Unbabbled
Unbabbled
Rachel Czar: What is Occupational Therapy? | Season 5, Episode 8
In this episode, pediatric Occupational Therapist Rachel Czar answers all our questions about the basics of occupational therapy (OT) including our most commonly asked question- what is OT? Throughout the episode Rachel discusses signs a child might benefit from OT and how to obtain an evaluation. She also discusses ways specific areas of difficulty may impact a child at school and at home, as well as skills an OT may address with a child. While the profession is broad, Rachel helps break it down for parents, caregivers and other professionals.
Rachel Czar, MS, OT, is a pediatric occupational therapist at The Carruth Center in Houston, Texas. She holds both a Bachelor’s of Science and Master’s of Science from the University of Texas Health Science Center and is Sensory Integration Praxis Test (SIPT) Certified. Prior to joining The Carruth Center, Rachel worked as a lead in a DIRFloortime® preschool group in Dallas. She also has experience working with children in outpatient clinics, home health and in schools. She has experience helping children with feeding issues and has Handwriting Without Tears® training. Rachel is passionate about helping children with autism and sensory processing disorder. She believes that a child’s occupation is to play.
The Parish School Website
Stephanie Landis (00:06):
Hello and welcome to UN Babbled, a podcast that navigates the world of special education, communication, delays and learning differences. We are your host, Stephanie Landis and Meredith Crum, and we're certified speech language pathologist who spend our days at the parish school in Houston helping children find their voices and connect with the world around them. Hey, this is Stephanie jumping in really quickly to tell you about our sponsors soccer shots. Houston, the Parish School has been lucky enough to have a group of students participate in soccer shots right here on our campus for the past couple of years. And it has been an amazing way for our students to be a part of a team. Soccer shots began programming in Houston in 2009 with a goal of positively impacting children's lives and supporting their learning of their favorite game soccer. Their program was formed under the guidance of childhood education specialist, professional soccer players, and experienced and licensed soccer coaches. They use a developmentally appropriate curriculum that meets children where they are, and the coaches place an emphasis on character development and skill building. The coaches use words like respect, confidence, and determination in their weekly classes. To learn more about soccer shots, visit their website@www.soccer shots.com/houston. Again, that's www soccer shots.com/houston.
(01:26):
In this episode, occupational therapist, Rachel Czar, answers all of our questions about the basics of occupational therapy or ot, including our most asked question. What is ot? Rachel is a pediatric occupational therapist at the Cruise Center in Houston, Texas. She holds both a bachelor's and masters of Science from the University of Texas. Prior to joining the Cruise Center, Rachel worked as a lead in a D I R floor time preschool group in Dallas. She also has experienced working with children in outpatient clinics, home health, and in schools. Rachel is passionate about helping children with autism and sensory processing disorder, and she believes that a child's occupation is to play. Throughout the episode, Rachel discusses signs a child might benefit from occupational therapy and how to obtain an evaluation. She also discusses specific areas of difficulty that may impact a child at school and at home, as well as skills in OT may address with a child. While the profession is broad, Rachel helps break it down for parents, caregivers, and other professionals. Welcome. Today we have our guest, Rachel Zar. She's an occupational therapist at the Crew Center, and we're excited to talk to you today.
Rachel Czar (02:32):
Thank you. Good morning. Thanks for having me.
Stephanie Landis (02:34):
So what got you into the field of occupational therapy?
Rachel Czar (02:37):
Well, I knew that I wanted to work with people. I wanted to help people and I wanted to have a career, especially that I could work with children. My mom was a speech and language pathologist and my dad taught special education. So I was used to being around just people that might need some extra help. So I, the more I looked into it, the more I enjoyed it and thought it would be a good choice.
Stephanie Landis (03:01):
Fantastic. So I get this question a lot and you probably get it even more when I talk about occupational therapy. People are like, what is occupational therapy? Especially with kids when they're like, my kid doesn't have a job, why they need occupational therapy. So can you give us a brief intro into like what occupational therapy is?
