Rotational Menus for Picky Eaters

Featured by Leah Foreman, OTDS, COTA/L, posted in blog, for OTs

Picky Eaters and Parent Personal Chefs

Sometimes, kids can get stuck in what are called “food-jags.” A food-jag may look like a kid only wanting yogurt and waffles for breakfast, every morning. Or, refusing to eat anything but chicken nuggets and mac and cheese for dinner.

Food-jags set parents up to be personal chefs for their children and they set up children to have potential issues with nutritional intake and growth.

Kid Foods

Parents: no shame here! This is common with kids these days. “Kid foods” are pushed on parents with some pretty amazing marketing and a lot of adults fall into this way of feeding their kids. If you haven’t heard of this term, “Kid Foods” are what I define as any food that has been altered to cater to children or altered to be marketable to children and their parents. Think Eggo Waffles, Puree Packets, Kraft Mac and Cheese, Kids Cereals, GoGurts — the “kid food” industry is massive!

Unfortunately, Kid Foods create narrow food varieties and most importantly to me as a feeding therapist — the nutritional content of these kid foods are minimal. My last complaint on these foods and the most inconvenient for the parents I work with — kid foods make parents personal chefs for their kids.

I have worked with parents who make a different meal for each human in their family, every meal. Holy cow.

FIRST, know you are not alone, and SECOND – please, know it does not have to be this way!

You know what’s easier?

Kids eating whatever you put on their plate.
Kids eating what you’ve already prepared for the rest of the family.

How do we get to this point?

Here is how I use Rotational Menus in my feeding therapy practice to combat food-jags and increase the items on kids’ accepted food lists.

Remember the end goal: they eat what you serve.

How-to use Rotational Menus for Picky Eaters

Be excited, make it fun, and disclose your intentions and plans fully.

Guidelines:

The name of the game with any picky eating recovery is to keep it fun, light, and stress-free.
The first rule of Rotational Menus: we can’t eat the same thing two-days in a row.
MOST IMPORTANT: COMMUNICATION! Children understand more than we give them credit for. To be respectful of our children, we need to tell them what is going to happen. This may look like:

“Hey ____, remember how mommy is always asking you to try new foods? I know you LOVE toast, I love it too! It’s so yummy. I want you to be able to go to friends’ houses and eat fun things with them, and I want you to go to fun places like (insert favorite place here) and eat their fun food. So we’re going to try something new. There will be a menu on the refrigerator for breakfast, you get to choose what you want to eat but you cannot eat the same thing two days in a row. I’m so excited for you to try this game! We’re going to start tomorrow. I can’t wait.”

Alright, Let’s be like Mike

Let’s pretend we’re using Rotational Menus with a kid named Mike. Mike is a “picky eater.” Mike eats plain toast for breakfast, every day. That’s what he asks for and it’s the only thing he is willing to eat. So, that’s what mama makes.

Per Rotational Menu rules: Mike CAN in fact eat plain toast, but he cannot eat it two days in a row.

Week 1

Sometimes with kids like Mike, I start slow and introduce the concept of Rotational Menu’s where he’s already at.

Week 2

Mike also likes cereal and butter on plain bread — so, per Rotational Menu rules he can choose toast with butter, cereal, or plain toast. BUT, if Monday morning’s choice was plain toast, Tuesday’s breakfast has got to have another choice. The fun part for Mike, he gets to choose his breakfast from these options.

Week 3

NOW we’re expanding. Mike likes peanut butter and crackers. So we’re taking that preferred food (peanut butter) and adding it to another preferred food (toast) in order to expand variety.

Week 4

Look at the AWESOME variety Mike has!! Let’s layer the variety! Mike loves bananas, so let’s put some of those on his peanut butter toast.

At this point, Mike has a Rotational Menu AND routine of variety with his preferred foods. Now that he is used to variety, introducing new foods into this line-up can begin. This is where we start bringing in more nutritious options like berries, eggs, avocado, etc. etc. etc.!

Communication and the way Rotational Menu’s are presented to children are the MOST IMPORTANT part of all of this. We need to be sure kids know what is happening during mealtimes so they are prepared and grounded, not surprised and stressed at change that is out of their control.

What questions do you have? Comment below or reach out for a Free Consultation if you feel this may work with your little one.

Featured Photo: by Hal Gatewood

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Co-occupations: the Importance of the Mama + Baby Bond

August 19, 2019August 19, 2019 by Victoria Briltz, OTDS, posted in blog, for OTs, hey mama babes, occupation

Written by Contributing Writer, Victoria Briltz, OTDS

As an occupational therapy student, one of my favorite topics is co-occupations! Occupations are anything that you do in your life that occupies your time. Anything from happy hours with friends, brushing your teeth, or working – if it’s occupying your time, it’s an occupation. What’s really amazing, is that we can participate in occupations together, which then become co-occupations.

