Episode 240: Change At Any Age with Danielle Amster, MS, OTR

Hi and welcome to episode 240 of the Untethered Podcast. Today we have Danielle Amster joining us. Danielle completed her graduate degree in occupational therapy from Columbia University in 2000. After working for many years with children experiencing sensory difficulties, learning disabilities, difficulty developing friendships and self regulation issues, she recognized that no one was working with the teenagers and adults who experienced the same challenges. This prompted Danielle to found sensory wellness in 2015, a practice that is dedicated to working with individuals throughout the lifespan, including adults and teenagers. Danielle is passionate about helping individuals feel empowered to make changes in their own lives, and she strongly believes that people can affect positive change at any age. She enjoys working with her clients to uncover the root causes of their difficulties. Danielle is dedicated to staying up to date on the latest advances in relevant areas of study, including sensory processing theory, reflex integration, neuroscience, movement science, and the biology of trauma, anxiety and self regulation. She's known for her gentle cheerleading style and her commitment to making life easier for her clients. Danielle is a dedicated mother above all and finds her greatest enjoyment spending quality time with her husband and five beautiful children, especially outdoors. Quick Disclaimer all information, content and material of this podcast are the opinions of the speakers and is for the informational purpose only and not intended to serve as a substitute for the consultation, diagnosis and or medical treatment of a qualified healthcare provider. Welcome to the Untethered Podcast. I am your host, Holly Balkan. I'm a certified myofunctional therapist, feeding specialist, podcaster, business owner and mentor. This podcast is all about getting your questions answered and collaborating with colleagues to bring you the most up to date information in the orofacial myofunctional therapy, airway, tethered oral tissue and pediatric feeding therapy space. If you're new here, I challenge you to keep an open mind and join my mission to spread this message far and wide. If you've been around since June 2019. Thanks for being a loyal listener. As we jump into today's episode, remember to listen with correct oral rest. Posture, tongue up, lips closed, teeth apart.

Breathe through your nose.

Let's get started. Hi Danielle. Welcome to the podcast.

Hi. Thank you so much for having me.

I'm excited to chat today and to dive in. You know, everyone just heard a little bit about your, your background and the intro, but I really want them to fully understand what it is that you do because I know that, you know, you're truly the first ot practice that's really been dedicated to working with individuals of all ages. Right. That experience difficulties with sensory processing. And so I think that's A very unique type of practice to have opened and so I'd love for you to speak to that.

Okay, great. Yeah, it's definitely been a unique experience and it's really been a lot of fun and a work in progress, I will definitely say. So. I graduated from OT school with my master's in 2000. And I will just tell you a little bit about my background and how I came to do this because it definitely was not in my original plans. So I started out working in the school system as so many therapists do, primarily with. Exactly. Primarily with learning disabilities. Kids on the autism spectrum, a lot of social, emotional concerns, behavioral concerns, auditory processing, visual processing, fine motor skills, more in this type of realm. So I did that for many years. I also worked in school schools dedicated to children diagnosed on the autism spectrum disorder for about seven years. I did a little early intervention and then I worked in a really fun and great environment in a sensory gym, in a private practice where I learned a lot, had great, great co workers and great supervision there. And then eventually I ended up opening up this practice in 2015. So we're doing this for a little while now. And by now we've definitely seen hundreds of adults, teenagers and children. So I'd say the youngest in our practice right now is about 18 months and the oldest is 70. We've worked up to the 80s and I definitely give a lot of credit to people in different stages of life for coming forward. Definitely you have a lot of, you know, women and men in their 40s who are just like, I can't do this anymore and I need to help myself. And really through all the ages. So it's really been fun. So I will tell you, I originally got into occupational therapy because I love the concept of working with the mind and working with the body and the whole interplay between those. So I really am very fortunate to have really, really melded that. And I almost see myself as a mental health practitioner from the bottom up, like a real, you know, from the body trying to help the mind. We see a lot of individuals with self regulation challenges. That is definitely, you know, something we see, I'm sure you see often in your practice with kids and it's definitely through the ages and I think in today's world there's lots of that everywhere. But I'll tell you how specifically I ended up working with adults. I was working in the sensory gym and very often you would see the parents coming in and looking very similar to their children, you know, because of genetics and environment. I once worked with this really lovely social worker. We were collaborating on a client and she said to me, you know, I was working with this child and I, you know, I was seeing the mom is so regulated and together and then the father walked in and I said, oh, hello tree, I know your apple well. So I think we often do see that. And I think, you know, it can be very eye opening for parents to see this in themselves and to say, oh, that's why I've been having those troubles and that's why that has been so hard for me. And to know that they really can get help at any age is really, really empowering and helps them to help themselves lead a real full and fulfilling life and also helps them to raise their children with similar issues and can create a real bond between parent and child as well because they're working through similar things. I'll say also that we do tend to see also a lot of adults coming from that, you know, that parent role who just from having challenging children that are difficult to raise with a lot of social, emotional, behavioral concerns that they lose the ability to self regulate easily for themselves because life is just really so stressful. And so we often will see the parent for those reasons. But really we see a whole array of, lots of diagnoses in our practice from you know, at all ages, from, you know, from classic sensory issues to learning disabilities at any age, visual and auditory processing. A lot of people that have experienced trauma really an on and on. And I'll tell you when we, when I was working in this sensory gym and I was seeing some of these parents and someone approached me, can you help me as well? And I thought, you know what, let's try it. And I did see a few adults in that environment and it was, it was working, but it was really, it was really not the best for the clients. I'll give you two examples. Maybe we had one woman who was a teacher and she said, I don't mind, I'm going to stay in this, you know, I'm going to come to this practice really fine. Until one day she ran into her students there who was also, you know, coming for therapy and it was just very, very uncomfortable. Had another woman also who was coming, didn't want to be seen, she'd come in the back door. We had all these arrangements. But you know, there's a lot of in, in sensory gyms. Very often in these kinds of practices, people share rooms, there's shared spaces and also it's very kitty focused, very colorful little chairs and all of that. And you know, if you think it's hard to get an adult in that environment, it's even harder to get a teenager in that environment. They do not want to be treated like that. So we ended up opening up our practice. Really, I blame my husband for it. I know that you in your heart are a businesswoman all the way. And I really was not in that mindset. Although thankfully I find I do have the skill set for it. But I really am a clinician at heart and a detective and a, like a lifelong learner. And my husband said, you know, I think you should do this, I think you should open something. There's no one working with adults and teenagers. And I said, I don't know, I already have a full time job. And so in the end he won and I started seeing, I started this practice on the side keeping my full time job and then it grew and grew. And we've really found there are so many people that really could benefit from this type of service either because they have developmental disabilities. But I'll say primarily in our practice we end up really seeing a lot of individuals that are just struggling to function, that from the outside may look typical, and this is for kids and adults, but are really, really struggling. So we ended up opening up this practice and now we have many therapists on staff. I have two new therapists coming on board now. We have two offices, one in New Jersey, one in New York. And we have a lot of people that even fly in and do intensives, you know, over a week or over two weeks from other states, from other countries, because there's just not many people out there. But I'll say, like, our spaces are really friendly for all ages. They're very calm and very regulated. And every therapist and client has a private space with the door shut. Parents obviously can come in with their kids, but it just gives people privacy and it's just a mature, sophisticated, dedicated space. So it's been really fun.

