Diving into the sensory system with OT, Lori Goodrich

voices of your village Feb 21, 2018



00:00:00    Alyssa

You're listening to Voices of Your Village, episode number four. Guys. I'm so pumped for today's episode. I have learned so much from this woman. Today I get to talk with Lori Goodrich. She is an occupational therapist by training, And she works with kids, infant through teenagers, and has been doing this work for over a decade. And she has this brilliant mind. She's able to look at the tiny humans, figure out the why of what we're seeing. She can figure out what is happening below the surface, And also what we can do to help the body start to fire in a different way, to turn on different muscle groups, or to help children with organizational plans, how to enter a group of friends, or how to physically crawl over and stand up at a table and engage in materials. Lori is one of those people that once I met her, I just knew she was my people. I love how she explains occupational therapy. OT was one of these things that from me for a while, I would just say, I don't know, is this an OT thing? I didn't really get what they did or what it was, or how it played a role in development. And the more I've learned, the more I realized it's at the basis of really everything. If your sensory system isn't firing the way it should be, then we're going to see some other things that are off or things that kids have a really hard time with. And not only have I learned from her different ways to identify what's going on with the sensory system, but also have learned tips and tricks along the way of what to do to support kids. So that little things don't become big things for them. So that life doesn't have to be so hard, and they can process information, and they can enter social groups, and they can get their body to do what they want it to do. Lori is so so brilliant. And I love that I get to sit here and chat and have this real honest conversation and ask her these questions that I've had for so long. And I think this episode is so valuable for anyone who has a tiny human, who comes into contact with tiny humans. I also think this is so valuable for adult. Now I, after this episode, went and chatted with my husband, about our sensory systems, and how differently they work. And what we can do to best support ourselves to function best in the workplace or in social groups, or in a large family function, or even just to communicate with one another in a way that works best. How we process information is so important. So without further ado, let's dive into my conversation with Lori. 


00:02:59    Alyssa

Welcome to Voices of Your Village, a place where parents, caregivers, teachers and experts come to support one another on this wild ride of raising tiny humans. We combined decades of experience with the latest research to create the modern parenting village. Let's dive into honest conversation about real parenting challenges, so it doesn't have to be this hard. I'm your host, Alyssa Blask Campbell. 


00:03:31    Alyssa

I'm so excited for today's episode, in my journey, there have been so many people I've learned from, parents, other teachers, pediatricians, directors, slps. This list goes on. But the woman I get to chat with today, opened my eyes to a whole new way of looking at the tiny human, Lori is an occupational therapist, and is one of the first people I turn to when I need to talk through developmental and sensory questions. She's a wealth of knowledge when it comes to kiddos. Lori, thank you so much for hanging out with me today. And letting me pick your brain. Why don't you start the listeners off with a little bit about yourself and what led you to where you are today. 


00:04:06    Lori

Thanks for the lovely intro Alyssa, as Alyssa mentioned I'm an OT. I've been doing the work that I've been doing for about 15 years. And what brought me to doing this kind of work is a really strong interest in science, and also helping people. And I feel like OT kind of bring those things together. And as that career has evolved, I realized how much I like to figure out the why of things. And that really speaks to me of what OT's do is figuring out looking at something and figure out, why is that happening? And I think that's why Alyssa and I work so well together because I think you have the same mindset. My background and training is in sensory integration, and also in neurodevelopmental techniques and oral motor therapy. So those are sort of my specific training areas that I've done extra work in after school. 


00:04:55    Alyssa

Awesome! Can you explain to me just like what an OT does? It's this mystery question. I feel like even teachers in the field. They're like, is this an OT question?


00:05:06    Lori

Right, I get that a lot, and I feel like every OT has probably practiced their sort of elevator speech of OT, what's that? And then, when you say you work with children, I've actually had people argue with me about what the word occupation means, because most of us, as adults occupation is our jobs, the place we go to do our job, whether we're an accountant or a teacher or a lawyer. So I usually start with letting them know what occupation actually means. And what an occupation is in sort of layman's terms is, it's all the stuff you want to be able to do during the day to interact with other people and the community to kind of get what you need to do out of life. For us part of that is our jobs but for a child, it's much different in terms of what are their occupations what do they have to be able to do during the day. It could be I'm a student. It could be I'm a friend, and it could be I am going to explore the environment, it could be a lot of different things. As kids get older, it becomes self help skills and learning and being a student. But that word occupation seems to kind of get in the the way for a lot of people. What OT's background is, you go to school and learn quite a bit about a wide range of things, including development, through the lifespan, including neuro in anatomy and a lot of work about sort of activity analysis which is like breaking down a task. So my background, isn't I actually am trained to work with the entire lifespan, and all OT's are, and usually people end up specializing in different areas? So OT's are healthcare practitioners that are promoting engagement in these occupations, and figuring out, kind of how to do so using different treatment approaches. Does that make sense? 


