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Adaptive Response — Transcript

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0:03And I have also
0:05sorry
0:05>> a question because in this week me and
0:08Anna were we're looking at the levels of
0:12adaptive response and
0:15>> we have some that Raz talks about.
0:17>> Yeah. I don't know if you if you can
0:19talk about a little bit more and give us
0:22some examples for each level because we
0:25are trying to
0:27>> understand each level and trying to
0:29understand what is supposed in each
0:31level.
0:32>> Yeah. probably if you can
0:34>> and and one of our questions, one of
0:38your our questions was um if that levels
0:42were only for uh postural control issues
0:47or for everything because it it likes
0:52uh very motor, you know. Mhm.
0:58>> Um yeah, let me I'm trying to find
1:01>> I in each we don't know in which book it
1:05is that levels. So we just have that
1:09part of the levels and so we don't read
1:12all about it. So
1:14>> it's it's in um
1:18what is this?
1:20No, it's in
1:22uh the
1:24SI um theory and practice book. I think
1:27it's the second edition.
1:30Um
1:32>> probably
1:33>> the orange
1:34>> I think it's the orange one.
1:36>> Yeah, I'm looking for I have um a
1:40picture of that those levels.
1:43>> I have a print screen. If you want I can
1:46share.
1:46>> Yes, please. Let me let me make sure you
1:49can share. Hold on. Um, that will just
1:52make it go faster rather than me
1:53searching through things.
1:57Okay.
1:58>> Yeah.
1:58>> Um,
2:01so response to passive stimuli, holds on
2:03and stays put. So, I mean, I think these
2:08are really um
2:11like kids that some of the kids that we
2:14see, they're they're up much higher in
2:17these levels, right? they're not they're
2:19initiating sustaining activity.
2:22Um,
2:24but what these are is they're just a way
2:26to kind of understand where a child is
2:30in terms of their adaptive responses
2:32that you're looking for. Um,
2:35and I don't, you know, I know, um, like
2:38in the UK with, you know, Roz's Roz's
2:40group, they do a lot, they do use these
2:42in their ratings. Um, I think it's an
2:45interesting um thing to consider. We
2:48don't use use these as a rating for um,
2:52you know, how we're collecting data or
2:54we're documenting on a child. Um,
2:57but I think it is an interesting way to
2:59look at things. Um, you know, I think if
3:04you look at this and you also overlay
3:07like the scaffold of treatment um, that
3:11we've talked about, it's on page. It's
3:13on page 77 of the I've said it I found
3:17it so many times I now know where it is,
3:19but it's in the clinical reasoning SI um
3:22clinical reasoning and diverse
3:24populations book. Um
3:27there's that scaffold of um
3:31in treatment. Do you know what I'm
3:32talking about?
3:35>> I think so. I think I saw Zen.
3:39>> Yes, it's um
3:41>> the intervention model.
3:43>> Yeah. Yep.
3:47I just saw where did it go.
3:54Um,
3:58where
4:04I think this
4:07is an expanded version of this.
4:13Um, this is a I'll show it to you in a
4:16second, but um
4:20Oh, wait. put up put up those those
4:22levels again Anna if you can.
4:26So
4:28So what were you trying to understand
4:30about these levels?
4:32just
4:33>> what is supposed to the child to do in
4:36each of the levels and um if it's just
4:41related to postural control to motor
4:43aspects of um
4:48>> it is and then as you know as it moves
4:49up higher you'll see some of those are
4:51more related to practice
4:53>> practice also. Yes. So, some of those
4:55initial pieces, yes, they're related to
4:57postural control um and stability. Uh
5:00because if you can't hold yourself up,
5:03you know, you're not going to be able to
5:04do much or you know, and and this
5:08response to passive stimuli holds on and
5:10stays put. So, what does that look like?
5:12Like they respond, they're responding to
5:14your p just being passively moved. What
5:17is their response looking like? Um
5:20>> like a smile or asking for more
5:23>> smile asking for more changes in
5:26arousal.
5:27>> Um
5:28>> yeah like you see like which I guess a
5:31smile smile would be um a change in
5:33arousal could could be interpreted as a
5:35change in arousal. Um and then you start
5:39to see them discriminate a little bit
5:40different a little bit more with holds
5:42on and stays put. Um,
5:46because now they're they're starting to
5:49to discriminate movement. Like they're
5:51recognizing I'm moving and I need to
5:53hold myself on this piece of equipment.
5:56Um,
5:58and then they're starting to, you know,
6:00alternately contract and relax their
6:01muscles to pump the swing. So, you're
6:03starting to see that they're responding
6:05to the movement and they're starting to
6:07initiate their have their own initiation
6:10of of movement. Um, and there I think to
6:16me that's where we see like that true
6:18integration of sensation. Um, because
6:21now they're putting it to use, right? So
6:23holding on and staying put, they're
6:25starting to put it to use, but now
6:26they're really starting to enact it,
6:28right? They're they're um
6:32hold they're contracting their muscles.
6:34They're holding on um in response to
6:37that movement.
6:39This is this uh level would be like uh
6:45uh hold the posture in the swing without
6:49falling.
6:50>> Yes.
6:51>> Yeah.
6:52>> Yeah.
6:52>> Okay.
6:53>> Um
6:56>> or just or just stay in the chair.
6:59>> Just stay in a chair climbing on a
7:01bolster.
7:03um
7:04>> Mhm.
7:04>> that they're just starting to like kind
7:06of, you know, well, if they're climbing,
7:08they're being much more active, right?
7:10Um but like just this passive things
7:12just to get them there. Like you put
7:14them on the swing,
7:16>> can they stay on the swing, right? Like
7:18how what is their response? So like
7:22>> maybe we can get a video of this little
7:24boy that we see in the clinic. He's um
7:26he has autism and cerebral pausy and um
7:31you know his body awareness is just he's
7:34just all over the place and he you know
7:37even just passively lying down on the
7:40glider swing he cannot do that he falls
7:42off um once the swing starts moving. Um
7:47but then you know we instead of giving
7:49him like the linear linear movement if
7:52we put him on bunggees and start kind of
7:54using more of his odeliths and really
7:56like trying to give him some more
7:58there's more propriception in that as
7:59well. um he he does show an adaptive
8:04response of holding on and staying put
8:07um and then starting to contract his
8:09muscles and maybe he might move from um
8:12that supine position into um or a prone
8:17position actually move from a prone
8:19position into a seated position like you
8:21might start to see that kind of change
8:24over time and that's that that um
8:26integration of sensation he's starting
8:28to like really gain gain the skills to
8:31do it. Um, and when I mean over time, I
8:34mean like, you know, within 20 minutes,
8:37you know, within a session, not over
8:39sess, the course of sessions. Um, but
8:42that's that, you know, change in
8:44sensation that he's he's starting to
8:46discriminate. Um, let me put up the
8:49scaffold now. Um so
8:57um
9:01okay
9:02all right can you see um this table
9:07>> okay so this is this is from module six
9:10um so I can't share the doc I can't give
9:13you the document because it's it's from
9:16module six um if you take module six
9:19it'll be
9:21We have these documents. We
9:22>> you have it too. Okay. Um so this is
9:26just an expanded version of that those
9:30that table that's in um the clinical
9:33reasoning book. So Suzanne's kind of
9:35fleshed it out a little bit more, added
9:37more thoughts to that. Um
9:41so again, here's that arousal. Um, and
9:45we're really just kind of looking at
9:47proximally homeostasis, acquiring and
9:49sustaining a calm and alert state,
9:52right? Just kind of those lowlevel
9:54um goals of can they sustain engagement
9:59or just to sustain themselves
10:02um within the environment.
10:04Um,
10:06and then, oh, here comes Maria. And then
10:09um here are different activities that
10:11you might do to support that.
10:16And then um any distal goals might be
10:19that might be related to that. Okay.
10:23Improve nutrition. So health and
10:25resilience. Right. Hi Maria. You made
10:27it.
10:29>> I made it. I'm sorry guys. I'm late. I'm
10:31sorry.
10:32>> No. No. I'm glad you're here. Um we're t
10:35we're talking about um scaffolding and
10:39then those levels of adaptive response
10:42that um we've talked about a few
10:44different times. Um Roz Roz has brought
10:46them up a few times because they use
10:48them um in their documentation
10:51in her clinic. Do you know what we're
10:53talking about the levels of adaptive
10:54response?
10:59>> I don't know. I don't know if I know
11:02exactly uh or maybe
11:06I am calling something different in my
11:08in my head. Are you are you calling like
11:10the aa aaa or
11:13>> no? Um Anna, I'm going to stop sharing.
11:16Do you want to put them up really quick?
11:17Anna has a
11:18>> um
11:21>> so these are from like the theory and
11:23practice book. Um the second edition. I
11:26I believe it's in the second edition. Um
11:28these are just kind of errors. Um she
11:32considered these levels of adaptive
11:33response that a child might go through
11:35as they're
11:37>> they're improving their sensory
11:39integration. Um so you might see this
11:42happen within a session. And so this is
11:44kind of um an original model and then we
11:48kind of overlay that with the scaffold
11:49which was just up on the screen. Um so
11:52I'm gonna put that up now.
11:54>> Yeah, I got it.
11:56>> Okay. So um so we're kind of overlaying
11:59that with this scaffold where we can see
12:03um
12:05you know how those those interplay
12:07within this. Right? So this is how we um
12:10we might elicit those adaptive
12:12responses. And typically if a child is
12:14just responding passively to sensation,
12:17we're working on arousal, right? And if
12:20they're starting to hold on and stay
12:22put, maybe we're working more in um
12:26sensory perception.
12:28Okay. Um and then they're starting to
12:30respond
12:32um by pumping the swing, pushing and
12:34pulling. Maybe we're starting to see a
12:36little more postural control.
