Week 4: Listening Program

Week 4 at Rainbow Creche! This week it was only the student Occupational therapists and Audiologists at the creche, as the Speech therapists were conducting assessment at another venue.

We have been looking at doing listening activities with the children in the creche to develop various auditory skills. Up until this point, the only clinical therapy I have done as a student audiologist has been speech therapy, language therapy and currently, aural rehabilitation. So again, I felt challenged and slightly out of my comfort zone, not knowing where to begin. Thankfully, I have found a program for preschool children that is soley focused on developing auditory skills.

The program can be downloaded for free off the UK's Department for Education here. The activities are quite lovely! Many of the activities are active, which is great for us as we can add in some goals for OT and Speech therapy. Reading through some of the activities, I am learning to think more creatively about activities and developing listening skills.

We started this week off by making bunny ears with the children, which were used to make the children aware of their ears and listening during later activities. The children were required to colour in a template- which incorporated fine motor skills, while we whispered instructions to them. Whispering requires the children to actively listen and pay attention to what is being said (This worked out well for us as we had to keep the noise levels down for hearing screening that was being conducted next door).

Before beginning the session, we met and discussed how we can correct the children if they are colouring incorrectly, and how to encourage better listening and concentration. I feel that this was highly beneficial as the OT's and audio's each learned something from the other profession, that enabled us to actively participate during each activity. I learned about identifying if a child is using the incorrect grip when holding a pencil, encouraging the children to rest their hand on their page and move their wrist while colouring, and that children should be using longer crayons and pencils, as opposed to small stubbs, as this will help to develop the right grip. The OT's also explained how different hand strengthening exercises can be done using playdough that will aid in the development of fine motor skills.

As student audiologists, we were able to share with the OT's about getting a child's attention before explaining an activity, encouraging them to sit still and not talk while listening, and gently holding a child's hands while talking to them if they are finding difficulty in sitting still and paying attention.

I feel that this time of sharing before beginning activities should be done each week, so that we are able to learn valuable skills from each other that we can apply both to CBR and other clinics.

This week we were able to begin hearing screenings on the children. We decided to start with the children who are most at risk for having a hearing loss (eg. child with cleft palate, delayed fine/gross motor skills, and those who battle to follow instructions). This required us to consult the OT's, as they have spent more time with the children than us. Our aim is to screen all of the children, but since we are only there once a week, it may take a while to accomplish this. One of the children that the OT's suggested that we screen first did not pass the hearing screening and is being referred for a full diagnostic assessment. I now realise how beneficial a team approach can be for identifying those at risk.

We wont be at the creche this coming week, as it is human rights day! I look forward to being back the following week, with our full team :)

Week 3: GO TEAM

We had a busy morning at Rainbow Creche this week! It is a great feeling to arrive and see the kids faces light up when they see our team. We arrived earlier this week, which meant that the children were all eating their breakfast. It was interesting to note that they were all given porridge before they started their day, and I can only imagine that in an impoverished community, ensuring that the kids tummy's are full can make such a difference in how they perform during the day.

Our team, made up of audiology, speech therapy and occupational therapy students spent our extra time discussing how we can each achieve and incorporate our aims into the activities that had been planned for the day. We are slowly learning how to incorporate the aims from each discipline into each activity, however it is proving to be a bit tricky! I feel that we are improving as we get to know the other people in our team better- moving from being 3 separate teams of OT, Speech and Audio towards one big team. It is also becoming easier to share ideas between the disciplines as we leave room for input, correction and ideas from others!

I am learning a lot about occupational therapy and the kind of activities that they use to help children develop fine and gross motor skills. I'm also learning valuable skills from the OT's such as how to use the resources around me to create activities. The creche has a room full of equipment such as hoola hoops, blocks and rope, which the OT's have been using for different games and activities- hoola hoops for spatial relations (Getting the children to stand inside the hoola hoop, infront of, behind...) and blocks and rope for balancing activities. They also recycled cardboard from cereal boxes to create a 'threading through cardboard' activity for fine motor skills.

Working with so many children brings a lot of challenges. While most of the children are engaged and participating in the games and activities, there are always 2 or 3 who aren't. Some of the children don't speak English, so if we forget to repeat the instructions in Zulu they don't understand what is required of them. There are also a few that seem to be way behind their peers in different areas of development, every now and again we notice that we have forgotten about them in the group and they haven't even started the activity. Then there are the children who have a LOT of energy- if we take our eyes off them for 1 minute they end up at the other end of the room throwing their shoes at the other kids ( Okay, that exact scene hasn't happened yet, but I wouldn't be surprised if it did!). But we are beginning to find our way around these issues, and hopefully within a few weeks we will know exactly what each of these kids needs to keep them engaged. This week I learned that choosing one of the children who tend to get distracted, and sticking with them for the whole activity makes a tremendous difference, instead of bouncing between kids as they stop participating. We have a large team, so if we are each able to give our attention to one kid the activities might go even smoother.

This week I am working on letters to send home after screening to the parents/caregivers of children with impacted wax. It has been brought to our attention that the local clinic does not do syringing anymore, so the likelihood of parents/caregivers taking their child to the closest referral hospital for wax management is quite small (For most caregivers it means missing a day of work & school, paying taxi fare for 2 people and waiting hours for their appointment). I hope to be able to explain what impacted wax is, as well as explain treatments that are more relevant (an likely!) for their situation- such as using wax drops or olive oil to soften the cerumen.

I am learning a lot about considering the circumstances of the people in the communities that I am working in before making the typical referrals...and I think that is one of the big lessons we are meant to learn while doing this prac...being relevant, applying what we know to each individuals situation and meeting people where they are at...