The new kind of play....

On January 11, 2013 Hannah attended her Occupational Therapy Evaluation. The Occupational Therapist, named Sharon, worked with Hannah in a room filled with fun activities to evaluate her physical abilities. When we walked into the room, Hannah was introduced to a swing that hung down from the ceiling. The swing was a small square platform so she could safely stand up and swing. She was rather nervous but cautiously stepped onto the swing, swung for about a minute and then stepped off. Hannah then was shown a task of burying small ducks into a huge tub full of dried beans and asked to dig them out with her feet. The therapist showed her, by example, then allowed Hannah to dig to her heart's desire, with her feet, while she asked us some questions about Hannah. Hannah; however, did not enjoy the beans being on her feet too much and quickly changed the activity to digging for the ducks with her hands and funneling them through a funnel. We discussed the fact that she does not enjoy getting her feet dirty and how particular she is about things such as her jacket being zipped all the way to the top, her lack of enjoyment for wearing sleeves, and if she wears sleeves, they have to be put into the jacket in a particular manner so she doesn't panic. We also discussed how she hates to sleep with Pajama's on and has since she was a toddler. We talked about how Hannah seems to have the inability to sit still on her own. That can be rather exhausting. Except when watching a movie or playing a game on my tablet or her reader, Hannah is constantly fidgeting, flipping, rolling, jumping, and in our faces, she struggles with being gentle, and is usually in need of a space where she can run back and forth, spin in circles on the floor, or act out movies she has seen. Most of these actions are not seen as Hannah misbehaving but trying to fulfill a sensory need, we just could not figure out what sensory need that was.


Hannah was asked by her Occupational Therapist to change games and transition to drawing on a chalkboard in the room; however, Hannah did not do well with the transition, and needed some encouragement for the change by putting away the ducks and beans to change her focus to the chalkboard. The Therapist cleaned off the chalkboard so Hannah could draw on it; however, Hannah could not concentrate on the requested task until the ENTIRE chalkboard had been cleaned off. We discussed that Hannah struggles with some Obsessive Compulsive Tendencies that cause panic if they are not to the standard which she feels comfortable. After the board had been cleaned off, to Hannah's preference, she was able to complete the task of drawing. After that, she was able to blow some bubbles, play with some blocks, and she even decided to get on the swing again; however, she did not stand on the swing, instead, she laid down on the swing and giggled as she was swung back and forth. The Therapist decided to see how Hannah would react if she lightly pushed the swing so it would spin a little bit instead of simply doing back and forth movement. Hannah did not reach very well. She yelled for the swing to stop and so we stopped it.


During the session, the Occupational Therapist, discussed with John and I that Hannah seems to really struggle with knowing where her body is located. We talked about how she loves boldly flavored and very spicy foods. Sharon told us that those bold flavors and spices in her mouth tell her where the food is located in her mouth. For Hannah, she does things in particular ways so she knows where her body is located and how it is postured. She has issues with something she called a Vestibular Sense. I had been reading the book "Out of Synch Child" by Karol Stock Kranowitz M.A. to try and make sense of sensory issues; and while it is an amazing book, I expressed to Sharon that I really felt more overwhelmed by the information that I was reading because I didn't know exactly which portions affected Hannah--and that is where I wanted to start and then expand into the other areas. She understood. For those of us who are unfamiliar with the word Vestibular, www.scholarpedia.org, describes the Vestibular System:






The vestibular system detects motion of the head in space and in turn generates reflexes that are crucial for our daily activities, such as stabilizing the visual axis (gaze) and maintaining head and body posture. In addition, the vestibular system provides us with our subjective sense of movement and orientation in space. The vestibular sensory organs are located in the petrous part of the temporal bone in close proximity to the cochlea, the auditory sensory organ. Although the vestibular system was recognized as a separate entity from the auditory portion of the inner ear only in the middle of the 19th century, it is phylogenetically the oldest part of the inner ear. The vestibular system is comprised of two types of sensors: the two otolith organs (the saccule and utricle), which sense linear acceleration (i.e., gravity and translational movements), and the three semicircular canals, which sense angular acceleration in three planes. The receptor cells of the otoliths and semicircular canals send signals through the vestibular nerve fibers to the neural structures that control eye movements, posture, and balance (Figure 1).


