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In the video, Briana experienced behavioral changes which impacted her due to changes in her brain. Schizophrenia, which affects the frontal lobe and other areas of the brain cause changes in emotions, executive functioning, and other mental functions. Each individual has a unique experience because everyone's brain is different and depending on the progression of the disease, each individual will have different barriers. Briana's brain is still developing and the disease is affecting her ability to control and regulate her emotions and her physical reaction to the environment, situations, and other people. From an occupational therapy perspective, her atypical behaviors and emotional outbursts interfere with her ability to participate successfully in her IADLS, particularly social interactions. Teaching Briana and her family to identify when she is feeling a certain emotion and develop coping strategies to execute when she feels those emotions. This might be going into another room to color, going for a walk, squeezing a stress ball, or something else that is a more positive response. By changing the physical actions that she performs when she feels a certain emotion, it will train her brain to react in a more productive and acceptable manner. The brain has learned negative coping strategies, so it will take many intentional repetitions to create neuroplastic changes in Briana.- Brianne McMahon, OTS

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Julia Neppel:

The video of Briana and her family relates to neuro-occupation as the connections in her brain have developed in a way that produces strong negative beliefs for Briana that result in harmful behavior. Engagement in occupations that are meaningful and calming to Briana would positively impact her when she is experiencing negative thoughts. Neuroplasticity would be a part of interventions by all healthcare professionals. Briana could benefit from a referral to psychological counseling for the use of psychological techniques such as cognitive behavioral therapy to encourage Briana to challenge her thoughts. Briana’s family would also benefit from the stress and anxiety of their current family dynamic. OT would benefit Briana’s entire family to help to develop strategies to keep themselves safe during a time when Briana is experiencing negative thoughts. OT could help to identify activities that would be positive sensory experiences for Briana when she is feeling overwhelmed. Looking at Briana’s sleep routine and other daily routines could be another aspect of OT intervention that would positively impact Briana’s occupational performance.

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Lena Volkers: Briana is a 6.5-year-old girl who lives at home with her mother and older sister. Briana has been diagnosed with dissociative disorder, autism spectrum disorder, sensory integration disorder, psychosis disorder, and mood disorder. The side effects of her diagnoses have affected her neural development and habilitation of valued occupations. Due to the fact that Briana currently experiences daily psychosis episodes seven to eight times on a minimum and they sometimes result in violent behaviors, it is challenging for Briana to have fruitful relationships with her family members. She struggles to regulate her emotions and calm herself without medication. As schizophrenia is not fully understood, the intricacies of the brain of a person with schizophrenia are continuously questioned. As there are functional implications as a result of having schizophrenia and therapeutic intervention has not yet been considered, it is likely that maladaptive neuroplasticity has deepened the neural pathways and increased the cortical representation of violent and self-harming strategies. Occupational therapy would assist Briana in helping her regulate her emotions and calm herself, possibly with decreasing levels of medication, educating her and her family about schizophrenia and how to intervene in healthy ways, and promoting adaptive neuroplasticity through positive behaviors and personal advocacy.

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Jennifer Mitton- While watching the video "Seven" I was struck by a few things.  First, the mother seems to be very open about talking about the daughter in front of the daughter, even when the comments or topics are heavy.  Her mother discussed that 7 is the age that a clinical schizophrenia diagnosis is possible and that 7 is the alter ego that can be extremely harmful.  This leads me to wonder if her alter egos are created due to strong emotions tied to memories/sensations of interactions as we have discussed in class.  Another thought is tied to competitive neuroplasticity.  If these thoughts are created based on strong reactions to an event, then other more healthy (weaker) pathways may be pruned out or reorganized.  OT would be of benefit to this family in many ways.  One of which would be to find occupations that are meaningful to her and bring about strong positive feelings that may override the strong negative ones and possibly reintegrate her back into functioning as one person.

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Taylor Hiebert:

Neuro-occupation relates to this case due to the neurological changes Briana is experiencing which influence her behaviors and impact her daily life. For individuals with schizophrenia, it is hypothesized that changes occur within the frontal lobe that change emotional and mental functions. Briana’s brain is still developing and the symptoms she is experiencing may be due to changes within her brain that cause her difficulty to regulate emotional and physical behaviors, such as aggressive outbursts. An occupational therapist may help this family by educating on Briana’s diagnoses, as well as education on methods to recognize and effectively address specific challenges that Briana may face. Further, an OT can help introduce different methods and coping mechanisms Briana may use when she is feeling overwhelmed, angry, or upset. Lastly, adjusting the home environment to ensure the safety of Briana and her family members will be important.

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Kylie Dirham
This relates to what we learned in Neuro-Occupations through maladaptive neuroplasticity. Brianna, at her young age, is going through a critical period in her life where she is building neuronal pathways that strengthen her actions, moods, behaviors, and thinking process. The more Brianna participates in abnormal personality changes and aggressive behaviors, the stronger the neuronal pathways become for her to continue her current actions, behaviors, and thoughts. An OT can be helpful in this case by coming in and dealing with the family as a whole. The OT can work with Brianna herself as well as the mom and sister. The OT can help pinpoint triggers of Brianna's personality changes or abnormal behaviors. Coping strategies can also be good tools for OT to help with. Also finding activities that Brianna enjoys doing to help keep her occupied and in a good state of mind might help decrease psychosis episodes.

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Kylie Dirham

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Coleman Lay:  This case of Briana relates to neuro-occupation because of how the maladaptive neuroplastic changes that have occurred in her brain have affected her ability to participate in age-appropriate occupations for her. In this case neuroplasticity is occurring in a way that is interfering with her typical development. Her diagnoses and resultant behaviors may be causing the neural connections that support these negative behaviors to grow stronger. OT can help this family through skilled evaluation that will help identify things that worsen her behaviors and through development of an intervention plan to weaken the connections that support her negative behaviors. In addition, OT can help this family by provide providing strategies and routines to better manage her behaviors and create a safer home environment.

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Molly Marin: As Brianna has been growing up and experiencing hallucinations during cortical development, her brain is building pathways based on those experiences. As she continues to experience different personalities those pathways becomes stronger leading to even more deep routed investment in those personalities. As she continues to experience personalities that lead to violence her thoughts and tendencies are likely to continue in that direction because those neural pathways become more prominent. OT can assess the child, family and environment and discover triggers for the child. Finding things in her environment that support the positive personalities will be key during intervention with Brianna. The more positive influence, and promotion of elements that trigger positive and happy Brianna will help rebuild those neural pathways. Ultimately the goal would be to work with the family to support the context for Brianna that will suppress the triggers of negative behavior and promote the good.

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Tina Dano: Briana’s case relates to neuro-occupation through maladaptive neuroplasticity. Although neuroplasticty can positively impact the brain by helping us acquire new or relearn skills, neurplasticity can also negatively affect the brain through reinforcing behaviors that cause us harm. In Briana’s case, negative pathways are being reinforced, such as angry outbursts, causing a loss of engagement in occupations. Also, Briana’s brain has rewired itself to think that her hallucinations are her reality. An OT could help through education, specifically what is happening within Briana’s brain and ways we can stop the negative pathways from firing in her brain. An OT could also provide calming techniques and home modifications for Briana and her family’s safety during her outbursts.

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Cristina Sisneros

This video relates to occupational therapy because Briana’s life is affected by her psychological disorders and symptoms. Her episodes of psychosis are limiting her roles as a daughter, sister, and child. Since she does not have control of her anger her function is greatly affected. Primarily OT could work on safety for Briana when she is experiencing episodes where she is compelled to self-harm. Additionally, steps could be taken to develop ways to keep her sister and her parents safe when she is experiencing episodes of anger or aggression. OT could also help her and her family by developing coping strategies to work through her episodes of anger. Finally, occupational therapists could also help her reach age appropriate milestones so that she can have more typical experiences. Since she is benefiting from medications, she could likely benefit from neuroplasticity and teaching her brain to re-wire with assistance from the OT strategies.

