Sunday, May 3, 2015

The Therapeutic Benefits of Flow: Storytelling Cards


I’m excited to tell you about this fun storytelling card game! Use the 48 beautifully illustrated cards that can be used to make up a story with your client. There are also 4 blank cards that you or your client can use to add characters, places, or objects when making up the story.

The set includes instructions for several different ways to play the game, including “creating a story chain” and “story race.”

In addition to working on storytelling, these cards are perfect for addressing additional skills, such as naming colors, objects, and shapes, as well as sequencing. They are also wonderful for language development, including using adjectives and adverbs appropriately.  The illustrations are appropriate for adult or pediatric clients. For more information, or to order a set, click HERE.

Wednesday, April 29, 2015

OCCUPATIONAL THERAPY: It's the Little Things that Make Life BIG!



As an occupational therapist that will have been practicing for 24 years next month, I am privileged to have spent most of those years working in pediatrics.  In fact, when I first heard about the topic of this series of posts, my initial thought was that it would be much easier for me to write about the many ways in which I have benefitted from interacting with the children with whom I have worked.  As my perspective has shifted many times over the years as a result of connections I have made with others in my role as an O.T., one of the most powerful lessons I have learned also happens to involve a situation in which the thinking of others changed because of something that happened during an O.T. intervention.

About midway through my years as a school-based O.T., the kindergarten teacher of a child on my caseload approached me in the hallway one day after school.  She told me that the student, whom I will call “Carol,” had refused to follow directions given by the teacher in class earlier that day.  Evidently, the teacher had been calling on students one-by-by to go up to the front of the classroom and count to 20, as part of her assessment of their progress in math skills.  When Carol’s name was called, the child did not get up from her seat.  Even with prompting and encouragement from the teacher, Carol didn’t comply.  The teacher said she hoped to be able to document that the skill had been mastered by this bright little girl the following day and had emailed Carol’s mother to let her know what had happened.  Later that night, I got an email from Carol’s mom asking me if I had any ideas about what was going on or what could be done to remedy the situation.

As an O.T., I know that there are many dimensions of a person that go into his or her ability to perform a skill or to complete an activity – from vision and hearing, to focus and cognition, to motor skills and more.  Two things I learned early in my career to consider, especially when a child refuses to even try to do something, are motivation and emotion, and, with that in mind, I sent an email back to Carol’s mother asking her to bring Carol to school a little early the next day.

The following morning, after talking to the teacher to let her know my plan, I took Carol into the classroom and told her that I was going to do some “morning stretches” that she could do with me if she wanted.  After she had imitated my movements for a few minutes, I asked her what had happened the day before when she had been asked to count for the class.  “I felt way too hot,” she told me. “I wanted to do it, but I was just so hot.”

Realizing that motivation wasn’t a factor in her decision not to comply but that emotion likely was, I decided to shift gears.  I picked up a couple of beanbags from a bin in the corner and told Carol that I wanted to see if she and I could catch and throw together.  I said “Now!” as I released one beanbag to toss it to her, and she threw the second beanbag to me at the same time.  It took us a few minutes to get the rhythm just right, but after that we were able to keep things going without dropping either beanbag for several minutes at a time.  Once I could tell she was really focused, I said, “Let’s count each time we catch one and see how high we can get!” Without any help from me, Carol started counting and made it up to 24 before a beanbag fell to the ground.

“You’re really good at counting,” I told her, and she grinned from ear to ear.  “Do you feel hot now?” I asked.  “No!” she exclaimed. “That was fun!  Let’s do it again!”

“OK,” I said, “but this time, stand at the front of the classroom while we do it so you can practice counting there.”  After she had moved into position, we got started again, and she counted to 27 that time.  “Let’s try something a little silly,” I said. “Let’s do the same thing again, but this time let’s just pretend that we’re throwing the beanbags to each other.”  She willingly agreed, and that time we made it to 31, at which point I saw the teaching coming through the door. When I pantomimed dropping a beanbag, Carol looked up and saw her teacher and said, “Guess what!  I’m not too hot to count anymore!” 

