Everyday Therapy: Gross motor and sensory fun outside

Going outside with your child is probably the easiest "everyday therapy".  There are many opportunities for practicing skills.

Baba has some mild sensory issues that affect his ability to eat, to tolerate sounds, and try new things.  However, when he's outside he shows a remarkable ability to tolerate sensory input.  It also motivates him to try new things and practice his gross motor skills.

getting muddy

Normally he wouldn't touch anything wet or muddy, but he was inspired to walk through mud on this day!  He got the mud all over his feet.  Of course, he was unhappy afterwards and I had to wipe them.  Several weeks later, he walked in on his bare feet and didn't mind that his feet were covered with mud!

This is typical of children with sensory issues.  They are more willing to try new sensory experiences, when they can do so on their own terms, when their neurological and mental systems are prepared.  They also have days when their systems can tolerate more sensory input and days when they can't tolerate much at all.  Their body is affected by sleep, diet, stress, developmental stages, etc.  This is true of adults, but we have more coping skills to help us when we wake up on the wrong side of the bed.  Children are in various stages of learning these coping strategies.

walking on grass

It took Joshua a long time to start walking on grass.  He really didn't like how it felt.  We started with completely covered shoes, then the fisherman sandals above, and now he can walk on grass barefoot!  He had trouble with both the uneven ground and the feel of the grass.  He still has days when he can't tolerate it, but he no longer goes out of his way to avoid it.

beginning to run

Being outside, helped Baba learn to run.  I would write the numbers in chalk and he would walk from number to number, until he slowly began to run.  In this picture, he is still mainly walking fast.

vestibular/movement therapy

Baba hated the swing when he was younger, but watching other babies increased his curiosity, until he agreed to get on himself.  Now he loves the swing.  We recently installed one at home, so we wouldn't miss this important treatment during bad weather days.  Vestibular/movement treatment is one of the "big guns" for sensory integration treatment.

trying different things

Baba is very cautious and reticent of trying new things, especially if they involve possibly falling.  Yet when he's outside, he regularly tries new things.  In this picture, he decided to take the ball to the grass area, which required climbing over the barrier.  It's beautiful to see your child try things they might not try at home, when they feel inspired.

climbing a hill

There is a much larger variety of surfaces and inclines outside, giving your child more ways to practice or learn to challenge their balance.  In this picture, Baba practices going up and down a steeper incline, on a slightly slippery surface.

Even if your child is not really walking, they can still benefit from being outside.  If they're crawling, let them crawl on different surfaces.  It's a great sensory experience.  If they are using wheelchairs, walkers, or any other device, the different surfaces outside give them opportunity to challenge their skills.  Even if your child is not moving much, let them lay on a blanket and take in the sights.  They might just love it!

Why not enjoy the outdoors, while you still can?

Therapy Secrets: How to incorporate therapy into your everyday

Chasing Mama=gross motor

Incorporating therapy into your daily life was not easy, especially in the beginning.  Like all change, there's a steep learning curve.  Yet it is definitely worth investing time to make therapy a part of your everyday life.  When therapy becomes a seamless part of your day, it just becomes a different way of doing things.  It slowly becomes a new habit and habits are easier to maintain.  Once therapy is regular way of doing things, it can also make things easier overall.  It's also important to remember that we're in this for the long haul, so balance is key. 

Since I used to preach this with fervor, I was quite surprised at how hard it was to put this ideal into practice as a special needs mom.  But I can honestly say that it is worth the effort, which is why I decided to share my personal experience.  I hope that my "techniques" may prove useful to other special needs moms.

I am going to start another series called "Everyday Therapy".  These will be short little ditties with ideas and examples of how I incorporate therapy into my day.  Hopefully, these will be shorter, thus easier to write and I will be able to share information more frequently.  Well, that's my hope anyway.

On this post, I will share 10 general tips, which will soon be followed by posts of actual examples. 

Overcoming obstacles=gross motor

1. Write down or think about your child's current goals.  Is it independent dressing?  Is it handwriting?
    
2. Think about how you can help your child achieve their goals.  Brainstorm with your OT about activities   that would improve strength, coordination, endurance, motor planning, etc.  Ex.  Let's use independent dressing as an example throughout this post.  Activities that improve your child's body awareness, motor planning, sequencing, spatial awareness, and coordination will also improve their ability to dress themselves. 
   
   Body awareness can be improved by a variety of activities.  Perhaps your child could push the shopping cart?  Maybe they can help organize the books and carry them to the new location.  Maybe they can jump on a trampoline?  Perhaps hiking up a mountain would catch their interest?  Maybe they would like to decorate a life-sized outline of themselves?  Perhaps they can use a rough loofah to wash their body parts in the bath, while naming each body part.  Virtually any activity that increases sensory information to their bodies and helps them feel their body will help improve body awareness. 
    
3. When possible go outside.  Something about being outside gets everyone moving.  There are things to see and things to explore.  It naturally gets us moving and it is the best and easiest form of therapy.   
 
4. When possible, let your child do things as independently as possible. 
   
   For some, this may be pushing their arms through the  shirt, pulling their shirt down in the front, wriggling their leg through the pant hole, and pulling up the sock the rest of the way.  It may take 15-30 minutes to dress, instead of 5, but you can consider it a chunk of therapy time.
 
5. Start slow.  Work with your therapist to figure out which area would be most fruitful to start: dressing, exercise, play, standing, or therapeutic techniques.  Start with one area, practice until it feels like a habit ( usually 25 days), then add another.  Over time you'll start to think like a therapist and it'll feel more natural.
 
