Gateway Therapies
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Featuring articles from our principal Occupational Therapist, Dr Nicole Grant, members of the therapy team, and guest posts from members of our community.  

Posts tagged assessment
What's Best - Handwriting or Typing?

A few years ago, I conducted an Ergonomic Workstation Assessment for an adult who was employed in an administrative role. This particular employee had the task of completing a large number of forms by hand and she was experiencing symptoms that her GP thought might be early signs of Carpal Tunnel Syndrome. This recent assessment again got me thinking about writing.

Computers and other electronic devices are being used more frequently to communicate - either in real time or to convey a story or recount an experience. It appears as though typing has become the preferred method of communicating over writing and even at times over speaking. I wonder if this is the reason why there is an increasing number of both kids and adults who struggle with writing - either by writing poorly or by developing pain in their hands and wrists during this task?

It's important with any skill to practice often. Use it or you lose it - basically. My approach with working with kids is to firstly correct their pencil grasp, and then practice, practice, practice. Work on letter formation, letter height, width and word spacing. With adults who are reporting pain or other symptoms e.g tingling in the hands, I encourage them to continue writing, but to alternate written tasks with other activities. I encourage all clients, both young and old, to perform hand stretches before commencing writing tasks - just like a footy player would stretch his muscles before running onto the field.

I would love some feedback on this post. Which is more important - handwriting or keyboard skills? Do you experience hand or wrist pain if writing? What about your kids?

Please note, if you experience pain, numbness or tingling when writing or typing, and it does not go away, seek medical attention.

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Should my child get a diagnosis?

A post from Director, Nicole.....

I often receive requests to assess for delays with development or dysfunction in the areas of sensory processing, fine and gross motor development, attention/ concentration and other areas of function. One of the questions I am frequently asked by parents, particularly when obvious issues become apparent, is - what do you think it is? Many parents are aware of neurodevelopmental disorders like those on the autism spectrum, and I often get asked about ADHD and sensory processing disorder.

I will always refer to a paediatrician for diagnosis, but can assist with the process by providing a report outlining my observations and recommendations.

Parents often feel reassured when they at least have a little more information as a result of an initial assessment, particularly as my focus is always on providing information and strategies to assist - regardless of whether or not a name is given to the challenges identified.

Once specific issues are identified, the treatment options or interventions used tend to be the same, regardless of what the diagnosis is, or will be. The problem here is that without a diagnosis, parents can have limited access to Occupational Therapy services. Government funding is available in Australia for children with special needs via such schemes as Helping Children with Autism and the Enhanced Primary Care Scheme. However, a diagnosis is required. Parents who wish to pursue intervention with a private allied health professional, and do not have a diagnosis, may be able to claim some of the expenses from their private health fund, or self-fund the fees.

Occupational Therapy services are available to the community via community services and more specifically to school age children through the Department of Education and Training. Waiting lists are often lengthy, which can affect access to early intervention services, however it's worth contacting your local department to check.

My concern with seeking a specific diagnosis or giving a name to the difficulties a child is experiencing, is that some children just do not meet all the criteria to be given a diagnosis. This doesn't mean they are any less in need of assistance. Many children can benefit from Occupational Therapy services, to develop skills to help them with their school work, social interaction, and self care. Click on the links or email me for more information.

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Low Muscle Tone and Poor Attention - A Case Study

A young boy, 4 years of age, was brought to me for assessment about 9 years ago. He had not been diagnosed with any particular disorder, but was easily distracted and found it difficult to pay attention to the task at hand. He had been seeing a Speech Therapist for some time due to a slight delay in his speech development and he dribbled.

The boy's mum was mostly concerned that he would not be able to concentrate in class when he started prep next year. She wondered what she could do to help him at home, in readiness for school.

I gave the child some activities to complete and observed that he fidgeted in his chair, and was easily distracted, and yes - had difficulty paying attention. One of the first things I noticed was that when needing to apply force or pressure, e.g to mould playdough, he would move to position himself over the table to use all his strength, rather than relying on his hand strength alone. When I asked him to throw a ring or ball, he needed to use two hands to get any sort of distance. Throughout the assessment I asked the boy to complete desk-based tasks that assessed things like posture, attention, and fine-motor skills, and more active tasks that assessed his balance, coordination and proprioception.

During the assessment, the 4-year-old managed to respond to multi-step directions, and complete age appropriate puzzles and games. I found that when he began to lose focus and become distracted, his posture also changed and he would recruit compensatory muscle groups to move or exert force on an object. I asked this child if he ever got tired in the neck, back, arms or legs when sitting for a long time. He thought for a second then answered "Yes. Sometimes my elbows hurt." His mum hadn't heard this before and wasn't sure what he meant by this.

