Interoception: The Eighth Sense

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Our sensory system is how we experience the world around us, and when we have difficulty processing one or more of these senses, our daily experiences can be hugely impacted. Children also use their senses to take in the world around them and learn new skills, whether through watching a bubble float by with their eyes, feeling gooey slime squish between their fingers, or tasting that delicious piece of cake with their tongue. While some of the senses are better known, there are others that are “hidden,” but equally as important in your child’s development. Some children have difficulty processing sensory information and producing a response that is appropriate, which can be seen through a variety of challenges in completing important daily activities. Understanding what our senses do for functioning is the first step in improving our ability to process them!

What is interoception?

It is likely that you learned about the “five senses” sometime early in your life: touch, taste, smell, sight, and hearing. These senses help you initially interact with the world around you and are important in helping you participate in everyday activities as an infant and young child. As you got older, you may have learned of the next two senses that are not as obvious but still very important to daily functioning: the proprioceptive and vestibular sense. Proprioception is the sense that identifies the position of your body in space with the use of receptors in your joints and muscles, and the vestibular sense helps us with movement, balance, and controlling our posture.

Interoception is the eighth sense we have; it is often called the “hidden sense” because it is not something we can see, but what we feel on the inside of our bodies. Imagine it is 2:00 in the afternoon and you have not eaten since 7:00 in the morning. Your stomach starts to make a growling noise. That is your interoceptive system working to let you know that you are hungry and that your body needs food to maintain a balanced state. When responding appropriately, you would recognize that sound and feeling to mean hunger, and you may go to the kitchen and get a snack.

Our interoceptive sense allows us to feel important body functions like hunger, pain, nausea, itch, needing to use the bathroom, coldness, and even emotional states such as nervousness, fear, or excitement. This sense uses internal signals that tell us how our body is feeling and can give clues to how we can respond to restore balance and find a place of comfort. Our bodies want to feel regulated, and how we get there may be different for everyone.

What does it look like when a child has difficulty with the interoceptive sense?

When the interoceptive sense is not processed appropriately, your child may have difficulty understanding what the signals inside of his/her body are trying to communicate and then will have difficulty responding appropriately to these messages.

Generally, this means challenges with:

  • Bedwetting, constipation, and frequent accidents
  • Identifying appropriate ways to dress for the weather/temperature
  • Not being able to identify hunger, thirst, sickness, pain
  • Self-regulation, self-awareness, and emotional outbursts
  • Having flexible thoughts and behaviors
  • Problem-solving
  • Social skills and participation

Self-regulation, or the ability to monitor and manage your emotions and behaviors, is a vastly important aspect to consider with your child who may be struggling with interoception. For example, your child may not be able to feel or recognize getting angry; that is, a faster heartbeat, the face getting hot, or muscles tensing. Your child will then have difficulty identifying that these feelings mean anger, possibly not even until the emotion has already produced an inappropriate response. Without understanding and being aware of how these body sensations are making us feel, it will be difficult to identify the emotion being experienced and react in a way that is appropriate.

How can occupational therapists address interoception skills in children?

As daily occupations (i.e. using the bathroom, dressing for the weather, interacting with friends) are often affected by our understanding of our internal body sense, occupational therapists have a role in working with children who may have difficulty with the interoceptive sense. Occupational therapists (OTs) at PlayWorks follow guidelines from the Interoception Curriculum, a program designed by Kelly Mahler, a licensed occupational therapist and expert in interoception.

Using a step-by-step framework, OTs work to improve awareness of sensations within the body by introducing body experiments and body checks. These activities seek to improve your child’s understanding of how his/her body feels and can enable him/her to respond appropriately to improve participation in daily activities. Following this curriculum, OTs may also use a visual representation of the body to aid in recognizing and understanding body signs. This can be accomplished by using a visual drawing of a person with different body parts, combined with a list of different sensations or describing words. This will enable your child to practice matching the descriptor words to different body parts to increase understanding and connection of internal body cues and daily activities.

What can I do to support interoception in my child?

While interoception should be addressed in therapy, you can also support these challenges while at home. It will be helpful to start labeling body language as you notice it during different activities. For example, you can say, “I see that your breathing is getting heavy and your face has become a little red. I think you might be feeling angry.” This may help to link specific body language to emotions that they are feeling.

