Understanding Occupational Therapy

About This Episode

Adam Dayan, NYC Special Education Attorney sits down with Abie Levy, Licensed Occupational Therapist and Senior Director of Occupational and Physical Therapy Departments at Imagine Academy. Throughout the episode, Adam and Abie will untangle common misconceptions of what Occupational Therapy is, ways it may benefit a child who is facing barriers with physical, sensory, or cognitive problems as well they will clarify some of the often-confusing jargon used in the realm of Occupational Therapy. Abie discusses with Adam the unique approach and various techniques he utilizes with some of his own clients as well he will share some very encouraging success stories with our listeners. 

(LISTEN) The Curious Incident Podcast Ep. 21 - Understanding Occupational Therapy

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Transcript: Understanding Occupational Therapy

ANNOUNCER:  This is Curious Incident, a podcast for special needs families, and your window into the world of special education. Special needs parenting can be challenging, and we want to make it easier by providing you with the resources you need to help your child. Dive deep into the world of learning differently with your host, special education attorney Adam Dayan.

Adam:  I am pleased to present my next guest on this podcast, Abie Levy. Abie is joining us to talk about the subject of Occupational Therapy Services. Abie has been a licensed occupational therapist since 1993. Abie is the Senior Director of Occupational Therapy, Physical Therapy, and Respite and After School Programs at Imagine Academy for Autism. Abie is also an educational leader and a consultant for design of environments and therapy for optimal function. Abie Thank you so much for joining me here today. Abie.

ABIE: Thank you for having me.

ADAM: So let's get something out of the way. People are often confused by the term occupational therapy. They picture job accidents and returning to work. OSHA signs with pictures of protective eye gear. What is occupational therapy and what is it not?

ABIE:  It's funny that you say that my wife to this day tells everyone that, yeah, he just gets people jobs. But what I do is I do help people of all ages do their job well at whatever stage in life they're in. So an infant needs to move to explore, a student in school needs to sit, pay attention, focus, have social skills and hygiene. A toddler needs to play with toys to develop cognitive skills and motor skills. An adult needs to care for himself for herself and care for others. So that requires all those skills and more. What OT is is it helps people of all ages who have sensory, physical and cognitive problems. We help to gain and regain independence in all stages of life.

ADAM:  How is OT different from physical therapy?

ABIE:  Physical therapy works on the muscles for function. Physical therapy works on the sensory, the physical and cognitive underlying challenges or deficits for the muscles for function. So I like to give an example where a physical therapist will provide opportunities for an individual with cerebral palsy or CP to increase standing tolerance. They might put them in a standard or they might put them in a standing box. And really encourage a stretch on those leg muscles. Occupational therapists will make sure that the student is provided with the sensory, cognitive and physical opportunities to encourage standing.

ABIE:  So there's the leg muscle element for the person to be able to stand and there's also the perception that's happening in the person's body and the brain piece of processing the information they're taking in. It's motivation.

ADAM:  If without motivation, without intrinsic desire, it really makes a tremendous difference.

ABIE:  Do you want to talk a little bit more about what the sensory piece consists of? What does that mean?

ADAM:  So everything we do involves a sensory experience. We have to be able to understand what we're seeing, tolerate what we're smelling, coordinate what we're hearing in order to be able to process how to adapt for the situation at hand. So right now I'm a bit nervous, chills on my arms, still focused. And I'm able to perform, I think, for this podcast. But I will tell you that individuals who have sensory processing challenges, they cannot filter sites. They cannot necessarily understand what they're feeling in their bodies, the chills. They may misinterpret those and they withdraw or they can become aggressive.

ABIE:  That's a really, really great example. I'm happy you shared that because we're constantly taking in information. We're making sense of what that information means to us. And then we're taking action based on that information. Absolutely. At all times. But for some people, students with special needs, there's a significant impediment there. The information they're taking in and the manner in which their brains are processing the information is impeding them from taking the desired action.

ADAM:  Absolutely. And it affects many, many areas in their lives.

ABIE:  What are signs or symptoms that a child may need occupational therapy?