Later that day, the teacher reported that Carol had counted to 20 in front of the class without hesitation, and then she leaned a little closer to me and said, “I didn’t think about why she wasn’t getting up to count yesterday.  It seems like she was just unsure of herself and so she was afraid or nervous.  Next time I run into a situation like that, I will think about the emotions that go into that kind of thing.”  In the weeks that followed, the teacher told that story to Carol’s parents, to the principal, and to the other teachers at the school; each time I happened to hear her talking about what had happened, I heard her end the tale with, “Who’d have ever thought that courage could be found through pretending to catch beanbags?”

Stephanie is an alumnus of Washington University in St. Louis, where she graduated with a degree in Occupational Therapy in 1991. As a school-based OT for almost two decades, Stephanie specializes in pediatrics and holds a certification as an Assistive Technology Professional (ATP) through the Rehab Engineering & Assistive Technology Society of North America (RESNA). Her professional interests include providing intervention services for individuals with disabilities and working with their families and other professionals in the field to promote evidence-based practice and to decrease barriers for people through design, selection, and implementation of A.T. materials and strategies. Please visit her website @ https://stephanielancasterot.wordpress.com.

Tuesday, April 28, 2015

OCCUPATIONAL THERAPY: It's the Little Things that Make Life BIG!


I first met Sarah when I was a brand new OT.  Despite having grown up with a sister who had significant physical disabilities, I will admit that I was overwhelmed when I met her for the first time.  Severely impacted by a very rare and progressive neurological condition, Sarah was completely dependent for all movement and positioning, was nonverbal, and had already long outlived the very short life expectancy her doctors had set for her when she was diagnosed.
I am a school-based OT, and there was a stark contrast between the hustle and bustle of my usual primary school setting and Sarah’s home when I arrived there for our weekly sessions.  It was so quiet and at first, I felt awkward trying to chat with Sarah while I stretched her, positioned her, transferred her, and applied all of her orthotics.
Gradually though, I began feeling a warmth and closeness with Sarah – her strength and spirit shining through despite her limitations and silence.  Her mom and I also began a very comfortable friendship.  She shares stories about Sarah as a baby and toddler before she was diagnosed and I get a little glimpse into who she was, who she really is underneath all of the plastic splints and braces.  The funny, sassy things she used to say before she lost her ability to speak.  The quirky ways she used to scoot herself around as a baby and toddler before she lost her ability to move.
There are times when we as a therapy team worry about how we’re going to document progress in this case, how we are going to show that we’re a necessary part of Sarah’s school programming.  But it’s pretty clear to all of us that school for Sarah means something quite different from what it means at our hustling, bustling primary school.  Yes, we provide services related to preserving range of motion in Sarah’s body, we ensure that she has appropriate devices for seating and positioning, and we evaluate the fit and function of her orthotics.
But more importantly than progress and goals, for Sarah, therapy really means consistency, stimulation, touch, familiar sounds and voices, and support and routine for Sarah’s mom and dad. It is the truest case of “therapeutic use of self”.
For me, being Sarah’s therapist is about showing up. Not just physically showing up and going through the motions, but showing up in a very real and emotional way.  It’s about receiving the lesson Sarah teaches me every week – that life can be painfully fragile and unfair but that the human body, the strength of the human spirit, and the love of a family can go far beyond labels, diagnoses, and expectations.
Claire Heffron holds a Master of Science in Occupational Therapy from The University of North Carolina and has been practicing in public and specialized school-based settings for 10 years.  She and Lauren Drobnjak, PT, are the co-creators of The Inspired Treehouse, where they share useful information about common developmental issues along with hundreds of activities for kids designed to promote healthy gross motor, fine motor, and sensory development.  Follow The Inspired Treehouse on Facebook, Pinterest, Twitter, and Instagram!

Sunday, April 26, 2015

OCCUPATIONAL THERAPY: It's the Little Things that Make Life BIG!


It’s the little things that make life big:  “See those pictures, mommy?”

