43. Occupational Therapy: Erin Stanford of McRory Pediatrics – Part 2

Transcript

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 an occupational therapist from McRory Pediatrics and this is part two of our interview with Erin she was able to provide so much information and we didn’t want you guys to miss a beat of it so we hope you enjoy again with us welcome Aaron Stanford Erin it’s really nice to have you back I’m so excited to be back we had so much fun last time so let’s see where we go you had mentioned sensory would sensory fall under occupational therapy well it it really depends on your schooling and your location around the country within Los Angeles where I am I attended a school that is very %HESITATION has kind of always been central to the outside world so I got I got a lot of sensory integration training %HESITATION I do have an advance a certification you know in in sensory integration so I think it’s part of a team in general other areas also will look at sensory processing potentially you know you get a little bit in physical therapy there’s body stuff involved in %HESITATION but I’d say that at least here if you have a child who has sensory processing differences you’re going to go to one O. T. if you have concerns and be evaluated and kind of see how it impacts again function you know you’ve got your your major sensory processing pieces like tactile you your sense of touch in your sense invasion and taste and smell and hearing and the big one that you know everything goes back for fresh for me I got indoctrinated with lots of pay attention to proprioception that’s the hidden six let’s hope reception it is it is the sensation that is received in that joins the muscles ligaments that really informed body awareness turning on your again I mentioned kind of eat %HESITATION it’s not straight but it’s how much do I need to insert %HESITATION and so you know the the example I love to give in terms of per reception is you you you buy a jug of milk crate a gallon jug of milk yesterday and today you go in and you’re like I’ve got so much will come and go grab it out of the fridge I know it’s gonna be heavy so I’m gonna go grab it and when you go to grab it it actually somebody drank all the milk and there’s a tiny bit and you go to pick it up with all that force and it’s going to go flying if you don’t respond to the reduced weight now right which kind of goes into your muscles your joints and goes Hey Hey too much too much during the downturn forced down so it doesn’t go flying conversely maybe about it two weeks ago thinking it’s going to be empty but nobody’s ring in all these days do you go in thinking you don’t need to use too much force and you can’t pick it up unless you to recruit more of that muscle you know turn more about those muscles on so it’s not about how strong you are but it’s really about how much is the grading of force and exertion of of force or reduction based on what you get from an item so not really informs body awareness and being able to you judge your your your space based on your awareness of your body if I put my arm out I know I’m not going to hit the the bookshelf next to me I have an idea of how long my arm can extend and so the activities that are really great for that for for increasing and supporting body awareness are things that involve weight bearing and pulling and pushing and all those home activities they gave you a stirring in lifting and and being on those on your on your elbows to really Q. those muscles in your shoulders when your tummy time coloring on the floor %HESITATION you know get out of the chair get your body in in positions where you’re gonna wait there and you’re gonna give more input to your muscles all over your body and and the awareness the ability it’s also going to increase your strength as you turn those muscles on you’re still building said those muscles are firing and and you know building fiber and as far as kids with down syndrome where tone is something else that is a key feature that we see in kids with Johnson is that lower tone tone is not going to change over the lifespan %HESITATION you can see it change in response to certain types of movement or activities with in you know in the commentary or in a in a short period of time or change a whole lot but %HESITATION the lifespan someone with low tone is going to have to help and that doesn’t mean they can’t build strength that’s a totally different piece of what we’re looking at tone is there a logical and so in order to support our kids with down syndrome who have lower tone oftentimes joint laxity %HESITATION they are at risk for you know especially in the neck you know there there is %HESITATION there the joints are more vulnerable what we want to do is build strength so those weight bearing activities those activities that get the body moving or going to build strength and build stability around the joints that would otherwise not be do not be as stable essentially as a great description of low tone because I was always confused by that I remember talking to therapist and just having that question of what is low tone mean it compared to the strength you know that you could build the strength and that the low tone really wouldn’t you’re always building around that distracted because I think it’s you know as parents were given this this laundry list of things that are that will be challenges for our child which I’m not a fan of that I’m a fan of using that information to give us knowledge and to support our children I’m not a fan of that being used as a boundary or to create barriers for children and I think one of the things on that list that’s huge and hit hard as they have low tone and the way it’s presented is this is detrimental and they’re gonna be weak and they’re gonna there’s all these things that come along with it that then we fill in the blanks so and I love the definition and just knowing that tone is different than strength and strength can still be built but tone is just going to affect these other things like in the NAC and certain and and that’s how we use it for power that’s how we take that information and use it to support our kids because we know they can they can be strong and I don’t think that you know I say that and that may sound a little silly but I don’t think I think that that’s something that’s used as as a deficit we’ve encountered it over the last ten years so many times that that even when people say they have low town they don’t know what they’re saying and they think they they think it’s something else so you know you could have a P. E. coach say Hey he’s got low tone now they’re not an occupational therapist or a or a physical therapist or any of these things so their perception of what this means to your child is they’re not gonna be