Ep. 9 VR and Pediatric Brain Injury (3 Takeaways to Apply Across OT Settings)

Ever wonder how virtual reality could change your pediatric occupational therapy practice? Michele and Lacy dive into a randomized control trial where VR helped kids with brain injuries make progress in just four weeks of OT intervention! Hear about 3 game-changing elements occupational therapists can implement: instant feedback, kids actually wanting to do more repetitions in therapy, and automatic adjustments for that perfect "just right challenge" every OT strives for. No fancy equipment? No problem - these main ideas work in many OT settings. You'll also hear about a creative occupational therapy "Nailed It!" moment where a high schooler went from frustrating handwriting goals to playing guitar with adaptive equipment!

We share our own thoughts in the Research Review and encourage you to read the article too.

Choi, J. Y., Yi, S. H., Ao, L., Tang, X., Xu, X., Shim, D., Yoo, B., Park, E. S., & Rha, D. W. (2021). Virtual reality rehabilitation in children with brain injury: a randomized controlled trial. Developmental medicine and child neurology, 63(4), 480–487. https://doi.org/10.1111/dmcn.14762

KEYWORDS: Occupational therapy; OT; evidence based practice; OT ideas; Peds OT; pediatric occupational therapy; virtual reality; brain injury; cerebral palsy; CP

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Transcript

Michele: If you've ever worked with a child who has a brain injury, you know how hard it can be to recover those upper extremity movement patterns, especially forearm supination. What if I told you that you could do that in as little as four weeks? This study gives us ideas on how to work on upper body coordination to improve activities of daily living in kids with brain injuries.

Michele: 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. Michele Alaniz, director of pediatrics at a rehab hospital in Southern California. And with me is my good friend and former coworker Lacy.

Lacy: That's me. I'm Dr. Lacy Wright, an occupational therapy professor in Kansas City. We're peds OTs who love [00:01:00] 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.

Michele: This week we'll be discussing virtual reality and pediatric brain injury. Let's get started.

Lacy: I usually listen to podcasts when I'm driving or working on chores around the house, and that's a great way to make the most of that boring time. But it's not good for taking notes. So if you're in the same boat, we've got you covered. Sign up for our weekly newsletter where we'll provide a quick summary of the research and links to any products or places we discuss in the episode. Email us at ideasatplaypodcast@gmail.com. 

Lacy: Up first we have our Nailed It or Failed It where we discussed what worked and what didn't in our practice this week. 'Cause if you're pushing for that just-right challenge, sometimes you're gonna nail it and sometimes you won't. [00:02:00] Michele, you have a Failed It for us this week. What happened?

Michele: Well, first I was meeting with this mom and I felt so super proud of me 'cause we had this great meeting and we came up with this, a new treatment plan that I was honestly pretty excited about. And I had some cancellations. So I spent like hours planning everything and doing the research and coming up with my ideas. And then my big day comes where I'm gonna put.. 

Lacy: Oh wait. I know since you put so much into this, it's for going to

Michele: Mm-hmm.

Lacy: fail. Isn't that how it always works? Where the ones you're most excited about, just bomb and then the ones that are spur of the moment like, oh, that's a nice surprise.

Michele: It is like when you just let yourself go and just do the thing, your brilliance comes out. But when you pin in all the plans, disaster strikes, and that's what happened here. So I'm here with my fancy new plan, and basically I think I'm thinking I'm about to revolutionize this kid's therapy. And within minutes, absolute meltdown, like full on tears.[00:03:00] 

Lacy: No.

Michele: Through most of the session and the failed it was that I kept trying to push through thinking like she's gonna adjust. This can be great, but nope, it was a total disaster.

Lacy: Oh man, you, you were just holding onto that idea that it was a beautiful plan. Surely it must work right.

Michele: Yeah, I completely missed what was actually happening with this poor kid who doesn't have words yet, so she can't tell me, “Hey, what the heck is going on? You've like changed everything and I am scared and a little bit confused because everything is suddenly different” and I was just so wrapped up in my plan that I couldn't see that that was the problem.

