42. Occupational Therapy: Erin Stanford of McRory Pediatrics – Part 1


Hello and welcome to the If We Knew Then Podcast I’m Stephen Saux.

And I’m Lori Saux

And today we’re joined by Erin Stanford and occupational therapists from McRory Pediatrics and this is in our series of supports. We are so thankful for and Erin was such a great source of information we are so fortunate to have two episodes with Aaron so this is the first of two and talking on everything from the wholeness of all the supports and how we work together going over centuries she gave us so much information and we’re so thrilled to be able to share this with everyone so welcome Aaron Stanford good morning Erin the morning it’s nice to be with you guys thank you thank you for joining us today for our McRory series. These are little gems and little gifts that we want to put out there to the community because Erin you work in occupational therapy so a lot of parents are new parents don’t know what occupational therapy is are not sure when to ask for occupational therapy don’t know the difference between occupational therapy and perhaps like physical therapy and so we want to give as much information out there as parents so they can build their foundation and the best way possible that supports their child and family so why don’t we start with you can you tell us a little bit about yourself Erin sure I am a T. M. N. O. T. for over nine years %HESITATION I did have a background for that coming from the behavioral field working with kids primarily with the diagnosis of autism and when I eat B. M. O. T. I went right into my first job out of Korea actually been with Corey for the duration of my career as an I. T. %HESITATION I have two kids my L. they are six and a half and three and a half and %HESITATION I think that has really strengthened me as no T. and me having my O. T. hat strength in me as a mom so I mean that’s me in a very tiny not shop but as far as your your question about what is on TV I kind of love this because a lot of people do it %HESITATION I think we’re definitely becoming more noticed but essentially what we do is help people do the things that are important to them on a daily basis your occupations are what’s meaningful to you on a daily weekly monthly yearly basis so for children which is the primary population that I work with and that we work with and very we are looking at kids as part of a family were looking at them doing their daily activities of self care we’re looking at the students were looking at them as peers and siblings %HESITATION we’re looking at them as kids who may love to play basketball or may lead to do art and we want to be able to win power those kids you may have some differences and may need a little bit more support maybe aren’t hitting milestones as quickly or as on time %HESITATION as other peers their age so we want to have them do the things that are important to that and that’s in a nutshell that applies to geriatrics and it applies to the adult population after you know someone has a stroke or just in the net natural eating process things become more challenging and we want to remedy or we want to work around and find accommodation I’ve never made the correlation before between occupational therapy and your occupation yeah that that’s such a clarifying defining moment of just helping to support you in your daily and your daily lives and you’d mentioned family do you work a lot with families as well absolutely %HESITATION I think because we have kids as our primary clients hello hello they are part of the network they need support all kids need support diagnosis no diagnosis it doesn’t matter we all need support even as adults but really the primary care givers are the people who are going to facilitate on a daily basis when you come to see me in the clinic that’s one time a week maybe two times a week but the real work happens at home and the real work happens with parents facilitating and following through with the Chechens and following through with with strategies that we give them and then we get to fine tune I get to see it within our sessions really it I the emphasis has to be on parent participation and it’s a team we we are a team and the parents are the point person really so because they need to advocate for their children who can’t necessarily identify the challenges that they’re having with the sterile strength you know parent really needs to also be able to have my kids really good at this how to capitalize on that and I think that absolutely you’re big on parent involvement most times we’ve talked to a therapist I’ve always said how important it was to have the therapist when they came to our home or even when I get to watch how important it was for us as parents to use the information for the other hours of the week and days of the week and how much we can learn from therapist and it’s a real tool that probably parents to take take advantage of but I just want to say again that if you’re not sit down and really listen to this therapist and and so then you can learn and use this throughout your day I I couldn’t agree more and beyond just listening to the therapist get involved in your therapy sessions a lot of kids will work better when the parents like if I’m just a distraction you know and I can watch and not works and I absolutely have to each child is different in the way that they respond to a initially make before an individual we get to know each other and they are R. my condition is always built on our core building in play and making it fun when you come to see me but some kids really are more wary and they’re willing to do a lot more for parents or caregivers I should say caregivers because we have a lot of grandparents and aunts and uncles and other individuals who can’t care take but sometimes they are more willing to do things for those caretakers and so I can coach and I say if I’m going over these kids you know if your kid is having a challenge emotionally there’s nothing that’s going to get done before just missing a kid to go through the motions and they’re upset and they’re going there’s not in there trying to get mom or whoever and so I go to you know come over you want to do this I can coach you on where the hand positioning so should be what we’re doing dressing I can coach you on what we want to be looking for where you can facilitate your child during our session I think that that is absolutely it’s critical to kind of figure that out what’s going to work %HESITATION and I can say with out a doubt hands down I see significant differences in progress based on whether caregivers are following through and whether the Carragher thinks that here I’m going to take my kid for the next fifty minutes please fix that I can’t emphasize that you used you absolutely said it and I think it’s so important the Kerr was really own their part of the process and I know it’s a break a lot of our care givers are exhausted and we’re got kids up in the middle of the night sleep challenges and