Deck The Halls...

Deck the halls with holiday lights....Fa-LaLaLaLa...LaLa-La-La!  Thankfully for you there's no volume button for this post so you'll have to sing it yourself :-)   When I arrived at school today, the halls WERE decked with these festive holiday lights that were adorable and oh so very OT-ish! The students had to CUT out the lights, COLOR the letters, and STRING the lights together by LACING in and out of the holes they made using a HOLE PUNCHER.  Whew!  Those little fingers were workin' for this one and the kiddos were proud of their efforts.  Younger students admired the fun colors and holiday "lights" in the halls.  A whole bunch of them hanging together on the wall simply "lit up" the halls!   Here's a little peek~~

This is a good one to try at home too where you can challenge your little elves to hang LOTS of lights!  For pre-readers, the lights can be cut and laced without letters or you could spell out names of the children.  I've never met a kiddo who doesn't love to decorate for the holidays so take advantage of that enthusiasm!

Jen Dermody, OTR/L



Zaner-Bloser Handwriting

While I'm a self-proclaimed fan of the Handwriting Without Tears program, I was invited to attend a Zaner-Bloser course last week and I took advantage of the offer!  Lots of schools use Zaner-Bloser handwriting books and I was interested to hear more about the curriculum they offer.  I was so happy to hear that Zaner-Bloser is now including music, movement, and a multi-sensory approach as Handwriting Without Tears has always done.  There are also digital resources to use with smart board applications that could be very helpful when teaching!   It was great to hear about the resources offered by ZB, however, it was a surprise to me and to the other OT's I  met at the course.  I'm hoping ZB will be getting the word out more to OT's and teachers/administrators who use the ZB program with their students so they can USE what's out there.  In the mean time, I'll do my part of sharing the link to their Facebook page at http://www.facebook.com/ZanerBloserHandwriting and to their website at http://www.zaner-bloser.com/ .  If you are currently using the Zaner Bloser handwriting books/curriculum, I encourage you to check out the resources offered and see if you might find something you like  :-)

Jen Dermody, OTR/L

Holiday Gift Guide!

It's already December and holiday shopping is in full force!  If you're wondering what to get the special little person in your life this year, here are a few things you might find on an OT's list to Santa:

AGES 0-3:

• Touch and feel books
• Colorful rattles
• Oral motor teething toys
• Music
• Activity center (for TUMMY TIME!!!)
• Tubby toys for bath time
• Blocks
• Unbreakable mirrors
• Textured balls for sensory awareness
• Push toys such as a mini-grocery cart or toy stroller
• Pull toys
• "Pop" together beads
• Shape sorters
• Balls
• Hammering toys
• Ball pit
• Sorting toys

PRESCHOOL AGES 3-5

• EASEL!   (EVERYTHING on a vertical surface is great for fine motor development!!)
• Stacking/building blocks
• Crayons
• Finger paints (be brave parents!)
• Fiskar scissors and some things to cut---construction paper, ribbon, play-doh
• Paint and brushes
• Puppets
• Craft items/sets
• Musical instruments
• Play-doh and some rollers, cookie cutters, etc.
• Pegboards
• Stringing beads
• Lacing cards
• A piggy bank and rolls of pennies (kids put the pennies in the slot one at a time---great fine motor task!)
• Magna Doodle or Etch a Sketch
• Dry erase board (hang it on the wall for a VERTICAL surface and it's even better for development!)
• Stickers and sticker books
• Dress ups
• Water/sand table
• Sidewalk chalk
• Toy kitchen
• Toy workbench
• Sorting toys
• Sit n' Spin
• Tricycle
• Kaleidoscopes               
• Bean bags
• Puzzles
• Board games (Candyland, Lucky Ducks)
• Card games (Go Fish, Memory)
• Lite Brite

                           

AGES 6 and UP:

• LEGOS and other block sets for building
• Jump ropes
• Tanagrams
• Puzzles
• Beads and strings to make bracelets, simple jewelry
• 
  

  Arts and crafts
• 
  

  Stencils
• 
  

  Connect 4 game
• 
  

  "Just Dance" for Wii or similar video movement games
• 
  

  Musical instruments
• 
  

  Model kits to construct
• 
  

  Bike
• 
  

  Scooter
• 
  

  Balls
• 
  

  Dolls with accessories/clothing for practice with dressing/fasteners
• 
  

  Sand and water toys
• 
  

  Gardening kit
• 
  

  Lincoln Logs
• 
  

  Tinker Toys
• 
  

  Puppets
• 
  

  Sidewalk chalk
• 
  

  Ping Pong
• 
  

  Roller skates/roller blades
• 
  

  Basketball net
• 
  

  Sled
• 
  

  Board games (checkers, chess, Chinese checkers)
• 
  

  Dominoes

  

                                                   

                   

HAPPY SHOPPING!

