(upbeat music)
Welcome to Ideas at Play,
where we discuss pediatric research
and help you apply the ideas to your daily practice.
Each week, we'll review evidence-based ideas
to make you a better therapist.
I'm Dr. Michelle Allen Ease,
Director of Pediatrics at a Rehab Hospital
in Southern California,
and with me is my good friend and former co-worker, Lacey.
That's me, I'm Dr. Lacey Wright,
an occupational therapy professor in Kansas City.
We're a pediaties who love research and making it fun.
We've helped thousands of therapists
just like you to become more informed,
more playful, and more effective in their sessions.
Today, we'll be discussing
how to improve motor skills in kids with autism.
Let's get started.
Our first segment is nailed it or failed it.
Where we discuss things that worked
and what didn't in our practice this week.
Because if you're pushing for the just right challenge,
sometimes you nail it and sometimes you fail it.
So we're gonna be real with you on both sides.
Michelle, I think you have a failed it for us this week.
Oh, do I ever Lacey?
As you know, I sometimes work with kids in the pool.
So I do clinic-based OT,
but I also do aquatic-based OT.
And I have this little guy that I'm working with
and he's been progressing so nicely.
My focus for him is on drowning prevention.
That's really what I want to achieve with him.
And so it's really important that if he submerges accidentally
that he can make it back to the surface of the water, right?
So he's been doing so good and making so much progress.
So this week I was like, yes, I'm gonna test him.
So I had him jump off this little aisle into the wall
knowing that he wasn't gonna make it
and he was gonna sink to see if he would come back
to the surface and I'm telling you,
this child sunk like a rock.
Oh, no, no reaction to save himself
and come to the surface of the water.
And to make matters worse, he is a kid
that has high medical needs.
He doesn't take water by mouth normally.
So worse, he's cleared to be in the pool.
It is, he's cleared to be in the pool,
but I'm telling you, I felt like, okay, now I'm murdering children
in the pool.
So that was definitely my failed it for this week.
I will know next time to go a little bit slower
before I test him for that skill set.
Oh, Michelle, I totally know that feeling.
When you're excited and think your kid is ready
for that next step, but they're just not.
Well, lace, as you know, sometimes you're gonna nail it,
sometimes you're gonna fail it.
And it was my week to fail it.
So lift us up with your example of how you nailed it this week.
- All right, I work with transitional age youth
and adults with intellectual and developmental disability.
And we were doing a class learning about conflict management
and I found the best video.
And we shared it kind of like a video modeling thing
on conflict resolution, but not only did it go well,
but the video was an English as a second language video.
And it was perfect because the actors talked a little bit
slower, they had better facial expressions.
And the video was the perfect cognitive level.
So it was like one of the best classes that I've ever taught
with my group, woof.
- Now that is a good nailed it.
I mean, finding a good social modeling video
is worth its way in goal.
That is so hard to get.
- Yes, especially for that older age group,
there's a lot of videos for really younger kids.
You think of Disney movies, cartoons,
but this was great because it was adults,
modeling work behaviors for adults.
So I was thrilled, nailed it, nailed it.
- Our next segment is the research review
where we break down the latest in pediatric research
and explore how to apply it to your sessions.
This week, Michelle has an article about motor skills
in autism.
- Lacey, I'm excited about this article
that we're reviewing today because it is so applicable
to our daily practice.
I feel like by the end of this,
you're going to be able to take ideas from this study,
push it into your practice, and hey,
maybe it'll show up and our nailed it
and failed it next week, I guess we'll see.
- That'd be great.
The research is titled "Efficacy of Motor Interventions
on Functional Performance among Preschool Children
with Autism Spectrum Disorder,
a pilot randomized control trial."
Now, that is a mouthful.
- That is long.
You got to break it down for me.
- I'm telling you, all of these research studies,
like who names these?
They need to have a character restriction.
Basically, this is a study where they're looking at autistic kiddos
who are in that preschool age range.
And they want to see what type of intervention
is going to be really effective
for improving their motor skills.
And the reason I love this is because almost every kid I see
with autism, I'm working on motor skills
because it's something like,
I think that statistic is 86% of kids with autism
also have a motor skill delay.
And so it's really important for our kiddos.
- Oh yeah, definitely.
So what did they do in this article?
- Okay, in this study, they gave us a step-by-step play-by-play
of how to implement the intervention in your session.
But the first thing they did was they identified a target motor skill.
And the motor skills that they were choosing from
are called fundamental motor skills.
- Okay, fundamental motor skills.
Tell me more about that.