Yeah, that's amazing. I have so many things to say. Very cool. Just the diverse nature of your clientele, but I love that you've been able to adapt the environment to meet their needs and also to allow them to be themselves. Right. I mean, you spoke to how so many people will say, oh, it's fine, it's fine. But truly, if you're not, if you're not feeling comfortable in the environment in which you're going to, for some type of intervention, therapeutic intervention, I mean, are you really going to maximize your, your time there, your experience? So I love that you were able to see that. And I think, you know, there's, there's all these conversations around people, you know, being really great clinicians and not great business owners or vice versa. And I truly think that the best private practice owners are those who have a heart for what they do. And, you know, that's really. You were like, you know what? This doesn't exist. Or maybe something exists that I want to do differently, but.

Right.

And that's where I've seen a lot of therapists who go kind of like, I'm not a business person, but here we go, like open a practice. And it's just, it's amazing, right, because we know there's such a need. And I think it's just incredible because I was sitting here as you were talking and I'm trying to think. I'm like, I don't, I don't think I know of any practices where if somebody came to me and they said, I have an adult who has sensory processing, you know, concerns, is there like an OT for that? Is there a practice I can send them to? And I'd probably be like.

Definitely. You know, it's been interesting. And in terms of like hiring staff, you know, I have to really train each individual therapist myself at this point because there's really not much out there. Although I will say I'm giving a course in December for TheraMoves in Brooklyn in New York, where I'll incorporate a lot of this information. So I'm hoping to really push this as an agenda. You know, there's no reason that I'm here in New Jersey and I'm getting calls from California and from Montreal and from Paris and it's like, we really need to get this out there. And yeah, and we've really developed a unique approach as well. You know, when I started out this practice, it was really interesting because I thought, okay, let me network with the other OTs that are working with adults in this space. This is going to be great, you know, and so I called up, there's actually a woman who is an advocate for adults with sensory processing disorder. So I gave her a call and she said, let me connect you with this really big, well known center. They have a section that deals, you know, works with adults.

So I said, great.

And I call them up. This is a number of years ago already. And I said, you know, hi, you know, I'm interested in working with adults. I'm, you know, I'm on the east coast, you're not in this area. And I'd really like to learn about what you're doing. So, you know, they said to me, well, we're really just doing assessments for people and evaluating them so that we can let them know that they're not crazy. I said, what? And they said, yeah, people just want to know that it's not in their mind that this is a real thing. So I said, well, you're not treating them. And meanwhile, I had already opened my practice about a year prior, and they said, well, not really. Sometimes we give them some fidget toys or relax on a bean bag. And they said, why, what are you doing? I said, well, I've been treating them. And they said, oh, interesting. Can you tell us about that? And then six months later, I saw they opened an adult program.

So.

So that was really exciting to see because really there should be, you know, but definitely we've had to come up with our own types of techniques. The classic sensory gym definitely wasn't going to work for the adult population. And in the end, really, you know, I did a lot of research into the world of neuroscience and movement science. A lot of reflex integration, a lot of just understanding the connection between the mind and the body and how like, physiologically that's a real thing. You know, it's not this hulala kind of fake thing out there, but it's really a real thing. And when you shift something in the body, you shift other things in the body at the same time and in the mind. And you really see this whole shift overall. And it's been great because really when I work with the adults, it feeds back to how I work with the kids, you know, and it's really changed a lot. And so I would say that our approach is really quite different than the sensory gym at this time.

