65 How to approach Occupational Therapy – with Tamar Nevo

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Disclaimer: The information in this Podcast is for educational purposes only. Vaishnavi Sarathy, Ph.D. is an educator, not a doctor, specifically not your child’s doctor. Please consult your physician before implementing any supplement or diet recommendations.

Audio Transcription: 

Vaish:

Hey, hey, welcome back to functional nutrition and learning for kids, your podcast about all things nutrition, learning, and movement is like today. I’m your host Vaish, you can reach me at www.functionalnutritionforkids.com. In fact, I have a freebie for you today. If you click on functionalnutritionforkids.com/constipationtoolkit, you will find this freebie you may have noticed over the past few weeks that this podcast has been a little less than regular.

The past month has been a seesaw of personal and societal trauma faced by my family, my friends, and relatives in India, where debts have continued to mount and many struggles for something as essential as oxygen. As I give thanks for the air I breathe today I wish you health and if you feel like you would like to donate towards this cause the organization that I have donated to is the International Association of human values www.iahv.org Again, that’s www.iahv.org Today’s guest is very special to our family.

Tamar is SIDS occupational therapist and has worked with him for at least seven years, I think and I was going to ask you about this tomorrow. So I’m not sure but I’m really sure that it’s at least seven years. Now she’s become part of SIDS life and family and she’s one of the select people that said communicates with easily. Tamar graduated from Haifa University, Israel in 1995. And since then, she has been practicing occupational therapy in a variety of pediatric settings in the US and in Israel.

Tamar uses a holistic approach combining different frames of reference with a focus on motor development, communication, and sensory processing. She has extensive continuing education, and she’s certified in MDT, dir, SOS feeding, therapeutic listening, and more. Maya is a mother of three wonderful girls. And as a mother, she understands the importance of including parents in the treatment process and working with them as a team.

She is also a Pilates trainer and has trained as a personal life coach to Mars wisdom in the functioning of the body-mind complex, and the whole field of occupational therapy is really vast. And I’m so glad to have you on this podcast. Mr. Thank you for coming.

Tamar Nevo:

Thank you happy to be here.

Vaish:

And I know that we were having a discussion, I’m not quite sure I’m pretty sure almost everybody listening to this podcast, has an idea of what occupational therapy is. But it’s always good to start with a definition. So would you like us to lead? Lead us gently into that area? What is occupational therapy?

Tamar Nevo:

Yeah, so I don’t know if it’s the definition, but it’s occupational therapy really looks at so many areas of performance. And the main thing is occupation. We’re looking and I’ll talk about children. So we’re looking at the child’s occupation. And a child’s occupation involves a lot of things it’s learning it’s playing, it’s getting dressed or eating or so many different things is the child’s occupation. And as OTS we work on all of them. So it’s very vast.

I think sometimes maybe people don’t really understand I think it’s maybe handwriting or maybe posture, or maybe, but it’s all of the above. And our goal is to get the child to participate, and their occupation as a child. And of course, that would be very different with different kids, depending on their development, developmental level, on their interests, motivations, and on their physical abilities, cognitive abilities, so the child’s occupation is not what he needs to do for his age, but what this child would benefit from.

Vaish:

That’s, that’s really good to hear. I haven’t heard that before. And for me, the word occupational therapy had always melded into this. This broad, I thought it was just fine motor. So I think it’s just that it’s helpful for me to know, that you’re talking a lot about motor as well. So can we talk about functioning labels, there’s a lot of controversy about low functioning and high functioning. And oftentimes, when you’re talking about this, we’re talking about motor functioning, but it’s thought I mean, it’s confused with cognitive functioning. So, you know, this is all over the place, but I wanted to see if how any assumption of these labels may affect the therapy for a child, or that a child receives.

Tamar Nevo:

I don’t think we ever get, or at least not recently, we don’t really get from doctors or from psychologists who give the diagnosis. We don’t really get that label of high functioning or low functioning. We would sometimes get it from the parents, especially if it’s high functioning. They will say My child was just diagnosed with Asperger’s, which is not a term anymore or autism, high functioning. Right. But that is so you know, what is high functioning like if they know math or if they know how to communicate or if they know how to, it’s something that is very unclear what is high functioning.

