April is not only Occupational Therapy Month, but also National Autism Awareness Month. After about 17 years, the American Psychiatric Association (APA) has undertaken a revision of its authoritative text, The Diagnostic and Statistical Manual of Mental Disorders (The D.S.M.) and with it, a tightening of the definition of autism. The current D.S.M. definition requires a child to exhibit at least six of twelve specific developmental and behavioral characteristics, which fall into three broader categories: deficits in communication; deficits in social interaction; and repetitive and restricted behaviors and interests. In addition, these symptoms cannot be attributed to any other similar condition, such as Rett or Asperger's Syndromes, and their onset must manifest before the age of three.
The revised definition reduces these symptoms to seven and collapses them into two groups: deficits in communication and social interaction; and restricted, repetitive behaviors and interests. The change is reflective of recent research and more closely mirrors how clinicians and therapists currently view autism; as one part of a spectrum of related disorders and not as a separate entity. Autism Spectrum Disorder (ASD), as it is known in the field, is a continuum of disorders including: autism, Asperger's, childhood disintegrative disorder and pervasive developmental disorder not otherwise specified (or PDD-NOS). The APA's belief is that a more compact definition of autism will lead to fewer and more accurate diagnoses of clients overall.
Nonetheless, there is still disagreement among the experts, as well as unease among parents of ASD children, as to whether or not patients at either end of the spectrum, those with low level symptoms or those with higher-functioning capabilities, will be excluded under the new criteria. The APA views the D.S.M. in general as a set of guidelines to be used in patient evaluations, allowing for subjective interpretation by the clinician. Given the direct correlation between diagnosis and treatment services rendered, it is clear why many are concerned. The APA plans an open review of the final revised definition before final publication of the D.S.M. in May of 2013, and experts believe that some tweaking will occur that will help to allay some of these worries.
How would this proposed change affect Occupational Therapists and their clients? OT services are not diagnosis-driven, but client-driven, with treatment customized to the individual's unique occupational profile. Therefore, no change is anticipated in Occupational Therapy services provided to any diagnosed and referred client. What may change, however, is the number of referrals based on these new criteria, which in turn could greatly affect funding streams. The goal to bring real world precision to the diagnosis of autism, will likely change research of the disorder, especially outcomes research. Sharpening the scope and recognized symptoms of ASD, enables OTs to construct and execute more efficient and effective therapeutic interventions. For example, many ASD children and young adults exhibit sensory processing complications. The proposed redefinition includes this issue in its revised diagnostic benchmarks. It seems reasonable to assume that as a result, there will now be an increase in research and Occupational Therapy treatment plans designed to address this specific symptom. Although it is clearly too early in the process to know all of the ramifications for OTs and their clients, there appear to be more benefits than detriments.
If you are a master or a novice in the field of Occupational Therapy and are looking to find a challenging and cutting edge position, contact the Centra team at 800 535 0076 and let us help you make a difference in the life of an ASD patient
A small but significant number of infants and children under the age of fifteen, 6 in 100,000, annually suffer a stroke. The incident of stroke is noticeably higher for in utero and premature babies, as well as children under the age of two. These high risk groups likewise exhibit a higher incidence of cerebral palsy stemming from their stroke. In adults, the causes of stroke are often the result of life-style choices, such as smoking or drinking; or the consequence of high blood pressure and/or cholesterol. In children, strokes are generally caused by birth defects and trauma, along with infections, such as encephalitis or meningitis or blood disorders such as sickle cell.
Due to the prevailing myth that stroke occurs only in adults, child victims often seek out and receive delayed treatment. The National Stroke Association notes that while adults usually pursue treatment within 12-24 hours of a stroke, it may take as much as 48-72 hours before children are taken to a hospital when exhibiting similar symptoms. Studies have shown that there is a critical effective treatment window of 3 hours following the onset of child stroke symptoms. Professionals recommend that parents implement the F.A.S.T. method for immediate assessment of a possible stroke (F.A.S.T. stands for Face, Arms, Speech and Time). Through a series of simple performance requests, followed by "time is of the essence" action in seeking treatment, caretakers may be able to mitigate the disabling effects of these incidents in children.
