develop sensory-based selfregulation strategies to increase on-task participation in school activities. To evaluate the effectiveness of the intervention, I developed two scales to document baseline and outcome levels of attention. Teachers completed a Teacher Observation Scale, in which they answered questions about each student’s ability to pay attention and the
15

PHOTOGRAPHS COURTESY OF THE AUTHOR

Table 1. Overview of Alert Program Intervention
Session
1 SelfReport Scale

Goal
Students learn engine words.

Activity
• Introduce engine analogy. • Engine Speed Guessing Game and Collages

Materials
• Sample of laminated pictures of people with high, low, and just right engines (from Alert Program Manual) • Large laminated poster with words HIGH in red, JUST RIGHT in green, and LOW in yellow • Poster putty 52 - 3x4 inch playing cards picturing boys, girls, and animals in high, low, and just right levels of alertness • Caterpillar cloth tunnel • Scooterboard • Large pillows • Therapy ball White paper plates, scissors, brass paper fasteners, markers, pencils and/or crayons, stickers Engine Tune-Up Tools for the Mouth grid from Alert Program Manual (1 per student), pencils, oral-motor inputs Copies of Ways to Move pictures from Alert Program Manual

Procedure
• Students guess a person’s engine speed from pictures presented. • Students create engine collage by matching and attaching engine speed pictures to corresponding sections on the poster. • OT labels own engine level. Students follow directions to play Alert: Go Fish! and Alert Concentration. While students complete obstacle course, OT comments on students’ engine speeds. Students fabricate engine speedometer. Students try out different oral motor inputs (sour, sweet, spicy, salty, crunchy, chewy; licking, sucking, biting, pulling, blowing) and mark box on grid accordingly. Introduce how moving our bodies can change engine levels. Students experience ways to move: front/back, up/down, circles, upside down, crash/ bump, and heavy work (to muscles). Attach funnel into balloon opening. Use spoon to scoop beans into funnel. Use coffee stirrer to push beans into balloon. Remove balloon from funnel when approximately half full. Knot top of balloon. Introduce visual and auditory inputs.

2

Students learn engine words and identify “engine speeds.” Students develop awareness of the feel of their engine speeds. Students learn to identify and label levels for themselves. Students are introduced to sensorimotor methods to change engine levels. Students are introduced to sensorimotor methods to change engine levels. Students are introduced to sensorimotor methods to change engine levels.

Alert: Go Fish!

3

Obstacle Course

4

Engine Speedometers Engine Tune-Up Tools for the Mouth

5

6

Engine Tune-Up Tools for the Body

7

Engine Tune-Up Tool for the Hands

• Assorted beans (lentil, kidney, pinto) and barley • Balloons, funnel, spoon • Sample of tactile inputs such as Koosh balls, stuffed animals • Variety of visual inputs: toys, pictures • CD player • Variety of CDs • Test Drive CD • 3x5 cards printed with five ways to change engine speeds • Cards for the mouth, body, hands, eyes, ears (in Appendix) • Alert Bingo game • 3x5 cards used in session 9. • “When I Want to Keep My Engine Running” chart “Keeping On Track: Alert Program Companion Board Game”

8

Students are introduced to sensorimotor methods to change engine levels. Students begin experimentation with choosing strategies.

Engine Tune-Up Tools for the Eyes and Ears

9

Sorting Engine Tools

• Students match engine speed cards to the cards for mouth, body, hands, eyes, and ears. • Students play Alert Bingo game. Students complete chart describing specific strategies used to change engine speeds. Students answer questions pertaining to engine speed levels and ways to change engine levels.

10

Students choose strategies independently. Students learn to change engine levels in varying settings.

Customizing Engine Care Board game that encourages problem solving and independent self-regulation Develop plan to implement engine strategies within the classroom setting.

11

12 SelfReport Scale
16

Therapist shares effective strategies with classroom teacher.

Self-developed “Tools for the Classroom” chart

Students chart appropriate and preferred tools for classroom use.

JUNE 4, 2012 • WWW.AOTA.ORG

PersPecTives

Chai and Biscuits

s
20

Strategies to Create a Collaborative International Occupational Therapy Experience
Asha Asher

imilar to many fellow therapists, I was inspired by AOTA’s Centennial Vision of our profession to promote collaboration within the global occupational therapy community. For that and other reasons, I was very excited to be awarded a Fulbright grant funding my recent project in India as a visiting lecturer on “Enhancing Services for Students With Developmental Disabilities Through Collaboration Between Occupational Therapy and Special Education.” I trained as an occupational therapist in Mumbai, India, in 1977 and worked there for 8 years. I subsequently spent 25 years providing pediatric services in Belgium, Canada, and the United States. I thought returning to work in India as a Fulbright Scholar would be easy because of my cultural connections. Wrong! I still had to use the skills developed over the years to negotiate cultural differences and experience a truly collaborative international exchange. The following are some tips and the insights I gained as a Fulbrighter that I hope may assist other international sojourners in planning successful ventures.

Asha Asher (center) lights the ceremonial lamp to inaugurate the lecture series. Looking on are Dr. Jyothika Bijlani (left), former professor and head of the occupational therapy school and center, LTMM College; and Dr. Nirmala Barse (right), deputy dean, LTMM College.

INITIATING AN INTERNATIONAL PROJECT
I suggest that you start by identifying why you want to participate in a particular experience. Recognizing that you stand to gain as much as you will give will help to establish a mutually respectful exchange with your hosts. Our understanding of a foreign culture is interpreted through media reports that unfortunately are generally sensational. Reflecting on your reasons for the exchange will also

allow you to recognize the bias you bring to the interaction. My intent was to “give back” to the institution that shaped my professional career. By extending my work further in India and Sri Lanka, I gained invaluable insights into the similarities and differences of providing pediatric occupational therapy services globally.

additional resources exist for funding your project.1–2

SETTING UP YOUR PROGRAM
You will need local support to facilitate your project. To establish connections within specific countries, I used the World Federation of Occupational Therapists Web site (www.wfot.org) and the individual national occupational therapy associations, my Fulbright connections, and my contacts with special schools cultivated earlier. I worked with my contact at my host affiliation, the occupational therapy school at LTMMC, Mumbai, to understand their needs and to clarify what I could and could not do within the limitations of my stay. Although
JUNE 4, 2012 • WWW.AOTA.ORG

