Education Resources Blog

A Pep Talk for Clinicians. Restoring Focus – We Are Making A Difference!


Kathryn Biel

This isn’t about helping our kids who struggle to pay attention. This blog is a pep talk for us, the clinicians. I’m mostly coming from the stand point of the school-based clinician, but this can certainly apply to those in other settings, so keep reading.

I have 26 days left in the school year. Not that I’m counting or anything. 26 days is not a lot of time, especially when you consider that I have at least one meeting scheduled on 16 of those 26 days, and I’m taking one of those days off while my son graduates from elementary school (please pass the tissues). Then there’s the packing and cleaning and sorting. Not to mention all the reports I have left to write. I’m starting to—no, I’ve already got angina—thinking about it all.

And the worst part is, I don’t feel like doing anything. I’m rapidly approaching burn out. I don’t have time to finish my evals. To chase down prescriptions for summer school that the parents haven’t sent back yet. To deal with the parent demanding to know why we won’t evaluate at her child, even though no concern has been raised all year. I’m still trying to treat. To squeeze my kids in where I can. I do (HAHA) make-ups, especially if I chronically miss the same kids.

Then I look at the kids who either haven’t come as far as I’d hoped, or who are starting to fall apart. Why wouldn’t they fall apart—the adults are even having trouble keeping it together at this point. I write up the eval for the student with the progressive, terminal condition and try not to make it look too bad, even though we all know it is. I work with the child who I just cannot seem to get through to and wonder what kind of goals I can even write for him, because he ignores me the entire session as it is.

But then, I have a day like yesterday. A day that brings it all into focus. A day that reminds me why I’m here, and why I work so hard. A day where I made a difference in a child’s life. For this child and his family—a heartbreaking situation where nothing we’d tried made a difference. Watching the mom cry at meetings because her child was suffering. This mysterious condition that has been robbing him of his ability to communicate with the world. To make friends. To participate in life. And I said to her, “He doesn’t live inside the box, so we’ve got to think outside of it to help him.” And that’s what I did. And it may have changed his life. At least for yesterday, he had the ability to communicate. We’ll see what next week brings.

I am going way outside the box. I’m a physical therapist, but I’m trying to figure out what is going on in this kid’s brain. What is driving (or getting in the way) of his motor control. Way outside my comfort zone. But I stepped outside of my box and tried. And this one time, it was successful. Yesterday, my heart was full. I knew that all the paperwork, the bodily fluids, the tantrums (from students, parents, and coworkers alike), the running around, the exhaustion—it is all worth it.

For the rest of my 26 days this year, I will remember that. Why I do what I do. Why we all do what we do. When you’re approaching that burn out. When you don’t want to think. When you’re ready to just phone it in. Remember, what we do makes a difference. We may not be told that. Parents may not express their gratitude. Students may not realize that all that hard work has had results. Teachers may not realize what we’re doing. But we’re making a difference. We’re helping, each and every day.

And that is something on which we should stay focused.

~Kathryn Biel, PT, DPT

Posted in Dear ERI - Clinical Challenges and Gems, GUEST BLOGGER, Professional Development | Tagged | Leave a comment

Cancer Rehabilitation – There is a Need.

Great article from the New York Times in April related to Therapy in Cancer Rehabilitation

After Physical Therapy, Why Not Cancer Therapy? – The New York Times
By Susan Gubar April 7, 2016 12:30 pm

“Cancer patients like me would profit from supportive care aides who could spring us from this induced passivity and its accompanying fear. In my case, such a counselor would have allayed the bewilderment of treatment and also empowered me to exert a modicum of control over the broken rhythms of everyday existence.
Why not use the model of the occupational and physical therapist in orthopedics to create a central role for therapists in oncology, advisers who could help cancer patients help themselves in taking small, strengthening steps? After surgery and at the start of chemotherapy, my family and I would have given anything for the house calls of a creature we never imagined: an oncological therapist”.

Please click here for full article

We are excited to offer this course presented by Lisa VanHoose:
Evidence Based Cancer Rehabilitation Resources and Its Role in Cancer Survivorship
Advances in the medical management of cancer have steadily increased survival rates. Research shows that most cancer survivors will have at least one physical side effect of cancer treatment, including fatigue, neuropathy, muscle weakness, and balance deficits. This interactive course will provide evidence-based tools and strategies for the care of patients with diverse cancer types across the cancer continuum. The course will also address functional outcome measures and reimbursement concerns.