Textbook definition – co-occupations occur when people perform an occupation in a mutually responsive, physical and emotional interconnected manner.

During a co-occupation, both participants (mama and little one) are actively engaged. Maternal-infant co-occupations happen all the time when a mother is in a caregiving/maternal role.

Co-occupation in action:

A mother is engaging in the reciprocal occupation of breastfeeding (mother feeds, baby eats)
A mama is helping her baby to go to sleep (mother comforts, mother-baby complete nighttime routine, baby sleeps)
Even perinatal doctor appointments are a co-occupation (mother attends appointments, baby is healthy)

Per definition, co-occupations are mutually responsive in a physical and emotional manner.

When a mama is connecting emotionally with her baby, it is a reciprocal response to her child’s emotional tone (i.e., mother and baby smiling at each other). Why is this so important? Co-occupational engagement greatly influences a child’s brain and overall development.

Let’s talk maternal-fetal attachment and how it affects mamas

Maternal-fetal attachment is an emotional bond between a mother and her unborn child. Maternal-fetal attachment begins and evolves during pregnancy. It has been positively associated with the over all well-being of the mother and the fetus. The quality of the maternal-infant relationship is directly related to both the physical and emotional health of mama and baby.

As a future health care professional who plans to work with mother’s and their babies – knowledge about attachment, how to promote healthy attachment, and how to prevent a lack of attachment, is very important to me!

I have an opportunity to promote an optimal relationships between moms and babies and I take that responsibility seriously. When a insecure attachment forms between and a mother and her child, children can be significantly impacted in the way they are able to participate in every day occupations such as feeding and sleeping.

A lack of a secure attachment can also lead to children having trouble regulating their environment – this may look like a child getting overwhelmed more easily than other children, or having trouble processing every day emotions like disappointment or anger.

What does research say we can do to promote secure relationships between mama and baby?

Handling and holding babies

There are ways to hold a baby that creates more of an attachment. Any position where baby can see mama and feel securely held, can held lead to a feeling of safety and security. Communicating or singing to your baby while holding them is even better!

Everyday activities (occupations)

Bathing, dressing, diaper changes, feeding – you do to help your baby maintain their health and hygiene is a co-occupation and an opportunity to promote a secure bond.

Playing in the bath, singing a song while you change their diaper, and allowing babies the space to lead their feeding activities, can all be ways to increase your bond with your child.

Communication

Leah Foreman, OTDS, COTA/L wanted me to make sure I included a piece on communication, here is what she feels on the importance of communicating with your little one:

“Your infant knows what you are saying, and they understand more than you may know! Communicating with your baby is vital for a healthy bond and attachment. They understand your tone and they understand when you are paying attention to them and when you are not. They know how to read your facial expressions as early as 2 months. So communication matters! Tell your baby what you are doing when you are changing them. When they are crying for food, tell them you are working on it and you hear that they are hungry. When they are sad, tell them it’s okay to be sad and that you are right there with them. All of these are ways to help increase the health and security of your bond with your baby.”

Great point! Have you seen this video? It’s an amazing example!

There are so many ways to promote a healthy and secure attachment with your little one, I hope this blog provides some ideas on how to get started developing a bond with your child that will last a lifetime. Please do not hesitate to reach out with any questions!

Resources

Beetz, A., Winkler, N., Julius, H., UvnäS-Moberg, K., & Kotrschal, K. (2015). A Comparison of equine-assisted intervention and conventional play-based early intervention for mother–child dyads with insecure attachment. Journal of Occupational Therapy, Schools, and Early Intervention, 8(1), 17–39. https://doi.org/10.1080/19411243.2015.1026017

Evans, T., Whittingham, K., Sanders, M., Colditz, P., & Boyd, R. N. (2014). Infant behavior and development: Are parenting interventions effective in improving the relationship between mothers and their preterm infants ? Infant Behavior and Development, 37(2), 131–154. https://doi.org/10.1016/j.infbeh.2013.12.009

Johnson, S., & Marlow, N. (2014). Seminars in Fetal & Neonatal Medicine Growing up after extremely preterm birth : Lifespan mental health outcomes. Seminars in Fetal and Neonatal Medicine, 19(2), 97–104. https://doi.org/10.1016/j.siny.2013.11.004

Karin, J., Britt-Marie, T., & Jens, S. (2003). From alienation to familiarity: experiences of mothers and fathers of preterm infants. Journal of Advanced Nursing, 43(2), 120-129. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=edsovi&AN=edsovi.00004471.200307020.00003&site=eds-live