Post- treatment, there are a number of effectual OT interventions for use with child stroke victims. These include therapies to improve eye-hand coordination, optical tracking, and peripheral visual awareness. Another proven method is Interactive Metronome (IM), a therapeutic modality designed to improve motor and cognitive skills. A newer therapy combining Modified Constraint Induced Movement Therapy (CIMT) with neuromuscular electrical stimulation shows great promise as well for improvement of coordination in these young victims.
Armed with a $1 million challenge grant from NIH, Gillette Specialty Healthcare and the University of Minnesota are studying this new technique which entails short-term immobilization of the non-affected arm/hand and OT, alternate use of a noninvasive magnetic field to stimulate the healthy side of the brain. OTs work with these patients on a series of exercises for the stroke-affected side to increase strength, flexibility and hand function. Funding runs out for the study in August of this year, and with results still incomplete, can it really be determined how stimulation enhances gains made by OT alone? The next step researchers hope for is a more extensive study which applies low level electronic stimulation simultaneously with OT to determine the answer.
If you are a pediatric/neurologic Occupational Therapist interested in working with child stroke victims or seeking a new environment to showcase your skills, call Centra at 800 535 0076 and let us find your next challenge.
Massage, music and exercise as therapeutic methods for treating mental illness can be traced back to the Greeks, but only in the early 20th century was occupational therapy widely accepted as a legitimate healthcare profession. Modern OT practices can be traced to World War I and treatment of injured combatants, many suffering “shellshock”, what is now called PTSD. From 1917-1920 there was significant demand for “reconstruction aides” to rehabilitate these injured. Many of the aides were women trying to do their patriotic duty, with little or no mental health training. The dearth in skilled personnel accelerated the professionalization of the field, codification of its practices and establishment of nationwide network of training programs. By the end of the 1920s, the groundwork had been laid for occupational therapy as we know it.
To this day, PTSD remains an important OT specialization in both civilian and military sectors. Increasing numbers, as high as 20% by some estimates, of deployed soldiers and returning veterans of the wars in Iraq and Afghanistan, both male and female, are being diagnosed with the syndrome. There are 17 officially recognized symptoms of PTSD, which fall into 3 broad categories:
- Re-experiencing: nightmares and flashbacks
- Avoidance: isolation and emotional numbing
- Hyper-arousal: insomnia and outbursts of anger
PTSD affects the physical and emotional well-being not only of the victims, but their loved ones as well. It is well-documented that sufferers have higher incidences of drug and alcohol abuse, as well as a higher rate of divorce and other family issues than in the general population.
Of growing interest to the DOD, the VA and others, is the direct correlation between PTSD and a significant annual uptick in driving-related issues among service men and women. USAA, a leading insurer of active duty troops, reports that auto accidents involving a deployed service member are up 13%. In addition to DUIs and drug-related accidents, PTSD manifests in this population as aggressive driving and road rage, or the opposite, very defensive driving and extreme caution. Soldiers and veterans may suffer severe anxiety attacks and/or hypervigilance, resulting in unusual driving strategies such as straddling lanes. Given the modern driving distractions of civilian life, such as texting, hypervigilance on the part of drivers might be a positive. The problem for the PTSD sufferer is when they cross the fine line between real and imagined dangers and it affects their driving habits and perceptions.
Studies show that OT is particularly effective in providing PTSD victims with the coping and management skills needed to conduct their daily activities, and driving is no exception. There are a myriad of PTSD videos, audio tape programs and smartphone apps available to service personnel and their families. As yet, OTs have fewer clinician-grade tools at their disposal, but can integrate many of these self-help formats into their treatment programs. OTs should check out the reference app ”Co-Occurring Conditions Toolkit” from The National Center for Telehealth and Technology, as well as the their “Life Armor” app which provides support and practical tools for patients. Both apps are free and specifically designed for military personnel.
