Episode 3: Patti Oetter
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Transcript:
Amy: Hi, and welcome to OT Mentor Moments Podcast, where we explore advanced occupational therapy practice, mentorship, and the work that we can all do to become the best version of ourselves. I'm Amy Lewis, and I love the profession of occupational therapy, particularly pediatric practice. Over my career, I have had the great fortune to have some amazing mentors who have helped me to grow both as a clinician and as a person. Mentor Moments is my way of paying it forward by sharing their wisdom with all of you.
Today I am welcoming one of my earliest and most influential mentors, Patti Oetter. Patti was in the generation of therapists that pioneered sensory integration theory and practice. She has taught at the university level and has lectured and taught internationally for the last 40 years on topics around sensory integration, including her own MORE course, which stands for Motor, Oral, Respiratory. She is a master at observing breath and subtle motor patterns, and she has a gift for seeing the details of function while also seeing the whole child and keeping the big picture of who that child is in the world in mind in everything that she does with them to support their development. She has influenced my other mentors with her extensive understanding, and I am excited to share a bit of her knowledge with all of you today.
Welcome Patti, I am so excited to have you here with me today.
Patti: I am delighted to be with you.
Amy: Thank you so much for being here on Mentor Moments. I think that you were probably one of the first people that I thought of when I thought of doing a podcast, because I count you as one of the most important mentors of my career, and I think I'm probably not alone in that.
Patti: Oh, bless your heart. Thank you.
Amy: So, I appreciate you continuing to share your knowledge with us, and I look forward to introducing some people to you today that might not have heard your information and just giving them an opportunity to learn a little bit more about you. So, one of the things that I want to do in Mentor Moments is talk about mentorship. That is one of the concepts that we'll be talking about on this podcast, and I would like to ask you to share with me about some of your mentors. I'm sure you have had many over the years, but what mentorship has meant to you and maybe a couple of people that you would like to highlight?
Patti: When I first got my first job, I was the only OT in a mental health facility, and there were no other OTs in this small town that I was in. And then I went to Kansas City and got a job in the children's rehab unit at the university. Then I was surrounded by all sorts of professionals, but no OTs. And then I got to teach the pediatrics portion in the OT department, so I was around some of them, but mostly they just gave me a course and went away. So I was desperate for OT stuff, and I was taking courses like crazy. I took a course in Wichita, Kansas that Pat Wilbarger and Barbara Knickerbocker were teaching, and what they were doing was introducing the SCSIT. I was fascinated by that whole concept. That was the first time I'd really been introduced to it in a class. I'd read stuff, but... And so my very first real mentor was Pat, and she still is. She's also a very good friend.
Amy: That's a pretty good first mentor to have.
Patti: And she got... my strategy, and this would be good for everybody else to know, when you find somebody that really has something that you want to know, start stalking. I don't mean that in a nasty way, but find out where they are. I did that with Dr. Ayers. I took my first course from her because Pat introduced me to her, and then I just started following her around, and I always sat in the front. And finally we were placed in the middle of Missouri, and she's talking and she's looking at people, and she looks at me and she goes, are you here again? And I about croaked. Anyway, I had dinner with her that night. So, she was another one, but not anywhere near as often as Pat. Mary Kawar is another one. I was so fortunate once meeting Pat that I got to meet Lorna Jane King from Northern California, Lila Lorenz. All these famous people, and she just introduced me to them and just let me do my thing, which was to pound them with questions. I don't know about pounding them with questions, but just listening, listening, listening, and then asking some. And they were so, so gracious. So I would tell anybody, because now I'm sort of in that position, and people very rarely will they come up and ask me something. And if they do, they seem nervous, and it just breaks my heart. Because as OTs, we're just all people. And I think that it's really important for younger therapists how to get to us. Camp has done wonders for me in that respect, because once you get to camp, put your shorts on and don't have makeup on, and your hair's standing up everywhere. We're just all people.
Amy: Right. So I'll fill in our audience on what camp is.
Patti: Good, good.
Amy: Yeah. So Patty and I actually met when I was trying to attend Camp Avanti as a Practicum Therapist. And Camp Avanti was founded by Pat and Julia Wilbarger as an opportunity for kids who had challenges with sensory integration to have the opportunity to go to camp. And camp is facilitated by a bunch of occupational therapists. Do you want to add anything to that, Patti?