Jen Dermody, OTR/L

Mac Discount for Educators

If you are looking to use a Mac computer or Apple software technology with some of your kiddos, here's a deal!  I just learned that any employee of a K-12 or higher education setting is eligible for a discount on Mac computers, Apple software, and some accessories. You're also eligible if you are serving as a PTO officer or if you're a college student or a parent who is buying for a college student. Good to know if anyone you know (or maybe yourself!) will have an apple under the tree this year :)

You are also eligible for decent discounts on productivity software (like Office) from websites like JourneyEd.com .

You can check out all of the details at http://store.apple.com/us/browse/campaigns/education_pricing

Jen Dermody, OTR/L

Homemade Playdoh Recipe

Here is a traditional playdoh recipe that some nice teacher passed on to me many years ago.  Kids love playdoh AND they love to COOK so be sure to get them involved with the pouring and the mixing too!

* 1 cup flour
* 1 cup warm water
* 2 teaspoons cream of tartar
* 1 teaspoon oil
* 1/4 cup salt
* food coloring

**You can also add all sorts of yummy scents to add a bit more sensory input!  Maybe try pumpkin pie spice with your orange playdoh or some peppermint oil for the holidays.....YUM! 

Mix all ingredients, adding food coloring last.

Cook over medium heat until smooth. Continue cooking after the mixture thickens, and continue to cook until the dough comes together in the pan to form a ball. Remove from pan and knead until blended smooth. Place in plastic bag or airtight container when completely cool.
Store in a cool place and avoid allowing condensation to form in the storage container.

If there are lots of little people in your world, make up a big batch of this playdoh and divide it up in small containers.....add a couple of cookie cutters tied up with a bright colored ribbon and you've got an instant smile to share!

Jen Dermody, OTR/L

Successful Snipping

Oh my goodness, the school year has picked up speed and we're well on our way through the 2nd quarter already!   New referrals are coming every week and the paperwork is piling up....I've got all sorts of things I want to share on Jen's OT For Kids but can't seem to find even a few minutes in the day to get it done :(  I promise to keep trying so be sure to keep checking back.

I did want to share a quick tidbit about getting kiddos to improve cutting skills without having to keep those darn scissors on the line.  Try playdoh!   Playdoh is awesome for a whole bunch of reasons but you'll see your "non-cutters" getting excited about using scissors when they have an opportunity to cut something other than paper.  Here you'll see one of my preschool friends who needs hand over hand assistance with cutting on a line having a grand ol' time cutting her playdoh into a bunch of pieces all by herself! 

Without any reminders she is using her left "helper hand" to hold the playdoh and snipping with her right hand.  Cutting paper is difficult for this sweet little girl who is often "FINISHED!" before we can really get practicing.  HOWEVER, she stuck with this activity for a much longer span and had lots of practice with the motor skills required to "open/close" the scissors. Along with the cutting, kiddos can roll the playdoh into balls or snakes and use lots of fun tools to dig into the fun.  

I promise to get a playdoh "recipe" on here soon so that you can make your own!  It makes a ton very inexpensively and is even better than what you buy at the store.  Kids LOVE to help make their own playdoh, plus you can pick and choose the colors and even the scents you want to use.  So much FUN!

Jen Dermody, OTR/L

Pumpkin Pounding

You have to love preschool teachers for being so darn creative!   This week the children had an opportunity to do a little pumpkin pounding using golf tees and a small hammer.  There were 2 large pumpkins and a bunch of golf tees in a jar (they even had practice opening a jar) and the children could pound as many golf tees as they wanted into the pumpkin. Kiddos can even create patterns or designs if they want!

Of course no builder is complete without his

 SAFETY GLASSES!  

