Summer Work at ESY

Summer Work at ESY

For the past six weeks, I’ve been working as a teacher’s aide at a special education school district in their extended school year (ESY) program. Within this position, I’ve been in a classroom of five students between the ages of 9-11 years old. I have learned a lot in the past six weeks and I’ve been able to apply an occupational therapy lens to my interactions with each of the students. I want to take this time to reflect on my learning experiences in hopes of looking back at this summer with a full cup of knowledge.

To begin, I’ll describe the type of classroom I was placed in (with anonymity for privacy’s sake). Four of the five students were non-verbal. All five children wore diapers. Two of the children required feeding tubes. One of the children needed every meal to be pureed. One of the children carried around a bucket for frequent incidences of throwing up. One child recently learned to walk and wore MAFOs (modified ankle-foot orthoses) for gait support. One of the children wore hearing aids. One of the children grinded their teeth continuously throughout the day. One child frequently hit, pinched, and grabbed hair.

All children were mobile without assistive mobility. All children received PT, OT, and speech. Four of five children loved tactile play (i.e. sand, slime, shaving cream, water play, etc). Four of five children fed themselves – the other is feeding tube limited. Four of five children completed lower body dressing with verbal cueing.

Upon arriving in the first week, our classroom faced a huge learning curve. The teacher had a new class of kids as they had moved up to the “big kid” classrooms/teachers; therefore, all four staff members assigned to the classroom had to learn the children quick. On the first day we had a field trip (that’s one way to learn quick) to a nearby sprinkler park. Within the first week we started to learn what the kids liked/disliked to eat, their sensory needs, their behaviors, and their weakness and strengths. I remember feeling slightly overwhelmed trying to learn their personalities and abilities. With time, the overwhelmed feeling started to subside.

I not only had to learn about the children but also the teachers’ expectations. Every teacher wants their classroom ran a certain way and their students to behave in a certain degree of discipline. Expectations became pretty obvious within that first week!

I started to apply an occupational therapy lens once I started feeling more comfortable with the kids and expectations of the children. I tried turning our everyday routines into opportunities for occupation-based interactions.

During the first week of school it was obvious that one child (named, “P,” for anonymity’s sake) had no clue what to do when they got to a closed door. So, for the first few days I showed P how to open the doors (push the bar in and push, or rotate the handle down and pull) with hand over hand assistance and verbal cueing. There were many instances throughout the day in which we could practice this task (walking into the bathroom, walking down to the nurse’s office or to get lunch, walking out to the buses). Within a few days, hand over hand assistance was faded. Verbal cueing remained, but eventually P learned that upon approaching a closed door, P could open it.

For the weeks following, we tried teaching P to hold the door for the people behind them (this is something that still needs to improved). My suggestion was to have P be the line leader but then hold the door for everyone else in the class as they pass through the doorway. Again, this is still something that needs to be worked on once the 2019-2010 school year commences.

Additionally, P refused to put their backpack in their cubby upon entering the classroom. With physical guidance and LOTS of verbal cueing, I am happy to say that in this last week of ESY, P can put their backpack in their cubby independently after one verbal cue. What a day that was!

P also started ESY with total dependence for lower body (LB) dressing. P refused to LB undress and dress during toileting and needed hand over hand assistance with verbal cueing. Again, I am happy to say that in this last week of ESY, P no longer needed hand over hand assistance for LB dressing (still required max verbal cueing).

P does not know how to zipper/unzipper their backpack independently. I noticed a lack of pincer grasp development with P. To adapt the backpack’s zipper, I attached a loop of yarn to the zipper in hopes of providing P a larger surface area to grab with an alternative grasp (perhaps a palmer grasp?!). As the summer program ends, this skill is not yet developed for P; however, I am hopeful that the adaptation will promote independence in the future.

Another child (named “R”) would begin to cry when seated if their feet could not touch the floor or could not sit cross-legged (signs of potential gravitational insecurity & poor core strength). During assemblies in which R needed to sit on skinnier and higher lunch table benches, R would cry and repeatedly try to move onto the floor. In the classroom, R could be observed sitting cross-legged on their chair the majority of the day. Upon moving R to a chair of a smaller width or lower height, R would still try to move to the ground to sit cross-legged. R also strongly disliked sitting on the toilet during toileting, requiring staff to hold him securely on the toilet seat. With all of this in mind, I theorized that R had decreased core strength/endurance; therefore, requiring a larger base of support provided by sitting cross-legged or distaste towards seated positions in which the cross-legged position was impossible (i.e. toileting).

