World OT Congress #3

The disaster preparedness workshop that I began my day with.
Fascinating stuff, read about it below.

This event has been an interesting experience. I'm reminded again of what I felt when I left uni. That Occupational Therapy isn't so much what you do and know, it is how you think. They spent four years training us to think like OTs. 


A couple of core OT skills are problem solving within the current context and drawing on resources you have already available to you. Another is looking at the world in terms of occupation. Occupation being anything that people do, and particularly OTs are concerned with every day occupation. When people encounter limitations like injury or disease they are often driven back to the basics of living, and even taking care of themselves, doing "Activities of Daily Living" (or ADL) become hard.

Even though I no longer have a strong work identity as an OT, I still think like one. I'm a problem solver. Someone who's concerned about people's independence. Someone who sees environmental limitations and ergonomic problems earlier than other people.

Gotta love Japanese convenience stores. Here was my lunch. Cost less than
500 yen (under AU$5). Not only tuna/crab salad, but rice "ball", OJ, and
convenient hand wipes that I didn't even ask for.

This conference has huge proportions. During most time slots from 8.30 to 6pm there are at least 16 choices of things that you could do or listen to. The interesting feeling for me is that this is a bit like being back at uni, except that you aren't obligated to be at anything. No one is keeping track, there will be no exams. So at any time you'll find people not in sessions, if there's nothing that attracts their interest.

There are so many people. Over 5,000. The closest I've come to meeting someone I know is someone who happened to mention a colleague in her speech the other day. That colleague I lived with for three years, but haven't seen since I graduated nearly 20 years ago. Amazing!

The very enormous programme that you
almost need a degree to negotiate your way
through and definitely need an OT degree
to comprehend.

There is at least one of my old lecturers here, but I haven't seen her, I only know she's supposed to be here because her name appears several times in the programme, the inch-thick programme. Such are the proportions that there is no way to guarantee meeting someone unless you have their email address or phone number and arrange to meet.

_______________________________ But for my OT friends who want to know. Here is what I saw of the conference today.

I attended an hour and a half workshop about disaster preparedness. It was fascinating. We had OTs in the room from many recent major disasters: Sri Lanka's tsunami, Philippines' typhoon, Christchurch's earthquakes, Japan's tsunami, US hurricane Katrina etc. We spent time in groups talking about what we'd do in a hypothetical disaster: what we'd pack immediately, what we'd do 3 weeks later in a temporary housing situation etc.  It was interesting to note what OTs thought of packing that others might not, including diversional-type activities, like cards, puppets, assistive devices etc. But also looking out for the most vulnerable and noticing that some will have trouble accessing the bathrooms, getting up off mattresses on the floor etc.

It was quite enlightening to realise how much insight I have into this now, having experienced the events of 2011. Others in the group were fascinated to hear from people who'd lived here at that time and what it was like to experience earthquakes. Even though We weren't close to the epicentre.

Later in the day I went to a couple of sessions about children. The topics included 

• comparing the HST and DASH (handwriting assessments) checking their reliability (and yes they are reliable), and also looking at hand pain.
• goal directed intervention with children with disabilities: quite effective.
• evidence based approaches for children with DCD.
• this was interesting. It was a national project by the Dutch and they've definitely come up with the recommendation that CO-OP and not Sensory Integration is the way to go according to the data available.
• ASD – have more difficulty following the gaze of others
• ASD and sensory stimulus (I had trouble concentrating on this. It was by a Japanese OT, but in English, so I'm not really sure what her conclusions were.)

In actual fact I find that this conference attending is a bit of a lottery, even at such a prestigious event. The quality of  presentations varies considerably. All you have to decide on whether or not you'll go is a single line of text and the name of the presenter. Some have surprised me, others disappointed.

Tomorrow we have a Keynote speaker: a Nobel Laurette! A Japanese author who won the nobel prize for literature in 1994. I wonder what he has to say to a large gathering of OTs?

I'm off to bed. We've received some exciting news tonight, but I'll leave you in suspense for now about that!

Pencil grip: not as important as we thought?

