Thursday and Friday, July 17th/18th, Week 3 Day 4/5 of Pediatric Fieldwork Level II Occupational Therapy Placement
I wear my new blue-ish undertone pink lipstick – my first ever since I always thought I looked like a cyanotic zombie but apparently I don't – that my OT friend got me as we are working on my makeup skills – and everybody told me how bright my face looked and stuff, so apparently it took 25 years for me to get the right color lipstick. I love my friend. Yay!
I was really, really, really, really proud of some of my OT skills today – it wasn't a perfect day and I was frazzled or unsure at times, but I had several great sessions. 🙂 Which I'm about to share in mind-numbing detail!
Layla, 1 hour: I was ready for her based on the informal visual perception (VP) lecture I got from my OT friend the other day after I went home so stressed out about what VP includes and how to treat with a kid. She is a six year old that is cripplingly shy and has severe VP issues. She is repeating kindergarten. I'm going to end up inserting pictures into this post later of some of the things we did – pictures of the worksheets that is, not her. Sorry.
We started with some basic sensory stimulation – I don't know if I'm necessarily doing anything helpful here, but I figure it's a little playful, which she needs, and that it probably doesn't hurt any to give her hands a little input. We pat our hands, clap our hands, rub our hands, I use a vibrating tool on her hands/fingers/palms, we shake our hands in the air, wiggle our fingers….then we're ready to work out our hands with writing.
PICTURE 1 – PENCIL GRIP
First I gave her a pencil with a pencil grip on it – I like the one shown her because it forces the fingers into a good position but apparently the COTA Miss Charlene, who is a handwriting guru, finds them too restricting, so today we used one that only emphasizes the two main fingers and doesn't have an under-part for the middle finger. Also, the shorter the pencil, the more likely it is the child will hold it correctly, and will also have better control, if you hand a kid a normal sized pencil they tend to hold it closer to the top than bottom (if the kid is a struggler). I want to try out the new Pipsqueaks – short markers. I wonder if Crayola has an OT working for them. They are a doing a good job coming out with helpful utensils.
PICTURE 2 – BACK DRAWING.
I got this idea from my OT friend. I drew lines in various ways on her back, then a circle or two, and some shapes…she had to draw on her paper what I drew on her back. This is complicated for a child who struggles with VP issues – translating the feeling on her back – interpreting it in her brain and sorting it out so that she can then visualize what that was and then give her fingers motor output commands on what to draw. Lots of steps. I butchered the neuroscience of it but you get the picture.
Then I gave her a drawing I copied from one of my two adult coloring books – I wanted her to pick out five circles, five triangles, five stripes etc, and color them, from this very visually distracting picture.
PICTURE 3 – ADULT COLORING BOOK
Then we used wiki sticks – which are like tiny sticky pieces of like, waxy yarn, I don't know, that are really pliable – to have her make shapes out of them. We did like four. Then I had her use AquaDoodles on the wall – a vertical surface, just for a minute . Then I really wanted to do a poem from the book Joyful Noise which are duet poems, but I realized that even though she reads well, the vocabulary would still be too hard. I think I'm going to make her an easier one at the suggestion of my OT. I think it's a great way to work on social cooperation and playfulness.
PICTURE 4 – JOYFUL NOISE
PICTURE 5 – RAINBOW
Here is a picture of the rainbow she drew for me the other day and the nail polish she gave me on my fingers, LOL…had to put it in somewhere.
PICTURE 6/7 – ALPHABET + FILTER.
Then we worked on a simple maze in her my Little Pony book – she could not do this to save her life – am not exactly sure how to coach her on this? Hmm.
Finally we got to work on the hard stuff – handwriting. She tends to shrivel up her handwriting, so that her bellies look like raisins and her sticks are all osteoporotic, bent over and shrunk. I would verbally coach her to make sure her lines she drew hit both top and bottom line, and even show her, but somehow this was really really hard. Here is what we did – I gave her a sheet of lined paper and made the top and bottom lines extra thick with a Sharpie. Then I had her write a capital letter alphabet from memory, one at a time. For example, she did the letter A. Then we'd look at the letter A from a worksheet- using a red filter i cut out so it was less distracting – and figure out how to make it better, so that she'd end up doing it again with those verbal cues. At first nothing seemed to work to make her hit the lines properly, but by the end of the alphabet, she was doing awesome. But I've been really thinking hard about fun, NOT drill-y, ways to work on hitting her lines top and bottom…I think I'm going to bring in raised bump paper next time and ask her not to stop the line until she hits that bump.