6. It's okay of you need to take a break now and then.  If your child has special needs, this is a long term investment.  It won't hurt to take a short vacation.  Besides, your child needs you to stay healthy and happy.  Taking care of yourself is part of the package.  Yeah, it's hard not to feel guilty, but you really need the occasional break.  You deserve it!
 
7. If you start to feel burned out, change activities or focus on a different aspect of therapy.  I'm currently taking a break from the Masgutova Method, but focusing on feeding and language.  I just needed a break after 16 months! 
 
8. Everything therapeutic should feel like play!  Play is the medium by which children learn.  So tap into your inner child, what gets you excited?  What makes you giggle uncontrollably?  If you're not at least smiling, than you're probably not having fun.  If you're not having fun, you're probably not playing. 
   Try to find common interests with your child and play together.  This will take some of the stress off your shoulders and you'll both have fun. 
   
   THERAPY=FUN!
    
9. Share the joy with others.  Don't be the only one responsible for therapy with your child.  Get the rest of the family involved, this includes any interested extended family and friends who are interested!  Therapy may help the other family members bond with your child.  They may feel like they don't know what to do with your angel.  Show them.  Inclusion starts at home. 
    
10. Re-evaluate how things are going at least once a month and make adjustments as needed.  Write down what progress you see your child making.  Discuss it with your family, friends, therapists, and doctors.  Celebrate the successes, no matter how tiny.  It will help you stay sane and happy for the road ahead.

Swing time=vestibular therapy

Honestly, it's not easy.  Sometimes, I wonder how long I can keep this up.  Yet I keep focused on the big picture.  Helping my son become independent will make him happy, but it will also make things easier down the line.  It's hard to focus on the big picture when exhaustion begs us to stop, but it's the big picture that motivates us to keep going.  Right?  All we want is our children to be happy, functioning at their potential, and included in the community that surrounds us.  The effort we put in now, will make that dream a reality in the future. 

Therapy Secrets: How temperament affects therapy-Part 2

Read part 1 here!

Eating things that stick to the spoon

 How does temperament affect reaching milestones? 

Most babies learn to roll when they are trying to reach for their favored toy.  However, there are different ways to accomplish this desire. 

Laid back baby
The laid back baby will see the toy, try to reach it, decide it's too hard, see a closer toy, pick that up instead, and is very happy to play with this toy instead.  Both toys are cool! 

In general, a super laid back, typical developing baby may reach their milestones a little later than their same age peers because their enjoying themselves and aren't really in a hurry to "grow up".  Many people tend to describe these babies as "good" babies because they are easily comforted, aren't very particular about what they want, and just seem to roll with the punches. 

Physical baby
The physical baby will see his desired toy, try to reach it, try to scoot, try to pull his body with his arm, try to reach it with his leg, try to reach it with both his leg and arm, starts to play by rocking back and forth, and suddenly finds himself on his stomach.  This is so much fun!  He rocks again and rolls to his back.  Surprised, but delighted, he keeps practicing this knew skill until he's tired!  What toy?  Rolling was so much fun!

A baby who is super physically oriented, may reach all their gross motor milestones sooner than their same age peers, but may be a little later reaching their fine motor milestones.  They love to move and they may focus most of their energy on becoming mobile.

The verbal baby
The verbal baby will see the toy, try to reach it, make a cooing sound, try to reach it, make a frustrated sound, try to reach it, keep making frustrated sounds or cry until mom figures out what she wants and brings the toy to her.  Then she cries in delight...making sounds worked!

A very verbal baby may be a little later in reaching their gross motor milestones, but may begin to "communicate" sooner than their same age peers. 

The thinking baby
The thinking baby sees the toy, tries to reach for it, tries to reach with the other hand, takes time to think, tries to reach with his legs, takes time to think, he lunges with his whole body and rocks towards the toy without enough strength, then he leers at the toy.  Finally, he scoots closer using his legs against the floor.  He still can't reach the toy!  In his frustration, he flails his limbs and somehow ends up on his stomach.  It takes a moment to orient to his knew position.  He's not sure what happened, but he sees the toy, reaches for it and grabs it with delight!

A thinking baby may develop their cognitive skills a little faster than their peers, but may have more difficulty developing their physical milestones at the same pace as their cognition.  This often leads to a very frustrated baby who may be more fussy in the beginning.

Every baby can display some aspect of all these behaviors, but most will show a tendency towards certain behaviors over others.  Just like the adults they become, children are all different and their corresponding areas of interests are also different. 

Using laughter to encourage

What temperament is my baby?

I have used the Myers Briggs method of assessing personality for over 10 years.  I was originally introduced to it when I read "Do What You Are" by Paul D. Tieger and Barbara Barron-Tieger, a book about finding your perfect career or job based on your personality.  It shows you how to assess your own temperament and match it to a career or job situation.  Then I found the book, "Please Understand Me II" by David Keirsey.  It's a much more detailed book about the same personality descriptions. 

The above baby descriptions are somewhat based on these personality descriptions, only simplified for clarity.  "Please Understand Me" has a great section describing what these temperaments look like in children, but I also bought "Nurture by Nature", written by Barbara Barron-Tieger. 

It would take too long to go into detail on this post.  If there is interest, I may write a separate post.  In summary, there are four basic types of personalities: Guardians, Artisans, Idealists, and Rationals.  Then there are four subtypes in each main group, which makes 16 different personalities.  It sounds too simple, but there many things to consider and in the end everyone is a unique individual.  However, these descriptions can help us understand some general tendencies, especially if they are very different from our own. 

I really use these descriptions more as a guide, not as a definite description of a person or child.  It's only there to help me understand, not to replace my observations of the real person.  For everyone is affected by their life experiences and choices, making us all very unique.  However, as the examples of the different baby temperament shows, this general guide can help you understand your child and help you find the key to their inner motivations.

