Should Middle and High School Students Participate in the Evaluation and Annual Review Process?

Should Students Have a Voice?
Absolutely! Most students at the middle and high school level are looking for a sense of independence. Students of this age are often at a point where they want to know why they should continue therapy, and if they continue, why they can’t decide what they need to work on. In a school setting, the goals need to relate to a student’s educational and/or vocational needs. There is so much more information that a therapist needs to know to determine a student’s perception of his or her abilities and further determines whether or not a student really needs to continue. Standardized test scores, although important, are only a snap shot of the student’s abilities at the time the student participated in the assessment. It is not a clear and thorough picture of the student’s ability to function in a classroom.
I have often found that a student will provide more information if the questions are presented in a written format, particularly with sensitive areas, like activities of daily living, presented in checklist format. Students will review the document, quickly at first, check an answer [which the therapist or teacher can expand on later] and then move on. The written format provides a canvas, if you will, to create a dialogue with the student. For example, let’s say that the student checks off that he or she can make a sandwich, ask the student how he or she makes that sandwich and you will get a better idea if he or she really is capable of making that sandwich.
I have developed a written interview, which I began using with some of my students over the last few years. I was able to better assess a student’s abilities and perceptions of being able to care for him or herself and support classroom skills. It prevents that ‘oh no’ moment when something is revealed in a CSE meeting that you should know but don’t surfaces. When interviewing a student verbally, many of those items are glossed over and the interview proceeds. A written document is a bit impersonal and the student may just answer more truthfully and feel more comfortable in doing so.
Let’s go back to that sandwich; a student checks off that he is able to make a sandwich. Later, when reviewing the interview with the student, you ask, “How do you make that sandwich?” The student lists all the items that he needs for the sandwich but is unable to describe how to actually make that sandwich. This may indicate that a student has a form of dyspraxia or apraxia that has been addressed in other areas through years of therapy, but not yet in the area of self-care. In very basic terms dyspraxia (problems with) or apraxia (unable to) refer to sequencing the steps to perform a skill.
This is enlightening and indicates other areas need to be explored. When evaluating a student, all methods of gathering information should be used. Standardized and non-standardized testing is important but so is the interview of the student and the teacher. On my website, I have included a checklist that both a teacher and a parent can complete to provide information on the student http://www.mseleanorsapples.com/Forms.html. I have actually developed a questionnaire to give to a student, also available on my website http://stores.mseleanorsapples.com/StoreFront.bok . The checklist [for teachers and parents] is free. The Student Interview is available for a nominal cost and is able to be copied freely for each therapist or teacher once purchased.

My 12 Christmas Wishes

I am sitting at the computer working on one of my projects. As I work, I often have the television on for background noise. One of those cheesy holiday programs is on. The main character as just lost her job, her boyfriend wants to write a novel and she had to put her dog in the kennel for boarding since her lease does not allow pets. Her best friend recommended that she visit a ‘Life Coach.’ And so the story begins. Her life coach tells her to go to her website and log in. Once logged in, she can enter 12 Wishes, hence the name of the story. Her life coach was, of course, a ‘Mrs. Claus’/Angel type character with an intense love of all things Christmas. Needless to say, the character’s wishes all came true.
So what does this have to do with my blog or my own future? A sense of all that I have accomplished in my life, a sense of what I want to do in the future and a sense of what I need to do right now. More important, what are my visions for world and where do I fit in. As in this cutesy movie, I need to be careful for what I wish for; not for the content of my wishes, but for how my wishes impact myself and those around me.
These are wishes that I really want or need to happen, so here goes:
1. I wish to be debt free [selfish].
2. I wish for a new house [selfish].
3. I wish for a new car [selfish].
4. I wish that all my family and friends will have a healthy and happy year [getting better but not there yet].
5. I wish that every time I leave a client or student, that they have acquired a new skill or feel more comfortable using the skills that they already have.
6. I wish that Republicans and Democrats could reach across the table and help each other and bring us off this fiscal cliff that everyone speaks about.
7. I wish that all the families affected by Hurricane Sandy get their homes and jobs back better than they were before.
8. I wish that everyone in the military comes back safely. I wish that everyone in the military has the services that they need to be healthy and happy, free of physical and emotional distress.
9. I wish that all those suffering from mental illness find the medications that they are comfortable with. I wish that both they and their families find peace and contentment.
10. I wish that all weapons of any kind would disappear from this earth and that we never, ever again have a Sandy Hook. I wish that the families affect find happiness again and can celebrate the lives of those who lost their lives.
11. I wish that everyone in this world has a cozy, comfortable home and food to eat no matter where they choose to live.
12. I wish everyone would decide to do the right thing, just because it is the right thing.

