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Understanding Motor Planning and Coordination

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UNDERSTANDING MOTOR PLANNING AND COORDINATION

This month we are going to talk about motor planning and coordination.

Each child develops at a different rate and at Explore and Soar it’s our job to identify and offer intervention solutions to help that process. 

Developmental Coordination Disorder is what postural and motor sensory based disorders are diagnosed under, in the DSM-V. We use sensory based motor disorder definitions, information and research to help us identify behaviours consistent with this, as occupational therapists.

One of the most common reasons we find that children are referred to Explore and Soar is difficulty with gross motor skills. This could be concerns regarding poor coordination, appearing clumsy and falling over a lot, difficulty with crawling or an inability to jump with two feet at a time, to skip or to ride a bike. 

As part of our initial assessment process and during our intervention sessions, we pay close attention to how your child moves their body in various scenarios. This provides us with vital information regarding how your child is processing the varied types of sensory inputs around them.

Last year we wrote about Sensory Processing Disorders on our blog, how to correctly identify the warning signs and how to best assist your child. One of the types of sensory processing disorders that we only spoke briefly of was sensory-based motor disorders (SBMD) also commonly known as a developmental coordination disorder, as recently outlined in the DSM-V under the category of neurodevelopmental disorders.

In SBMD, we see children who have difficulties with “stabilising one’s body or thinking of/planning/sequencing or executing a series of movements based on sensory information outside and inside the body” (Miller, L.J., 2014, pg.14). SBMD can be categorised into two groups; Postural Disorder and Dyspraxia.

Postural disorder is seen in a child who has difficulty in maintaining the control of their body, to meet the demands of an activity. It involves our muscle tone, core strength and stability. It is the action part of all motor movements. 

Children who have difficulty with ideation (forming an idea in the brain), planning and sequencing (identifying what steps are involved) and execution of motor movements fall into the dyspraxia category. This can occur across all motor movements including gross motor, fine motor, visual motor and oral motor. This is known as the planning part of all motor movements.

Motor planning is an automatic subconscious process that occurs every time we seek to move our body. We tend to take this process for granted. It occurs with many common daily activities such as opening a door, putting a jacket on, writing our signature, or chewing our meals. Once acquired it becomes like riding a bike – once you know how to do it, it begins to happen without too much conscious thought. Everything we do can be broken down into steps that our brain automatically executes via motor movements for successful completion of the desired activity. Children who are experiencing difficulties with motor planning find such tasks difficult, awkward and exhausting because of the level of conscious energy they have to put into completing each and every task! 

One common result of motor planning difficulties is an impact upon the ability to form social connections and self-worth. This is often due to difficulties with oral motor (eg. speech), visual motor (eg. difficulties copying work from the board at school), fine motor (eg. difficulty with buttons, shoelaces) and gross motor skills (eg. difficulty keeping up with their peers at recess). 

So how do we address motor planning difficulties in OT sessions?

We practice all the steps involved – ideation, planning and sequencing, and execution – so that it eventually becomes an easy and automatic process for the child. We provide opportunities for the child to create their own ideas for an activity, we break skills down into smaller steps to achieve success and we provide high repetition rates to allow feed forward and feedback loops to develop around the sensory information the child receives from the world around them. This is where we apply our knowledge and skills of activity analysis as OT’s to coach and teach your child skills that allow them to increase their independence. 

This is not a quick process. It takes time to rewrite neural pathways in the brain for autonomic responses to sensory input. By addressing motor planning goals within intervention sessions, we are not only looking to increase a child’s skill level but also their self-esteem and confidence to complete activities that are meaningful to them, ultimately leading to a happier successful life!

If you have any questions around motor planning, please reach out to one of our therapists who will be able to provide more information to you.

Reference:
Miller, L.J. (2014) Sensational Kids: hope and help for children with sensory processing disorder (SPD). New York:Penguin Group.

Until next time,
Lori

ORIGINALLY PUBLISHED JUNE 2, 2021

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The Impact of Relationships on Social Development

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THE IMPACT OF RELATIONSHIPS ON SOCIAL DEVELOPMENT

Over the last few months, I have seen a consistent theme emerge with clients and families within our communities, centered around personal health, well-being and relationships. 

As we are focusing on the importance of mental health this year, I thought it would be good to talk about the impact of relationships on social development – especially in that of our children in their early stages of life. 

