OT 1:30am update

Well I slept too much today so now I'm awake. I have tons of pics to post to the blog, but for now just going to do my typical rambling 😉

The other day one of my little 3rd grade boys with autism walked in (on his toes, of course!) to the Learning Center and I said “Good to see you, my friend.” He said in his stilted voice “I really liked to hear that.”  I thought that was so insanely cute. He was also very excited about an upcoming jog-a-thon, saying “I am going to run like Lightning McQueen.”

I had another 3rd grade boy with autism say “Miss Karen, let me read this to you.” He's hyperlexic. So I sat with him and he showed me what was on his iPad. He started to read it, and matter-of-factly was reading “blah blah overweight nudist blah blah lesbian wedding blah blah” I was like WHAT! It turns out it was a Seinfeld episode summary he had gotten off of Wikipedia. I was like “This isn't appropriate for school” but it was all I could do not to laugh. That same child loves to translate words into Spanish using Google Translator, and when he wants to do past-tense, he just adds an “ed” to the Spanish verb.  Clever!

I did a duet poem with a 2nd grader with autism the other day from the book Joyful Noise. The poems in that book of duet poems are not really intended to be read by someone so young, as the vocabulary is advanced, but he is hyperlexic as well so had no trouble. I like using it because it forces the child to wait his turn and work with you at reading at the same pace at times (you each have a column you read at the same time – some times just you, sometimes just him, sometimes both of you). We took a little video of us doing it and he started by saying “My name is John Doe, and this is my trusty assistant Miss Karen, otherwise known as Miss Awesome” AHAHAHAHA I love it.

Someone asked me today what my favorite part of my job was. I thought about it for a second and decided it was when I showed a child they could do something they didn't know they could do, or they mastered a skill for the first time (like tying a shoe, or writing neatly). Really just seeing a big smile on my child's face is what I live for.  And um, I love toys. AHAHAHAA

I took out ALL the toys from my car finally, including a bunch buried in my trunk, and re-organized them. I'm going to end up with a fine motor bag, visual motor bag, sensory motor bag, and seasonal bag, in my car. Because for example I just bought a ton of seasonal toys that I love, like the tower of bunnies, bunny spring-ups, etc etc. I want to post pics soon of all that stuff.

As a therapist who runs from school to school each day, I have to carry every thing I am going to use with me. I've done this a year now – literally my one year anniversary was this Saturday as a school OT – and I'm still trying to figure out the best way to organize myself so I don't get so loaded down. I've also been more in a toy mode lately, especially as we get close to spring break, but we're still certainly working on goal areas! One thing that frustrates me with organization is that a lot of things that are fine motor are also visual motor, etc, so having separate bags isn't that easy.

I'm slowly starting to catch up with work, although I have a long way to go in some arenas. Good thing break is coming up soon, I can try to catch up a little, although I have a friend coming into town for most of it! I just thought to myself I should go see Grandma over break, and then remembered she is gone now. 🙁 That makes me sad.

My friend who came over tonight to provide moral support while I organized toys, is a great artist/creater, so we got out Sharpies and decorated a bunch of plastic Easter Eggs. It started when I realized some of my easter eggs had little holes in top, so I stuck toothpicks in them, but they wouldn't go all the way through and looked like antenneas. So I decided to put an alien face on it. We ended up decorating a bunch either with patterns the child would have to match up, or just silly stuff. I am going to make a laminated checklist (maybe a normal piece of paper in a sheet protector), and have a brief description of each egg, ie blue jumbo egg, and have the child come check off each egg as they find them…….another good one is to write words in each egg and then they have to write the word, or a sentence, etc. Or write an action and when they find it they have to do what it says such as 10 jumping jacks. So many ways to use plastic easter eggs for handwriting, visual motor, hot/cold game, lefts/rights directionality, etc etc……I guess speech therapists could do the directionality up/below etc too!

I bought some like seventy cent putty “knives” and scrapers at the hardware store recently….the kids are way more into play-doh when they have actual grown-up “tools” to use with it.