August 26-27, 2016 – Laguna Hills, CA
September 23-24, 2016 – White Plains, NY
October 28-29, 2016 – Framingham, MA
November 18-19, 2016 – Hollywood, FL

There is obviously a need for Cancer Rehab. Therapy.
What are your experiences and thoughts?

Posted in Adult and Geriatric Rehabilitation, Home Care | Tagged , , | 1 Comment

Another Winner – Celebrating OT Month Competition


We asked OT’s to share their thoughts about being an OT.
We received an outstanding number of responses, all so wonderful to read.
We struggled to come up with a winner so we decided to announce two winners!!

Congratulations Rachael, another winner!

This was Rachael’s patient clinical experience that transformed her professionally 

As an occupational therapist, we advocate. I have always advocated for my patients and I do so frequently working as a pediatric outpatient clinician. But one day I got a girl on my caseload who really changed the way I looked at advocacy. It became so much more than just a discussion or a well written letter of medical necessity.
B, was a 10 year old girl with a diagnosis of Autism. B had a very low frustration tolerance, often becoming aggressive and a danger to herself and her family, as a result of poor receptive language and no expressive language skills.
As I worked with B, I realized that something was really wrong with her school placement, a public school self-contained classroom. B’s mother told me; via interpreter phone as the household spoke only Spanish, that because of B’s aggression her mother was frequently called to take her home from school “sick”. B was not bussed into school because they couldn’t ensure she would stay seated, making her mother drive her. Additionally, I was told there was never an interpreter at IEP meetings and paperwork wasn’t provided to her in Spanish.
Things weren’t going well in B’s OT sessions either. She would urinate whenever I placed any demand, requiring her mother to change her underwear, pants, and socks, sometimes up to 2x within the hour. This happened often at school too, and at the school’s request B was brought to the doctor multiple times with no results. During one session, she became aggressive attempting to bite, hit, kick and pull hair resulting in the need for me to bring in security. When I told her mom she would have to be discharged, as she was inappropriate for our setting, her mother was in tears; but I assured her even though we were no longer going to treat B we were going to continue to help.
I needed to find a way to assist this family who was clearly struggling. Our clinic has a designated person who is employed as a resource. So I got her involved. This person actually went down to the school the next day with B’s mom to advocate for a bus with a 5 point harness and an aide. She provided her mother with bilingual child advocate services who went to IEP meetings. I spoke to the teacher at B’s school who was willing to talk to the child study team on behalf of B and her mother. B’s mother and I spoke every day on the phone to see how things were going, just to let her know that we were still there. In the end, B was finally moved to a private school that met her needs.
It was absolutely amazing what we were able to do for this child and family. Now every time I think about advocating for a child I think just what a small bit of time and care can do, and what a huge difference it can make.

Rachael wins a free 2 Day live course of her choosing: $435 value. 

Education Resources offers many relevant CEU courses for , Occupational Therapists and assistants. Join us to learn creative, effective, evidence-based strategies.



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Zones of Regulation and Learning


Kathryn Biel

I sat in a meeting recently with the entire team and a concerned parent. The student, a very young kindergartener, is struggling. And I mean struggling. He’s a hot mess. No matter what angle you look at, this child is not doing well. And his parents are concerned. Retention is an agreed-upon consensus, except for the team members who think he should be moved directly to a self-contained classroom. These are never the meetings you want to have.

I watched this parent on the verge of tears with frustration about his son’s difficulties. His explosive temper, his behavioral outbursts, his attention difficulties. They’re exploring some pretty serious things, including some pretty serious pharmacologics for a little guy.The parents just want to know, “What’s wrong with him?”

The truth is, none of us knows.

But here’s what I do know, and what I shared with the parent. The student can’t learn right now. His benchmarks indicate that, but there’s a reason for it. This student is so poorly regulated. He’s got all the classic signs—emotional outbursts, anxiety, shutting down, aggressive behavior, refusals, toe walking, inattention. This student, for whatever reason, is in a constant hightened state of arousal. He’s always in that fight or flight state. His body is ever on the lookout for that primitive threat—that saber-tooth tiger—to attack. Learning letters and decoding isn’t going to help him survive. Add to this sensory regulation difficulties and very poor motor planning, and this kid is at serious risk for being eaten by a dinosaur. Not really, but that’s probably how he feels. He’s a complex kiddo for sure.