I wish all the readers of this blog, peace, joy and freedom this holiday season.

Occupational Therapy and
Technology for Clients with Disabilities

By Eleanor Cawley
President & Senior Occupational Therapist
Ms. Eleanor’s Apples
eleanorot@mseleanorsapples.com

Working with clients with disabilities is often as fun as it is challenging. It is very rewarding, particularly when he or she achieves a goal that the client has contributed to. Sometimes, it is difficult to figure out what that goal or task might be, other times, he or she figures out how to tell you. It might be as simple as tying shoes or as difficult as cooking a meal. In my opinion, cooking a meal is more difficult due to the safety issues involved. Another concern is the method that we teach them to do the task and communicating that successfully to both the client and the caregiver.

In therapy sessions, it is often helpful to create a video of the task with the client. It is also helpful to provide some sort of prompt schedule. Both methods are recommended for each task, I would like to discuss the video component first. Videos become important for the following reasons:
1. The therapist becomes the model for the caregiver and the client.
2. The caregiver can learn the prompts that the therapist uses to help the client learn to complete the targeted task.
3. The client can review the task as it was learned and problem areas can be addressed.
4. Generalization of the task to other areas, locations and included in other larger tasks, i.e., shoe tying as part of dressing in the morning.

Let’s take the example of shoe tying. A client [with Autism and limited language skills] is trying to tie his shoes. The client becomes perseverative [repetitive] at the knot tying step. For the therapist, it is clear that the shoe tying method needs to be adapted so that the client can circumvent the step or move past the step. Prompts need to be individualized so that the client can consistently follow the steps. A method of demonstrating the task by the therapist is important for the caregiver and an additional segment with the client completing the task is reinforcing. Clients are often proud of accomplishments and their ability to successfully communicate the desire to achieve that task. He or she will demonstrate their pride by watching the video over and over. This may also become perseverative and it is important to build on each new success.

Videos with the therapist, as instructor, should be made from the client’s perspective. In other words, the camera should be placed above the shoe and the shoe should be positioned so that it is in the same direction as when the client will tie the shoe. The heel of the shoe, or back of the shoe, should be toward the client or bottom of the viewing screen. In that way, the hand movements appear the same, as if the client were moving his or her hands. A tripod becomes very important part of each therapist’s bag or tricks. Videos can also be inserted into a PowerPoint presentation which maybe the caregiver’s preferred method of prompts.

The next step is to develop prompts [verbal, visual, and/or gestural] that will trigger the correct motor response from the client. For the shoe tying client, it was important to circumvent the initial knot when tying the shoe. A knot was placed at the point of pinch to form the loops. Using the double loop method of shoe tying, the client was prompted to pinch the knots; make two loops; make an “X” with the loops; then one loop goes over the other through the space (bottom of the “X” created by the loops) then pull. Hold the loops; make an “X” with the loops; one loop over the other; through the space and pull. Once the client is successful in the task, the video is made of the client completing the task.

When developing the prompts, the method of delivery becomes an important factor to determine. A number of methods are available from simple technology [pencil, paper and scissors] to tablets, iPads and computers. Whatever method is chosen should be easy to use and modify by both therapist and caregiver. These methods can include:
1. Acronyms
2. Simple list
3. Checklist
4. Simple line drawings of each step on a prompt board.
5. True object pictures [photographs] of each step, again, on a prompt board.
6. True object pictures in a PowerPoint program with or without a video.
7. Using a tablet and app to develop prompts using pictures or graphics.

The method of training should also be explored, remain consistent and included in the video. The methods can be a forward chaining model in which the steps are taught from beginning to end. Another method is called backward chaining. In backward chaining, the steps are completed by the trainer from the beginning and the client completes the last step. As the client becomes more successful, the next to the last step is added to the training and so on. There is also the consideration of a schedule of reinforcement, if required. This should be discussed with other team members including the caregiver.

So as you can see, working with clients with a disability can be as rewarding as it is challenging. With organization and planning, clients with a disability can achieve great success. We need to be very organized, patient, encouraging and kind in addition to being firm in our expectations. Therapists also need to be adaptable and look for clues as to what our clients want to learn. The more open a therapist is to his or her client, the more successful the client becomes.