12:38Okay. Do you see how those are they're
12:40kind of like laying on top of each other
12:43now? These two
12:45two concepts. I think those original
12:48adaptive
12:48>> Yes. I'm kind of lost in that in that
12:51chart or table. Sorry. Uh can you
12:54>> can you show show us the the titles?
12:58Um above above.
13:02>> Okay. Assessment areas.
13:06>> You mean like arousal or uh some sensory
13:10um motor functioning? So what this is,
13:13this is that treatment scaffold that um
13:16Suzanne Smith Rolley has in her clinical
13:19reasoning book.
13:21>> Um and so we're going over like the the
13:25different parts of the scaffold, which
13:28you know, like in a treatment session,
13:29first we address arousal
13:32>> and then we address then we see if
13:34there's challenges. You know, we kind of
13:35when a child walks in that we're kind of
13:37quickly assessing where are we going to
13:39fall in this scaffold.
13:40>> Yeah. And then Anna and Patricia were
13:44trying to grasp the the adaptive
13:46response levels that other other
13:49document we showed you.
13:50>> Um trying to trying to understand you
13:54know where that you know how is that
13:56really just limited to motor skills and
13:59practice or is there something more to
14:02that? Um like where does arousal fall?
14:06And so I wanted them to see that there's
14:08kind of similarities between that those
14:11levels of adaptive response and this
14:14scaffold
14:17and and really
14:19they kind of are embedded within the
14:21scaffold, right? Those those levels of
14:23adaptive response. So you can kind of
14:25see a little bit. I would say the
14:27scaffold is a more um indepth
14:31um
14:32application of those levels
14:36if that makes sense
14:38because they're they're just kind of
14:40woven into this. Um
14:44but what this table is, so Maria, this
14:47is from that clinical reasoning book
14:49>> and this is um Suzanne has kind of um
14:55expanded it a little bit more and um
14:58this is in the module six course. So if
15:01you take module six, you would get this
15:02document. I can't give it to you because
15:04it's not mine to give um but
15:08but I can show it to you. So the so
15:11here's like the arousal and then what
15:13Suzanne's done is she's started to
15:14include some of the data driven
15:16decision-making language into this to
15:18help us apply like how does this
15:20scaffold address you know our proximal
15:24and distal goals and how do we what
15:27therapeutic activities are we using to
15:29get there.
15:31So,
15:33you know, if we're just looking at
15:34arousal, so so you know, approximately
15:37what we're looking for um with a child's
15:39arousal is that they really are can they
15:41can maintain homeostasis, that they can
15:44stay calm and alert, right? They don't
15:47have these wild flex fluctuations in
15:49arousal or attention. Um and that they
15:52can kind of stay stay with us generally.
15:55Um,
15:57and then here's, you know, here's what
15:59we're doing therapeutically to support
16:01that. And then distally, what our goals
16:04might look like, right? When we're
16:06talking about these kids that are really
16:07disregulated,
16:09um, that their arousal is kind of really
16:11fluctuating, um, you know, their ability
16:14to have improved nutrition, that they
16:16can, you know, exercise and sleep, um,
16:19that there that they're kind of more
16:21regulated, right? Like we've we've had
16:24um coming out of COVID, we've had a lot
16:26of families with these kids that, you
16:28know, have toileting issues. Um a lot of
16:31feeding issues, little lot of picky
16:33eating. Um and and big emotions, big big
16:38emotions. Um, so a lot of our kids like
16:41these are what our goals are around that
16:43they can have like improved regul
16:46regulatory functions so that their
16:47interactions and participation are um
16:52are more comfortable um for everybody,
16:54not just them, but for the people
16:55interacting with them too. um
17:00and that they're like I really like this
17:02is reduced passive use of free time
17:04throughout the day, increased active
17:06participation in play activities alone
17:08and with others, right? So, you know, so
17:11many of our kids are using more passive
17:14participation activities, right? Like
17:16just they're on devices um and they're
17:20um they're, you know, just gaming.
17:23they're in this kind of passive world.
17:26And is it passive or is it not? Like
17:28there's some kind of executive
17:30functioning that's, you know, there's
17:32more like higher level engagement
17:34happening cortically. Um, but if we're
17:37talking about like their physical
17:39engagement in the world, especially
17:41those really young ones, right? Like
17:43it's really important that they're using
17:46their bodies to help them self-regulate,
17:48right? that a lot of kids are, you know,
17:50they're being given devices
17:53um or they're getting on devices to help
17:55them regulate. So, we're we're just
17:57plugging kids into these passive passive
18:00things. So, you know, one of our goals
18:03might be that they choose to initiate
18:06more active play um rather than um
18:11passive play.
18:13Um,
18:15so that's kind of what the scaffold, you
18:18know, what where those adaptive
18:20responses fall into the scaffold. But I
18:22think with that those um adaptive
18:24response levels that that um Anna had
18:28put up, what I think what they do is
18:30they really help you to know what you're
18:31looking for. Um, I remember, you know,
18:34when I was first out of school, I think
18:37my first year, and um, I just really
18:40struggled with what adaptive respon,
18:42what am I looking for for an adaptive
18:44response? What is the adaptive response?
18:47And that those levels right there just
18:49helped to give me some guideline, you
18:52know, guidance of like, okay, can it
18:55these are the responses to sensation
18:56that we're looking for when a child um
19:01when a child is in therapy, we're
19:03looking for these motor responses. And I
19:05think um especially especially newer
19:08graduates, we're not as we we haven't
19:11developed that skill of observing motor
19:14responses. Like we can easily observe a
19:17smile or a request for more. Like that's
19:20pretty clear to us. Those are really
19:22clear adaptive responses. But those more
19:24subtle adaptive responses of not falling
19:27off the swing, like that's that's what
19:30we're looking for is that they can they
19:32can hold on to a swing. And I think um
19:35what's important for us is that that
19:38seems like a really reductionistic
19:41um
19:43uh observation for occupational
19:46therapists, right? That they can sit on
19:47a swing and hold on. Well, okay, big
19:50deal. Because that's not occupation. And
19:52so our what's important is for us to be
19:55able to translate that information from
19:58well, so what if he can sit on a swing
20:00and pump it? What does that mean? Okay.
20:02Well, that means now he can participate
20:04more fully in childhood play,
20:07exploratory play, right? He can sit on a
20:09swing on the playground. He can climb a
20:12ladder because he can hold on to the
20:14ladder now and he's got the postural
20:15skills to sit in the chair and sit at
20:17rug time at during school. Um, so now
20:21he's got some of these skills that are
20:22going to translate into these broader
20:24occupations.
20:26Um, and I I also think that we spend so
20:30much time in school learning about
20:33occupation
20:34and the value of occupation that our
20:37newer graduates still have to learn how
20:41to observe those underlying pieces that
20:44build to occupation. Um, and you know, I
20:47think sensory integration gets a lot of
20:50um, a lot of people argue with sensory
20:52integration, saying that we're very
20:53reductionistic, that we're too too
20:56focused on the mechanical pieces of
20:59occupation and not occupation as a
21:01whole. Um, but you know, I think our
21:05lens is that if your sensations are not
21:10providing you the information they need,
21:12you can't participate in occupation. Um,
21:16so we're not, you know, and I think this
21:18is where people get confused that we're
21:20not just training occupations.
21:23We're we're training foundations for
21:25occupation.
21:28So, um, you know, and you know, I feel
21:31like that's just a daily discussion,
21:32right? Like everybody's always wondering
21:35what we're doing and why how we're doing
21:37it.
21:38Annie. Uh, I was I was uh thinking about
21:41a kid I had uh yesterday and um I was
21:46wondering because I felt like an adapt
21:50adaptive adaptive adaptive or adaptative
21:53in English.
21:54>> Adaptive
21:55>> adaptive response. Um uh but I think
21:59like sometimes we we used to um call
22:03adaptive responses more uh more related
22:07with the performance of the kid uh in
22:09something uh in in in a in a play in a
22:13task or or or whatever. Uh but this this
22:17kid um
22:20uh I I felt like it was an adaptive
22:23response. But you tell me uh he was I uh
22:27for me the adaptive response that I saw
22:29uh on him was he for his own decision
22:34um uh wanted to explore in his time uh
22:40when he wanted to uh the ball pit um
22:44without me to say uh nothing like uh
22:47let's go to the ball pit I'm on the ball
22:50I'm I'm I'm in the ball pit. No, nothing
22:52like that. I just opened the space for
22:54him to explore. H and and I felt and
22:58because he is a a kid with a very uh
23:01lack of um with a very
23:06uh uh I mean he he doesn't have a a very
23:10big uh inter list of interests. Um and
23:15so he is very restrictive uh on it. Uh
23:19and and and the fact that he wanted to
23:23go to the ballpit that that was
23:25something that he never wanted to
23:27explore for me was an adaptive response.
23:30uh even not in performing something
23:35but uh in a global sense for me it was
23:39uh I don't know if you if you but
23:42somehow
23:42>> that's self initiation right ideiation
23:46self initiation like yes he that was
23:48promoted for him because he had these
23:51foundations that allowed him
23:53>> to um let go of his focus on his body
23:57right he doesn't have to because all of
23:59the the sensory systems are doing what
24:01they need to do. And now he's like
24:03pushing to that just right challenge of
24:06okay, well just kind of being passive
24:09and and waiting for Maria to do things
24:11for me. I'm I'm outgrowing that, right?
24:14I'm moving past that and now I want to
24:16start being more independent and look at
24:19my space and explore my space. Yeah,
24:21that's definitely an adaptive response.
