Communication Shutdown

Yesterday, 1 November 2010, I participated in Communication Shutdown - a charity event raising awareness and support for those affected by autism spectrum disorder (ASD). This was a global event which required participants to cease accessing Facebook and Twitter for the day.

I feel compelled to write of my experience yesterday, as I was far greater affected than I had predicted. I work with children who have autism, and decided to participate to demonstrate my support for these children. In doing so, I also gained some interesting insight into my own use of social networking sites, and also discovered that I rely quite heavily on social interaction throughout the day.

My day usually starts very early (having a 1 and 3 year-old who wake at 5:00am), and I more often than not will immediately jump on to Facebook to see what's going on out there in my world. I have a sister overseas who I catch up with regularly online, and love to read what her family have been up to. I scan down my page to see what interesting information can be found in the different 'groups' I belong to, and on the various 'fanpages' I follow.

I use Facebook, and to a lesser extent Twitter, for both personal and professional reasons. There is some great information being shared on individuals' experiences with various illnesses, injuries and disabilities, and great resources to be found.

I had thought that 'switching off' for the day would be easy, but it wasn't. An email I received announced that I was 'tagged in a wall post'. It took all the willpower I could muster to not look! My fridge had broken down over the weekend, and I had a new one arriving. For some reason, I really wanted to share this with my 'friends'! At one stage I came across a site that I wanted to become a 'fan' of on Facebook so that I could receive regular updates on their products - but I couldn't. This would have meant accessing Facebook.

So in addition to showing my support for this cause, I also learned a little about the concept of communication shutdown too. Working with children who experience communication difficulties, I thought I understood. I probably still don't entirely, but I think I am a little more aware. Communication is not just about expressing wants and needs. It's about validating your own opinions, preferences, and experiences. It's about feeling connected with the world around you and its people. For me, communicating is a way of learning, and educating too. I use Facebook and Twitter to obtain and share interesting information and resources. It appears as through the Communication Shutdown project has been a huge success - for fundraising, and for raising awareness for autism. A truly worthy cause.


For more information, visit www.communicationshutdown.org

Where have your blog posts gone???

I will now be contributing regular blog posts to Be a Fun Mum and writing a column for Connect2mums! Both of these sites aim to provide mums with information and advice to help their children (and themselves) reach their full potential. Their philosophies closely mirror my own, and I am very excited about being asked to write for them.


Visit connect2mums

What's in a name?

I often receive requests to assess for delays with development or dysfunction in the areas of sensory processing, fine and gross motor development, attention/ concentration and other areas of function. One of the questions I am frequently asked by parents, particularly when obvious issues become apparent, is - what do you think it is? Many parents are aware of neurodevelopmental disorders like those on the autism spectrum, and I often get asked about ADHD and sensory processing disorder.

I will always refer to a paediatrician for diagnosis, but can assist with the process by providing a report outlining my observations and recommendations.

Parents often feel reassured when they at least have a little more information as a result of an initial assessment, particularly as my focus is always on providing information and strategies to assist - regardless of whether or not a name is given to the challenges identified.

Once specific issues are identified, the treatment options or interventions used tend to be the same, regardless of what the diagnosis is, or will be. The problem here is that without a diagnosis, parents can have limited access to Occupational Therapy services. Government funding is available in Australia for children with special needs via such schemes as Helping Children with Autism and the Enhanced Primary Care Scheme. However, a diagnosis is required. Parents who wish to pursue intervention with a private allied health professional, and do not have a diagnosis, may be able to claim some of the expenses from their private health fund, or self-fund the fees.

Occupational Therapy services are available to the community via community services and more specifically to school age children through the Department of Education and Training. Waiting lists are often lengthy, which can affect access to early intervention services, however it's worth contacting your local department to check.

