Still time to register, Treating the Medically Fragile Child

When is a child considered medically fragile?  What special precautions and medical considerations must be taken when treating the fragile child in the home?  This evening will cover treatment interventions, contraindications, recognition of medical problems that may require referral, positioning, medical monitoring and equipment planning for this population.  Videos will be used to demonstrate treatment interventions.  Participants will observe compromised children with a variety of conditions and plan treatment together

Don't let these questions go unanswered...

Register for the seminar...

Inform yourself...

Share your concerns... 

See you there. 

Treating the Medically Fragile Child
Dates:     March 27th  or March 29th   
Time:       5:00-8:00PM
Location: Therapeutic Resources, 36-36 33rd Street, Suite 500, Long Island City 11106
Cost: $139. If you currently hold an early intervention case through Therapeutic Resources, this course is FREE!   To register, call 212-529-9780 or click here to view our website.

Hearing Loss Linked to Three-Fold Risk of Falling

Hearing loss has been linked with a variety of medical, social and cognitive ills, including dementia. However, a new study led by a Johns Hopkins researcher suggests that hearing loss may also be a risk factor for another huge public health problem: falls. The finding could help researchers develop new ways to prevent falls, especially in the elderly, and their resulting injuries that generate billions in health care costs in the United States each year, by some estimates. 


To determine whether hearing loss and falling are connected, Frank Lin, MD, PhD, at Johns Hopkins, and his colleague Luigi Ferrucci, MD, PhD, of the National Institute on Aging, used data from the 2001 to 2004 cycles of the National Health and Nutrition Examination Survey. This research program has periodically gathered health data from thousands of Americans since 1971. 


During those years, 2,017 participants ages 40 to 69 had their hearing tested and answered questions about whether they had fallen over the past year. Researchers also collected demographic information, including age, sex and race, and tested participants’ vestibular function, a measure of how well they kept their balance. Their findings are published in the Archives of Internal Medicine. 


Lin, an assistant professor at the Johns Hopkins University School of Medicine and the university’s Bloomberg School of Public Health, and Ferrucci found that people with a 25-decibel hearing loss, classified as mild, were nearly three times more likely to have a history of falling. Every additional 10-decibels of hearing loss increased the chances of falling by 1.4 fold. This finding still held true, even when researchers accounted for other factors linked with falling, including age, sex, race, cardiovascular disease and vestibular function. Even excluding participants with moderate to severe hearing loss from the analysis didn’t change the results. 


Lin, an otologist and epidemiologist, says among the possible explanations for the link is that people who can’t hear well might not have good awareness of their overall environment, making tripping and falling more likely. 


Another reason hearing loss might increase the risk of falls, Lin adds, is cognitive load, in which the brain is overwhelmed with demands on its limited resources. 


“Gait and balance are things most people take for granted, but they are actually very cognitively demanding,” Lin says. “If hearing loss imposes a cognitive load, there may be fewer cognitive resources to help with maintaining balance and gait.” 


Funding support for this study was provided by the National Institutes of Health.

(Source: news-line.com)

Hi Ho Hi Ho, It's Off to Work We Go!!

Part-Time Physical Therapists Needed in Brooklyn and the Bronx.
 
A Physical Therapist is needed for a part-time staff position in Brooklyn, two days a week.  Interested candidates will have to travel to two schools in one day (11210 and 11235).

A PT is also needed 4 days a week from 8:00AM-4:30PM for a part-time staff position in the Bronx that requires travel to three schools (10459, 10453, and 10474).
 
Contact Pam 212.589.1229



Huge Occupational and Physical Therapy Need in Westchester!
Be part of the growing trend in Adult Health Home Care

The demand for Occupational Therapists in Westchester has grown exponentially with the increased trend in treating adults in the home.  Set your own schedule, choose your location, and take cases!

Also, we are still  seeking a Physical Therapist in Westchester for a full time adult home care caseload.

Contact Marcia 212.589.1226




Upper East Side Early Intervention Cases for OTs.

  
The Early Intervention Department is looking for experienced Occupational Therapists for cases on the Upper East Side. 
 
Contact Maria 212.589.1203

 
CPSE cases are rolling in...
 
Occupational Therapists are needed for CPSE cases in the following locations:
•    Upper West Side School 3 days a week
•    Individual CPSE cases in the Bronx
Physical Therapists are also needed for individual CPSE cases in the Bronx
 
 Contact Bridgette 212.589.1214

New Upcoming Events Posted!

We have new pediatric seminars posted on our website.  
The best news?  Take work from us and some of these events are absolutely free.

In Small California Hospitals, the Marketing of Back Surgery

HAWAIIAN GARDENS, Calif.—Consuelo Solorio, a middle-aged tomato-cannery employee, traveled three hours from her home in the San Joaquin Valley to have spine surgery here for an injury from tumbling off a ladder.


Her destination was Tri-City Regional Medical Center, a hospital that has developed a thriving business doing back surgery on workers' compensation patients.


It built up this business rapidly. For an operation known as spinal fusion, which joins two or more vertebrae, the small hospital billed workers' compensation insurers $65 million in 2010, up from less than $3 million three years earlier, state hospital discharge data show.