ADAM:  I like to think of it as very typical situations, difficulty with hair cutting or fingernail cutting, difficulty tolerating grooming. A lot of challenges paying attention or remaining focused, difficulty with shoelace tying, buttoning, so dressing oneself, getting ready, organizing oneself, having their materials disorganized. And it's not because they're lazy. It's just something that they need help in the executive functioning.

ABIE:  To explore that a little bit further, what they're experiencing when you talk about not being able to tolerate the thing, you gave some examples. What is happening inside their body that's causing them not to be able to tolerate the thing?

ADAM:  The piece that they need in order to coordinate their fingers to button, the things that they need in order to keep their materials in their notebook and in their backpack and in their desk at home, organized, that thing is an executive function. You can't have an executive function without attention, regulation, engagement, and the higher level skills that come after that, after that foundation, which are coordination, core strength, and eventually the development of finer skills. And it all comes to a point where there's a comprehension of what each task requires and how to be able to perform those tasks.

ABIE:  I think you've touched on this a little bit already. Talk about some other ways in which OT-related impairments can impact a student's functioning.

ADAM:  In the classroom, at home, in a social setting, physical sensory cognitive challenges can really, it can really be an obstacle. It affects their participation, their comfort level. It really does affect their success at home, at school, as well as socially. So, I give an example often where a person who has difficulty with dominance, the dominance affects their ability to maintain balance. Their difficulty maintaining balance affects their ability to have coordination skills. So this individual who has these challenges is often overlooked when friends want to play basketball. They'll not choose that particular individual. And if the person can just get the balance addressed, that would make such a tremendous difference in that student's life.

ABIE:  I think anybody can relate to that example, special needs or not. Someone who has dealt with an inner ear issue or vertigo or anything in that realm. My ear got clogged about a week ago and my balance was entirely off. Forget about the fact that I could not hear what people were saying to me. The balance was off. My whole equilibrium, I couldn't focus in a typical way. In a special needs individual who is experiencing that sort of thing on a daily basis to a greater degree and maybe you can start to imagine the extent to which it's interfering with a special needs child's daily activity.

ADAM:  And I think it's important to really make the distinction that your experience was coming from having clear auditory comprehension and not having any balance issues. An individual who has special needs is made that way. So they go through life thinking that this is typical. Imagine having to use the walls, use the furniture, use people around you to keep you upright and stable, to lean on people, to annoy their colleagues, their peers in order to help themselves, getting feedback from others of why can't you just stay in your space? Why can't you just keep your hands to yourself? Well, I can't. This is how I'm built.

ABIE:  I think we can all picture that student in our classroom when we were kids who had difficulty maintaining space.

ADAM:  When I hear specific people in the education field say, oh, they're just looking for attention. It's not true.

ABIE:  It's not that. So just clarify. What is it? What are they seeking?

ADAM:  They're seeking stability and they're seeking help to maintain their own position. They want to stay upright, but they need support. Because they're born this way, they don't understand that the neurotypical individual who's being annoyed doesn't have that same experience. And they don't understand, well, what do you mean? I'm not doing anything wrong. Isn't this how you live and breathe? I need you to help me to stay upright, to be in my personal space. Without invading your personal space, I don't have a comprehension of my personal space.

ABIE:  Are there any emotional or behavioral issues you typically see as a result of a student's having these types of challenges?

ADAM:  Absolutely. People with these sensory processing issues can have a very difficult time tolerating or remaining seated or behaving appropriately, quote unquote, in an auditorium, in a cafeteria, in a classroom. They may withdraw, isolate themselves because it's too overwhelming. They may have an outburst because of being so overwhelmed that they just can't take it anymore. They had enough. They may even become aggressive.

ABIE:  And a child with OT challenges or OT-related challenges is seeking movement in the classroom. What are they gaining from that movement?