Patti: I do, because the second major part of that was training. So that we invited a bunch of people as practicums to come to camp, because either Pat or I had figured out certain people that we wanted to bring into the family, I guess you'd say. And that was one of the priorities, I think, between camp being a laboratory, a study place, that kind of thing for some of us. It was also about mentoring and getting other people involved in asking the questions and watching the kids, and what can we change up here, and that sort of thing. So, I would say training, plus to have camping experiences for kids, our kind of kids have a terrible time trying to fit in with other kids, or sometimes just their environment. So, Pat really felt strongly about making sure that those kids had an environment that was attuned to and supported sensory processing. And the very first camp, she wanted to do a SCSIT training, too. That lasted one year.
Amy: Yeah, that's a lot.
Pat: Julie and I were just like, oh, golly. But we called that “Wilbargering”. She always wants to do 10 things at the same time. And I don't fault her for that. It's just hard to participate.
Amy: Yes, it can be an exhausting experience just by itself, invigorating in another way, but also exhausting. And I can't imagine trying to add a full training in. But I will say that we have the practicum program…
Patti: That's what we evolved into. That we would do training during camp about stuff that was happening at camp. Right. So when practicum therapists come to camp for the first time, they are coming partially to volunteer and be a part of the camping experience for the campers. But they are also coming as learners and receive instruction from the experienced staff who has been there for a very long time and has a lot of information to share.
Patti: Correct. It's a, you know, I'm a camp fanatic.
Amy: Yeah.
Patti: I've been there since the beginning, and I plan on being there till the end of my ability to be there. It's just an amazing week because just bringing a group together and our intent is always about supporting the kids and supporting the people that are there. And I think that just puts us in a bubble. Yeah. And that bubble allows for everybody there, even the cooks, to just participate in the joy that we have in providing an experience for kids and younger therapists, you know, to just grow.
Amy: Yeah.
Patti: It's just exciting. So I wouldn't give that week up for nothing. And these last three years have just killed me to not be there.
Amy: Yep. It's been hard, but I think we're going to have a really strong year in 2024 and looking forward to that. So if anyone's listening to this podcast and wants to learn more about Camp Avanti, we will give some information in the show notes on how to get involved.
So, let's dive into, well was there anything else before I start that you would like to tell me about mentors that you have had?
Patti: Um, no, I think I would turn that into… if you've been practicing for a while, even if you haven't been training students and especially if you are to become a mentor, to figure out what it is to not just teach certain skills or grade certain performances, but to really support the growth of that individual person. It's not about OT. It's about Amy as an OT. You know, what are your strengths? What are your dreams? You know, and you can kind of figure that out by the glimmer in somebody's eyes when a certain topic comes up or a certain kid walks in. So, I would say if you've been mentored well, even if you haven't, figure out how you can mentor, get involved with study groups and things like that. And you'll find that you have something to offer, even if you've only been in practice for three, four or five years. You've already got questions in your mind and things that you're thinking about, things that you've tried that have worked really well, you know, stuff like that. So, I would say mentorship is important. To be one and to get some. Go ahead and start stalking.
Amy: And I love what I hear you saying in that, because what I'm hearing you say is that it's not all about the declarative knowledge or the tools and strategies that it is also, if not more so, about knowing ourselves well enough to be able to see a person clearly and provide what they need, which may or may not be clinical information in a particular moment.
Patti: Exactly.
Amy: Yeah. And I would say that that is definitely something that I didn't always know that I was getting from you, but I know now that I was, that you were able to see me as a person and provide me with the reassurance that that person that I was at that time needed to keep going. So, I thank you for that.
Patti: You're quite welcome. You were, you were, you were a real trip. I first met you, you were so in your head, but I was like, how are we going to go from here to here?
Amy: I was so in my head until six years ago, I was still there.
Patti: I think not nearly as much, not nearly as much. And then having kids of your own started changing that.
Amy: I would say that that's probably true. But I think that for anybody out there that feels like they are always in their head, there is hope that you can move beyond that. And as we said, right before we started this call, you can believe in just the magic that's there in life and it makes life a lot more joyful.
Patti: Certainly, certainly does.
