Episode 14: From Sensory to Speech: The OT Perspective with Sara Sheppard

In this episode of 'Hear Me Out,' podcast hosts Niki Lampi and Tamara Pogin, both speech language pathologists at the Masonic Children's Clinic for Communication Disorders, interview Sarah Sheppard, an occupational therapist. Sarah, who has worked with the clinic for three years, shares her journey from a special education teacher to an occupational therapist. She discusses the unique approach of the Masonic Children's Clinic that allows therapists to spend more time consulting with families and creating individualized sensory tools for children. Sarah elaborates on the importance of understanding sensory systems and emotional regulation, dynamic sensory systems, and co-regulation. She also highlights the intersection of sensory issues with everyday tasks like sleep, feeding, and potty training and talks about her holistic approach to therapy.   

Transcript

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Hello and welcome to Hear Me Out, the official podcast of the Masonic Children's Clinic for Communication Disorders. This is the place where we dive into all things related to communication disorders and how we can best support the kids and families affected by them. We will be talking with speech language pathologists, clinic staff, families and donors to share stories, insights, and the impact of providing free speech, language and hearing services to children across our community. I'm Niki Lampi speech language pathologist and director of the clinic, And I'm Tamara Pogin, also a speech language pathologist with a focus on working with autistic children and their families. And we are your hosts. We're so glad you're here. Welcome. Today we have the privilege of having Sarah Shepherd here with us, an occupational therapist who consults here at the Masonic Children's Clinic helping us do our job better. Welcome Sarah. Thank you. Thank you for Sarah. Sarah. Hi. So Sarah, just off podcast. We were talking about how long you've been working with us, and, Nikki said three years. Mm-hmm. That's really exciting. So you, your job has been building with us. I think, you started off doing some assessments and some consultative work to help, in our sessions help speech without. Help speech therapy go better. But now there's a lot of stuff that you're doing. Can you tell us about that? Yeah. I feel like I, there's a OT student that made the phrase, rebuild the plane as we fly it. And that's kind of what I feel like I've been able to do with this program, which has been really nice. I love creating programming and to be able to have that kind of flexibility and look at what. Is the need at the clinic as far as how OT can consult and support speech therapists and families has been amazing and so fun to be a part of. And do you find that it's different from other settings as far as the ways you provide treatment here? Because you've worked in private practice, you've worked in medical settings, you've worked, I think in, have you worked in schools? I, as a teacher, I was in schools and special ed teacher, but not as an ot. Oh, that's right. We'll get to that. But for here do you find that it's different in the way you provide treatment? Yes. Yes. I think here with so much being covered and not having to use and, rely on health insurance, we have so many more open doors and I love that I get to be a consultant for families. In a lot of traditional healthcare models. An OT will take a child back and sometimes the parent comes back with us, or we'll have five minutes, 10 minutes at the end of our session to go through what we did with the child. But our focus and primary is on the child because that's what the insurance is going to cover. What I like about this model is I am supporting the child through the families, so I'm able to spend more time with parents. Guiding parents, giving them ways through with programming that they have never maybe thought of before, and maybe even teaching them how to observe their child. I've been able to do that with the speech therapists as well, like teaching them how to observe and see things from a different perspective from that maybe sensory lens or behavioral lens. To shift their outcomes. That's my hope. Mm-hmm. And you've done a really good job. Just opening us up to. And you know, I call it like the different layers. we might have been told like, there's certain environmental supports, like how we've always learned and I love to provide speech therapy with movement. 