I love this activity for encouraging bilateral hand use and fine motor coordination.  There is even some hand strengthening involved and visual motor skills to get the hammer to hit the tee.   The best part is that kids are super motivated to do any activity that involves a big pumpkin!



Happy Fall!

Jen Dermody, OTR/L

Free HWT Webinar on November 8th

Handwriting Without Tears is offering another FREE webinar---this one is Design to Teach: A+ Worksheets and will teach you how to utilize their free online worksheet program.  You'll learn how to design worksheets that reinforce skills and support student learning.  I use this all the time with students and it's so helpful!  If you'd like to register, go to http://www.hwtears.com/sites/default/lpform/webinaraplus11form.php?pc=emailconnections1111&utm_source=bronto&utm_medium=email&utm_term=Reserve+your+space+now&utm_content=HWT+Connections+-+November+2011+-+CTA&utm_campaign=11%2F02%2F2011
and sign up for this November 8th program before it's filled up!

Jen Dermody, OTR/L

Happy Fall!

Fall is such a wonderful time for children to see, smell, and touch the wonders of nature!  Miss Paula is one of my preschool teacher friends who took her class on a nature walk to find some special "treasures".  Each of the children carries a bag and collects leaves, twigs, and acorns.  When they return to class, the children have a large piece of paper where they lay all of their treasures.  An adult uses clear contact paper to cover the items so that they kiddos can proudly display their Autumn collage. 

Children learn from ALL sensory experiences!  This simple activity awakens the senses and teaches kiddos about the beauty of Autumn.  Looking at a pile of leaves from a distance is different than picking them up and seeing how leaves come in all shapes, sizes and colors.  So simple and yet so FUN!   Happy Fall!

Jen Dermody, OTR/L 

Lovin' Letters

You've heard me say that it's just so important for kids to practice letters in lots of ways BESIDES using a pencil.  OT's call this a multi-sensory approach and it helps for kids to use ALL of their senses when learning.  The kindergarten students at one of my schools are learning the alphabet and their teachers did a great job using a multi-sensory approach!  Students were given large paper cut outs of all of the capital letters.  They painted the letters and then glued on items that start with that letter.  For example, the letter B has lots of BUTTONS:

Letter C is decorated with COTTON and CANDLES:

And while letter Q can be a challenge, this student used Q-TIPS!

The students used all sorts of creative items to glue on their letter paintings.  The various items will help the children learn and remember the letters which in turn will improve literacy and writing skills!   If you want to practice at home and don't want a whole hallway of big letters, you can modify the activity and use smaller letters to find just 1-2 items for each letter. Maybe put a funny hat on the child.....we'll call it the "Thinking Cap"......and search the house for items that match the letter.  Lots of fun!

Jen Dermody, OTR/L

Another FREE Webinar!

FYI, Handwriting Without Tears is offering another FREE webinar on October 25th!  This one will help OT's and teachers learn how to build a session as a handwriting tutor.  You can register at Handwriting Tutoring: How to Build a Session on the HWT website.  I just love FREE!

Jen Dermody, OTR/L

Pinch, Pinch a Rainbow

I was looking at paint samples over the weekend and all of those pretty colors got my wheels turning!  I stopped by the dollar store and picked up a $1 pizza pan and some clothespins.  A hot glue gun and 15 minutes later, I had a colorful rainbow wheel to use with my preschool students!

Besides the fact that I love COLOR, my primary purpose was actually to get my kiddos practicing their 3-finger grasp with clothespins.  Pinching the clothespin strengthens fingers and helps to develop a 3-finger grasp that's important for writing skills. 

This was such a simple game to make and the children loved it! They worked together to match the colors and clip all of the clothespins.  There could be lots of other variations on this game too---besides colors, you could match letters, numbers or sight words.  Whatever the theme, just keep pinchin'!!

Jen Dermody, OTR/L 

I've Got My Eye On You!

Leavespacesbetweenyourwords!  That's a little bit hard to read, right?  Lots of kids have illegible handwriting because they leave little to no space between their words when writing.  It's reeeeally hard to read because everything looks like one giant word.  These little guys often end up having to re-write their work because the teacher can't read what's on the paper and it can be frustrating for the kids AND the teachers and parents.  With CONSISTENCY, this can be pretty easily fixed!

