Wednesday, April 20, 2011

My Secret Weapon Revealed!

A commitment to following through with a home program can make a huge difference in a child's ability to function.

A couple of mornings a week, I see children at a little clinic in a very poor neighborhood in upper Manhattan.  My treatment room is the size of a walk in closet, and instead of a beautifully equipped sensory gym with a large assortment of swings, a zip line, a ball pit, a climbing wall, a slide, and a loft, which is what I have available to me at my practice in Greenwich Village,  I have a couple of collapsible tunnels, a small assortment of therapy balls, a little portable mat,  a few puzzles and toys, a chalkboard, and whatever else I can scrounge from my own stash.

However, despite the lack of equipment, I have been able to help make remarkable changes in some of the children I treat, because I have a secret weapon up there: their mothers.

I've had some amazing turnarounds at that rickety little  clinic, sometimes getting better results than I do at the sensory gym, mostly due to the children's mothers following through at home.

For instance, I recently started seeing a four year old boy who was referred by the district because he was having so many problems adjusting to preschool.   I must confess that when I met him and his mother, my heart just sank.  He looked like a thundercloud made flesh, he was so unhappy in his body.  And his mother, who looked like she was still in high school, wore low cut, skin tight clothing and was pierced and tattooed everywhere.

My initial impression was that he seemed unreachable and unapproachable, and that she was scattered and not very bright.  {Which only proves that first impressions are misleading, and that you really can't judge a book by its cover, etc.  And I should have looked past that, and noted that he was beautifully groomed and dressed.}

This child was so sensory defensive that he was practically feral.  Any time anyone came into his personal space, he screamed "NO!" and either lashed out with his fists or folded into himself and crawled under furniture.  School was not going well at all.  He threw things, hit, bit, kicked, hid, and would not participate in any activities.  Because of his tactile defensiveness, he could not bring himself to touch glue or paint, and his ears were so sensitive that music class was a disaster.  When he was upset, which was often, when he wasn't lashing out, he would hit himself, smacking himself hard in the head with a fist.

His mother told me that he fell frequently.  When he wanted something from the floor, instead of bending his knees and squatting to pick it up, the way toddlers and small children so beautifully use their bodies, he had to drop down on all fours, or else he would collapse onto the ground and sit with his legs on either side of him.

When he wanted to pick something up, instead of using his finger tips, he used his hands like paws, and raked.

He had some language, but not much, and what he did have wasn't especially intelligible.

That first day, about 20 minutes into his treatment, he got so overstimulated that he punched me.

The second time I treated him, his mother casually mentioned that she had gone to Target in search of a collapsible tunnel like the one I had, but they were out of stock.  "You want to do things with him at home?"  I asked, surprised.  She said she wanted me to give her a list of things to do with him every day.

I pointed out that he was quite weak in his legs, which made his balance poor, and that he needed to crawl a lot, not only to integrate and strengthen up his pelvis, but also to stabilize his shoulders and help his hands be ready to hold a pencil.  I suggested that she put him on her back and give him piggy back rides without holding on to him, so that he would have to grip her with his arms and legs.  This would give him some much needed joint stability, so that he wouldn't fall so easily.  "Put on some music and dance with him on your back," I said.

We put him on a therapeutic brushing program, and gave him lots of blow toys.   His mother bought a couple of therapy balls and duplicated the activities we did in his sessions.   I urged her to keep him outside as much as possible.  I suggested that she take him to a park and have him go on the swings, and, since he liked to spin, to twist the chains.

Since he tended to isolate himself, I taught her some basic FloorTime techniques, and asked her not to punish or threaten him when he was being obstinate, but to attempt to be patient and to remember that his sensory defensiveness and balance issues caused him a lot of distress.

I then spoke to his teacher, taught her how to brush him, and asked her to please stop trying to force him to learn to write his name, since {like all four year olds} he was nowhere near ready developmentally to do that.  He was still only scribbling, could not duplicate a straight line or curve, and had not developed a three point pinch.  I also requested that be be excused from attending music class, since it was so painful to his ears.

He's been coming to OT for about ten weeks now, making slow but steady improvements, beginning to be interested in the toys and doing some exploring.   Last week, though, when they arrived, instead of hiding behind her, he walked into the clinic ahead of his mother, and grinned at me.  Instead of forcing me to walk on eggshells while gently coaxing him against his will into the treatment room, he bounced right in and started talking to me a mile a minute.

 As we settled down to work,  his mother lifted up one of his pants legs, and showed me where skin on his knee was darkened and scuffed.  "That's from crawling!"  she told me.  She had devised all kinds of crawling games at home, like putting his favorite toys under the sofa, so that he would have to frog crawl on his belly to get to them.  She was playing with him on the therapy ball, doing all the foot activities, all the brushing, all the piggyback rides, tons of crawling, and spending time at the park every single day.

She reported that he had stopped falling.  He was starting to use his legs to squat, instead of dropping to all fours or collapsing.  And he was participating much, much more at school.  He did not hit himself once during our session, and instead of hitting me and screaming when I started to remove his shoes so I could work on his feet, he helped to pull them off.

This child made his remarkable turn around so quickly because his mother was committed to helping him decrease his sensory defensiveness, which she did by diligently following through on his therapeutic brushing, and to improving his respiration, balance and strength, by doing the exercises and activities she learned in our sessions.  Nothing she did was very complicated, she accomplished everything in a tiny little  Manhattan apartment, and she was creative, improvising and expanding on what she had learned,  making  it challenging and fun.

If your child is seeing an OT, ask your therapist for activities you can do at home to improve his balance and strength.  If you invest in a few small, inexpensive pieces of equipment, like a therapy ball and collapsible tunnel, and spend a few minutes every day working on core strengthening, you can make his therapy go much faster.

And make sure he gets outside every single day to play!


Regula said...

Wonderful story!

Anonymous said...

great story? Thank you for sharing.
What is a name of the practice in Greenwich Village? I have been looking for a sensory gym in that area. Thanks

Loren Shlaes said...

I'd be very happy to talk to you. The clinic where I have treat is shared by several practitioners who all maintain separate private practices , so it does not have a formal name. It's located near Union Square on 14th Street.

My email address is in my profile.