Activity Level vs. Arousal Level? What does it All Mean?
If you have been around No Limits Pediatric Therapies long, you have probably heard the terms AROUSAL level and ACTIVITY level; but what do these terms really mean? Let’s go to one of No Limit’s OT teams favorite sensory gurus named Dr. Julia Harper for some more information. Dr. Julie Harper, PhD, MS, OTR/L is a wife, mother, occupational therapist, business owner, psychologist, life coach & mentor, speaker and writer. She holds a BS in Occupational Therapy from SUNY Health Science Center (Downstate), Brooklyn, NY, a MS in Occupational Therapy from Boston University, Boston, MA and a PhD in Psychology from Capella University, Minneapolis, MN. She brings all of these roles together to serve her mission of helping people-all people to live their lives beyond limitations. For over 20 years, Julia has worked as a pediatric occupational therapist focusing on creating brain-based therapeutic programs that tap into neural-plasticity, the brain’s ability to adapt and change. Her world-renowned therapy center offers a W.A.Y. to H.O.P.E.™ which merges her two models: HOPE (Harper’s Optimal Protocols for Enrichment), which focuses on re-wiring the brain of those with physiological, learning and limitations in attention and W.A.Y.™ (What About You), which retrains the brain to move beyond emotional and thought limitations. Creating change is at the center of her work, as she knows that to best serve the world, she needs to be an agent of change. This begins with the work she has done to change her own life, from becoming a Certified Master Life Coach, a Master Clinician, a Certified Daring Way Facilitator and Master Practitioner of MER. She hopes that through her change, she can change her clients and have the ripple effect of changing the world. She is a firm believer that all change begins with her. Daily, she lives this change to be the change. (http://therapeeds.com/en/about-us/julia-s-story) Now you know a little background on one of our favorite resources when it comes to sensory processing, arousal level, and activity level, but what does it all mean? Activity level can be broken down into two categories: high activity and low activity. When speaking about activity level, we are referring to physical activity. The World Health Organization defines physical activity as any bodily movement produced by skeletal muscles that requires energy expenditure. Physical activity refers to all movement including during leisure time, for transport to get to and from places, or as part of a person’s work. Both moderate- and vigorous-intensity physical activity improve health (https://www.who.int/news-room/fact-sheets/detail/physical-activity). This is leading to the idea that a child or adult who demonstrates a high activity level demonstrates significant physical activity and seeking of movement. It then leads us to an idea of a child or adult who demonstrates a low activity level demonstrates minimal physical activity at any given time. Activity level is visible, fluid and changing. You can move from high to low activity level or low to high activity level at any point in the day and it usually changes multiple times during a day. It can even change hour to hour or in shorter time spans. Remember, activity level is seen and is changing; although you may have a child who typically demonstrates either a high or low activity level. Now, let’s move on to arousal level. This can easily be confused with activity level, but it is different and cannot be used interchangeably. Your arousal level tends to remain unchanging and can be considered more as your state of being. With that said, according to Julia Harper, a child or an adult can be considered high arousal or low arousal. She describes the different neuro-chemicals and brain wave patterns within the body that determine arousal level, but that will be left for another day. What we will discuss today is that depending on your child’s arousal level, the occupational therapy team can better serve your child’s sensory needs by meeting their specific sensory input needs. This is based on neuro-chemical needs and we can then help create a protocol to meet those needs based off of Julia Harper’s research. Moving forward, let’s discuss how we determine if your child is high arousal or low arousal. We can typically describe a high arousal child as a child who thrives on routine, structure, and predictability. A high arousal child is unable to start off their day with intense sensory input such as spinning and participating in inverted activities, because intense vestibular input is only going to dysregulate your child even more. This would be working against the whole goal of working with your child to build a toolbox to help improve attention, participation and overall regulation based on their individual arousal level. They tend to benefit from deep pressure touch and passive proprioceptive input which is calming and regulating. Now on the other hand, you have a low arousal child. A low arousal child is a child who tends to be unpredictable, constantly changing, and unrhythmical. You can usually see this in everything they do. A low arousal child may always be on the go because they are seeking input to help regulate, but they do not need to start the day off with calming activities. Instead, they need to start off with intense vestibular input that is constantly changing, unrhythmical and unpredictable. Starting with intense input followed by deep pressure and tactile input will help set your low arousal child up for success. Now, here is where it gets tricky! Is my child high or low arousal? Or are we just looking at if they have a high or low activity level? This is where your OT comes in. We at No Limits want to work with you as a family and complete a variety of clinical observations to help determine if your child is high or low arousal. We can then work with you to see how their activity level usually runs at different points in the day. After determining your child’s arousal level and gaining a better idea of how their activity
What is Torticollis?