00:06:59    Alyssa

Yeah, Absolutely. You guys are amazing. You do like, you're jack-of-all-trades here. 


00:07:08    Lori

You're right and because of that, I think the question of I get a lot of "is this an OT thing?" 


00:07:18    Alyssa

I feel like I ask you that a lot.


00:07:18    Lori

And it does come up a lot. And I think even within the healthcare world, there's confusion around what OT's do. I think the confusion is, is because we can work in a lot of different populations and settings. So I work primarily in the Pediatric setting, although I do work with some adolescents and adults. But if you, if you had a parent or a sibling that was, had an injury and was in a rehab hospital, they have OT's there too. They just do something completely different, because it's a different approach to what the challenge is and how to promote it. So that someone that had a hip replacement, for example, we're obviously not going to do the same things with them then we do with the child that's learning how to crawl. Yeah, so that it's very different. Yeah, I think most people have even had heard the term. But I think because there's OT's that do different things, it can make it a little bit tricky. 


00:08:06    Alyssa

Yeah, for sure. And I guess, like when I met you, I didn't realize how much everything I was doing really came back to what you were doing and how closely they were linked. So right now, I work in an infant toddler classroom, and I kind of want you to chat about what that looks like in an infant toddler world like, what is your role? What are you looking for when you come in the classroom? 


00:08:35    Lori

Excellent question. Usually what happens is, I'm either coming in just to kind of eyeball kids or teachers sort of line up sort of, I'm kind of wondering about this. And as I mentioned earlier, OT's are the like, why is this happening people? So I'm going to kind of play detective and see if I can figure out what are some components that might be true in that situation. Some of the things that I would specifically look at are looking at how their processing, sensory information, and maybe with the how they're responding to two different inputs and those things I'm just going to I'm going to talk about sensory just for a minute, because I feel like this terminology gets kind of tossed around, and maybe it's not a hundred percent clear to people. 


00:09:14    Alyssa

Yes, please. 


00:09:15    Lori

For sensory processing, I guarantee everyone's doing it right now. I know my own house, I have a air purifier going. There's a little bit of a hum. My body automatically says not important, don't pay attention to it. So sensory processing helps us filter out extra information. It also helps us understand, sort of the basis of who we are as a person in space. So right now, I'm actually kind of sitting on a nice squishy couch, and my body just adapts and forms to the position of the couch, because it understands the properties of the touch system, and where I have to put one hip in the other hip to kind of get myself comfortable. And that's understanding the qualities of the input, which is really important for, it can be important for sitting on the couch can also be really important for understanding my body to be able to go out there and explore and develop motor skills. So most people are more familiar with that filtering piece, which is important for things like attention and comfort with experiences like maybe diaper changing in clothing. And then that understanding quality is important more for, how do I go out there and explore the world? How do I develop motor skills? And those kind of things, does that make sense? 


00:10:26    Lori

Yeah, that makes so much sense. I feel like when I call you into my classroom, I'm often like, hey, there's this thing going on, and I'm trying to figure out the why, can you bring your brilliant brain in here and help me figure out the why as well. And so a lot of times, I feel like one piece of development feeds into the other piece. So when I'm seeing like a language delay in a kid, sometimes I've learned from you and chatting with you that it could really come back to sensory processing that if there's so much going on and they can't focus on me and the sign language that we're bringing in, or the conversation we're having that they can't pick up that language. Can you kind of speak to that in better terms than I just threw at you. 


00:11:12    Lori

Right? I mean, I look at sensory processing if you're thinking about a pyramid, just like the one of the cornerstones of pretty much everything you do during your life, and most of us just kind of just do it automatically and easily which is how it's supposed to work. We do see kids have a wide range of challenges that can come up with sensory processing. I think one of the cool parts of my job is also one of the challenging things is it can affect a lot of things, including this language piece that you're talking about Alyssa. When they think of the language piece some of the core things that I think of are those kids that aren't filtering like we're talking about earlier. And also, who are working just harder to understand their body. Right? So I'm, I could be talking to you, walking around my house, cooking, doing all those things at the same time. And then young children don't necessarily do that. But the idea of they're working so hard in one arena that they can't necessarily access that language piece, or wouldn't even maybe even be interested in engagement in the world, because they're so over stimulated, or they're just working incredibly hard to figure out how their bodies are working. And part of that, the tricky thing here is part of that. There's some, lots of kids that are have typical development experience that right, I'm sure you've seen kids that like as their motor skills are going up, their language kind of goes down. The thing that we see with children that are experiencing sensory processing issues is they can't always access that sort of at all, like the developmental trajectory is not happening across the different areas. So it's not just that, oh just for a little while, while that big motor leap was happening their language kind of goes down a little bit. It sort of a more like permeating challenge. And then when kids get older, there's a speech therapist that I work with that we're, I feel like we're really refining this sort of concept, but for kids that have planning issues, so they don't really understand how to explore and approach tasks. As they get older, you'll see a kid with planning issues sometimes talk like, I wanna do that! Or let's do this. They don't, they can't identify an action or what the toy even is called, because they haven't built up that repertoire what their experiences are. Does that make sense?