able to participate well as a parent now you can say just so you know because they are trying to do their best tone and strength are two very different things we can work to build their strength but let’s be aware that tone could present these challenges so we want to build their strength while keeping them safe absolutely a hundred percent I completely agree and I can say as a generality to parents to have kids with developmental differences whether they are genetic differences are not a muscular differences nor a logical differences I know this doesn’t really tell me who this candidate is it tells me little things about the likelihood of certain things happening or being part of who they might be but you know when I get a kiddo who has a diagnosis and I’m reading the chart I go okay so let’s say they have done since %HESITATION I have an idea of you know some of the things that I might see but it doesn’t tell me about like we said the potential it doesn’t tell me about who they are as an individual it tells me it gives me a guide it’s a guy and I think that there is nothing that I read in a chart that gives me a clear out picture of this is what we’re going to do a this is how it’s gonna turn out I can see I am seen handfuls of kids who have the same diagnosis and each one is different and they’re like you said the milestones get hit at different points and the way they reach those milestones are reached in different way in the way they do it is different ways and different strategies work for different kids and that’s just in the visual difference diagnosis or not so I I completely agree that it’s a it’s a it’s a guy and I think parents can put that in their pocket take that and put that in your pocket so when you go into a specialist or would you go into and I’m always talking about finding the team that supports you in the way that you think in the way that you see your child so when you go into an office and someone does make a blanket statement or try to tell you who your child is going to be take that take that from our occupational therapists and Stanford and and know that she’s a good knowledge in that she can only read it it’s just a chart and that doesn’t tell you who your child is so just know that if you get one of those blanket statements that you can smile and know that the truth is is nobody who can tell you who your child is your child is going to tell you who your child is I have literally seen kids who are under your under six months under three months doctors have told the parents your child will not lock your child will not talk your child won’t eat the way another trolley and that breaks my heart because a parent who is not informed at that point because you have an infant who spent three months in the Nick you you know and all you know is the NYC you and you haven’t gotten to the therapist and you haven’t gotten to the specialist and all you are is in this frankly greedy which is important for a parent to go through an experience and that you can talk to her and she was on staff about but I think that what’s so important is that doctors don’t know everything and they can’t predict the future and I don’t mean to pick on doctors because a lot of other people will say that too it’s an example because I have one in my head specifically when working with now who is a beautiful healthy walking still working on talking little boy was told he wouldn’t eat he is now eating a temple his G. two was going to come out all these things and we just can’t predict nothing is predictable in life other than what they say death and taxes right well we’ve we’ve discussed that many times that the limitations that almost subconsciously put on your child because of what you’ve heard from professionals you could be told something and then in your mind that’s just what the factors and so then it gets projected on your child and it can be detrimental if you wouldn’t do that to any kid any it’s the standard to say to any typical kid you can do anything you can do anything so let’s do that for kids with challenges as well and I just want to encourage doctors to stop saying these they’re never going to it does I don’t know why they do that it’s like it doesn’t help in the moment it doesn’t help the parent it doesn’t end there because you can’t ever say never like that is you can you could say there’s a possibility that this will be a challenge there’s this but but that the weight of those words are are a day just land on parents because we’re humans that are very vulnerable at those moments and when we hear this these blanket statements so if you’ve heard that take into consideration this conversation that we’re having is that it’s a malleable saying right and I think those changes are happening is just gonna have to come from right side the the profession itself I think those things also come not just from doctors but I think my anticipation is that a young doctors therapists specialist we come into what we’re doing because we want to help right no doctors going to med school going I’m gonna tell everybody I can I’m gonna find the ones that are going to right that’s not what they’re getting but I think we don’t trying to get into that mindset is going I want to give them just I want to guard them from the pain of when it doesn’t happen right maybe that’s where they’re coming from and and I want to give you look just a heads up this is probably an async you don’t even OTC PT’s may say things where it’s where they see that we get this particular skill and I think that it’s about you know what other things can we do and that’s what we go okay if this child really is not going to walk or talk or use a hand that’s been impacted by neurological let’s say you know %HESITATION events what else can we do let’s problem solve let’s be problem solvers instead of just sorry this isn’t gonna happen as a tease I mention we look at when mediation fixing a problem and application working around a problem and so when we come across those play areas where kids got towed and it’s a it’s a very real thing when you have kids with developmental differences you may hit a plateau and you will okay that’s fine what else can we do to support this individual’s ability to participate in X. Y. Z. what else can we do are there splits are there things that we need to bring in as adaptations do we modify the environment do we change the way that his table is oriented do we you know there are so many things we can do to modify %HESITATION and that’s one thing that will tease specialize in we really look at what else is a possibility we are the professional possibilities that there I like that I never thought of it that way we look at how can we help you do this given all of the limitations all the challenges all of the speed bumps how do we make