RCOT OT Week 2019

Small Change, Big Impact : Sarah's Story

by Rhi Carpenter

Sarah (not her real name) was a 10-year-old girl who lived with her mum, dad and older sister. She was a pretty young girl who loved music and playing in the bath. She also had profound and multiple learning difficulties with significant sensory processing needs.

the Challenge

Sarah was not aware of when she needed to go to the toilet and so she was still wearing pull ups.

The biggest participation challenge Sarah and her family faced was with the daily routine of changing her pull-ups. She would often kick, scream, scratch and shout as her parents or sister held her on the bed to change her. This was understandably very upsetting for both Sarah and her family and they needed something to change.

the Change

As her occupational therapist I talked to her family at length and watched Sarah doing a number of activities in her home. It was clear she was very sensitive to touch but also to movement. She was still crawling despite the fact she could stand up. With this in mind we wondered whether Sarah was upset at lying on her back as this made her feel even more insecure in an activity that was already uncomfortable.

So we made a small change. We tried changing Sarah's pull-ups while she was stood at her bed. We put her keyboard on the bed to play and sing along to and we encourage her to shift her weight and lift her legs to help.

the Difference

And there was a big impact!

Suddenly nappy changes went from being very upsetting and anxiety provoking for everyone involved, to being a pleasant happy time. It also reduced the number of people needed. Job done!

An unexpected Bonus . . .

A few months later I bumped into Mum at school. Mum told me that that after starting to change Sarah in standing, she had started to furniture walk. Her tolerance of standing and ability to shift the weight between her legs when up against gravity had developed. She was learning the skills and more importantly gaining the confidence to start walking instead of crawling. This young girl was making another giant leap towards greater independence, and all because of a small change suggested by her OT.

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Rhi Carpenter Photo

Rhi Carpenter

BSc Occupational Therapy

Compassionate, professional and meticulous, Rhi has over 14 years experience as an Occupational Therapist working with children and young people with complex physical, cognitive, environmental, sensory and social needs both in the UK and Kenya.

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