33. Another Look at Praxis: Stories from the OT Clinic

In this episode, we dive deep into the clinical reasoning behind a recent case study involving a 3.5-year-old boy. We do our best to link the experiences of this little boys daily challenges, such as dressing, social interactions, and emotional regulation, and unpack them through the lens of sensory integration and praxis.

We explore the vital difference between "high route" and "low route" brain processing of sensations and affect, and how we can use playful, relational interactions to bridge the gap. We also discuss the intersection of sensory integrative knowledge and Polyvagal Theory. With another aha moment in how the foundation of safety becomes a way we can facilitate sensory discrimination for motor planning.

Key Topics & Highlights:

• Real-Life Application: A look at how praxis deficits manifest in the daily life of a 3.5-year-old.

• High vs. Low Route: Unpacking the processing of sensation and affect and what this means for our interventions.

• Safety First: How Polyvagal Theory informs our sensory integration approach to create the safety needed to unlock discrimination.

• Targeting the Systems: Strategies for supporting proprioceptive awareness and vestibular processing through connection and play.

  
  

Timestamps

00:00 Introduction

01:30 Case Study: Functional hallenges

02:52 Observations in Daycare

04:39 Therapeutic Approach and Techniques

07:04 Progress and Insights

09:15 Discussion on Sensory Integration and Praxis

19:17 Practical Applications and Tools

26:22 Playful Beginnings: Exploring Interaction

26:48 Progress and Social Development

29:23 Understanding Sensory Discrimination

32:28 Trusting Theories in Practice

33:19 Praxis in Action: Another Case Study

36:42 Reflecting on Clinical Observations

43:01 Developmental Pathways and Testing

TRANSCRIPT

Here we go. Ah, another time, another joy. Um, we are continuing on our terminology journey, although we're going to do a case today. We decided that five minutes ago, so bear with me as I remember, um, the details of the little beautiful individual that I worked with. I will chat about my little guy and we can chat then about terminology relating to.

Praxis because in the last episode we were sitting in the high routes of S, so sensation and A, and we beautifully linked that to the low route. So the sets of circuits that help you with your motor system, setting up the postural system. And we talked about it in relation to vestibular system discrimination and eye control.

So we wanted to come at it again. But this time through the lens of Praxis because the higher out of sensation and the higher out of affect don't just support, um, eye control. They do lots of things. So we will chat about Praxis and we can give some more examples, I guess, of the sensory discrimination and higher out of affect processing in relation to Praxis.

So. All those crazy terms aside, my little guy, he came to me that three and a half, no diagnosis, just really struggling with, I would call it activities of daily living. So super frustrated and emotional with dressing and. In a family with a bunch of other siblings, wonderful family. Then the mom's already like, what's going on?

Like his younger siblings can already dress better than he can. You know that story. He does have a little bit of a disrupted early development in that he had like sepsis in a bone in his foot and he had to get all this treatment, but at the time he'd come to me that had all. Resolved. There was still some, I would say, midline challenges around finding his center of stability, but it wasn't the core feature of what I was looking at, if that makes sense.

So that it's in his history there and that's there. So I'm aware that that's a thing, but it wasn't like

salient

thing that

Yeah,

yeah. It wasn't really shining, um, in the, the brightest to me anyway, so. He's struggling with his dressing and he's also really emotional and not just in relation to dressing, but generally I go and see him in a daycare environment.

And the third thing that was also tricky for him is that he had glue ear to the point of almost being deaf and wasn't picked up. All of that again had been resolved, but his speech was still, it was almost incomprehensible still to understand him. Anyway, so I go and see him and he is a gorgeously, delightful little boy.

But in the daycare environment, I can see a lot of hesitancy socially in terms of another kid comes along, wants the toy he's got, takes it off him, and he's a little bit frozen or immobile. He's kinda like, whoa, what just happened? You know? So a little bit. Behind the beat in in that dance and he was highly compliant and so would kind of go okay, like, you know, wasn't able to assert his ideal or his need in the interaction anyway.

So they're the functional things that were tricky for him. He's got this social element going on, he's got a dressing challenge and he's also got some emotional regulation. Things happening for him. So they're the three kind of goals that mom was like, I need help. We need help with these things. And he had been to an ot, so he'd already been seeing an OT for at least six months prior to coming to me.