all these different things and they are on twenty four seven it is now it you don’t get a break as a care giver and when you come to therapy you go great I got fifteen minutes I’m gonna sit back on my phone and watching YouTube or Netflix Netflix or whatever it is that is completely understand mental health breaks are important for caregivers but if you can Chris is available as part of the time so that you can get a little bit and be able to take it home your progress will be more noticeable I promise you and I think that’s something that’s very real in our community because as a parent or as a care giver as you said that’s what gets lost first you do have to take care of yourself and in order to take care of somebody else in order to to support and to support the services so I think that’s something really for our listeners to understand definitely taking care of yourself during any kind of therapy that it’s probably gonna be easier to be present at the therapy and be able to implement those you’re going to see the progress more readily and then in the long run I think that will make it a little bit easier and provide those breaks because I’ll have to say that the first like nine years I think it’s just it’s just last year the first nine years are very were very intense for us just now we really advocate for self care but yeah but maybe this is the best place to do it maybe if if you can choose try to choose a different place than during the therapy because you definitely see the benefits as to you know someone being present and being able to support than the patient so becomes a way of life and not just one session or two sessions a week during their schedule exactly because one thing that I feel is that occupational therapy is something that exist all day every day and different activities you know from them from the time we wake up we’re we’re working on that the occupational therapy works with the fine motor right not the gross motor is that correct can you get can you or or is there more there’s more there’s always more it really is %HESITATION within our clinic we have physical therapists so we have the luxury of kind of separating and being able to sit to allocate fine motor really more toward occupational therapy we do look at gross motor in the context of function it’s all about unction for us %HESITATION but we do have physical therapist you can really look at the nitty gritty of the gross motor Inc and so we we play a part we really team up a lot especially because in pediatrics there’s so much overlap in there so much gray area and you look at occupational therapy in child development and you look at occupational therapy and physical therapy and even occupational therapy and speech therapy I mean there we look at oral motor and we’re looking at you know the differences in speech or motor versus eating oral motor and how they work together and communication for accessing things that you know so there’s so much gray area in pediatrics in particular but as far as your question with regard to find their Grossman because when we absolutely look at work what %HESITATION tees will look at is motor planning how to engage with something novel if I Google play structure how my gonna make my body do what I wanted to do to get up that rock wall and so so there are components that are very %HESITATION that %HESITATION tease we’ll look at we’ll look at it and not you know motor planning really comes from a sensory processing kind of foundation from what we look at and body awareness and understanding what your body can do and what the item in front of you can afford to land and what it can allow you to do so there’s a lot of overlap there but we absolutely look at gross motor can you talk a little bit about that again I’m gonna break it down because you had mentioned how you how %HESITATION T. overlaps with speech and with P. T. and the different services so can you first break down how does occupational therapy %HESITATION overlap with speech with the fine motor that you had started to speak on that and I and I just want to kind of give parents some insight yes so so with regard to speech and O. T. it really does fine motor muscles in the mouth you know %HESITATION especial ly for kiddos if you have a diagnosis of down syndrome we’re looking at kids with lower facial tone we’re looking at decreased strength a lot of times and so that muscle refinement you you the muscles in your mouth are considered fine motor muscles fine motor is not exclusive to the hands %HESITATION and so really being able to target activities because again we look and function that are going to strengthen things like lip closure a lot of times we see with %HESITATION you know kids with down syndrome that open mouth posture there’s a lot of drooling when their babies may be excessive to what it what it typically developing baby maybe maybe looking like %HESITATION and not again comes to the strength of the cheeks which have muscle the strength of the of the John and being able to keep that job and a close now posture I’m looking at lid closure all of these things the tongue is a muscle the tongue is a complex muscle and SO in coordination with each with their gonna look at mount you know formation of the oral musculature and I don’t want to speak beyond might complain but I you know having experienced you know so it’s so much I’ve learned so much from the speech pathologist on our team %HESITATION but they’re really looking at those muscular movements to create %HESITATION if articulation and being able to remove them the mountain different ways to create sounds and we’re looking more from oftentimes the feeding perspective and being able to suck on the structure and the child create lift closure in order just to suck effectively %HESITATION and chewing right progression of textures so we work really closely a lot of times are exercises look really similar we’re looking at it from different when and for different purposes but our cheeks or lips are tongue or jaw all these things are needed for for both speech and four feet and so it and and that’s where you see a little bit in the most %HESITATION significant area of overlap between %HESITATION teen speech again we work really closely when it comes to communication and kids being able to make choices do you want to go on the swings or do you want to go on the slide do you want to do some coloring right now or do you want to play with the blocks and for our kids who had to lead expressive language we work this with the speech pathologist to say okay are we using a choice for are we using signs %HESITATION and just to make sure that we’re incorporating the things that they’re using within speech whether it is %HESITATION just various indication styles and and supports we want to make sure that we’re incorporating those things within our sessions also and do you have any resources %HESITATION exercises that you could recommend to parents and regards to speech with regard to speech I would defer you to a