Helping spur the business was Paul Richard Randall, a consultant to whom Tri-City has paid millions of dollars in marketing fees. According to people familiar with his role, it was twofold: bringing surgery cases to the hospital by recruiting surgeons to operate there, and supplying metal implants for the surgeries through distributorships he owned.


The U.S. attorney in Los Angeles has investigated Mr. Randall's practices. By last August, federal prosecutors had prepared a charge that, if filed in court, would accuse him of conspiring to inflate the cost of spinal-surgery hardware and use part of the proceeds to pay kickbacks to doctors to refer workers' compensation patients for surgeries at Tri-City, according to a copy of the charge reviewed by The Wall Street Journal.


Mr. Randall said he is just one of a dozen spinal-implant distributors in the Los Angeles area who mark up the price of the surgical hardware they provide to hospitals, and "there's nothing illegal about what I'm doing, my lawyer tells me." As for the kickback allegation, "that's not true," Mr. Randall said.

                                                                      Mr. Randall


The U.S. attorney's office declined to comment. The status of its investigation is unclear. A lawyer for Mr. Randall said no charges have been filed against his client.


An official of Tri-City said the hospital ended its relationship with Mr. Randall in the middle of last year, a few months after it ousted the executive who had hired him. An internal investigation involving various issues at the hospital is under way, a review that a hospital tax filing said has found numerous "improprieties."


A lawyer who is conducting the internal inquiry said the hospital didn't know that Mr. Randall was inflating the cost of spinal-surgery hardware he sold to the hospital until late in 2010, and it never has been aware of any possible kickbacks to doctors. Hospital officials also said they weren't aware of any federal investigation of the hospital or Mr. Randall.


Tri-City, a 107-bed facility just south of Los Angeles near Long Beach, illustrates a U.S. health-care trend, the increasing total bill for back surgery, that the Journal has traced in articles over the past 15 months.


In California, this trend shows up in the workers' compensation system. California employers paid $7.1 billion in insurance premiums to cover their workers' compensation liability in 2010. Spinal-fusion surgery is a growing part of the care these premiums pay for. It accounted for 40% of inpatient hospital charges to the state workers' compensation system in 2010, up from 30% in 2001, a Journal analysis of hospital discharge data shows.


Mr. Randall, 52 years old, an entrepreneur with a collection of sports memorabilia and a yen for gambling, began his career as a hospital marketer in the mid-1990s after serving a stint in federal prison for racketeering. He was convicted of the felony in 1993 for deals that involved buying wooden shipping pallets on credit and reselling them without paying the original vendors, and was sentenced to a 21-month term.


After serving time in the Terminal Island federal correctional facility in Long Beach harbor, Mr. Randall went into business with Michael D. Drobot, the owner of another small hospital near Tri-City called Pacific Hospital of Long Beach.


A Naval officer in the Vietnam era, Mr. Drobot bought Pacific in 1997 and shifted its focus to spine care for workers' compensation patients, a clientele other hospitals weren't keen to treat because of bureaucratic and legal headaches of dealing with insurers and uncertainties about payment.


For a decade, Messrs. Randall and Drobot operated a business that arranged for magnetic resonance imaging, or MRI, services. Mr. Randall also introduced Mr. Drobot to doctors to increase spine-surgery business at Pacific Hospital, according to a person with knowledge of the arrangement. Asked about that, Mr. Drobot said through a spokesman that Mr. Randall introduced "a few" doctors.


He said Mr. Randall was paid $25,000 a month to run the MRI business plus a share of profits. For a time, the two men also co-owned a weekend retreat in Bullhead City, Ariz., along with a doctor.


Mr. Drobot created several businesses focused on workers' compensation patients: a van service to shuttle patients, a provider of Spanish interpretation and a distributorship of metal implants used in back surgery. His hospital became one of the most prolific spine-surgery facilities in California. Between 2001 and 2010, Pacific performed 5,138 spinal-fusion surgeries on workers' compensation patients, according to state hospital discharge data, and billed $533 million for them—three times as much as any other hospital in the state, including much larger ones.


Through his spokesman, Mr. Drobot said the number of surgeries was even higher than that tally but the money received for them was lower, just $231 million. Insurers often fight hospitals over billings and end up paying less.


After a business dispute between the two men, Mr. Randall in 2008 moved to Tri-City, a hospital eight miles away that then focused on bariatric surgery.


Tri-City, which is a nonprofit institution, paid Mr. Randall more than $3.2 million between 2008 and July 2011 as a business-development consultant, according to its filings to the Internal Revenue Service and a hospital lawyer. Mr. Randall recruited some of the same spine surgeons to Tri-City that he earlier introduced to Mr. Drobot at Pacific, according to a person familiar with the matter.


Like Pacific before it, Tri-City soon was doing many more back operations; within three years, Tri-City's billings for spine surgery on workers' compensation patients soared twentyfold to $65 million. A lawyer for the hospital says amounts actually collected totaled just $22.5 million.


