A therapist harnesses the power of play

By Louise Kinross

Salma Kassam landed her first job as an occupational therapist at Holland Bloorview 22 years ago and has been here ever since. She works with inpatient children who have brain injuries sustained through trauma or serious illness.

BLOOM: Why did you get into occupational therapy in children’s rehab?

Salma Kassam: When I was a student I was one of the lucky few who had several placements at Bloorview. I did community outreach visits to nursery schools and had an inpatient placement working with the babies and young kids on Unit C. After one of my placements, I volunteered with the babies and would come and do 'cuddle time.' I fell in love. I thought the kids were amazing and the clinicians walked on water. I was so enthralled with everything we could help the children achieve. Once I discovered Bloorview, I was in it for life. It was magic.

BLOOM: Who do you work with now?

Salma Kassam: I see mostly school-age and older children who have a brain injury as a result of a motor vehicle or other accident, or from a tumour or encephalitis. We usually see kids four times a week for about 45 minutes. There are kids who are still very acutely ill, and who are learning to eat, walk and talk from the beginning again. And there are others who are more able and doing more fine motor and cognitive assessments to look at skills to get them back into the community.

BLOOM: What kind of changes do you see in the kids?

Salma Kassam: We’re so blessed. We see amazing things. It shows the resilience of children and the importance of family support. The big difference working with children is that children are motivated by play and move on with play. They don’t harp on the negative as much as adults do.

Kids have an amazing spirit that drives them forward. It takes them time to learn that this is a safe place that’s engaging and playful and fun, and not just all of those intrusive procedures they may have had before getting here.

I remember one mother who videotaped her child during rehab. He went from having a thumbs up and down to [communicate], and not being able to stand, eat or hold a block, to walking independently, eating regularly, speaking and going back to his community. Of course he still had things to work on, but it’s nice to see the critical role we play in the early stages.

BLOOM: But not all children with brain injury have that kind of recovery. Some of them are very changed from the child they were before.

Salma Kassam: There can be an overwhelming sense of grief and loss for the family and client, and we see that. But kids are able to get past some of it in a way that’s amazing and that’s the resiliency I’m talking about. They still want to do the things they used to do, and they find ways to do things. Not everyone makes the same recovery. There are children we couldn’t help as much as we would have liked, as well as ones who defy expectations. There are so many things you can’t predict. Children who recover physically but have invisible cognitive impairments or personality changes face different challenges in the real world.

BLOOM: Because everyone sees the same person on the outside and assumes they have fully recovered.

Salma Kassam: Exactly. There are also kids who look very impaired physically and have cognitive strengths. The range of ability is so broad that we really have to look at the uniqueness of each individual—at their strengths and limitations—in the same way we would for any of us. We have to shed our preconceived notions when we see someone with a certain presentation.

BLOOM: What’s the most challenging part of your job?

Salma Kassam: I think time. We want to be able to spend the quality of time with each client and we try to make the most of every minute. But there’s a lot of things behind the scenes: documentation, communication with community people or accessing resources or getting information about equipment. And other demands to participate in education, as a teaching hospital. So prioritizing and managing and helping each family to the best of your capability is the challenge.

BLOOM: What about those times when a client doesn’t make the progress hoped for?

Salma Kassam: The brain is unpredictable and it heals in its own way, and we can only do what the brain will allow. I may try the same intervention with two similar clients and one may respond to it and the other not. It’s outside our control. It can be very difficult when two families with similar children have completely different experiences in rehab, and it’s not necessarily to do with the clinician but with the client’s type of brain recovery.

BLOOM: How do you deal with that?

Salma Kassam: I have a reputation for crying. I do sometimes wear my emotions on my sleeve. I celebrate with families and I grieve with families. I think we can still maintain a professional relationship without giving away our human qualities. I want to support the parent. We have a lot of things in place for families, but we often need to remind parents that they need to look after themselves and have an opportunity to express their grief and loss and their joy.

BLOOM: What is most rewarding about your job?

Salma Kassam: It’s always the kids. They always bring sunshine to my day. In so many ways I learn something every day and I help someone every day and that’s a pretty good life.

BLOOM: What advice would you give parents?

Salma Kassam: Be patient. It’s hard. Listen and learn from experts, but recognize that you’re an expert in your child, so share what you know. Hope is important and acceptance is important. Be there as much as you can, but also, sometimes you can help your kid by not helping them, which allows them to grow.

BLOOM: What advice would you give a therapist starting out on the unit?

Salma Kassam: There are so many skilled clinicians here who I’ve learned from and who continue to inspire me. So take the expertise of those people who’ve done this for a lifetime. You can learn so much from the people around you and from the kids.

Sometimes, as adults, we’re very product oriented and focused on the end result. Children are about the process. They learn from the act of doing and if the product isn’t perfect, it’s okay. Remember that in the end your therapy session with a child may not be perfect, but you’ve both learned from the session and that’s the important thing.

Take care of yourself and know when to ask for help. If you’re overwhelmed either physically or emotionally, go to occupational health or go to your family doctor or go to your massage therapist or whatever it takes to get you through that day. We do have days where our body or mind gives up.

Value your time outside of work—whether that’s recreational opportunities or family or whatever makes you happy and joyful. Brain injury can happen to anyone, at any time, so appreciate every day the things you can do. And wear good shoes.

BLOOM: You mean comfortable ones.

Salma Kassam. Yes. It's a very busy place.