Additionally, you can try out some mindfulness activities, such as meditation, yoga, or reading a book centered around being mindful. While doing so, you can point out or ask how their body is feeling when they are doing these different activities to bring awareness to internal body cues. While this may be a challenging sense to understand for some children, there are many ways we can work with you and your child to increase his/her knowledge and recognition of these cues to improve participation in daily activities!

Questions or concerns?

If you have questions or concerns about your child’s interoceptive sense, please contact us at info@playworkschicago.com or 773-332-9439.

 

Molly Ross

Occupational Therapy Student Intern

 

References:

Interoception: The Eighth Sensory System (2016). Retrieved from https://docs.wixstatic.com/ugd/b303b5_ab07aaedc04c45b3a96e519fc262ecd1.pdf

Mahler, K., McLaughlin, E., & Anson, D. (2020). Interoception Across Varying Degrees of Mental Wellness. American Journal of Occupational Therapy, 74(4_Supplement_1), 7411505251p1-7411505251p1. https://doi.org/10.5014/ajot.2020.74S1-PO9513

 

Photo Credit: Ketit Subiyanto via https://www.pexels.com

SNOW WAY! Sensory Activities for Winter Days

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Winter can be cold and snowy, but it’s always a wonderful time to engage in different sensory activities! Use the snow, cold weather, and holiday season to expose your child to countless sensory-based play activities, both indoors and outdoors. Playing with objects of various scents, textures, colors, and sounds, or engaging in activities that require your child to move their body in different directions and transition between various positions are great for providing sensory input. This will help them learn more about the world and how to process the sensory information they are constantly receiving.

Build a Snowman

Do you want to build a snowman? Yes! Getting outside to roll snowballs and build a large snowman provides great proprioceptive input. Proprioception is also known as the “joint sense” and lets us know where different body parts are in space, how they move, and how much pressure our body wants or needs to stay regulated. Encourage your child to pack the snow in their hands, roll it on the ground to gather more, and build massive snow balls to stack on top of each other!

Watch those Snowflakes

While you’re still outside, why not lie in the snow, make some snow angels, and stare at the snowflakes falling down? This provides great visual input! You and your child can pretend you’re inside a snow globe, looking at all of the snowflakes falling around you. You can also gather snow in your hands and encourage your child to blow it into the air! This provides great oral and visual input, all while your child is simply enjoying the snow day.

Sip Something Tasty

Go on inside and warm up with some hot chocolate! Sipping and sniffing a warm cup of hot-cocoa will give your child some great tastes and smells for their sensory system to process. Put a spin on the classic hot chocolate by stirring it with a candy cane or adding whipped cream or marshmallows. The added flavors and textures will provide increased oral input for your child.

Create a Snow Sensory Bin

Sensory bins are a great way to explore different textures, colors, and smells in one place! Help your child create a snow sensory bin by gathering some snow and adding other items. Feel free to include items from outside, such as rocks, leaves, or sticks. Add some from inside the home too, such as spoons and cups to scoop and pack the snow. Hide waterproof toys inside the bin and encourage your child to search for them. Sprinkle some glitter, paint, or food coloring into the bin for a visually-exciting spin on the usual white snow. The options are endless!

Questions or concerns?

If you have questions or concerns about your child’s responses to different kinds of sensory input, please contact us at info@playworkschicago.com or 773-332-9439.

 

Morgan Haak

Occupational Therapy Student Intern

 

References

Proske, U., & Gandevia, S. C. (2012). The proprioceptive senses: their roles in signaling body shape, body position and movement, and muscle force. Physiological reviews, 92(4), 1651-1697.

 

Photo Credits: Nelly Aran via Pexels; Victoria Borodinova via Pexels; Nelly Aran via Pexels; Jill Wellington via Pexels; Matej via Pexels

Green Screen Teletherapy

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I spy, dinosaur hunts, and apple picking, oh my! As pediatric therapists, we have been faced with the challenge of engaging children of varying ages and diagnoses over teletherapy. Children, families, and even therapists are still getting used to this virtual format. I want to walk through some ways I have utilized green screen technology for speech therapy during my time as a graduate student clinician at PlayWorks Therapy, Inc. I have found that using the green screen technology creates a fun and engaging way to target goals, while keeping our clients’ attentions for longer periods during our virtual telehealth sessions.