The simplest and most convenient solution is to have the child "finger space" by placing his pointer finger after each word like this:

Pointer fingers are always available!  Give reminders to "finger space" before and during writing.  If that is not enough of a visual reminder, you can always use a "space stick".  This could be a popsicle stick or a tongue depressor.  The kids always like these and are motivated to use them. 

To keep it fun, DECORATE the space stick!  You can decorate or have the kids decorate with stickers, markers, or glitter glue.  One of my favorites is "the EYE".....a big googly eye glued to the top and I tell the kids they need to remember to space because "I've got my eye on you!". 

I've yet to meet a kid who doesn't giggle at googly eyes :)  Others are just as happy with a simple smiley face for their "space man".

Learning to space between words might not sound like fun but you'll be surprised when ALL of the kids want a space stick!  Why not make them available for everyone?  They're super cheap and will help the ones who need to use it to REMEMBER to use it.   

Until the habit is formed (this can take anywhere from a few days to a few weeks), you'll need to offer some verbal and/or visual reminders every time the child starts a writing assignment until they remember on their own.  The kids often surprise themselves when they see how word spacing makes their writing look so much nicer and easy to read!  For some, that's motivation enough PLUS no more re-writing because the teacher can't read the work.  The spaces might seem too wide but this is OK!   It helps to over exaggerate the spacing when the child is learning so that they can really see the spaces.  With practice, they will naturally adjust to typical word spacing. 

Happy Writing!

Jen Dermody, OTR/L

Blow Out Your Candles

Kids loooove to blow out candles!  Here's a sensory strategy that will get your child practicing for that next birthday party while helping to calm their bodies to be in a "ready state" for learning.  Most people know that deep breathing is an effective tool for calming however it can be tough to teach that to little ones.  If you need to help a child (or a whole class of children!) calm their bodies when they are upset or just a little too excited, ask them to hold up their "candles" (all 5 fingers); take a big breath (you can model this) and "blow out your candles".  You can model how each "candle" goes down as it gets blown out.  Also model a long slow exhale to get all of those candles down.  If there's still a bit too much fidgeting going on, say "Let's do it one more time.....put your candles UP!".  Again, you'll model taking a big breath and slowly blowing each of the candles.  This is such a quick and easy strategy that doesn't cost a penny and it really does work!  Here are  a few pics of my student utilizing the candle technique:

When might you use this strategy?  It works great for group time on the carpet, lining up and getting ready to leave the classroom, or maybe if a little friend needs help to stop crying.  It's a technique you can use on a daily basis, once a day or several times a day.  It also helps when you use a calm voice when modeling the technique for the child.  Give it a try!

Jen Dermody, OTR/L

Your Name in GLITTER!

I've never met a kiddo who doesn't love GLITTER!  As I've stated in earlier posts, it's really important for kids to practice letters in LOTS of ways and not just with a pencil.  This activity helps children to get more familiar with letters and also works on hand and finger strength. 

An adult prints the child's name on a piece of cardstock and then have the kids "trace" the letters using glitter glue.  It takes some muscle in those little fingers to be able to squeeze out the glue and manage the coordination to keep the glitter on the lines.  When the tracing is complete, sit it aside until the next day so that it's good and dry.  Once dry, the letters are raised up and the child can trace the letters with his finger.  I found this great bucket of 50 glitter glue tubes at a local craft store.....look at all of the colors!  With my Sunday paper coupon, it was only about $5.00 for this bucket of fun! 

This activity could be done with other letters too or with shapes.  If the child isn't able to do the glitter glue himself, an adult can glue and the child can practice the tracing once it's dry.  OR if your goal is simply improving hand strength and muscle development, then don't worry about learning letters and just put out a fun bucket of glitter glue in lots of colors and let the child create a beautiful picture!

Jen Dermody, OTR/L

Free Webinar

Periodically throughout the year, the Handwriting Without Tears website offers FREE webinars to anyone who's interested!   There is one coming up on September 27th called "Top Ten Questions About Handwriting" and all you have to do is follow the link at http://www.hwtears.com/hwt/training/webinars to register.  It starts at 8pm ET and the webinars usually last about an hour.  I'm always a fan of anything FREE so I wanted to pass it along!

Jen Dermody, OTR/L

Buddy Art

I love this activity!  This is a picture from an early childhood classroom, however, I've done this with K, 1st, and 2nd graders too and they always love it too!

