Evidence Based OT Practice, Part IV: Fact or Fad? A Case Study with Bal-A-Vis-X


This post is part of a series on evidence-based practice in OT. Read the previous posts in the series here, here, and here.

Many rehab therapists have fallen prey to using fad treatments that have little or no evidence to support them. There continue to be many lively Facebook debates and polarized opinions about various occupational therapy interventions. Those who believe the intervention is effective make a point of highlighting the many clients they’ve treated who have experienced significant gains, and non-believers turn their noses up and ignore on any evidence presented by those on the other side. As I’ve stated in previous posts about evidence-based practice, the issue in these cases is not whether to use new interventions without a ton of research evidence behind them, but the lack of clinical judgment and application of evidence-based practice principles when choosing and using OT interventions.


For example, in one setting where I worked I witnessed a department of over 50 experienced and intelligent clinicians buy into the promises of an intervention with only weak evidence to support it due to its extreme popularity in the pediatric professional sphere. No matter that this intervention required costly trainings and materials, was unlikely to be generalizable outside of a highly specific context, and was barely occupation-based – therapists wanted to learn it anyway! I was shocked that the department was spending limited continuing education funds on a popular pseudoscience program rather than a well-researched, evidence-based training that could help clinicians obtain better functional outcomes for young clients. Unfortunately, this is the case in many settings and with many practitioners.


The goal of this post is to closely examine one such program and break down how principles of evidence-based practice can be used to help make a determination about the validity, clinical applications, and utility of this program for occupational therapy practitioners. Read on to learn more about whether the widely-used Bal-A-Vis-X program is an evidence-based intervention or a highly-flawed fad!

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“Day in the Life” Series on OT Cafe

_Day in the Life of an OT_ SeriesonOT

Happy Friday! Today is the only day of the week when I don’t have class. Which means I actually have time to write a post! (This is clearly way more important than reading, homework, or finishing any of the 12 billion projects I have due throughout this month. -__-)

In case you didn’t know, my friend Abby over at OT Café has an AMAZING new “Day in the Life” series on her blog to celebrate OT Month. She has reached out to OTs all over the place to learn more about what they do, the populations they work with, and what they love about their jobs, and if you’re interested in a career in OT, working in a specific practice area in OT, or learning more about the OT school experience, you should check it out!

All of the posts can be found HERE, and they will be updated throughout the next few weeks as she rolls all of the posts out in April. I’ve been following all of her posts in the series, and it’s great to have practitioner stories and perspectives from different practice settings in mind as I begin thinking about what I’d like to do when I leave school.

Who needs to do work/pay attention in class/be productive on a Friday when you can spend your time being immersed in the wide and wonderful world of OT? (Answer: NOBODY)

Happy reading!

OT Observations: Pediatric Feeding Therapy – An Adolescent with ARFID

Peds Feeding 1
Pediatric occupational therapists often work with clients who have difficulty with feeding, eating, and/or swallowing as a result of physical differences, behavioral issues, or psychological disorders.

Yesterday was quite an unusual day for fieldwork, as I was able to observe an initial evaluation session with a young client who was being treated for an eating disorder. When my classmate/fieldwork partner and I initially heard the diagnosis, I think both of us immediately jumped to conclusions about the client we would be seeing. This is probably due partly to our own personal experiences both in and out of the OT clinic, but also by the dominant narratives about people with eating disorders that are shown in popular media. In my experience, I have really only seen shows and read narratives of young (middle school to high school age), Caucasian females with disordered eating habits. However, the client we saw fit few of these stereotypes!

Instead of the “scary skinny” young girl we might have expected to see, our client was a tall, talkative 16 year old male who was classified as obese in his medical records. He was an agreeable and intelligent young man who expressed himself clearly, and whose goals included being able to go to restaurants with friends and find something on the menu that he felt comfortable eating. “Josh” had a repertoire of only 10-15 foods that he would eat (like hot dogs, pepperoni pizza, cucumbers, and ranch dressing), and reportedly he would rather “go hungry” than eat a non-preferred food. In addition to his limited diet, Josh was dealing with a somewhat unstable home situation, gastroesophageal reflux disease, and crippling anxiety about his performance in school that frequently caused him to miss multiple days out of school at a time. Josh was being seen at the OT clinic because he had been diagnosed with Avoidant/Restrictive Food Intake Disorder (ARFID), and here is a brief description of the disorder from Sheppard Pratt’s Center for Eating Disorders website:

 ARFID was introduced as a new diagnostic category in the recently published DSM-V.  The ARFID diagnosis describes individuals whose symptoms do not match the criteria for traditional eating disorder diagnoses, but who, nonetheless, experience clinically significant struggles with eating and food.  There are many types of eating problems that might warrant an ARFID diagnosis – difficulty digesting certain foods, avoiding certain colors or textures of food, eating only very small portions, having no appetite, or being afraid to eat after a frightening episode of choking or vomiting. And most of all, individuals with ARFID may have problems at school or work because of their eating problems – such as avoiding work lunches, not getting schoolwork done because of the time it takes to eat, or even avoiding seeing friends or family at social events where food is present.

Although the other components of the disorder are also very significant, an occupational therapist is most likely to become involved when the client’s disorder disrupts his or her engagement in occupations like eating in new surroundings, going to school, or “seeing friends or family at social events where [non-preferred] food is present,” which are examples of the real occupational performance issues that Josh faced as a result of his eating disorder. Continue reading


(As in, What the Fieldwork!)