00:13:23    Alyssa

So interesting. Yeah. So what do you, what do you do then? Right? Like, if you see this kid who is having a hard time filtering, like what does your work look like with them? 


00:13:37    Lori

So when we do, if I was doing, there's a couple different ways to think about it. So I do, in my clinic that I work at, we do direct Intervention, which means we're using we're doing a sensory integration approach to intervention, which means you're using sort of targeted enhanced sensory input to help rewire the central nervous system to be less responsive. So there's a couple of different sensory inputs that most of us can relate to, because it works for most people, deep touch pressure, which is like pressure to your skin, that's why like a massage feels so good, proprioception, which is input your muscles and joints. I am not a runner, but I know runners really like proprioception. I was actually getting my fix of it this morning cleaning my house as I was getting ready to kind of shift gears. So we do get a lot of those things normally during our regular experiences that the children that we work with just don't get that from their everyday experiences to enough degree. So we're going to use it to kind of use enhanced sensory inputs to organize that nervous system to calm it down. So they're not in that sort of constant, I'm over stimulated state. Does that make sense? 


00:14:45    Lori

Yeah, it does. So it's a new are working with them, say, on a weekly basis, does their body then learn how to do that on its own. 


00:14:55    Lori

It does, and really the work we do rewires the central nervous system, which is pretty cool. It's changing things, that yeah, it's pretty cool. And then the other thing that I'm sure you know from working with me is I do a lot of we don't want to be like, oh, there's all these challenges. Sorry, you're going to have to wait a really long time for intervention to work. We want to think of, how do we help a family or teacher in the moment, and how to support the child so that they can function to the best of their ability? And sometimes that's providing opportunities for regular sensory input during the day. If you've ever heard the term sensory diet, if we think of, we need nutrients for our body for like energy, we need ongoing sensory input to kind of keep our bodies and that regulated state and a lot of kids with sensory processing issues, just doing more and more frequently. So working with things like doing squishes with pillows. Or having some muscle opportunities that we see, there's a little boy that's always carrying things up and down the stairs. So that idea of can can he get enough input to get his body to be more focused and so he can access the curriculum in the classroom. He's a little bit older than the kids that you see. And then helping parents and teachers understand, okay that environment, or the situation really doesn't work we need to accommodate and change the situation. Because right now, there's not, a sensory diet by itself isn't necessarily going to like, remediate everything. So that's just going to help kind of in the interim. How do we, how do we think about, oh, that person doesn't really do well when there's a lot of people around them. So maybe they wait a little bit longer, or they go first to go outside. So it's not them having to be in the bustle of getting change with other kids when they're all putting on their snowsuits and things. 


00:16:36    Alyssa

Absolutely. I feel like I use a lot of like your tips and tricks around sleep, like when we're getting ready for sleep, making sure that our tiny humans have like their sensory diet occurs before then, right? So right before we even eat lunch, because sleep comes after lunch for us, we have Rody, which you introduce to us and is a game changer. We brought it into our room and you know, we have a yoga ball and things that we can bounce the kids on. But the nice thing about Rody is that even my old infants can climb on it by themselves and ride. And we see such different kids when they get off, and they're able to engage in a different way. And we really started using it as a part of our routine right before lunch. And so they would do Rody and then come to lunch and then go down for a nap. And it was so much easier to put these kiddos down for sleep, probably because they were more regulated. 


00:17:38    Lori

Right. I think you're right about that. Yeah, that's a really good, simple strategy, right? It's an accessible toy, it's not a big routine, it's a small change that you can make have a really big outcome, change for you. And then, potentially for if that works with school, that could possibly work at home too if sleep this tricky. 


00:17:57    Alyssa

Yeah, absolutely. So I guess I'd like to talk about a couple more like tips and tricks like that, like the Rody, or things that if our kids are having a hard time engaging, what are some things that we can provide for them that help build those tools for them, at least In the meantime, I know you mentioned, like, squishes with pillows, if you want to kind of expand on what that might mean? 


