Today at the elementary school, we had a motor sensory group activity. It was all about the circus. The kids came to the therapy room in groups of three or four. There were a total of 15 that came through today. The other 8 that my COTA and the OTR see will go through the activity tomorrow. Each child got a paper ticket that they handed to one of us ( me, Tammy, Tracey Martin-OTR, or Christine Thomas-OTR/S) .Then the child went to a balancing beam, this simulated walking a tightrope. We had hoola-hoops with orange ribbons on them and we had the kids crawl through them as the “ring of fire”. There were coffee cans made into stilts that the kids had to walk with. There was a play house they had to crawl through and on the floor of the playhouse, bubble wrap was taped, so the kids got that tactile awareness. There were a total of 9 stops around the room. At the end we all sat in a circle and had the kids smell different things we had put in little bags. We had cinnamon, vinegar,garlic, peppermint and chocalate. The kids had to try and guess what they were smelling. Then we had popcorn,peanuts ,lemons and juju fruits. After the kids put each piece of food on their tongue, we then would ask them to describe what it was like. Alot of the kids would say that the lemon was sweet instead of sour. The final thing the kids got to do was make a small snow cone. It was really fun. We each had to go around with a child one on one and the children are used to me now, so I did not have any problem. Tammy took the kids that had more deficits, but even they did most of the activity and seemed to enjoy it. The only one that did not participate today was the boy that takes his shoes off all the time. Tammy went to his room to get him, but said his aid was having a rough day today and there was no way he would want to come to the therapy room. The only thing Tammy said she would do different is change the order of the kids coming through. The first group we had go through had all the talkative kids in it, so it was a little bit hectic keeping up with them. All in all it was a good experience and Mary Arnold got to see it because she was visiting my site today.

Tracey Martin OTR has a student with her that is attending Findley. She was telling me that she had been a COTA in the Zanesville school system. She said she made good money on the hour- $25.50, but the outfit she worked for did not offer health ins. or retirement. She said it is very common to run into that situation. Also she did not work summers-no school. My COTA, that works in Guernsey county, works through the hospital. So in the summer time she fills in where she is needed there. She has ins. and retirement through the hospital. I do not think she makes as much as 25.00/hr but I think it is close. I just thought I would share that information. I like to hear from COTA’s that actually work in the field. The OTR student also said that on her first day of class, she had a huge test on the OT framework and all its terms. She said she had trouble with it because she had been out of school for awhile and had not kept up with the evolving framework. Friday we are doing the circus activity for 5 middle schoolers that go to OT therapy.

The only day I observed this week was Fri. due to a scheduling conflict. On Fri, when I arrived Tammy had a boy sitting on a therapy ball at the desk. This is the same boy that threw his shoes last week and ran from therapy. As I came in Tammy instructed me to sit in a chair behind him and put my hands on his waist for support. Tammy told me that he had started the same thing this time and I noticed his shoes were off. She said that he had just returned from an assembly at the high school where they watch students sing and danced , and he had sat still for 45 minutes. His aid said that he had done a good job and had even clapped when the other kids had clapped. His aid really does a good job with him. He is not in a regular class at all during the day and she is with him all day long. She works on the same things a teacher does but it is all one on one. This month she started teaching him sign language and he has picked up on a few signs. Anyway, the ball gave him something to bounce on and he was able to concentrate on tracing his name. Then he took the scissors and did his cutting activity. Tammy has him cut out a square, triangle and a rectangle. She never asks him to cut a circle because he has a fascination with circles and would then cut the square and rectangle into a circle. For the fun activity, Tammy had a new magnet puzzle. It could be formed into a cube. The student has to assemble the sides and then pull them up and connect all the sides with magnetic balls on each side. She thought he would have a hard time, but he didn’t. Tammy was making the puzzle beside him and after each move she would tell him to copy the move on his puzzle. He did it. Tammy and I were both so surprised. We thought he would just want to play with the parts and not comprehend what was expected of him. Even with his occasional outbursts, this is one of the children I have definiely seen an improvement in over the time I have been observing. Next Wed. I  get to attend another faculty meeting at the hospital with Tammy and then we are going to a different school. I look forward to seeing different children and different treatments.

Narrative note on observing boy trace his name.

Client begins sequence without verbal cue. Client traces a capital W without assistance.

Client needs verbal cue to begin tracing capital E. Client traces E without assistance. Needs verbal cue to start tracing the S. Begins tracing the S by starting at the bottom. After verbal instruction, client is able to trace the S without assistance.

Teresa Garrett S/OTA

On Wed. my COTA (Tammy) and I went to the cafeteria to observe an eight-year old little girl eat lunch. Her teacher had mentioned to my COTA that the girl was not eating and everytime any meat ( like a hamburger) was for lunch , she would just put it on her tongue and seem to gag. My COTA sat next to the girl and prompted her to start eating. She seemed to be eating just fine, but she was also so distracted by the other kids in the room. The COTA had to keep reminding her to face forward and eat. One thing we did learn was that the girl sits across from a little boy, J, that asks her all the time if she is going to eat her sandwich. She says no and gives it to him. While we were there he asked her if she was going to eat her hamburg and if she was going to finish her tater tots. To both questions she answered no and preceded to hand them over. My COTA stopped her and told J that she needed to eat and he needed to quit asking for her food. It was really pretty sweet how she would just give him the food when he asked. This little boy is also a pt. of my COTA’s, so she is familiar with him.