speech pathologist %HESITATION I think it’s important that we get information from the rogue resources as much as I again learned a ton but I would say if you don’t have a speech pathologist right now nine one if you have concerns about your child’s speech %HESITATION exercises that I would recommend that probably would help with speech things like drinking you know you’ve got your little apple sauce containers and instead of opening the lid and using a spoon stick a straw in it and stop that extra thick liquid milk shakes are great for those kinds of things and it’s fun for a kid %HESITATION it changes things up it doesn’t always have to be you know let’s do these exercises ten times %HESITATION again we look at option you know going back to the peace about mental health and parenting right now I don’t know when this is necessarily get error if it’s going to have repeat dates but we’re living through a pandemic and a very large number of us are in our homes all day long with our kids and I think that we have to prioritize what is really important for us right now and the biggest thing for me as I say you know these kids are on the screens getting their schooling and their mom or dad or whomever the caregiver is is a parent and a teacher and therapist and are doing everything so I see get out of your chair and make it fun when it comes to this oral motor exercises you want I say let’s go around the house let’s get some cotton balls in the straw and play a cotton ball hockey on the table you know it’s about how do we make this fun and get some work it you know even even something like different food textures took for that really will get the mouth moving I I think that there are ways to strengthen and to hone skills in natural functional ways I keep going back to the same part of realizing that that’s so important it does not there P. for adults looks very different than therapy for children and I think that’s a given but it’s really important to underscore that with kids it has to be about play and it has to be about what’s gonna get them motivated to do those things %HESITATION you can tell an adult to going to a clinic and you know for fine motor you’re gonna squeeze this ball ten times and then you’re going to squeeze this bond with this hand and you can’t tell the kid to do that but it has to be about something that’s going to get them interested and excited and honestly a little distracted and not even really thinking about what they’re doing they’re just having fun so as far as again I keep getting side tracked but you know those those activities for oral motor this the six strong who doesn’t love them all milkshake right even for kids who maybe have some delayed oral motor skills in terms of chewing and with with more complex textures that’s a great activity caramels and straws whistles and bubbles %HESITATION those are all really fun activities for most kids because I feel like with development that if it’s been done all day that’s the most conducive to growth like making it a game and and things like that I feel like instead of like for me if I if I hurt myself I go in for thirty minutes three times a week when we’re talking about actually developing something exactly again particular to this population comes down to a low tone and decreased strength and strength is the hardest thing to build I mean you know you go to the gym if you go to the gym once a week for fifty minutes are you going to see the progress that you would see if you did it thirty minutes every day or three times a week you know sometimes less is more if it’s more consistent it’s all about consistency building strength is challenging but it’s possible absolutely and you know to it to parents to not be discouraged because sometimes it it takes a while to see the progress or to see the milestone come and I wanna go back and talk about well let’s talk about milestones then because then I do want to hit these other how you overlap so you know do you want to take it as just a beat to talk about that pressure of of reaching milestones or comment on height on parents reaching milestones sure it’s the magic eight ball question that we get all the time right when is my kid going to blink %HESITATION I think I can fairly say that that happens in every discipline in it you come in and you just don’t know what the future holds for your child %HESITATION none of still you know regardless of diagnosis regardless you go what does the future hold %HESITATION and all I can say is I don’t know but I can tell you that based on the research based on lots and lots and lots and lots of other people who have gone on your path and trajectory based on my clinical experience and the kids that I’ve worked it worked with we are in you know that cliche it’s a marathon not a race %HESITATION and and progress is absolutely going to happen your child will not look the way that they look at this moment in six months maybe a year maybe two year I’ve five years old things will progress and as far as you know what will those milestones get hit that’s a really individual question it’s very it’s very individual specific and I think again regardless of diagnosis everybody hates those milestones at different points some individuals will get to a point and to some degree plateau in certain areas and then maybe it’ll be awhile but then they’ll make a little jump then maybe we’ll take a step back but I think that is it is without question progress is positive it wasn’t possible I would have a really hard time going to work I would have a really I would be out of a job if progress were not possible I I I get questions from from family from friends I I see it you know kids with a variety of diagnoses some with our bleaker prognosis frankly and they go on cable you do what you do you know it’s so hard to see these kids and I go it’s really hot I you know if it if I looked at it that way again I couldn’t do the job if I didn’t think I was going to make you know it it helped change make change %HESITATION and so I see what’s possible and I go okay we we absolutely have speed bumps and some of those speed bumps we can work around and some of the C. bus we can actually remedy yeah it’s a it’s a you gotta be a glass half full kind of person you have to see what’s possible and we work as hard as we can tempted to make those changes to make those occupations possible and we get as far as we can no I love that and I think I think those are things for parents remember because I know for us our reality of what’s in home that joy that journey that that progress is so different compared to what we experience in the outside world whether that be society or school and challenges like that so I think sometimes that’s the question that we that we feel like if we had the answer that it would just bring comfort if we just knew when but the truth is even with our typical children either even with myself I don’t know when my change is gonna come I don’t know when I’m going to be able to overcome a certain challenge