Decision Points

More like connecting the dots than a split-second-decision.

I’m working with a child.

Paying attention to several things at once. 

Alignment, maybe first, but definitely early.

If she’s calm. Dry. Fed. Alert. All checked before the ‘work’ began.

Set her into a position from which to move how I want her to move.

Hands-on, support here, re-align there, long gentle stretch.

Few words, role-modeling for her Dad.

Touch yellow.

Hand-over-hand demo.

Repeat as necessary.

So she had a good night, Dad?

Yellow is new, reaching across midline is not.

She likes yellow, because it makes a fun sound when she touches it.

Not needing hand-over-hand or verbal cue.

Self-initiated touch yellow.

Yellow gets moved, slightly.

No seizures since last visit you say, Dad?

She’s loving yellow today.

Has to sit-to-stand to touch yellow now. 

Sit-to-stand 3x with minimal assist, good control.

Standing with minimal assist, 3 minutes.

Gets to hold yellow.

Give? (My palm open.)

My turn?

Not today.

Yes, Dad I can tell you the reason Cinco de Mayo is celebrated. [Hidden in comments on my post last year: Camping is life.]

Stand to put yellow on table.

Standing for 4 minutes, 25 seconds.

Decision point.

Will she shift weight in standing to touch yellow?

She’s cruising today. First time.

Can you set her up to do this at home sometime, Dad?

Yea, I think the orthotics make a difference.

3 feet to the right in 5 side-steps with minimal assist.

2 feet to the left in 3 side-steps with moderate assist.

Therapists have to decide in the moment when to push to the next level by connecting the dots.

If your child’s therapy visits look the same for months at a time, you have a decision point, too.

Comments

[K - Floortime Lite Mama]

your line on parents making decisions soooo resonated with me -
I can so easily make out good therapists from bad ones by the way they change
Another probelm is when therapists think that all people with a particular disability are alike
R was not making much progress in his ABA at one point - his therapist resisted my idea of making changes- her worry was that until he had mastered and complied with all the commands he could not move ot the next level
I suggested to her he was simply bored and we should try to change and see if he regressed or not
As it was my own paid private therapy - she wwas willing to tryi out my suggestion
Lo and Behold - R mastered the next set of programs ( new ) with ease
Now we change his program more frequently LOL

[Trish]

Thanks for the inside look, Barbara. We have just started private OT after running into this issue at school. I feel strongly that we need to work through some of the things we are dealing with now so that we aren't (hopefully) faced with a teenager who is out of control. But the school doesn't see the connection between the fine motor and sensory issues and the behavior, so they won't do add any goals or therapy time unless the academics are suffering. So frustrating!

[Your Therapy Source]

To expand on this, therapists also have to instruct parents and school staff on how to "connect the dots". I agree it is a therapists job to change the repertoire and to always ensure a child is motivated and engaged. In summary, therapy sessions must be active along with therapy instruction to caregivers must be ongoing and understood.
PS - Love the task analysis of a therapy session.

[Stacey Harris]

I enjoyed the play by play of this post...

[Barbara who lives here]

K, the ABA-teacher (I do not call them therapists) was following rigid protocols. At least she was smart enough to defer to the customer. You certainly do know R best!

Trish, you are wise to look ahead. Difficult for many parents to do. Too much to get into here, but the battle for (a particular) therapy in the schools is exactly that - a battle. I laud you for round-about-ing instead of fighting. I expect you will be more satisfied with the results.

Margaret (YTS), I think we are saying the same thing with different words. Probably not among the readers here, but this was yet another way I was saying to parents - developing a therapeutic lifestyle is the best treatment frequency. (PT is not a pill.)

Thanks, Stacey. I enjoy your posts, too.

[Barbara]

We have been lucky in that all of our therapists have been great so far. One of the best things they've taught me (mostly by me watching and assisting with therapy sessions) is how to make use of those spontaneous hidden opportunities by paying attention to what Bennett is interested in and what he is doing at the moment. For example, when we walk through a particular mall we make a game of walking between the lines of the ceramic tiles. When he is helping me shop, he grabs items from shelves that are over his head, etc. As you mentioned in your previous comment, we truly have adopted a therapeutic lifestyle in many ways.

[Elizabeth Channel]

It is so, so hard to find a therapist who is a good fit in our case, particularly an OT who can challenge and hold E accountable to what he is capable of achieving. I guess so many parents feel that way. And now I am hearing that his special ed teacher may change next year, and I do not want that, so I am fighting for the woman I know is best for him. It's exhausting.

[Barbara who lives here]

Outstanding, (other) Barbara! You get it and Bennett benefits from your participation and learning during his therapy sessions. Great examples!

I feel the pain of my professions, Elizabeth. I will not estimate the occurrence of good matches, but having professional personnel change frequently challenges the adaptability of many parents. As many divorced parents are advised to not disparage the other parent, children probably benefit from not knowing the angst their parent feels towards a teacher.

There are not enough therapists. With each one you reject, the pool from which to choose is smaller.

Exhausting indeed.