This episode is a recording of a journal club that was done in our OT Graphically Library Membership on The Current Evidence for Sensory Processing. We discuss an article titled Evaluating Sensory Integration/Sensory Processing Treatment: Issues and Analysis by Camarata, Miller, and Wallace from 2020, including how to put the information gained into our clinical practice despite the barriers.
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Welcome to the OT Digest podcast. I'm your host, Katie Caspero, the founder of ot graphically.com, where I synthesize research into visually appealing graphics. On this podcast, we take research and make it more fun and interesting in order to quickly hear the most updated evidence all around the world. I interview authors, share research, tips, and provide practical examples.
That I hope you can use and incorporate into your interventions the very next day. Thanks for listening.
Hello and welcome to the OT Digest podcast. Today I wanted to give you a little bit of context for what this podcast will be about. So this is going to be a recording from one of our journal clubs through the OT graphically library that. Was completed on what the current evidence for sensory processing is.
A lot of times we'll hear that there's not enough evidence for sensory processing or the evidence is very weak or flawed, and there's a lot of reasons for that, which this article that we reviewed dive dove into the article is from 2020 and it was kind of a review of kind of where we were at. So far, so it's not necessarily a, a structured research paper, but it's more of a, a review of the evidence and, and kind of a Discussion and conversation starter.
So I would definitely encourage you to listen in. It's a little complex. So I tried my best to explain the process and what they, their recommendations were. It's a lot of neuro things going on. But definitely listen towards the end you'll hear a little bit of a discussion between our members and.
How we can kind of navigate putting this into practice, which I thought was really valuable to share with, with other OTs around the world. So I hope you're doing great and I hope you enjoy this conversation. All right, everybody. Well, welcome to the Journal Club today. We are gonna be talking about this specific article, which is Evaluating Sensory Integration and Sensory Processing treatment issues and analysis.
So this is a really new article. It's from 2020. It is kind of the newest one that I could find on this topic of. Sensory you know, where are we at? Why is there not enough evidence or why is there a challenge in getting the evidence? And, you know, what can we do, you know, in the meantime both as researchers and clinicians.
So I thought it was a really important article. Lucy Jane Miller is one of the authors, so definitely a strong OT presence, which is nice. I believe it was done through Vanderbilt University, so. It's not necessarily an article, it's more of a review, a research study. It's more of a review, but I thought it was really helpful.
So by the end of the today the goal is to understand what strength of evidence is available for sensory processing and sensory integration interventions. Identify three challenges to gaining these more larger scale studies for this specific intervention. Learn a new proposed solution to track if those interventions are working, which I think is kind of the most helpful for us as clinicians.
So if you could share in the chat or if you're watching this later, you know, on a scale one to 10, how often do you use sensory processing or sensory integration interventions? One being, you know, not at all, 10 being most of my, most of your day, all the time in your, in your clinical practice. For me, I would say it's about like a five to seven.
I have a lot of kids that are autistic. Eight and nine. Yeah. Yeah. I feel like it's kind of just the majority. I have a lot of feeding kids too, so I feel like it just naturally lends itself to being just a pervasive part of our, of our therapy if working with kids. So yeah. That's helpful to know.
We'll review a little bit about just the treatment in general, but I'll try to go through that a little quicker. So why am I saying both sensory integration and sensory processing? There is a reason for that. So sensory integration was coined by heirs. She defines it as sensory integration.
Dysfunction is a problem in the ability to organize sensory information with for use, and along with motor performance is a key element for intervention. So that term she coined as sensory integration. And then in 2007, Miller described it as difficulty detecting leading. Interpreting and or responding to sensory experiences, which is severe enough to disrupt participation in daily activities, routines, and learning.
And she described that as sensory processing. So there, during that time she said, I think we should call it sensory processing and sense of, instead of sensory integration, which I thought was interesting but clinically and in the literature, people use it kind of. Interchangeably sometimes. So I'm gonna say both as they did in the article, but it's just something to think about.
Cuz if we're talking about different things or if we're talking about the same thing, we could be studying the same thing or discussing the same thing without realizing it. I think of sensory integration more as like strictly air sensory integrion and I think of sensory processing as more like, The process.
I don't know. That's kind of how it makes sense in my head. But it's just good to be on, to be on the same page and know people might be talking about different things. So basically this is just gonna be a review of all the literature that's currently available as well as kind of a framework for how to test these interventions because clearly there needs to be more support for it and in specific for autistic individuals too.
