“Wow!” “She’s never done that before!” Naomi’s dad and grandmother exclaim. They watch in awe, alongside Naomi’s great grandmother, as the 4-year-old splashes in delight. Naomi flashes a bright smile as she lifts a small treasure chest above her head and lets the water trickle down over her face. 

It wasn’t long ago that this would have been an impossible task. Bath times were particularly challenging for Naomi’s family as their bright, blue-eyed toddler dreaded the idea of water in her face. “What a difference,” Naomi’s grandmother, De Anna, remarks. 

Aquatic therapy with Marnie Nicolaus, MOT, OTR/L, of the Johns Hopkins All Children’s pediatric occupational therapy team, is Naomi’s happy place. “Naomi and the pool just go together. She's so motivated by the pool,” Nicolaus says. 

An Early Inkling

Very early on, De Anna says she and her family recognized Naomi was unique. She communicated by using hand signals and seemed to struggle making eye contact. By age 2, Naomi was diagnosed with level three autism, which often requires more substantial support. Doctors also found she had apraxia, which means Naomi’s brain does not communicate with the muscles in her mouth to form words. 

None of that has stopped Naomi from finding her own ways to communicate and interact with those in her inner circle, including Nicolaus. 

“We are very fortunate that we have a child that’s just been so good,” De Anna says. “And I can't stress that enough. We're the right family for her. She's the right fit for us as a family. Naomi is an incredible grandchild. She’s a godsend.” 

Seeking Resources

De Anna, an early childhood educator with a passion for special needs education, immediately sought out resources for Naomi, working with her son, daughter-in-law and Naomi’s papa. That led them to Johns Hopkins All Children’s Hospital in St. Petersburg, Florida. While Naomi sees a range of specialists from cardiology, to gastroentrology, to feeding and speech therapy, it’s been her occupational therapy visits with Nicolaus that have led to immeasurable progress. 

“When we first came here for occupational therapy, Naomi walked in the door, looked around, and went right back out the door,” De Anna recalls. “She's like, no, not going to do this. It took months. Marnie Nicolaus didn’t give up. Now, Naomi uses eye contact, which she didn't do before. She follows directions.”

De Anna says Naomi adores Nicolaus and she is the first person outside of her immediate family who has breached Naomi’s inner circle. “Marnie has the gift of being able to read a child,” De Anna says. “And there are people that teach children for years or do therapy for years, doctors, parents … and they don't possess that gift. Marnie has it, and she reads children’s hearts. That's how Naomi reads people too.”

Nicolaus learned to adapt her sessions, allowing Naomi to run or play in between lessons to enhance Naomi’s focus. 

Immeasurable Progress

Her progress has been outstanding. The skills Naomi is learning inside the pool and in the activity gym at Johns Hopkins All Children’s Outpatient Care, East Lake, in Palm Harbor have allowed her to blossom outside of therapy. Naomi can now dress herself, tolerate baths, put on lotion and has drastically increased her bilateral coordination skills where both hands are working together to accomplish tasks like using scissors.

“We've been working together for about a year and a half. When we first started, she wasn't really using her left hand at all,” Nicolaus explains. “Now she's getting so natural with bringing it into our play. So, she's doing awesome.”

Family Support

Nicolaus says the best part is knowing Naomi has incredible support at home, helping to reinforce the lessons she gives to Naomi two hours a week. 

“If I know anything about Naomi, I know she's going to be unstoppable. She always brings her cheer section to therapy. She's got her dad, mom, grandma, grandpa (papa) and great grandma,” Nicolaus says. “They are a family that you can fill up their cup and give them so much to work on at home, and they're like, we're game. Let's do it. She's going to be unstoppable because of their great support.” 

“Whatever it is you're doing, we're going to take it home, and we're going to repeat it,” De Anna adds. “Marnie’s work is so important, and we recognize that. And we recognize how much it's helping Naomi to grow.”

Nicolaus feels blessed to have made such an impact on Naomi and her family. “You know, it just touches your heart,” Nicolaus says with emotion, “The connection you make with the family is just so meaningful. It’s been the best journey.” 

Modeling Acceptance

De Anna knows Naomi will likely have trouble fully communicating in the future, but she hopes others will model acceptance. “Anybody who meets Naomi will be lucky to know her. She's nonverbal, but she says everything,” she explains. “If you listen to people like Naomi, she’ll teach you compassion and empathy.”

Nicolaus agrees: “I don't really look at the diagnosis. I just look at the child, and I meet them where they are. Some days, Naomi comes to me, and she didn't sleep so great the night before, so we just ebb and flow and meet Naomi where she needs to be met. I think if the world kind of took on that approach of just accepting everyone for their amazing qualities, we could make tremendous leaps in inclusivity.”

Aquatic Therapy Expansion

Seeing Naomi’s progress, and the progress of other children in the aquatic therapy program, is encouraging Johns Hopkins All Children’s to expand its pool-based programs to several Outpatient Care locations. Last year, the hospital trained several physical and occupational therapists in aquatic therapy to prepare for future expansion. 

“It’s exciting because we’ve noticed what a difference the pool has made for Naomi,” Nicolaus says. “I’m blown away with her progress and I know this will make a difference in the lives of many kids.”