LLA Therapy: Meet Occupational Therapist, Vladimira Krstin

It's difficult to pick just one thing...It has to be the look on a child's face when they can finally do something that they thought they would never be able to do. That look and new confidence you see is immeasurable.

What made you decide to become an OT?

I actually met an OT that had rheumatoid arthritis and her hands were really affected so much so that she was not able to able to open or close them all the way. She worked with children in the schools helping to overcome their challenges. That really made an impression on me and so I decided to volunteer in an OT department and then decided that I really wanted to pursue a degree in OT.

What do our facilities allow you to accomplish as a clinician?

A lot. First LLA makes it easier to collaborate with your other co-workers. Then the equipment and support offered is amazing. I think these things really help us as clinicians do more for our patients.

What is a day in the life of an OT practitioner like?

One thing that is always certain is that it is never certain. You always have to prepare for the unexpected and go with the flow. Sometimes you might have something planned for your session but it all depends on the child and even the parent. If they had a very difficult day, if they were on the verge of tears or having a melt down you really have to take their lead and go to plan b. Then there is paperwork, luckily LLA management is open minded and always thinks of the patients interests and therapists time over

What is an OT topic you are passionate about and why?

There are many but I'll just mention a couple of main ones. First the fact that it is so function oriented. Helping kids be as independent as they can with whatever difficulties they are trying to overcome. Helping the child to improve skill sets so that they can do things themselves. Then I would have to say that I am passionate about sensory integration. It just makes such perfect sense that a child that can not process information from the environment or their bodies would be more challenged in reacting to environmental demands appropriately. Peers who don't have these challenges do things automatically where the kids we work with often find the same tasks much more demanding. Helping them to have an even playing field, so to speak, is important to me.

What are the top 10 ways an OT can help clients?

1.) If there is some area of function that the parent, health professional or doctor is questioning, an OT can complete standardized tests so they can compare results with normative data to ID problem areas if there are any and make a plan with appropriate goals if needed.

2.) Help them be as independent as they can through exercise, therapeutic play, and sensory integrative strategies.

3.) Crossing midline is a skill that most children get at 7 to 11 months; if they cannot cross midline they will have problems in getting a dominant grasp, which will make bilateral coordination tasks more challenging. Handwriting will be difficult as well as functional fine motor skills. Crossing midline is a precursor to many other milestones in a child's life.

4.) Motor planning. Typically if a child has motor planning difficulties they also have some expressive oral motor difficulties. Motor planning deficits can contribute to lower self esteem, stress, and decreased play, social skills, and activities of daily living like putting their clothes on or writing their name.

5.) Sometimes a child might look strong but in fact they are not. They need to have balanced strength throughout their muscle flexors and extensors. Typically for the children that we see, maintaining extension is more challenging and those muscles along with core muscles are weaker. Frequently the children we see have lower tone, they will sit, hyper-extend at their joints and have a very difficult time with static positioning against gravity. So things like the superman pose or sitting at a table for a normal period of time for their age, or standing in a long line can be very challenging for them. A child with low tone will always be lower tone but the muscles around their joints and core control can be strengthened. This will help with the tasks mentioned above.
6.) Self regulation and coping skills. First our knowledge in sensory integration can help children with sensory processing problems so that they can control or regulate how they respond to environmental demands more appropriately. OT has a history of working in psychiatric settings helping children function and cope with more resiliency.

7.) Visual perceptual difficulties are very common in children who have special needs. The fact that a child wears glasses and is said to have 20/20 vision now does not mean they do not have perceptual deficits or challenges. We can administer tests and exercises to help with this. The child may get fatigued with visual tracking at school so they have difficulty keeping up, or they might have difficulty with writing, putting puzzles together, locating objects in the environment or attending to specific items on a page or in environment.

8.) Speech, yes OT is a perfect adjunct to speech therapy and can work together with speech therapy to facilitate speech faster. Many times underlying deficits pertaining to motor planning or sensory integration can be one of the reasons for difficulties with speech.

9.) Attention, many things can help with attention that the OT uses in therapy, sensory integration strategies, protocols like the Alert Program teaching kids to recognize when they need to work on their attention and strategies to improve their attention. There has been a lot of research in using yoga with kids for improved coping as well as attention and more and more OTs are using Yoga in their sessions.

10.) Gain the confidence, skills and resilience too meet future life goals.

What advice do you have for parents who are seeking an OT evaluation?

Trust your instincts and ask for explanations as needed.

What are some activities you would recommend for a child to practice at home?

Playing outside with other peers and decrease computer time.

What is your favorite smartphone app for clients?

Too many to name but they do have special ones for kids who are dyslexic and some that have social stories that help with modeling appropriate behavior.

What are ways you make therapy fun for your clients?

Always take their lead and then guide the session appropriately for success oriented tasks and just the right amount of challenge. Kids are like sponges and are wired for learning. We just have to be careful to provide the right challenge and listen to their needs/wants. Frequently the kids show me new ways to have fun.