So right now S I S P or sensory integration, sensory processing treatment is widely implemented, but it doesn't have, it has a limited evidence base, which is the opposite of most interventions as the opposite problem, where we learn about something new and then we try to implement it. So it's kind of interesting in that way.
Just because it has limited evidence based does not mean that it's ineffective. We just don't know for sure without those larger scale studies, you know, if there's other things that are causing the intervention to be successful. So this article's main point is that naturalistic developmental behavioral interventions show moderate to large effect sizes and that we can use the way they track.
Information and intervention, like pre and post to test whether S I S P is effective. So not necessarily using the same interventions, but using the process that they use to help strengthen our evidence, which I thought was interesting for sure. And I'll give some examples of that. Ethically, you know, we, our practice guidelines include a preference for using treatments that have credible evidence versus those that do not.
And I would argue also insurance companies are a little stricter as well. Yeah. I also agree that sensory integration, sensory processing, It, it definitely is difficult with the dysfunction based approach versus a strengths-based approach. And doesn't it kind of more of is a bottom up approach too.
So I think that's something to keep in mind. Oh, you were saying, Jenny, that sensory processing fits better versus integrating that, that topic of Strengths base will come up a couple times. Some of this article, I don't totally agree with everything they said. And I think just as we look at that lens right now, everything through that lens can be tricky.
So this article doesn't do that totally great, as many don't. This is just the levels of evidence pyramid that I have part of the library. So basically, level one is the strongest, and level five is the weakest according to this article. And the sensory integration. Sensory processing tends to be between the three to five range.
So either like non-randomized studies or case studies. Again, not necessarily. That it's not effective, it's just not as strong according to this level of evidence. So just like a really quick overview. So sensory integration sets to sensory processing can impact initiating, initiating peer interactions, developing relationships and daily activities and re re regulating arousal.
So for example, somebody a child might respond to input quicker than someone else, or, as I like to say, have a smaller cup. And their response response would be extreme to maybe touch of a certain clothing texture or, you know, trying to move on the playground. They also may try to over control their environment because there's just too much information that's coming too quickly.
It can also result in the opposite, which is a slower response to sensation and having a bigger cup requiring a lot more information to fill. They might enjoy crashing or falling. So this is kind of just your classic hyper hyperresponsiveness. And that's kind of what the framework of, of sensory processing is, so it can impact our learning outcomes.
It can impact motor delays, like kind of like figuring out how to initiate or motor plan something new. And so much of the literature does not use this sensory integration, sensory processing framework, but a behavioral lens. So theoretically and hypothesis driven clinical studies are needed to resolve this disagreement.
Basically, the way like a research paper is set up is for. You do this, this causes this, did this help you? Whereas sensory integration, sensory processing, it's, it's like fitting. It doesn't fit into that model of like the scientific process as much, which I think is one of the main challenges. It's not wrong.
It's not, you know, incorrect. It's just the way we, it's so holistic that it can be really hard to fit into that, that model. So the reason, again, why there's limited evidence is we're using different words for different things. There's a variety of frameworks that are being used and there's limited high quality evidence.
And it's also hard to get to that level one because all of these studies are doing kind of different things. So if you try to combine them, it's nearly impossible, which I think Blyth mentioned Aero sensory integration is a protocol. It's more standardized. You can't say you're doing a s i unless you are trained in it, which is a pretty intensive training.
They we'll talk about that a little bit later. That's the only one that really has like a manual, so to speak for, for right now, and that's the one that has been the highest tested one. Aero sensory integration. Basically, you know, the, the way we're trying to help kids with sensory integration and sensory processing is things we can do is to have a fidelity treatment scale, which they have one for air sensory integration.
It's like a fidelity checklist or using observational coding. So I am going to share this first cuz this was helpful for me. So they discussed kind of putting it in this. Naturalistic model. That sensory is kind of like the learn learning pyramid that we know pretty well, but sensory on the bottom, it impacts everything else.
But for example, a child is having, you know, playing in sand. They have increased touch activity and they start moving their hands more. And decreased tactile defensiveness, and then they move to improve, play on the playground and interaction with art or different supplies, and then they move into more social interaction and learning because they're in their environment more doing that.
So, That is kind of the process for other behavioral interventions to track how are they moving through that process? I think of it also very similar to how they're moving through the steps of eating. So that's their argument in this is that we would test similar to those Naturalistic interventions.