Many innovations in evaluation and treatment of PTSD are the product of DOD and VA research and development in collaboration therapists, engineers and scientists. Though currently being tested in military and VA clinics, presumably in the near future advances will be available to the general public on a broader scale. Simulators, such as the ones developed by DriveSafety, show particular promise for resolving PTSD related driving issues. These machines reproduce a variety of driving scenarios and exercises and are designed to target specific skills for patients with functional losses. The more that OTs can improve functionality in their patients’ living skills, including driving, the more rapid they can effect patient integration back into civilian life and start them on the road to full recovery.
If you are an OT looking to make a difference in the lives of PTSD patients or interested in exploring new and exciting challenges in your field, contact Centra at 800 535 0076 and let us help you achieve your goal.
In a recent article in "US News and World Report", Nathan Hellman declares occupational therapy to be one of the "Best Jobs of 2012" stating that the profession "should see significant growth over the next decade". Occupational Therapists work with patients across the age spectrum, but it is the substantial increase in America's older population that is fueling the demand for more therapists. OTs service diverse populations, helping them execute diverse daily living tasks, while performing these services in diverse work environments: hospitals, rehab centers, schools, medical practices and even clients' homes. The broad diversity of this field, necessitates choosing an OT specialty at the beginning stages of your career. Finding a niche early on that you are passionate about, will only enhance the longevity and quality of your performance in the field.
As with many healthcare professions, the entry level educational requirement is an advanced degree. There are a limited number of combined B.Sc. / M.Sc. degrees programs in occupational therapy. However, completing a master's degree from an accredited graduate program is the most accepted educational requirement to sit for the NBCOT, and upon passing the test, for working in the field. "US News and World Report" has just come out with its list of 2012's top occupational therapy graduate schools. Here are the Top Occupational Therapy Schools that ranked in the top 10:
- #1 University of Southern California, Los Angeles, CA
- #2 Boston University (Sargent), Boston MA (tie)
- #2 Washington University in St. Louis, St. Louis, MO (tie)
- #4 University of Illinois-Chicago, Chicago, IL
- #5 University of Kansas Medical Center, Kansas City, KS
- #6 Colorado State University, Fort Collins, CO (tie)
- #6 Thomas Jefferson University, Philadelphia, PA (tie)
- #6 Tufts University-Boston School of Occupational Therapy, Medford, MA (tie)
- #6 University of Pittsburgh, Pittsburgh, PA (tie)
- #10 New York University, New York, NY (tie)
- #10 University of Florida, Gainesville, FL (tie)
- #10 University of North Carolina-Chapel Hill, Chapel Hill, NC (tie)
If you are a graduate of these or any other accredited OT programs and are looking for the right environment to utilize your passion and skills, contact Centra at 800 535 0076 and let us help you reach your goal.
April is designated as Occupational Therapy Month. OT students and practitioners are encouraged to organize and participate in a events and educational formats promoting the profession. AOTA (American Occupational Therapy Association) strongly supports these efforts and offers various tools and educational materials to be used specifically for promotional activities. To show our support, Centra is dedicating all of its April blogs to topics relevant to the practice of OT and its benefits for patients of all ages.
To begin, here are a few AOTA suggestions for celebrating and promoting your profession:
- Download, view and share the wealth of educational materials available on AOTA's website with your colleagues and clients. These include practitioner fact sheets and the podcast series "Living Life To Its Fullest", the AOTA slogan for OT Month 2012.
- Organize and sponsor fundraisers, contests and OT-focused health fairs, designed to highlight the positive effects of OT in the lives of individuals and families. AOTA has a number of items for sale that can be used as prizes or giveaways for these purposes.
- Schedule speaking engagements with local schools and colleges, agencies and institutions for the aged, as well as with local and state government officials to educate about the profession. Augment speeches with newsletters; encourage your city or state to issue proclamations designating April as OT month; and invite local media to cover all of these activities.
Check out the AOTA website for a full list of ideas and promotional materials. Continue reading the Centra blog for trending issues in the field and useful tools to enhance and facilitate your work.
If you are an OT, whether you are just starting out or a seasoned veteran, the Centra Team can locate the best employment situation to start you on your path and showcase your talents in this important and very practical field. Contact us at 800 535 0076.