Special Needs Exercise Prescription for older children and Adults

Our older teen and adult special needs children benefit from exercise and motor skill development programs, just like the younger ones.

There are two key differences in the approach however;

1. Identifying the developing health and mental changes

2. Educating on lifestyle habits and body awareness

The developing health challenges can include such things as being overweight, joint problems, high blood pressure, hormone issues, posture and muscle imbalances, low tone or strength and poor endurance.  Mental changes can include misunderstanding the above, poor self care, sexuality, social connectedness, depression and opposition.

Lifestyle habits can be educated regarding self-care, leisure, sexuality, social graces and activity.  Body awareness is an ongoing educational process. Teaching about the muscles, bones, proper activity, eating/food/nutrition, posture and exercise for their particular needs.  Something as simple as how strong are you, can lead to a conversation about how to feel stronger.

For parents, its having access to appropriate programs and professionals that is a challenge for this age group.  In our opinion, the one on one approach has always been the best way to address the above elements.  The importance of the relationship between the individual and the Instructor cannot be understated.  This is the social connectedness for many - especially those out of high school as the pool of others around them diminishes and their adult sense increases.

Keeping active frees the mind and provides self-esteem increases. Especially one on one exercise prescription - where an individual's needs are specifically addressed and a relationship developed.  Something to think about!

www.healthisfreedom.net

Leisure - easy to cast aside but Important for Development

Leisure

This group of occupations is the one that is most universally understood:
Leisure includes any activities that you might do in your free time and that you enjoy.

This can include more active recreation such as playing sports or going to the beach or can be quieter in nature such as gardening, listening to music or reading a book. Leisure can also encompass activities involving groups of people like attending a party or ones that are more individual-based.

Compared to self-care or productivity, leisure is often cast aside as ‘not that important’. While it is vital to address our basic care needs (eating, toileting, dressing), the importance of engaging in activities that we enjoy and that have a positive influence on our mental health should not be ignored. 

A fundamental tenet of Occupational Therapy is that every person, no matter their age, diagnosis, or any other factor has the right to and will benefit from having ‘occupational balance’: a balance in their daily life activities of self-care, work, rest and play.

Example: Going to the movies

Your 15-year old child expresses both a desire and an apprehension to wanting to go to the movie theatre to watch a movie with their friends. They have tried to do so once before in the past but experienced various difficulties in the process. The end result was that your child did not want to go back to the movie theatre for some time and the group of friends that they went with did not want to go see another movie with your child, who was left feeling hurt and  confused. 

In this instance, an OT would use their skills in activity analysis to gather information from the parent, child and observing the child in the relevant environments 

to identify the specific issue(s):

·       Transportation: Was the route to the theatre planned out in advance? Was the child familiar with the route? Have they been to this particular theatre before? Do they know the layout/how to navigate the signs? Do they have any physical limitations?

·       Money Management: Does the child have experience handling money? Do they normally use cash or a card? Do they have any cognitive delays which would hamper this aspect of the activity?

·       Environment: Are they able to scan information on screens to identify the theatre and starting time? Did they look up this information prior to arrival? How do they perform in other high traffic environments? Are there sensory challenges?

·       Do they understand the relevant Social Cues: standing in line to wait their turn, leaving enough personal space for others, not talking during movie, etc?

·       Emotions: How did their first experience affect their self esteem, sense of well being? What emotional barriers may be getting in the way?

Once the OT has a clear understanding of the issues, some relevant recommendations and strategies might include:

·       Transportation training: learning to navigate the bus system independently

·       Practice and strategies for managing money appropriately

·       Practice and strategies for dealing with busy environments, adaptations if possible

·       Social skills training to learn to understand and react to social situations

·       Supportive counselling to address the initial adverse experience and mapping out a new plan to ensure a future successful experience

This is just one example of what seeing an OT for a leisure concern might look like. If you or a loved one is experiencing challenges with any sort of LEISURE activities, please contact your Occupational Therapist today for more information.

Thank you for reading this blog series in support of Occupational Therapy Month. I hope it helped deepen your understanding of the value and benefits that OT can bring to life. I will leave you with a final quote, representative of the OT process:

“You need to be content with small steps. That’s all life is. Small steps that you take every day so when you look back down the road it all adds up and you know you covered some distance.”
—Katie Kacvinsky

Please feel free to leave comments below. We welcome all your input.

www.healthisfreedom.net

Written by:

Rachel Tavares, OT (Reg.) Ont., Registered Occupational Therapist, Bodiworks Institute

Why Productivity? - helping for better successes

2nd blog of OT series...