How do you use green screen technology?

Green screen technology is easily utilized over Zoom (PlayWorks’ medium of delivering teletherapy).

To set up the green screen: You need a green screen, or another brightly colored background. Mine is a plastic green tablecloth hung with command hooks. Next, log into zoom. Click the up arrow in the “stop video” button on the lower left corner of the zoom window and click “choose virtual background…”. Now, in your camera view, there is a small circle in the bottom right that has a color. Click that circle, then click your mouse on your background in the camera view. This tells Zoom what color to detect as your background, so it can transfer your given image to your green screen.

To transfer activities to Zoom backgrounds: Download/export your activity in a “.jpg” format to your computer. Follow the above directions to get to the virtual backgrounds settings. Then, click the plus sign (+) to upload the background images.

What goals can be targeted in green screen teletherapy?

I have targeted my clients’ speech and language goals using elements of the green screen. I have even used the same green screen activity for clients of varying ages and goals by modifying the way I use the activity, my language level, and my prompts. Using green screen activities is a great way to create a “theme” for each week. Being fall, my clients have enjoyed a variety of fall-themed activities from apple picking to exploring a spooky mansion for Halloween.

Articulation

Articulation is easily targeted using these curated, story-like green screen activities. For example, for the apple picking activity, courtesy of “GoGo Speech”, I will have the client say their given target word 5 times, put the word in the sentence, and then we pick the apple together. You pick all the apples this way, but watch out for the worm who just might eat all our precious apples!

Language

Language goals can be targeted as well, including expanding language to age-appropriate utterance lengths, spatial concepts, pronouns, wh- questions, and more. I have used “I Spy” to practice expanding a child’s phrase length. I have used “GoGo Speech” materials for spatial concepts, where the clients must tell me where they see the chipmunk during our picnic: “is it behind me? Is it on top of the rock? In the tree?” I have used a “fall hunt” activity, modeled off of the classic “we’re going on a bear hunt” story, to target wh- questions and expressive language. The opportunities are endless!

What are some go-to resources?

My go-to resources come from a private Facebook group, entitled “Green Screen Speech Therapy”. Speech-Language Pathologists post many resources that can be downloaded, personalized to meet your client’s speech and language goals, and then added to Zoom for use during a speech therapy session. This Facebook group also has an incredibly useful video explaining how to set up a green screen and how to use it. My other go-to has been “GoGo Speech”. If you subscribe to their services, they send activities for free (and videos on how to use them) to your email inbox.

Is green screen technology only useful for speech therapy?

Other disciplines can use green screen technology to keep their client engaged and target goals simultaneously, too! This means that physical therapists, occupational therapists, social workers, and developmental therapists can use green screen resources as well.

Do I have to have a green screen to use these resources?

No, you do not. You can download the resources in a PowerPoint format. Then, share your screen during your sessions to take advantage of the same resources without having a green screen.

 

Gwen Berglind, B.S.

Speech-Language Pathology Graduate Student Clinician

 

Credits: “GoGo Speech”, “Green Screen Speech Therapy” Facebook Group

Express Yourself: Building Self-Esteem

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Self-Esteem and self-confidence are something we think of adults either having or lacking… but can kids either have or lack these skills? (Answer: Yes and yes!)  And if so, how do we help boost a child’s confidence and self-esteem?

What is self-esteem?

Self-esteem is having the confidence in one own’s worth and abilities, in addition to self-respect.

What is self-confidence?

Confidence is the trust in oneself, a measure of faith in one’s own abilities.

Why is this important for children to develop?

A positive sense of self is important for children to develop in order to establish and maintain a healthy lifestyle, coping skills, and interpersonal relationship skills with others. Having increased self-esteem and self-confidence is essential for children to grow up with a positive mindset, have the ability to try and complete new challenges, and identify their strengths. Children who are mindful of their self-esteem and self-confidence levels, have the potential to manage unexpected stress with more resiliency and the ability to accept and forgive themselves and others.

