COTA Sensory Integration Masterclass with Mary Kostka

Foreign. Welcome, everybody. Keep typing in where you're watching from. It's always fun to see. I'm in Leavenworth, Washington, which is right in the middle of the state, and we just got dumped with a foot of snow. Kind of early for us. Angelina's from New Mexico, and I've just been doing a bunch of traveling, and my brain and my body don't know what to think because I was in Okinawa. I was in Florida, just. And it was, you know, obviously really warm. And then I came back here and it got really cold and it snowed. So I'm. I'm just getting used to it. So crazy snowy. Indiana, you have snow, too. Iowa. Wisconsin. Orlando. Florida. Tennessee. Welcome. Welcome, everybody. California. Rebecca's. California. Madeline's. Oregon. Tiffany. Tennessee. Rita. Orlando. Colleen. Wisconsin. All right, awesome. Well, we're going to get started here. I'd like to start on time so it is being recorded. So that way, if technology all works beautifully, then we'll be able to automatically send a recording out to people that weren't able to come in during this time. We had a little bit of a. A little worry right before because it was looking like our webinar link wasn't working, and we thought we might have to make a new link all of a sudden. So we're super excited that you guys are hopping on and that the link. So you know how technology is. All right, so. So this is sensory integration success master class. It's really geared for codas, but really, everybody's welcome. And I know that so many codas. I know you're just wanting to excel. Put yes in the chat. If you're like, yeah, I want to. I want to improve my skills. I want to be able to, you know, do a better job. And I'm sure that's why you're here. There's not a handout, but you will get sent the replay. And so I'm sure if you said yes for excelling your skills and you're here, that you want to be helping kids with sensory processing disorder. Write in the chat. Passion. If you're just like, if you just have passion for these kids. I know I do. And. And as I train different people and have different people work with me, I think a lot of us just intrinsically relate to these kids. I know I was a. I was a pleaser, but I was a seeker. And I was always rocking on my chair, sneaking gum in, doing all kinds of things, but I was well behaved, but I was always getting input. Total passion for this. Karen. I'm Right there with you. Oh, and yeah, Haley's making a point that because there's the. The chat will be flooded with so many things you'll want to put your question. There's a specific place you can put your questions, and I'm going to answer all the questions at the end. So let's make a real impact together. And I'm going to share with you some strategies that will definitely help you elevate. And honestly, elevating others is like, where my passion is, whether it's the kids, the therapists, the practice owners, all of that. And right now we're focusing on clinical skills. Help you gain a little confidence. So here's the thing. Like, I've been. I've been where you are, like, feeling really passionate, and I really wanted to help, but just didn't always know how. And, and, and, you know, just seeing kids struggling and just, you know, you just want to have the answers. So when I took a lot of, like, little, you know, lots and lots of continuing ed, just weekend classes here and there, but it wasn't really until. Actually, I'll get into that in a second. But it's. It's some special training I had that really made a difference. And my clinic, I have a clinic Ohana occup therapy. And we've treated thousands of kids and we consistently see. We have just consistently see. My slide isn't moving. Come on, go to the next slide. There we go. We consistently see children thriving, meeting their goals. My favorite thing is parents just feel relieved. Like even in the evaluation, they're so used to people judging them, saying that they're not a good parent or just giving them look the look. And when we do an eval and we're able to identify these physical reasons that the kids are acting the way that they're acting, and they realize it's not their fault, they just cry, they're so relieved, and their confidence is boosted. So first, I'm going to tell you just a quick little bit about myself because I know some of you know me and some of you don't. I've been an OT for 36 years. I absolutely, I think I'm in the best profession in the world. I love OT and I spent 17 years of my career working in schools. I did my best. I. It's not that I did a bad job, but I really wasn't able to address the underlying causes that the kid were causing the kids problems. So I basically didn't. When I look back, I wasn't doing it right. And then Having my own clinic the last 16 years, it's like day and night, the kids make progress 10 times faster and you know, I'm able to do it right. So the difference, this is what I was kind of alluding to before, but I realized up, it's later in the slides. So what changed is I did a really thorough training in the air sensory integration and it was 120 hours of training and I just really connected all the dots for me and it helped fill in all the pieces. So I really began to understand how to really help the kids. And that is when everything changed. So not only did I have the techniques and the skill, but I could create my own environment. Having a private practice, the parents were with me and I had more