24:23And
24:25>> and I was just saying that uh that also
24:29uh I think that it also means uh for me
24:33that he was able uh in a sensory motor
24:36perspective he was able to uh plan and
24:40manage his body to uh uh go into the
24:43ballpit because it's it's really high
24:45this this ballpit. It's not it's not a
24:47small one. Um uh and and I for me it
24:52also means that that he he he wanted to
24:55go there because he knew that he was
24:57able to um independently. Uh and and as
25:02you were saying like this is not
25:04occupation but it impacts impacts
25:06occupation. Um uh because it means that
25:10probably in his uh uh in his place or or
25:15at his school um he's more um uh able
25:21capable to explore also his body in the
25:24space. So
25:27>> it's not it's not occupation but it
25:29impacts occupation. it impacts
25:31occupation and you know I think I think
25:34we also need to
25:36reframe how we're talking about
25:38occupation when we talk about a
25:40developmental model right when we're
25:42talking about children occupation is
25:45very different it's not you know when
25:49they get into school like occupation is
25:51you know being a student participating
25:53in the classroom all of those pieces but
25:56we're talking early childhood right and
25:59developmentally even I mean even if
26:01they're not chronologically in early
26:03childhood maybe they're six or seven
26:04years old but developmentally they might
26:06be like a three or fouryear-old and when
26:09we're talking about development
26:12occupation is play and exploration and
26:16and if a child can't do that they cannot
26:18develop um and I think that's where
26:22where we get a little lost and confused
26:25in this discussion of occupation
26:28um because we
26:30you know, we're we're taught in more of
26:32an adult model. Um, and and the focus on
26:35occupation and children is kind of like
26:37it's one class, right? It's we don't get
26:39a lot on pediatrics and occupation. We
26:44get a lot on adult and life lifespan
26:47occupations really, but and and we apply
26:50a lot because it's what we know as
26:51adults, right? We we can we just
26:53extrapolate all that information that
26:55we're learning about occupation because
26:56it's it's relevant to us as adults. We
26:59know what occupations are for ourselves.
27:01But when we think about those
27:03developmental models, I think it's
27:06really important that we
27:08we we
27:10reframe what occupation is. Um, and you
27:15know, I know there's there's lots of um,
27:18you know, books on pediatrics and
27:20understanding occupation. Um, I think
27:22the playbook by Linda Fasio and Diane
27:25Prim really explores occupations in
27:27childhood. Um and I think it's a really
27:30wonderful book. Uh but I wish we could
27:34use that more wholly in our discussions
27:37um around occupation because I think
27:40people get confused especially when
27:42we're working in pediatrics how that
27:44relates. Um it's it's an old discussion
27:48like we've been having this discussion
27:49forever. Um, and I even um I had a
27:54discussion with um uh Roseanne Sha years
27:58ago. She was talking with um the at the
28:02time she was the president of um of AOTA
28:06and um the president was really pushing
28:09for everyone to use these really
28:11occupation centered um treatment
28:15sessions, right? They didn't and and she
28:17was talking about adults. she truly was
28:19talking about adults, but she didn't
28:21have the lens of children at all. So, um
28:26I believe it was Amy Lamb was the
28:29president at the time. Um, but she was
28:31she was telling Roseanne the story of
28:34how she had Amy had an arm injury and
28:37she went to occupational therapy to
28:39improve um her injury. And the
28:43occupational therapist had put her on
28:45like a hand bike and was doing all these
28:48exercises with her to strengthen her arm
28:50and improve her function. and Amy Amy's
28:53a tennis player and she and so she made
28:56the occupational therapist do every
28:58treatment session with a tennis racket
29:00in her hand. Um, very occupation-based,
29:03right? Like that makes sense. And so Amy
29:06was saying, well, that's how all
29:08treatments should be. If the goal is to
29:10improve function towards playing tennis,
29:12then every every activity should be
29:14around playing tennis. And and I'm
29:17thinking, well, that doesn't work in a
29:19developmental model because the goals
29:20are like shoe tying. Like I'm a child is
29:24not going to want to do every activity
29:26around shoe tying. But maybe we are on a
29:31pirate ship and we tie the pirate ship
29:33up to the post, right? And then we do a
29:36little bit with a rope and we work on a
29:37knot and you know, but we're not going
29:40to sit there with shoes in our hands the
29:42entire session
29:44and practice shoe tying because that's
29:46just not a develop model.
29:48>> How boring. A child would never make
29:52progress, right? Um but but that's what
29:56that that's what you know I think I
29:58think it's up to us as pediatric
30:00therapists to to clearly define what
30:05that looks like what occupation looks
30:07like in our treatment sessions. What is
30:09an occupation-based session and how does
30:11that relate back to the goals? Because
30:13it's not as straight of a line as it is
30:16in an adult model. Right? If I'm going
30:18to play tennis, I'm going to have every
30:20session about tennis. That makes sense.
30:23But it doesn't make sense in a
30:25developmental model because that's not
30:26how children grow, right? We don't we
30:28don't work on handwriting with a child
30:31who's two. We don't work with the goal
30:33of the child being able to write their
30:35name, you know, when they're four and
30:37five years old by sitting down and
30:39having them write their name and
30:40practice writing their name and showing
30:42them letters and putting their name
30:43together and all those thing all
30:44different ways. No, we start with like
30:47can you even hold a tool in your hand,
30:49right? can you can you do you know what
30:51are the basics like we have to break it
30:53down for them because you can't write
30:55your name you can't you know you can't
30:58run if you can't walk so we have to get
31:01we have to get that discussion I think a
31:03little more clear um because we continue
31:07like people continue to um misunderstand
31:11what we're doing and why and then I
31:13think that's where um you know the
31:15behavioral approach starts to get more
31:19informed um becau or more useful more
31:22understood because that's that's more of
31:25a straight line right to
31:29this is just my opinion but I think uh
31:31what changes that is is our our p
31:35perspective in air sensory integration
31:38because uh when an occupational
31:40therapist does uh his work uh without
31:44this um this lens uh I think It's it's
31:49much more difficult to uh prove or
31:52explain why he's just playing because
31:56when we are playing we know that we are
31:58working uh sensory motor functionings or
32:02uh even hyperreact uh reactivity and we
32:05know exactly why we are doing what we
32:07are doing for uh participation in in
32:12daily life uh tasks and everything. uh
32:15but but when we don't have this
32:17perspective I think it's much more
32:20difficult to link um everything I mean
32:25play and occupation uh and and I think
32:29that probably the lack of therapists
32:31without this um
32:35perspective uh I think uh maybe uh or
32:41maybe not I don't I don't know I'm just
32:43generalizing but uh Maybe they uh
32:46contribute for that misunderstanding
32:49around occupational therapy in
32:51pediatrics.
32:53>> Yeah. I mean, I feel like I'm constantly
32:56having to explain what an occupational
32:59therapist does when when um a parent
33:03comes to me from another clinic that
33:05doesn't have this training. And so, you
33:07know, I'm I'm having to kind of
33:09reintroduce occupational therapy to them
33:12um because they think it's it's
33:14exercises and like very behavioral
33:17approaches and um a lot of executive
33:21functioning, cognitive behavioral kind
33:23of activities. And I'm like, "Wow." And
33:25she's like, "My child doesn't like
33:27occupational therapy." I'm like, "Well,
33:28no wonder because this is really boring
33:31what they were doing and probably not
33:34getting to what they needed." Um
33:37but yeah, I think I think we all need to
33:40continue to um
33:45make th that lens that understanding
33:48clearer of what childhood occupation is
33:51and why our sessions
33:53look the way they look and what we're
33:55doing within that.
33:57>> I'm remembering uh something else. Um
34:01also uh when I don't know
34:06uh about you Patricia and Anna, but uh I
34:11felt like that I uh put the
34:15little
34:17uh how do you say like prepar you know
34:21like uh
34:23>> the games?
34:23>> No, when you have game Yeah. Yeah. Thank
34:25you. Yeah. when you when you you have uh
34:28prepared games. um uh when at least uh I
34:34felt that when when um I came through
34:37this sensor integration perspective uh
34:40to understand the kids that I uh the
34:44kids um I I put the games aside uh
34:49because I understood that I I need the
34:52body and to function with the bo with
34:54the body uh in the space and this is
34:58what this is something that I really
35:01feel that is really different from OT's
35:03with SI and without SI because when you
35:07don't have SI you you you rely all your
35:10work based on games different games even
35:14for fine motor skills for example
35:17>> but when you have the sensory
35:19perspective you understand that you need
35:22to work uh uh out of that games because
35:26you need you really need to work
35:27foundations
35:29and and and they are not uh uh workable
35:33with games with
35:35>> No. And the children don't make their
35:37progress is so slow and minimal,
35:40>> you know, when you Yeah. when you're
35:42just doing the games.
35:45>> Yeah. But I think now in Portugal, I
35:47don't know if it's in the US too, but
35:49now in Portugal, like going online,
35:53having your own OT page, there are a lot
35:56of people putting games like do this for
35:59practice handwriting, do this. So we are
36:02seeing more of these things that parents
36:06think that this is the way for him to
36:09improve his handwriting. This is the way
36:11to improve these people are and selling
36:15games and that kind of stuff. So I'm
36:18thinking
36:18>> ah okay like people
36:21with with own projects. Yes, like
36:25showing like I do these games to improve
36:28this and I think
36:29>> okay okay
36:30>> I think in especially I think the
36:32intervention it has to be like
36:35personalized right to to that kids not
36:38doing some game that I don't know where
36:42it came from and having it prepared
36:45>> I and you know I think our culture is
36:48kind of um
36:50I don't know I call it like the
36:52Instagram culture like everybody body,
36:54they feel like they can learn anything
36:56online for free, right? Like, you know,
36:59and everybody's an expert in something
37:01and let me show you how to do it. And I
37:04just had a a call with a a new family
37:07that was um that we did an intake with
37:11and and the whole time the mom the mom
37:14was like, "Yeah, you know, I was I
37:16followed this this Instagrammer and she
37:18told she said this and this and this and
37:20this. So, I tried it and it didn't
37:22really work and some of the things did,
37:24but some of them didn't. And, you know,
37:27they just went on and on. Like, I mean,
37:29I spent like 15 minutes listening to all
37:32of the junk that she's tried to do for
37:34her child that isn't working.
