Monday, November 7, 2016

Buttons and Zippers

buttons-and-zippers

Dear Melissa, 
Now that colder temperatures are hitting, I am noticing that my 7 year old son has great difficulty buttoning and zipping his coat. Do you have any suggestions?  

It’s easy to forget about dressing skills in the carefree days of summer. Pull on comfy shorts, t-shirts, flip flops… All easy-peasy. But it seems that every year, as the layers begin to pile on, we are suddenly hit with, “Oh yeah… I forgot that Johnny can’t fasten his jeans, zip up his hoodie, tie his shoes, or button his coat.” Well, never fear, OT’s can help with all of these things!

I am an OT/mama who tends to focus on easy on/off clothes for my clients and my own kiddos. For fastening buttons and zippers I'm turning to my fellow Children's Therapy TEAM OT's Allison Schmitz and Cody Stoops for some fun ways on how to improve your child’s buttoning/zipping skills.
  • First, start with splinter skills of bilateral fine motor coordination. These skills can be improved with many fun and crafty activities such as stringing beads, lacing boards, cutting with scissors, etc.
  • Strength is important, too! Most fasteners require strength AND dexterity. Coloring, sidewalk chalk, clothespins, Play-Doh, Theraputty, tongs… All of these activities will help your child gain finger strength, which ultimately will make these fasteners easier.
  • Practice, practice, practice. Many fun OT/mama/crafty sites have loads of buttoning/zipping activities. Generally, these tasks start with large buttons, which are at tabletop level so that the child can be successful at this level before moving on to trickier buttons on the coat or jeans. Some examples of these include:
Practice unbuttoning first  Unbuttoning is much easier than buttoning. Unbuttoning is basically pulling the fabric apart, with a twist!
Buttoning food  This involves large buttons attached to a felt base piece, and then top pieces having button holes in order to create various “snacks.” Excellent ideas for these crafts include making cookies, pizzas, or sandwiches. Directions for how to make your own “button sandwich” can be found here.
Buttoning/zipping dolls  Many young children like to play with dolls or stuffed animals, and there are a wide variety of dolls and animals available that have fasteners attached. Therefore, it wouldn’t really be “practice” but “play.” Find an example for these dolls here.
Buttoning boards/vests  No-frills. Simple. Classic. An example of these can be found here.
Make your own button strip  Simply sew a large button to the end of a ribbon. Then take pieces of felt with a button-hole-sized slits cut in them, and “string” these pieces of felt onto the button ribbon string. Have I not explained myself very well? Find the directions for this task here.
Find sturdy fasteners  I am NOT one who likes to spend a lot of money on kids’ clothing. They are kids! They should run, jump, play, get dirty, and NOT worry about their clothes getting ruined. I am all for some cheap Walmart, or Target clothes. However, I have noticed that in years past, when I have opted for the cheaper heavy coat, the zipper tends to wear out well before winter is over. Therefore, no matter where you choose to buy your child’s coat, test out the zipper a few times yourself to make sure that it is good and sturdy, and will not “catch.” If the zipper is nice and smooth for you, it has a much better chance of being smooth for your kiddo.
Go big or go home  We all know that it can be a bit tough to button our pants after Thanksgiving dinner! Same for our kiddos. Buy pants or coats a bit on the loose side to allow your kiddo a bit more room for finger dexterity.
Know when to step in  It is perfectly OK to step in and help sometimes. Ladies, don’t we try to get help with our back zippers when we can? Therefore, it is perfectly fine to insist that your child make at least a valiant effort on certain items of clothing, but go ahead and step in when you know that those overall buttons are a bit snug and tricky.

Want more ideas? Check out these additional websites below!
Sugar Aunts: Teaching kids how to button the fun way (accessed November 2016)
Therapy Street for Kids: Self help skills (accessed November 2016)
Mama OT: How to use a button snake for fine motor development (accessed November 2016)

Monday, October 24, 2016

Celebrating Abilities - Down Syndrome Awareness Month

down-syndrome-parents-perspective
During the month of October, we celebrate people with Down syndrome and help others become more aware of their abilities and accomplishments. It’s not about focusing on disabilities, it’s about celebrating abilities

To gain a parenting perspective on Down syndrome, we turned to TEAM parents, James and Stephanie Mertz, to discuss their family’s story. James and Stephanie have two biological children who do not have Down syndrome, and two adopted children with Down syndrome.