Furthermore, R constantly grinded their teeth. In the first week, I theorized that R might be grinding for sensory reasons; therefore, I suggested providing sensory stimulation on R’s cheeks using a vibrating bug. This, however, did not resolve the issue. Still to this day, I am stumped as to how to decrease the grinding. Perhaps, in the future I will learn a method for limiting this behavior. Suggestions, anyone?!

R often enjoyed playing catch with me during our free time. To increase social interaction skills, I would often wait for R to make eye contact with me before throwing the ball back to them. Some times I would wait 30 seconds before R would make eye contact. I simply wanted to promote social skills by playing with R in this way.

Another child (named “D) often hit, pinched, and grabbed hair – especially during instances of loud, sudden noises. After analyzing the antecedents to such behavior, our classroom staff recognized that the hitting/pinching/grabbing was D’s way of communicating they wanted deep pressure and/or that D was startled. After a child hits/pinches/grabs, it is our natural instinct to “restrain” the child to prevent further hitting/pinching/grabbing. “Restraining” results in deep pressure; therefore, D had learned from previous experiences that when they hit/pinch/grab, they will receive deep pressure. To prevent such actions, we integrated a sensory diet of sorts. I often provided deep pressure to their upper extremities intermittently throughout the day. We would put D’s weighted vest on after lunch. I would also take D for walks in the hallways for the D to receive deep pressure sensory input through their feet. As the summer progressed, the hitting/pinching/grabbing became less frequent and we were able to pick up on instances that might trigger such behavior.

Another child (named “M”) was repeatedly observed removing their hearing aids when loud noises were occurring. In response to this behavior we taught M to cover their ears when loud noises occurred. This seems like a simple solution; however, for children with developmental disabilities this is something that needed to be taught and demonstrated. By the end of the summer, M knew to cover their ears; however, there are still incidences when M would remove their hearing aids instead of utilizing the alternative method to reducing auditory input.

At the beginning of the summer, the girls in our classroom did not know how to utilize the paper towel dispenser in the bathroom. With hand over hand assistance and verbal cueing, slowly but surely the girls learned how to operate the paper towel dispenser (push the “lever” in multiple times, then rip the paper towel off). Again, this seems like a simple task; however, it is an essential part of the hand-washing process. All the girls now how to push the lever now and do not require hand over hand assistance; however, one girl still needs hand over hand assistance to rip the paper towel off the dispenser itself.

Throughout the summer, we went on three field trips – the sprinkler park, the bowling alley, and the zoo. At the sprinkler park (on the first day), it was overcast and somewhat chilly. The one child simply wanted to walk the perimeter of the area, barely getting wet. Other children were observed absolutely loving the spritz of the water and various sprinklers. A true sensory experience!

During the bowling trip, our class (and most of the school), utilized the bowling assist ramps. With hand over hand assistance, we helped them carry the 6lb balls to the ramp. Once placed on the ramp, each child independently pushed the ball down the ramp. Some of the kids even had fun in the swivel chairs!

At the zoo, the kids in our class didn’t find much enjoyment looking at the animals even the big animals that were close up. Instead, they found enjoyment feeling the fences as we walked throughout the zoo. Honestly, I loathe the zoo so this wasn’t the best environment for me to keep my occupational therapy hat on. More appalling to me was the crowds within the zoo who weren’t always the most aware of who was walking near/around them. With unsteady walkers, it was important for me as a field trip chaperone to make sure adults weren’t bumping into the kid(s) I was walking with. I wish that people in crowded, public places were more attentive to their surroundings!

Most of the school assemblies this summer were music-based. My favorite assembly of the summer was a sports team drumline. Our one student was frightened each time the drums were pounded so I provided continuous deep pressure to their hands to help calm the child throughout the duration of the assembly. The drumline did a great job including the kids throughout the assembly and even allowed them to use the drumsticks to bang on the drums.

With my occupational therapy thinking-cap on throughout the summer, I also took notice to things that I wish the school would change to better the environment for the students. The classroom I was in constantly had music playing which for some of the kids was a constant auditory distraction. Once the screensaver for the computer would appear on the SmartBoard, a few of the students would instantly become visually distracted by the colorful orbs rotating on the screen.