37:38And
37:39>> it's really dangerous to put online this
37:42dangerous. And she was and she was
37:44calling because she said, "Well,
37:46somebody said you'd be able to give us a
37:48really good home program and sensory
37:50diet for my child." And
37:52>> that's a very good point.
37:54>> What?
37:55>> That's a very good point.
37:57>> They they just want like they they think
38:00that sensory can't be improved that it
38:02just you just need strategies to get
38:05around it. And
38:08I I was when I started talking to her
38:10and telling her about what we do, she
38:13she said, "So wait, you can get my child
38:16can be can get better like these he just
38:20doesn't need a fidget." And I'm like,
38:21"Well, do you want your child to have a
38:22fidget for the rest of his life?" And
38:24she's like, "No." And I said, "Okay,
38:27well then let's get him better. Like you
38:29can always get better. The brain and the
38:31body changed." She goes, "I never
38:32thought about it like that. I thought it
38:34was just a behavior.
38:37And I'm like, yeah, like they think
38:40these are like they they know that it's
38:43not a behavior, but it is a behavior.
38:45So, let's give them a little strategy so
38:47it's not this ugly traumatic behavior
38:50approach. So, let's honor how they're
38:53feeling and give them give them
38:55something to make them feel more
38:56comfortable. that
38:58they don't un they didn't even under she
39:00didn't even understand that you can
39:02actually make changes so that they don't
39:05have to have all these strategies. So I
39:07so I explained all that to her, you
39:09know, I gave her my whole like let's
39:11let's get them better and strategies get
39:14them by and I gave her that whole talk
39:16and um and she really understood it at
39:19the end and she was like oh and she's
39:21been doing there's this occupational
39:23therapist in the area that does just
39:26programs like protocols
39:28and they use all of the sensory
39:31equipment and um it's a group program.
39:33Nothing's individualized. They don't
39:35assess the child. they just do things
39:37with them and give them some give
39:39parents like strategies and and they
39:42have no training in SI none and um
39:47maybe they did like a weekend course
39:49somewhere I don't know but um they so
39:52you know
39:54>> what
39:55>> this I saw it online somewhere and
39:58>> yeah and um and the mom the mom was like
40:02oh
40:03that's so different than what we're
40:05doing with my child and I'm like, "Yeah,
40:08it's really specific, very individual.
40:10Like, your child is very different than
40:12any other child." Like, and it was just,
40:15it's amazing that that I'm still hearing
40:19that from families that they think that
40:22it's
40:24>> something. Go ahead, Maria. I I was
40:27saying that I must confess you guys that
40:29I um many times feel the pressure from
40:33family from families um to have
40:38strategies uh for for them at home and I
40:42understand from where that that comes
40:44because they are anxious about their
40:47child and and and I understand
40:49absolutely understand this but uh it's
40:52really complicated and sometime I many
40:55times I feel that pressure to uh to give
40:58strategies instead of explain uh all the
41:02clinical reasoning because what I tell
41:04them is if you understand the the the
41:07reasoning uh beyond this um then you
41:10will be able to to um adapt the
41:14environment in such a particular way
41:18that your child needs. But if I give you
41:20a list of of strategies and and works
41:24for home and and everything uh that
41:28might will be um um has like a finitude
41:34I mean it's not you understand it's it's
41:38um how do you say um final
41:44final it's final
41:46>> not not exactly final but um it it will
41:50not work always.
41:53>> And if they understand the reasoning,
41:55they can adapt the the environment and
41:58adjust it while the the child responses
42:02are also changing.
42:04>> But if I give them a list, a list will
42:07will respond to a behavior, but not the
42:12the the change of that behavior.
42:16But I really feel that families they
42:18don't they they it's not that they don't
42:22want I don't believe that but
42:23>> they want to fix the problem.
42:26>> Yeah. want to fix the problem and it's
42:28really difficult for them to uh engage
42:31with us to understand reasoning because
42:34they need they they I feel that they
42:37need something prepared a program
42:40protocol something and it and I feel
42:44that pressure
42:45>> and I feel like
42:47>> even from schools I sometimes feel from
42:50schools like even especially in
42:53kindergarten that they ask the parents
42:55to oh uh please ask the therapist to
42:59send me what can I do with the child?
43:02>> Yeah.
43:03>> And I tell the parents I'm not saying
43:05what what they can do with the child.
43:06They have to
43:08>> the the child has has to do almost
43:11everything that the other kids do do. So
43:14we we just need to adapt some things and
43:17then I suggest the meeting with the the
43:19the teacher and
43:21>> teacher
43:22>> trying to explain to her why the the
43:26problems the the sensory problems from
43:29the sensory motor problems and in which
43:32occupations it impacts and how we can
43:34adapt because but the people is like oh
43:37send me what can I do send me the recipe
43:40for me to to know how to how to work
43:43with this kid And it's not that way. It
43:46doesn't go that way.
43:47>> We we call it kind of like the the
43:50cafeteria approach to OT. Like you walk
43:52into a big cafeteria and there's all
43:55kinds of food and you can you can choose
43:57whatever you want and sometimes you
44:00don't like it and it's no big deal
44:01because there's other things to choose
44:02from, but you might not get you might
44:04not actually enjoy your meal because
44:07it's you're just picking and choosing.
44:10You're not really doing it with like
44:12thought. Um, I just had a call with a
44:15parent the other day and we she said she
44:17wanted um classroom strategies and so we
44:21gave her like you know four four or five
44:24classroom strategies for her daughter
44:25and she's like oh no we need more and
44:28we're like well why don't we just start
44:30with this?
44:32This might be all she needs. And then
44:34like that same
44:36>> Yeah. And that that same mom said she
44:38has this wonderful teacher um who's
44:40who's been using different strategies
44:42with her daughter and some of them work
44:44and some of them don't. And they put her
44:46in a rocking chair and it seemed to be
44:47helpful. But then they put her in
44:51um and the little girl falls out of her
44:52chair all the time, like just falls. And
44:57um
44:59and then they put her in a wobble, like
45:00on a stool that kind of wobbles. And
45:03that was tragic. She like just kept
45:06falling and getting hurt and and and she
45:11was upset about it. The little girl was
45:12upset about it. And I told the mom, I'm
45:14like, "Look, that's why that's why you
45:16want an individual approach." So your
45:18teacher has lots of ideas of what
45:20sensory kids might need because she's
45:22probably seen them on Instagram, but now
45:24your daughter has had a traumatic
45:26experience because the teacher made a
45:29choice that wasn't relevant for her, an
45:31uneducated decision on what she might
45:34need. and now your daughter's had a
45:35traumatic experience around it and she's
45:38uneasy having any kind of chair that
45:41moves. So now it's backfired. This is
45:43why you need a professional to come in
45:46and say like what this specific child
45:50needs. And and so the mom said, "So what
45:54does she need?" And I said, "She needs a
45:55rocking chair with a back and arms. She
45:58needs to be this size and something
46:00needs to be under her feet." And you
46:01know, and so we gave her all this. She's
46:03like, "Wow, you really are very specific
46:05about what her seating needs to be." I
46:07go, "Yeah, because she has terrible
46:09postural control issues and she's
46:11fearful of falling. So, if you do
46:14anything else, you're going to just
46:18sabotage this whole process. So, let's
46:21not do that because we don't want to
46:23have to undo the emotional trauma of the
46:26wrong tool."
46:27um and her feeling like a failure, you
46:29know, like for every kid like you see
46:32when when they're having a problem, they
46:34know that something's wrong. And when
46:36you show them a tool that's going to
46:38help it, their faces light up and
46:41they're so excited. And then when it
46:43doesn't work, they're devastated and now
46:47they're the problem. So, I don't want
46:49kids to feel like that. That's why we
46:50need to have these evaluations that are,
46:53you know, people just need to stop like
46:57trying to fix it themselves. They need
46:59to have a professional come in and and
47:02identify what the true issue is and how
47:05to make it the best way for this child.
47:07Um but this so then I went through that
47:11whole discussion with this parent and
47:13she said yeah the teacher at the very
47:15end she goes yeah our teacher so excited
47:17to get this report because she knows
47:19that these activities will also help
47:20some of the other kids in the class
47:23and I said actually they won't they will
47:25only help your daughter
47:29and I said perhaps those other kids
47:31might need an evaluation too so you can
47:33get the best choice for those children.
47:36It was just so she just didn't. It was
47:38horrible.
47:39These poor kids. And this little girl,
47:42you know, it's, you know, some kids,
47:43they can they they are um resilient
47:48enough that, you know, if they get put
47:50in the wrong chair, it's not that big of
47:51a deal. But some children really they we
47:55can't mess with that. We really can't
47:57mess with that. And those are the kids
47:58that we see. um we we don't want to make
48:02these empty promises to them because
48:04that just makes them feel like failures
48:06and it devastates them.
48:09>> So
48:11I just feel like that that Yeah. I mean
48:13the evaluation is so important.
48:16>> I just talked with a psychologist of a
48:19kid and the kid was um chewing
48:23everything the the clothes the pences.
48:26So they put it what a chewing necklace
48:29to the kid but of course it wasn't
48:31enough. You chew on the necklace and
48:33then the draw from it was even was
48:39having a stain on the his clothes and
48:42the other kids were making fun of him
48:44because of that.