SECURING FUNDING
The Fulbright Scholars Program is administered by the Council for International Educational Services, a division of the International Institute of Education (see www.cies.org for more information). It has many different grant categories that you can take advantage of. A number of other

PHOTOGRAPH COURTESY OF VIKRAM ASHER

cAleNdAr
To advertise your upcoming event, contact the OT Practice advertising department at 800-877-1383, 301-652-6611, or otpracads@aota.org. Listings are $99 per insertion and may be up to 15 lines long. Multiple listings may be eligible for discount. Please call for details. Listings in the Calendar section do not signify AOTA endorsement of content, unless otherwise specified. Look for the AOTA Approved Provider Program (APP) logos on continuing education promotional materials. The APP logo indicates the organization has met the requirements of the full AOTA APP and can award AOTA CEUs to OT relevant courses. The APP-C logo indicates that an individual course has met the APP requirements and has been awarded AOTA CEUs. July Lymphedema Management. Certification courses in Complete Decongestive Therapy (135 hours), Lymphedema Management Seminars (31 hours). Coursework includes anatomy, physiology, and pathology of the lymphatic system, basic and advanced techniques of MLD, and bandaging for primary/secondary UE and LE lymphedema (incl. pediatric care) and other conditions. Insurance and billing issues, certification for compression-garment fitting included. Certification course meets LANA requirements. Also in Palm Beach Gardens, FL, July 14–24. AOTA Approved Provider. For more information and additional class dates/locations or to order a free brochure, please call 800-863-5935 or log on to www.acols.com. Introduction to Driver Rehabilitation. Course designed for individuals new to the field of driver rehabilitation. Topics include program development, driver training, adaptive driving equipment, and program documentation. Course will also emphasize collaboration with mobility dealers and consumers and families. Contact ADED 866-672-9466 or visit our Web site at www.aded.net.
interventions and document. Topics include: visual inattention and neglect, eye movement disorders, hemianopsia and reduced acuity. Faculty: Mary Warren PhD, OTR/L, SCLV, FAOTA. Also New Orleans, LA, March 9 to 10, 2013. Contact: www.visabilities. com or (888) 752-4364, Fax (205) 823-6657.

Continuing Education Sensory Integration Certification Program by USC/WPS Philadelphia, PA: Course 2: July 12 – 16 Santa Rosa, CA: Course 1: July 12 – 16 Los Angeles, CA: Course 4: Aug. 24, 25, 26 & Sept. 8, 9 For additional sites and dates, or to register, visit www.wpspublish.com or call 800-648-8857
D-5784

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Baltimore, MD

Jul. 14–24

October

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Jul. 27–28

tion of Part I course, this intense practicum provides hands-on experience in administering, interpreting, and using evaluation results to develop intervention for visual processing deficits including eye movement disorders, hemianopsia, reduced visual acuity, and visual neglect. Offered only once a year. Faculty: Mary Warren PhD, OTR/L, SCLV, FAOTA. Also Boston, MA, November 8–10, 2013. Contact visAbILITIES Rehab Services: www.visabilities.com or (888) 752-4364, Fax: (205) 823-6657

Eval & Intervention for Visual Processing Deficits in Adult Acquired Brain Injury Part II. Continua-

Oct. 12–14

Susan bazyk, PhD, OTR/L, FAOTA. This important new SPCC provides a framework on the role of occupational therapy in mental health interventions for children that can be applied in all pediatric practice settings. The public health approach to occupational therapy services at all levels puts an emphasis on helping children develop and maintain positive mental health psychologically, socially, functionally, and in the face of adversity. Earn 2 AOTA CEUs (20 NbCOT PDUs/20 contact hours). Order #3030, AOTA Members: $370, Nonmembers: $470. http:// store.aota.org/view/?SKU=3030

Mental Health Promotion, Prevention, and Intervention With Children and Youth: A Guiding Framework for Occupational Therapy. Edited by

AOTA Self-Paced Clinical Course

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Application of Vehicle Modifications. Course

Jul. 27–28

Internet & 2-Day On-Site Training

designed for those desiring knowledge of adaptive driving equipment as well as the process for prescribing and delivering such equipment to individuals with disabilities. Contact ADED 866-672-9466 or visit our Web site at www.aded.net.

Become an Accessibility and Home Modifications Consultant. Instructor: Shoshana Shamberg,

ADED Annual Conference and Exhibits. Professionals specializing in the field of driver rehabilitation meet annually for continuing education through workshops, seminars, and hands-on learning. Earn contact hours for CDRS renewal and advance your career in the field of driver rehabilitation. Contact ADED 866-672-9466 or visit our Web site at www. aded.net. September

Kansas City, MO

Jul. 29–31

OTR/L, MS, FAOTA. Over 22 years specializing in design/build services, technologies, injury prevention, and ADA/504 consulting for homes/jobsites. Start a private practice or add to existing services. Extensive manual. AOTA APP+NbCOT CE Registry. Contact: Abilities OT Services, Inc. 410-358-7269 or info@aotss.com. Group, COMBO, personal mentoring, and 2 for 1 discounts. Calendar/info at www.AOTSS.com. Seminar sponsorships available nationally.

Chandler, PhD, OTR/L, FAOTA. This course is an enlightening journey through occupational therapy with children at the earliest stage of their lives. Explores the driving force of federal legislation in occupational therapy practice and how practitioners can articulate and demonstrate the profession’s long-standing expertise in transitioning early childhood development into occupational engagement in natural environments. Earn 2 AOTA CEUs (20 NbCOT PDUs/20 contact hours). Order #3026, AOTA Members: $370, Nonmembers: $470. http://store. aota.org/view/?SKU=3026

Early Childhood: Occupational Therapy Services for Children Birth to Five. Edited by barbara E.