'cause movement equals learning. But you're like, yes, but where are they on their energy level when you're providing this movement? What kind of movement do they need? That's been so helpful. Mm-hmm. Because just because I have a swing in my room doesn't mean it's a good tool for this. Child. Right. Or however using it or whatever. So that's been very helpful. And then can you talk a little bit more about the parent, components that you've been doing? what are parents mostly asking for? A lot of parents are, are asking for ways through their. Ideas are ways through their child's behaviors. Mm-hmm. That comes up a lot. They'll be looking for ways through just simple developmental skills like dressing or potty training, feeding, eating, and if there's any sensory components with those, they'll ask a lot about that as well. And sleep. Sleep can come up a lot. That I think. Teaching parents how to understand what we've learned even in the last 10 years about our nervous system. And how it's arranged for our emotional regulation and what we can do from a sensory perspective to shift that. Because oftentimes we don't always go to that sensory perspective first, to create a shift in emotional regulation. We are trying, let's talk it out. Mm-hmm. Let's, let's find a different activity for you to focus on. So, and those are good strategies, but they're not the only ones. And so learning some of those sensory tools that are actually individualized to that child. Not, like you said, a swing isn't gonna work for every child, but actually looking at that child's sensory system. And finding their tools has been so eye-opening to so many parents because then they have this toolbox that's built for their child that they can use. So it is, you know, a traditional sensory diet, but what's shifted is. When I first started as an ot, I would give cookie cutter sensory diets. Now I listen to the family and I have time here at the clinic to listen to the family and really dig and investigate and find out how their child experiences the world. And then I'm able to provide sensory tools for that family and that child. And you're like you said too, you're also helping parents and therapists also do that investigation and that observation. 'cause one thing that I've noted is that we kind of think about language as a pyramid and, but the base of the pyramid. Is always emotional and sensory regulation. Mm. So you're helping with that because unless the child is regulated, they're not gonna be able to benefit from our speech language therapy and access that language. Or they might not be able to tell us that's uncomfortable. The lights hurt my eyes. Mm-hmm. And we're working on observation with that. Mm-hmm. And then once they're regulated, they could say, this is fun. Or maybe they can start to get, gain that language. And that's why you're the piece that is part of the clinic because we are a. Communication disorders, language clinic, and they're like, why is there OT here? Mm-hmm. Well, that's why we're having the podcast to be like, well, it's for this or it's for, it's to help these kids. Reduce frustration. Yeah. And parents too. Yeah, and I, I think that's one of my favorite things to teach families is a lot of times I'll start by teaching the parents about their own sensory baseline and how they process their senses and how it affects their emotions and their regulation and their nervous system. And once they start to understand it, then they can start to learn that method to investigate it at home on their own. And I keep, I tell 'em often, you're the detective, you're the expert. I'm just the guide. So it's just trying to get them to understand how it all works and give them that method and then they can just roll with it. Mm-hmm. Mm-hmm. That's beautiful. For most of my career, I've had the pleasure of working with OTs and I've learned so, so much from my OT coworkers. And I think my biggest aha moment was. When I was seeing a child for speech and they were making progress, they were doing well, but I knew they had some sensory needs, so I referred them to ot. That child started to see OT and I just saw maybe a month into it, this huge increase in progress. And that was kind of that light bulb of, oh, this sensory peace, sensory motor peace really, really impacts communication. Mm-hmm. You know, we work on different goals and we work in different ways, but each piece. Is linked to the other. Yeah, it's a whole, it is a whole, and I love that you're part of our organization now to help really teach kids in that holistic way because you can't, piece things out like that. No, and that's something that, you know, at a, as a pediatric therapist, we. Are looking at all of development, but there's so many things that tie together. So when I am talking with a family about sleep or addressing or body training, I'm still talking about sensory and emotional regulation. We're still looking at the whole. Yeah, so the, basically the main takeaway is we have the privilege of not doing cookie cutter. 'cause cookie cutter is, is okay. It's always like one of those things like first do no harm. Like there are some definitely some things that you can recommend as a baseline mm-hmm. For, for people. But then it's that's that privilege of being able to dig deeper in with the. With the experts, the parents, and having the time to do it and being able to talk with the parents, and I can have a child in the room playing, but my whole purpose in there isn't to be interacting with that child. It's to be able to teach that parent. Mm-hmm. And to be able to really educate from that understanding of this is what neuroscience is showing us. And because we have this, we have a guide, we have a way forward. We, we know that every behavior exists for a reason. And we now have tools to be able to investigate what that reason is. That's really cool. And then we're saying parents, but that really is a fill in for many caregivers. Caregivers. Mm-hmm. Because I know that you and I have both worked with personal care attendants. Yep. Absolutely. Grandparents. Mm-hmm. Right alongside