00:18:22    Lori

Sure, sure. So, different, I'm going to speak very generally, obviously, I haven't met every child, every person that's listening, so these are very general ideas and maybe just some concepts to think about. One is I always just think promoting general like sensory input. A lot of active play is good for anybody, whether you have a sensory processing challenge or not. It's what we all grew up with, running around the backyard, and those things, I think just general activity level is great to promote for kids. But if someone's having maybe some suspected sensory processing challenges, there's different things you can do for different challenge, different areas. So the sensory modulation piece, which is, what Alyssa was referring to as sleep debt, our ability to, can I focus, can I attend, can my arousal level can it shift for a  necessary task. So, for example, going to sleep, or I was outside on the playground, and I'm coming in to have lunch. So can your arousal level shift? Those are some things that you might see that might be suggestive of challenges. There's some really basic things that really work well for a lot of people, tiny humans and big humans. So that deep touch pressure is something that can be really helpful. And what I mean by deep touch pressure is like firm, even pressure to the skin. And you can get that different ways. You can get it through physical contact as in like skin on skin. So a parent or a teacher massaging a child, other really great ways to get it yoga balls, which are like pretty commonplace these days out of people's homes or big like couch cushions like the ones that I'm sitting on, they're nice and if you use pressure on a child's body, so like put them between two couch cushions and put them under a yoga ball and squish them with your hand, you're going to get that deep touch pressure. And that really calming inhibitory kind of input would be good to add before sitting down at the table if sitting at the table is hard before sleeping. For a lot of kids in school that they have a hard time shifting between like active play and quiet play. Which can be really easy things to add in. Spandex sheets and like, snuggling can be good. So wrapping a child in a blanket and it could be just sitting with Mom, or a parent or teacher. Those can be opportunities that can provide that input and also provide a nice connection point during the day, I think, as well, 


00:20:42    Alyssa



00:20:43    Lori

And then for the kids that are like having a hard time understanding where their bodies are. So some things that you might see with this are sometimes it's like motor skills are harder. So maybe they're not meeting the milestones quite yet, or you see them just working harder, motorically to figure things out like they don't approach things. They're not exactly sure. They might be really clumsy. Those are some things that you might see, I think, with younger kids, you often would see, like the kids that you're working with. The motor skills and quality aren't necessarily where we would expect them to be. And then often their play fields they're not exploring things in the way that you'd expect them to. Those can be signs that they're not quite understanding of where their body is in space. 


00:21:27    Alyssa

Yeah, we see sometimes kids who have a hard time initiating play. So even if I like, put paint on a paper. They might not come over to the table, even if they do want to play. If we help them over to the table, they might stay there for a while, but they don't know how to initiate that play. And also with conflict, if somebody comes up and takes their toy, they might be mad, but they don't know how to communicate to get it back. How to like engage in that interaction in a way that other kids might even just like hit or yell our kiddos, who have these sensory challenges will a little sometimes just stare at the kid who kind of took the toy and not know where to go next. 


00:22:12    Lori



00:22:13    Alyssa

Which I didn't realize. This is all stuff like you kind of opened my eyes to. And now we know how to better support them and help them learn to stick up for themselves in these situations and advocate for themselves. It's just so interesting how connected it is. 


00:22:30    Lori

Right, yeah, I agree. And then you think of what that gives you access to, right? Sort of social participation and just trying, exploring the world and trying things. Right? I mean, so, and that's that those challenges can come from a couple of different areas from an OT sort of end. One is we look at that, for how we were talking about like, understanding the qualities of input. You have sort of three basic systems, two of them most people have never heard of. So I'll try to be really simple here. So you have, everyone knows about things like hearing and vision. And those are really important things is also, but we have these three basic systems that let us know where our body is in space and make us feel safe. I'm able to go out there and be like I can do this. I can, I'm up on that structure. I can go be in that group of friends, and I can try different things. So if your touch system, which is, I think that's pretty familiar, right? It's like, I always think of the classic example I give as an adult for this is, you put your hand in your pocket or your purse. You would understand, like a quarter versus a paper clip. So that touch awareness is really important for understanding the qualities of how you're interfacing with other objects and things in your environment, and it gives you a sense of like sense of self, I have a map of where my body is. I know where I end and the world begins. And then proprioception is just like a terrible word. It's pretty much, just ignore that word. It's like receptors in your muscles and joints and say, I am here, so I can do things like walk up the stairs without looking and touch my, I can touch, I can close my eyes and touch my nose. I know where I am in relation to my other body parts. Giving a quick intro because it's going to give a clue into what the activities might be for this. So, don't mind my little nerdy sensory comment.


00:24:16    Alyssa

No I love it! 