We don’t, I don’t really look at that. And a lot of the times the kids that will come with, like, they’re low functioning, or they seem low functioning, they’re very high functioning, actually, because they can think really well, and they have really good ideas in their head, but we can’t really see it because of motor difficulties, or because of difficulties communicating it to us. So I feel like those labels are wrong in many ways. And they don’t really give us as therapists information, because I don’t know what to do with a kid who’s low functioning, because is he low functioning? What does it mean? And if he’s high functioning the same? So why is he here? If he’s high functioning, what does he need?

Vaish:

So both kids need, they need what they need, and that has nothing to do that may have nothing to do with their labels, whether labels

Tamar Nevo:

Yeah, so it is important for me to know if they have ADHD or if they have autism, or if they have cerebral palsy, because my, the way I would treat them with maybe differ a little bit. But I don’t really care if they’re considered high functioning or low functioning to me, they’re all considered having potential, and I just need to work with them to unlock that potential of them being happy in their lives successful and what they want to do. And what they want to do is not always what I think they need to do.

Vaish:

That’s a good point. Have you noticed motor skills as being different from cognitive skills is that help is it hard to make that distinction, but and you work with so many kids, I would love to know your perspective Because with said, as you know that the body-mind gap is huge And I always like to hear from people like you that are so experienced what you notice in your practice

Tamar Nevo:

I think when, I get kids with motor difficulties, and I get kids with language difficulties, and I see kids with that are just super-shy or so I never use, oh, this is what this kid will be able to get to. Or, and I also think maybe as a younger therapist, I was thinking, Okay, where we need to fix this or we need to fix these abilities. Now I think more about I need to make things accessible for this child. So because the motor is something that I started with, and that’s where I came from, into OT, I always look at, I always look at the motor, we have very few kids that there’s no motor aspect to their even to their function.

If I see a kid, if I see a kid with obvious motor difficulties, it’s easier for me to say, Okay, if you can’t stay stable, he can’t focus his head on me, he can’t look in my eyes. So of course, he doesn’t have eye contact. If he can’t sit stable, of course, he can’t use his hands. Because of his body is moving all over the place, he can’t stabilize his arms and dexterity. So I never look at it as Oh, because he can’t do this.

That means he’s not smart, or he doesn’t have other things. And it goes the same with kids that appear cognitively low. And so I never assume I have a child. And together we need to figure him out. It’s always like a mystery. I never assume this kid, oh, he can’t do this. And he can’t do this. So I think their cognition is really low. So this is how far I think we could get.

Vaish:

I think that’s a good mindset shift for anybody that’s listening to this podcast about how if you’re a parent, how your child should be treated? And you probably already answered this question, but I had it in mind. I’m going to ask it anyway. How has presuming competence in a child made a difference to your practice?

Tamar Nevo:

I think it again, first of all, I never think of myself as coming to fix a child but I’m coming to understand a child and I really need them on board. I really need them to help me understand them. And once I understood that, I don’t really understand all the kids and they are very individuals and they have their own skills and they don’t always show them it’s like it just changes your you don’t come from I’m up here, and I’m going to help you and I’m going to teach you and I’m going to fix you. It’s like, we’re here. And we want to go up here together. And there are kids that I, maybe, you know, I always kind of think, Oh, I think this kid maybe doesn’t have great cognitive skills. But I never, I never stay there.

I always say, Okay, so I’m going to make things more simple to him. But I always am going to tap into the higher levels, because maybe he can’t do it. So I’m not going to say, Okay, I’m going to assume this, get it smart, even though I don’t see it. And I’ll start up here because he won’t be able to get there with me, and I’ll lose him. So I do start here. But then every time I’ll make it a little bit higher, and I’ll see oh, that was too much.