This article was a doozy. I tried my best to, to understand it, so I would highly recommend reading it too bit, but it was, it was a real brain, not in my head, but but currently, you know, the evidence for this. There's some small studies like weighted vest and brushing programs, which suggests procedures are not effective AC actually.
And there's a limited NU number of studies that use the goal attainment scaling, which this article said that is kind of another solution using goal attainment. Using CEN air sensory integration. There's several systematic reviews, much I mentioned before indicating inconsistent, consistent week and or inconclusive evidence.
But the issue that is kind of, it's isolating really specific things like a weighted vest or just a brushing program and not the sensory brace proc procedure that we use. So it's just taking those things out of context. And they didn't necessarily follow the recommended protocols or target specific sensory processing problems.
We just need more of those trials that have manualized protocols to evaluate for children with, with autistic children and sensory processing problems. So there's a lot of flaws in the study. So, which is good because the ones that we, we saw weren't very effective. So at best there's emerging but limited evidence with few positive outcomes and some null or negative, you know, as in like this is not going to work, which you don't often see either.
Because there's limited and inconclusive results. There's short-term results, you know, lasts for a month or a week or a day, and then it, it goes away. Small number of studies and lack of credible studies. But still this is frequently used in the clinics despite this evidence. So in addition to, you know, trying to do this tracking of using naturalistic Behavioral interventions in play to kind of get that process better, understand how do we capture that process, not this like individual intervention or individual item.
They propose to use multisensory perception as a window into this treatment and, and how it's actually working. So not necessarily just one sensory input thing, but the whole, you know, multiple systems sensory integration. So, And being able to integrate them in real time. But people, therapists and teachers are already really doing this.
They realize that multiple sensory inputs are improving multi-sensory integrations in order to develop learning and cognitive abilities. So, There's recent studies are del developing highly effective methods for characterizing multi-sensory integration in children's. So basically I think what they're trying to do here is kind of tackle it from a different angle and really get the full picture of what we do when we're doing sensory integration and sensory processing.
So, There's no current studies of sensory-based treatment procedures have an effect on the multisensory integration, but it, but they think this is a way to go for future in, for future studies. So, r is the child able to integrate multiple sensory systems And if so, that is gonna lead to the engagement, social engagement, or learning.
That we're looking for. So one thing that they talked a lot about is confounding factors. So another tricky thing about sensory processing is that you, the therapist, are so involved in the process. It's really hard to take out your words and your Role in that impacting the child's success. And also, yeah, just the other, other, there's so many other factors that are going on in that play-based child led.
Situation that it makes it really complicated to pull that one away from the other. And that, that's another thing this study kind of shows, is that you do have to control for those things. And, and there are ways to do that, but right now that's not happening. And that's why a lot of peop, a lot of the evidence is getting judged for that.
The, the really big takeaways are that there is an ongoing need for fair clinical trials comparing Using these naturalistic developmental behavioral intervention treatments as a framework to help us test what's going on and using these as a way to gather the information in a really complex process.
Also, being able to. Use things like pole attainment, scaling or the gas to be able to get this understanding of what's the end goal and see if we get there and what are we doing, which is the sensory processing information in order to make that happen. And then also not forgetting to. Focus on multisensory integration to be able to test this framework and see if that is a novel way to have more promising results for some of these interventions.
And that what we're studying and what we're doing in the clinic is actually authentic to what the original protocol or the original intention was. So for example, air sensory integration, making sure you're infidelity with that checklist and doing kind of the key. Things, is it child led? Is it you know, using their interests?
Is it, you know, being able to slowly challenge them in, in new ways while you're in that play space? And then also controlling for confounding factors. So, I think as though a lot of this is for, you know, future research. I also think it's really important for us to really think about how we track what we're doing and use this model of.
Of testing. So I'm curious if anybody has any, any thoughts on this. This was a really challenging article. I think what makes it so challenging is what we do is really complex and we should give ourselves some credit for that. It's a lot of heavy neuroscience and it's a lot of, it's a lot of things working at the same time, which makes it hard to capture in a research study is basically the nutshells.
So this is, you know, the best way we have right now to be able to track really breakdown. We move kids from sensory to motor, to social, to behavior and make sure that our interventions are doing that. So some of the comments Does anybody wanna share out loud? Basically what I just inserted into the chat was some background about air sensory treatment.
