He'd, in his words 'smashed' his hand up in a crush injury, and developed what seemed to be complex regional pain syndrome in his non-dominant hand, which would have been fine if he had a pen and paper job. Joe didn't, he worked as a joiner, a craftsman. What's worse, he was self-employed, and during that two years his business went under, and his future as a skilled craftsman looked bleak.

Yes, he had compensation - 80% of the income he'd declared for tax purposes, which was nothing like what he'd actually made because much of his income had been plowed back into his business. And with compensation came a whole lot of requirements: to attend various people for assessments (he worked out he'd had 9 different assessments just for the medical or treatment part of his rehabilitation, a further 4 for vocational rehabilitation, and several for necessary equipment and support for home); to attend treatments (none of which had resolved his pain); to tell people about his distress and worries about his future; his life which had been very private, was now an open book to more people than he wanted to think.

Joe was asked to see me because he had refused to consider any of the options that his vocational assessment had come up with, and because when he had started to think about work, he became depressed and anxious. He told me he threw the vocational assessment in the bin because the suggestions were, in his words, 'insulting'. He told me the assessor had no idea what a craftsman joiner actually did, and the list of potential jobs included 'retail assistant', 'carpenter', 'builder', 'courier driver'.

When I reviewed the concerns Joe had about work, it's no wonder he was stressed. I used a work self efficacy assessment to identify the areas he felt confident about, and those he didn't. The areas he felt fine about were his ability to work out ways to keep himself safe at work, to let people know what he needed, and to be 'a good employee' - but he had very low confidence in these areas:
(1) ability to work a full day
(2) ability to meet quality requirements
(3) ability to tell others about his pain
(4) ability to obtain support and assistance from others
(5) ability to work in a way that used his skills

He told me the work was important because 'it is who I am'. And who he was was a very capable, highly skilled man with an 18 year history of work as a joiner who produced quality goods that he could be proud of. He said he felt ashamed of his pain, and that he couldn't be a 'real man' because his pain hadn't resolved. And what's more, he felt frustrated that the job options he'd been given were of such a low skill level. He'd put a huge investment of himself and his time and energy to develop a high level of technical skill into being a hands-on craftsman.

A couple of interesting things about this case - first of all, although details have been changed, this is a real situation. His angst is real, and his concerns about his future - and his response to his situation - are real.

He'd waited two years to hear that his pain was either going to go, or not. No-one had been clear with him that pain can become chronic, and that this is neither a death sentence, nor a life sentence. Life is possible with persistent pain. Instead he'd been held in stasis for that time, being uncertain which way to turn, and consequently he lost his business. Once he'd received the diagnosis and prognosis, he was able to confront his future - and yes, admittedly for a while he has become very distressed, but he told me that at last he could make clear choices.

What do we learn from that? Don't fudge! If the chances of pain resolving are slim, let the person know so they can start to live.

The second point is that work is so much more than a way to earn a living. I don't know whether this particularly applies to men, but it certainly applies to tradesmen - their work is part of their identity, it carries more emotional significance than the pay-packet, it represents years of skill development, and no, suggesting that someone like this consider a job that is a step down is just not going to sit well!
I don't know whether Joe will return to his previous work. He won't be able to return to his business.

I do know that he now has a sense of hope as I've started to help him review his situation and see that what he views as a liability (ie his functional limitations) can be turned into an asset - he's much more likely to be careful, safety-conscious, and efficient at his work because it matters to him if he hurts himself.

It will be a long road for Joe, he has a lot of pain management to develop, as well as addressing his lack of confidence and the mismatch between his expectations of himself and his current abilities. But this is pain management at the coalface - this is what I love.

The Great Pay-It-Forward Children's Book Giveaway!!!

Remember, the drawing will be held tomorrow (Sunday) evening at 5pm. So far, at the time of this posting, there are only 6 or 7 entrants. Give me some comment love on the above-mentioned post and enter yourself!

School starts up again in a couple of weeks. As I've mentioned before, Little Man's preschool offers Junior Kindergarten and Senior Kindergarten to follow their preschool programming. The decision to send Little Man back to the same place has been, since his diagnosis with Sensory Processing Disorder, a bit of a no-brainer. In our region, there are very few schools where half-day Kindergarten programs are offered. Most places, for the convenience of the adults mostly, have switched over to whole-day, every other day, Kindergartens.

For us, full-day Kindergarten would be a nightmare: Little Man would end up overstimulated and most likely starving, because he won't eat in large groups of people. One of the first discussions we had with the Occupational Therapist was about this dilemma. You see, eventually, we'd like for Little Man to attend the Christian private school that Hubby attended when he was a kid. That too is kind of a no-brainer, because thanks to Hubby's late grandmother, the money is there to pay for private education. If we had to pay for this ourselves, it would mean changing our lifestyle significantly; we'd certainly have to tighten up the purse strings, if not just cut them off altogether.

So back to this year, at the preschool. I have recently had a couple of email exchanges with the director of the preschool, just asking a few questions about what will be happening, so that I can prepare Little Man as much as possible. Preparing him ahead of time is worth, well, its weight in gold. Predictability, at this point in his life, is certainly key to life going well.

A few days ago, I asked the director if she knew yet who the kindergarten teacher(s) would be. Her answer has left me stymied. At first, I panicked, called Hubby, and told him we had a horrific turn of events that might require me to homeschool Little Man for Junior Kindergarten, at least. I'll admit it now, that was perhaps a wee bit on the harsh side of reality. Maybe even ridiculously harsh. I have been known to overreact occasionally in my life. Alarmist? Extreme? Perhaps.

Whatever.

So here's the skinny: last year, at the preschool, there were about 5 teachers. Little Man alternated between two of them. They were both kind, sweet, and seemed genuinely happy to see the kids as they trickled in on Monday and Wednesday mornings. There was another teacher, in the other part of the school, who I had limited interaction with (she supplied in LM's class occasionally), but just had a generally bad less-than-great impression of. She always kind of moped around the school and sort of looked like she would rather be spending her day in hell anywhere else but here.

Know what I mean?

Can you guess where I'm going with this? I'm sure you can...

