Self-Care with Flair! Goes International… Read on!

By Bhanu Raghavan, MS, OTR/L & Ginger Mc Donald, OTR/L

We were lucky to experience Occupational Therapy on an international level when we were invited to present Self-Care with Flair! at the annual conference of the College of Occupational Therapists (the educational arm of the British Association of Occupational Therapists) in Brighton, England this past summer. We applied to present at the conference over a year before, hoping to spread the word about our book, Self-Care with Flair!, and were thrilled when our proposal was accepted! We immediately began to adapt our presentation to our British audience. Our presentation was well received, and we enjoyed the interaction with our British cohorts. In general, the Brits showed their trademark politeness and hospitality. We had several OTs stop to talk with us when they saw our Therapro name tags to tell us how much they enjoy Therapro’s products.

What we didn’t realize is what an educational experience it was going to be for us! We had a wonderful time roaming the Expo Hall, and learning about the technology and solutions that British OTs have devised for the same problems that we grapple with in the States. Because of the expense involved in shipping over the Atlantic ocean, many of the companies whose booths we visited do not market their products in the USA. Of course there were many products we see in our catalogs in the US, there is so much stuff out there that we don’t know about! We saw an ingenious sling that allows parents and teachers to strap pre-toddlers to their legs, to give them some weight-bearing experience as they learn to. We saw canvas and PVC “quiet rooms” built over beds, much like a tent, meant to give a child having a sensory meltdown a place to safely calm down. Another very brilliant invention was the weighted and huggable beanbag chair. Weighted should pads and lap pads made us “melt away” and say “ahhh..this is life!” We spent time in the BAOT booth just chatting and comparing how our “health care systems” differ.

The educational sessions were fabulous. We attended a general session describing an exciting study co-conducted by British and Dutch OTs that was able to come up with figures for how much money OTs save the health systems in their countries per year. In their socialized medicine systems, the numbers were in the millions! Our system, with private insurance, figures our costs differently, but the potential savings are obvious. The study is not completed, but when the results are fully published, the American health system will notice OT! Ginger attended informative sessions on new evidence about the usefulness of hip precautions (the Brits are slowly dropping them), a company that builds elevators in tiny British homes, and together we attended a fabulous session on night time positioning to prevent the many orthopedic issues with individuals with multiple handicap.

As much as we joked and laughed about our differences, our new OT friends agreed with us that we OTs are very much alike. The emphasis on function and purposeful engagement in meaningful occupations is the foundation of our profession in every country. We were honored to be asked to pose for a photograph featuring the “international therapists”.

Many therapists that attended our presentation emailed us about their thoughts (see below some comments from the participants). Thanks to Self-Care with Flair! we felt the kindred spirit as OTs due to our global emphasis on balance and meaningfulness to life regardless of whether or not one has a disability.

Since we were going to go such a long way for our two hour presentation, we decided to make good use of our time in Europe to visit old friends in England and Scotland, and to tour Budapest, Vienna and Prague. Every country with its own charm kept us hopping!

Bhanu and Ginger
Authors of Self-Care with Flair!

Comments From Participants

“Thank you for visiting England and sharing your Self-Care with Flair – your session at the conference was fabulous.” – Sally Townend, Children’s Occupational Therapy

“Firstly thank you so much for a wonderful presentation on Self Care with Flair at the recent COT conference in Brighton. I could have listened to you all day, it was fascinating and I really enjoyed the session. I love the whole concept of your innovative program, it’s so simple yet effective, I loved your rhymes and only wish I had invented it as you must have had so much fun making them up. Thank you once again for a brilliant talk and may I congratulate you on an inspired and very useful OT tool.” – Janine Hackett, University of Derby

“I must say I am super happy that I had the wonderful pleasure of meeting both of you and learning something new and wonderful too!!! Your presentation was FANTASTIC!!!!” – Vlada Poliakov

“I thoroughly enjoyed your interactive workshop at the COT conference last week and I learnt a lot so thank you!” – Nicole Tee

