Thank you to Kim Barthel for joining us to discuss vision and visual attention! Kim is always a wealth of up to date information!
Mary Kawar joined me for a chat about the vestibular system. Mary is a wealth of knowledge and experience and we are grateful for her sharing!
Mentor Moments with Sheila Frick
Proprioception: Does it have to be active? What is the current science? Sheila Frick and I had fun with this quick answer to a complex question.
Mentor Moments with Robyn Gobbel
Robyn Gobbel, LCSW, answers a question about what to do when a child is not participating in therapy.
The question comes from a therapist who is treating a young teenage child who has been in foster care since she was a baby, had traumatic early years. She has been diagnosed with attachment disorder and ADD. No medication at the moment.
The therapist reports she has difficulties keeping up with school even if the teachers have stretched to max making sure she manages. It's a two-sided sword: it supports her going to school however she has never actually failed because the teachers offer her alternatives, for example she knows she will be forgiven that she skips school (300+ of absence hours last school year).
Social services have been involved since young age. She was referred to OT last year. Initially, the therapist was able to build rapport and the child and eventually the child came up with a goal of making and eating breakfast, which the therapist brought into sessions with good results in eye contact and conversation. During this period of time her attendance at school also increased.
Now, however, social services is trying to relocate the child, despite the parents’ wanting her to stay, and the child has ceased to participate in any OT activities.
This OT reached out to ask for help, now knowing if continuing services was appropriate while the child is not participating.
Robyn Gobbel on Mentor Moments
Robyn Gobbel, LCSW, answers a question about what to do when a child is not participating in therapy.
The question comes from a therapist who is treating a young teenage child who has been in foster care since she was a baby, had traumatic early years. She has been diagnosed with attachment disorder and ADD. No medication at the moment.
She has difficulties keeping up with school even if the teachers have stretched to max making sure she manages. It's a two-sided sword: it supports her going to school however she has never actually failed because the teachers offer her alternatives, for example she knows she will be forgiven that she skips school (300+ of absence hours last school year).
Social services have been involved since young age. She was referred to OT last year. Initially, the therapist was able to build rapport and the child and eventually the child came up with a goal of making and eating breakfast, which the therapist brought into sessions with good results in eye contact and conversation. During this period of time her attendance at school also increased.
Now, however, social services is trying to relocate the child, despite the parents’ wanting her to stay, and the child has ceased to participate in any OT activities.
This OT reached out to ask for help, now knowing if continuing services was appropriate while the child is not participating.
Mentor Moment with Kim Barthel
Kim Barthel blends her knowledge of mental health, sensory integration, and the brain to answer a members' thoughtful question.
Mentor Moment with Gail Richie
Gail Ritchie, OTR (not on Facebook) answers the question:
I have a 20 month old who when place in supine (ex Diaper changes) will not transition to sit or roll over. He will become very upset and cry but will not move, stay there frozen and screaming. He will pull up if given your hands. He is bottom scooting and walking confidently. He has a genetic condition...(condition removed for privacy purposes) and the family is wondering if this is related to his vestibular system. Any thoughts or experiences with this?
Occupational Therapist Patti Oetter answers this question, posed by a school OT:
"I know this isn’t something we specifically address in the school setting, but my friend constantly has his tongue this far out, walking, writing, standing, reaching, bending etc. Any tips on what we can do to retract it? I’ve given him a chew tube but he doesn’t prefer it, but will still bite on pencils. We’ve also focused on breathing exercises since he does have behaviors with peers in the classroom, however, nasal breathing is hard when we definitely can’t tape his mouth closed like how adults practice."
**[picture of the child not included for privacy purposes]
A personal note: If I had to name one mentor as having had the most effect on my professional growth over the past 20 years, it would be Patti Oetter. In my experience, her ability to see movement patterns and breath is unmatched. Her understanding of oral motor control and the suck/swallow/breathe synchrony as a foundation of function is a gift she has shared with the world of pediatric OT. Thank you, Patti, for sharing your knowledge with us. Amy
Mentor Moments with Tracy Stackhouse
Tracy Stackhouse OT answers the question:
“I have a patient who is almost 1 year - (born at 26 weeks) who has olfactory and auditory sensitivities to specific stimuli (candles, dog barking, sounds on a melissa and dough pincer grasp puzzle, sound of balls/marbles dropping on a sensory spin board, etc.) Parents are able to control the environment enough at home that he is rarely set off, but he has a very distinct cry if exposed to these triggers in other environments. I'm having hard time finding evidence on how to support someone in his age range in decreasing this sensory response. The startle reflex is integrated. His parents do a good job of comforting him and letting him know he is safe. He's otherwise a very calm child.”
KIm Barthel OT answers the question:
"I am seeking advice on a patient. She is 3 years old and has spastic CP. She is also visually impaired due to damage to the occipital lobe and does not have her skull fully formed in the back. She is nonverbal and cannot hold her head up or sit independently. She has some pretty severe behaviors. She has what I believe is Tonic bite reflex and bites very very often not just when things are put in her mouth. she also bites when she gets upset. She has chipped her front tooth from biting so hard. She scratches, she hits herself in the face and bruises her lips, face, and hands. She also gags herself until she throws up often. I have no idea how to help mom and how to come up with a positive reward system and how to discourage the bad behaviors. We have attempted a switch system and she was able to request more but then became bored with the switches. Please help! This family is really struggling with the behaviors!"
This is a hard question and, as usual, Kim provides clarity and compassion in her answer.
Shelley Mannell, PT, answers a question about crawling and the benefits of doing so.
There are questions these days around crawling as a developmental milestone and Shelley is my go to for postural control and dynamic core. She also shares with us a blog on crawling that will provide you with additional information on analysis. To watch her video click below. Visit her blog: https://heartspacept.com/analyze-that/
To watch more mentors sharing their expertise follow Mentor Moments!
**Captions available in post setting or on cc**
Kim Barthel answers the question:
“I recently started seeing this 8-9 month old little boy. I assessed his development and generally speaking he is right on track with all developmental milestones. However, he isn’t rolling at all. He will tolerate being in prone, but will not transition to his side or supine. When I attempt to roll him either from prone to supine or supine to prone he almost becomes rigid. He does appear to still have a Moro reflex intact that is slightly exaggerated. I am wondering if anyone has had any experience with a similar situation and if it could be related to his Moro reflex? And then also…. Does anyone have any suggestions for Integrating the reflex or assisting with rolling. The Infant’s pediatrician told the mom it is nothing to worry about… but the mom is eager to help her child meet all milestones.”
Kim Barthel