Melissa:  What made you choose to adopt children with Down syndrome, rather than "typical children"?
Stephanie:  We had always felt open to adoption. With our first two pregnancies, prenatal testing showed a higher risk for Down syndrome. We just felt that was God’s way of preparing us for our life to come. I was also teaching in Special Education at the time, working with children of differing abilities. After our oldest two kids were born, we looked into adoption and just really felt God leading us to adopt kids with Down syndrome. We found a wonderful agency through a chain of events and were able to adopt both of our boys with Down syndrome through Spence-Chapin in New York.

Melissa:  How is parenting a child with Down syndrome the same as parenting your "typical children," and how is it different?
Stephanie:  We have 2 older biological children who do not have Down syndrome. You would think they would be easier to parent than our two children with Down syndrome. This is not always the case. Our kids who do not have Down syndrome can be just as difficult to parent. They are currently teenagers and have minds of their own. 
Raising two kids with Down syndrome certainly has it’s challenges. Most of the time, especially when they were very little, I didn’t think of them as different unless we went somewhere like maybe the park. Other kids were running and playing, whereas mine weren’t very mobile yet, even though they were the same age or older than the kids playing at the park. I honestly don’t think of them as having a disability until a challenge arises that prevents them from doing something like their same-age peers. They are children just like everyone else. They laugh, cry, reach milestones, throw fits, etc., just like all other kids do. The Down syndrome part is secondary to who they are. When I notice the differences between them and their peers, it’s things like meeting a milestone, but in a completely different time frame than other kids do. For example, a phase that a typical child goes through in 6 months may last a couple of years in a child with Down syndrome. They throw fits, just like their peers do. The difference is that it’s my 10 year old throwing that fit in the doctor’s office, not a 2 year old. 
You sometimes have to get creative when it comes to helping them understand what it is you want or need them to do. You have to remember that just because they are 10 doesn’t mean they are going to act like your typical 10 year old. However, you also can’t treat them like the 3-4 year old they may be acting or thinking like. There is a fine line between parenting them respectfully (due to the fact that they are older than they act) and parenting them at their developmental age. There are other challenges when their chronological age is greater than their developmental age, like a seven year old who isn’t potty trained is much more challenging to deal with than a much smaller child.

Melissa:  In your opinion, what are the benefits/joys/gifts of having a child with Down syndrome?
Stephanie:  There are so many joys in raising a child with Down syndrome. The greatest thing is that they see life through the eyes of a child for so long, whereas the rest of us “grow up” and become hardened to the world. There is also nothing like the sound of our boys’ genuine laughter of pure joy. I have also found, as have many of our friends and family, that through the boys, we have learned to appreciate so much more in life. We appreciate the seemingly small achievements that are such big achievements for them, like being able to tie our shoes. Seeing how others relate to the boys is also very rewarding. Our boys seem to bring out the best in people and have touched so many lives. 
A special thanks to James and Stephanie Mertz for their wonderful insight into the special challenges and joys of parenting children with Down syndrome! 
Down syndrome (DS), also called Trisomy 21, is a condition in which extra genetic material causes delays in how a child develops, both mentally and physically. (kidshealth.org)
  • DS can present with a wide range of developmental delays and health problems, from very mild to more severe. Some of the ways Down syndrome can affect individuals include:
    • Low muscle tone
    • Intellectual delays
    • Slower growth rate
    • Heart defects
    • Hearing and vision difficulties
    • Spinal instability
  • 1 in every 691 babies in the US are born with Down syndrome – About 6,000 per year (www.ndss.org)
  • There are approximately 400,000 people currently living with Down syndrome in the United States (www.ndss.org)

Monday, October 17, 2016

Halloween Handouts... of the Non-Sugary Variety

teal-pumpkin

Halloween is coming! If your kids are anything like mine, they have been dreaming about their costumes for weeks already! I am very fortunate to live in a large neighborhood that is FANTASTIC for trick-or-treaters. Therefore, I have around 200 little pumpkins and goblins knocking on my door each year happy to receive my Halloween handouts. I love Halloween, but I am not a fan of all of the candy that is consumed. PLUS, so many children have allergies to peanuts, gluten, milk, red dye, etc., that it is really too much to keep up. There is even the Teal Pumpkin Project to raise awareness of food allergies and to help encourage non-food treats! 

