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.

 

 

 

 

Occupational Therapy Month: Vision

Occupational Therapy Month: Vision

“V” is for vision, specifically low vision.

OTs can address low vision across all populations. There are many aspects of vision beyond the scope of 20/20 visual acuity. Vision also requires cognition. Are we able to see the change from carpet to hard wood flooring in our homes? Are we able to see each step going up or down the stair case so we don’t fall? Can a student copy what’s written on the board at school without teary eyes (fatigue) or pain? How sensitive are one’s eyes to light? Are both eyes working together? Vision is all-encompassing and there are SO many aspects that go into what we see and perceive.

So as OTs, we can help to strengthen the eyes to minimize fatigue. We can provide compensatory strategies via in-home modifications to prevent falls (putting bright colored tape at the edge of each stair to make each stair distinguishable). We can educate teachers on strategies to promote success in the classroom so a child can go through the school day without getting a headache.

Because occupational therapy is such a holistic field of health care, all of these components are within our scope of practice which is super exciting to me!

Only a few more letters until the OT alphabet is complete!

Occupational Therapy Month: Universal Design

Occupational Therapy Month: Universal Design

“U” is for universal design!

Universal design is a term to describe an environment that is accessible to everyone no matter their age, size, or ability/disability.

This means have accessibility to all public buildings (i.e. ramps available for wheelchairs).

This means having a playground accessible for all children even if they are in a wheelchair.

This means having push buttons near doors so that going in/out of a building can be done independently.

This means having Braille throughout public buildings that provide understanding of the environment.

This means having those tiny little bumps (called “tactile paving”) at the ends of sidewalks so individuals who are blind know when they are about to step out into a road.

This means having a sand table at appropriate height available out on the playground so children in a wheelchair can play in the sand with their peers.

The list goes on forever.

For OTs, we are advocates for universal design. We make sure that environments are accessible for everyone. We make sure to advocate for universal design when new community playgrounds are being built. We remind the decision-makers in big plans that accessibility is key (and within the law). Universal design is essential and it is our responsibility to promote that within all contexts.

 

Occupational Therapy Month: Sock Aid

Occupational Therapy Month: Sock Aid

“S” is for “sock aid”, also known as “sock donner”.

A sock aid is an adaptive device used to help individuals put on socks! The sock aid is beneficial for individuals with arthritis who have limited range of motion to bend down and put on socks. Additionally, it can be beneficial for individuals with poor motor planning who may experience difficulty knowing how to put on their socks.

How it works: you put the sock over top the end piece so that there is an opening for your foot. Slip your foot inside and pull the strings/straps. The sock stays on the foot and the end piece is ready again to put on the second sock!

Here is a picture of my friends practicing with the sock aid!

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Occupational Therapy Month: Research

Occupational Therapy Month: Research

“R” is for research…..dreaded research.

As the health care field constantly changes, research becomes more and more important. OTs are responsible to stay up-to-date with the latest topics and evidence-based practice approaches for interventions. Additionally, research becomes important when working with a diagnosis you’ve never heard of to ensure clinical competence and adequate application of clinical reasoning.

As the semester unwinds, our first research experience is coming to a close. My group completed a literature review on the effectiveness of augmentative and alternative communication for promoting functional language development in children with autism. Research is tedious and can be monotonous at times but its implications for OT practice are imperative so it’s just something that I need to come to accept.

Also, I will be completing a research project next semester with my graduate assistantship supervisor (more on that once I know exactly what we will be doing).

All in all, research isn’t the best part of this field, but it comes with the territory. As our world continues to change, as technology becomes more advanced, and as new medical diagnoses are discovered and better understood, research becomes essential for continued competence in the health care field.

Occupational Therapy Month: Quality of Life

Occupational Therapy Month: Quality of Life

“Q” is for quality of life!

Occupational therapists strive to enhance quality of life for all clients. Quality of life involves being able to do what a person wants and needs to do – the essence of OT! What makes everyone’s quality of life different depends on what the person finds meaningful. We, as OTs, try to amplify quality of life as much as possible!

Additionally, it is important for OTs, as health care professionals, to maintain quality of life through occupational balance and self-care. It’s easy to get caught up in the stress of education and job responsibilities. Quality of life may be hindered when self-care isn’t prioritized. Being able to find occupational balance in doing things that one finds enjoyable is equally as important as trying to augment someone else’s quality of life.