time with them. So one of the reasons that, that I'm doing this presentation is because there's a lot of misinformation out there and there's a lot of things where people think they're doing something and they think they're providing sensory integration therapy when it isn't at all. And it's really what has mucked up the research too. And now there's a, there's a really nice fidelity statement for research that really identifies what sensory integration is and isn't. So, so first up I'm going to talk about what it's not. So if you're just providing sensory input, then that is not sensory integration therapy. It's still good, but it's, it's not great and it's not sensory integration. So for example, if you put a weighted vest on a child that is putting, you know, it might be calming input, it might be helpful, but it's really overused a lot because most of the kids I treat have a really poor core strength. And if you're putting weight on weakness, that's not good for the kid. And also it really only has about a 20 minute effect for, you know, for helping the child. So I'm not, I'm not against it. It's just, I'm very selective on who I'm going to do it with. They have to have a decent core strength and you know, it might be something like, hey, we're going to put it on just for circle time and then take it off. Same goes for a weighted blanket. It's calming sensory input, but it's not sensory integration. And we'll get more to what sensory integration is later. And brushing, a lot of people use brushing. We call it brush and squish. It's essentially a, a version of like Wilburger Deep pressure protocol. But just. It's a little different how. How we've implemented it. And honestly, this can be a phenomenal thing for some kids. It's actually one of the. The things that got me in. Interested in all of this in the first place, because I learned it, and there was a little. It was one of the first sensory type things I learned. And there was a really tough preschool. I was working in schools. We had a really tough, tough preschool. We had three kids that were just really violent. Biting, throwing. Throwing things, just. Just out of control. And. And so I was walking down the hall, and the teacher kind of pulled me in and like, ah, can you help? And so I didn't have the brush with me, but I had my hands, and I had just learned this. So I'm like, oh, I wonder if this will calm him down? And I started doing the deep shoulder compressions and then the arms and just. Just did that with him. And he just was like, can you do that a hundred times? And I thought, well, he's not being violent right now, and he's enjoying this. So I just did it a whole bunch for him, and it calmed him down. And then the next time I saw him, he's like, can you do that thing to me 50 times? And then the lot. And then the third time, it was just the normal 10. So fast forward to, I think it was last year, the apartment complex X ray. I'm at my mom's right now. She has better Internet. But just down the hall, I ran into Trey, and I'm like, hey, Trey, how's it going? He lives in the same apartment complex as my mom, and he was, hi, Mrs. Koska, doing great. And I'm like, wow, I'm impressed that you know my name. I mean, I had seen him off and off and off and on in the school since he grew up, but I really hadn't seen him in his adult life. And he was in his upper 20s, and he's. And I'm like, well, I'm impressed that you remember my name. And he says, well, of course. You're my favorite childhood memory. He said that you. You made me feel good. And I was just like, wow, that's. That's incredible. Like, you know, because obviously he was very scared and in fight flight, and I calmed him down, so he remembered that. So I'm not against these sensory inputs. They're very valuable. But I'm just clarifying that it's not sensory integration. So here's what sensory integration actually is. Number one, it. You're collaborative with the child. And that's the big difference about sensory input. You're just kind of doing something to them or get, putting something on them. But it's a collaborative process. They are integrating because they are an active participant in the therapy and it's play based. So during the session you're respecting their emotions. You're not forcing anything on them. You're, you're, you know, keeping it very positive and you're making sure they feel safe, that they tr. They're feeling trust and safety. Those things are very important for the child to actually integrate the senses. So they have to be an active participant and, and be feeling good and, and just, you know, feeling respected and safe. If you don't have those pieces, then you're not doing sensor integration. So here's a fun example. I, I have this distinct memory of this kid coming in and he came in and he was a pirate. He was like all about being a pirate. And you know, I had an idea of what I wanted to work on. I was going to work on balance and maybe it was core strength for this session. But the second he said he was a pirate, that's what we went with the whole session. And that's one of the things I love about sensory integration, is that you can, is how you get to just incorporate the child's interests and that's really important. And so of course, what did we do? We were walking the plank. So the balance beam was the plank. So you just turn everything into what they're, what they're thinking about. And so this is the main thing that I always tell my