That OT went on a year long holiday kind of thing, and they found me. And so they'd been working on dressing for six months and it was still very, very tricky. So I'll give you a picture of what it looked like. So I didn't get him to dress his whole body. I just got him to do his shoes and socks at the start and the end of the session so I could see what was happening.

And he would, so he was trying to use his hands to hold up his body instead of. Being able to sit upright and reach down and work his socks and shoes at his feet. So he didn't have enough stability in his postural system to even get his feet and legs to work independently of his trunk. That's a postural part.

But the second part that's really I think, useful in terms of describing the praxis function is the not knowing. The tension of the sock, like which direction his foot is pulling. You know, you get your, the toe gets caught in the heel and not realizing that that's tension there and it's pulling on my toe and I need to back it up and shift it around and pull it a different way.

And I know he's only, he probably was a bit more than three and a half. There's just not even any understanding of any of that. So it was kind of just as soon as he hit an issue, he was flooded 'cause it was so hard for him. And same with his shoes. The tongue getting caught and chomped down the bottom of the shoe.

Like not knowing to open it up, not knowing which foot which, all that sort of stuff.

And what do you then, Cora, would he give up in frustration and have like quite an external, like, ah, you know, yelling and shaking off the shoe or just a. Giving up, like, I can't even do it and can someone do it for me?

There was, there was a sort of a floppy of like a, ugh, like a, you know, that flopping like the whole body kind of going, like giving out on them and if you try to encourage and push, then more. Eh, irritation would come out, if that makes sense. So I wouldn't necessarily push him that far, but I, I was trying to get an idea of what it looked like normally.

And that's, that would've been the same with his shirts, with his shorts. You know, there would've been just the whole process and having done it so many times every day and getting frustrated and not getting any better for him, it was at that point. So triggerable, right. The emotional dysregulation around it would've been so quick because it's.

Like so familiar. Um, yeah, it would've been so frustrating. Anyway, so does that help paint the picture of what it would look like if I was to get him to do that? I was gonna add in some strengths because the, in terms of treatment, um, it was so important for me to use the affective system for him to relationally.

Support him. So it just was he, he, I mean, I know that's often for all the kids, but that he was so delightfully social and so able to do things with some positive socials interaction and support. So it was just his key. The key strength that I could draw on for all of my sessions with him was. Uh, some sort of play social interaction to supplement the discrimination challenges he was having have.

So you were acting as his co-regulation when it got a bit sticky, but also helping that motivational bias system to kind of be driven to do the thing that was tricky for him and he kind of maybe didn't, wasn't driven himself to do it.

Yeah, and usually to be honest. I wasn't even necessarily working on dressing a lot of the time, so the only time I even worked on dressing was just getting your shoes off to start the session, put your shoes on to finish.

Um, and most the, the majority of the session otherwise, was me finding ways to play that provided him with relational somatosensory input. So, um. Uh, through an interaction with me, I was giving, trying to get feedback to him about his own body. That's what I mean by that. So, um, I was looking for deep pressure and a whole bunch of tactile stimulation, um, led by him in terms of interest, but in a relational kind of playful way so that.

Just worked so well for him. Like he, yeah. And it was cool to watch it unfold. So, um, do we need to unpack

Yeah.

Any language before we move forward into treaty things? Because I could

just keep going. Yeah. Maybe. But as I'm doing this coding of what you're saying. This kind of interesting question has come to my mind here, Corey, and I just wonder, so when you first described him, it took a while for us to get to the sensory to scrim box.

'cause we were hearing so much about, you know, really what's happening for him in, in the regulatory capacity and his postural system. And, and then. As you were talking about that, you said a couple of things about how socially at school he goes into almost like a appeasement collapse, a little bit of almost like I'm going to withdraw a little bit.

Mm-hmm. And I'm gonna be in this space. And his kind of, the way that the autonomic nervous system and his postural system. He was losing stability. He couldn't figure out how to activate and he, he couldn't really figure out that tonic phasic relationship because activation for him probably was a little threatening 'cause he was used to sort of re releasing that.

But, so as you talk about helping his somatosensory system in co-regulation, help him find the agency of his body. That's so powerful. And before, when we thought about this guy before we were thinking of it really from that praxis perspective. But one of the things that I think happens is that when the autonomic nervous system is really loud, it doesn't make space for the other discriminative function to do its job.

And he was kind of living in this. Other landscape of the low route of S and the low route of a and the low route of m being. So dominant in a way that then it didn't give him room to work on this upstairs stuff. And it just, as you were describing it, it was like, wow, this is really the sensory integration story of why the low routes and the high routes have to come into integration.