Amy: Yeah. So, I want to know about particular parts of your practice. I could have you on 10 different times and talk about 10 different things, I'm sure. And we would never run out of things to say, but I would like to start today with talking about the MORE concepts that you have brought forth into our OT practice and let you define for us what MORE is and kind of tell us a little bit about how that came about.
Patti: It was one of those magical moments. I ran across a little guy that was in for an arena assessment. He was about 14 or 15 months old. And with Down syndrome. And so I'm watching him and I'm watching how he's interacting with the other people that were evaluating him. And there was just something about this kid that I'm just like, this kid knows more than this entire group together. And mom knows almost as much as he does. I want to know that stuff, whatever that is. And so I was one of the ones that talked with the family afterwards, and he was the youngest of nine kids and lived on a farm. And the more I talked with them, the more I realized what it was that was going on for him. He was just, they were so open to him as a person, not as a diagnosis. And his dad had him on a tractor. He had the best sensory diet that anybody could ever have designed. But anyway, we offered to, you know, he can come in for therapy or we could go to the home. I think we were doing home stuff then, you know, that sort of thing. And they said, no, no, thank you. And so that was the end of that. And then when he turned three, I had started working in an early childhood unit that was attached to a school. And these kids are getting off the bus and I saw him and I'm like, I know this kid. And it turned out to be Philip. And so for the next nine years, he just kept teaching me stuff. He made my mind go that I was racing to the library and I'd lived in a small town. So, we were constantly asking for stuff from other university libraries. I wound up with, when I moved, I had to get rid of some of that stuff. But I had four drawer filing cabinets full of articles on oral motor and respiratory function. Some of them on Thermofax that had already rolled up and turned brown. You probably don't even know what that is.
Amy: I don't even know what that is. I can imagine.
Patti: That was the old copying strategies. But anyway, so as I'm working with him, part of what everybody was concerned about with him was his oral motor stuff. I was more concerned about his postural stuff. And I certainly agreed that he had some oral motor issues and I figured that if we could get to those, we could probably get to the postural stuff. Then I tried to figure out what kinds of things we could use for taste, texture, that kind of stuff, and discovered that he was not about to eat at school ever. So that wasn't gonna work. So, then I started talking with the family and wanted to know if I could come around mealtime so I could see exactly what it is he would eat. Well, whatever he picks off the table, whatever he wants to eat, he's got a healthy diet. We have not seen that. So I followed him until he was in fourth grade and then I moved to New Mexico and that was the only time he didn't follow me. Because I kept switching schools and he kept switching schools. So, every time I switched a school here, he came again. But I was never done with him. And then he was working at the Pizza Hut. And I found that out. So, one time when I was at camp, I went to the Pizza Hut and asked if he was there. Oh yeah, he's here. He's in the back, probably bossing everybody around. It went very lightheartedly. And I said, really? He's really the manager. Yeah, he says, I've only been here for two years. This kid is beyond belief. So he comes trotting out and he looks at me and goes, surprised and stuff. And so we were talking and he was just an amazing kid and an amazing grownup.
He's the one that started me on all that stuff. He took whistles out of my purse. He was always going through my bag to see what was in there. And my daughter had just had a birthday party at McDonald's and there were whistles that were part of their little party pack thing, a siren whistle and one of those big straw whistles. But it was one of those that expanded and retracted kind of things. And so he went into my bag. And of course, if there was anything extra that went into my purse. So he found those and he picked out a white siren whistle and a purple tube, put one in one pocket, one in the other, and then I'm watching him. What is this? And so he would sit there and he'd get this far away look and then he'd reach into a pocket. He knew that he couldn't blow that whistle hard because it would make noise. So he was just doing that kind of thing. So I said, oh, okay, he's working on his breath. Why is he working on his breath? Don't know. Then I took a bunch of slides of him and he was in an inner tube swing on his belly and he pulled out his purple whistle. And started blowing on that every time he came forward. And then he'd inhale and then, and I'm like, what does this kid know that I do not know? And so I'm taking slides of him so I can see if I can see that later and try and figure out what that might mean. And what I noticed looking at those slides was, I joked this kid with his such poor binocular vision has perfect binocular vision when he's blowing on that whistle. But I kept watching and watching and watching that. At that time I knew Steve Cool. So I asked him about that and he just goes, ooh, there's no research on that. Okay, well, that's your job. Yeah, I mean, that's what you do, you figure that out. And he's working in the ophthalmology school at the university he was teaching at. So, but anyway, yeah. So he was the instigator of everything that's come out of that workhorse. And as the years have gone by, because this has been going on since 1985 