As Mr. Drobot had done at Pacific, Mr. Randall formed spinal-implant distributorships, which purchased hardware and resold it to Tri-City hospital.


California's Workers' Compensation Division permits hospitals to bill separately for spinal implants, rather than include their cost in an overall charge for surgery, as is the case in the Medicare and Medicaid systems.


The California Workers' Compensation Institute, an insurers' group, has estimated that separate billing for implants added $55 million in costs to the program in 2008. The workers' compensation division says it is considering modifying the system in a way that would eliminate the extra costs.


The workers' compensation division doesn't put a limit on how much a distributor may mark up the cost of implants when it sells them to a hospital, although it does restrict how much a hospital may mark up its own implant cost when it bills an insurance company.


Mr. Randall's distributorships imposed some steep markups, invoices reveal. Invoices for 16 spine surgeries at Tri-City between July 2010 and March 2011 show items for which suppliers charged Mr. Randall's distributors $326,000, while his distributors charged the hospital $1.1 million.


The draft charge the U.S. attorney's office prepared last year, but hasn't filed, stated that in 2010 Mr. Randall submitted to Tri-City an invoice for spinal-surgery hardware that listed the cost as $42,467, when the actual cost of the hardware bought by the Randall distributorship was $3,600.


The draft charge further alleged that Mr. Randall conspired to pay chiropractors and physicians kickbacks of approximately $15,000 to $20,000 per spinal surgery to refer workers' compensation patients for operations at Tri-City. It alleged that he "paid the kickbacks…from his profits on inflating the cost of the spinal surgery hardware" by "2-10 times the actual purchase price."


By August of last year, the federal prosecutors had prepared a proposed plea agreement for Mr. Randall. He said he hasn't signed it.


Kenneth Yood, a lawyer hired by Tri-City's board in late 2010 to do an internal investigation of various matters at the hospital, said that Tri-City isn't aware of any possible kickbacks to doctors.


He said Tri-City's board didn't become aware until the fall of 2010 that charges for spinal implants by Mr. Randall's distributor "were arguably excessive." Mr. Yood said the hospital has since made changes "to address several matters related to vendor-supplied implants," including requiring vendors to attest that they comply with all applicable laws and regulations.


Mr. Yood said his review is examining what he called "highly questionable transactions" a former chief executive "caused the hospital to enter into with third-party vendors, including Paul Randall." The former CEO, Arthur Gerrick, was removed for misconduct in April, according to the hospital's general counsel, Beryl Weiner.


Mr. Gerrick "categorically denies" all Tri-City allegations against him, his lawyer said.


Messrs. Gerrick and Weiner were partners in a company that managed Tri-City for several years through the end of last year. The nonprofit hospital paid this management company about $3.4 million a year.


Mr. Weiner said Tri-City ended its relationship with Mr. Randall last summer, after receiving an anonymous letter that described his criminal past.


The chairman of Tri-City's board, Brian Walton, said that "over the past three years, the hospital went through some traumas. As best we can, we've been trying to clean up the mess…. Obviously, we could concede that there are things that went on in the past that could be upsetting."


Ms. Solorio, the tomato-cannery employee, is one of hundreds of injured workers treated at Tri-City during those three years.


She worked as a cleaner in a Rio Bravo Tomato Co. cannery in the San Joaquin Valley, an area home to many Hispanic field workers. Over the past decade, at least 550 workers from the region had spinal fusions at the two Long Beach-area hospitals Mr. Randall was connected with, chiefly at Pacific, according to state discharge data.


Ms. Solorio lived with her husband, Rafael, and a son in a brown bungalow around the corner from a trailer park in Shafter, an impoverished town along a stretch of rural highway. She injured her neck falling off a ladder at work, according to Mr. Solorio, a Mexican-born ranch hand who speaks little English.


An attorney who handled her workers' compensation claim, William Berry, said he first referred her to a local chiropractor and then to a spine surgeon, who, Mr. Berry said, didn't recommend surgery.


At some point, according to several people familiar with the matter, Ms. Solorio became a patient of Edward C. Kolpin, a surgeon who operated at both Pacific Hospital and Tri-City. Dr. Kolpin scheduled surgery for the 52-year-old worker at Tri-City, which is 150 miles from her home.


The surgery on Oct. 6, 2010, joined four neck vertebrae, in what is known as a three-level cervical fusion.


State hospital discharge records show Dr. Kolpin used a bone-growth product that accelerates fusion, called bone morphogenetic protein. The Food and Drug Administration approves this substance only for a particular type of surgery of the lower spine; the FDA warned in 2008 against using it on the neck area because of reports of life-threatening tissue swelling that compressed patients' airways.


The day after the surgery, Ms. Solorio experienced difficulty breathing and died. The surgeon, Dr. Kolpin, didn't return calls and text messages seeking comment.


A surgeon who assisted in the surgery, Khalid Ahmed, who also operates at Pacific, said the outcome had nothing to do with the surgery, which he described as "well performed."


State hospital discharge data show Tri-City billed $177,138 for Ms. Solorio's surgery. Tri-City, citing patient privacy, declined to comment other than to say it regrets any instances "in which patients expire while in the hospital or thereafter."