I was working with a Hispanic little girl who had an accented I in her name, but didn't like it, and would just do a normal i instead. Mom reported this to me and I was like hmmm. I had an angry bird on my keychain the little kids were looking at, and the diagonal eyebrows gave me an idea. I told her that she had an “angry I” in her name just like the angry birds….and then all the kids around her wanted to show me how they could draw an angry i. So now she is okay with using her angry i in her name most of the time, and she notices when other kids have an “angry” letter too. I love it 🙂 So many kids just need a little gimmick and then it's fine.

I realized a few hours ago I could maybe use Jenga blocks to make little angry bird structures….now just need to get an angry bird to throw at them…..I could maybe draw an angry bird on an Easter egg and weight it with fishing weights or something, I dunno. The slingshot part is the hard part. I know they have games you can buy but I already spend a ton of my own money on toys, am trying to think of ways to do it for free with what I have. 🙂

The other day I did a lesson on flexibility for my self-regulation seminar with four little guys. I thought about it for quite a while. I did several things. For one thing, I showed them how a hard rigid tree can fall over in a storm, but a flexible tree sways in the storm and survives. I had them stand and be rigid or sway as I gently (Very gently) pushed against them so they could see what happened. Then I had brought a bunch of different objects such as an orange, a sock, etc. We talked about how an orange could be a ball, it could be eaten, maybe it could be used in a game, etc etc….and that a sock could be a mitten or a stocking etc. One of the items I grabbed on a whim was a stuffed snail I had gotten in Colombia that was beautifully colored and how it too could be several things. At the end of the lesson, I asked the kids what they had learned. One kid said “I learned about a snail” and all the other kids agreed. The snail was apparently their favorite part. I was like……wow. Awesome. So glad my lesson on flexibility boiled down to liking my snail. AHAHAHAAHA.  I clarified the lesson, but it reminded me I should weave more concreteness throughout the lesson as to what we are specifically trying to understand. I tend to be quite verbal (and I speak fast) so it's not exactly ideal for little dudes with autism. I'm also very aware of the children's need for structure so we begin and end the same way and I tell them the schedule of our seminar in advance, ie first this, then that, etc. However, I'm not a teacher in the classic sense of the word and tend not to use typical teaching strategies. An aide was telling me after the seminar how she liked my style and I was like ??? and she explained that when I was handing out hair things (as one of the items that had many uses), I basically slung-shot/threw one to each kid, instead of being like “Okay, each of you stand up in a line and come get one thing from me.” I wouldn't have even thought of that. Not very teacher-l
ike I guess. The aide said she thought it was good for them to get a different experience where they did get a little more freedom/wackiness. I dunno. In some ways I think I need to work on talking more slowly, being more strict, etc. And then in other ways I think she is right and it's good for them to see different styles with slightly less structure….who knows!! I do know as a general rule I am super lenient with things like having to walk single file in line. I see the point when there is like 30 kids, but if there is only like four…..why does it matter that much?

The things I ponder to myself at 2am. Learning out loud, right?

AOTA conference is coming up, and deadlines are looming for our social media presentation. I need to get crack-a-lacking on that ASAP along with taxes, NBCOT renewal, etc…no biggie…NOT. Yikes. Today I was only semi-productive, mostly rested….my toys are about completed though. Tomorrow is paperwork day!!!! Bleh…

Ok I guess I am going to try to go to bed now that I've de-cluttered my brain into my blog. Hopefully I'll also upload a bunch of pics tomorrow to the bloggie.

BTW I wrote to Abilitations to submit ideas, but never heard back from the person who is supposed to send me the forms etc. Does it sometimes take a while to hear back??

Karen

perceptual issues?

This is going to be included in the IEP report I am writing. 🙂

OT stream of consciousness

It’s funny to me to see what gets re-posted or commented on versus not. I love my blog and I wish I could return to my obsession with it….mostly lately I’m obsessed with Facebook and sloths. Fun, but not exactly good for my career, lol. I had a rough night! So tired! Blegh! I wanted to write something though, and now I am blanking on what exactly it was.

