Occupational Therapy Consulting, LLC


Glass half full

Wonder-ful Autism

Today is World Autism Awareness Day, 2012 and while I’d like to think I have lot’s to say about autism, to help others understand it, I pale in comparison.  There are so many other fantastic places out there that people can go for information.  I came to the conclusion, I would serve readers best, by sharing some of these other sources..  Below are places you can go to find out more information about autism, find helpful resources, or become a donor, to help find a cure.  What I can tell you about autism, is that I used to be afraid of it.  Before I worked with kids who have autism, I didn’t understand it.  Ironically, I was afraid I’d feel useless and not know what to do around them.  I have always used my relationship with my clients, regardless of age, to help them and work with them more effectively.  One of the main things people with autism struggle with is social relationships.  Imagine my uncertainty.  But through circumstances at the clinic in which I was working, my first individual client, had autism.  And he was WONDERFUL!!!  He made significant progress.  His family was WONDERGUL!!!  They helped me make significant progress.  And together, we worked on a weekly basis.  What I learned is that Autism really is just a part of who that person or child is.  Autism changes every part of a person’s experience.  Autism is complex.  Autism can make life complex, for those who have autism, for those who love someone with autism, and for the work I do with people who have autism.  BUT…the energy, smiles, emotions, desires, and actions of a person with autism are intensely pure and can bring joy like that of a person or child without autism, and beyond!

For more information about Autism go to Autism Speaks 

Locally here in Frederick, you can contact TACT or the local chapter of the Autism Society of America.  Both organizations have some WONDERFUL people working with them (my word for the day seems to be “wonderful”).

Now…watch this (and have a WONDERFUL day!)

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1-2-3 breathe

My word for the week is “breathe”…

Typically we don’t need reminders to breathe, as it is an unconscious action controlled by the brainstem.  It is remarkable however, the impact that deeper breathing can have on one’s thoughts and actions and the role that deeper breathing can play in one’s ability to function.  I have taught what I call nose-mouth breathing to people of all ages, including young children ages 5 and up and elderly people aged 85 and older.  My reasons for working with these various people have been different (obviously given their ages), but my intended purpose for teaching this breathing technique is always the same; calming, energy conservation, and control.

The technique goes simply like this…”breathe in through the nose and out through the mouth”.  Try it.  It sounds simple right?  Not so much.  Many people actually breathe only through the nose or only through the mouth and when asked to follow this “simple” in through the nose out through the mouth sequence, they struggle.  That said,  if one is able to master this sequence, it causes them to take progressively bigger breaths in and bigger breaths out, which results in slower breathing and ultimately a slowing down of the heart rate and thus a decrease in energy expenditure and an overall calming response.  One tool that OT’s (and other disciplines) use to measure oxygen levels during completion of daily activities is called a pulse oxymeter.  If you’ve ever gone to the ER or an Urgent Care Center and had a little clip with a red light attached to your finger, you know to what I’m referring.  The pulse oxymeter usually also measures heart rate.  Breathing and heart rate are (not surprisingly) linked and are both regulated by the brainstem.  The brainstem also helps to regulate arousal and consciousness and provides the main motor and sensory innervation to the face and neck.  In fact, all sensory and motor nerves to the main part of the brain pass through the brainstem.  In this way, breathing and the changing of how we breathe can impact everything we do and how we experience the world because it is connected to all systems of the body at a neurological level.

Those who do yoga know that breathing is essential to getting the most out of the practice (and life).  Research now validates what yoga has been teaching people for many years.

Esther Sternberg is a physician, author of several books on stress and healing, and researcher at the National Institute of Mental Health. She says rapid breathing is controlled by the sympathetic nervous system. It’s part of the “fight or flight” response — the part activated by stress. In contrast, slow, deep breathing actually stimulates the opposing parasympathetic reaction — the one that calms us down

As an OT I continue to teach deep breathing and nose-mouth breathing.  I use it with adolescents who have a history of trauma and abuse because they very often get triggered into a panicked state, similar to PTSD.  Through use of a pulse oxymeter which gives them an immediate heart rate and shows them numbers they can use to see their oxygen levels, they can learn to monitor and change their stress response.  I use nose-mouth breathing with younger school-aged children who have low frustration tolerance and high anxiety levels.  If they are cued to breathe in through the nose and out through the mouth, and often if an adult does it with them they mirror what they see, and they can learn to decrease their reactivity and then verbalize what they need or what is bothering them.  I have used nose-mouth breathing with adults who are experiencing panic attacks.  Explaining the basis of breathing and that fight-or-flight response to them, along with giving them a tool they can use and practicing it when they feel the onset of symptoms, helps to empower them and give them confidence that they can master another episode at any time of day, should it arise.  Nose-mouth breathing has been an effective and simple tool, along with other interventions, to help my clients young and old, take control when their lives and most basic functions feel out of control. And who doesn’t like to breathe?!  I know I’ll take all the “breather’s” I can get.

Fidget or fun?

The word “fidget” has come across my radar multiple times this week, and while the word itself doesn’t sound inspiring, the difference it makes for those who need it, really can be.  To help highlight the significance of this little word, I give you some background or context as to why it holds such relevance for me in my practice.