Lazarus, K., & Rossouw, P. (2015). Mother ’s expectations of parenthood. The impact of prenatal expectations on self- esteem, depression, anxiety and stress post mothers’ expectations of parenthood: the impact of prenatal expectations on self-esteem, depression, and anxiety. International Journal of Neu, 3(August), 102–123. https://doi.org/10.12744/ijnpt.2015.0102-0123

Maas, A. J. B. M., Vreeswijk, C. M. J. M., Braeken, J., Vingerhoets, A. J. J. M., & van Bakel, H. J. A. (2014). Determinants of maternal fetal attachment in women from a community-based sample. Journal of Reproductive & Infant Psychology, 32(1), 5–24. https://doi.org/10.1080/02646838.2013.853170

Muller–Nix, C., Forcada–Guex, M., Pierrehumbert, B., Jaunin, L., Borghini, A., & Ansermet, F. (2004). Prematurity, maternal stress and mother-child interactions. Early Human Development, 79, 145–158

Pierrehumbert, B., Nicole, A., Muller–Nix, C., Forcada–Guex, M., & Ansermet, F. (2003). Parental post-traumatic reactions after premature birth: Implications for sleeping and eating problems in the infant. Archives ofDisease in Childhood: Fetal and Neonatal Edition, 88(5), 400–404.

Pizur-Barnekow, K., & Erickson, S. (2011). Perinatal posttraumatic stress disorder: Implications for occupational therapy in early intervention practice. Occupational Therapy in Mental Health, 27(2), 126–139. https://doi.org/10.1080/0164212X.2011.566165

Spittle, A., & Treyvaud, K. (2016). The role of early developmental intervention to influence neurobehavioral outcomes of children born preterm. Seminars in Perinatology, 40(8), 542–548. https://doi.org/10.1053/j.semperi.2016.09.006

Treyvaud, K., Inder, T. E., Lee, K. J., Northam, E. A., Doyle, L. W., & Anderson, P. J. (2012). Can the home environment promote resilience for children born very preterm in the context of social and medical risk ? Journal of Experimental Child Psychology, 112(3), 326–337. https://doi.org/10.1016/j.jecp.2012.02.009

What is Early Intervention?

August 4, 2019August 5, 2019 by Leah Foreman, OTDS, COTA/L, posted in blog, for OTs

Why Early Intervention?

As a pediatric COTA practicing in EI OT, Early intervention is my PASSION! Currently, there is no area of practice I love more. If you’re wondering what exactly early intervention is, you’re in the right place.

When you think of early intervention, think babies, specifically children 0-3 years old. There are also speech therapy, physical therapy, and other services available through EI.

Why Are These Services Free?

EI services are provided by in the United States with federal funding. This funding is provided through Part C of the IDEA (Individuals for Disabilities Act), although a child does not need to have a disability to benefit from EI services and qualify to use this funding.

EI is provided through government funding for children who are 0-3 years old who are experiencing delays or interruption in function and development. This can be due to a medical diagnosis, or a general delay due to many different happenings including but not limited to low birth weight, preterm birth, birth trauma, etc. Sometimes, a child will have none of these concerns and for some reason, they are not keeping up with their developmental milestones and just needs some extra support.

Sometimes a pediatrician will notice these delays and refer to services, and sometimes parents notice themselves and are able to self-refer into EI (more on this below).

Capitalizing on the Brain’s Plasticity

What I love about early intervention is that it capitalizes on the immense amout of growth and development that occurs during the ages of 0-3 (Knickmeyer, 2008)(Nelson, 2000). The brain grows immensely during these years and we have an opportunity to provide therapy during a time where neuroplasticity is more readily available than other phases of life. Neuroplasticity is the brain’s ability to forge new connections and prune old ones that are not serving us. Watch this video for an amazing explanation of how neuroplasticity works!

Long story short: if a therapist can come into a family’s life and help support a child during this time, they can more easily help the child and change the course of their lives! So, so awesome!

Also – it is important to note that 0-3 is not the only time we can use neuroplasticity in this way. Adults have neurologically plastic brains and so do kids who are 3+, alas, there is never a time in our lives where our brains are more plastic than when we are infants, and that is the beauty of EI services.

How to Begin with EI services

Watch this video and read more about how the EI intake process. This video explains the process here in Denver where I practice, it may vary a bit in your area.

Pediatrician Referral

A pediatrician can refer a family in early intervention services as they typically would refer you to any other specialist. If your pediatrician notices you may need the services, they will help you get started. You are also able to ask your pediatrician about starting EI services if you feel your child is in need.

Self-referral

What is also amazing about early intervention services – you can refer yourself! A simple call to local early childhood resources in your area can direct you on how to set-up an evaluation to see if your child qualifies for EI services. All the state and local numbers for self-referral can be found here.