How can I improve my child’s self-esteem?

You can increase your child’s self-esteem at any time: during the day, when they are trying something new, or picking out their clothing.

  • Start by giving your child lots of praise (“I’m so proud of you!”)
  • When giving your child praise, explain what they did and why you are proud of them (“I’m so proud of you for cleaning up after yourself by putting your dish in the sink.”)
  • Identify their differences and support their choices (within reason), even if they are not always correct. (“I love the way you used *pipe cleaners* to build the wall, very creative!”)
  • Try as much as possible to stay and remain positive with your child. They will imitate and learn from your reactions. (“It’s so frustrating we are lost, let’s do some teamwork to solve this together.”)
  • Identify and comment on positive traits and characteristics about your child (“Wow Johnny, you climbed all the way to the top, you are so strong, brave, and determined!”)
  • Be supportive, understanding, and caring when your child fails. (“I know learning how to ride a bike is tricky. You are tough, hard-working, and intelligent! We will keep practicing together when you’re ready.”)

 

Questions or concerns?

If you have questions or concerns about your child’s self-esteem, please contact us at info@playworkschicago.com or 773-332-9439.

Kelly Scafidi, MSW, LCSW, DT
Licensed Clinical Social Worker
Developmental Therapist

Photo Credit: Haydn Golden via Unsplash.com

The FUN in Executive FUNction

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Have you ever heard someone say that your brain is not fully developed until age 25? When someone mentions that, it’s usually to explain how teenagers can still make risky decisions, even when they feel like near adults because their “decision making warehouse” in their brain is still making new connections. That’s true! The frontal lobe of your brain is responsible for many of your executive functioning skills! So, what does that have to do with your child? Executive functioning skills that are required for all those complex adult decisions begin with foundational skills that emerge in early childhood that are necessary for your child to pay attention, finish tasks by themselves, and stay in control of their body and reactions. All children need to develop well-rounded executive functioning skills for success in the classroom and at home.

What are executive functioning skills?

Executive functioning refers to a complex collection of skills across areas of neuropsychological development that include how your child’s brain is able to focus on one subject, plan ahead, organize, follow steps in order, follow familiar routines, have self-awareness, hold thoughts in our memory, switch between activities, and control our responses to events. In general, executive functioning skills are responsible for our general external and internal organizational and attentional processing. In general, executive functioning skills help us make a decision or goal, plan how to achieve that goal, carry out the steps in the plan, and check that we were able to do it right.

What does it look like when a child has difficulty with executive functioning skills?

Executive functioning develops typically in children who are participating in learning opportunities with gradually decreased support from an adult, everyday social interactions, games that challenge inhibition or memory, and lots of trial and error with activities. Early signs of difficulty with executive functioning skills may look like any of the following:

  • Having difficulty staying on task and avoiding distractions
  • Becoming easily frustrated, at times resulting in outbursts
  • Needing frequent reminders to slow down with work or think before acting
  • Forgetting directions almost immediately
  • Skipping steps from directions with more than one step
  • Trouble getting started with instructions or finding the materials they need for an activity
  • Disorganized when re-telling a story or event that happened
  • Getting stuck on one idea, or becomes frustrated when having to transition from one activity to another
  • Needing more reminders to complete daily routines than same-aged peers
  • Difficulty adjusting to in the moment changes

What can I do to support my child’s executive functioning?

Infancy:

  • Anticipation games such as peekaboo, “1-2…….3!” with any silly action, and this little piggy
  • Pausing during their favorite familiar fingerplay song for them to fill in the blank with a gesture or word
  • Hiding games with their favorite toys to search beneath a cup or cloth for them

Toddlers:

  • Increasing gross motor challenges such as a one-step obstacle course for them to control their bodies during movement
  • Movement songs and dances that they can follow along with and remember all the steps
  • Exposure to emotion words such as happy, mad, sad, and scared on themselves and on characters in books
  • Completing simple matching puzzles or sorting games

Early Childhood:

  • Have your child “read” a familiar story to you while looking at the pictures
  • Play freeze dance
  • Sing backward counting songs such as the three little ducks and have the child keep track of how many ducks are left
  • Play games where your child has to identify which object is not like the others

