Diving into the Sensory System with OT Lori Goodrich


00:00:00    Alyssa

You're listening to Voices of Your Village. This is episode 225. I got to hang out with one of my dear friends, Lori Goodrich. She is an occupational therapist and truly transformed how I live my life, how I show up as a parent, how I show up as a teacher. She was so influential in my journey and continues to be. We're going to dive in to the sensory systems, what they are. We hear that word sensory a lot, but what does that even mean? And spoiler alert, it's how we function in the world. It is the foundation for how we show up, for how we feel, for how we process emotions, for everything. This episode is pure gold, and I'm so excited to share it with you. Before we dive in, I wanted to let you know that we have our Seed Teacher Summit, our first ever virtual summit. It is free April 10 to April 12. We have 18 workshops for professional development for early childhood educators. Head on over to www.seedandsew.org/summit to sign up right now for free. Don't miss out on these incredible workshops from brilliant minds and Early Ed. 18 different workshops coming at you, www.seedandsew.org/summit. All right, folks, let's dive in. 


00:01:31    Alyssa

Hey there. I'm Alyssa Blask Campbell. I'm a mom with a Master's degree in Early Childhood Education and co-creator of the Collaborative Emotion Processing method. I'm here to walk alongside you through the messy, vulnerable parts of being humans, raising other humans with deep thoughts and actionable tips. Let's dive in together. 


00:01:56    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 humans. 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. 


00:02:31    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 brings those things together. And as my 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 do is figuring out looking at something and figuring out why is that happening? And I think that's why Alyssa and I work so well together, because I think we have the same mindset. My background in 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. 


00:03:18    Alyssa



00:03:19    Lori

That's me. 


00:03:20    Alyssa

Can you explain to me just, like, what an OT does? This like a mystery question. I feel like even teachers in the field are like, is this an OT question? 


00:03:30    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 think occupation is our job. It's the place we go to to do our job, whether we're an accountant or a teacher or a lawyer. So I usually start with sort of 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 in 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. It could be I'm learning to explore my 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 way for a lot of people. What OT's background is, is we go to school and learn quite a bit about a wide range of things, including development through the lifespan, including neuro and anatomy, and a lot of work about sort of activity analysis, which is like breaking down a task. So my background is I actually am trained to work with the entire lifespan that all OTs are, and usually people end up specializing in different areas. So OTs 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? 


00:05:24    Alyssa

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


00:05:29    Lori

Yeah, I would agree. You're right. And because of that, I think the question I get a lot of is this an OT thing? And that could be I feel like. 


00:05:41    Alyssa

That must get said that at you a lot. 


00:05:42    Lori

Right. And it does come up a lot. And I think even within the healthcare world, there's confusion around what OT's do. And I think the confusion is because we can work in a lot of different populations and settings. So I work primarily in the pediatric setting, although you work with some adolescents and adults. But if you had a parent or a sibling that 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 than we do with the child that's learning how to crawl. So that's just very different. Yeah, I think most people have even have heard the term, but I think because there's OT's that do different things, it can make it a little bit tricky. 


00:06:30    Alyssa

Yeah, for sure. And I guess 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. What is your role? What are you looking for when you come in the classroom? 


00:07:00    Lori

Excellent question. Usually what happens is I'm either coming in just to kind of eyeball kids or a teacher sort of flagged 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 creating that situation. Some of the things that I would specifically look at are looking at how they're processing sensory information and maybe how they're responding to different inputs and those things. 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 100% clear to people. 


00:07:39    Alyssa

Yes, please. 


00:07:39    Lori

So sensory processing, I guarantee everyone's doing it right now. I know my own house. I have an 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 and 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 in a couch. It could 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 and clothing and then that understanding qualities 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? 


00:08:50    Alyssa

Yeah, that makes so much sense. 


00:08:53    Lori



00:08:53    Alyssa

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 a lot of times, I feel like one piece of development feeds into the other piece. So when I'm seeing 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? 


00:09:37    Lori

Right. I look at sensory processing. If you're thinking about a pyramid, it's like 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 off of sensory processing. I think one of the cool parts of my job, and 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 I think of the language piece, some of the core things that I think of are those kids that aren't filtering like we were talking about earlier, and also are working just harder to understand their body. Right. 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 that idea of they're working so hard in one arena that they can't necessarily access that language piece, or even maybe even be interested in engagement in the world because they're so overstimulated, 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 have typical development experience. That right. I'm sure you've seen kids that 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, oh, just for a little while why that big motor leap was happening. Their language kind of goes down a little bit. It's sort of a more like permeating challenge. And then when kids get older, there's a speech therapist that I work with that. 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 kids with planning issues sometimes talk like, I want to do that, or let's do, they can't identify an action or what the toy even is called because they haven't built up that repertoire of what their experiences are. Does that make sense? 