this work I am I love profession a possibility and I’m sorry I do too so it would be encouraging our listeners to when they do get and and I and I’m right there with you and I know I would I do believe that everybody is doing their best and I believe that I think that what we’re coming through as a community is is making a change in change in a conversation and that sometimes is work and that sometimes doesn’t feel good so it would be just encouraging our listeners to have the conversation because that person that just made that blanket statement that doesn’t mean that they’re riddled with prejudices against your child that’s just where they’re coming from that’s just all they know so if you can invite them to have a conversation with you of this is what you believe so let’s work around it and let’s let’s find our way through it this journey is like climbing a mountain in the dark you you’re hiking hiking up up up this mountain and you get to a plateau let’s say you don’t know it’s a plateau T. been walking on flat ground for a while and so we have to figure that out as we go not at three months or at birth you’re told or enter diagnoses or diagnosis right so the ideas that will experience this together as a team as a family and and we’ll we’ll find out where these plateaus common limitations are or where the strings come is about empowering parents to ask questions for those of us who are in this world we know how many resources exist and we know the questions that we know that we hear something that maybe doesn’t sit quite right you can always get a second opinion and there are lots and lots of parents for everyone of us you know that there are questions I ask and there is somebody else there are lots of the parents who feel like the first person that tells us something is the ultimate work and I think that it’s about empowering parents when they have that feeling in the gut to go a little bit further and you know sometimes Google really hurts but sometimes Google leads you to great organizations and people and parents who are in that same world with you and you can learn from and they’re also parents are seasoned butter give you just the worst was negative but you really have to go out and explore and get that information for yourself and I think that you know again parents who are early on in it it’s hard to do that and you’re in this the state of just I’m just gonna let the people who were in my life right now the doctors the professionals tell me and I I think that it’s so critical that the parents become empowered to search for more answers and not settle all the time you know what it’s good news get other aunts got get other perspectives because one person does not have all the answers no matter who you are and and it’s exhausting and it’s time consuming and the bureaucracy of insurance and all the funding sources that you know it just in LA here it’s so complicated and I don’t know systems outside of you know this world because I’ve always been in Los Angeles but %HESITATION I imagine that in other states and other countries you know there are other hoops to jump through and it’s exhausting but everybody wants to do the best by their kids every parent every you know professionals who are in this field we want to do right by the kids and so parents the point person so you know I I encourage your listeners to really take that and go out and find groups like the club twenty one here in Los Angeles I don’t know if they extend beyond that I know that were you know I’ve got lots of parents and can clients who’ve been connected with club twenty one and the buddy walk and you know there there are lots of resources out there to get more information going back to that half glass full thought processes you could have that attitude surround yourself that you’re gonna run into people that aren’t thinking that way outside our community and in our community we can butt heads on certain thinking in our community and positive attitude so surround yourself with the people that are like minded and seek that information also listened to everything else but everything doesn’t have to have such a heavy weight especially the negative things don’t have to be so so waited I think you pointed out that there are people with like new new babies and I just enjoy that just from my experience we were doing therapies so much from further it it became it became more about this machine the schedule this schedule and just take the time to really enjoy your baby your child because they’re they’re they’re pretty great you know and and I think that some of that gets lost you know with the worry in the stress and the fears so make sure you check in and that you’re you’re enjoying the entire experience of that that life I had questions for you on your what do you cook pro perception is that what we’re talking about sensory is that lake when your child will go to give a hug and it’s too strong because I’ll use the terminology gentle I just a gentle like to stick to pull back a little would that be like when they’re talking to two hard or pushing against your face and then it becomes like a a face plant is is that what that is or dig in their chin maybe into digging the Chand’s shoulders yeah it could be proprioception absolutely it’s it’s that feeling %HESITATION a lot of students to beat that sensory need without even thinking about it you know I have a professor of mine who talks about like she can’t function unless she goes for a run she needs that be hounding the concrete in order to really organize her body it’s a very organizing sensation %HESITATION it’s actually something that we use to combat uncomfortable or painful feelings %HESITATION and this comes into I could go on and on about this one so imagine you’re you know you’re walking you fall you skin your knee okay your pain is a tax happens he should not your tactile system responding but what do you do you crap on your knee you clench your jaw right you’re squeezing really tight your body gets tight and all of that muscle tightening the jaw all of it that is proprioception that activation of all those muscles serves to balance out and and really modulate that uncomfortable that painful feeling that’s happening in the tax system so the hugging the deep hugging that sweet yeah absolutely if it if it’s an activity that is where the where you’re seeing that they’re overshooting or undershooting us a hug that’s too strong %HESITATION even stacking blocks that gradation of force and be able to understand if I do it too hard I’m gonna smack about the whole tower down if I do too so it’s going to fall out of my hand and it won’t stay that balance of power essentially physical power and yes giving a really Big Bear hug and what your child may be looking for and they’re squeezing you is