Danielle Chirhart: Neuro-occupation relates to this case through the concept of maladaptive neuroplasticity and rewiring of strong pathways. Briana’s brain is wiring in a way that has a negative consequences and impacts. Her brain is firing in patterns that result in different personalities in which have negative qualities. Briana enters psychosis episodes where she can’t control or calm herself. These repetitive episodes are contributing to her behaviors becoming learned and creating stronger and more automatic pathways. These behaviors are preventing Briana from participating in occupations, building relationships with her family and friends, and living a meaningful life. It would be beneficial to ask her family about her episodes. Such as how often do they occur, what makes them worse, what makes them better, what triggers a change in behaviors, etc. Her family should be encouraged to log her behaviors to help identify triggers that they can modify to decrease the occurrence of episodes. As OTs we can educate the family on neuroplasticity and provide way to promote positive neuroplasticity and re-wiring of Briana’s brain. 

This video was extremely sad and hard to watch. When it comes to Briana’s case, each time she becomes seven or any other character this increase the neuroplasticity connection. This shows the impact of negative neuroplasticity. The more times this happens the stronger the neuroplasticity connection becomes. This could explain why Briana has been having episodes more and more frequently. As an OT, it would be important for us to identify triggers for each character she becomes as well as also coping mechanisms. What coping mechanism works best when she becomes angry or frustrated. 

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. 

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.  

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. 

 

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. 

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. 

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. 

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. 

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. 

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.). 

 

 

 

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. 

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. 

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". 

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. 

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. 

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. 

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.  

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. 

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. 

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. 

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. 

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. 

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. 

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.