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. 


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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!

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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

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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

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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

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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.

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

Many occupational therapists support individuals and families on a daily basis whose lives have been changed forever as the result of a challenging disability or diagnosis. The hard work of engaging in rehabilitation therapy is often a big part of the individual's recovery. But you know what is sometimes an even bigger -- and sometimes more powerful -- component of recovery?

Hope.

The following is a story about how HOPE has been driving the progress and recovery of one little girl and her family. I want to extend a warm THANK YOU to the little girl's mother, who has so graciously granted me permission to share her story of hope and inspiration here, with all of you...

If you had met four-and-a-half-year-old Rachel in May 2011, she would have stolen your heart with a dance move, her laugh, her inquisitive nature and her big, beautiful blue eyes. Should could swing a baseball bat and throw whiffle balls with her mom, who had bought mother/daughter baseball gloves for the summer ahead. Rachel was potty trained and wearing big girl underwear. She could serve up her own juice box while her mama drove around town running errands. Not yet in Kindergarten, she could write the alphabet, write words, and draw pictures.

In June 2011 this healthy, active little girl somehow contracted E. Coli and, within a month, experienced strokes on both sides of her brain. To this day, Rachel's family still does not know exactly where or how she contracted the food-borne illness. Rachel's mother, Melissa, shared with me that, when an EKG test was run at the Children's Hospital to measure Rachel's brain activity shortly after the strokes, "Her brain waves were as flat as notebook paper. She came very close to dying."

As a result of the strokes, Rachel lost her ability to walk, talk, and engage in all the "normal" fine and gross motor activities that active children her age enjoy. She was unable to sit up independently and she was left with very high muscle tone (spasticity) in both arms, with her hands closed in tight fists. Despite the dramatic physical changes that occurred following the strokes, Rachel's wide smile remained.

After approximately one month at the Children's Hospital, Rachel and her family were discharged and transferred to a rehabilitation hospital.

Rachel's mother, Melissa, led the charge as rehabilitation therapy became a part of their family's "new normal." According to her mother, Rachel participated in rehab "boot camp," participating in physical therapy, speech therapy, and occupational therapy twice a day.

In late 2012 -- a little over a year after the strokes occurred -- Rachel's mother contacted me to ask if she could share her story. This was the first time I learned about Rachel. Her mother wrote a guest post on my blog in early 2013 about the powerful role occupational therapists were playing in her daughter's recovery. She titled her post, "An Appreciation of Occupational Therapists."

Melissa shared that soon after the strokes occurred, Rachel spent four months living inside that rehabilitation hospital and participating in the intensive therapies to support her recovery. Her daughter's occupational therapists worked hard to help Rachel make progress toward reaching her goals. In the early days of rehabilitation (the weeks and months immediately following the strokes), Rachel's OT goals involved basic actions such as being able to push a button and being able to open and close her hands (while engaging in sensory activities like playing with shaving cream).

From the start, all of the therapists who worked with Rachel noted that, even though she had good days and bad days in her rehabilitation, she was a hard worker. That's an important piece of the puzzle in the road to recovery.

Melissa commented that, though recovery from a traumatic brain injury is hard work for the patient (i.e., her daughter), it's not exactly easy for the family either. She remembers the joy she felt when watching her daughter attain a goal, but also won't soon forget the fear that welled up inside if she didn't see progress. Though the therapists were committed to helping her daughter and smiled with encouragement as they worked with her, at the end of the day, Melissa just wanted her healthy kid back.

The occupational therapists who were working with Rachel listened to her grief-stricken mother and reminded her that she couldn't measure success in days at this point in the rehabilitation process; she needed to expand her perspective to weeks and months. This was tough for Melissa at the time. It meant she needed to be patient with the process. But she didn't want to accept that. Her patience was shaky after nearly losing her daughter.

Rachel's occupational therapists encouraged Melissa to document her daughter's recovery and monitor her overall progress by taking pictures. Melissa shared this was challenging for her at first because her daughter's face was so "vacant" after the strokes; the last thing she wanted to do was take pictures. But she did it. And, over the course of several months, Melissa began to capture the "light" returning in her daughter's eyes.

With those pictures, Melissa was able to measure her daughter's physical progress, "trading shade for sunlit possibilities for my girl's future."

She began to experience HOPE.

