Cabin Fever? Beat the Winter Doldrums

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“I’m bored.”  In the middle of winter, this phrase can make any mom or dad break out in a sweat.  And a snowy winter day with children who cannot find anything to do may seem to last centuries.  A long day at home or a lengthy winter vacation is the perfect time for children to participate in fun activities that will build their skills, as well as put a stop to the classic complaints of boredom.  Coming up with creative ideas in a variety of skill areas, along with ideas for adaptations for children with special needs, can be a daunting task for parents as well.  Consider the child’s age and/or developmental level, safety, needs, and preferences to help you select appropriate activities to bust those cries of boredom!

 

Plan Ahead

To avoid being put on the spot in coming up with a fun activity when the famous “I’m bored…” complaint erupts, put together a “boredom box” with ideas from which the children can select.  Assist your child with coming up with his or her own ideas of what to include.  This can be a good strategy to use whenever your child has more ideas of things to do than time.  Include skill building activities that are developmentally appropriate and are “just the right challenge” with a fun twist so that the activity is not viewed as work.  To avoid having to scramble for materials for activities at the last minute, organize an additional “supply box” with basic craft supplies (e.g., construction paper, crayons or markers, cardboard tubes, paper plates and bags, glue, glitter or other decorations).   Consider including small craft sets with instructions, puzzles, and small travel games that are new or seldom-used.  Examine the skill categories below and adapt the following activities to your child’s skill level and safety needs.

 

Make Dressing and Self-Care Fun!

Winter break, snow days, and weekends afford plenty of opportunities for children to master the art of getting dressed, due to the extra time to get ready, and the extra seasonal clothing, such as snowsuits and boots.  If your child needs additional practice mastering fasteners, or resists getting dressed without assistance, incorporate fasteners and dressing into a game.  When multiple children are present, have a suitcase race where children don clothes (over their own clothing) as quickly as they can to win a prize—this can be done as a relay race for more than two children.  Institute a fashion show where the children can practice putting together their own outfits from old clothes (including parents’ clothing), or a doll or stuffed animal fashion show.

 

Visual and Fine Motor Skills

As visual and fine motor skills are an integral part of the school day from an early age, incorporating some of the fun activities below at home will help to boost skills

  • Make some homemade Valentines or birthday cards.
  • Write letters to family or friends on personalized letterhead.
  • Design scrapbook pages from a recent vacation or holiday to incorporate cutting, coloring, and handwriting.
  • Dust off the jigsaw puzzles, legos, lincoln logs, or travel editions of games (these have smaller parts).
  • Encourage building from a model made by a parent or older sibling, or if appropriate, building from instructions on the box. In addition to visual motor skills, word finds or crossword puzzles build vocabulary, and your child can design his or her own puzzle for someone else to solve.
  • For imaginary play, set up a pretend office with supplies such as paper clips, binder clips, old folders, or junk mail to practice manipulating common items. Get messy with squirt bottles (to spray a window or shower), hole punches, or clay tools and presses to strengthen fingers.
  • You can make handwriting fun by designing a secret code to write with fun squiggly pens, bathtub or window markers, or invisible ink markers.
  • Institute a “no-talking, only writing” time to communicate for fifteen minutes or so to encourage writing (this also might help to calm a noisy household).

 

Gross Motor Skills

After spending too much time indoors due to inclement weather, children will need to find a safe way to move around and expend some energy.

  • In a large, open area (basement, family room), provide your children with common household items, such as chairs, plastic juice bottles, a broom handle, hula hoops, or jump rope to design an obstacle course (with adult supervision for safety).
  • Hang up an over-the-door basketball hoop, or design one from a box with the top and bottom cut out to play rag basketball (from knotted up towels or t-shirts), or use a lightweight sponge ball.  Using these homemade toys or games can be more fun than purchased ones, and this will encourage their creative development.
  • If your child enjoys dance or aerobic exercise, consider renting or purchasing an inexpensive exercise or dance video for kids, use a dance pad video game, or have your own dance choreography contest.
  • Consider games from birthday parties or gym class, such as “Twister,” hopscotch (many toy stores offer foam mats), hula hoops, jump rope, “Simon Says,” or “charades” to encourage development of certain movement skills and physical activity.  By playing these games in a fun, friendly atmosphere, rather than being graded in gym class, or being concerned with winning a prize in sports, children who have difficulties with coordination may become more comfortable with motor planning.

