13 Oct 2011

Occupational Therapy and TOYS!

I have found myself infront of the computer again tonight because the eldest boy has taken over and has his cartoons on the TV before going to bed.  This is my way of tuning out the same cartoon he's seen at least 10 times!

I've said before that I'd rather browse around online, read the news, the daily gossip, browse other blogs and whatever else I stumble across.  This is my way to unwind.  Tonight while checking out what's going on in the world, I learned it is National Occupational Therapist Month in Canada (and other countries.) 

Prior to my introduction to the World of Preemies, I knew the basics of what an Occupational Therapist was, but I did not know they also worked with newborn babies.  My concept of an OT was that they worked in some form of rehabilitation for individuals who have suffered illness or injury and required one-to-one help with re-learning physical life skills. 

Our first introduction to an Occupational Therapist was during our first NICU hospital stay with Preemie #1.  We met with her a few times to discuss how to avoid "Flat Head Syndrome."  Yes, that's a real thing!  The technical term is "Plagiocephaly."  Say that 5 times fast!  The OT discussed how to use blankets rolled up and positioned in a manner that would help prop him while he slept to avoid him favouring one side or the other.  She showed us how Preemie #1's head shape was showing signs he'd been favouring one side and how we could work to pretty easily correct it.  He now has an awesomely shaped head, if I do say so myself.

Our second/third experience was Round #2 in a different NICU with Preemie #2 and #3 (AKA: Twin A, Twin B.)  This time around we had very different needs, with two very different little babies.  I would say Occupational Therapy began in the very early days of our 27 weekers' lives.  The simple things like positioning the baby, draping them on their tummy in their isolettes was one of the first things done.  Positioning them from side to side, as we did with their older brother.

Then came our introduction to Hydrocephalus.  This is where the greater scope of Occupational Therapy kicked in.  Now our one boy had been diagnosed with Hydrocephalus and the OT stepped in to assist with propping with special pillows to attempt to assist with flow of the cerebral spinal fluid...I guess I should say, to help alleviate some of the swelling of the head.  

Getting ready to come home.
After our little man's first surgery, we were introduced to the "butterfly pillow," which looks like a butterfly.  The baby's head/upper back are placed into the butterfly's centre and the wings basically envelope around the baby's head, giving him a soft, comfortable place to rest his head.  Pillows aren't usually used in the NICU in the isolettes or cribs. Once the baby had his second surgery, his VP shunt inserted, he really needed the butterfly pillow.  In the first few days the baby showed obvious signs that his head hurt if we touched it or when moving him around, therefore being able to prop him on his pillow and build up behind the pillow we could angle him on the opposite side, taking pressure off his sore little head where the new shunt was.  It's amazing what a simple little idea can help with.  These are the ideas of Occupational Therapists and the families they work with.

Propped on a Butterfly Pillow
NICU Discharge Day, August 20, 2010

We were fortunate to work with two different OTs while in our second NICU stay.  The two of them sometimes would meet with me and we would collaborate and think of the best way to handle whatever situation had come up.

After surgery number two, the little man decided he didn't want to be bottle fed or breastfed and started to cough, choke, sputter, every time we attempted a regular feed, and he basically freaked me out!  This is when you could say some "hard core" occupational therapy began.  The OT scheduled during this period worked hard to help me work with the baby and think of how to overcome this latest obstacle to getting discharged from the hospital.  No baby can be discharged if they are unable to eat and continue to gain weight.

We tried smaller amounts of expressed breast milk from a bottle, we tried formula, we tried a combination, we tried just nursing, we tried just bottling...We tried thickener put in with the EBM or formula.  This boy had attitude and he didn't want to have anything to do with any of it!  The OT was so helpful and rational.  She would schedule to come in during one of his feeding times and feed him herself.  She would try re-positioning him during the feeding time.  Holding him in different ways to see how he responded.  In the long run, it was a combination of her hard work, my work and everyone's overall determination and just a matter of time for him to figure it out again.  For a period of time we chose to let him rest and he had a NG tube re-inserted to assist with feeds and help him continue to gain weight.

Eventually we all figured it out and he began to come around.  He was discharged home with a NG tube and only a few days later it was out.  Once home in the comfort of our own space, he caught on to eating well and never looked back.

Twin B Home and propped up with his new Butterfly Pillow,
courtesy of The Linden Fund.

Once discharged from the hospital we didn't lose our connection to the fascinating world of Occupational Therapy.  We had the privilege of being connected with another OT through our local community and health care program.  This OT paid us visits on a weekly basis to assess Twin B's progress and any other concerns that popped up.  She assisted him with physical activities, eating habits and other ideas to help me help him.  For example, we eventually graduated him to his high chair for meal times, along with his twin brother.  He slumped over in his high chair and looked completely lost in the chair.  Our OT came in and assisted with the best positioning and propping to get him comfortable for mealtime.  It's amazing what a coffee towel and some bath towels can do!

The concepts that OTs use at times may seem simple, but to an over-tired mother and father, these simple things to try most likely won't click in our minds.  When you think of it, the techniques OTs sometimes use, as simple as they are, aren't really things the average parent ever has to worry about and therefore it probably doesn't come naturally to most.

Eventually I noticed Twin A was definitely falling behind for hitting the many milestones, so he was able to work with the same OT in the home.  She would exercise both babies, assist with their basic motor functions and see how well they were grasping cause and effect and basic reasoning abilities.

Thankfully we have access to many options and services for our boys.  We have been able to work with a particular children's centre for development and so we have had the privilege of having two different OTs, who focus on different areas of our twins' development.

Recently we were able to part ways with our first OT who had been with us since NICU discharge.  The boys had mastered the skills she was hoping they would and they were discharged yet again.  "Discharged" is a nice word.  Music to my ears.

We continue to work with our second (technically fourth) OT, who works on both boys' motor skills, assessing their abilities and working with them to figure out new ways to teach them and ensure they don't fall too far behind.  This OT gets to play with toys and the boys.  Who wouldn't want a job where you get paid to play with toys and babies??  Although it may seem like innocent and simple playtime to the average bystander, to a mother and an OT, it is a time for assessment, planning and implementation of concepts and ideas to assist the boys in becoming stronger, smarter and capable little boys.

One of our favourite toys at OT sesssions
and at home! Simple, but fun!

I've learned to look at toys and figure out what the true value of the toy is.  Does it help my kids' fine or gross motor skills?  Does it teach them cause and effect?  Is it pretty much a useless toy, that I don't want to waste my money on?  I've found that some of the simplest toys are the best toys for playtime.  Toys don't need all the bells and whistles to be a good toy.  I never would have thought about these things without the help of our Occupational Therapists.

So this month I am very thankful for our Occupational Therapists and I'm glad to recognize October as Occupational Therapists Month! They deserve it!

Thank you Carolyn, Auna, Veronica and Herdip.  Awesome Occupational Therapists!

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