Lacy: Mm-hmm.

Michele: So I had to spend like the next few sessions basically rebuilding trust with the child. Like, Hey, I'm still that same safe person you knew before. Let's work together and just get that trust back. And then I implemented the plan, just tiny pieces at a time. And I guess the lesson I learned is that even if you have the best plan, it means [00:04:00] nothing if you don't pay attention to how the child is experiencing those plans. And when someone can't tell you with your words, you better pay attention when they're telling you with their actions instead.

Lacy: Yeah, I get that you're, you're so excited and kind of in your own world that you forget to pay attention to the kids' cues along the way.

Michele: That's right, Lacy. Uh, hopefully next time I'll do a better job with that. Now you are up for a Nailed it for this week. So tell us about how you killed it.

Lacy: This is one of my favorite therapy stories of all time. I was going about my day doing school-based therapy and I noticed that I got a new high school kid on my caseload. I go to my mailbox, I read his IEP, and he has handwriting goals. So I go and see him and it turns out, 2 things. His handwriting was actually pretty good and he hated working on handwriting.

Michele: [00:05:00] What world are we in where we're doing handwriting goals for a kid that's in high school?

Lacy: High school right?

Michele: High school!

Lacy: I know. I was like, what therapist is still writing handwriting goals? So fortunately because he was pretty good, I felt like I could dismiss that goal at his 30 day IEP, or at least I would plead a case for it. But I didn't know what to replace it with and I knew I had to come up with something fast. We got talking and he loved talking about musical instruments. We actually played musical instrument charades where we acted out playing different musical instruments, the bass, guitar, drums, flute, and he was so into it. While we were doing that, I noticed that there was a guitar in the classroom as well that I had never seen before, I thought, aha we can do fine motor skills potentially, 'cause I still saw that need. But let's pivot from [00:06:00] handwriting to playing guitar.

Michele: What a win. I love that you looked at what he loved, what he is passionate about, what he's motivated by, and used that as the occupation to get the job done.

Lacy: Yes. Yes. And then better, I went to the 30 day IEP and the parents and the teacher were totally on board but I knew I was gonna have to get a little bit creative.

Michele: How are you gonna do this?

Lacy: Fortunately, Shark Tank saved the day.

Michele: Okay. Shark Tank.

Lacy: That week, yes, that same week a product was advertised called The Chord Buddy, it's basically a contraption that you put on the neck of the guitar to learn how to do chords really easily. In the OT world, it's an adaptive piece of equipment for anyone to learn to play. So I bought that - best 20 bucks I ever spent and took it to the school [00:07:00] and I got it set up. I changed the, the music so it was all color coded to match the chord buddy and the buttons that you hold down. And he was thrilled and I left feeling like a hero.

Michele: Yeah, that's definitely hero of that story. Actually, the cord buddy is the hero of that story.

Lacy: The Chord Buddy was the real hero. Yes, yes. but wait, there's more. I went back the next week and he was playing the song, you Are My Sunshine and he was actually crying

Michele: Oh sweet boy.

Lacy: Yeah. Something about that song just brought up a lot of sadness in him and the song is actually really, really sad. So we changed it

Michele: No.

Lacy: uh, so he learned, oh my darling Clementine, and that song was the winner.

Michele: Oh my darling. Oh my darling. Oh my darling. Clementine. That's taking me back to my Texas days.[00:08:00] 

Lacy: Yeah. And that song, he mastered and actually went around touring other classrooms a few months later, playing it for the different special ed classes on campus.

Michele: He is the cover band for Oh My Darling Clementine.

Lacy: He sure was. So

Michele: Oh, that's great.

Lacy: from that series of therapy sessions. I really learned that it's so important to use the student's interests and get creative and just really lean in hard into that.

Michele: Yeah, go with their passions and then, hey, if it makes them cry, that's not necessarily a bad thing because music does connect to our emotions and it creates empathy and it unleashes memories. So you were able to get both sides of the coin. The happy and the sad.

Lacy: Yeah, and I got away from the handwriting goal.

