Tuesday, September 11, 2012

Adaptation.

As a school physical therapist, a large part of my job is about adapting the environment so that a child can access his or her education.  This includes things like stair climbing ability (or access to elevators), using more supportive chairs with arms, modifying the desk by using a slant board.  I "come up" with these adaptations to bridge the gaps where we cannot help a child adapt to his or her environment.  For example, a child with CP who is non-ambulatory and will never be ambulatory needs seating and access adaptations made.  We do our best to help the child gain the skills necessary, but sometimes we rely on external rather than internal adaptations.  I think it is a job I'm fairly decent at.  I think I do well with the out of the box thinking that it requires.

I've been having the discussion lately with many people about whether it is best to adapt to the environment or have the environment adapt to you.  For example, it has come up when discussing food allergies.  Some parents are (with good reason) hyper-vigilant about what food is served and where.  I get it.  I understand that ingesting or inhaling allergens can be fatal.  This issue came up last year at a Cub Scout cookie event (each family was asked to bring a batch of cookies/dessert to share).  There were a few boys in the pack with nut allergies.  It was decided that if food was made, packaging should be brought so parents could inspect it, and "nut-free" foods would be kept separate from "non-nut-free" foods.  Sounds like a reasonable solution, right?  Of course not.  Some parents (not necessarily even the parents of the boys with allergies) were up in arms that people would even dare bring foods that may contain nuts.  The event was taking place in the school cafeteria where all the boys eat everyday, and where peanut butter sandwiches are served everyday.  The school nut-free table was being utilized to avoid cross contamination.  I still can not figure out what the big hub-bub was all about.  Those children with allergies were being accommodated by any families willing (one would think their own would be willing to donate).  Other families made treats that were nut-free as well, so additional choices were available.  But some people were not satisfied that these boys could not pick from ALL the cookies.

In life, there is no nut-free table.  Sometimes, due to health issues, physical disabilities, mental limitations, etc., we will all be limited.  I believe the saying goes, "Be all you CAN be."  It does not say "Be all that you WANT to be."  We all have constraints upon us for one reason or another.  We need to learn to live within those boundaries instead of always chafing at the bit.  It is nice to push the boundaries to grow.  It is not nice to always be running into a brick wall.  It is why we say that everyone has their niche.  I think we all recognize this.  We all see someone doing a job that we know, in theory, we are capable of doing, but would NEVER want to do it.  We all know there are things we are just not cut out for.  Most of us accept this and carry on, finding other things to do that make us happy and productive members of society.

For example, I have very short thumbs (frankly, they look like toes).  As a result, even though I liked to play the piano, I have difficulty reaching an octave.  I really can't do it--I can only reach 7 keys.  It limited what I was able to play, and while it didn't cause me to give up playing, it certainly contributed it.  I did not bemoan this.  It simply was.  There was nothing I could do about it.  I would like to have continued and been a better player than I am, but, c'est la vie.

But there's this new generation out there.  This whole group of kids, being raised by parents who want to be friends with their kids.  Who want all kids to get a trophy.  Who don't want to say no.  By doing that, we're hurting our kids.  We're telling them that they are so unique that THEY cannot be changed.  That THEY cannot adapt.  That the environment MUST adapt to them.   These are the kids who were not given grades so that the kids who were failing did not feel badly about themselves.  These are the kids who got an award for showing up, rather than for performing.  By doing this, we are not teaching our children to adapt or evolve.

But we need adaptation and evolution.  We need to grow.  We need to accept that we ALL have limitations in one way or another.  We need to teach our children that.  We need to encourage growth and development, and not put a damper on creativity.  But, we need to be realistic, and remember that the world does not revolve around us.  For all the kids out there with peanut allergies, there are also kids who are not able to eat/digest/tolerate a variety of foods and need to get the excellent nutritional value out of that peanut butter.  Making the world nut-free comes at an expense to others.

We need realistic goals in how far the world can be adapted.  Expecting a person with only one functional arm to have a career in carpentry and wood-working may not be the most wise thing to do.  Maybe that person's talents would be better (and more safely) expressed in the design aspect, rather than the wood-carving aspect.

Here is the issue I am currently personally struggling with:  for a child with attention issues, how much stimulation can you take away?  I am working to create organized spaces that are task specific (a small desk against a bare wall for homework).  But dinner time at the counter (where we normally eat) is always a chore, as there are always more interesting things on the counter than on the dinner plate.  We can try eating at the dinner table, which is much bigger, but could (in theory) be free of extraneous objects.  But in life, tables always have things on them--salt and pepper, menus, other people's lunchboxes, etc.  Is it better to learn how to eat while stuff is there, since I cannot de-clutter the world for my child?  (Heck, I can't even de-clutter the counter at this point!)  Do I remove all the toys from the bedroom, since they are distracting when getting ready for school in the AM?  Or, do we figure something else out so I don't end up losing it every morning screaming to get dressed for the seventh time?  (I'm trying plan B right now)

I am caught in an emotional and professional conundrum.  My job is to adapt the environment, which I generally believe in for the kids I work with.  For my own kids, I really want them to learn how to adapt.  I feel it is a better life skill.  I feel that, when applicable, the choice that leads to the highest level of functioning should be the option picked.

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