48:45>> Yeah.
48:46>> And I told her he needs an an assessment
48:48because I think it's more than the
48:50mouth. It's probably he needs um
48:54intervention because we need to figure
48:56out what is happening because he has a
48:58lot of anxiety.
49:00He doesn't want to fail and I don't know
49:03how his sensory systems are. So
49:07because it's not just giving it a
49:09chewing necklace and it will go is going
49:12to help because the chewing necklace is
49:14giving him other problems because now
49:16other kids are making fun of him. We
49:19don't want to be around him because he
49:21chews and he has draw on his clothes and
49:24it smells bad and
49:26>> yeah
49:29having another problem now.
49:31>> Yeah, it just adds to the problem.
49:34>> At every school we should be there.
49:38Every school needs an OT.
49:40>> Yeah, they need somebody. And you know
49:42they're like, "Well, we'll just get our
49:44classroom OT to come or our school OT to
49:46come look at it." And I was like, "Well,
49:47oh, do they have training? Are they
49:50trained in this?" Um, no, but they're
49:53the OT. Like, okay, well,
49:57you can only help who wants help. That's
50:00what I'm now I can fight it. I can argue
50:03it with everybody, but at the end of the
50:06day, the only people we can help are the
50:08ones that want it.
50:10So,
50:12yeah, I'm open to helping everybody.
50:15They just need to want it. So
50:20>> anyway, okay. Um, Patricia, did you want
50:23to share your case?
50:25>> Maria, do you have a case or anything?
50:31>> Maria,
50:32>> ah, sorry.
50:33>> Yeah. Do you have a case or anything
50:35that you wanted to share?
50:36>> I don't have nothing specific. No, I
50:38just wanted to share something with you
50:40guys. Uh but just just to share and I
50:44can do it in the end.
50:45>> Okay. All right. We'll let Patricia do
50:48her case.
50:50>> Uh so this is a case that I'm doing
50:52intervention for almost two years now.
50:56Uh he's four but he's almost five. He's
50:59doing five years turning five this uh
51:02this month in the end of this month. Um
51:05he's premature. He was a premature kid
51:08and he has a brother with autism.
51:11and he came for intervention because of
51:14the language he doesn't he doesn't speak
51:16and that's the mainly problems mainly
51:19problem for the mainly concern for the
51:21parents
51:23uh so when I'm I met him almost two
51:26years ago uh I saw that he was a very
51:29hypo kid that kind of kid that is busy
51:33but doing nothing like he was the the
51:37sessions were were were him going up and
51:40down on the ramp up but doing nothing
51:42with it. Uh just moving around on the
51:45space but doesn't exploring doesn't
51:49involving anything. Um and he had uh
51:53poor balance, poor body control,
51:57uh poor body awareness, tactile
52:00perception also and his practice also
52:04really really bad. Um
52:07he loves intense stimuli. He loves to be
52:11he loves rotation. He loves up and down
52:15in the the swings.
52:17Um and I'm seeing I I see I'm seeing
52:22some changes in him during the
52:24intervention especially on the relation.
52:27He's more connected with me. He looks to
52:30me more. He asks for more in the play in
52:34during the play. He's more risky. He's
52:37exploring more. Um,
52:40and now he's putting less objects in his
52:42mouth because in the beginning he
52:44everything was to the mouth to the
52:46mouth. Um, now not that much. But now he
52:50he he chooses specific things to put in
52:53his mouth like really really hard things
52:56like that he tries to
53:01he it doesn't especially the the Z vive
53:05and everything has to have to be really
53:07really hard because it doesn't if it's
53:11really wobbly like uh I don't know how
53:14to say the piaza I don't know how to say
53:17in English, but
53:20>> um
53:22>> rigid.
53:23>> Yeah. Yeah. More rigid things. Yeah,
53:26that's it. That's it. He likes to put in
53:28the mouth more rigid things. Um
53:31but I think he's now two two times a
53:34week. Uh he started once time a week and
53:37now he's twice times a week. There was a
53:40time during the intervention that I was
53:41seeing a lot of improvement. But then he
53:46for almost three three months is two
53:49months ago he's
53:52he's constantly getting sick like he's
53:55one week he's sick then he's okay when
53:58he um and I think that that is not
54:02helping even now he's having um he had a
54:07lot of things COVID
54:09everything all the diseases he's getting
54:12a lot of virus
54:13Everyone is. Yeah.
54:15>> Yeah. And now he's having a skin
54:18problem.
54:21The doctor think it's a food allergy to
54:23a lot of things like eggs. Uh even um
54:29respir respiratory allergies to the dust
54:33and a lot of things.
54:36But the problem is that he needs to
54:40I can see when he's not okay because his
54:43skin is when he's not okay the skin is
54:46really dry and he's always how do you
54:49say this
54:52>> scratching scratching his head
54:54scratching his arms.
54:56So it's a kid that for like two two
55:00weeks, two months is three months is
55:02it's not that good healthily good.
55:06But when he's okay, you can see that
55:08he's more able to try new things. Um but
55:13even even when he's okay, he's he's
55:18really strict in the things that he
55:21plays. Like he just likes to go to the
55:23Lyra. It's the only swing that he goes
55:26in the he goes to the to the the the gym
55:30the SI gym and he only goes to the the
55:32lyer and he can stays in he's able to
55:35stay in the lyra for a whole session
55:38and just having rotation going up and
55:42down going really fast this is what he
55:45enjoys the most when I try to do
55:48different things now he's
55:51another thing that it's improved that
55:53now he is like when I don't want a thing
55:56I I I scream I don't I don't want and
56:00you are not going to do in the in the in
56:03the beginning he was more a passive kid
56:06like you putting him doing a thing and
56:09he
56:10>> he stays there not involving too much
56:12but he stayed there but now he's like oh
56:15I don't want this I I'm not doing this
56:17I'm going to scream until you stop so
56:21h he's showing what he wants and what he
56:23doesn't want and I think that's that's a
56:25good thing but it's being really hard to
56:30get him out of the the Lyra doing
56:33different things. Um
56:36and my sessions it's that it's putting
56:38him in the Lyra and he's asking for more
56:43I I sing a song then he knows from the
56:48song when it's going to be more fast and
56:50more intense because he smiles. he
56:53starts to to shake himself because he
56:55knows something is going to happen,
56:57something that he likes.
57:00Um,
57:02but it's that it's that's it's just and
57:05and when I
57:08>> How long has he wanted to just be in the
57:10Lyra?
57:12>> We can be there for a whole session.
57:14Yeah.
57:14>> But has this been going on for months?
57:17Yeah, he
57:20it was hard to take him out of the ramp
57:22because he just wanted to do the ramp
57:24the ramp and then I tried to do
57:26different things in the ramp.
57:29But since he discovered the then we he
57:32he started to go to his platform swing
57:35when he he liked to lay down and be
57:39spinning or moving fast. So being sh
57:42>> all passive
57:44>> all passive and now he's he he
57:46discovered the lyron is just just the
57:50lyra what he likes to do um when we are
57:54looking at the levels of adaptive
57:56response I think it's always on the one
57:59and I'm like oh my god I'm not doing
58:01nothing with these kids because
58:04yeah there was a time when I tried to to
58:08do some the games in the like putting
58:11balls inside the lyra and having a
58:13basket outside.
58:15He kind of be like, "Oh, you are doing
58:18this and I don't like it." But he he
58:21grabbed the balls and put it on the
58:23basket like grabbing and coming outside
58:25to put it on the basket. But now he's
58:28like, "Oh, I'm not going to do this." So
58:30he runs away from it. Um, and even when
58:35he goes to toys from the the place where
58:39we have the toys, it's like um
58:43a thing. Well, we have the choice. I
58:44don't know.
58:45>> Cabinet or shelf or something.
58:46>> Cabinets. Yes. Yes. He goes there and he
58:50just grabbed things that he can put
58:52rolling.
58:54>> Just that just put just he just puts the
58:58things rolling. Um, and sometimes I try
59:01to, oh, now it's my turn. I'm going to
59:04deliver this to you, but he doesn't give
59:07a Yeah, I can show you a video of him. I
59:10have
59:10>> And Patricia, for how long is he
59:13choosing to be in the Lyra yet?
59:18>> I think almost three sessions for
59:22>> more more more
59:24>> more than that.
59:24>> For a long time. Yeah, for a long time.
59:26Definitely. And he wants to do always
59:29the same thing inside the Lyra.
59:31>> Always just being shaken, just being
59:35moved inside the Lyra. Yeah.
59:38>> Yeah. It doesn't accept the balls inside
59:40and everything.
59:42>> Yeah. I'm I'm thinking maybe of taking
59:45off the Lyra. I I I tried that once. I
59:50took it off. Um but then he found it on
59:56on the the he goes
59:58>> put a barrel inside of it
1:00:01like do something inside of the lycra.
1:00:03Put a barrel in the lycra before he
1:00:05comes.
1:00:06>> What do you climb in the barrel?
1:00:09>> What? It's a barrel is what?
1:00:12>> The big tunnel like foam.
1:00:15>> Um
1:00:16>> I don't have that but I have like a a
1:00:18ball or something.
1:00:20But inside the lyra, you see
1:00:23>> a big
1:00:23>> something for him to crawl inside of
1:00:26even like a box or something inside the
1:00:28lycra
1:00:30that he is inside of um just to get to
1:00:34change it on him.
1:00:36>> I mean I just remember Dean remember how
1:00:39how long you were on that ramp?