Questions?

What questions do you have? Reach out to me or comment below!

Unsure?

If you’re unsure whether or not your child would qualify for these services – schedule a free virtual consultation with me. If your family is local to Metro Denver, my team and I would be happy to complete an in-person consult with you and your child – please reach out directly for those services either by email at hello@reborn-collective.com, or give me a call, 303-900-8710.

EI funding is an amazing resource that families can take advantage of to help their children have a great start to an amazing childhood and adult life.

References:

Knickmeyer, R. C., Gouttard, S., Kang, C., Evans, D., Wilber, K., Smith, J. K., … Gilmore, J. H. (2008). A Structural MRI Study of Human Brain Development from Birth to 2 Years. The Journal of Neuroscience, 28(47), 12176 LP – 12182. https://doi.org/10.1523/JNEUROSCI.3479-08.2008

Nelson, C. A. (2000), Neural plasticity and human development: the role of early experience in sculpting memory systems. Developmental Science, 3: 115-136. doi:10.1111/1467-7687.00104

Using Mindfulness in OT Intervention — my ever-evolving opinion

February 4, 2019 by Leah Foreman, OTDS, COTA/L, posted in for OTs, life & adventure, occupation

updated: 2/8/2019

I date this because, my goal in this life is to evolve — to always be changing, learning, growing — to always be a student of this life. So naturally, by tomorrow, this opinion I will share with you may shift, change, evolve — I hope that it does, for this will mean I am shifting as well.

I write this at the one-year anniversary of me discovering and beginning my mindfulness practice. I have been intentionally seeking myself and healing through a mindfulness practice for an entire calendar year — and oh, what a journey it has been.

I have healed things and traveled through pains that I was previously terrified to touch. I’ve touched true emotions of sadness, joy, and yes — even true anger in their purest forms for the first time in my life. I have observed patterns I was stuck in subconsciously, due to old wounds and childhood traumas. It’s been a heavy and beautiful, challenging and rewarding, work.

*This is me — finding mindful space in my meditation practice on a sunny Christmas day last year in Colorado — always a student…*

When I was recording an episode of The Occupied Podcast, with Brock Cook — we started talking about a brochure I received in the mail advertising a two-day mindfulness course for occupational therapists. We asked the question, “Can OTs use mindfulness with clients if they do not practice mindfulness themselves?”

I left the question open during our podcast recording, and recently I posed the question to all my followers (mostly OTs) on the Life’s Occupation’s Instagram page. The overwhelming answer I got back was, “no” — they said, “no,” “nope,” “no you can’t do that,” “no that wouldn’t be safe,” — interesting…

After a year, I’ve just begun to feel slightly comfortable using my experience and my mindfulness with those around me — family, friends, and my occupational therapy clients. Which is why this “2-Day Mindfulness Course” offering really threw me.

What are these people teaching in two days — after I have been through weekly meetings with my teacher, Kristina, and a year of dedicated, challenging daily mindfulness practice, and I am just BEGINNING to feel ready to lead others and hold safe space for their mindfulness.

I turned to my teacher, who herself has been practicing mindfulness for 20+ years. Her response sums it up for me and her words feel good to sit in when I am considering using mindfulness with my clients —- she says, “Ah — I strongly believe and the research I’ve found is that it needs to be integrated and practiced on a daily level to then guide others best. A two day course is a great start — and as we (you) know from your work, it’s a more complex system”

For me, the integration portion of her message is the most important. You see, mindfulness is a process. First, there is awareness, then there is work that is done to integrate what you learn out of your awareness.

Which leads me to more questions, big questions;

How am I to hold and guide someone through anger and grief, if I myself have not held my own anger and grief?
How am I to hold and guide someone’s pain — emotional and physical, if I myself have not held my emotional and physical pain?

If I do not know myself, how can I maintain groundedness while diving into the deep of someone else’s journey — grounded enough to end that connection when the session is over and show up for the next client as fully as I did the last? (this is my current work and practice!)

And, this is my dilemma with mindfulness in OT practice.

It’s a dilemma I am constantly ebbing and flowing through, and sometimes battling with — on a daily basis. In my OT practice and my life — there are constantly opportunities and conversations I am ready for as a mindful practitioner, and even more consistently, opportunities I am not prepared for. I find beauty both moments — as my awareness means I am showing up to my mindfulness practice with a heightened awareness of the present moment and heightened awareness of my beautiful, newly formed skills. All of this while finding and maintaining my boundaries, which protect not only myself, but those I am serving.

This is why I (currently) believe that in order to safely utilize mindfulness with our clients, we first, need to have a daily, integrated, mindfulness practice — “Healer, Heal Thyself.”