This little girl was also in therapy after lunch. She had problems writing her name so the COTA decided to take her out and let her swing on the swings. The little girl was all for this, until we got to the swings, then she was scared of falling off and would not attempt it. Tammy sat on the swing and put the girl on her lap, but this did not make the girl feel any better. She squirmed and Tammy let her off. Next we went over to the slide, but the girl would not go down it. Tammy explained that the girl has very little body control or body awareness, so the swings and the slide will scare her until she is sure she is safe. We plan on taking her outside again next week. I asked my COTA how she connected having trouble writing to using the swing and she said she just wanted to try it and swinging has to do with the vestibular senses (?). When the girl tried writing again while we were outside she wrote significantly better. I am still not sure about the connection and plan on asking Tammy about it again this week.

S- ” I am trying to observe and learn as much as I can from my COTA.”

O- I observed grip strengthening exercises by using theraputty and gripping the putty ten times in the pts. dominant hand. I hid three pegs in the theraputty and instructed the pt. to find the pegs by pinching the putty with her fingers. I observed the pt. write their first name on lined paper. The pt. showed difficulty with the size of their upper case M letters.

A- I was able to learn this week that swinging is an activity that could be used as a therapuetic activity.

P- I will continue to observe and learn while I observe Tammy Schwartz COTA/L in the Rolling Hills School district.

On Wednesday of this week I went to the out patient facility in Cambridge with my COTA. She only goes there for an hour on Wed. to stock up on supplies and do paperwork before school starts at 8:00. While I was there, I observed the OTR give a 20 yr. old girl an initial evaluation. The girl had put her left hand in a stand up floor mixer at work. The skin was not broke, but there was swelling and minor bruising. She also had very little movement. The OTR used a dynamometer to test the girls grip. She used a pinchometer to test her also. The OTR’s paperwork was formed so she just had to fill in boxes with her results of the tests- no math was involved. The OTR also had her do the 9 hole peg test. Before she did any tests, the OTR measured her fingers and wrist ext. and flexion using a goniometer. She has a OT student with her , so she just read the measurements out loud and the student recorded them. She performed these tests exactly the way we are being taught in school, so it was fun to see it actually being done this way.

Then we headed to school. The grade school was doing standardized testing on students, so they needed the OT room for testing. We took a little corner in one of the classrooms. This turned out to be a big distraction for most of the students Tammy saw in the morning. One boy took his shoes off and threw them , then he was trying to tear down a cardboard wall. Finally Tammy asked me to see if they were still using her room- they weren’t. The boy’s aid picked him up and carried him two doors down to the therapy room. As soon as he sat down in his chair, he was a completely different child. He sat still ( he still wouldn’t put his shoes on), he used scissors and he matched up shapes together to form a frog. Tammy said he doesn’t handle change very well and something like being in a different room for therapy really threw him. When therapy was over, we walked him back to class. He has pictures of his therapists that they put on a velcro board and they show him the pictures to let him know what he is doing next( he is non verbal). When he got back to his room, he calmly walked over, took Tammy’s picture off the board and put it neatly back into it’s spot-for next time. It was amazing how he changed.

I also got to see Tammy bring a ball into a classroom for a child to sit on during class. It is supposed to help him stay focused, because he can bounce on it a little bit when he starts fidgiting to get that stimulus he needs. His aid came and told Tammy later that it seemed to be working.

We also went to the middle school to check on the boy with Aspergers. Tammy got a print out of all his assignments and seen that he was failing three classes. He had alot of missed assignments. She went and found him in his life skills class. When we walked in, the students were all writing down recipes. He was at his table reading a book. Tammy asked him about his grades and he told her it was the teacher’s fault. She asked him why he wasn’t doing his classwork and he just shrugged his shoulders. Tammy told him she was going to send the copied grades home for his mother and he didn’t care. I could tell Tammy was at a loss on how to handle this. She went back and talked to his teacher , but the teacher wasn’t sympathetic at all. She basically said she was tired of his attitude and he needs to be more responsible. He has already failed classes from last semester and he’s going to fail them this semester too. I asked if he would fail 7th grade and Tammy told me that the school will probably pass him anyway. This has to be frustrating for Tammy. She said that working with kids , you become so emotionally involved that sometimes it is hard to just let go.

On Wed. April 22 I observed a OTR give an initial evaluation. A pinchometer and a dynamometer were used to test grip strength on a young female’s left wrist and digits. OT also measured wrist and digit ext. and flexion.