like all, sometimes have PCAs and parents and grandparents all together. Yeah. Mm-hmm. Yeah. Big room. Mm-hmm. But a great room. Yes, yes, yes. So, Thinking back Occupational therapy has been your main career, but, can you tell us how you got into occupational therapy or what made you decide to become an occupational therapist? Sure. Yeah. I graduated in the late nineties from Luther College in, a dual degree of elementary ed and special ed. So it wasn't, OT wasn't my first. I didn't even know what OT was. Um, and I started to work, uh, in a special ed classroom and I. Knew about development from a teacher perspective, but there were still questions I had for some of the behaviors that were happening in my classroom as to why, and I didn't have those answers. And I had always been kind of excited about biology and trying to figure out how things work. Um, I toyed with the idea of being like a pediatrician or a doctor. But then, I was working, in, actually in a regular ed classroom and an OT came in and was measuring a table for a boy in a wheelchair. And she had a slant board and she was making sure the measurements lined up. And I was like, who are you? And she told me about what she did. And it kind of brought back, I had met a couple OTs as a teacher, who had, had like taken kids out. I've, I'd seen, you know, brushing protocols and things like that and I didn't, I was curious but didn't really know what an OT did and she said you should shadow. And so I shadowed for a day in OT and I was like, this is it. This is, this is what I wanna do. So time for a career shift? Yes. That's scary. Yeah. So leaving the teaching field was hard. I loved being a teacher. How long were you a teacher for? I was a teacher for, I gotta think about this, about five, five years. Okay. So enough to feel like you were no longer a newbie, right? Yep, exactly. And. I the shift for me when I got into OT school, it felt right because I was learning about those developmental skills from that biological perspective, and they were answering the questions of why. And so that met a lot of those needs. But even at that time, like this was early two thousands or like, and there still was not, there was a lack of neuroscience around emotional regulation. And so there still was like a gap of biology understanding or biological understanding of our nervous system and how it works with our emotions and. As those things have come forward, I've latched onto those. So when Leah Kuper came out with zones of Regulation and Shellenberger had, they had, um, how does your engine run? We had had that at the beginning of when I started ot. And I liked it. It was a simplified model. It works for little kids. But when I learned, Leah Kier zones, I thought this was brilliant. Like this is, this is what I'm looking for, is this kind of understanding of a nervous system, it being different states and levels within your body instead of using an emotion word. Because it can get really ambiguous so you can be happy and tired. Mm-hmm. And you can be happy and excited. And those are different places in your nervous system. So learning about all those pieces, I knew that that was the, the right fit. What I. Didn't plan on was when I went into ot. I thought I was a teacher. I used to manage a classroom of 15 special ed students and I went from that to one-on-one and I thought I'll be able to do this, but it took me five years as an ot. Before I had my aha moment of I can see all the dynamics to this one-on-one session. Now I can see all the developmental pieces and I thought as a teacher it'd be an easy shift into ot, but it took that, those five years for me to be able to be like, okay, now I see it. What that does when you have that shift. You can be in real time working with a patient or talking to a parent, and it becomes more about listening. And watching and observing and making subtle changes during that time. Instead of, I have a set plan, I'm gonna follow it A to B2C. We talk about that in speech therapy too. Oh. You might look at it and be like, you're just playing with the child, but what's going on in the therapist's brain. Mm-hmm. What are they shifting through and saying, oh, the child can do this, or They need support here. And so you're talking about. That automaticity took the five years to make those decisions. Absolutely. Rather than having to have it on paper. Mm-hmm. I would think that that, mm-hmm. Three to five years happens for a lot of people in mm-hmm. In the helping professions like speech and, and ot. Mm-hmm. Mm-hmm. I agree. I think three years I felt like, yes. Now I'm, I really had a good handle on it in five years. It was like. that bigger picture comes into play. Absolutely. Um, and we talk a lot about how you see a child. With different lenses depending on what field you're in. Mm-hmm. So we might be all working with a child. And Tamara, you might see behaviors interpreted from a communication standpoint. Sarah, you might see them from a sensory standpoint. Mm-hmm. Psychology might see them from a parenting behavioral mm-hmm. Type standpoint, you know? None are right or wrong. They're just all, we just have to all get, get together. They're all different. Yeah. They're are complex behaviors are complex. It's not, not an easy answer. Mm-hmm. We have to all get together and put