You may have heard of the term “torticollis,” also known as wryneck. Torticollis is the twisting of the neck that causes the head to rotate and tilt at an angle. The twisting of the neck occurs when the large muscle running on both sides of the neck, from the back of the ear to the collarbone, is too tight and/or shortened. In newborns, torticollis can happen due to the baby’s position in the womb or from consistent positioning following birth. The following are the most common symptoms of torticollis; however, each person may experience symptoms differently. Symptoms may include: Inability to turn the head (rotation) Spasm of the neck muscles The top of their head may be tilted to one side and their chin may be tilted to the other side. Difficulties visually tracking Difficulties holding the head in an upright position Preference among breast-fed and bottle-fed babies to eat on one side over the other or problems latching onto the breast or bottle. Physical therapy helps prevent permanent shortening, head and neck pain, and helps prevent developmental delays that could occur secondarily. Early physical therapy for torticollis is very helpful and effective. The physical therapists’ focus includes passive range of motion, active range of motion, stretching, muscle strengthening, and parent education for positioning, stretching and activities that they can incorporate into their daily lives in order to increase the child’s ability to turn and move their head and continue to make gains towards their developmental milestones. If you have any questions or concerns in regards to torticollis, please reach out to your doctor or your child’s physical therapist.
Occupational Therapy and the Adolescent Years
Adolescent years bring about many changes including taking on responsibilities in the home, more demands at school, employment, driving, bodily changes, relationships, money management, increasing independence as they prepare for adulthood, and more. Occupational therapists come alongside adolescents to help support and increase their independence in these daily occupations, or everyday activities one engages in. More specifically, within the OT Practice Framework (AOTA, 2014), daily occupations consist of ADLs and IADLs. Activities of daily living (ADLs) are considered to be nine activities: bathing/showering, toileting and toilet hygiene, dressing, swallowing/eating, feeding, functional mobility, personal device care, personal hygiene and grooming, and sexual activity; whereas, instrumental activities of daily living (IADLs) encompass 12 activities that “require more complex interactions than those used in ADLs” including care of others, care of pets, child rearing, communication management, driving and community mobility, financial management, health management and maintenance, home establishment and management, meal preparation and cleanup, religious and spiritual expression, safety and emergency maintenance, and shopping (AOTA, 2014, p. S19). An occupational therapy session with this age group can include so many functional, important skills, while keeping the session fun! When working with adolescents, a treatment session might include activities such as hygiene tasks including brushing teeth, applying deodorant, nail trimming, and combing hair, dressing skills, simple household chores such as separating and completing laundry, bed making, loading and emptying a dishwasher, sweeping, or vacuuming, meal prep and cleanup, and kitchen and food safety. Other sessions might include walking to a nearby restaurant or store to complete a point of service transaction to purchase items, going for a walk outside to address environmental safety awareness, or completing simulated work tasks such as sorting, stocking, and typing for vocation/job-related skills. Moreover, when addressing ADL and IADL skills, the occupational therapist is also incorporating skills such as problem solving, organization, planning and ideation, initiation, flexibility and regulation. These skills are important and are used regularly throughout our daily activities. Regulation is also an essential skill during the adolescent years with the various changes these individuals experience. Self regulation can help work through emotional regulation, self consciousness and negative self-talk that is often difficult during these years. Ultimately, it is the occupational therapist’s goal for each child to be as successful and independent as possible in order to participate in their daily activities and fulfill their dreams and aspirations!
Articulation: When should I be concerned?
If you google articulation, there is a wealth of information at your fingertips. The problem, which data can you trust? Which list of developmental norms is the correct one? There are charts and blogs and articles that are all contradictory. IT is overwhelming, at best. As speech pathologists, we also see many confusing documents. This blog is meant to help parents have a quick, concise explanation based on research based articles and data from the national board for SLPs, ASHA (American Speech-Language Hearing Association). Here are some important facts: What is an articulation disorder??? An articulation disorder is defined as a speech disorder involving difficulties articulating specific types of sound Sound developmental milestones-it is important to remember that children can master these sounds early in age and many sounds have a time range of mastery Age 2: /h, p, n, d, b, w, m/ Age 3: /t, f, y, ng, k, g/ Age 4: /ch, l, v, dz, s, z, sh/ Age 5: /zh, r, th (“the”)/ Age 6: /th (“thumb”)/ If your child is not yet making these sounds, here are a few tips: How can you help improve your child’s articulation at home? Play: engage in play where you model and use lots of different sounds while playing (Example: “ch ch ch ch” as a train passes by, animal sounds, etc) Talk to your child throughout the dat to model correct production of sounds Reduce background noise when engaging with your child so there is less distraction Look at your child while you are speaking to them so they can see your model of words/sounds Read to your child Repeat your child’s sentence if it is not clear. By repeating what your child has said you are producing a good language model and you are showing that you have listened to what the child is saying What are activities to do at home to help improve articulation? Naming items together Copying facial expressions in the mirror Playing something together and modeling words they are having difficulties with Modeling and using different sounds during interactions (“s” for a snake sound, “shhh” the baby is sleeping) Listening to and identifying sounds in words (“sh” is the sound shoe starts with) Correcting if the child says a word incorrectly and having them repeat correct production back to you Finally, If you have additional concerns or want more information, reach out to your pediatrician. They will be able to listen to your child and determine if a referral to a Speech-Language Pathologist is appropriate. Early intervention is research based and helpful to many children who are not reaching the expected developmental milestones. If you have concerns, trust your instinct and talk to your doctor. NWA has many wonderful therapists that would love to help your child reach their highest potential. Happy Articulating! Miss Bailey and Mrs. Vanessa