By August 2011, Mr. Randall said, he was back to doing spine-surgery marketing work for Mr. Drobot at Pacific Hospital of Long Beach.


Mr. Randall said he signed a $100,000-a-month marketing agreement with Mr. Drobot—technically between Mr. Drobot's spinal-implant distributorship and a Randall marketing firm—under which Mr. Randall is to provide services such as "recruiting surgeons to the medical staff of hospitals that use" implants Mr. Drobot distributes. The Journal reviewed a copy of the purported contract.


Mr. Drobot said through a spokesman that he didn't recall entering into any such contract and that he didn't believe the signature on the document was his.

(Source: online.wsj.com)

Occupational Therapy Program Seeks to Cure Picky Eaters

A newly initiated pilot program by the College of Health and Human Services called Finicky Feeders aims to pair occupational therapists with families in an attempt to help selective eaters.

Finicky Feeders was originally intended for children with sensory processing problem or for children who have an intense sensitivity to certain stimuli, such as texture or smell. There are a wide range of causes for a finicky feeder, according to Professor Michelle Suarez, head of Finicky Feeders.

“Around 40 to 70 percent of kids with autism have some sort of food selectivity issue. They have a hard time eating a variety of foods, but that’s not unusual for this diagnosis. It’s kind of a mix, kids with sensory sensitivity problems and kids with autism,” said Suarez.

The population itself is kept small, with only five families and their children aged 2 through 8 participating in the pilot run of the program. Sessions are one hour of group work, designed to help a finicky feeder learn how to deal with foods they can’t stand normally, Suarez said.

Finicky Feeders incorporates a form of systematic desensitization with the children participating in the program. First, the children must tolerate being exposed to the food. Then the children are asked to play with the food, kiss the food, lick the food, and finally occupational therapists encourage the children to take a bite, said Suarez.

Finicky Feeders not only helps kids eat new foods, but also serves as a level one fieldwork requirement for students in the Occupational Therapy program here at Western Michigan University. The program is currently handled by seven occupational therapy students, one interdisciplinary health services student, and two independent study students.

“Students are the ones that are basically running the finicky feeders group. They have been required to learn about treatment techniques, and we’re trying to give them lots of support in order to be successful. They’re going to be in charge, running the clinics with supervision at this point,” said Suarez.

The program is not only a valid commodity for its dutifully employed students, but for the families enrolled in the program.

“So far, it’s been running very smoothly. We have some kids that have difficulty sitting next to somebody at lunchtime that was eating yogurt, and in our clinic they were able to try some yogurt for the first time. We’ve been seeing some improvements,” said Suarez on the subject of the program.

(Source: westernherald.com)

How Fast You Walk and Your Grip in Middle Age May Predict Dementia, Stroke Risk

Simple tests such as walking speed and hand grip strength may help doctors determine how likely it is a middle-aged person will develop dementia or stroke. That's according to new research that was just released and will be presented at the American Academy of Neurology's 64th Annual Meeting in New Orleans April 21 to April 28, 2012.

"These are basic office tests which can provide insight into risk of dementia and stroke and can be easily performed by a neurologist or general practitioner," said Erica C. Camargo, MD, MSc, PhD, with Boston Medical Center.

More than 2,400 men and women with an average age of 62 underwent tests for walking speed, hand grip strength and cognitive function. Brain scans were also performed. During the follow-up period of up to 11 years, 34 people developed dementia and 70 people had a stroke.

The study found people with a slower walking speed in middle age were one-and-a-half times more likely to develop dementia compared to people with faster walking speed. Stronger hand grip strength was associated with a 42 percent lower risk of stroke or transient ischemic attack (TIA) in people over age 65 compared to those with weaker hand grip strength. This was not the case, however, for people in the study under age 65.

"While frailty and lower physical performance in elderly people have been associated with an increased risk of dementia, we weren't sure until now how it impacted people of middle age," said Camargo.

Researchers also found that slower walking speed was associated with lower total cerebral brain volume and poorer performance on memory, language and decision-making tests. Stronger hand grip strength was associated with larger total cerebral brain volume as well as better performance on cognitive tests asking people to identify similarities among objects. "Further research is needed to understand why this is happening and whether preclinical disease could cause slow walking and decreased strength," said Camargo.

The study was supported by the National Heart, Lung and Blood Institute's Framingham Heart Study and by the National Institute of Neurological Disorders and Stroke and the National Institute on Aging.
Source:  (sciencedaily.com)

Still Time to Register for Therapy Ball Techniques

Do not fret, there is still time to register for Therapy Ball Techniques for Early Childhood Skill Development. Click here to view details. If you register today, receive a voucher for $10 off of a future seminar.

This course will focus on the therapeutic value of therapy balls in the development of vestibular responses, balance, spatial orientation, body awareness, muscle strength and tone. As a foundation there will be a review of normal development of the central nervous system and a discussion of what happens  in the child exhibiting delayed motor development. Participants will be shown how to develop appropriate treatment strategies using handling techniques with the therapy ball.  Through videotaped treatment sessions of  children, the speaker will demonstrate effective hand placement and how to use the ball for maximum treatment impact. Participants will be able to experience actual handling and ball activities via a lab demonstration in the latter part of the workshop day.