staff and the parents that the child is the motor and we're the driver. So you're taking their intrinsic interest and their intrinsic motivation, but you're steering it to what, what it is you want to do. So I always am very clear in my mind what kind of goal we're working on, what we're trying to accomplish. But I'm just kind of steering it. But I'm using as much of their intrinsic drive and motivation as possible. And that is where the magic happens. So the next thing is that the environment is really important that it had that it's just rich with safe sensory opportunities. So one of the main areas is having a lot of tactile experiences available to the child. So we really like doing, I feel like we make a lot of slime, slime shaving cream. We do a lot of rice. The kids love the rice. In fact, I had this one kid that he was so pro seeking and so crazy and so wild. It just seemed like we could never give him enough. And then one day I was like, we just got to try something different. And so we had, we get these long plastic bins that you can actually sit in with your leg straight to sit in the rice. So I'm like, I'm just going to try something different. And I, I sat him in the r. He was calm for an hour. It was incredible. Like I was going at it completely wrong. He needed tactile input and he wanted to kind of like shower himself with it. I ended up putting a pup tent over him so because he kind of wanted to throw it and let it fall on him and he was in seventh heaven. It was just the craziest thing to see. So you really need to have like lots of tactile experiences, different textures that they can experience. It's really key to have vestibular. Vestibulars really important part of sensory integration. I'd say about 80% of our kids are under responsive vestibulars. So when you give them the post rotary nystagmus test, 102 second turns with their head at 30 degrees and you stop them, they might not even feel it. And they should, their eyes should be, they should have that nystagmus like 7 to 14 seconds. And a lot of times it'll, their eyes will beat one or two times or they just won't even feel it. So most of the kids that are bouncing off the walls, that system has not been developed. And so they need opportunities to move in all the different directions. Up and down, angular and spinning and spinning. You have to do with a lot of caution because vestibular input lasts seven hours. So my rule of thumb is once you've filled up their tank and they actually are feeling it, then to stop and back off and do something else. And the more that they're in control of it, the better. Proprioception. You're always safe to do as much proprioception as possible because for one thing, it'll calm down the vestibular if you overdo the vestibular. But it just makes them feel centered and calm. And the proprioceptors are in the muscles and in the joint. So they respond to any kind of. Anytime you're activating the muscle, you're contracting the muscle or anytime the joint is compressed. And so basically push, pull, carry, anything very physical. So like, like this little girl's getting a lot of pro just doing, you know, just by using her muscles to do the, to do the monkey bars. I think my favorite, if I really need to give somebody a lot of pro, is tug of war. And you can also do push of war. So I, I tell parents, like, say they're acting up in the grocery store or something, they can put, you know, push on their hands, just push as hard as you can. And so like contracting every muscle in their body. That will give them like a whole bunch of quick pro. And I really like adding to all the swings, swinging activities. If you add pull ropes or just some kind of way that they have to pull as they're moving, then you're going to add a lot of probe to the activity. This is just a little example, a little story I wanted to tell about the, just the idea of the environment and how it can make a really big difference on participation or not participation. So I had this little kid and I had a horse swing like this, hanging pretty low, maybe a foot off the ground. And, and, and he just looked at that thing and he ran to the corner and hid under the crash pad. And so for him, he looked at that and he thought it was too scary. So what I did is I took the. Took a crash pad and I put it underneath the swing so that there was maybe an inch between the swing and the pad. And he took one look at it and he ran to it and jumped on it. And it just really hit me like, what a difference the environment makes for the kids, if they are, if they're interpreting it as something safe for them or not, that they can just go from one extreme to the other. So a big thing, probably the biggest thing with sensory integration is that you're providing the just right challenge. And so I always tell. Tell my staff and my parents that we're walking on a tightrope, and some of these kids have a thread for a tightrope. So basically, to me, the just right challenge is, is. Is what fun is. So fun is that it's not too easy because the kids are smart and they're like, it's not. If it's too easy, they're bored. Their thing is dumb. But if it's too hard and they can't succeed, then, then they either, you know, they either won't do it or, or they get upset or they shut down or whatever. So they, I call it falling off the tightrope. So when they're on the tightrope, they're feeling challenged, they're having fun, and they're feeling success. But. But they, but