Every year, for over a decade, I have handed out a mixture of food and non-food treats so that both the chocolate-lovers, and the candy-avoiders can be accommodated. My husband always cringes and says that our house will get “egged” with handing out trinkets instead of treats, but I am always surprised that the kids seem to really like the novelty of receiving a non-food item. SO, this year, I am going all in, and I will NOT buy any candy to pass out. However, I am scouring the stores and the internet to find the coolest, most cost-effective trinkets for my cauldron. Here is what I have found:  
  • Glow sticks/bracelets/necklaces:  I handed out glow bracelets last year, and these are #1 on my list this year. The kiddos LOVED them, and I also like that they keep the little monsters highly visible to any passing cars. Wal-mart, Target, and Oriental Trading Company have glow bracelets for under 20 cents a piece if you buy in bulk. I actually bought mine at Wal-mart and got 100 bracelets for $10. And, they are so cool, that I have never had a child complain at just receiving one.  
  • Glow-in-the-dark items:  Its Halloween, its dark, and glow-in-the-dark items are fantastically spooky. Oriental Trading Company, as well as Amazon, have a variety of glow-in-the-dark items for only pennies a piece. I picked up glow-in-the-dark bouncy balls and glow-in-the-dark bugs for my hand out basket!
  • Pencils/erasers:  Helllloooo! I'm an OT! I work on handwriting! I am always shocked when the kids actually say “cool, a pencil,” but they really do say it! Again, these can be found in stores or online for under a dime a piece, and yes, of course, pencils will be in my hand out basket this year!  
  • Bouncy Balls:  I can't stand these things, but my children love them. They bounce all over the house and knock things over, and make a mess. But they are not staying at MY house, are they? I am causing headaches for other parents! These can be found at stores or online for a few cents a piece.  
  • Stickers:  I always give out stickers, and they will be in my shopping cart again this year. They are perfect for the toddlers who might choke on candy but love the immediate gratification of getting a sticker on their hand when they come to my door.  
  • Mardi Gras beads:  Talk about cheap! You can get dozens of these things for only a few dollars. Halloween is a time to dress up in crazy costumes! More is better! Help your guests add some pizzazz to their costumes! 
  • Crazy straws:  I got this idea from a fellow OT and loved it! The kids can use the straws right away, as they hopefully drink something semi-healthy with all of that candy. AND… As you will remember from past blogs, oral input (including sucking & blowing) is calming. Way to help out your fellow parents by calming down the wild little monsters and goblins!
  • Mini bottles of water:  OK… maybe a little bit lame, but practical. Halloween costumes tend to be geared toward cooler weather. But, the past few Halloweens here in Arkansas have been quite warm. The costume-laden kiddos who have knocked on my door have been dripping with sweat! Yes, bottled water is a bit boring. However, it does allow for continued trick-or-treating fun without taking a break to find refreshment.  
Also… Recycle, recycle, recycle! I am not a total Scrooge - I love chocolate as much or more than the next person, but there is simply WAY too much candy at Halloween. Don’t throw it away; put it to good use:
  • Re-gift:  After your own children take a trip around the block, have them pick out a few of their favorite pieces of candy. Then dump the non-preferred candy items in your own hand out bucket, and re-gift that candy to the neighborhood kids. Again, I get around 200 trick-or-treaters at our house, and it definitely cuts down on the amount of candy I buy.
  • Buy-back programs:  Many doctors’ and dentists’ offices will buy back your child’s candy. Your child gets a couple of bucks, and the candy is sent to soldiers overseas. Get more details in the resources section below.  
We still have a couple of weeks until the big day, when I will have 200 monsters knocking on my door! Please share any additional non-food treat ideas you may have!

Monday, October 10, 2016

Tabitha Mayberry: Living Life with Spinal Cord Injury to the Fullest


Did you know that September is Spinal Cord Injury Awareness Month? I know I am a tiny bit late, but better late than never, right? I actually didn’t know that September was Spinal Cord Injury Awareness Month until I stumbled upon an article that TEAM speech therapist, Tabitha Mayberry, shared on Facebook. It was an article in the in the Huffington Post about living life with paralysis.
Since the fabulous Ms. Tabitha Mayberry shared the article that informed me of SCI Awareness Month, I decided to ask her to share a bit of her story on living life with paralysis. (Cool tidbit of information:  Tabitha is the reigning Ms. Wheelchair Arkansas. You can read more from my Ms. Wheelchair Arkansas Q&A interview with her here.)