AOTA Self-Paced Clinical Course

Clinician’s View Offers Unlimited CEUs

Two great options: $177 for 7 months or $199 for 1-Full Year of unlimited access to over 640 contact hours and over 90 courses. Take as many

Kavanaugh Scheinholtz, MS, OT/L. A comprehensive discussion of recent advances and trends in mental health practice, including theories, standards of practice, and evidence as they apply to occupational therapy. Includes content from several federal and non-government entities. Earn 2 AOTA CEUs (20 NbCOT PDUs/20 contact hours). Order #3027, AOTA Members: $370, Nonmembers: $470. http://store.aota.org/view/?SKU=3027

Occupational Therapy in Mental Health: Considerations for Advanced Practice. Edited by Marian

AOTA Self-Paced Clinical Course

courses as you want. Approved for AOTA and bOC CEUs and NbCOT for PDUs. www.clinicians-view. com 575-526-0012.

Dysphagia Care and Related Feeding Concerns for Adults, 2nd Edition. Edited by Wendy Avery,

St. Louis, MO

Envision Conference 2012. Learn from leaders in

Sept. 12–15

AOTA Self-Paced Clinical Course

the field of low vision rehabilitation and research while earning valuable continuing education credits. Attend the multi-disciplinary low vision rehabilitation and research conference dedicated to improving the quality of low vision care through excellence in professional collaboration, advocacy, research, and education. Envision Conference, September 12–15, 2012, Hilton St. Louis at the ballpark. Learn more at www.envisionconference.org.

Syracuse, NY

Eval & Intervention for Visual Processing Impairment in Adult Acquired Brain Injury Part I. This

Sept. 29–30

intensive updated course has the latest evidence based research. Participants learn to identify visual processing deficits, interpret evaluations, develop
OT PRACTICE • JUNE 4, 2012

Edited by Margaret Christenson, MPH, OTR/L, FAOTA, and Carla Chase, EdD, OTR/L, CAPS. This new SPCC consists of text, exam, and a CD-ROM of hundreds of photographic and video resources that provide education on home modification for occupational therapy professionals. Practitioners who work with either adults or children will find an overview of evaluation and intervention, detailed descriptions of assessment tools, and guidelines for client-centered practice and occupation-based outcomes. Earn 2 AOTA CEUs (20 NbCOT PDUs/ 20 contact hours). Order #3029, AOTA Members: $370, Nonmembers: $470. http://store.aota.org/view/ ?SKU=3029

Occupational Therapy and Home Modification: Promoting Safety and Supporting Participation.

MS, OTR/L. Provides occupational therapists at both the entry and intermediate skill levels with an up-to-date resource in dysphagia care, written from an occupational therapy perspective. Earn 1.5 AOTA CEUs (15 NbCOT PDUs/15 contact hours). Order #3028. AOTA Members: $285, Nonmembers: $385. http://store.aota.org/view/?SKU=3028

AOTA Self-Paced Clinical Course

barbara Hanft, MA, OTR, FAOTA, and jayne Shepherd, MS, OTR, FAOTA. Engages school-based occupational therapists in collaborative practice with education teams. Identifies the process of initiating and sustaining changes in practice and influencing families/education personnel to engage in collaboration with occupational therapists. Perfect for learning to use professional knowledge and interpersonal skills to blend hands-on services for students with

Collaborating for Student Success: A Guide for School-Based Occupational Therapy. Edited by

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Earn Your CEUS. As Many As You Want. Only $99/year.
A subscription to OccupationalTherapy.com keeps it simple!
Experience online continuing education on your time. Access expert courses in live, recorded, podcast and text-based formats. Earning your CEUs has never been more convenient and a ordable.

Take advantage of this month’s most popular online courses:
Listening Approaches
(REC #1239)

All courses approved for AOTA CEUs and NBCOT professional development units.

Presented by Britt Collins, M.S., OTR/L

Implementing Sensory Strategies in the Home
(REC #1185)

Presented by Britt Collins, M.S., OTR/L

Current Sensory Based Interventions for Autism: The Evidence
(REC #1204 and POD #1219)

Presented by Alison Lane, Ph.D., OTR/L and Chelsea Hetrick

Autism and My Sensory Based World
(REC #1014 and POD #1015)

Presented by Temple Grandin, Ph.D.

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Use Promo Code OTC604. O er expires June 29, 2012.

Visit OccupationalTherapy.com or call 1-866-782-9924.

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cAleNdAr
team and system supports for families, educators, and the school system at large. Earn 2 AOTA CEUs (20 NbCOT PDUs/20 contact hours). Order #3023, AOTA Members: $370, Nonmembers: $470. http:// store.aota.org/view/?SKU=3023 tive case studies and resources to enhance learning on this topic. Earn .1 AOTA CEU (1.25 NbCOT PDUs/1 contact hour). Order #4882, AOTA Members: $45, Nonmembers: $65. http://store.aota.org/ view/?SKU=4882 Occupational Therapy Approach, 3rd Edition. Earn .6 CEU (7.5 NbCOT PDUs/6 contact hours). Order #4881, AOTA Members: $210, Nonmembers: $299. http://store.aota.org/view/?SKU=4881

AOTA Self-Paced Clinical Course

AOTA CEonCD™

AOTA CEonCD™

Strategies to Advance Gerontology Excellence: Promoting Best Practice in Occupational Therapy. Edited by Susan Coppola, MS, OTR/L, bCG,

FAOTA; Sharon j. Elliott, MS, OTR/L, bCG, FAOTA; and Pamela E. Toto, MS, OTR/L, bCG, FAOTA. Foreword by: Wendy Wood, PhD, OTR/L, FAOTA. Excellent resource for gerontology practitioners today to help sharpen skills and prepare for the spiraling demand among older adults for occupational therapy services. Special features include core best practice methodology with older adults, approaches to and prevention of occupational problems, health conditions that affect participation, and practice in cross-cutting and emerging areas. Earn 3 AOTA CEUs (30 NbCOT PDUs/30 contact hours). Order #3024, AOTA Members: $490, Nonmembers: $590. http://store.aota.org/view/?SKU=3024

AOTA Self-Paced Clinical Course

OTR/L. Occupational Therapy Practice Guidelines for Adults With Alzheimer’s Disease and Related Disorders (ADRD) provides an evidence-based perspective in defining the process and nature, frequency, and duration of the interventions that occur within the boundaries of this serious illness. This new CEonCD™ course takes a further step on the topic with Practice Guidelines principles presented in a multimedia format highlighting concepts for occupational therapy practice and case studies of adults at different stages of Alzheimer’s disease. Earn .2 AOTA CEU (2.50 NbCOT PDUs/2 contact hours). Order #4883, Member Price: $68, Nonmember Price: $97. http://store.aota.org/view/?SKU=4883