Ball Pit
Pediatric therapy fieldwork is just like this ball pit. It’s all fun and games at first, but you have to beware of the hidden dangers!

So my second round of Level I fieldwork began at 7:45 AM today, and it was a whirlwind of an experience! I was at a large research hospital’s outpatient pediatric clinic, and I probably saw about 7-8 kids today. For my spring Level I rotation, my program has me in two different sites for 10 weeks total, with myself and a classmate/partner spending five weeks at each site. Until March, I will be spending one day per week at this first pediatric site, and after spring break I will be at a new site with a new partner. The “partnering” and “50/50” fieldwork is new to my program, but I enjoyed having another person to talk to and bounce ideas off of today as I observed the therapists and engaged with the kids.

While my CI “Jay” was a friendly, experienced therapist who had been practicing for 10+ years, a lot of the things I saw in her practice and the setting in general were somewhat disconcerting and at times discouraging to me as a budding OT. However, because I believe in having a strengths-based approach to life and other pursuits, I’m going to start with what I liked about working with Jay and my classmate “Lily” at the site!

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Bop OT!

Sometimes I think the universe knows I’m destined to be an occupational therapist, because on some particularly good days it gives me OT-related blessings!

During my most recent position as a pediatric OT volunteer, I was able to observe the therapists using all kinds of games, toys and activities to work on fine motor, gross motor, cognitive, social and other skills with their young clients. My mentor Helen was always challenging me, asking me to consider how I could use a toy differently to work on a different skill or how I might go about using a particular game during a session to help a child work on his or her goals. Coming up with answers to her queries was sometimes exhausting, but I appreciated the mental workout and the exercise’s applicability to my future treatment sessions!

One of my favorite “tools” that Helen used was the “Extreme Bop-it” game. After I had played a few rounds of Bop-it with her young clients, Helen asked me how I thought the game could be used to work on different functional skills. I pondered the question for a moment or two and gave a brief answer, not quite understanding how useful a treatment tool it could be. I continued to play Bop-it for the rest of the time I volunteered, and I never really gave the question another thought.

Fast forward to a few days ago, during my family vacation in East Texas. I was out thrift shopping (one of my favorite occupations!) and I was about to leave the store when I spotted…Bop-it! (I’m sure the people in the aisle near me had no idea why I was freaking out about some old ‘90’s toy, but I was super excited!) I debated whether or not to buy it for just a second before I plopped it on the counter and bought it for less than two bucks.

When I got back in the car with my older brother, I excitedly asked him if he wanted to play and we spent several hilarious minutes sitting in the parking lot playing Bop-it! When I blurted out that it was the first therapy tool I had ever really purchased for myself, his blank stare informed me that I could use that moment to provide a little OT education. So I told my brother all about my future career and how I would be using games like Bop-it and other everyday items to help people regain their independence and continue engaging in the activities they loved. When I finally stopped my “all about OT” spiel to draw a breath, he was grinning from ear to ear and told me how cool my career was and how excited he was for me to start helping people! It was a great sibling moment, and I added one more person to the list of earth-dwellers that have heard of occupational therapy!

I am now the proud owner of one gently-used game of Extreme Bop-it, and I can’t wait to email Helen and let her know that I’m following in her very fun footsteps! With this one small purchase came the huge realization that in just a couple of years I will be an officially licensed and registered occupational therapist – which means I’d better start building my collection of therapy tools now! And personally, I think Bop-it is a really great (and truly meaningful) first tool to add to my belt. At first I had trouble understanding how this challenging toy could be used to benefit a child in therapy, but as time went on – and as I played more games of Bop-it –I began to think about this game and many others more like an occupational therapist.


To me, my game of Bop-it is more than just a toy – it is a fun, tangible reminder of my continually-developing understanding of OT. After Helen’s mentorship and my own experiences, I now see the potential in this game to build fine motor, gross motor, social and cognitive skills. I also see it being used to encourage social interactions and build frustration tolerance, as well as improving coordination and strength. So who knew that a chance find at a thrift store would fall into my lap and convince me all over again that occupational therapy is where I am meant to be!

To Friend or Not to Friend…

So it’s summertime and I just finished an 8-month long volunteer/OT intern position at a pediatric therapy clinic. I learned a lot while I was there, but most importantly I met some AMAZING therapists and staff! Since I’ve just graduated and I’m moving away to go to graduate school, I probably won’t meet them again until I get ready to do fieldwork.

I feel like I developed positive personal relationships with all of the people I worked with, and I would like to stay abreast of important developments in their lives as well as keeping them informed about my progression through OT school (and life). However, I’m not sure what the appropriate thing to do is in this situation.

I have friended several of my previous employers, but only in cases where I was no longer working for or with them. I feel that being Facebook friends before ending the employer-employee relationship is inappropriate – unless your employer, coworkers or company social media makes it clear that it is a normal policy.

I’m not exactly sure what I’m going to do, but I’m thinking that I’ll probably just email my main supervisor and ask her if she’s comfortable becoming friends. Maybe a little formal, but I’m more comfortable putting the ball in her court and seeing what happens from there!


Have you ever been in a similar situation and been uncertain about “social media etiquette”? Have you friended former or current supervisors?