So I got trained through U S C, which is university of Southern California. They have a center there that is focused on training in like a sensory integration as it was like meant to be because that's where she came out of and did her neuroscience related research. So the key things really with.
ASI is that they, it's essentially, it's a trademarked protocol, so they don't want you saying that you're doing it unless you're doing it per the protocol. A lot of the components of the protocol are things that we're incorporating kind of day-to-day, like the flexibility kind of in our space and opportunities to, for children to be challenged, but also be engaged and intrinsically motivated to engage with you and play.
However, A lot of the components that are key and like kind of central to errors are things that a lot of people are not doing when they're providing sensory processing related treatments. So one of the keys being really that it's 100% child led. So when you think about a traditional OT session, we might be structuring the environment in a way to try to challenge the child.
But in an air sensory approach, if that child walked into that room and didn't engage with any of that stuff, we would be taking, we're following them. Like, you know, if they co co walk over to something that we constructed and they knock it over, we're not forcing them to reconstruct it. We're following their lead about what to do next.
The whole idea there obviously is. With intrinsic motivation comes the intrinsic motivation to be challenged. So therefore it can often look kind of dysfunctional because it's really child driven. It looks like you're, it's supposed to just look like you're playing with them. So that aspect I don't think is something that comes up a lot in.
Traditional sensory treatment because we are so data driven and we're so driven around specific kind of goals. Another, another two things that I don't think most people are aware of that I just figured would be worth bringing up errors protocol necessitates that a child has seen at least three times a week, which in.
Almost no settings is actually happening. There's a big focus too on family participation and the idea obviously with more being better is that the more intensive treatment in a short period of time can be more helpful, which absolutely we all know is absolutely true based on Other protocols that are focused on high intensity of treatment but again, not something that's happening in daily practice.
The third thing being, there's actually quite a lot of rules about what the environment has to be looking like when you're offering airs treatment. So in almost no setting that I've, I, I've never worked in an environment that even meets all the criteria. For example, like I've, I literally pulled up some of my training so that I could reference it.
Exactly. So for example, they have to have three points. Of suspension from the ceiling. So at least three. I've never worked in an environment that had more than two. Because if you think about it, that's a very large space. In order for that to be safe has to ha and one of them has to have allow for the ability to rotate up to 360 degrees, which again, It's not necessarily something I've seen a lot of.
There has to be very really, that requires just a ton of space in itself. And. A lot of times too, the, the push, you know, is for kids to be kind of stringing together these experiences with proprioception and vestibular and tactile, cuz those are considered like kind of our, our base senses on like, you know, that sensory integration pyramid that oftentimes gets referenced.
So the keys. There is that you're doing things to kind of incorporate those senses, so therefore you're, there's a lot of focus on motor planning kind of activities and activities that are incorporating those more growth senses. So therefore you have to have an environment that. Is big enough to offer the opportunities to do things, to build things, to construct obstacle courses, which is just not something that's possible in, say, a school environment or in a home environment, because there's just not, there's just not space for those things.
Do you feel like the outdoors or a playground is more effective, as you were saying that? That's what I was thinking of. Well, I mean it technically like a playground. I mean, technic, I technically, I guess, It could be possible that a playground could meet like the basic criteria. Like I'm sure there's a, there's probably a solid argument that there's many playgrounds that could just thinking, I'm just curious as you're thinking.
Yeah, no, I've, no, I mean, that's an interesting thought too because I mean, there's all these people now that are trying to focus private practice on out, like outdoor driven kind of play experiences for kids, or at least I've seen lots of people that are trying to focus on that. But I don't know. I had never really thought about that.
I mean, it certainly would be possible. I think it would probably be more challenging because the environment isn't flexible and it could be pretty unpredictable. But honestly, if probably c realistically, I mean, if a family had a trampoline and a basic swing set with two or three swings, we could probably meet all those things realistically.
Yeah, I think it's, it is, it's very strict. But I think it's almost like, I mean, you heard me struggling through that like, cuz it's so. Hard to put what that is into this very structured approach. It's just mm-hmm. It doesn't fit. And it's like, yeah. And I think the thought process with her was, I mean, if you look at like a's gene heirs, like her background is as a, she was an OT bachelor's, but she got a PhD in neuroscience.
So her focus was really to be a scientist and to find like a very standardized way to. Bring everything forth because she wanted, basically, you know, she came up with this really amazing idea about, you know, how can we treat children that as she was talking about them, she talked about them as being learning disabled at the time.