I don't often write about my Occupational Therapy "hat" here, but I came across a study on pencil grip and this stunning conclusion that challenges popular opinion:

There was no difference in the quality or speed scores among the different pencil grasps before and after the copy task. The dynamic tripod pencil grasp did not offer any advantage over the lateral tripod or the dynamic or lateral quadrupod pencil grasps in terms of quality of handwriting after a 10-minute copy task. These four pencil grasp patterns performed equivalently. Our findings question the practice of having students adopt the dynamic tripod pencil grasp. 

This was published in the Australian Occupational Therapy Journal, June 2012.You can read the abstract here. 

Pencil grip is one of the most common problems people talk to paediatric OTs about within mainstream education. This is quite a finding because it's been assumed for a long time that dynamic tripod*, is the only valid grip. Much anxiety and pain has resulted from children not wanting to use this grip.

This illustration of mature pencil grips comes from here.

The article ends with a recommendation that the dynamic tripod rasp be recommended for children when they commence writing. But if difficulties occur and one of the above four grasps are being used, then remediation should look beyond correcting the pencil grasp to other factors impacting writing. In fact, it has been proven that it is intensely difficult to change a child's pencil grip beyond the beginning of second grade (though I've heard of it being done, but only when the child has high motivation).


*Fingers involved include the thumb opposed to the index and middle fingers, with all three fingers positioned in a tripod. The ring and little finger stabilise against the writing surface.

"Why Does My Child Hate to Write?"

Every now and then my Occupational Therapy "hat" finds me. Strangely enough, at the moment, most conversations I have about this topic are sitting or standing with teachers at interschool sports events! 


One of the commonest questions I get is about students who have handwriting difficulties. I found this great article the other day that I wish every primary/elementary teacher would read. And it wouldn't hurt middle and high school teachers to take a look at it too. And every parent who has a child who can tell great stories, but cannot get them down onto paper.


It is written by a home schooling mum who's son has ADHD. She is great at thinking out of the box, so this article is full of ideas of ways to help and get around the difficulty of handwriting. It is a challenge for a teacher in charge of a whole classroom of kids, though. The default is to get kids to write. That is the easiest thing for the teacher, but not always the easiest thing for the student!

A feast of nostalgia

You might have thought the weekend at Kingaroy was enough nostalgia for one week, but apparently not. Today I went back to university. Back to my old haunt. Back to hitting the books. I've mentioned earlier here and here that one of my goals during this year in Australia was to refresh my knowledge and skills in Occupational Therapy and specifically kids and handwriting. So, when two separate things were cancelled for today, leaving a big empty square in my diary, I made a quick decision to go to the uni library, where I knew I could access research and textbooks at almost no cost. It was a little scary this morning before I left, I'm not sure why. Maybe a case of being off the horse for too long? But once I'd found a park and started wading into journals, I had no problem slipping back into the whole deal. I spent about four hours reading, taking notes and photocopying. Trying to not only catch-up on what's happened in research over the last 10 years, but also trying to get a grasp on how I could apply that to working in Japan. I think I've made some progress. I also think that I'll have to go back and do a little more research and a lot more thinking. In the meantime, I'm pretty pleased with myself. The whole day of professional development cost me only $10 (not including petrol or food). There isn't much you can get for $10 these days!

Handwriting

It has been a long time, but in another life I spent a lot of time being an Occupational Therapist. When I became pregnant with our first child, I gave up my registration as we had plans to go to Japan and no opportunities for me to practise. In fact I wasn't sure I would ever get to do it again. It was the end of an era, I thought. Little did I know that 10 years down the track my skills would come in handy again. We've been confronted with the lack of resources available to English-speaking residents in Japan who have children with therapy needs. Particularly Speech Therapy, but also Occupational Therapy. Last year I was called upon to assess and write a report on a fellow missionary's child. Now I am giving advice about the handwriting problem of another missionary kid. The future? Last week I mailed off my application to rejoin our professional association: OT Australia. 12 months in Australia will give me the chance to upgrade my skills. I will not pursue re-registration at this time, so I won't be able to work in Oz (just to be clear on that). However, hopefully as a volunteer at CAJ I'll be able to help that handful of kids who struggle to get their words clearly onto paper and who knows what else God might have in store for me? I'm beginning to learn that in God's economy nothing is wasted.