Kara Sheesley has an uncanny way of making her job as an occupational therapist on Akron Children’s Beeghly campus look like child’s play. She runs, crawls, swings and plays patty cake.
But, make no mistake, it’s all part of a master therapeutic plan to get her patients on track.
“I get them to work by playing with them,” she said. “This way they don’t realize they’re doing work and they gain skills more quickly.”
Occupational therapy by definition is the occupation, or work, that occupies a person’s time. This can mean activities of daily living – from eating, dressing and grooming to playing.
From infant therapy evaluations and developmental delays to post-surgical rehab, Sheesley sees a little bit of everything.
On this particular day, her schedule leans heavily toward outpatient appointments.
Two-year-old Jeremiah is in for his second session with Sheesley to address sensory concerns.
The toddler with the Lightning McQueen shoes can go from calm to agitated in the blink of an eye, but Sheesley knows just what to do.
“Giving him deep pressure helps to calm him down,” she says, as she gives the boy a bear hug while seated on her lap.
She explains to mom how she can use this tactic at home.
“Push his hands together when he’s washing them or put pressure on the soles of his feet when you help him put on his shoes.”
Since Jeremiah has sensory issues, one of Sheesley’s goals is to get him to touch different textures.
She pulls out a Tupperware with small toys buried in rice. The idea is to get Jeremiah to dig around in the rice and pull out the toys.
When it’s time to clean up, Sheesley asks Jeremiah to fetch the lid to the Tupperware. This simple request allows her to test Jeremiah’s executive functioning skills like his capacity to follow directions.
Adaptive toys and equipment
Sheesley’s next patient is 2-year-old Eloise. Eloise has a condition known as microcephaly, a neurodevelopmental disorder in which her head circumference and brain size are small for her age. She also has hypotonia, or lack of supportive muscle tone.
Since Eloise is unable to sit up or crawl, Sheesley lays her on her belly across a foam wedge. She places a mirror in front of her.
“Eloise loves to look at herself in the mirror,” she explains. “By placing her over a wedge she doesn’t have to work as hard against gravity to lift her head and look in the mirror.”
Eloise is one of Sheesley’s many patients who receive co-treatment with other disciplines within the rehabilitation department. In addition to feeding, occupational and speech therapy, she receives physical therapy to work on different actions in different positions. Oftentimes the therapists work in tandem during a session.
Eloise has made a lot of strides since Sheesley last saw her.
“What we do in therapy is only 30 to 50 minutes once a week,” she says. “We teach parents what they can do at home on a daily basis in order to see improvement. Kids are going to respond better in their natural environment.”
“She’s not throwing up and her energy levels are so much better,” says Melissa.
She pulls out a dog toy that has been adapted with a switch. Eloise pushes the button to make the dog move.
Melissa updates Sheesley on the adjustable bath chair and standing chair that Sheesley and her co-workers helped secure for them.
“She’s safer in the tub now, has more freedom, and it’s much less strain on my body,” Melissa said. “She’s had her standing chair for a little more than a month and she’s already built up to standing twice a day for 30 minutes at a time. Our ultimate goal is to get her to walk.”
Sheesley’s next patient arrives dressed to the nines in a flower headband and matching socks.
“When babies are born premature, they have to finish developing in an isolette instead of in utero. It can be very stressful,” Sheesley said. “We perform a lot of massage to help calm and organize their body systems so they can better tolerate being touched and handled.”
“We correct her age based on mom’s due date and that means right now we’d like to see her doing things that a 5 ½ month old can do – reaching, grabbing, grasping and bringing her hands to her mouth,” Sheesley said. “By the time preemies are 2 years old, we want them to be caught up and able to do the things that typical 2 year olds can do.”
One of the common conditions the staff sees in premature babies is an extending pattern where the baby’s arms flail out instead of coming to a midline orientation.
“We want to break that pattern,” Sheesley says. “We want to see her bring her hands together and bring toys up to her mouth.”
Sheesley is working on helping Aubree sit securely and reach in different planes to challenge her balance. “A lot of what I do with my body is to support her, yet still make her feel independent so she’ll want to do more.”
Sheesley stacks blocks just out of Aubree’s reach and places a mirror in front of her to motivate her to crawl toward the mirror and reach for the toys.
Physical therapist Meghan Ball pops into the room to check on Aubree’s progress.
Ball often co-treats Aubree during her occupational therapy sessions.
“I help get her in the right position and Kara can work on a certain skill like reaching,” explains Ball. “By using her left and right sides evenly we want her to do movement in a mature pattern. If her posture isn’t right, the next step becomes more difficult.”
Working with NICU grads
Four-year-old Michael is another one of Sheesley’s NICU grads. He’s a triplet, and as the result of a brain bleed at birth, has cerebral palsy that affects the right side of his body.
“I’m working on getting Michael to spontaneously use his right arm,” said Sheesley. “We work on dressing, zipping, buttoning and bilateral skills like cutting and stringing beads.”
Michael has participated in Constraint Induced Movement Therapy (CIMT), an 8-week program that trains the neurological pathways to use the right side of his body.
“For 2 hours a day Michael wore a splint on his unaffected side and this forced him to do everything with his affected side,” Sheesley said.
The first order of business on this day is getting Michael to change clothes – an activity of daily living that Sheesley uses as part of his therapy. She encourages him to use both hands to pull off his shoes and socks.
“Do you want to have a scooter board race?” Sheesley asks.
Once lined up face down on the boards, Michael says, “Ready, set, go!”
She then links 3 boards together and has Michael lie on his back. She ties a TheraBand to a pole and has Michael use a hand-over-hand method to pull himself toward her as she holds the other end of the band.
Next, they move on to a board game called Pop Up Pirate where they insert swords into a base to try and make a hidden pirate reveal himself.
Sheesley allows Michael to alternate his hands through the 8 rounds until the pirate finally pops up.
A delighted Michael wins the game. “I win! I win!”
Her strategy of mixing work and play is yielding the results she wants – ultimately making them both winners.
If you’re interested in a career at Akron Children’s Hospital, check out our current job opportunities.