In the weekly combined gym class (two classrooms, one gym teacher), the gym would be extremely loud causing some children to experience a meltdown because of overstimulation. Some kids wore noise-cancelling headphones; however, I believe more kids could have benefitted from wearing them.

I took this entire 6-weeks as a learning experience. I wanted to gain more experience with the pediatric population in a school-based setting as I feel my Level I fieldwork experience was too short to truly get a full understanding working with this population in this setting. Being immersed with the population in a school four days a week for six weeks was highly beneficial to my continued learning and comfort level with this population.

I learned that it takes time and patience to understand how non-verbal children communicate. Observation skills are imperative! I’ve learned to be aware of body language and behaviors that are communicative in nature. I’ve learned that one day a certain behavior might be communicating something different than the day before. It takes patience and persistence to truly understand how a non-verbal child communicates.

I also learned that every child needs to be given a chance to be independent. Before doing something for a child or helping a child do something, give them a chance to do it themselves. If they don’t take action, provide assistance. They might be more capable than you think so don’t jump to conclusions and always give them a chance.

Furthermore, positive praise is critical in some cases but sternness is also essential. I’ve learned that discipline requires a firm tone of voice and consistency. I’ve acquired a “teacher’s voice” in the last six weeks. It’s important to speak clearly when giving directions and setting expectations. Speak firmly!

I’ve also learned that ESY is EXTREMELY laid back. I’ll be honest, not a lot of academic learning has occurred in the last six weeks. A lot of general life skills have been taught but other academic-related things have lacked. It’s frustrating from an occupational therapy perspective to see so many staff members on their phones or distracted by their own personal drama. Most of the days, I found myself playing with the kids trying to teach fine motor skills, play skills, or social skills. I would give the kids puzzles to play with or blocks to build. I would keep them as occupied as possible during the hours they were technically supposed to be learning.

In reflection, I’ve enjoyed seeing the kids progress in their general life skills. I got overexcited the day I saw a child complete lower body dressing without my assistance. I got overexcited when a child independently walked over to the paper towel dispenser and pushed the lever in order to dry their hands. I’ve enjoyed giving a child sensory breaks with the vibrating bug and allowing them to feel the vibrations on their cheeks, head, ears, and hands. The pediatric semester last spring helped shed light on the sensory needs of this population and I am glad I got to apply my knowledge throughout ESY.

I’m still pretty confident that this population isn’t a population I want to work with full-time. In the last six weeks I’ve seen how the school system is “broken”. I’ve seen the drama amongst staff members. I’ve seen how much patience is required to work with this population. I commend teachers and teacher aides for working with this population as a full-time career – it can be exhausting.

This setting and population may not be for me as an aspiring occupational therapist, but the experiences and opportunities from the past six weeks have given me irreplaceable knowledge and learning that I will never take for granted.

I’ll be sad to send these kids off on the bus at the end of the day tomorrow but I will remember these kids for many years to come. I hope that I can read back on this blog post in the future and remember that the little things can be the most critical steps for increased independence – the occupational therapist’s primary objective.

 

 

 

 

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Reality.

Reality.

I haven’t blogged in over two months. Mostly because I feel my life is the farthest thing from exciting. I’m working three jobs, barely enjoying running/cycling, and not going on any vacations.

Everyone else right now seems like they’re having the time of their lives on summer break. Here I am dealing with kids putting their hands in toilet bowls and puking. Far from being a glamorous summer.

I spend the weekends working for tips to supplement minimum wage. At least with that job, I’m working with individuals over 21 years old and toilet bowls and puke are kept for the aftermath of drinking too much wine (long after they’ve hopefully tipped me).

The third job is for our family business as I oversee social media platforms. I work tirelessly to promote events, engage a community of runners/cyclists, and bring customers in the front door. It’s pretty easy work but it can get time-consuming.

I’m just trying to offset the inevitable debt of grad school. I question how everyone else can go on week long vacations in far off lands. Maybe they don’t care about debt. Maybe someone is supplementing their bank accounts. Maybe they have some top secret connections for discounted excursions. Whatever it is and however it’s possible for them, it’s not possible for me.

Don’t get me wrong, I’m grateful for the days I get to spend with Josh, friends, and family. Josh & I both are simple people so we don’t need expensive vacations or international travels to fulfill our existence this summer. Honestly, we just enjoy taking a half mile bike ride down to the river to watch the summer glow of the sunse, taking a morning to spend out on our favorite nearby trails, or visiting our favorite Main St rrestaurants during happy hour.