Yeah, no, I, I think that that shift in perspective from having worked across, you know, ages, I experienced something similar to that when I got into the MYO world and I started to treat adults. And I never worked with adults prior. I was always, you know. Right. It's like grad school. And that was it. I'd only worked with infants and toddlers and little ones. And I was starting to work with school age children and teens and adults. And, you know, and it opened my eyes because here are these adults who also, you know, when you said they, they wanted to tell them they're not crazy. This is legitimate. Right. You know, I had grown men sitting across from me in tears because they'd been to a dozen other practitioners over the past seven years, and people just think they're crazy. And you know, I've had a woman who was diagnosed with PTSD and she's like, I know I don't have ptsd. I have issues that are being ignored because nobody knows how to assess them or treat them. And you know, I was like, this is so, so fascinating. But it really also then drove my, my passion towards working with children and younger, you know, and older children, younger children, infants, toddlers. Because I was like, if we can deal, if we can address this now, if we can help them now and get them on the right path and give them the tools that they need to thrive, we can avoid having these adults, you know, need us later in life. We can put ourselves out of business. Right. You know, that would be the best.

Thing, which is definitely the goal. Yeah. And you know, in the area of sensory processing issues and all these related concerns, regulation, learning issues, definitely, if we can put it on course, when they're younger you avoid all these later issues. You know, so many of the kids turn into teenagers that are bullied and adults that have poor self esteem and just can't make the cut for all the things that they want to achieve and has this whole snowball effect and life is really different. You know, it really, it really can be shifted so much better when they're young. But I will say that you definitely can make changes at any age. And that's something I have discovered. And what's actually interesting, when I started working with adults, I thought that it would be a much longer process than with kids, but in the end it's actually much faster. So you know, at first I thought is it because they're more compliant? Is it because they're more motivated? But then I started to realize over time is that, you know, even if things didn't go smoothly, they're still, still was a lot of neurological development. So all those pathways in the brain are there, so we don't need to take the time for them to grow. You know, it takes like nine months to really build a nerve pathway and really insulate it properly. We call it myelinating it properly. But adults have these pathways and we're kind of just straightening them out and making them more organized. So that was a really good, a really good thing to find. I will say in general, like the approach that we use is very much based in all of these different things and the diagnostics like you said, I would definitely agree with you that and I think you also work in a very heavy bottom up approach, like looking for the root cause, like you gave that example of this woman with trauma. So much of the time, you know, we really need to look deeper and see what's really going on. It's interesting. We have a child in our practice right now who came in. He is about 5 years old and he's actually repeating kindergarten. And I had a long talk with the principal before school started. He just started with us in August, actually. And the mom had gotten a message from the principal saying, actually, you cannot come to the school. You need to put your child in special ed. And this was a week before Labor Day. And, and you know, he said, we just can't handle your child. He's all over the place. And he has behavioral concerns. He. And you know, I had met this boy a few weeks earlier, maybe three, four weeks earlier. And very, very, very sweet, very sweet child. And I had a long talk with the principal and we made a deal. And because I know I said this child has no school for September. He's going to sit home until all that paperwork goes through for months. I said, give me three months, give me three months. And another one of the therapists in my practice actually working with him, and they give us three months. And if it's still not working, then we'll go that route. But let's see what we can do. And really, this child has such poor postural control. He can't hold himself up to be still. And so he's all over the place, which is bringing his eyes all over the place and his ears all over the place. So he's really unfocused. And so he can't just sit and be. And I'll tell you that the mother showed me two weeks ago. She got a text from the teacher saying, you know, I don't think he was actually the teacher was made aware of all of these issues. And he just said, your child's doing amazing. I just wanted to let you know how great he is. And he's so appropriate and age appropriate for kindergarten. And just those few weeks of being able to be very targeted with the approach that we were using allowed him to be successful. It's only October now. You know, the three month mark hasn't come yet. So hopefully by that three month mark, we'll have much better visual processing and auditory processing and a lot more maturity. But it really allows us to, to make change really quickly and efficiently. When I worked in previous environments, in school environments, in the sensory gym, I felt like we were making change, but that it would take about 200 years until we got these kids to really get there. And what's so exciting is that over the last number of years, been able to really wheedle that down to a couple of weeks and months and a year, things like that. And then people can just move on and really be functional in their lives.

It's amazing. You're telling the story and I'm over here getting chills because I started working in the schools as well, right. I was on all those IEP teams. I was also the person who was like slipping parents of paper, like under the table, going like, you didn't get this for me, but call this person.

You know, it's like.

Or I was coaching them before the meetings. Like when we go in to ask for X, Y and Z, I can't offer it unless you ask for it, right? Because, you know, I think it's tough, right, Being in some of these schools, they are not trained, they do not know how to help these children. And it's just very sad. It's very sad to see children not have opportunities because again, we're not asking the right questions. We're not getting them the right supports, and maybe those supports don't exist where they live, but we're not seeking further information, right? We're not taking that, that root cause approach and going, what else can be done for this child before we just write them off to a different track of learning or a different school or, you know, and. And again, it does. It's a hard conversation, right? It shouldn't all fall on teachers.

And I think a lot has. So much has changed in development.

Yes.