And sometimes we can see a child struggling with Praxis, but really what's happening is that there hadn't been space for Praxis for

him. Mm-hmm.

Probably just thinking about him and you know, when you observe a child, there's like things that kind of jump to you or seem to stand out. And one of those things was just like not really knowing how to discernibly and skillfully use his hands, like having.

Hands that kind of just don't seem very precise somehow. I just remember thinking, you've got hands, but I don't really feel like you know how they work. Like, I don't know if I can explain that well, but like the tone and quality of his hands and the way that he used them really jumped out as like a somatosensory issue from the get go.

But also the second piece that I remember. Um, talking to mom about was the social piece of this kind of freeze, uh, appease kind of profile. And remember saying to mom, he's so wonderfully delightful, but I, I really want him to be able to advocate for, or express a thing and have agency socially, because that's.

Like really important for him and his wellbeing. And I, I that like, from my, I didn't think about the autonomic p like I could see it, but I didn't label it as that. I was just like, oh, he's, he's not able to stay in that. That's a struggle for him. It's outside of his current capacity and I was kind of putting it down to like a processing.

Issue as well. Like not kind of keeping up, but also, and then not having the praxis to be able to adjust to know what the what to do. But you are a hundred percent right? It's like the autonomic piece came and doesn't allow the praxis to be built so. He'd get like a little bit like, whoop. And it wasn't even super, if you were an outsider observing and didn't have a polyvagal lens, you wouldn't know.

You probably just sort of saw this kid that was like, oh yeah, he's very kind. Do, do you know what I mean? Like, oh yeah, he just, he just lets the other kids do what they want, or, you know, he doesn't, but I could see a moment of like, oh, and then. I don't know if I really wanted to give that toy away, but now they've taken it and they're gone.

And now I'm really a bit lost and now I've gotta find what now what now, you know? So, um, that's such a good point. Tracy definitely could be his story of getting flooded or autonomically dysregulated, and then not having opportunity to develop. Some of the sensory discrimination mm-hmm. Functions

mm-hmm.

That he needs for his skill for skillfulness,

including talking so that auditor, auditor screen because of, you know, yeah. The, um, hearing issue that he's had, and then the som amount, somatosensory de scrim around the mouth and in the mouth, and so that he can articulate, Hey, that's my toy, like. It's almost the praxis of communication, really.

Um, yeah. Sustain, regulated to be then able to communicate.

Yeah. All of the above. Genuinely. So, yeah, I, it's funny how, I guess my treatment was very ventral in terms of helping him access a state of. A ventral vagal activation for safety and embodiment. But it wasn't intentionally like that wasn't necessarily what I had planned, although I'm always trying to access ventral.

But I think that was the allowing factor for working on Derim, because if I think about the fact that he had six months of work on dressing and hadn't been able to be effective, then. Without the ventral vagal access to work on the discrimination integration. Mm-hmm. Gosh, that's so much terminology. Um, then he couldn't build the capacity to do more refined use of his hands.

More refined use of his body.

Mm-hmm.

You know, regulate his emotions, stay with the interaction, advocate for his needs. All the above. Yeah, yeah,

yeah. Absolutely. And you know, part of. Integration is differentiation, and he wasn't really differentiating, right? My body kind of goes into this pattern, and then it isn't really a reflex so much as it is that the autonomic nervous system was.

Holding him. So then he couldn't figure out the top of space, the bottom of space. He couldn't figure out the holding pattern, the release pattern, you know, his tonic system was kind of on guard, um, and pulling him away instead of. Helping him lean in and activate and participate. So it's, it is a really curious and cool story about how the spirit helps us to see that.

And, you know, by default, because you as a therapist are gonna be in ventral and you're gonna know safety. Um, I think very often when we have more of a play-based relational approach, we, we have that as like a safety net because it, it is like so essential in the treatment. But then the differentiation into.

I really want your body to feel all of this somatosensory information. So you have a lot more ability to use your hands effectively. Yeah. To use your body in all the planes in

Yeah.

All the spaces. And those were important goals on top of that. Um, but I don't think we can overlook how essential that safety kind of ventral piece was really for the success that you had for him.

Yeah, what a beautiful description as well of how nicely the sensory, integrative knowledge and the polyvagal theory work together.

Mm-hmm.