Tabitha’s Story
I was 21 years old when I sustained a spinal cord injury in a car accident. When I was first injured, I fought diligently for the longest time to walk, mostly to satisfy my family. I attended regularly scheduled therapy sessions. After approximately 18 months, however, my insurance company decided to cease payment for therapy. Despite the progress I had made, it was not enough to warrant continued services, according to the insurance company.
I shared with my rugby coach my desire to use an AutoAmbulator. This is a treadmill device to help patients train to walk and learn gait patterns. It was not available in Arkansas at the time. Some dear friends of mine, including my college rugby coach, decided to make their very own version of the AutoAmbulator. They completed the task with an old treadmill, a harness, some 2x4s and their own strength. For an hour every day throughout the entire summer, we would gather in my rugby coach’s garage where they hooked me up to a harness and took turns moving my legs for me while we laughed, sang, and truly enjoyed each other’s company. However, once the summer was complete and my right leg consistently began to swell, we had to make the tough decision to stop.  
You see, my spinal cord injury may have been an accident, but I am much stronger now. I am grateful for the human I am today. I have become a firm believer that things in life happen for a reason. A reason we may never know, but a reason nonetheless.  In order to make an attempt at receiving additional therapies, I decided to try KAFO (knee, ankle, foot orthotic) braces. This allowed me to receive 6 more months of treatment. Anything to continue therapy. I set a goal to walk across the stage at graduation to receive my Bachelor’s Degree. I completed the goal and obtained a standing ovation during the ceremony. It was one of the proudest moments of my life. It was a moment in my life that changed me – a moment when I realized we can accomplish anything we set our minds and hearts to do. After that moment, therapy was no longer an option. I made the decision to stop focusing on the desire to walk again, and instead, focus on living. Really living.  
Want more information on truly living life with a spinal cord injury? Check out our links below a few statistics on Spinal Cord Injury (SCI) in the United States, obtained from the National Spinal CordInjury Statistical Center. All of these numbers are listed as “approximate.”  Since my injury, I have sky-dived from an airplane, been to the beach several times, become a Speech-Language Pathologist, purchased a home, attended professional rugby matches, attended many concerts, traveled to Guatamala to serve orphans with disabilities (through TEAMworks), survived a second back surgery, and much, much more. These things I could never have imagined when I first woke up in that hospital bed on June 6, 2005. And for that, I am extremely proud of myself. I can only hope to inspire others around me and to let them know that limits do not exist.  
  • 17,000 individuals sustain a new spinal cord injury in the US each year
  • 282,000 people in the US currently living with a SCI  
  • Males account for 80% of new SCI cases each year  
  • 38% of new injuries are caused by car accidents, while an additional 30% of new injuries are the result of falls  
An Interview with Ms. Wheelchair Arkansas!, Children’s Therapy TEAM Blog, May 2016
The Precious Commodity of Time: Taking a Second Look at the Effects of Paralysis,The Huffington Post, November 9, 2014
Spinal Cord Injury (SCI) Facts and Figures at a Glance, National Spinal Cord Injury Statistical Center, accessed September, 2016
United Spinal Association, accessed September, 2016
MelissaFosterThumbMelissa Foster is the leading contributor to Children’s Therapy TEAM’s Weekly Blog. She is a Pediatric Occupational Therapist with over a decade of experience in the field. An active public advocate in the NWA community, Melissa addresses topics related to Autism, Sensory Processing Disorder and general health and child development.


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Children’s Therapy TEAM believes that every child who may benefit from therapy should be able to access it… PERIOD. We feel strongly about it. That’s why we offer financial assistance to families at every income level, even those with insurance, if the cost of treatment creates a hardship. Therapy may even be provided at no charge, depending on a family’s level of need. Please don’t hesitate to contact our Family Support TEAM to learn more about options. Every child deserves the best we can give!