ADAM:  It could be a combination of things. I feel very strongly about saying that it's a combination of things because it is not unusual for a student, a child, an adult who's receiving occupational therapy or received occupational therapy had or has low muscle tone. The muscle tone is not necessarily related to strength, but having low muscle tone means having challenges to maintain certain postures and having efficient and fluid motor skills. So you and I sitting here in an upright position with our feet flat on the floor and hopefully we're at a 90-90 degree angle. We're ensuring that we're attentive for about 15 minutes now, I think, have been able to sit this way and not get up and move. A person with low tone, however, needs the movement to wake up the muscles so that they can continue to have the ability to stay focused and attentive. Without the movement, they begin to deteriorate and not offering someone the opportunity to move within a 30-minute or 45-minute classroom period would end up with the student having real difficult comprehending what the classroom material was about, their daydreaming, their fidgeting, their interrupting, their asking to use the bathroom often and teachers often don't let them leave the room because they want to get the material across. So that's, I think, an answer to the question, which is so important.

ABIE:  How about the aggressive piece? Why do students struggling with these issues sometimes become aggressive?

ADAM:  The first thing I think about is the sensory processing. It's the amount of people in the room, the colognes, the deodorants, the food, the lights, the clicking of pens, the shifting of papers, the teacher speaking, the students speaking, all these things and the individual who has these challenges, what he or she is feeling within their own body and not really fully comprehending, being hungry, being thirsty, having difficulty understanding that they have an urge to use the bathroom, but really don't get a good sense of that because of this sensory processing challenge. That can come to a boiling point, especially when you add the criticism, the pressure to perform and to present oneself in a certain way, not being able to meet those expectations. So the aggression can happen.

ANNOUNCER:  If you like what you are hearing, please let us know by subscribing to the Curious Incident podcast and letting other special needs parents know about it too. If you have thoughts, questions, comments, or would like to suggest ideas for a future episode, we'd love to hear it. So email your feedback to podcast at Dayanlofirm.com.

ABIE:  Let's quickly address some jargon. Talk about vestibular and proprioceptive skills. Those are terms that come up often in this space and I just want to make sure our listeners know what they mean.

ADAM:  Vistibular equals movement or balance, I should say. I'm going to correct that. I'm going to say balance. So one who has adequate balance has the ability to move through the corridors, go up and down the staircase, use the playground equipment. And proprioception, on the other hand, is the coordination or the position in space. So proprioception would be different in that that student walking up and down the staircase is being able to maintain their personal space up and down the stairwell that's crowded. Walk across the hallways or get from classroom A to classroom B without bumping in to others, really maintaining one's own personal space. That's proprioception. Those are definite, basic senses that really are what we call the hidden senses. So you have the five senses, the touch, sight, hearing, taste, smell, then there's the vestibular and the proprioceptive and I think that's very important.

ABIE:  ABI, are there evaluations that would need to be conducted to confirm whether a child needs occupational therapy?

ADAM:  There are. There are some things that we use that could definitely help to figure out where the challenges and the deficits are. It can help figure out how much of a delay there is and it can support the therapist's decision in how many times a week, for example, or whether or not the student would benefit from individual or group or consultative therapy. It could definitely support any of the decisions the therapist needs to make.

ABIE:  And what kinds of evaluations are we talking about if parents think this might apply to their child, what should they be asking for?

ADAM:  In a school setting, there should be asking for assessments that assess school functioning. If there are challenges at home, for example, with an infant or a toddler, they should be asking for assessments that address that job in that person's life and that moment. So a child who's at home and has difficulty eating is tantrums when bathing has a lot of difficulty falling asleep. I think that the parent should know to ask for evaluations that assess the sensory processing for that developmental stage.

ABIE:  In your experience, what kinds of students can benefit from occupational therapy?

ADAM:  There's really a constellation of challenges. It's not just the inability to address oneself. It's the inability to address oneself and the difficulty with handwriting so much so that even the individual himself or herself is unable to read what they wrote or the teacher can't grade the papers because they can't read what the student wrote. It could be someone who has a lot of difficulty staying focused and paying attention. It could be behavioral issues. Those are the kinds of areas that are typically what an occupational therapist is called in for help.

ABIE:  So let's talk about how OT can help them. What does a typical OT session look like?