they may be looking for you to squeeze them back now that you know there’s there’s a difference between deep pressure when you’re just applying passive touch to to the muscles birds is active we were really looking for that deep squeeze so if you’re getting why if you’re getting if you have a child who comes up and really just looks for that big squeeze maybe we need to incorporate things a little more consistently throughout the day to be able to give them that information be able to give them what they’re looking for so they’re not doing it in a way that they hurt someone and I know that you know it’s probably not intended I can see that you really like you really need a book big squeeze right now and maybe we have a hug hello we have one of those big cushy fluffy animal kinds of things that we can do or we can not a crashing area we can go climbing on our on our crashing area and really get those muscles working to give that sensory information that that kid was looking for was funny that sensory activities that give comfort to children sometimes are I looked at negatively but you just pointed out we all do it yeah when you fall down and are you bump your elbow and something you kind of right you read that right and you think about that’s just the anatomy of of a human being but that brings comfort I don’t know why he has had me you would know high but you do it so these feelings come out in a natural typical way but they’re not always look that way no they’re part of the they’re part of the perception of I guess that what we get a lot is and we’ve actually been said he love actually said to us does have superhuman strength and now I can say no it’s appropriate perception thing and we all do it he wants that information sent his body and what that also again it’s it’s giving him a sense of what his body is K. people what it’s giving about him not body awareness right I’m going %HESITATION it’s really okay to say %HESITATION Liam that’s a really strong how that hurts me let’s see if we can do a gentle hug and now we can go okay we’ve got our bear hug now what was it what would a rabbit how do you like it so often it’s code right and gentle and maybe we can find some middle ground they’ve got a very now what would be an elephant came and gave me a giant hug with his trunk right and we can create up to we can great job giving kids kind of visuals that are less abstract it’s a very very abstract thing is a very complicated topic even for adults you were talking about it and it’s really complicated to express but when you can put it in terms of things that are familiar to a child right if they like trucks maybe we’re doing a big bulldozer hug or maybe it’s a little motorcycle and you can change things to give them a visual of the intensity that they might be able to change within them physically and and that’s a really important thing for them to understand in order to then make that change and make those little modifications and adjustments in the way that they’re engaging SO good yeah well we’re always learning ways to bridge that communication you know it’s it to make it a picture something that is identifiable for the child and could it be something that under like a stressful environment or a new environment that maybe we’d see those activities as well absolutely I think that %HESITATION again like you said it he’s really we’re talking about them not be able to communicate I don’t have the words to say I’m frustrated and what do we do more frustrated with things he did right I love this track of where my body is when I’m upset or when I’m when I’m stressed when I don’t want to do something and I throw myself on the ground and I don’t realize that there’s a wall right there and I hit my head all these things I look for that input when I met a heightened sense state of a motion or dysregulation %HESITATION and so yeah we absolutely look at those things right kids that that are more physically aggressive maybe we need to hit something it’s okay did something but let’s find something that’s appropriate let’s have our pillow you need to go and and get that physical expression out because you don’t have the verbal expression absolutely we look for sensory outlets for sure we have so many questions and it’s such great information just to give to parents because when I see a lot of Erin is the lack of information that’s out there and plus when you start this journey if you don’t know anybody or if you don’t have information readily at hand it can get overwhelming and then you start behind the ball and then you kind of stay there and then taking into mind than that just the perception and fears and other challenges the information is an out there and so I’ll see when then something comes up like a behavior or they’re not eating or whatever it it holds so much weight so just to be able to provide this information and even I mean as you’re talking Steve and I are having these light bulb moments of %HESITATION that’s a good idea %HESITATION that’s a great idea %HESITATION that’s what that is and so I think that’s what it provides to the people for listening as well want to give yourself it’s used well %HESITATION I also think that you know in terms of you’re talking about being behind the ball if you don’t get started I was brought in to make for you to replace it he was in one of our early intervention programs and we have a few center based programs at Macquarie and we have two that were that are designed for early intervention %HESITATION so kids under three one of them is designed for kids who are likely to get a diagnosis of autism or may already have a diagnosis of autism and the other one is for the other %HESITATION the kiddos with global delays various genetic neuromuscular unknown things going on %HESITATION and so I got to come in and work in early intervention where you know that critical development those that zero to three %HESITATION they have to be ready it’s an intensive programme it’s every day for three hours and so that usually we we have kids at about eighteen months or so but the earliest we’ve actually had I think probably the two earliest kills it started were sixteen months both had down syndrome I’m so I’ve had that’s that’s been the largest grouping of clients that I’ve had with down syndrome has been the underserved population and I think whether it’s not or something else early intervention is so critical it is so important because it really does allow you to get ahead and get early resources going hit those critical periods of development and get started when the greatest so impressionable and you really want to get those good foundation so we did not program we have you know it’s it’s %HESITATION TTT speech and child development %HESITATION on a daily basis for that three hour chunks