Well, Miss Mopey is slated to be Little Man's teacher this year. I'm really disappointed. And worried. I had a conversation with Little Man yesterday about it, just casually talking about the fact that there's a visitation day at his school next week and about who would be in his class and who his teacher would be. I told him about Miss Mopey. He said he didn't like her and wanted someone else to be his teacher. Of course.

Hubby and I have talked this through. He thinks that I should talk to the director about it right away and at the very least, let our concerns be known. He might be right. Once I got over my initial alarm at the situation, I sort of thought that maybe we should let LM start the school year with Miss Mopey and just see how things go. Not say anything unless problems develop.

My question to you is this: What would you do?  Would you avoid saying anything more to LM about it, in order to hopefully avoid laying any undue stress on him? Would you talk to the director so she at least knows your concerns? I know from talking to one other parent from the school last year, that I'm not the only parent who dislikes/has a bad feeling about Miss Mopey. I just don't want to cause trouble before the year even starts. BUT: I don't want my kid to end up stressed out at a school where, until now, he's had mostly happy experiences. And I'm afraid that being with this teacher will stress him out. What if there are even more parents who feel the same way about Miss Mopey and, like me, not wanting to cause trouble, also keep their mouths shut and hope for the best?

Your input here would be greatly appreciated!

Kia

I've had a lot of people tell me "You're so fortunate your son speaks." Yes, they're right. We are. And we are grateful. But, speaking doesn't mean communicating. An autism diagnosis means that there's some problem with communication, now or in the past. Some people who see children with autism that are verbal fail to grasp that autistic kids can talk, as in "where's the communication issue?" Not only do they not see how far the child has come, but they don't get the difference between speech and communication. They are two entirely different things. So while a child may have language, it doesn't mean they use it right, or that they comprehend the meanings. Then throw in body language, and communication can even get much more difficult.

Last night, cuddling with my sweetie after the last meltdown of the day, I was really sad for him. He felt that he'd been telling us so clearly what he wanted, and not only was he trying to get out of doing what we wanted, but we really didn't get his meaning...at all. And because he was so busy trying to get us to understand his meaning, he was getting more upset as time went on and making less sense. But, in his mind, he made sense. What exactly do you do then?

Since school is starting soon, and this problem seems to be getting worse (because he's getting older? getting bored at the end of summer? who knows?) I want to make it a priority to work on. I'd really love some recommendations of good books to address the communication gap we're experiencing. Or a suggestion of who to speak with: social skills therapist? speech therapist? psychologist? I don't think he needs help, but rather we need to know how to work with him to help him express himself sufficiently, without the anger that builds up, then the sadness that just breaks our hearts.

And maybe it will also help tackle the meanness that comes along with it. I'm so glad he can say "I love you, Mama," but the "You're a jerk, Mom" hurts.

About two weeks ago, I was invited to take part in a parent panel by the clinical director of a proposed new autism center in our area. After two hours of discussions with 8 other parents and representatives from the center, I left feeling completely overwhelmed. The center would be one of the first of its type in Canada and one of only a handful in North America, creating a truly integrative team for autism intervention to include medical doctors, nutritionists, speech and occupational therapists and family supports such as counseling and social groups for siblings. I don't think I'm overstating it when I say the creation of this center, for my family, would be like winning the lottery.

I love to talk about my opinions and experiences so this was an opportunity to have an impact, however small, on the way this center will be designed and run. The panel discussion required me to wrap my brain around the things we've done that have worked, the things that haven't, and my own beliefs about what constitutes healing and intervention - not to mention the financial implications of autism and how families afford it. Most people see the public face of autism and can understand that yes, it's demanding to be a parent of a kid (or kids) with autism. What most people don't see is the devastating financial toll the whole thing can take.

I bring this up because one of the questions asked of the parents at the panel was this - how much do you spend annually on 'autism-related' expenditures? We went around the table and the costs varied, with families of preschool-aged kids spending between $10k and $40k per year and the families with older kids between $10k and $20k per year. Per Year.

Lest you think the figure is exaggerated, consider the following: two hallmark treatments of young children diagnosed with autism are speech and occupational therapy. One hour of speech therapy, depending on where you are, can cost between $70-$180. Most kids with severe language deficits need at LEAST 2-3 hours of speech per week to make a real difference. The costs are similar for occupational therapy, up to $200 per hour. Most insurance companies in the US don’t cover these treatments. In Canada, children can get a limited amount through autism funding and supplemental insurance. Our supplemental insurance is $1000 / year so that’s roughly 10 hours with a speech therapist or OT, not even once a month! Some families employ full-time behavioral interventionists for their children, who work 30-40 hours per week and cost between $40-$60k per year.

In my lower moments, I wonder what 'typical' families do with the money we 'autistic' families spend on interventions - Luxury cars? Robust college funds? Vacations? We've managed to do without the luxury cars and elaborate vacations and as for the college funds, we set aside what we can and pray for scholarships.  :)

So if I won the lottery, I would open the kind of center being considered right now, but I’d offer services at the lowest possible cost, or free, for those families who needed it. For all the single parents currently raising children with autism (the divorce rate among these families is roughly 80%) I’d create a place where they could go to relax, socialize with other grown-ups and have a cup of coffee while knowing their child was receiving the best intervention available from an enthusiastic and caring staff. I’d create a sensory gym the likes of which has never been seen so that the kids could get all the deep pressure, swinging and climbing they could need. And I’d create a cool game room so that siblings of kids with autism would have a place to go where they not only fit in but also are with other kids who ‘get it’.

The school I would love to build is a subject for another day, as is what I would do to take care of Lola and Jenny. You'll learn more about them soon, too.

There are ways to ‘afford autism’ and I hope to post many of my ideas and strategies, as well as complete a compilation of strategies that I’ve been working on for a long time.

I suppose if I want to win the lottery, I should actually play it. But isn’t it a little sad that the odds of affordable, comprehensive care for all kids with autism, regardless of their parents' income, are akin to being struck by lightning?

Peace.

Last weekend we went to a small butterfly conservatory in a little town about 30 minutes from where we live. We saw so many amazing things and really felt that we got more than our money's worth, which is hard to do these days.