I know it’s imperative to remember that social media is often a highlight reel. If someone else can live so freely that their summer is one neverending highlight reel, go get it.

I’m going to keep working, striving for supplemental incomes, dealing with toilet bowls, puke, wine, and marketing (not simultaneously though), and enjoying my spontaneous sunset bike rides.

This is my summer.

Race to Save the World 10k Race Recap

Race to Save the World 10k Race Recap

A few Saturdays ago Josh and I raced the Enoch Lee Race to Save the World 10k at Middle Run Valley Park in Newark, DE. A week before the race, while on our way to go mountain biking, Josh and I saw one of those yard signs (the ones politicians usually use) advertising for the race so we quickly Googled it to gather more information. A few days later, Josh convinced me to pre-register for the race as a way to celebrate the official start of my summer break. Although I knew I was no where near in race shape after a stressful semester of grad school, I figured it would be fun. After all, the course looped through some of our favorite trail running trails.

Saturday morning arrived and I ate my typical pre-race meal – peanut butter and banana on toast. The race began at 10 AM so we were able to sleep in a little bit and prepare for the day ahead of us (which we planned out to be a 10k race, followed by brunch, followed by a group mountain bike ride through the same trail system). We departed Josh’s around 8:30AM with race attire, mountain bike gear, and two mountain bikes.

My stomach was a bundle of nerves on our drive to the race. Multiple times I told Josh I felt like I was going to throw up (disclaimer: I never did). We arrived an hour early to the race, picked up our bibs, and waited anxiously for 10 AM to arrive. The morning was chilly and I felt unprepared with the clothing I had packed – shorts and a tank top. I scavenged up Josh’s arm sleeves and swapped out my tank top for a short-sleeve racing jersey. Josh paced around the truck and opened and closed his truck doors 5000 times.

Around 9:30 we decided to do a 1 mile warm-up. I was still a little chilly and my legs felt unprepared but by the time we ended our warm-up, I had decided to leave the arm sleeves in the truck. Better to start the race a little chilly, knowing I was going to warm up eventually.

Before the race started, the cadets from the University of Delaware (UD) did a flag ceremony and a group of women from a local church sang the National Anthem. It was Memorial Day Weekend so this was a nice touch to the morning. A family member of Enoch Lee, whom the race is memorialized for, made a brief speech explaining that race profits contribute to a scholarship for a biology major at UD. As a broke college student myself, I know how important scholarships can be!

The race started with a small loop around a grassy field before diving into single track. I started comfortably, not wanting to overexert early but also knowing that I needed to beat some of the crowd to the single track. I could see Josh up ahead at the front of the pack – go, Josh, go!

A lot of the race itself was a blur because the trails just kind of blend together. I knew that two women were ahead of me but didn’t have any intention to work to go catch them. The course terrain varied from smooth twists and turns to longer uphills to rewarding downhills. The trails were in great condition!

A local Delaware bike shop was stationed at the approximate half-way point with water and encouragement. It was nice to have people cheering out on the course as most of the course was isolated from spectator view. Trail runs are rarely spectator-friendly. After the water stop, there was a long uphill. It felt soooo long and I could feel myself progressively slowing as the climb continued. I probably could have walked faster, but I trudged along, my breathing becoming increasingly labored.

At the top, we were rewarded with flat, twisty single track. At this point, I was completely alone on the course and I couldn’t see anyone ahead of me and couldn’t hear any footsteps or breathing behind me. I just continued trudging along.

I didn’t recognize where we were in the trail system at this point in time even though Josh and I frequently mountain bike on these trails. The course followed trails we hadn’t looped through in over a year so I was completely disoriented.

Eventually the course landed us on my favorite downhill in the whole trail system. I was familiar with the downhill from mountain biking it and I knew exactly where the course was taking us!

After the downhill we made a left onto a long bridge and one of the race volunteers said “there’s a women not too far ahead of you”. That literally meant NOTHING to me. I was completely gassed. I hadn’t seen anyone ahead of me since about mile 2 and I definitely didn’t have the legs to go catch someone. So, I dismissed the comment and kept trudging.