Monday, September 26, 2016

TEAM Mom's Perspective on Pediatric Cancer




September is Pediatric Cancer Awareness Month. In the United States in 2016, an estimated 10,380 new cases of cancer will be diagnosed among children from birth to 14 years, and about 1,250 children are expected to die from the disease. Although pediatric cancer death rates have declined by nearly 70 percent over the past four decades, cancer remains the leading cause of death from disease among children. This week, TEAM parent, Megan Rutledge, shares her son Drake’s story.  
Megan:  Drake was diagnosed with leukemia at age 3 on June 20, 2014. This diagnosis came only 17 days after he was diagnosed with autism. He had been sick for a month, if not a little longer. It was nothing too alarming; he just didn’t feel well. We took him to his pediatrician numerous times, as well as the ER. Nobody saw anything other than normal sick kid stuff. He had an ear infection or a cough, nothing major. The developmental doctor who diagnosed him earlier in June had requested that labs be taken to test for any vitamin deficiencies. The order was sent, and we were told we could do it at any time. June 20, Aaron and I were both off of work. We were tempted to go to Silver Dollar City that day but instead decided to go ahead and have the lab work done and then spend the day at grandma’s pool. Within an hour or so of leaving the Schmeiding Center and having blood drawn, I received a call from our pediatrician’s office. I was told that the blood work had come back already and that Drake needed to be seen at Arkansas Children’s Hospital due to some concern with a POSSIBLE cancerous infection. Being that it was a Friday afternoon and not knowing that he was sick, I naively asked if that meant early next week or what? She told me that no, he needs to go NOW and as long as he was stable, he could be transported by car, and that we needed to pack for several days. Stable? He was about to jump into the pool… Of course he was stable. I’m sure a lot more was said during that conversation, but I could not for the life of me tell you what it was. I blanked out and only heard bits and pieces of it. We got packed and met Aaron’s parents to drop our youngest off with them. We headed straight to the ER with grandma, grandpa, and brother following shortly after.
The ER was waiting on us. We waited in the waiting room MAYBE 3 minutes. More blood work was done, and we were eventually given the leukemia diagnosis late that night. We were moved to the pediatric intensive care unit for the first night. Drake’s blood counts were so low that they were surprised he was still able to function normally. The first several nights were very rough for everyone, but especially Drake. He had spiked temps of 104+ and was having allergic reactions to the medications. Type testing and plans were not made until Monday morning when we learned that given our situation, Drake had the best type of leukemia to have. He was diagnosed with Acute Lymphoblastic Leukemia, type B. While in the hospital, he had a surgery to place his Port-A-Cath, and it was discussed that after he was well enough, he would have surgery to place a G-Button (he refused to take ANY medication by mouth). We were finally released 7 days post-diagnosis.
Drake’s treatment plan is a total of 10 years. The first 6 months was very intensive, but now that he’s on maintenance, it is much better. He is seen once a month in Little Rock and has blood draws every week at Highlands in Rogers. August 2017 will be his last dose of chemo, and then he will been seen once a year until the 10 years.
What a powerful story. Can you tell me what friends and family did that was helpful for you during that time? 
Megan:  We had an absolute outpour of help from not only our friends and family, but from the community as well. Before Drake was even released from his initial hospital stay, there had been fundraisers set up, our house had been cleaned, and we had numerous offers to mow our yard. Mowing the yard was something that a ton of people offered to help with. We, at the time, did not need it done, but it was definitely something that you don’t think about having to do.  
Aaron and I were both off of work for several weeks after Drake came home, just to make sure that we were all accustomed to our new normal. A meal train was set up where friends and family signed up to bring us a meal everyday for a certain number of days. That was incredibly helpful.  
The biggest blessing for us though, was working for a department (we both work for the sheriff’s office) that was so understanding and willing to help. We did not have to worry about anything work-related. We are so appreciative of our work family and the sacrifices they have made in order to help us.  
Money, of course is going to be one of the largest burdens on someone going through a situation like ours. The hospital is amazing at helping, and every child is automatically matched with a social worker to help during hardships (gas money, paying bills, etc.). For the first 6 months of Drake’s treatment, he was seen once a week at Arkansas Children’s Hospital in Little Rock. Because his appointments were very early in the morning, we stayed in a hotel every Wednesday night and had clinic on Thursday. Without the help of others, we would not have made it. Even though Drake was not staying in the hospital, our friends and family realized that it was still very expensive making that trip every week.  
Was there anything people did that was NOT helpful?  
Megan:  In the very beginning… it was talking about it. We knew that people would have questions, but we didn’t even know the extent of what our new life was going to be like.
Another thing was visitors… Drake could not be around visitors for quite some time. His counts were too low to go into public or be around a lot of people. During the first several months home, he didn’t leave other than going to the hospital and the only people that came into our house were family members and therapists who had already received their flu shots.    
What tips you would give to other families dealing with pediatric cancer, on how to manage doctors appointments, side effects, other illnesses, school, friends, siblings, etc.?
Megan:  Just like every other stressful situation, you are your child’s advocate. If you don’t understand or like something, be their voice. The side effects of chemo SUCK. There is no way around that. There is nothing to prepare a parent for the sleepless nights, the constant vomiting, or the change in appearance. I personally did not want to see Drake’s hair fall out, so we chose to cut it as soon as he came home from the hospital. School is a whole new bag of worms now. There are restrictions and special forms and meetings that have to be had.  
How is Drake doing now?  
Megan:  He is doing AWESOME. He has doubled in weight since being diagnosed and truly looks like a normal, healthy boy. Looking at Drake, you would not know that he has leukemia. When we were going over his treatment plan during his initial hospitalization, they told us that they have NEVER seen a child NOT be admitted at some point during treatment. That was true for us. Drake was admitted in December 2015 for about 4 days. He developed cellulitis and his counts bottomed out. Once they got his counts back up, he was good to go. We have not (knock on wood) had any ER trips or hospitalizations since then. He started Kindergarten in August and is doing great.
The whole familyA couple of months ago, Drake was having HORRIBLE issues with PICA. He was putting any and everything into his mouth. We talked to his OT. She hadn’t had much experience with it, but it didn’t stop her from helping. She talked to any and everyone that she could and suggested a handful of different things. I believe that she had even talked to you about it, Melissa! We did end up having his iron levels checked (big ordeal with what the chemo does to his levels and having to do additional tests), and we also had him seen by a behavioral doctor. With the help of his OT, other therapists, his pediatrician, and his oncology team, we have not had any issues with PICA in quite some time. It just goes to show that his therapists don’t stop caring once his treatment hour is up.  
It definitely hasn’t been JUST cancer with us or JUST the need for therapies. Therapy has helped Drake during our issues with cancer. 