I am honored to be a guest blogger on Dr. Anne Zachry’s “Pediatric Occupational Therapy Tips” as part of her special series to honor OT month!  Thank you, Anne.   I hope you and your readers will enjoy one of my favorite moments of my career.

Have you ever worked with a child and his mom who have both been around the therapy and medical scene for some time?  You can picture them now, can’t you?  They are both accustomed to a life that is basically a medical/therapy routine but have found creative ways to fit something besides appointments into their daily schedule!  Sometimes they have to travel an hour or so to their appointments, with most of their medical concerns being addressed in a larger hospital outside of their home town.  And almost from the day of his birth, the child has been put through rounds and rounds of tests, hospital stays, and treatments.  Let me introduce you to my “mom-and-son team” and the way that a “little bit of OT” made a “big” difference in their lives.

For confidentiality’s sake, let’s call my little man, Jack, and say that he is 6 years old.  Jack had been coming to this particular clinic for quite some time for occupational therapy to address his overactive sensory behaviors.  I was new to the clinic and Jack was one of the first children to be placed on my caseload.  Jack was small for his age; but what he lacked in size he made up for with mega amounts of energy and enthusiasm. Each time Jack was greeted at the clinic, he’d run headlong into you and grab your legs and yell, “Hello, Katherine!”  Yep.  Yell.  He loved people and couldn’t wait to get into the sensory gym to find out who was in there to play with him.  As soon as I’d open the door between the waiting room and the corridor, Jack would be slipping and sliding down the hall toward the gym, running face first into the walls and corners, and flying into the ball pit room by the seat of his pants, yelling, “Hello, guys!”  Everyone loved Jack.  There was no way you could resist his huge smile and extra warm greetings.  All of us did need to stand clear of him, however, whenever he wanted to hug you or run toward you.  Jack found it difficult to judge the pressure of his hugs and the force of his body as he “threw” it against something or someone.    Jack had been working on the underlying causes for these behaviors, as well as his unsafe movements, for some time and had not realized much success.  Let me note that this was not the result of inexperienced therapists or lack of family involvement.  So, when Jack was placed on my caseload, I was hoping that a new pair of “eyes” would uncover a different approach to address Jack’s needs.

One day about a month into our sessions, I had an “ah, ha” moment.  Jack’s activity of choice during therapy was the zip line.  Ours ran from one side of the room to the other, stopping right over the ball pit.  Each day, he’d run over to the ladder, stumble up it, grab the zip line (usually with only one hand), and zip  about half way to the ball pit and let himself drop off.  (Thank goodness for totally padded floors!)  I had worked on several strategies with him to help him maintain his hold on the handle; but I began to feel that the reason why he was “falling off” wasn’t due to a sensory or strength issue.  It was most likely a sensory issue, yes, but it was his visual sense!  Jack would attempt to grab the handle with both hands but only be successful with finding purchase with his right hand every time.  And although we would guide him with tactile, auditory, and visual cues toward the ball pit, he would always fall very short of the mark.  In the corridors, slowing down or holding hands did not prevent Jack from coming in close contact with walls, corners, and people.  All clues led to a visual concern.

My passion as an occupational therapist is the development and remediation of the visual skills.  I have worked closely with developmental optometrists in both the adult and pediatric populations.  That day at the zip line, I thought, “Now why did this take me so long?”  I continued to assess Jack’s visual behaviors during both fine and gross motor work and I found that, for the most part, he did well with fine motor activities.  In fact, they tended to calm his overactive movements.  But his unsafe gross motor behaviors certainly indicated that he might have a vision need in that area.  It was time to talk with mom.

Now, Jack might have been energetic and in constant motion; but his mom, in contrast, was quiet, but very confident.  She carefully weighed Jack’s therapy and medical options and was an active participant in his treatment sessions.  When I discussed my concerns about Jack’s vision needs with my supervisor, I had been guided against offering this mom any more to “put on her plate.”  It was felt that she was overloaded with bad news and should not be burdened with thoughts about possible vision needs.   However, although mom had worked closely with my supervisor before I came into her life,  she respected my work and my suggestions.  So, I made the “big” decision to say a “little” about vision at our next visit. 

