Friday, August 10, 2012

A Ball of a Time

On my first day of occupational therapy (OT) observations at the Green Therapy Pavilion (CORF), I arrive to meet Jill Boeglin, Jamie’s occupational therapist.  Upon Jamie’s arrival for her OT session, Jill introduces us, explaining I’m observing as a new employee learning our services.  We ask Jamie if she’s okay with my observing her sessions to which she replies “sure.”  Jamie by all appearances seems to me like a normal young woman, leaving me to wonder why she’s even in OT.  At this point, I have no background information on Jamie or the OT goals set by her and Jill. 

We walk to the therapy area where Jill selects a large ball similar to an exercise ball and gives it to Jamie with instructions to bounce it with her right hand.  Jamie does, successfully maintaining control of it as she bounces it in one spot without any problem.  Jill gives Jamie a medium-sized ball, asking her to do the same thing again.  Jamie bounces this ball but now I notice her struggle to keep control of its bounce.  Her arm movement appears gangly and stiff while her hand bounces it with heavy-handedness.  Suddenly, the ball moves out of her bounce zone; despite bending over to extend her reach for it, it gets away from her.  Rather than moving herself with it, Jamie simply lets it bounce away while standing in the same spot, making no effort to retrieve control of it.  Jill retrieves the ball, returns it to Jamie with further instructions:  When the ball moves away from you, move with it, moving your feet with the ball to maintain control as you bounce it.  Jamie bounces the ball, and again, the same thing happens after the first several bounces.  She bends at the waist, feet planted where she’s standing, attempting to maintain contact with the ball.  As a result, she loses her balance in the overcompensation from the upper body effort to stay with the ball.  The ball makes its get-away.  Saying “this is hard,” Jamie nonchalantly retrieves the ball.  Once again, Jamie bounces, and once again struggles to coordinate her upper and lower body to work in unison to maintain control of it. 

In later OT sessions, Jamie shows improvement with this exercise, moving from a medium ball to a smaller ball, then a tennis ball.  The tennis ball really challenges Jamie’s gross motor skill coordination.  At one point when the tennis ball bounces away to rest under an immovable object, Jamie goes to it but seems unsure as to how to get to it.  To retrieve the ball, the action would require someone to bend down, even on one’s knees, bend further over at the waist with an extended arm under the object to retrieve it.  Jamie stands as if unsure of what she needs to do to get access to the ball. 
Initially, I think Jamie’s just being lazy, especially since she’s repeatedly stating “I’m tired” during the activity.  When Jamie bounces the ball, the movement appears as if both halves of her body are awkwardly interacting with each other.  One or the other moves, but both struggle to work together to perform the task.  Later, I learn Jamie’s lack of effort reflects her inability to process the physical coordination involved in moving with the ball and getting the ball out of its tight spot. As children, we naturally learn to get on our knees, lower our upper body enough so we can extend our arm under a dresser to reach a toy lodged in the back next to the wall.  We learn this activity unconsciously giving no thought to the mechanics of the effort.  For those with cognitive and physical challenges like Jamie, this activity requires conscious thought and concerted effort in performing this physical coordination.  As we get older and our bodies age, bones creak and joints stiffen, we take greater care and thought into maneuvering our bodies through the task of retrieving something under a chair. Through OT, Jamie learns how to coordinate her muscular movement so both the upper and lower body work in unison to perform the activity. 

Over time, Jamie managed the ball bouncing activity better some days than others, and I definitely saw improvement.  Jill explained and showed Jamie how to move her feet and body with the ball when it tried to get away from her.  One day, Jamie proudly announced she’s been practicing at home which occupational therapists encourage of their clients. This exercise helps Jamie build upper body strength while facilitating coordination between her larger muscle groups.

I quickly learn OT involves breaking the simplest of tasks down into several steps for greater understanding and performance, which becomes more evident when the time comes for Jamie to make brownies.

Mmmmm, brownies. . . . . . . .
In the Next Blog Entry: Brownie Therapy -  Wondering why these gals are going “Martha Stewart” on me, I figured Why not? Brownies have been a form of therapy for me in the past.

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