Rachel Czar (03:17):
Absolutely. And yes, that is very common. Um, so we are in the allied health profession and our job is to help people of all ages, um, complete their routines, complete activities of daily living that are meaningful to them. Um, if they're struggling in that area, we provide therapy to help them complete the occupations that are important to them.
Stephanie Landis (03:42):
So a child's occupation,
Rachel Czar (03:44):
Their main occupation is to play. So it makes for a very fun job,
Stephanie Landis (03:49):
<laugh>.
Meredith Krimmel (03:51):
So for parents of young children, what might they see that would be concerning that would lead them to believe maybe occupational therapy is something they should look into?
Rachel Czar (04:00):
Well, for one thing, if they're having trouble coming up with ideas, um, maybe they're, they take their child to the playground and they don't seem to know what to do or how to navigate the equipment. Um, if they're struggling as they get older in their daily routines, if they're having trouble, maybe as they're learning to eat, pick up the cup or drink from a straw, pick up food feed themselves, um, if they're having trouble learning how to take their clothes off, like taking their shoes off when they come inside, things like that. Um, if you're presenting them with toys at the home or in other settings and they just don't seem to have a plan or seem to be playing, um, purposefully and meaningful, meaningful,
Stephanie Landis (04:42):
We end up seeing a lot of referrals on, in our school for occupational therapy with handwriting. Do you address handwriting as well?
Rachel Czar (04:49):
Yes, absolutely. We focus on a lot of, um, task that are required by the upper extremity. So the whole arm and hand. We work a lot on helping children learn how to hold the pencil correctly, form their letters and numbers correctly, tons of fine motor skills. We also work on gross motor skills, but we really focus on those things that require, you know, using your hand like scooping with a spoon, um, cutting, doing puzzles, blocks, um, tying shoes, things like that.
Stephanie Landis (05:21):
Do you find a lot of overlap with physical therapy?
Rachel Czar (05:25):
There is some, but it's definitely very different. Um, they focus more just on the gross motor. There is some things that do overlap. Um, you know, sometimes we do work on balance. I do work on core strength. Core strength is needed, so you can sit in your chair and sit upright, um, and attend to the teacher or be able to do your, your writing. Um, so there is, but it's definitely a completely, um, different profession.
Meredith Krimmel (05:51):
So in my personal experience with ot, my son was in kindergarten when his kindergarten teacher recommended. We get evaluated because of his handwriting, but also because, um, more of the sensory. He was kind of slumped over in his desk. He didn't always feel food on his face or glue on his fingers. Can you talk a little bit, we talked a little bit about the handwriting, but can you talk a little bit about the sensory piece of what occupational therapists do?
Rachel Czar (06:17):
Yes, definitely. So we all modulate to the sensory stimuli in our environment differently. So sometimes you'll see a child that might be under responsive, like what you're talking about, maybe they have decreased body awareness, so they're not realizing when they're getting messy, they're having trouble knowing where they are in space, knowing where their body ends and space begins. So we definitely wanna address their sensory needs. On the other end of the spectrum, we might have some children, um, that need a lot of extra sensory input to get their bodies organized and regulated. So you might see some maybe unsafe or maybe inappropriate, um, sensory seeking strategies. So it would be our job to work with the family and the, the team and the teacher to give them safe and appropriate sensory strategies to get that extra input that their body needs to be regulated. And what
Meredith Krimmel (07:08):
Might that look like in the
Rachel Czar (07:10):
Home or a preschool? Well, at Carruth it definitely, um, we use suspended equipment. So we have swings and tunnels and crash pads at home it might just be doing something like, you know, pulling a wagon, a heavy wagon around the block or, um, you know, spending, taking a, um, a warm relaxing bath at night before bedtime, maybe doing some squeezes, um, before getting in bed, maybe a weighted blanket, things like that. Um, yeah, so those would be some, some simple examples. Maybe at the home, in the classroom we might introduce like a wiggle cushion or maybe a fair band around the chair so they have an opportunity to stretch the band with their legs. They might need a fidget, they might need mints, they might need gum. A lot of times when kids are seeking out that extra input, they're wanting something for their mouth and that can really help them, um, be, be regulated.