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Autism Challenges in Public Entertainment Venues

Ironically, the reasons why we go to these venues are the reasons people with Autism do not like them! Here are a few challenges that may be faced in public entertainment venues:

  1. Sensory: People with Autism often struggle with sensory input and how to deal with it.
    • Many of these venues may smell strange (or someone may be wearing perfume) and cause a negative reaction for some people. This can be so subtle that the person with autism may not even know that it is causing him/her to act out of control.
    • Sudden and loud chaotic noises can cause confusion for them in addition to all the chatter and background music in the room.
    • Sitting too close to other people can cause unwanted light touch that we know can be very irritating. Speaking of touch, a theatre setting may have textured chairs that are uncomfortable
    • And not to mention all the visual stimuli that occurs – all the bright lights, some moving and others flashing can put a nervous system into overload.
  2. Social Skills: These venues involve social environments which is an area of real challenge for people with Autism
    • They may be highly anxious in knowing how to interact with the rest of the group.
    • As a result they may seem aloof or, on the other hand, blunt.
    • In an attempt to communicate, they may not be able to read the body language or facial expressions of the other person and then their behavior may appear to be inappropriate.
    • People with Autism take things very literally which may cause misunderstandings with others at the venue.
  3. Routine and Anxiety: Routine is very important for people with Autism
    • Going somewhere new outside of routine can cause a lot of anxiety.
    • Even if a person with Autism is used to going to a venue each week, even the absence of a staff member, different layout, etc. could cause anxiety.
    • Unexpected events are anxiety producing for them.

Other diagnoses that might experience similar challenges:

  1. We as occupational therapists working with people with developmental disabilities are trained to assess their ability to process sensory information as part of their evaluation.
  2. We are finding that many people with no known diagnoses also have challenges with entertainment venues. Recently, I have been privileged to attend professional baseball games in Baltimore, Philadelphia and San Diego. That venue has changed since I went to baseball games as a child – now there is loud music, flashing lights, huge TV screens and people getting up and stepping on your toes which all make me wonder why I am there. It is challenging for me!

Suggested Solutions

Preparation, Preparation, Preparation:

  1. Social Story:
    A social story can be a written or visual guide describing various social interactions, situations, behaviors, skills or concepts and were introduced and described by Gray and Garand (1993). They are designed to improve the social skills of people with autism spectrum disorders (ASD). Social stories are used to educate and as praise. Social stories model appropriate social interaction by describing a situation with relevant social cues, other’s perspectives, and a suggested appropriate response. About one half of the time, the stories are used to acknowledge and praise successful completion of an accomplishment. These have been used successfully in preparation for entertainment venues. For further information, Therapro, Inc. offers the Newly Revised Book on Social Stories here.
  2. Sensory Stories:
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    Sensory Stories, published by Therapro, are similar to Social Stories but with the specific approach to teaching children with autism and over-responsive sensory modulation issues to successfully engage in social activities within the home, school, and community. Sensory Stories comprise 30 individual stories about daily activities. These Sensory Stories instruct the child to use calming sensory strategies in order to deal with the unpleasant sensory aspects of that particular situation. When read on a regular basis, Sensory Stories assist the child in developing effective routines to manage the sensory experiences surrounding typical daily activities. The authors have conducted several studies to demonstrate their effectiveness. They can be viewed on the Therapro website.

The Venue Itself

  1. Call ahead and see if the facility has a visual tour for an iPad of the venue. A 360 degree tour to show as much of the rooms, location of bathrooms, etc. would be helpful for knowing the physical layout.
  2. Find out what the venue rules are, how services operates so everyone knows what to expect of the routine
  3. Ask if there could be dedicated time that can be with just families with autism
  4. Would there be a quiet area or small area available for families and individuals who might experience stress during the venue? Here at the Therapro Showroom, we have a sensory area for individuals including a bean bag chair and a basketful of sensory tools. This helps when the parent or caregiver want to look around the showroom. Also, our showroom does not have all products out as that could be overwhelming to individuals. Instead, we ask the parent to make a list of interested products and we go into the warehouse to pick them. Shoppers can sit comfortably at a table and make their decisions as to what they want – no rush.