One role I play as an OT, is to help establish “sensory diets” for the kids with whom I work.  A sensory diet is exactly what it sounds like…making sure a child gets their daily requirements of necessary sensory inputs to fuel the brain and body, to optimize function or health of the nervous system.  Every person has individual preferences and needs for certain types of inputs, based on their individual neurological systems.  Some people need more movement, some people need more sound, some people need more chewing, and some people prefer to touch everything they can get their hands on. The theory is (and I’ve seen it work) when a person gets the inputs they need, their nervous system is more organized and efficient and that person can function more optimally to meet the demands of what is going on around them, whether it be work, school, conversation, or reading a book.  Case example, one young boy I worked with had difficulty staying awake at school but when he was awake spent much time touching other people, invading their space, and/or touching their belongings.  He was constantly seeking food or drink and the ongoing requests for snacks or walks to the water fountain became disruptions to the classroom routines and the learning for other students.  Not to mention the negative social interactions and aggression that ensued, when this boy invaded other people’s personal space and belongings.  In OT, we implemented multiple activities for him to do at school at various intervals throughout the day, such as use of a bite and suck Camel Bak water bottle (see previous post), trigeminal face-tapping 2-3x/day, use of an inflated seat cushion, chewing gum, use of therapy putty to squeeze, regular walk-breaks, and use of deep touch pressure in the form of a steam roll, as often as could be provided.  This young man no longer falls asleep on the floor, he is able to complete approximately 80% of his written work vs. refusing all of it, he remains in class x approx. 20 min’s at a time vs. 5 min’s and while he still seeks food and drink and touches other people way too often, he has decreased those incidents by nearly 30%.   While this boy has received multiple interventions in addition to his sensory diet including medication, therapy, and behavioral incentives, he is now able to ask for the input he desires or needs, and clearly changes his ability to participate in class, when he is using them.   This boys “sensory diet” included fidgets, which helped him meet his daily needs of various sensory inputs.  Fidgets can be like little snacks throughout the day that prevent us from needing a larger meal or tide us over until it’s time to really eat.  By tuning into our small activities that help us focus or “feel better”, like fidgeting, we can begin to help ourselves function better in multiple environments and for kids with problems of attention, offering fidgets can be one way of helping them learn to manage some of the more difficult tasks they face.

Many people are familiar with the word “fidget” as a verb, meaning to move around nervously: to move around in a restless, absent-minded, or uneasy manner (Bing dictionary).  But in my (OT) world it can also mean doing an activity that uses a sense other than that required for the primary task (think doodling while talking on the phone, clicking a pen while giving an oral presentation, or listening to music while doing homework or reading the newspaper).  According to Sydney Zentall, Ph.D., fidgeting can enhance performance in children with ADHD. A great overview on use of Fidgets: Toys or Tools can be found at KidCompanions blog.  They reference several books that are now on my work list of books I want to read.  If a person shows a need for fidgeting, putting something in their hands to hold, manipulate, feel, or play with, could actually improve their concentration.  In the case above, the young boy I worked with was able to improve his class participation by adding things he could do at the same time as his classwork or lessons (water bottle, chewing gum, therapy putty, wiggling on the seat cushion).  These types of inputs likely work because our sensory systems are all designed to work together simultaneously and spontaneously.  When one sensory system (or several) are not doing their job(s), the brain and body struggle to make sense of what’s going on around us or to figure out how to automatically respond.  Thus some people (and many of the kids I work with) seek out more input.  It is the nervous system’s inherent way of getting the input it needs to make sense of the world.  A child who is touching everything, may be looking for more touch input.  A child who is constantly moving, may need that movement to get more information about where he is in space.  If holding or playing with something in the hands gives more input through the sense of touch and the small movements of the fingers and hands, why not use it?  If it becomes a distraction in and of itself, that item clearly isn’t meeting the need and other options may need to be explored.

I talk with teachers, parents, and direct service staff about how to use “fidgets” appropriately, all the time.  Unfortunately, people assume that giving a child a “stress ball” will limit temper tantrums, and is in and of itself a “sensory diet”.  This is not the case.  My general approach is to use fidgets as “helpers” and small doses of increasing the tactile input a child might get throughout the day.  If a child reaches the point of being so upset or so distracted that they are aggressively interacting, or they have already created or engaged in a power struggle, we’ve missed the opportunity for a “fidget”.  Small hand-held items are not going to offer the intensity of input that child needs to re-organize.  Additionally, there are kids who look like they are “seeking” extra input when in fact they are looking for ways to self-calm, and so identifying the root of why that child is moving around so much, becomes the primary task.  If the fidget isn’t working, a referral to an Occupational Therapist trained in sensory integration, may be in order.  It’s not the fidget that failed, there may be underlying sensory processing problems that need to be addressed in order for that child to improve their function.  Carol Stock Kranowitz (author of “The Out of Synch Child”) writes in her blog, about look-alike conditions such as SPD & ADD, and gives an overview of the sensory diet concept.

Locally, The Dancing Bear Toy Store, is one source for many enticing and developmentally appropriate fidget toys, like stress balls and magic mud.  Online, Fun and Function  offers many fidget options like squoosh pets, therapy putty, and theraband.  Parents can likely find many fidget options at a party store near them (finally a use for those trinkety little party treat bag toys I routinely throw in the garbage).  Use of fidgets within the context of a sensory diet can make a significant difference for people with sensory processing and/or challenges of attention and for those without significant attention problems, can serve to make things, just a little more fun!  Who doesn’t want that?!