My concern with seeking a specific diagnosis or giving a name to the difficulties a child is experiencing, is that some children just do not meet all the criteria to be given a diagnosis. This doesn't mean they are any less in need of assistance. Many children can benefit from Occupational Therapy services, to develop skills to help them with their school work, social interaction, and self care. Click on the links or email me for more information.

Healthy Home Office Habits

If you work from home, chances are you have or will experience musculoskeletal pain.

Remember back in the 80's there was an epidemic of RSI (Repetitive Strain Injury)? You may at least, have heard of the term. The sudden increase in RSI cases coincided with the increased number of computers being used by office workers.
Following this, workplaces began to focus more on strategies to prevent the onset of injury related to constant computer use. Most workplaces now have training or other methods of ensuring their workers are aware of safe work practices and ergonomic principles. Unfortunately, most of us employ these principles at work, and then forget all about them at home!

There is a fantastic cartoon called the Evolution of Man that depicts a hunched over Neanderthal man evolving into modern upright man, and then over time becomes a man hunched over a computer – mimicking the posture of the earlier man. It's a cartoon that is often shown to us Occupational Therapists as students. It is humorous, but illustrates one of the reasons why so many people now report back, neck, and wrist pain.

An insightful client once pointed out to me that humans weren't designed to sit for long periods of time working on a computer. This is true. The largest muscle groups are in the lower limbs, to help us move around. Prolonged sitting, particularly with using a computer, can lead to fatigue of the smaller muscle groups, and eventually pain and injury.
Most offices now, are equipped with fully adjustable, ergonomic chairs and sometimes height adjustable desks. Monitors can be moved to an appropriate height, angle and viewing distance and screen settings can be adjusted to suit varying visual deficits. People who spend a lot of time on the phone often use headsets or the loudspeaker function, freeing their hands for note taking.

Then there's the whole range of ergonomic mouses, track balls, keyboards with wrist rests... the list goes on. Interestingly, workers still report symptoms of pain that are later diagnosed as Occupational Overuse Syndrome (OOS), or RSI.
One reason is that ergonomic and adaptive equipment may be in place, but used incorrectly. Another reason is that stress is contributing to muscle tension and/ or the worker is not taking enough rest or posture breakers. And the reason that applies to most of us – we don't apply preventative strategies at home.

Many of you are now working from home and trying to squeeze in computer time around meeting the needs of your families. Laptop computers, blackberries, iPhones and other electronics have made it easy to work while sitting on the couch, on the floor or even in bed. Unfortunately, safe work practices go completely out the window.
The ideal working position is this:
• knees, hips and elbows at a 90 degree angle when seated
• feet flat and touching the floor
• spine supported to maintain the natural curves
• the monitor or screen height should be at eye level or just below
• the keyboard should not be higher than your wrists, when your elbows are kept at a 90 degree angle
• Your wrists should be neutral (flat)
• Your mouse, phone or other frequently used items should be within arms reach.

In addition to the above, you should not be seated for longer than 20 to 30 minutes at a time. Go and grab a coffee or throw yourself on the floor with the kids, but don't stay seated for too long. Even if you are sitting in the position described above, your muscles will still fatigue and injury can result.

So what now? Find somewhere in your home to set up a workstation that allows you to adopt healthier work habits. If you must sit on the couch or in bed, make sure your back is well supported and you adhere to as many of the above points as you can. If you are still experiencing pain, numbness and/or tingling anywhere (except the good places!) see your doctor. It is also possible to consult with an Occupational Therapist (OT) who works in the area of vocational rehabilitation or ergonomics.
An OT can visit your home or office, assess your individual work needs, and provide you with advice, strategies and equipment recommendations if relevant. If you have employees, this is a good idea as a preventative measure to avoid expensive workers compensation claims.

Write or Wrong?

I have an increasing number of requests from parents to assist their child with handwriting. I have posted about this before in a blog post entitled - A Gripping Story.