Productivity 

Productivity refers to anything you might do to develop your skills, earn a living, manage a home or help others.

For adults this can take the form of paid/unpaid work or managing a family/home i.e. on the job skills such as conflict resolution, teamwork, time management or home tasks such as cleaning the dishes, doing laundry or caring for children.

For children and adolescents, learning through play and at school, encompasses their main productivity occupations i.e. writing/typing, taking turns, creative expression, socializing

People place a lot of value on productivity occupations as they often make up the fabric of who we are, or who we may or may not be one day in the future – their self-identity! For this reason, OT assessment and intervention for productivity type occupations can provide valuable insight. The process the OT would take is the same as described for self-care occupations.

...Let’s take a look at a more in depth example:

 Let’s say you child is having difficulties paying attention in class. 

An OT would start by observing the child in the environment they are experiencing the most difficulties in, which in this case is at school, to gather information on the specific challenges that child may be experiencing:

·       Is there a specific subject that is more challenging?

·       What is the child doing in the moment where attention is challenging?

·       Are other children experiencing difficulties as well?

·       What does their workspace look like?

·       What is their seating arrangement like?

·       Where are they positioned in relation to the teacher/other students?

·       What is the environment like – lighting? Noise level? Temperature?

In addition to observation, interviews with the teacher(s) and the parent(s) as well as the child, would be necessary for the OT to gain a clear picture of the issues and potential barriers. 

...As for solutions:

·       Sometimes frequent movement breaks throughout the day are what a child may need

·       Adaptive seating may also be required, seating that allows for more movement

·       The classroom environment is just to stimulating for some children, so working collaboratively with the teacher and other school stakeholders to mitigate this stimulation is sometimes what is needed

Similar to self-care occupations, each individual presents with their own set of unique circumstances that may be hindering their performance in productivity type occupations, so each treatment plan will vary according to the individual.

If you or a loved one is experiencing challenges with PRODUCTIVITY type occupations, please contact your Occupational Therapist today for more information. Stay tuned for the final week of our OT Month Blog to learn more about the most enjoyable type of occupations yet: leisure!

www.healthisfreedom.net

Written by:

Rachel Tavares, OT (Reg.) Ont., Registered Occupational Therapist, Bodiworks Institute

Self Care - Help for this important part of life and development

October is Occupational Therapy Month! What better time to learn more about OT?   

...If you are not quite sure what Occupational Therapy (or OT for short) is, don’t worry, you’re not alone!

‘Occupational Therapy is a health profession that empowers people of all ages to overcome barriers in their everyday lives so they can do more and live better’ (OTOntario.ca, 2018)

Occupational Therapy looks at your ‘occupations’, or any daily activity/task that is meaningful in your life and works together with you to figure out ways to accomplish that task. Sometimes we might suggest an assistive device, other times we might modify your surrounding environment, or we may explore different ways of completing a task. The possibilities are endless!

OT’s tend to group occupations into 3 categories:

1)    Self-Care

2)    Productivity

3)  Leisure

In this series of blog posts, we will be exploring each of these 3 categories to help you better understand what they are all about and what OT can do to help.

First...

Self-Care

Self-care encompasses everything that you might need to do to take care of yourself. This can include basic personal care such as getting dressed, toileting, feeding yourself or it can be more complex tasks such as shaving, taking medications or nail hygiene. Anyone can experience difficulties with self-care at any point in their lives, which can be due to injury, chronic disease, disability, age, mental health or a multitude of other concerns.

So what can OT do to help?... Well, an OT would start by looking at all aspects of your life, the activity in question and your surrounding environment to first establish what might be getting in the way of you being able to take care of yourself. From there, an OT would work collaboratively with you to determine appropriate solutions to the problem.

Let’s look at an example... Let’s say your child is having difficulties feeding themselves during mealtime.  An OT would start by observing a typical meal time and gathering information on the challenges:

• Is the child having difficulties holding their spoon? 
  

  
• Sitting in their chair? 
• Do they understand how to feed themselves? 
• Do they look like they are in distress?