Because I could have sat just in like, okay, I need to give this child safety, and that would, that would've been useful for him, but. I also had the precision of what, once I had safety, what particular thing I was aiming for, which I got from the model.

Right. So I had a knowing that the feedback from his own body,

mm-hmm.

Around the bits and the parts and where they were in space and how he planned them and how he could use them, that wasn't helping him very well to be skillful.

Mm-hmm.

So, um. Yeah, his proprioceptive awareness and his vestibular processing weren't helping him once safety was available.

Mm-hmm.

Right. So safety was available, but he still had this underlying integration challenge around knowing where his body was using it for a skillful action, um, planning that in a social way. Um, yeah, like being in relation to another, all the things. So once. Once I had sort of, he was so easy to develop a re relationship with too.

'cause he's just so, it was kind of in, in him to be social, right? He wanted to be social. He's not, yeah. So yeah, so I didn't have a lot, like I'm treating him in a, in any space. Right. Like on the lounge room floor of his house or in, in the daycare. And so I took a Lycra sheet, um, and I took. Uh, tunnel. I think I had a cloth tunnel and I had like a dinosaur puppet and I had this like claw grabber.

So you know where you squeeze the handle. Mm-hmm. And it kind of closes the end of the toy. That's my best description I can give. But yeah, so he, he didn't every session spend just those things. Like he did a variety of things. I have a bunch of other toys there, but they were the main tools I used to help me with.

The discriminate, the somatosensory awareness and the discrimination that I was trying to work on. So we did a lot of wrestling with the Lycra sheet. So like he, first, he just wanted me to be inside the Lycra sheet with him, so we would just put it over top of us. We would kind of sit there. Yeah, we would just gonna sit there and, and then he liked the bear hunt, so he's a bear.

And it was like, whoa, where's the bear? Kind of thing. So a lot of that. And then eventually it was, he was. The dinosaur or whatever, and I would, um, kind of, he would try and eat me different parts of my body and I would be like, you can't eat me, kind of thing. And I'd kind of grab him with the sheet and I'd give him an opening so that he could, all the tension of the lac of sheet would pull on him and he would then try and have, get out of it.

And he was loving that, right? He would play almost the whole session doing that. And then. He wanted to do the puppets, and again, this is where the somatosensory dis discrimination piece really came. Like was really obvious was just knowing that this puppet that I had was like a rubber dinosaur head, and it had a very big opening, so it wasn't a hard puppet to put your hand into and you just had to make your hand like all the fingers together, and the thumb needed to oppose the fingers to use the puppet, and he, for the life of him, could not figure out how to.

Select the schema of his hand to match the object that the puppet was right, that fingers to thumb. Um, and that, that was like the first time he tried to use it. And the same with the claw grabber. Like he just couldn't discern. Which direction to tug that.

Mm-hmm.

Um, part of the toy that you pull down on.

So he'd tug the inside and the little lever would twist and it would get stuck and he couldn't, and he didn't know where to put his thumb, like, and he couldn't orient his hand in the right way to even know which way to grab it, even though I was showing him like didn't matter to him. Right. And then a couple of weeks later, he's putting his hand in the puppet and he's doing the claw grabber and he's like, it's just so fun to actually see when the.

Outcome is that they make progress. Um, so yeah, that, I guess that was the big el like elements of my treatment were just as much total sensation I can give. And then I guess see if that results in more adaptive skillful movement.

Mm-hmm. Yeah. Yeah. So cool. It is like a real example of the power of somatosensory play and exploration and how it helps you to find.

Your body as an actor. Mm-hmm. You know, your, the limbs were not effective before, and you kind of saw that quality just shift in front of you because it's like, oh, hello, dorsal column, medial lip disc system. I see you, I feel you, you're, you're happening for me. And as that happens, it's like I have a thumb, I have a thumb that can touch my fingers.

I have fingers that can squeeze. Um, and before. That system was kind of, it was in the background because the, the phasic control was being activated more to be away from, and the purpose of our nervous system is to give us the foundation so we can then free up skill. Mm-hmm. But if that regulatory system is competing, it really does make it harder.

So it was both the somatosensory. Experience from a discrimination standpoint, but that was sitting on top of the right foundation.

You know?

Mm. Yeah.

And then you can see that unfolding. Like I'm just thinking about, I've got a praxis, um, process in my mind and I'm, you know, in ideations, even though you were visually queuing him into, Hey, this is how you hold your hand.

