I babysat some kids recently and we played an impromptu game called “Was it the time…?”….because the 7 year-old, let’s call him Bob, said, Guess what, and I said what? And he started to tell me something and I interrupted him (ok that was rude of me) to ask Wait! Was it the time your eyeballs fell out and then you used them as marbles? The kids (Bob and 6 year-old Pete) thought that was hilarious and we all went around taking turns saying things like “Was it the time…your head fell off? Was it the time you turned into an alligator”? They were cracking up and eagerly taking turns coming up with silly scenarios. This sounds like a completely stupid and/or random game (and it was), but it’s actually also working on quite a few skills. (Skills that come easily for many kids but are great to work on with kids with some delays)

1) Social skills – taking turns participating – responding to each others comments appropriately by laughing or groaning – coming up with answers based on something just heard – being patient – knowing how “far” to go before it becomes inappropriate, including picking up on the cues of others.

2) Imagination – appreciating the absurd and having fun thinking up ideas that have not or would not actually occur…

3) Sibling rivalry – kids nearly the same age fight sooo much…a game like this is very silly and it’s all about laughing…not trying to win a contest or show who is better…

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4) It’s great for an OT to watch…to observe how well the child participates in such a game…can he wait his turn…can he laugh appropriately…can he keep his comments appropriate for the age group…can he modify his statements based on what he has just heard…can he come up with absurd ideas that he has clearly not encountered before…can he appreciate silliness and come up with something funny…can he speak clearly and quickly…etc etc.

It doesn’t matter what game you play…you can learn a lot by observing!
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Story two that I originally intended to write up like a month ago:
I had an encounter with a child today who had holoproencephaly and spina bifida. She was an 11-year old girl with big sparkly blue eyes. She only weighed thirty pounds. She was in a special wheelchair with bilateral AFOs and she was “airplane-ing” her arms. She is nonverbal, apraxic, and has limited understanding. Most children with holoproencephaly are essentially “vegetables” – nonresponsive living beings. She defies this definition as she CLEARLY shows some responses and is social….she is probably at the level of a 3 month old though in most ways.

This little girl was present at a graduation party and I was immediately intrigued by her…This beautiful blond toddler-sized girl in an elaborate wheelchair. It was a FunKart or something by Sunrise I believe…I forget now. Her parents were AMAZING and treated her the same way they would treat any young girl…offering her choices even if she couldn’t truly make them, talking to her normally…patient and loving and sweet. I held her hands and smiled and talked to her and asked her parents questions. They certainly knew what OT was as they had lots of experience with her and OT, even though she was no longer receiving it! I was confused as to why she had some types of therapy but not others. I handed her a pretty napkin that she grabbed and enjoyed looking at …you have to wonder if she gets bored. She can certainly cry if she isn’t happy.

I was trying to think of what you would do with a child like this…one who is at such a low level with no likelihood for progress…just consultation and maintenance I guess? Like ensuring no pressure sores, wheelchair maintenance, making sure caregivers have access to transportation aids, etc?

I asked her mom about the Ashley Treatment (one of my obsessions) as Ashley is very similar to this girl except that Ashley is essentially nonresponsive while this little girl is responsive. She said she could understand both sides and why Ashley’s parents wanted her to remain as small as possible…they had been lucky their little girl was only 30 pounds and probably wouldn’t get much bigger…but couldn’t imagine how much harder it would be if she were a normal sized child.

Her spina bifida wasn’t much of an issue apparently since her holoproencephaly kind of um, dwarved it. She was incontinent but that was about it. I watched her get her clothes changed and eat and stuff….very interesting.

She was a beautiful little girl….sweet and glowing…and I was really happy to get a chance to observe her and spend time with her in a non-clinical setting. I am going to admit that I am extremely intimidated by children with CP or other issues where it is hard to determine responsiveness…and especially children in elaborate wheelchairs. I feel completely useless and stupid…like…what can I give you as an OT that has never encountered this, that you as her full-time parent don’t already know?…..

If my professors read that line they would all have immediate heart attacks since the whole point of OT and our curriculum involves knowing the answer to this question….we have access to many resources parents don’t know about….have many tricks up our sleeves…etc. So it’s not truly that I wouldn’t have anything to offer…but when I sit there trying to figure out even how to like, adjust the wheelchair, and the parent watches me fumble, I feel like it wouldn’t be much of a confidence-booster for any of us. This is just hypothetical – this hasn’t been an issue – but I imagine it would be!!! I guess practice makes perfect.