Michele: That was the big win.

Lacy: Yes.

Michele: Well, I'm gonna have to look up this Chord Buddy, because I wouldn't mind a little help learning to play the guitar. Maybe I'll put it on our social media so other people can see [00:09:00] it.

Lacy: 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, Michele has an article about how to use virtual reality for pediatric brain injury. Michele, tell us about your article.

Michele: This article is out of the Developmental Medicine and Child Neurology Journal. It was published in 2020, and it is titled Virtual Reality Rehab in Children With Brain Injury: A Randomized Control Trial. It's actually a international study, meaning it has multi-sites, one site is in China and one site is in South Korea. For this,

Lacy: Oh wow.

Michele: yeah.

Lacy: very

Michele: It is cool. They're looking at kids with brain injuries and they describe that as kids that either had CP, a stroke or they had a traumatic brain injury. The large majority of the kids in this study had CP, [00:10:00] but there were a couple of the others and they had a huge age range, so it was something like between three and 16 years old,

Lacy: Wow,

Michele: I know.

Lacy: sounds is like super diverse.

Michele: I know, I thought that was.

Lacy: usually they narrow it down a little more.

Michele: It's a little nutso. I mean, they must not have done a power analysis, a power analysis is when you're writing research and you're setting your method, you have to decide how many participants do we need to make this statistically significant? And the way you figure that out is you look at the age range and you look at the test measures and like how high quality they are, and you do a math formula and it tells you how many participants you need. If they had done a power analysis with this age range, they'd have to have like 6,000 participants,

Lacy: Oh my

Michele: but still they had 80, which is a lot for an OT related study. Normally the sample sizes are small, so I'm not hating on them.

Lacy: I'm excited about this article. So what did they [00:11:00] do?

Michele: They randomly assign these kids to two different groups. There's a control group where they just got their therapy as usual, and then there's an intervention group. And the intervention group have therapy as usual for 30 minutes, And the second 30 minutes, they did the virtual reality. So in the traditional intervention group, they gave a breakdown of what they did in their session and they were doing stretching. Strengthening and task oriented training, that's how they described it versus  the virtual reality, of course they were doing the, the gaming aspect, which probably included those elements, but that's the difference of the two, um, programs. So they had these two groups and I'm assuming they were in some sort of like inpatient rehab setting, or they just recruited them for the study because the frequency was one hour a day, five days a week for four weeks.

Lacy: Whoa. Five days a week. That's a lot.

Michele: It is, but it's only 20 hours of therapy in total. So that's very [00:12:00] doable on an outpatient basis. But yeah, the frequency was crazy.

Lacy: Mm-hmm. Yeah, it's like a big burst for a short amount of time.

Michele: Yeah. I mean, you know, that kind of approach, that high intensity approach is becoming more popular. I don't think that it's necessarily, um, strongly represented in the evidence, but hey, maybe that's the way to go. I wouldn't mind just doing 20 visits, you know, badda boom, badda bang, and now you're done.

Lacy: Mm-hmm.

Michele: So Lace, before we go into the specifics of this study, I'm just wondering, have you ever used virtual reality either for your treatment or just in your personal life?

Lacy: I haven't used it for treatment, but I love it in my personal life. We recently got, the Oculus and I thought I was buying it for my boys, but actually, I use it way more for myself. And it is so motivating. I do this virtual reality exercise program where I'm [00:13:00] literally like. On top of the Grand Canyon doing like kickboxing and um, yoga,

Michele: I would like to see a video of this.

Lacy: Oh, I will, I'll send it to you. It's awesome. But it's literally the only way I'll exercise. 'cause like walking or even watching a video is just too boring. I just can't do it. But in my virtual reality world, I'm a rock star and an exercise queen.

Michele: And you get to go to all these exotic places for it. Now, the Oculus is that one of those really giant masks that attach to your face. I cannot even imagine doing yoga with that on my face.

Lacy: It does get sweaty.

Michele: Oh, that's funny, 

Lacy: Yeah, it's a great time and a really good workout.