NEW! Using the Occupational Therapy Practice Guidelines for Adults with Alzheimer’s Disease and Related Disorders (ADRD) To Enhance Your Practice. Presented by Patricia Schaber, PhD,

Autism Topics Part I: Relationship Building, Evaluation Strategies, and Sensory Integration and Praxis. Edited by Renee Watling, PhD, OTR/L,

FAOTA. The first in a 3-part series on content from Autism, 3rd Edition to expand occupational therapy practice with children on the autism spectrum through building the intentional relationship, using occupational therapy evaluation strategies, addressing sensory integration challenges, and planning intervention for praxis. Highlights include video clips and strategies that will enhance the provision of evaluation and intervention services. Recommended Reading: Autism: A Comprehensive Occupational Therapy Approach, 3rd Edition. Earn .6 CEU (6 NbCOT PDUs/6 contact hours). Order #4848, AOTA Members: $210, Nonmembers: $299. http://store.aota.org/view/?SKU=4848

Low Vision: Occupational Therapy Evaluation and Intervention With Older Adults, Revised Edition. 2008. Edited by Mary Warren, MS, OTR/L, SCLV,

AOTA CEonCD™

NEW! Autism Topics Part II: Occupational Therapy Service Provision in an Educational Context.
Edited by Renee Watling, PhD, OTR/L, FAOTA. The second in an important 3-part CE series that offers supplemental content from chapters in the AOTA Press 2010 book Autism: A Comprehensive Occupational Therapy Approach, 3rd Edition. Specifically addressing the unique aspects of occupational therapy practice within the public school systems, the course will enhance your ability to meet the needs of children with autism spectrum disorders, and their families, from early intervention through elementary years and the transition process. Recommended Reading: Autism: A Comprehensive

FAOTA. Occupational therapy practice in low vision rehabilitation services has changed significantly since the first edition of Low Vision. The Revised Edition helps practitioners maintain professional competency by supporting the AOTA Specialty Certification in Low Vision Rehabilitation (SCLV) credentialing process. Special features include first-edition updates and revisions, new information on evaluation, lessons related to psychosocial issues and low vision, eye conditions that cause low vision in adults, and basic optics and optical devices. Earn 2 AOTA CEUs (20 NbCOT PDUs/20 contact hours). Order #3025, AOTA Members: $370, Nonmembers: $470. http://store.aota.org/view/?SKU=3025

NEW! OT Manager Topics. Authors: Denise Chisholm, PhD, OTR/L, FAOTA; Penelope Moyers Cleveland, EdD, OTR/L, bCMH, FAOTA; Steven Eyler MS, OTR/L; jim Hinojosa, PhD, OT, bCP, FAOTA; Kristie Kapusta, MS, OT/L; Shawn Phipps, PhD, OTR/L, FAOTA; Pat Precin, MS, OTR/L, LP. This CE course presents supplementary content from chapters in The Occupational Therapy Manager, 5th Edition, and provides additional applications that are relevant to selected issues on management. The course focuses on six specific topics related to occupation-based practice, evidence-based management, evaluating OT services, continuing competency, conflict resolution, and employee motivation. Participants should read the selected text chapters prior to studying the CE topics. Earn .7

AOTA CEonCD™

AOTA Self-Paced Clinical Course

Continuing Education

PhD, DipCOT, OTR/L, FAOTA. This Series includes 4 components—the Core SPCC and 3 DiagnosisSpecific SPCCs. The Core SPCC is highly recommended as a prerequisite for the Diagnosis-Specific courses. Each of the Diagnosis-Specific SPCCs is based on a case study model supported by key concepts presented in the Core. Core SPCC: Core Concepts in Neurorehabilitation: Earn .7 AOTA CEU (7 NbCOT PDUs/ 7 contact hours). Order #3019, AOTA Members: $130, Nonmembers: $184. http://store.aota.org/view/?SKU=3019 Diagnosis-Specific SPCCs: Neurorehabilitation for Dementia-Related Diseases (Order #3022 http:// store.aota.org/view/?SKU=3022), Neurorehabilitation for Stroke (Order #3021 http://store.aota.org/ view/?SKU=3021), and Neurorehabilitation for Traumatic Brain Injury (Order #3020 http://store. aota.org/view/?SKU=3020). Each: 1 AOTA CEU (10 NbCOT PDUs/10 contact hours), AOTA Members: $185, Nonmembers: $263. Call or shop online to purchase the Core and/or 1 or more Diagnosis-Specific SPCCs together for significant savings!

Neurorehabilitation Self-Paced Clinical Course Series. Series Senior Editor: Gordon Muir Giles,

AOTA CEonCD™

NEW! Ethics Topic—Duty to Warn: An Ethical Responsibility for All Practitioners. Presented by

Deborah Yarett Slater, MS, OT/L, FAOTA, Staff Liaison to the Ethics Commission. Ethics Topic—Duty to Warn helps you understand your professional, ethical, and legal responsibilities in the identification of safety issues in ADLs and IADLs as they evaluate and provide intervention to clients. The importance of using data from both objective and subjective sources is emphasized as well to determine risk of harm in performing daily activities. Course material includes not only lecture format but also interac-

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OT PRACTICE • JUNE 4, 2012

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CEU (8.75 NbCOT PDUs/7 contact hours). Order #4880, AOTA Members: $194, Nonmembers: $277. http://store.aota.org/view/?SKU=4880 bers: $68, Nonmembers: $97. http://store.aota.org/ view/?SKU=4876

AOTA CEonCD™

AOTA CEonCD™

PhD, OTR, FAOTA. The focus of occupational therapy on living a satisfying life embraces a global view about wellness. In this course, we will explore the official documents and materials that support our concept of wellness, review examples of interdisciplinary literature on wellness, and explore strengths models from other disciplines as a way to inform our bigger thinking. Earn .25 CEU (3.13 NbCOT PDUs/2.5 contact hours). Order #4879, AOTA Members: $68, Nonmembers: $97. http://store.aota.org/ view/?SKU=4879

Let’s Think Big About Wellness. by Winnie Dunn,

AOTA CEonCD™

The Short Child Occupational Profile (SCOPE).