School Age:

  • Help follow simple cold meal recipes with a plan ahead of time. Your child can help gather the materials and put them together in the provided order.
  • Play games such as Spot it, Quick Cups, and cooperative board games
  • Play Red Light, Green Light, Musical Chairs, or Simon says to increase the child’s attention and impulse control
  • Play games such as Guess Who, where your child has to keep track of characteristics already said

Executive functioning challenges are common in children with Attention Deficit Hyperactivity Disorder (ADHD), autism, anxiety disorders, and learning disabilities. However, not all children with difficulties in these areas may have one of those diagnoses. If your child is demonstrating persistent problems with some of the skills above, consider contacting one of our occupational therapists, who can provide your family with helpful tips and tricks to build your child’s executive functioning skills.

Questions or concerns?

If you have questions or concerns about your child’s executive functioning skills, please contact us at info@playworkschicago.com or 773-332-9439.

Caroline Stevens, MS, OTR/L
Occupational Therapist

References:

Center on the Developing Child. (2020). Enhancing and Practicing Executive Function Skills with Children from Infancy to Adolescence. Retrieved November 5, 2020, from https://46y5eh11fhgw3ve3ytpwxt9r-wpengine.netdna-ssl.com/wp-content/uploads/2015/05/Enhancing-and-Practicing-Executive-Function-Skills-with-Children-from-Infancy-to-Adolescence-1.pdf

Cramm, H., Krupa, T., Missiuna, C., Lysaght, R., & Parker, K. (2013). Broadening the Occupational Therapy Toolkit: An Executive Functioning Lens for Occupational Therapy With Children and Youth. Retrieved November 06, 2020, from https://ajot.aota.org/article.aspx?articleid=1863088

Photo Credit: Olav Ahrens Rotne via https://unsplash.com

Falling in Love with Fall Sensory Activities!

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Photo Credit: Mel Bailey via KneesBees

Fall is a season full of creative activities to do both indoors and outdoors. Use this season to expose your child to creative and different sensory play activities to get their imagination flowing. Sensory exploration can occur through different textures, smells, visual input, and even using something ordinary in a new way.

Paint a pumpkin 

Finger painting a pumpkin exposes your child to a whole new world of painting. From the slippery textures of the paint to the rough texture and ridges of the pumpkin your child will be able to allow their imagination to run wild on this novel canvas!

Photo Credit: Shaunna Evans via Fantastic Fun and Learning

Pumpkin carving

Gooey gooey goodness! Pumpkin carving is a great way to encourage your child to get hands-on with a mixed texture…the gooeyness of the inside of the pumpkin mixed with the firmness of the pumpkin seeds. This activity is a great way to promote your child to engage in more messy play!

Photo Credit: Cat Bowen via Romper

Crunching and jumping in leaves

Crunching in your hand or even stomping with your feet, fall leaves are a great way to engage your child in sensory play using a familiar object. Have your child help in creating a leaf pile to jump into to get their senses ready for the big jump. The crunchier the leaf the better!

Photo Credit: Sarah Clouser via Herviewfromhome

Fall sensory bin

Creating a fall sensory bin is a fun and exciting way to explore the different textures and smells of this season! Have your child help in creating the bin to increase their excitement. This bin can be created using all sorts of textures and everyday items from dried corn, popcorn kernels to pine cones and even cinnamon sticks to get their senses ready for the season.

PlayWorks Therapy

Questions or concerns ?

If you have questions or concerns about your child’s responses to different sensory inputs, please contact us at info@playworkschicago.com or 773-332-9439.

Urooba Khaleelullah, MOT, OTR/L
Occupational Therapist

 

Crossing Midline: What, Why, and How?

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What does it mean to “cross midline,” and why is it important?

The ability to cross midline involves moving a body part across the center of the body (midline) to the opposite side in a smooth or fluid manner. This movement is essential for learning to use both sides of the body together. This skill is closely associated with brain development, as the two sides, or hemispheres, of the brain must communicate to coordinate learning and movement. Crossing midline promotes a child’s ability to reach for and explore new toys or objects, learn to creep and crawl, develop patterns for self-feeding, and interact more fully with the environment as infants and toddlers. As children continue to grow, crossing midline becomes an important skill needed for the development of fine and visual motor coordination.