App Thursday: Autism Therapy Apps Balloon, but Therapeutic Benefits Remain to be Proved

Although we are believers in using technology as an aide for goal outcomes...we found an interesting article based in the UK that questions the effectiveness of the tablet boom in treating autism.


With one honk, the course of Shannon Des Roches Rosa's day abruptly changed.


"It's my son," Rosa announced, as she quickly removed the microphone pinned to her shirt. "I've gotta run," she said, as she hurried out the door of her sprawling home. Her 11-year-old son, Leo, just home from school, must be met at the bus at the top of the driveway before coming indoors.


Once inside, Rosa immediately showed him the schedule of activities. First up: Bathroom, hand-washing, then a snack.


Working with an easy-to-understand schedule that usually includes picture icons is key for a smooth day for Leo and many autistic children. Experts say autistic children respond best to things they can see. Too often, things they hear or feel are off-putting and stimulate their senses in ways that can cause pain or irritation.


"Auditorily they have a difficult time processing something, it's sort of like someone speaking a different language to you," said Jennifer Sullivan, the executive director of the Morgan Autism Center, which is Leo's school. "So from the very beginning we would draw pictures of 'this is what your schedule would look like for the day.'"


But after his snack, Leo's free time usually involves the family iPad. Rosa believes his instinctive draw toward visual learning is letting the iPad reach her son in ways no other therapy had done before. The iPad, she said, has changed Leo for the better, making him more independent. And she's quick to point out that he's still an 11-year-old boy who deserves to play sometimes, which he also does on the family's iPad.


The advocacy organisation Autism Speaks estimates there are hundreds of apps built for use on iOS devices, specifically for autism. A search of the Apple iTunes store brought more than 580 autism-related apps, while an Android Market search for autism apps yielded about 250 results.


"The more we dig, the bigger the rabbit hole is and we're starting to think tech is a really big key for how we can develop therapies quickly," said Marc Sirkin, vice president of social marketing and online fundraising for Autism Speaks.


However, the organisation is cautious about the iPad's popularity. Its quick ascent means no one has actually studied which apps are of therapeutic benefit. Sure, Sirkin said, parents may hear anecdotal stories of apps completely changing a child's life, but there is no measurable proof yet that the apps really work.


"The challenge with iOS apps is a lot are developed by well meaning parents but under no guidance with autism experts," Sirkin said. "For us, it brings in questions as an evidenced-based organisation and we're starting to ask: Does any of this actually make any difference... the danger is that the iPad becomes a really expensive toy."


But some parents are OK without the proof just yet. Eric Tanner, the father of an 8-year-old with autism, said what the iPad really offers is accessibility and hope that a better life is possible for his child.


"The reality is for people like us, it's a huge amount of hope," Tanner said.


Tanner said the previous machine available for his daughter Sophia cost a few thousand dollars and was programmable with only 20 keys to ask for specific things, like helping Sophia to say if she was hungry or thirsty. But it couldn't help her express emotions. Just a year later, Sophia's iPad is loaded up with a nearly £300 app built to help autistic children expand their vocabularies.


"It's a huge learning tool, it's massive," Tanner said. "It's really been one of the biggest things in her life so far."


Still, the iPad remains just one many tools to help Sophia, who has a full weekly schedule complete with equine therapy, floor therapy, speech and occupational therapy, to name a few.


Some app builders are coming to the process by seeing a need, themselves. Karen Head is a speech therapist from Boston. She and two colleagues often talked about writing a book to help their patients, but it wasn't until they hit on the idea of building an app that they started their business. Now, All4myChild's packaged app called "Social Adventures" has 44 activity descriptions, nine visual cartoons that are mostly focused on social interaction skills, and a new game coming out as a separate app.


"We wanted to have a platform we could continue to add to, so families and kids could grow with the app and we could make changes" Head said, pointing out that anyone able to invest about $10,000 can have an app ready for the marketplace within six months.


Which is exactly why Autism Speaks warns parents about finding salvation in apps. In some ways, Head agrees there is reason to be cautious.


"The dark side of all the bells and whistles is that in some cases it's too much, and kids get overly focused on things that jingle and jangle," Head said. "As a therapist, we want them to listen to us."




Sullivan seconds that idea, saying that even Leo, in particular, can get drawn to the patterns in an app rather than actually learning the content it is trying to provide.


"It's a little bit tricky because it's such a compelling medium for kids with autism, they want to do it intensely," Sullivan said.


Autism Speaks is excited about two different areas of research that could use gaming consoles to teach autistic individuals how to interact in social situations and learn how to read facial features better.


(Source: features.techworld.com)

Building Self-Control, the American Way

EACH year, it seems, a new book emerges to capitalize on the parental insecurities of Americans. Last year it was Amy Chua’s “Battle Hymn of the Tiger Mother.” This time it’s Pamela Druckerman’s “Bringing Up Bébé.”