Modern life seems to be filled with more stresses as humanity progresses. From a social emotional perspective, as a society, many of us are struggling. Our emotions are high, and we are feeling anxiety and uncertainty more than ever before. Once felt, this stream of thought and instability transfers to all aspects of life. But what if I told you that there is an intervention model designed by a psychologist, Stanley Greenspan that acknowledges our emotional social development and how it stems from relationships developed soon after birth? As health professionals we can use this model to support our families, both parents and children in developing the skills to maintain healthy relationships from the first 3 months of life! At Explore and Soar, we reference this model and use it as a guide in our intervention sessions. It is called the DIRFlootime Model; a Developmental, Individual Differences and Relationship based model that acknowledges each child’s unique differences and uses relationships and connections to establish a strong emotional social connection to further enhance development. This model is integrated into our sessions by following the child’s lead and adapting their ideas to enhance these skills through play. 

So why DIRFloortime? 

Well for us it aligns perfectly with our core values and supports our ability to develop connections and relationships with all our clients. But most importantly, it is an intervention model that acknowledges the emotional social development from birth into our adult years. It allows us as clinicians to work through developmental milestones from an early age. It is also a model firmly based on parent coaching; supporting our client’s parents/carers to further develop the skills needed to support healthy relationships. 

So how can we support our communities and families in developing these skills from birth to increase emotional development, resilience and social engagement, in order to avoid seeking intervention at an older age? This is done through awareness, education and acknowledging that the first months up to two years of life are of great importance when developing healthy relationship skills. 

In the first 3 months of life the foundational skills of regulation begin. This is the beginning of co-regulation between the parent and child and fosters shared attention; where the baby can seek the mother’s attention and they respond or vice versa. This then becomes the child’s foundation to a secure attachment. Attachment between the caregiver and the baby. The start of co-regulation is around the caregivers/mother’s ability to understand the baby’s wants, needs and desires. It’s the ability to answer cues and answer questions like are they hungry, uncomfortable, do they require a nappy change or are they in fact tired? The connection and relationship is based on love and learning to soothe the baby, creating a positive experience and strong connection. This ability comes from the baby having their own unique cries or cues to indicate to the mother or caregiver what they need. This is where the baby and caregiver become entrained with one another forming a bond; the foundations to co-regulation.

In an ideal world this seems simple, easy and realistic. However, every baby enters this world differently, every mother has a different experience and every baby has different sensory processing capacities that then impact their own biological rhythms. There simply is no one size fits all when it comes to taking care of an infant. 

As a new baby comes into the world, parents are presented with an array of challenges. Difficulty sleeping, reflux and feeding concerns, high stress births, babies being unable to settle or babies that simply do not enjoy being touched or soothed. These difficulties that arise for every parent, have a flow on effect with little to no sleep, stress, anxiety, self-blame and hormonal changes being merely a few of the impacts on our parents. This too then has an affect on the relationships that surround mum and dad, including their relationship with one another.  

This is all normal. But why don’t we talk about it more? Why do we gloss over the early stages of parenthood and try to make it look as easy as possible to the outside world? I remind my clients and friends that as parents, you simply are NOT a failure for not being able to soothe your baby. The only way you will ever fail is when you stop trying to understand your child. It is about asking questions and seeking medical advice when required, but also not being afraid to ask for help from your family and friends. 

It takes a village to raise a child. 

As OT’s we provide an extra level of support to parents, children and families. We understand and work with children in motor movement patterns at a young age to support their discomfort and the development of their sensory systems, including their sleep-wake cycles. We have the skills and ability to discuss with you your routines and support in identifying cries and ability to connect with your babies. We also acknowledge where other health professionals’ unique strengths can provide positive impacts for you and your child. But most importantly for us, our skills lie in the development of connection. We look to support our parents/caregivers by building the skills to interact, laugh, smile and play together with your child from a young age. We work with you to build upon the ability to co-regulate emotions, to keep you calm in challenging circumstances and to be present in order to assist in the soothing and engagement of your child. 

If you have any questions around the foundational skills of co-regulation and shared attention please don’t hesitate to reach out. The first three months with your baby’s life is the starting point to all engagement, self-regulation and social skill development for life. My hope is that in having these conversations, we will increase our ability to ask for help when needed. We will foster strong, resilient children who have confident, calm parents who are a little kinder to themselves in challenging circumstances. If we make an effort to start from birth, we can positively impact the mental health of our children as they get older. I know I’d love to see our children’s quality of life, self-esteem and love for themselves be greater in future generations. 