Example: 
My son is definitely a Rational (see thinking baby description).  It's not always easy to figure out a baby's personality, but he is an extremely opinionated little guy, making his preferences and personality quite clear.  I am also pretty sure that he is an INTJ: introverted, intuitive, thinker, and judger (the words have different meanings than popular definitions). 

In general, INTJ's are super independent, innovative little thinkers, who tend to be socially awkward.  They are super competitive with themselves and refuse to accept anything less than their own expectations of themselves.  They are the quintessential nerds, who tend to be lovers of technology all their lives.  They are super intuitive and are great people readers. 

So I try to take his temperament into consideration, when I set up his environment.  If you look at my previous post on setting up the environment, you can see that there are places for independent play, technology toys, blocks, and a private zone.  Rationals seek autonomy all their lives and they have a great need to experiment and achieve their visions.  So I give him plenty of freedom to try things at his own pace and I try to give him space even when I'm right next to him.  He's very sensitive to "failure", so I make sure to set things up for success whenever possible and try to show him through example that it's okay when things don't turn out the way we planned. 

Why is this important?  When we work with a child's temperament, they feel honored and accepted for who they are inside.  This increases their confidence and their willingness to be courageous and try new things.  This translates well into therapeutic goals because we frequently ask the child to try things differently.  If they feel confident to try things without falling apart, they are going to be more willing, not only to try it but keep practicing until they succeed.  As their experience of success increases, they're willingness to practice outside of therapy increases.  Then this leads to a child to practice skills in a variety of settings and situations, making reaching milestones a smoother process.

Learning to balance, while discovering the new

How does this fit into therapeutic goals?

Though we make very specific goals to measure progress, progress is really an organic process, especially in children whose condition affects their function overall.  In my experience, when I'm finally able to motivate my client intrinsically, they seem to suddenly make progress in many areas.  It seems like something finally clicks and they are excited to reach goals and try new things.  This process can be quick for some and longer in others, especially if they are not using words to communicate.

The light-bulb moment is amazing to see.  Some of these moments happened right in front of me and they stay with me forever. 

One moment that comes to mind happened with an 11 year old boy, diagnosed on the Autism Spectrum.  He was considered non-verbal and also suffered from severe sensory issues that prevented him from participating in social gatherings.  After 6 months of therapy twice a week, he seemed more relaxed and even began to smile and giggle in response to appropriate stimulus.  One day, I was playing around with paint in a silly way, just to make him laugh.  He kept giggling and watching my "amazing" painting skills.  When I finally stopped, he slowly looked up at me with a huge smile and a look of happiness and said, "funny!". I was floored!  Not only did he say something appropriate, he was describing my a qualitative action!  It was the day that changed everything.  He began trying to communicate more, he had fun at parties, he began to cuddle with his family, and he made amazing strides in his academic skills.

This young guy was a cautious, quite, thinker.  He preferred and needed to observe first, before he could trust.  He didn't like being rushed and he learned best on visual mode.  He really liked art and being silly tickled his sense of humor.  I used this knowledge to set up the treatment sessions progressively.  It started with the swing and providing plenty of vestibular (movement) therapy.  It was a slow progression, but it was worth every moment. 

Taking temperament into consideration when setting goals and setting up treatment can lead to success.  This process tailors treatment to an individual and creates the opportunity to motivate the person from within themselves.  This can really affect their ability to generalize their skills from one setting to another and can also lead to progress in many areas.

How do I take temperament into consideration?

Many parents automatically start learning the preferences of their children and may begin to take a child's preferences into consideration before making decisions on everyday activities.  For example, you might realize your baby loves being around a lot of people, so you sign up for a mommy/baby class.  Or your child may prefer quieter occasions, so you make a play date with a mom and another gentle baby.  Your child may prefer being outside, so you go walking everyday.  We are naturally affected by our baby's temperament and we adjust our lives to make things smoother. 

Well, this consideration can be taken to the next level.  You can begin to actively use the knowledge about their temperament to encourage progress towards their goals.  Notice I emphasize "their goals".   As you're observing your child, try to figure out what they are trying to do.  Are they trying to roll?  Are they trying to put the peg in the hole?  Are they trying to talk?  Then figure out how you can help them succeed by making the task just hard enough to be interesting and easy enough to accomplish.  If you need some ideas, this is a great question for your OT. 

Then set up the activity and wait.  Let your child take the lead.  This will make them feel more independent and it will give them time to figure out the task on their own, a very good cognitive exercise. Don't worry if they don't do the activity "the right way".  If your child asks for help, show them how to do it, but let them finish the last step.  This will make them feel accomplished, despite needing help.  Plus they will begin to learn the activity.  If they end up needing a lot of help, it may mean the task was still too hard, so next time set it up with fewer steps.

Remember to consider your child's strengths.  If they are good at sitting, but have difficulty standing, set up a sitting task that is challenging.  If they want to stand, make the task easy, so they're mainly working on standing.  Make sure to give positive reinforcement on the actual goal.  (You can do that standing!  Amazing!).

What if my child doesn't use words to communicate?

Observation is important with all children, but is especially useful, when your child is not using words to communicate.  When your child isn't using words to communicate, observing their behavior can tell you a lot about what's going on inside.  Try to take time to observe without speaking.  Communicate on their terms.  If they're using gestures, use gestures.  If they use eye contact, use eye contact.  If they aren't really communicating, use silence with action. 

It's important to balance their communication style, with our talking.  Yes.  It's important that they learn language, but it's also important that they feel understood.  When a child feels understood, it opens the door to try and communicate with us, using "our language". 