I just think that as parents it gets compacted because we’re talking about our kids or as care givers were talking about someone we care about very much and so we want to know because we want to bring them comfort and you know some behaviors are some challenges we we wanna know what’s going to end we want to know that it’s going to be better and I guess the truth this is it it’s always getting better I think it’s you know again as parents it’s hard to see it’s hard to see that progress because we’re with them day in and day out it’s kind of like you know maybe you have family or friends that you don’t see but maybe every six months and you you get together you only well god I can’t believe that they got you know the group %HESITATION and our kids are doing the same things we don’t notice it because it’s happening constantly amber with the counseling so you don’t get to see that jump %HESITATION but taking you know taking those photographs you look back you all my gosh what a little you were at this point right look at look at how look what you’re playing with you it’s such a hard time and now look at this right we have to leave to look back and you know sometimes it’s a big jump we have to look through okay the past %HESITATION and really get that perspective it’s all about perspective and it’s hard for for caregivers were in it day in and day out to have that perspective but yeah absolutely it’s it’s really hard I don’t have children with special needs of Michael but I can imagine that it’s really challenging to to be in the grind every day the exhausting grind of we’re working so hard and we’re working so hard and you know it’s those little teeny tiny glimmer sometimes you have to really notice my gosh did you notice any changes gas on it on the bike we don’t working on that for so long and he just did it on his own right and it’s those teeny tiny things that other people don’t pay attention to but it’s it’s those tiny moments of the glimmers of Hey it’s working right it’s actually it’s thinking it and I think that’s one of the guests of this is that you do notice the little things and we’ve talked about milestones with our daughter and so much was like one right on top of the next that it seemed like for her I was always catching my breath like what’s next once I thought I had a hold on it it change it change it changed and one of the gifts of this journey is to to really be able to acknowledge because the truth is at the human body in every single person everything that we can do when we wake from the time we wake up we wake up that we take those breast at our feet hit the ground that we go for a walk in whatever we’re doing that our brain your every action for every human has encompassed so much so many lessons tells yes and and sometimes in life we don’t I’ve no I wouldn’t say sometimes the most at times we just go through and that’s just things that we do until we’re stopped and then you know we twist her ankle and then we appreciate walking but for the journey with Liam that we’ve had we’ve really been able to celebrate those milestones can slow down a little yeah we slow down were present and when that hits it you know we celebrate and I think for all the challenges that were presented on this journey that that’s one thing that we can take and and note that the gift is that we can celebrate because we see it and we know how much work goes into it and the truth in a very compacted like sped up version of that that’s really what all of us do every day to do these things and so it is it is a great gift within within the challenge I agree and good for you let me say I applaud you for seeing those moments and slowing down we all moved too fast and it’s you know it we everything moves too fast and sometimes it really is a gift to be able to go okay let’s let’s appreciate what’s happening right now I completely I I apply apply to honor we get so much great information from therapists is because I think individuals take things for granted like you talk about all these little things just to get up in the morning then walked to the mirror and look yourself is like all these things that you just take for granted I remember working with no tea with Liam last year and and it really dawned on me that just using scissors was something I just didn’t think about but to have a therapist say well you’re cutting your right hand but that left hand is like a helper hand you need to you need to move that hand as you’re cutting a line or circle and and it was something that I was able to go home now I know that I can now use that on a daily basis but it it’s things that I wouldn’t even know how to help my child because I don’t think about that other hand or how I’m doing things and I have to take so much time just break down what I was doing such an intense lesson of awareness and being present it really is yeah well you you had talked about the overlap of speech and %HESITATION T. and when I first heard about %HESITATION T. I just would think it was a fine motor movements and and PT physical therapy was this gross motor movements but as I’ve experienced %HESITATION tea and and witnessed some things I know there is an overlap there and maybe can get into that a little bit just explained that P. T. O. T. overlap sure sell it within the context of pediatrics again it’s the big emphasis for us is we look at that function right how is this child going to go to a playground and climb on a climbing structure %HESITATION how’re you know however the processing movement are they able to get on the swing are they are they do they have the postural stability to respond to movement when they climb up when they get on the swing will they climb on their hands and knees when they’re going through that obstacle course %HESITATION you know in terms of head position are they comfortable with weight bearing through their opportunities in their lower extremities were looking at strength and stability of the joints and the the big pieces is that function and %HESITATION with with physical therapy they’re they’re looking at a lot of those same things they’re looking at range of motion and they’re looking at strength and they’re looking at stability %HESITATION it’s really it’s hard to define the differences I think some of the big you know pieces where we are at taking into account body awareness how that’s impacting %HESITATION gross motor access %HESITATION depth perception visual perception things for things like you know walking on a sterile we all have the client %HESITATION that is shared with us with the P. T. and they’re working on the gross motor aspect of look of going up or down stairs and holding on and being able to you know move their feet in weather reciprocal pattern or step two potter you go one foot the other foot catches up one foot the other foot catches up and I will come in and kind of go he you know a lot of %HESITATION you know especially with our kids with with down syndrome oftentimes had visual perceptual differences are visual acuity