 

Cognitive and Social Skills

We all continue to build our cognitive and social skills throughout life, establishing systems to do things and how we appear to other people; therefore, these are very important skills to practice.

  • If your child has difficulties interpreting emotions from facial expressions and body language, try body language charades (what is this person telling you?) or making an emotions collage of people from magazines with a designated facial expression or body language.
  • Practice teamwork by building something together or use an obstacle course as a relay race.
  • Work on sequencing via the oldie but goodie “follow directions game” by having children write down the directions to make a peanut butter and jelly sandwich, then have someone else make the sandwich following the directions exactly (use your *clean* hands if the directions don’t specify a knife)!

 

Sensory Skills

For children who have difficulties interpreting and processing sensory information, winter may be a difficult time to get used to seasonal changes in sensory input, and less access to outdoors (where many calming strategies might be located).

  • You can put clean snow in a dishpan or large plastic container for some table play inside to adjust to the sensation and temperature of snow prior to immersing the child in snow outside.
  • For a slightly easier to clean up sensory experience, place rice, beans, flax, or popcorn kernels into a bowl/bin/container with some of those summer sand toys!
  • Also, pull out the summer mini child’s pool, and fill with lightweight plastic balls (available at many toy stores) to create your own ball pit.
  • To create an indoor quiet area, your children may enjoy draping old sheets or blankets over two chairs to create a tent or use a large (appliance) box for a calming space with cushions or pillows for resting.
  • Children may enjoy spending a day inside making pretzels, kneading bread dough, rolling out cookie dough, or making “slime” as a tactile sensory experience.
  • Some household heavy work can be calming to children with “cabin fever,” such as pushing or pulling a vacuum, pushing a shopping cart, shoveling snow, pushing a wagon or wheelbarrow—all of these should be of appropriate size/weight (toy or regular), depending on the child’s size/abilities.

 

Seeking Expert Assistance

If your child has significant difficulties with dressing/fasteners, fine motor or handwriting skills, visual motor skills, motor planning, or sensitivity to tactile experiences, he or she may benefit from a physician’s referral for a pediatric therapy evaluation.  A pediatric therapist working in an outpatient center can determine if your child could benefit from skilled services and home exercise programs that build on these skills.

Navigating the Experience Spectrum

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fork in the road webIn a world where changing technology and demographics have forced some careers to rapidly evolve or even go extinct, the therapist’s job description has largely gone unchanged.  So many of our Tx:Team clinicians, whether 30 days out of school or 30 years on the job, find that their passion for treating patients is very similar to someone who’s been treating for far longer or far less than they have.  Often times, academic backgrounds are identical, but clinicians are treating on polar opposite ends of the spectrum when it comes to clinical experience.

With all attention focused on the patient, it’s always very exciting for a therapy company to find instances where clinicians, either experienced or inexperienced, are relying on their counterparts for advice and opportunities to collaborate on patient care.  The clinical experience component that is so vital to any clinician’s career is helped by the teamwork and collaboration that seems to come naturally to the associates in our facilities.

We’ve paired two clinicians from the same discipline but with different experience levels to get a sense of their team interactions.

We’re appreciative of their input and really proud of their interactions and contributions to their respective teams.

Kelly, OTR, treats in the Assisted Living setting in Charleston, SC.  Kelly is a 1992 graduate of Towson State University.  She specializes in dementia, low vision, neuromuscular, orthopedics, and urinary incontinence.

Q: As an experienced clinician, what do you feel is one thing that you bring to your team?