When I first immigrated to the US, I didn't speak English.  Not only did I not understand English, I didn't understand the accompanying gestures or cultural nuances of people's actions.  The more they talked, the more everything sounded like gibberish.  I usually felt confused and ended up with a headache.  But as soon, as people stopped talking to me, I was able to focus, observe, and understand.

So, it's important to give someone plenty of speaking breaks, so that they can observe and learn while you're spending time together.  Learn to speak less and do more.  Give them time to process what you're trying to communicate.

A place of his own

What does this look like everyday?

As a parent of a special needs child, I can honestly say that it's hard to be "on" all the time.  In fact, it's impossible.  I'm a therapist, but being a mom is my primary role with my child.  That means I have to fit therapy in little 15 minute spurts throughout the day.  I try to think of what I can fit into our day, then decide what goal I'm working on that day.  At most I have, one structured activity per day.  Then I try to fit in as much "physical" activity as I can.  Then I do one session of the Masgutova Method per day.  I also try to give Baba the opportunity to do things on his own when possible, as therapy.  Honestly, some days one therapeutic thing may be the only thing I can do that day.  I try not to go longer than three days of zero therapy, though that's not always possible.   But this is really okay.  I know that we're looking at the long term, not just the short term goals.  We are creating our own pathway.  One that works for us, and so far it's been successful. 

Every family must find their own rhythm.  It's best if the whole family can be involved, sharing the load is so much better.  Even if the person can only be a supportive helper, it can really help the main caregiver.  It's also okay to take short breaks...one to two weeks.  Everyone needs to be refreshed and have time to just be a family doing "family" things.  Though if you're feeling loaded down, it's also a good opportunity to see if things can be re-arranged or re-organized.  Most of the therapy should be fun, not difficult work.  Be sure to enlist the help of your OT and request for ideas on how to make things easier and what to focus on.

Most importantly, remember that having loving family support is the most important thing for your child.  They are children first.  Their diagnosis does not define who they are.  It just something they deal with, just like everyone deals with some sort of difficulty. 

Easy next to hard activities

Conclusion

The act of trying to figure out your child's temperament will have another important effect.  It will help you to see your child first, his diagnosis will fade into the background.  It will also help you help support your child, they way they would like to be supported.  In this arena of special needs, it's often easy to forget our children are unique individuals that have preferences that may not fit into nice little "diagnosis" molds.  Their temperament has a huge effect on how they will navigate their lives.  Their temperament may hold the key to what will motivate them to push through whatever obstacles lie in their path.  Setting fire to this intrinsic motivation will also reduce the pressure on the main caregiver to provide extrinsic motivation, since the child will be motivated to try things on their own.  In the end, this motivation will help them create a path to their maximum potential...whatever that may look like. 

Therapy Secrets: Wilbarger Deep Pressure and Proprioceptive Technique

Looking dapper!

 I have added new treatment regimens to Baba's daily schedule.  Honestly, I didn't want to and I resisted it for quite some time.  However, I have seen immediate improvement, which is wonderful and awful.  I feel guilty for not doing it sooner.  Sigh.  Anyway, I thought I'd share them with you.

We started the Wilbarger Deep Pressure and Proprioceptive Technique.  It is a Sensory Integration technique that I have used for years in my practice.  We use a special brush (looks like the brush surgeons use to prep for surgery) to brush a child's back and limbs.  Then we gently push various joints together (joint compressions). 

Click here for link location.

Why?
My son suffers from mild tactile defensiveness and some sensory modulation difficulties.  I have noticed an increase in tactile (touch) defensiveness since our move, resulting in less solid food consumption.  This isn't unusual, as stress can increase sensory issues.  He was also getting more easily startled, scratching around his diaper, tugging at his clothes, pulling off his sun hat, and generally appeared uncomfortable.


Does it work?
It's only been a few days and there is dramatic improvement.  He seems more comfortable, he isn't tugging on his diaper as much, he is able to tolerate tooth brushing and face washing, he kept his sun hat on, and does not seem as easily startled. 


Is it easy?
Yes, it's easy to learn.  No, it's not easy to brush a very mobile toddler, every 2 hours.  At least I can rest when he's sleeping!


Who should do it?
Any child who experiences sensory modulation problems could potentially benefit from such a program. Seriously, I used it on almost 90% of my caseload.  It really seemed to help children modulate their senses, calming their mind and body, so they could concentrate on the rest of the therapy session.  Children with Autism, cerebral palsy, or any illness that causes movement issues are also likely to suffer at least a mild sensory processing issue, so they would benefit from this technique too.  


Who can do it?
Anyone can be trained to do this technique.  In fact, it has to be implemented by parents, babysitters, nannies, teachers, aides, or any person who will be watching your child for more than 2 hours. 

It is very important to be trained, for improper technique can actually make things worse.  But it's worth the effort. 


How long do I have to do it? 
It's usually for at least 2 weeks of intense treatment (brushing every 2 hours when awake) and than as needed for high need periods, or a regimen recommended by your therapist.  It can be helpful for children who really respond to deep touch.

I hope you found this helpful.  For more information and training ask your occupational therapist for details.  NOTE:  Not all OT's are trained in this technique, though many are.  Ask your therapist if they have been trained.  If they don't have the training, ask if they can refer you to someone with the training to help you.


Can you show me how to do it online?
It's really not a good idea to get this training by video.  It's really important to know how hard to push, how to set up your child for the technique, how to get over any resistance, and what pattern of movement to follow.  It's also important for a trained therapist to give you a sensory diet...which is part of this program.  They can only do that, if they know your child and is able to prescribe the appropriate program.


Here are some links for more information.

