#178 - Motion Sickness Toolkit From a Sensory Perspective

by Jessica Hill, COTA/L & Rachel Harrington, COTA/L, AC November 10, 2021

#178 - Motion Sickness Toolkit From a Sensory Perspective

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Motion Sickness Toolkit From a Sensory Perspective 

Motion sickness is caused when your brain can't make sense of the information sent from your eyes, ears, and body. Many of us have experienced motion sickness at some point in our lives and many of us experience it frequently. 

This episode is full of helpful tips and tricks related to motion sickness! 

We talk about using a variety of sensory strategies including olfactory strategies, oral motor and gustatory strategies, and of course proprioceptive strategies. 

We also chat about the vestibular system and completing different programs that may be beneficial for those experiencing motion sickness, including the Astronaut Training Program.

If you, your child, your client, or someone you know experiences motion sickness or gets sick during movement based tasks, this episode is for you!

Key Points From This Episode:

  • Learn about what motion sickness is.
  • How to use oral motor input and sensory stimulation to overcome motion sickness.
  • Why proprioceptive input like weighted blankets can help with more than just motion sickness.
  • Learn the best multisensory processing activities combining movement, vision, and auditory input.
  • Strategies for regulating your nervous system using proprioceptive work.
  • For you to benefit from these activities, consistency is key!
  • Find out how to identify and avoid vestibular overstimulation. 
  • Remember, everyone is different!

Highlights:

“When in doubt, prop. it out.” — Rachel Harrington[0:12:58]

“If your child goes to OT once a week, and they’re working on these things, you also should be doing them at home as much as possible.” — Jessica Hill[00:13:52]

“Combating motion sickness from the inside out, consistency is key.” — Rachel Harrington[00:16:11]

Links Mentioned in Today’s Episode:

Harkla

All Things Sensory on Instagram

All Things Sensory on Facebook

The Astronaut Training Program from Vital Links

The Listening Program from Advanced Brain Technologies

 

Full Show Transcript

[00:00:02] RH: Hey, there. I’m Rachel.

 

[00:00:03] JH: And I’m Jessica and this is All Things Sensory by Harkla. Together, we’re on a mission to help children, families, therapists, and educators live happy, healthy lives.

 

[00:00:12] RH: We dive in to all things sensory, special needs, occupational therapy, parenting, self-care and so much more. In each episode, we share raw, honest, fun ideas and strategies for everyone to implement into daily life.

 

[00:00:25] JH: Thank you so much for joining us.

 

[EPISODE]

 

[00:00:32] RH: Hello our good sensory friends. We’re so happy you’re here. This is All Things Sensory by Harkla. You’re listening to Rachel and Jessica.

 

[00:00:40] JH: This is Episode 178. We’re getting closer and closer to 200 episodes. Holy crap!

 

[00:00:50] RH: Today, we are talking about motion sickness.

 

[00:00:53] JH: Oh!

 

[00:00:54] RH: Yes.

 

[00:00:55] JH: Okay. Okay.

 

[00:00:56] RH: If you have a sensory kiddo or if you are a sensory individual…

 

[00:00:59] JH: Which you are because everyone has a sensory system.

 

[00:01:02] RH: Thank you. Then chances are, you are probably all too familiar with motion sickness. If you’re not, then lucky you.

 

[00:01:11] JH: I had motion sickness when I was a kid.

 

[00:01:13] RH: I had the worst.

 

[00:01:14] JH: When I’d be in the backseat of the car, driving through a canyon, my parents gave me the little Dramamine pills so I’d pass out. But now, as an adult, I don’t typically experience motion sickness. I can even read in the car now. It’s really interesting.

 

[00:01:33] RH: I threw up all the time in the car as a kid. Before I got pregnant, I would get motion sickness. I wouldn’t throw up but I would get really uncomfortable and nauseous. After pregnancy, I feel like a new woman.

 

[00:01:46] JH: Oh! What?

 

[00:01:48] RH: I know. It’s weird, but it just goes to show that your sensory systems can change.

 

[00:01:52] JH: Constantly changing.

 

[00:01:54] RH: We’re going to share what motion sickness is, strategies that you can help in the moment, as well as what you can do to help reduce motion sickness from the inside out. Finding the underlying cause and working through that.