Monday, September 19, 2016

Guest Writer Cassie Nolan: Kinesio Tape Advantage

kinesio-tapeThe Paralympic Games are underway in Rio in September. And like the Olympic Games, we again see a lot of brightly colored tape on the skin of world-class athletes. I was recently asked about the purpose of this tape. In the health profession we call this “super stretchy tape constructed of cotton and elastic fibers” by a simpler name: Kinesio Tape. It has applications not only in the world of sports medicine but also in my own world of pediatric therapy.

Athletes use Kinesio Tape for multiple reasons such as stabilizing a frequently used shoulder. The same taping application can be used for a child with Down Syndrome who has low muscle tone and needs extra input to stabilize her shoulder while she crawls or plays with toys. Kinesio Tape can also relieve pain by promoting the draining of fluid from an injured area.

The “magic” of Kinesio Tape stems from how it is applied. I heavily rely on my training in anatomy, physiology and the musculoskeletal system every time I use Kinesio Tape. For example, where I first apply the Kinesio Tape to the skin and the direction I stretch the tape really matters. One direction will facilitate movement while the opposite direction inhibits movement. This has many wonderful applications in pediatric therapy such as helping a child develop better posture control or addressing pain in joints and tendons.

After I incorporated Kinesio Tape as a component of my treatment plan for 11-year-old Steven to address toe walking, I laughed when he asked me to also put tape on his arm to help his basketball shot. Steven loves sports! When kids know that part of their therapy also helps world-class athletes, they can’t help but feel stronger and more courageous.

As a therapist, I strive to provide the best, most effective treatment for kids to have success meeting their therapy goals. However, an even greater goal is to help kids build the strength and courage to win “gold medals” in their most important contests…THEIR LIVES!

TEAMworks Guatemala May 2016 2
Cassie Nolan (pictured right serving in Guatemala with TEAMworks) holds a Master’s Degree in Occupational Therapy from the University of Central Arkansas. She was initially introduced to Kinesio Tape applications during her field work at Children’s Therapy TEAM as a graduate student under the supervision of Occupational Therapist Julie Marvin. After becoming a licensed therapist, she honed in on her Kinesio Tape skills through training with Pam Samaniego, a certified Kinesio Tape instructor and physical therapist. In her work with children with special needs, she holds strong to her favorite quote by Olympian Scott Hamilton, “The only disability in life is a bad attitude.” 





Monday, September 12, 2016

Guest Writer Amanda Wherry: I have Something to Learn from You

cultural-difference-2
When I first started my job in Central Asia, it wasn’t because I was proficient in the language. In fact, my language was pretty terrible. (I had just barely completed one semester of language study.) It wasn’t because I was a renowned expert. (I had worked in the States as an occupational therapist for just over two years before moving – certainly not enough time to feel completely confident and competent in my profession.) And it wasn’t because I was itching to dive into the insanity of paperwork required to get a work visa in the country where I lived. I don’t think anyone is crazy enough to actually enjoy filling out that many forms and finding that many government offices! Rather, I started working because there was a massive earthquake in the area – an earthquake that flattened an entire village. The city where I lived was inundated with earthquake victims – victims that needed surgeries and rehab and… occupational therapy. For weeks after this earthquake, most nights were filled with the sound of ambulances screaming their way through the chaotic 45-minute drive from the airport to the hospital.
img_0319Shortly after the earthquake, while news reports continued to focus on victims who were still being found under mounds of rubble, and either tragic or miraculous stories consumed household dinner table conversations across the country, an employee at one of the local hospitals sent out a rather peculiar email. He wrote it solely to the expat community, specifically asking if there was an OT who would be willing to volunteer their time at the hospital to treat the earthquake victims and also train the local people how to do OT/PT. Since I was the only person who met that description, it seemed pretty clear that this was a setup from God. I’m a “doer” by nature. And I had started to grow a little restless, not having an outlet to work and truly dig in deep with the community. Language learning is obviously a necessary part of moving overseas, but unlike some expats, simply learning a language to learn a language did not fuel my soul. I love people. So I learned the language because my options were to either: 1) learn the language proficiently enough to make local friends; or 2) have no friends and therefore be forced to talk to walls. Crazy people talk to walls, so I chose option one and studied hard.
But I needed an outlet for my “doer-ness.” Although it seemed completely intimidating and moderately terrifying to begin working as a medical professional with medically critical cases while having only beginner level language skills, I started volunteering one morning a week. This wasn’t a huge chunk of time, but it was all I could manage while still being a full-time language student. Within a year, I went on staff full-time at the hospital, but it was that first year of volunteering that really helped me gain so many cultural experiences, greatly shaping how I would later serve that population as a therapist.