For general information on the technique:
http://www.ot-innovations.com/content/view/55/46/

More detailed information on why we use this technique despite lack of research:
http://www.thetherapyplace.net/newsletter/3_2.htm

If you want very detailed information:
http://www.sensory-processing-disorder.com/The_SPD_Companion-Wilbarger-Protocol.html

Have a great day!

Bea


Update and precautions:
Baba is having a flare of of eczema so we have to stop the treatment until the flare up goes away.  It's usually not a big problem for mild skin issues, but it's not a good idea to brush on any part of the skin with an open soar.  If it's a small area and you can avoid brushing it, then it's probably okay to continue the program.  However, it's best to ask your occupational therapist for recommendations. 

Therapy Secrets: Setting up for success

This will be a series that will feature things that might be helpful for a parent who has a special needs child.  It will showcase some things I'm doing, but it will also include things I've learned from my experience as a therapist.  This is not intended to be therapeutic advice, but rather a place to get ideas.  Please discuss with your occupational therapist on how to incorporate these ideas with your child's goals.  If you have questions or ideas please feel free to leave them in the comments or email me at astrokeofot@gmail.com.

Setting up up the Environment:

Setting up the environment is one way to encourage your child to pick therapeutic activities on their own.  It takes some thinking through, but it's very rewarding. 

To be successful, there are some things to consider.

1.  Your child's physical abilities.
2.  Your child's cognitive abilities.
3.  Your child's sensory issues, if any.
4.  Your child's current goals.
5.  Your family's availability to supervise.
6.  Your family budget.
7.  Available space.

Yes.  I know it's a lot, which is why it's ideal to have your OT visit the house and do a home evaluation.  They can give you specific ideas based on your house and the current goals of your family and your child. 

However, there are some simple ideas that can help you get started. 

1.  Get down to their level and take a look around. 

Are their toys easily accessible?  Are there places where they can practice their physical goals?  Are there places where they can play without supervision, if appropriate?  Is there furniture that fits there size?  Is the house accessible to their physical needs (If your child uses a wheelchair, have you tried getting around in your house on a wheelchair)? 

Example:

 When my son started to learn how to pull to stand, I made sure there were plenty of places to practice safely.  I put a few favorite toys on top of the sofa to entice him to practice standing and to encourage him to start cruising.  He was so excited the first time he was able to play standing by the sofa.  After a few practice sessions, he was able to play mostly on his own with supervision.


2.  Who's in control?

The great thing about setting up the environment is that your child will feel like they are in control.  They can choose to do the activity and they can feel independent.  Fostering this independence can increase their self confidence, their curiosity, and their ability to generalize one skill into many different tasks. 

This technique is based on the "client centered" approach.  The idea is basically that your child often knows what they need and want.  If they are given the opportunity to follow these desires, they will develop their skills according to their timetable, rather than our own.  This development feels more natural to your child and it will foster their desire to practice the skill frequently because they are motivated intrinsically (on their own). 

I used this method in my practice for ten years.  It's a great way to motivate your child to find their own therapy path, which leads to independently choosing therapeutic tasks.  The truth is you are choosing their activities by setting up their environment, but they get to choose which activity goes first and for how long.  This also encourages play, especially when they're young.  There's no need to finish a task.  They can go from one task to another as a natural progression of play.  As their skills increase, they will naturally be motivated to "complete a task". 


3.  Choosing the right activities

Ideally, the activities should be a variety of gross motor and fine motor tasks.  At least one activity should be something they already know how to do.  This will be the "go to activity" when the hard ones get frustrating. 

The other activities should be the "just right challenge".  This idea was promoted by the Sensory Integration Model.  It means the activity is just challenging enough to make it interesting, but easy enough for your child to accomplish with minimal or no help. 

This is the hardest part of this method.  In fact, this is where a skilled therapist can really help you.  Every activity can be broken into multiple steps.  Each step requires different skills.  Being able to set up the activity so your child can be successful is priceless. 

Example:

I put his electronic piano and his easy to grab balls on the sofa first.  Why?  Because he liked playing with balls and he enjoyed playing the piano.  He already knew how to do those activities.  I chose easy tasks because his goal was was pulling up to stand and standing during play.  So the activities were there as a prize, not as a task.  Why?  So that he would feel good about being able to stand and enjoy his accomplishment without being frustrated by another work task.  This made practicing standing enjoyable, not work.


4.  Change activities

When your child seems to finish everything quickly without too much effort, it may be time to change the type of activities you set up.  I usually leave the favored activity and change the ones he seems bored with at the time.

If your child is not happy about change, only change one activity at a time.  Also leave her favorite activity as home base, so she can use it as a comfort activity.


5.  How to play

Try not to overly show your child how to play with the toy "the right way".  Children who are allowed to play with toys "their way" tend to develop more imagination and confidence.  Only show your child how to play with a toy when they seem at loss or are bored doing it their way or they seem stuck doing only one thing with the toy.

I usually start playing with the toy, as if I'm playing with the toy, not showing him what to do.  I model play so he can watch without pressure to do it my way.  Besides play is fun, not stressful.  And play is how children learn.  This is the key ingredient.  If everything you teach is done in a playful way, they will learn faster, better, and smarter.


6.  Benefits

This method will also teach your child how to play independently.  At first, they might need a little more help, but eventually they learn to explore and play on their own.  The basic goal is to set them up to succeed.  The success encourages them to practice their skills even more.  The continued success, increases their motivation and their confidence.


7.  What I've done for my son.

Below are pictures and explanations of what I've set up for my son.

adult's view

From an adult's viewpoint, things just look messy.  Now enter from the viewpoint of a child who is just learning to walk.

child's view 1

As you can see, your height drastically changes your perspective.  This is true at any age.  This activity table is great for a baby who is cruising pretty well and needs a little more practice cruising and standing.  It encourages them to learn how to turn and increases their standing tolerance.