Michele: Very fun. Well, I was hoping that they had used something like the Oculus in this study because it's something that all of us have available to us. But unfortunately, they used a fancy dancey virtual feedback system. The virtual reality thing they have is a sensor, [00:14:00] so it kind of looks like. I don't know. It looks like it's about the size of like an Apple TV remote control that's attached to the forearm, and then it has little sensors that attaches to the back of the hand, and I think maybe to the forearm. So it's like a sensor based thing on the arm. And then it connects to the software where they have games and the child is trying to do all these different activities using that hand. So when they did the intervention, they targeted just one arm. So if the child had just one-sided weakness, then they did the weak side or if they had bilateral involvement, they chose the dominant side and that's the side that they trained for this intervention. And they did like, you know, games and simulated activities of daily living and stuff like that. I thought of three key elements that came out of this and how it embedded into the practice. So the first thing is, it gives real time biofeedback as to how they were performing.

Lacy: Mm.

Michele: The second was that they were able to adjust the challenge to the child's [00:15:00] ability level. And then the third, going back to the motor learning theory of like getting a lot of high frequency repetition, they found that it was very motivating for kids and so they were able to get more of those repetitions in to be able to really, impact that, change. So they had their intervention group doing their thing. They had their regular group just doing regular. Traditional rehab, ot. One hour a week, 20 hours. And do you wanna know what they found?

Lacy: yes, I wanna know what they found, but first I wanna know like, did they do cool games? Were they at the top of the Grand Canyon? Like I go in my virtual reality world?

Michele: I cannot exactly tell what games they did. I mean it, it definitely was a game-based thing. The sensor thing is called RAPAEL Smart Kids, and that stands for something, it's R-A-P-A-E-L, all in caps, but it doesn't say what it stands for. So RAPAEL Smart Kids, and it looks like a [00:16:00] video game. They have a picture of it. It looks a little bit like an Angry Birds thing. Maybe you're like trying to throw something to knock something over, but I can't tell exactly what the games were, but it does say that they did games. I don't see the Grand Canyon in this one.

Lacy: No. Okay. Maybe next time, maybe in there RAPAEL 2.0.

Michele: Exactly. But you know, that does remind me I am hoping to bring to our clinic a new, there's a new intervention tool out there that is really like more what you're thinking of where they're climbing and they're doing all these. Different. I mean, it's got hundreds of games. They can target motor skills, they can target executive function, social skills, all sorts of things in it. And it also, not only does it give real time feedback, but it uses machine learning to actually adapt in real time for how the child is performing. It's so cool. And they can do it in the clinic, and then you can give an account to the parent and they can practice it at home too. And it collects. All this [00:17:00] data because it's got all these sensors, so it's collecting data on the child as they're moving and it generates reports for you. It's really cool and I'm hoping - fingers crossed - to bring it to our clinic.

Lacy: Yeah, I it's like, it sounds like it's, uh, like a robot. Just write challenge kind of therapist.

Michele: Well.

Lacy: I think I've seen it. Um, I've seen, some therapists talking about it. 

Michele: Yeah, so the one I'm talking about is called Korro AI, K-O-R-R-O and what's really neat about it is right now the president of a OTA is piloting this in her pediatric clinic, and they did a demo for us, and I'm so excited about the potential for it.Unfortunately, in order to use it, you have to enter in patient information, like sensitive information. And so because I'm part of a hospital has to go through all these layers of approval. So I got like cursory approval when they were demoing it to us. [00:18:00] But when I went to actually like pay for the course and get the product, now I'm in like the doom cycle of, you know, compliance and HIPAA and PHI and trying so hard to get it approved so we can do it.