So you gave him that opportunity, which I guess he's very visual dominant, so he was looking, looking. Mm-hmm. But he couldn't create that from his eyes because he didn't have access. Internal from a somatosensory to, oh, this is how I do my hind. So I often see kids who are looking, looking, looking, comparing hands or whatever it is.

It's wildly. Not, uh, looking, I was trying to say wildly not correct, but I don't wanna use that word, but, you know, they're not similar as like, wow.

Inaccurate.

But it's just like how, you know, they're looking, looking, Hey, does that look the same? You know, you're queuing them and it's like, ah, it's just not even there yet.

But they're kind of not noticing because they don't know how to move their hands. You turn, you know, from that felt sense embodied, oh, this feels right. Oh, let me visually check. Yeah. That, that visually, you know, that monitoring then looks right. Um, yeah. So that, and that almost with the object I was thinking about, um, I think we spoke about in another, but that, um, perceptual action piece, that affordance piece that he's starting to see his hand.

Can act on a thing. You know, his intention was, I wanna get my hand in that puppet and do what you know, chomp eat Corey. So then he had to look at the perceptual qualities of the puppet, noticing it was hard. It's gotta be opening, and then I've gotta put my hand, okay, my hand could go in it if I put it in this way.

And then there's a match and there'll be a natural opening so I can kind of act on the perceptual qualities of the. Object, but that, you know, you can see that as you described twice, you know, with a puppet, but also the claw. Yeah. I can't, I'm not putting together the perceptual qualities of the object.

And being able to change or alter my h shape to come up with a, is it schema come up with a shape that it makes me act on and have, um, some interaction with an object. So,

yeah, and it was all in the bigger picture of the gestalt of wanting to eat me with the dinosaur, right? Like as in he doesn't care about the getting.

Like he, the goal was not. To work on getting his hand in the puppet? No. The goal was like, I want to eat you with this thing that

helped.

I just wanna get my hand in it.

And that was the sticking point. It was like if you were giving me a soft to put my foot in, like, no way Jose.

Yeah.

I'm gonna eat you with a puppet.

Yes, yes, yes. Stick, stick motivational bias. Mm-hmm. And you all contagion energy and you know, yeah. Let me change my hand seven times to work out how to do it.

Yeah, and he, this is the cool part as well, is like, over the course of working with him, he, they were like, wow, he's so, like, his daycare reported, he was socially going really much better, like joining in and stuff, which was really fun to hear.

And um, like his ideas. Expanded. Mm-hmm. So it wasn't just like, oh, I'm just going to eat you. And that's it. The whole session, which it started out being, you know, it's like just the most basic of game, which is okay, that's where he was at. But his ideas, it was like, oh yeah, no, but now what, what else can I eat?

And no, now I've eaten something and I need to do a poo. Like, you know, there's like, which is a big thing as well because he put together in this time as well, that um, if he doesn't do a poo, his tummy hurts. Like, again, another discriminative. Thing. Mm-hmm. To feel and know and put together in a sequence.

Like, you know, that's not necessarily a A to B connection there for some kids. Right. So anyway, there's so much going on and. It's fun to kind of see, like, talk about it. 'cause you only were chatting about it. Do I remember these other bits and parts that happened?

Yeah. And the theme in the category, um, cues you right?

It's like, oh, that also is sensory discrimination. And that also is the way that this, um, level of inters sensory integration, right? Yes. Where I can. Feel something here and it means something else here I can see, feel, and do together, and those. Ways that the integration happens is, um, based really on the purpose, right?

The primary purpose ofri for skill, and you can hear that in that theme, but that purpose of skill has to be freed up by being in enough of a state of ventral access. So we don't see kids access above engagement in their. Emotional development if they don't feel safe and connected. Mm-hmm. Mm-hmm. Um, and so then it restricts, you know, it also, the story of treatment is the story of capacity, right?

It's for the purpose of skill is our sensory discrimination, but we don't, the skill is broader than a skill. It's the fullness of the capacity of praxis that is unfolding. And so we, we move into capacity because it, it is that rich, it's that, you know, um, trove of where things emanate out of. So cool.

Yeah.

Yeah, it's fun because, um, I guess because the nervous system that I was working with, his nervous system, right? He didn't have any particular diagnosis that lays on top of. The things that were going on for him, um, at this point anyway. And it was just a really nice way for me to see the efficacy about treatment when in each nervous system there's capacity, but the movement of the nervous system and the way that it develops is different, right?