1:00:43>> I mean it was like six months,
1:00:46eight months of just going up and down
1:00:48the ramp. Um,
1:00:50>> you know,
1:00:52>> I'm always thinking of I I need to get
1:00:54him moving because I need him to improve
1:00:56his practice. But I think it's just so
1:00:59passive that I'm like, oh, even he
1:01:02doesn't have any interest in notes
1:01:05because when sometimes kids have
1:01:07interest in toys, I can put the toys
1:01:09like, oh, it's here in the Lyra up. So,
1:01:13he he has to crawl or climb to get
1:01:16there. But he doesn't have he doesn't
1:01:19doesn't give a damn for any
1:01:25>> Yeah, he has internally his nervous
1:01:29system is really inflamed. It sounds
1:01:32like he's so sick and um
1:01:37>> you know it's probably really
1:01:38uncomfortable for him to do anything
1:01:40else.
1:01:43you know,
1:01:44>> when his skin is not okay, I feel like
1:01:48>> he has that sensation of I I need to
1:01:50take this out. And I I I imagine it's
1:01:53it's kind of awful. Yeah. But but the
1:01:56parents is they are the kind of parents
1:01:58that think that going to the therapy
1:02:00like they they can't they can't skip it
1:02:04because it's it's a huge problem because
1:02:06he can so sometimes he goes to the
1:02:09therapy and he's sick. There was a time
1:02:11when he gets to therapy and I check his
1:02:13fever and he was he was hot and I I
1:02:16needed to send him away.
1:02:18>> Yeah. You can't come to therapy.
1:02:21>> Yeah. Because
1:02:21>> the kid is trying to survive.
1:02:25>> Yeah. And and the parents think it's he
1:02:28needs to go all the times to session
1:02:30because this is the time he he is going
1:02:33to get better, you know, but it's not.
1:02:35He's it's not okay. So,
1:02:37>> he's sick. Yeah. He needs to get
1:02:39healthy.
1:02:40>> Yeah.
1:02:41>> I mean, I think I want to see a video,
1:02:44but he, you know, he's he's sick and
1:02:49it's going to take him a long time
1:02:50because he's sick.
1:02:52>> Yes. Yeah. Yeah.
1:02:56Let me just put this was in the
1:02:58beginning of the session. He was already
1:03:01on the when I put it video. He's able to
1:03:05climb to it. He was not on the
1:03:07beginning, but now he climbs and he goes
1:03:08inside for for himself.
1:03:19And when I do this more, he goes to my
1:03:22my hands and ask for more.
1:03:26>> What if you wrapped the Lycra around
1:03:29that platform swing
1:03:32next time he came? So he has it even
1:03:35even if it was under the like the
1:03:37platform swing but so he's on the
1:03:39platform swing
1:03:42>> the the green one you are saying or the
1:03:45black one this one
1:03:47>> the black one the black one and make
1:03:49like a tent around it sort of that's
1:03:51suspended
1:03:53um just clip the lycra swing around it
1:03:56don't even hang it up but just clip it
1:03:58around it so it's enclosed
1:04:01um
1:04:02in the in the red one. Uh in the the
1:04:05green one, I already put it a lycratone
1:04:08in
1:04:10>> but he didn't he didn't want to go
1:04:11inside there
1:04:13>> because he had the other one. So
1:04:15probably if I took off the other one,
1:04:18maybe he will.
1:04:20Yeah, he will. But sometimes I feel like
1:04:23if I take this off and he cames in and
1:04:25he's really bad
1:04:27not in a good like
1:04:31he's not feeling okay. Um he he won't
1:04:34have the thing that he loves the most
1:04:36and the thing that it calms him calms
1:04:39him down the most.
1:04:41But yeah, I I have to try I have to try
1:04:44to take it off because now he's able to
1:04:46find the lyra where it's um when I take
1:04:51it off, he already knows where it is and
1:04:53he goes there and he he asks me to put
1:04:56it.
1:04:57>> So I mean that that can be part of part
1:05:00of the therapy too is you know put it
1:05:03places that
1:05:05>> yeah it's harder for him to get to. it's
1:05:08harder for him and he has to help you
1:05:09pull it over. He has to help you clip it
1:05:12up. He, you know, build things to get up
1:05:15there. So, that process is really
1:05:18important, too. Um,
1:05:20>> I don't know if he's able to engage that
1:05:22much. Uh, but
1:05:25>> yeah, you scaffold it the way you think
1:05:26he needs, but just to add in a little
1:05:28bit more
1:05:30>> if he really wants that lycra, you know,
1:05:33you can get a little bit more. you know,
1:05:35put pillows in his way, let him crawl
1:05:37over pillows, through a tunnel, whatever
1:05:40he needs to get to it. Um, so you're
1:05:43getting a little bit more propriception,
1:05:46some, you know, postural work if he's
1:05:49crawling across the pillows.
1:05:52Um,
1:05:58>> he won't hold on to a rope or anything
1:06:00in there.
1:06:02>> I already tried. He doesn't. He let it
1:06:05go. Yeah.
1:06:09[Music]
1:06:17>> Yeah. You want him will he hold on to
1:06:18the Lyra at all?
1:06:22>> Uh I think when he feels that he's
1:06:24falling, he tries to to put himself uh
1:06:28>> Oh, he repositions. Okay, that's good.
1:06:31>> Yeah. Yeah. Okay. That's an adaptive
1:06:33response that he's registering.
1:06:36>> It is. It is. Yeah. He now he's able to
1:06:39do that. Uh
1:06:41>> but you know his ideation and practice
1:06:43are so poor he's really limited.
1:06:46Um and he likes to roll things. You said
1:06:50>> yeah.
1:06:51>> Yeah. So I I don't know if you remember
1:06:54the tube that Dean would put balls in.
1:06:58We just put balls down a tube and the
1:07:01tube was really tall. So he had to climb
1:07:04up to he had to be up high to get a get
1:07:08the ball and then the ball was down low
1:07:10and he we only had one ball
1:07:12>> and he put it down the ramp put it down
1:07:15the tunnel.
1:07:16>> You don't remember? It's it was like a a
1:07:19long box. I think we got a carpet or
1:07:22something in the box. Um, but it's just
1:07:25a tube and a ball pit ball fits through
1:07:28it. And so I would stand it up really
1:07:30tall and he'd have to climb up on
1:07:32something to put the ball in the tube
1:07:34and then it roll out the bottom and then
1:07:36he'd have to go and get that ball and
1:07:38then come back and do it over and over
1:07:39again.
1:07:41>> But just, you know,
1:07:44challenging his
1:07:47his his gravity and his propriceptive
1:07:51system. it,
1:07:53>> Patricia. It's remember it was months.
1:07:55It was a long time.
1:07:57>> I know. I know.
1:07:58>> Long, long time before Dean started
1:08:01doing anything.
1:08:04>> At least it looks like he enjoyed when
1:08:06when he was
1:08:08>> He loves that. That's tickling. Tick
1:08:10tickling. I don't know.
1:08:12>> Yeah. And look, he got in there by
1:08:14himself. That's not easy.
1:08:16>> He He does. He does. That's That's
1:08:19improvement. Yeah, because he didn't do
1:08:21this by himself. He asked me to help him
1:08:23and now he's is able to go inside by by
1:08:26himself.
1:08:28>> What about uh I don't know if it makes
1:08:30sense, but what about if you join him
1:08:32inside the Lyra and maybe with the
1:08:35interaction
1:08:37with you know like with your interaction
1:08:40>> mediate mediating something different
1:08:42like can we change? I go to that side
1:08:44and you come to this side, you know,
1:08:46like all inside the Lyra. But
1:08:49>> use the relationship as your the
1:08:52meaningful activity. Yeah.
1:08:54>> Yeah.
1:08:55>> Yeah.
1:08:56>> Because now that's a good thing. I think
1:08:57he when he sees me, he's he's happy. He
1:09:01hugs me because he likes to to come to
1:09:03to the room. And that's an improvement
1:09:05because
1:09:07uh months ago he he didn't it's like
1:09:11it's me or other person. It's for him
1:09:15it's all the same.
1:09:16>> But now
1:09:18>> now he enjoys uh
1:09:21he asks more for relation. Yeah. More
1:09:25touch like the tickling and everything.
1:09:27He asked for it. Yeah.
1:09:30>> Then yeah, Maria's right. use that use
1:09:32that relationship.
1:09:34Um
1:09:36>> and maybe if you you're inside with him
1:09:39and he he likes to spin maybe you can
1:09:43ask him now we are here uh uh with you
1:09:47together. How can we make it spin? How
1:09:50can we do that? So maybe it can
1:09:52challenge him to think about something
1:09:55different to put I don't know if he can
1:09:58put his hand on the floor to make it
1:10:01spin, but maybe you can and you're
1:10:02giving him a model or maybe you can use
1:10:05the rope with yourself like giving him a
1:10:08model to use the rope to spin and then
1:10:11you two spin inside a lyra. Maybe he's
1:10:17>> Yeah.
1:10:17>> Yeah. You pull the rope and he puts his
1:10:19hands on you.
1:10:21Yeah. You know, help me pull. Help me
1:10:23pull.
1:10:24>> Yeah. Yeah. Yeah.
1:10:25>> Those kinds of things.
1:10:27>> Um,
1:10:28>> that's a good idea
1:10:29>> because he accepts you when you are uh
1:10:32down
1:10:33and almost inside the Lyra.
1:10:37At least it looks like he's he's not
1:10:39rejecting you.
1:10:40>> No, no, no, no.
1:10:44I'm I'm I'm showing him um emotions like
1:10:48you are really happy when
1:10:50>> like just now
1:10:52>> I'm showing him I give him to him the
1:10:54happy face and I'm telling him oh you
1:10:56are so happy when you are in the LRA and
1:10:58then I'm showing him because I'm trying
1:11:01him to use more the the images. So now
1:11:05I'm trying to get getting showing him
1:11:09there is a images where if he points to
1:11:12it he can have more that it's the same
1:11:15of this. It's the images the images. So
1:11:19we are because me and the speech therapy
1:11:21we are trying to use more these uh
1:11:25images to get him communicate more
1:11:30to get him more involved. Yeah.