PhD. begins with an introduction to the three basic types of interviews most commonly applied in occupational therapy practice: structured interviews, semi-structured interviews, and general clinical interviewing. Through evidence-based examples of frequently used interview-based assessments within the occupational therapy literature, this course will describe a set of norms and communication strategies that are likely to maximize success in gathering accurate, relevant, and detailed information. Earn .2 AOTA CEU (2 NbCOT PDUs/2 contact hours). Order #4844, AOTA Members: $68, Nonmembers: $97. http://store.aota.org/view/?SKU=4844

Strategic Evidence-Based Interviewing in Occupational Therapy. Presented by Renee R. Taylor,

essential for engaging in vocational, social, and educational opportunities. The course is appropriate for occupational therapy practitioners practicing in educational settings and in driver rehabilitation. Earn .7 AOTA CEU (7 NbCOT PDUs/7 contact hours). Order #4833, AOTA Members: $175, Nonmembers: $250. http://store.aota.org/view/?SKU=4833

ADED Approved AOTA CEonCD™

Presented by Patricia bowyer, EdD, MS, OTR, FAOTA; Hany Ngo, MOT, OTR; and jessica Kramer, PhD, OTR. Introducing The Short Child Occupational Profile (SCOPE) assessment tool, this course provides a systematic way to document a child’s motivation for occupations, habits and roles, skills, and environmental supports and barriers. The SCOPE can be used with children and youth ages birth to 21 in a range of practice contexts. Earn .6 AOTA CEU (7.5 NbCOT PDUs/6 contact hours). Order #4847, AOTA Members: $210, Nonmembers: $299. http:// store.aota.org/view/?SKU=4847

AOTA CEonCD™

Everyday Ethics: Core Knowledge for Occupational Therapy Practitioners and Educators, 2nd Edition. Developed by AOTA Ethics Commis-

AOTA CEonCD™

An Occupation-Based Approach in Postacute Care to Support Productive Aging. A collabora-

tive project between the American Occupational Therapy Association and AOTA Platinum Partner Genesis Rehabilitation Services. Authored by Denise Chisholm, PhD, OTR/L, FAOTA, Cathy Dolhi, OTD, OTR/L, FAOTA, and jodi L. Schreiber, MS, OTR/L. Course reviews occupation-based practice with a focus on postacute care practice settings for older adults. Practical strategies to promote the practitioner’s ability to integrate occupation throughout the occupational therapy process are presented in an interactive format to maximize clinical application, and real-life scenarios illustrate the occupation-based approach for facilitating productive aging. Earn .6 AOTA CEU (7.5 NbCOT PDUs/6 contact hours). Order #4875, AOTA Members: $210, Nonmembers: $299. http://store.aota.org/ view/?SKU=4875

sion and Presented by Deborah Yarett Slater, MS, OT/L, FAOTA. Provides a foundation in basic ethics information that gives context and assistance with application to daily practice. Learning objectives include what is meant by ethics, key ethical theories and principles, and the rationale for changes in the Occupational Therapy Code of Ethics and Ethics Standards 2010. The course reinforces the value of self reflection on practice for enhanced competency and increased ethical behavior. Earn .3 AOTA CEU (3 NbCOT PDUs/3 contact hours). Order #4846, AOTA Members: $105, Nonmembers: $150. http:// store.aota.org/view/?SKU=4846

Monahan, MS, OTR, CDRS, CDI. Occupational therapy practitioners in the driver rehabilitation area are challenged by students with Asperger’s syndrome, nonverbal learning disabilities, autism, traumatic brain injury, attention deficit disorders, and lower IQ scores. This new course is highly visual and creative in addressing critical issues related to driving assessment and training. Course highlights include skills deficits related to these diagnoses, methods and tools that address driving skills (including video review), assessment techniques to determine the readiness to drive, and intervention techniques for developing specific social and executive function skills necessary for driving tasks. Earn 1 AOTA CEU (10 NbCOT PDUs/10 contact hours). Order #4837, AOTA Members: $249, Nonmembers: $355. http:// store.aota.org/view/?SKU=4837

Driving Assessment and Training Techniques: Addressing the Needs of Students With Cognitive and Social Limitations Behind the Wheel. Miriam

AOTA CEonCD™

Model of Human Occupation Screening Tool (MOHOST): Theory, Content, and Purpose. Gary Kielhof-

AOTA CEonCD™

Skilled Nursing Facilities 101. Christine Kroll,

MS, OTR and Nancy Richman, OTR/L, FAOTA This new course is designed to help practitioners better manage practice within skilled nursing facility settings. It addresses the importance of documentation, requirements for different payers, significance of managing productivity, understanding billing considerations, and maintaining ethical practice standards. Earn .3 AOTA CEU (3 MbCOT PDUs/3 contact hours). Order #4843, AOTA Members: $108, Nonmembers: $154. http://store.aota.org/ view/?SKU=4843

ner, DrPH, OTR/L, FAOTA; Lisa Castle, MbA, OTR/L; Supriya Sen, OTR/L; and Sarah Skinner, MEd, OTR/L. Occupation-focused practice and top-down assessment make occupational therapy unique when assessing and documenting client services. Unfortunately, therapists often turn to quicker impairmentoriented or performance-based assessments. The MOHOST occupation-focused assessment tool is comprehensive and easy-to-administer with a wide range of clients at different functional levels. This new course teaches you how to use a variety of information from observation, interview, chart review, and proxy reports to complete the MOHOST tool. Earn .4 AOTA CEU (4 NbCOT PDUs/4 contact hours). Order # 4838, AOTA Members: $125, Nonmembers: $180. http://store.aota.org/view/?SKU=4838

AOTA CEonCD™

ADED Approved AOTA CEonCD™

AOTA CEonCD™

Young Adults on the Autism Spectrum: Life After IDEA. Authored by Lisa Crabtree, PhD, OTR/L
and janet DeLany, DEd, OTR/L, FAOTA. Explores the critical issues of autism in adulthood and provides occupational therapy practitioners with the knowledge and tools to advocate for the health and community participation of young adults and adults on the autism spectrum. The course uses multiple sources and perspectives that provide information, strategies, and resources. Earn .3 AOTA CEU (3 NbCOT PDUs/3 contact hours). Order #4878, AOTA Members: $105, Nonmembers: $150. http://store. aota.org/view/?SKU=4878