Message me if you have your own mindfulness practice that you have been able to use in your client’s sessions. Message me if you feel you are ready to find a practice, or if you just have questions. I would love to connect. My practice changes my life daily, and I feel it changing my occupational therapy practice with every new client interaction and connection.

Sensory Toy Ideas for Littles

December 18, 2018May 27, 2019 by Leah Foreman, OTDS, COTA/L, posted in blog, for OTs, occupation, product reccomendations

The following is a list of toys I typically send to parents and fellow therapists around the holidays. There are all great ideas to get some movement and sensory play in while the weather may be keeping kids inside. These ideas are great for holiday shopping but can really be used year round!

Parents typically like to pass this list along to grandparents, or anyone asking for ideas on what to get their little one. Most are sold on amazon, but a simple Google search of the toy name may provide additional purchasing options. Please feel free to reach out with any questions at OT.LeahForeman@gmail.com.

PEA-POD

Great for sensory breaks, joint compression, and a make shift swing for small spaces if hanging a swing from your ceiling at home isn’t an option! If you want the swing feature get one with handles — I found this one on Amazon.

WEIGHTED BLANKETS and VESTS from The Sensory Project

**please collaborate with a therapist or a staff member of The Sensory Project for selection of weight and guidance in use **

KINETIC SAND

Texture, fine motor skills, pretend play, all of the fun things with Kinetic Sand, one of my favorites!

POP TUBES

Provide deep heavy input and auditory input for the movers and the seekers. I got mine on Amazon but I’ve seen them randomly in Dollar Stores too!

CANDO® VESTIBULAR DISC

Great wiggle seat for meal time or table time activities. Two sided texture depending on the child’s preference of level of input seeking.

SENSORY GEL MAZE

These are wonderful fidgets, car time activities, and amazing for finding calm. I also love that these address fine motor skills, finger isolation and strengthening, enhancing tactile awareness, and so many cognitive skills! Great buy.

SQUIGZ

Fine motor strength, joint input. These are so fun to put on a window and pull off, build towers — there are so many games and activities to play with these and kids just love them!

BALANCE PODS

For walking and balancing on. They make them in a smooth version as well depending on your child’s preference on texture.

POD SWING

If you are able to hang this swing in your home (maybe from a basement beam?) — they are awesome! Great for sensory breaks and for those who calm with swinging. IKEA has a similar version.

BALANCE BOARD/WIGGLE SEAT

For sensory seekers who may also need to work on coordination and impulse control. Can be used with adult safety supervision to stand or as a wiggle seat.

Z-VIBE

For oral sensory seekers (chewing or mouthing everything!) and low oral motor tone/strength or kiddos working on feeding. *these are typically used under the treatment plan of a feeding therapist (Occupational Therapist or Speech Therapist). It is best to at lest collaborate with a therapist on effect and safe use of this product*

PEANUT BALL

For bouncing and providing deep pressure during sensory breaks or within an OT prescribed sensory diet. There are many options on Amazon but make sure to buy child size, not adult. Most come with hand-pump.

SHAPE BEANBAGS

For color and shape learning and great for heavy work/proprioceptive input.

SENSORY TUNNEL

These are awesome for interactive play or sensory breaks. Amazon also has some with ball pits in the tunnels! So cool.

SCOOTER WITH PADDLE

Upper body strength and joint input for calming, strengthening — also helps with motor planning. And they’re just fun for the whole family.

INDOOR TRAMPOLINE

Awesome for use with sensory diet or before kiddo needs to attend to activity or family outing.

SIT AND SPIN

For kiddos who love to spin! This one can be used with a friend or by themselves.

WEIGHTED ANIMALS

Similar concept to weighted blanket or a weighted lap pad.

Re-applying to Graduate School

October 17, 2018 by Leah Foreman, OTDS, COTA/L, posted in for OTs, occupation

To be honest, the process of applying to OT school may have been more stressful for me than actually completing the program. As many of you know, it took me 3 application cycles to finally get in!

If you are re-applying next year because you didn’t get in this year — check out this short blog discussing what to do in between application cycles if you did not have success on your first try.

Part of talking about this is in my efforts to decrease the stigma around not having success in something on your first try! Our culture praises success, not effort — but there is beauty in the effort and process. 100% — growth does not occur when we are not challenged.

Here are some pieces of advice to consider while you’re waiting for the next cycle to start:

VOLUNTEER//WORK

Volunteer or work in a rehab setting to increase your experience and your hours that you add into your application.
⇢There are opportunities available for Rehab Aids and OT Aides that can get your foot in the door somewhere and also increase your listed experience hours on apps.