ADAM:  A typical session is a minimum of one individual session for 30 minutes. It could involve equipment that you might see in a sensory gym. Sensory gym equipment would be, you know, I like to call it like Disneyland. If it looks, it just has mats and wedges and swings and climbing walls and spider webs to climb up and down an air pogo's zip lines. A lot of fun, but what it does is it works on the muscle tone. It works on the muscle strength. It works on the motivation to be able to stand little examples I gave before. It helps those movement needs and craves that the student who's getting OT was looking for in the class. It feeds those voids. I call them potholes really. It fills the potholes so that focus attention, engagement, communication, and participation, real performance happens.

ABIE:  Definitely the funnest room in the school. Absolutely. I've toured a lot of schools. I've seen a lot of sensory gyms. They look fun, but as you emphasize, it has an important purpose and it's helping kids activate what they need to activate.

ADAM:  Absolutely. 100% makes a huge difference.

ABIE:  Talk a little bit more about what tools or techniques you have found to be effective.

ADAM:  What's effective in occupational therapy? I encourage my colleagues, occupational and physical therapists that I work with to use visually stimulating tools. That could be a light board. It could be a light up desk so that someone who has visual discrimination challenges, someone who's unable to focus when the surface is lit, they're drawn to the surface area. It helps them to filter. It's a modification. I like to use activities, games, and obstacle courses to encourage the student to move and by moving be able to sit longer and longer and longer periods of time. I like to incorporate the cognitive challenges in the exercises or the activities that we're doing. In that way, we hope that and we've seen that it generalizes to the classroom environment and it generalizes to the gym, it generalizes to home life, that their ability to endure and tolerate sitting with their family at a restaurant table or at home at the table have dinner together or breakfast on Sunday together with family. It's a tremendous, tremendous change. Sure.

ABIE:  I think it goes back to the central theme of more stimulation, right? Kids struggling with these issues need more stimulation, whether it's lights, whether it's movement, whatever it may be, it requires a higher level to activate their abilities. I think what you said about generalization is really important being able to show up the same way in different settings.

ADAM:  I can't agree with you more. I think what you said really resonates because it's counterintuitive for so many people. Why would you give someone who's disruptive, who moves around so much, movement? Why would you give someone who has difficulty balancing rollerblades? If you think about it, the person who can't maintain their balance has to use 100 times more attention and focus tool balance, thereby working on their balance. It's intrinsically motivating because they want to do what their peers are doing. Given the opportunity, it makes it a tremendous difference. I think that that's key.

ANNOUNCER:  If you like what you are hearing, please let us know by subscribing to our podcast and letting others know about it too. If you have thoughts, questions, comments, or would like to suggest ideas for a future episode, we'd love to hear it. So email your feedback to podcast at Dayanlawfirm.com.

ABIE:  What do you do a one-on-one session versus a group session?

ADAM:  Individual one-on-one sessions are I consider students, adults, infants that have moderate or significant challenges or delays in an area or multiple areas. A group setting, I feel that it is appropriate for someone who has minimal challenges or delays in a specific area.

ABIE:  What credentials and qualifications should parents be looking for in an occupational therapist?

ADAM:  It's important, first and foremost, that the therapist be licensed in the state that you're having your child or your loved one or yourself receive the therapy. I think that you need to find a therapist that has experience, specific experience in the specific job of that person needing therapy finds themselves in. So when in Fint, you want a therapist who has early intervention experience, solid experience, not just part-time. Someone who's in school setting that definitely makes a difference for the student who's receiving occupational therapy. You want someone who works in school setting. They understand the challenges and they understand the expectations. More than that, I think that if there's a very significant or severe challenge that the person needing occupational therapy, that they find a therapist who has a specialty or specializes in a certain field. For example, I specialize in a therapeutic technique called quavismatic exercise therapy. So I use that for individuals specifically who have difficulty learning to walk or walking. And that comes from an occupational therapist, not a physical therapist.

ABIE:  Let's go on a brief tangent then. How does quavismatic work?

