OT what is it??

OT what is it??
Kids learning through doing!!

Monday, October 14, 2013

Learning "Sculpts" Brain Connection

Spontaneous brain activity measurably changes after a person learns a new task.

Spontaneous brain activity formerly thought to be "white noise" measurably changes after a person learns a new task, researchers at Washington University School of Medicine in St. Louis and the University of Chieti, Italy, [Proceedings of the National Academy of Sciences, 106:17558-17563].

Scientists also report that the degree of change reflects how well subjects have learned to perform the task.

"Recent studies have shown that in the absence of any overt behavior, and even during sleep or anesthesia, the brain's spontaneous activity is not random, but organized in patterns of correlated activity that occur in anatomically and functionally connected regions," stated senior author Maurizio Corbetta, MD, Norman J. Stupp Professor of Neurology. "The reasons behind the spontaneous activity patterns remain mysterious, but we have now shown that learning causes small changes in those patterns, and that these changes are behaviorally important."

At the start of the experiment, Corbetta, graduate students Chris Lewis and Antonello Baldassarre and their colleagues in Italy used functional connectivity magnetic resonance imaging to scan the spontaneous brain activity of 14 volunteers as they sat quietly.

Next, researchers scanned the subjects as they spent one to two hours a day for five to seven days learning to watch a display inside the MRI scanner for the brief presence of an inverted "T" in a specific part of the screen. Two sets of brain areas were particularly active during the task: part of the visual cortex that corresponded to the portion of the visual field where subjects were looking for the "T", and areas in the dorsal part of the brain involved in directing attention to the location on the screen.
After the visual training, scientists again scanned the subjects' brains while they did nothing.

When the subjects rested at the start of the experiment, spontaneous activity in the two parts of the brain that are important to the visual task was either not linked or weakly correlated, with the two regions involved in the upcoming task only occasionally being active at the same time. After learning, though, each region was more likely to be active when the other region wasn't. Subjects who were more successful at the task exhibited a higher degree of this "anti-correlation" between the two regions after learning.

Corbetta suggested this learning-induced change in the brain's spontaneous activity may reflect what he calls a "memory trace" for the new skill. The trace makes it easier to use those parts of the brain together again when the same challenge recurs.

"It's as though these two brain systems are learning to get out of each other's way," he said. "After learning, the brain can identify the targets at a glance in a way that requires less direct attention and thus less interaction between the regions involved in the task."

In addition to helping "grease" anatomical connections between different brain regions, Corbetta speculates that the changes in spontaneous brain activity may maintain a record of prior experience that constrains the way the same circuitries are recruited at the time of a task.

"This suggests that disruption of spontaneous correlated activity may be a common mechanism through which brain function abnormalities manifest in a number of neurological, psychiatric or developmental conditions," he said.

Funding from the European Community's Seventh Framework Programme, the National Institute of Mental Health, the National Institutes of Health, and the Third PhD Internationalization Program of the Italian Ministry of University and Research supported the research.

 From Advance for OT 2009

Happiness ~What Every Parent Wants: Mission OT

Susan N. Schriber Orloff, OTR/L, FAOTA

Every parent just wants his or her child to be “happy”.  That is their bottom line.  Therapy, academics, home life, whatever, “just makes my child happy”.  Anyone who has worked with children for any length of time has had this said to them repeatedly over and over again.

It is really not their fault.  Ingrained in the American psyche and in our Declaration of Independence is the “right to pursue happiness”.

Aristotle had it even more precise, he wrote, “happiness…is at the end of action”.

And so in helping children is all about action in the pursuit of happiness.  But as Dennis Prager wrote in his book, “Happiness is a Serious Problem”.

Those actions that we ask of the children are often fraught with frustration and in the pursuit of the happiness derived from increased skills that are not easily achieved.  Along the way it just plain gets “too hard”, the struggle too intimidating and the progress seemingly too slow coming.

We often attribute this to low self-esteem, fragile coping skills, processing issues, etc. In truth it could be related to the definition one is using for Happiness.

What Moms Want
The main goal of most all parents is to have a child who can meet life challenges with confidence. In other words, she wants a happy child in school and out in his/her world.