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Taylor Sadler
Neuro-occupation relates to this video through the concept of maladaptive neuroplasticity and feedback loops. Based on what we have learned about her diagnoses, her difficulty with processing sensory information, understanding reality, and behavior/self-regulation are due to brain changes such as a smaller hippocampus and an increase in neuronal connections in the frontal lobe due to the irregular release of BDNF. Her behaviors and the responses they elicit from the environment and people may be strengthening the connections. The brain is very plastic throughout childhood so as an OT, it is important to assess her habits and routines and how her current level of functioning affects her participation in everyday life as well as her ability to achieve developmental milestones. As an OT, I would evaluate her sensory processing abilities and how that might be impacting her self-regulation and participation in ADL's. I would assess what activities she can do and adapt them to help her reach other milestones or use it as a way to reinforce positive behaviors. Are there common interests or abilities amongst the personalities? If so, what are they and how can we use those meaningful activities or feedback loops to create healthy brain changes?  Assessing safety and making environmental modifications would be an important way to support the family.

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Rachel Schroeter: Brianna is 6.5 years old, due to her young age she is more frequently undergoing critical and sensitive periods of cortical development where her brain is more susceptible to change. In addition, she is experiencing many diagnoses that impact the chemicals in her brain which thereby impact wiring, structure, and function of her brain. These two factors are causing her to create strong pathways of maladaptive behaviors because the chemicals in her brain are telling her that these acts are more successful than following more typical routines and patterns of behavior. One way that OT may be very helpful for this family is explaining the importance of medication. It is understandable that Brianna's mother does not want her to be on medications continuously, neuroplasticaly it may more positively impact her life to take medications in conjunction with OT and psychotherapy. If Brianna is only receiving antipsychotics medications once in a while that means a majority of the time her brain is wiring together maladaptive behaviors. If she were to consistently take medications to minimize her symptoms she would be able to develop more meaningful and productive routines in her critical periods that would likely carry on into adult hood and be less susceptible to disruptions. In conjunction with medication OT could help Brianna and her mother to develop daily routines and meaningful occupations of interest such as drawing. Lastly, OT could help connect Brianna and her mother with others who are experiencing similar circumstances.

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Katie Petersen: Neuro-occupation relates to this case because of the many personalities that the young girl has. The personalities range with many different traits, most of them being negative traits. These negative traits reinforce maladaptive neuroplasticity in her brain and most of these negative behaviors occur everyday. Due to the negative connections that have formed, it is affecting her ability to participate in her daily occupations. Occupational therapy can be helpful by providing education on coping strategies and addressing safety concerns. Another area that can be addressed is reinforcing routines of her ADLs and other safe behaviors.

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Angela Ingram: Briana's case relates to neuro-occupation, because her hallucinations, mood and psychosis disorders are affecting her function, performance and development. Her brain is wiring, neuroplasticity, but the learning and habits she expresses are not conducive to happy, healthy environment. She is showing atypical signs of development in relation to other peers her age. OT is in a great position to help this family, first with safety and education. Some of her moods/personalities are violent and that makes things unsafe for Briana and her family. Helping them essentially child-proof the home could make a safer space for all. OT can also help in creating ways to help de-escalate her more aggressive behaviors, and ways to keep her calm on a routine basis. Due to the fact that she is so young and her diagnoses may change, OT would the most help in the areas of education, safety and coping skills for Briana and her family.

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Inna Kathreen Chang: B.'s case relates to neuro-occupation because she has neurodevelopmental disorders that have negative impacts to her brain, which consequently prevent her from participating in her daily occupations. Her many personalities may promote maladaptive neuroplasticity as these connections within her brain become stronger the more she engages in these personalities. In addition, her frequent negative behaviors of aggression may become more automatic throughout her daily life the more she performs these maladaptive behaviors. Occupational therapy may help her family by addressing safety concerns and promoting positive behaviors. Safety is a priority and environmental modifications may prevent dangerous events from occurring. Positive reinforcement and promoting safe behaviors would be the next priority. At her young age, B's brain is capable of changing its connections and repeatedly redirecting her behavior during engagement in safe activities may replace maladaptive connections to promote stronger, positive connections.

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Paige Engbers: This case relates to neuro-occupation because Brianna has several different psychological disorders that are present, which is affecting her development and causing several behaviors that impact function. This maladaptive neuroplasticity could be caused by the possible diagnosis of schizophrenia, which means that the brain is wiring, but in a way that is causing atypical behaviors. These behaviors are ultimately keeping her from engaging in activities that are developmentally appropriate. OT can play a big role in helping this family simply by educating them on how her diagnosis could be affecting the development of her brain and providing resources for helpful tools in the community. An OT can also work with Brianna and the family on relaxation strategies and coming up with activities that help Brianna feel safe and calm. Another way OT's can help is advocating for services that may help Brianna (such a therapy or treatment).

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Maggie Griffin: Briana is a 6.5-year-old that has been diagnosed with dissociative disorder, autism spectrum disorder, sensory integration disorder, psychosis, and mood disorder. She is also experiencing hallucinations that have greatly affected her activities of daily living. Due to these hallucinations, Briana has caused self- harm and harm to others through violent behaviors. Neuroplasticity is maladaptive in this situation because Briana is participating in daily violent outbursts. These repeated violent behaviors make this neural pathway stronger. Therefore, her brain is always creating new pathways that relate to violence and hallucinations. Occupational therapy (OT) can be helpful for Briana by identifying potential triggers and implementing self- coping strategies. OT can help the family establish daily routines and activities for Briana. By promoting positive activities and daily occupations, it can facilitate positive neural pathways in the brain. OT can educate her parents on how to communicate with her during episodes of psychosis and provide education on ways to keep her safe during these episodes. Overall, it will be important for OT to figure out positive activities and routines that can help create positive neural plasticity in the brain and educate the family in order to increase Briana’s quality of life.

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Anika Hansen: Maladaptive plasticity means that the brain is wiring, but it is wiring in a way that produces negative functioning and development. This is exactly what is happening to Briana with her diagnoses. Since she has a variety of mental diagnoses along with Autsim, she may be having issues with the amount of synapses that are in her brain that are inefficient. With the mental health and possible diagnosis of Schizophrenia the hippocampus and ventricles are what are most likely involved anatomically. All of these aspects of neuroplasticity are contributing to her behaviors. OT can be involved by assisting the family first off by education on neuroplasticity, anatomy, and development. This can be the first step to give the family a sense of understanding of what is happening with Briana. Another way OT can help is to work on self-regulation techniques that can assist Briana when she becomes overly emotional and can potential prevent harm to herself and her family members. Working on reinforcing routines and positive ways to get Briana involved in ADLs and IADLs in a more efficient and successful way.

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Shaun Kramer: This is an example of maladaptive neuroplasticity through the relationship of Brianna’s diagnosis and her behaviors. This is an example on how neuroplasticy can interfere with typical development. An OT can help the family by educating them on neuroplasticity  and typical development and to look at ways that her condition is interfering with her ADLs. An OT can try to help Brianna and her family by providing information on local resources and also helping with safety awareness (environment) that might affect them.

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Kaitlyn Ellerman:  How this video relates to neuro-occupation is that it depicts some of the possible outcomes of maladaptive neuroplasticity. Although it is currently suspected that schizophrenia typically doesn't arise until later, in the teenage years, Briana demonstrates many of it's symptoms and her doctors believe that it is likely she has schizophrenia. If she were to have schizophrenia, it is currently hypothesized that what is going on in her brain is an inappropriate release of BDNF, causing maladaptive neuroplasticity to occur in areas such as the hippocampus and the ventricles of the brain. These changes in the brain may have lead to the development and reinforcement of the negative behaviors Briana is exhibiting, such as anger, aggression, paranoia, insomnia as well as harm to self and others. How occupational therapy may be able to help this family is to work with them to develop strategies for relaxation, that can be used when Briana is experiencing anger or aggression. This will include discussing with the family things that Briana enjoys doing, maybe coloring, watching a show, or playing with putty. Then, using the activities that she enjoys, OT could educate the family on how to employ these activities and other relaxation techniques, like breathing exercises, when Briana becomes agitated or upset. Helping Briana and her family identify ways to address her anger externally, may begin to help Briana identify ways to internally address and regulate her anger and other emotions.