maybe, maybe before that. And every time I was keeping up with the literature as much as I could. And then I got to the university and then I had access to a whole bunch more literature. And that kid was always on my mind, always. And so I would try things with other kids and I'd watch what they were doing. And then if we had all the options that I had sort of come up with for Philip, then they would give me another one or another one. As time went on, I started figuring out more and more and more about how incredibly important that our respiratory system is for all function. I started with this next one of suck swallow breathe because for some reason, the more I got into it, what's going on with Philip, oral motor-wise and breath-wise, because he constantly was in that inner tube, bouncing in that inner tube right across his diaphragm. And then he would make more noise. He wasn't talking, but he would make more noise. And he seemed to get more organized posturally. So I started reading about that. And I realized that at some point in the 60s, suck, swallow, breathe was not looked at as a unit anymore. It was looked at as suck or swallow or breathe. And that there were different professions focusing their attention on one or more of those things. So I thought, okay, I think we've missed a big thing here. And so I started looking at what all that was. And it's that the cranial nerves just keep overlapping on each other. So as I'm looking at that, I'm looking at how many outcomes there are from those cranial nerves and the way that they pattern themselves.
Amy: So let me summarize. You were saying that the cranial nerves that innervate the musculature that is responsible for suck, swallow, breathe, that there is overlap in that system.
Patti: As well as the sensory. Yes. Because this is a sensory motor operation, if you will.
Amy: Right, so the sensory motor receptors and the motor output.
Patti: Exactly. Yeah. And that there are different scenarios for different outcomes. So if you look at cranial nerve number seven, it interacts consistently with cranial nerve number eight, the vestibular nerve. And it also goes to, or a motor function in five and nine. And I could figure that out from the literature. You know, because I really looked at the cranial nerves. And so I would say, okay, this does this, this, and this, this does this, this, and this. This does this. So does this. How do I get to those two things? What is the common denominator? And can I get to the pattern by using some of those things that each piece of the pattern is responsible for or takes in sensory information or puts out? And that made a huge difference. Just a huge difference.
Amy: So the interventions that you offer, can you give us a little summary of what some of those look like when you're thinking in terms of the information you teach in the MORE course?
Patti: Right, so it's so hard to get specific because it so depends on the cluster of things that are going on for a child. So for Philip, he knew to use his vestibular system. He knew that one. And he would do that as much as possible. And being on a farm and riding on the tractor and sitting on top of cows coming in from the pasture. I mean, all the things that he was doing was just firing that up. And he was eating okay at home, although the oral motor stuff there was still not good at all. And so I thought, okay, so if we want to get to oral motor and he's already working vestibular and his postural stuff is coming because I was using a ton of vestibular stuff with him. So maybe when I found out that cranial nerve six or seven hooks up with vestibular in the brainstem and then up higher, higher all the way up actually. And when I figured that out, I thought, okay, so taste, texture, temperature, I should start doing that and put that pattern together. So, if I use sensory that was, I mean, all of those things, taste, texture, size, whatever, all of those things were going to support stuff at a higher level for oral motor function, not just for eating, but also for speech. So I started doing that with him and bing, bang, boom, we started getting jargon and then we started getting words in the jargon and then he dropped the jargon and just started using words. I mean, he just went zip, zip, zip, zip, zip in a couple of months that all happened really rapidly. So it's that kind of stuff. You'd look and see where the patterns are that aren't working well and where is something that is and how can you hook that to something that isn't by knowing what goes together.
Amy: So in that case, knowing that vestibular and breath and taste, texture, temperature, all of those things supported functioning together helped you to improve his outcomes. Would that be accurate?
Patti: Yeah, you threw respiration in there and I didn't say that, which was good because that was a big issue for him. He was constantly into upper respiratory problems. Respiration is not really part of the oral motor output, but it is certainly, respiration is a rhythm. And if you can set that rhythm into whatever's going on with oral motor output, then yes. So yes, he was always doing the whistles. That was good that you threw that in there because that's important, especially if I was going after speech stuff, which came down the road. That isn't the first thing I did. And I was mostly using sound for rhythm for him. And that took a while. He wasn't even relating to the music in the room. So I would sit with him on something that would bounce and put it in there. And then pretty soon he'd do a couple with me and then he'd get off again. That one took a long time. I think the thing that finally changed that up was to give him a drum. And so he was beating on it while I was bouncing with him on a ball or swing or whatever. And as soon as he started doing it himself, then the rhythmicity came for his breath.
