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Suggestion of the Month

Taken from a work in progress:

"Occupational Therapy in the Management of Pediatric Neuromotor Challenges: A Neuro Developmental Treatment Approach"

From a Chapter on "Theraputic Use of Self"

By Regi Boehme

I treated a child once who was one of the most physically disabled children I had ever worked with. All he could do was turn his head toward his left shoulder. He could not turn it back to the middle. He could move no other part of his body. His muscles were completely rigid making it hard for an adult to move his joints. He required total care. He was fed through a tube in his stomach and had to be suctioned through the nose and throat regularly to prevent aspiration. He had five brothers, one was his twin who had no neurological problems.

I followed the appropriate protocol for maintaining range of motion and positioning in an adapted seat. I used casting to maintain his heel cord length and the integrity of his feet. From my perspective, my initial contribution was to spend time listening to the mother verbalize her anger and frustration. This parent had fired the first two therapists that had worked with her child. So I knew she was most likely suffering on the inside. Just listening to her seemed to help, because afterwards she would always ask me when I was coming back.

I strongly encouraged the family to relate to the child, in the same way they related to each other. I cannot take any credit for their actual creative ability to do this. It was amazing to watch how each family member related to him in their own way.

The family built a house more suitable for their child's needs. He spent most of his day in a bed, which was specifically constructed to hold all of his equipment and food needs. This bed was kept in the kitchen/dining room area, which was the entry way for the house. It was also the room where they gathered for meals and conversation. There was a phone in the kitchen as well.

Everyone who entered the house would make an instant connection with the child. This was so therapeutic that over time, when the child was teased, he would laugh. When they would pretend to argue with him, he would make argue sounds right back at them. His communication was made up of different pitches and lengths of sound production and we all understood him.

By the time he reached his early teens, his body was very fragile. His bones were brittle. It was getting harder to breathe. Eventually he passed on. But as I look back on his life and the life of his family, I see a child that had a good self-image in his own way and definitely had that sense of belonging with a group of others. He experienced a good life and was deeply loved by all of us. The family itself went through their own transformation process as families do. The one thing that this family seemed to experience so gracefully was unconditional love and acceptance. This is something that will stay with them long after their child is gone.

Therapeutic use of self occurs when I am fully present to the child in this moment. My thoughts do not float back to what we did during the last session. I do not think about what I wish the child could do or stop doing. I don't think about paper work that lays in wait for me. I fill my mind with the presence of the child.