But talking about, you know, these kids that have these developmental challenges, how do we approach this and. Like now there's a lot of people that thought she was crazy, and so her thought process was like, I have to come up with a standardized way to offer this treatment so that I can build the evidence base to provide it.
However, in doing that, she also like kind of. Put herself in a box, kind of essentially put practitioners in a box because there's, there's only but so many people who can do it the way it's supposed to happen. Like, the only place that I could really think of where it very likely is happening is at a place like the Star Center that's in Colorado which is.
Very likely offering something like that. However, if you if anybody's unfamiliar with the Star Center, they're more of a, essentially a private clinic that's offering a very highly specified child individualized, family individualized approach to kids that have sensory processing challenges.
A lot of times people are flying out to live in Colorado for a couple months at a time and their kid is in constant therapy. Whether it's O T P T speech family oftentimes has psychological stuff they're doing, working on together too in therapy. So if you think about it, That's like, that's amazing.
But I, I know very few people who could probably do that. Yeah. It's very feasible or implementable. No, no, not at all. Yeah, not at all. Even to, like, I, I had looked at. You know, like, I forget exactly what they call it, but it's almost like a practitioner training program. And even for say, like an ot, like your I to go out there and receive intensive couple day training, it is thousands upon thousands of dollars.
So even if the thought there is, you know, like we're gonna take the train the trainer approach so that we can spread all these people out across the United States, across the world to be able to do their thing and do this in other places. They're not making that accessible to the trainers essentially either.
So really it seems like, you know, places like that, like they're doing it the way they c they're doing it in the ideal circumstances, which most of us cannot do that. Yeah. More of a research feel. Yeah, I yeah, there was just a, if anyone's interested in. Like discussing this a little bit differently.
There's a Twitter, if anybody spends time on Twitter, there's something called ot, OT Talk or ooc. And it's, it's about this exact issue too, which I thought was kind of funny. I didn't realize that. But Jenny, I'm very Jenny mentioned that it's very hard to control variables and, and focusing on one type of treatment approach is a big mistake that we see happening a lot.
Yeah. Especially the evidence to support it, which I think is so true. And I think. I, I mean, Jenny, if you wanna share too, feel, feel free to interrupt me. Yeah, no, absolutely. I've I've actually, I'm familiar with the Star Center. I've actually gone to their you know, workshops that they do and everything, and they do use the foundation of si but it's really in addition to that, it's very heavily relationship based.
It is child led, but. You know, SI is not the only one that's child led. I mean, I'm, I'm currently getting certified in d I r floor time, for example, which is also completely child led relationship based. So my point is, I just think it's a mistake, you know. That we put so much focus in our profession in one treatment approach.
And I think it's kind of like backfired on us a little bit because Yeah. Now, you know, kind. Yeah, I agree. A b a has kind of now become the gold standard working with these kids because they are, they're evidence based and OT is not evidence based. Mm-hmm. So, you know, I think we really need to you know, talk about.
The use of so many different theories and frameworks that we have to pull from to support the children as best as we can. I agree. I think part of the reason. To consider too that a, you know, a, b a calling themselves evidence-based, which they absolutely are. They have a lot of evidence, but they also, right out of the gate we're developed sort of with the psychological approach of we're gonna take a ton of evidence.
So that's really. What is the key for building their evidence base is the fact that they're taking data by the second and they're taking data about all kinds of things, and they have very standardized procedures for how they're doing everything versus that is just not how we do things in ot. We just, we don't do things in a standardized fashion because that's just not the nature of our profession.
And in thinking too about even. Like thinking too about like d i r. So like I also have I'm also familiar in d i r and I've done training in it and thinking about d i r and like sensory kind of approaches to treatment. The whole point again is that it's supposed to be highly, highly personalized and highly, highly focused on, you know, what's driven, what's drives the child, what drives this family, what are the motivations in the individualized struggles for this particular kid versus You know, an approach like ABA could be looking at three different children and taking essentially the same behavioral approach to address the, what looks like the same problem.
We're just looking at, we're looking at the kid in a different way. I also think too of, yeah, I also think too, like if you think about the kind of I think that a b a because you can collect so much data as a result, there's a lot more literal research studies out there that can, you know, kind of toot like, this is the approach we took and it worked.