This caterpillar pictured above kind of makes me worry. Today especially. I look at it and I think it's just that: a caterpillar. Truth be told though, it won't be that for long. Just when it really becomes comfortable with itself, it will either form a cocoon or a chrysalis around itself and metamorphasize into either a moth or a butterfly.

"But Kia," you're thinking, "why are you worried about the caterpillar becoming a butterfly? That's what caterpillars do."

The reason I'm worried about this caterpillar is because it kind of makes me think about Little Man and his diagnosis with SPD. We're getting comfortable with calling it SPD and trying to give it a home in our lives. We have even shown it to our friends and family. We've explained it to them and asked them to try to accept it too. We know what it looks like, we know what to call it, and we kind of even know how to treat it.

But here's where it gets tricky.

I'm afraid to get used to the SPD because it's starting to look like something else. Becoming something different. Changing. Morphing.

You want examples? The picture isn't evidence enough? I've got examples. From today alone, I can give a few...

* Little Man refused to poop at all today because he's afraid that there are worms and snakes on the toilet seat. While my housekeeping skills may never get me a job at Merry Maids, they are not so bad that we actually  have critters roaming our toilet seats.

* Little Man, whenever it's time to eat, will ask me if I washed my hands before I touched his food, because he doesn't want my hands to have touched my own food and then transferred any "yuckiness" to his food.

* Little Man begs us, at every meal, to let him eat in another room so that he doesn't have to see our food.

* Little Man won't go into the bathroom and pee by himself (which, up until recently, he's been doing alone for almost 2 years). He says he's scared. And if we don't go with him into the bathroom? He cries. It's a scared, please help me, kind of cry. Heartbreaking.

* Little Man has become really irritable around my dad (his Papa), because Papa doesn't 'follow the rules' that LM believes should be followed.

* Little Man repeatedly, when I'm not in his direct line of vision, will say, "Mommy, mommy, mommy, MOM-MY," and then, when I finally give in and ask him what he wants, he says, "Hi, Mommy," or, "I love you, Mommy." This goes on I don't know how many times per day. It's annoying and exhausting.

* If it's possible, I think he's becoming more and more insistent on following his rigid routines for mealtimes, bathtimes, bedtimes, etc.

* At least once every day this week, Little Man has complained that his tummy and his back hurt

The biggest thing that has me so upset tonight? He repeats himself to the point of ridiculousness. Today, he had a major tantrum because I told him to stop asking if we could go to the Dollar Store. We were visiting my dad and LM wouldn't let us carry on any type of conversation whatsoever. He just kept repeating, "I want to go to the Dollar Store. Can we go to the Dollar Store? Let's go to the Dollar Store." I told him that if he kept saying it, we would go straight home without a lolly from Papa and without going to the Dollar Store. I know he understands the consequences, and yet he kept on repeating it . So, we didn't go to the freaking Dollar Store and he had a complete meltdown/rage because of it.

The thing is, I know my kid's not stupid. I made the consequences for his rude behaviour abundantly clear. I know he understood what the consequences would be. And yet, he continued this repetitive behaviour. It's almost like he loses control of himself once he's gotten too deep into a situation. Could this be over-stimulation somehow? I have no idea. What I do know, however, is that when Hubby or my dad tell me, "You're doing the right thing. You have to follow through," it doesn't help. At all.

I'm really afraid tonight, as I sit here looking at this list. I've already cried my eyes dry about it. I did that earlier while I made dinner and Little Man played with his Lego. I cried because of the behaviour and the fact that I don't know why he's acting this way and also because I, in my emotional desperation after the meltdown, tried to call the intake office at the mental health clinic that our doc referred Little Man to. The receptionist that I finally got to speak to, after being given several different numbers to try (don't even get me STARTED), informed me that she hadn't "had a chance to look through the faxes this WEEK yet," and that I really didn't need to call their office because "if we have an appointment for your son, we'll call you."

Oh, that's rich. Fecking rich. The old, Don't Call Us, We'll Call You, Or Maybe We Won't, But Whatever You Do, Don't Call Us. Oh, and Did We Mention? Don't CALL Us.

Feckers.

How's this? How about I go through your fecking faxes while you spend the week mothering my child and then we'll see who's calling who, you tarty little receptionist betch. Don't call us. Don't call us.

I'll call you. And I'll call my doctor's office. And then I'll call you again. Because something is fecking well wrong with my kid and I need some bloody help and I don't know where to find it. Talk to you on Monday morning, tart. Know what, I'll even sing The Song That Doesn't End to you while you GO THROUGH YOUR FECKING FAXES...

So yeah. Tonight I'm wiped out. I'm looking at lists of behaviours to expect from kids with OCD, from kids with Asperger's, from kids with general anxiety (well, DUH!), etc. I feel like one of those moms who thinks she can diagnose her own kid, but at this point with our bloody roadblock called the Ontario Healthcare system, what the feck else am I supposed to do? I've even started looking for private paediatric psychiatrists, because if that's what I have to do, I'll do it. I don't care what it costs.

Any words of wisdom? Anyone? Anyone?? Helllloooo?????

Kia

P.S. Did I mention that our OT postponed yet another appointment this week? Who took the "professional" out of the word "professional," and when are you going to put it back?

P.P.S. I realize that I might come off as a little bitter in this post. I'm sorry, but I am kinda bitter. It's been a rough week.

Julia Swann is an Occupational Therapist

Abstract:  Music influences our lives and forms an integral part of our culture. Julie Swann discusses the importance of considering what music may mean to different people and how it may evoke memories and affect mood.

For the full-text of this article please email: susan.jennings@lancashirecare.nhs.uk

"Occupational Therapy. Living Life to Its Fullest."

It set me to trying to remember other tag lines occupational therapy has had and I wondered whether it would show changes to how we were describing the profession. However I have decided my memory isn't as good as I thought or maybe there haven't been that many?

Late 1990's to mid 2000's "Occupational Therapy. Skills for the Job of Living." or sometimes shortened to "Occupational therapy skills for living" this one seemed to be used by occupational therapists worldwide.