it all together. Yeah. It's that goal of that holistic formation of therapy for a child. Like what's gonna help them get, get further along in the development. Yeah. Cool. And one interesting thing that I, well, I've learned many interesting things from you, but one was actually my, one of my daughters worked with you and she has a lot of hypersensitivity in many areas and I knew enough to Okay she's visually overstimulated, so, you know, turn lights down. Try to limit the clutter around her, or auditorily, hypersensitive, give her the noise canceling headphones, see what in the environment we can manage to make it easier for her. Mm-hmm. And then we saw you, you taught us the importance of yes, you're auditorily hypersensitive, but it doesn't mean you dislike all sounds. So when you're in those times or in those spaces where you're having a hard time with noises, you don't like, what can you provide yourself that you do like from that sensory piece? Yep. And I think that that has shifted, so I've been working with children and understanding sensory since 2008 and over time. Of, I've always done the sensory profile or the SPM and teaching families about what we can from those models, but over time and working with many different patients, even adults and adolescents, I would talk about their sensory system and they would say, Hmm, that doesn't fit for me, or, well, I'm different. And instead of. This model of saying, well, I don't know how I can help you. It became, it became a, let's see how we can fit this in, how we can figure out how to help you. And it has shifted what I know about sensory to understand that there's this big spectrum between hypersensitive to lower registration and people can be anywhere across it, and it can shift and change dynamically with our regulation system. And understanding that one sense, like your auditory sense isn't just loud sound, it can be white noise. And then like you said, when you're hypersensitive to white noise, what kind of white noises help your system? So doesn't have to be when you're hypersensitive to some sort of sensory input. It doesn't have to be a negative. It can be turned into a strength-based approach. Mm-hmm. It can be a positive. You are now discerning and you can make those preferences and pick and choose what you know, you can tolerate and like. Mm-hmm. And you can purposely with control, change your emotional regulation based on that knowledge. That's so cool. It's so interesting and for my daughter, she found out that like the noise canceling headphones were helpful, but it was still irritating to her. So if she even just has one AirPod in with some music in the background that she's familiar with, that is all she needs to help regulate her. And I love that she found that like Yeah, and that's the thing. Like, and that's because of you, I think you mentioned that to her to have that thing that she enjoys is part of her. And toolbox. Yeah. And so often people will use tools like in a sensory diet and they'll think, well, I just have to use them one way. And if it doesn't work the one way, then I don't like that tool. And so I'll use weighted blanket as an example. And so I'll tell people like, if you need a weighted blanket, like maybe you try it and you don't like the way that it feels all the way up your body, but that doesn't mean you won't like it a different way. You might like it on your feet. You might, you know, like it around your shoulders. Or you might like it when you're sitting like a lap pad. Like there's, there's alternative ways to use almost every tool and like headphones are a perfect example. One, you know, one ear in with sound, still hearing something else versus full on noise canceling. So. There are shifts and changes of how we can use tools all the time, and teaching families to how to investigate a tool and trial a tool in more than one way is very important to be able to test all those different ways to find the right way. One thing that I learned from you too is that sensory regulation and emotional regulation is a moving target depending on. What they've experienced that day. Mm-hmm. Maybe their auditory threshold, meaning that what sounds they can tolerate is, um, total chaos and loud music. And one day, they're still able to be to happy and dance with you, and then the next day they come and they're crying and you put on the same song. And we're like, why is that Sarah? Mm-hmm. That's right. And that's when we have to put on our investigative hat and be like, maybe they came on the day that they were fine. It was a day they didn't have preschool. Mm-hmm. And then the day that the next day they just had four hours of preschool and then they came to you and it was a different ball game. And I think that that's what's limiting right now about a lot of the models that are out there. We're looking at them on screens or on paper, and they look like 2D models, like they, and there's no dynamics, like you can't adjust. Like if you look at zones of regulation, it looks like there's like certain zones and they're all the same capacity and size. Or if you look at the energy meter on the autism Level Up tool, again, great tool, all the sizes look the same, but. If you are having no night's sleep, like you can shift, those are dynamic. Like we're, we might not have the capacity to be calm and focused that day, and so that just shrinks and our, you know, we're either gonna be tired or we're gonna go up and shoot up into a heightened state. And so I think understanding how dynamic these are. And families how capacity shift. Yeah. Yes. I talk a lot about, about parents. Like what percentages, like maybe, they have, maybe they're 75% capacity today. Yeah. Or some people use the spoons theory. Um, talking about how many spoons do they have to be able to invest in the activity that we have planned. Right. And so something like that. Yep. And I noticed that a lot with my daughter with foods too. And when she was younger I didn't understand it as well. 