But rather than trying to emulate the strict discipline supposedly instilled by child-rearing techniques in other countries, it may be more useful to consider the science of successful parenting in general. Like their Chinese and French counterparts, American parents can make a child’s mind strong — by enlisting the child as an ally.

In any culture, the development of self-control is crucial. This ability, which depends on the prefrontal cortex, provides the basis for mental flexibility, social skills and discipline. It predicts success in education, career and marriage. Indeed, childhood self-control is twice as important as intelligence in predicting academic achievement. Conversely, poor self-control in elementary school increases the risk of adult financial difficulties, criminal behavior, single parenthood and drug dependence.

Traditionally, Asian students succeed in part because they show good self-control from an early age. In one study, Chinese preschoolers were six months ahead of American children in developing mental control, like the ability to look to the left when shown a face pointing to the right. Another study found that Korean 3-year-olds did as well on such tasks as British children who were 17 months older.

Like many brain capacities, self-control can be built through practice. Chinese parenting emphasizes child training, which combines close supervision of performance with substantial support and motivation for the child’s efforts. This approach comes at a great cost to parents and children. East Asian students study long and hard — in South Korea, 14 hours a day. Parental pressure there is so intense that the government has hired inspectors to enforce a 10 p.m. curfew on private tutoring.

In “Bringing Up Bébé,” Ms. Druckerman, a journalist, is envious of Parisian parents whose children don’t throw tantrums in public or fight on playgrounds. She ascribes this good behavior to stern French methods like forcing children to follow schedules and wait for attention. But in the school system, this strict approach translates to a rigid curriculum with an emphasis on memorization. French children also are tracked into different academic paths by age 12, a practice that reinforces the influence of parental socioeconomic status on educational and career outcomes, reducing social mobility.

Fortunately for American parents, psychologists find that children can learn self-control without externally imposed pressure. Behavior is powerfully shaped not only by parents or teachers but also by children themselves. The key is to harness the child’s own drives for play, social interaction and other rewards. Enjoyable activities elicit dopamine release to enhance learning, while reducing the secretion of stress hormones, which can impede learning and increase anxiety, sometimes for years.

Effective approaches for building self-control combine fun with progressively increasing challenges. Rather than force activities onto an unwilling child, take advantage of his or her individual tendencies. When children develop self-control through their own pursuit of happiness, no parental hovering is required. Find something that the child is crazy about but that requires active effort. Whether it’s compiling baseball statistics or making (but not passively watching) YouTube videos, passionate hobbies build mental staying power that can also be used for math homework.

Play allows children to practice skills that are useful in adult life. Young children build self-control through elaborate, imaginative games like pretending to be a doctor or a fireman. Preschool teachers can promote self-control with simple techniques — for example, handing a child a drawing of an ear to remind him that it’s his turn to listen. Frequent practice is crucial. Montessori preschool instruction, which has been shown to lead to strong academic achievement, incorporates self-control into daily activities.

Learning a second language strengthens mental flexibility, an aspect of self-control, because the languages interfere with each other and because children must determine which language the listener will understand. Bilingual children do well on tasks that require them to ignore conflicting cues, for example reporting that a word is printed in green ink even though it says “red.” Bilingual children are better at learning abstract rules and reversing previously learned rules, even before their first birthday. People who continue to speak both languages as adults show these benefits for a lifetime.

Aerobic exercise, which increases prefrontal cortex activity, is another way to build cognitive flexibility. Further benefits may come from Asian practices that require sustained attention and disciplined action, like martial arts, yoga and meditation. Though parents often worry that physical education takes time away from the classroom, an analysis of multiple studies instead found strong evidence that physical activity improved academic performance.

The connection between self-control and social skills seems to be a two-way street. Helping children to identify their emotions and think through possible consequences before reacting improves self-control, in the classroom and at home. According to an analysis of 213 studies involving more than 270,000 students from kindergarten through high school, programs to enhance social and emotional development accelerate school achievement as much as interventions targeted at academic subjects.

Children do not all start at the same place, but they all can benefit from building self-control. Though many children develop this ability at home, children of stressed and overwhelmed parents have fewer opportunities to do so and benefit greatly from preschool programs as preparation for later schooling. In addition, boys, on average, develop self-control later than girls. Regardless of initial ability, increasing self-control improves life outcomes.

Americans could take one tip from Asian and French parents: abandon the idea that they must support self-esteem at all costs. Children do not benefit from routine empty praise, like the cries of “Good job!” that ring out over American playgrounds. Chinese and French parents are sparing in their praise, yet children from those cultures do not have noticeably lower self-esteem.

More effective is to praise a child for effort. “You’re so smart!” doesn’t suggest what to do next time; “Wow, you kept working on that math problem until you got it right!” carries a clear message about the desired behavior. Communicating high but achievable expectations confers tools for real success — the best route to true self-esteem.

An internally motivated approach to building self-control plays to traditional American strengths. Being self-motivated may lead to other positive long-term consequences as well, like independence of thought and willingness to speak out.