Determining Capacity to Drive for Drivers with Dementia Using Research, Ethics, and Professional Reasoning: The Responsibility of All Occupational Therapists. Linda A. Hunt, PhD,

AOTA CEonCD™

OTR/L, bCP, FAOTA and jean Polichino, OTR MS, FAOTA. Provides core components of RtI, the role of occupational therapists at each tier, and case studies. RtI is being implemented nationally to ensure high quality instruction and data-based decision making within the general educational system, and content highlights opportunities for occupational therapy within RtI frameworks in public education. Earn .2 AOTA CEU (2.5 NbCOT PDUs/2 contact hours). Order #4876, AOTA Mem-

Response to Intervention (RtI) for At Risk Learners: Advocating for Occupational Therapy’s Role in General Education. by Gloria Frolek Clark, PhD.,

OTR/L, FAOTA. Emphasizes the role of occupational therapy in the evidence-based evaluation process and focuses on the required professional reasoning and ethics for making final recommendations about the capacity for older adults with dementia to drive or not. Provides the Multifactor Older Driver with Dementia Evaluation model (MODEM) to both general practice and driving specialist occupational therapy practitioners who work with older driver clients with dementia. Earn .2 AOTA CEU (2 NbCOT PDUs/2 contact hours). Order #4842, AOTA Members: $68, Nonmembers: $97. http://store.aota.org/ view/?SKU=4842

Smith Roley, MS, OTR/L, FAOTA; janet V. DeLany, DEd, OTR/L, FAOTA. Explore ways in which the document supports occupational therapy practitioners by providing a holistic view of the profession. Earn .3 AOTA CEU (3 NbCOT PDUs/3 contact hours). Order #4829, AOTA Members: $73, Nonmembers: $103. http://store.aota.org/view/?SKU=4829

Exploring the Domain and Process of Occupational Therapy Using the Occupational Therapy Practice Framework, 2nd Edition. Presented by Susanne

AOTA CEonCD™

Sensory Processing Concepts and Applications in Practice. Winnie Dunn, PhD, OTR, FAOTA. Ex-

ADED Approved AOTA CEonCD™

Creating Successful Transitions to Community Mobility Independence for Adolescents: Addressing the Needs of Students With Cognitive, Social and Behavioral Limitations. Miriam Monahan, MS

OTR, CDRS, CDI, and Kimberly Patten, OTL, AMPS certified. Addresses the critical issue of community mobility skill development for youth with diagnoses that challenge cognitive and social skills, such as autism spectrum and attention deficit disorder. Community mobility is vast in that it includes mass transportation, pedestrian travel, and driving, and is

amines the core concepts of sensory processing based on Dunn’s Model of Sensory Processing. The course explores the similarities and differences between this approach and other sensory based approaches, examines how to implement the occupational therapy process, and reviews evidence to determine how to create best practice assessment and intervention methods. Case studies and applications within school-based practice, and knowledge and practice issues on the horizon are also discussed. Earn .2 AOTA CEU (2 NbCOT PDUs/2 contact hours). Order #4834, AOTA Members: $68, Nonmembers: $97. http://store.aota.org/ view/?SKU=4834

AOTA CEonCD™

Ethics Topics—Organizational Ethics: Occupational Therapy Practice In a Complex Health
JUNE 4, 2012 • WWW.AOTA.ORG

26

eMPlOYMeNT OPPOrTuNiTies
Faculty Faculty

Assistant Professor of Occupational Therapy
The Depmtment of Occupational Therapy in the School of Medicine and Health Sciences at the University of North Dakota, is seeking applications for a full-time, 12-month faculty member beginning August 1, 2012. Rank and salary will be determined based on qualifications and experience. Candidates will have the opportunity to be an integral part of an occupational therapy program that grants an entry-level Master of Occupational Therapy degree. The program is based in Grand Forks, ND, with a satellite professional level MOT program available at Casper College, Casper, WY. The faculty position is located in Grand Forks. Position Qualifications and Responsibilities Required: Occupational therapist with eamed master’s degree, minimum of 3 years of clinical experience, evidence of teaching experience, strong leadership background, and familiarity with a variety of educational approaches (e.g., traditional, online education, distance education). Candidates must hold current certification by NBCOT and be eligible for licensure in North Dakota and Wyoming. Each full-time faculty member is responsible for supporting the teaching, scholarship, and service missions of the department as designated in collaboration with the department chair. The faculty member is responsible for providing effective learning experiences for students with diverse interests, abilities, and expectations. Faculty members are expected to engage in creative/scholarly activities and be involved in activities that support individuals and or groups in the institution, University System, professional associations, or external communities at the local, state, regional, national, or international levels. The position also includes student advisement and advisement for graduate students completing the scholarly project and/or independent study process. The individual will be responsible for teaching in his or her area(s) of expertise in relation to being able to teach a variety of courses within the physical disabilities and pediatric practice areas and healthcare management, which requires broad clinical experiences. The individual must have strong writing and interpersonal communication skills. Preferred: Earned doctorate (or progress toward this degree) experience in higher education and proficiency in using multiple modes of teaching/leaming technologies including video-conferencing and online instruction. Application Process: Apply only online via: https://secure.med.und.edu/search/occupational-therapy/ Application review will begin May 1st, 2012 and remain open until the position is filled. Interested candidates should submit: 1) a letter of application that includes a copy of current and information on past state licensure; 2) curriculum vita; 3) a teaching statement and; 4) the complete names, addresses, and phone numbers of three references. A Criminal History Record Check will also be completed per SBOHE (State Board of Higher Education) Procedures 602.3 Questions concerning this position may be directed to: Dr. LaVonne Fox, Search Committee Chair, University of North Dakota; UND OT Department; Hyslop 210; 2751 2nd Ave. No. STOP 7126; Grand Forks, ND 58202-7126; Phone: 701-777-2216; Email: lavonne.fox@med. und.edu.
Currently, over 13,000 students attend classes on the UND campus each year. UND is one of only 47 public universities in the United States that has both accredited schools of law and medicine. UND offers 89 undergraduate majors, 63 undergraduate minors, 57 master’s programs, 23 doctoral programs, two professional programs (medicine and law), and a specialist diploma program in educational leadership. UND is an equal opportunity/affirmative action institution. F-6017