If a child is unable to cross midline, they may tend to use their left hand to complete activities on the left side of the body and their right hand to complete activities on the right side of the body, impeding their ability to develop a preferred or dominant hand. Hand dominance impacts a child’s ability to use tools effectively, including pencils, markers, and scissors, so difficulty crossing midline often affects handwriting, cutting, and other school-related fine motor tasks. A child’s ability to smoothly cross midline with their eyes, arms, and legs also plays a significant role in developing reading skills, eye-hand coordination, gross motor skills, and independence with self-care tasks and impacts overall quality of movement within age-appropriate activities and routines.

Difficulties with crossing midline may be present if your child:

  • Uses their left hand to complete tasks on the left side of the body and their right hand to complete tasks on the right side of the body
  • Switches writing utensils between hands to avoid crossing midline during writing, drawing, or coloring activities
  • Demonstrates difficulty coordinating smooth gross motor movements that involve both sides of the body (for example, skipping, catching/throwing/kicking a ball)
  • Rotates their trunk to retrieve objects during play or seated activities instead of reaching across midline

How can midline crossing and coordination be encouraged at home?

You can support continued development of your child’s ability to smoothly cross midline during a variety of daily activities, using toys and items you likely already have at home:

  • Pour water back and forth between two cups while in the bathtub, ensuring the second cup is positioned on the opposite side of the body as the first cup.
  • Color with crayons or markers, ensuring one hand stabilizes the paper and the other is used to draw or scribble. Larger paper will encourage a greater reach across midline.
  • Dig in the dirt or sand. Have your child sit, kneel, or squat on the ground. Place a bucket on one side of your child and a shovel on the other side. Encourage your child to dig with the shovel and then transfer it to the other side of their body to dump the dirt in the bucket, ensuring they do not switch the shovel to the other hand as they cross midline. This activity can also be modified by using one hand to pick up small stones and placing them in the bucket on the opposite side of the body.
  • Play tennis or baseball, which require the arms to work together to cross midline during each swing. Encourage your child to hold the bat or racquet with both hands and ensure that both arms and hands cross the body during the swing.
  • Play tug-of-war or have a pillow fight. Your child’s arms and hands will naturally move back and forth across midline during each activity while promoting overall strength and coordination.
  • Play with a large car mat, draw roads across a large piece of paper, or use tape to create a figure eight pattern on the floor. Encourage your child to use one hand to push cars along the road or path while their body remains in place.
  • Set up activities to specifically target crossing midline by positioning pieces on one side of your child’s body and positioning the container on the opposite side. Encourage your child to use one hand to retrieve a piece and then place it in the container or on the designated space. This works well when participating in container play, completing shape sorters and puzzles, and placing objects, such as coins into a piggy bank or pompoms into a jar.
  • Play Twister! This game will naturally encourage your child to cross midline with both arms and legs as they match body parts to the colored dots on each turn.
  • Play Simon Says, ensuring that when you are Simon, you direct your child to engage by crossing midline and using both sides of their body to complete each task (for example, “Simon Says, touch your left hand to your right knee” or “Simon Says, skip around the table”).
  • Place stickers on one of your child’s arms or attach clothespins to the clothing on one side of their body and encourage them to use the opposite hand to remove them.

Continued practice with crossing midline will promote overall fine motor, visual motor, and gross motor coordination for improved independence in self-care, recreational, and school-related activities throughout your child’s day.

Questions or concerns?

If you have questions or concerns about your child’s ability to cross midline, please contact us at info@playworkschicago.com or 773-332-9439.

Caitlin Chociej, MS, OTR/L
Occupational Therapist

 

References:

Cermak, S., Quintero, E.J., and Cohen, P.M. (1980). Developmental Age Trends in Crossing the Body Midline in Normal Children. The American Journal of Occupational Therapy, 34(5), 313-319. https://dx.doi.org/10.5014/ajot.34.5.313

Photo Credit: Pragyan Bezbaruah via Pexels

Employee Spotlight: Rachel Weiser, MS, DT

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What do you love most about working for PlayWorks Therapy?