Meeting the Happiness Goal
Helping both parent and child understand that happiness, while most Americans feel the right to pursue it, is and elusive moving target and is really a by-product of the very hard, and sometimes-slow work of meeting challenges.

As OT’s and teachers we need to brace ourselves when a parent says, “He just isn’t happy in OT”.  Our response needs to convey that our goal is to  “make him/her happy after OT (learning interventions)”.   I often use the analogy about diets: no one goes on one unless their clothes get tight and that is not a happy feeling. Dieting is not fun. But the results are gratifying.

It is also important to help our clients understand what “happy people” do differently so that we can help them modify their behaviors to get to a less fearful place.  Todd Kashdan and Robert Biswas-Diener in a recent Psychology Today (July/August 2013) research article stated that, “ one of life’s sharpest paradoxes is that the key to satisfaction is doing things that feel risky, uncomfortable and occasionally bad”.  In addition, they state that curiosity is another important factor. “…Curious people knowingly invest in activities that cause them discomfort as a springboard to higher psychological peaks”.   The authors continue that, “…good life…is a matrix that includes happiness, occasional sadness, a sense of purpose, playfulness and psychological flexibility…mastery…belonging.” 

The take away here is that part of therapy should be about helping children embrace the unknown and the process of figuring “it” out.  OT as a part of this “life matrix of being” encompassing all the range of feelings, is not about having fun each session, but about getting to brave.

Getting to happy is not a destination, it is a process and OT’s are the guides for each child’s individual pursued journey.

Sunday, June 30, 2013

Keeping "it" a secret…NO!!

No parent wants their child labeled, made fun of by peers, or ostracized in any way.  But when does “protection” go too far?  When is “keeping the secret” more harmful than helpful?

Being an occupational therapist is a commitment to life-long learning.  So in my 35+ years of practice I had not encountered a child with XXX Syndrome until  recently.  I had to get a handle on what it was, prognosis, treatment and life consequences. 

I have chosen this scenario because it was new to me, and perhaps is to my readers as well.

So what is it? It is a chromosomal variation that puts an extra X chromosome in each cell of the human female.  It is not inherited and is caused by an error in cell division in utero.  Generally speaking, these children are usually within normal IQ but may be lower than their genetic siblings, have speech delays and/or poor language skills, and have delayed motor skills with specific coordination and generalized clumsiness.  There are also some slight physical differences but nothing too pronounced that would set them remarkably apart from their peers.

So here I am working with a parent who wants “all of this kept quiet’; not allowed to share with the teachers or the head of school, I am in a therapeutic communication no-man’s land. 

During the evaluation, when trying to help the mother feel less anxious, I said “as one parent to another, our children are who they are and what they are we cannot take blame or credit”.  At this she promptly replied, “oh but it is my fault, it was my egg that did not split right, this is all my fault”.  Stunned and incredibly saddened all I could do is take her hand.

How many of our parents are in this situation?  How many parents live the with misplaced burden of blame (about their children)?  How often do we get so caught up helping the child that we miss what is going on inside the parent that lives daily with these overwhelming feelings? 

As parents, and particularly moms, we (myself included) are in charge of “making it right”, “fixing it” and “kissing away the hurts”.  When hurts just cannot be made right or kissed away, when the diagnosis is devastating, when the earth starts moving under their feet, parents become our patients too.
How we deal with the families is equally as important as making sure that the child is achieving developmental gains.

This is something parents cannot “just get over”; it is a seismic life shift that impacts them, their child, and their other children.  Below is a list of ideas that my be helpful for the family and that can easily be incorporated into OT sessions and/or therapy.

1.     Including siblings during some of the therapy sessions
2.     Cooking cookies during a session with siblings and then having a “party/snack” together—letting the child in TX be the “leader”
3.     Helping families structure homework or quiet time (if not homework, drawing, reading, etc.)
4.     Talk about it, and then talk some more, there is no monster in the closet it is a fact that just is—keeping it natural makes it OK.
5.     If needed suggest a support group for the parents/family if there is not one, contact a psychologist or a counselor and with respecting privacy, ask for resources
6.     Former client’s families that have been through similar situations are often a great resource for both information and support.
7.     Encourage the parents to share confidentially with the school, so that accommodations and modifications can be offered and learning stresses decreased.
8.     Celebrate each other:  make a “WOW Board” and each week each person in the family gets to post at least one thing that they are really proud of.

