sensory/cog 1
Structured Observations: Observe the following sensory systems:
Vestibular Tactile Proprioception Vision Auditory Olfactory and Gustatory
Areas of SI dysfunction per Ayres
Vestibular-proprioceptive dysfunction Tactile processing dysfunction Developmental dyspraxia
Motor Execution
completing the motor act itself •This is what we observe to assess ideation & schema
Emotional ABC's
computer/training program, interactive, understand and manage emotions, age 4-11, helps build child's emotional vocabulary, identify emotions in others, proper responses to their own feelings, C = choices, B = behavior, A =
Ideation
conceptualization, having an idea of what you want to do -ideation = can carry it out, but its uncoordinated
6 states of arousal in infants & children:
deep sleep, light sleep, drowsy, quiet alert, active alert, & crying -quiet alert state ideal for functioning
Organization of a response
determination of a cognitive, affective, and/or motor response
Interoceptive DD
difficulty .interpreting stimulation form internal organs (may not feel the need to use the toilet or may have frequent somatic complaints such as stomach aches)
Gustatory DD
difficulty determining/interpreting characteristics f sensory stimuli that is tasted
Visual DD
difficulty determining/interpreting characteristics fo sensory stimuli that is seen (may be called dyslexia)
Proprioceptive DD
difficulty determining/interpreting characteristics of sensory stimuli experienced through the use of the muscles and joints
Tactile DD
difficulty determining/interpreting characteristics of sensory stimuli that is felt on the skin or interpreting higher level visual/spatial characteristics of touch (includes stereognosis and graphesthesia disorders)
Olfactory DD
difficulty determining/interpreting characteristics of sensory stimuli that is smelled
Auditory DD
difficulty interpreting characteristics fo sensory stimuli that is heard (may be called auditory discrimination disorder)
Vestibular DD
difficulty interpreting characteristics of sensory stimuli experienced through movement of the body through space or against gravity
Informal Observation Structured Observations
during play, ADLs, school, etc.
If your engine is low
not attending, lethargic, decreased arousal, sluggish
proprioception
pressure on the joints (ex: jumping), helps us know where our body is in space
Calming techniques
rhythmic vestibular input (ex: rocking chair) Deep pressure (ex: weighted blankets) Proprioceptive input (ex: exercise)
Orientation
selective attention to new input
CHART ON SLIDE 18
sensorimotor integration supports development of complex behavior and interaction skills -difficulty in anything on the bottom --> everything above it is effected -ex: motor planning difficulties (coordination, etc.) -tactile is the first sense to develop -can detect issues early -everyone is different in what is effected with main dysfunction
types of sensory rooms
sensory integration rooms sensory modulation rooms Snoezelen rooms
What is the definition of Sensory Integration?
the neurological process of organizing and processing sensory input from one's body and the environment for function within the environment.
•Sensory integration is
the neurological process of organizing and processing sensory input from one's body and the environment for function within the environment. -integration is actually processing it and functioning in the environment (reacting appropriately) -constantly processing information to function in everyday life
We know that ...Not all engines (nervous systems) are created equal!
some kids have engines that are very extreme
DYSPRAXIA
1.Poor ability to perform slow arm movements 2.Poor thumb-finger touching 3.Poor tongue to lip movement
Sensory Rooms in Mental Health
"Sensory Room" is an umbrella term used to categorize a broad variety of therapeutic spaces specifically designed and utilized to promote self-organization and positive change -Help create a safe space -Facilitate the therapeutic alliance -Provide opportunities for engagement in prevention and crisis de-escalation strategies, as well as a host of other therapeutic exchanges (teach skills,) -Promote self-care/self-nurturance, resilience, & recovery
why SI works
" ...aspects of the environment actually become incorporated into the biology of the organism via altered neural processes. Such neural changes then influence the way the organism subsequently interacts with the environment"
Guiding Questions: Vestibular
"How does the child respond to age-appropriate types of movement?" "What kind of movement does the child seek outOR avoid to function in everyday life?"