1:11:32>> Yeah.
1:11:34the the parents are are really all they
1:11:38want is him for him to speak but I don't
1:11:41know if that's going now he's producing
1:11:44more sound especially when he has this
1:11:46intense distillary input but they are
1:11:50just sounds not that
1:11:55what they want they want him speaking
1:11:57>> well you want words yeah
1:11:59>> yeah and he's almost five so we need to
1:12:01get him communicating
1:12:06Yeah,
1:12:10>> I was trying to put it okay and he was
1:12:12getting angry like
1:12:15>> I know you're probably very bored in the
1:12:17session,
1:12:19>> but keep it up. He'll change another
1:12:22piece of equipment.
1:12:23>> Two times it's two times a week and I
1:12:25feel like I'm always doing the same
1:12:27thing. I'm like, "Oh my god."
1:12:30>> But he might need it. He might need that
1:12:32more. Yeah. But yeah,
1:12:35it's not,
1:12:35>> you know, if his skin is really like if
1:12:37he's itchy and his skin is
1:12:39uncomfortable, the Lyra probably feels
1:12:41really good to him.
1:12:43>> Yeah.
1:12:43>> You know, his tactical system is
1:12:45probably really confusing for him.
1:12:48>> Yeah.
1:12:50There are some days that even his face,
1:12:53you can see that something is wrong with
1:12:56him.
1:12:57He didn't sleep much because sometimes
1:13:00he don't sleep much because of this
1:13:01because he's scratching and everything.
1:13:05[Music]
1:13:07>> Yeah.
1:13:08>> Would he like to
1:13:09>> I don't know if it was the COVID that
1:13:11gets that
1:13:14I don't know. We don't know much about
1:13:15COVID, but he didn't have this kind of
1:13:17problems um before
1:13:20>> before he gets get CO.
1:13:22>> It might Yeah, it might have triggered
1:13:23something.
1:13:25>> Yeah. I mean we know causes inflammation
1:13:29but
1:13:29>> I even have a kid with diabetes that his
1:13:32diabetes get worse uh after he had co
1:13:36the levels the levels are are always
1:13:38disorganized getting really high
1:13:42and I get like oh was this the COVID
1:13:44thing I don't know yeah
1:13:47we don't know much
1:13:49>> we don't know much we know more than we
1:13:51used to but we're still learning more
1:13:53and more right Yeah. Yeah.
1:13:57>> Well, you're doing the right thing for
1:13:59him.
1:14:02>> Yeah, I know. I know it's it's the right
1:14:04thing because he enjoys it, but
1:14:06sometimes I get like, oh, I need to do
1:14:09more because these kids needs to improve
1:14:12more. I don't know. And
1:14:15>> well, I think just take some of the
1:14:16suggestions you got like what Maria was
1:14:18saying about using your relationship and
1:14:21um and then put things in the way if he
1:14:23wants to get to the swing like you know
1:14:25make it a little more challenging for
1:14:27him to to get it and
1:14:30>> and the process of hanging up the swing.
1:14:32Help him with the process and even if
1:14:34it's just like communication gestures
1:14:38um those kinds of things
1:14:41>> that would be beneficial too. And do you
1:14:43think that the it's okay the spinning
1:14:46because he enjoys a lot and I think he
1:14:48gets really really good after the the
1:14:51spinning because he spins really a lot.
1:14:53He can
1:14:55>> Yeah, because you spin him and you
1:14:57bounce him. Um so you're giving him some
1:14:59more propriception and maybe like give
1:15:01him a little squish in there too so he
1:15:03gets some propriception with it.
1:15:05>> Um
1:15:07>> have you done his PRN? Do you know what
1:15:09his post diagnosis is? Yeah, it's I I
1:15:13tried but he was not on the right
1:15:15posture because on the chair it was
1:15:18impossible. He was always leaning out of
1:15:20the chair. I just tried it on the swing
1:15:22but with him laid down and I didn't see
1:15:25any.
1:15:26>> It's the wrong one. Yeah. Okay.
1:15:28>> But it was not the right position of the
1:15:30head. So
1:15:31>> yeah, you want to get that lateral.
1:15:33>> Yeah.
1:15:35>> Yeah.
1:15:36Okay. Well, you're doing your best.
1:15:38You're doing I think you're doing the
1:15:40right things. It's gonna take a long
1:15:42time, but once practice turns on, it
1:15:45really takes off. It really does.
1:15:49>> Yeah.
1:15:50>> I hope so.
1:15:51>> Yeah.
1:15:52>> And for tactile perception, do you think
1:15:54that I should do more? Sometimes I put a
1:15:56vibration toy inside and you
1:15:59>> No, I mean full body tactics. Sometimes
1:16:02he takes it off from the like he doesn't
1:16:04want that the vibrations. I mean, you're
1:16:06giving him full body tactile and deep
1:16:09pressure and every time he moves the the
1:16:11input changes and you know, if you twist
1:16:14it, you know, there's a fold in the
1:16:16Lycra and he that's a different tactile
1:16:18sensation. No, I think you're doing his
1:16:21t you're giving him all the tactile he
1:16:22can can handle right now. You know,
1:16:27>> when he's ready, you can bring in foam
1:16:29and like wet textures, but
1:16:33the best way to get the full body is
1:16:35what you're doing.
1:16:36>> Yeah. He doesn't like to touch the wet
1:16:38textures, too. Yeah.
1:16:40>> Yeah. So, wait, you know, wait on that.
1:16:43But, I mean, you're crashing him in the
1:16:44pillows, you're squishing him. He's he's
1:16:47getting all kinds of tactile sensations.
1:16:48And every time he moves, it's different.
1:16:50So, and he has to re reregister that. So
1:16:54>> that's good.
1:16:56>> Yeah.
1:16:57>> Um
1:16:59>> yeah, keep on
1:17:02>> Maria, what was your update?
1:17:04>> Uh I was uh I wanted just to give you
1:17:07another suggestion or or asking you like
1:17:10does he this kid like to uh go from one
1:17:15layer to another? Do you think he he
1:17:17would enjoy it or he just wanted to stay
1:17:20inside? You know, he doesn't want to
1:17:23explore one or or another layer of
1:17:25lyros.
1:17:26>> He likes to be on the the higher layer.
1:17:29Sometimes he falls to the the lowest and
1:17:32he goes up again. Yeah. He likes to be
1:17:35on the higher because he I can swing him
1:17:39more on the higher low level.
1:17:43Yeah.
1:17:46Okay.
1:17:46>> Okay. Well, he moves. He's moving. So
1:17:53>> what I what I was sharing uh it's
1:17:56something that it's just curious uh
1:18:00especi
1:18:04uh something symptom in kids or not but
1:18:08especially in this last year I I'm
1:18:10receiving a lot of kids with two three
1:18:13uh sorry with three four five years um
1:18:17uh that kind of the girl that I shared
1:18:20with you in the the last call. Uh that
1:18:24busy kids that are everywhere but not
1:18:26really anywhere doing something. Uh or
1:18:30they are but then they disorgan they
1:18:32they keep the almost every session in
1:18:36the same activity. uh because there's
1:18:38something with motor planning and
1:18:40ideiation and everything but um uh but
1:18:44they are not really good doing something
1:18:47and then it they change and then they
1:18:49change again and then they get
1:18:51disorganized because because of all the
1:18:53movement and and and and sensory uh
1:18:57input um uh but but I I I'm really
1:19:01receiving these kids and they are uh uh
1:19:04the majority of them are really smart
1:19:07actually like with pretty good cognitive
1:19:10functionings functioning. Um
1:19:14uh but really disorganized and intense
1:19:18like usually parents call them like uh
1:19:21it's an intense kid really intense kid
1:19:24frustrates a lot every a little thing
1:19:27it's a big uh problem and then they
1:19:31crave autonomy because I that's what I
1:19:34feel like they want control in their
1:19:36lives and so they crave for that
1:19:39autonomy and independence so they
1:19:42doesn't want parents to to do um uh
1:19:47things for him because they want to do
1:19:49by theirelves but then they fail and
1:19:52then then they frustrate and then they
1:19:54are very intense in the in their
1:19:56behavior and then when when they go to
1:19:58the therapy it's the same pattern and
1:20:01I'm really receiving a lot of kids like
1:20:02this um and actually I have to uh still
1:20:07listen the last call because you you you
1:20:09you suggested a lot of good ideas to um
1:20:13to assess when we we can't we can't have
1:20:17the collaboration to sip them. Um and I
1:20:20still have to to do that work.
1:20:22>> Uh but I just wanted to share that with
1:20:25you. I don't know if you're you also are
1:20:26receiving this with this kind of kids
1:20:28and that's some kind of new for me. Uh
1:20:32and yeah and suddenly a lot of kids like
1:20:35this.
1:20:37>> Yeah. a lot of big emotional kids,
1:20:39right? Like and and they're three, four,
1:20:42and five. So, they were probably born
1:20:44during the pandemic, right?
1:20:46>> Um or just before. So, I mean, they were
1:20:51they were born during such a um
1:20:54stressful time, right? Their parents
1:20:56were stressed. They were and they were
1:20:59being raised in that stressful
1:21:01environment as infants. Um, so I wonder
1:21:05and and I also wonder if um you know
1:21:09what also happened to those babies. Were
1:21:11they were they not held as much as they
1:21:14normally would have been?