I love the community PlayWorks provides. Every day I have the opportunity to learn new skills and tricks from my fellow coworkers and the families I work with.

What is your favorite children’s book?

I’m a big fan of anything by Mo Willems! I love his humor and the messages his stories provide.

What do you enjoy most about living in Chicago?

I love that there is always something to do in Chicago! Exploring new restaurants, going to a museum, I love being a tourist in my own city!

Would you rather a mountain or beach vacation?

This is tough for me! Both? My most recent favorite vacation was Grand Lake, CO featuring both a beach and mountains.

Share a proud “therapy moment” with one of your clients?

I was seeing a child with a gross motor delay. He was still learning how to walk. Through a motivating play scheme, I was able to see him take his first steps! It was a great moment!

What’s your hometown?

Deerfield, IL

What do you specialize in?

I specialize in social emotional development. I love helping families increase their child’s frustration tolerance and attention span to adult directed (structured) activities. I incorporate my knowledge from my previous teaching career to set my clients up for success for when they exit Early Intervention.

What do you do in your free time?

I love to do anything outdoors- especially when the weather is nice!

What is your favorite therapy toy?

I love Mr. Potato head! Mr. Potato encourage growth of symbolic play, concept knowledge, and turn taking!

What is your favorite Telehealth activity?

I love doing scavenger hunts! I will hold up colors or shapes and ask a child to find something in their home that is the specific color or shape I am holding up! It’s a great way to get the kids moving and work on following directions!

Share a fun fact about yourself:

I was an extra in the Muppets movie!

Rachel Weiser, MS, DT
Developmental Therapist

Teletherapy 101: What to Expect and Common Questions

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PlayWorks Therapy Inc. is committed to ensuring your child receives quality services during this time of uncertainty and have transitioned to all online teletherapy sessions. We are looking forward to this virtual experience with you!

What is Teletherapy?

Teletherapy, also referred to as telehealth, is a type of therapy provided by your child’s therapist online through video chat, much like FaceTime, Skype, or Gchat. Although teletherapy is a new offering at PlayWorks Therapy, it is a model of therapy that has been used and researched in the field for several years. PlayWorks Therapy is remaining current with best practice and continuing to provide evidence-based therapy through this mode of therapy.

What can I expect from a Teletherapy appointment?

Depending on the type of therapy your child receives, the structure of the therapy session may differ slightly than the in-person appointments. The session itself may consist of the therapist reviewing goals and techniques with caregivers as well as assisting in choosing appropriate toys, games, and materials to target those goals. The therapist would then provide recommendations for how to use each material, including specific prompts to use throughout the activities. We realize that your child may not be as engaged or motivated to sit in front of a video so we require a parent or caregiver to be present or nearby for the majority of the session.

Will this really be a productive mode of therapy for my child?

Many providers have been using teletherapy as their primary mode of therapy over several years with success. Because the structure may look different than usual the in-person appointments, our expectation of what makes a “productive” or “successful” session may also change. Your child’s goals may shift slightly in this period but just know that every and any interaction your child has with their therapist informs their continued work. With a strong partnership, both the therapist and caregivers can use techniques with the child to reach targeted goals.

Won’t it be awkward that my child and the therapist are in different rooms?

At first, some children do find it slightly awkward or uncomfortable to work with therapists virtually. Below are strategies we recommend trying to increase your child’s comfort level with this new type of appointment:

  • Find a space that works for you and your child. This does not need to be the quietest or cleanest room in your home; however, be mindful of the visual distractions (e.g. toys, games) in the room as this may affect your child’s attention. We recommend that you choose a favorite place or comfortable space you usually spend time in as this may help your child with the transition.
  • Help your child settle in by allowing them to have a favorite toy or other comforting object with them.
  • With supervision, allow your child understand the technology by gently touching the screen and exploring the different functions, provided by the therapist.
  • Check in with others in your home to see if they want to be present or out of view for the session and ultimately let your child know who will be with them.

I’m not great with technology. Will this be challenging to set up?