We see so much more of this now than we ever had. I mean, we have three kids in our practice just this September who started. Who all were asked to leave general ed because of being all over the place, as they termed it, and really was very similar. We have one of the other little boys also. He actually moved into special ed at the school's request for kindergarten all over the place. And he was adorable. He came into the evaluation, he wanted to do something on a mat. So we had these mats that roll up. They're actually like wrestling mats. So he unrolled the mat and was playing on the mat and then it was time to put the mat away. So he said, I'll put the mat away. I said, great, put the mat away. So he sat on the mat and tried to roll up the mat. So that didn't work because he was on it. So then he tried another way and he ended up rolling himself in the mat like a hot dog trying to Roll it up. So then it was also really funny. Genuinely. That was really funny. So then he got silly and he got funny, you know, so that was a little distracting to the task. But then he tried a third way, couldn't do it, got up and left, and that was the end. He's not going to do it. And, you know, those kind of things happen so often in school for this child. But it really. He didn't know how to. Where to use his body. He didn't know how to motor plan that whole task. He couldn't organize it for himself. But then as soon as I said to him, hey, you know, should we just do it this way? I'll roll up the first little section. And then you go. And then all of a sudden he was like, oh, cool. Came over, did it and put it on the side. So if we can identify what the cause is, then we can avoid all these meltdowns, you know, across the board.

Yeah.

You know, I see this with adults also. It's interesting. I see a woman now who is 70, and she's fascinating because she is super motivated to help herself. So she is a woman who has been doing. She said she's been in the same yoga class for 25 years, and she does hiking and biking and tai chi and yoga and. And lots and lots of athletics, but is really uncoordinated. So she told me that, you know, she goes on these bike paths, so very often they're like, you know, you could fit, like, five bikes across, but sometimes you have to go through these two pillars, you know, at the end of a new section of the bike path. And she said in order to get through those pillars, which are, you know, 10ft apart, she has to get off her bike, walk it through, and then get back on. And she said, I still can't figure out how to just stand, which is, like, wild. And she's. You know, I think because she's done so much work for herself, she's definitely avoided a lot of back pain, joint issues that could have occurred, but she does have some of that. But, you know, it was really instructive to me because sometimes we tell kids, well, you have motor coordination issues, just do some martial arts, just do some yoga. And sometimes that really is enough, and sometimes I'll recommend that it really is enough. But sometimes you see that there's, like, really underlying mechanisms that just didn't hook up right. And all of a sudden we're hooking up. And she said, now I can stand. And I feel like I'm on Two legs. So, you know, we're, you know, it's still a work in progress. We just started also not that long ago. But it's just so fascinating because then we need to look back at our kids and then say, well, is that enough or is that not? Let's look closely. What is the source of your problem so that we can really be more directed in our treatment.

Yeah, well, and you had mentioned earlier the mind body connection. And I think this really, these examples that you're giving really speak to that mind body connection and how this actually plays out and daily activities that these patients, you know, the children, the adults are trying to achieve for themselves. And it's that, you know, this connection. Is it. Do you feel that it's the connection that's missing? Do you feel like there is more to it? Would you speak to that a bit?

Sure. So I think in the diagnostic process, like in our assessments, we really need to look at, I look at things in, as two paths, which really, it's more complicated than that, but that's really how I look at it. So sometimes we have, we see self regulation issues because there was either a trauma or some really challenging experience that, you know, led the person to be dysregulated. And then sometimes we see that there's developmental concerns which led to that. And I'll speak to that in a moment. But really helping identify that is key because sometimes you'll see somebody who, their development looks amazing and you see though that they have this fight or flight and their whole system is heightened and they just can't calm that whole system down. You see a lot of freeze response, a lot of fight and flight. And by just coming into that part of the autonomic nervous system and just getting that parasympathetic rest and digest system to come online, then all of a sudden we can reset that baseline and we're good to go in. Other individuals, though, will see that there's really some developmental concerns and then there's a lot more work that needs to be done. You might have some of that where you just need to reset the body to be calm, but you really need to address some of these developmental concerns. So let me give you a couple examples, maybe that would be more helpful. So if somebody has poor posture, for example, so they're all slumped over, you know, we could slump over now and you know, you know, then when you stand up, you don't have a great center of gravity, so you're kind of tilted over and you'll notice you're looking out of the top of your eyes, which is really stressful. How long can you do that? You're not going to spend that much time doing that because it's uncomfortable. And you know, you're compressing your diaphragm and your rib cage so you're not going to get good breaths in. And all this is going to lead your body to send off more stress hormones. If I can't breathe deeply, something must be going on. And then you'll see this, you know, shallow, high breathing pattern send off more stress hormones and all of a sudden you see this cascade effect. You know, similarly, we see a lot of these kids or adults who they're very rigid and they kind of walk like a board. So it's not that they can't look to the right or look to the left, but it doesn't happen with ease. So when they're walking around, they don't have that like nice swagger where they take in all this information from the environment. Because we don't realize that when we are in our space, whatever environment we're in, whether we're moving or we're sitting, we're in school and familiar environments or foreign environments, our brain takes in all this information and filters it. Not all of it comes to our consciousness. You know, it's kind of like, you know, the Alexa, which we think is off, but it's really always on so that it can hear when you call its name and all of a sudden it wakes up. So our brain is kind of like that also, where it takes in all this information from the world but doesn't bring it to our attention because it's not important. But then when something important happens, it alerts you to that. So if you move very rigidly and you tend not to have that nice, you know, comfortable swagger and you're not really getting all that information from around you. Your space becomes very close to the space in front of you. You don't take that information in and that's also going to send off stress hormones because you don't really know what's going on around you more comfortably. So you become more hyper vigilant. This is not conscious, but you know, unconsciously you start to be more hyper vigilant because you don't really know what's around you. You become less comfortable and this whole cascade event will happen. And you know, we can kind of trace back where the developmental pieces are to shift that to really impact the self regulation. And that really, really works. It really works. You know, like I tell my Clients often, especially the teenagers and the adults. I said, the CEO of the company stands nice and tall and is grounded and can move smoothly. And that's how you feel comfortable and confident and grounded, you know, so you can really impact the emotional pieces and social pieces through the body.