PICK UP THE PHONE

Call the school(s) you are trying to get into and talk to the admissions staff.
⇢Ask to go over your application and ask which areas you can improve in. If you are applying for the first time — call and ask what they focus on for applications. I found that some schools favored prerequisite GPA’s and some focused more on the essay! — tailor your application accordingly.

ENROLL

Become enrolled in your local community college and retake prerequisites.
⇢If you have any prerequisite grades that are a B or lower, you can take them online while you work. I retook sociology, psychology, abnormal psych, biology, and psychics to improve my grades which then increased my overall prerequisite GPA. I found out this is something schools look at even more so then your overall GPA

Find PATIENCE — but also KINDNESS

Yes, be patient but also be KIND to yourself.
⇢When we are pursuing something that we are passionate about, and we are not immediately having success, we can get wrapped up into others opinions of ourselves and even our own opinions of ourselves. Most do not share all of their failures or denials letters, only their acceptances and the announcements of their successes. Looking back the only regret that I had was the negative self-talk each time I was denied! Be good to yourself and try your best to trust the process!

featured image: psychologytoday.com

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Pelvic Floor Dysfunction Series #1 – Introduction

September 9, 2018 by Leah Foreman, OTDS, COTA/L, posted in for OTs, occupation

Welcome! This is the introductory post for the Pelvic Floor Health blog series. In this post, we will be discussing the Pelvic Floor – what it is, what dysfunction in the pelvic floor looks like, what the symptoms are, and the anatomy behind the dysfunction.

I am an Occupational Therapist (OT) and a Certified Low Pressure Fitness Instructor. I completed continuing education and training through The Core Recovery Institute. The Low Pressure Fitness protocol I am trained in addresses Pelvic Floor Dysfunction (PFD) with the use of hypopressive exercises as treatment (intervention). If this topic interests you, be on the look-out for follow-up blogs in the upcoming months!

Introduction to Pelvic Floor Dysfunction

What is the pelvic floor?

The pelvic floor is a group of muscles and tissues that have many, many, MANY jobs. Some of those jobs/functions include:

postural control
support of organs
support for the hips
support of the spine
support of respiration (breathing)
lymphatic drainage
sexual function
control of sphincters that control urine and stool

For my fellow healthcare practicioners — the pelvic floor consists of three muscle layers:
(1)The Superficial perineal layer: innervated by the pudendal nerve. Bulbocavernosus, Ischiocavernosus, Superficial transverse perineal, External anal sphincter (EAS) (2) Deep urogenital diaphragm layer: innervated by pudendal nerve. Compressor urethra, Uretrovaginal sphincter, and the Deep transverse perineal. (3) Pelvic diaphragm: innervated by sacral nerve roots. Levator ani: pubococcygeus (pubovaginalis, puborectalis), iliococcygeus, Coccygeus/ischiococcygeus, Piriformis, and Obturator internus.

http://www.beyondbasicsphysicaltherapy.com

Why does Pelvic Floor Dysfunction occur?

Pelvic Floor Dysfunction can have many causes — but the underlying cause of PFD is increased intraabdominal pressure. Intraabdominal pressure is the amount of pressure that is in your abdomen/torso (the area between your ribs and your hips).

Naturally, there is always some pressure in your abdomen — if there were not, our organs wouldn’t be contained! Typical intraabdominal pressure at rest is 5mmHG. Certain activities and events increase this pressure.

These activities can be anything from:

coughing (90mmHG)
sneezing
valsalva — (bearing down) during child birth (60mmHG) or during defecating (35mmHG)
constant poor posture
running (34mmHG)
laughing
abdominal/core exercises like crunches (50mmHG!), bicycle crunches, leg lifts, etc.

**any activity that compresses the abdomen will, in turn, increase your intraabdominal pressure**

When intraabdominal pressure is increased on a consistent or repetitive basis, this is what happens within your body (anatomically):

The organs are pushed down and move out to the sides and out to the front (the occurs due to Pascal’s Law) Pascal’s Law states that when pressure is applied to an enclosed system, that system will then disperse that pressure equally in all directions within that system. Think of squuezing a balloon — when you squeeze and apply pressure, the pressure tries to escape through the areas that are not being squeezed by your hand.

http://www.boredpanda.com

The pelvic floor is already naturally heavily weighted by our movement and organs; it reacts to this weight by contracting. When muscles contract they shorten, and when they are always contracting they can permanently shorten and become what is called, ”hypertonic.”
The pressure also causes blood flow to decrease to the pelvic floor muscles, and when muscles are not receiving proper blood flow, function is impaired. This impairment may look like leaking urine or an organ prolapse.