parent involvement and support and then I you know after that we we help them transition to the school district at that point you know getting their other email services set up through different funding sources outside of that early intervention program and and then you know we also see early school age kids most reckons tend to B. under about eight we have some you know kids who beat and go beyond that but most of my clientele have been under it about that point so %HESITATION but I I completely agree that getting involved well at this time enjoying those early moments of just parenthood is really important but also get your things in line so that you can make that change and have it become part of your daily vernacular and part of your daily routine to be working on these things comfortably and you don’t feel like you always have to be go go go go go it just becomes more fluid in the things that you’re naturally deal and if you haven’t started yet that’s okay be where you are when you start and then and then just move forward from there without any kind of judgment or guilt or anything just that you’re you’re moving forward but what would because sensory is something that’s huge and it impacts a lot in the daily lives what would parents look for when it comes for sensory to know that they would then need to seek some kind of support that is the big question what we have all these different sensory systems you know I can break down each one in terms of you know the tactile system looking at you know acceptance of textures are they more sensitive do they really looked at today need to touch everything are they getting into things where exploration is excessive I think we’re all a more often than not particularly with the population that has down syndrome we see mark what’s called under responsiveness it takes more for them to register so they don’t have the awareness there’s less awareness at least of tactile media so we’ll see kids with higher pain threshold you know I a lot of my a lot of my kiddos who have down syndrome the parents go yeah I didn’t realize that that tooth was coming because they didn’t have the discomfort with it you know they’ll fall down and not really noticed that they’ve skin their knee there’s just less awareness in particular to those bodies stations things like in terms of movements and difficulty with %HESITATION you know if the child has difficulty being looking down for a diaper changing it’s beyond just I don’t want my neighbor change but they really are screaming when they have to have their head tilted back or on sweets or in the car the fight going into the car seat the movement sensation %HESITATION you’re moving as part of a stimulus system and the receptors or inner ear %HESITATION and so head position we actually are always responding to movement because we have gravity pushing down in our body needs to step so we look at this is a big one postural control with kids and possible writings when you know we see that we’re slouched posture a lot of times and with that low tone those muscles that aren’t firing in our domino’s are back to keep us up right but you’ll see that D. postural muscles are heavily impacted by the movement sensation and the ability to kind of respond to gravity pushing down on us %HESITATION is a really complex concepts to be able to give you what a teeny tiny understanding of but doing things where if if they’re rolling on the ground you know are they will they roll are they moving %HESITATION a lot of our kids just kind of a more sedentary and content to be with decreased strength it’s harder to lose so they don’t seek out those movement opportunities and so they really unique things you need to be exposed to things or to develop that so when a child is more sedentary you know is is being propped up in baby carriers or is sitting in a in their seating positions or being carried and they’re not given the opportunity to kind of explore more and build that strength and do the exploring you may see challenges with movements because that system hasn’t been given the opportunity to integrate and take and learn all your sentry systems need to learn %HESITATION it’s %HESITATION it’s about messages being sent your central nervous system in your brain and going all what’s that little how do I respond to that that’s that’s the crux of sensory processing is that it’s about making creating responsible adaptive responses to sensory input when I experienced this particular sensory input my body does what my brain does what to to respond to it so that you know your tactile sensitivities your movement sensitivities you know with again the the proprioception one you’ll see kind of just poor grading a force that’s the biggest you know when you’re working with kiddos that have difficulty again with the stacking blocks and they’re holding a crown really really loosely and not really pressing on the paper %HESITATION efforts some of our older kids who may be doing those kinds of things grading of force you know even holding a cop can they drink out of a couple of one hand or two hands or is it spilling because they’re going to fast or too slow and they can’t get it adjusting those movements pushing with a fork this is a big one that we work on we do a lot of self care are they spearing with a fork you know when they when they can get on top of the peace and then they’re pushing but it’s not enough are they learning how to push hard enough so that they can be successful right respond to you %HESITATION I’m touching that piece but it’s not working are the messages traveling up the arm into the brain going Hey you gotta push harder sent back out that border message to say okay go muscles go so those are some of the things just kind of functionally that you might see where well that could be and what else there is I mean there there are so many little things that we look for we you know we responses to light you know visual again beyond you know there’s the depth perception things if the kid stacking blocks they keep overshooting week okay well wait a minute that could be something more maybe we refer you to a developmental optometrist maybe it’s something where there’s something we’re where we actually need glasses to help with security but then we also can work on that visual processing and taking in the environment from a visual standpoint and hoping you create more clear visual you know understanding the visual representation in front of you %HESITATION sensory is an issue or a concern and so what I’m hearing from you is that when it comes to sensory there is the traditional sensory that we’re used to our custom to which is that sensitivity to sensory input but with kids with down syndrome there’s also the existence of lack of sensory lake at diminish sensory would you say