Yeah, yeah.

And I'm.

As you're talking, I'm thinking about children, right, that I've either worked with or that I see regularly. And I'm going, huh? And it's, you know, sometimes, too, we see these kiddos who almost, you know, you said they're very rigid. Is it that sometimes they're rigid because they're, you know, they're. They have hypertonicity. Is it rigid? Because they're actually. Lower tone. And they're bracing themselves, like. And kind. It's kind of like a compensatory pattern. Is it, you know, do you see certain patterns along those lines that are common in some of these children?

Yeah, so that's a great question, because that's definitely where it's at. And to look very closely at what's causing that rigidity, for example. So sometimes it'll be like that first scenario where there's just a lot of stress. And as human beings, we all have the same patterns, right? We tighten up at our shoulders, at our hips, at our heel cords and our neck, and we have this posture of. And we hold our breath, you know, so sometimes it will be coming from there, and we can help the person to relax, and then they feel great. Sometimes, like you're saying, it comes from the body not having that stability and needing to shore it up. Here's a great story. This is from years ago. This kid is probably in high school now, but he was in kindergarten at the time. And I remember very specifically, it was like the beginning of the school year was actually November. And I remember the mother said, he's having trouble with book reports. I said, november of kindergarten. What kind of book reports? He doesn't read yet. So that stuck in my mind. But the mom brought this little boy in who was adorable, and she said, I brought him to four different doctors. One diagnosed him as on the autism spectrum. One diagnosed him with add, One diagnosed him with oppositional Defiance disorder. And the fourth one said, there's nothing wrong with your child. I don't know what. I don't know why you're here. And she said, what do I do with that? So that's a whole other discussion about diagnostics. But what we really do is we look at the symptoms and see what's going on. So here is this adorable boy, and I did some, like, deep pressure things with him to help his body to relax. We're actually at a massage table, and we were chatting, and all of a sudden he got really relaxed. And then he shouts out, my energy is shrinking. Like, he just. He felt like all of a sudden he was a puddle of mush and his superhero strength disappeared. And he needed to, like, jump up and gather it all together because once we relaxed him, he didn't have that stability. So then we need to look at that and say, we need to have our body parts connected, right? You have to have your core. Everyone talks about the muscles in their abs, but really your core is this whole rectangle of your shoulders and your hips, the front, the back, the side, and everything in between. And you have to have really great awareness of that. You have to know how your shoulders and your hips are each connected to each other so that you have that stability so then you can relax and still be strong. So we can look quite deeply at that to see what's the cause. Is it a reflex integration issue? Is it a muscle tone issue? But like you said earlier, the diagnostics are so crucial because then you can be so targeted, and in a very short period of time, you can shift those things and really start to see them move along. But that was such a great story. It was so instructive.

Love it. I love stories. I love stories. Connect so many dots. And it also helps, you know, like, for me, for example, right, I'm an slp. I, of course, work with children who have had, you know, sensory processing struggles in the past, but I've never been that. That expert on the team who is speaking to that directly. Like, I understand, you know, that we need to address it. I understand we need to get you to the right person. But also, as a team, we need to come together so that I also can understand how best to support that child, you know, or AD with whatever treatment plan may be put in place by the other provider. And I've found that, you know, one of the things that I've just become so very open to, especially in the past handful of years, is like, you were talking about that mind body connection, which I've always known, right? I've always understood that to a certain degree. But seeing these babies who struggle to feed, for example, or children who they just, you know, they walk into a room and you can just see their entire being shut down, and you're like, there's something in their being that knows that they are not safe here. And that's not the experience we want them to have. And their sensory system, right, Their nervous system, everything's just kind of going hard. Stop. No, not the place for me. And so how do we overcome that? Right? And that. That really opened up my eyes because I said we are never going to make progress, whether it's in speech, language therapy, it's in feeding therapy, it's in anything that an SLP may do. Being an SLP myself, until we know we're in that rest and digest, or until we have the tools to help that person move from where they are right now into a state of rest and digest. Because we know fight or flight, there's nothing. Nothing's happening, right?