Helpful Tools During the Venue Visit

  1. Fidgets:
    During stressful times, fidgets help reduce agitation. Therapro’s selection of fidgets have increased through the years as each nervous system finds a fidget helpful and others offensive. Please see our website for numerous fidgets. Our very popular Fidget Kit includes a variety of fidgets so a person can determine which ones they like or dislike. We have many quiet fidgets that can be used unnoticed!
  2. Additional Tools:
    • Sensory Strategy Cards: These are small cards with such strategies as “I can grasp my elbows and squeeze hard”, “I can put a heavy backpack or fanny pack in my lap”, “I can do an elbow-check to make sure no one is too close.” They are visual reminders of the various strategies that children can use. They can be tucked in a shirt or pants pocket for a quick reference to a preferred strategy or put on a belt loop or backpack.
    • Noise-reducing headphones
    • sunglasses

Guest Blogger: Karen Conrad Weihrauch, PhD, OTR/L

Weaving Mindfulness and Visualization into Your Practice

Drive Thru MenusPopular speaker and Therapro author of The Drive Thru Menu Suite of Exercises Tere Bowen-Irish, OTR/L made a return visit to Therapro on Saturday, September 19th to present a seminar on: Weaving Mindfulness and Visualization into Your PracticeTere has spent over 35 years as a practicing occupational therapist in a variety of school settings.  She effectively meshes her expertise in mental health with pediatric practice.

The ultimate goal for the school-based occupational therapist is to help students access the curriculum. Tere discussed that because today’s students appear to be increasingly stressed, angry, and anxious, they may have difficulty achieving academic success. Recognition of every student as “neuro diverse” bears the responsibility of assisting students to increase their resiliency. One way to do this, Tere suggested, is by helping students develop mindfulness. With daily practice of mindfulness, students show decreased stress and improved coping mechanisms when they become dysregulated. A simple task like focusing on breathing is an exercise in centering. For example:  ‘Put your hands on your stomach, inhale through your nose (to the count of 5), exhale through your nose (to the count of 5) 3 times’.

As therapists, we can teach students and their teachers highly effective methods of becoming focused and calm. Tere taught us to use visualization to achieve mindfulness.  Instead of a reactive, impulsive model of “acting, thinking, then stopping”, mindfulness can be achieved with “stopping, thinking, then acting.”

Tere_Bowen-IrishTere is always an engaging and interesting presenter. She used humor and anecdotes liberally to engage her audience. The more than 50 attendees at the seminar eagerly participated in visualization exercises individually and in pairs. The room was alive with energy and laughter!

In a world filled with anxious, stressed-out children, incorporating mindfulness and visualization into their day makes sense.  Mindfulness and visualization strategies can easily become part of the student’s day and can complement self regulation programs which the student may also be using.   A quiet mind and calm self helps with better focus in the classroom, which can directly affect academic success. As Tere taught us, ”Just Breathe….”

Take a look at what attendees had to say about Tere’s seminar:

“She incorporated interactive approaches and was enthusiastic and passionate.  She used wonderful examples for us to apply in school and practice.” Mary E., Occupational Therapist

“Excellent presentation and a lot of great ideas for treatment to address stress, attention and anxiety.” Kelley M., Occupational Therapy student

“I have attended several sessions with Tere.  I always come back from the session with ideas for my kindergarten class.” Ann Marie H., Teacher

“What a wonderful way to address the growing level of students with stress and anxiety.  Took so much away from this seminar.” Nicole R.,  Occupational Therapy student

“Tere is dynamic, keeps things moving, makes it fun.”  Becky S., Teacher/Parent

Thank you, Tere!

Filomena Connor, MS, OTR/L