Teresa Garrett  S/OTA

This week my COTA was back on her normal schedule because all the IEP’s were done. Wednesday I sat in on the monthly therapy meeting at the Southeastern Ohio Reg. Medical Center. There were two OT’s and three COTA’S. Also, a second year OTA student from our program was there. In the meeting they talked about OT awareness in the month of April, changes that were going on in the hospital and recent feedback the OT department had received from passing out surveys to clients. The OT department received really good comments, especially about how the clients felt their therapy was purposeful to activities they wanted to continue. As I sat there I also noticed how well the therapists got along with and supported each other. The ethuisiasm they have for their jobs also was evident in the way they spoke of cases they have worked recently. I could tell this would be a great work environment.

After the meeting, we went to the grade school and started seeing children. Tammy let me lead an activity with a 10 yr. old boy who has trouble with his finer motor skills. He had to use his thumb and index finger to squeeze a dropper in order to drop the right amount of water in a cup. He exhibited difficulty in holding the dropper vertically. Also, he had difficulty calibrating how hard to squeeze the dropper. Tammy seemed surprised by this and admitted that maybe she should of done this activity with him sooner. I was a little nervous when she told me to take over, but I had seen her do this before with another child and it wasn’t bad at all. This boy will ask you the same questions over and over and Tammy had to tell him more than once to work and quit asking me questions. I, of course just kept answering them. Tammy explained that she has learned from experience with him how to handle his questioning and get him to focus on his work. I told her that I hope that I will be able to be as stern and focused when dealing with children as she is. She said that it just comes with experience and that she has seen the same children for awhile now so when she is stern with them, they know she means businness.

When we went to the Middle School, Tammy found out that the boy with Aspergers was getting in trouble for not doing his homework. He was discharged from the OT program last week. Tammy still has him as a consult though, which means she checks on him from time to time. Apparently he has work to do on the computer and instead he sits and argues with the teacher about how lame this work is. Last week he tested at an 18 yr. old level( he’s 12) and he could do the work, but refuses. Tammy spoke to one of his teachers and said she is at a loss on what to do about him. I could tell Tammy was disappointed about this. She had been treating him since he was 6 yrs. old and she only wants him to succeed. I am interested in what the next step would be in this case. I’ll find out this week.

I continue to observe Tammy Schwartz, COTA/L, in the Rolling Hills School district.

My hours have changed to Tues. 12:30-3:00 and Wed. 7:00- 3:00.

I led a fine motor skill activity involving a child with a deficiency in this area on Tues. I enjoyed this and expect to help my COTA with treating her other students in the weeks ahead.

Teresa Garrett S/OTA

Hey guys, for some reason my name was deleted off my blog. I must have done it when I was picking my theme or something- so here it is.

My clinical assignment is working with Tammy, a COTA that visits the Rolling Hills school district in Guernsey County. She has a really busy day. She works 7-3 Mon.-Fri. without a lunch break, that way she sees as many kids as possible. We spent 30 minutes with each child on her schedule for Wed., no more ,no less. Tammy is very aware of the time allotted for the children she sees. On Wed. I went with her to the classrooms to get the children, then we brought them back to the therapy room. The children range from age 7 to 11. One of the boys she sees is non verbal and I observed her helping him to write his name. First Tammy wrote the letters for him with a magic marker, then she had him trace the letters with his pencil, next she told him to try and write his name under the tracing. He had a hard time keeping his letters on the lines and staying focused. Tammy kept giving him verbal clues as to when to start his letters and how big to make them. She had him trace her letters 3 more times and then try writing his name again.  He did better this time, but was still having trouble. Tammy also worked with him on using scissors. She had a paper with a square drawn on it and told him to cut it out. He did pretty good with this. The only problem he had was that he wants to go too fast and sometimes he doesn’t close the scissors when he is cutting, instead he wants to open them and push them through the paper. Tammy would make him stop and start over if he did this. Tammy also had him put together a magnet puzzle on the blackboard. While he was doing the puzzle, he stood on a balancing board. The board was to help him with his muscle tone and balance. An interesting thing about this boy is that he only worked for a reward.  Tammy had to give him a snack after he did each activity or he wouldn’t do the next one. She said that he is the only one she does this for and the other children get to choose a sticker at the end of their therapy session with her, but if she doesn’t have snacks for him, then he’ll just sit there and do nothing. I thought it was so interesting interacting with the kids and I could tell that Tammy really likes her job. She let me see all the kid’s goals and treatment plans before we went and got them from their classroom. I had alot of questions for her and she had no problem answering them. I am interested to see if there is any improvement in the children we see during the 10 wks. I have clinicals with them.

Initial note: March 31, 2009 met Tammy Schwartz COTA/L to begin my level I fieldwork assignment. Tammy is a COTA/L that travels the Rolling Hills school district.

I will meet with Tammy on Wednesdays and Fridays 10 a.m to 3 a.m. to accummulate my 100 hours of observation needed for my OTA 130 course this spring quarter

My goal for this assignment is to understand the treatments and processes needed to work OT with children in a school setting.

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