At first, mom was reluctant to consider that Jack would benefit from a vision assessment by a developmental optometrist, as Jack was being seen regularly by a doctor at a prestigious children’s hospital for all of his medical needs, including “eyesight.”  I set the idea of a developmental optometrist aside and asked if she would consider having his medical doctor assess his vision skills in more depth, to include peripheral vision, depth perception, and visual perception.  She agreed on the spot.  She felt that if I was that concerned about his needs, she would make an appointment right away and provide the doctor with my written note about my observations.

A few weeks later, she and Jack came back from the doctor’s with great news.  Jack was going to get glasses.  My first thought was, “Yikes!  Glasses and the zip line and the ball pit!”  But, I also felt relieved and hopeful that Jack’s behaviors would be modified if his vision skills were indeed one of the culprits responsible for his unsafe behaviors.  The glasses were dispensed quickly, and the best part of this story was mom’s face and smile when she said to me, “Katherine, after he put on his glasses and we walked down the hall of the hospital – a hall he’s walked down many,many times – he looked up at the wall and said, ‘See those pictures, mommy?’ “  Now, that’s when a “little bit of OT” makes “life big!”

Now, it’s difficult to identify “the chicken or the egg” in this story – if his movement behaviors/sensory needs were indeed the result of a lifelong visual need or if the sensory behaviors developed in tandem with his poor visual skills.  But, considering the impact that vision development has on the learning of both gross and fine motor skills, I felt that it wasn’t important to determine which came first but to provide Jack with improved visual skills so that, in turn, our work on the sensory behaviors would benefit.  Vision leads the body in movement activities.  And now, Jack could actually “see where he was going.”

Happy OT Month!
Katherine J. Collmer, M.Ed., OTR/L, is a pediatric occupational therapist who specializes in the assessment and remediation of children’s handwriting development skills.  You can find her on her website, www.handwritingwithkatherine.com

Saturday, April 25, 2015

OCCUPATIONAL THERAPY: It's the Little Things that Make Life BIG!


 Photo Credit-David Castillo Dominici @ Freedigitalphotos.net
Imagine being the only child in class who can’t write your name.
Imagine being the only child who completes a cutting activity with jagged edges, when everyone else hands in beautifully cut pictures.
Imagine being the only child who has no idea which way to turn when the teacher tells everyone to turn left.
Imagine being the only child who can’t complete the “spot the difference” worksheet that the teacher has handed out.
Imagine being the only child who thinks the school bell is too loud, the class lights are too bright and who wants to be at the back of the line all the time so as not to get bumped.

Those are the children who get referred for occupational therapy. By the time they come to me, they are usually feeling sad or mad inside, because they know they are not meeting the expectations of the adults around them. Their struggles are through no fault of their own, though those around them may think they just need to try harder.

I have seen all those kids in my therapy sessions. Some stayed for a short while, just needing a little bit boost to get on track with their peers. Some stayed longer, having challenges that needed months or years of intervention.

When I assessed them, my aim was to find out WHY they were struggling.

What was the root cause of their challenges?

And armed with that knowledge, I could not only plan effective therapy sessions with the child, but also help the parents and teachers and other important adults to UNDERSTAND what was happening in that child’s life.

For me, the key word is “understand”. It seems like such a little thing, but it makes a huge difference in a child’s life.

When a teacher understands the challenges the child faces, they can be more patient, grade the task to the child’s ability, and make the necessary adaptations in the class to help the child reach his or her potential. No good teacher wants to see a child struggle!

When parents understand why their child behaves differently to others, or why their child struggles to keep up with peers in any area, it can be a huge relief. They are able to help their child without taking the challenges personally, without feeling like a bad parent.  They feel empowered. Empowered to make their home a safe, non-judgemental place for the child to be, empowered to anticipate and meet their child’s needs, and even empowered to answer questions from nosy relatives!

That’s why, for me, occupational therapy is not just about my time with the child. It also includes those little conversations I have with parents and teachers, little tips, explanations, ideas and adaptations to make the child’s life easier and their smile bigger.