they're feeling challenged. So that's what I call the Tightrope. And that's the challenge with sensory integration. And of course we want to make sure they're in the optimal arousal state. So when they, when they come to you, they've been stimulated from the time they woke up to the time they came to you with different amounts of stimulation. Some kids just need to decompress. I had one child that he came to me school and he, he just needed, he wanted to get inside the, the blue barrel with ball on top. Basically get in a little completely quiet space, tight little quiet space. And he needed to do that for about five or 10 minutes at the beginning of the session. And then he was engaged and able to do everything. But if we didn't do that first, he was a mess. He wasn't cooperative. But he, he needed like that little bit of peace. And it was great. Cuz mom and I could catch up and, and talk a little bit and then he'd pop the ball off and be ready to go. But some kids, you know, we have to bring down their, their heightened state of arousal and other kids, you know, they come in looking like a snail and, and we have to bring it back up. So, so that's always the first step in the sensory integration sessions. This pretty much what I was just saying. Like you have to like always be figuring out do you need to upregulate or down regulate, do you need to make the, for this sensory input and for the challenge. And all the input needs to be organized, intentional. You're not just doing things just haphazardly in order to help the child succeed. You're very, you, you're going into it knowing, okay, I want to make sure they get you just, you know what they need. Like they need some probe, they need a certain amount of tactile, they need a certain amount of vestibular. You're not just kind of randomly just doing whatever and when it's not working and you're just kind of randomly doing things haphazardly, they're just going to fall apart. So this is a picture of a clinic, just a random clinic. I don't know whose it is. And this environment for some kids would be a perfect amount of stimulation and arousal. For other kids it would be too much. So it's always. That's the thing about sensor integration. You're customizing the environment for the child. So in our clinic we have, every room can be, is, is pretty much empty unless we have, you know, we have in it what we want. So basically it can be like empty and we just have One or two things in it that we want to do, or the room can look like Disneyland. So we have just a ton of equipment, and so it's just always customized to the child and what they need to make that just right. Just right. Challenge. We want to keep them on the tightrope. So another really helpful thing to understand that I learned when I was getting my air sensor integration training was how to grade the activities so they're not too hard, not too difficult, but. Or they're, you know, you could level it up to the very next challenge. So there's. So all movement isn't created equal. So stable. Stable is the easiest. So the child's not moving and the object is not moving. So in this example, it's just sitting down, and you're picking up a block and putting it on. So the block's not rolling around, the child's not moving. So that's the easiest. And then the next level is stable moving. So, for example, the equipment is stable. The monkey bars aren't going anywhere, but she's moving. Another example would be, let's say a child's on a platform swing, and you're holding out a stuffed animal for them to grab. And so they're moving, but then they. But then the object is still, and then they have to. They have to time it for when they can grab it. That would be another example of stable moving. And then the flip side moving stable is that the person isn't moving, but the object is. So example like here is just, you're not moving, but the ball is coming to you to catch. So the object is moving, but the person is stable. Now, the highest level is the object is moving in and the person is moving. So say like kicking a soccer ball, the kids running, the ball's moving. That's the highest. Highest level of difficulty there. In this example, it's kind of like when you're moving through a hanging obstacle course. Like, she's moving through these different tires, so she's moving in the. And the. And the swings are moving. So a lot of times, the way I do this with the kids, they all. They all love the analogy of, like, level one, level two, like, you know, like, game levels. And so I'll be like, oh, level one. That was just too easy for you. We got to go to level two. And then level two might be like, say, level one is they're going through an obstacle course, and I'm actually holding the swing still while they're moving onto it. And then maybe the next level. I don't hold on to it. The next level maybe I move that swing to make it a little harder for them to get to it. So they really respond well to. They always want to feel successful. So the level thing works pretty well for me. So the takeaway from this is that all movements not created equal. And so remember you've got stable, stable, you have stable moving, moving, stable and then moving, moving. So we talked about what sensory integration is and what it's not. And so just to kind of sum it up, environment matters. So remember you want to have those different opportunities for vestibular, tactile and prop and you want to control what's in the