THE UNIVERSITY OF SOUTH DAKOTA Assistant/Associate Professor – 12 months
Department of Occupational Therapy
The University of South Dakota, nationally ranked for research and academics, continues to take the lead in Health Sciences through innovation and state of the art technology. The University is currently seeking a fulltime faculty member for the Department of Occupational Therapy in the School of Health Sciences. The Occupational Therapy Department resides in the newly constructed Lee Medical Building with state of the art classroom and laboratory space and technology including a driving simulator and an Activities of Daily Living Suite equipped with remote patient monitoring systems. Beginning fall 2012, the program will have access to the new Parry Simulation Center for health and medical sciences. As members of the School of Health Sciences, Occupational Therapy faculty and students engage in interdisciplinary study and scholarly activity with colleagues from several related disciplines. The University of South Dakota is located in Vermillion, SD, a dynamic academic community in a rural setting well within a one-hour drive of two metropolitan communities. Minimum Qualifications: Applicants must have a doctoral degree (or demonstrate significant progression toward completion), a minimum of 5 years of clinical experience, and eligibility for an Occupational Therapist license in South Dakota. Preferred Qualifications: Record of scholarly productivity or potential to develop an active research program, teaching experience, and professional service will enhance the candidate's application. Experience in adult rehabilitation is preferred but other backgrounds will be considered. Responsibilities will include teaching in a learner-centered curriculum, engaging in scholarly activity and grantwriting, mentoring graduate student research, and university and professional service.

AD REGION COLOR KEY
Faculty opportunities in education Northeast Connecticut, Washington, D.C., Delaware, Maine, Maryland, Massachusetts, New Hampshire, New jersey, New York, Ohio, Pennsylvania, Rhode Island, Vermont South Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Mississippi, North Carolina, Oklahoma, S. Carolina, Tennessee, Texas, Virginia, West Virginia Midwest Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, South Dakota, Wisconsin West Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, Wyoming National Multiple locations within the U.S. International All countries outside the United States

Faculty

Health Sciences and Family Studies Division

Full-time Tenure Track Occupational Therapy Assistant Program Coordinator
Qualifications: Five years clinical experience; one year experience in full-time academic setting. Green River offers excellent benefits. For a complete listing of qualifications and to submit an application, please visit our website http://agency.governmentjobs.com/greenriveredu/ default.cfm.
Green River is an EEO/AA Employer
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Salary/Compensation: Appointment at the rank of Assistant/Associate Professor is dependent on qualifications and experience. Salary is commensurate with rank and experience.
Apply at: http://yourfuture.sdbor.edu Review of applications will begin June 30, 2012. EEO/AA

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JUNE 4, 2012 • WWW.AOTA.ORG

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eMPlOYMeNT OPPOrTuNiTies
Faculty School of Health Professions Department of Occupational Therapy 1 University Plaza, Brooklyn, New York 11201-8423 Faculty Faculty School of Health Professions Department of Occupational Therapy 1 University Plaza, Brooklyn, New York 11201-8423

The Department of Occupational Therapy at Long Island University–Brooklyn Campus is seeking to fill two full-time, nontenure-track faculty positions (NTTA). We are seeking educators with experience in teaching (in class or online) and student advisement. We are looking for one educator with expertise in mental health/health and wellness promotion and one educator with expertise in physical disabilities. Qualifications: Qualified applicants will have an earned doctoral degree or would be at the final stage of completion of their doctoral degree. Clinical experience of 5 years or more and eligibility for state of New York licensure required. One of the positions is currently available and the other position has a starting date of September 1, 2012. Our department offers high quality education to students from diverse socio-cultural backgrounds, using innovative teaching pedagogies that integrate theory, evidence-based practice, and ongoing clinical experience through community service and fieldwork education. Our faculty is committed to teaching, scholarship, and service to the university and the community. As an Equal Opportunity Employer/Affirmative Action Employer, LIU seeks a diverse pool of applicants. For consideration please forward your letter of interest, Curriculum Vitae, and three letters of references to: Supawadee-Cindy Lee, Ph.D., OTR/L, Chair, Faculty Search Committee Department of Occupational Therapy Long Island University–Brooklyn Campus 718-780-4332 E-mail: supawadee.lee@liu.edu

Applications are being accepted for a full-time 12-month Assistant Professor /Academic Fieldwork Coordinator in Occupational Therapy Program at Salus University. This position involves leading curriculum development regarding fieldwork education, teaching graduate level courses, scholarship, and service. The person will develop clinical sites, mentor students, and integrate clinical education into the program. The mission of Salus University is to protect and enhance health and well-being through education, research, patient care and community services worldwide. Our vision is to be recognized nationally and internationally for excellence and innovation, and we are seeking an Academic Fieldwork Coordinator who will help us to attain these goals through a targeted plan of mutual growth and development. We are also seeking Occupational Therapy consultants and Adjunct Faulty to assist in the development of syllabi.

ACADEMIC FIELDWORK COORDINATOR

The Department of Occupational Therapy at Long Island University–Brooklyn Campus is seeking to fill a full-time, tenure-track faculty position. We are seeking a seasoned educator with experience in teaching (in class or online), a well-established research agenda, and experience in student advisement. Candidates with a research focus in health and wellness promotion will be preferred. Qualifications: Qualified applicants will have an earned research doctoral degree and 5 years or more of clinical experience. Eligaibility for state of New York licensure required. The position has a starting date of September 1, 2012. Our department offers high-quality education to students from diverse socio-cultural backgrounds, using innovative teaching pedagogies that integrate theory, evidence based practice, and ongoing clinical experience through community service and fieldwork education. Our faculty is committed to teaching, scholarship, and service to the university and the community. As an Equal Opportunity Employer/Affirmative Action Employer, LIU seeks a diverse pool of applicants. For consideration please forward your letter of interest, Curriculum Vitae, and three letters of references to: Supawadee-Cindy Lee, PhD, OTR/L, Chair, Faculty Search Committee Department of Occupational Therapy Long Island University–Brooklyn Campus 718-780-4332 E-mail: supawadee.lee@liu.edu

Qualifications:

Earned doctorate and eligibility for licensure as an occupational therapist in Pennsylvania required. Ability to travel to clinical rotation sites required. Particular expertise in children and youth desirable. Record of scholarly activity and experience in teaching preferred. Salary and faculty rank are commensurate with qualifications and experience.

or submit resume and cover letter to Fax: 215-780-1265 For program information, contact Marian Gillard, PhD, OTR/L, FAOTA at
F-6052 F-5999

https://home.eease.adp.com/ recruit/?id=1281731

Please apply online at:

mgillard@salus.edu

EOE

F-6000

West

West

West

OCCUPATIONAL THERAPISTS
Anchorage School District Anchorage, Alaska

Competitive salary • Great benefits $3,000 signing bonus for 2012-2013 school year $2,000 salary supplement for SI or NDT
Contact Kate Konopasek at (Konopasek_Kate@asdk12.org) or apply online at www.asdk12.org

Join a dynamic team of 30 OT’s!