What about their environment ? – does the social and physical environment set the child up for success? What is the lighting like in the room? What about the noise level? The kitchen set-up? Further assessments are often necessary.

Then onto solutions! ...Sometimes a modification such as an adapted utensil or seating may be all that is needed. Other times, a more in-depth and routine feeding therapy involving gradual exposure to a food might be the answer. Often social-sensory issues are at play.  Each situation is unique and requires an in-depth look and evaluation. 

OT’s recognize that each individual presents with their own set of unique circumstances. This means that no single treatment plan will ever be the same! If you or a loved one is experiencing challenges with SELF-CARE, please contact your Occupational Therapist today. Stay tuned next week to learn more about productivity occupational therapy.


www.healthisfreedom.net

written by Rachel Tavares, OT (Reg. Ont), Occupational Therapist, BODiWORKS Institute 

Sensory Importance and Difficulties

Sensory Processing

Our SENSES – where would we be without them? They allow us to experience the world in so many different ways – from smelling the scent of fresh flowers, to being able to feel the soft fur on a puppy, to listening to your favourite song on the radio. Sensory processing is essentially our ability to conceive, plan and carry out an action so that the sensations that we experience are translated into a meaningful bodily response. So, turning up the volume and singing along when you hear your favourite song come on the radio!

Some individuals experience difficulties processing sensory information, which in turn greatly affects how they are able to live their lives. Current estimates indicate that between 45—96% of children on the autism spectrum experience sensory processing difficulties (Ben-Sasson et al, 2009; Lane et al; 2010). Many people may experience challenges processing sensory information, but it is only when those challenges start to interfere with their everyday functioning i.e. their ability to participate in school or complete self care tasks, that this becomes a problem.

We all know and have learned of our ‘5 senses’:

             Touch (Tactile)

Taste (Gustatory)

Smell (Olfactory)

Sight (Visual)

            Sound (Auditory)

But there are also 3 more, less well known, very important senses that affect the way we interact with the world.

Our vestibular sense, or our sense of BALANCE, relies on receptors located in our inner ear to help our body regulate and adjust to movement in any direction i.e. riding in a car, train or plane.

Our sense of proprioception, which uses information from receptors in our muscles and joints, helps our bodies understand their POSITION IN SPACE and apply the appropriate amount of pressure we may need for i.e. writing with a pencil, pushing pedals on a bike.

Last but not least, our sense of interoception, or our ability to sense what is happening INSIDE OUR BODIES, relies on a variety of receptors in our organs, muscles and skin, to help us identify things like when we are hungry, need to use the bathroom, feeling changes in temperature or pain level.

Individuals with sensory processing difficulties will often be either:

• HYPER-sensitive (extra sensitive), 
• HYPO-sensitive (under sensitive) or 
• have difficulty discriminating what sense they are feeling entirely!                               
• This can differ between senses too. For example many individuals with sensory processing challenges have trouble with either getting dizzy easily or never getting dizzy, feeling the need to push, jump, pull or hang or feeling the need to avoid these sensations. Or maybe they can only handle certain textures of foods in their mouths or don’t like to get their hands messy. These are all examples of sensory challenges, which may or may not be impacting on the individual’s ability to function in their daily lives.

If you are concerned that your child’s sensory processing abilities may be impacting their daily activities, please speak to your Occupational Therapist for more information and guidance.

Written by: Rachel Tavares, OT (Reg.) Ont. Registered Occupational Therapist, Bodiworks Institute 

www.healthisfreedom.net

Special Needs Development - its a marathon, not a race!

It’s a Marathon, not a Race…

Children’s development often follows a set of pattered “milestones” set forth by the medical establishment.  These milestones seem to be imperative and predict later success as a youth or adult.  However, for those with special developmental needs or delays this simply is not the case.  Developmental milestones seem to aid in diagnosis and comparative analysis child to child, yet do little for achievable perspectives for the families with special needs.  Once a child becomes 8, 9 or 10years the differentiation between neurotypical and special needs widens, which causes distress among the families of these children. What will happen in 5 yrs, 10 yrs…?

There are two important premises to remember with special needs children:

-         It is never too late to work on something

-         If you do nothing a lot, improvement will not occur

The above sounds simple, but in actuality most families still believe they may outgrow these delays or it is too late to try.