00:24:17    Lori

And then the third one is your vestibular system. Which one, people are familiar with, it's pretty much your movement system. So those three systems work together for us, really to understand our bodies of, I am here. And I know where I am, and I can move through the environment to do things. And that could be crawling. That could be, I can put on my own pants. Could be I can negotiate through that group of kids on the playground. It could be a lot of things. So when I think of the kids that don't understand where their bodies are in space, I'm thinking of activities and those three systems, that are going to help promote them understanding where their bodies are, so that they can access exploring and doing whatever capacity feels meaningful to them. So the activities we just talked about that were the deep touch pressure ones from the previous discussion would also apply here. Also doing things like the sensory bins that you see in the in classrooms. Those are really great. I always think as much body parts as possible. If you're at home doing those things, doing water play, and having like things like paint brushes that kids can like, brush on their bodies on their skin is a great way of promoting that tactical awareness. Proprioception is just active play. So it could be rough and tumble stuff. It can be more opportunities for things like climbing, those kind of activities. And then vestibular is movement. So the most common one is swings. But also when kids are little you can like, pick them up and put them in different directions. Rody is a good example of the muscle work. Which is the proprioception and vestibular together. So there's different activities. I always think what I'm thinking of kids broadly. I'm thinking, are they getting those general inputs enough? And then following their lead with what feels comfortable. So if a kid really doesn't like spinning. It's not me spinning, spinning, spinning, them. It's "Oh, that's actually not comfortable. I'm going to follow their lead with some field space for them." Does that make sense? 


00:26:17    Alyssa

That makes total sense. So does this also like play a role I'm thinking of like their like physical development and I have some kids who their posture is just so different. And I, they tend to be kiddos for me who have sensory processing challenges. How does that play a role in this? Or does it? 


00:26:42    Lori

Yeah, it totally does. The sensory, understanding qualities of sensory input. Those basic systems are what creates the ability for motor function. So things like understanding where up is, which is your movement system feeds neurologically into your postural muscles and lets you know where up is, and those muscles start to activate and work. So when you have sort of challenges with understanding qualities of sensory input. It's not just, it's not just, oh, I don't understand it. I understand, I have a body. It's there's motor actions and motor functions that come off of those systems working. So some really common ones we see are, a kid with postural based challenges. That movement system is really not feeding into their their their trunk muscles. To say this is where up is, and move. And then also, if you don't feel comfortable with movement, and don't understand that, you're less likely to want to move through space, because it doesn't feel safe, so it's sort of this interesting cycle of I'm unsure of myself. I don't want to go out there. And I know you, there's a couple kids that I've seen that are much younger that I picture the potted plants they can sit, but they're just like sitting there. And that idea of my muscles aren't quite strong enough for this. And I don't really feel safe in my own self to go out there and move through space, because my movement systems not giving me good information. And then therefore, they don't have practice and opportunities to develop those postural muscles. In addition, to them sort of already being a little bit sort of at risk for that being a challenge area. 


00:28:17    Alyssa

And does that also feed into kiddos, who like kind of find a different way to move? For instance, I have, you know, seen kiddos who scoot instead of crawl or, or they crawl, but it's not that typical crawling position. They might drag one leg or something. Does that all feed into the system as well?


00:28:37    Lori

It can. I mean, kids can have, there's, we're talking, I'm talking primary, but I could do a sensory issues. There can be lots of other challenges that kids have that creates that, but for the profile that we're talking about kids that have more sensory processing, these challenges. So your movement system is really important for a lot of things. It's important for posture. It's important for bilateral coordination, which is using both sides of your body together. Also important for eye skills, but that bilateral coordination piece, You'll see kids doing all sorts of different crawling things. Sometimes because they're, they're weak, and they can't get the right muscles to work sometimes, because they don't have that good coordination of both sides of your body. And also, sometimes kids that don't want their head in different positions will stand upright and do like the bum scooching. So it's a little different for each kid. When people, when parents see things like that, I know my own nephew, Who's now five. He crawled with one leg with one knee down and one foot, always. Always. I remember my my mother was his grandmother was not sort of like what is that? And it was like the only marker for him that was a little bit, it was just a little bit different. I remember talking to one of my professors or an instructor I had at the time, and we both kind of agreed It was like a one, a one point thing. It wasn't that big of a deal. So one thing, small thing, I do think good crawling is important, but it's important for us not to get stuck on like one little teeny thing. 


00:30:03    Lori

And so it can be a sign of something. It could be just I don’t want to say it could be nothing, but it could be nothing. But if we're thinking about if they had a pattern, right?


00:30:15    Alyssa

If it's like that one off, it's different. But if it would then be combined with other things, we might look at it differently.