ADAM:  Quavismatic was created by a physical therapist from Chile, named Ramon Cuevas, phenomenal. He developed this series of motor handling techniques that provoke the body to react. The provocation on the body wakes up the brain in so many different ways and areas that create the opportunity for the body to be able to stand where a person who has physical challenges is unable to stand without braces, without buckles, without being locked into place. So the quavismatic exercise therapy provokes the brain to react to those physically challenging positions so that the individual is actually experiencing what it's like to stand or to step or to crawl or to sit up without tools, just hands handling.

ABIE:  Thank you for indulging me on that. I wasn't planning to ask you about quavismatic and the truth is that I need to do a separate episode just about quavismatic. This has been coming up a lot in our special education, legal practice. Let's say briefly what is assigned to parents?

ADAM:  A parent has a gut feeling. I know my child should be able to roll. I know my child should be able to get up from lying down. I feel strongly that my child is capable to take a step. Why isn't my child taking steps? They've gotten physical therapy and occupational therapy. They have their wearing their braces. They have the walkers. They have the standards. I need something more alerting, more arousing to really make a difference. Quavismatic exercise therapy does that.

ABIE:  CME. Parents who are listening, you know your child best. You have that parent intuition. If you know deep down in your gut that your child is capable of more, listen to that voice and speak to the necessary experts to get the therapies that will help your child activate what they're capable of. Very well said. Thank you. A.B. are there any special considerations in the realm of occupational therapy for students with autism or other developmental disabilities?

ADAM:  Absolutely. Student with autism or any developmental disability has a constellation of challenges and it affects their sensory processing. It affects their physical skills, it affects their cognitive skills. What I found that such an individual benefits from is a sensory diet that's constantly modified, often adjusted and it can be provided proactively to help them be able to maintain a certain state and it can be performed reactively to help the teachers, to help parents to be able to better cope. The sensory diet really helps the individual be ready and available for whatever the situation is. So in school, ready and available to learn. At home, ready and available for chores, for the family dynamics with their friends, ready and available to socialize and to play.

ABIE:  The sensory diet comes up in a lot of the cases that we handle at my office. It's a point of contention with the school districts. There's always the question, did you school district create a sensory diet? Was it appropriate for this child's sensory needs and we examine it? For those who don't know, it's a sheet of paper. And it has instructions. The same way a food diet might specify what a person can eat and the proportions they should stick to and caloric intake, the sensory diet will specify what. Talk a little bit about what that sheet of paper will say for the student.

ADAM:  I've created a sensory diet that on one side, it shows activities that are appropriate for a specific student. So it might have a picture of the swing, a picture of skates, a picture of a body sock, a picture of a tunnel, a picture of yoga poses and one more, a picture of a spider web, climbing spider web. These are choices that the student has and if the student is unable because of their developmental stage to make a decision that the staff person or the family member has to provide that individual opportunities to wake up their body if they need to be woken up or to bring to calm their body if they need to be calmed. And yes, it's paradoxical. It's the same activity. The skates can be arousing, it can really wake someone up or it can also be calming and soothing. It can calm someone who's hyper down. All those examples that I gave have this paradoxical effect. So depending on whether or not someone needs what we say, up regulating or down regulating, those exercises, those activities, those tasks can help the person throughout the day be ready and available for whatever it is that they need. It was in school to learn at home to engage.

ANNOUNCER:  If you like what you are hearing, please let us know by subscribing to the Curious Incident Podcast and letting other special needs parents know about it too. Give you a thoughts, questions, comments, or would like to suggest ideas for a future episode, we'd love to hear it. So email your feedback to podcast at Dayanlawfirm.com.

ABIE:  Where does an OT fit in on a child's education team?

ADAM:  Occupational therapist works alongside the teacher, the gym teacher, the counselors. We use a lens, I think, that really makes others outside of our discipline aware of challenges that stand in the way of someone's performance. So we are there to promote success in whatever area in the school setting that this child is having difficulty in.

ABIE:  Talk a little bit more about the specific skills you help students develop.