The knowledge of my past trial and error situations which have worked for some and not for others.  Even with experience, you will run into challenges and need to realize that it’s ok and necessary to try another approach or technique to get the optimal outcome.

Q: What’s one thing you feel you gain from the younger clinicians on your team?

The excitement and energy of being a new therapist.

Q: What advice would you or do you give to new members of your team?

Sometimes there will be some really stressful days, but just take a deep breath and take one patient at a time.  Positive energy in a clinic goes a long way.  Also, it’s ok to not know something.  That’s what other team members, resources, etc. are there for.

Q: Has the role of an OT evolved at all in the time you’ve been treating?

I don’t know how much the role of OT has evolved versus me evolving as an OT. When I started, the focus was self-care and craft based activities. Now, I feel like OT’s have the opportunity to take on more specialized areas at a more technical and educational level such as low vision, urinary incontinence, and power mobility devices.  I know in the past, my co-workers (especially PT’s) would joke around about doing needle-work and wood working projects. I haven’t heard that for a long time.  Maybe we have earned a little more respect from even within the interdisciplinary team.

Q: What’s one thing you know now that you wish you would have when you started treating?

The education and value of using modalities. My college only offered 1 day for modality education for estim, u/s, and paraffin.  I sort of shied away from it for the first several years as an OT.  There are certain areas of OT which modalities can make a world of difference.  I would have started off much earlier taking courses and getting hands on experience.

Q: Have you found the change to the EMR system difficult?  In what ways did you rely on your team in making the transition?

First of all, I had to look up what EMR stands for…guess a new grad would know that.  Electronic Medical Records (EMR) was fairly easy for me.  I actually learned the most by helping others with their questions and we often figured things out together before asking for help.

Q: The nature of the documentation you’re required to do today, in what ways is it better and worse than when you started treating?

With EMR, I have used a lot more objective functional and pain/disability assessments than I used in the past.  It actually helps validate the necessity and makes goal writing more objective like it is supposed to be.  With the forms being right on the computer, there is no need to carry around or anticipate the appropriate forms. It also cues you in areas that you may have forgotten to address.  The only negative to EMR is when computer systems are down or unavailable for use when you need it.  That’s when you wish you could just grab an eval form and a pen.

Q: Could you give an example of a technique that you learned on-the-job and not as a part of your formal clinical education?

In 1997, I worked in a facility where I was assigned to only wheelchair seating and positioning.  I knew almost nothing in this area and was so nervous.  An experienced OT taught me an unbelievable amount over that year and, without that on-the-job training, I don’t know if I would have ever known what I do now.

Q: What was some of the advice or things you learned from the experienced clinicians back when you started treating?

I was always told to constantly look at the whole person.  Whether you are working with UI, low vision, pain, ADL’s, weakness, whatever it is, always step back and look at who that person is, what is important to them and what they want to gain from you. 

Q: Why do you think certain techniques of occupational therapy have gone unchanged despite changes in types of medication and imaging that may have taken place in other areas of healthcare?

We work with people.  People still have the same bones and muscles, the same brain, and overall, the same physical, cognitive and psychological needs to live, work and play.

 

Leslie, OTR has been treating at Frederick Memorial Hospital and the outpatient FMH Rose Hill clinic, both in Frederick, MD.  Leslie came to Tx:Team following her recent graduation from Bridgewater College and Shenandoah University where she completed her clinical education in two and a half years.  Leslie treats both geriatric and pediatric populations, and is a gifted writer, having written a blog on pediatric patients with autism for the company website.

Q: As a younger clinician, what do you feel is one thing that you bring to your team?

I think being a new clinician right out of school, I have a lot of knowledge in regards to current evidence-based practice and new interventions to use with different diagnoses.  So, where as an older clinician may have a lot of experience, I’m bringing forward that new research and new evidence-based information to the clinic.

Q: What’s one thing you feel you gain from the experienced clinicians on your team?