00:11:48    Alyssa

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


00:12:04    Lori

There's a couple of different ways to think about it. So I do in my clinic that I work at, we do direct intervention, which means 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. It's why, like, a massage feels so good proprioception, which is impotent to your muscles and joints. I am not a runner, but I know runners really proprioception. I was actually getting my fix of this 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. 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 overstimulated state. Does that make sense? 


00:13:09    Alyssa

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


00:13:19    Lori

It does. The work we do rewires the central nervous system, which is pretty cool. It's changing things. Yeah, it's pretty cool. And then the other thing that I'm sure you know from working with me is we 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 on 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 energy, we need ongoing sensory input to kind of keep our bodies in that regulated state. And a lot of kids with sensory processing issues just need more and more frequently. So working with things like doing squishes with pillows or having some muscle opportunities. I always see there's a little boy that's always carrying things up and down the stairs. So that idea of can he get enough input to get his body to be more focused so they 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 this situation really doesn't work. We need to accommodate and change the situation because right now, a sensory diet by itself isn't necessarily going to remediate everything, it's just going to help kind of in the interim. 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 changed with other kids when they're helping getting on their snowsuits and things. 


00:15:00    Alyssa

Absolutely. I feel like I use a lot of your tips and tricks around sleep. Like when we're getting ready for sleep, making sure that our tiny humans have their sensory diet occurs before then, right before we even eat lunch, because sleep comes after lunch for us. We have Rody, which you introduced to us and is a game changer. We brought it into our room and 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. 


00:16:02    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 and it can have a really big outcome change for you. And then potentially, if that works at school, that could possibly work at home too, if sleep is tricky. 


00:16:22    Alyssa

Yeah, absolutely. So I guess I'd like to talk about a couple more 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 can 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. 


00:16:47    Lori

Sure. I'm going to speak very generally. Obviously, I haven't met every child and every person that's listening, so these are very general ideas, but 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 in 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 areas. So the sensory modulation piece, which is what Alyssa was referring to as sleep, that our ability to can I focus, can I attend, can my arousal level? And it shift for necessary tasks. So, for example, going to sleep or I was outside on the playground and now 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 skin on skin. So a parent or a teacher massaging a child, some other really great ways to get it. Yoga balls, which are like pretty commonplace these days out in people's homes, or big, like couch cushions, like the ones that I'm sitting on are nice. And they're nice 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 hands, you're going to get that deep touch pressure. And that's a really calming inhibitory kind of input. Could 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, if they have a hard time shifting between active play and quiet play, those can be really easy things to add in. Spandex sheets and snuggling can be good. So wrapping a child in a blanket and it could be just sitting with mom or a parent or a teacher, those can be opportunities that can provide that input and also provide a nice connection point during the day, I think, as well. 


00:19:06    Alyssa



00:19:08    Lori

And then for the kids that are 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 milestones quite yet. Or you see them just working harder, maturely 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 you would expect them to be. And then often their play skills are not exploring things in the way that you'd expect them to. Those can be signs that they're not quite understanding kind of where their body is in place. 


00:19:51    Alyssa

Yeah. We see sometimes kids who have a hard time initiating play. So even if I 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 kind of initiate that play. 


00:20:11    Lori



00:20:12    Alyssa

And also with conflict. If somebody comes up and takes their toy, they may be mad, but they don't know how to communicate to get it back, how to engage in that interaction in a way that other kids might even just hit or yell. Our kiddos who have these sensory challenges will sometimes just stare at the kid who kind of took the toy and not know where to go next. 


00:20:36    Lori



00:20:38    Alyssa

Which I didn't realize. This is all stuff that 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. 


00:20:54    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. Those challenges can come from a couple of different areas, from an OT sort of end. One is we look at that. Remember how we were talking about understanding the qualities of input? You have sort of three basics of systems. Two of them most people have never heard of. So I'll try to be really simple here. Everyone knows about things like hearing and vision and those are really important senses also. But we have these three basic systems that let us know where our body is in space. It makes us feel safe, able to go out there and be like, I can do this. I can climb up on that structure. I can go be in that group of friends. I can try different things. So if your touch system, which is I think that's pretty familiar, right. I always think of the classic example I give as an adult for this, is if you put your hand in your pocket or your purse, you would understand like a quarter versus a paperclip. 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 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. That's like receptors in your muscles and joints that say, I am here. So I can do things like walk up the stairs without looking and touch my nose. I can close my eyes and touch my nose. I know where I am in relation to my other body parts. I'm 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. And then the third one is your vestibular system, which some 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, it 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 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 things like paintbrushes that kids can brush on their bodies, on their skin is a great way of promoting that tactile 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 pick them up and dip them in different directions. Rody is a good example of the muscle work, which is proprioception and vestibular together. So there's different activities. I always think when 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 what feels safe for them. 