In our socials this month we will go through some examples of challenges and strategies that can help to support you. Take a look at our instagram or facebook to see more. Please don’t hesitate to reach out if you need a helping hand or would like further information on how we could help you!

Until next time,
Jess

ORIGINALLY PUBLISHED APRIL 7, 2021

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The Emotional Continuum

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THE EMOTIONAL CONTINUUM

Emotions; the one thing that many people find hard to acknowledge, understand and express freely. 

Yet they are the one thing that binds us together. They are a constant in out lives, changing as we navigate through day to day life. Our emotions live on a continuum and on any given day we eb and flow between them. 

At Explore and Soar, we describe this by using the terms optimal band of arousal and window of tolerance. Each allow us as humans to function optimally on any given day, to be able to maintain a home and  hold down a steady job as adults. For our children, being able to participate in everyday self-care activities, maintain engagement at school for learning and be flexible and dynamic in their thinking and feelings when socialising and playing with peers, is obtained when their optimal band of arousal is reached. 

There are many everyday functions and aspects of our lives that are relying on us to live in our optimal band of arousal, in order to attend and achieve these expectations. However, this is not always achievable and on any given day, our body and minds experience a range of emotions from our internal and external environments. When this happens, our ability to remain in an optimal band of arousal is not always achievable. Instead, we start moving on the emotional continuum either into a high arousal state of survival with responses of fight, flight, fright or freeze where an array of emotions and behaviours can become apparent or alternatively into a low arousal state where fatigue, tiredness or sickness can become apparent. 

Our ability to move consistently on the emotional continuum is guided by natural and unique instincts. 

By doing so, our body is expressing how we are feeling in the moment by telling our mind and body to respond in a particular way. As an example, if we are beginning to feel overwhelmed and stressed, moving into a heightened state, we are required to slow down to allow our body to rest. We can all become unstuck in this state from time to time, when we have difficulty regulating our emotions appropriately and being able to respond to our internal and external environment in an appropriate way, such as size of problem vs reaction. This is where the foundational emotional regulation skills of co-regulation from a young age and the development of self-regulation capacities is fundamental in supporting our children, but also enhances our adaptability and flexibility in all situations when we are older.

Take a look at our previous blog on co-regulation and self-regulation strategies >

In everyday life, if a child is expressing themselves with an action or emotion, that is their way of asking for help. As social beings we do not like expressing ourselves in a way that is perceived to be out of the norm, yet when things are not going ok for young children, their way of and asking for help is through emotive behaviour. As adults it is our job to be role models, provide support and teach them how to express their emotions appropriately. We must offer support to them as they move through these feelings, whilst trying to understand the situation at hand. That’s not always easy. Sometimes we as adults alone are unable to figure it out. This is where we as occupational therapists working within emotional regulation and sensory processing capacities can come in and help, to further breakdown what is going on, determine what is impacting our children and to determine the best strategy to support them in their daily experiences, on their own individual emotional continuum.

As occupational therapists there are a range of strategies and intervention options that we can do to support your whole family in better understanding each other’s emotional continuum. 

Our ultimate goal is to work successfully through everyday activities and allow you and your children to live your life to the fullest.  

Regulation strategies: As occupational therapists we can determine where each individual’s band of arousal sits on the emotional continuum. Once identified, we develop goals and implement strategies to support increased time in optimal throughout the day. Goals and strategies are targeting the development of co-regulation strategies with parents/caregivers and loved ones, self-regulation strategies and increasing the independence in identifying how your body is feeling and reacting, then completing strategies to calm, additionally reducing the time frame and recovery time if their emotions heighten. These are all powerful approaches to supporting our children in order to be successful in everyday activities. 

Take a look at our previous blog on co-regulation and self-regulation strategies >

Sensory processing activities: Utilising our individual sensory needs helps facilitate and develop regulation and achievement in maintaining an optimal band of arousal. Well known strategies such as heavy work, respiration and roughhousing strategies can be quick sensory activities in your everyday life in order to facilitate this. Over the years we have written about the benefits of all these strategies and you’ll see them regularly in our social media posts. This is because the benefits are paramount. This is also why you will see us in sessions working with our children with things like whistles, utilising oral motor strategies to support the development of skills, and individualised heavy work strategies (movement with resistance such as push, pull, lift, carry) to help achieve these outcomes. 