It’s really cool that this job has the opportunity for me to work both in the outpatient setting and in the acute setting.  I don’t have as much experience in the acute setting, but the OTs there have really taken me under their wing.  One of the big things that I picked up over there was the verbiage they would use to educate patients.  It was very concise and to the point and it really got the message across in that setting, especially in regards to orthopedics and precautions as far as final preparations to really educate their patients and keep them safe before going home.

Q: What advice would you or do you give to new members of your team in terms of relying on more experienced clinicians?

I know a lot of therapists, myself included, who want to get everything done and learn everything in the first day, but it really is a learning experience.  It is a process where you’re going to make a few mistakes along the way, but it’s okay.  It’s been instilled in me that I’m still new, and I’m still learning, and they can fix documentation mistakes.  Learning a new EMR system is hard for anyone, and so when you’re starting out of school and you’re a new clinician, you’re not only learning to be a new therapist and learning a new job, you’re learning all the procedures along with it, so just be patient and know that it will become routine and everything will fall into place.

Q: How valuable have you found clinical experience to be in your career thus far?

Experience is very important and, even in the evaluation itself, you pick up verbiage when you’re around certain clinicians it’s really helpful and it kind of becomes a script for you to use as you’re going through your evaluation.  When you’re used to the same verbiage and repeating yourself with every new evaluation that you do, asking the same questions, it becomes habit and routine.  You make sure you’re covering all your bases thoroughly, evaluating all different areas of need for the patient.

Q: Do you feel like using an EMR system is easier for you as a newer clinician?

Our EMR system is pretty unique, and I feel I’m getting a lot of support from the older clinicians as far as navigating through the EMR system just because it has many layers.  However, in terms of technology, I do feel that I am able to help other clinicians find those evidence-based research articles by going through a lot of the university databases.  I think in that aspect, I’m helpful.

Q: What’s one thing you know now that you wish you would have when you started treating?

I think for any career you’re still learning each day and, when I’m treating a patient, it sparks my interest to research further.  I know as I continue to grow and gain more years of experience, I’m going to continue to have to go back to my research and my textbooks to find some of the answers to the questions that my patients spark in me or other questions that I may find interesting as far as diagnoses go and interventions.

Q: Did you have a certain fear coming out of therapy school?

There was some apprehension in that working with the geriatric population, there’s that age difference and although I am young, I appear a lot younger to some of my patients that I’m working with and it’s really important to establish that rapport with your patients, and fill that gap or that bridge between the two of you.  And I think through my first few days of working, I really felt comfortable building that rapport with my patients and treating them individually and making sure my therapy is very client-centered.

Q: Could you give an example of a technique that you learned on-the-job and not as a part of your formal clinical education?

I think some of the educational components I’ve learned in working with the orthopedic patients at the hospital and in the acute care setting, and also along the lines of orthopedics, at FMH Rose Hill, we have a certified hand therapist, so I’ve been doing my best to pick up tidbits from him as far as splinting, to strengthen knowledge in my area of practice.

Q: What do you think you may be learning ten years from now from an incoming therapist?

Manual Therapy techniques change often, so I can imagine looking to them for the most current Manual Therapy techniques and, again, the evidence-based research because it’s so important to our field.

Q: Why do you think certain techniques of occupational therapy have gone unchanged in comparison to some of the career types that have evolved over time within and outside of healthcare?

I think, in general, occupational therapists are really unique. I think we all have a passion for the humanities.  What drew me to occupational therapy is that it incorporates a lot of my different loves: the health field, architecture and modeling, art, working with children and the education component there.  It’s a very creative field and I feel that all OTs have the passion for a lot of different fields in life.  I don’t really think that our field has changed much, of course, there’s new research that comes out that helps change how we treat our patients a little bit, but at the same time, I think our roots of occupational therapy, based in psychology and the basis of educating and adapting ways to complete purposeful and meaningful activities.  I think that’s where the core of occupational therapy is and I don’t think it’s changed so much in that regard.

Is Love an Open or Closed Door for Children with Autism?