In most cases, your teletherapy appointment will take place on a website or app platform. Your therapist will communicate with you about your child’s specific platform, and whether or not to download an app, based on what type of therapy they receive. Your therapist will then send you a confirmation email with the link and any other information you will need to access the appointment. It will be as simple as opening your email and selecting the link! You will then be directly connected to your therapist’s video chat.

I am in the appointment, but now I am experiencing a problem with the connection.

Below are technology tips to help you get the most of your therapy sessions:

  • Be sure to switch on audio and video settings at the start of the session.
  • Confirm a plan with your therapist in case the connection is abruptly ended.
  • Check the use of additional devices. Streaming or heavy use on another device at the same time as your session may slow your connection and video quality.
  • Having multiple tabs open on your device may also impact video quality.
  • If possible, try not to sit in front of a bright window or light.
  • Let your therapist know if you cannot see or hear them clearly – we want you to get the most of your session!

Questions or concerns?

If you have questions or concerns about your child’s eligibility for teletherapy, please contact us at info@playworkschicago.com or 773-332-9439.

Amanda Deligiannis, MSW, LSW
Licensed Social Worker

Photo Credit: GSCSNJ via photopin.com

Brush It Off! Brushing Protocol for Sensory Integration

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Therapeutic brushing may be recommended for your child due to tactile defensiveness, or difficulty tolerating a variety of textures. However, engaging in a therapeutic brushing protocol may also help to ease sensory-based anxiety, promote falling asleep, increase attention to task, increase coordination, and overall self-regulation.

What is Therapeutic Brushing?

The Wilbarger Deep Pressure and Proprioceptive Technique (DPPT), also known as the Wilbarger Brushing Protocol, is often used by occupational therapists to promote sensory integration. It is typically used with children demonstrating sensory defensiveness, or children who exhibit signs of over-responsiveness in the protective responses of the nervous system. Oftentimes, it is used with children who exhibit tactile defensiveness, or difficulty being touched by people or a variety of textures.

What Does the Protocol Look Like?

DPPT begins with systematic brushing of the body, followed by joint compressions to a child’s arms, legs, hands, feet, and head. Brushing is completed using a soft surgical scrub brush, often called a Therapressure brush. The correct brush is required in this protocol, as it provides a specific type of sensation to the nerve endings in the skin. Firm, even pressure is used to sequentially brush the arms, back, legs, and feet. Areas such as the stomach and chest are always avoided, as they are particularly sensitive. Following brushing, 10 joint compressions are provided to the child’s hands, wrists, elbows, shoulders, hips, knees, ankles, and feet using gentle pressure. This provides the child with deep pressure proprioceptive input which is calming to the nervous system. The protocol is repeated approximately every two hours while the child is awake. DPPT must always be taught by a trained therapist to ensure that it is safe, effective, and beneficial for the child.

What Does Brushing Do for Sensory Integration?

The brushing portion of DPPT stimulates the nerve endings of the skin, generally serving to “wake up” the nervous system. The joint compressions provide the body with deep pressure proprioceptive input, which typically calms nervous system. Performing the two elements of the protocol helps the central nervous system to better utilize information from the nerve endings of the peripheral nervous system more effectively. This can result in increased overall regulation, decreased anxiety to sensory triggers, and improved ability to transition between challenging tasks.

Who Would Benefit from Therapeutic Brushing?

Your child may benefit from DPPT if he or she:

  • Demonstrates difficulty being touched, wearing a variety of clothing, or tolerating a messy play.
  • Becomes reactive with grooming activities, including having his or her hair washed, or fingernails clipped.
  • Demonstrates difficulty maintaining a calm, alert, and organized state.
  • Experiences difficulty calming down and falling asleep at night.
  • Demonstrates difficulty transitioning between activities
  • Appears to have trouble noticing when he or she is hungry or needs to go to the bathroom.

Questions or concerns?

If you think your child could benefit from DPPT, please reach out to your occupational therapist or  us at info@playworkschicago.com or 773-332-9439.

Natalie Machado, MS, OTR/L
Occupational Therapist

References:

OT-Innovations.com. (2018). Therapeutic brushing techniques. Retrieved from https://www.ot-innovations.com/clinical-practice/sensory-modulation/therapeutic-brushing-techniques/.