Today’s post is written by Stefanie Kruger, longstanding member of the SAISI board, lecturer and private practitioner.  She contemplates the current phase we all find ourselves in and how we’re adjusting to it.


“Why, sometimes I’ve believed as many as six impossible things before breakfast” – Alice in Wonderland

Who would have thought… it might be possible to bring the world to a standstill: from work, school, and sport, to restaurants, movies, flights, conferences and many more unthinkable events? That lions would be resting on a golf course, that penguins would walk down the street, and that a kudu could calmly roam a suburb. It was also noted that the pollution levels have dropped so significantly, that the Himalayas can be seen from 200km away.

Adapting to the COVID-19 lockdown

An adaptive response is defined as an “appropriate action in which the individual responds successfully to some environmental demand” (Ayres 1979).

 The nationwide lock down due to the COVID-19 (Coronavirus disease 2019) pandemic has brought about various challenges, not only in our capacity as occupational therapists, but also as individuals who form part of different families and communities. This is highlighted by the fact that we are all participating in different occupations and have many roles to fulfill, in our profession as well as in our personal lives (Occupational Therapy Practice Framework 3rd edition, AJOT 2017). Everyone was faced with a sudden and unpredicted situation where the “normal” routine made a radical shift and, in some instances, came to a complete halt.

The situation forced everyone out of their comfort zones of familiarity where things had a certain flow, to a place where we all had to find a new daily rhythm and routine, and find a new way of doing familiar things. In one way or another, we felt some pressure.

Our adaptive behaviours have been challenged on many levels, including autonomic nervous system responses such as heart-rate, sleep-wake cycles and digestion, to emotional stability, finding a calm-alert sensory midline, and on a praxis level, becoming more organised in a new social-distancing and stay-at-home routine with implications for time and space. (Smith Roley, Blanch and Schaaf 2001).

As occupational therapists working in the field of Ayres Sensory Integration (ASI)®, we are familiar with concepts such as sensory and emotional regulation, adapting to demands from the environment, and being able to develop ideas and problem solve in novel situations or deal with unpredictable changes that challenge our praxis. And yet, the past couple of weeks have brought about many different challenges and scenarios, which resulted in various responses; to cope, make sense and possibly to merely just survive by taking one day at a time. Various support groups got formed, and platforms were created where people could connect, and where we could share ideas, resources and even frustrations. Despite being physically distant, we were not alone. This level of connectivity (although a bit overwhelming initially) is empowering us to have courage and to face the coming weeks with confidence. Some might be able to relate to the words of Bruce Lee: “Courage is not the absence of fear, it is the ability to act in the presence of fear”. Others might be able to relate to the gentler words of Mary Anne Radmacher: “Courage does not always roar. Sometimes courage is the little voice at the end of the day that whispers I’ll try again tomorrow.”

Dr Jean Ayres, the pioneer in the year 2020

The year 2020 marks what would have been the 100th birthday of Dr. A. Jean Ayres. We are grateful for Dr Ayres’s wisdom, and being more of a visionary and pioneer in the 1970’s than we might have realised, without the luxury of the technology we have at our disposal today. The ASI® approach is an evolving and adaptable theory with terminology and strategies that can be applied to different diagnostic groups, ages, and therapeutic settings. We came to realise that digital therapeutic support would be possible over an electronic platform. As ASI® practitioners, we have the neuroscience to fall back onto in terms of identifying to some degree what was happening, to ourselves, to our partners, and possibly even our own children. We are also able to identify some strategies (some might be more effective than others) to assist our households to adapt to the new routine and getting stuff done.

However, we also find ourselves in a situation where our own sensory midline is being challenged to the point of feeling unbalanced and probably concerned about finances, work commitments, catching up with household chores and keeping up with school work, where desperate times could easily lead to desperate measures.

Ethical considerations for providing electronic therapeutic support

For many ASI® practitioners, providing digital therapeutic support over an electronic platform might have seemed impossible, an unthinkable thought. However, 45 years ago Dr Ayres already offered to provide long distance assistance by mail, to her nephew Philip “providing that he would like to do so” (Ayres, 1975 in Ayres, Erwin & Mailloux, 2004).

The ASI® approach is child directed, implying that clients have a say in their intervention whether it is face-to-face or on an electronic platform. ASI® advocates for empathy, implying that we should try and understand the position of the client and the family in their unique context. It is imperative that we keep their best interests at heart and only give what they have capacity for: whether it implies the time and energy to implement those strategies, or the money to pay for the services provided. We therefore have to keep in mind that they too are possibly experiencing pressure to manage the emotional well-being of everyone at home, are trying to stay on top of household chores, and possibly feeling financial pressure of losing income. We should therefore be sensitive in terms of what their need is, and what they request. It is true that it takes time to prepare and set the stage for online intervention. However, we should take heed not to overstep the fine line between assisting parents/clients who are asking for help, and over-servicing clients who are already feeling like they are not coping, and over-charging for a service that was not asked for. The parents and caretakers play a vital role in presenting long distance support. We should value their and respect their feedback, and keep in mind that they too are probably taking one day at a time, and proceed at a pace that is comfortable to them.

Growth and evolving into the new

The one thing that is certain, is that life as we knew it, will be different after the COVID-19 lockdown is over.

“It’s no use going back to yesterday, because I was a different person then” – Alice in Wonderland

The butterfly has to make peace with the process of metamorphosis, and endure the pupa phase to become a butterfly, spread its wings and enjoy the freedom of flying. There shall be a shift in us too during this uncomfortable period of lock down.

They say hindsight is 2020 vision. We too shall obtain new perspectives looking back at the year 2020. We learnt knew technical skills, showed our children how to appreciate the small things and learnt not to take life and our loved ones for granted. With our evolved 2020 vision, we might have new ideas that can possibly influence the way we work and prioritise our work-life balance in a positive way. Once we emerge from this proverbial pupa phase, we will all have grown into a new person, found new direction, developed a new way of being, and doing old things in a new way. May God bless everyone.

“Grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.” Reinhold Niebuhr


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