differences were classes %HESITATION and legally maybe the steps need a strip of color on them because it’s hard to see when you’re looking down it just kinda all blends together and so we can help create a we can change the environment minimally by giving them a little bit of a color strip on the edge that that changes so we can take into account kind of those visual perceptual differences that will assist in the gross motor act of going up or down stairs and they can look at you know the the flexion of the knee and the hip and where you know where the weight shift is and all those more reductionist it kinds of NIT picky little fine tuning things that are critical %HESITATION and so there’s there’s this really nice marriage between us so we can kind of make sure that we’re taking into account the the person anything any personal differences the environments how we can modify the environment and and the actual occupation or %HESITATION activity when you said that that perception it reminded me I’m from New Orleans and it reminded me of leaving the Superdome after a saints game they well they’re trying to assist people leave but they have these big ramps going down you take escalated to go up to the to your seats but you to have these big ramps going down and going down a ramp to kind of pick up your speed well the carpet was as bright like Mardi Gras color carpet that when I took the tour the Superdome they said well yeah we do it in this pattern because it looks like steps it would make people slow down and and look at the stats is the go now they may have had some alcoholic beverages prior to that but it’s a way to just have your mind look at your service a different way and so you can then accomplish even if it’s just getting out of the Superdome you’re able to accomplish that act and I and I never thought of that depth perception and putting taper color tape on stairs and totally makes sense I think that example is a really good example of and I’m and I always go back to that for the parents and for our journey you know we put this pressure as if it’s this outside the box kind of thing that we just have to do but the truth is in life those supports are there for all of us like those those things are taken into account for mainly the typical community that will be there these are things that we can do so I I love that I I’m always for the neutralization of our differences because we all are different we all need support and I think to take that stigma away from that we have to do it exercises are we need support or we need to provide this to reach a milestone is really a goal because we don’t see that really everywhere in our community there are supports there for everyone right I mean you know high voltage %HESITATION handrail different signage and it’s all things that are to guide us and and that’s what we’re trying to do for our children and everybody needs it and and that’s the thing is that everybody needs it and so if that message can provide a little bit of respite to parents and caregivers is that everybody needs support in different ways and these are just these are just methods that we can you know educate and empower so that that we have them as tools in our lives in the beautiful thing is that we are able to get this information and we’re able to support our kids and were able to to to have these little tricks and and then we can see when we do see the changes really as it is it’s beautiful in relation to the overlap with physical therapy again do you have any resources or exercises or anything that you would recommend I’ll defer to a PT had come up with your physical therapy resources but for the gross little things in home again we’re all trapped inside look it gets fun so you want to do an obstacle course but we can’t go real parks let’s say our clothes summer open summer clothes depending on where you are right now some people just feels comfortable make your house an obstacle course play the floor floor as well but this is the time to let the house get a little bit messy get the bills on the floor the floor is lava is a super fun game you know you gotta find anything that’s not the floor to stand on so it’s claiming it maybe it’s a jump from one pulled excellent pulls a little on state unsteady which each will turn on %HESITATION those a little bit more imagine walking on the sea and the beach verses on cement it’s a lot harder to walk ons on sand %HESITATION things that are dynamic walking across the couch %HESITATION you know you can if you’ve got the little pop up tents that you know you can fold and they don’t take much space it’s little things to get you moving I at the beginning of all of this stay at home stuff I bought %HESITATION multicolored Peters tape I turned my name’s tire first floor into an obstacle course that we put boxes for hopscotch it will kill your paint it won’t ruin your floors and the different colors are fun because they meant different things and you can make arrows and we went you know I have a toddler slide that you brought inside and we went down the slide and we we put an X. where you had to do five jumping jacks and the women hopscotch you know space down the down the hallway and then they had to climb on the couch and walk over the pillow and this is all stuff that’s already here I bought the painter’s tape which you can use other things but it’s all things that we have in our homes %HESITATION thank sidewalk chalk you know it’s getting cooler here right now we’re we’re we’re talking in December but we also live in southern California so we’re a little more lucky than some of those east coasters right now probably but you know side walk chalk is a great activity in terms of strengthening instability you are never too old for tummy time get on your belly and hold yourself up with your elbows you’re going to strengthen your shoulder girdle muscles which are gonna support fine motor skills down the road as you get more stability you’re going to be able to use those were fine movements in your hands more effectively and sidewalk chalk is great because you really have to use more effort it’s a lot harder than looks a coloring with a marker it’s you know kind of slides on paper using chalk even crayons versus markers that you have to push a little bit more so you’re going to turn on the muscle little bit a little bit more doing sidewalk chalk outside or even on a screen door so that your vertical %HESITATION there are lots of things that you can do that you may already have around the house and %HESITATION we’re inside we’re cooking a lot more bring your kids in the kitchen have them pouring have been mixing right it’s holiday season maker make your holiday cookies or just your everyday cookies if you’re in my house and and have your kids during dull have your kids mixing up those ingredients don’t forget your helper hand you totally hit it on the nail on the head with your bilateral integration I’m gonna throw some jargon use your hands together watch your kids make sure that