ADAM:  The simplest way to say it would be the sensory as the bottom ground level, the physical as the next level, because without the sensory pieces, the sensory processing pieces, you really do need those to have good physical abilities and skills. And then the next level, I believe, and I've learned is the cognitive. And of course, higher than that is the executive functioning. You really need the sensory, the physical, and the cognitive pieces in that order. But it's fluid. It can be happening, and it is happening simultaneously. You need those addressed in order to be able to really succeed. How do you measure progress? We look at teacher reports, teacher tests, how the student is performing, so they're great. We have our own observations, checklists, clinical observations. When I say observations, I mean clinical observations. We have our own assessments also. And parent report. I mean, these are all ways to monitor ourselves as well as the student's progress.

ABIE:  What differences do you typically see in a student's emotional or behavioral functioning when progress is being made?

ADAM:  The parent will report that their child is tolerating hair washing, which was a tremendous issue. The teacher is reporting that the child is more attentive or more regulated. There isn't that outburst or the behavior piece in the class. Those are key. And those really, really make a significant difference. What makes your approach unique? I make sure that I have the child's attention, the regulation, their engagement, and communication. And that can look different depending on the disability. Those are key elements to a frame of reference that I use that I'm trained in. It's called the DIR floor time method, the developmental individual difference relationship-based model. It's a mouthful. Yeah. I also expect competency. I've been told that I have this effect. Once I have engagement and regulation and attention and communication, that the person I'm working with understands that I'm there not to do for, but I'm there to support. You're going to do it for yourself because I know you can do it. I expect competency. I know that the person I'm working with, I have this mantra in my mind, you're able, you're capable, and they feel it, and they like it, and they perform. I think that really, really makes a tremendous difference. I think that's, for me, that's been a really good formula. No matter the challenge.

ABIE:  I'm just thinking of what a powerful concept that is, bringing that approach to your work, that the child is capable, and instead of focusing on the shortcomings or deficits focusing on their abilities and potential, and getting progress from the individual based on that

ADAM:  approach. I have all these images in my mind of all those times, and they continue to happen where the student is just so incredibly impressed or not even aware that they did something that they hadn't done before, and it's those moments that just keep me going. That's why I keep it's three years now. I keep doing this.

ABIE:  Wow. So we talked about progress a minute ago. Let's talk about success. How do you define success for the population you work with?

ADAM:  It's when a student is able to perform an action or a skill that they were not able to before. A good example would be someone who's significantly challenged instead of scribbling being able to draw a line, whether it be a straight line up and down or a line across. Another example that I like to give is someone being able to, for the first time, put on their shirt. I mean, if you think about it, it's just it's something that we really take for granted. And if it's not a severe, challenged person, then it's someone who's able to figure out how to unpack their own lunch, open that zip lock, be able to use the knife and fork to cut really something that I think that's overlooked but essential.

ABIE:  I'm picturing a dinner with my wife and my uncle where we were talking about all of the things that have to fire properly in the body to be able to do basic daily functioning. And the reality is that for some people, some of those things miss fire. And I think what the positive here is that there are therapies such as occupational therapy that can help students focus on those misfireings and improve them. Am I correct?

ADAM:  Yes. You're touching on the sensory integration frame of reference where those are exactly the processes that as occupational therapists using a sensory integrative frame of reference, that's what we do. We find the activities that will help not only fire but help adapt so that we know that the firing of the information is being received in the appropriate areas of the brain and therefore the body to be able to perform successfully because you're right. It's often misfiring or if it's firing, it's being received in another area and it's confusing. So the therapy helps to pave. Remember those potholes helps fill those potholes and pave a smoother path so that there is better and better and better performance and success.

ABIE:  Can you share any success stories with our listeners?