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Kaitlyn Stangl: This relates to neuro-occupation because the child has various neurological/psychological disorders that are effecting her developing brain. The child may have early onset schizophrenia and has dissociative identity disorder, which has lead her to have multiple personalities and act out aggressively. These personalities and behaviors could be a form of maladaptive neuroplasticity. The brain has wired itself in a way that is nonfunctional and producing behaviors and personalities that are not functional as well. As the child grows these neuronal connections are growing stronger and stronger. OT can help in trying to make these neuronal connections weaker and/or help foster more functional neuronal connections. OTs can also help in trying to help the child and family cope and plan for the child's aggressive outbursts so they all can feel safe. OTs can also advocate for the child's mental health and advocate that the child and family get all the resources they need.

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Devry Birdsell: Briana’s case relates to neuro-occupation in that her multiple co-morbid diagnoses have resulted in maladaptive neuroplasticity. Her brain is more susceptible to developing neuropathways that result in negative consequences and impaired function. She has not yet been diagnosed as schizophrenic, but Briana’s doctors believe that this diagnosis is probable. It is hypothesized that the improper release of BDNF promotes neuroplasticity and leads to schizophrenia. Briana and her family are impacted by the symptoms of her diagnoses in their familiar relationships, Briana’s violent outbursts, and Briana’s current inability to participate in typical occupations. Occupational therapy could help Briana in improving her sleep hygiene, understanding her sensory needs, developing productive coping mechanisms, and becoming more self-aware. In addition, the occupational therapist could work with the family on developing skills and routines to support Briana’s needs as well as addressing how Briana’s symptoms has affected her family.

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Devry Birdsell: 
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Hilary Kircher- There are a number of way this case relates to neuro-occupation, one way is the way in which Briana's brain is working to organize the information and the feedback she receives from acting how she does when she is in one of her other personalities. By allowing her to get away with certain actions, the areas of her brain associated with these actions gain connections and become stronger. A way that occupational therapy may be able to help is to identify various temporal, environmental, or other triggers that put her into certain personalities. Once OT could identify these, we could also try to find alternative activities for her to participate in when those personalities are being triggered.

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Marlise Williams: Neuro-occupation relates to this case because her brain is processing information in a manner that leads to routines and habits that are harmful, but because they are repeated, those neuronal connections are reinforced. OT can help with this family by establishing routines and habits that assist Briana in having safe coping strategies. Maybe a designated space where Briana can go when she is upset. At school, the OT can work with teachers and counselors to ensure that Briana has the support she needs while she is getting her education.

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Dudley Yacinthe: Neuro occupation relates in the case of Briana in the way of developing/establishing routine that allow her to have independence in here roles as a daughter, sister and little girl. Due to Briana’ multitude of dx in the area of behavior/mental, this affects her ability to function through her daily life. In terms of neuro occupations, we know that a child around Briana age must have a sense of self in the area of reality. As such, when behavior’s apparent, it disrupt the typical developing process. I believe that in order for Briana to be success in achieving those typical routine within here roles, she would first need to be placed on medication for management and then intensive OT, ABA, and mental health counseling.  Ways that OT would help , is ensuring that the child is meeting developmental milestone such as working on fine motor, as well developing and establish routine and preparing for school.

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Jessica Junio: Briana’s complex diagnosis can definitely be related to near-occupation, through the concept of maladaptive neuroplasticity. At such as young age, the brain is so malleable and impressionable. Due to Briana’s diagnosis, she experiences extreme personality changes, each establishing a pathway in the brain. The more she is constantly experiencing these personalities, the stronger the neuronal connections will be. Which can reinforce negative behaviors and actions, like from “Seven” or “Izzy”. There are many ways OT can intervene in this case. One, could be implementing coping skills training for both the child and her family for their mental health. This could include a variety of skills that an OT has knowledge of( ie. stress management, education of diagnosis, exercise, diet, relaxation techniques, emotional regulation, etc.) I imagine that, it must be extremely difficult for both Briana and her loved one’s to cope and address her diagnosis. Another way would be a way to adapt the environment to Briana’s benefit, to increase safety for both herself and her family. For example, using plastic utensils vs. metal utensils; just in case one of Briana’s egos decided to self-harm or harm someone else. In addition, I think it would be beneficial to identify her triggers to try and decrease the amount of times her personality changes occur. With that, come up with a regular routine for Briana.

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Emily Ludwig: With this case, I would say that neuro-occupation relates because Briana is living with several mental health disorders that effect her daily occupations which have developed from maladaptive neuroplasticity. I imagine it has been difficult for her to participate in almost all occupations, but more specifically in the areas of play, social participation, sleep and education. After hearing from her family, it appears that safety, communication and coping strategies would be helpful areas that an occupational therapist may address. For instance, if Briana's more aggressive personalities are present, an OT could help devise protocols for each to specify how to communicate to de-escalate situations. Then, coping strategies in combination with appropriate medication regimens may also be useful for episodes of hallucination. Overall, it seems like a general safety plan would benefit the family, such as child-proofing the house for sharp objects.

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Emily Walker: This relates to neuro occupation because Briana presents with many conditions that elicit maladaptive connections in the brain that affect her occupational performance. I believe OT could help this family by explaining to them what maladaptive neuroplasticity is, help determine what her triggers are for the various personalities she display, and help determine what aspects of her occupational performance are most effected by her numerous conditions. The biggest concern I would have would be safety. Her mother stated that she has been injured before and I would like to sit down with her and determine what steps we could take to ensure not only Briana is safe, but the entire household.

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Morgan Britton: I think that Briana's case is related to neuro-occupation because she has many diagnoses that relate to mental health and her brain. Since she has these multiple diagnoses, she is prevented from participating in typical occupations that other children would participate in at her age. When she takes on different versions of herself such as "seven" it seems to affect her ability to strengthen relationships with her family and friends. One of the personalities described by her mother is hurtful and tries to hurt her mother. I think that an occupational therapist could help Briana. Ways that I think OT could work with Briana include: an interview with Briana to better understand each of her different personalities and the occupations that each personality enjoys participating in, and seeing what each personality needs to be safe and happy. Being able to describe each personality and how to best interact with each personality could help Briana keep herself safe, and could help her family better communicate with her.

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Whitney Hewitt: Neuro-occupation relates to this case because Briana has been diagnosed with multiple psychological conditions that affect her engagement in her daily life and meaningful occupations, as well as her relationships.  Our brains tend to make stronger connections with whatever it is that we repeatedly use most often.  In Briana’s case, her hallucinations and episodes of psychosis are essentially creating a continuous feedback loop of maladaptive neuroplasticity.  OT in this case would look at ways in which they could help both Briana and her family utilize both coping and adaptive strategies.  With her episodes of psychosis, an OT could educate or encourage the use of recording devices (audio or video) for Briana to be able to look back and see what is "real" and what is not.  Her mother also mentioned that Briana will not sleep for long periods of time due to her hallucinations of rats in the room.  This alone is an occupation that is essential for health and lack of sleep could be another cause of negative behaviors/symptoms.  An OT could help educate the parent with modifying the environment to make it more conducive for sleep and help address any sensory disorders by teaching self-management.

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Catherine Boyle: Briana's case is related to neuro-occupation because she has multiple psychological diagnoses with associated symptoms that elicit maladaptive neuroplasticity. According to Briana's mother, Briana has diagnoses of dissociative disorder, Autism spectrum disorder, psychoses not otherwise specified (NOS), and mood disorder NOS. Briana's symptoms include violent physical harm to others, tantrums, difficulty with mood regulation, hallucinations, and self-harm due to hallucinations. Maladaptive neuroplasticity is associated with negative consequences like loss of function and increased injury. Based on Briana's symptoms, one could hypothesize that maladaptive neuroplasticity is at play in her brain. Occupational therapists (OT) can help Briana and her family greatly through education, action plans for Briana's triggers and tantrums, and providing community resources like support groups. OTs can provide Briana's family with education about the maladaptive neuroplasticity that may be occurring in Briana's brain and how they can help. OTs can explain that Briana's tantrums, hallucinations, and other adverse symptoms can be reinforced through repetition and may be caused by dysfunctional brain rewiring. OTs can explain to the family that they, as a team, can focus on strategies to rewiring Briana's brain. Additionally, OTs can help the family by creating action plans for Briana when she has a tantrum and needs assistance to calm down. Finally, OTs can help the family by providing them with community resources like support groups.