Let’s go down a little bit. But I never say okay, this is where we should be, because that’s what he can do. And I think it is an amazing example. Because when I first saw him, I did not know if he was cognitive. I didn’t know if he understand. I didn’t know that he understood because he did. But I didn’t know what his abilities are. Yeah, he’s a great example

Vaish:

of a comedian that doesn’t show anything, right. So it’s very hard for him to express anything.

Tamar Nevo:

And especially in the beginning, I think he also didn’t have a relationship with me and didn’t have the trust. And he had so many other therapies that didn’t work. So he wasn’t even it seemed like he doesn’t have motivation, which I know is not true. But even then I knew it wasn’t true. So I didn’t say, Oh, this child is not very motivated.

I don’t know if he understands a lot. I don’t know if he cares. I just knew that I am not in a place where I know what he cares about. And I think that makes a big difference when you come to treat kids, especially kids that are not, I mean, I know none of the kids are obvious, but especially kids that we that are a little different to us as therapists, because they’re not like most of the kids that we see that maybe are less involved, or you can tell some other difficulties. Faster.

Vaish:

Yeah. And now, I mean, I think it’s a good time to talk. But now your relationship has changed where you have, you have communication going on where you can discuss motivation, you can discuss whether you can actually somewhat build a plan together, correct?

Tamar Nevo:

Yeah, yeah. So our therapists always child-lead. I mean, I’m talking about myself, but, and child lead sometimes is actually providing things in the clinic, but not really using them, because a child goes to do something else, and you really go with them. But sometimes the child is not leading you anywhere. Like said, for example, or like a lot of other kids that they just don’t have good motor planning, they don’t have ideas, and they don’t know what to do. So child lead is looking at their interests at their skills that I know about, and every child has a skill, it’s a skill to sit down. And wait, that’s a skill to have because some kids can’t sit down and wait.

We always find the skills and we tap into that, and we go with it. So even if the child doesn’t physically lead me to do things, their personality and who they are leads me. And I think would sit again, it’s a good example because sometimes I’ll have a plan. But I’m not going to do what I plan because he needs it that day, he needs to get his arousal up higher, to be able to be more alert, and to be more focused. And so we’ll do more swinging than I planned, and less of the fine motor or some days.

Motor-like his motor execution is slower. So we’re going to do things that don’t require fast. And sequencing will do slower things. So it changes by the day too. And it’s not just it’s all all the kids that sometimes have, oh, this is what I’m planning to do today. But that’s not the right thing for today, and they want to do something else. And there’s a reason why they want to do something else.

Vaish:

Changing tack a little bit. I know that you work with younger children a lot. And if you had to talk to parents of younger children, you notice any trend in specific you could call them mistakes but missteps that parents make with babies, younger children that affect motor skills, something that you’ve been really wanting to tell everybody that don’t do these things or do these things.

Tamar Nevo:

So I one of the things that I’ve learned is that as parents we make mistakes and that is okay, it’s totally okay to make mistakes, and kids who are it’s, again, it’s a language that I have a problem with, but that are typically developing and don’t have a lot of motor issues, sensory issues. We can’t make huge mistakes with them. They We’ll get there. It’s the kids that have more of like very subtle motor or not subtle, but motor difficulties or sensory difficulties or cognitive difficulties, that if we tweak it, we can help them kind of go make their way easier. I don’t, I don’t think parents can really do harm.

Vaish:

Okay, with intention I cific that you think they can they can do at home that that that impacts the kids positively or at least sets them on a path for

Tamar Nevo:

I do think that now when they tell parents to put their babies on their back as a problem, and we need to put babies on their stomach for a lot longer. I know that all the different equipment that we put babies sitting and standing before their time, does cause some changes and delays in the way kids develop. Now, because they go, they don’t get the muscle training to do what they’re doing now. And they’re not strong enough to sit up or to stand when they do it. Because they just put them in all these ports.