Occupational Therapy Month: Proprioception

Occupational Therapy Month: Proprioception

Letter “p” is for proprioception!

Proprioception is one’s awareness of one’s body in space. Proprioception is actually one of our eight senses… yes, there are eight. This is knowing how far to stay away from a wall so you’re not rubbing against it. This is knowing how how much strength to use when picking up a glass of water so that it doesn’t slip out of our hands. This is knowing how much pressure to use on a pencil when writing so the lead isn’t too light nor too dark.

Individuals with poor proprioception are often seen as clumsy – bumping into things, tripping frequently, and stomping while walking, among others. Proprioception can be improved with deep pressure (i.e. hand squeezes, being covered up in pillows, or being rolled on by someone else laying on top of a stability ball (true fact), etc). These are the “crash and burn” kids we may come into contact. These are the kids that crave proprioceptive input.

We learned about proprioceptive input during our sensory lab earlier this semester. Here is a picture of my friend, Erica, providing deep pressure with the stability ball and then me rolling through the steam roller!

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Occupational Therapy Month: NBCOT

Occupational Therapy Month: NBCOT

“N” is for NBCOT – the National Board for Certification in Occupational Therapy.

As of right now, I am an OTS (occupational therapy student). After I complete my didactic work and both Level II fieldworks, I will sit for my boards to become an OTR (registered occupational therapist). In order for my to “earn my R” I have to pass the NBCOT exam. The NBCOT is the National Board for Certification in Occupational Therapy. The NBCOT is the governing body of registered OTs. In order for be to add those three little letters to the end of my name, I have to pass the NBCOT. No pressure. After I earn my “R”, I will apply for licensure in whichever states I want to practice. Once I obtain licensure I will be an OTR/L. So fancy!

I will probably be taking the NBCOT at the end of winter in 2021. I still have A LOT to learn between now and 2021, so this is a fleeting thought in my mind right now. I just wanted to explain the process to the Internet about what actually needs to be done in order for me to become an OT because I still feel like there’s a lot of confusion. I hope this has cleared things up. Happy Thursday!

 

Occupational Therapy Month: Mental Health

Occupational Therapy Month: Mental Health

“M” is for mental health!

As discussed in earlier letters of the alphabet, OTs work with a variety of diagnoses, some of which include mental health. OTs can work with individuals with schizophrenia, bipolar disorder, oppositional defiant disorder, generalized anxiety disorder, depression, PTSD, and addictions, among countless others. OTs who work with these populations can work in community-based settings, in-patient settings, psychiatric hospitals, or prisons.

Even though some OTs specialize in the mental health field, because our continuum of care services is so broad, OTs in all settings may work with individuals with mental health diagnoses. OTs always view clients holistically; therefore, it is our responsibility to address mental health issues during treatment, if applicable.

For example, consider an individual who just had a stroke. He/she has lost significant independence in many occupations, including independently dressing, cooking, and playing tennis. An OT will teach them compensatory techniques for dressing, provide adaptive equipment for cooking and tennis in addition to addressing mental health issues that has recently developed because of the sudden change independence levels. If the individual is demonstrating signs of depression, we address it. If the individual is showing signs of anxiety to return home, we address it. What ever is happening “up there”, we can address it!

Mental health has effected everyone’s life in some shape or form whether directly or indirectly. OTs always treat clients holistically; therefore, it is an important aspect of our role as health care professionals.

Occupational Therapy Month: Leisure

Occupational Therapy Month: Leisure

“L” is for leisure – one of my favorite occupations to engage in!

Defined by the American Occupational Therapy Association (2014), leisure is “nonobligatory activity that is intrinsically motivated and engaged in during discretionary time”. In simple terms, leisure is what you engage in during your free time or for fun.

Leisure is important for self-care. Leisure can help us unwind after a stressful day. Leisure can provide us with opportunities to build relationships with others. Leisure can bring meaning and growth to our lives. Leisure can be healthy…and unhealthy.

For me, unsurprisingly, my two favorite leisure activities are running or biking. Engaging in these forms of leisure helps me destress, has provided me with countless friendships, and is healthy for my body. These activities are meaningful to me and I hope that they will be my favorite leisure activity for years to come!

What’s your favorite leisure activity?

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