they’re using both hands together for an activity it’s so critical to combat it it really works both sides of the brain you want everything working in unison holding your holding your bowl using a wooden spoon really getting in there mixing having them learn how to scoop and pork and it’s fun right what’s the product we love that if we can get cookies after everything that I thought you reminded me of when Liam was was really young this is under three because we had some service at home where R. O. T. used use shaving cream on the on the sliding glass door and I remember how much Liam love that and I know the activity wasn’t like pushing a crayon and and and really being intense but it was it was the start and and it was creative in it was like let’s get messy and feel texture and and it was easily clean cleaned aids wipe it up it was great %HESITATION teens love shaving cream you will find a candidate agreement at the office hands down guaranteed I put money on it we love it it’s it’s the cleanest messy fun you can have you can pretend play you can make snowmen you can do a car wash for kids that don’t really want to touch it sometimes using manipulatives like cars or giving an animal a bat you know do we little the little plastic animals are back to the creatures that you can give a bath doing it in the bath tub for kids who don’t like that feeling doing finger paint in the bath and bath tub in the bathtub crayons for the kids that don’t like to do it at the table you can do it in the bath and then look at hands in the water it’s gone %HESITATION you know we have it in in my house we’ve saved old toothbrushes to do painting on the walls I’m in the bath tub also and then you can screw about the grout with a toothbrush and it’s another really nice fine motor activity and %HESITATION gets a little help clean the house in the house when you let me rephrase that but absolutely you know the textures and that and that goes more into that tactile in kind of the sensory processing and then some of the fine motor things you can do with in those activities and with those different textures %HESITATION Plato played as another one you’ll find in every of Chiapas it’s a nice double slight bit of resistance so you get a little bit of muscle work to a little bit grating that creating a force in knowing how much muscle to to exert is called proprioception the sense processing function and you know those things are are just great again it’s like the dell you can use your cutters you can really get in there and and push and pull and roll %HESITATION so I’m a huge fan of all those different types of of materials and manipulatives for sure and those are great at exercises because we are you know we’re going into the holiday break those are great exercises for not only when you’re in home and and schools on but if you’re in home and in any kind of you know quarantine or or lockdown to to have all those fun exercises and cleaning the house yeah I like this always helping that’s always helping listen I have got your cleaning the house that’s the case for kids let me tell you pushing and pulling laundry baskets taking what goes out of the out of the wash putting it into the dryer that extra weight from the water it’s great and honestly kids like to be hopeful they want to be acknowledged for being part of the team they look for things to be helpful if you really you know ramp up your excitement when they do something super teeny tiny all my gosh that was so awesome thank you so much for your help right thirteen fifteen weekends all I can pull this back it’s so let me I need your help you’re such a strong kid %HESITATION let me see your muscles and rate you get them excited you get them involved and the tiniest thing if you give them praise and you make them feel like they did an amazing thing they’re probably going to want to do it again and help you %HESITATION pushing a vacuum right there can divert back in the living room if your kid doesn’t have any auditory sensitivities to the to the vacuum and they’re not super you know uncomfortable and freaked out by it it’s a great activity %HESITATION heavy either dust buster plenty things you can do around the house to pull their weight right earn your keep kids earn your dinner tonight it’s like the Mister Miyagi of occupational therapy Hey Michael you get clean let’s go outside with the hose in this and %HESITATION what so he said he you know sponge for sure I love it and I think that does leave because we’re because we’re putting it into our everyday activities that’s going to alleviate having to make this break in this lump out of time to sit there and do a therapy we’re just we’re just incorporating it into our day and into our lives and and and I love that I think that create such a positive feel for everybody involved we whenever we let’s if you use the vacuum I was taught well she’s not gonna do the best job right but something’s being done unified to go back and do it myself I would have to do it anyway when I have her do a little bit of it and and then she’ll learn my my older son was obsessed with the broom from the time you could stand we got in the kids bro no joke my mom bought him a Swiffer it’s his birthday gift as a two year old and we made this handle shorter and he walked around the house with ring and it was no it was not the best job but he he loved it and I’m sure it helped a little yeah that’s that’s fantastic yeah we had talked at your target on that role of overlap can you talk about the overlap between occupational therapy and behavior sure sure absolutely %HESITATION having a be real background I can see the benefits and I can also see where it may not be right for every child %HESITATION and I think that there are some really great things that behavioral principles can can bring to an occupational therapy session %HESITATION teen behavior kind of by definition almost of O. T. and and especially in pediatrics things being child directed and sometimes they can be at odds a little bit because we want to make sure that we’re not just making it about you know adult Americans still don’t demands right there’s this there’s this balance and and not the behavioral therapy is is just on adult men’s but there’s this balance of reading child’s cues and going what’s motivating to them and I think the big thing %HESITATION particularly with you know kiddos with downstream who one of the personality traits that we oftentimes see is a little bit of stubbornness which perhaps we can say strong willed right they know what they want some answers they don’t know what they don’t want and at the same time just like any other child any other adult sometimes we come across things in life that we don’t want to do that we have to do and you know so so from a behavioral perspective of providing reinforcement and providing %HESITATION you know giving them an understanding of what we really love to see great job right I incorporate the simple behavioral principles is providing reinforcement for %HESITATION