Helping your children learn to manage themselves, rather than rely on external orders, could pay big dividends in adulthood. With a little luck, they may end up agreeing with the legendarily hard-striving Thomas Edison: “I think work is the world’s greatest fun.”

(Source: nytimes.com)

Available Jobs: Updated February 21st

Jobs available in all boroughs, all disciplines, all hours.

Profession: SLP
Population: Pediatric
Location:  Bronx
Schedule: Early Intervention Homecare Case
Description: A 17 month old male requires speech therapy twice a week to address limitations with comprehension, and decreased understanding of phrases and gestures in the familiar context of his home. He lives with his parents and 7 year old brother in the Bronx. Spanish and English are spoken in the home.

Profession: COTA
Population: Adult
Location: Brooklyn 
Schedule: Coverage 
Description: This rehab facility that is  located in scenic Coney Island on the beach with views of the ocean seeks a COTA for coverage on 2/23. Within this placid setting, over three hundred residents are served.

Profession: PTA 
Population: Adult
Location: Brooklyn 
Schedule: Coverage Description: Over 500 beds are served at this scenic Brooklyn Heights/Cobble Hill located facility that needs a PTA from 4/12-4/13. Providing baseline, adult day health, clinical and radiology services, this facility is not-for-profit.

Profession: COTA
Population: Adult 
Location:  Brooklyn  
Schedule: Coverage 
Description: This rehab facility is located in scenic Coney Island on the beach with views of the ocean seeks a COTA for coverage 3/1, 3/2, and 3/5. Within this placid setting, over three hundred residents are served.

Profession: OT
Population: Adult
Location:  Bronx 
Schedule: 2 Week Coverage
Description: Central Bronx located, not for profit acute care community hospital and Level 1 Trauma center has over 450 beds seeks an OT immediately for a 2 week coverage. This facility offers nearly twenty programs for adults and children including services for mentally ill, day treatment
programs and special programs for victims as well as  employee assistance programs.


Profession: OT
Population: Pediatric
Location: Brooklyn
Schedule: Part Time
Description: An early childhood school nestled in the Bedford-Stuyvesant section of Brooklyn that offers a center based treatment environment for children ages 3-5 seeks a PT for a part-time contract position until mid-August (2 mornings, 13 sessions). Their mission is to provide a success-oriented, supportive, and nurturing environment within a developmental learning center model.

Profession:  OT
Population: Pediatric
Location: Bronx
Schedule: School Based Caseload  
Description: An OT is needed for a part time caseload in near a school in the Bronx. The school is conveniently located near most forms of public transportation.

Profession: SLP
Population: Pediatric
Location: Queens 
Schedule: Early Intervention Homecare Case 
Description: A 25 month old male that resides in Woodside, Queens, needs a SLP for services 3x a week. He has expressive language delays and the evaluation reveals that he does not imitate sounds or words despite prompts by his mother. There is decreased strength in oral musculature as well.

Profession: OT
Population: Adult
Location: Queens
Schedule: Full Time 
Description: A recently renovated, state-of-the-art rehabilitation facility in scenic Rockaway Park seeks an OT for a full time contract position. This facility offers enriching and social recreation programs, provides therapy services 7 days a week, and specializes in long and short term care
rehabilitation.

Profession: SLP
Population: Pediatric
Location: Manhattan 
Schedule: Part Time  
Description: A SLP is needed for a part time contract position at a child development center in Inwood. The population presents with minor speech and sensory delays and autism. Interested candidates should be available 8:15-3:00pm (Monday-Thursday).


Profession: Special Ed
Population: Pediatric
Location: Manhattan 
Schedule: Full Time 
Description: A renown pediatric program in Manhattan that provides Early Head Start among a multitude of other educational programs seeks a Special Educator for a full time contract position. Candidates will plan and evaluate program goals, participate in trainings and monitor case records so that program standards are met.


Profession: OT
Population: Pediatric
Location: Brooklyn 
Schedule: Full Time 
Description: Brooklyn based school provides educational services to preschool children (age 3-5) diagnosed as emotionally disturbed, autistic, or having other health impairments seeks an OT for a full time contract position 5 days a week. This school age program offers services for children (age 5-8) with needs. Services are fully funded and include a community daycare program with extended hours for on-site community children as well as children of the employees.

Profession: OT
Population: Pediatric
Location: Bronx 
Schedule: Early Intervention Homecare Case
Description: A 17 month old male that resides in the Bronx needs an OT twice a week to address postural/gross motor limitations, and short attention span. He displays eye contact and exhibits sensory processing issues.

Profession: PT
Population: Pediatric
Location: Bronx 
Schedule: Part Time 
Description: A school or program within a school that provides services and training to students with moderate to severe mental and/or physical disabilities in the Bronx seeks a PT for a part time position, approximately 4.5 hours a week.

 
Profession: OT
Population: Pediatric
Location: All Boroughs 
Schedule: School Based Opportunities 
Description: Join our team of  OTs who service students in the New York City public schools. Choose a full-time or part-time caseload. Schools are available in the Bronx, Brooklyn, Manhattan, and Queens. It's so much easier to be in a place with a support system - great Principals, Assistant Principals and IEP team.