For an older child, a table might be set up at their height with appropriate activities.  For children practicing their fine motor skills, a table and chair perfect for their height is essential.  This means that when they're sitting their elbow, hips, and knees are all at a 90 degree angle.  Why?  Fine motor skills begin with good trunk control.  More about that coming up soon!

child view 2

child view 3

child view 4

We have fantastic bay windows, where the window ledge is just the right height, for a baby who's balance is getting better.  When his balance was still poor, we blocked off this area, so he wouldn't bang his head on the ledge.  Now he can spend all day playing for a few minutes at a time with a variety of activities.  Mostly, he takes everything off the ledge and I put everything back on.  He loves spinning toys, so I put them high enough so he needs to slightly tip toe to reach it.  This improves his dynamic standing balance, which is necessary to walk better.

child view 5

 The sofa is one of the best places for standing activities when you're still a baby.  It's a great place to practice pulling up to stand, as you can see here.  I also have a mat on the floor, so he can "read his books", breastfeed, and practice walking on a different surface...harder to walk on, but softer landing.  I use the stuffed elephant to hold his scooter in place, so it won't slide on him, since he's not ready to get on the scooter independently.  I still leave it out because he can play with the buttons and he's the kind of kid that needs a warm up period with his toys (more on how temperament and sensory issues affect therapy coming soon!)

child view 6

Many children with sensory issues like to have a space all their own.  Somewhere small enough to feel cozy and yet big enough to have their toys, their way.  This tent is from Ikea and works for Baba because he doesn't seem to have visual sensitivities.  This tent needs to be on top of a soft non-slip surface.  This is a great idea if your child shares a room and needs to have her own space.  I know a mom who used the space under the stairs to create a special place.  Inside this space, your child is the interior decorator.  You can add things if they're still young, but let them take the lead so that the space will really be their space.  A place where they can decompress in peace.  If your child goes into the tent or space to decompress, try to give them the space they need.

These are just some ideas.  I know there are moms with fantastic ideas, who create amazing little places for their children.  Making the space therapeutic for your child may give them a chance to practice their developmental milestones, independently.  This gives you a break and at the same time increases their self confidence!  I say that's a win-win.

What do you do?  Feel free to leave some of your great ideas in the comment section.  I would love to get more ideas!

Have a lovely day!

Wearing Baby and Sensory Integration-part 5-the conclusion

Side note:
I think next time I'll write the whole article split it into parts and publish it one after another.  This was difficult to write separately and I feel terrible that so much time passed between posts!  I hope you will be patient with me as I figure out how best to share information.  If you have any suggestions, please let me know!  I would love to hear from you at astrokeofot@gmail.com!

I've re-read part 1 through 4 and I wanted to add a few more things that were helpful to me.  In case you haven't read them yet...part 1, part 2, part 3, and part 4.

I also decided to do a completely new series about vestibular (movement) based treatment, where I'll share the story about the boy whose life changed with that treatment. 

In Balboa at 1 month old

1.  Use music

I am not an expert on therapeutic listening, but I know that music has a powerful effect on all of us.  I also know that it affects the same area as movement, the inner ear.  The place where we learn balance and a general sense of where our body is in space, is right next to where we hear.  In fact, as we listen to music, it activates our eardrum and moves the little hairs in our cochlea, our balance center.

For this reason, having the right music on while wearing baby around the house can also have a therapeutic effect.  It can work in concert with your body movement to provide the maximum therapeutic effect.  I usually choose music without vocals that have a heavy regular beat.  I organize a playlist that starts with a fast beat (think babies current heart rate) and each subsequent song is a slower beat (leading to mom's resting heart rate). 

Baba likes the following CD's: Jazz meets Cuba, Classic meets Cuba, Dreamcatcher by Secret Garden, Jewel's Lullaby CD, and Enya. 

So turn up the sound and dance with your baby!  The movement and music will help them fall asleep too! 


2.  Keep air flowing

Make sure your baby is not squished against your body without air.  Frequently check baby for comfort and safety.  When using a sling type carrier, always use your non-dominant hand to support baby.  This is especially important when you're getting things done.


3.  It takes time

It takes time to get used to wearing baby, but it can be very rewarding.  It may really help you bond with your baby and read your baby's signals.  You may find yourself knowing when your baby is hungry or uncomfortable.  Your ability to read your baby and your baby's increasing ability to modulate their sensory needs may drastically reduce crying.

4.  If you're breastfeeding...

Both the Ergo and the sling are perfect for discreet breastfeeding.  It takes a little practice to find your groove, but once you do, it's great!  I can breastfeed anywhere!

5.  When to wear baby

I try to time wearing Baba before nap time.  The movement relaxes him and by the time I breastfeed he's ready to nap or sleep.  When he wakes up, he's refreshed and ready to learn.  I also wear him when he doesn't feel well or he needs help to modulate. 

Newborns get overwhelmed easily by all the sensory stimulation, but babies with sensory issues have an even harder time.  So I use the expensive stroller to carry the diaper bag.  I usually wear him to all our outings, especially if I think it might be too stimulating.  When I'm too tired, Auntie takes over. 

I usually wear him when we go for our daily walks.  This is definitely a great way to lose the baby weight and get in shape!  It also helps boost my mood. 

If you're a working mom, just wear baby as you do chores before and after work, except when you're cooking.

In Bjorn with Auntie at around 4 months

6.  Who can wear baby

This is a great way for the father/partner to bond with your baby.  I know my son has a close relationship with his aunt because she frequently wears him.  So even though, he still prefers mom at this stage, he is happy to be worn by his auntie.