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Leslie Crawford is an Occupational Therapist with Tx:Team treating Pediatric patients in Frederick, Maryland.

 

If you are a parent of a school aged child, or have recently viewed YouTube’s top viral videos of 2014, you may have already heard Disney’s hit song “Love Is An Open Door,” from the PG rated flick Frozen.  However, with the warm sun and a plethora of outdoor activities in mid summer, the only thing with icicles in July may be your own AC unit, on the brink!

With the enticing outdoor activities summer offers and the rise of children away from their normal routines of school, it is important to raise awareness regarding wandering and elopement of children with Autism and take a minute to second guess that “open door.”  Children with Autism, or an autism spectrum disorder (ASD), are often known to wander away from safe places and familiar environments resulting in increased danger and sometimes tragedy.  Particularly in the summertime, wandering behaviors contribute to increased risks of drowning and emergency medical service calls.  Therefore, preparedness by both parents, the community and first responders is essential.

Try “walking a mile”in the shoes of a child with ASD.  If an adult were to actually wear a child’s size 4 shoe all day, they would most likely have throbbing feet by their workday’s end!  I know I would!  Think of this throbbing as the continued discomfort and hypersensitivity that a child with Autism experiences on a daily basis.  Not only may children with Autism be hypersensitive to tight shoes, but to clothing in general with itchy tags around their collars, environmental temperatures, lights, sounds and vestibular motion.

While sensory processing in the brain is quite complex and can vary from person to person, we can all agree that when we are overwhelmed by a specific sensation, it is hard to filter out the extraneous input and attend to the task at hand. If you can’t relate to this experience, I challenge you to go to your local convenience store and buy a bag of “Pop-Rocks”or sour “Warheads” candy.  Next, open the candy and place some in your month.  Now, simultaneously begin a crossword puzzle.  How long will it take you to complete this task?  Are you having difficulty?  As I place candy in my own mouth while typing this blog, my mind is concentrated on the explosion of candy in my mouth: at my left cheek, now gums, now right cheek!

To promote Autism awareness in your community, help others to identify characteristics and potential behaviors a child with ASD may demonstrate.  Aforementioned, try the simulation above with random community members to help them understand sensory integration difficulties.  Further educate the community on communication difficulties children with Autism may experience, such as their ability to accurately interpret help, or those able to help them, their ability to identify danger, and their need for extra sensory, gestural and communication processing time.  With more knowledge regarding pervasive developmental disorders, the easier and safer it will be for all involved to respond to a situation regarding wondering or elopement.  Additionally, while some behaviors may prove to be challenging during a crisis situation, remind members of the community and first responders that certain behaviors may be self-soothing to the individual, and halting this behavior may exacerbate stress and increase the present danger to a child with Autism.

If your child has ASD, I encourage you to establish a plan and be proactive in anticipation of wandering and elopement.  Alert neighbors and your local EMS squad of you child’s diagnosis, as well as provide EMS with contact information of family members to be reached in case of emergency.  Know your neighborhood and preferred places your child may like to visit.  Occupational therapists can assist children and a family establish sensory diets and strategies to manage challenging behaviors, as well as their overall health, wellness and functional independence.  Many resources are available to practitioners and parents to help plan for wandering and elopement, such as The Big Red Toolkits for caregivers, clinicians and first responders.  This resource, developed by the Autism Wandering Awareness Alerts Response Education team, helps establish safe occupational engagement in the community.  The Big Red Toolkits are available online and contain educational materials, caregiver resources, tip-sheets, social stories to help child habituate to common events.

With the appeal of water in community pools, lakes and rivers, the risk of drowning associated with elopement and wandering is highly prevalent.  Ask your community pool about sensory supported swimming classes lead by an Occupational Therapist, who can provide aquatic training techniques to instructors to interact and teach children with ASD.

In order to make our community like Disney’s, “Magic Kingdom”, we must increase awareness and educate those around us of the Autism population’s needs.