Vaish:

Now there’s a lot of there’s just sort of passive sitting around kids babysitting and car seats, and like really slouched postures, I remember reading about this after I had done all of these things, which is given that he had low motor tone, he was on his back most of the time, he was in car seats a lot of time, and he never, because he’s low on initiation, he’d never asked to be led out of that. And I remember reading about it. Afterward, it was two or three years old, and we had done pretty much everything that I didn’t want to do at the time.

I mean, like later on, I realized wasn’t the best thing to do. So with my daughter who’s neurotypical I, I did none of that she was on her tummy a lot more, she was never in a car seat, she was always kind of, I never aim for comfort, I always aim for movement. I think that that really helped. I wish I had known about it with said, but I’m glad I at least got a second chance.

Tamar Nevo:

Yeah, we do see, like, when my daughter was in, maybe fourth grade, I came in to do a screen at her class, and maybe 40% of the kids were not holding the pencil correctly. And part of it is because of shoulder stability and muscle tone and muscle strength. Because as babies, I think it’s a lot more than in the past was like 10% When I went to school, and now it’s more and more kids. Yep. Because they didn’t have that experience of being on their stomach staying for longer.

In baby positions, rather than sitting up our tendency, when in development is to be upright. So we will get there. But if we bring the kids to be afraid before they’re ready for it, they have less of a drive to learn how to do it on their own. So the kids that are a little slower in development are typical but slower, they’re even slower.

Yeah, and being able to do it on their own. And then we get fussy our kids because they’re on their tummy. And they know they could sit up they can’t but they want to, they want the parents to sit them up. So I think that affects regulation as well. And like behavioral regulation to Yeah, their own regulation because they’re fussier, and they don’t learn to initiate it on their own. So I do think giving the kids that time to develop those skills on their own and not rushing to sit them off, stand them up.

Give them all those toys and all the input that we give them now.

Vaish:

Yeah, and for me, I think the learning was to just be okay with a little bit of discomfort not paying it ever, but just the child moving around struggling with a little bit of struggle and being occupied because we’d said I had I remember zero tolerance for any sign of discomfort it like immediately fixing him and making him comfortable but was not the best idea.

Tamar Nevo:

Yeah, maybe he was a more vulnerable baby. So yeah. And he was the first and yeah, I was I was pretty mean to my stomach.

Vaish:

Yeah, yeah, I mean to my daughter. This is for parents, but what is your advice to someone starting as an OT, working with kids with disabilities and you’re really experienced and a lot of other OTS look up to you. And I know that many people have perhaps trained with you. But if somebody were just starting out, and I know it can be very intimidating, working with kids that, you know, even kids like sitting because it sometimes kids it can seem like you’re working with a black box because you don’t have an output you don’t know what’s going on. What would you advise notice?

Tamar Nevo:

What I usually advise annuities is because we have students that come and train with us and our clinic is more sensory-based and really child led, which you don’t always plan the treatment and do what you planned. So what I, I always liked them to first have a good experience with motor, which sometimes means working at a hospital, or working at an inpatient or outpatient clinic with kids with I mean, again, I’m talking about pediatric OTs, doing some work with kids with cerebral palsy or with injuries, just to know that base of what the body is like and development in the stages and what motor patterns we want to have because we use it all the time as part of our session. So I think they really need to have a good baseline and motor development. Because it affects circulation because it affects fine motor. And then I think sensory integration theory is very important to learn.

There are so many different classes and so many different, even theories within the theory. And I think after a few years of experience of the more we can say concrete work with kids, it’s a good time to transition to a sensory clinic and integrate all that knowledge together.

Vaish:

Thank you, are there certain other modalities that you’d like to have onboard, I know you’re trained in therapeutic listening, and you do a lot of work with that. So when you work with children other are there other therapies that add on to OT to make the combination significantly more effective than doing either of those alone?

Tamar Nevo:

I told you before, I’m very old-fashioned, I’m very, OT, mostly bottom-up, which is coming from the body from the lower areas of the brain and feeling it and doing it and learning it in that way. And I do less of the top-down, I do use it and but less of the talking explaining understanding it here. And then although a lot of times I do combine it. But I do see the benefit of a lot of other modalities. And I’m lucky to work at a clinic where there are other clinicians. So for example, the interactive metronome, which is teaching sequencing and motor actions and motor planning.