I guess instead I’ll mention some random things or ask questions.

1. I really am perplexed as to how to handle emotionally disturbed kids. I don’t have many on my caseload, but I am around them becaus of time spent in learning centers, and they really perplex me. If they don’t listen to adult instructions and consequences don’t really matter to them, where do I go from there??

2. I need to write about rythym sticks ,but not the normal ones. The ones where you kind of juggle. Have to send a picture though so you know what I am talking about, first.

3. I can’t spell rythym to save my life.

4. I feel like I could do some occupational therapy with sloths. I’m aiming for Costa Rica next summer (this summer I’ll be in Scandinavia).

5. My mind is constantly, constantly trying to think of new OT things.

6. I am doing a ton of inservices to different young grade levels on fine motor center possibilities using cheap things such as styrofoam pretty soon – we are seeing more and more kids, an absolute epidemic, of kids who have no idea how to use their hands or body or eyes. But they’re awesome with things involving screen time. Ugh. So we need to bring back some fine motor centers during short breaks or free choice etc to work on those skills.

7. I have “invented” a cool game that I want to post about, it’s so straight-forward, but first I need to submit it to Abilitations ….I am pretty big on creative commons and sharing everything, but at the same time I don’t want one of my ideas taken and submitted by someone else.  Actually I have 3 inventions I want to submit. I speak with Tonya over at TherapyFunZone.com about them, it’s nice. Oh that reminds me, I need to send her some things.

8. I was thinking about imagination and playfulness and how rigid some of our kids are, especially those with anxiety and/or autism. I turn EVERYTHING into a game more or less. It’s very rare I say “Crumble up this paper and throw it into the recycle bin.” Instead I say “Okay, here is our hungry shark (referring to recycle bin which has a taped shark face on it). Feed it carefully!!! I don’t even really do it on purpose, it’s just how my mind works. But kids get really into it. Seriously. Feeding a hungry shark is way more fun than a normal recycle bin. It doesn’t have to be elaborate..most kids “get it” right away. Try turning all your instructions to do something into mini games and see how it goes. Also, I feel that sometimes lots of tiny steps help kids become more aware of flexibility and imagination. So. For example. When I pick a kid up from his classroom for a 30 minute session, I may say brightly and exaggeratedly, “Today we’re going to do nothing but really hard high school math!” or “Today we’re just going to sit and stare at a wall!” – ludicrous things. Challenging them to say something like “That’s not true” or “Really?” or “Are you kidding?” Or I’ll ask them to come up with new names for the session. “Pick a new name! You are no longer John, you are X”…and I’ll suggest some fun names. Some kids can’t even handle that much change and just want to be their own name. So I chip away at their concept of reality with a lot of absurdity, exaggeration, silliness, etc. Tiny steps. But I strongly believe tiny steps make big changes over time. 🙂

9. Still working on the Pied Piper concept. So many kids hate being singled out and taken somewhere. At my schools, for whatever reason, there doesn’t seem to be much awareness of special ed or stigma attached, but I work with pretty high functioning kids. It’s definitely impressive and makes me glad. But it’s still weird for an adult to show up and take a kid away. (Phones make me nervous, I almost never call for a kid unless the kid prefers it). But random kids come up to me all the time to comment on my hair tinsel, or eyeliner sparkles, or my Mario laptopcase, etc etc. Some of my classrooms get really into me showing up because I told them once I never smile (obviously a total lie) so when I walk in they get really excited about whether I’m smiling or not. My guys love that the entire classroom gets into it before I take them away. The same is true for being “Miss Awesomeness”….kids will ask about me and remember that in a way they won’t remember Miss Karen. (I am Miss Karen to MOST of my kids, but some do way better with miss awesomeness). Is all of this a fool-proof thing? No….but I think it helps my kids feel special to know the other kids are jealous, rather than snickering at them being singled out.