Finally it was time to go. We have a big round rollerboard that I asked her to sit on Indian-style, I mean criss cross applesauce, LOL. She was hesitant. I hadn't realized she had gravitational issues either, but she was rather terrified. I encouraged her and let her know I would go very, very, very slow. And I did. I very very very slowly walked her, her on the rollerboard, into the waiting room. When she saw her grandmother she smiled faintly, but that was her first smile on that board…she was scared…but I think I can get her to get on that board each time we go into the waiting room and with time I bet she'll even like it. In the waiting room I gave her handwriting grip to her grandmother, showing her how to put it on a pencil and how Layla will use it (letting her know Layla already knew how to hold it), and letting her know things she could do – like drawing on her granddaughter's back and having her draw it on paper – to work on skills. I felt very OT-ish giving the grandma these instructions and it was really neat.
When you think about Layla's shyness, and what apparently amounts to a lot of sensory processing problems and fear – you have to wonder a little bit about the chicken and the egg. Did her fear of everything cause her shyness since she held herself back, or did her shyness keep her from ever exploring, thereby fearing new things? My guess is that it's both and that primarily her unstable sensory needs have caused her to hold back. She needs to work on social skills and tolerating others but I think merely tolerating me – more or less a stranger – and me trying to encourage a little playfulness from her – is enough for now.
I don't think I am particularly talented compared to other OTs in most ways, but I think I have a much stronger grasp of playfulness than even most pediatric OTs – in terms of figuring out creative ways to be silly or bizarre in a way that appeals to the child – so I have a strong hope of encouraging some new forms of playfulness with this little girl in the next few months.
I wonder if I'd get in trouble if I let the little girl put her hands on the copy machine so that she could paint HER nails next time on the paper – (using marker on her copied hands) – hmmm. Okay anyway, I had a wonderful session with this little girl and it was primarily due to the suggestions my friend gave me. 🙂 I think she may be favorite kid to work on because she has so much room for growth.
I have a lot of issues myself with visual perception, sensory processing, fear…and so again I see a lot of myself in her and have a lot of compassion and empathy for her fears…and w
ant to see her one day be able to run and jump and have fun with friends.
Okay. This was a crazy day starting from this point on, the schedule kept changing every few minutes as kids would not show up, or other kids would show up unscheduled or unexpected, plus we had a new OT grad (from UT), come by for an interview, plus we have the COTA out of town, plus we have two PRNs coming in to help out, Vanessa and Karen, plus we have lost our old tech but have a new tech, so things were INSANE!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! INSANE!!!!!!!!!!!!! INSANE!!!!!!!!!! Luckily at this point I've now become familar with almost all the kids so it's not so much as a shock when things get moved around.
I next took on my little nonverbal kid that has gravitational insecurities and hypotonia and just needs work on basic EVERYTHING. The first few times he came he wouldn't even get in the ball bath and now he loves it – well, I've basically seen him from session 1 – bearing in mind I've only been here 3 weeks now – and I've tried to get him in the hammock swing in the door a few times, but he never tolerated more than say, I don't know, 15 seconds, before whimpering to get out. I took advantage of the fact he now LOVES the balls, and LOVES throwing balls through a tunnel, and that he had just watched another child swing happily….which is great incentive. I put him in the swing and immediately dumped a load of balls in his lap and held up the tunnel. He was a little unsure at first but eventually ended up swinging happily within the hammock, throwing balls, smiling and giggling, for about 10 minutes. It was AMAZING. A big deal and a big turning point. 🙂
Ok let's see…we had a kid with Down syndrome show up and he had a joint session with a boy who has VP issues as well…what interests me is most of these kids do not have issues with each other….they all accept each other and play with each other to the best of their abilities. Nonverbal, autistic, Down, VP issues, ADHD…whatever. Pretty cool. I had a little trouble figuring out things to do with my severely ADHD kid in conjunction with another kid – I get a little stumped if I come in partially through a session or if there is another kid in the works.