I’m not certified in it, but we have other therapists who are and they can do that. So I think the basic skills for me that I really need is the motor, the DIR, which is the floortime approach, which is very important for every therapist who works with kids, autistic kids, or non-autistic kids because there are so many aspects that you can use with typically developing children. at Abt, they do Qigong, they do massage, there are a lot of other modalities. And again, I do less of those. And but I love that we have it because I can integrate other therapists to do that, with the kids that really need it.

Vaish:

So to round up our conversation, what brings you joy as a therapist,

Tamar Nevo:

I’m shocked. Almost every session when a kid is successful, I’m just so excited. Like even was said, If he tells me something or communicates with me. I’m, I’m so excited and so happy almost more than he is. And I see it with so many kids. And sometimes I take it a step back. I’m like, I’ve been doing this for 25 years, and okay, the kid has I just, I still feel it in the same level of excitement. Wow, he did that. And I think that’s the kids feel it too. Because it’s

Vaish:

I think that’s what you have to you know, get up in the morning and look forward to what you’re doing. Right. And, and only then can you actually I think for anybody that’s doing any work, not necessarily IoT, but you need to find something like that, that brings you joy, and I’ve seen I’ve seen you excited.

Tamar Nevo:

I’m like, Okay, I mean, kids do it. And it’s awesome and happens almost every day. But big achievements. I’m like, and the big achievements are sometimes small. Like, yeah, wow, we did it. And I’m just so excited for real and I think that’s really that’s the reason I do it. And so I really think the kids helped me the same as I helped them. That’s what I think it’s a combination, and it’s a joint effort. It’s not me helping them or me. It’s together because they’re really helping me to it. It’s really fun to see Oh, we did it. It’s and it’s always we did it. It’s always the child and me because we worked on it together, and then it happened. And wow, it’s so fun.

Vaish:

Thank you for having this conversation with us. Any parting thoughts?

Tamar Nevo:

I don’t know. I just think, really, for parents, I would say because I want to say how helpful you were when you first brought suit to see me? Because you told me I don’t know. I don’t I don’t know what his abilities are. I don’t know, kids that were before. Before he could communicate. Yeah. And, and you said, I don’t know, I see this. And I see this. And I see this. And we kind of worked together to figure out what we might want to do, or directions we want to go. And I think some parents come with us, this is what we want to do more, some parents come very worried.

They don’t think their child is able. So I think, and it’s hard. Of course, I wouldn’t be worried to a lot of times. But I think your approach, I don’t know where he’s at. But I really want to find out. And being in that mode of let’s explore what we want to do rather than being very, very anxious about it or being very, let’s do this, this and this. I think that’s very helpful. And I know it’s a hard place for parents to be but you are very ready and ripe for that.

Vaish:

Yeah. And I think that what, what I would probably distill as a message or motto or whatever it is that from this conversation was what you said at the beginning was that a lot of us start with the fixate approach. I did that too when Sid was younger is that I have to fix this child I have to make sure he is like any neurotypical peers so on and then we but growth and joy only come when you realize that you’re just on a learning journey together and there’s no fixed destination. And I think that when we’re in that mode, there’s actually joy in every day there’s looking forward to what, what can happen today, because it’s all a mystery, and there’s just the field of all possibilities. Right. So I think that’s really exciting for me.

Every day as a parent, it’s exciting for you every day as a therapist.

Tamar Nevo:

Yeah, yeah. Yeah, I think it’s the being there with them and then being there with us. And together figuring out where do we want to go? Oh, we can even go further or no, we don’t. We can go further. We’ll stay here and just make this really good. A really good place.

Vaish:

Thank you for listening. I hope you enjoyed this podcast. Be sure to grab a constipation toolkit for your child at functionalnutritionforkids.com/constipationtoolkit. Signing off. I’m your host Vaish and today’s music was by my daughter Maitri Gosh. See you next week. Bye.