10. The other day I brought in some CVS fine motor toys that are seasonal (cheap and cool…check them out). One were those pop-up things? Where it’s a suction cup and spring bunny, you press down, and about 10 seconds later they jump into the air? Those were SUPER popular. One of my kid flinched each time they jumped, but still loved them. Plus I’d say things to the bunny while it was still down like “Be chill, man. Don’t freak out. Don’t explode. Just calm down.” and then of course it jumps up and the kids thought that was hysterical. 🙂 Then started imitating me. Hearing a 2nd grader say “Be chill, man” cracked me up. ahahahaha. Anyway, these little jumping bunnies are pretty explosive and silly, so for one of my kids, we ended up writing a police report on those bunnies! I just wrote “Police Report” on the top of lined paper, then we wrote Who: Bunnies. What: Exploding. Why: Angry. When: Date Where: Work Room. They were cool with writing a police report, lol.

11. A lot of my kids are supppperr excited to watch themselves on video. Photo Booth has all sorts of funky effects, too. I know you can’t video/tape and show others without permission, of course, but they watch themselves immediately after (like 2 minute clips) and then I erase them. We do a lot of “teaching” videos. I have a kid who is a reaaaalllyyy poor drawer and hates it and avoids it, but when he got to do a teaching video on how to draw, he drew more than any of us had ever seen before. So I’ll say something like “Do you want to make a teaching video on shoe tying, handwriting with special paper, drawing, etc”….they always say yes and never seem to think about the fact it goes no farther than that, lol. They just want to see themselves on camera as an expert. Sometimes we’ll start iwth “What not to do videos”. For example, most of my kids get so frustrated with shoe tying. So we talk about it first. I’ll say, some times my kids get so frustrated, they try tying the shoe a few times, then throw it down and stomp away. Let’s make a video showing that and how that’s NOT what you should do. So we make the video of them throwing the shoe down and being angry and how it’s not okay. Then I’ll chat with them a little about their frustration tolerance that day. “You know, John, sometimes kids get really frustrated with shoe tying. Have you had a frustrating day already? How many times do you think you can try tying the shoe without getting too frustrated? 3 times? 5 times?” They think about it…most end up saying about three times. Which is fine with me. I know that I think of frustration as being a daily budget, and sometimes I can tolerate more frustration than others….so I like to get them thinking about what they can handle that day.

I guess when I think about it, a lot of what I’m talking about is kind of the psychological aspect of OT more so than actual tasks. But getting them to do actual tasks is so much easier when the “psychology” is right…
.that they feel special and not singled out….that they realize they can temporarily change their rigidity with tiny things…that they can teach others…that they can gauge their own frustration and what they can handle at that moment….etc. The actual fine motor tasks are the easy part….getting them in the “just right” zone to attempt a task is the hard part.

12. I’m not perfect. I screw up all the time. I get tired, or say something the kid doesn’t get, or use too much verbal language. (But do remember I have relatively high functioning kids by typical OT standards). Sometimes things don’t go as planned for a variety of reasons. So all this blabber up above is just a stream of consciousness of IDEAL practices that I strive for, but um. It doesn’t always happen that way. 🙂 But I do hope that at the very least, you see some aspects of your OT in a different light, or consider incorporating some of these elements…

13. I would love, love, love, to know if any of you have thoughts/comments/suggestions on any of the above….but please remember I’m a real person with feelings, so if you disagree with anything I say, please use constructive criticism….

Have a great day everyone….I’ve got a cat on my wrist helping me type…am watching the crazy wind and white-capped waves rolling in while I lie in my bed…am super tired from a bad night…….gonna be kind to myself for a few hours while I can and just rest….then off to visit a friend and then to my dad’s house for St Patrick’s food tonight, yum. I haven’t seen my dad since his mother/my grandmother’s funeral. Will be good to see him. Hopefully I can get some more paperwork done tonight too. I FINALLY got all my toys put up, now I need to figure out my papers.

8.