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Want an Adventure in Alaska? Immediate vacancies for Occupational Therapists in the Fairbanks, Alaska School District • Up to $5000 relocation costs • Competitive salary & benefits • 190 day contract (summers off!) • Safe schools • No state/sales tax • Permanent fund dividend • Doctoral level state university • Unparalleled outdoor recreational activities • Urban setting • International airport Fairbanks North Star Borough School District 520 5th Avenue • Fairbanks, AK 99701 Ph: (907) 452-2000, ext. 380 Fax: (907) 451-6008 E-mail: maria.mucha@k12northstar.org www.k12northstar.org

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Become a Member

CONNECTIONS
AOTA’s Online Community

www.otconnections.org
JUNE 4, 2012 • WWW.AOTA.ORG

OT O p e n i n g S aT f i v e l O c aT i O n S Dallas Fort Worth oDessa longvieW

Select Specialty and Regency Hospitals are acute care hospitals designed for patients who need a longer hospitalization for their recovery. We put patient care above all else. The result has been a culture that invests in its employees, and is deeply dedicated to their continuous improvement and learning. We are looking for people who embrace our mission and core values: those who work with a passion for excellence. • Opportunities for full-time occupational therapists • New graduates considered • Current OT Texas licensure required • 8-hour shifts Monday through Friday • Autonomy to develop individualized patient plan of care • Intimate environment for critical care means more time with patients and families • Benefits include 401k with company match

Join uS today. youR futuRe awaitS.

to learn where positions are available,
CONTACT tricia Cogdell AT 877.582.2003 OR tcogdell@selectmedical.com

Select Specialty and Regency Hospitals are part of a national knowledge network of 111 long-term acute care hospitals.
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Q &A

uestions and Answers
May 9 was the National Center for Safe Routes to School’s Bike to School Day. But for many occupational therapy practitioners’ clients, biking to school is not a realistic option for any number of reasons, including the distance between home and school, an intellectual or developmental

disability, the weather, and more. Susan Shutrump, OTR/L, supervisor of occupational therapy and physical therapy services at Trumbull County Educational Service Center in Ohio, believes more attention in general needs to be paid to the transportation needs of students with special needs, and she has focused much of her career on the subject. She recently spoke about safe transportation with OT Practice associate editor Andrew Waite.

Waite: Why do you think this practice area is so important? Shutrump: Let me start with an example. I have a child on the spectrum who moved from elementary to middle school, and he has significant sensory processing disorders, including visual problems, that cause him real difficulty. He never rode the bus in elementary school, but the middle school just sent him out to this sea of buses and expected him to find his way. He freaked. Waite: How can occupational therapy help? Shutrump: OTs really need to evaluate carefully how safely children with the non-obvious disabilities can get to school. That’s the big issue. When a kid rolls up to the bus stop in a wheelchair, everybody says, “We need to do something.” Kids with sensory processing disorders and high level kids on the spectrum have just as many needs, and sometimes more needs, that can really quickly turn to an unsafe situation. Waite: How might it be unsafe? Shutrump: We may need additional equipment or need another adult ride to the bus, but in any case we need to ensure that our kids get the additional support they need to get to school safely. For example, one of my students has significant light touch problems. He is not big enough that his feet touch the ground. So every time his bus goes over a bump, the back of his legs are getting a lot of light touch—brush, brush, brush— and he becomes emotionally distraught.
OT PRACTICE • JUNE 4, 2012

OTs really need to evaluate carefully how safely children with the non-obvious disabilities can get to school.
Now, if I put that same child over a wheel well, his feet are supported, and if I put him in a safety vest that is well fitted, he’s great—he loves the bus. So it’s taking what we know about these kids and what We have to think that if students need that level of support in a school environment, they still need it when they board the bus. So we really need to make certain that the environment is also looked at. Occupational therapy practitioners are the best people to lead that fight because they know the sensory processing issues and they know what kinds of equipment and support are needed in the classroom and on the bus. Waite: So more than the therapists just being able to lead the transportation team, they need to be the ones advocating for such an assessment in the first place? Shutrump: Absolutely. Occupational therapy practitioners can teach children to do all kinds of wonderful things and support them and get really good work skills and prevocational skills, but the bottom line is, practitioners often don’t do any of those things at the child’s home. The ball is dropped if we don’t look at the transportation component, because if you can’t get someone somewhere, he or she misses out on important occupations. We’re a very mobile society. If you have a disability there are a lot of risks throughout your day, but the place that is most risky is a vehicle. And, unfortunately, that’s not getting a lot of attention. We are putting on these drivers of kids with special needs lots of responsibility without the training, and that needs to change. n

works in the classroom and making sure it happens in the school bus environment as well. Waite: How can occupational therapy practitioners begin thinking about incorporating transportation within interventions? Shutrump: In the IEP [individualized education program], there is a section that talks about whether or not the child qualifies for specialized transportation. What therapists need to do when they are looking at that section is go beyond the obvious and think about the child’s judgment, sensory processing issues and sensitivities, and cognitive level, and work with the team to analyze the route to school and make certain that all of the supports that are necessary are built in.

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PHOTOGRAPH OF CHILDREN & SCHOOL bUS © KALI9 / ISTOCKPHOTO.COM / FOR ULLUSTRATIVE PURPOSES ONLY. CHILDREN IN PHOTO ARE MODELS.

PORTRAIT PHOTOGRAPH COURTESY OF SUSAN SHUTRUMP

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