Lacy: Yes. Waiting, waiting,

Michele: Exactly. It's like the spinning wheel. Well, I'll tell you how it, how that turns out. Maybe it'll be a nailed it or maybe it'll be a failed it in future episode. But back to this study, they, so they're using the RAPAEL Smart Kids, it looks like a pretty basic program. It doesn't look so exciting, but they did find that the experimental group outperformed the intervention group. On basically all the measures, so they, yeah. both groups showed. Improvement. So that's important for just therapy in general. But they did find that the virtual reality one outperformed the other one. I'm curious though, they did standardized testing, you know, for the outcome measures, [00:19:00] and I'm not that familiar with some of these measures and I'm wondering if you know about them. The first one that they did, which was a direct measure, is called the Melbourne Assessment of Unilateral Upper Limb Function 2.

Lacy: Ooh. I've heard of it, but I've never read or seen anything about it. I'm guessing it's from Australia, if it's called the Melbourne, but

Michele: Wow, we're brilliant.

Lacy: Yeah.

Michele: We didn't even need Chat GBT to help us with that one. I'm curious about and think this all the time when I read these studies, because they did it in just four weeks. So they tested the kid and they tested 'em again four weeks later for post-testing. Right. So how does that.

Lacy: I feel like that's against like every pretest post-test thing I've seen with like direct measures, like the BOT, I think you have to wait like six months, feels short. Doesn't feel quite right to me.

Michele: Yeah. And that's why I was wondering if you had heard of it, because [00:20:00] I mean, they report on how it's scored and that it's reliable and valid, but they don't. Report on like whether or not there's a test retest issue if you're gonna do it. So in such close proximity. So I, I, I don't know. I low key, throw a little shade on the findings 'cause I'm not sure if some of that is just a learning effect. They also did an upper limb physician's rating scale, which is kind of like a semi quantitative assessment where it seems like maybe the. Clinician is rating the child based on their movement patterns, which I kind of like because you know, you see like that quality element that normally standardized tests don't use. And then they use the PEDI, which all of us know that's, you know, for like a parent proxy report for functional measures. And they found improvements in all of them.

Lacy: Wow,

Michele: I know.

Lacy: I really like that. Were there certain categories or items that they were looking at that they saw the most improvement in?

Michele: They found clinical significance across the board in all the different areas, including [00:21:00] manual dexterity, which I know that can be so hard to get change in if you're working with a kid with CP. So I thought that was really cool. And then they found with the Upper Limb Physician's Rating Scale, that both groups showed significant improvements with that, but there wasn't a difference between the two. So on that one, both of them performed pretty much the same.

Lacy: Hmm.

Michele: And then for the PEDI, they found that the virtual reality group outperformed the control group with the performance of activities of daily living, which is super important because yeah, you see it. That's always my question with something like this is does it translate into real life? And it turns out it did translate. So that was cool.

Lacy: Yeah. That's awesome.

Michele: Another thing they did was because they were doing virtual reality, the computer was recording how the child was moving and all of these things. They did the three dimensional motion analysis for a good portion of the participants, both from the control group [00:22:00] and the virtual reality, and they found that forearm supination was significantly improved in the virtual reality group, and that's another one that's really hard. When I've worked with my kids in the clinic, like man, dexterity and supination are the two things that are so hard to get. You know, you can get more of that gross motor movement. You can get more of it as like using the effective limb for support. But those two skills, that's something else.

Lacy: Yeah, and I feel like that supination gets so tight, so fast and can be really hard. 

Michele: To get back.

Lacy: To get back. Yeah. And then to maintain that motion. Wow, that's really impressive.

Michele: Yeah. Yeah, it was, I mean, I thought it was, it was a really good study. It showed some nice evidence. I do have a few questions about some of it, but overall, I thought it was a great study and it got me really excited about trying to use some of these things in clinical applications.  What I was thinking about in regards [00:23:00] to like, what would I do in my clinical practice, the first thing is looking to see that it's giving biofeedback, it's giving like real time feedback on your performance. So I was thinking about what I use already. That gives real time feedback. You use your Oculus? I have personally, I have a thing called, um, the Muse. Have you heard of that? It is a meditation support. So you, it's a headband that has sensors and it literally has like EKG sensors and it reads your brainwaves and it translates your brain activity into audio feedback. So while you're doing the meditation, if your brain becomes active, it will give you that feedback. So like the one I just did was, it's raining, and if my brain gets busy, it rains really hard. And if my brain is quiet, it is barely raining and you can like hear the birds twe tweeting. I find it very stressful. I don't use it that often because meditation is.

