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Amanda Wilde (Host): Welcome to Healing Heroes PDX, the podcast series from the specialist at Shriners Children's, Portland. Today, we are discussing occupational therapy for children with insights from pediatric occupational therapist, Eva Ma. I'm Amanda Wilde. Eva, welcome. It's so great to have you here.

Eva Ma: Thank you, Amanda. It's a pleasure. 

Host: Occupational therapy, I know I always get this wrong. It sounds like things to help you with your job, your occupation. But what is occupational therapy and what does it mean for children to receive this kind of intervention?

Eva Ma: Oh, good question. I get that kind of question a lot of times. You know, parents will say, "My child's too young. They're not ready to work yet." Yeah. So, occupational therapy was framed in the early days of using our hands as a tool. So, we typically would be viewed as, how do we use our hands in coordination to help with our daily lives? That would be our occupation. Maybe for like an older adult, maybe how to drive, how to get dressed. But particularly with children, we just really feel that we learn through play. So, children's job is play, and with all different types of skills that they develop through infancy to early childhood to school age and to teenagerhood. So, it really depends on the specific person. We work with children with maybe some genetic disorders, maybe learning disabilities. It could be something like children being on the spectrum of autism spectrum. So, it is really a wide field.

When you talk to me, I can think of maybe in a day I would work with children with four or five different types of profile. But as a pediatric occupational therapist, we work with children from infants or early birth up to they are 21 years old.

Host: So, there's a reason their doctor might refer the child to you, something they've observed. Do you find the reason for that, whether it's a genetic disorder or a learning disability or whatever, from the wide range of possibilities?

Eva Ma: Yeah. Well, with modern technology, sometimes for some mothers during pregnancy, we have early detection. So, definitely, the doctors would have some knowledge about the newborn or the child. And sometimes they are not. So, I might have children coming in to see me. The mom might say, "Oh, they are sort of clumsy," or maybe a child that is not meeting the sort of expected milestone. There are certain, milestones that we would observe in a infant or a toddler. So if they were slightly delayed to maybe just wanting to make sure, sometimes the pediatrician might refer them. 

Here at Shiners, we do have a community referral program so that the community physicians can refer the children to come to see us at Shriners. And there are other children, maybe they are diagnosed early on with, say, musculoskeletal deficiencies or maybe a neurological condition, or maybe a child with cerebral palsy. So, they would be in general needing therapy at home or in a community setting like Shriners or some of them can get services in their schools.

Host: I imagine kids that are old enough or families in general might be a little nervous about getting referred to occupational therapy. What can children and families expect when coming to see you for the first time? 

Eva Ma: It's hard to be a parent and when you are being told that your child is needing therapy, that's definitely a layer of concern and anxiety. So, I really like to use a play-based approach, really to try to connect to the child and seeing their fullest potential because I'm a stranger to them coming in. I really wanted to make sure that the parents have some ways to communicate with me their concerns.

But my primary focus when I meet a child is I like to know them. I want to know what they like to do, what interests them, what motivates them. What do they like to eat? What kind of subject they like in the classroom setting? So, really building that relationship as the foundation of the therapeutic activities that I would like to design for them. So, I would like to say my approach is more a child's interest or a child's motivation approach is not a compliance approach. Typically, adult to children, we always say, "Do this," but we really want to focus on what the child is good at and what are the growth that we like to see them?

Host: You were saying children. Their job is to play and they communicate through play. So, that's how you're going to find those attributes that are going to help you design the program that's going to make it the most successful occupational therapy experience for them.

Eva Ma: Exactly. Because when we play, it shows our thoughts and feelings. And with that thoughts and feelings, our brain is going to say, "Hey, we need to move our arm that way," or "I need to move my body that way," or, "Hmm, I need another tool. I need to go get a pair of scissors," or "I need to go climb over to that ramp." So, all that involves a lot of brain functions. That would be the base of our being, so we call it sensory motor. You have to feel it, sense it, have an execution of the motor movement, and then you learn from it. And then, you say, "Oh, I like it. There's a feedback that I do pretty well. I want to do it again to a feedback that, "Mm, that's not quite what I want to do. I need to change it, but I will do it again" to the feedback is, "Mm-hmm. I don't like it at all. I want to go away," and me as an adult would be attuned to that and to redirect or reorganize so that we can promote to that next calm phase to learn again or to do it again.