'Cause I'm like, well you, you really like this food yesterday. Why can't you eat it today? And now that she's older, she can tell me, she's like, my body feels totally different today. Mm-hmm. It's like, if that food does not work for me today. I love that she can tell you that. Yeah. I've learned a lot from her too. Awesome. Mm-hmm. Another thing she told me recently, 'cause we know she has auditory hypersensitivity and, um, but we were sitting outside recently and a, like a bee came by and it was noisy and, and she shuttered and. We kept talking and it came by again, and she like visibly shuttered again. I said, oh, I know you don't like that sound. And she said, well, it hurts. And I said, oh, I thought you just did. It was irritating. She's like, no, it feels like there's a screwdriver being stabbed into my ear. And it hurts. I love that you have a daughter that communicates that well to you because I think, you know, there are so many components of sensory with hypersensitivity and even with lower registration, where we will like, make judgements or we'll mm-hmm. You know, like it'll come up when I'm talking to families about, visual clutter and like a family who is, you know, there's someone in the family who's very sensitive to visual clutter and so their house is like. Nothing streamlines like on their countertops and everything, and they have to have their house like that, or they move up into a heightened state, like a regular dysregulated state. And then you can have people who. Are really low registration to visual clutter, and their house is super cluttered, or their office is super cluttered and they can still perform all of the tasks that they need to, and they're totally fine with their emotional regulation, and I think it's so good to see that across the two perspectives that neither one is wrong. Mm. It is not like the person who has the Immaculate House is thinking, you know, or should be thinking that the other one is lazy. 'cause it's not about that. It's truly that they just don't notice. Mm-hmm. And then, so when I teach parents this, they start to kind of open their eyes of like, oh, like now I see, like I get frustrated with my husband when he leaves the radio on, or, you know, different, different things and he just doesn't notice. I notice my system is different than your system. Exactly. And that, that. It's amazing when we start to understand neurodiversity, how different our sensory systems are from each other, and it's fascinating when you start to kind of map it out as a family to be like, here's where I am, here's where my other partner is, or here's where my child is, or my other child is. It starts to help you wrap your head around why you function as a family the way that you do, and it helps you find ways forward where you are more lenient and create more opportunities for each other. And compassion. And compassion. Mm-hmm. One thing that you have talked about. Um, several times because again, we work with children zero to nine, so they might not have the language skills that your daughter has now at an older age. Mm-hmm. To convey and to problem solve these things. But you talked about even before, they can fully talk about it themselves. You can observe their behavior and we need to map out and model the language that's gonna save them in the future. Yes. We need to talk about wow. I'm really, I can see that you're going into a heightened state. Mm-hmm. We might call it yellow, like in zones of regulation, or we might call it dysregulated. And using those words are important, but also linking them to let's try a tool. Mm-hmm. Or let's you know, let's try a mouth tool. So then they're like, oh, when I eat these fruit snacks or chew on my chewy. I do feel better, and maybe they can't talk about I need a chewy, but maybe they can go and grab it one day or maybe a year later they'll be like, Hmm, mommy, can I have a drink? Mm-hmm. And then you're like, oh, good for you for asking for a tool. Exactly. Mm-hmm. And even, even kids who are completely non-verbal, like I've seen it here at the clinic, I will often part of, of understanding sensory is I'll try different. Sensory experiences just to see how a child reacts so that I can help to explain the parent. So like even turning a light on and off in a room, I'll often do that when I'm working with a child or just evaluating with a child and a parent just to see how they respond. And even a non-verbal child, you can tell if you turn the light off and they notice, and you can often tell by their behaviors or their facial expressions or gestures, whether they want it on or not. And if they're that