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,

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