If possible, your baby can also be worn by the nanny/babysitter.  This will ensure that baby continues to get the therapeutic benefits of being worn.

7.  Interaction

I frequently interact with Baba while I wear him.  I showed him the leaves on the trees, I played with the lights around the house, I moved objects up/down/upside down, I sang, I taught him vocabulary, taught him about art, encouraged him to touch things, and I asked him questions...which I answered for him. 

I didn't always talk because that can be over stimulating, so I used exaggerated facial expressions and gestures too.  I also stayed quiet when he seemed to be trying to figure things out, so he could try to problem solve himself.  All this interaction can really increase brain activity to make more connections.  Of course that's really important for a child whose brain is compromised.

8.  Bonding

Most importantly, it's a great way to bond with your baby and get to know him.  When your child suffers a stroke, you might suffer from the trauma too.  The experience of finding out your child is ill and all the anxiety associated with that time, may leave you feeling less joy and more depressed.  It can interfere with bonding, especially with prolonged periods in the NICU.

I feel like I'm still healing 11 months later.  However, the time I spent wearing my baby, helped me see him...not a damaged child, but my little guy.  I got to know his personality and I was able to help him meet his needs because I was able to read him.  This made me feel good about my ability to care for him and also boosted my confidence...something we need after such a trauma.

In Ergo with Auntie at 10 months

More than anything, enjoy your time wearing your baby.  He won't be little for long.  I know that this time in my memory will be filled with our togetherness and happiness more than the worry and trauma of what's happened because we've spent so much time just hanging out.  When I wear him, I try to breath and focus on the present.  This has helped me tremendously.  It's so therapeutic for the both of us.  It's also an easy "therapy at home activity"...no thinking involved. 

Wearing Baby and Sensory Integration-part 4

If you haven't read part 1, part 2, and part 3.  On a side note, I am not being compensated for any of the products, I'm just sharing what I've used.  It may or may not be useful to you.  If you want to see more information on the product, I provided a link on the caption for your convenience.


Before Baba was born, I bought the Bjorn carrier.  It seemed to be a good fit and I liked that baby could be faced forward.  However, when he suffered a stroke the Bjorn didn't have the positioning I wanted and it was hard to get him out after he fell asleep for naps.  I started to look at other types of carriers, but I was overwhelmed.  Some books I read absolutely warned against slings and I couldn't decide which carrier would give me the positioning I wanted.  Why was positioning important?

Bjorn Carrier

Since Baba had a stroke, apart from the sensory issues, he also began to develop spasticity.  His right arm would catch when I would try to move it and it seemed to be getting worse.  He also had a tendency to draw his arms and legs backwards.  This positioning of the body is typical of babies who suffered a stroke.

favoring this position at 1 month, 2 weeks after discharge from hospital

Before I ruminated too long, my sister bought the Balboa sling.  She knew I was looking for a different type of carrier and figured we could try it.  It turned out to be perfect.  The sling put Baba in a flexed position, which broke up the extension tone.  It also provided proprioceptive input (deep touch). Which is comforting.  This combination of proprioception and vestibular input helped Baba tolerate movement without getting motion sickness.  It also helped him tolerate a flexed position for a few hours a day.

Baba in Balboa Sling at 1 month, same day as above

Within a month, Baba displayed decreased spasticity (We were also co-sleeping for positioning.  A post about that is coming in the future.). He also stopped favoring an extension position and began to play with his hands.  It was so exciting to see him start to explore his hands.

Baba on same day as above, after being worn, on Boppy Total Body Pillow

So I used the Balboa sling most of the time, but when we went for walks, I put him in the Bjorn.  He loved facing forward and being able to see everything.  This system worked well, until he got really heavy.  I didn't know the Bjorn had a new back support system, so I bought the old version.  When he was small it didn't matter, but when he got heavy (20 pounds by month 4) it really put a strain on my back.

Around that time, another mom introduced me to the Ergo Carrier.  She let us try it before committing to it.  Baba seemed to enjoy it and immediately fell asleep, so we bought the Ergo.  It has been a life saver.  Baba was starting to feel uncomfortable in the Balboa sling because he was so big, yet he wasn't able to tolerate being on the hip because he couldn't sit up.  It was good timing because he was no longer showing spasticity (increased muscle tone) and he was able to keep his limbs forward.  It seemed like we didn't need to use the sling for positioning anymore.

Baba in Ergo at 6 months

I still use the Ergo for carrying Baba.  He weighed 23 pounds by month 6 and now weighs 25.5 pounds at month 10.  Yes.  He's a big baby!  For a mom with physical limitations, I can't carry him without the Ergo.  This is especially true when he's sick and needs to be carried more than usual.

At 10 months, I carry him for 1-2 hours a day, mostly to help him sleep.  He is still working on modulating his arousal level.  He has a hard time winding down.  He has improved in his ability to tolerate movement and for the first time enjoys the swing!  If I could install a swing at home, I would leap tall buildings, but my landlord says no.  Sigh...

As far as choosing a carrier, mainly it has to be comfortable for both baby and mama.  Try out the carrier/sling and use it if it works!  If you're concerned about positioning, there are alternative ways to work on that.  Ask your OT or PT for specifics about your child's treatment, as spasticity, extensor tone, and sensory issues can be very different and unique to each child.

So what if your baby isn't a baby anymore?  This is when the swing becomes crucial.  Look for part 5, where I also share how I changed an 11 year boy's life with a swing!  Yes, I said swing!

I tried to provide definitions as I wrote, but if I missed something, feel free to ask me in the comments section or by email astrokeofot@gmail.com.