that so went when we when we do see that pain threshold or things like that I want to diminish sensor but I would say it’s an under responsiveness to wheat takes more to hit a threshold a lot of kids have a higher threshold for pain a higher threshold for things where they’re not alone where until they get a lot a lot a lot a lot a lot of input niggle he’s right so that’s the other piece you know with those big strong hugs he may be giving that big strong hard because that’s the point where he can really feel his body turned on and so yes there is there is a spectrum of awareness within the sensory system and so that’s something that parents can you know just to put that information out there that’s something that you can also be aware of yourself and then start to seek an occupational therapist service therapies to support your child it’s not just the sensory in the fashion that I am accustomed to knowing about we can also get support in the under sensory to to work on work on those and that and put sensory has become this buzz word and I think that in particular because they’re oftentimes sensory components and you see some three differences in diagnosis like autism which has become prevalent and so you see you hear these things you hear it you know there’s all these buzz words and then parents one over diagnosed to kindle he’s still he’s he’s he’s sensory seeking he’s he’s always thinking is climbing and you go well wait a minute because you can’t spot me other cleaning but there is also an appropriate next to certain sensory B. he century seeking behaviors okay so we want to make sure that we’re not just past the holiday sing everything because it’s really easy to do that we don’t want in that pic on our kids just being kids we live in a hyper critical society everything is being scrutinized you know when you talk to your parents and things back in the nineteen fifties like I out whatever they were jumping off the roof top into the pool and now the parents go there seeking movement they’re looking he’s climbing so high right and I think that it’s so easy to palletizing go what’s wrong with my kids you know you know what let’s step back let’s look at is this impacting your child’s ability to function and sometimes when you’re over responsive and you are finding really quickly to things it it can impact function or it could just be your little hypersensitive do you know what I don’t like that Mr but it’s also not gonna restrict me and sent me into a meltdown or maybe you know what you’re a little unresponsive and you’re not quite responding as quickly in and be able to to create a response but it’s not out of the out of the range of normal normally quotes I don’t like the word normal but this range of within normal limits since it is a very therapy term so if you have concerns and evaluation does not hurt it doesn’t mean you are going to qualify for services it means that you were looking for support it means you are looking for an answer and I think that that’s all we can do is if you don’t have any answer look for an answer you’re a valued or may go you know what it’s a little off but I’ve noticed that they’re actually really participating nicely in these activities here are some things you can practice at home and I don’t think that this is necessarily like it’s not negatively impacting their ability to participate and so you know it and then you could go you know what this actually really is I can see that they get super stuff on there so they’re just so unaware of their surroundings or what they’re capable of doing that yeah and then it’s really impacting meal time or you know sitting here or participation at school or whatever it is %HESITATION so we can go either way but in a valuation never hurts if you have a question find an answer and I like that and I like that you you know bring to the attention that your your parents in the nineteen fifties would be just that’s just for the kids just a kid just to a person and there is that you know it says like technology there’s a certain part that take advantage of the technology that’s there how we’ve grown with supports and medicine and knowledge take advantage of that but then there is that element of he’s just a kid he’s just a human he’s there just you know that that be a part of that the personality we can’t just as they are we can’t just take away all of what what makes us us right and that’s it is negatively impacting and then we can get those supports that that we need help at what age can someone start seeking out occupational therapy really at first if it’s necessary within California and there are other states but you qualify if you qualify for regional center support either with a diagnosis at birth a child with down syndrome we’ll call for services you know there are certain things that are known that will need support it’s very likely they’ll have to go through an evaluation system but you can go to your regional spinner and apply for services they are free they’re state funded and %HESITATION basically what would happen then is the the regional center team when they’re evaluating him state have outside contractors like us will get valuations I’m from the regional center and for kids you know it really is technically zero three oftentimes it starts to look you know after three it’s a few months so that’s when you start to kind of look at those milestones %HESITATION oftentimes you know even though you have a diagnosis at birth you don’t really start to see kind of where things are being impacted until little bit later other than feeding feeding is something from the get go that can be impacted obviously you’re not looking at grasping and holding on to things that the primary occupation of birth essentially for instance is making sure that they can eat and if low tone is musculature if you know reflexes are not quite there that we have natural reflexes allow us to suck and swallow and breathe and those things sometimes need support you may see a feeding therapist %HESITATION you know oftentimes southern California at least that’s often times done by an occupational therapist or speech pathologist %HESITATION when it comes to swallowing you would see someone with an advanced practice %HESITATION teas are not automatically qualified to look at swallowing so for oral motor %HESITATION feeding we look at bringing to the house and manipulation within the mouth but you needn’t dance practice certification to look at swallowing it is in the automatic license %HESITATION of speech pathologist to look at the swap so just for your parents that aren’t really sure if they’re concerned about feeding you know obviously see your pediatrician they need to give you a referral we need a we we do need a prescription for an evaluation early on it would be probably