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Hannah Lee: This relates to neuro occupation because Briana's brain has created maladaptive connections that interfere with her ability to function.  In order for OT to be helpful to her I would want to know more about how her brain operates. Do certain stimuli trigger different personalities to emerge? Is there anything that helps calm her down? Because she is six I would want to consider ways to help increase participation at school. I would want to know what her social participation looks like with peers.  I would also consider her home environment.  The parent interview revealed that she can sometimes become violent.  In these times is the house set up in a way that makes it difficult for her to access dangerous items?  Schizophrenia is not a diagnosis I know a lot about but, my first thought regarding specific interventions might be exploring different relaxation techniques.

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Sarah Gerken_This relates to neuro-occupation because her maladaptive neuroplasticity is affecting her ability to have meaningful relationships and engage in occupations. Additionally, she seems to not be able to regulate the sensory input from her environment and the sensory hallucinations in her brain which caused more interference with her participation in meaningful occupations. OT can help this family by proving services gearing towards coping mechanisms and sensory integration. They can also be a resource for the family to help their child participate in meaningful occupations.

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Carina Watson_The sensory experiences she is making throughout the day creates a strong path way within the brain. She could be potentially hypersensitive to auditory stimuli due to the auditory hallucinations. OT is in a good position to provide education and interventions geared towards calming strategies supporting emotional regulation.

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Yunyi Wei: This video relates to neuro-occupation, because the girl in the video has a lot of diagnoses relating to her brain and mental health, she sometimes could control herself from angry. That is part of the brain’s function about emotional issue. This emotion issue could influence her social interaction and participation in ADLs. OT could help her to calm down by finding a sensory input that is suitable for her, giving her and the family some advice about how to interact with other people. OT could also help her with those ADLs that could benefits her emotion management. For her family, OT could give them some advice about what they could do when the girl is out of control.

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Nicole Willse: This video relates to neuro-occupation because schizophrenia, especially in a young children, affects typical development. This disease can impact the child in all areas of life. It can affect social participation, school/classroom skills, basic ADLs, attention, routines, etc. Research has shown that the amygdala and hippocampus are significantly smaller in people who have multiple personality disorder. The orbitofrontal cortex has also been shown to be different in individuals who have multiple personality disorder. The OFC is involved in decision making and with decreased functioning it can cause impulsivity and alter ones personality. Occupational therapy could help the family by making home modifications. If the child does get aggressive it is important to have sharp objects and items up and out of reach from the child. Along with this we could try and create stress free areas for the child when she gets stressed out or frustrated. We could also work on ADLs and school based activities teaching the child methods on how to cope with the hallucinations. We could help create routines for her to follow each day to help create structure in her life.

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Macy Hoskins: This video relates to neuro-occupation, because many of her diagnoses stem from areas of the brain that are vital during childhood development. With a possible diagnosis of schizophrenia, her frontal lobe is affected, which can cause problem areas in emotional development and higher mental functions. Reduction of the hippocampus due to schizophrenia can affect sensory filtering, an area which most likely is already affected by her other diagnoses such as autism and sensory integration disorder. These diagnoses can affect her development throughout her childhood and adolescent years. These diagnoses could increase participation in risky behaviors as well. Occupational therapy can help through family education, educating her parents on safety concerns that can be involved with these types of diagnoses. OT can also participate in practices such as cognitive behavioral therapy or other behavioral therapies.

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Laura Campion: Briana is a 6.5yo diagnosed with ASD, DID, sensory integration disorder, psychosis, and mood disorder. In addition, she also is experience hallucinations. These things have greatly affected her ADL's. Her case relates to neuro-occupation through maladaptive neuroplasticity. Briana has self harmed, and has daily violent outbursts. Due to neuroplasticity, her brain is creating new pathways relating to her violent and self-harming behavior. These behaviors may become more automatic in her daily life. Occupational therapy may be helpful to Briana by promoting positive behaviors. In addition, OT may address any home safety modifications that may need to be made. The OT could also provide family education on ways to address her anger, and to help her regulate her fluctuating emotions.

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Hannah Schramm

This video relates to neuro-occupations because Briana is experiencing multiple brain diagnoses that are impacting her ability to participate in the roles and activities that she enjoys and are important to her. Briana is 6 1/2 years old and is at a vital point in her brain development. Developmentally, her brain is pruning unnecessary information and reinforcing the neuropathways she uses the most. In Briana's situation, her habits and responses are maladaptive and could be harmful to her and her family. Her brain is currently reinforcing those behaviors. Occupational Therapy could be vital to Briana and her family. OT could provide education to the family about how to help Briana when she is experiencing hallucinations and maladaptive behaviors. Ot could also assist Briana in providing picture schedules to help her transition from place or activity, being able to identify her emotions and communicating them with her family, as well as find some activities that she finds meaning in and helping her adapt them so she can achieve her goals.

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Brianna Gibbs: Neuro-occupation relates to this case because this little girl's brain is preventing her from engaging in typical occupations for a child her age. The different persona's that her mom describes seem to limit her ability to form meaningful relationships at times, or perhaps even participate in play or school. Occupational therapists might first be able to help this family by creating occupational profiles of each of the personalities the girl presents with. By creating a profile and understanding each personality, the occupational therapist can then truly be client-centered and focus on every part of the child and help the parents do the same. From there, working with each individual personality and addressing any unique needs (i.e. emotional regulation, self-calming, or other unspecified needs) might help create platform for better family interactions. There are many other ways an occupational therapist could work with the family, but this might be a good start.

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Darcy Baker. With this case, neuroplasticity is involved with the different pathways that connect the different personalities the young girl has. Maladaptive neuroplasticity seems to be occurring, which is the plasticity in the nervous system that leads to a disruption of the function. These violent personalities and hallucinations have embedded pathways that are difficult for her to avoid or over come. I think one of the ways occupational therapy can be helpful in this situation is by advocating for the child and mental health. Additionally, occupational therapy can help establish healthy behaviors and routines that may help the child overcome these barriers. Occupational therapy can also help the family with healthy coping strategies and what to do when the aggressive outbreaks occur.

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Krizelle Magdirila: This relates to neuro-occupation because her actions, specifically the different personalities, are products of the changes in her brain. As she grows older, her pathways are becoming stronger which is probably the cause of her behaviors become more aggressive and longer in duration. Her brain is making those connections are she grows up therefore her hallucinations are become more evident to the extent that they become personalities. The first thing OTs could help this family is making sure the child and everyone at home is safe. First thing I would so is a home modification to put away any sharp objects that she could reach. Next, I would try to establish an everyday routine the Briana could follow as closely as possible everyday.

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Carissa Stratton.  Neuro-occupation relates to this case in the video "seven" in several ways.  One concept that really stood out to me was the concept of maladaptive neuroplasticity.  Each time Briana changes identities, it may be her brains way of coping with something it does not want to handle.  Each time that happens, it becomes easier for her to switch identities and strengthen those habits and behaviors.  It becomes easier to take that "pathway" of switching identities than to stay as Briana.   Occupational therapy can be vital in identifying environmental triggers or thought processes that lead to the switching of identities.  Through modifying these aspects, Briana may be able to advocate for herself on potential triggers or harmful situations that may lead to her changes in identities.  Through this strategy,  hopefully the concept of neuroplasticity will take charge and she will be able to facilitate those positive behaviors and habits instead of changing her identities.

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Sydney Thomas: This case is related to neuro-occupation because Briana's multiple diagnoses are neurodevelopmental disorders and originate in the brain. With the principle of neuroplasticity, change in the brain can occur in healthy and damaged brains. In Briana's brain, maladpative neuroplasticity has occurred, promoting dysfunctional patterns. Briana has multiple identities within her brain, in addition to hallucinations resulting in a tactile response. When individuals establish habits and routines the neuronal pathways are strengthened. For Briana, every time she experiences a different personality or hallucination the neuronal pathway is strengthened for the maladpative behaviors. These maladpative behaviors are the behaviors the family identified such as kicking, screaming, and other negative physical encounters. Occupational therapy's role would be to engage Briana in occupation based activities that promote function and do not trigger the maladpative behaviors. The goal would be to break the cycle of the maladaptive behaviors and create new neuronal pathways promoting positive engagement with occupations and her environment. In addition, occupational therapy could educate the family on positive coping mechanisms and strategies to maintain a daily routine in the household.