Amy: Yeah, so when you say sound, I hear, oh, I'm sorry, go ahead.
Patti: I said, it's different for every kid and it's different as they progress. And then you can throw something else in there and get more of an outcome because when you look at normal development, the rhythm piece is huge because that's a self-regulation thing. That's the majority of self-regulation. And so if you can figure out where that rhythmicity is, and that's got me starting to check heart rates and heart rhythm and respiratory rates and respiratory rhythms. And then I realized that I could use low frequency rhythmicity to trigger cerebellar brainstem interaction to get that regulation started. Gulp didn't even have a good suck thing to use for regulation. He really didn't have much of anything. And so he was never quite settled. He always used the environment to make him feel better. He couldn't do very much of that on his own. Unfortunately, with that many siblings and cousins, there was always somebody there to provide the environmental stuff to keep him in rhythm or keep some of his rhythms going. You could always tell when he was off because his face, he was so blonde and so fair-skinned that he would start flushing. And I knew that he was off. So it's stuff like that that makes you think because more is not a treatment thing. It's a theoretical construct that helps you design treatment.
Amy: Right. It's not a set of activities, even though you do offer activities in the course, but it's not a set of activities as much as it is an understanding that that motor, oral, respiratory, and I include postural in what you do in that course, that all of those are linked together and that sometimes we have to find the entry point that is going to start helping all of those functions work together that works for the child in that particular moment.
Patti: Correct. And what worked yesterday may not work today. So you gotta figure out what that range is and start supporting their own library, if you will, things to use under different conditions. And I know that that sounds like, oh dear, I just wanna know what to do. If you know how the nervous system goes about processing information and directing output, and you know where the overlaps are, you can start putting things together. That's what sensory integration is all about. Putting things together that are gonna support that outcome. So my first thing always with kids is to look at cerebellar brainstem interaction. What's going on there? Because that cerebellum does so much. stuff for auditory, for visual, for aural motor, for motor planning, for praxis, on and on and on and on. It sets stuff up. And if that connection is not made, you can tell whether it's made or not by postural control, reflux stuff, not being integrated yet. The oral motor stuff is really important from that end. And then self-regulation, you know, that's the kind of thing that you should start seeing and see in the first year of development. Actually, you see that in fetal development, you know, that's already working well. And those are the babies that have pretty normal births and deliveries. And so I'm always looking at birth history, and not just the birth itself, but the whole pregnancy. And what's going on here, what kind of stressors were there, that kind of stuff. So I don't think you can do all, learn all of that at once. I think you find out which kid on your caseload represents whatever it is you were trying to learn about in that moment. And then that gives you one set of criteria. And then you just keep going, pick the next kid that's got a piece of what that kid had. And you just keep growing and growing and growing. And, you know, I mean, the more stuff certainly can help you know what patterns you're looking for. You know, what part does what. That postural piece is so connected because respiration musculature is postural musculature. So you're going to get that, which means that you can use vestibular and postural stuff to get to, you know, reflex integration, get that cerebellum going back to the brainstem, get the regulation stuff going, and then you can climb up to other stuff.
Amy: I love what I hear you saying. And it really resonates with what I want to convey in this podcast. And that is that sensory integration, which I'm sometimes now referring to it as sensory integrative processing, is really based on what's happening in the brain. And I think that people who were in your generation of learning understood that well, that that's where Jean Ayres was coming from was an understanding of the brain. And that somewhere along the way, by the time it got to me, it, it became a little less clear how the things that I was seeing aligned with what was happening in the brain as far as my, my early learning. And so meeting people like you and other mentors who have a great understanding of the brain has helped me to start relating what we do back to those structures and their functions. So I'm just, I want to highlight that for people and encourage people who maybe haven't related sensory integration to the actual brain structures and the functions to look back at that, and then also bring in the parts that you're talking about. Where you have learned to offer opportunities to the kids that just right challenge, as Jean Ayres would have said, that build the capacity of those, those brain functions to work well.