Wearing baby and Sensory Integration--Part 2

Read Part 1 here!

Some babies are more likely to have sensory issues: premature babies, babies who suffered a stroke, and babies whose movement abilities have been affected by any illness.  Babies who spend a long time hospitalized may also be more prone to suffering sensory issues.

Before everybody freaks out and thinks their babies are all seriously ill, let me tell you a secret.  Almost everybody I know has some sensory sensitivity.  How many of you chew your pens?  How many of you prefer certain fabrics because they make you feel better?  How many of you tap your fingers or feet?

Being sensitive to sensory input is not the same as having serious sensory processing difficulties.  When someone has serious sensory processing issues, it affects their lives profoundly.  How we perceive the world through our senses, vastly affects our development and how we perceive the world around us.  When our senses are misfiring or our brain is scrambling what these senses are telling them, the world can be a frightening and uncomfortable place.

In babies, it affects their ability to reach milestones and the way they perceive the world.  As they grow up, it affects their success in school and even their social life.

So if your baby seems sensitive to sensory stimulus, but is developing on schedule, they don't need occupational therapy.  However, they may benefit from vestibular input, such as "wearing them", if they are sensitive and have difficulty being soothed in other ways.      

My philosophy on treatment is: "do whatever works".  If what you're doing works, proceed.  If what you're doing is not working, stop and re-evaluate.  If you're not sure and it doesn't seem harmful, continue a little longer, then re-evaluate.

If your baby is sensitive to sensory stimulation (i.e. gets fussy and isn't easily soothed, has a difficult time with noises, seems sensitive to light touch, gets overstimulated easily, etc.) and seems to be delayed in many areas, it's a time to let your pediatrician know.  He may refer you to an occupational therapist for an evaluation.  It's best to catch it early because the brain is much more malleable when your baby is a newborn.   

So what does all this have to do with wearing a baby?  Find out in part 3...coming soon...hopefully.

 Auntie wears Baba in a Balboa Sling

Read part 3 here!  And part 4 here.

Fibromyalgia brain fog mess

I'm finally over my cold!  Yeah!  But...I still have a mild flare up (fibromyalgia)...boooo!  I wanted to write lots of helpful articles about treating a stroke, but I can't think straight.  Why?  Brain fog.  What's that, you say?  It's another symptom of fibromyalgia.  Yup!  My good friend does not disappoint.  Ugh!  

I open one of my many drafts, but I stare at the screen.  Sometimes, I attempt to write a few sentences, but they don't make sense.  It's harder because I have to write them in "layman's terms".  That means I have to define everything and attempt to explain myself in a way that would make sense to anybody, not just therapists.  

In person, I can easily adapt to the person I'm speaking to by reading their cues, but online I have to be clearer.  Otherwise, y'all will think I'm incompetent.  Or, at least that's what I think.  I guess it could be part of my perfectionism problem.  Sigh!  Aren't I supposed to be over this personality flaw by now?  I'm 39 years old!  Ugh!

The good news is that I've started to do the Masgutova Method with Baba again...with good results!  I was so sick, that we had to put this method on hold for 3 weeks!  I feel terrible, but it couldn't be helped.  It was just too hard.  He no longer wants to lay around while his mom "massages" him.  He's always on the go.  That means Auntie and I have to do crazy things to get all the reflexes done.
 

He's starting to cross crawl (on knees, rather than on his feet), which is good.  We still have a ways to go, but it's much harder now because he's used to bear crawling (on his feet). He's decided he wants to crawl that way, even when it's obviously harder on certain surfaces.

We are also working on developing his pincer grasp.  He finds it extremely frustrating that he can't pick up small objects.  He's not behind per typical charts, but it's obvious that he finds it frustrating.  Each child has their own developmental timeline and I believe Baba would be more advanced in his fine motor, if he hadn't suffered a stroke.  How do I know?  Mommy intuition, coupled with therapeutic observation.

If I don't help him develop his fine motor at his pace, he might get so frustrated that he'll give up.  This will adversely affect his motivation, making it harder to work on later.  It will also affect his self confidence, which will affect performance in other areas.

Baba suffered a stroke mainly in his frontal lobe, on his left side, though it also damaged part of his parietal lobe.  The frontal lobe controls executive functions (problem solving, memory, etc.).  It also can affect frustration tolerance, attention, and learning.  Many children with this type of injury may also develop emotional problems when they're older.  

The left parietal lobe houses the language centers.  It is my secret fear that he'll understand language, but won't be able to communicate his thoughts.  It's not the articulation part because with IPads, kids can now speak.  No.  The worst language problem is understanding everything, but not be able to communicate verbally, written, or sign.  In this type of problem, the person thinks he is clearly speaking, but it sounds like gibberish to everyone else.  They can't communicate in any medium.

It doesn't look like he has this issue, as he is perfectly able to use gestures and intonations to communicate now.  Yet I still have panic attacks that Baba has this communication problem.  Yes, I know it's crazy.  I know it's most likely not true...yet...  What can I say?  My mind seems to like drama.

Hopefully, my brain fog will clear soon, and I'll be able to finish writing "wearing baby, part 2" or any of the other 5 articles I've started, but can't seem to finish.  Perhaps I will have a posting spree when I finally finish the articles!

All the photos are from our day in the park, last weekend.  He really seemed to love it!  He's usually reticent, but this time he couldn't wait to explore.

The crazy kid tried to go down head first!  I guess he hasn't learned about heights yet! 

I think he wasn't happy that I was "helping" him.

We had so much fun!  The milestone of the day was trying to climb back up the slide.  Of course, he needed much help!  However, I thought we'd celebrate the attempt!