00:30:21    Lori

Right. So we're always looking for that, remember how we were talking about, we look for the why. We're also looking for patterns. If a child is having an issue with the one isolated thing, I mean, most of us, right? I mean, we always joke in my clinic that all of us, did we all end up in this field because we all have some sensory processing thing? Or when you talk to lots of other people, you realize, like everyone's got something it's sort of, how much does it matter? So for my nephew, he can ride a bike, his gait is fine. Everything else is fine. So to him, I look back, and I'm like, that was a good experience for me to have to be like that. That one thing wasn't actually indicative of like lifelong challenges or anything, because it was one thing. I think the thing that I know from working with kids that, most of the kids that I see are between maybe two and eight and then there's a sort of fading number of kids after that. But I have worked with a decent number of teenagers and adults. And they can, I think, what we know from working with them is a lot of this stuff doesn't actually always go away. So it's good for us to us, as clinicians for a therapist to say, okay, we know I'm sure there's people that nothing, it became nothing. And also for some people like the challenges, that are compounded over a long period of time. So working with adults, that probably could use Intervention when they were kids. I don't if that's feels helpful at all to include here. 


00:31:48    Lori

Yeah no, for sure Is it, I mean, a lot of what we're doing in early childhood we know that we form 90% of the brain by the time these kids are five and 80% by the time they're three. And so when we look at intervening at all in development, that's what we're looking at Is that we know it's so much easier and faster to make these changes when we do them younger than if we wait and kind of try to go back and reset these neural pathways. So it sounds like you're seeing a lot of the same stuff. Where maybe as a teenager, it'll take longer, and it'll be harder to kind of set new patterns than if we would have worked with that child when they're one or two. Right. And we still see pretty good, the neuroplasticity research, which I'm not going to be able to quote sitting here. Because I don't have it in front of me. I think they're really noting that the change really is possible through the lifespan, which is fantastic news. I think the main reason for me that the early intervention is so important is, when we work with clients that are older, they've now been coping with whatever this has been for very long time. And what that means is a lot of them, a lot of other challenges that exist because of that. So my cousin, who's a couple years younger than I am, He's in his thirties, came to our clinic. And the reason he ended up there was I was talking about my job when I first started working, and he was like, I think I have that. And sure enough, he had some vestibular processing challenges and some planning challenges that were in the mix. He's if someone ended up having, we see a lot of sort of more like anxiety, not to scare anybody, but depression. If you're coping with something for a long enough period, usually you're going to see other symptoms that stem from that sort of like, yeah, that drowning in the demands. 


00:33:39    Alyssa

No I Think that's very helpful. I think it's good, too. I didn't understand, kind of what the, what it would look like long term for people and how it could affect them longer-term. And I think that those are good things to look at it. I mean, we don't want parents or teachers to over analyze every situation, but to really just be aware of what early intervention, or you know, just even if you don't go through the early intervention system, but intervening earlier with with kiddos in general, how that can affect them for the positive, Even when they were like going to kindergarten, right things that they might not have to at that point, still be working through or coping. All right. Yeah, It's very beneficial. 


00:34:29    Lori

Yeah, I think, when I think of my work in a clinic and not in a school, school interventions is a little bit different than us, and that their primary way of approaching things, which is also great, is how are the children functioning right now, because otherwise, it could be like, well, maybe there's going to be an issue. We'll just do therapy for everybody. But we in the clinic, have the, which I totally get that like I totally understand why schools are like that, because where would it end? Right? But for us, we have the luxury of we work with families, we can really talk about and be open about like potential challenges that can exist. We're not a hundred percent sure for each client. There's not like a definite, but when I think of younger kids, if they're, if they're having a hard time when they're younger with language or social engagement, or emotional intelligence, or motor skills. I will in my head rack through what is this look like as they get older, maybe they have some planning challenges when they're younger. Planning is the foundation for executive functioning, which we all know is a huge part of learning and being able to function in school, There's no way to know a hundred percent is that going to happen? But I've worked with enough older clients that have that profile, that I at least have it in the mix. And I'm honest with families about, it's hard to know exactly, but it can impact things like social emotional development significantly and learning and those kind of things. So it's just good to think of those things in the mix of like, why does it matter but it doesn't mean it's the same for every single person. 


00:36:04    Alyssa

Yeah, thank you for that. I know you've been doing work around eating and like oral motor. I have no idea what that looks like, or how that relates to OT. Can you explain that to the listeners and me? 