Meredith Krimmel (08:07):
So one of the signs that might lead you to believe there are concerns would be maybe chewing on their clothing or chewing on non-edible items in the classroom or at home, um, or like crashing into people and things like that. Is that kinda what you're looking for in terms of knowing if you should explore this route?
Rachel Czar (08:23):
Yes, absolutely. Just that they're demonstrating a bunch of sensory seeking behaviors that may not be safe, like eating something that's not edible or may be disruptive or just may not be appropriate. So maybe providing instead of if they're crashing into a peer in class, maybe there's a beanbag in the class where they can go and lay down on that or crash into that. Parish does a really nice job though of giving the kids a lot of movement breaks with all the, the time outside, um, et cetera. So that helps too. But if it's just, if they're, if it's really disrupting their day and disrupting the rest of the class, it may not hurt to get a referral and get an evaluation if we want them to be safe, still get that input that they need. But let's do it in a really, a nice, safe way. Mm-hmm. <affirmative>?
Meredith Krimmel (09:10):
Yeah, especially for my son because he was a climber and a jumper, but also he was that hyposensitive, so he didn't really seem to feel pain like a lot of other people did. So I was so glad when we got him into ot, we saw, we went to the cruise center and we saw great improvement both on his handwriting and some of his sensory needs. And he now still climbs and he still jumps, but he does it in a much more safe way.
Stephanie Landis (09:34):
What would be the first step in seeking out an occupational therapy eval?
Rachel Czar (09:39):
Well, a lot of times I just tell the families to have their pediatrician write a, write a referral or maybe just talking to the teacher if they're having trouble.
Stephanie Landis (09:47):
And where would most people go to get occupational therapy?
Rachel Czar (09:51):
Well, you can always call your insurance if you're looking to do something that's in network and have them provide you a list of providers. A lot of our, the clients that I see are students at the parish school, so we have the convenience of, of carruth being, um, really close by. But just talking with your doctor and you know, calling your insurance if you're wanting to go that route. Maybe if you have like a friend or family member that has also had, you know, ot, maybe talking to them and getting some advice from them.
Stephanie Landis (10:21):
Word of mouth is always a great way to find a good therapist.
Rachel Czar (10:24):
Mm-hmm. <affirmative>, yes.
Meredith Krimmel (10:25):
We talked a little bit about the hypo kids, but what kinds of things might you see in a kid who's more hypersensitive? Um, which would be another reason I would think you would wanna look for an occupational therapist.
Rachel Czar (10:36):
So the hypo would be like, they have low registration, so the, they need extra input to know like where they are in space, when they're getting messy, when they're feeling pain. Um, the hyper might be if, if their visual system is hypersensitive, they might have trouble just attending to their desk or what's on their desk. They might be looking around or looking at other students. That's a big sign. They might be distracted. Um, and or it might be an auditory, um, hypersensitivity. So that would be, you know, maybe extraneous. Sounds like the air conditioner running or other people talking can be really distracting for them. So we would wanna provide them with opportunities to probably get some proprioceptive or vestibular or heavy work to be able to regulate themselves and hopefully they wouldn't be quite as hypersensitive to that unimportant information in their environments.
Meredith Krimmel (11:30):
I'm one of those people who can hear like the low buzz of the lights. Yes. I feel very sensitive to it.
Rachel Czar (11:36):
<laugh>, yes, ev all, all of us have our own sensory needs and sensory issues. Um, but if we're able to manage it on our own then that's great. But a lot of the kids that we see just, they need that extra help. They need that team approach and that home, uh, program to be able to get everything regulated and organized.