Because it’s the little things that make life big!



Tracey le Roux 
Tracey le Roux is a South African pediatric occupational therapist who is currently homeschooling her three kids. She writes to encourage, empower and inspire parents and teachers who may have some struggling kids in their lives. You can read her writings over at www.ot-mom-learning-activities.com


Friday, April 24, 2015

OCCUPATIONAL THERAPY: It's the Little Things that Make Life BIG!


Thanks to Lauren for sharing this special "OT Month" post!
        When I think about my career as an occupational therapist and all the lives I have touched, the experience that always comes to mind first is when I worked in a day treatment program.  The day treatment team consisted of a speech therapist, physical therapist, and an occupational therapist. The therapists worked together to improve the independence of young individuals who had experienced a CVA or TBI.  Our purpose was to help them achieve their goals of returning to work and/or school. My experience as the OT on the this team was meaningful because I worked collaboratively with the speech therapist and physical therapist. We worked with the patients individually and also in a group, planning outings and going into the community to relearn the skills needed to gain independence.  Our outings consisted of grocery shopping, going to Target to buy Angel Tree gifts, and going to restaurants, etc.
Out of all the individuals I had the pleasure of working with on the day treatment team, there is one client who sticks out the most.  He was a man in his twenties who had a brain tumor that had affected his memory and cognition, as well as his ability to drive.  One of his goals was to enroll at the local university to pursue a degree, so we planned an outing to visit the campus and speak with the Students with Disabilities Office.  Because he was not going to be able to drive himself to campus, we rode the MATA bus to the campus.  This was a learning experience for both of us because I had never taken the bus either!  We had to learn how to transfer between buses in order to make it to our destination.  Once we made it to campus, I worked with him on reading the campus map to find the Students with Disabilities Office and helped him begin the enrollment process.  I feel like we both learned something new that day. There is nothing more rewarding than to feel like you are truly making a real difference in the life of anther person.
 

Lauren Woods graduated from The University of Tennessee Health Science Center in 2002 with a BS in Occupational Therapy. She is currently working on a Master's Degree from The University of Memphis, and she works as a therapist for the Shelby County School System. She is also on the Admissions Committee for the MOT Program at UTHSC.

Photo Credit t0zz @ FreeDigial Photos.net

Tuesday, April 21, 2015

OCCUPATIONAL THERAPY: It's the Little Things that Make Life BIG!

Thanks to Heidi at PediaStaff for asking Susan to write this "OT Month" post. Visit pediastaff.com 
to learn about therapy job openings. Their website is full of amazing resources for parents and therapists!

Greetings from the Last Frontier, the 49th state!

Alaska…where salmon is a staple and hearts, mountains, glacial lakes, eagles, bears, and moose are BIG!

The role of occupational therapy in a place of pioneering spirits and independently minded individuals can take varying forms and occurs in a variety of locations, including hospitals, skilled nursing facilities, rehab centers, home health, outpatient clinics, school systems and pediatric practices. Problem solving is heightened to a new level when considering the natural elements such as developing methods to make the trudge from a dry cabin residence with no running water into an outhouse at -40 degrees on a snowy path while using a walker or with reduced vision except for Northern lights swirling above. It may include donning a pair of mittens with one hand in order to observe an Ice Carving Competition or perhaps to assist and place a child in a car set during a blizzard. Plugging in your car while avoiding frostbite and hypothermia with reduced sensation or mobility can be quite a challenge as well!

Adapting a sled for a child with cerebral palsy or helping an injured ice hockey player with arm propulsion and balance to make a strike against the puck would also be vastly appreciated by many! Perhaps the task would include exploring how to most effectively use an electric scooter on the sidewalks of the renowned University of Alaska at Fairbanks so a college student can maintain independence and live in the dorm. A “ simple” task of successfully carrying a bag of groceries while maneuvering safely over an icy parking lot with a cane or wheelchair can surely be reason for celebration! How to sew on a moose hide or attach a beaver ruff on a pair of beaded slippers with arthritis or after carpel tunnel surgery may be culturally relative dependent on who is seeking assistance. Adaptively harnessing a sled team of lively Huskies would also “increase the anty” or stretch the adaptive mind and create an interesting scenario of trial and error. Whatever the daily task, one knows that duct tape is certainly on a list of adaptive devices and OT’s have a role.