A kid named hmm Bob showed up that I haven't worked with before – he is like 3 and he is afraid of EVERYTHING and basically cries all the time. His goal mostly involves just tolerating ANYTHING and being away from Mommy. At one point we got out busy bugs (cute colorful bugs like dragonflies) and he was terrified. Afterwards I had a talk with Mom and was letting her know how scared he was and she was telling me about this fake spider her husband brought home because SHE is scared and how he was terrified too when he saw it because he knows how she responds- we talked about, obviously I am paraphrasing here, how her fears are legitimate and obviously it's ok to be afraid of them (I am too), but pointing out gently that her fears will affect HIM (and teach him to be afraid too), so that might explain HIS fear of these bugs – she wanted to know if it was just spider bugs or everything – I told her it was all the bugs in general, but that he was probably generalizing spiders to include all bugs remotely like it – and that maybe she should consider getting some cute little bugs to play with, to show him there is nothing to be afraid of. The more I spend time with parents the more I realize the power my scrubs has – they treat me like I am an expert – so I need to be careful what I say or do.
Okay I only want to talk about one more big thing. The severely autistic kid I had a good session with the other day, is having medication problems, and is on a patch that, when it wears off, sets him off nuclear. He had an okay session although was agitated about wanting his mommy, although when it was time to go and surrender the spongebob toy, he FLIPPED OUT. He was screaming and throwing himself around and it was all my OT could do to keep him from hitting his head…this is a tall boy. She would hold him in her arms firmly to restrain him and he would calm down and stop moving, but when she would finally loosen her grip slightly, since historically he'd be calm at this point, he kept going. After about 15 minutes of repeating this, we finally took him out to his mom. She immediately put him in a restraint that was clear she had practice – she said he had a behavioral plan and so she had undergone training – she wrapped his arms around himself like a straitjacket, put her knee against his bottom, and pushed him against a wall – not meanly, but gently, and solely to immobilize and calm him. He was immobilized against a wall and it was clearly calming to him, although if she eased up at all, he'd start flipping out and kicking his feet again. She had to hold him against the wall in this position for a good 10+ minutes, and was telling us they needed to go back to the neurologist to discuss this, as this is now what happens when the patch wears off, which is obviously unacceptable…it was pretty amazing. I was actually really glad to see this restraint and while I hope I never need to use it, it was good to learn.
By the time we finished with him and I did some cleaning of the absolutely chaotic office – remember it had been a ZOO – it was almost 7:30pm. I met Allison at the track near the dorms and we walked a while and talked about our days….I got home around 9pm and was exhausted ….and realized that the only thing I had eaten that day was my bowl of yogurt with cherries and almonds at 1pm. Oopsies. LOL. I'm a little overweight because I eat when I'm bored – and I was bored a lot in June – plus I sat around a lot. But I have the opposite problem in general – when I'm busy, I forget to eat until I get sick from low blood sugar. Today I was so wired that adrenaline kept my sugar from dropping too low until I finally chilled out. So I had a tomato cheese baguette around 11pm for dinner. I'm slowly losing weight I gained in June since I'm on my feet all day long and don't eat that much.
I got frustrated because I had so many e-mails and Facebook messages I wanted to respond to, many of them from strangers about OT, plus I really wanted to blog about my days, plus I wanted to clean, but I was sooo tired. I finally got to bed around midnight without hardly doing any of that stuff. Oh well. I got the call Friday evening to meet in the office around 930pm and that we'd be done by 2pm. Great. (These hours sound cool, but remember that I've worked overtime like every single day (without pay of course since we work for free and actually pay tuition for the honor of it), plus we work 10+ hours on Tuesdays and normally Thursdays, so it's not as awesomely little as it sounds). Anyway, we're going to Oxford, Misssippi for the day. I didn't realize how far away this was – it was almost 200 miles roundtrip. A speech therapist wrote down directions and unfortunately messed them up slightly since it was from her head – so we got a little lost – we left around 930 but didn't get there until a little past 11amish.
Then we did an eval with First Steps people + some speech therapists at Ole Miss, of a little boy with expressive aphasia, following in the footsteps of his older brother. Because the speech therapists didn't have a lot of experience with First Steps and therefore hadn't done evals with OTs before, there was some confusion over assessments, and so we didn't get done until 12:30pm. Oh, let me add in that I had had a bad headache from the middle of the night and it hadn't gone away, so I was in a lot of pain and definitely not feeling up to being very um, mobile. Anyway, the first steps people wanted to grab a bite to eat with us, so we ended up eating at Chili's. Unfortunately we got a waiter that probably could have benefited from First Steps as a child, as I'm not sure we've ever had a waiter be so slow to catch on. I ordered a cup of soup
, a piece of corn on the cob, and a chocolate shake for lunch…I had to ask about the shake at least 4 times. Then he completely screwed up our easy bills…etc. And it was sooo slow. Good thing he was pretty, but he had odd mannerisms and we ended up being at this place forever. On the plus side, the first steps coordinator re-taught me the method of calculating a child's age in months based on the current date, which can get complicated (like an eval on 7/17/2008 for someone born on October 20th). You can also just kind of figure it out on your head/fingers, but I wanted to reknow the formula for it.