And it's. You know, I always. I always give this example to my clients to understand this, but when you go into a fight or flight state, parts of your brain actually go offline. You know, that, you know, your hippocampus, which is responsible for learning and memory, is not active. You know, they've done MRI studies with individuals, and when they recall their trauma, for example, that puts them into stress. There is no activity there. You know, I. I always say, you know, your. Your brain needs to focus on surviving. It can't be distracted by your math homework or your grocery list, you know, or what you need, what laundry you need to do. It can't even come in that you push that thought off if you're stressed. So our, you know, our brain really does shut that off. And I think so much of the time we'll see kids like. Like that. I often see this. This is a. An analogy that I have in my mind often, where we see kids with, like, a brownout going on. So, like, when I was a kid, you know, we used to have more blackouts, I think, than we do now, and you'd lose power and you'd be in the dark. But then there were times, especially in the summer, when everyone's using all their air conditioners and all this is going on, and, you know, the power wouldn't go out, but it would, like, dull a little. So the lights would be dim and your air conditioner would be going. Little tiny puffs of air. So it's like a little on, a little off. And I think so much of the time we see kids like this in school, where if they're in this fight or flight state for such a long period of time, meaning that's their baseline and they live there. You know, sometimes things come through and sometimes they don't. So very often, you'll Hear a teacher say to a child, like, I know you know this, you knew this yesterday, and they did know it yesterday and it's still in there. But if they're really in that fight or flight state, they can't access it. You know, we have to be able to help bring that baseline down. And I'll say also speaking to what you just mentioned about different practitioners in different ways, like, I really believe strongly in collaboration between different disciplines. I think, you know, off sometimes, I don't want to say often, but very often you'll see practitioners who think like, I can solve this whole problem myself. And I always say if one person with one approach could solve everyone's problems, then everyone would see do that approach and see that practitioner and they'd be fabulously wealthy and you know, all the rest of us would be out of business. But I think when something is offline in the body, everything else adjust accordingly. And we, you know, by the time you've moved even into early childhood, you have a lot of things going on and very often you do need to collaborate. You know, I'll give you, I'll give you another example, since you like stories. So I had been working with this 17 and then he was 18 year old boy and he came in primarily because he was having bedwetting. And this is a general ed, typically developing boy. And that's obviously an upsetting issue. And he had wanted to go to a sleepaway camp and it was too embarrassing. And he's going to graduate soon and go to college and how could I wet my bed in college dorm? You know, none of that was going to work. So he came in and really there were lots of, lots of pieces going on. He was very rigid and you know, his auditory processing was low. So I would, you know, ask him a question and you'd have that delay where the answer wouldn't come quickly enough. And you know, he said it was hard to follow in class. He couldn't take notes and listen at the same time. It was either one or the other, which created a lot of struggle for him. So we worked through a lot of these developmental pieces. But then in the end, really what I found is that, you know, we worked through a lot of these developmental pieces. His posture improved. He actually got a few inches taller because, you know, he was standing so much straighter. And he's, you know, he said he could follow in class now and he became much more social. He was organizing events for his class, like, you know, buses to go on certain trips. But that bedwetting was still there. And then I take a look at him and I said, you have a tongue tie. I am pretty sure that's what it is. You know, and because there were so many issues, you know, we noticed it at the beginning. We were debating addressing it. And then I said, you know what, we need to take a break. You know, you're mostly there, but in order to get the rest of the way, you got to have this address. And, you know, the mother was a little skeptical. I said, take a break and just go. And then it took a couple of weeks. And then she called me back. She said, you know, it's crazy. He has a tongue tie. I said, I know. So you need to do some mayo first. You need to get that tongue tie release, if that's what they say. Do the myo after, then come back and we'll finish up whatever else needs to be finished. And, you know, without that collaboration, you know, we couldn't get to that place.

Yeah, well. And I think that really, you know, you spoke about the holistic approach, just looking at the patient, figuring out the root cause. But I think that holistic approach also comes from working with other practitioners.

Right.

And figuring out who else needs to be on the team for that patient, whether it's child, adult. You know, we all typically need a team of providers. And I know sometimes it can even be a little overwhelming. And so I always have my rule of, like, I may educate a parent in a, you know, following an assessment, but I will typically never ask them to go see more than one person at a time because it's just going to put them into a state of fight or flight, and the parent's not going to be able to handle it. If we're talking about a child or an adult, you put an adult who's already in fight or flight further and deeper in because now they feel like they have more things to do. It's expensive. It takes time. I came to you for help. Are you sending me here? You know, it's like you, you get a lot of that. And while it's well intending, and while, yes, we do need that team approach, we also, I think as providers, just speaking on this topic of the mind, body connection and fight or flight and rest and digest and the nervous system, you know, I think we have an obligation to also figure out how to talk to our patients, how to counsel them, and how to also help them navigate this, because just, just throw it. You know, I've seen, you know, we have a certification that we've created in the Myo space. And I love it because it's given us a really great opportunity to give feedback to therapists and to say, okay, this is a great treatment plan, but what about this? But what about that? Or how would you deliver this information? Or how, you know, And I actually had an amazing counseling class when I was in grad school. It's like one of my highlights of my grad school program. And I think that really gave me a skill set that can't just be. It needs to be learned. In some cases, it maybe comes more naturally to certain people than others, for sure. But a lot, A lot, A lot of medical practitioners are missing that counseling side of it. And, you know, I think that sometimes, again, adds to this, like, overwhelm for patients. But anyways, I wanted to. I wanted to point that out because I think that it's. It's so critical to be addressing everything that you're talking about. And I think that having them work with somebody like you, too, can help to alleviate some of what they're feeling and actually maybe help them also better cope with things coming their way. Right. I mean, that's all part of the sensory system, the nervous system, all these systems trying to work together. And we just. We see it so often. We see this, like, freeze amongst patients and parents of little ones. And.