After spending four months inside the rehabilitation center, Rachel and her family were discharged to an outpatient rehabilitation clinic, where a new team of therapists facilitated her continued, albeit slow, recovery process.

Melissa described herself as a "hopeful parent." When the new OT asked Melissa what her hope was for therapy, she told her she expected a full recovery. "As parents of kids who require therapy," Melissa shared with me, "we must be clear in our expectations without being overbearing. And I've learned that therapists and parents must be honest about what we see in the present and the future."

What is it, specifically, that Melissa wants for her daughter?

"I want Rachel to play baseball again with me," her mother shared. "I can't help but dream about the warmth of summer, picnics with Rachel, and a game of catch with a whiffle ball. Better yet, I can't wait to go on walks, holding her hand as we stroll."

"My dreams may not come true as soon as I want them to," Melissa continued, "but therapists like (the OTs who worked with Rachel) have taught me the virtues of patience and new measurements of progress. If Rachel continues on this path with our help as parents and therapists, I believe a full recovery is possible."

Hope. It's what has been driving Rachel's recovery.

So much so that, early on in Rachel's rehabilitation, Melissa began writing a newsletter to update friends and family of her daughter's progress. She titled her newsletter "The Bus of Hope," conveying just how influential a role hope has played in driving Rachel's recovery. The Bus of Hope isn't just a newsletter, though. It's a living, breathing organism. It consists of all who participate in and support Rachel's recovery, whether through directly working with and caring for her, or through supporting her and her family from afar.

I have been following Rachel's journey as a passenger on the Bus of Hope ever since Melissa first contacted me about sharing her story, nearly two and a half years ago.

So you want to hear how Rachel is doing these days? The good news?

Rachel is now back in school, in second grade. Though spasticity hinders her right arm from fully functioning at this point, her left hand has seemingly fully recovered! She can feed herself with a fork or spoon with her left hand, and she can also finger-feed herself. She can hold her juice box with her left hand to sip her juice, and she is re-learning how to drink from an open cup. She surprises the grown-ups in her life with the occasional ability to use her right arm/hand to grasp or reach for an object, and she grins proudly after doing so. She is continuing to learn how to more independently propel herself in her wheelchair using one arm, and she is making slow progress in her ability to re-learn how to stand and walk. She has re-learned how to ride a tricycle at school and can even hold on with both hands, fueled by the cheers of her therapy team and a lot of determination from the little girl who continues to surprise everyone around her. She can speak words and short phrases. She can demonstrate that she comprehends what is going on in the world around her, from sharing that a school classmate is sick, to commenting on the traffic while stuck on the freeway. And best of all, she can tell her mama, "Love you."

Progress is happening.

Hope is still alive.

And it's that little bit of hope that can make a BIG difference in this long road to recovery.

Melissa remains hopeful that, someday, she and Rachel will get to use those mother/daughter baseball gloves they bought in May of 2011, playing catch under the budding trees of spring.

Rachel has come so far. Though she is not yet completely healed from the effects of her strokes, her mother knows that, "OT has played a strong, powerful role in Rachel's impressive recovery."

This summer, Rachel's mother is embarking on her own journey. She has nearly four years of updates saved, summaries of Rachel's progress that she has shared with those who ride the Bus of Hope. Now she wants to write a book about their story. Melissa shared with me, "I want to get the scenes of our lives down in a book for the world to see how one little girl fights back."

When Melissa is not commuting back and forth between her daughter's various school, therapy, and medical appointments, she works as a college English professor. She has also written for publications such as the Star Tribune, Pioneer Press, Minnesota English Journal, and Hearing Magazine. You should read her email updates. They are eloquent and inspiring, to say the least.

Melissa has started a GoFundMe account in an attempt to help keep the bills paid over the summer while she writes the book. She is relying on the support of friends, family, and strangers to help her share her daughter's story of hope with the world.

To learn more about Melissa's book-writing project (and to donate to her project if you're interested), CLICK HERE. Feel free to spread the word.

And if you're interested in continuing to follow Rachel's story of recovery, email Rachel's mother, Melissa, at mcastino@hotmail.com and ask to be placed on the Bus of Hope. You will receive updates that typically range from weekly to monthly (depending on how hectic and eventful life becomes for them). It's a story of recovery I'm proud to follow and support.