As I’ve mentioned, my language was my greatest barrier when I first started volunteering. Learning one of the hardest languages in the world for native English speakers was no small feat for me. And so, at the beginning, I obviously was a “student” at the hospital just as much as a “teacher.” I needed my local staff to teach me medical terminology, and they needed me to teach them therapy techniques. But what was just as important, if not even more important, was that I needed them to teach me the ways of their culture.
Cultural differences can make or break a relationship, and I’ve seen it “make” AND “break” many a friendship or marriage. Cultural differences can make your skin crawl. I will never enjoy walking into a store and have an employee non-stop holler the daily specials at me, using a poor quality microphone and crackly loudspeaker. I honestly think I have hearing damage because of my years overseas. Or I’ll never understand why the hospital did not have a rule that employees and patients could not smoke in the hallways, the stairwells, and in their rooms – especially while hooked up to oxygen. (In fact, I became a little bit famous for chasing people down and forcing them to put out their cigarettes. I constantly used the line, “If you blow up and kill me in the process, my mother will cry. And you do not want to make my mama cry!”) There were so many cultural differences and interesting experiences bombarding me on a daily basis.
Here are just a few examples:p1040645
  • Once, while at work, I saw a hospital patient peeling a tomato with her teeth and placing the skins like a patchwork quilt all over her face. My coworkers thought it was maybe good for her skin.
  • Every spring, workers would paint the tree trunks of every tree in the city white with a colored ring at the top. I asked dozens of people why paint the trees, but no two answers were the same.
  • The hospital did not have air conditioning, and so there would be several weeks during the summer when the clothes under my white coat would be soaked through with sweat. But my staff refused to open a window while having the therapy room doors open at the same time because they claimed that the refreshing cross breeze would cause paralysis over half of their face.
  • Women who had just given birth couldn’t brush their teeth, couldn’t take a shower, and couldn’t wash their hair… for weeks.
Cultural differences. Not necessarily wrong. Just different. (And sometimes completely scientifically incorrect… but fascinating nonetheless.)
In order to gain more and more understanding of the local culture, I became a constant question-asker. I took on the mindset of, “I have something to learn from you” – with the “you” being absolutely anyone in front of me. This meant laying down any sort of thoughts or opinions that I was the “foreign medical expert” or that I “knew better.” This sort of learner mindset was regularly challenged, however, and there were several incidences where I fumbled to know how to encourage my staff to perform evidence-based practice methods and to think outside of their culturally created box, while at the same time honoring the fact that I was living in their culture.

One such incident was when we received a patient with ALS – Lou Gehrig’s disease. He had technically been diagnosed approximately eight months before at a much larger hospital, in a much more technologically advanced city, but no one had told him his diagnosis. Not the doctors. Not his family members. No one. This was the way it was done in this culture. If the patient had a negative diagnosis or prognosis, they simply were never told. I worked with patients who didn’t know they had cancer but were taking “preventive chemo.” (There obviously is no such thing as “preventive chemo.” No one would put him or herself through chemo unless they actually had cancer. But this person did not know this.) I also worked with patients who had Parkinson’s disease, multiple sclerosis, and muscular dystrophy, but had never been told by their family and therefore had become depressed because they couldn’t understand why their symptoms kept getting worse and worse.
That was the case for this man with ALS. He was a successful businessman who had worked hard his whole life and had retired less than one month before beginning to show signs of ALS. He had spent a vast amount of his savings to see doctor after doctor, specialist after specialist, and try drug after drug. I’m assuming that each new place saw a copy of his medical files and knew his diagnosis, and yet no one told him that he was never going to recover the use of his legs. No one told him that, in fact, he would eventually die from this disease. Initially, my staff at the hospital began with this same cultural approach. He had come to our department because he had heard that a foreigner was working there and that physical therapy would be beneficial for him. When my staff told me his story, I was alarmed. In my opinion, this man needed to know that he was dying. He needed to be honored with the time he had remaining to put his affairs in order and say his goodbyes. His disease was moving swiftly, and within the short time frame that I saw him, he lost the use of his arms. But, my staff was afraid. They were afraid of breaking the cultural taboo and telling this man the truth of his diagnosis. I could have done it. I could have walked right up to him and announced, “You are dying. Stop wasting your money looking for different treatment or a cure and take care of your business.” But, that would have destroyed my relationship with my staff, and it would have lost their trust for forever. What I did, instead, was have a private meeting with my staff and ask that we brainstorm a solution together. I told them that I wanted to learn from them, learn about how to honor their cultural norms, while at the same time honoring the man in front of us. I asked them, if they were sick with this disease, would they want to know if they only had a short time to live? They all emphatically said yes, that they would want to take advantage of each and every day. By telling them that I both wanted and needed to be a learner within their culture, and by not attempting to “prove” to them that the way my culture would handle the situation was a better way, my staff was willing to brainstorm options with me. They eventually worked out the situation in a way that I never could have imagined. Another patient at the hospital was an old classmate of this man with ALS. In this culture, classmates bond together as close as family members. So, we told this man’s classmate, and he told the man about his diagnosis and prognosis. (Somehow, this wasn’t breaking any cultural taboos.) The man promptly left therapy and went to visit his children who lived on the other side of the country. I never saw him again.