Yeah, I mean, I'll say two things, you know, one about, like, having so many therapies and what's first and what do we need and what do we not need, in what order? You know, here's another story. This was interesting. A number of years ago, this girl came in. She was about 12, I want to say. And, you know, her body was disorganized, you know, and she had just finished, actually, that morning was her last session of vision therapy, which I promote vision therapy. This is a good thing, you know, and for anyone who doesn't know, that's really helping with the motor coordination of the eyes. The eyes are a fine motor skill, just like in the mouth and in the hands, and that's a great thing. But in that particular case, what I will say is that her body didn't really support her eyes. So she came in and when I did, like, just a basic functional vision test, I'm not a, you know, I'm not an eye care practitioner, but it's important to. For us to see what's going on. And her eyes were what I would call. I don't know if this is a word, but therapized. And she could really focus her eyeballs and track With a lot of effort. And it was just. It was just too much work. Because really, our body has to support our eyes. If our body is not stable, we have these two eyes that need to move off of a stable base. And if our body's moving all over the place, you know, imagine someone who's drunk and their vision is all over the place. Their, you know, their coordination is off. So, you know, we need to really have that. And so much of the body really impacts the vision. So here's another example that I often give to my clients to help understand this concept. You know, they always say, you know, flex your whole body. You're sitting in a chair. You know, bend yourself down so you're looking at your lap, and your whole flex, your whole trunk is flexed, and you'll notice that your eyes are pointing at a single point. And then if you sit up again, and now you lean all the way back, and you look up at the ceiling, you'll see that your eyes are wide, and they see the whole expanse and of the ceiling. Because that flexion of the body is what brings the eyes together, and that extension of the body is what brings the eyes apart. And that's how we learn that skill. So we can train the little tiny muscles of the eyes to come in and out through vision therapy, but it's so much more efficient. If you have that flexion and extension, then your body can naturally do it. And sometimes you'll still need vision therapy after, and sometimes you won't even need that because now you own that skill. So, you know, it's important to be able to put that together. So when you say about seeing all these different practitioners, you know, sometimes we need to look at the underlying pieces. And I definitely made that mistake earlier in my career. I had this little boy that I was seeing who was 6, and he was supposed to sit in class and watch the teacher while they taught. But instead, he would look at the ceiling and listen. And you got 100 on everything. You knew exactly what's going on. But the teacher said, no, you need to look. If you're not looking, you're not listening. But for this boy, he could either look or he could listen. So since it was such a big issue, as soon as I started seeing him, I sent him right to the vision therapist. And they saw him for months and months with not much change because the body hadn't shifted yet. And the mom was not so happy with me. Why did you send me to this therapist? You know, it took months and months. It was very Expensive. And in truth, it was really the eye care professional's responsibility to know that he wasn't ready for it yet, you know, but. But I learned from that, you know, you can't send so quickly to all these people. You really need to know what comes first so that you can be targeted. These therapies are expensive, you know, and very dynamic.

Right. I mean, I always explain to people, like, what we do. I like to call it dynamic assessment, because I feel like there's a piece of assessment in every session and how that present is different than the next day. And what we may see three weeks from now may look very different than what we saw in the assessment. It could be that the information was new. Maybe we're asking them to do something for the first time and they simply didn't know how to do it, or they didn't have the coordination yet to do it. They had that motor plan, you know, and. And so oftentimes, unless there is a dire situation and I'm. I get like a baby who is about to be put on a feeding tube or there's some kind of, like, more medically complex thing that really calls for a different plan of action. We will often say to families, give us three to four weeks. Let's start working together, and let's see how things present in three to four weeks. Because sometimes that tongue tie no longer appears to be a tongue tie. Things have relaxed, the fascia's relaxed. Right. The symptoms are starting to resolve, and we're going, huh. All right, well, that tongue tie that someone may have sent for a release three weeks ago, I'm not sure that this actually needs to be sent for a consult at all, you know, but I do see that they're still struggling with X, Y and Z. So let me pull the OT in. Let me send them to this provider or, you know, or maybe, you know, they are definitely narrow. Their palate's narrow. We need to get some expansion going. Let me send them. Send them to some type of a dental or ortho, you know, colleague for a consult. So I think it really helps to shape that individualized treatment plan. Right. When we also can kind of go, okay, pump the brakes. I just met you today.

Right, Right.

That's one of the things that, too. I'm like, these are people first. And they will tell you whether it's a parent for a child who can verbalize, you know, or communicate with you in some way, or an older child or adult.

Right. If.

If they're there, they're going to tell Give them the opportunity to tell you why they're there. They're going to tell you exactly what is going on, and we need to believe them and figure out why that is their truth. And if we can't help them get from where they are today to where they want to be, then you're probably not the right practitioner for them.

Right.

And that doesn't always fall just on you. Right. But part of getting them from where they are now to where they want to be can involve other, and often does involve other team members at the right, you know, timing. And that, again, is different for everybody. So I love that you speak to a lot of that because it's just, I think, such a critical conversation. And, you know, we still have this conversation happening, right? Not still have. I feel like it's happening a lot more. But then I will get people who say, well, I live in an area where this is not available, or, well, I. You know, these families are on Medicare or Medicaid. Oh, well, these families can't afford X, Y and Z. And I see this as a challenge that we need to solve as practitioners. I know it doesn't all fall on us, but, okay, well, let's figure out how we can still get them to somebody who can help them. Maybe it's not your first line referral. Maybe it's, you know, maybe they do a consult virtually instead of in person, but this person can actually help them. I don't know. I don't know what the answer always is, but I've always taken it upon myself to help, you know, solve whatever challenge is presented and not just wash my hands of it and go, well, you know, I can't. I don't know anybody. So, like, you're on your own. And then, you know, the thing that actually drives me a little crazy is then some people will keep these patients in therapy for years on end. And, you know, that's the other piece of it, too, is if we are not making progress, and I know progress is not made every single session, but if we are not making progress over time and we are not moving toward, you know, our goals, we have got to pump the brakes and ask, why? What is missing? What am I missing? Who else can we invite into this team to maybe help us figure out the next steps at the end of the day, right, we want to make progress. We all want to make progress. That's why we're here. And so it's. It's a. Interesting conversation, especially when you work in a field where people will say, oh, this Child's a lifer. And I'm going, well, I hate that. I'm like, I'm like, is it, Are you saying that. Because you know that they're going to have ongoing needs in different ways. And so we're going, you know, as they cross different milestones or they, you know, come into different parts of their life where they're going to require a different level of support or care or therapy, you know, you're referencing that, I don't know. But to say a child is a lifer because they present with maybe apraxia of speech or a tongue tie or speech sound disorder and they're in preschool or elementary school, I'm over here like hitting my head against the wall. Please stop saying this. Like we should be figuring out how do we get these children off of our caseloads. Meaning that they've successfully graduated with the goals that they came in wanting to achieve. Right.