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Erika Petty: The case of Briana relates to neuro-occupation and occupational therapy in several ways. Her behaviors and hallucinations are due to chemical imbalances in her brain. This is causing her to see things, hear voices, and even become a different person at times. This is related to occupational therapy because these behaviors and hallucinations due to her brain are causing her to not be able to participate in a lot of activities of daily living. The brain has plasticity and the OT can help Briana work on ADL's and other meaningful activities using maladaptive plasticity and redirecting the negative neuroplasticity. The OT can work through some of the current barriers with Briana and her family to help improve family structure and function.

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Mitch Huesca: The video has concepts of maladaptive neuroplasticity. Briana is learning new ways to cope with things around her environment, but the way to cope might not always be a positive way. Her hallucinations affect the way she completes occupations and the relationships with those around her. The role of occupational therapy is to re-wire the brain to be able to complete desired occupations. OTs can potentially try sensory intervention, complete an observation play where she can have a sensory integration environment. Ot can also help to establish calming mechanisms that the patient can use when she is feeling frustrated or overwhelmed. Ot can also give family members some tips on what to do whenever Briana is feeling frustrated and overwhelmed.

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Emily Hollmeyer: Brianas case is related to neuro-occupation and OT because the symptoms and the maladaptive plasticity that she is experiencing are affecting her ability to participate in meaningful activities and occupations. OT can help in this case by educating the family on the concept of brain plasticity and maladaptive plasticity. OT can provide the family with strategies to incorporate activities that are meaningful to Briana into her daily routine in order to help reconnect pathways and limit some the negative behaviors that she is displaying. Addressing the psychosocial needs of the entire family is another intervention that the OT could provide.

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Dezarai Zepeda: The case of Briana relates to neuro-occupation because the chemical changes in her brain have organized her brain.  Her hallucinations have become frequent enough to appear real and influence the child's behavior. This reorganization could have the potential to affect her development and ability to participate in ADLs.  Occupational therapy services can help the child and the family emotionally cope with the diagnoses, as well as assist with medication management, creating habits and routines to limit outbursts, and set in place visual cues or education tools regarding appropriate behaviors and how to kindly treat friends and family. In addition, the occupational therapist could assist with communication with other health professionals and implement occupation based  treatments that have other psychological components.

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Jared Baker: Neuro-occupation relates to this case by Briana demonstration of maladaptive behavior. Since she was a young child, Brianna has experienced negative neuroplasticity. Her brain's neural pathways strengthen and become hard-wired with every hallucination and personification of her violent alter egos. Her family suffers as a result of these violent outbursts that are associated with these alter egos (including 'Seven' and 'Isie'). OT can help identify barriers to her successful completion of meaningful occupations and provide strategies to address and/or cope with those barriers. We can also model and promote healthy behaviors to Brianna and her family that will ultimately result in positive neuroplasticity.

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Mackenzie Payne: This case shows how neuroplasticity plays a role in a neurodevelopmental disorder. It relates to neuro-occupation because Briana's neurodevelopmental disorder is affecting her daily activities and occupations. Her diagnosis of schizophrenia is affecting her brain and the way she performs her daily occupations. Her diagnosis also affects how her brain is wired and connected. Occupational therapy can play a huge role in this case because we can help re-wire and re-connect the pathways she is using in her brain. It is important as OT's to understand her daily occupations and routines so that we can provide the best care. We can provide strategies and resources to the family that can help with her behavior and occupations. We can also give the family coping strategies because it is important to make sure the family has a positive mental health outlook.

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Madeline Wille: This case relates to neuro-occupation because the more Brianna Brianna experiences these hallucinations and delusions, her brain is changing and reinforcing that what she believes is truly real. The fact that she becomes scared or is a possible danger to others can affect her daily life such as who she is able to socialize with or what activities she does every day.

OT could help this family by training them to possibly observe what triggers these episodes and to do what they can to prevent these types of triggers Brianna’s life. OT can also train the family on how to communicate with their daughter if she is having one of these hallucinations so that she is able to be calmed and prevent someone from getting hurt. OT can also communicate with Brianna and her family on possible mechanisms of coping with her diagnosis.

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Marit Borth: Neuroplasticity is a critical part of development and if the brain develops maladaptively, it can cause the variety of diagnoses Brianna has developed. Her diagnoses have caused dsyfunction in her daily occupations and those of her family as she has daily outbreaks of aggression causing safety concerns. Occupational therapy can help to regulate her emotions, provide education to the family, identify triggers for each personality, and work on sensory integration. Because she is so young, it is important to identify and regulate her maladaptive behaviors and to provide coping mechanisma for her and her family. Just as maladaptive neuroplasticity has caused her illnesses, it is possible to use neuroplasticity as away to manage certain behaviors.

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Siera Becker: Briana is a very good example of how maladaptive neurplasticity can drastically alter ones lives and occupational performance. The changes that occur in the brain due to schizophrenia cause the neuronal pathways to become stronger every time that she has a negative behavior, such as acting out a negative or harmful personalities. As an occupational therapist, it is important to ensure that Briana and her family is safe. I would want to educate her family on her condition and help them understand that these actions are due to changes in her brain. I would want to know what triggers different personalities to emerge and what they are currently doing to calm her down. I would teach the family coping mechanisms to teach to Briana when she has an outbreak. Educating the family on establishing positive daily routines that help to keep her on track. I would also teach the family about self-care and coping mechanisms for themselves. Situations like these can be very stress inducing for the family members and they need to remember to take care of themselves as well.

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Madeline Coughlin : This video relates to neuro-occupation as it provides an example of neuroplasticity interfering with a child's development. This is an extreme case, in which Briana's neurological dysfunction is affecting her neural pathways. Her behaviors and symptoms are greatly impacting Briana's routines, roles and occupations. Skilled OT services could help Briana and her family in several ways. OT could work with her family and healthcare team to develop strategies to manage Briana's violent behaviors to protect herself and her family. In addition, Briana's sensory processing deficits which could be addressed by OT. Addressing Briana's sensory processing deficits could help her manage her behaviors and could promote neuroplasticity as Briana will be able to strengthen more functional and healthy neural pathways when she is able to better regulate sensory stimuli and is receiving the appropriate amount of sensory input.

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Jocelyn Young-Hyman: This relates to neuro-occupation because when children are young their brains have the greatest neuroplasticity. In Briana's case, this is how neuroplasticity is interfering with her development rather then enhancing her development. As seen in the video, her mother asks her to draw her different personalities. OT's could use art and play as a way to help her engage in occupations for six year old's to help with her anger and "episodes".

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Taylor Wienkes

This child demonstrates what can occur when neuroplasticity interferes with typical development. This case relates to neuro-occupation because the atypical neural development greatly impacts this individual's (and family's) ability to perform daily functional tasks. An OT can help this family by providing education on the child's state of mind, typical and atypical development, available community resources, and medical supports that may be utilized when the child becomes unsafe. With children, one of the biggest factors for future success is having family and caretakers that are knowledgeable and involved with facilitating a more functional life.

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Ashley Hottman:

This was a hard case to reflect on, especially when offering skilled OT services to the family. I would need to know more information about the family and the daughter which would be achieved during the evaluation and occupational profile. During this process, I would want to know several things:

-Are there any safety measures in place for everyone, including the child, the parents, and the sister?

-Is there any personalities that are present more often? Can you describe them? How do the personalities promote or restrict participation and engagement in occupations such as play, school readiness skills, and ADLs?

-How they are currently handling episodes and whether there are any triggers that warrant a change in personality?

-How is the child developing? And Are there differences in skills across her personalities? For example, can Lizzy or Seven draw, get dressed during the day, eat with utensils, go to the bathroom independently, etc.?

-How are her social skills and play skills since these are primary areas for general development and occupational skills.

-Are any areas where the child and the family needs additional services that interfere with the child’s daily occupations?

Understanding how the brain develops offers insight into the therapeutic process and effectiveness of interventions.

Neuro-occupation provides insight into how the brain develops, how habits form, how to provide effective interventions catered the child’s needs. Neuroplasticity and related principles provide a foundation for understand the role therapists have in assisting families with monitoring safety and general development, promoting new or maintaining current skills, or even adapting family and environmental contexts for growth and development to occur.

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Ashley Hottman

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Kathryn Carano: The case example from this video relates to neuro-occupation, because it is a neurodevelopmental disorder that affects engagement in occupation. It is hypothesized that in the brains of people with schizophrenia, BDNF is not released properly. BDNF affects neuroplasticity, so the developmentally necessary pathways may be getting pruned or unnecessary pathways may not be getting pruned. To help this family, we could use repetition to promote necessary pathways, help the family have Breanna avoid using unnecessary pathways so she loses them, and the like.