In the mid 2000's The New Zealand Association of Occupational Therapists had for a short time the tag line

"Occupational therapy - live the life you want"

and way back in the1980's? there was one I am struggling to bring to mind. Was it

"Occupational therapy a vital link to productive living" ????? (not to sure that I have this one correct).

Maybe there is someone out there who can add to the list?

Sensory Processing Disorder, Exhibit # 3,498:

We're in the car, today, riding with my dad, Little Man's Papa. Little Man's CD of the Watoto Children's Choir is blaring quite loudly. My dad and I are trying to carry on a quiet conversation...

Little Man: "AGGGGHHHHHH!!!! STTTOOOOPPPPP IT!!! STOP YOUR TALKING!!"

Kia: "Little Man, please don't be so rude. Papa and I are trying to have a little chat while you listen to your music."

Little Man: "BUT I CAN'T hear my music. It's my favorite song and now you've ruined it!"

Kia: "Buddy, you need to get over yourself! " (I didn't say this was a proud moment)

Little Man: "But, aggghhhhh...the talking is hurting my ears and I can't listen to my music when my ears are hurting."

Kia: Sigh. Turn to face dad. "Sorry*, dad. I think I need to get him his own little portable cd player with headphones so that he can 'hear' his music without his 'ears hurting' from the quiet conversation."

*I feel like I do a lot of apologizing and compensating for my son's behavior. I feel kind of disloyal to him sometimes when I do it, but I'm always too frigging worried about what other people think.

Sensory Processing Disorder, Exhibit # 3,499:

We're in Little Man's bathroom, going through the agonizinglovely parts of his bedtime routine. I'm holding LM's spidey toothbrush in my hand, clenching my jaw and yet still managing to spit out the words...

Kia: "Little Man, we do this every single day. TWICE! You know  that you have to brush your teeth. You know   that if you don't brush your teeth, you'll get cavities. Just brush. your. teeth."

Little Man: "I caaaaaaannnnnnnn't..... It's grrrrrroooooossssss. It makes me puuuuuuuukkkkkeeee. I caaaaannnn't....."

Kia: "LIT.TLE. MAN! Brush them!"

Little Man (gagging and begging me with his eyes to pleasemakeitstop, inserts toothbrush delicately into his mouth)

Kia (realizing, again, for the millionth time, how incredibly hard and uncomfortable this is for my boy): "Aw, baby, I know it's hard and you hate it. I'm so proud of you for doing such a good job. Just a little more. You're doing awesome babe."

Little Man (spitting, very dramatically): "Blech. Gross. Can I be done now?" (And he's gone. Out of the room.)

This same routine happens twice daily in our house. Don't you wish you could be me? Better yet, don't you wish you could be Little Man? Poor little dude. I just wish I could find more patience. Be less of a bitch, you know? It's so bloody hard.

Sensory Processing Disorder, Exhibit # 3,500:

Tonight, as I'm gently  tucking Little Man in to bed,

Little Man: "Ow! Mommy! You're hurting me!"

Kia: "Oh. Sorry buddy. I was just trying to give you a love touch."

Little Man: "Love touches shouldn't hurt, Mommy."

Kia: "Ok, next time I'll warn you before I'm going to give you a love touch. Would that be better?"

Little Man: "Yes, Mommy. Much better. Next time, you ask permission  before you give me a love touch."

Kia: "Ok, baby."

At times like this, it really saddens me to think of how hard life can be for my boy. A simple thing, like a tuck-in from mommy, is such an ordeal for his little body and mind. It should be a warm, fuzzy kind of thing, but instead it's just one more thing that he needs to prepare himself for. Prepare me for. I know it could be so much worse, but it makes me sad.

Good Enough Mothering

I read in one of the books about SPD that it's smart to only plan one or two "events" or "errands" in the day for an SPD child. The reasons for this are blatantly apparent, to a parent of an SPD child: overstimulation, tantrums resulting from overstimulation, and embarrassment for the parent and the child as a result of the overstimulation and its resulting tantrums. I read this a while back, and I'll be honest: I kind of poo-pooed it and went on with my busy little life and did whatever else I could to avoid the outbursts and tantrums.

Lately though, Little Man has become quite a home-body. He likes his own stuff, he likes his own environment, and he doesn't do well around strangers. Again, it's easy to see why. He knows how his own stuff works, he knows where to find everything in his own environment, and strangers are unpredictable and therefore undesirable.

This means that he will avoid errands such as grocery shopping or clothing shopping like the Plague. He begs me to just "stay home today." He yells and cries when I tell him that we haveto go out because we need groceries or we have a playdate booked or an appointment with a doc or an OT. Lately, he's even resisting walks to the park, which he used to love.

All of this tantruming and fuss has led me to re-evaluate things. A lot. And the conclusion I've come to is that the authors are right. How original, huh? The experts are right. I bet they're glad to have this affirmation from me. Little old me. Hahaha! Riiiigghhhtt.

I've made some changes over the past few weeks. We have a new Rule. Basically, we have one thing planned for each day. Be it grocery shopping, a playdate, a swimming lesson, an OT appointment, whatever. There is onething planned for each day. It's easy sometimes, especially when a friend asks if we can get together, to contemplate a little breakage of the Rule, but you know what? It's sooooo not worth it. The breakage (almost) always leads to a meltdown, which always leads to me beating myself up for even thinking about breaking the Rule. So I'm doing my best to stick to the Rule.

And when I do it? It works. I've seen some good results from the Rule. Little Man is calmer. He really enjoys being at home. He, in his own quirky way, shows his gratitude for this Rule (even though he doesn't officially know that the Rule exists): by being a happier (or less ornery?) kid, by not losing it before dinner time even rolls around, just by being slightly more predictable in his behavior.

So although the Rule can't be written in blood and its breakage be followed by a severe, bloodied punishment, it can be strictly enforced. There will be days where we just have to do two things within a 24-hour period. There will be times that, for fun's sake (hopefully!), it will be broken or bent. I realize this. But for the sake of my own sanity and Little Man's happiness, the Rule will be in place.