And I think you hit the nail on the head when you, in this discussion, when you said that during each session, it is an ongoing assessment. Every assessment is a treatment and every treatment tool and strategy is an assessment. And we need to be constantly, you know, viewing our clients in those ways. And I'll just say, you know, a big part of the two day course that I'm going to be giving in December is really targeting our treatment and understanding how to be constantly assessing to know that we can see change. And the model that we use and the type of work that we do, either using reflex integration or different postural mechanisms, different movement patterns, we should be able to see change every session or two sessions or three sessions, even if it's tiny. And that also helps us set a home program because then you can give someone a 60 second exercise because you know exactly what you're working on and you can really target it and see that change. I think so much of the, all of our fields in the therapy world, you know, it's this open ended, we can have years of therapy. Kids are on, you know, therapy program from when they're 5 to when they're 18. And I think it's time to shift that a little bit, like you're saying. And I think the way to do it is to really learn how to be carefully assessing and ensure that your treatment is targeted, that you're not just throwing things at a wall and seeing what's going to stick. And I think it takes a lot of effort and a lot of work. And I think also in terms of being able to properly send our clients to other practitioners who we need as an adjunct to the type of therapy that we're providing. I think we have to learn about those other therapies, too. You know, I think that's how you and I came together, because I needed to know about all this, my world, so that I can send my clients for that kind of therapy who are having breathing issues and that's affecting their stress or feeding issues, and that's also affecting their regulation. And I have others who that little tiny tongue tie affects their posture in such a way that they can't stand up straight if they tried, even though it's so tiny, which brings their eyes down and they're not engaging in the world. And you release that, and all of a sudden the world is open, you know, and really being able to understand other types of things that are out there. You know, when we see someone who has flat feet, for example, if you have flat feet and your arches are. I'm not talking about you.

I'm interested.

You know, if you, if, you know, if you have flat feet, it changes the angles of everything in your body. And you can have TMJ and jaw pain and the alignment of your jaw can be off just from those flat feet. So, you know, you really need to look up and down. And it makes me laugh sometimes. I've had on occasion someone come either for themselves or with a child and say, do you think you're a pt? What are you doing working on feet? Or why are you in their mouth? Do you think you're a speech therapist or a dentist? You know, and really it's because you have to be able to look somewhat holistically and know when you're. When you're out of your space and you need to refer. But just to at least have the ability to assess when you need to refer is so important.

Absolutely, 100%. And this has been. This has been amazing. So tell us, where can they find information on, you know, your course? I know we're going to share the. The link to your practice below the episode and everything, but tell us where we can find you. Otherwise.

Okay, so you can look up our website. It's sensorywellness.com and you'll see information on there, and you'll see the email on there, either Infoensory Wellness, or you can email me directly at daniellensorywell and our phone number's up there. You can call or text that number. I will say I'm not really on social media because I am so busy. I spent, you know, I have a full caseload and I'm training lots of therapists and you know, we opened a second practice only about a year and a half ago and you know, it's out there. But definitely I have people who even call just with questions and if you call the office, they'll set up some consultation time. I don't charge for that. You know, I can give anybody a half hour just to see, you know, if we can be of help to you, you know, so you can get what's out there. If you're far away, you know, I'm happy to share advice on, you know, what other practitioners to seek in different areas. I feel like, as a, like I said earlier, like I am really a clinician at heart and not a business person, which is probably why I spend so many hours doing these outside things. But I really am just so passionate about helping people to feel self empowered and to feel regulated and to be super functional in their most optimal way. So anyone can feel free to reach out and, and we'll definitely make some time to speak. And I will definitely also send you the link to the course. If there are any therapists out there, OTPT Speech, you know, psychologists, mental health professionals, you can definitely look into that as well. It's through theramoves. You can also look up theramoves.com and you'll see it up there as well.

Awesome. Well, we will definitely include sensorywellness.com and theramoves.com the link directly to the course under this episode. So if anybody's driving, please be safe. It will be there for you when you're done. And yeah, just thank you so much again, Danielle for joining me today.

This is Me. This was really fun. Hope we could do it again sometime. Take care.

Thanks for listening to this podcast. If you found value in this episode and want to hear more of these Myotots, Airway and feeding related episodes, be sure to leave a review on Apple Podcasts and share this episode on your social media platforms. You can access free resources and all I offer@hallie balkan.com or pop over to Holly Balkan on Instagram to get all the latest updates.