sensitive to it, then that could be sensitivity at home. And there might be parents who are just turning lights on and off at home and not paying attention to those signs, but they're there. Mm-hmm. The child giving you their own aha moment. Mm-hmm. Because they're like giving you that eye contact or that you got it kind of, I see that a lot when their children are seeking out, um, certain kinds of, of input. Like, um, they wanna be flipped over and so you're like, and so she's like, oh, that's your vestibular system. And they wanna flip and they, they wake up and their energy is big within and then are giving you lots of eye contact. And maybe they're saying more mommy or they're saying, let's go or up and. Because it's working for them. Their system is regulated because you're flipping them or throwing them and other kids are, so that's really cool that, that they're telling us with their behavior for sure. Mm-hmm. Mm-hmm. But I think it's interesting when you bring up the whole family dynamic. We talk about these tools being used for, kids with sensory integration issues, but really it's beneficial to everybody, everyone to know what their, everyone sensory system is like. Everyone, yes. Yep. You mentioned that just a little briefly, like you have talked to, the SLPs here as a team and how us being aware of our own systems on the daily is gonna affect how we treat and, It will affect how we see and treat our, our clients. Yeah, and I think part of that is when with, when we understand emotional regulation, we're looking at co-regulation too. And well, can you explain that for people who might not know what co-regulation is? So co-regulation is usually it's a caregiver and I think of it with a caregiver and child, but it could just be two people. It's you or one of those two people matching each other's energies. Or matching their kind of emotional state. Mm-hmm. And so oftentimes co-regulation will look like, um, like mothers do it with babies. Like, if you're holding your baby and they're dysregulated and crying, you're going to not, you're gonna try not to be dysregulated up there with them. You're gonna try to have a calm, nervous system. And that's gonna help to shush and calm your baby. That's co-regulation. Um, co-regulation can happen with anybody. It can happen with two adults. It can happen with an adult and child. And so speech therapists, since you're working one-on-one with your, with your children, you have that opportunity to use co-regulation and co-regulation. There's a lot of like pictures on social media. I think one said like. Where the storm meets our calm co-regulation lies, um, which I like and that's true, but that's not the only way to co-regulate. If we want someone to go higher or we want to, maybe if someone is higher and we have tried being like calm and it's not working, they're not coming down, we can move up to their state and use excitement and energy. And match them and then pull them down and guide them down so you can co-regulate to somebody who's excited. Just like if you are a coach of a team, you are going to try to get everyone excited, so you're gonna use your excitement and you're gonna try to co-regulate them up. And you can also co-regulate down, you were just telling us about that earlier today, about how your last client of the day, who was really excited and, and a ton of energy, how, you're maybe more tired, but you would meet them where they were at and that would help. You have to rally. Yeah. You would rally, get your, your energy up, but then after you were able to be there with them, you could help bring them back down. Mm-hmm. So you were, you're both helping each other. Yep. One thing that you do really well is you teach parents and the clinicians here the vocabulary of regulation. Can you talk about some of that vocabulary and give super short definitions right now? I know you're tempted to give us the whole talk. Super short. Um, so I think about emotional regulation. I think about your states that you're feeling at any given point in time in your day. So it can be so low to where you're asleep and tired. Is there, like, I think of it like a, like a hierarchy, within your body and your nervous system from a low state. To moving up to a more middle of the road state to heightened states to full on out of control. And that's where we have fights and flights and then past that where we have freeze. So all of your parasympathetic and sympathetic nervous system for your anatomy and physiology folks like that's in those areas, in those states of being. States of being. And when I teach, when we're teaching it to parents, we're using a lot of the models that were created by OTs, and by developmental psychologists. So we're using three, we're using the, shellenberger model, which is, how does your engine run? We're using Leah ER's model, which is zones of Regulation, and now we're using autism level ups. Energy meter and that one does not have emotion words. It's just focused on what your energy feels like in those different states. In the nervous in your body. In your body, trying to connect everyone. People to their own bodies. Yep. Yep. Without, without emotion, language. 