1:21:17um because parents had to work and they
1:21:21didn't have the you know normally when a
1:21:24baby's born there's lots of people
1:21:26family and everybody's coming over and
1:21:29helping and holding the baby and caring
1:21:32caring for the baby with you and those
1:21:35babies didn't have that most of them
1:21:38right they they were just with their
1:21:40parents and um perhaps their parents had
1:21:44to work so they had to put the baby
1:21:46down. So, the baby was wasn't being held
1:21:49as much as they were they usually were.
1:21:51So, now they're not getting any of that
1:21:52like nice movement, the regulating
1:21:54movement, but also that movement that
1:21:56teaches them about their bodies. And
1:21:59then, you know, are they are they even
1:22:01being put on their tummies? Are they
1:22:04just being put in a seat, right? Are
1:22:06they just being put in these containers
1:22:08and just being held in different in ways
1:22:11that weren't facilitating their motor
1:22:13skills either? Um but then their
1:22:15exploration was limited because they
1:22:17couldn't go out. And then the novelty of
1:22:20just having different people around too,
1:22:22right? Like everybody brings a new way
1:22:25of doing something every person that
1:22:27they meet. And if they're really
1:22:30isolated,
1:22:31they're probably not getting exposure to
1:22:35novelty and that exploration of how to
1:22:38do something different. They're stuck in
1:22:40their house and the house never changes
1:22:44and they just go to these static
1:22:45environments that just don't change,
1:22:48right? The playground, they probably
1:22:49went to the same playground all the time
1:22:52and then their home doesn't change. And
1:22:53unless the family is really good about
1:22:56putting those changes in place and
1:22:58giving environments for their child to
1:23:00explore,
1:23:02yeah, I think those are the kids that
1:23:03that we're starting to see. And they're
1:23:05anxious because they don't know how to
1:23:06move their body. They're anxious because
1:23:08their environment was anxious.
1:23:10>> More use of devices. I had a lot of kid
1:23:12that spend the time with devices because
1:23:15parents were working.
1:23:18>> Yeah.
1:23:18>> Even the relation they don't know how to
1:23:20relate to other people because they
1:23:23didn't learn it.
1:23:24>> It also makes me think about uh I don't
1:23:27know if it was Suzanne but Chel Lane
1:23:31said the same in the SI and neuroscience
1:23:34course. Um and maybe because of of that
1:23:39p family dynamic
1:23:42um uh they they uh kind of got um uh
1:23:50attached to an a an arousal state and
1:23:56>> and you know and and like that anxious
1:23:58and everything and that toxic cortisol
1:24:02uh without can be um liberated
1:24:07um and maybe they attach to that arousal
1:24:09state
1:24:10>> to maybe just something else
1:24:13>> because that's what they know. They know
1:24:14stress.
1:24:15>> Yeah. Because that's what they know and
1:24:16how to interact.
1:24:18>> Yeah. And so
1:24:20yeah, I mean it was a stressful time and
1:24:23it was a stressful time for a long time,
1:24:25right? A lot of families were for a
1:24:28year, right?
1:24:29>> More.
1:24:30>> And then some families are still working
1:24:32from home.
1:24:34and having to raise children and and
1:24:38you know work and have a livelihood. So
1:24:42it's there's a lot of stress I think and
1:24:45yeah I think that arousal state is
1:24:49is pretty embedded and so we need to
1:24:51kind of help with that arousal state.
1:24:54Mhm. Mhm.
1:24:55>> I have I have a kid now that it was a
1:24:59few months ago. She went for the first
1:25:01time to um she she was four and she went
1:25:05for the first time to a restaurant and
1:25:08the mother told me that she was like she
1:25:10told me she never sits stay seated for a
1:25:13long time and she was seated and like
1:25:16observing everything like people talk
1:25:21different colors and lightnings and
1:25:23everything and she was like just sitting
1:25:26still for the whole meal for the whole
1:25:28time sensory deprivation. It's like
1:25:30those
1:25:31>> Yeah,
1:25:31>> they've had some deprivation. And I
1:25:34mean, I think if we probably look back
1:25:36at some of those Romanian orphan
1:25:37studies, we might see some similarities,
1:25:40>> some similarities.
1:25:42>> You know, they these kids have been
1:25:44really isolated.
1:25:46>> Yeah.
1:25:48>> So,
1:25:49>> yeah, it makes sense. Absolutely. Yeah.
1:25:53>> Yeah. And and I also tell the parents
1:25:56about what once a thing you once told
1:25:59that probably these kids have a fragile
1:26:02nervous system and if you don't if we
1:26:04didn't have a COVID they probably get
1:26:07through it with more or less
1:26:09difficulties but we had a COVID and they
1:26:13nervous system it was not
1:26:16>> didn't get the opportunities it needed.
1:26:18Yeah.
1:26:19>> Yeah.
1:26:19>> Yeah. They don't have the the
1:26:21strategies, the the things they need to
1:26:24cope with everything.
1:26:28>> These poor little guys. It'll get
1:26:30better. You just have to keep up.
1:26:32>> I hope so.
1:26:32>> I'm just interested in all the research
1:26:34that's going to come out. Like just
1:26:36>> Yeah.
1:26:37>> So interesting. Like what
1:26:39>> do you know if there's is anything uh
1:26:41being released or
1:26:44No,
1:26:44>> I don't know. I mean, I know there's
1:26:45developmental research happening like
1:26:47people are looking at, you know, we and
1:26:49we know kids are two years delayed. Um,
1:26:52they're seeing that academically
1:26:55um in the testing scores. So
1:26:57>> there's an occup there's a Portuguese
1:27:00occupational therapy doing a research uh
1:27:03I think uh related with her uh master uh
1:27:07I don't know if you girls uh knew about
1:27:10this um if she contacted you somehow I
1:27:14can share the link she's um sharing a
1:27:18Google form uh for us to um respond with
1:27:23with our experience but I really got
1:27:26stuck when she asked me like how many
1:27:29kids were you receiving before COVID per
1:27:32month and how how many kids are you
1:27:35receiving new kids per month after CO
1:27:38and I I was like I have no idea
1:27:46>> but many
1:27:49>> before I was like one or two and now I'm
1:27:52like four
1:27:54>> do I what see a difference in the number
1:27:55of kids we're seeing.
1:27:57>> Yeah. Per month before and after.
1:28:00>> Yeah.
1:28:00>> You felt you feel I saw a difference
1:28:03too, but I don't know the numbers.
1:28:05>> Exactly. And I I really wanted
1:28:07>> numbers, but I've never like looked at
1:28:09them.
1:28:10>> Yeah. I really wanted to participate.
1:28:12It's so interesting and we really need
1:28:14this data, but I don't know how to
1:28:16answer that.
1:28:18>> Yeah. I mean, I would say on average I
1:28:20was talking to like one or two families
1:28:23a week.
1:28:24>> Uhhuh.
1:28:25um before COVID and now I'm it's like
1:28:28four or five families a week are
1:28:30contacting me.
1:28:31>> Okay.
1:28:31>> Every week.
1:28:35>> Yeah. I just did four four intake calls
1:28:37last week. I've got another four this
1:28:39week. Um four or five this week. Yeah.
1:28:45>> Yeah.
1:28:46>> It's a lot. And psychologists in our
1:28:48area are like they have six month
1:28:50waiting lists. They're not even taking
1:28:53anymore. And
1:28:56>> yeah,
1:28:56>> our weight list is about two months.
1:28:59>> I felt just after COVID, but because all
1:29:04of us were at home.
1:29:06>> So just after COVID were a lot of kids
1:29:08because uh on that month they were
1:29:11waiting to start developmental
1:29:15um appointment with the doctor and
1:29:17everything. So there was like every
1:29:20everything stopped but because of that
1:29:23because of that because there was like a
1:29:26break uh
1:29:28>> I think there was the break people were
1:29:30waiting and now they now they want to
1:29:31move forward but I also think
1:29:34>> um that we were getting a lot of
1:29:36school-aged children for a long time
1:29:38like six and seven years seven eight
1:29:41year olds
1:29:42>> and I think because parents were seeing
1:29:45finally seeing the issues their children
1:29:47were having at school um that they they
1:29:51were like, "Oh, no. This is a real
1:29:53issue." Like, I thought the teacher was
1:29:54just kind of saying it, but now I really
1:29:56understand what the teacher's been
1:29:58saying. Like, so there's been a lot of
1:30:00that. Um
1:30:03>> and now we're Yeah. In the beginning,
1:30:05and now we're getting a lot of young
1:30:07ones, like the three and four year olds,
1:30:08the ones that were born during COVID.
1:30:10>> Um those are starting those kids are
1:30:13starting to come with a lot of emotional
1:30:14issues. We also have like four or five
1:30:17little girls with um a lot of tactile
1:30:19issues around not wanting to wear
1:30:21underwear
1:30:22um and then having trouble recognizing
1:30:26if they've dry dried themselves enough
1:30:28when they wipe after they go to the
1:30:30bathroom
1:30:32>> and very upset that they feel like
1:30:33they're not dry enough and they
1:30:35obsessively obsessively wipe themselves.
1:30:39It's an interesting phenomenon that
1:30:40we're getting like repeatedly from
1:30:42families.
1:30:44big emotional issues around toileting.
1:30:47>> Okay.
1:30:48>> Yeah, it's really interesting the things
1:30:51that we're seeing. So, anyways, okay,
1:30:55time is up. Um, our next group meeting
1:30:59will be the 18th.
1:31:02>> Wednesday. Yeah,
1:31:03>> Wednesday. Yeah.
1:31:04>> Yep.
1:31:05>> Okay.
1:31:05>> Thank you. Was a really nice discussion
1:31:07today.
1:31:08>> Yeah. Thank you you guys. All right.
1:31:10Take care.
1:31:11>> Have a nice weekend. Bye.
1:31:12>> Bye. Have a nice weekend. Byebye.
1:31:15>> Bye.

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