Patti: Yeah, I would just add one more thing to that. And Jean always said this, that she calls it sensory integration. And for you to translate that into sensory motor integration. And I think that that's the thing that gets people off. They think, is this a sensory issue? Excuse me, but you know, without sensory, you don't get motor without motor, you're not processing sensory. So, you know, to just keep that in mind, it's really about sensory motor integration. Great. That will help you figure out what activities do motorically that will help that the sensory processing that will help the motor output back and forth, back and forth. That's really how it works.
Amy: And they really can't be separated when we're talking about functions. So, I appreciate that, that reminder that we always have to be looking at the motor system to understand what's happening in the sensory systems. And often the motor system is where we are going to go with intervention, not just providing passive sensory input.
Patti: Yeah, yeah. And, and I truly do not believe that just, just putting sensory in there for sensory sake, without an out without an outcome in mind, or without observing, okay, so if we do, if we do rotary vestibular, what is the kid doing with that? Right? What what is their next? What is their next choice when they when they stop that activity? What's their next choice? And of course, you want to put up or you want to put the options out there. And then just watch what they go after or not, which means you pick the wrong thing.
Amy: Yeah, you have such an amazing ability to watch, wait and wonder. And to really be present. And we had a conversation one time where I said, you know, when I hear you talking about your early practice, what I don't hear is you judging yourself for what you don't know. And your answer back to me was, why would I do that? And, and I said, well, it's a good point, Patti, but that's how I spent most of my young career was judging myself for the things that I didn't know. Yeah. And what you shared with me, then was something that your grandmother told you, which was to, and I believe I've got that right, that it was your grandmother who said, just to go into the day wondering, what am I going to learn today?
Patti: Yeah, that was her.
Amy: And I think that that idea that we don't have to know everything, and that we don't need to criticize ourselves for the things that we don't know.
Patti: You just need to support yourself to learn new things all the time.
Amy: Right. That, that isn't something that all of us move through life with the skill to support ourselves and understand ourselves and give ourselves grace for the things that we don't know. So I really appreciate hearing. I think it's helpful for everyone to hear that it's okay not to know all of the answers and that you will actually best serve your clients if you can be compassionate to yourself and support yourself in order to learn new things. I think that, you know, I walked into every single treatment, wondering what this kid was going to teach me today. Every time.
Amy: Yeah.
Patti: Because whatever it is, you thought you knew they're going to throw a wrench into it somehow, because they're going to go off in a different direction and you just better catch up and follow along and pay attention. And then I, I would, you know, put these mental notes down so that I could go think about it later, which is what I did almost every evening after the kids are in bed. You know, I'd sit there thinking about what so and so did and what so and so didn't. And I realized that even, you know, if some kid did something that was really astounding to me, good, bad, indifferent, whatever, just different, right. I realized I was carrying that through and starting to notice that in the kids that followed.
Amy: Yeah.
Patti: You know, which means, okay, I'm learning something here. Don't know what it is yet, but that's, what's exciting. That was, that was what drove me to get up and go to work every day.
Amy: Right.
Patti: Not about what I didn't know, but what, what I was learning.
Amy: Yeah.
Patti: Always. So I think you just got to have that drive to keep acquiring information just because it's fun to acquire information.
Amy: Yeah. I think something you said a few minutes ago made me think, you know, people will ask about what courses they should be taking, you know, feeling like they need to take the thing that everybody else is taking. And, and I do think that there are some foundational courses that really set us up to be prepared for a new career as an OT. But then beyond that, I also think that my personal philosophy is to follow your fascination that you're going to have that kid that you go, Oh man, there is just, I need to know something about this thing that I am drawn to for this particular child. And, and sometimes in my path, that hasn't always even made sense. Like the thing that has fascinated me might not be something that I can tie to a particular patient or a particular situation at that time, but I've been practicing long enough to know that when I follow that, at some point, that information becomes really relevant and changes my practice.