 

[00:02:10] JH: There you go. Okay. What is motion sickness? We will link the article that we got this definition from because it’s a pretty good one. Motion sickness occurs when your brain can’t make sense of information sent from your eyes, ears and body. Lots of motion in the car, airplane, boat, amusement park ride can make you feel queasy, clammy, sick to your stomach. Some people vomit. Being car sick, sea sick or air sick are all motion sickness.

 

[00:02:44] RH: Okay. You brain receives signals from your motion sensing parts of your body. Your eyes, your inner ears, your muscles and joints. When these parts send conflicting information, your brain doesn’t know whether you’re stationary or moving, and your brain gets confused and that reaction makes you feel sick.

 

[00:03:03] JH: Let’s talk about this from an OT perspective. Our vestibular system is our sense of movement. We activate our vestibular system with head position changes, or head movements because our vestibular system is located in our inner ear canals. Any time we are in motion, that is our vestibular system in play.

 

[00:03:27] RH: What’s so weird is you can be sitting in a car stationary, but moving. 

 

[00:03:32] JH: Because you’re still moving through space.

 

[00:03:34] RH: But you’re sitting stationary, so it’s weird.

 

[00:03:37] JH: It’s a weird concept.

 

[00:03:38] RH: Yes. Your vestibular system is directly connected to your visual and auditory system. Looking at those definitions that we just gave, when our brain can’t make sense of that information from our body, movement, vision, auditory input, we feel that motion sickness.

 

[00:03:59] JH: So, if you, your child, your clients, your students have challenges in any one of these or three of these sensory systems, you’re probably going to experience motion sickness.

 

[00:04:11] RH: If you don’t experience motion sickness…

 

[00:04:14] JH: What is your secret? Tell us how you do it, please.

 

[00:04:19] RH: Okay. Here are some strategies that we came up with that you can use during your car rides, boat rides, airplane rides, whatever ride you’re on to help alleviate the motion sickness symptoms.

 

[00:04:31] JH: The first one is going to be oral motor input, because oral motor input is a form of proprioceptive input which is calming to our nervous system. Chewing gum, pushing your tongue to the roof of your mouth, sucking on hard candy. Chewy, crunchy foods or candy, those are all going to help your body feel more regulated.

 

[00:04:55] RH: I thought that said meditation, so I put deep breathing next to it. Which, meditation might work.

 

[00:05:04] JH: [Inaudible 00:05:03].

 

[00:05:04] RH: Another one, medication, like Dramamine can be helpful. 

 

[00:05:07] JH: Yeah. It helps you pass out.

 

[00:05:09] RH: I don’t like it, but…

 

[00:05:11] JH: Well, I am taking it since I was a kid, so I actually know. I know that there are other medications out there that can help with like the nausea, and just overall.

 

[00:05:19] RH: Yes.

 

[00:05:20] JH: Yeah. That’s always an option.

 

[00:05:21] RH: If that’s not your route, then work on taking deep breaths, smelling the roses, and blowing out the candles, really consciously present in the moment. Get a little woo-woo. 

 

[00:05:32] JH: If you’re in the car, you can roll down the window and get a little bit of fresh air, if the air is nice and cool outside.

 

[00:05:38] RH: I love using olfactory input, such as smelling peppermint, essential oils. I used doTERRA, so I also love balance, wild orange is helpful, spearmint, [inaudible 00:05:50] is another really helpful one too. 

 

[00:05:54] JH: If you’re chewing minty gum, you get the added benefit of also being able to smell that calming mint scent. Someone tell us, why is that minty scent so calming?

 

[00:06:06] RH: I don’t know. I could probably figure out a reason, but…

 

[00:06:08] JH: I’m sure we could look it up, but not right now. We’re busy recording this podcast for you. Someone else look it up and tell us.

 

[00:06:14] RH: There are also pressure points on your wrists, that if you push like right where your watch would be. When I do that, I can feel — this sounds really weird, but I feel like it’s easier to swallow when I’m pushing on my wrist and afterwards.

 

[00:06:29] JH: Oh! It’s harder for me to swallow.

 

[00:06:30] RH: Afterwards?

 

[00:06:32] JH: During.

 

[00:06:33] RH: No. Push on your wrist, push on those pressure points.

 

[00:06:35] JH: I know. It’s hard for me to swallow when I’m pushing on that pressure point. That freaked me out.