Start with a box and 2-3 small rubber balls.  Each student works with a buddy and there's quite a bit of team work involved.  In this case, they were given a choice of 6 colors and were asked to pick 2 (that alone was a challenge for some!).  Then they decided if they wanted 1 ball or 3.  There is some motor planning involved as they coordinate how to roll the balls around the box "just right" so that they don't go flying out.  These little guys had a plan that they wanted their paint to go "up and down" in lines and they did a pretty nice job with that!  Other kiddos tried for circle swirls or just a plain ol' pretty design. 

From an OT perspective, I love that this task incorporates bilateral hand skills.  It's a great team task and fun to do at the beginning of the year to encourage students to work together.  Give it a try!

Jen Dermody, OTR/L

A Little Attention Please

I've been very lucky to work in some really amazing early childhood classrooms over the past 9 years!  The little cuties returned to class this week and everybody is learning the new routines for the day.  Our class is an integrated classroom that consists of 6 typically developing children and 6 children with special needs that can range from speech delays to developmental delays to cognitive impairment to autism....and everything in between.  I've learned A TON from working in these classrooms with outstanding team members.

We work hard to help our kiddos increase their attention span so that they can maximize their learning.  Sometimes our goal is to help a child attend for even 1-2 minutes with a specific task such as cutting with scissors or coloring.  One or two minutes might not sound like a whole lot of learning time but it can be a real challenge for some kiddos. 

My own baby girl started high school last week and she attended an assembly this week where the speaker talked to the freshman class about how to be "successful learners".  One of the ideas she brought home to share is a tidbit that is good for all of us to remember when working with children.  She was taught that a person's optimal attention span is equal to their age + 2.   That would mean that a 3 year old has an optimal attention span of 5 minutes.  Obviously this is a general equation and some folks will have longer attention spans and others will have less.  The key word here is "optimal" and I think that's pretty important when it comes to educational tasks.  If you take time to work on a targeted skill such as learning letters or writing activities,  consider that you can expect the best learning to occur within that "optimal range".  In other words, planning  three 5 minute tasks will likely be more successful than one 15 minute task when working with a young child.

I don't know about you but I think this equation idea takes a turn at some point!  My attention span seems to diminish with every birthday :-)

Jen Dermody, OTR/L

Now on Facebook!

Jen's OT For Kids is now on Facebook!  You can find blog updates to read and share at Jen's OT For Kids Facebook or click the link on this page.  Feel free to post a question or comment you might have about OT =)
Thanks for following along!

Jen Dermody, OTR/L

Join the Club

If you're visiting Jen's OT For Kids, then you must have an interest in child development, right?  I was introduced to a new website this week that I love and wanted to share with you!  It's called Child Development Club and it has loads of information.  This site was started by another OT, Laura Efinger, who splits her time between practicing in the US and Egypt!  She initially started a Facebook page related to her experiences in Egypt and as it grew, she saw that there was a need for a full blown website to encompass forum discussions, exchange of resources, networking, blogging, and sharing great ideas.  I am excited to say that Laura has asked me to be an active contributor on her website and I'm looking forward to it!  You'll want to take a look....I know you'll learn something new! 

PS---The web address for Child Development Club is http://www.childdevelopmentclub.org/

Jen Dermody, OTR/L

Fuzzy Ball Fix

I have a 2nd grade student who has looooong challenged me for trying to correct his pencil grasp.  He holds the pencil with all of his fingers on the pencil and it is a super INefficient grasp!  Looks like this:

When I give him assist to correct it, he INSISTS that it "hurts", trying to describe that it feels funny for him to hold it any other way.  If I can catch him in a cooperative mood, he does well with my "fuzzy ball" game.  I give him a small fuzzy ball that he places in his palm and holds in place with his 4th and 5th finger.  He "wins" if the fuzzy ball is still in his palm when he finishes his writing. 

Keep in mind that the pencil  is a little too upright in the picture ---this was when he first picked up the pencil---I had another picture a moment later with the pencil positioned down a bit more but unfortunately the picture didn't save!  This little guy's teacher is on board with trying to help him correct his grasp consistently.  I gave her a couple of fuzzy balls to use with this student and any others she thinks could use it (also helps this student to not feel singled out).  I'm going to set up a chart where he'll earn a sticker for each targeted time he uses the fuzzy ball for writing and have him earn a little prize of some sort. 