Another metaphor…

In my training at The Core Recovery Institute, the instructors explained it this way; ‘You can think of your pelvic floor like an elevator – it job is to be move freely betweeen floors (body stuctures) to stop or start an action (hold urine or release urine). Our pelvic floor is meant to be healthy enough to be so mobile it can go to where it is needed as soon as it is needed. When our pelvic floor is dysfunctional it does not make it in time to where it needs to be, or it is not working at all.’

Symptoms of Pelvic Floor Dysfunction

Possible symptoms of Pelvis Floor Dysfunction include:

Incontinence (urine leakage) with exertion, coughing, laughing, etc.
Dysmenstria (irregular or painful menstration)
Organ Prolapse (seen as uterus, bladder, rectum poking through vagina in females and hernias in males)
Frequent urination (more than every 2-3 hours or 6-8 trips to restroom a day)
Trouble releasing urine (needing to push or strain to begin stream)
Irregular bowel movements (1-3 times a day is typical)

Impact on Occupational Performance

As an OT, I have to break down why this impacts our lives from an occupational standpoint. It seems a bit obvious to some, but I think what struck me the most, is how many individuals are willing to live with these symptoms and allow them to interfere with their daily lives and occupations.

There is a general consensus that if you are a runner or a mother than you just will have problems holding your urine — that it comes with the territory. It may come with the territory if our pelvic floors are not healthy, but it does not have to be an accepted norm!

Pelvic Floor Dysfucntion can interfere with so many occupations; toileting and toilet hygiene, dressing (needing to change or wear extra items to manage in continence), fucntional mobility (standing or sitting a particualt way to prevent leaking), personal hygiene and grooming, sexual activity, care of others (child rearing or petcare), home establishment and maintenance, religious activities and expression, shopping, sleep ppreparation and participation, formal education particpation, job performance, employment, volunteer particpation and retirement preparation for our senior cilents, play particpation and social particpation with loved ones or peers. Just to name a few!

As you can see, this is a real issue for our human population. In the following posts in this series, I will address evaluation and treatment options for this population. Please comment below or email me with your feedback, thoughts, or if you have expereince in this area — I would love to hear from you!

Information within this blog is based on education and training in Low Pressure Fitness through The Core Recovery Institute and within the following articles; Thompson & O’Sullivan (2003). Levator plate movement during voluntary pelvic floor muscle contraction in subjects with incontinence and prolapse: a cross sectional study and review. Int Urogynecol J, 12, 84–8. Sugrue M. (1995). Intraabdominal Pressure. Clin Intensive Care. 6,76-79

Essential Oils in OT Practice

August 18, 2018 by Leah Foreman, OTDS, COTA/L, posted in for OTs, occupation

Essential Oils can be so difficult to navigate. What does this one do? Where do I put it? You can put it on your body? IN your body? Diffusing? What’s diffusing? I GET IT. Continue reading “Essential Oils in OT Practice” →

The Power Threat Meaning Framework

July 27, 2018 by Leah Foreman, OTDS, COTA/L, posted in for OTs, occupation

I think this framework is very OT in the way that it looks at trauma Continue reading “The Power Threat Meaning Framework” →

Low-Vision iOS Device Adaptations

July 20, 2018 by Leah Foreman, OTDS, COTA/L, posted in for OTs, occupation

Apple has created the iDevices (iPhone, iPad) with settings to make them accessible for all sorts of situations. One major area of accessibility is for individuals with low-vision!

I am sharing some of the settings that I found most helpful when I sat in a class at The Braille Institute — San Diego. These are not all of the ways to make an iPhone accessible for someone with low-vision — there are dozens, and some can get very complicated with outside software and devices.

To begin…

You’ll need to navigate through these menu settings, most of the adaptations I will talk about below are found in the Accessibility menu option in General Settings:

VoiceOver

VoiceOver will read what the person has touched before they tap again to choose it. This way the person can navigate the phone with touch rather than sight, and use auditory cues to determine what they have selected before fully choosing it.

When I was practicing with this feature, I was a bit overwhelmed by the number of auditory cues being given — if I were using this setting personally, I would need to customize the feature. VoiceOver is fully customizable and in the VoiceOver settings, you can:

change the voice rate
change the tone of the voice
change whether it speaks “hints” or the full text (to reduce the number of auditory cues given)

Gestures to use VoiceOver:

Single-tap on the screen and your iDevice will read out aloud the item you’ve chosen. You can continue to tap around until you find the item you are looking for.
Double-tap on an item to select it.
Scrolling is little different when in VoiceOver mode, you have to use three fingers instead of one because one is the signal to read aloud.
VoiceOver ON/OFF you can turn this setting on and off by double-tapping with three fingers when the screen is locked.
Action command – whether you would like to end a call or take a photo, double-tapping with two fingers tells the phone you would like that app to do something (this action will vary from app to app).
Notifications you can customize if you want your notifications and text messages read aloud automatically in the VoiceOver settings.