when we want to see something continued and and I’m not can sometimes help in terms of you know we get those nope arms crossed no right and again we see this with just about any kids are but when we can empower kid and and have them see that we’re really proud of that legal what just happened or maybe we need to re shape behavior and kind of steer it in any way I can incorporate %HESITATION people strategies %HESITATION that way %HESITATION it think the biggest thing is that it’s about facilitating %HESITATION facilitating whatever it is that the activity %HESITATION and no it’s not always preferred as much as you know I talk about making it child directed and and stolen in games and we have to we have to do some writing that’s that’s the long and short of it is you know some days I don’t want to go to work I’m exhausted I have twelve reports but I need to get done and at the same time I know as an adult who has learned through life of going to school and following directions sometimes you do it you don’t want to do so you know sometimes the it’s using those behavioral strategy sometimes to help %HESITATION a kiddo engage through some of those non preferred O. T. activities does that help a little bit yes %HESITATION behavior the overlap is more seeing the influence of behavior on occupational therapy just you when we’re dealing with if it’s not something that’s fine %HESITATION that they enjoyed doing being able to approach them and then you know they they importance of the communication between the entire team were trying between all of the support providers is that you can talk to your behavior less about some exercises or some approaches to doing %HESITATION T. because one of the lessons in occupational therapy is sometimes we do have to do things that aren’t on our preferred list you can positively impact behavior by just even with these activities that are non preferred this is what we’re gonna DO set them up for their their successor however they do it that’s going to start to get integrated into it and again into their everyday activities it’s about compliance and fill up the ability to follow an adult direction you’re in a classroom you’re gonna need to follow directions and I think that that’s where we can definitely use behavioral strategies and principles and and also you know sometimes we have more maladaptive behaviors that come up the Duke impacts their ability to participate you know we don’t see as much with this published but their self stimulatory things or maybe we get distracted and we you know some kids are either vocalizing kind of you know what we’re it’s distracting and it’s not allowing them to focus things like that and taking different beaver strategies or even combining going Hey is this a sensory behavior is this something that we can provide a century a century strategy to alleviate and allow them to kind of re engage %HESITATION but looking at the function of the behavior and not as you know the core of behavior therapy is really looking at what the function of this behavior why is this happening and I’m sure that you know when when you talk to our fevered specialists he spoke about you know looking at the function of behaviors and sometimes you know we go over this falls more in line and maybe they’ll be in maybe their eggs exhibiting maladaptive behaviors because it’s hard because they don’t have the strength and the no that they don’t want to do this and so it’s really about you know the find let’s say a fine motor tasks where they don’t have the hamstrings and so they’re throwing their pencil well great now I know that we need to kind of take a step back and go what else can we do to strengthen we don’t have to necessarily follow through with the with the paper and pencil task let’s look at other things that we can use to address those same foundational skills so that’s where there’s this this kind of background of constantly reevaluating and going okay why is this happening maybe why is this thing that’s impeding our ability to function and participate why is it happening and how do we then addressed it and do we need to use a vehicle strategy do we need to put it on something like extinction where we ignore the behavior and we don’t give it attention or do we need to actually address it but in a different way where we can create modifications well let’s go back to the stairs if we killed having tantrums and having the hardest time when it comes time to do stairs and physical therapy a behaviorist may come and go you know why are we having so much trouble in no case did because the task challenging is it because they’re afraid because that visual perception right if not for the O. T. the behavior in the P. T. are all looking at this one task we all get to kind of have our take on what’s going on from the old east perspective on Google again look at that vigil perception and I’m going to say he maybe they’re afraid because they can’t tell what they’re about to step into %HESITATION and and then being able to create those supports using the Hubble strategies also to help them you know follow through reinforced rates %HESITATION I love the way he went up on that one step let’s try again great work that’s a simple everybody’s gonna praise a child when they’re having a hard time and they actually do it or even with support right and that’s technically a behavioral strategies or or or our principal is providing reinforcement and we’re getting the PTO so everybody there so much that the overlaps in almost every moment right and there’s so much that can be done when you work as a team and you are willing and able to see things from or ask for other people to see things from their lines so that you know it’s all about helping this one kid right it’s not about me as an O. T. sometimes what I provide does it work maybe it’s not official perception maybe I can just doesn’t want to do it and I think that it’s fair and it’s important to acknowledge the fact that I don’t have all the answers my suggestions are based on my clinical judgment based on my knowledge of the child based on whatever research that I have you know at my disposal on this particular topic or or what we’re doing but it’s not always correct it’s not always what’s implacable so so being able to be a fluid team is huge what a wonderful way to to truly listen to the child because that child maybe just because they’re young they they’re not able to actually communicate the reasoning for not want to do something or or why they’re having difficulty and it’s wonderful when you see a group get together and and then listen to those cues many times nonverbal cues to learn how to do this and I think as parents to sometimes we do get caught on that this is this is what we need to do we need to be able to hold the pencil to write down the words and we get so stuck on what we’re trying to achieve with this fact of that it is you know the the human that’s trying to learn this activity is on their own journey and they have all their emotions