VMI in action

I always take a picture of the child's pencil grip (avoiding the face) during the VMI or a handwriting task, and include it in my report for the IEP meeting. It's popular.

Tower of Bunnies in OT action

tower of bunnies in action

Tower of Bunnies by CVS found near Easter, great OT game

It only cost 3 dollars, and the game itself of stacking the bunnies in disc towers and then hooking them out is pretty hard and so I am not a fan of that, but seeing how high they can stack them, and/or having them balance the bunnies, etc, is fun. I think it’s worth it just for the bunnies to do sorting, counting, whatever. CVS has it.

augh

i have SO much to share but I get overwhelmed!

Today's quote of the day by a 3rd grade boy with autism: “That's Miss Karen, and she is not an alligator.”

Somebody comment telling me how much they live for my updates and how they'll die, simply die, if I don't do it. It's okay if you're lying. I just need the guilt trip.

🙂 and also mention i better rspond to my emails!!!

and also mention i better buy my tickets for conference. and um, do my part for the socia media presentation. cough my battery is at 6% gotta go sweet dreams

Grandma

This is what I posted on Facebook right after Grandma passed….

I have lots to eventually write about, but for now I just want to write about the last few days. Grandma was brought home from the skilled nursing facility on Saturday, for hospice care. They were estimating about 3 weeks to 3 months. They brought her back to the suite she has been living in for the last year, at Aunt Julie's house. It is a beautiful suite with lovely large windows and lots of light. They positioned her hospital bed by the window, so she could look out. We kept rosaries all around her, and there was a never-ending parade of friends and family. Her daughters Debbie and Julie were her main caretakers, attending to her around the clock. When she came home Saturday, she was still looking at people, talking a little bit, and drinking/eating a small amount. I remember carefully spoon-feeding her tiny spoonfuls of Oreo ice cream, she had about 1/2 a small scoop at best, and didn't want anymore. Pretty shocking as even a few days before she could easily down a large vanilla milkshake, which my dad was bringing her daily. 🙂

By Sunday, she wasn't really eating, and was becoming increasingly non-responsive. At one point it was time for her oral morphine but she latched her lips closed. We were trying around it when dad showed up with a milkshake. We dabbed a little on her lips with a straw, and she went to lick the milkshake off. We did this several more times with miniscule amounts, then snuck in the morphine at the same time. If you came up to her, she'd turn her head to look at you, and you could get possibly get a few words out of her, but not for more than a second or two at a time. She might say something like “Thank you” or “Hi darling” but that was the extent of it. It was as if the fog could lift just long enough to say that, and then she would retreat back again. She was clenching her fists, elbows, limbs etc, with really high tone. We put rolled up washcloths in her hands to keep her from clenching her nails into her fists. She was not using her hands at all or moving on her own more than an inch or so. She was getting morphine every 4 hours on the clock and frequently in pain, but we were working on managing it.

I got her to “laugh” three times that day, which I am proud of. The first time was when I teased that my cousin's fiancee actually wasn't as perfect as I thought. The second is when I pointed to something on the TV screen and made a sarcastic comment, and the third time was when I repeated a Carol Burnett TV show joke, “It's raining cats and dogs. I know because I just stepped in a poodle.” That was the last laugh I ever got from her.

The next few days kind of blend together. I didn't see her Monday, but I was there most of the day Tuesday and Wednesday. We spent a lot of time making sure she was comfortable, and she had so many visitors. She was becoming increasingly non-responsive, withdrawing from this world. Wednesday night she had some rough patches and we encouraged her to go be with Grandpa, but she wasn't ready for the end. We couldn't figure out what she was waiting for. It was clear it was time for her to pass. Everybody had said goodbye to her in some way, and we kept talking to her, telling her it was okay. We all spent a lot of time by her bedside, holding her hands, stroking her face, talking to her, singing to her, playing music for her, loving on her, comforting her. We all had our highs and lows, times where we could laugh and other times where we could only cry. It was such a gift to just sit with her. We all thought she would pass on Ash Wednesday, but we were wrong.