In the past, the assumption was that challenged kids would eventually outgrow it, but research is now telling us that these challenges persist throughout the child’s life.  Studies have also found that children who have motor skill deficits as children are less active as they grow older. Children with *dyspraxia are especially at risk for developing sedentary lifestyles because of their lack of success being active and interest in peer interaction.  Progressive intervention therefore aims at improving motor skills, social and emotional capabilities, improving problem solving when approaching a motor task, and helping children find recreational activities that will prepare them to be active for the rest of their lives.  

How can this all happen?  Well, only with a long-term perspective.  Remember it’s a marathon, not a race. An intervention that last 8 weeks will not affect a long-term change.  A child needs frequency, repetition, relationship building and solid strategizing by professionals.  From our experience, we see long-term progressive change and improvement compared to those who do not participate.  Such things as resolving fear of heights, running and gait improvements, focus and attention increases, relationships, enjoyment of activity, confidence, knowledge, skipping, biking and other complex motor skills. We have seen the results of a long term perspective and know its really the best way to help families.

 written by the team at the BODiWORKS Institute

www.healthisfreedom.net 

*Dyspraxia is a term used to describe children who appear clumsy, have poor balance, and have difficulty performing activities in their daily lives, such as dressing, self-care, toileting, coloring, and playing on the playground. Children with dyspraxia often have challenges with visual perceptual skills, motor planning, and academic demands. Dyspraxia falls under the diagnostic term Developmental Coordination Disorder (DCD), but is also frequently seen with other developmental disorders (ie.GDD), including ADHD, hypotonia and autism spectrum disorders(ASD).

GDD Diagnosis - Now what?

A significant number of children a year are diagnosed with Global Development Delay (GDD) or some version of development delay issue.  We commonly see children in programs with this diagnosis.

If you are reading this blog you are probably aware that a child may be described as having global developmental delay (GDD) if they have not reached two or more milestones in all areas of development (called developmental domains). These developmental areas are:

·      

motor skills - either motor skills like sitting up or rolling over and finer motor skills, for example picking up small objects

·       speech and language - which also includes babbling, imitating speech and identifying sounds, as well as understanding what other people are trying to communicate to them. Oral motor included here.

·       cognitive skills - the ability to learn new things, process information, organise their thoughts and remember things

·       social and emotional skills - interacting with others and development of personal traits and feelings, as well as starting to understanding and empathy

The causes of GDD vary depending on Congenital or Acquired determinants.  Essentially the child is affected by some sort of "insult" to the nervous system during development.  Often the exact cause of GDD is never identified. This is contributes to difficulty in treatment and outcomes prediction

Developmental disabilities are relatively common in children, with a 5-10% prevalence. GDD is estimated to be prevalent in 1-3% children < 5 y.o, and it is estimated that between 40,000 - 120,000 children born each year in the U.S. and Canada will manifest GDD. There are many possible causes for the clinical picture of GDD and some causes are treatable. Therefore, early recognition and diagnosis is important. In addition, some of the etiologies are genetically transmitted and may affect future family members. An underlying etiology can be identified in approx 25% of cases of developmental delay, with higher rates (50%) in GDD and motor delays, and lower rates (<5%) in children with isolated language disorders.

What if catching up is desired??...As a parent the emotional strain occurs when becoming aware of the issues your child has, especially as they enter the school system.  The common clinical understanding is that the child may never "catch up" to their developmental milestones.  This is very difficult to hear, especially if the goals of therapy are measured in this way.  What if the goals are measured another way? 

Individuating the goals are most important. Focusing on multiple levels of development.  Child development is extremely complex and ever changing.  A standard of focus is best on a global neurological perspective with "microassessing" (identifying small components of change).

For global muscle adaptation, simultaneous engagement of multiple motor neurons (within muscle) is helpful for development.  The 'old' idea is we avoid or negate many activities in replace of the one to encourage improvement.  Unfortunately, we have seen the long-term result of this type of therapeutic approach. Children who develop into adults this way have very limited neurodevelopment and therefore function.  For MOST GDD children, the delays are significant enough to warrant caution, however this should not translate into lack of neuromuscular stimulation. 