00:36:19    Lori

Sure. So eating and mealtime participation is another occupation that we have. And it's one of the few things that you can't really avoid doing, right? Like if kids can't function at birthday parties or a certain sport, you can kind of get around those things, right? But eating happens multiple times a day, and there's a really big emotional component that comes into it for kids. And quite frankly, for parents, the feeling like parents feel like the primary important part of their job is being able to feed their children. And so we this is actually one of my sort of areas of interest in work. And it just I think it was just based on the nature of the clients that I was I was seeing years ago. So eating is a pretty complex skill. And I think of most of the families that I work with. If I asked them what they thought the challenge was, they usually think it's for the that sort of sensory sensitivity. My body is over responsive to texture or taste, or whatever, which is often true. So my job again, as an OT, why are they having the challenge? So I would look at a variety of components that come into mealtime performance. So I would look at I would, it's usually interviewing around the sensitivity, we're not trying to ask them to, let's torture you and see how this food feels. We're also looking at that sort of that sort of sensory awareness motor piece that comes in. Is your tongue, moving to the side to chew. Can you manage different size bites? Do you even know how big the food is that goes in your mouth? Do you know that it's clear, and out of your mouth, is your swallowing mechanism working right? So based on what we were talking about before, we look at the mouth. But we also look at how the body and the central nervous system are processing information. That gives us a clue that might just be creating some motor challenges that are going on in the mouth. So we're going to look at the sensitivity piece. We're going to look at the motor piece. We're going to look at some other things that are really important for eating, like sip, swallow, breathe and postural control for things like the being able to sit in the chair, and how all these things interplay together. And interfere with functions. And really common things that we see with kids are really select diet or kids that are grazers. Kids who can't eat a full meal, some kids with safety issues, like overstuffing their mouth, Those kind of things. So the parents give us a food list, and our job is to figure out why, why are they not eating things? And then how do we put together a treatment plan to work towards food.


00:38:50    Alyssa



00:38:51    Lori

Yeah. So pretty cool. 


00:38:52    Alyssa

It's something I never thought of. 


00:38:54    Lori

Yeah, it's, I think it's I think it's fascinating as a clinician for a couple reasons. One, is it the very concrete thing. And it's so it's so complex. I think the, my colleague and I are working on sort of figuring out, we're writing sort of a manual on how to do more like systematic treatment for this. Because what happens is there's a lot of different modalities out there, but no one's kind of bring them to you like first, you do this, and then you do this. Or how do you plug in what you're learning into sort of a framework? Because I think what we're seeing is a lot of a lot of people are like, oh, they're not eating. Let's practice eating. You're like, it's kind of like if a child eyes aren't working the way we want them to, practice catching the ball is not going to do anything. Right? So you have to think of where, what? What is the body doing? And how is it interpreting information? And then how do we work on those in the central nervous system to give it the best foundation as possible? And and this applies to all age brackets. This is babies up through we work with young adults that are restricted eaters. Yeah, I think it's fascinating. So I hope does that answer your question?


00:40:06    Alyssa

Yeah, very much so. Okay, so I have like two more questions for you here. It's been another topic that I've just been wondering about is how, I worked with a kiddo once, who had some sensory challenges and was constantly sick. I'm assuming it's related to like postural stuff. I don't know like what it was. Just something that I was really curious about. And I guess still am curious about like, how could OT like the OT game here play a role in sickness, or does it?


00:40:50    Lori

And it could be everyone, everyone cough right now, that's your posture muscles will let you do that and having good like rib mobility. So if you, if you do have postural challenges it can create, I can't clear things. I can't get things out. Other things that I've had with other clients that I work with, one is kids that have oral sensitivities, don't like having their teeth brushed and can have oral hygiene issues, which can lead to other sicknesses. And the other one that I feel like this again, there's no, there's no like evidence on this. But it's my own sort of thought process is, I think some of these kids, their bodies, are constantly under stress from what they're being asked to do, or can't do, how hard they have to work to do things that should be easy and automatic. So I think sometimes their bodies are just under sort of a constant stress. And we know as adults when we're stressed, That's when you get sick. Yeah, those are some like basic principles. Obviously, there's lots of other things that make kids sick, right? But those are some of the ones that I often think about when that happens. But also plenty of kids that don't get sick. So it's not a it's not always a hundred percent. But if those are things then not clearing, the not clearing things when they're sick, I feel like is one that I've had with a couple of kids that have some pretty big postural challenges. So that's an important one to be thinking about in terms of their health and wellness. 


00:42:24    Alyssa



00:42:25    Lori

So good point, a good point Alyssa. I know it's that, it's OT. I feel like the whole like does OT do this. You're like, maybe? 


00:42:38    Alyssa

Right, thats why you're one of the first people I turn too. Yeah, and then and I'm a fellow "why" asker. So we go back and forth on the why. 