Which having, you know, having been in an a, b, a preschool and seen a lot of the stuff that they do, the abso absolutely a lot of kids can make progress in that kind of model. But at the same time, They can track so much more than we can in a, because they can take data about every little millisecond of things that the kid is doing because they have a, a scale or a rating for something to go along with all of the stuff that we're tracking versus a lot of times, I, I know, I'm sure Katie, you can probably resonate with this, a lot of times with sensory treatment, us tracking data looks like.
Improved in comparison to last session or like better focus in this area. So like that to, of course, looking at that somebody, you know, somebody outside looking at that data is gonna be like, what are they talking about? Yeah. Because that isn't data. That's like, unfortunately our data. Exactly. A hundred percent.
I agree. And you know, there is some question as to the validity of, of that, that data. Mm-hmm. Sure. You know but. You know, the fact that it's just only taking into account observable behaviors is concerning and not taking into account anything, you know, what's causing those behaviors. So, you know, I think the sensory and relationship, individualized based approaches are all wonderful.
And I think that the. Airs Si is wonderful. Unfortunately, I just think it's not realistic, like what you mentioned for a lot of situations. Yep. Yeah. I don't, I don't think we're realistic. That's where we could happen. Yeah. That's where it becomes really tricky is, you know, working in a clinic, working in a.
In a home, you know, now, you know, a lot of, you know, we're, we're focusing a lot more on parent coaching aspects, so we're doing a lot more in the home with the families, but like you said, we, that's not a type of a thing that can be done in a home environment. Mm-hmm. So it just makes it really tricky to Yeah.
To offer something like that and for it to, we know with Phil Validity. Yeah. I think That is why I, I think maybe next Tuesday. Yeah, next Tuesday I'm going to spend some time talking about like practice based evidence and how, what kind of that looks like, how to track it what kind of tools. We can try to use, it's definitely, you know, not perfect, but I do feel like that is kind of the answer to this issue.
In a way, I don't know, you can definitely disagree with me there, but being able to have enough clinicians showing like, look at what we're all these things we're doing and improving how many goals we've improved. How many cool attainments we've made. Yeah, I think that'll be an interesting topic.
And something I've personally been really passionate about to try to figure out how to capture this in a way that is easy for clinicians and also means something to, to people who have who care about data in a way that I think honestly that like. Teaching OTs how to collect data, you know, more about what evidence-based practice is, is so important.
Like I did a study on evidence, like the use of evidence-based practice mm-hmm. In school-based therapists. And the majority of them did not even know the definition of Yeah. Let alone that that tracks, that sounds about right. Unless they had graduated, like within the last, you know, You know, five years.
This was done in 2012, but unless they had graduated in the, the last five years, they had no idea what it was. So I feel like it kind of went from one extreme where you have si, which is, you know, like you said, very strict, very structured. And then it went to the other extreme where people were just throwing any kind of SI intervention they could at the child.
Well, let's give 'em a weighted vest. Let's give them this, let's give 'em that. Well, First of all, if you give them, you know, five interventions at once, you have no idea if any, which one is working, if any of them are working. Right, right. So it's almost like we have to be trained as a profession on how to look at an intervention, a singular intervention, and determine if that intervention is effective or not.
Mm-hmm. And then if it's not, we move on to the next, but instead of this idea of just like throwing different things out there and seeing what sticks basically. Yeah. We have to get, we have to get better at taking data. Yeah. So I, I, I appreciate that point of one at a time too. I, I don't think I do that well and that's definitely a good point cuz you can't, you, you, you can't control those other fa va variables.
So unless you're doing just one thing. So I think that's a very good point. Also, Jenny, I'd love to learn more about that the study later on too. That's awesome. Well, yeah, I will my goal for that session, or that it'll be like a live video, is to have a re resource at the end that I will, you know, be trialing myself to see if it works.
And hopefully something that can be user friendly and, and quick to. To track. I know a lot of like electronic health records are also trying to do this, but just to have something that you do yourself yeah, that's kind of my goal. So look out for that. This has been an awesome discussion. I think.
I really apologize. I don't think this was my best journal club. It was really hard because of this issue. So thanks for bearing with me. I would love to hear, you know, more thoughts. To about people listening to this later. Thanks if you got this far and definitely keep this conversation going. I think it's an important one and not one to get overwhelmed with.
I hope it wasn't like sad to see the, the data, but more empowering to, to say, okay, let's do this. Let's figure this out. And there is a solution and at least you know, one we can work on together. So thank you all for being here. I really appreciate it. And. I hope you all have a great rest of your Tuesday and stay, stay cool wherever you are.