Telehealth: Navigating New Norms
During the last year, many of us have grown accustomed to alternative ways of receiving medical care. For our therapists and other healthcare workers, they have had to find a way to prevail through the unfamiliarity and continue providing necessary therapies and treatments. Thanks to the possibility of Telehealth, No Limits Therapies and our therapists have been able to do just that. As you could expect, many of our therapists expressed some uneasiness when they were informed that some of their treatments would be conducted through a computer. Although our therapists felt immediately grateful for the opportunity to carry out necessary treatments to clients during this time, the transition was all new to them. Our therapists, whether it be an occupational therapist, physical therapist, or speech therapist rely heavily on physical cues and interactment from their clients. Our therapists soon realized they would have to become more innovative in order to determine new ways of treatment that didn’t rely on being physically present with their clients. The biggest struggles in this journey, expressed by our therapists, has been adjusting to the use of technology and things like Zoom, Google powerpoints, and other resources. With limited activities and more obstacles with technology use and limited patient interaction, they have had to set aside time to create new games and activities for their telehealth clients. Our team expressed that what normally motivated their clients in the clinic, might not have the same outcome in virtual treatment. Our therapists told us that they had to figure out what resources their kids had at home. With some kids, it was possible for them to create their own obstacle courses at home using household things like couch cushions and rolled up blankets. One of our physical therapists, Karina Moore, told us that one of her clients uses bags of dog food to walk across or jump over for an altered activity. Our therapists have learned to utilize whatever the kid has at hand. Our occupational therapist, Emily Barber, told us that her clients often use items like cans of beans, grocery bags, laundry baskets, and other common items in their telehealth sessions. Emily also told us about the positive effect of being able to track their clients eyes on the screen during Telehealth sessions for visual motor skills and processing. She explained that this is something she might not otherwise notice in a clinic session. Therapists expressed that they have not been alone in this journey as client’s parents and families have been very involved and eager to help in Telehealth sessions. With a patient that is younger, parents have been able to help their kid and the therapist by creating an obstacle course, finding access to items that could be used as alternative equipment, or encouraging their kid through treatment. Our therapists feel that they would not be able to make it through this time without such positive influence from parents and families. In turn, parents and families have been able to gain a positive impact from the experience as well. By being more involved, they have been able to encourage their kids more frequently and effectively. By having the opportunity to witness their child’s session from home, they have been able to pick up on activities that they could do with their kid outside of treatment sessions. Our therapists have been able to work with the parents and families directly and discuss their kids development first hand. This benefit has been impeccable to the overall support of a patient as well as their progression and well being.
Simple Ways to Increase Language
Vanessa Boomer, ED.S., CCC-SLP As a mom of three boys, I often feel like I am running in circles to get them to after-school activities. Throw in therapies and two jobs and you have a three-ring circus on my good days. As a mom to a child with significant speech-language delay, I understand that homework isn’t always as easy to complete as your therapist might think. As a therapist, I still know that ANY extra language activities are super helpful for carry-over and skill improvement. Here are some great ways to work simple language activities into your current schedule: During car rides make games for your child(ren) to play. Here are some fun and easy examples! Name items using the alphabet/categories: Example: Name foods, apple, banana, carrot; name things you can buy at Walmart: anchovies, books, car air freshener. The possibilities of the ABC category game are endless and it can be made as simple or hard as needed for your child. Name as many things as you can think of in a category such as ” things that are green, things that are hot, things we use in the bathroom. Is your child working on articulation? Focus on naming categories that contain that letter. Are problem-solving or social skills an area of concern? Play a game that has your child predict outcomes! For example: “If the road to our house was closed, what could we do?” “If our best friend’s pet is lost, what should we say?” Do you eat at home? In the car? Out at restaurants? If you eat, meal time if a wonderful time to discuss the day and ask specific questions that target the skill deficit for your child. Have your child order for the table (with help as needed, start out with drinks or an appetizer). Have your child name three things they know about (anything) they see in the environment. Tell me three things you know about carrots. Name three different things we drink that are hot. Why do we peel a banana before eating it? Menus are wonderful visual reminders and will be fun ways to incorporate more discussion and skill practice at home. Contact me for more ideas of activities that you can do in 5 minutes or less!