environment to match what the child needs. When I worked, when I worked in the schools we had a well when I had a space which was almost never but there's one school that we did have a room and it was like a little part of a room but we would put sheets over, over our shelves and stuff to control the environment to make it less stimulating. Secondly, remember the child having that child's intrinsic interest and drive to be the. You know that they're the motor. That's what makes it makes everything integrate. It's not just you doing stuff to them, but you're, you got the steering wheel, you're the driver, they're the motor. And not all movement is created equal. So understanding sensor integration was an incredible game changer for me. So I would love for you to put in the chat. What is your biggest takeaway from what I shared with you thus far? Go ahead and type in the chat what your biggest takeaway is so far. Oh, nice. We have 52 people on. I hadn't really looked grading up and down just right. Challenge, stable, moving vice versa. Nice Angelina. Thanks for putting that in there. And Bethany says clearing space of clutter. Sometimes I people feel people do too much decorating spaces more for adults and other kids. And what's up with classroom decorations? I I was always astonished that there was like never like just a little space in the room with nothing like the ceiling and the walls. I don't know why they do that so over stimulating child's Sher says child centered therapist lead Kathy says the moving stable. Yeah, it's kind of, it's kind of. She said she's done it but not thought about it. I think a lot of things that we do are kind of intuitive but we don't always realize what, what we're doing. But it's really helpful for when you're writing goals or trying to figure out how do I grade this activity? When you have, have the, you know, have the knowledge vestibular lasting seven hours. I know I didn't know that until I had the training, but I'm sure you have felt it because if you've ever been like on a boat, have you ever been on a boat and then went to bed that night and you could feel still like, feel like you were rocking or if you've had a kid and you're, you're swaying, holding the kid a lot, swaying or, or rocking them and then you don't have them, like they're in bed or whatever and then you find yourself like you just feel like you're still moving. I think most of us have experienced it, just didn't realize it. Rebecca says that the child is the motor and then we're the driver. Awesome. You guys are good listeners. Jason says the duration of input in the vest difference between SI and sensor narration. Jennifer, different levels for the just right challenge also lets the child be the motor and we're the driver. JD says my biggest takeaway has been sensory input versus sensory integration and having the child be in control and we're steering them. I, I love it. You guys are getting it. Karen says the amount of kids with vestibular under registration. Doris says guide by steering in the direction you want to go. Rita says I like the level approach. And Jenna says length of vestibular effects. Oh, that's so interesting that that was a big takeaway for all of you guys. The biggest takeaway is that OTs can demonstrate what the kid might love right in front of a parent. As long as child has intrinsic motivation. Yeah. I think like when I'm working with kids it's really helpful. Like I'm always kind of like talking out loud of what I'm thinking so the parent understands why I'm doing what I'm doing. I think that's really, really helpful of sensory integration. I feel like, I feel like vestibular is like, it's like the most potent medicine and it can be easily overdosed. But you have to get like the right dosage and I think it's the trickiest one to really get, get down pat. But some kids are so under responsive that the only way that I've been able to like get their system to activate was doing something like having them lay with their head upside down while I'm basically I'm simulating like amusement park ride input, you know, like doing a lot of changing directions and fast spins. But what I would always do is Give them short bursts, stop, interact with them and see if, you know, just look at them and see if there's any change. Are they having any. Are their ears getting a little red? Are they staring off? Just any kind of change? Then I stop. But because you can. You can overdo it, and then they could shut down, they could throw up. They could just, you know, not feel good, basically. But. But a lot of them need, like, some real intense input to. To turn that system on. And then once it gets turned on, they. You don't need as much the next time or as much the next time. But it's the trickiest. Like I said, it's like, the most potent medicine. So it's an interesting. It's an interesting system. And the semicircular canals, they're fluid filled with little hairs, so they respond to acceleration and deceleration. That. Because that's when the hairs move. So, you know, some kids will just. They could spin for hours one direction. And you're like, how. How do they not get dizzy? Well, it's because they're trying to get enough input, but they're not getting it because they're going one direction. Those hairs are just, like, laying down. So when you are trying to give somebody more intense input, fast, short bursts. I'll usually do, like, three. One direction, the other direction, the other