- So it's skills that we would test on the bot
or the Peabody-like balance or locomotion
or bilateral coordination, things like that.
So first you identify what is the target skill
you're trying to improve.
And then you do three different activities
that are targeting that skills.
So for example, if you're working on balance,
they have one where they have the child on a bosu ball
and they're collecting bullets off the ground
to throw at the monster
and they're working on balance in that way.
And they have another one where they have them
also on a unstable surface
and they're trying to avoid being hit by the monster.
So they have these three different activities.
Yeah, it's play-based, it's targeting balance.
And the key difference between just like a regular session
is they're videotaping some of this.
So after they've done the three activities,
they sit down, they talk with the child and they say,
what was hard that we did today?
And then they go back and they do that one hard thing again
and they videotape it.
And that video is gonna serve as their starting point
for the next session.
So when they come back the next week,
they review that video together.
They talk about what made it hard, what made it successful.
And then they try it again
and then they just build on it
week after week session after session.
So that's the summary of the intervention.
Oh, I love a good routine.
So it was like the same kind of three steps every session
and they just kind of kept building on each other, right?
Yeah, isn't that great?
I love it when they provide me with a recipe.
Step one, step two, step three and do this much of it.
Yes, thank you.
I need a little bit less problem solving in my life.
Well, it sounds like a great study,
but let's get down to it.
Did it help the kids or not?
It actually did help the kids.
I am always shocked when I see that someone improves
on the bot because I feel like none of my kids
ever show change with that test.
But they did, they improved on the bot
and they also improved on the Vinland motor skills.
So win, win.
Excellent.
And it sounds very like cognitive.
Did they use the co-op at all?
Did they mention that?
Yeah, it does sound very co-op-ish.
Co-op stands for cognitive oriented orientation
to daily occupational performance, I think.
That's it, that's it.
So yeah, it does sound very co-op-ish.
They didn't explicitly reference that intervention,
but it's definitely leaning in on collaborating
with the child, reviewing the work,
and discussing how to improve it.
So of course, the kids that were included in this study
are those kids that have less severity of their autism,
have more language ability,
have more ability to have that kind of discussion.
Yeah, it sounds like you'd have to have a lot of self insight,
right, to pick the hardest thing and then do it
and reflect on it again afterward.
Yeah, absolutely.
So I can see, I have a subset of kids
that I could definitely use this with,
but a large majority of the population I see
are not quite at that level of being able to do that reflection,
especially if they're at the preschool age.
So I've been thinking about how I might play this out
in my session.
Yeah, what do you think you do with those kids?
Well, I'm thinking like, okay,
so I've used video modeling in tons of sessions before.
For example, I have one kid who's an emerging verbal client,
he is still learning how to sit and follow directions
and all those things,
and he's working on shoe tying.
And so we've worked on video modeling
to facilitate that shoe tying.
And I do think that that's been helpful for him,
but the difference between that and the study is,
in this study, they're not videotaping
a particular occupation like shoe tying.
They're actually videotaping the performance skill,
like the balance, because I think
the concept is let's improve this fundamental motor skill and then in turn that's going to have
an amplifying effect where it's going to improve a bunch of occupations instead of narrowing
down and focusing on just this one occupation of like shoe time for example or my kiddo that maybe
has less language ability I would still use the video modeling but instead of recording the
occupation record the actual session and then just put it on a playback for him maybe give it to
the parent because I know with those kids a lot times just more repetition helps so they could
play it at home over the week until I see them the next time and see if that helps with it.
Wow that's really interesting. Yeah I will tell you something kind of funny then when I tried
team number four. Okay is this like a bonus failed it? No no well well maybe or maybe it's a
nail that I'm assuming the worst. It's kind of bug. Okay so a lot of the studies have shown that
video modeling is helpful and that it should be first person perspective right when the child's
looking at the video it should look like what they're seeing when they're looking so I was trying
to record a task with the video camera and first person and I like had it like propped up on a
thing and it kept falling over and the kid got obsessed with the camera and then it was like
recording me on accident because I had the camera. Oh no. Many people did it with it comes to video
modeling. I highly suggest having a student with you when you're doing this because they can be
your extra setting ends. Yes. Which is very nice. Or maybe a GoPro you know I mean that can work.
Yes yeah it is so nice. Shout out to students. Capstone students field work. I love it. So helpful.
I love it. So what else do we need to know before putting this into practice? There's three things we
should always think about when we're reviewing research and seeing how we can apply it to our clinical
population. We want to think about what was the population of kids that were included in the study.