Classification-Based Therapy No Better for Back Pain

Treatment of patients with lower back pain (LBP) using a classification-based physical therapy approach shows no statistically significant superiority to treatment with usual physical therapy care, according to a study published online Feb. 13 in Spine.

Adri T. Apeldoorn, of the VU University Medical Center in Amsterdam, and colleagues compared outcomes of classification-based physical therapy treatment to those of usual physical therapy care for 156 patients with sub-acute or chronic LBP. All participants were classified by research physical therapists using a modified version of Delitto's classification-based system, and were then randomly allocated to receive Delitto's classification-based treatment approach (74 patients) or usual physical therapy (82 patients). Patients underwent follow-up at eight, 26, and 52 weeks.

The researchers found that there were no statistically significant differences between the two groups for outcomes at any time points. After eight weeks, patients in the classification-based group had increased global perceived effect scores (adjusted odds ratio, 1.01; 95 percent confidence interval, 0.31 to 3.28). They also had higher adjusted Oswestry Disability Index scores and pain intensity (numerical rating scale) scores (0.48 and 0.49 points, respectively). None of the differences were found to be statistically significant.

"The classification-based system as used in this study was not effective for improving physical therapy care outcomes in a population of patients with sub-acute and chronic LBP," the authors write.

(Source: doctorslounge.com)

Helping Those With Memory Impairment Regain Independence Using Smartphone Training

The treatment for moderate-to-severe memory impairment could one day include a prescription for a smartphone. 


Baycrest has published the strongest evidence yet that a smartphone training program, theory-driven and specifically designed for individuals with memory impairment, can result in "robust" improvements in day-to-day functioning, and boost independence and confidence levels. 


The promising results appear online this week, ahead of print publication, in the international journal Neuropsychological Rehabilitation. 


"The goal of our study was to demonstrate the generalizability of our training protocol to a larger number of individuals with moderate-to-severe memory impairment," said Dr. Eva Svoboda, a clinical neuropsychologist in the Neuropsychology and Cognitive Health Program at Baycrest, and lead author of the study. 


"Our findings demonstrate that it is possible to harness powerful emerging technologies with brain science in an innovative way to give people with a range of memory deficits some of their independence back." 


Memory impairment, particularly when it is severe, can impact virtually all aspects of everyday life. Individuals are unable to readily acquire new information making it difficult or impossible to keep appointments and stay on top of changing personal, social and occupational responsibilities. 


Two decades ago, Baycrest pioneered a theory-driven training program that tapped into preserved implicit memory systems in people with amnesia to teach them to use assistive memory devices. Implicit or procedural memory is a type of memory that supports learning but does not require conscious executive control. Common examples of this type of memory include riding a bicycle or brushing one's teeth which doesn't require conscious remembering of where the procedure was learned in order to perform it. 


Commercial technologies such as smartphones and other mobile electronic devices have immense potential for individuals with memory impairment as they offer high storage capacity, auditory and vibration alerts, rich multimedia capability and high user acceptability. 


The Baycrest study involved 10 outpatients, 18 to 55 years of age, who had moderate-to-severe memory impairment, the result of non-neurodegenerative conditions including ruptured aneurysm, stroke, tumor, epilepsy, closed-head injury, or anoxia (insufficient oxygen to the brain) after a heart attack. 


Participants completed two phases of training on either a smartphone or another personal digital assistant (PDA) device. Prior to the training, all participants reported difficulty in day-to-day functioning. Some required ongoing supervision and regular assistance from family members due to their forgetting to pay bills, take medications or attend appointments. 


In the first phase, instructors from Baycrest's Memory Link program taught participants the basic functions of their device, using an errorless fading of cues training method that tapped into their preserved implicit /procedural memory. Each participant received several one-hour training sessions to learn calendaring skills such as inputting appointments and reminders. 


In the second phase, participants took the device home to apply their newly-acquired calendaring skills in real-life situations. This included setting alarm reminders to take medications and attend future appointments, charging the device, and remembering to keep the device with them at all times. They also learned how to use other software functions, such as phone, contacts, and camera. 


As part of the outcome measures, participants were given a schedule of 10 phone calls to complete over a two-week period at different times of the day - to closely approximate real life commitments. Family members who lived with participants kept a behavioural memory log of whether real-life tasks were successfully completed or not by their relative. Participants and family members completed a "memory mistakes" questionnaire which involved rating a list of common memory mistakes on a frequency-of-occurrence scale, ranging from "never" to "all the time". 


Participants and family also completed two additional questionnaires. One measured confidence in the participant when dealing with various memory-demanding scenarios (e.g. dentist calls to change appointment dates). The other examined the participant's use of the device to support traveling back in time (e.g. searching activities and events from preceding days, weeks and months), traveling forward in time (e.g. planning ahead, entering future events and appointments), and technical ease of use of the device. 


All 10 individuals showed "robust increases" in day-to-day memory functioning after taking the training, based on results from the functional and questionnaire-based measures. Participants continued to report benefit from smartphone and PDA use in short-term follow-up three to eight months later. 


(Source: occupational-therapy.alltop.com)