Stephanie Landis (11:55):
I think that's a great point. I mean, we all have something that we're a little bit sensitive to or sensory needs. You're saying that once it starts impacting their daily life is when they would reach
Rachel Czar (12:06):
Out? Yes. Yes. Because you'll see as they get older, their occupation changes from just being, from playing to being a student and that creates a whole new, you know, set of challenges and demands. And if it's really impacting their ability to learn or get along with peers, um, in social situations, then you might wanna seek that out.
Stephanie Landis (12:28):
One of the things you discussed was then difficulties with planning and you spoke about play. What would a difficulty with planning look like in an elementary age student?
Rachel Czar (12:37):
Um, that's a really good question. So I mentioned, you know, a lot of times they'll, they'll go on the playground and they won't seem to have a plan or know what to do. Um, they might have difficulty, you know, coming up with um, an unstructured game with peers. If there's not a set list of rules, they might have trouble, you know, coming with up with ideas on their own or being flexible. So that might be one example.
Stephanie Landis (13:03):
Mm.
Meredith Krimmel (13:04):
What about in academic work? What would you look for in the classroom when they're working
Rachel Czar (13:09):
For difficulty with motor planning? Mm-hmm. <affirmative> probably just coming up with, you know, ideas, flexibility, um, maybe needing the teacher to repeat the instructions if they're distracted or if they're just having trouble coming up with something they might need extra time for. Um, assignments that need, you know, more creativity or not a complete specific set of rules.
Stephanie Landis (13:37):
I've worked with students that also seem to have difficulty with like visual tracking and so like looking at the board and then copying in on their paper and going back and forth seems to be a difficult Is that another area?
Rachel Czar (13:48):
Definitely, yes. My own son has dysgraphia and that is very hard for him. So one of the things that they do at his school, well he's, he's, he's getting occupational therapy and his OT is teaching him cursive cuz sometimes that's a lot easier than writing in print. Um, they're, they provide him with a copy of the notes to have on his desk so that can, and there are some occupational therapists that, um, specialize in ocular motor exercise to help with that convergence, divergence in the visual tracking and switching their visual attention from near to far.
Stephanie Landis (14:23):
Can you explain a little bit more about what dysgraphia is?
Rachel Czar (14:26):
So dysgraphia is difficulty with handwriting, so there's really no cure for it. So as an OT we did lots of handwriting without tears, um, when he was in first grade and kindergarten and preschool, but it just didn't seem to stick. So now we're providing him with, you know, alternative strategies and decreasing his writing, uh, workload
Stephanie Landis (14:50):
In the classroom. A lot of our students here at the para school have difficulty with fine motor handwriting, uh, reading and we found that using an iPad and having them do speech to text has really improved their ability to get more out cuz they don't shut down when they have to physically write a whole sentence and they come up with so much more. It's amazing how much technology has been able to support these kids.
Rachel Czar (15:14):
Yes. And that's such a great alternative and that's so great. They can be more successful that way and get more of their thoughts out, like you said. And if you think about it are the world that we live in, we do write, we need to fill out forms, we need to fill out a birthday card, we need to make a grocery list, but a lot of what we do is on our phone, on our computer, on the tablet. So I think that's a perfect way to help the kids. And like you said, when they have that extreme dysgraphia, if you're, if they're continuing to have this huge written workload, they will shut down.
Meredith Krimmel (15:48):
Just thinking about other kids I've worked with in the past, something that I noticed for a lot of our kiddos who maybe needed some occupational therapy was trouble with daily routines in the classroom, like unpacking their backpack or getting their lunch and kind of manipulating their lunch items. Would that be another sign that your child might need extra support?
Rachel Czar (16:07):
Yes, absolutely. I always try to talk to the teachers like, are they able to pack up at the end of the day? Are they able to unload? Do they lose their materials? Yes. Cuz that's part of their, that's part of their daily routine. They need to be able to manage their own belongings and their supplies. So that's absolutely something that the OT can work on.
Meredith Krimmel (16:26):
Yeah, I'm thinking about my son who has dysgraphia and adhd and um, a lot of the things you're talking about, these executive functions, the organization, that's, that's a lot of, um, he, he struggles with a lot of those things and I know his occupational therapist at school was really there to support more of the organization. How do you support that? What is what what are some tips or strategies we could use at home to help our children manage their belongings?