feeding coming into you know three months for as we start to see kids holding on to things you start to see babies paying attention more to their to their heroes you’re starting to see more movement that’s early early kind of you want to see some rolling those things are likely to be a little bit to lead especially you know particular with with a child with down syndrome and so you want to kind of get out again get ahead of the ball and start working on those things knowing that need to work on strengthening we need to work on that stability in that postural piece you know getting in that time time can often be really hard because it’s a strain on those muscles it’s really challenging for typically developing babies that hate tummy tuck but %HESITATION though it usually it would be you know on the earlier side sometimes a bit later and that’s fine again like you said do it when you can but we oftentimes see when we have a clear diagnosis we know that our guys are probably going to need the support of T. P. T. early and and start really getting those muscles kind of working a little bit more you know with a little more intentionality that kind of naturally letting it happen yeah that’s great because I think that we need to just know and knowing what to look for and what to ask for because I believe with with Liam we didn’t understand because we did get the diagnosis ten days after he was born so we weren’t really sure what was required or what could be done or what might be a challenge so it’s good to take the information if you have a diagnosis beforehand or %HESITATION as soon as you get that diagnosis and start seeking out the supports and resources and these are the supports and resources that are out there for you and you can talk to your pediatrician and get the prescription and get the evaluations and and get that ball rolling and get the support that you need because I’ll be honest I don’t think we took advantage of that we have a phenomenal pediatrician that was really our guidance and she would she actually would be the the person to say no this is what you you need to get this evaluation this is what they need to and she was very she was she advocated for us before we know what application was as to empower us to ask for these things because I think another thing that happens to parents as they’re afraid to ask they don’t want to take a hand out they don’t want to be a burden they don’t there’s there’s so many just different feelings and emotions and thoughts that go into it that come from various places but this is different this is for your child and this is actually what’s out there because of research because of doctors and because of people who came before us so we know what challenges might be there and this is available and this will help and the early intervention the earlier the better absolutely I’m O. T. and school so when parents go into school there’s a difference between what the school provides as far as occupational therapy and what is if you were just going if we’re just going to go to Macquarie and seek occupational therapy for the different support can you talk a little bit about the difference between occupational therapy when it comes to school versus at home sure so it really comes down to you unfortunately comes down to funding source the school district is looking at all things related to a child accessing their curriculum accessing their learning environment %HESITATION when you come to see me in a clinic you’re probably gonna be coming through with your under three maybe regionals %HESITATION or private insurance and sometimes we get ours from a U. S. T. sorry Stephen the school district here it’s all USD and we then we need to kind of adhere to the school district’s guidance and perspective so within school we have to look at okay is this child able to participate in the classroom that comes down to more of those fine motor things like being able to you know engaging writing tasks and cutting tasks and sequencing a multi step craft or something like that using glue attention for a task like that look at engagement and participation in terms of sustaining tension to it to a task also sitting in a chair does the child have the pastoral support again we go to those Donna muscles the spinal muscles that allow a child to signature %HESITATION I drop my pencil I need to bend over and pick it up can I get up do I have the core strength to be able to sit in this classroom setting %HESITATION looking at access to the U. playground within %HESITATION tease you know domain it’s still it’s part of their learning curriculum as part of their learning space and we want to make sure that they can climb up the obstacle you know off the the climbing gym with their friends and and you know can they access those things more heavily though it’s really about classroom participation so school T. often you know also be around those fine motor tasks and coloring in and letter formation as you get older we really kind of you’re more into you know away from just participating in a multi step activity or attending to a teacher directed activity and then moving into actual letter formation letter alignment orientation on the lines cutting the online’s drawing lines imitation of strokes formation of shapes and things like that and as you get higher you move into those things sometimes with some of our kids end up working on typing you know if writing comes significantly challenging for a child again here’s an adaptation everything in high school they’re not gonna be here writing their papers they’re gonna be typing their papers when they get to college they’re gonna be typing their papers nobody wants to see a hand written asset so we don’t look they can write their ABC’s do they have a foundation of handwriting yes what is the speed impacting their participation is it taking excessively long does the strength of their hands you know impact how much they can write within a period so make we go look let’s work on typing let’s get those little finger muscles working in a way that’s going to make this more legible make you successful so there’s a lot of things but it’s really about targeting the academics and the school environment requirements in the clinic here Los Angeles when it’s insurance funded therapy what they want to see is that it’s called medically necessary and what is medically necessary %HESITATION typical that means that it is related to self care they don’t want to see the academics that is not medical that’s not the medical model at the academic model so we have more of an emphasis on things like dressing and self feeding and maybe oral motor progression for textures of foods things like that we work on hygiene handwashing sequencing of tasks again the more they stop activity from school