Enabling Function Through “Guerilla OT”

Quick Overview

In this presentation, Kelly Beins discusses the concept of “Guerilla OT” and how it can enable function in therapy. She shares her experience of adapting therapy sessions during the COVID-19 pandemic, including providing therapy over a fence. Beins emphasizes the importance of understanding principles of development and using evidence-based strategies in non-traditional ways to support skill-building. She discusses the role of sensory input, task analysis, and activity modification in therapy. Beins provides examples of play-based activities that can be modified to build various skills, and she highlights the importance of finding the right fit and balancing compensation and remediation. She concludes by encouraging parents and caregivers to change how they do activities and to remember that hard does not mean can’t.

Hello, everyone! Thank you for joining me at the 2020 FAST Educational Summit. I am grateful to the FAST board for inviting me to be a part of this virtual event. I would also like to extend my thanks to David and Martha Gerzik for allowing me to share their content and pictures, and to David for capturing most of the images in the video.

Before we dive into the topic, I want to take a moment to express my gratitude for this opportunity. It has been one of the highlights of my year, and I hope to continue participating in events like this for years to come.

The Evolution of Therapy

Let’s start by looking at what therapy used to be like before COVID-19. As you can see from the pictures, therapy sessions involved a team of therapists, treatment rooms, and a wide range of supplies. Clients would come to the clinic, and it was a traditional treatment model that we were proud of.

However, the pandemic changed everything. Therapy sessions shifted to a remote format, and this became the new norm for therapists all over the world. In my case, I closed my clinic for good. But amidst the challenges, there was an opportunity for innovation.

Embracing “Guerilla OT”

One day, while on my way to David’s house to drop off teletherapy supplies, he jokingly suggested doing therapy over the fence. I initially laughed it off, but then I thought, “Why not?” So, we decided to give it a try. Little did I know that this simple idea would inspire many other therapists to step outside their comfort zones and find creative ways to provide in-person therapy.

In today’s session, I want to inspire parents and professionals to think creatively about how they can use effective, evidence-based strategies in non-traditional, creative ways to support the development of the children they love.

Exploring Different Therapy Models

To begin, let’s compare clinic-based therapy with other models of therapy. Each model has its own advantages and limitations, and it’s important to consider which approach best suits the needs of the child and their family.

Understanding Developmental Principles

Before we can effectively support a child’s development, we need to understand the principles of development. These principles provide a framework for setting realistic expectations and structuring therapy activities. Some key principles include:

• Polyvagal theory: We are wired for connection, and our sensory input can be the most therapeutic tool we have.
• Hebb’s law: Neurons that fire together, wire together. Repetition and multiple neural channels are crucial for learning.
• Sequential order of development: While development is not strictly linear, there are predictable stages to gross motor, fine motor, and cognitive development.
• Piaget’s stages of cognitive development: Children’s cognitive abilities progress through different stages, but they can also regress or fluctuate depending on various factors.

Understanding these principles helps inform the science and efficacy behind in-home and mobile therapy models.

The Importance of Positioning and Stability

Positioning and stability play a crucial role in optimal function. Just as it would be challenging to do high-level math while standing on one foot, children need physical stability to support their learning and physical development. Proper alignment of the spine and pelvis, along with the ability to hold a position without feeling off balance, are essential for functional movement.

Task Analysis and Activity Modification

As occupational therapists, task analysis is one of our superpowers. By breaking down activities into basic categories such as gross motor, fine motor, visual motor, and social function, we can better support a child’s learning of new skills. Activity modification allows us to adapt tasks to the child’s abilities and gradually increase or decrease the challenge as needed.

Building Skills Through Play

Play-based activities provide excellent opportunities for therapeutic intervention. By using effective strategies and adapting activities to meet the child’s needs, we can create meaningful learning experiences. Let’s explore some examples:

• Gardening: This versatile activity can be adapted to work on fine motor skills, hand-eye coordination, and sensory exploration.
• Going for walks: Walking can be modified to include various movements such as hopping, jumping, or marching, depending on the child’s abilities.
• Target toss game: Simple games like this can improve visual attention, hand-eye coordination, and timing and rhythmicity.
• Tactile exploration: Engaging in activities that involve tactile input, such as dragging a hand along a metal post, can provide valuable sensory experiences.

Remember, the goal is to find the “just right fit” for each activity, considering the person, environment, and task variables. Adapting and modifying activities allows for successful engagement and skill development.

Compensation vs. Remediation

When working with children, it’s important to consider whether we are compensating or remediating challenges. Compensation involves finding ways to make tasks doable, while remediation focuses on teaching and building skills. Both approaches have their place, but it’s crucial not to overcompensate. By finding the right balance and gradually reducing support, we can help children develop their abilities and achieve functional independence.

Adapting Activities at Home

Therapeutic activities can be done at home using simple household items. By changing how we do activities rather than what we do, we can create meaningful learning experiences. Here are some suggestions:

• Use what you have: Repurpose kitchen items, packaging materials, or scrap mail for therapeutic activities.
• Change position: Explore different sitting or lying positions to provide varied sensory input and challenge the child’s balance and stability.
• Slow down: Slowing down our responses and providing repetition can help children with hyperexcitability and improve their ability to process information.
• Simplify or enhance: Modify the number of items, steps, or instructions in an activity to match the child’s abilities. Enhance touch and vestibular input to engage multiple senses.
• Follow their interests: Incorporate the child’s interests into activities to increase motivation and engagement.

Remember, regardless of whether you are compensating or remediating, the ultimate goal is to promote function and independence.

Embracing the Challenges

Transitioning to new therapy models and adapting activities can be challenging, but it is possible to provide effective services in any environment. It requires creativity, flexibility, and a willingness to try new approaches. On the difficult days, when progress seems slow, remember that hard does not mean impossible. By finding different ways and adapting to the child’s needs, we can continue to support their development and growth.

Thank you for joining me today, and I hope these insights and strategies inspire you to think creatively about how you can enable function through “Guerilla OT.” If you have any questions, feel free to reach out to me.