In contrast to the senses of vision and audition which can easily be understood by simply shutting our eyes or plugging our ears, the significance of vestibular function in our daily lives is more difficult to appreciate. When the system is functioning normally, we are usually unaware of a distinct sensation arising from vestibular activity since it is integrated with visual, proprioceptive and other sensory information such that combined experience leads to a sense of motion.






We discussed things such as tight fitting clothing that might help her know where her body is, deep pressure squeezing which might help relax her and relieve anxiety, weighted vests, and backpacks with books, not too heavy, but heavy enough to be therapeutic (certain amounts for different weights in children), monitoring to see what physical activities cause her to be hyper and which ones help relax her. Sharon also shared with us that Hannah's movements, can cause deep pressure on her joints, can release serotonin and help her to relax, and, as a result, cause self therapy in a way. We discussed that a lot of Hannah's behaviors (not all...she is definitely mischievous from time to time by choice!) but much of what we are seeing is not a behavioral choice and needs therapeutic attention. We discussed some goals, such as, helping Hannah to regulate and control her body movements so she can participate in activities and public settings more appropriately. We discussed helping Hannah learn coping skills so when things seem to be too much, she has a way to handle them and calm down appropriately. We talked about how Hannah doesn't transition very well at all and how these things are going to cause her difficulty in the classroom; therefore, we have the big goal of getting Hannah ready for school. I felt that Hannah might struggle in school due to some things I observed as social skill issues; however, I had no idea certain things like the ones we discussed and observed in her session would hinder her in the classroom. I could see that more clearly as we discussed it; however, I have to admit, I was kind of shocked. We explained to her how things operate in our home with Hannah and she complimented us on how we have worked with her so far. We explained that Television is limited to no more than 2 hours a day, if she watches that, and how things like games on tablets and her reader are reserved for trips to the grocery store or when we really need her to stay in one spot. We talked about how when Hannah feels anxious we try to find a way to help her cope. It was nice to hear her tell us we were doing a good job. I think every parent needs to hear that.


They recommend that Hannah participate in Occupational Therapy once a week to help achieve these goals. As the session came to a close and I drove away from the facility, the first things that came to my mind were my failings. I thought about how I just didn't get it. We had talked about things during Hannah's infancy that might have signaled these issues, and it shed some light on early issues we dealt with; however, all I could think about was how I didn't get it. I remember thinking, we have been dealing with this all along and now there are only 7 months until she starts kindergarten...is there enough time to get her ready? Would it have made a difference if I caught it earlier? All the moments I possibly incorrectly disciplined her quickly flooded my mind. Did those moments harm her? The answers to these questions: yes, it would have made a huge difference if we knew earlier and I don't know if 7 months is enough time, and yes, there is a 99.9 percent chance....let me change that.....there is a 100 percent chance that I have disciplined Hannah incorrectly about a lot of things, but what I know more than those things that flood my mind, is this: GRACE. It is mentioned 170 times in the Bible. 2 Corinthians 12:9 states words that God said to Paul, "my grace is sufficient for you..." My encouragement that day was, "Brittany, my grace is sufficient for you...Brittany, my grace is sufficient for your parenting, your work, your marriage, your ministry...my grace is sufficient...I don't just fill in the gaps, I AM SUFFICIENT FOR EVERYTHING."


I am thankful for grace. I have no idea what I am doing besides the best I can and even that is not enough but that is okay because of GRACE. I don't have it all together but what I do have is Jesus and His grace is sufficient for my needs. ALL OF THEM. There is too much grace to be ashamed....there is too much grace to be afraid...and in my heart, though my body might not feel it and my mind might not think it, all the time, is a "peace that surpasses all understanding" (Philippians 4:7). I want to close with a quote from The Hobbit, the movie, as Tolkien's work are  some of my favorite stories and recently the Hobbit came out which I find appropriate for most situations for the season we are in as a family:


"Gandalf: You'll have a tale or two to tell when you come back.
Bilbo Baggins: You can promise that I will come back?
Gandalf: No. And if you do, you will not be the same."