The parent looked at me and said, “Of everything we’ve heard about our son, that makes the most sense.”

Kids today are presenting with an ever-challenging host of not only sensory but emotional regulatory needs. Many simply cannot regulate, because they don’t know how. They’re not being disruptive for the sake of being disruptive. They do not know how to modulate, how to regulate.

You can think about regulation in terms of a stop light. Red, yellow, green. We all know the red kids. Emotionally and physically volatile, that heightened state of alertness and arousal. Intense. No control over one’s self.

Yellow is working it’s way up to being worked up. When in the yellow state, emotions and arousal are heightened, but some self-control is still present.

Green is the state in which learning can occur. It’s the ready state, with optimal levels of arousal, attention, and regulation. This state is calm and focused.

There is also what can be called a blue level, which is understimulated. Again, this is a difficult state for learning to occur, as the appropriate level of attention and emotional connection is not present.

The next time you are struggling with a child, try to assess what color he or she may be functioning at.

If you’re interested in learning more about these Zones of Regulation and cognitive behavioral strategies to help children learn and regulate their own zones, check out the 17th Annual Therapies in the School PRE-CONFERENCE: The Zones of Regulation: A Framework to Foster Self-Regulation and Emotional Control.

Please Click Here for Course Information, To Download a Brochure, or to Register

~Kathryn Biel, PT, DPT


Posted in Pediatrics, School Based Therapists | Tagged , , , | Leave a comment

Winner – Celebrating OT Month Competition


We asked OT’s to share their thoughts about being an OT. We received an outstanding number of responses, all so wonderful to read.We struggled to come up with a winner so we decided to announce two winners!!

Congratulations Michelle, our first winner!

This is her story on what inspired her to choose Occupational Therapy as a career and how it has been important to her:

My mother’s resilience and determination to fight unbelief and strive for independence inspired me to become an occupational therapist. She, along with two of her siblings acquired a retinal disorder that left them legally blind since childhood. Her experiences and inner strength inspired me to want to try to help others find ways to counter societal stereotypes and environmental barriers while facilitating inner strength, hope, and the ability to live life to the fullest. She helped me see the importance that independence and productivity play in a human’s physical, cognitive, and emotional health. I wanted to help others be able to live their life according to their dreams and aspirations no matter the barriers. I enjoy problem solving with my patients and families in finding solutions to barriers, success in daily activities, and self-esteem and belief in themselves to continue their life as they dream possible! It has been a gift to discover and participate in the occupation of occupational therapy. I am continually learning from my patients, co-workers, and mentors. from my experiences with my patients I have learned to look at possibilities over struggles, even in my own life struggles, which is truly a gift I attempt to give back. It has been an honor to be part of this incredible occupation and life passion and I thank my mother, patients, and all who have helped me along this journey thus far.

Michelle wins a free 2 Day live course of her choosing: $435 value. 

Education Resources offers many relevant CEU courses for , Occupational Therapists and assistants. Join us to learn creative, effective, evidence-based strategies.



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Clinical Question: Movement to Help Stuttering


Kathryn Biel

I received this clinical question, and am hoping that other have insight to share:

I am working with an 8 year-old boy with one of the most difficult presentations. He was initially diagnosed with ADHD and a tic disorder. He was put on stimulant medication around age 6, and subsequently developed a severe stutter. He has become terribly dysfluent, and is barely able to verbally communicate. His stimulant has been changed several times. When he’s off his medication, his school function plummets, but his fluency improves. His tics and OCD are becoming worse and worse, and are impacting every aspect of his life. He’s recently been diagnosed with Autism, and has just started attending a speech clinic outside of school. His vocal tics and stutter, as well as dysfluency continue to grow worse. His attention, while better on the medication, is still poor. While working with his PT, she noticed that if he jumps from one foot to another (like jogging in place with a little more lateral movement), his fluency improves. It takes him about 1/3 of the time to say a sentence while “wiggling” as it does while standing still. His tics diminish as well. Walking does not seem to have this effect. Tapping his hand while speaking helps, but not as much as this. Does anyone have any input or strategies to try? Any idea as to WHY this might be helping?

This seems like a pretty complex situation. Any ideas? Thanks in advance!

