Horses & Friends

In observing occupational therapy (OT) sessions in our Green Therapy Pavilion (CORF), I begin to understand the breadth of treatment this therapy offers to its clients.  An “occupation” is considered everything that’s meaningful, purposeful, and/or functional for a person that s/he does from the moment they wake up until they go to bed.  I don’t know about your day but for me, that’s a lot of stuff!  From household tasks (making a bed, making breakfast, cleaning up dishes, turning on and off lamps, cleaning house) to self grooming habits (brushing teeth, washing face, brushing hair, getting dressed, bathing, toileting, applying makeup, shaving) to communication  (social skills, computer skills, writing, operating a telephone, taking messages) to leisure activities (fishing, crafts, baking, pet care, playing with toys).   Taking into consideration the outpatients’ values, interests, history, roles, routines and needs, OT examines the limitations that may be preventing or challenging their participation in daily activities.

Do you realize how complex the process of learning is? The brain is a sophisticated organ, the human computer if you will.  Many cognitive skills contribute to both academic and occupational success.  Critical skills include attention, working memory, processing speed (how fast we figure things out), long-term memory, logic and reasoning, and visual and auditory processing; all are interdependent though they often are integrally used in their work with other skills.  Individuals with brain injuries (cerebral palsy, CNS dysfunction, autism, epilepsy, etc.) experience “malfunction” in how their brain processes information, pays attention, reasons or remembers things.  Jamie, the young woman I observe in OT, experiences what I call “cognitive disconnect,” a very non-medical term.  She struggles with cognitive reasoning, social etiquette and attentiveness to details. 

One of Jamie’s OT goals in working with her therapist Jill is to learn social appropriateness. 
Jamie loves horses.  And the television show “Friends.”  And socializing.   One day prior to her appointment, I found Jamie sitting in the lobby waiting for Jill.  I decided to wait with her and take the opportunity to learn more about Jamie outside the therapeutic setting.  As we visited, I better understood the social aspect of her challenges. 

After the obligatory preamble of “how are you” exchanges, Jamie suddenly launches into discussion about a horse, who the brood mare was and its bloodline.  Mildly off balance by the sudden, disorienting flow and rhythm of the conversation, I struggled to track Jamie’s line of thinking as she jumps around within the exchange.  She tended to talk fast, sometimes mumbling her words.  Once the topic came to a pause, I asked Jamie if she owned a horse.  No, she said but she rode them.  Familiar with a local organization called Dream Riders of Kentucky, a therapeutic riding program for individuals with disabilities, I asked if she participated in their program.  She does, and off we go again on another conversational ride as she names all the horses’ she ridden, which are her favorites, one that recently died, and other particulars she felt important to share.  Jamie even pulls her cell phone out to show me a photo of a horse and launches into more details about the horse and its personality.  I relax in resignation to simply listen.  She loves riding horses with Dream Riders; she plans riding again later this summer. She doesn’t work; she goes to a pet store where she volunteers to help with the animals; she really loves animals.  She’s a huge fan of the TV show “Friends;” she stays up late watching the show; she’s tired.  Her sister is an OT therapist in CORF.  She lives with her mom; she goes out with a gal to do fun stuff in the community.  She has a boyfriend who she says better not make her mad.  (I did manage to inject that I’ve yet to meet one that doesn’t, wishing her luck with that one.)  She wonders aloud where Jill is; she tells me she’s getting old, and she’s tired.  She shares what happened on the “Friends” episode; she thinks Joey’s cute but says he’s a mess.

And all this in the five minutes we spend waiting on Jill.  Jamie loves visiting with people, and she’s a charming young woman that grabs your heart with her openness, honesty, and compassion, especially for animals.  This conversation offered me greater insight to what was important to Jamie, and a better understanding of her social challenges. 

With Jill’s arrival, we move to Jamie’s OT session where today’s activity is “Survey says!”

In the Next Blog Entry: Survey Says! - “Jamie misses or forgets . . . . to say “Excuse me” but launches into “Hi, I’m Jamie.”  Sometimes, she goes right to the question . . . . without introducing herself.”

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Reverse Discrimination

Twenty-three years old, Jamie lives at home with her mom but for the most part is fairly independent and self-sufficient.  Upon our initial meeting, I notice no obvious disabilities but through my observation of her occupational therapy (OT) sessions, Jamie’s challenges become evident.  Jamie has central nervous system dysfunction; at some point her brain suffered an injury, mildly impacting her cognitive skills and muscular motor skills.  Cognitive skills include attention (both focus and to details), memory, the speed at which one processes information, logic and reasoning.  Motor skills involve movement of the body’s muscles: gross motor skills are the abilities to control the larger muscles of the body for walking, jumping, running and other such activities.  Finer motor skills deal with smaller actions, such as grasping an object between a thumb and a finger.

Jamie’s developmental disabilities are mild and subtle, leaving me to wonder upon meeting her as to why she was even in OT at all.  In conversation, Jamie will often repeat a statement over and over again, injecting it into the conversation at unusual times. She’ll also change the subject dramatically from the topic being discussed, revealing some social challenge.  Jamie also struggles with follow-through on basic tasks or projects.  Her attention to details, for example, to cooking something or brushing her hair may go unattended or unfinished. I notice an awkwardness in Jamie's body coordination when undertaking an activity that involves both her upper and lower body (gross motor skill).  Most wouldn’t notice these subtle cognitive impairments, and may perhaps pre-judge Jamie as “odd” or “inappropriate.”  Unfortunately, I’m told by her sister that these very subtleties challenged the diagnosis process of her disability through the years.  Without obvious presentation of her disabilities, others’ have refused to accommodate Jamie's needs, which could ironically be considered “reverse discrimination.”  For example, Jamie’s request for bumper pads for the gutters at a bowling alley was once rejected.  According to the bowling alley, this accommodation tool is used for children, elderly and those with disabilities, and thus initially refused the family’s request for their use because Jamie didn’t "look like" someone with a disability.

Jamie started her OT sessions in November 2011 with Jill Boeglin after a therapeutic evaluation.  With input from both Jamie and her mom, they together identified a few OT goals for Jamie:  improve follow-through and safety awareness when performing a task, especially in the kitchen; develop attention to details when performing a task; improve social skills and etiquette; develop gross motor coordination as well as muscle strength and endurance in Jamie’s upper and lower body.  These goals will support Jamie’s ability to become more independent, and lessen concerns for her safety and well-being.

With these goals identified, Jill incorporates a variety of OT activities and exercises that will address the identified challenges Jamie experiences in her day-to-day function of living.  I am fascinated by the creativity Jill uses in administering the OT treatment, designed to support Jamie’s efforts in achieving Jamie’s goals in a fun and entertaining way.

First up:  Bouncing balls!

In the Next Blog Entry: A Ball of a Time - “Jamie bounces this ball. . . . I notice her struggle to keep control of its bounce. . . . . . Suddenly, the ball moves out of her bounce zone. . . ”

We want to hear from you!  Please share your responses and comments by clicking below on “Comment” – you may post them anonymously or using your gmail.com profile name.

“The educated do not share a common body of information, but a common state of mind.” ~Mason Cooley
Please share our blog with others via Facebook, Twitter, or email!  Follow our blog!  Click on “Join our Site” below.

Blog content is copyrighted property of Wendell Foster’s Campus for Development Disabilities and Carolyn Smith Ferber and/or other blog authors).  Content may be used, duplicated or reprinted only with the expressed authorization of the Wendell Foster’s Campus.  Permission for use, duplication or reprints may be made to wfcampus.org@gmail.com.