Christie Kiley, MA, OTR/L is a mama and a licensed pediatric occupational therapist with experience working in early intervention, clinic-based, and school-based settings. Christie is author of the blog Mama OT, where she shares information, insights, and kid-friendly activities from an occupational therapy perspective. Her goal with her blog is encourage, educate, and empower those who care for children. Stop by Christie’s blog, say hello, and check out all her fun, helpful resources at http://MamaOT.com!

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

Photo Credit: thanunkorm @Freedigitalphotos.net

Thanks to Cara Koscinski, MOT, OTR/L (The Pocket Occupational Therapist) for this informative "OT Month" guest post!

Is it Sensory or is it Behavior?

A child screams, yells, and hits other classmates at school.

Your daughter refuses to get her hair washed.

People stare at you because your son has thrown himself on the ground and has a tantrum-right in the middle of the mall!

The scenarios above occur daily in some of our lives. Our children have difficulty processing sensory input, making transitions, expressing their feelings, and controlling behavior. People often stare and offer suggestions about discipline, which we know won’t work for our kids. This situation is not only frustrating for the child, but leads many parents to believe that they are failing. So, the question remains….how much is behavior and how much is a sensory processing difficulty? Occupational therapists can help parents to determine the answers and provide strategies to help your child. Behavioral therapists may imply that the child is looking for attention. Each discipline has their theory as to what underlying issues are. Often, parents argue among themselves whether the child is ‘acting out’ or having a response to sensory stimuli. The entire situation becomes frustrating and overwhelming for everyone. As a result, cooperation from the entire team is a must!

Sensory processing and integration is our ability to take in information and make sense of it. Our brain compares the information with our previous experiences in order to determine what is dangerous to us and what/how we should respond. Children who have mature sensory processing systems are able to effectively take in and process the information and form an appropriate response. For example, a child is at school and the fire alarm sounds. He quickly raises from his desk, gets into line, and exits the building. However, a child who has sensory processing difficulty hears the fire alarm and screams in absolute panic, next he runs for the hallway in attempt to escape. He is unable to organize himself to finish his day and is sent to the counselor’s office. He is labeled a ‘difficult child’ because he often exhibits aggressive behavior in response to something that others consider harmless.

Determining sensory verses behavior requires some detective work. In my book, The Pocket Occupational Therapist for Families of Children with Special Needs, I encourage families to take a step back and analyze a child’s behavior by asking some key questions. What is the environment in which the behavior occurs? What happened before the child began the behavior? What was the child’s response? How did the adult respond to the child’s behavior? How did the child recover from the episode? If the behavior was prompted by a sensory experience then talk with your child to determine how he/she felt during the experience.

The old saying is true, “An ounce of prevention is worth a pound of cure.” Talk with the teacher to make a plan for the next fire drill (of course, there may be unplanned alarms). Involve your child in the process. Create a social story book and review it on a regular basis. Use actual pictures whenever possible. So, take a picture of the actual fire alarm at school. Consider purchase of noise-cancelling headphones or earplugs that your child has quick access to.

Working as a team to help a child is always best. Keep a journal of your child’s outbursts and tantrums. You might see a pattern. As a parent, make sure to get support from a friend or loved one. Always remember that you’re not alone and millions of others (parents and professionals) are trying to determine the question: Is it sensory or is it behavior.

Cara Koscinski is a long-time pediatric occupational therapist, speaker, and author of the Pocket Occupational Therapist book series. She is the mother to two sons with autism. Her books include, The Pocket Occupational Therapist for Caregivers of Children with Special Needs and the Special Needs SCHOOL Survival Guide for Autism, ADHD, learning disabilities, and More! For more information, visit her website at www.PocketOT.com.

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

Thanks to Rachel for this encouraging "OT Month" guest post. (We pediatric OTs love our swings!!!)

What a Difference a Swing Makes!

Lexi is a cute-as-a-bug 4-year old with two long pony tails with giant bows.  She loves pink and purple and stuffed animals.  She has a history of motor skill delays and apraxia, with no specific cause discovered.  Lexi’s parents have her in dance, swimming and a Little Gym class, in addition to Physical Therapy.

When Lexi first came to see me, she was carried by her mother, and sat on her lap in the waiting room.  She moved hesitantly in new environments and her mother reported Lexi would fatigue quickly with physical activities.  She had considerable anxiety related to meeting new people and being in new situations.  During the evaluation it was determined that Lexi had considerable challenges with postural stability, trunk stability, bilateral coordination, processing movement (vestibular) input and motor planning.  It was also discovered that she loved to swing!