'cause sometimes people have a hard time with emotion language and so teaching the right model to the parents that want that model. And then having them understand the language around that model helps them have access to that communication to be able to talk to it with their own bodies and their children's bodies. And then can you give us some quick definitions of the different kinds of input and how they can be different for each kid? 'cause you kind of talked about load registration. So we talked about sensitivity, but then we also threw out some different words. Auditory obviously means the information that's coming into our ears. So you're talking about our eight senses? Our eight senses, yeah. Okay. So we have our five that we always talk about, which are the ones we learn about in school. Those haven't changed,, but the three that are hidden, that we talk about and that OTs really focus on are, proprioception. Which is input into our joints, and we have so many joints in the body. So thinking about the sensory receptors that are in our joints and how we take in that information. So body awareness, coordination. Motor coordination, all of that is part of proprioception. 'cause you have to have that to feel it, to notice it, send those impulses to the brain so that you know that they're there. Um, vestibular input is our sense of movement. So I think about rotation or linear movement, and it's in our inner ear, in our cochlea and our semi-circular canals. And again, completely different scent. But we know we have this when we can sit in a chair and spin it with our eyes closed and know where we are in space and how some people are rollercoaster people and some people are not. Mm-hmm. Exactly. Or any spinny ride. Mm-hmm. That or swings. So all of those are components to that vestibular system. And then interoception and interoception. Is probably the newest sense of understanding of what we can feel, and that's everything that we feel internally from our head all the way down, like to our abdomen, everything that we feel inside. So heartbeats and our breath and hunger and thirst and going to the bathroom. All of those things are. Sensory experiences that we feel internally that we are, our brain is picking up and feeling temperature too. Right? Um, temperature, ambient temperature is yes. Internal interoception. And then there's also some tactile temperature as well. Mm-hmm. Mm-hmm. Well, thank you for those definitions that'll help us in our talk today. Yes. As we bring up different items and how people are all different. Mm-hmm. Sarah, what's something that surprised you in your work? I think over time learning that we, we didn't have the full picture and I still don't think we have a full picture of a person's nervous system and everything that is being. Put together and used in a dynamic way. I think learning that there was no guide as an OT, like early on, was a surprise to me. And then now learning how to basically create a guide from all of my years of working with, adolescents and adults, I, I had worked, I dunno if I talked about that. Why don't we, yeah, we go back to your history. Yeah. Yeah. Well, you talked about, you talked a little bit about that, about being a teacher and then getting into about teaching, but not about, and I, I don't know if I talked about outpatient. so you graduated, and now you're an ot. And then what was the gaps between there and the clinic? Here? I have, yes. I So I became a pediatric OT in the cities, in a small, pediatric clinic in Coon Rapids. It was a great small little clinic and I loved it. When I had my child, I stopped and I stayed home with her for a while. Which I loved being able to be a mom and then look at like reflexes and like all these developmental things that babies can do. And I'm like, what can I like train my daughter in as a baby, which was beautiful. And then I moved up to Duluth and I. Worked, actually, I switched practices, ods, we can work in so many different settings. I moved into inpatient rehab, filled in there for some needs. And so I worked with spinal cord and brain injury and, stroke patients. And in rehab it was easy to see how my experience in. Pediatrics with sensory still applied mm-hmm. To people no matter their age. And so I was able to bring some of those ideas and strategies and work with some of the pediatric, patients in that setting as well. And then was brought into the outpatient world because of that knowledge. So I was able to move into working with adolescents and adults,, and an outpatient clinic who came from, behavioral health model or from a neurological model of, I don't know why I'm feeling this way on my body anymore. It's shifted since my injury and I need some guidance. And from working with those adolescents and adults. And understanding what we know about emotional regulation, I would teach them just like I'm doing here, I would teach them the language, but then we would start to establish a baseline of their senses and what we had as far as knowledge. And what I had for my knowledge base wasn't enough. And I working with them over time, I started to listen to them more and be like, okay, so this is what it looks like. I've always been really interested in systems and dynamics, and so I was able to create kind of a baseline or a guide. And I'm hoping to write a workbook and get it published about this, um, but a baseline or a guide based on all these different components to