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Emily Garcia: This video relates to Neuro-occupation because of the concept of maladaptive plasticity. In the PowerPoint for class their is a quote, "When we wish to perfect our senses, neuroplasticity is a blessing; when it works in the service of pain, plasticity can be a curse." (Doidge, 2007, p. 177). I believe that this family would view neuroplasticity as a curse, because each time Briana had a hallucination or brought 7 out the wiring for those hallucinations or 'individuals' was made stronger, increasing those connections and the probability of them reoccurring. These negative connections leading to maladaptive neuroplasticity can also lead to a loss of function or increased injury which Briana is already at a higher risk for due to her other diagnosis. I would help this family by introducing them the applied behavioral analysis (ABA) therapy as that may be beneficial to Briana. I would also complete family/caregiver education on coping mechanisms that can be utilized in the home for when Briana is upset. Finally, when working with Briana I would try and create a chart with her that would allow her to indicate how she is feeling and when she is becoming upset or having a hallucination if able to do so.

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Kenzie Twaddell: Briana's myriad of diagnosis contribute to the thought that the wiring in her brain is creating dysfunction in her occupations of play, leisure, and her role as a child. Without treatment and intervention, her neural pathways are going to continue to fire in the manners that are being presented in her diagnoses. OT can help Briana and her family by restructuring the firing in those neural pathways. It is important to engage with Briana through interventions and occupations that primarily address the dysfunction in her brain. Yes, she is not performing functionally in ADLs and IADLs, but without addressing the route cause of her diagnoses then she will not truly get better. OT can help regulate Briana's behavior through sensory integration, behavior techniques, and reality based interventions.

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Jaclyn Williams: This video related to neuro-occupation because both Brianna's brain and occupations are greatly being effected. Brianna has been diagnosed with early onset schizophrenia which is a diagnosis that is occurring in her brain, yet it is being acted out through her occupations. She has different personalities or characteristics that she displays throughout the days which causes her to act out or to act in ways that she usually would not. As an OT I would begin to try some emotional-regulation techniques not just with Brianna, but also with who she claims to be "Seven". It is unknown whether or not these other personalities or characteristics will ever fully disappear so it would be beneficial to treat and focus on interventions with them as well.

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Morgan Huffman: This case is an example of maladaptive neuroplasticity represented by the relationship between Brianna's diagnosis and her behaviors. As her mom noted in the video, Brianna experiences hallucinations and moments of psychosis up to seven times per day. This has led to changes in her behavior and perception of reality. From what we know about plasticity and the brain, we know that the increase in episodes will create a stronger neural connection. With that said, this video applies directly to the occupational therapy scope of practice in terms of using daily occupations as part of building new connections. Because of Brianna's very young age, it is imperative that measures be taken to counter the maladaptive  connections that are being created. This will include identifying triggers for Brianna and developing coping mechanisms to practice with her as well as to educate her family on. It is also important to make sure that her family understands that Brianna's brain is capable of changing and re-wiring. Another focus could be identifying what is important to Brianna and incorporate these activities into therapy to give her a sense of control and motivation in order to foster healthier and positive habits and relationships.

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Catherine Ramiso: The implication of neuro-occupation to this case is negative neuroplasticity. With her diagnosis of mental illness at a young age, Brianna appears to be creating neuronal connections that correspond to her illness which may not leave room for her to fulfill the role of a child. OTs can provide assistance by arranging respite for her family members and also to Brianna. Her mother mentioned that Brianna would not sleep for days because of her episodes and personalities. An OT can perhaps evaluate each personality's preference and then develop strategies on how to manage each persona as they appear. Hopefully some could respond to relaxation techniques that way Brianna can receive some much needed rest.

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Theresa Kennelly:

Briana is a 6. 5 year old girl experiencing hallucinations as well as the effects of multiple disorders (ASD, dissociative disorder, psychosis disorder, etc.). Due to these the impairments from these disorders, Briana's daily occupations are greatly affected. Briana displays outbursts, violent behaviors/actions, hallucinations, etc. everyday, thus creating negative pathways and connections in her brain due to these actions and behaviors. Due to nueroplasticity, though, these pathways can adapt and change with the help of occupational therapy (OT). OT can assist Briana in making and using a picture schedule to help establish daily routines and habits. Additionally, OT can assist Briana in regulating her emotions by  identifying things that may trigger negative behaviors and help Briana and her family come up with a plan of how to address these outbursts (i.e. creating a safe space, requesting for a break, etc.).

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Michaela Stevenson: Neuro-occupation relates to this case because schizophrenia occurs in the brain. We have learned how maladaptive neuroplasticity is influencing the onset of schizophrenia. Among schizophrenia, the child is also experiencing many other diagnoses and symptoms that all include aspects of neuroscience. I think OT would play a big role in understanding the routine and habits of the child, triggers for different outbursts, familial support, and overall improving occupational function for the child. It appears that the family has a difficult responsibility in caring for the child. This affects the complete dynamic of their family life. I also think it would be important to understand what self-cares and play that the child does in a typical way at this point, and then creating goals centered around what is most important for the child and family.

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Alicia Borcic: This case relates to neuro-occupation because this little girl has schizophrenia, which prevents her from age-appropriate play, ADLs, and more. It is really important to examine when the onset was and see if there were any environmental, biological, and other factors that may have influenced her brain to develop this disease. By knowing this we may be able to adapt her environment to prevent outbursts or reduce them. This makes it safe for her, family, friends, and school. Educating family on how to cope and strategies to help with this disease will be helpful also, along with providing other groups in the community.

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Chase Gronowski: This video and case of relates to neuro-occupation because the feedback Brianna gets from others when she reacts in certain ways create deep rutted reward systems in her neural pathways. Even if she is experiencing life as one of her personalities, the neural reward pathways are still present and can influence her behavior. It’s also possible that slipping into other personalities other than her own may become easier or more frequent the more it occurs due to her brain strengthening the connection to that personality. OT can help this family by providing education on ways to cope with or compensate for the negative aspects of Brianna’s diagnosis. OT could also provide or recommend sensory dampening or stimulating equipment that can maybe help regulate Brianna’s mood and behavior due to her stimulation level.

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Caroline Schmidt: This video and story relate to neuro-occupation because the activities and tasks that Brianna participates in impact her brain. She also happens to have additional diagnosis that impact her brain further. The possibility of a diagnosis of early onset schizophrenia shows us that her brain development is atypical, as discussed in the lecture. Those differences in development change how she sees and interacts with the world around her. Her family discusses her multiple personalities and encourages her to draw them out. This could be a beneficial communication tool and trust builder or it could be reinforcing  maladaptive pathways. Brianna is also very young and her brain has an easier time of facilitating neuroplasticity. So the role of the OT in this situation would be to help her family find the best way to communicate with Brianna when a episode of psychosis occurs. Educating on how to best keep her safe and providing her with relaxation strategies when she feels not in control of her body. It would also be important to keep in mind the mental health of the family. Teaching them fun and meaningful activities that can be incorporated into a routine for Brianna. By redirecting her participation in functional daily activities, her brain will begin to form new, more productive connections.

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Jared Breyer: Neuro-occupation relates to this case through the concept of maladaptive neuroplasticity. As Briana's alter ego come forward and she acts our aggressively and exhibits poor behaviors she is rewiring her brain to think that those behaviors are acceptable. Her episodes prevent her from participating  in family relationships. they also inhibit her ability to participate in her occupations in a positive manner. As OT's it would be important to find out from the family how frequent her episodes are, what triggers them and if they have coping mechanisms in place. It would be prudent to find out what if any outside resources the family has for support. Having a child with special needs can be very stressful and taxing on a family. Sometimes families don't like to ask for help when help is needed. Providing information to the family about different resources in their area could be beneficial.

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Jenna Pelchat: This video relates to neuro-occupation because schizophrenia occurs within the brain. As said in the lecture there are specific parts of the brain affected by schizophrenia and Brianna most likely has a underdeveloped brain. Earlier in the semester we also learned about pruning which Brianna's brain may not be doing. If she has an underdeveloped frontal lobe, prefrontal cortex, hippocampus or neurons are not being pruned this could lead to her symptoms of emotional distress and multiple personalities. As OTs it is our job to give the family suggestions on where she can get help and how to cope with a child who has multiple different disorders. It is our job to help develop her brain, teach her emotion regulation, and educate her about her disorders.