The swing became a staple part of OT sessions.  We started just sitting and swinging back and forth, moving to laying on her tummy, tall kneeling, and even standing, with Lexi moving between different positions to “rescue” her beloved stuffed animals from the floor and put safely in a bucket at the top of the swing.  Many activities and games took place on the swing to strengthen core muscles, develop postural stability, think about new motor plans and improve processing of vestibular input. 

Lexi has become much braver on the swing and loves the feeling of her “hair getting messed up!”.  Her mother is excited that Lexi does not lose her balance as often.  She easily tolerates her swimming class and requests to go to the park afterwards, instead of home for a nap.  Lexi’s mother was also so happy to see the new ways Lexi played in the snow on vacation. 

Rachel Ottley

Rachel was originally trained in Sydney, Australia, in 1994, and currently lives in Oklahoma with her husband and four kids.  She works for CAPES, Child and Adolescent Program Enrichment Services, providing comprehensive and coordinated mental health, physical and educational care recommendations to parents of children and adolescents who present with significant problems in two or more areas relating to their development.  Rachel teaches locally and nationally on sensory contributions to Toe Walking, Sensory Processing challenges and her favorite subject, Play. 

Rachel can be contacted at CAPES 918.747.8282 or rottley[at]me.com

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

Thanks to Abby at OT Cafe for this special guest post!

One of my favorite things about being an occupational therapist is celebrating all of the “little things” that make a big difference in the lives of the children and families we work with. It is truly an honor to help guide families through challenging situations.

Tyler* was a 7 year old boy whose mother brought him into the clinic for an occupational therapy evaluation. Tyler was bright and active and inquisitive. An outsider might have called him “all boy” and told his mother that that’s just the way boys are. As an OT, I immediately noticed his sensory seeking behaviors. Not only did Tyler have difficulty sitting still, but he was touching EVERYTHING and bumping into EVERYTHING and making noise with EVERYTHING. And not only was Tyler constantly on the go, but I could tell that this constant activity was sending him straight to a place of overstimulation. Not a good combination.

Tyler’s mother, as mothers often are during evaluations, was embarrassed by his behavior and trying to get him to calm down. I assured her that what he was doing was just fine; that I wanted to see Tyler in action. I explained to her that the best way for me to help her and her son was by getting a clear picture of their current challenges. I could tell that Tyler’s mother was exasperated and not sure what to do. She wasn’t even sure if bringing him in for an evaluation was the right thing to do. I assured her that it never hurts to get a professional’s opinion and that I was there to help her, not judge her parenting skills.

So what was the little thing that made a big difference for this mother and her son? Education about sensory processing. As a pediatric OT, this is something I do every day, but for the mother it was life changing. I could see it all click for her as I explained why I thought Tyler was doing what he was doing. I tried out some potential sensory diet** activities with Tyler and brainstormed with his mother how they could incorporate these activities at home. By the end of the session, I sent them on their way with a list of activities to try and a piece of Theraband. We scheduled a follow-up visit for the next week.

So why the Theraband? When I asked Tyler’s mother about her main priorities, the first thing she said was, “I would love for Tyler to be able to sit down at the table when we eat dinner. He just can’t sit still.” Tyler and I tried out some seating options in the clinic and he reported that he liked kicking the Theraband while he sat. I told you this kid is bright! With just a little guidance, he was able to identify what his body needed.

I will never forget when Tyler and his mother came back for their follow-up session. They walked into the room and Tyler’s mother said, with tears in her eyes, “Thank you so much! I put the band on Tyler’s chair as soon as we got home and that night we were able to eat dinner all together at the table for the first time.”

It truly is the little things that make life BIG!

 -For more information on using Theraband on chair legs, check out this post at Therapy Fun Zone. 

 - Looking for an alternative to Theraband on the legs of chair? Check this out!

*name changed

**Always consult with an occupational therapist to determine appropriate sensory diet activities for your child.

Abby Brayton-Chung is a pediatric occupational therapist with eight years of experience helping families and children in a variety of settings, including public and private schools, clinic-based, and home-based early intervention. She shares her passion for OT on her blog at www.abbypediatricot.blogspot.com. You can also find Abby on Twitter (@AbbyPediatricOT), Instagram (@abbypediatricot), and Pinterest.

To read another post in the "little things" series, click HERE!