So my intent for this blog was to help other students or OTs thinking of going into early intervention to have a window into what it's like. And then somewhere along the way it became more about my personal reflections... whoops! So here's to getting back to the meat and potatoes of EI! I'll also post soon about toys we like to use - cheap ones you can make from the dollar store and nice ones you can buy and do lots with. :)
A "Typical" Day
To keep things confidential here, I have to muddy the details. Which gives you a chance to use your imagination :) So kids will only be described as a baby or toddler and some genders have been swapped. I cannot paint the real picture for you about each family situation. So just allow your imagination to explore. You walk into some of these homes and are taken back by the smokey smell or your eyes water from the strong cooking spices. You start sweating because the heat is something like 80 degrees because they don't pay for it, and the child has only a diaper on. Some have large family sizes or older siblings present who are also excited to see us and become a part of the treatment session - working on sharing, turn taking, using words etc. while addressing the issue you're there for. Then we have custody battles, interesting mom and dad stories, personalities, and decisions...interesting living situations.. So.... here we go...
8:00-9:00am We see a young baby with neonatal abstinence syndrome (NAS) - meaning he was exposed to drugs in the womb. He is developing well but has high muscle tone, which is common for NAS babies. There's a tightness to his arms and legs that can make rolling harder. Movements are fast and jerky rather than smooth. Each week we check his neck range of motion (following a toy all the way to the right and left) because he has a preferred side to look at. So we monitor this, play intentionally looking to the non-preferred side, give the caregiver tips on incorporating looking to the non-preferred side into the daily routine. And we work on tummy time, rolling, and making sure we are bringing both hands to the mouth, not just the one he tends to look at more. Leave and drive to the next.
9:30-10:30am We see another young baby, but this one has torticollis and plagiocephaly. In plain language, her neck is tight on one side creating a head tilt, and she has a flat spot on the side of her head that she is typically laying on. So we play with her, putting her on her belly and reaching for toys. We have her track objects to both sides, checking the range of motion in her neck. One side is easier than the other. She resists looking at the non-preferred side. So we basically sing and dance for her to look to the non-preferred side. When she is looking that way for 20+ seconds, we consider it an active stretch. Getting a child to actively look to a side makes a more powerful impact to the muscles than us (passively) stretching her. But we do both because she is really tight. She screams at times when we stretch her, but recovers immediately when we stop, which tells us she is ok, just does not like the feeling of the stretches. Which is understandable. Like when your calf or quads are tight. It's a little heartbreaking that she gets so upset, but we always end on a good note with snuggles and smiles. Leave and drive to the next.
11am-12noon We see a toddler who has some funky movement patterns and has some social concerns. She's not talking yet so we use lots of repetitive language in our time with her, which sometimes she will imitate and sometimes she stays mute. Getting her interested in an activity for 5 mins is a victory! (Meaning that she loses interest easily and walks away or tantrums). We are still trying to figure her out, so we try new activities and change our plans on the fly constantly with her to try to peak her interest. Sometimes we do not honor her requests to move on, because we want her to experience the cause and effect of a toy and attend for a few minutes. When she is interested in an activity, we hold the pieces she needs up high for reaching, going on tip toe, and on the floor to get her to squat and come back up to put it in. We are trying to strengthen her muscles and help her balance. We also have her "fly" in our arms, swing her back and forth, do jumping, and sing songs with fun movements because that's a way we've found to connect. Leave a little late because the caregiver was chatty at the end... text the next one we're running late and drive off. Eat your lunch in the car because there are no formal lunch breaks. :)
12:30 - 1:30pm We see twins who should be crawling or walking by now but are delayed. We do as much tummy time as possible! Tummy time is the answer for almost any motor need! And we have some lungs, and if one starts going, the other follows, so it's quite a show. :) We hold down their bums so they can't roll onto their backs and prop their arms under their shoulders so they can lift their heads up and see toys just out of reach. We do lots of toys just out of reach to get them to reach either hand and lift their heads. Then we let them have it for a few, and then take it away and start again.. torture, I know. How mean we are to help you strengthen your core so someday you can crawl! ;) We also support them while they sit and challenge their sitting balance by putting them on a small exercise ball with our hands on their hips. Or having them sit on a squishy rubber cushion that's filled with some air. Both of these just make them work a little harder to stay upright. On the ball we sway them back and forth to see if they'll put their hand out to catch, and bounce them, which again, challenges their balance. We also do tummy time on the ball with our hands holding them on and controlling the ball. It's good for reaching for toys out in front of them, or held at eye level by another adult. Leave and drive to the next.
2:00 - 3:00pm We meet some other staff at a home for an IFSP (individualized family service plan) meeting. This happens each time a child has been evaluated to see if they qualify for services. This happens when they first enter early intervention, and again every 12 months until the third birthday. The tool we use to see if a child qualifies is a standardized test called the Battelle. It tests 5 areas of development: cognition, communication, motor skills, social skills, and something else.. ? Upon qualifying, we come back and write a plan, which is when we figure out the family's concerns and priorities, which we make into goals we will reach in 3-6 months. (When we reach these, we write new goals). And in this meeting, we decide who will be the service coordinator for the child and what disciplines the child and family will see (OT, PT, nursing, speech, social worker, ABA therapist, dietitian, etc) and how often (typically 1x/wk but can be more or less). Basically a conversation with the family, some Q & A, a lot of paperwork for us to fill out on the spot, and some parent signatures.
Probably got out of the IFSP meeting late and are zooming to your last appointment. Eating a snack in the car.
3:15 - 4:15pm This boy has Erb's Palsy, which means he has nerve damage in one arm due to a difficult birth. When his head was yanked out, the network of nerves in his neck/shoulder area were stretched, causing some paralysis which has slowly been gained back. He has movement down to his elbow but not much in his wrist or hand. We play lots with 2-handed activities, and do hand-over-hand so he can grasp things and participate with both arms. We encourage as much spontaneous movement of his arm as possible (him moving it himself), which we've discovered through bubbles, some songs, and certain toys he gets excited about. We also change up his sitting positions while playing because his opposite leg is tight, due to how he keeps his balance when sitting or standing. So we sit him in ways to get an active stretch through that hamstring.
The End! :)
(Mind you, this is a good day in E.I. where there were no cancellations. Many mornings you're schedule starts like this but you're kids get cancelled because they're sick, you arrive to the house and it's a no-show, or you get to the daycare and they stayed home that day. Sometimes you can scramble and fill the slot with another family, sometimes you go back to the office and do paperwork, sometimes you chill in your car because there's not enough time to see another friend before your next visit.)
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