What were the key ingredients and what was the mechanism of action? Perfect and I think you covered
the population already right? Preschool age children who had autism. Great so we got the population
down. Tell me next what are the key ingredients? The key ingredients are the things that need to be
present in any session if you're going to try to apply this into the session. So you want to make
sure that you include targeted practice. Augmented feedback and in this study the augmented feedback was
the video modeling and the discussion around what was happening. You want to do collaboration with
the child and also engage in that guided review. Excellent. And what was the mechanism of action?
So the mechanism of action is why did this actually work? And it's so important when we're thinking
about how we can apply it because maybe our population is kind of different. Maybe we can't do
every single piece of the study exactly like it was done. But if we understand why it worked,
then we can apply it to a bunch of different types of clients. So the mechanism of action in
this study is really heavily leaning into the motor learning theory. And I know you as a professor
know what I'm talking about when I say motor learning theory. I love some motor learning theory.
This is a funny backstory with me and Lacey but when we used to work together she was always
talking about like the frame of reference or the theory. And I'd always be like what is that relevant
to anything? And I just it's always a point of discussion with us. And it's coming back around
today Michelle. It isn't for a note at all. Yeah I have to say definitely you're the winner
in this debate. The theory is important. So in this one the motor learning theory of course
relies heavily on high repetition practice and then also identifying what type of feedback you're
giving to the client in order to improve that motor action. And there's tons of different types of
feedback and tons of different types of feedback schedules. But in this case they're using that video
modeling as visual feedback to help the child to improve their performance time after time.
I love how the researchers really play to the strengths using video modeling right because we know
a lot of kids with autism really rely on their visual skills. Yeah it's actually really interesting
because when you read the studies on autism they find that people with autism ironically tend to
rely on proprioceptive feedback as their primary feedback for motor skills. Even though their
visual skills are so much stronger it's like there's something about that body sense that that
inward sense that they rely they want to rely on that more. But we know that oftentimes the
proprioceptive system isn't working that great for them. And so it's not giving them the best
feedback. So it is interesting how they decide to use a visual support to help with that feedback
even though it might not be intuitive that that's the way someone with autism wants to learn the
feedback. Wow fascinating. So yeah using visual system to show them where their body is in space so
that they can learn more about their proprioceptive sense. That's right exactly. Yep that's it.
And that's it for our research review for this week. Now Lacey is going to share with us our next
segment called People Places and Products where we give a shout out to something we're really loving
this week. Lacey? Yes my shout out this week is to the most fabulous toy store in Lawrence Kansas.
Ironically it's called the toy store. It's three stories tall and has every kind of toy you
want. I went with my family recently and we spent so much time in that toy store. I feel like
I might not ever leave if I went in there. No it was we got lost on like the different floors and
it felt like Indiana Jones adventure everything. But anyway I came across a section that was
cooperative board games for younger kids and it brought me back to when that we were working together
and and with our dear friend Kristen with pediatric groups right these are our groups where we're
working on making friends sportsmanship taking turns all those good things and these cooperative
cooperative board games were from game right and peaceable kingdom and they had these really
cute games. One was like Hoot Owl Hoot. I remember doing one like dinosaur escape. So anyway
these games are just really really fun. I see a lot of cooperative games for adults. I love a good
cooperative game but these are tailor made for like preschool young elementary age and they're so
special and fun when you want to work on these skills but don't necessarily want that competitive edge
losing can really mess up a session if that's not something you're targeting at the moment. So
shout out to the toy store Kristen and cooperative board games. Well I can't wait to come out to Kansas
City and see that toy store we'll have to take a little field trip together. Yes yes we'll get
lost together in there. So fun. In this next section we are going to answer listener questions
because we know you have questions and we have answers for you but because this is our first episode
we don't have a question yet so we're relying on you please send us your questions to ideas
at
[email protected] or you can dms on social media and we may include your question in a
future episode. Yes please send us your questions we want to hear from you. This week we reviewed how
to use high repetition practice partnered with video modeling to help our autistic preschoolers
learn new motor skills. Remember the steps include choose a fundamental motor skill to target
like balance or manual dexterity. Provide augmented feedback. Collaborate with the child and do
a guided review of how it went at the end of the session. And that's it for today thank you for
listening to ideas at play. If you learn something new from today's podcast be sure to leave a rating
and review. This helps others find our podcast so we can all be evidence-based therapists.
Until next time try to make each session better than the last. Stay informed, stay curious, and stay
playful.
We did good. I can't believe we did it. I'm so proud of us.
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