TRE (Trauma Release Exercises): Known as trauma release exercises are a simple yet innovative series of exercises that assist in the body in releasing deep muscular patterns of stress, tension and trauma. TRE can be implemented through an active way of exercises that activate the natural reflex mechanism of shaking or vibrating that releases muscular tension, required for calming down the nervous system. I have been utilising this strategy as a self-regulation and self-care tool for myself consistently since 2013. Due to the extreme benefits of TRE and my own love of it I then studied his intervention approach and have completed my qualification in 2018-2019 to become a trained trainer. Since then, I have been implementing these strategies within our sessions with our children where needed through a passive, non-invasive and safe way. This strategy has been successfully implemented with adults and children in altering their band of optimal arousal and increasing their control and confidence in sitting in the emotional continuum. Do not hesitate to seek further knowledge and information from us on this method.

Cognitive emotional strategies: When working on the emotional continuum, sometimes using sensory processing and bottom up strategies are effective, but can be complimentary providing top down cognitive strategies to assist in the refinement of knowledge and applying these skills in social situations or transfer these skills in everyday environments, including home, school (classroom and playground), and the community. Some strategies you will see us utilising in sessions are concepts of ‘Zones of Regulation’, ‘Size of Problem vs Reaction’, ‘The Alert Program’, ‘The Incredible Flexible You Series’ and ‘The Social Thinking Detectives’. These strategies for us are generally used once the development of the above mentioned skills have been supporting each individual’s emotional continuum and then building these skills on top of. 

As a team we are always building our knowledge and exploring further strategies and intervention approaches to enhance our children’s emotional capacities and independence. Ultimately we are all learning to understand and identify their emotions on a daily basis. The emotional continuum is so important to us as it allows our children to build their confidence, self-worth, self-awareness and to develop strong foundational blocks in order to achieve success in their life. Don’t hesitate to chat to us further about how we can support you and your children with their emotional regulation capacities. 

Until next time,
Jess

ORIGINALLY PUBLISHED MARCH 3, 2021

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Multidisciplinary Approach

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MULTIDISCIPLINARY APPROACH

Building a multidisciplinary team involves a range of professionals from different disciplines, working in harmony to provide care. 

At Explore and Soar, a multidisciplinary approach is about building a strong team around our families, in order to provide high quality, best evidence intervention, coaching and strategies to reach the desired outcomes of each individual and family. 

This process can be somewhat overwhelming but incredibly powerful and rewarding.  

So let’s start by talking about the definition of multidisciplinary care, in order to give you a little more detail on what’s involved.

The following definition outlines the objectives as well as some of the challenges involved in the provision of multidisciplinary team care:

Multidisciplinary care – when professionals from a range of disciplines work together to deliver comprehensive care that addresses as many of the patient’s needs as possible. This can be delivered by a range of professionals functioning as a team under one organisational umbrella or by professionals from a range of organisations, including private practice, brought together as a unique team. As a patient’s condition changes over time, the composition of the team may change to reflect the changing clinical and psychosocial needs of the patient.

Mitchell G.K., Tieman, J.J., and Shelby-James T.M. (2008), Multidisciplinary care planning and teamwork in primary care, Medical Journal of Australia, Vol. 188, No. 8, p.S63.

So now that we know what it involves, how do you find the right team?

Trying to navigate the world of health professionals and creating a seamless connection between each discipline can become somewhat arduous. Deciding on the right individuals that best suit your family and that work well together as a team can take years to build. Having a strong connection and trust with each member of your team is essential. 

It’s important to remember that nothing worth having, ever comes easily. Building the right team can take time and may mean that you will be seeing multiple different professionals until you find the right ones for you. 

But here is the key to successfully building a great multidisciplinary team – it all starts with just one connection and finding that first perfect fit.

Whether you are just starting your journey in the allied health world or you have been working with different professionals for years, exercise patience and keep searching for that first perfect fit. Once you find one professional that you trust, everything will change for the better. This will have a flow on effect with the rest of the required team members. Often if you find a great fit with your OT, they can then recommend a wonderful speech pathologist or physiotherapist that would be the best fit for your family. 

Personally, I too am building my own allied health team after my recent accident.

A team that I can trust, connect to and one that fits seamlessly with my values and goals. One that will support me as I continue to embark on my journey back to full health. In doing so, I have learnt the complexities behind my own injuries, long term implications and affects I will be working through and on, for the years to come. My own team is now quickly building around me in order to personally help me through these challenges, and this is what I hope and wish for you. A strong team to build you up, to inform, educate and support you in the decisions you make for you, your child and your family. 