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Shelby Rozenboom:

This scenario relates to neuro-occupation in that Brianna’s behaviors have become integrated into her brain as a result of maladaptive plasticity. As with the typical neural plasticity, the principle of “use it or lose it”, still applies. Brianna is continually experiencing various hallucinations and multiple personalities that have become integrated into her brain through maladaptive plasticity and causing the violent behaviors and different maladaptive expressions. Since Brianna is continually experiencing these situations, she is regularly using and integrating these behaviors and making their connections stronger within the brain. OT is able to help the family with providing them information about what is occurring in Brianna’s brain and why these maladaptive expressions and behaviors seem to increase. Additionally, OT may provide Brianna’s family with alternative behaviors and activities that are meaningful to Brianna but provide a more structured and accurate picture of reality that is not as violent.

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Brianna Starr

Maladaptive neuroplasticity occurs when the brain strengthens connections for something that creates a negative impact or dysfunction. I believe this is what is causing a sense of dysfunction and disarray in Briana’s daily life. Because Briana is young, we know that her brain is still very malleable and susceptible to change or adaptation. It is possible that the psychosis episodes and dissociative identities occur, or are present, regularly because the brain has “hardwired” these experiences; making them more likely to occur frequently.

When the brain strengthens connections, they become more permanent. Often times these behaviors are expressed more throughout a person’s daily life. In Briana’s case, her brain knows and understands behaviors/actions that impact her ability appropriately express emotion, communicate, and successfully participate in regular daily activities. OT can address these areas of impairment by through providing education and training to Briana and her caregivers on appropriate emotional expression, coping mechanisms and relaxation techniques (ex. deep breathing). OT can also aid in creating and implementing a specific routine that involves fun and meaningful occupations to keep Briana busy and allow her brain to form new, connections that improve function and promote participation in daily tasks.

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Rebecca Jensen: This video relates to neuro-occupation because it demonstrates maladaptive plasticity. Maladaptive neuroplasticity occurs like normal neuroplasticity with repeated exposure and learning. Briana’s experiences of hallucinations, psychosis, and dissociative personalities has caused her to learn maladaptive emotional expression. When these repeat and continue, it causes the brains neural pathways to them to become stronger. This occurs more easily for Briana because she’s at an age of optimal neuronal growth. OT can provide Briana and her family to participate in meaningful activities that promote structured realities, emotional regulation, and education about her condition.

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Audra Miller- OT could help the family through education and coping strategies with how their emotions are affected by Briana as well as how their emotions are affected by their reactions. Neuro-occupation is related because of the neuroplasticity that occurs due to the dissociative identity disorder and other disorders she experiences. The disorder disrupts Briana's relationships with her parents and sister, and her ability to self-regulate to perform functional activities. These disorders may affect the brain the same way that PTSD affects the brain through long-term memory, decision making, emotion, and executive functions. Hopefully when Briana turns 6-7 and her physicians feel they can make a more specific diagnosis it will open up resources for her and her family.

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Katherine Olmedo: The child is presenting symptoms of early on-set schizophrenia. Her behaviors range from paranoia, aggression, and disassociation. This relates to neuro-occupation because the child's level of social participation is affected by her repeated negative behaviors. In the concept of maladaptive neuroplasticity the negative behaviors become patterned since the amount it occurs is frequent. The stronger and more consistent the behavior is the more the brain adapts to it's pattern. As a result her sister is fearful of her outbursts, her mother is weary around her, and the idea of community integrations seems challenging. As an occupational therapist I would investigate contextual triggers for her, and try to develop a routine schedule or strategy that she can turn to when she has her episodes. The goal would be to try to redirect her negative behaviors into a more positive goal-directed behavior to disrupt the original feedback loop. Another intervention I would focus is education. Assisting the family to resources, and community to support to help them with this situation.

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Taylor Knecht: This video relates to neuro-occupation because it is a neurodevelopmental disorder in which there is no clear answer regarding the neuropathology. Various areas of the brain are impacting from this diagnosis such as the hippocampus, BDNF excretion, and recurrent epilepsies. OT helps this family by identifying potential "triggers" and implementing ways on how Briana can self-cope. Environmental modifications could be done to promote this and routine planning.

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Katie Adams:

How does this relate to neuro-occupation?
Her hallucinations and personalities affect her relationships, role as a sister/daughter, and meaningful occupations in which a 7 year old has.

How does OT help this family?
OT can be beneficial in identifying environmental supports - possibly adding a room in the house/safe room that is fully padded/dim lights (with sensory stimulation which helps her/calms her). Also, it may be beneficial to set up a daily routine which allows for structure which can help re-wire her brain in a beneficial way.

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Sydney Dickerson: This video relates to OT and Neuro through the concept of maladaptive plasticity. The girl in this video who demonstrates symptoms of schizophrenia has trouble managing her emotions and behaviors. These behaviors happen about 7 times a day, strengthening these neuronal pathways. Briana is only 6 and a half years old meaning her brain is still fairly plastic. As an OT, intervention earlier rather than later would be ideal. I would ask questions to understand what triggers the poor behaviors and other personalities to come out and what helps calm Briana down. I would introduce coping strategies for Briana and her family as well as plans for the family to use in order to keep Briana organized with her daily activities. Giving Briana structure may help her be able to focus on positive changes within the neuronal network rather then adding to the disorganized thought she is already displaying.

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Audra Feehan: The hallucinations Briana is experiencing directly affect her ability to complete daily occupations as well as form meaningful relationships with her family and peers. The possibility to early onset schizophrenia is causing her to have these hallucinations. Due to her young age , the pathways and neural connections in her brain are constantly being pruned and refined. Unfortunately these pathways are being wired incorrectly which is causing the behavioral outbursts. When working with Briana it is important to understand that her behaviors are symptoms of a diagnosis, not who she is. In order to rewire these pathways repetitions of appropriate behavior would be helpful. Individuals with schizophrenia also benefit from structure and routine. Setting up a daily routine which includes rewards for appropriate behavior and error-less learning will encourage strengthening of appropriate neural connections. This in combination with medication will allow Briana to become more functional in her daily life.

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Taylor Dalbey:  This video relates to neuro-occupation with the concept of maladaptive plasticity. With this concept in mind, the brain is changed though repetitive negative consequences or experiences. Briana is experiencing hallucinations, and personality changes causing her brain to change and unwanted neuronal pathways to grow stronger. Occupational therapy’s role would be to try to re-wire the brain to promote positive engagement in meaningful occupations. Occupational therapy can also help with education for Brianna’s family in regard to daily routines and coping strategies. Education to Brianna can be helpful as well to teach her about various coping mechanisms that could be useful to her.

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Peyton Stork: Neuro-occupation relates to the base of Briana because of the principle of neuroplasticity. The brain's ability to change occurs in healthy and damaged brains. Specifically in regards to the case of Briana, Briana's brain is undergoing plastic changes, just in maladaptive forms. Studies have proven that the brain likes habits and routines. Therefore, when Briana experiences her different identities and hallucinations, her brain is being reinforced, strengthening the neuronal pathways, forming the external behaviors testified by her family members. Briana and her family could benefit from skilled occupational therapy services. OT's are exceptional at integrating motivating tasks/occupations into the plan of care. Utilizing Briana's motivations, OT would allow her to engage in activities without experiencing emotional and behavior outburst. Additionally, I would educate the family about how to increase carryover affects from therapy into the home setting.

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Emily Carothers

Being 6.5 years old, Briana is in a critical period of neuroplastic change in the brain. It is possible that she is experiencing improper release of BDNF, which is causing of her episodes. If Briana’s brain is learning that it is easier to express strong emotions through “Seven” and other dissociative identities, those strategies may be reinforced, demonstrating maladaptive neuroplasticity. OT can help Briana by working on emotional regulation and providing Briana and her family with education and strategies for expressing emotion in a safe way. This would hopfully promote efficient neuroplastic change that would help Brianna express emotion safely going forward. OT could also help Briana and her family establish daily routines that would give them consistency and opportunity to bond over daily activities.