Keep sharing with the family all the wonderful things their child can do. Shine “light” on the achievements.  If they haven’t shared the child’s issues with grandparents, or a close trusted extended family member or friend, encourage them to do so.  Sharing this information allows the parent to not be alone and creates for them a caring community of support.

So, shhh no more, and shoo away the guilt—my daughter (now 34 years old) wrote a song when she was in 7th grade; the refrain was:  “Kids don’t come with instruction books, and they don’t come with guarantees, I’d like to thank you Mom and Dad for taking care of me”. 

And that is what parents do …they take care of their child…and OT's can help not just the child but parents and siblings as well.

Sunday, March 17, 2013

Respite Care: an essential not a luxury!

We have this need to find the right band-aid, kiss it just right, and make all our children’s hurts magically disappear.  When they do not, we, the Mothers, have failed.

I am not talking about just your average mistake and move on type failures, these are FAILURES, worthy of expulsion from the “Mother Clubs of America”, revoking all PTA cards and as well as their rights and privileges there unto appertaining; an indelible black mark on our transcripts from the University of Parenting.

This is probably true for most of us Moms, but even more so if our children have developmental challenges.

We are a particularly fragile bunch of Moms.  We have endured the stares at the baggage claim in airports as our child had a meltdown for no real particular reason.  We have gotten the “look” at restaurants when our child spoke to loudly or impulsively touched something.  We have sat across from the well-meaning teacher who stated rather matter of factly, “your child is just different” (from the other kids).

And so, we the ultimate family fixer set off upon hearing those words to find, not just a solution, but the best solution. It was a journey into an unknown arena where everyone was an expert but us. At times the advice made our heads swim and squeezed out what little confidence we had that we were really up to the challenge of doing the right thing for this child with whom we had been trusted.

All the advice, do this therapy, take this medicine, no one seemed to get that the caregiver needed some attention too. “What do you mean you are not taking him to OT/PT/Speech and hippotherapy, he needs it!” “Oh, and by the way let’s not forget Hebrew School.” So we are easily misguided into thinking more is better and better means Moms Never Rest!

STOP!!! BACK UP!! Is this you or someone you know?

If it was anyone else, doing anything else, we would advise, “don’t burn the candle at both ends”… “don’t stretch yourself too thin”… “don’t ear yourself out”  “you could make yourself sick, you know”…and somehow this good advice is denied the parent of the challenged child. Instead the message is do more, don’t stop, this is how you show love. Oh, you have other kids, a husband, they’ll understand!

B-o-l-o-n-e-y!!! You show love by being able to be there as a whole person, and as the song goes, “…the greatest love of all is learning to love yourself”.  Ride in an airplane and the stewardess reminds “adults traveling with small children, in the case of an emergency, to put the mask on themselves first”.  How novel, you can’t be functional for someone else unless you are first fully functional.
And that is where Respite Care comes in. Everyone needs a break. It is not desertion. It is not a lack of love. It is not bad parenting. It is the one and true way of saying to everyone, I care so much about what I am doing as a parent that I am going in insure that I am here 100%, not just for my challenged child and for the rest of my family as well.  And I am going to do this by making sure I fill my emotional and physical “tank” when the levels get low.

Respite care does not have to be expensive. It can be a weekend 36-48 hours away at a friend’s home, a trip to family, etc.  And it is the best gift the rest of the family can give Mom. Not Super-Mom, just Mom, who is there for all of them all the time.  It can also be a trip away for the child. Visiting place without the family can be a growth experience for the child, and give Mom some uninterrupted focus time for the children who might be feeling short-changed in the scheme of things.

So the next time Mom looks a bit frazzled, the atmosphere a bit tense, step back and offer her the “mask first”. Respite Care can be the most caring thing we do for the whole family.

Susan N. Schriber Orloff, OTR/L, FAOTA is the author of the book. “Learning RE-Enabled” a guide for parents, teachers and therapists,(a National Education Association featured book) as well as the GA OT of the Year 2006 and  the CEO/Exec. Director of Children’s Special Services, LLC an occupational therapy service for children with developmental and learning delays in Atlanta, GA.  She can be reached through her website at www.childrens-services.com or at sorloffotr@aol.com.