How about you? Do you have a Rule in your house? One thing in particular that you can think of, that you really do your best to stick to, for sanity's sake?

I shall update properly soon. It's been a while and I have a lot of thoughts ..

To keep you entertained, here are a couple of videos on Mindfulness...

Oh and this one is actually not 'for fun' so read it seriously, it's about health literacy and how to make what you write work for people who end up reading it!
This page introduces you to Helen Osborne (she's the Director of this consultancy) - and, just waving the flag for occupational therapists, she's an occupational therapist!

Abstract:  Green care is a concept that involves the use of farm animals, plants, gardens or the landscape in cooperation with health institutions for different target groups of clients. The present study aimed at examining psychiatric therapists' (n = 60) and farmers' (n = 15) knowledge, experience and attitudes to Green care and animal-assisted therapy (AAT) with farm animals for people with psychiatric disorders. Most respondents had some or large knowledge about Green care, but experience with Green care was generally low in both groups. Both farmers and therapists believed that AAT with farm animals could contribute positively to therapy to a large or very large extent, with farmers being significantly more positive. Most of the therapists thought that AAT with farm animals contributes to increased skills in interactions with other humans, with female therapists being more positive than males. Two-thirds of the therapists believed that AAT with farm animals to a large extent could contribute better to mental health than other types of occupational therapy. There were no differences in attitudes to AAT between psychiatrists/psychologists and psychiatric nurses. This study confirms the marked potential of offering AAT services with farm animals for psychiatric patients by documenting positive attitudes to it among psychiatric therapists.

For the full-text of this article please email: susan.jennings@lancashirecare.nhs.uk

• a shift to project-based work - instead of seeing virtual worlds as a place to hold classes (and create rather traditional looking classrooms to house them), take a primary theme (Living Life to its Fullest) and build exhibits around it related to our aims in Second Life®
• use interactive media whenever possible to provide education. Displays such as slide shows have their place but should be used minimally.
• create a structure for projects through regular meetings
• collaborate with other health professionals, persons with disabilities, and others to create experiences within virtual worlds.
  On some level, I think I "knew" these things were best practices a year ago, but experience provides a deeper, richer understanding and commitment.
  For a description of current work, see the updated YouTube video at:
  http://www.youtube.com/watch?v=t1gFem4YnWA
  ]]> http://rhymerchick.wordpress.com/?p=151 Fri, 01 Aug 2008 17:10:14 +0000 rhymerchick http://rhymerchick.wordpress.com/?p=151 Disclaimer: although many autistic children have sensory processing disorder (SPD), not all do; also, not all children with sensory processing disorder (SPD) are autistic. In our son's case, he has both. Since there is a high coincidence, it is definitely worthwhile to have your child assessed for SPD, since sensory issues will interfere with any other therapies or discipline you may want to use with your child.

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  I no longer remember the name of the book that first introduced me to sensory integration dysfunction (now often called Sensory Processing Disorder), but it was authored by A. Jean Ayers, who first described the disorder, and developed the therapy for it, called Sensory Integration (SI). Other terms you may hear used: sensory defensiveness, tactile defensiveness, sensory over (or under) stimulation. At the time (mid-1990s), Ayers' was the only book available, since it was at that point a very controversial diagnosis and therapy. Now there are quite a few resources available, although some (uninformed) physicians still consider it controversial. DO NOT let your doctor brush you off on this, and if your insurance company won't pay for it, see a licensed physical or occupational therapist anyway, who specializes in diagnosing and treating sensory issues. Fortunately, it is much more commonly recognized and treated by insurance companies now than it was when we pursued it, and even school districts provide some services.

  ----------------

  How the diagnosis and treatment of sensory processing disorder helps with discipline:

  Children with this disorder often act out or throw tantrums because their brains do not interpret sensory input accurately. In Rob's case, he was tactilely defensive, had problems with his vestibular and proprioceptive systems, and engaged in sensory seeking behavior. In other words, he could not tell where he was in space, could not accurately tell how hard he was hitting or throwing things (or how hard he was being touched), and was ultra-sensitive to things touching his skin (like clothes). This caused him to have tantrums over the feel of his socks, shoes, and clothes, to be throwing things constantly; and his hitting, jumping, banging, pinching, etc were signs of his brain desperately trying to get some accurate information about his environment. His extremely hyperactive behavior was the main symptom, but there were others: his insisting on the same clothes every day, hating to be touched, throwing tantrums about getting wet or being bathed; wearing rubber bands around his wrists and ankles, a cloth tightly around his head (or a tight hat); cinching his belt or tying a rope extremely tightly around his waist.  He was also oversensitive to the textures and smells of food, sensitive to loud noises, etc. These issues often led to tantrums about going places (because we would want him to change his clothes); bedtime (because of bath and brushing teeth); meals (because of sensitivity to food texture and smell); public places (too noisy, too busy, too strange); being with other kids (because he would often throw things, hit and pinch them, or cry when they just touched him).

  The treatment consisted of daily exercises designed to normalize his sensory processing. Each child will have different needs, so you need to see a specialist to have him assessed, because the exercises have to be highly specialized to the needs of each child. They will do some of them at a clinic 2-3 times a week with special equipment. Some of the exercises you will have to do at home several times a day. The main thing that helped Rob was deep pressure, either by wrapping him in a blanket and squeezing him, or by brushing his skin with a surgical brush in a very particular way every hour and a half.  We also had to compress his joints in a particular pattern.  We did this 5-6 times per day, daily, for almost 6 years. So don't give up or get discouraged. The exercises help the brain re-program itself, which takes time.  He also had other exercises that he did once daily, either at school (which was equipped with a sensory room), or at home ( certain swings, playing on a large inflatable ball, etc). He also went to physical therapy 2 times per week - once in group therapy, and once a week in a private session with the occupational therapist.