Rachel Czar (16:52):
Um, definitely visuals. So a visual schedule is nice. Um, having a spot for things. So every day the backpack goes on this hook, every day the shoe goes, the shoes go right here on the shoe rack, the jacket goes on this hook. Um, prepping as much as you can the night before to help that morning routine. Um, be a little bit smoother and faster. And then also in the school setting, what we do every me and my husband, every year when the school starts, we go in and we label every single one of my son's school supplies because if not, he will lose it. Everything has his first and last name and we also put um, mandalorian stickers. So he has <laugh> two visual skew, uh, cues. His supplies look very different and we also have like an open container for him so he doesn't have to put, try to shove it all in a pencil box and put it in his desk. He has the open container, each section is labeled and he can see it. It's a nice visual for him.
Meredith Krimmel (17:55):
Oh yeah, that's great. We buy my son the very bright colored water bottles that hopefully will stand out because I am now convinced that his school is a graveyard for his water bottles. They just go and they never come home ever. But we label everything and we were still really struggling and the visuals is what we ended up doing. We clipped these little laminated squares with a picture of his actual water bottle onto his backpack and it has actually been more successful and his water bottles are like very bright and we send the same one every day. They don't look different. He doesn't have to remember which one he brought. It's like the same water bottle every day. We're finally having some success
Rachel Czar (18:34):
<laugh>. That's great. Yes, sometimes they do need, instead of a printout, an actual picture of the item can help. So that's a great idea.
Meredith Krimmel (18:42):
Sarah Ward,
Stephanie Landis (18:43):
She's great. It sounds like occupational therapy as a field is extremely broad. One of the things you talked about at the beginning was if children were having difficulty with like feeding and swallowing, do you work on that with only young kids or will you work on that through elementary age as well?
Rachel Czar (19:00):
So for OT, we work more on the oral motor piece and the sensory piece. Um, all ages. So the actual mechanics of the, the swallowing would probably be more in the speech, the slp, um, their realm. It just depends on the therapist and what they're training. But I work a lot with older kids, um, on expanding their pallets. So we want them to have, you know, eat a variety of foods, we wanna make sure they're not eliminating an entire food category. So we do a lot of um, really fun play with food to try to help them feel more comfortable. It's probably be that and handwriting are probably the two biggest things that I see, um, as a need, uh, that the kids need at um, as far as our referrals to Carruth for ot. So sometimes it's, it's usually not just an oral motor thing, it's usually an oral motor and a sensory thing.
(20:00):
So we try to work on both of those things. Some kids have trouble drinking from an open cup. Um, if they're having some di difficulty with fine motor coordination, stabbing food might be difficult. Um, scooping food, especially like, you know, really thin liquids like maybe cereal and milk might be tricky. They might be spilling a lot. So we definitely work on feeding. It's, it's important we want, um, our families to have um, peace at mealtime when we go to social situations. We don't want our families to constantly have to be packing um, food for their child. So we really, really try to help the families in that areas as well because eating is so important. We have to eat to live and it's something that we do every day throughout our day.
Meredith Krimmel (20:43):
And when you say oral motor, can you talk a little bit what you mean by that?
Rachel Czar (20:47):
Yeah, so some kids will, they have difficulty, they might have decreased, um, you know, awareness like you were talking about your son, they may have that in their mouth. So a lot of the children that we see may be pocketing their food so they may put it in their mouth and it stays in their cheeks. They might have trouble, um, chewing with their molars on their own. They might just put everything in the middle of their mouth and they might have difficulty with their tongue movements. So lateralizing their tongue to be able to move the food over to the molars for more efficient chewing. Some have difficulty with lip closure, which you might see, you know, them spilling their liquids or their food out of the front of their mouth.
Stephanie Landis (21:29):
And any sensory difficulties. What would that look like in feeding?