direction, stop. See how they're feeling. And the second I see any kind of change, even if they're usually at that point they felt something, they're so like, more, more, more. But as soon as I see that they're. They're having some response of some kind, I stop. Because I know their system isn't used to it yet, and it can last a long time. So then I'll move to something else. That's pretty much how. How we'll do the vestibular. But it's. It's fascinating because most of these kids that this system is just not working well. And it's the first system to develop in utero, which I think is pretty. Pretty fascinating. Let's see if there's anything else to share here. Biggest Annie says biggest takeaway is ots can demonstrate what a kid might love. Right? Oh, I said that one already. Great info on vestibular. Thank you, Jennifer. All right, great. Well, I'm glad you got some value out of it. That's awesome. And obviously, this is just. Just like tip of the iceberg. I. I think I'll be learning about this stuff for the rest of my life. There's just so much to Learn in our clinic. We do a lot of. We do a lot of training. And Abigail is one of our new graduates ot and she relocated to Washington from Nebraska, and we helped her with a relocation stipend. And she loves Washington State. If you don't know about Washington state, it is just. It's the most beautiful state, I think, in the whole country. I moved here from Illinois 36 years ago. So she's benefited from intensive training and mentorship at Ohana. And if you want to learn how to implement SI and get rapid results, increase your skills. As a coda, we have something exciting. We have started a residency program. And after our residency program, you'll be in the top 1% of skill level as a coda, because we do so much training. So if you want to take the fast track becoming a highly skilled ot, then something's going on here. Make a real impact. Some reason it went backwards. I encourage you to apply to our residency program. So we only taking three in 2025. We have one. One spot we've already filled one that's close to being filled. We're still kind of interviewing for that spot. And then one. One more that we can take later in the year. So if you have a passion for helping the kids, I encourage you to apply. And that's a nice picture of Washington. We do relocation bonus. And it's a really rare opportunity because you don't, you know, people aren't doing residency programs. But what we realized is our training is so intensive that that is essentially what we were doing. So we decided, hey, we're gonna actually call it what we're doing. Because we do so much training, there's a lot of support. You have a mentor, you have regular meetings, and it'll just increase your skills and your confidence and you'll get the results. I wish something like this was available when. When I was. I was so hungry to learn. And the other thing that we do very much in depth is primitive reflexes. They're an even more essential component to the sensory integration because if the. If their primitive reflexes are not matured, it blocks all the development. So we're. We go very much in depth into primitive reflexes. So people get paid to learn. And here is the QR code. I'm going to answer questions. So if you're interested in more information on the residency program, I'll leave that up for you so that you can apply. We're very excited to. I've just had the best team. They love teaching, they love helping people along, and it's a two year program. Let's see. I have to figure out how to get to my questions and then I'll start answering questions. Oh, here we go. Q and A clicked on you. Sorry, I'm trying to find where the. Where I can see the questions. Huh. Mary, try clicking the more tab at the bottom and that should pull up the option to view the Q and A. By the way, Haley is my amazing. Well, that's what I'm doing. Like, I see it says Q A and it says five, and when I click on it, nothing's coming up. So maybe. What? Could you just paste them into the chat? For some reason, I can't see them. Okay. That's weird. I don't know why it's not. Well, we're just happy the webinar happened because we were getting a message that the link was expired. We're like, what the heck is going on? It's one thing Covid did is it made us used to technical difficulties. Yeah, I don't know. It won't let me see the questions. Okay. Rebecca. How to get clients. Okay, so this is an interesting thing. There isn't really a specific diagnostic. Oh, what happened here? Hang on there. There isn't a specific diagnosis code for SPD but. And Dr. Lucy Miller had been trying for decades to get it added to the diagnostic manual. But the main argument for not adding it as a separate one is there's already a lot of components of sensory integration that have codes. So like say they have tactile defensiveness. There's a code for that. So if you go on my website, ohanaot.com under resources, there's a tab that says physicians. And that is where I put a bunch of the codes that people, a lot of the physicians use. But one of the most common ones that's used is it's unspecified disorder of the nervous system, and that's in that tab. And it always gets covered by insurance. So it's such a vague diagnosis, but it seems to work. You can use sensory diet. I'm. I'm just clarifying. There's nothing wrong with sensory diets, by the way, or the sensory, you know, the sensory input. I'm just clarifying that it's not sensory