Patti: Yes. And. The thing that's important for me to keep reminding people is that if you see somebody that's got, Oh, this is a visual thing. I got to learn more about vision and you go do that. And then you get a whole bunch of information about that. And then, then you've got a kid with language processing, auditory processing, and then you go learn a whole bunch of things about that. You just get confused. And what you start offering kids is a little, the treatment pieces you learn from here, the treatment pieces you learn from there. And it's just, so my suggestion always is if you think you need to learn more about vision, why, why are you asking that question? What is there about what else is going on with that kid that makes you, makes you think you need to learn more about vision? Because if you do that, you're going to push yourself back down developmentally to see what ran amok before the visual system should be able to do whatever it is you're thinking that it should be able to do. So it's the foundational courses that I think I would just keep taking even at this point in my career. Are there, are there other things out there? Yes. But there's also a whole bunch of other professions that are digging into that thing in particular, which is where the kid is going for treatment. I'm not doing that. I'm an OT.
Amy: Right.
Patti: So what I can do is just support that foundational stuff so that they can wind up being the heroes.
Amy: Right. So you're talking about when you're going out and, and looking for the thing for the particular child, we're not pigeonholing ourselves into a particular method.
Patti: Correct. Yes.
Amy: And I agree with that. That hasn't been a path that I have felt drawn to. I think that I was lucky that Eileen had the company called PDP Pro at the time that I was coming up as a therapist and she offered many of these well-rounded courses that give you that foundation that's really solid. But there's a time where a child that I had a strong feeling would really benefit from a listening program. And that's when I went down that path. But I do think that it's important. And what I hear you saying is that we always bring this information back into the big picture and that we always trace back to where did this problem first come from and that we're not trying to treat the symptoms, but rather we're trying to go back to the beginning and provide an intervention that's going to be supportive of higher skills. So we're not just putting a band-aid or teaching a task rather we're going back and enabling them to develop in a way that supports global change.
Patti: Absolutely. You know, you brought up listening. That would be one of the foundational courses I think people should take. I agree. Because that particular course tells you about the auditory system, what it does, but it also relates to all the rest of the sensory stuff and postural stuff and visual motor stuff, those things that aren't visual motor activities per se. It's supporting the development of those things. So that would be one of those foundational courses I'd certainly go with.
Amy: Absolutely. So maybe this will be a moment where I'll ask you to tell us where your course is available because that is another one of the foundational courses that I tell everyone they really need to have this piece of the motor, oral, respiratory, postural kind of intervention. So where can people find that information from you?
Patti: So our course is now on, COVID did this one, is now an online course. And we can list that in the play notes
Amy: I can.
And then I had one more question that I was going to ask you and I will share with our audience that this question was actually inspired by you. And that is a question about something that you might've considered to not be a positive about yourself at some point in your life and how that has affected you and may have become something that you see as a positive and maybe even a superpower. And the way that you inspired that question for me is by talking about how your vision was not great as a child and how you found yourself observing people's posture and movement as a way of recognizing them. Is that something you remember about yourself?
Patti: Absolutely. I was too vain to wear my glasses because I was too young and nobody else in the entire school wore glasses. So, I would go walk into school or then when I was on the bus and find this bush and hide my glasses underneath there and move on. What that meant was I couldn't recognize somebody more than 15 feet away from me. I've learned what people wore. I knew what their jackets looked like. Looking back, those are the things that I know I knew. I don't know that I knew that at the time. But just shoulder movements or head movements or flipping your hair or walking from foot to foot. There were so many things that are so distinct about different people's posture and movement patterns that has turned into a a real gift, not that I hid my past, but that I had to figure out something else or everybody thought I was being rude or up in ears, whatever. So yeah, because now I can look at a kid's movement and I know, bing, bing, bing, bing, what's going on, which makes it hard for me to teach that.
Amy: Yes, I will tell the audience that watching you treat and your ability to see breath and see how posture is supporting a child in the way that they move is something to behold. Kim Barthel has said if she could just have Patti's eyes that that would be amazing. And sometimes I will admit that as a young therapist, you would say, well, you see how they did that? And I thought, no, Patti, I didn't see that at all. I can't see what you're seeing. And I think that that really drove me to learn to observe movement and learn to observe breath because I knew how much that drove your interventions and how effective that was. It took me a lot of work to get there. And I may have even gone down a different route than some people did to be able to see those movement patterns. But I think that it's just really cool to think about the fact that your vision and your vanity maybe are two things that led you to having a skill that makes you an incredibly special practitioner. And I think everybody has those things about them that make them unique and that are actually a superpower if you learn how to use them.