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Chris Flucke- This case is a great example of neuo-occupation. It shows a young girl who is unable to control her impulses and her functional behavior. The way that her brain responds to stimuli is not typical for a child of her age and it makes her behavior difficult for her family to handle. All of the extra stimuli her brain is receiving is too much for her to handle and her brain does not have a way to compensate. The behavior she exhibits seems to be a coping mechanism for this type of malfunction within her brain. Occupational therapy could help Brianna find other outlets for this type of aggressive behavior and help with some of her sensory integration abilities. It is possible that OT could help the family as a whole and help them find ways to adapt their environment to make it more of a cohesive family unit.

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Jimmy Roberts: Briana's symptoms of maladaptive behavior influence her ability to complete occupations that children her age typically do.  The neural pathways associated with Briana's actions (violent behaviors, screaming, yelling, crying, hallucinations) are strengthened on a daily basis.  To help establish new neural pathways that promote functional behavior,  Briana may engage in healthy occupations while on medications.  This can be accomplished through working with family member to create a daily plan and goals for Briana to engage in activities that children her age consistently do.  OT may also offer caregiver support by implementing strategies and techniques to promote emotional well being.

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Lauren Zweig: Maladaptive neuroplasticity can occur with frequency of exposure and learning. When Briana experiences hallucinations and triggers, the consistency of the exposure wires in her brain to continue firing. This can make the neuronal pathways stronger. Occupational therapy can work to adapt the environment to prevent triggers and prevent the frequency of hallucinations. OT can also work to find preferred tasks and items that Briana likes. This would help occupy her time and wire healthy interests for Briana. By participating in meaningful activities, Briana could have a structured reality, rather than her altered one.

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Ellie Goerdt: This video relates to neuro-occupation because it displays the concept of maladaptive plasticity. Briana’s brain has learned maladaptive behaviors of expressing emotions through episodes of psychosis and dissociative personalities. Each time that she displays these maladaptive behaviors, her neuronal pathways are further solidified as she is only 6.5 years old—a very plastic time for the brain. OT can help this family by providing education on emotional regulation and providing forms of art therapy that have proven to be effective with clients experiencing neurodevelopmental disorders. Additionally, OT can help the family and Briana identify meaningful occupations to engage in, instead of engaging in aggressive behaviors.

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Elliana Kastner: The child with schizophrenia is experiencing maladaptive plasticity. Although there is much yet to be discovered about the development of schizophrenia, we think it may be linked to improper release of BDNF. This may lead to negative behaviors. The child is experiencing psychosis, multiple personalities and self-destructive behaviors that create negative changes in the brain that further perpetuate the behaviors. As occupational therapists we can help to form positive connections in her brain and establish positive behaviors. It is important to establish calming techniques and ways to cope with emotional frustrations.

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Marti Hitz: This case relates to neuro-occupation because of the maladaptive plasticity that is happening for this young girl. She has had repeated hallucinations and episodes where her personalities have created violent episodes or moments where Briana is losing control of her own functioning. The connections of the maladaptive behaviors are able to become stronger because of each occurrence. It is also stated that the child has many other co-morbidities (sensory, Autisim, etc.). For OT, it would be important to recommend calming techniques during episodes and capitalizing on things Briana enjoys while she has control over her personality.

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Chas Eberle: Neuro-occupation relates to this case in the form of negative neuroplasticity. As mentioned in the video, she has been experiencing episodes of psychosis that are becoming more and more frequent as time goes on. She experiences hallucinations and manifestations of various personalities that interfere with her ability to function in her daily life. As mentioned in lecture, a cause of her symptoms may be due to an improper release of BDNF, which influences the brain’s ability to go through neuroplastic changes that reinforce learned habits and routines. Briana is still within her “critical period” of development, so habits learned at this age may form even stronger pathways at a more rapid pace, which may ecacerbate her symptoms and explain the rapid change that is mentioned in the video.
An OT could help this family by developing a thourough occupational profile, and possibly identify triggers that may be positively or negatively affecting Briana’s ability to cope with the symptoms that she is experiencing. An OT could work with the family to develop or maintain routines to help support the management of her symptoms and find strategies to avoid potential triggers in the future. Doing this will give her the best chance of preventing the development of strong neural pathways that are formed by the symptoms of her illness.

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Nick Kellerhals: This video relates to Neuro-Occupation by the concept discussed in class called maladaptive plasticity. This is where the brain is changed through repeated negative consequences or experiences. This can be seen in the video where Briana experiences hallucinations and displays multiple personalities.  In the end, this can have an overall effect on her perception on reality due to her age since the younger someone is the more malleable their brain is. Over time the more this happens the neural connections will become stronger in the end resulting in more frequent episodes of seven for Briana. OT can help with the family in helping find out what are potential triggers for Briana. We can then modify the environment because this could have an impact on her. If she experiences more episodes of being seven in a certain environment we can address this and change up the environment and see if that lessens the neural connection to seven. In addition, as an OT we can also educate both Briana and the family on coping mechanisms to see if this helps with her mood and stress she is experiencing.

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Bri Bulleigh: Neuro-occ relates to this video through the concept of maladaptive neuroplasticity and the wiring changes in the brain that occur because of that. When Briana experiences violent behavior or personality changes her brain is changing in structure and those pathways are growing stronger. As occupational therapists we can first start by educating Briana's family about what specifically is happening in her brain. One family member who stuck out to me was her sister. Since she is young it is important to explain it to her in a way she is able to understand and cope with. Additionally, occupational therapy can help Briana by finding occupations that are meaningful to her, and possibly each individual personality to help eliminate the aggressive behavior. Sensory integration can be beneficial as well to help find coping mechanisms for Briana when she feels angry and aggressive.

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Nichole Vasquez: Because of Briana's multiple diagnoses, she is having difficulty participating in her occupations. Her diagnoses may be examples of maladaptive neuroplasticity. Maladaptive neuroplasticity is associated with a loss of function and increased injury, and this is the case with Briana. In the video, her mother and sister expressed that Briana has exhibited violent and angry behaviors, such as stabbing, punching, etc. By engaging in these behaviors, maladaptive neuroplasticity is occurring, and these neuronal connections are becoming stronger. The role of OT would be to try and re-wire the brain in order to promote positive engagement in occupations. OT could try different sensory interventions, as this was one of her multiple diagnoses. Perhaps different sensory inputs could calm her. OT could also do task exploration, and find meaningful activities that she enjoys doing in a sensory-friendly environment. OT could also look into teaching Briana as well as her family coping mechanisms.

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Sierra Bailey-Peterson: Briana has multiple diagnoses that demonstrate maladaptive neuroplasticity at work. Her behaviors that stem from the different diagnoses have created a potential increase in injury and decrease in occupations (such as self-care). Neuro-occupation concepts can be utilized for intervention ideas. For example, the brain supports strong connections and Briana could use strong neural pathways throughout her day to complete and engage in occupations that are meaningful. OT can be used to find what those meaningful occupations are and capitalize on them. This would help the family by providing potentially preventative measures to have Briana's behaviors not escalate to violence. Briana could use her drawings as an outlet for when she does begin to have aggressive behaviors.

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Amy Piekosz: Just as with typically developing children, children with schizophrenia are experiencing neuroplastic changes in the brain. In this clip Briana’s mother describes specific hallucinations as well as alternate personalities experienced by Briana. Through neuro occupation, we understand that these hallucinations and alternate personalities might be reinforcing neuronal pathways in Briana’s brain leading to unwanted behaviors/ emotional outbursts. Briana would be an excellent candidate for occupational therapy. OT could help Briana discover ways to inhibit her hallucinations and personality changes. It could also provide her with alternate activities to occupy her time and hopefully prune those less healthy connections to form new ones.

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Macall McFall: Briana's multiple diagnoses and interaction of behaviors inhibits her ability to participate in meaningful occupations. If she continues untreated, the behaviors could become a pattern and therefore strengthen the neuronal pathways of negative behavior. Fortunately, she is so young and her brain is highly plastic so she can more easily learn new techniques and change her behavior. I would recommend OT for Briana to learn deep pressure techniques to calm and organize her brain. Deep pressure releases neurotransmitters in the brain that calm the CNS. I would also recommend a lot of family education on the part of the OT to help the family cope with behavior and give them resources to manage in different situations.