integration. They're two different things. So I think that there's a lot of benefit to sensory. Sensory diets if it's what, you know, the child needs. So, like, kids need movement, breaks, kids, you know, whatever. If, if there's something, you know, that they need and to provide it to them regularly. There's Nothing wrong with that. Let's see. I have a. Sher says I have a student with toe walking and constant moving. Very rough with everything, zero focus. She hasn't responded to deep pressure or heavy work. What kind of sensory input would you recommend? You know, it's interesting. There's a lot of different reasons you can have toe walking. Sometimes they're doing the toe walking to increase their proprioception because they want more input. Sometimes it's because they don't like the way the socks are feeling. One thing that I really like is I like getting a very contoured shoe insert into the shoe so that it gives them a firm, deep pressure all across the foot. And there's a product called Patty Bob's by what's the company? I think if you just search Patty Bob's, you'll see it. I'm drawing a blank on the name of the company. They're here in Washington. I'll look it up and we'll add it to the replay list because we always add in links to that. I just can't think of it off the top of my head. But that's one thing that I have found helps. And sometimes they just have really tight heel cords. I think toe walkers, it's really good to get them into a PT so that they can kind of look at some of the other things that might be going on. Okay. From Jenna, with grading levels, is it client first, then object, or it really doesn't matter. This stable. Moving, moving, stable. It. There isn't really a. One is necessarily easier than the other. I think it depends on the child, Depends on the object, depends on the activity. But it's just the concept that one is moving and one is not. I'm trying to think what I typically do. Yeah, it depends on the kid, you know, and it depends on what you're doing, because I'm just thinking like, okay, if they're on the swing and they're moving and they're reaching out for something, is that easier, harder than if they're still and I'm tossing them something to catch it? It really depends on the activity in the child, what's going to be easier or harder. Okay. Yeah. Any other questions? Any questions about the residency program? I really appreciate you all taking time out of your day to join us. And. And like I said, we'll be sending out a replay. We had quite a. Quite a few more that signed up. And then they'll get the replay because I know most people are working during this time. So we will do that and thank you. I appreciate you all. Do I use the sensory profile? I use this. I. I don't use a sensory profile. I used to. What I use is a sensory processing measure. I like it a lot more, and actually I learned about it with. When I did the air sensor integration training. I hadn't really been aware of it before, but it's a. I think it's a lot easier to score, and it's a lot easier to interpret. If you have the. The physical sheet, it has carbon right inside it. And so with the sensory profile, you know, you're having to go like, okay, question number 22. The score was this. And now I got to put it over in this column. There's none of that. So there's this paper and carbon paper inside it. So when it's filled out and you open it up, you're just going. You're just adding. It's really fast. And they have electronic, too, if you want to do that. Bethany says this has been better than the classes I've paid for. Thank you. I appreciate you. Appreciate you very much. I'm glad that you guys found it helpful, and I'm glad you feel like you can use it right away. Jenna, are you talking about. Melissa, are you talking about the name of the. It's called the Sensory Processing Measure as spm. I'll type it in the chat. I think it's so much easier to interpret because they have it, like, broken up in, like, it just. The sections are just more clean, I think. I just think it's a lot easier to understand. Yeah. Feel free to share the recording with other people. Will I be doing another zoom like this anytime soon? I think we're going to do this particular class pro. We'll probably do it again. Well, until our residency program is. Is filled up. But like I said, it's getting pretty close to being filled up. But if you guys are not that. I don't. I don't know, put new in the chat. If you are new to me, if you didn't know me before this, I'm kind of curious because. Oh, a lot of you guys are new. Okay, so let me give you a little more info. Back in 2020 when we. Oh, you guys. Almost everybody's new. Wow. Okay, here. I think people know me. Well, now you know me. Okay, so back in. In 2020 with. When the pandemic hit, there was, you know, every psych. How do we do. How do we do this? On Telehealth. And it was kind of like this moment where we had to think fast and figure things out. And there's a large pediatric therapist group that one of the Washington therapists started. I think there's like, 50,000 people in it now. Started it more than a decade ago, kind of way back when Facebook was new. And I was in it, like, when she just started, like, there's maybe 100 and 200 people. Anyway, somebody in that group said, hey, is there a group to help us with telehealth activities? And, no, there wasn't one. And I'm like, oh, we need that group. And so I just made that group. And it was fascinating