Recently I conducted an Ergonomic Workstation Assessment for an adult who was employed in an administrative role. This particular employee had the task of completing a large number of forms by hand and she was experiencing symptoms that her GP thought might be early signs of Carpal Tunnel Syndrome. This recent assessment again got me thinking about writing.

Computers and other electronic devices are being used more frequently to communicate - either in real time or to convey a story or recount an experience. It appears as though typing has become the preferred method of communicating over writing and even at times over speaking. I wonder if this is the reason why there is an increasing number of both kids and adults who struggle with writing - either by writing poorly or by developing pain in their hands and wrists during this task?

It's important with any skill to practice often. Use it or you lose it - basically. My approach with working with kids is to firstly correct their pencil grasp, and then practice, practice, practice. Work on letter formation, letter height, width and word spacing. With adults who are reporting pain or other symptoms e.g tingling in the hands, I encourage them to continue writing, but to alternate written tasks with other activities. I encourage all clients, both young and old, to perform hand stretches before commencing writing tasks - just like a footy player would stretch his muscles before running onto the field.

I would love some feedback on this post. Which is more important - handwriting or keyboard skills? Do you experience hand or wrist pain if writing? What about your kids?

Please note, if you experience pain, numbness or tingling when writing or typing, and it does not go away, seek medical attention.

Three Little Words

As the end of the school year draws to a close, I find that my school age clients get a little bit impatient, frustrated and less cooperative. I think it's a combination of fatigue, burn out, and anticipation of the holidays and Christmas.

One particular client, a boy with Cerebral Palsy, flatly refused to cooperate one day. Knowing that he was likely to be a little difficult, I had prepared activities that I thought would be fun. I only had a few things with me as I was seeing this boy in his home. When he showed no interest in any of the tasks I had on offer, I knew I had to try harder, as there was no alternative. In my therapy room I have a huge range of resources, but on home and school visits I am limited.

"I don't want you in my house", said the boy. "I'm the boss here" he added.

I told him that he wasn't and that we were there to work, that his father would be disappointed if we did nothing, and that it was to help him to use his arm better. "You need to practice using both your left and right hands to play the Wii!" His favourite thing to do.

"I don't want to", he said when I offered him different games. He had not even looked at them.

Complete resistence.

I needed him to understand that I wasn't going anywhere.

"I like you", I said. "I want to be here, and I would really like you to play this game with me".

Well those first three little words made the biggest different. The boy looked at the game I had in front of us, looked up in to my eyes and said "OK". For the rest of the session he was involved, he participated, and he worked hard. I was so proud of him and so thrilled that our therapy session was productive.

I think there are so many messages here in this story. It's important to show consideration and care for other people. It's nice to be told nice things, and it's nice to be nice. I meant what I said, and I think that's important to.

We Did It! Hooray!!

Working with young children and having several of my own, daily achievements are often celebrated Dora The Explorer style by singing "We did it! We did it! We did it! Hooray!" This is one of the first things that came to mind when I discovered that a client of mine, a 12-year-old boy with ASD, had learned to shower and toilet with minimal intervention.

My last blog post focussed on a particular therapy session, spent role-playing the steps involved in wiping after using the toilet. I had mentioned this particular client to help explain the many ways in which OT's work with people to improve their ability to participate in daily living activities.

This last session was one of many that had been spent developing and introducing schedules for daily self-care tasks. Weeks before had been spent discussing the steps involved in tasks such as showering and toileting, role-playing each step, and perfecting posters for actual use, in addition to coaching the child's mum on how best to introduce these concepts at home.

Mum had been particularly worried about this last point. After years of developing a routine that worked, this was a big step for both of them. It was bound to cause some stress as any change in routine often does, and it was going to be a time consuming process.

I never expected to be so excited and proud when I discovered that my client had learnt to both shower and wipe himself when toileting with only minimal supervision required for each activity. Only months beforehand, he had been completely dependent and showed little interest in changing that fact. We now have new goals for therapy based on other daily tasks and I can't wait to see what else this amazing kid can do. Hooray!