 

[00:06:40] RH: Maybe it’s because you weren’t like ready to swallow. You were trying to force it.

 

[00:06:44] JH: I don’t know.

 

[00:06:46] RH: Okay. Maybe that’s just me, I don’t know.

 

[00:06:49] JH: I hope you tried it with us just now, because I was trying it.

 

[00:06:51] RH: But looking out the window, rolling it down like Jessica said, sitting in the front of the car.

 

[00:06:57] JH: Versus the back, yeah. Using weighted items. That weight is proprioceptive input, which we’ve already said is calming to the nervous system, so try it out.

 

[00:07:08] RH: There you go.

 

[00:07:09] JH: Can you say go with a weighted blanket on a carnival ride?

 

[00:07:11] RH: I don’t know. Probably not.

 

[00:07:13] JH: You could wear your weighted vest on the carnival ride.

 

[00:07:16] RH: Yes. But these are all great, right? These are good, last minute — I feel like I’m going to hurl, what am I going to do strategies. 

 

[00:07:25] JH: Sometimes you just got to throw up though.

 

[00:07:28] RH: Oh gosh! I hate vomiting.

 

[00:07:29] JH: Have a throw up bag in your car. They have them on the airplane, but they’re small.

 

[00:07:34] RH: Always. Gross. Okay. I’m not a vomit person, so I’m going to — we’re going to work from the inside out.

 

[00:07:40] JH: We’re going to move on.

 

[00:07:41] RH: We’re going to try to help you, your family, your kiddos improve vestibular, visual auditory, that multisensory processing so we don’t get car sick…

 

[00:07:53] JH: Or at least reduce it, right? At least reduce that motion sickness. Because this is not like a cure-all. We’re not guaranteeing that you’re going to not have motion sickness if you try these strategies, but these are things that could potentially help your sensory system process better.

 

[00:08:10] RH: Mm-hmm. First one is The Astronaut Training Program from Vital Links. This program works specifically to improve visual, vestibular, auditory triad and we love using those preparatory activities to do throughout the day.

 

[00:08:26] JH: Yep. Without the spinning board. If you’re familiar with the astronaut training, a lot of their activities are with the astronaut board, which is the rotation device, the spinning board. But they also have the different ones that you can do without the rotation board, so different things like — there’s one called robot zapping, which is my favorite. Just different visual, vestibular auditor activities. We’ll link the link for the astronaut training in the show notes so that you can check them out.

 

[00:08:55] RH: Yep. Another one that we talk about all the time is primitive reflex integration. If your reflexes are not integrated or if you are holding on to these innate, immature reflex patterns, you’re not going to be able to perform at an optimal level. Let’s work on integrating those reflexes and we might see some improvement, especially with the Moro reflex.

 

[00:09:19] JH: Yes, so true. Okay. Another thing that you can do and this is great in therapy sessions, but you can also do this at home if you have a swing or access to a swing, is to complete controlled and functional swing activities that include a visual component. The first one that comes to my mind is to sit on a swing, have a visual chart on the wall and you’re going to read that visual chart while you are swinging. Now, if you want to also add more of an auditory component, you can listen to music at the same time or you can also turn on a metronome and do this in coordination with the metronome.

 

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[00:09:56] RH: We just want to take a minute and talk to you about our company, Harkla. Our mission at Harkla is to help those with special needs live happy healthy lives. Not only do we accomplish this through the podcast, but we also have therapy products, easy to follow digital courses and the Harkla Sensory Club to try to bring holistic care to you and your family.

 

[00:10:17] JH:Listeners of the All Things Sensory podcast get 10% off their first purchase at Harkla with a discount code, “SENSORY.” 

 

[00:10:25] RH: We would highly recommend checking out some of our best-sellers, like the compression sensory swing, weighted blankets or our course on sensory diets and primitive reflexes.

 

[00:10:35] JH: The cool thing is, that 1% of each sale gets donated to the University of Washington Autism Center to support autism research and fund scholarships for families in need to receive in-clinic therapy for their children.

 

[00:10:49] RH: Learn more about Harkla and all we have to offer at harkla.co. That’s H-A-R-K-L-A.C-O and use the code “SENSORY” to get 10% off your first purchase. That’s S-E-N-S-O-R-Y for 10% off.