the sensory system. Because it, a lot of our traditional models didn't just look at auditory and look at, you know, loud and unexpected sound or white noise. And they would look at, touch and they would be like light pressure, deep pressure on, off, on, off and, or not even all the different components. So someone would be, you know, I can handle it when I'm wearing a. Piece of jewelry and it's light pressure on my neck, but I cannot handle a blanket over me at night. And so you're like, well, that's light pressure and the jewelry is light pressure. What's different? I'm like, well, how many sensory receptors are being turned on at once is different? So we've learned the difference between. The active touch, like just touching an animal or, you know, playing with your hair is still light pressure, but you're actively in control versus passive light pressure where something's just sitting on you and just there. And so all of those components I've been able to kind of. Build out. As I've been talking to patients and they're like, this works for me, but this doesn't, this, I can't handle it. This I'm fine with. And so creating that model, I've been able to use that model here in the clinic and guide a lot of parents through that so they can understand their child. I bet that's so eye-opening to those clients too. Mm-hmm. Definitely hard to find a pattern when every type of input is so different. Yeah. Years and years of, of listening and trying to figure it out. Sarah, What would you recommend parents be on the lookout for if they're questioning if their child needs occupational therapy? I think there's many different reasons for. Looking into occupational therapy. I just was talking to a parent today and we were talking about handwriting. Something as simple as handwriting can be, taken, you can go see an ot, with your child for that. Um, but I think from a sensory perspective, looking at behaviors and saying, okay, if my child is having a hard time. Finding those mid-range and being able to engage in tasks in kind of a mid-range,, regulation. Like they could still be a little heightened and engaged. They could be, a little tired and engaged. It can be anywhere on that spectrum. But if they're having a hard time engaging and they're too low or too high and they, they just can't find the space to. Do what they need to do, then that's a really easy way to know if their child needs ot. And then you also talked about the why. if there's behaviors that they're seeing like a kid running around, crashing into things or something that's not safe and they don't know why. Mm-hmm. Or don't know the trigger. Mm-hmm. Definitely an OT could help with that. Oh yeah, we can help. We can help find the triggers. Definitely. That's so good to know. So when we have, therapists on here, we usually like to ask them some of the favorite things they like to do in their job. So like it, what is like. Some of your favorite go-to activities that you love setting up for kids to experience? I have loved, we we're doing right now, one of 'em is my favorite, is we're doing music and movement for a group right now at the clinic. And a bunch of toddlers who are non-verbal. And I think it's been really fun to be able to collaborate with speech therapists, in that setting and to be able to bring kind of like what, looking at things from a sensory lens and going, okay, these are all kids that dunno each other. They're coming into this setting. How can we create this environment that is calming and relaxing and engaging them in a lower. State and trying to keep them from being heightened. So just simple things like turning off the lights and adding some fun little star, like holograms on the ceiling. Shifting the music to something that's calm with a steady beat, and then just trying to pull them in and finding ways like. if it's not the sound or the lights, is it bubbles? Is it some activity that's is gonna pull them in? Is it something visual or is it a swing? What are we gonna do to be able to get them in the room and to gather in the room and be regulated? And I think that's been my favorite, is being able to help a group of children. Regulate with all of us in there and then bring them into some fun music, activities. And so that has been, it's been a pleasure. And then I also just love working with families here. And again, knowing that in a session. Here. They can come in, they can have their child go with speech, and I can sit and work with mom and or a caregiver and I can sit and have conversations around all of their things that are going on in their household. They can bring things up to me and troubleshoot. I also love doing home visits through the clinic. I love being able to go. I love that families trust me to come into their homes, and I love that I can go into their home and look at things through that sensory lens and give them ideas of things that they can have in their home to help regulate their child that we already have learned about that might help their child. So it's beautiful. Mm, that's awesome. So thank you very much for coming and exploring how we work together to help parents and their kids. Thanks so much Sarah. Well, it is a pleasure. That wraps up this episode of Hear Me Out. Thanks so much for listening. 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