ANYWAY then we went back to the health department so that they could give my OT the evals/forms on the kids we'd be treating once a week from now on since their OT is leaving…so now we will be doing Oxford once a week too I guess. That's a looong drive, luckily an easy one. At this point though, it was ridiculously late. We got back into town at 430pm instead of 2pm. 🙁 I had promised Patric, a 13 year old boy I try and take out for fun every once in a while, that I'd get him at 3pm, and I had to switch that to 430pm. He has been asking me when we'd next do something for a LONG TIME, and so even though I was tired with a bad headache and frustrated with being 2.5 hours late, I didn't want to let him down.). Note: I asked a friend what she thought a 13 year old boy would like to do, and her answer was “You”, LOL. Luckily he is immature enough that I don't think he's quite at that point…hmm. Anyway, I picked him up and we went downtown to eat sushi, play at Jillian's, and have ice cream….and he has grown a lot lately and I dunno, I did get to think he is starting to get to a point where he likes girls and likes me…but not in a creepy way at least. It was sweet. We played a lot of air hockey and I kicked his butt even though I tried not too – I have really good reflexes.
Around 715pm I dropped him back off at home and headed to a Vietnamese restaurant to meet my friend Doug…and I talked to him about my little girl and the lines and how I wanted to think of fun ways to work on connecting lines…then we went to my OT friend Kerri's and Brent's and they had their friends Eric and Melinda there so it was the six of us…we hung out and played games….but I was sooo tired that I spent most of the night lying on their carpet as if dead. We played scattergories and I agreed to play only if I could come up with whatever words I wanted because I don't care about points and I have very bad recall, so coming up with ethnic foods that start with “W” for example, isn't going to happen. I just make up things like wenchiladas. Eventually I got to the point that I was wandering around like a patient with dementia as they played their game…and finally left around 11:15pm because I was completely and utterly useless, period. I love being so busy in some ways because I am thriving mentally and physically (minus the headaches and such), but my exhaustion is pretty complete by the end of the day….and things have been extra tight because I'm trying so hard to see Doug a lot since he leaves Monday for England again to finish his dissertation.
Now I've been writing for several hours and once I get done blogging today I'm going to take a nap and THEN dance I think, LOL…I'm tired again. On Monday we go back to the new clinic but we only have two kids as far as I see, both of which we have seen before and I love, and then my kids in our normal clinic are all familar except one little kid with a mohawk but I'll read up on him….only one new kid, shouldn't be too bad of a day. Plus I've enjoyed meeting Allison after work at 6 or 8 or whenever I get off work to just walk around the track and talk about our days for a little while, and since she lives so close it's really convenient since by then I'm ready to collapse. It works best if I don't ever even get home until 9 or 10pm, because if left to my own devices I'll end up napping inappropriately. I always thought working would suck out my soul, but I've discovered NOT doing anything sucks out my soul worse – being busy all day, then seeing friends/working out, then collapsing, is pretty awesome, health-wise, for me. LOL.
Okay…the COTA is only gone one more week, plus I am getting to know like all the kids at this point, plus we might be hiring a new OT, so I'm thinking that life will get easier if I can just get through one more week of chaos…not that the chaos will stop, or the drama, but it should improve at least. My goal for this week, discussed with the OT on our drive back from Oxford, is to do an evaluation by myself. I'm already treating many patients a day (a full caseload in the sense I typically see patients nonstop), so with the exception of maybe starting to see two kids at once, I don't think there's much to add onto, treatment wise. And knowing the chaos of work, probably starting this week once I do my first eval, I'll probably end up doing most of the evals!
Since I've never been a Level II student before and my OT or clinic has never had a student before either, I'm really not sure what's normal…like I don't know if having a full case-load at 3 weeks is normal or not, but since there isn't a lot of documentation, and since its basic developmental peds, it seems pretty okay, I guess.
I do love my OT and the clinic and the people and the kids and everything…the chaos is a little much, but I'm proud of myself for keeping my frustration levels, fatigue levels, tolerance levels, stress levels, to an acceptable level…those of you who know me well or knew me in previous years, know how HUGE HUGE HUGE HUGE HUGE of an accomplishment that is for me, since historically I was an anal stress-filled overly prepared rigid freakoid 🙂 Now I'm just a somewhat stressed freakoid, woot woot. LOL