 

[00:11:07] JH: Don’t forget that all Harkla orders come with a lifetime guarantee and free shipping.

 

[00:11:13] RH: All right. Let’s get back to the show.

 

[EPISODE CONTINUES]

 

[00:11:16] RH: Another activity that you can do are things that require inversion. If you’re sitting on a therapy ball, leaning over and going over backwards, grabbing an item, picking it up and throwing it to a target. Inversion, summersaults, like your head is going upside down.

 

[00:11:32] JH: Then if you can add the visual and auditory component in there at the same time, you’re working on all three of those system. Another one is going to be trunk rotation, so that is where your lower body is stationary and you rotate your trunk shoulders and head to go to the other side, then you go the other direction. Maybe you have a visual chart on the wall behind you, so you’re rotating your trunk to read the chart, rotating it the other way to read the chart and you’re going back and forth.

 

[00:12:01] RH: Okay, great. Another one is the listening program from Advanced Brain Technologies. This is a great tool to have in your back pocket to really work on sensory processing from the inside out. It’s like a workout for your brain. It’s awesome and it’s all acoustically modified music.

 

[00:12:18] JH: There are other therapeutic listening programs out there. We aren’t trained in the other ones, but we know there’s other great ones out there that you can find.

 

[00:12:27] RH: Yep. Okay. Multisensory processing activities, things like doing the metronome with the infinity loop, and the visual chart where you have to process the auditory, the movement, the visual input. Dribbling a ball, adding that in there. That’s great, great practice.

 

[00:12:46] JH: All of those multisensory activities where you combine movement, vision and auditory, bam! You’re working on it. Easy-peasy.

 

[00:12:52] RH: Bam!

 

[00:12:53] JH: It probably won’t be easy, but you need to do it.

 

[00:12:55] RH: Yes. The last one that we want to note is, when in doubt, prop. it out. Any times you’re doing these activities, you want to follow with proprioceptive input. Heavy work, stretching, compression of the joints, the muscles, chewing gum, you have those receptors in your mouth as well. That helps – that’s kind of the cure-all of like regulating your nervous system.

 

[00:13:19] JH: Yep. Especially if your child gets really bad motion sickness or gets motion sickness really easily, then they’re going to need shorter amounts of time with these activities. So quick and fast, and then more time with proprioceptive input.

 

[00:13:38] RH: Yes. A couple more things that we want to note. It’s really important that if you are going to try these activities, they need to be done on a consistent basis in order to really make a difference, in order to see positive results.

 

[00:13:52] JH: If your child goes to OT once a week, and they’re working on these things, you also should be doing them at home as much as possible. We know that life happens and maybe you can’t do them every day, but do them as much as possible. It’s like going to the gym. We go to the gym once a week, you’re not really going to make a progress. But if you do it three times a week, you’re going to see some progress. You go five times a week, you’re going to see some progress. 

 

[00:14:20] RH: Yep. Same thing applies here. These activities can be done with adults, but typically, adults are a little bit more sensitive, so start slow with these activities and make sure you’re doing the proprioceptive activities afterwards.

 

[00:14:33] JH: Always, always with vestibular, watch for signs of overstimulation. This can look like dizziness, nausea, pale skin, sweating, vomiting, aggression or changes in mood or affect. These signs can happen in the moment, short amount of time later or even hours later.

 

[00:14:54] RH: Mm-hmm. That’s what happens to me.

 

[00:14:55] JH: I remember. You got very angry, right?

 

[00:14:57] RH: Very angry about an hour later after spinning ten times in each direction. I’ll never forget that. Okay. Let’s go through a quick example of how you would include these activities in your daily routine. 

 

[00:15:12] JH: Okay. Each one should take about one to three minutes to complete. Quick, simple, fast. In the morning, start with spinning five times in each direction. Go five time counterclockwise, stop, five times clockwise and stop.

 

[00:15:31] RH: Yep. When you are stopping, make sure that you’re stabilizing your gaze on a stationary object, like a door handle before you spin the other direction. Before lunch, try inversion over the therapy ball or doing some summersaults. Work on that inversion. Then after lunch, try a multisensory processing task.

 

[00:15:55] JH: After school, complete a swing activity while you read a visual chart. Then before bed, something calming. We don’t want a lot of vestibular input right before bed, because it’s going to be harder to go to sleep, so try the listening program for 15 minutes before bed. 