So, and the timing of that, so as how, how quickly or not that unfolds for each individual is just, is what it is. But for him. He had the capacity to unfold quite quickly. So it's really fun when you get those, those little individuals to work with because it reaffirms for you, it's a almost direct, you can really clearly see the impact of what you're doing.

Um, and in some just like, and there's never not an impact, but for some individuals there's so many external environmental factors as well that play into the mix of how things progress or not. Mm-hmm. That it can make it really hard to feel like you've got clear vision of how, how what you're doing

mm-hmm.

Is being effective, I guess. And so, yeah, what I'm trying to say is we are lucky. Sometimes we get that situation where what we did actually was just so clearly effective. Um, and then in other times you kind of like, was it, wasn't it? I think so. And then you, you know, you get a few months down the line and then you go, oh yeah, yeah, definitely.

But it took a bit longer or mm-hmm. You know, I wasn't quite right. I had to pivot or. You know, they got sick or just all the things, right. So I do hope that everyone gets cases like that on their caseload where they just, things unfold in a very clear way for you. 'cause I think it's them teaching us something like, clearly I was learning something specific about sensory discrimination relating to his overall occupational.

Participation and just the unfolding of that, I guess. But now you've brought in the autonomic piece too, Tracy, and that's even cooler because it's like Yes, that's so true. As a foundation for what you were doing.

Mm-hmm.

Um, and why the integration then occurs.

That's right. So I'm also, you know, aware that the outcome.

Related to the goals was yes, he learned how to dress and yes, he learned emotion regulation. And yes, he learned how to do these things, but he didn't really learn them. 'cause you taught them. Mm-hmm. You learned them because you allowed those capacities to be available to him. To be, have the just right experience of finding his body and space, understanding what push means, understanding what FO means.

Um, all those pieces come together. And then you do see. The direct impact in the outcome. Um, so it's a very definitely empowering story. I love it. Mm-hmm. Hmm.

I, um, just wanna pick up on that idea of trusting in our theories, like the polyvagal theory, our interpersonal biology theory, sensory integration theory.

I have the great honor of mentoring. I'm gonna give a little shout out to Cool Kaz and I at, cool, Kat sent me this video and it's just a two minute snippet, but it brings to life some, you know, when you can see it. And so she had some really. Specific, um, goals that she was trying to achieve in approaches She was using all those three approaches, but this idea of she's working to learn about Praxis and it's complicated, so we will continue to dive into it here on the podcast other, over other episodes, but there was this, um.

One minute piece of this little boy was introduced to a piece of equipment. In this case, it was a barrel. He'd never seen it before. So it was just interesting to see that he was able to come up with, um, initially he was looking at the different, um, colors on the barrel, so he was very into the perceptual qualities.

Picked up pretty quickly, um, that it was round and he was able to push it. And so then he was doing a few different things with it, and at one point he held onto it. And he was kind of just rocking it gently, but there was a real pause, I'm gonna say for 20 seconds. It was kind of obvious, and he was looking and then came back to the barrel.

Then he pushed it. So I'm gonna talk about what he did. He weight shifted. He grated his force to push the barrel. He ran alongside it. Weight shifted in the other direction's, hands on the other direction to. Catch the barrel, which had been a new way to use it, and I just could have cried and I got very energized because it was like, oh my gosh, we just saw.

Did you

see that? We, we just saw the process of Praxis unfold in that two minute clip. So I think he played with it for four minutes in until, so I didn't get to see all of that. But you literally saw him come up with different ways to interact with it. Shift. Body. Um, he wasn't that engaged in a real whole of body visually tuning into the ot, but he was in the game engaged with her, so they were sharing that opportunity.

I just was elated because if, if I could, I'd just have that, Hey, here's Praxis, everybody, you know? Yeah. And you know, just note take. 'cause it was like, I saw ideation happening. It was like that uptake, you know? It was motor planning happening. Yeah. Motor execution. Pretty sophisticated. And it was like, oh my goodness.

Even though I was. Quite hysterically excited about it and was, you know, able to like verbalize, oh, this is my, my thinking about what just is happening there. And that pause I think is a new idea. And, um, the gorgeous OT is. Wrapping her head about it and just like, you know, we are, continue to wrap our head around it, but I was like, you didn't get in the road because you are following that child's lead and you are waiting and watching and you were, gave him some space.