might be color this cut it out glued on the paper a multi step tasks in the clinic might be turn the water on get wet get the cell rub your hands turn it right so what we do essentially is %HESITATION tease no matter where your therapy is happening and who your funding source is as we do what’s called the task analysis which is essentially a breaking down of the task we look at the sub parts and instead of just wash your hands we go let’s look at all the little teeny tiny steps and break it down to help us okay great you can turn the water on all by yourself what do we need to do next right and we need to put our hands on %HESITATION and we’re going to count to ten how in this age of pandemic we count longer but it’s breaking up those stops and helping them get through a task more independently things like traffic you know it’s not just putting on or taking off her shirt and then once we can do individual pieces we sequenced them let’s put an outfit out and we can help you work through a multi step again and that’s attention box standing on attention following through with the task for feeding feeding the big one that we get it is you can still use it is oral motor to you a minute to like different textures of foods crunchy salads she we solids pureed sometimes it’s harder for a child to manage puree and mix textures you know so it’s really more it geared towards self care and also we incorporate the sensory processing the strengthening all those foundational pieces but it’s again we have to look at the the the big picture of a function in an occupation while we do those things is a straw about her for drinking to to strengthen that mouse and say it was a sports cap with the little sports cop on it would does both work to strengthen the mount there is one more conducive well with the strong you’ve got your lips pucker around it and you got a stock that that section is also using her cheeks %HESITATION when sports top you’ve got your lip pucker so I like that but you kind of Tibet so it just kind of bills in your mouth but maybe doesn’t feel in your hand a little bit to sweets so there is no right answer on it that looks at your drinking vessels the one thing I will tell you parents who have babies or toddlers who have gone from a bottle or breast and are now going into some really cups I will tell you that a Sippy Cup the spout Cup that comes off the edge %HESITATION that you kind of sit back not a strong but that like the spout cops are not a developmental milestones they were invented for parents on the go so they they went still but a child should go from breast to bottle too strong open cut there are lots of different stock ups now there are lots of different kinds there are some that don’t still we go and have a nice closure on you know on top and I as a pure clearly support using the toilets built but if you’re really looking at the wall motor development of your child you want to skip the stock the stock actually does not do anything to move your child support this content okay so and that was just a step backwards it just came into my mind we’re talking about self care we’re talking about all the different developments I thought that that did that question personally actually came into mine so it’s about working as a team so occupational therapy is there that would be a support and a part of a team to to help %HESITATION with your child when it comes to you know you have your your at your curriculum but you there’s certain things like cutting a piece of paper hold themselves like writing things there’s there’s certain like we I know Liam works is with his occupational therapist right now on I had an adaptive mouse to be able to actually navigate distance learning and and he couldn’t do it at the beginning the year and then we had a conversation and but by having that mouse and having the occupational therapist to work on that skill now it opens up the whole window of distance learning he can go on to the site he can he can click on his exercise see %HESITATION what is a Simon as he can and he can participate well it goes back to that function and an occupational therapy so this is his occupation his job right now right at this job what is it his role it is our role as we move through the day when he is doing is learning as a student absolutely and you were a teacher and they’re and they’re going to go Aaron we want to thank you so much for your time and for the wealth of your knowledge and this is definitely something this information that you’ve given us is something that I wish I had when lamb was born and I hope that it serves to empower up left and also alleviate you know at a little bit of worry and concern for our listeners well it’s it’s really my pleasure it’s been an honor I I appreciate you having won the platform it’s great that you guys are using your circumstances in your life to spread the wealth and to empower other parents and families and caregivers %HESITATION to really see what is possible you know I get for both because I think there’s passion between behind what I want to convey and I want to give you as much as I can %HESITATION without boring you with the nitty gritty of like the little neuromuscular things that happen but it’s really it’s fun for me to talk about what I do because I think that there is %HESITATION it it’s important and I want to make change and I’m someone who is trying my best to use what I have to help others and integrate what I have with what I’m learning from other disciplines and I just hope I represented other people other areas that I might have spoken on appropriately %HESITATION and I really I thank you for having me on it’s been it’s been fun it’s been a lot of fun is it a great morning I know I have I appreciate the nitty gritty because part of it is just getting to understand even the pro prefer section like that to me just to know that they %HESITATION this is an actual term behind all of the perception and the lists and and the words that are given to us at the core of that is the truth or where it begins and if we have that seat then we can we can plant it in any foundation that we want you know we don’t have to take take what it grew into for other people for other doctors or other professionals or whatever it meant in history in time we can take what that seat is and we can plant it now with everything that we have present in this day and all the beautiful resources and examples and we can make it something new so I love the nitty gritty of what’s committee gritty seats in a profession of possibility I love it I think we have something there Aaron again just such a wealth of knowledge we thank you for being on the show again thank you.

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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