On Thursday, I came back to see her sleeping deeply. She never once woke up and her breathing was loud and labored with her tongue blocking air in the back of her throat. We continued her morphine and other comfort measures but she remained fully non-responsive. At one point we rolled her over to do some repositioning, and a tear pooled in her eye. I had more or less been okay, but this absolutely broke my heart. I had a huge crying melt-down for a while, but eventually calmed down. All of us were experiencing crying jags hitting us at random times.

All of the family that could make it was there that night, as we knew the end had to be near. Her kidneys had stopped functioning and she hadn't eaten or drank since Sunday.The house was filled with people, all hanging either in her suite or in the kitchen. We all rotated around, spending time by her side, in her room, and just hanging out with Grandma in spirit. She was unresponsive but who knows what she could hear. We were all having our moments of tears and sadness but we were also doing our best to have a festive atmosphere, because that's how the Dobyns family rolls and Grandma always loved a good party. We were all ready for her to go Home to God and Grandpa, to be out of pain. We just wanted to be with her, making sure she knew how INCREDIBLY much she was loved by so many.

I spent most of the night right by her side. Those of us next to her were gently teasing her, saying things like “If I am your favorite grandchild, keep your eyes closed”. Somehow I ended up pulling out a “fart for free” app on my iPhone, which Aunt Julie and I started playing with. We were working on saying things with a straight face while making utterly inappropriate farting noises. We got Grandma into the action, and we were all laughing. You can see in the video that Tricia posted (on my Facebook wall) that we were all being silly and festive. I know it may look disrespectful, but I promise to you with all my heart it was the kind of thing that would have Grandma laughing hysterically. She would have been loving it, and it was all done in love. We were all having so much fun, and it was such a party, and I think Grandma knew it was time, that we were all together and loving each other, and ready. Minerva, her acupuncturist, had recently appeared, and said she felt confident she was within hours of passing away, and that one reason she was perhaps still holding on is that nobody familiar to her had shown up to take her. Minerva talked to her, letting her know an angel would come for her, and that she could go with that angel and go to Heaven. Well, somehow everything worked out, maybe an angel or Grandpa came for her, and maybe she was content in hearing all the laughter and party centered all around her. Her breathing began to stop, as it does in apnea. The first time it happened, I was seized by fear. We had just been playing with the “fart” app and I didn't want to be like “Hahaha, fart, fart…hey everyone, she just died”. Because as much as she loved a fart joke, that would have definitely lead to years of therapy, at least on my part!!

Luckily, she took another breath. We spread the word that her breathing was beginning to stop. Everyone gathered around her. Her hands, her forehead, her legs, everything that could be held onto was. We talked to her. We told her what a good mother she was, a good grandmother, a good person, etc. We praised her. We loved her. We prayed. We stroked her. We encouraged her. Her breaths became increasingly spaced out. And as we all were around her, not a single dog barked, no phones rang. We were all in the moment. And she took her last breath. It was beautiful, it was peaceful, it was sweet, it was loving. It was such a gift she gave us, allowing to laugh with her, but then letting us surround her with peace and joy and love in her final minutes. What an amazing experience, holding her, sitting with her, knowing she has ushered so many lives into this world, and we were able to help usher her out.

paper

The lava/worm paper is spreading which is awesome. It really can make a difference. I'm proud to say we just got some new paper that is Star-Wars related that a friend made for me – very similar concept to worms/bees/lavas. But I am not sure about how that works from a copyright perspective……

Have lots to say and share and am just so behind on work and catching up – lots of late nights and early mornings writing reports. So still thinking fondly of my blog and wishing I had all the hours in the world to catch it up.

OT returns

I have 383 new mails I haven't opened. And 400+ to deal with that I have opened. On gmail alone. Let's not even consider my 1,000+ work mails to file. 🙂 I've been in a sad place with my grandmother passing away, but I'm starting to feel the sunlight again. Will hopefully be writing soon…