  The improvement in Rob was almost immediate. So long as we did the exercises regularly, he was much calmer, and melted down much less often.  He liked the feel of the deep pressure so he did not resist doing it, especially if we worked it into his regular schedule so that he came to expect it. We were fortunate that his school had an occupational therapist on staff that would do the brushing and joint compression.  We also taught the school nurse, and he would go to her before lunch and again in mid-afternoon. At home, we did it when he got up, before he left for school, when he got home from school, before dinner, and at bedtime. We got into a routine so that the entire brushing/joint-compression protocol could be done in less than 5 minutes. Then we didn't make big deal about it; it was just the next thing in his schedule. We also made efforts to cut tags out of clothes for him, and if he found a certain article to be especially comfortable we bought several of those identical items. We instructed friends and family to always touch him slowly and with warning (and never from behind) so that he could have information about how he hard he was being touched.

  So the tantrums and hyperactive behavior were happening much less frequently; and when they did happen, we knew to look for a sensory cause first.  Sometimes he would be throwing a tantrum about an apparently unrelated issue; but we learned that if his socks were annoying him, he had less patience for waiting in line, for example. I carried a brush in my purse so we could do a quick skin-brushing to help calm him down, which also helped. As he got older we helped him to be able to identify and verbalize what was bothering him, rather than having a tantrum or screaming.  A time-out became a useful tool, not as punishment, but as a way for him to figure out what was bothering him, and to allow him to use a self-calming behavior like thumb-sucking, or brushing his own skin, or wrapping up in a blanket, to calm himself.  We encouraged him to try to tell us what was bothering him rather than screaming.  Sometimes the only thing to do was to leave the situation.  This is really frustrating, especially if you are shopping or have other children with you. But if there is something in the situation beyond your control (flickering fluorescent lights, for example) there may not be anything else to do. Sometimes it would help to give him a time frame, for example:  "I know the lights are really bothering you, but we will be done in 5 minutes." But then you needed to make sure you really were done in 5 minutes, so you can't use it as a stalling tool. The thing to remember is that he isn't "being picky"; the lights really are bothering him in a way that you cannot perceive. Moreover, he may not realize that the lights do not affect you in the same way. He may assume you already know what is bothering him, and so may not understand why you are not reacting the same way.

  -------------

  This leads to the second issue with disciplining autistic children: lack of comprehension about what you want from him....

  ]]> http://giftbird.wordpress.com/?p=48 Fri, 01 Aug 2008 14:52:36 +0000 giftbird http://giftbird.wordpress.com/?p=48 For those of you who have children that seem over-active, easily distracted, do not transition well between activities (reading to math during the school day), there is a great an easy solution for your children.  Gift Bird suggests purchasing a Weighted Vest for your child.  The weighted vests also help kids with sensory integration disorder, autism, ADHD, Fragile X Syndrome because they offer children the deep pressure that they need. 

  This topic is a far cry from my other gift ideas, but I think more publicity needs to be given to educational and functional adaptations for children.  I am soon to graduate with my occupational therapy degree and it is with my pediatric training that I have seen these vests work for children.  I think these vests are a great gift idea because they help children function better in their daily lives. 

  The following website offers weighted vests that are handmade for your child based on your child's size and customized with your choice of materials.  

  Custom Weighted Vests 

  ]]> http://pilgrimpathway.wordpress.com/2008/07/31/side-effects-what-about-rehab/ Thu, 31 Jul 2008 17:09:04 +0000 Greg Katz http://pilgrimpathway.wordpress.com/2008/07/31/side-effects-what-about-rehab/ We all want the best treatment for our illness.  Doctors are supposed to provide you with a thorough outline of the side effects of medications and the possible risks involved with any treatment plan.  We hear a lot about rehab when discussing cardiac health or following a stroke.  Do we need to extend our focus on rehab as part of the treatment process?

  I've known many women who have developed lymphedema following surgery for breast cancer.  There are physical therapy programs that have been created to help reduce the risk of lymphedema and/or prevent the onset.  How many breast cancer surgeons either know about these programs and/or are making them part of the treatment protocol?

  As you go through treatment the impact of any illness could be short term, but often the impact is long term.  If that's the case your "new normal" may have to include finding new ways of walking through life.  I've worked with a textile artist who has severe Rheumatoid Arthritis, as part of her own rehab plan she hired an Occupational Therapist to come into her studio and find ways of mitigating the impact on her body while creating art.  That's a form of rehab that we often don't discuss, as an example.

  I believe the goal of any treatment needs to be first and foremost to eradicate or mitigate the impact the illness has on our body.  Following the treatment the goal is to maintain your health, but also to maintain the highest quality of life possible.  In order for that goal to be met you may need to consult with a physical therapist or occupational therapist.  Perhaps you need to create order in your home or office, than a professional organizer may be able to help you turn chaos into order.

  There are many types of rehab both physical, emotional and spiritual.  Don't rule any out!  Have any stories about what you did to improve your quality of life following treatment?

  ]]> http://deborahbee.wordpress.com/?p=5 Mon, 28 Jul 2008 13:01:22 +0000 deborahbee http://deborahbee.wordpress.com/?p=5 Writing this and weaving are new enterprises in more ways than one.

   It all began when I failed to find a home for a dusty bundle of sticks I have carted around with me for at least 30 years which I now discover is a rather beautiful though somewhat dusty Bergman loom. All this time I thought it was unusable with vital parts missing. I had agreed to take it off my parents hands sometime in the 70s along with a spinning wheel. They had all belonged to a great great aunt who had lived in New York and was a weaver. I never knew her but when she died it was all shipped back to England and my father being a romantic and sentimental man took them in. My practical mother was not pleased and happily shifted the packages on to me. At that time I had four small children and definately no time to explore what I was given.

  Running alongside this event was my training as an Occupational Therapist in the 60's when the training was still mainly craft based. I am not a natural craft person, love making and creating but have never mastered the art of finishing off. At college alongside woodwork, basketry, anatomy and psychology we spent time learning to spin and weave. Our college in Oxford was situated in the grounds of a hospital and consisted of rows of ex-army Nissan huts, those curved corrugated iron temporary structures used during WW11. Each hut was devoted to an activity and a tall coal stove heated us up to tropical temperatures. There were few comforts. We learnt to spin whilst singing the Skye Boat song to keep the rhythm right. I was not very adept at the weaving. In a hut with a dozen foot power looms we had to weave a length of tweed. All my warp threads kept breaking and our elderly German teacher, a lady who had fled Nazi Germany was obviously frustrated at our lack of dedication. She walked up and down the looms clicking her tongue and shaking her head in despair. Outside the huts the sun was shining, flower power had arrived and the Beatles and the Rolling Stones were playing.  We also spent hours with table looms pattern drafting. I have to say that not once in my employment in the National health Service did I ever touch a loom again. As well as all this craftwork everything had to have a movement analysis done and a consideration of psychological attributes such as concentration and motivation identified in the different stages of the activity for its potential therapeutic benefit. I graduated in 1964 and immediately got married and started a family!!