Lacy: It's like, like [00:24:00] meditation next level.

Michele: It is, and it's, it kind of like stresses me out 'cause I'm trying to get a good score, which is not generally what you think of when you're doing meditation, but, uh, but anyway, so I wonder like, ooh, would it stress the kids out that they're, 'cause they're trying to get a good score, but they're also getting feedback. But I have found in clinical practice, it does not stress 'em out. I mean, they sometimes get mad if they don't get the score they want, but we have a device called the NEX Playground, N-E-X Playground. It's a newer gaming model and it's so amazing. It's, it's pretty inexpensive for a gaming model and it's easy for kids to use. Like we use it with all different levels of kids and it's partners. So it's two kids, playing side by side. So they show themselves and it like, finds them in the screen and then they pick a game and like, maybe it's like crushing ice and they're like pounding on the ice with their big, giant hands on the screen. Or my favorite one is where they're, it's called picture posing, but really it's postal praxis 'cause [00:25:00] they're trying to like, imitate the pose of the animal and then it takes their picture and it says which, which kid did it closer to the actual thing.

Lacy: Oh, so fun.

Michele: Yeah.

Lacy: So fun. and it has that social element and some competition. And along with the activities,

Michele: Yeah, and you get real time feedback. 'cause you can see like, am I crushing the ice well or am I not? There's one where you're like doing a hula hoop and you have to do like kind of this little shaky motion, you know, and it's like you can see is the hula hoop staying up or is it falling down? So that, those are the kind of things that we're like currently using in clinical practice. And then of course, Korro, the thing about Korro is that it. Not only gives the feedback, but then it adjusts in real time to how the child's performing. And I think that's like the special sauce of that program that's got me so excited. And then the second thing that they said is that this motivates the kids to do more repetitions. So yeah, I do find that when you have that extra kind of thing, um, to motivate [00:26:00] them, that you can get a little bit more, what do you think?

Lacy: Oh yeah, for sure. Especially if there's anything with technology, you know, the lights and the sounds and the game element. It sounds really engaging. When there's a social piece to it too, that just takes it to the next level. Okay, Michele, you said that you had three highlights about virtual reality from this article. The first one was that it provides real-time biofeedback. The second one is that it tends to be really motivating, which leads to high frequency repetition. What's the third highlight?

Michele: The third point that I took away from this was that. The virtual reality allowed them to get that just-right challenge because it was, they were able to adjust it to the child's ability level. And I think that that is so hard in real treatment because, like, especially if you're doing a dressing task or something like that. I mean you can backwards chain it or you can give them extra help [00:27:00] or, but it can be very difficult 'cause the task is the task. You know, I run into that with shoe tying all of the time where they can do the first step,but when it comes to the last part of it, it's just. So hard I mean, you can grade it. I can like make the laces bigger and easier to hold and stiffer and there's all sorts of things I can do, but man, you can't beat virtual reality where you can really, truly adjust it to the just right level. And if it's got machine learning built in where it's adjusting for you, that's even better. Because sometimes the kid gets frustrated when they can see that you're like sabotaging to make it harder or you know, you're adjusting to make it easier. Sometimes they get frustrated with that, but if it's just doing it seamlessly for you, that's a game changer.

Lacy: Well, I've definitely ruined some rapport with kids I've worked with because of this same situation. You're trying to find that just right challenge and undoing things that kids have done and it just makes everyone really frustrated. So when I hear that [00:28:00] a machine could potentially stand in that gap and do the tweaking, that's really exciting because then I can be on the same team with the kid against the task instead of a me versus the child kind of situation when we're working on some of those skills.

Michele: I love that. Yeah, I, I hadn't thought about that, but I love that concept of being on the same team instead of trying to hide that you're sabotaging, it's more authentic.

Lacy: Okay, Michele, let's wrap it up with the same three questions we ask at the end of every research review. Tell us again who was the population for this study? 