“I have something to learn from you.” It’s such a valuable attitude. As a therapist I have something to learn from every single child that I see. From every parent. From every co-worker. As a daughter and a sibling, I have something to learn from my mom and dad or my sister, every time I see them. As a human, I have something to learn from the toothless lady who bagged my groceries last week, from that person in line in front of me at the bank, or from that girl who hoots and hollers and makes classes at the gym so much more fun. I can’t afford to not engage these strangers, because I have something to learn from them. I would be remiss to not meet my neighbors, because I have something to learn from them. By taking on the attitude of, “I have something to learn from you,” we not only honor that individual, but we remove the nagging need inside of us to try and “be seen” or “be noticed” or “be in control.” By believing that I have something to learn from every person around me, I can no longer excuse hiding out, remaining “safe,” or staying comfortable. If I say that I want to learn, and if I believe that you have something to teach me, then I must engage. And, I must engage with honor and humility.

Honor. My staff was trying to honor the man with ALS in the best way they knew how – according to their custom. But that custom was based on a lot of never-challenged fears. Honor is driving, motivating, intoxicating even (so is fear). And dishonor is one of the biggest wrecking balls out there. When I honor someone by approaching our conversation, our every interaction with the honest belief that, “I have something to learn from you,” it engages and disarms the other person. The weapons of differences in ideas and personalities are laid down, and the white flag of togetherness gets waved. But the killer of that white flag is the battle cry of trying to prove oneself or gain approval from anyone other than the Lord.
When I approach anyone, at any time, in an effort to prove myself, I have effectively taken my eyes off of honoring them and certainly have back-burnered any desire to learn from them. Rather, my focus is now on me. Fueled by insecurities, brokenness, comparison, or previous hurt or offense, I want to take control of the situation, take control of the person, or force them to take back what had been said. Control and dishonor is trying to prove my knowledge, my ability, my prowess, my street smarts, my worthiness, or my willingness. When I step into a conversation trying to prove, I don’t want to learn from, but rather I want to be learned from. I want to be the center. I want to be the focus. And I want to exalt myself and exert myself over the other person. Out of my own insecurities or because I have taken my gaze off of Jesus and forgotten, even for the briefest of moments, that He gives me identity (not what I do or what I know), I want the other person to feel small in their knowledge. If I’ve just taken a hit or I feel like my skills or abilities have been questioned, then, consciously or subconsciously, I start to want to prove my worth. I begin to seek approval from man instead of from Jesus. But trying to prove myself will only leave me worn out, frustrated, offended… or having worn out and hurt the other person.

What eases the tension of a conversation that has gotten a little heated? Believing that you have something to learn from that other person.

What creates an atmosphere of togetherness and team? Believing that you have something to learn from that other person.

What bonds together spouses and parents and children? Believing that you have something to learn from that other person (even if that other person is your child).

What engages communities and creates connectedness? What adds health to relationships? And what encourages honor and humility? Believing that you have something to learn from that other person.

I have something to learn from you. Therefore, I am thankful for you. I need you. If I will lay aside my pride and insecurities, then I can allow you to make me better, stronger, and wiser.
I have something to learn from you.

Amanda+Wherry+2015Amanda Wherry serves as Children’s Therapy TEAM’s Faith-Based Program Coordinator. She is a local and international advocate for individuals with disabilities and their families. She spent nearly 7 years in a remote area in central Asia developing a hospital pediatric therapy program with teaching in physical, occupational and speech therapy as well as NICU therapy. read more