ADAM:  I'll talk about two that I'm working with right now. The one that I'm going to be talking about first is someone that I've been I think 14 or 15 years now I'm working with this individual. 19 years old has contractures of the arms and legs. It's not wheelchair bound. I'm is able to walk. Also has a significant vision impairment so legally blind. And has a swallowing issue so has difficulty chewing and eating. So imagine having very very limited ability to manipulate objects with your hands and you're in a classroom setting with classroom tools. Having almost no eyesight. You're in a classroom setting with you know the smart board or the white board and worksheets. You also have contractures of the legs and you're in a school setting you know and you have gym and you have stairwells and hallways and these challenges are so significant. But because of my expected competency and because the student is aware that I'm there to support and knows that I'm there for him he's been able to in the last year and a half been able to successfully find his lunch from his locker from his backpack unzip the backpack take the lunch out open the zip lock bag open the container the of food the Tupperware. Go by himself find the microwave open the microwave door. I want to be clear this is a person with contractures of the arms and hands of the legs and blind hands. Put this food in close the door turn on the microwave wait here the ding pull it out again ask for me by by gesturing because he also has significant communication should selectively mute turn to me and I know that that's communicating to me that he wants he's ready he knows that it's ready take it out for him I'll hold it for him I'll bring it to the table he comes to the table he'll decide where he wants to sit. This is something that's overlooked you know I want to take a step back that this individual may not be hungry. Okay he's 19 years old I don't want to eat now just because it's lunch time now I'm not hungry honor that maybe later and it's worked beautifully sits down is able to use a utensil a spoon and feed himself I have to tell you still to this day I I I discuss with the family not to feed him to allow him to feed himself they struggle with that not to sing to him while he's eating to expect that he's capable of eating with the family being participate and participate in family tabletop experience without being sunk to his 19 so it's that's something that I critique or judge it's just it's it's I want to bring awareness to the family that not only is he capable and able can generalize to the home just expect it it will happen.

ABIE:  In addition to what a remarkable success story that is that you just described the last piece of what you said the the guidance that occupational therapists can give to parents for the home setting what can you do that's going to be conducive to bringing out their capabilities more and respecting their individuality.

ADAM:  So important so important to keep that in mind it's a we don't have to constantly impose we can we can be flexible we can understand that just like you and I we may not want to eat just because it's dinner time we might want to snack before I fall asleep you know.

ABIE:  Any advice to parents who are new to the special education process know that there are a lot

ADAM:  of very very dedicated and supportive professionals as well as parents out there that they could seek advice and assistance from. What questions do you get most often from parents because of my my specialization I get this often in will my child walk will my child talk will my child be okay those are the three top I work with individuals like I just described who have a constellation of challenges but also work with individuals who have no contractures of the body you know who are very physically motorically capable but they don't speak it's hard are there any resources you would like to recommend.

ABIE:  I give the resource often to parents it's the toolbox the perfect them through through through perfect them it's the floor time parent toolbox and if I may share the website course perfect them dot org the toolbox is a series of videos with explanation about how to develop engagement how to develop a relationship specifically with the for with someone who has a development disability and it's meant for parents and caregivers and professionals so it's it's very powerful it's almost free I think it's a dollar it's it's wonderful.

ADAM:  Abie before we conclude what's one interesting fact about you it's funny because I don't

ABIE:  find it interesting but I'm I'm aware that it's interesting to a lot of people I'm a child of deaf parents my parents are both deaf my father recently passed away but the last eight or nine years of his life he was also blind their challenges and their ability to overcome and to provide for me and my sister growing up has been inspirational and I owe them everything.

ADAM:  I'm so curious how did you learn to communicate with them.

ABIE:  I get that question a lot so then the same way that you communicate as a hearing individual with the child in the crib in your arms by speaking to them the child hearing of course or not but let's just talk about a hearing child they're able to begin to understand the nuances of language the intonations the tones they watch the mouth and they begin to imitate the demotor reactions my parents use their voices and it sounds extremely different from a hearing individual they also use their hands simultaneously so I was lucky I think I got the benefit of not only the hearing what they're saying but also seeing with their hands and their gestures what they're saying so I learned sign language and to speak thanks to my parents because of the combination of the two. Hey beware can our listeners get more information about you can go to the Imagine Academy website imagineacademyforautism.com and I believe you can also be imagineacademy.com.

ADAM:  Abie thank you so much for joining me here today we must know each other for well over a decade at this point and it's been great working with you over the years I respect your vast expertise and knowledge in the area of occupational therapy and commend you for the great work you're doing to help children with special needs address their cognitive sensory and physical challenges so that they can live better lives thank you so much I really appreciate it.

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