Host: So, part of your expertise is to be extremely observant, and I know you have a lot of specific expertise. Can you just touch on some of your special accreditations that you have and how you incorporate them into your work? I know you're a Child Passenger Safety technician and a DIRFloortime expert. Can you talk about that a bit, what those accreditations mean to your work?

Eva Ma: Sure. And as an occupational therapist, we are required to have continuing education. And so, there are a lot of learning that involve each year for me, and I just love to learn and it's an ongoing process. So, I am a certified car seat passenger safety technician, to help parents to set up a car seat so that a child can be transported safely in the car vehicle as well as children with special needs. There is a different type of car seat or different type of setup so that the parents can transport children with different abilities safely. So, that's one unique credential I carry.

But I'm also a Floortimers, because that's one of the names that we give to that therapy approach, is respecting the child's developmental differences, sensory profile, and using a relationship-based approach to treat each one of them. And then, also, I am credentialed by the Rehab Engineering Society of North America as an assistive technology professional. And with the advancement of different types of technology, like low tech to high tech, maybe something similar to like a voice output device to something like a person using their head and neck control to drive a power chair. So, using different types of technologies that is commercially available or uniquely medically justified. So, I use those skills to evaluate and provide recommendations and treatment to all my children.

Host: That's truly amazing. I'm just wondering if there comes a time when a patient no longer needs occupational therapy, 

Eva Ma: I still remember the first year I was in school, my professor would say, the minute you meet your patient, you start thinking about discharge. That is an honor and a wonderful thought that eventually my kiddos would not need me. So, it's a mutual decision. We develop our goals together with the whole family. And some children coming to Shriners may not need us more than maybe several weeks. It could be because they have a fracture or maybe they have a little bit of learning problems at school. So, some of those children may need just a short course of treatment and we will develop a plan of care. And then, we'll project, maybe we'll see them say 10 weeks or 12 weeks. To some of the children, maybe they need therapy, but we also want to work on the goals together. And maybe taking a natural break sometimes will help the children to maybe at a place that they might have plateaued or sometimes the family is busy. For some of the children coming in, they might need occupational therapy, speech therapy, and physical therapy. So, we'll help the family to prioritize because modern life is busy. 

Host: You have to help prioritize. Because there's only so much time and energy in every day, right?

Eva Ma: Right. Yeah. Like at Shriners, we try to see some of the kiddos either first thing in the morning or being like lasting at the day, but still, it makes it a long day. 

Host: Yeah, that's definitely a consideration. You mentioned how you handle this at Shriners, and I'm certain that if I had a child that needed to go, everything you said makes me understand someone like you would be what I would be looking for. Someone who is multidisciplinary, has several accreditations and has been trained over some years and is very individualized with each child. Is this occupational therapy experience that I'm hearing about today different at Shiners Children's than at other facilities? 

Eva Ma: I want to say so. Of course, I'm biased. Shriners has been historically serving children with a lot of orthopedics needs. So, that's always a neuromuscular or musculoskeletal component to their profile. But as I mentioned, we are expanding and we are seeing children from all walks of life or the whole wide spectrum. But we really like to provide a whole child approach, and to support the family the best we know how. 

Host: Eva Ma, thank you so much for sharing your expertise and your compassion today. 

Eva Ma: It's really my pleasure, Amanda. Thanks for your time. 

Host: Eva Ma is an occupational therapist at Shiners Children's Portland. If you'd like to learn more or get involved, head on over to our website at shrinerschildrens.org/en/campaign/portland-therapy. And that concludes this episode of Healing Heroes PDX, with Shriners Children's Portland. Thanks for listening.