So she paused long enough to not interrupt his plan and it allowed that him to actively interact in a new way with that object without. Yeah, us getting in the road and so it was like, I know we are still wrapping our head around Praxis and like we are on this podcast. We are wrapping our heads around the, refining the detail, I guess, and trying to get as precise as we can.

But sometimes the not knowing is okay enough when we stay with those guiding principles of the theories that work for us, then. We'll learn, we'll, we'll catch up. The child will show us what will happen, but just don't get in the road. Yeah.

Especially when you clinically reflect after the fact, right?

Mm-hmm. Because that is where she's now built that knowledge. Like, 'cause in the moment she'd have been like, okay, something's happening. You know, when you have those sessions, you're like, something is happening right now. I don't know what it is, but I'm going with it. Like, I'm gonna let it unfold and I'm gonna go with it.

And then later you go like. What just happened? What was that? How do I unpack that? And, um, yeah, you, that's a beautiful way to, and I

think sometimes you have it in your mind and you just reflect and reflect. And sometimes you need a colleague to go, Hey, let me, can I just talk you through this? Mm-hmm. Like, is what we are doing here?

And, you know, adding a new insider, a different perspective to think about it. Sometimes with the video it's just like. Oh, whoa, whoa, whoa. So obvious. Yeah. So I can't love that more, and I'm so grateful that will be etched in my brain. You know, you've got some of those treasures, like your milk therapy. I'm being cheeky in the previous episodes.

Well, this, the barrel, the barrel rolling and catchings praxis for me.

Yes. Yeah. But that's so true. I love that you danced across, you literally danced across the box, um, on the spirit.

Mm-hmm.

There, Michelle. 'cause you were like, he started the perceptual qualities of the colors of the object and then like how it, it was

rounds.

It

was

rollable. Yeah. Round. And it could, it could rock, it could do these things. And then he moved across into ideation. Mm-hmm. And then he had the plan and he executed it and that became a game.

I love it. And the interplay between the affordance of the object and the affordance of what his. Body could do and that you could play and see how those two things give rise to ideation.

That was a very like, painted picture of that and, and such a critical part of Praxis. Yeah.

Mm-hmm. And I guess the different children, you know, their profiles are a little bit different and so his sensory Tori. Was more robust. And so he really quickly, he actually didn't do it again. So he had that one occasion of doing that rolling.

He, um, was pushing it. He ended up kicking it with his feet. The OT beautifully facilitated him. I, I didn't see the QE 'cause the video. Didn't show it, but he ended up leaning over it. So because of the quality of being hard meant that it maintained its shape. So then it's a rollover ball thing. So he was being over it and getting that some amount of sensory input and you know, that was really alerting for him.

So he, I found for himself with the support of, um. The therapist who did a little bit of imitation, the five opportunities to use that he didn't, um, notice, or in that occasion he didn't see the hole. There's a hole, it's a crawl through ball or a throw, throw through ball. So he didn't notice that. And it, um, it's flat on the bottom, so it's a standup ball, you know, it's just fascinating how quick he went.

Through some of the affordances and that once he did that correct, he actually didn't repeat it, which was like, oh, I did that in a refined way. Let me move on to the next thing now. And that's when he did the feet kicking. Um, yeah. So you know that your story about how the process can unfold for different people, you know, that was like, wow, four minutes.

That just unfolded really quickly, um, for him.

Isn't that mastery drive so cool as well? So cool. Like once they feel like it's mastered, I want to master that next thing.

Mm-hmm.

Like it's a constant kind of pull to the next. Landing pad, I guess Tracy. Yeah, that's

it.

Description. And

I think his monitoring must have been spot on because he did execute it with precision.

It was perfect. So it was like, I don't, I, I, I got that so I don't need to refine the catch or the grading of the force. Like, so I think that was embodied, you know, from monitoring in the exec functioning, um, which was spot on, and that his drive was. Curiosity to keep doing it in different ways where sometimes we just go, Hey, that's cool.

Let me do it again for the coolness sake, even though I know I got that precisely right. I wanna get five precisely right. Where he just was. What's next? What's next? What's next?

I'm curious as well, 'cause it sounds like he's really playing out the affordances of a new object.

Mm-hmm.

Which is like developmentally what you see children do, like when you present them with something new and that's not.

Clearly obvious that this is what it does. They play out the affordances of it before they really like. Play with it in terms of an a bigger gestalt of like a pretend ideal. You know what I mean? Mm-hmm. Like he can't decide that he's going use it as a cave to hide from a bear before he explores the affordance of it being crawl through ball.