00:24:43    Alyssa

Have you been scrolling the Internet? And there's all these tools for calming your child and how to regulate and whatever, and you try them and your child just gets amped up or that doesn't work, or you find yourself in these cycles where it's like epic meltdown, try to come back from it and you just feel like you're putting out fires all day long. If this is you, you aren't alone. And we collaborated with an Occupational Therapist to create our Sensory Profile Quiz. This is going to help you learn about what helps your child regulate what's happening in their unique nervous system. We are all different in figuring out what you're sensitive to or what helps you regulate is the key for actually doing this work, for getting to a regulated state, for having tools, for calming down, for having tools for regulation. Head on over to www.seedquiz.com to take the quiz for free. You can take it as many times as you like for as many humans as you'd like and we will deliver results right to your inbox to get you kick started on this journey. www.seedquiz.com. 


00:25:56    Lori

Does that make sense? 


00:25:58    Alyssa

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


00:26:24    Lori

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, it's of sensory input. 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 kids with postural based challenges that movement systems really not feeding into 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 it, 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 move. I know there's a couple of kids that I've seen that are much younger, that they're sort of 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 system is 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. 


00:27:58    Alyssa

And does that also feed into kiddos who kind of find a different way to move? For instance, I have seen kiddos who scoot instead of crawl 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? 


00:28:18    Lori

It can. I mean, kids can have, I'm talking primarily about kids with 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 weak and they can't get the right muscles to work, sometimes because they don't have that good coordination of both sides of their body. And also sometimes kids that don't want their head in different positions will stay and upright and do like the bum scooching. So it's a little different for each kid 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 and I remember 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 instructor I had at the time, and we both kind of agreed it was like 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. 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 patterns. 


00:29:55    Lori

Right, 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, right? 


00:30:03    Lori

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 one isolated thing, I mean, most of us, right, we always joke in my clinic that all of us, do 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 everyone's got something. It's sort of how much does it matter? So for my nephew, he can ride a bike, his gate 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 one thing wasn't necessarily indicative of lifelong challenges or anything because it was one thing. I think the thing that I know from working with I work with kids that most of the kids that I see are between maybe two and eight, and then they're sort of fading number of kids after that. But I have worked with a decent number of teenagers and adults and I think what we know from working with them is a lot of this stuff doesn't necessarily always go away. So it's good for us as clinicians, as therapists, to say, okay, we know, I'm sure there's people that nothing, it became nothing. And also for some people, 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 know if that feels helpful at all to include here. 


00:31:29    Alyssa

Yeah, no, for sure. 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. 


00:32:09    Lori

Right. And we still see pretty good, the neuroplasticity research, which I'm not going to quote sitting here. I don't have it in front of me. I think they're really noting that the change really is possible to 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 a very long time. And what that means is a lot of other challenges that exist because of that. So my cousin, who's a couple of years younger than I am, he's in his 30s, 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 drowning in the demands. 


00:33:20    Alyssa

No, I think that's very helpful. I think it's good to I didn't understand kind of 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. 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 just even if you don't go through the early intervention system, but intervening earlier with kiddos in general, how that can affect them for the positive. Even when they're going to kindergarten. Right. Things that they might not have to at that point still be working through or coping with. Yeah, I think that's very beneficial. 


00:34:10    Lori

Yeah. I think when I think of I work in a clinic and not in a school, school intervention is a little bit different than us. Is that their primary way of approaching things, which is also great, is how the children functioning right now. Otherwise they could be like, well, maybe there's going to be an issue. We'll just do therapy for everybody, which I totally get that. 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 potential challenges that can exist. We're not 100% sure for each client. There's not like a definite but when I think of younger kids, 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 does 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 100% if that can 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. 


00:35:45    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? 


00:36:00    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 feeling like parents feel like the primary important part of their job is being able to feed their children. And so this is actually one of my sort of areas of interest in work. And I think it was just based on the nature of the clients that I was seeing years ago. So eating is a pretty complex skill. And I think if most of the families that I work with, if I ask them what they thought the challenge was. They usually think it's sort of 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 it's usually interviewing around the sensitivity. We're not trying to ask them, let's torture you and see how this food feels. We're also looking at 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 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 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 suck, swallow, breathe. And postural control for things like being able to sit in the chair and how all these things interplay together and interfere with function. Some really common things that we see with kids are really select diets or kids that are grazers, the kids that can't read a full meal, some kids with safety issues that they're overstuffing their mouth, those kind of things. So the parents give us a food list and our job is to figure out why are they not eating things and then how do we put together a treatment plan to work towards food? 