because, like, within minutes, there were, like, 300 people. And by the time it was a few months in, maybe six months in, there was 12,000 people from 60 countries in that group. And it was really a really exciting, cool time because we were all just helping each other. And so that Facebook group, we can give you the link to that pro. Oh, she already put it in there. Haley's on it. And so when you join it, you'll get. Tell me if I'm right, Haley. I think they get. When they. When they give us the email, we just give them that list of activities. So what we would do is we'd put up, like, what are all the things you can do with pillows? What are all the things you can do with chairs? Like, we were just, like, picking household items and, like, brainstorming, like, how do we do our job through telehealth with what they have in the house? It was really fun. It was very. Just everybody just helping each other. And so I got to know a lot of people that way. And through that process, I just started realizing, like, it was actually easy for me because I had all this experience, and it was kind of a fun challenge for me. But I realized, like, all these new therapists, it was really, really hard because they didn't, you know, have that experience. And so I started helping them with whatever they needed help with. And I did some variety of different Zoom master classes and different Zoom meetings, and I was just helping to helping. And I'd say, what else do you need help with? And then at one point, it was, like, documentation. And so that evolved into me making. Making something to help clinics with their documentation. And so there's just a lot of things that I. I've been doing to help all along. So there's trying to think what else. I have a. I have a cheat sheet that I made that's, like, all the different developmental milestones. Lots of different things. Oh, yeah. Thank you for Mentioning that Christy got on here. I'm so glad you got on. We were having trouble getting Christy on. Yes. That is the other thing that I'm doing. I just made an app, the Sensory Hero app for parents. But it's also super great for therapists and it is very close to getting launched. We are just working out a couple of last little things, but I can't kind of show you what it looks like. We have a huge wait list for our clinic and so it was my, it's. It's my way of trying to help parents while they're waiting. But it's. It looks like, it looks like this. It has 30 day. It's a 30 day challenge, 15 minutes a day. And so there's things like what's the difference between a meltdown and a tantrum and root causes. Our Ahana 3C method, which is like this, this kind of what it looks like. They have videos and then like the 3C method is calming yourself, calming the environment, calming the child. And then it's broken into three weeks of like what are all the ways you can calm yourself so they can co regulate calming the environment? Different things and then different things for the child. So it's pretty cool. I'm very excited about it. And then we're also working on a starter kit. Hopefully move into a subscription box. But the starter kit has a bunch of them main tools that you can use that are in the suggestions for how to calm the child. So like Galaxy Light, we got custom made body socks. There'll be headphones in there, bubbles, what else is in there? And it'll be. It should be about 75 that. It should be pretty reasonable. The kit that has everything in it. So. And then on the items in the box there'll be QR codes so they can go right to a video on how to use it. Oh, I'm just reading a note from Haley here. So you did see it when I was holding up the app. Yeah. So lots of things I'm always busy doing, coming up with different things. This is what it looks like and it'll be, it'll be available through the app, you know, Google, Google Play and the Apple App Store and also directly through us through a link. So that is all coming soon. If you. We can probably add these emails to the. To let you guys know when it's ready for purchase. Like I said, it's getting close. All right. I went on a big tangent there. I don't even know how that started, but yeah. Oh, because you guys are so Many didn't know me already, but I, I just, I. I have such a passion for helping these kids because I love all the kids, you know, all the abilities. I love all ages. I mean, I've, I've done it all. I've worked with elderly, and just one of my favorite days, I worked with a 1 year old and 101 year old in the same day. I just thought that was so cool. But I just have such a passion for OT because we're all about, you know, meaningful activity and that intrinsic motivation of, of the person and, and just nothing makes me happier than helping people feel that excitement if I did it. And. Yeah. So I just love it. I love being able to help people. Anything else before we hop off? Oh, good, we got the wait list link on there. You guys are so on it. And I, I couldn't do. I couldn't help nearly the amount of people and do what I do without my team. And Christy. Christy's been doing all our marketing and Haley and Christy do it. Excuse me. And they're just. They make me look good. They are amazing. And I appreciate them both so much. Christy made all my beautiful slides. All right. Yeah, we're going to send out all the links. All right, sounds great. Sounds like we're done. I appreciate you all and have a great rest of your day. Oh, you're welcome, everybody.