Michele: The population for this study are kids with brain injuries, so different sources of their brain injuries, but all of them had some sort of brain injury. There was a wide range of ages, but they averaged out to five years old and all of these kids were at least one year status post their initial injury.

Lacy: Okay, and what were the key ingredients?

Michele: The [00:29:00] key ingredients were high repetition practice. With different types of feedback when you were getting, when you were doing that practice.

Lacy: And last, what was the mechanism of action? So this is the theory behind, or why this intervention was successful?

Michele: I loved that the authors told us explicitly what the mechanism of action was - gold star to them. They said that this is based off of the principles of motor learning and brain plasticity, and they specifically said they're including repetitive mass practice, practice dosage, task oriented and goal specific functional training, randomized variable practice, multi-sensory stimulation, and increasing difficulty. So those are kind of their key ingredients and their mechanism of action that the author stated.

Lacy: And I'm gonna add in one more theory, MOHO Model of Human Occupation. This theory really speaks to how motivating and meaningful [00:30:00] activities can really drive occupational performance.

Michele: Of course you would add a theory. Thanks, Dr. Lacy. And that's it for our research review. We hit the highlights and shared our own thoughts, but check out the article yourself and let us know how it impacted you and your therapy sessions.

Michele: Up next. It's people, places, and products where we talk about something or someone that we're loving this week. Lacy, what do you have for us?

Lacy: This week I'm shouting out the Golden Scoop, which is a place in Kansas City, This ice cream and coffee shop business was built and designed specifically for individuals with disabilities to have a place to work.

Michele: Well, let's just start with ice cream and coffee. Are those the two best things on the planet earth? The only thing that could make that better is if they had wine.

Lacy: I'll have to let 'em know. They can add that in

Michele: Yeah.[00:31:00] 

Lacy: Something for morning, noon, and night.

Michele: Lacy, I was just in Texas visiting my parents and they live in Georgetown, which is a suburb of Austin, and there's a place there too. It's called, um, the Big Cafe. And it was also designed specifically for adults with disabilities to have a place where they could do on-the-job training, and it was actually created by the parent of a child where they found that there just wasn't anything out there for them. So they did it themselves. They made their own. I thought that was so cool.

Lacy: Ya, definitely. One of the coolest parts is that the individuals with disabilities employed the Golden Scoop are called Super Scoopers.

Michele: Oh gosh.

Lacy: And on their website they are celebrated almost like superheroes with little bios and they have their pictures up on the wall. They're not just part of the team, but like really truly valued [00:32:00] like the heart and soul of the business too.

Michele: I'm gonna have to check that website out. I would like to see the superhero Super Scoopers.

Lacy: Yes. And the businesses flourishing. They just recently opened up a second location about six months ago, and I recently went myself and got the Gold Rush ice cream, which is amazing. It has, I think, caramel and Oreos and golden Oreos in it as well. I took a picture and I'll have to put it up on our social media.

Michele: It needs to be like a scratch and sniff so that I can, you know, at least have the experience of smelling it. If I can't taste it,

Lacy: Yes, yes. It was so good. I'm sure there's other places in the country. I'm wondering if our listeners know of any others too. I would love to know more about them and maybe give them a shout out in the future.

Michele: Yeah, listeners, let us know if you've seen a place in your area that's similar to this so that we can share with everybody and we can start visiting these places and making sure we give them our business.[00:33:00] 

Michele:  Today's listener question comes from Rhiannon in Missouri. Rhiannon wants to know, I have been an OT for one year. An OT program asked me if I would like to be a fieldwork educator for a level two fieldwork student. How do I know if I'm ready for this? Thanks for your question, Rhiannon. Lacy, what do you think?

Lacy: . Rhiannon. I love that you are considering this and really weighing both your passion for wanting to educate students and also making sure that you are ready to be a good fieldwork educator. 'Cause it's not something that you can necessarily just step into. There are some steps that you could take to make sure that. You're prepared and can offer a good experience for students. AOTA has a really good tool called the SAFECOM, which stands for the. Self-assessment tool for fieldwork educator competency, and this is something that you can look through and fill out as a self-assessment, [00:34:00] and this will give you information about how to best move forward or areas that you might want to look at to build up more skills before you take a student.