By the end of the assessment, it had become apparent that the attention difficulties experienced by this boy were more likely due to low tone, than because of any cognitive or intellectual dysfunction.

Low tone or hypotonia is explained well in Wikipedia:

"Hypotonia is a disorder that causes low muscle tone (the amount of tension or resistance to movement in a muscle), often involving reduced muscle strength. Hypotonia is not a specific medical disorder, but a potential manifestation of many different diseases and disorders that affect motor nerve control by the brain or muscle strength".

I recommended that the child engage in physical activities that promote muscle strength, balance and coordination, like climbing, running, and bike riding. He was already taking swimming lessons and going to structured gym classes, so he was already on his way.

With regards to desk-based work, I suggested that the boy be given a seat and chair that was appropriate for his size and that enabled him to sit with his feet flat on the floor and his back well supported. When performing desk-based tasks, it was probable that the child would become easily fatigued and possibly develop joint or muscle pain. He needed to be given the opportunity to stretch and change postures frequently.

With these strategies in place, and ongoing review of his progress and awareness of his needs, the 4-year-old boy should have no difficulty keeping up with his peers on commencing prep.

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Healthy Home Office Habits

If you work from home, chances are you have or will experience musculoskeletal pain.

 

Remember back in the 80's there was an epidemic of RSI (Repetitive Strain Injury)? You may at least, have heard of the term. The sudden increase in RSI cases coincided with the increased number of computers being used by office workers.

Following this, workplaces began to focus more on strategies to prevent the onset of injury related to constant computer use. Most workplaces now have training or other methods of ensuring their workers are aware of safe work practices and ergonomic principles. Unfortunately, most of us employ these principles at work, and then forget all about them at home!

There is a fantastic cartoon called the Evolution of Man that depicts a hunched over Neanderthal man evolving into modern upright man, and then over time becomes a man hunched over a computer – mimicking the posture of the earlier man. It's a cartoon that is often shown to us Occupational Therapists as students. It is humorous, but illustrates one of the reasons why so many people now report back, neck, and wrist pain.

An insightful client once pointed out to me that humans weren't designed to sit for long periods of time working on a computer. This is true. The largest muscle groups are in the lower limbs, to help us move around. Prolonged sitting, particularly with using a computer, can lead to fatigue of the smaller muscle groups, and eventually pain and injury.

Most offices now, are equipped with fully adjustable, ergonomic chairs and sometimes height adjustable desks. Monitors can be moved to an appropriate height, angle and viewing distance and screen settings can be adjusted to suit varying visual deficits. People who spend a lot of time on the phone often use headsets or the loudspeaker function, freeing their hands for note taking.

Then there's the whole range of ergonomic mouses, track balls, keyboards with wrist rests... the list goes on. Interestingly, workers still report symptoms of pain that are later diagnosed as Occupational Overuse Syndrome (OOS), or RSI.

One reason is that ergonomic and adaptive equipment may be in place, but used incorrectly. Another reason is that stress is contributing to muscle tension and/ or the worker is not taking enough rest or posture breakers. And the reason that applies to most of us – we don't apply preventative strategies at home.

Many of you are now working from home and trying to squeeze in computer time around meeting the needs of your families. Laptop computers, blackberries, iPhones and other electronics have made it easy to work while sitting on the couch, on the floor or even in bed. Unfortunately, safe work practices go completely out the window.

 The ideal working position is this:

·      knees, hips and elbows at a 90 degree angle when seated

·      feet flat and touching the floor

·      spine supported to maintain the natural curves

·      the monitor or screen height should be at eye level or just below

·      the keyboard should not be higher than your wrists, when your elbows are kept    at a 90 degree angle

·      Your wrists should be neutral (flat)

·      Your mouse, phone or other frequently used items should be within arms reach.

 In addition to the above, you should not be seated for longer than 20 to 30 minutes at a time. Go and grab a coffee or throw yourself on the floor with the kids, but don't stay seated for too long. Even if you are sitting in the position described above, your muscles will still fatigue and injury can result.

So what now? Find somewhere in your home to set up a workstation that allows you to adopt healthier work habits. If you must sit on the couch or in bed, make sure your back is well supported and you adhere to as many of the above points as you can. If you are still experiencing pain, numbness and/or tingling anywhere (except the good places!) see your doctor. It is also possible to consult with an Occupational Therapist (OT) who works in the area of vocational rehabilitation or ergonomics.

An OT can visit your home or office, assess your individual work needs, and provide you with advice, strategies and equipment recommendations if relevant. If you have employees, this is a good idea as a preventative measure to avoid expensive workers compensation claims.

 

Nicole is a qualified Rehabilitation Consultant and Occupational Therapist with over 15 years experience working with injured workers, helping them to return to work post-injury. Contact Nicole on 07 3398 9367 to arrange an assessment.

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