and you know I mean we have a thirteen year old daughter that sometimes feels things and you ask her why she feels something and she’s like I don’t know I just feel this way you crying I don’t know I’m just crying and it’s and it’s a lot of communication to get to the the core of it where is if you have a child who you know abstract is hard to pinpoint communication it might not be the strongest suit they might not even have the words I know sometimes within him he wouldn’t have the word like how can you say that this is what I feel if you don’t have that word right like I don’t know that word yet I haven’t gotten to that word and that’s a typical development that’s not you know it because of a diagnosis that is we learned on a certain we we learned in a certain way will we learn like I was learning sign language to support lamb with speech and I learned different words I didn’t get them all at once I learned them as I saw I couldn’t communicate and then I’d say what are you trying to say and then I’d have to figure out that word and then go find that word well that’s what they’re doing that’s exactly what they’re doing you have an umbrella word of bad but that bad does he like that could be sour that could be painful that could be so many different things to it I don’t like that the discomfort that could be so many things and I think that to take that pressure off of having to do it and make it more into being present and this journey of what is that moment because that’s that’s what we’re given is the moment it’s easy though ever I would just stop myself the other day when we were supposed to make some kind of craft and it was it was the ideal but that it wasn’t the finish is Kenny king let’s put this table here make stripes idea is that Liam’s pull on the masking tape off of the role and and hold in the loop and cutting it with it but is that a hammer this is and just for a second it was gone we get five more minutes let’s get I realize it’s not again he was a little upset that he had to wait till the next sun yeah we ended up in another sadly unless I find but that that can I wanna hang the candy cane it was we wanted to finish the green candy king yeah %HESITATION but yet no I think that’s a really good and that’s a very important thing for parents because again I’m going to go back to self characteristic present and taking care of ourselves because the not parents I’m sorry that caregivers because we’re having to provide care and if and if the pressure is the activity then we’re we’re missing whatever that moment is in our lives because that’s the moment at hand and that’s we’re not gonna get that moment back you know we’re not we’re not going to get whatever that whatever is right there and you know I am and in this team I am more of the one that’s like just but we’re just gonna put the tape down and if the candy cane doesn’t get made it doesn’t get made the thing is what are we gonna share what other things are we gonna bring out at this moment are are we gonna teach him a new word are we going to demonstrate how to deal with stress are we going to connect you know I I it it honestly it’s this year this year I looked at Liam not long ago just a couple months ago and I realized I hadn’t connected with him I haven’t seen him I see him every day but I I had to stop seeing him because there’s all these lists of therapies there’s all these things that had to be done there’s all this distance learning there’s the pandemic there is he has to have twenty minutes of exercise every day he needs to make sure what is he eating where is he how is he holding us for all of these things and he came up to me one day and he just put his hand on my face and he said something and it was in the middle of an activity and I was like I saw him and I realized that I was this like moving force moving him through whatever during which as as a parent that that is what you were doing but for me it was and now nine gene that I needed to find the balance of giving him support and breaking down the stereo types and pushing him to his potential that not everybody sees but then also seen him and being there with my son when he is nine and a half years old and experiencing what that is you know so I think that when we’re talking about all of the support and and stopping a behavior that’s again the gift the gift that we can find is to just be present and not take those moments because that’s what everyone says about their typical kids even I mean man the flu by she’s in college already you know and it just went by it’s gonna be the same as lamb is going to be knowledge already yeah we need to take those moments of him to you know make sure and he can teach us that plans for the harbor did you know he has a Harvard shirt and that what up with that I was gonna make hot that I think when we went to Boston and we got I was like getting a Harvard shirt the first day of school and that that your efforts that summer vacation and he probably walked in with this however certain things again where to go but I and I and I like what you’re saying about you know as everybody is working together as a team and really just being able to find what that moment is and what the need is and then to to go for and I love that what it what a gift that you’re at %HESITATION tea and a behavioral less because you know that the that it does it all it all works together just a great background I’m not a certified behavior analyst by any means and it’s been a long time since I formally like practice but it is it that you know especially with Nikki Macquarie being a CVS walk you know as well as an S. O. P. %HESITATION there is definitely and we have a you know a number of behaviorists %HESITATION out in the field and in school you know in school with our kids and working on the teams with our kids so there’s definitely an influence and and there are resources for us when we do we’ll come across behaviors that we’re really not sure how to address it is nice to have that %HESITATION that resource in house yeah we really enjoyed our conversation with Kyle Davis about behavior in for any of our listeners who have not had a chance to listen to that episode that check it out it’s absurd forty one and we dive into about every aspect of behavior we could think of I want to thank you for being here today and and we really look forward to continuing this conversation next week I am honored to be here and I just hope that your listeners can take a little bit of what I’m trying to put out there and help you guys Fred and I really appreciate the work you guys are doing.

Please follow us on Twitter @ifweknewthenPOD you can drop us a line on our Facebook page @ifweknewthenPOD or visit our website https://www.IfWeKnewThen.com to send us an email with questions and comments. You can join our mailing list there and get alerts of future podcast episodes. Thank you again and we look forward to you joining us on the next episode of IF WE KNEW THEN. 

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