~Kathryn Biel, PT, DPT

Posted in GUEST BLOGGER, Pediatrics | Tagged , , , | Leave a comment

School Based DPT Struggling to Move past Bachelors plus 36 – Needs Your Input


We received this question from one of the school therapists in our community, she would like to hear your thoughts and experiences:

I am a PT in the school system in Foxborough , Ma. I got my BSPT in 1982 and went back and got my DPT in 2005 thru a transitional DPT program at MGH Institute. The transitional DPT program was 8 classes but only 15 credits. They keep credits low to encourage enrollment. I went on to take 21 more credits of graduate courses. In my district this moved me to the bachelors plus 36/masters salary scale. However, I can not move past that level since I did not get my masters. Since there is no longer a master’s program in PT, I am trying to have my district look at my unique situation. It seems unfair I can not move past the bachelors plus 36 level when I have my DPT, the preferred degree in my field. It is a contractual year and I have asked my superintendant and union rep to look into this. They asked if I could reach out to other districts to see how other towns are handing the situation. I spoke with a college friend who is an OT with the Boston Public Schools and she said the entry level DPTs there are on the doctorate sale. I have gotten emails from your organization where therapists are trying to get ideas from other therapists. I wonder if there is a way to send this to a school therapist distribution list if you have one.

I am particularly interested if there are any BSPTs who went on to get their DPT through a transitional DPT program to see where they are paid on the salary scale. It is tricky since the entry level DPTs have many more credits than I do. Could forward this email to anyone who may have insight into this situation. Thanks in advance for your help. Lisa MacDonnell

Posted in Professional Development, School Based Therapists | Tagged , | Leave a comment

Pediatric Rehab Therapy Service and Unmet Needs

Recent research led by our distinguished faculty member Dr. Beth McManus, PT was recently published in Physical Therapy Journal 


McManus.2013“Which Children Are Not Getting Their Needs for Therapy or Mobility Aids Met? Data From the 2009–2010 National Survey of Children With Special Health Care Needs”
February 2016 Volume 96 Number 2 p.222

Objective The purpose of this study was to identify the prevalence of and factors associated with caregiver perceived needs and unmet needs for therapy or mobility aids among children with special health care needs living in the United States.

Conclusions This evidence serves as a baseline about the future impact of the Affordable Care Act (ACA). Pediatric rehabilitation professionals should be aware that children with special health care needs whose condition more frequently affects function and who have insurance discontinuity may need more support to meet therapy or mobility aid needs.

Don’t miss Beth present her popular continuing education course:

Advanced Clinical Practice in the NICU:
This intermediate-advanced course will focus on clinical decision-making for medically and developmentally complex patients in the NICU and transition to home and EI. Emphasis will be on in-depth knowledge of pathophysiology of common NICU diagnoses and special populations; choice and interpretation of evaluation tools and evidence-based therapeutic interventions, implementing developmentally supportive oral feeding interventions, and transition to post-NICU care. Labs and video case analysis to allow attendees to integrate course material for complex clinical decisions around behavioral, developmental and feeding intervention.

June 10-11, 2016 – Renton, WA
August 13-14, 2016 – Decatur, GA
September 24-25, 2016 – Washington, DC
September 30-October 1, 2016 – Robbinsdale, MN
November 4-5, 2016 – San Antonio, TX

Please click here for full course details, CEU information, to download a brochure, or to register

Posted in Instructor: Research Therapy, Tips and More, NICU | Tagged , , , | Leave a comment

How to Treat a Patient on a Heparin Drip


Post from Paula, PT:

Would you treat a patient that is currently on a Heparin Drip?

Please share your thoughts and experiences.

Posted in Dear ERI - Clinical Challenges and Gems | Leave a comment

NEW JERSEY CEUS in 2016 for PT’s, OT’s and SLP’s

Education Resources is thrilled to offer multiple opportunities for CEUs coming to New Jersey  in 2016 

We are pleased to  offer you our continuing education courses that are evidence based, engaging, relevant, and immediately applicable to your practice.

Education Resources applies to the New Jersey Board of Physical Therapy Examiners for all relevant courses being held in New Jersey and neighboring states.
You will not find all of our courses listed on the NJ Board’s website as they are behind in posting their approved courses on their site. However all our applications have been approved or we expect them to be approved.

Education Resources is an approved provider by the
New York State Board of Physical Therapy.

Education Resources is an Approved Provider of Continuing Education by the
American Occupational Therapy Association.

Applications are made to ASHA for all relevant courses.

Please click here for a full listing of our continuing education courses
hosted in New Jersey in 2016

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