I heard footsteps behind me and my gut told me it was probably a woman (note: I don’t look back ever during a race so I never know who might be closing in on me). The course crossed a stream (which I ran straight through, soaking my feet – no problem though, I wear the Altra Superiors which have optimal draining capabilities!). The person behind me, confirmed to be a woman once she asked me a question, asked “how much further?”. To this I said, “I have no idea”. Because 1) honestly, I had no idea where the finish line was in relation to where we were currently and 2) I don’t ever look at my watch during a race so I never know what mileage I’m at.

She ran right on my heels for 3/4 of the final uphill. For a second, I tried brainstorming ways I could get her off my heels (i.e. by sprinting up the hill) but I had no energy whatsoever to run faster than I was. I was simply in survival mode. My endurance meter had reached a big fat zero.

She eventually passed me and I felt bummed, knowing I had held 3rd overall female for 85% of the race. But I had nothing in me to try to physically react. So she trotted off, gapping me almost instantaneously. My only intrinsic goal was to keep running, no walking. And that’s what I did. Kept running until I crossed the finish line.

Once I got the finish, Josh offered me a cup of water. I stared at him and said “I’m at zero”. My endurance had expired around mile 5. The last mile was a slugfest. I probably could have walked faster but my own pride kept me running. We replenished with Gatorade we had brought and recapped our races.

Josh finished as the 1st overall male, 2nd place overall (figure that one out for yourself). He also had ran out of endurance which is to be expected considering he had only been running once or twice per week, not exceeding 3-4 mile runs (#naturaltalent). Regardless, I was proud of him. His natural ability to run fast amazes me time and time again.

I finished in 55:38, 18th/58 overall, 4th overall female, and 1/1 in my age group. Josh won a sweet travel coffee mug and a wooden phone holder (which he promises me to video chat with so he doesn’t have to prop his phone up awkwardly). I won a medal and some great S&S exposure.

I am glad that I did this race. Grad school had left me craving trail runs and races and, in a way, starting off summer break with a trail race was symbolic. Grad school requires endurance just like running. This race reaffirmed that I can be a grad student and a runner and be happy. I might not have as much endurance as I did last summer and the trails may challenge me even more so, but they will always be there for me to enjoy and for me to find bliss, serenity, and a welcoming running community.

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Occupational Therapy Month: Zones of Regulation

Occupational Therapy Month: Zones of Regulation

“Z” is for zones of regulation!

Zones of regulation is a method for teaching self-regulation skills. It is often used with the pediatric population for children who may have difficulties recognizing and controlling emotions.

There are a total of four zones – red, yellow, green, and blue – each of which correspond to specific emotions. The zones allow a child to identify how they’re feeling, how their behaviors might be affecting those around them, and how to manage/self-regulate how they are feeling.

OTs can teach and enforce use of the zones of regulation for children who may benefit from interventions addressing self-regulation. Teachers can implement it in their classrooms to promote carry-over and parents/caregivers can be taught its benefits to manage behaviors within the home environment.

This is the final day of ABC’s of OT. I hope that you’ve learned at least one thing from reading 26 posts related to OT. As the semester winds down, I hope to post a recap of the semester at some point….stay tuned.

Occupational Therapy Month: Xbox Controller

Occupational Therapy Month: Xbox Controller

“X” is for Xbox controller – the famous adapted Xbox controller that premiered during this year’s Super Bowl.

If you haven’t seen the commercial, watch it now with the link here. This controller was adapted with the help of an occupational therapist for video game players, of any age. For individuals with limitations in upper extremity range of motion or upper extremity amputations/congenital deformities, the adapted Xbox controller provided an inclusive way for individuals to engage in gaming.

I recommend you watch the video link to get a better understanding of just how important this adapted Xbox controller can be! I’ll let the video do most of the talking today. Enjoy!

Occupational Therapy Month: W Sit

Occupational Therapy Month: W Sit

“W” is for “w sit”!

This is something OTs advocate and educate against! “W” sitting, as seen in this classic picture of Brittney Spears (LOL), is a big no no for developing children.

W sit

The w sit is a sign of poor postural control for children. An increase in the base of support by sitting in the w sit position helps to counterbalance poor postural control; however, sitting like so will prevent continued development of essential core muscles. Additionally, w sitting puts unnecessary stress on the joints and can lead to other problematic developmental areas.

Pediatric occupational therapists can strengthen core muscles in many ways through playful interventions with children that promote improved core, better sitting positions, and postural control.

Moral of the story: don’t let kids sit like Brittney Spears.