 

[00:16:10] RH: There you go. Combating motion sickness from the inside out, consistency is key.

 

[00:16:16] JH: Remember, we’re not making any promises. These are just recommendations. Everyone is different, so you do have a little…

 

[00:16:23] RH: What?

 

[00:16:24] JH: What? They are. I know. It’s weird. So, you have a little bit of trial and error here on what’s going to work for you, and your child, your client.

 

[00:16:33] RH: Okay. That is all that we have for out motion sickness toolkit.

 

[00:16:37] JH: But don’t leave yet.

 

[00:16:40] RH: But wait, there is more.

 

[00:16:41] JH: There’s more.

 

[00:16:42] RH: Let’s go through some of the questions that we have this week. If you are new here, we are answering your questions at the end of every podcast. We try to do about two questions. You can send them to us on Instagram at All things Sensory Podcast or harkla_family, Facebook, email. Just send us your questions, a voice memo and we’ll answer them.

 

[00:17:03] JH: These questions today come from our Harkla Instagram. The first one says, “Oral stimulation while at school for a preschooler, who’s about three years old.” Now, I wasn’t really sure.

 

[00:17:20] RH: We don’t have a lot of context here.

 

[00:17:22] JH: Yes, that was it. If you are asking how to provide oral stim at school for this three-year-old, that’s a great question. Let’s talk about that. I think the first step for me anyways would be to provide lots of crunchy, chewy, harder, cold, frozen food for their snacks and lunch.

 

[00:17:42] RH: I love that. My guess is that they are probably having to wear masks at school, and that can be really challenging. A lot of kiddos will chew on their masks. I’ve seen masks that have little chewies in them, but if you can fashion that on there somehow. That can be helpful. If your kiddo isn’t using a mask, you can have a bracelet, a necklace, chewy, something that you practiced at home that’s safe for them to chew.

 

[00:18:09] JH: ARK Therapeutic has some great — what they call it chewelry.

 

[00:18:13] RH: Chewelry, yes. 

 

[00:18:15] JH: Okay.

 

[00:18:16] RH: I think that’s good.

 

[00:18:17] JH: I think that’s good for that. If this was your question and you want to expand on this a little bit, feel free to shoot us a DM and let us know.

 

[00:18:23] RH: Okay. Next one, “Tips for navigating crowds with a sensory-sensitive kid.”

 

[00:18:28] JH: Oh man!

 

[00:18:29] RH: Whoa! I think just navigating crowds in general is a tough one for a lot of kiddos.

 

[00:18:35] JH: For sure.

 

[00:18:36] RH: Then you throw in some sensory sensitivities.

 

[00:18:40] JH: Yeah, it’s really hard. If they’re sensitive to auditory input, try some headphones. If they don’t want to wear headphones because they feel like it makes them standout and people are going to look at them, maybe use headphones with music, so they’re very clearly listening to music, so it doesn’t seem as “weird.”

 

[00:19:02] RH: Even if they aren’t listening to music, just get headphones that have a cord or look like music headphones.

 

[00:19:12] JH: And you can tell them, “Hey! We’re going to pretend like you’re listening to music.”

 

[00:19:14] RH: Yep. Try that. You can have to block out some of the visual input, wear a baseball cap. You can have them wear sunglasses. Unfortunately, you can’t tell everyone to just move out of the way. 

 

[00:19:28] JH: No. If you’re going to a crowded area, see if you can keep it really, really quick. Shorten it as much as possible.

 

[00:19:35] RH: You can have them maybe walk behind you, hold their hand and have them walk behind you so they’re looking at you instead of everything else in their visual field.

 

[00:19:46] JH: Weighted items are going to be great because that proprioceptive input from weight can be calming for them. Maybe a weighted compression vest, weighted lap pad if they are like sitting in the grocery cart.

 

[00:19:58] RH: Mm-hmm. Yep, that’s a good one. If they’re old enough, some chewing gum would be helpful, pushing their tongue to the roof of their mouth, a fidget, a stress ball, things for them to hold on to, security items if that’s what they’re into. 

 

[00:20:15] JH: If possible, prepare them ahead of time. Do a social story, watch some videos about where they’re going and how crowded it’s going to be, so that they’re more prepared and they can anticipate what it’s going to be like, so that they’re not surprised. A sensory diet beforehand with lots of calming input could be helpful, so they’re not as anxious.