Professionally speaking, working as a part of a multidisciplinary team brings me so much joy! I have been working alongside some fabulous and highly qualified clinicians for the last decade and have witnessed the benefits of multiple disciplines coming together first hand. 

As occupational therapists we work closely with a range of allied health professionals; speech pathologists, physiotherapists, psychologists and chiropractors, just to name a few. The real power of collaboration lies in open communication and the transference of strategies across our therapy intervention sessions. 

Our love for working within multidisciplinary teams to build support around our clients, families and communities continues to be one of our greatest strengths and passions at Explore and Soar. We are always looking at exploring the best ways to support our families. 

At Explore and Soar we are always listening to the needs of our clients. We pride ourselves on being able to assist you in building a high quality allied health team that achieves your desired goals. So please never hesitate to reach out and ask us any questions that you may have! We want nothing but the best for you, your child and your family – and we won’t stop until that is delivered with a team that you trust.

Over the next month you will see some posts on our social media detailing how occupational therapists work with other allied health professionals to achieve our clients goals. Follow us on Instagram or Facebook (links below) and learn about the ways in which a multidisciplinary team can work together to achieve your goals. 

Until next time,
Jess

ORIGINALLY PUBLISHED SEPTEMBER 2, 2020

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The Role of the Therapeutic Assistant

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THE ROLE OF THE THERAPEUTIC ASSISTANT

It’s been an intense start to the back end of the year for the Explore and Soar Team and I. After breaking my jaw in multiple places during an accident on 2 July, I was forced to take some much needed downtime. I had my accident on the last day of clinical treatment for term 2! Timing is everything, isn’t it? Sometimes you are quite literally made to slow down. But not to worry, I’m on the mend now. In the meantime, the Explore and Soar team went on a well-deserved break for 2 weeks during the school holidays and we are now so excited to be starting term 3 feeling refreshed! 

We have been cultivating some positive changes at Explore and Soar over recent months, that we are now very excited to be sharing with you. 

Since June, the development of our therapeutic assistant program has been underway. We have now welcomed 3 new TA staff members; Kirrily, Steph and Kate. We have spent the last month training and educating our new team members on certain tasks and activities, supporting them in understanding the culture of our team, our communities and most importantly beginning to meet our families.

So why have we expanded our team with Therapeutic Assistants and what do they do?

The role of a Therapeutic Assistant is just as vital and important as an Occupational Therapist. Their ability to strengthen, increase repetition and exposure to activities consistently, helps build upon achieving a child’s goals at a rate or intensity that is much greater than working with an OT alone. An OT doesn’t always have the extra time to share with a child to further develop their skills at a faster rate, leading to time and availability limitations. This is where our assistants step in! 

Having therapeutic assistants on hand also allows our families to experience a range of different service delivery options and support in all our local communities, which ensures continuity in care. Our therapeutic assistants will be working alongside our OT’s completing 1:1 TA sessions, group sessions and peer sessions. This service allows for consistency and compliments the home programs designed for our children and their families.

So how do occupational therapists and therapeutic assistants work together?

It is important to note that therapeutic assistants are not allowed to make any clinical judgements, decisions or alter any clinical activities unless they have been directed by their leading occupational therapist. This highlights the communication and continued liaison with the child’s treating occupational therapist. The role of your treating occupational therapist is to assess, evaluate and make all clinical decisions in regards to your child and family. They are the one who completes clinical observations and assessments within a range of environments, including home, school and the community. They complete all the report writing that requires clinical reasoning content and are the creators of your weekly session plans and home programming strategies, in order to match your short and long term goals. 

For us OT’s, our skills rely on modifying, grading and providing clinical adjustments to your daily living habits, productivity, self-care and passions to achieve success. However, as most of you are aware, learning and ascertaining these skills will not happen overnight. Therefore, for best evidence and achievement of these goals, repetition is absolutely key! And this is where our therapeutic assistants step in to accelerate and further facilitate the process. 

We are thrilled to welcome some extra helping hands at Explore and Soar! We continually strive to be a highly motivated, energised team who look forward to making a difference and becoming an integral part of our communities. We know that having therapeutic assistants working with our families will only help to expand our service offerings and community outreach.

So keep a look out for our new therapeutic assistants and don’t be afraid to say “Hi”. They are so excited to be working with us! You will be able to learn more about them on our website and socials over the coming month. 

Until next time,
Jess

ORIGINALLY POSTED AUGUST 5, 2020

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