Besides a fuzzy ball, you could use just about anything little to place in the palm of the hand---a bead, a little ball of paper, or a cute little eraser like these:

Consistency is key!  Teachers and parents who encourage their students to practice everyday will surely see improvement!

Jen Dermody, OTR/L

Get a GRIP! [part 2]

"What can I do to FIX that?!"   That's the question I get a lot at this time of year as kids head back to school and teachers meet their new students who hold a pencil with all sorts of "funky" grasps.  As you read in my earlier post "Get a Grip! part 1", the goal is to have students hold a pencil or crayon with an efficient grasp that minimizes hand fatigue.  Most commonly, this will be a 3-finger grasp with adequate wrist extension (roughly 30 degrees extension at the wrist instead of having the wrist flexed forward and curled down).  If you took a look at pencil grasps this week, you probably know that LOTS of kids do indeed have "funky" grasps.  So how CAN you fix this?  I've got a SUPER EASY solution for you! Start by breaking all of those new crayons you just bought for back to school.  I know this can put some people over the edge....who doesn't LOVE a brand new box of crayons?!   While brand new crayons ARE a joy of back to school, using small pieces of crayons will be a quick fix for kiddos who have less than efficient grasps. 

You'll see that some of the pieces are pretty small but small is fantastic for correcting grasps!  Give it a try~~when you use a small piece of crayon, it FORCES you to use an efficient 3-finger grasp. 

 

The same idea can be accomplished with very small pieces of chalk on the chalkboard or with sidewalk chalk.  I used to joke that my kids would be so surprised when they got to school and saw that new crayons are so "big"!  

I found these cute little stacking crayons in the dollar bin at Target.  It's a stack of bunny heads and you can stack them or take them apart and color with each individually.  They are small but the kids love coloring with the bunnies. You can find similar stacking pencils for kids to use for writing too.  The dollar store is usually  a great place to look!

I hope you'll give this a try : )  Using small crayons and pencils helps ALL children with fine motor development but especially those with poor grasp patterns.  I recommend this to early childhood teachers who are "on the front line" for a child's fine motor development.  Poor patterns form early so providing kids with techniques and tools early will lead to a happy writer down the road!

Jen Dermody, OTR/L 

Get a GRIP! [part 1]

It's already a busy start to the school year!  Students are trying to get back into a good school day routine with some help from parents and teachers.  As you review skills from the previous year, please pay attention to your students' pencil grasp and help them correct it if needed.  Learning to use an efficient 3-finger grasp will help to decrease hand fatigue and improve overall legibility of written work.  A 3-finger, or "tripod" grasp looks like this:

Examples of inefficient grasps would include a fisted grasp.... 

or a thumb wrap grasp.

These 2 examples are inefficient because they will quickly lead to hand fatigue and also decrease control needed for letter formation, coordination, and legibility.  HABITS FORM QUICKLY!!  Believe me, there are LOTS of kids who already have strong grasp pattern habits formed before they ever enter kindergarten. Breaking those habits is really, really difficult and sometimes seems impossible.   It's important to train children to use an effective grasp when they are old enough to hold a pencil so that they can be successful writers as they get older.

 For the next couple of days, I'm asking you to take note of your kiddos' pencil grip and notice if it is an efficient 3-finger grip or some other inefficient grip.  Check back for part 2 of "Get a Grip!" so that you can learn some simple methods to teach a proper grip and/or remediate to correct a grip that needs some improvement.  I think you'll find that there are some simple ways to help your kids!

Jen Dermody, OTR/L

 

You're RIGHT! Or is it LEFT?

Does your child struggle with left and right?  Are they getting ready to go to school but still need to establish hand dominance for writing and other fine motor tasks?  Take a look at my posting on First Grade Connections to find some helpful tips!

Jen Dermody, OTR/L

Finger Puppets!

I found these fun little finger puppets today and I think my students will love them!  They are 3 cute little bunnies that fit right on your fingertip.  I thought they would be fun for fingerplay songs and impromptu puppet shows that encourage creativity.  There might be a favorite book about bunnies where these will come in handy too.  Finger puppets help to develop finger coordination that is important for writing and cutting.  There is some bilateral hand use required too as the child works to get each puppet on a finger.  Anything that gets those little fingers working is a GOOD THING!

Jen Dermody, OTR/L