Rachel Czar (21:32):
Yes, absolutely. So first of all, we all have our own sensory things. Like I said, like I've never, I don't think I've ever eaten cottage cheese, but just the side of it, I know I could not handle that texture <laugh>. So we all have our issues and things that we don't like to eat, which is def definitely fine, but if it's interfering, if mealtime is very stressful, if you're having to buy specific brands and if they've eliminated an entire food category, I usually ask families to send a list of everything that they do eat so that I can look for a pattern. So maybe they don't eat anything sticky, maybe they don't eat any mixed textures, maybe they only want crunchy foods. So that would be where you see the sensory component, um, come out.
Stephanie Landis (22:17):
One of the things you touched on at the beginning was talking about activities of daily living. Can you expand a little bit on more what those are and how that might, how you might support a child in that? Yes,
Rachel Czar (22:26):
Absolutely. So our ADLs are grooming, feeding, dressing, bathing. So if the child is having trouble or not meeting their milestones, if they're, you know, maybe they're older and they still never mastered putting their socks on, that might be a sign like you mentioned, as they get a little bit older, managing their, their supplies, their backpacks, things like that. They might have trouble, you might see difficulty with this if their fine motor skills are struggling. So, you know, tying shoes, zipping up their zipper, unbuttoning buttons, things like that to, you know, being able to tolerate if there's some sensory things going on, they might have trouble tolerating the bath or tolerate brushing their teeth. So anything that they need to be able to do to, you know, take care of themselves and be more independent in their everyday routines, we would definitely talk to the family and address in our sessions. Hand washing is another one.
Stephanie Landis (23:24):
I think that's an area where parents can be a little bit surprised about how much effort they are putting into helping their child and that they, their child, like mine might be eight and still having slip-on shoes <laugh> or oh I guess I am still pulling up my five-year-old's pants and buttoning them for them. Um, i that we just get so bogged down and it's easier for us to just do it that sometimes we don't realize how much we are sporting our kids until they're nine and they're like, I don't know how to cut my food.
Rachel Czar (23:54):
Exactly. Yes. I think as parents we all, we all have been there and done that. Um, I usually advise families to work on these skills in the evening or when you're not trying to rush out the door cuz it's very hard, especially in the mornings. It might be easier just to put their shoes on for them and so you can get going throughout your day.
Stephanie Landis (24:17):
Yeah, for my son it's not a lack of physically being able to <laugh>, you're just just like, no, you'll still do it for me. And I'm like, you caught me, we gotta go. So yes, I will pull your pants up for you cuz we need to leave for school. Gotta get better about that. All right, well we've really enjoyed learning more about the generalities of occupational therapy. Thank you so much. We do have one question that we ask every person at the end of the podcast and that's, if you had a piece of advice to give to our listeners, it could be on this or just any life advice, what would you give?
Rachel Czar (24:49):
Uh, my big advice lately is for those families that are struggling with feeding and my big piece of advice is just to have fun with food. Um, have positive experiences, even if your child doesn't eat a single bite, just creating those memories where they're doing something fun. Maybe they're baking something for a neighbor, they're making a salad for dad. Um, that's kind of my big advice that I've been giving lately. So
Stephanie Landis (25:17):
I love that. That's great advice. Mm-hmm. <affirmative>. And I think it goes for a host of things to just even when things are struggling to try and low pressure and have fun. Yes.
Speaker 4 (25:25):
Yeah. I like that.
Stephanie Landis (25:26):
Thank you so much. Yeah,
Rachel Czar (25:28):
Thank y'all.
Speaker 4 (25:33):
Thank you for listening to the Un Babbled podcast. For more information on today's episode, please see our episode description. For more information on the parish school, visit parish school.org. And if you're not already, don't forget to subscribe to the Un Babbled Podcast on your app of choice. And if you like what you're hearing, be sure to leave a rating and review. A special thank you to Stig Daniels, Andy Williams, Leslie Holly and Molly Weisselberg for all their hard work behind the scenes. Thanks again for listening.