  We moved house several times and eventually settled in a beautiful part of Derbyshire where we had 7 acres and I attempted to live out a fantasy of self suffiency which proved much harder than I had imagined and in the end we were both working and struggling with 30 ever escaping sheep. The sheep led me to the aforesaid spinning wheel. I had it repaired and jouned a spinning class. i started making use of our fleeces but only now and again and I found it impossible to give it the time it needed. The children were becoming teen agers and were always needing to be taken somewhere or other, my husband was a seniot teacher and working too hard and I was employed an a community meental health team .

  As the children went to University  we decided to sell our furniture and our house and the seven acres and the sheep and bought a 32ft American RV instead (just the two of us) and for a year drifted around the country. Well not quite true I did a Distance Learning Masters degree in Occupational Therapy and my husband worked free-lance as an advisor and researcher in Democratic Education and participation in schools.No spinning or weaving but lots of thinking and reading. I wrote a Dissertation about the way in which we contruct meaning through everyday occupations. I researched peoples beliefs, memories ,use of time, importance of objects used in the everyday activity of making tea. This demonstrated the importance of culture in the way we create our social environments. I read Bruner and Vygotsky(A Russian psychologist) and I remain fascinated by how we create meanings in our lives.

  Now we are grand-parents several times over and there is time and space to explore interests and discover what talents and skills may have evolved within us. My husband sails, watches birds and remains involved in improving the lot of young people in the educational system. We both have a hut/work place in our garden where we can work/play at our individual interests, and I have enjoyed dressmaking, and teaching myself rather badly pattern cutting. I also knit and have a Passap double bed knitting machine and a computer programme to design. I have experimented and made many samples but there is very little in the way of finished product. Discipline where are you!!!

  This brings me right up to date. The bundle of sticks was getting in my way Thinking it broken and useless but not having the heart to chop it up for the woodburner I posted it on our local Freecycle. A lady contacted me and arranged to visit. In the next 48 hours thinking I was preparing myself to twist her arm to relieve me of it I started to Surf the Interner. Lo and behold!! Wonder of wonders!! I fell into weaving blogs. There was a fantastic description of threading up a Bergman loom. With pictures. Suddenly my heal of sticks took form.The broken shafts were not broken. The higgledy piggledy short sticks were jacks which had lost the metal rods to hold them in the jack box. With rapidly growing excitment I started to unfold it and put it together. It looked just like the beautiful loom on Trapuntos site. I was so relieved that I could face my would-be customer with a good conscience. My husband asked me if I was sure I wanted to give it away. O yes I replied I will never have time to weave and I need the space.

  The lady came. She was enthusiastic. She said she would return home and measure her space. She failed to ring. Then she e-mailed me. She was ever so sorry uut it was too large for her room. My heart soared. Its mine! I can keep it!  What a close shave that was! Since then ,which was only two weeks ago I have been cleaning, polishing and avidly reading web sites and blogs. I have been to the library, though there was only one book. I havn't woven since I was a student. I am sure a beginner shouldn't start with an 8-shaft loom, but none of that is relevant.

  There is little about Bergman looms on the Web. My loom is only 32" wide and is complete apart from a back beam which my husband thinks he can make. I have ordered loom cord as one posting I found suggested Tes-solv was a little thick to go through the treadles. I don't dare buy anything else until I know it really works and that I can get a decent shed.The cord arrives tomorrow. This will be a test of all my new found enthusiam and a demand on my patience (minimal) and a face to face with reality. I will appreciate all your encouragement and words of wisdom. I have no flesh and blood weavers in my circle of friends only books and this virtual world which is proving to be an inspiration and I expect a lifeline to keep me on the straight and narrow.

  I want to post this and find out whether I have done all the correct things to start blogging. never tried before. I intended to include photos but at present I can,t download my pictures. I will have mastered that by the next posting. I long to show pictures of beautifully woven blankets, scarves and Chanel type tweed!!! One day......

  ]]> http://otsecondlife.wordpress.com/?p=61 Wed, 23 Jul 2008 21:45:31 +0000 zsuzsatomsen http://otsecondlife.wordpress.com/?p=61 The IM came in out of the blue, from Kathee Gibbs, whom I'd never met. She and partners Lucinda Bergbahn and Pecos Kid were finalists in the Second Life and the Public Good: A Community Challenge from USC. Kathee IM'd because she wanted to talk to me about donating the award Lindens to our Center. When we had a chance to talk yesterday, I found out that we shared the same idea for a program development project in Second Life: educate people about adaptations that can be put in place at home, to improve daily life. Specifically, Kathee's proposal was to "provide a tool that persons with mobility impairment can easily and cost effectively access to explore ways in which they can improve accessibility in their homes and thus the quality of their daily lives. " We met at the OT Center to talk, and Kathie shared her ideas about how the adaptation exhibit at the Center might be further developed to incorporate more interactivity and consumer choice.
  [caption id="attachment_62" align="alignleft" width="300" caption="Kathie and Zsu discuss ideas for expansion of the adapted home"][/caption]
  Today, Kathie told me she discussed the donation with partners Lucinda Bergbahn and Pecos Kid, who gave the green light to provide funding to our Center! I'm amazed at their generosity and so pleased to know that their gift will enable us to expand our work and, we hope, benefit persons with and without disabilities and raise awareness of the possibilities that can be achieved through home adaptation.
  ]]> http://goodmum.wordpress.com/?p=120 Wed, 23 Jul 2008 01:26:39 +0000 goodmum http://goodmum.wordpress.com/?p=120 Little Man had his second therapy session with the OT today. He was in a nice, quiet, calm mood today, so the OT did a lot of fine motor planning activities with him.