PRACTICE! — There is a VoiceOver practice setting on all iDevices that can help clients get comfortable with the adaptation before accidentally sending a photo of their dog to their boss, although if I was their boss, I think that would call for a promotion. 🙂

Siri for Occupations

Siri can be used to increase access and success in daily occupations! Below are some of the thousands of commands that can be used with Siri:

Safety

“Call 911”
“Call the Fire Department”

Social Participation

“Check my voice mail”
“Do I have new voice mail?”
“Play my last voice mail”
“Play the last voicemail from Scott”
“Play voice mail from Julie”
“FaceTime my Son”
“When is my wife’s birthday?”
“What’s Henry’s address?”
“What is my father’s phone number?”
“Show John Smiths’s home email address”
“Send a message to Michael”
“Send a message to Michael saying I” be home in about 20 minutes”
“New email to Jenn Smith”
“New email to Jenn Smith saying, okay I will see you tomorrow”
“Post on Facebook I love my Grandchildren”
“Write on my wall – going fishing today”
“Tweet Does anyone like LeBron James?”
“Read my notifications”
“Where is my wife?”
“Is my wife at home?”
“Let my husband know when I leave work”
“Let me know when my son gets home”
“Is my daughter at home?”

IADLs

“Create grocery list note”
“Find my grocery list note”
“Add eggs to my grocery list note”
“Read my grocery list note”

Home Management

“Reschedule my appointment with Dr. Smith to next Wednesday at 8am”

Work Particpation

“Reschedule my 11AM meeting today”
“Schedule a meeting with Mark tomorrow at 4PM”
“Schedule a conference call with Jamie today at 2PM”

Community Mobility

“Where am I?”
“How do I get home?”
“Directions to home”
“Directions to my mom’s home”
“Give me public transit directions to Home”
“Give me walking directions to Emily”
“What’s my next turn?”
“What’s my ETA?”
“Find pizza near me”
“Find coffee near me”
“Where’s a good Mexican place around here?”
“Find Starbucks near me”
“Show ATMs near me”
“Is there a pharmacy near me?”

iDevice Settings

“Turn on airplane mode”
“Turn on Wi-Fi”
“Turn on Bluetooth”
“Turn on do not disturb”
“Turn on flashlight”
“Turn up brightness of display”
“Make the screen brighter”
“Display privacy settings”
“Is Bluetooth on?”
“Open Phone Settings”
“Open music settings”
“Open mail settings”
“Open Twitter settings”
“Turn on/off VoiceOver”
“Open VoiceOver settings”
“Turn on Invert Colors”
“Show me the Accessibility Settings”
“Open (application)”
“Open Camera”
“Get my call history”

Zoom

The Zoom feature is similar to the Speak Screen feature (below) in the way that it “floats” over your screen at all times, ready to be used when needed. Once it is activated you can drag the Zoom box over what you would like to read and then use these gestures to control the feature:

ON/OFF to turn the feature on and off when you need it or want to put it away to look at a photo or something that requires the hole screen — Double-tap with three fingers anywhere on the iDevice screen.
Move it to move the zoom box around the screen to select something to magnify, Drag three fingers over the zoom box until you’ve found what you need to view
Scroll use one or two fingers to scroll within the Zoom box if you are reading text

Font Adjustments

Increasing the size of the text and boldening can really increase a client’s success in using their phone! My grandmother uses this option (she has Macular Degeneration, Cataracts, and Glaucoma) and it is really working for her right now. I think this is also a great first “intro feature” that could show a client how customizable and accessible technology can be.

Invert Colors/Grayscale

For low-vision clients, sometimes the color and brightness of the screen can be too much and turning down the brightness of the screen doesn’t cut it. Within the Accessibility menu you can find Display Accommodations — here you can invert the colors, or filter the colors based on the client’s needs. There are grayscale options and color filters. I also really like the Reduce White Point setting because it lessens the intensity of bright colors on the screen.

Speak Screen

Speak Screen is almost like a remote control for your iDevice screen — if floats over whatever is on the current screen and when you hit play, it reads the screen. I like this for low-vision clients because it is high-contrast making it more easily found.

Are there any settings you have found useful with low-vision clients? How savvy are you with adapting iDevices? I am just getting started, but I have been pleasantly surprised at all of the possibilities.

Photos and Tutorials Adapted from:

The Braille Institute, San Diego, Group Class, https://9to5mac.com, https://www.imore.com, https://www.applevis.com/guides/ios/ios-7-siri-command-list, http://mobilesiri.com/apple-homekit-smart-home/