The newest science is changing the way we think and understand adaptability in neurotransmission in the brain. In delays or neurological disorders it was known that synaptic activity was impaired and in some instances non-existent.  Now we know this not true. (myelin facilitation of whole brain neuroplasticity J Lieff, MD. Feb 2016) In fact we can produce new transmission through stimulation with a global use of the brain's synapses, therefore a multifocal approach to stimulation! This is the simplest way to explain a very complex neuroplasticity process in the brain and nervous system.

About GDD Treatment... the child will NOT grow out of the issues, nor will placing them in sports to fix the physical delays nor general education.  The speed at which a child with GDD learns is a major part of their impairment.  The idea of a multifocal approach and stimulation offers the child an opportunity to improve.  Focus on frequency, intensity, consistency and global stimulation when in comes to physical therapy-type programs.  When it comes to additional needs a Paediatric Occupational Therapist who knows about GDD can be extremely helpful. Additionally the use of Music and Art therapy by qualified professionals will enable advanced brain activity even beyond neurotypical counterparts.

written by the Team at the BODiWORKS Institute, 2018

www.healthisfreedom.net

Adaptive Programming for Expression - ALL ages

The Importance of Adaptive Programming

Art and expressive therapy can seem like an illogical choice for special needs individuals. As it can require vocalization, social participation,  and motor skills.

What people may be unaware of is... how adaptable the expressive arts programming is to special needs individuals, as it can adapt/change/incorporate limitation by using non-traditional material.

For example... painting with string instead of a brush, or using masking tape or stencils to create shapes and patterns to paint in.

As well expressive arts can incorporate sensory materials to engage in self soothing techniques like shaving foam, beads, and clean hands programming. The ability to adapt and change materials, techniques, make programming inclusive is why art therapies is a great and valuable addition to therapeutic programming.

Setting goals that anyone can achieve despite their limitations, and providing support so no one feels struggle or frustration is vital to our therapeutic perspective.

We can all participate together at our own levels and abilities and feel a sense of inclusion and pride in what we are able to create. It is important to support individuals and provide them the opportunity to learn, express themselves, and be included in a community. As well as present everyone with the opportunity to feel pride in what they can accomplish no matter the outcome.

Our perspective of: 

• support,
• inclusivity
• adaptation to needs... is what sets us apart from other services supporting special needs individuals.

We aim to provide service to whoever needs it and support them achieve and succeed in their therapeutic goals. Whether behavioural, motor skill development, language acquisition, emotional and contextual expression. Expressive arts therapy can be beneficial in all these areas, creating a well rounded perspective to therapy and developmental treatment.

written by Emily McLennan - Art therapist - BODiWORKS Institute

www.healthisfreedom.net

the Power of CONTEXT for Expressive Language

The Importance of Making Contextual and Social Connection in Expressive Language

When we teach a child, we want to develop their ability to communicate and use their language. We first focus on receptive based learning, labeling items, colours, numbers and letters etc. We do this to teach the child how to label things, how to ask for what they want, and these are the basics of how they can communicate. Although teaching children how to memorize and label pictures and items which is the building blocks to their language skills, it is not the whole picture.

It is important that we add and build on their receptive language.  This is accomplished by adding how to use these labels in context. If they know the colour blue, can their experience painting with the colour blue change how they use it. Can they paint blue sky, or blue flowers, what else can they paint blue? These social and expressive experiences expand the way children understand the receptive language they have learnt.  *Within the Autism brain it is particularly important to incorporate expressive tools such Art. When well directed, this allows the ASD brain's 'limbic system' to be overridden (calmed Amydala) so that the context can be learned and create a potential pathway for the expression.*

What do we play music with:

instruments, our hands, our fingers, our breath? Do we hit a drum, push a key, or blow a whistle? It is experiencing, music, painting, and other artistic ways of expressing ourselves that we learn the context of how things go together. By teaching children cause and effect of how things work, our aim is to build on receptive language to broaden the range of experiences.  Without exposure to new experiences, and social settings children don't have the ability to learn how to use acquired language in context.

“As we interact in a contextually rich learning environment, we
pick up relevant jargon, imitate behavior, and gradually start to act in
accordance with the norms of the cultural setting.”
—Source: Contextual Learning Strategies

written by Emily McLennan - Art therapist - BBAIM team

BODiWORKS Institute

www.healthisfreedom.net