Michele: Lacy, the name of that sounds like it's like a superhero. The SAFECOM, like some sort of superhero thing. You can be a superhero and be a field work educator too. You use the Safe-Com

Lacy: Or it's like a communication system like I was talking to my student on my Safe-Com. Roger Dodger.

Michele: Over.

Lacy: Work on that documentation. Over.

Michele: Uh, okay. Rhiannon. I also think that you know more than you think, and it's not until you have a student that you are able to get this realization. So sometimes you just have to take the plunge. Even when you feel like, what do I have to offer? I hardly know anything. I just figured it out myself. My experience has been every time a therapist takes their first student, they walk away with a confidence boost thinking. “Wow, I know. So much [00:35:00] more than I thought I knew” because you just get to educate them and you see the gap between someone who's in their field work versus someone who's a year out, and it's very satisfying. So I say go for it.

Lacy: I say go for it too. But if you want a little something to dip your toe in kind of halfway option, you could also think about. Talking to your school about taking a level one student. Sometimes that's a nice beginner step, sharing a fieldwork level two with another therapist. So you do two days a week and the other therapist does three days a week. That way you can bounce off ideas and not have to have the full weight of the student on your shoulders.

Michele: I think it also depends on how well developed your student program is at your facility. If they don't really have a student program and it's not well developed at all, that's a lot more work. It's harder to do. It's harder to know how to score, um, so that you might perceive more with caution versus if they have something that's really well [00:36:00] developed than it's easy peasy, just go with it.

Lacy: And last, be sure to have a good conversation with that program's Academic Fieldwork Coordinator. If you're on the fence, they might be able to help you decide and give you some more resources along the way to get ready if you feel like you're not quite ready yet, if

Michele: and I would take the fieldwork certificate. Uh, what, what's it called? Lacy.

Lacy: Fieldwork Educator Certification through AOTA.

Michele: I remember we, we've had a couple different universities that we've partnered with where we take their students and therefore they give us a free placement in this course. And I've taken it twice and I wish I had taken it just right off the jump instead of waiting until I've been doing it for five or six years and then taking it because it's really useful for getting materials and ideas and sharing, um, stories with other people that are also going through it. So that's something else you can look into.

Lacy: Well, I hope that answers your question, Rhiannan. email us and let us know what you [00:37:00] decided else we can help you along the way.

Michele: And if you've got questions, you can email us at IdeasatPlayPodcast@gmail.com or just DM us on our social media, and we may include your question in a future episode.

Michele: This week we reviewed using virtual reality for rehab in pediatric patients with brain injury. Remember, there were two different groups, and in the control group, they did 10 minutes of stretching, 10 minutes of strengthening, and 10 minutes of task oriented training. The control group made gains. The thing is the virtual reality group outperformed the control group. They made even more gains. So if you really wanna get those great gains, try using some virtual reality tools that you may have at your disposal, like an Xbox or a Nintendo and see if you can tap into that motivation that comes for the children when they're using virtual reality. And the target movements you wanna look at is wrist flexion extension, forearm [00:38:00] supination, pronation, and ulnar radial deviation. it a try and let us know how it goes.

Lacy: Thanks for listening to Ideas at Play. If you learn something new from today's podcast, be sure to leave a rating and review. This really helps others find our podcast so we can all be evidence-based therapists. If you want more ideas for your sessions, you can find us on Instagram under Ideas at Play, or email us at IdeasAtPlayPodcast@gmail.com.

Michele: Until next time…Stay informed. Stay curious. Stay playful.

Out-take:

Michele:Over and out. You know they have the funny names too. This is… I don't know, I can't think of a funny name.

Lacy: Flying Eagle ice cream pants.

Michele: Yes.

Lacy: I dunno.

Michele: Coming in loud and clear. Flying Eagle ice cream pants. What you got for me, over.