Patti: Agreed. I think another one would be to trust your intuitiveness. I was the oldest of five and I had to learn really quick what was going on around me because I was always set up to be the example, the model kid, you know, on and on and on. So I had to learn. I don't think you learn intuition, but I think it's a survival skill, you know, to know if so-and-so is doing this, get out of the room because you're going to get blamed for it or you're going to get blamed for each of that or whatever. And so, and then there's a part of me that isn't like any of my other siblings or like a lot of people that I know. And maybe it's because of the vision thing, I don't know. But I hear things differently, I see things differently and I feel the energy around things. Yeah. And I think that really helps me. It's gotten me in a lot of trouble, but I've learned how to kind of not talk about it so much. You know, just like we were talking about before the cerebellar stuff. You know, if I started talking about that stuff early on when I was first studying it, people would have left me right off the planet. So, you know, I learned real quickly about the things to just keep to yourself. And, but go on, but to go on figuring out what that's all about. And the Moore stuff is a perfect example of that because some of the things that I was absolutely certain were going on from watching kids and watching kids change was something that if I talked to my peers about that would just look at me like I was out of my mind. And Steve Cool, who's an amazing neurobiologist that I had the good fortune to know pretty well and teach with, was constantly, I mean, there's no research to support that as well. So how do you know what to research if you don't have a question? And I'm asking you that question, your job, go do that. And then he wound up doing a bit about vision and glowing and sucking and that sort of thing. And then he became a believer. But it's that kind of stuff that comes into your head and then you start working on it with your clients and then you refine it. And then pretty soon somebody is going to catch on and then you've got more things to read about. Don't stop reading. I don't know how, but however, I still do that. I want to know what's going on. I want to know what other people, and of course I look up the things that are of most interest to me because there's way too much now to keep track of. But if you have a thought or you think that this might be going or that, go look that up and see if you can find anything about it. If not, hold on to that and start looking at it in other kids. And if those things start resonating and you see it more and more and more, get a hold of that and then do whatever you think you need to do. There's the intuition part. Whatever it is you think you need to do to make a change in whatever it is you've been noticing.
Amy: Right. So what I hear you saying is in this day and age of evidence-based practice, we don't want to forget that we do have the ability to perceive things and that our intuition is something that we can follow. And we also should be backing that up by going to the neuro and going to the research to see if there's evidence for this thing that we believe we see happening. And then trying some things because like, I believe maybe it's Reggie Beam's quote, but I have heard you say it many times, that if it works, it's intervention, and if it doesn't, it's assessment, right?
Patti: Exactly. Yeah. Exactly.
Amy: So I think that gathering information through trial and error and taking data, which I believe I have always seen you collecting your own evidence of what's working. And I believe that that is what we all do every time that we're practicing is tracking what's happening. If we can be solid in ourselves and have a belief in what we are able to observe, then we can collect really good data on this particular client that is in front of us and what works for them at that particular moment and across time.
Patti: I totally agree. Now that does not mean that collecting data, it looks like a research project. That means that you are cataloging things in your brain that you're writing down in your notes for you, of things that you want to keep track of. And the more you do that, and then if you've got peers around you to bring those things up, and then a bunch of other people start looking at that particular thing, then pretty soon you've got the body of whatever it is to then have somebody else do real research. That's not my thing at all. I am sorry.
Amy: And that is okay. We can't all do everything, right?
Patti: Yeah, and I just, a long time ago, I just had to say, okay, I know what it is I want to look at. Please, somebody, you know, somebody do this.
Amy: Absolutely. Well, I think that we are getting to the end of our time and I have enjoyed this so much, and I hope that I can have you back to talk about some of the other myriad of things that I have learned from you over the years.
Patti: Perfect. It's been fun.
Amy: All right. Thank you, Patti, so much.
It is overwhelming to me to hear the brilliance of therapists in Patti's generation who didn't have the resources and courses that all of us have now and how they were able to learn so much about what is helpful for clients through observing and knowing the brain and trial and error. I've heard Julia Wilbarger talk about practice-based evidence, and I think about how important it is that we learn to become observers of development so that we can be good reporters of what we see. When we know how to observe functional outcomes, we can really discern what works for a child in a particular moment. And developing the eyes to see progress and posture and breath is challenging because it's subtle, but I've learned from my mentors that it is an invaluable skill. Thank you all for being here with me today, and I hope that you will join me for another Mentor Moments episode very soon. ♪♪ ♪♪