Or…..perhaps in the world of pediatric OT it may all begin with therapeutic play, observation and treatment of the whole child by nurturing adults, and inclusion of children in a challenging developmentally sensitive environment such as a preschool with disabilities classroom where I have happily worked the past two school years. Opportunity is a key phrase with a keenly organized educator who has designed a program where modeling and instruction in the areas of language, socialization, sensory and movement activities are the norm! It is in this setting that I have had the absolute privilege to be involved with a precious five-year old boy’s life here in Fairbanks, AK! In the large picture, the “ little things of OT intervention ” do add up!

A rough beginning, including possible substance exposure and being kept in a playpen for years, shifted when this un-named youngster began attending a preschool program for children with disabilities at age 3 ½ years old! With encouragement, support, and ongoing communication this kiddo has evolved from a starting point of being nonverbal with no eye contact and self injurious head banging (with rapid grabbing of a helmet by staff) to a child that is speaking in 5-6 word sentences, sharing toys, following two step directions, and now seeding and zipping his own jacket as I just sat in his classroom and watched as he independently put on his “ winter gear” in April to ride a bus home to his incredible foster family.

Earlier OT sessions consisted of sensory strategies and structured play focused on imitation of positions and actions, reciprocal play of rolling a ball and sharing space without aggression and with eye contact in a shared experience, and concentrated work on functional use of toys or use of hands for interacting with the world. Gone are the days of rice and bean trays, ball bath play, hoola hoops to mark the spot of where to stand and hand over hand assistance for fine motor activities.

This super star is now using his vision and hands in a coordinated manner and is writing his name on his own spontaneously, creating sand and starfish collages and Easter egg pictures with sequenced actions of cutting and gluing, offering dinosaurs to his friends, and is using greetings of “Hi and Bye” throughout the school with a broad smile! Story and circle time takes on new meaning when you can sit attentively and have the self regulation or nervous system readiness to look, sit, attend, and learn while taking turns in “ show and tell.” Lining up of trains has been replaced with dress up activities, puppet play, book reading, coloring and building of elaborate constructional towers with a friend close by while gaining a teachers attention because a peer is crying and empathy is budding! The building blocks for school success are in the making!

With the high expectations of a highly dedicated educator, speech language pathologist, OT, foster parents, paraprofessionals, and direct and collaborative OT services, this little guy has shifted from using his peripheral vision and hands to “fly” and touch air particles on a regular basis to being a jokester in class, demonstrating explorative play, being tuned in, and transitioning well within his classroom and in the school environment! A transition card is no longer needed and this young boy now follows in line for visits to the library, gym, outside recess area, and on treasure hunts in the hall! A silly rubber green octopus head is placed on the end of a yoga “magic wand” and my little friend was gleefully just crowned “ King Yoga” in his weekly OT led yoga class. The various poses of “Down Dog, Cobra, Giraffe, Rainbow, and Butterfly,” are proudly executed as this young boy meets the motor planning, sequencing, two sided coordination, body stability, balance, and listening skill challenge of the hour!

Our unnamed boy, this young bundle of joy, is chosen to be a helper up front and center and waits attentively for directions and then beams as he leads his friends! All of this is accomplished, these “ little things” as fifteen preschoolers from two classes move through their typical day, week after week. OT has been a small part of this student success and my heart is warmed even on a blustery 35 degree April day in the Northland. OT truly does make a difference! Happy OT Month to you!

The author, Susan Mullins, OTR/L, is an occupational therapist with 28 years experience who values life long learning, creative OT practice, and Northern Light gazing. She enjoys long distance hiking, leisurely strolls, reading, international travel, and relaxing with her adopted dog “ Belle.”A sojourner of life she continues to explore Alaska and many new corners of the world. Susan can be reached at smullins4[at]gmail.com for any who are interested in corresponding.