00:38:31    Alyssa

It's amazing. 


00:38:32    Lori

Yeah, it's pretty cool. 


00:38:33    Alyssa

It's something I never thought of. 


00:38:35    Lori

Yeah. I think it's fascinating as a clinician for a couple of reasons. One is it's a very concrete thing and it's so complex. I think 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 bringing them together to say, 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 people are like, oh, they're not eating. Let's practice eating. And you're like, it's kind of like if a child's eyes aren't working the way that we want them to practice, catching a ball is not going to do anything. Right? 


00:39:20    Alyssa



00:39:21    Lori

So you have to think of 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 them the best foundation as possible. And this applies to all age brackets. This is babies up through we work with young adults that are restrictive eaters. I think it's fascinating. So I hope that answers your question. 


00:39:47    Alyssa

Yeah, very much so. Okay, so I have two more questions for you here. 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 postural stuff. I don't know. It was just something that I was really curious about. And I guess still I'm curious about how could OT, like the OT game here, play a role in sickness?


00:40:27    Lori



00:40:28    Alyssa

Or does it? 


00:40:30    Lori

Again, it could be, everyone cough right now that's your posture muscles will let you do that, and having good rib mobility. So if you do have postural challenges, it can create, I can't clear things and 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 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. Stress from overstimulation, 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 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 it happens. Also plenty of kids that don't get sick, so it's not always 100%. 


00:41:51    Alyssa



00:41:51    Lori

But if those are things, then not clearing things when they're sick, I feel like, is one that I've had with a couple of kids that had some pretty big postural challenges. So that's an important one to be thinking about in terms of their health and wellness. 


00:42:05    Alyssa



00:42:07    Lori

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


00:42:14    Alyssa

That's why you're one of my first people I turned to because I'm like, yeah, and I'm a fellow why asker, right? Yeah. We go back and forth on the why.


00:42:26    Lori

Right. And sometimes I think even families that I work with, either at school or at my clinic, sometimes it's not an OT thing. And I think one of the things that we I know I always feel like is important is being informed on types of other types of practitioners, that it might be their alley of that's not me. But 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 is already an expert in that. Or if kids aren't eating, pulling into other team members like a dietitian to help support sort of a multidisciplinary approach for some of these more these bigger challenges. The food is 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 that have attachment and trauma histories. So the idea of those aren't things that we would necessarily treat them informed of what their challenges are. We want to make sure we're playing with other team members, but sometimes, because we're jack of all trades, people are like, oh, that's OT be like OT plus other people. 


00:43:37    Alyssa

Yeah, exactly. Well, and I think what you highlighted here is that 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 are all of our disciplinaries feeding into this? And it's amazing how much it pairs together. 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 all areas of development? 


00:44:35    Lori



00:44:36    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, and Z, all of these other things that are happening and they had any concerns, where would they look next to see to kind of look into this further? 


00:45:19    Lori

Right. So a couple of things. One is there are 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 Beil. And that one was co written with a parent whose child that therapist treated, which I thought was, parts of it are, which I thought was kind of neat, got some parent perspective in it, which was 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 some information. The clinic I work at is located in Newton, Massachusetts. We're called OTA, The Koomar Center, formerly OTA Watertown, up until about five years ago. And we have a couple of resources on, how do I know, that are 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, be like, you can just go and fill out the paperwork. And if you decide, I don't want to send this thing, 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 easy resources. The one thing I caution about if you do any web searches is sensory processing disorder is very common with autism. 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 that parents know when they're reading. It's very hard not to go down that sort of rabbit hole of, oh, my gosh. You can have them experience with the exclusive from other diagnostics. So please, when you read that, just try to separate that out in your head when you're thinking about your own child. We don't do intervention differently for different diagnostic sensory processing work and sensory processing work. Those are some potential resources. And if it felt helpful, if talking more about activities or anything comes out of feedback, I would be happy to do another podcast to share more information if that felt like that would be helpful. 


00:47:57    Alyssa

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's, like, driving or has a sleeping child in their arms right now.


00:48:11    Lori

What did she say? 


00:48:12    Alyssa

That way they can go back and find it. Awesome. Lori, thank you so much. You are amazing, and I feel like I could sit and chat with and learn from you all day. Thanks so much for hanging out with us today. 


00:48:25    Lori

Thanks for hanging out with me. 


00:48:28    Alyssa



00:48:30    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.


Post episode note: since the time of this recording, Lori has opened a small private practice called Thrive Together Occupational Therapy. You can find her at www. thrivetogetherot.com.


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