 

[00:20:36] RH: Yeah. Even a sensory diet afterwards too.

 

[00:20:37] JH: Oh, for sure. Definitely afterwards.

 

[00:20:39] RH: You could have them carry a backpack that is weighted and has all sorts of heavy items in there to give a more proprioceptive input. Anything else?

 

[00:20:49] JH: That’s all I can think of right now. If you asked this question and you want more specifics, let us know.

 

[00:20:54] RH: Okay. Cool. Thanks for the questions. Thanks for being here. Hope this episode was helpful for you. If it was, leave us a review on iTunes. 

 

[00:21:02] JH: If it wasn’t helpful, well… 

 

[00:21:05] RH: Maybe it’s just not applicable, that’s okay.

 

[00:21:07] JH: That’s okay. Okay. We will talk to you next week.

 

[00:21:11] RH: Thank you so much for listening to All Thing Sensory by Harka. If you want more information on anything we mentioned in the show, head over to harkla.co/podcast to get all of the show notes. 

 

[00:21:22] JH:We always have the show notes and links, plus full transcripts to make following along as easy as possible for everyone. If you have follow-up questions, the best place to ask those is in the comments on the show notes or message us on our Instagram account, which is at @harkla_family. If you just search Harkla, you’ll find us.

 

[00:21:42] RH:Like we mentioned before, our podcast listeners get 10% off their first order at Harkla, whether it’s for one of our digital courses, one of our sensory swings, the discount code SENSORY will save you 10%. That code is S-E-N-S-O-R-Y. Head over to harkla.co/sensory to use that code right now so you don’t forget.

 

[00:22:05] JH:We’re so excited to work together to help create confident kids all over the world and work towards a happier healthier life.

 

[00:22:12] RH: All right. We’ll talk to you guys next week.

 

Just a friendly reminder, this is general information related to occupational therapy, pediatrics and sensory integration. We do not know you or your child, therefore, we do not know any specific needs. Therefore, you should always refer back to your pediatrician and occupational therapist for more information.

 

 

BORING, BUT NECESSARY LEGAL DISCLAIMERS

While we make every effort to share correct information, we are still learning. We will double check all of our facts but realize that medicine is a constantly changing science and art. One doctor / therapist may have a different way of doing things from another. We are simply presenting our views and opinions on how to address common sensory challenges, health related difficulties and what we have found to be beneficial that will be as evidenced based as possible. By listening to this podcast, you agree not to use this podcast as medical advice to treat any medical condition in either yourself or your children. Consult your child’s pediatrician/ therapist for any medical issues that he or she may be having. This entire disclaimer also applies to any guests or contributors to the podcast. Under no circumstances shall Rachel Harrington, Harkla, Jessica Hill, or any guests or contributors to the podcast, as well as any employees, associates, or affiliates of Harkla, be responsible for damages arising from use of the podcast.

Keep in mind that we may receive commissions when you click our links and make purchases. However, this does not impact our reviews and comparisons. We try our best to keep things fair and balanced, in order to help you make the best choice for you.


This podcast should not be used in any legal capacity whatsoever, including but not limited to establishing “standard of care” in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the podcast.

Jessica Hill, COTA/L & Rachel Harrington, COTA/L, AC
Jessica Hill, COTA/L & Rachel Harrington, COTA/L, AC

Rachel Harrington, COTA/l, AC, CPRCS, and Jessica Hill, COTA/L, CPRCS are Harkla's in-house Certified Occupational Therapy Assistants (COTA) and Certified Primitive Reflex Clinical Specialists. They have been working with children for over 6 years in outpatient settings. They specialize in creating easy-to-digest, actionable content that families can use to help their child's progress at home. Jessica and Rachel are the in-house experts, content creators, and podcast hosts at Harkla! To learn more about Jessica and Rachel, visit the Harkla About Us Page. Make sure to listen to their weekly podcast, All Things Sensory by Harkla for actionable, fun advice on child development.


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#335 - Listener Question: Tips for an Overstimulated Child and Parent!
#335 - Listener Question: Tips for an Overstimulated Child and Parent!

by Jessica Hill, COTA/L & Rachel Harrington, COTA/L, AC November 20, 2024

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