  I asked Hubby to come along to the session today so that I could ask the OT a few questions about LM's behaviours and his therapy, while Little Man and Hubby played in another room. We've (the OT and I) come to the conclusion that, for now, Little Man definitely (maybe?) doesn't have Asperger's. She did say that he exibits some behaviours that smell of AS, but that there could be other reasons for them. She also said that if she really believed at any point that Little Man did  have AS, she'd be frank about it and ask us to get a second opinion and an official diagnosis.

  We discussed hubby's OCD a little more. And Little Man's increasing anxiety around other children and around routines. He is becoming more rigid in his expectations of the world, especially us, his parents. The OT reiterated that she really would like us to get our family doc to refer LM to the anxiety clinic at the children's hospital. While it is rare for children this young to show signs of OCD, with a parent such as Hubby having such severe OCD, it is definitely something we need to keep an eye on.

  Coincidentally, I have an appointment with our doc tomorrow morning to ask for the referral. This won't be a problem, as the doc had asked me before if we wanted the referral to be sent. At that point, we were already seeing a different child psychiatrist, so I didn't think we needed it. Then we found out the the child psych we were seeing was a jackass who couldn't be on time or keep an appointment book that wasn't double-booked. Now we've decided that we might as well get on the waiting list for the clinic at the children's hospital. Oh yeah...did I mention that the waiting list is 6 months to a year long? Fuck.

  Fuck.

                                                      ************************

  On another note, I wanted to clarify something about my last post. I want to make sure that I'm clear about the fact that when I talk about the friends "dropping like flies," I mean that they are dropping in my mind. They drop off the radar because I either don't initiate any contact or don't respond to their calls or emails. I am too worried all the time about how my kid will behave and react to all of the potential stressors. I might be embarrassed about a previous playdate. I might just be too tired to deal with it. So I avoid them. Not a good way to deal with it, but it's my  way.

                                                          ***************************

  On a happy note, Little Man has been spelling and reading up a storm (or, as much of a storm as a 4-year-old can read) lately. We were in Walmart (Don't even bloody well ask me about our Walmart. Fuckers. Ok, you can ask, but read this part first.), finishing up our grocery shopping (never again, WalFart Feckers), and having a  boring as hell  stimulating convo about Star Wars and Yoda and Lego dot com.

  ***Tangent*** Speaking of convo's, Little Man can TALK, girlfriends!! Lately, his one-sided conversations are getting longer and longer and more and more repetitive. I try hard to always appear interested and to reply in the (SHORT!) dead spaces of air that demand a reply of some sort. You know, you'd be surprised how well you can carry on a conversation with just uttering the odd "Really?" or "That's cool, buddy" or "I agree, Little Man."  Of course, you do run the risk of a "Mommy??!! Mommy??!!! You're not really listening to me, are you? Now I'll have to start over again."  If this happens, just start over again with, "Really?"

  Anyway, the little dooood can talk the shit out of a topic. Lately it's Star Wars and Lego Star Wars. I might be the only person alive who was born in the 70's who HASN'T seen the Star Wars movies, but please excuse my worldly ignorance. I don't know who's good or who's bad or who's good now but used to be bad and vice versa. I won't even pretend to care. Ok, yes I will. For my kid, I pretend to care. See above.  ***End tangent.

  So somewhere in the conversation, Little Man has decided that instead of just going to Lego dot com or Star Wars dot com, he should see if there is such a thing as Yoda dot com. He reminds me that he can spell Lego and that he can spell Star Wars and says he's going to figure out how to spell Yoda.

  "Mommy, I forget which letter makes the yuh sound."

  "It's Y, dood."

  "Ok, so it's Y, O, that one is easy, duh, D, hahaha, that one's easy too, aaahhh, A. So I'll type in Y O D A dot com."

  "That's right, buddy. You're amazing me with your smartness."

  "Duh, Mommy. Smartness isn't a real word."

  "Oh, ok. Sorry."

  Is it bad that my kid says "duh" to me a lot? I think it might be bad. Yeah, it probably is...

                                                        *********************************

  Dear WalFart Fuckers of My Town, Canada,

  I hate your asses. All of your asses. And you have a LOT of asses.

  I was in your store today, buying groceries and a couple of bribes for my kid. Pretty simple, right? Yeah, you'd think so, wouldn't you? Simple-minded Butt Wipes. (Please know that I am entirely aware that there are probably a lot of smart, kind, helpful people working for the WalFart Enterprise. I am also entirely aware that none of them are in My Town's WalFart store.) Yes, YOU! My problem lies in the fact that when I made my way to the check-out point, I was greeted with the samedamnthing as every other time I've tried to check out of your store: LINE UPS. LONG BLOODY LINE UPS. This is so NOT cool, WalFart of My Town, Canada. Not fucking cool.

  If the store was particularly busy on occasion (say a Saturday afternoon at 1), I could forgive you. If it happened once or twice, here or there, I could also forgive you. But I can NOT forgive you for this when it happens every time that I enter your store. I might add here that I'm usually in your store twice a week. On weekdays. In the morning. IN. EXCUSE. ABLE.

  I've called your managers on this. I've sent letters. I've sent emails. You must think I'm just fucking with you, because nothing ever changes. Samedamnthing, every time. So that's it. I'm done with you. The hate affair is over. I will now purposefully pay more for my groceries and other necessities because it will be better for my mental health. No more attacks of suddenly high blood pressure. No more stress headaches because I can't think of a way to talk to your manager without using the word "Fuck" six thousand times. I'm done with you.

  Oh, and just in case you're thinking that it's good to be rid of me and my insults? Be. Aware. I'm plotting WalFart Butt Holes. Plotting. I'm evil. I'm evil and I'm plotting.... Did I mention I'm evil?

  Kia, My Town, Canada

  *Note: No WalFart Butt Wipes employees were harmed in the making of this hate mail. No, I'm not actually plotting an attack. It's a joke. Ha. Ha.

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