00:42:46    Lori

And sometimes I think, even families that I work with either at school or in my clinic. Sometimes it's not an OT thing. And I think one of the things that we, I know I always say that is important is being informed and types of other types of practitioners that it might be up their alley of, that's not me. But I know where, I kind of know what you're looking for, because I want to make sure we're doing best practices with could I figure it out? Or hey this other person, are you an expert in that? Or if kids aren't eating, pulling in other team members like a dietitian to help support sort of a multidisciplinary approach for some of these, more for these bigger challenges, food being a big one.  A lot of clients that we work with have significant social emotional challenges that are either related to their sensory processing challenges and those challenges. But also a lot of kids have attachment and trauma histories. So the idea of those aren't things that we've necessarily. We treat them informed of what their challenges are. We want to make sure you're pulling other team members. So, but sometimes because we're jack of all trades, but like, oh, that's OT, well OT plus...plus other people. 


00:43:56    Alyssa

Yeah, exactly. Well, and I think what you like highlighted here, but it affects so many other different areas of development that it often could be multifaceted. I've worked with kiddos who, I had a family who had a baby who was having feeding issues, and the feeding team consisted of the pediatrician, a lactation consultant, an SLP and an OT. And everybody kind of came together to look at how all of our disciplinary is feeding into this. And it's amazing how, how much it pairs together. You know, I do work in emotional development and emotional development with the sensory development and language are all tied together. So it's never just, oh, we just have a sensory issue. It's okay. Now, how is that feeding into other things? And how do we then best support this kid in in all areas of development? 


00:44:53    Lori



00:44:55    Alyssa

Yeah, Awesome. Well, I guess from here, we just threw a bunch of information at families. I don't want people leaving like, oh, no, my kid needs all the things. What could parents do next? I guess where do parents turn, even if they have questions, or they want to check out more resources on OT specific things, or if they did notice. Like, yeah, every single morning, putting clothes on my kid is the biggest challenge ever, and it's coupled with X y&z. All these other things are happening, and they had any concerns. Where would they look next to see to kind of look into this further? 


00:45:38    Lori

Right? So, a couple of things. One is, there's some great books out there. "The Out of Sync Child"  is sort of the classic book that was written by Carol Kranowitz who's an OT. So that's a great one. The other one that I really like is Sensory Smart Parenting. And that author is Lindsay Diehl. And that one was co-written with a parent whose child that therapist treated, parts of it are, which I thought was kind of neat, to have some parent perspective in it, which is really nice. So those could be helpful If you just kind of want to learn more, or you're thinking, is this my kid? Those are good ways of collecting information. The clinic I work at is located in Newton, Massachusetts. We're called, OTA The Kumar Center, formerly OT Watertown, up until about five years ago. And we have a couple of resources on like how do I know, on our website. We also do really detailed intakes with families if they're considering intervention. So what that is is you go to our website. And it says, I want to look to initiate services. You fill out some paperwork. I've actually had some families. If they're thinking about if a sibling has a challenge. You can just go and fill out the paperwork. And if you decide I don't want to send this in, you don't have to send it in. But it's a checklist to get you thinking about some of the things that you might be seeing with your child. And then, if you decide that you want to send it in, you get a phone call free of charge with one of our fabulous intake therapists. So that could be a person that you could ask questions to before you decide to do anything. So that can be a really good resource. But filling out the checklist and thinking, is there enough stuff on here for me to think I want to move forward, or is it just more of an FYI kind of thing. Those can be some really, really easy resources. The one thing I caution about, if you do any web searches, is sensory processing disorder is very common with autism. They are not. They don't go together all the time, so you can have autism and not have sensory processing issues. You can have sensory processing issues and not have autism. So I always let parents know when they're reading, it's very hard not to go down that sort of rabbit hole of Oh my gosh, you would have them experience with you Exclusive from other diagnostic. 


00:47:48    Lori

So please, when you read that, just try to separate that out in your head. When you're thinking about your own your own child, We don't do intervention differently for different diagnostic sensory processing work with sensory processing work. So so there's some potential resources, and if it felt helpful, if talking more about activities or anything comes out of feedback, I will be happy to do another podcast to share more information. If that felt like you would be, that would be helpful Awesome. That's fantastic. Thank you so much. I will link to those books and to your Center in the show notes, so that anyone who is like driving or has a sleeping child in their arms right now. And what did she say? 


00:48:34    Alyssa

Awesome Lori. Thank you so much. You are amazing. And I feel like I can sit and chat with, and learn from you all day. Thanks so much for hanging out with us today. 


00:48:44 Lori

Thanks for hanging out with me. 


00:48:53    Alyssa

Thanks for tuning in to Voices of Your Village. Check out the transcript at voicesofyourvillage.com. Did you know that we have a special community over on Instagram hanging out every day with more free content? Come join us at seed.and.sew. Take a screenshot of you tuning in, share it on the gram and tag seed.and.sew to let me know your key takeaway. If you're digging this podcast, make sure to subscribe so you don't miss an episode. We love collaborating with you to raise emotionally intelligent humans.


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