Like mm-hmm. Like it's a space to get in, it's an in and out, and I can get in and out of it, and then that becomes a, oh, that could. Rep that could land me in a place where I could represent that as a cave or something. Mm-hmm. Um, yeah. Fascinating.

And interestingly, the story is that he, um, this is my words that he has, um, projects.

So he's in the rolling project now, so he really is ex, you know, get moving into that. Um, generalizing across, um, like, I guess he's noticing the roundness of a, um, object allows it to be rollable. So now he's just. Focusing on rolling where the last project was throw ball. So that was just in a lot of, you know, throwing kind of phase.

Mm-hmm. And we were just discussing like he's building his, um, uh. Classification system, I guess is me making it up. Like, okay, that's right. I'm gonna find all the rollable and I'm gonna be, are they soft? Are they hard? Are they bigger? They, you know, all that. And he's truly classifying. It just was interesting to me that some kids have to go through the execution of lots of things to classify that, where others can make some inferences and they don't have to roll every single thing they say.

Um, yeah. Anyway.

You, is that the cere, is that the job of uh, partly that generalization function, Tracy, is that Now I'm gonna go and bit neuroscience here and we don't have to go that way. But is that partly the job of the cerebellum? I thought that was related to those like pyramidal cells and stuff.

Yeah. Yeah. So the cerebellum is gonna help to hold that and help to create the prediction systems that that might be used. Predict. Okay. But then we also start to see the. Circuitry, you know, of the basal ganglia is also helping to hold that. And those two work as a partnership with the frontal cortex. So you have this like deep core of the brain that holds the.

Sensory motor functioning on the broadest level, and it's so you have a little bit of ideation that's happening from affordances in the cerebellum, and then you get that mapping into representational thinking up in the memory centers that are a little higher. And then you get that mapping into frontal areas where you can make decisions and problem solve and plan.

So it kind of works across that circuit. Uh, and at each level it kind of gives rise to. Different aspects of it, but when you have a child who can generalize, like, oh, round things are rollable, so now I kind of get it right. That schema formation is integration across that network. Mm-hmm. And for some kids, they can do that more bottom up, and for some kids they do it more top down.

That's also interesting to notice those differences. Yeah.

Hmm. So bottom up might be more that they do a lot, a lot more with their body to feel it.

Yeah. And they're probably very motorically inclined that way. Mm-hmm. So once I can climb on this one thing, I can climb on anything. Mm-hmm. And then I'm gonna be a mountain climber 'cause I'm super scalable.

Mm-hmm. You know, versus somebody who's like, I understand the, you know, in and out of things and I, I can be an inner outer. Person or an honor offer person, but I'm gonna be a little bit more, um, like you don't

have to do it on everything.

Yes, exactly. Mm-hmm.

Okay.

Oh,

that's cool. It'd be, be interesting to note though, whether they're choosing not to do it because of the motor execution or they're like, yeah.

Got it. I, it's a, it's sitting in exec functions now as opportunities and I can do it robustly

if I

want to.

Mm-hmm.

Yeah. Interesting qualities we have to discern and observe.

Mm-hmm. Yeah.

In sessions like that.

Exactly. Yeah. I love it

is, yeah.

I also love that our conversation includes the developmental.

Story. Mm-hmm. And the neurological story. Mm-hmm. And that we're always really interested in both of those parts. And I think Dr. Aris was really interested in all of that. And you know, it's part of trusting the theory is that we can find the neurological truth to what we're talking about. Mm-hmm. We can find a developmental truth, if you will.

And all of that is the evidence base that this work sits on. And. Gosh, it's so fun to talk about it with you guys. Thank you.

That was a pearl in that last episode For me, trace is that Corey and I, you know, and lots of us are trying to wrap our head around the development of all the. Um, functions and we are also trying to be really sound and precise administrator of the tests.

And so sometimes, you know, you're moving in that space where you're administering the test and you just want to get through that as quickly and you know, effectively, precisely as you can. But you've gotta hang on to, oh, I'll administer the tests that may not take me down. That developmental, you know, finding the path of where they're at developmentally.

Do the administration and then come back to that, maybe the next session or whatever. It's like, okay, test done, tick, let's go back and, you know, really try to land it developmentally where the administration didn't allow you to do that. But, um, that was, that was such a really good piece for me to do. Go back and do the work, Michelle.

Yeah.

Oh man. What a joy. So good. Ever learning. We are, yeah.