DEAR ERI COMMUNITY: I currently have a client with Rett Syndrome and this is my first case in my career to treat the child. She presents with very high functioning skills, she is able to transition from the floor to stand via bear stance, she can walk over uneven surfaces with out falling over, she can gallop and increase her walking speed without falling. She has a #3 DAFO on one foot and a #4 DAFO on the other. Cognitively she does not follow verbal commands and requires hand over hand assist to stay on task. This child is 10 years old and the previous therapy place was seeing her on a weekly basis. I reached to them to ask their recommendations and opinion on realistic goals and if she requires continued therapy on a weekly basis. The therapist philosophy was to treat this child on a weekly basis due to her progressive neurological decline and that if she saw the child, that the child would not regress. I treat what I see, I also work in an outpatient clinic which insurances drives to see improvements. Is skilled services required at this time with her current presentation?
Carol Loria, President ERI:
You just finished a continuing education course and you can’t wait to impart your excitement and the new knowledge you learned BUT you are so nervous.
You are afraid that your hands and voice will be shaking. No worries, you are not alone. Studies have shown that people fear public speaking more than death.
When I first started working with faculty at Education Resources, I was truly shocked to discover that many internationally renowned speakers got butterflies in their stomach (one even threw up her lunch) prior to taking to the stage and still looked so unbelievably calm and in control. I started asking how they managed it and through the years research has borne out their “home remedies”. You can train yourself to appear calm and most people can even overcome their nervousness completely.
Here are just a few tricks I’ve learned over the years:
- Think of this in-service as an opportunity to develop your public speaking skills….NOT as a performance
- Ask yourself if there were any “aha” moments for you when you learned the material. This will conjure up your enthusiasm and we all know that if you can impart that enthusiasm, you will engage their interest.
- Increase your confidence and ease by practicing at home, standing in front of a mirror (or a sympathetic roommate)
- DO NOT read from your notes but rather use them as talking points
- Speak with words and tone that is both comfortable and natural
- Make eye contact with your audience intermittently looking at your papers
- Always check out the space before you speak, even if it is a familiar room to you….make sure the lights; temperature and arrangement of the chairs are to your liking.
What are your tips to overcome nervousness?
Stay tuned; next time we’ll be talking about 4 critical questions to ask yourself when preparing a presentation.
DEAR ERI COMMUNITY: I’m looking for any advice regarding a current student I work with. He is a 9 y/o boy with severe Autism, hard of hearing, and cognitive delay. His stims have been increasing lately, approximately the last 6-8 weeks, we’ve seen new stims including drawing on himself and in the air, arm flapping, running in circles, can not stand still longer than 2 sec (I know these are “typical” stims). His normal stims are drawing on white board over and over, looking at his drawings with his peripheral vision, and rocking. The stimming is constant throughout his day and nights, compared to previously a handful of times throughout the day. We are a residential school, so he is here 5 days/nights a week. He has also started touching other boys in their genitals, repetitively. He has developed an unhealthy relationship with another classmate, who he needs to be next to at all times, is constantly touching him, if the other child leaves the room, he begins to cry and perseverates on that boy until he returns. The teacher and aides have them separated in the classroom so there is no touching that can happen, unless this boy runs over and grabs the other boy. The other boy does not encourage these behaviors. He is caring toward the other student, but often wants a lot of separation between the two of them.
I know that stims change, come and go, intensify at times, one needs to be replaced with another. We have always been able to redirct him in the past, we’ve worked with increasing his sensory diet and he communicates his needs most of the time now. He is never denyed sensory when we feel he needs it or when he requests it.
So, the real question is: does anyone have any ideas what can be causing the increase in stimming and behavior, plus treatment ideas please. Our behavior specialist is helping with the changes as well, but hasn’t come up with anything effective yet.
Are parents asking you about how this new definition will affect their child’s therapy?
As you know, revisions in the 5th Edition of the Diagnostic and Statistical Manual of Mental Disorders, set for publication spring 2013 has changed the definition of autism and will categorize Aspergers, PDD-NOS and Autism into one lump category of ASD (Autism Spectrum Disorders).
One pro of this revised definition is that there will be fewer misdiagnosed patients. “Better diagnosis can help give better numbers on those affected, causes, potential diagnosis and effectiveness in interventions” according to the Center for Autism.
One major concern is that some who may need occupational therapy, may not get the health care coverage needed to afford it. Many therapists believe that there will be a rise in high functioning children with autism that will become ineligible for health insurance coverage for their therapy treatments.
Another worry is that these patients that may be high functioning ASD cases will not be referred to therapists because they don’t fit the new definition.
At this point there is speculation as to what the new definition will include. The New York Times posted an article that showed the proposed Autism definition’s changes this past January. However we will not know for sure until the new version is released to the public next spring.
As a therapist what do you think of the new definition of Autism? Is your center doing anything to promote a grass roots effort to challenge the definition and educate the public?
DEAR ERI COMMUNITY: I have a client right now that I am having trouble teaching how to chew. He was on stage 2 baby foods at 14 months old when I first started working with him. He is now eating mashed table foods, but often needs pudding or appleasuce on the spoon with the foods to tolerate. His mother has done the Therapressure Protocol with him in the past and we saw great improvements with tolerating touching foods, diaper changes, etc. I have asked his mother to start the Therapressure Protocol again. Now that we are gradually making his food chunkier, we have noticed that he does not chew. I gave his mom a NUK brush and gave her suggestions on working on tongue lateralization to improve oral motor skills. He will briefly hold something between his front teeth, but he pushes the chewy tube forward with his tongue when I place it on his back molars. I have his mother inserting the spoon to the sides of his mouth so the food is placed on his molars and she said she thinks he chewed one time over the past week. Any tips or suggestions would be appreciated! Thanks!