Guiding Questions: Tactile
"How does the child respond to age-appropriate types of touch?" "What kind of touch does the child seek out OR avoidto function in everyday life?"
Guiding Questions: Proprioceptive
"What kind of proprioceptive input does the child need to function in every day activities?" "What kind of proprioceptive input does the child seek out OR avoid to function in everyday life?" (Similar questions could be asked about visual, auditory, olfactory, and gustatory input)
For each child we need to ask:
"What supports this child's performance and under what circumstances?" MORE SPECIFICALLY ... How can the environment, objects, or activities be modified on an individual basis to support the arousal needed for learning?
Put something in your mouth
"mouth work" Chewing (provides heavy work to jaw; chew on gum, licorice, hard pretzels, carrots, apples, raisins, etc.) Sucking (has an organizing effect on behavior; sucking hard candy, sucking through straw or water bottle) -chewing = heavy proprioception to the jaw -blowing can help organizing too (whistles)
Sensory Awareness
(eg. awareness of being touched)
Over-responsivity
(undermodulation of sensory input) Responds to sensation in greater than typical -Sensory defensive -Can occur in 1 or more sensory areas Symptoms: -exaggerated avoidant responses to non-noxious stimuli -resistance to certain age-appropriate activities -hypervigilence -unpredicted emotional and behavioral outbursts -difficulty with transitions and upset with change •SENSORY AVOIDERS!! -more sensitive than most children -ex: can be over responsive in vestibular and proprioception, but under responsive in tactile -increased anxiety, fight or flight response (feel sensation too easily/intensely) -may become dysregulated frequently -distractible (may wear headphones), want to withdraw from noisy or compact/crowded areas
Stage One:
*Analyze YOUR engine functioning* Apply the engine words Label your own engine levels -Think about how your engine varies throughout the day Help your child label their own engine and think about how it varies throughout the day -putting words to what the child is demonstrating (ex: you seem tired/your engine seems to be running low)
Stage Three:
*Encourage child to regulate own engine level* Have child try out various strategies to regulate own level of alertness Goal: Child will learn how to regulate own level of attention for learning in appropriate ways for home and school Another Goal: Want to set up the environment to enhance performance in classroom
Stage Two:
*Experiment with methods to change your engine level* Introduce the various sensorimotor methods that may change engine levels Identify your sensorimotor preferences and hypersensitivities Begin experimenting with sensorimotor strategies -what works and doesn't work for them
•Under-arousal
- child is "tuned-out" and doesn't look very awake or alert -Looks more sleepy
•Over-arousal
- may see "shutdown" •Looks awake & alert, but unresponsive to people or environment
Sensory Processing Disorder Versus Sensory Integration Dysfunction
-"terminology differentiates the condition of SPD from the cellular process of sensory integration" -When sensory processing difficulties actually impair performance and engagement •Daily routines or roles •Three major categories of SPD; SMD, SBMD, SDD (discuss more later) -look at when a person has an impairment in function, roles, routines, engagement, etc.
Auditory
-(Auditory processing) note if child has difficulty in understanding directions (e.g., child needs frequent repetition) -Read speech pathologist's report if applicable -Note unusual sensitivity to noise
Children with disabilities may respond to sensory input in more extreme ways
--> Tend to observe more intense responses •Autism spectrum, Aspergers •ADHD •Prodromal state of psychosis •Head injury -go through trauma --> react accordingly -symptoms/signs vary
Time Required for SIPT
-2-2.5 hrs to administer -30-45 min to complete forms and score Time - there is a mandatory break in the middle for PRN to "reset" -blocks 3 hours for administration
Video: Sensory Integration Therapy
-8-10 years = sensory integration matured -development of higher-level skills -perceptual motor defunction, learning disability, etc. -child may approach tasks awkwardly/differently -confusion in actions and behaviors -underlying dysfunction in sensory integration function -higher-level = senses work together (ex: allows the child to engage in activities, like drawing) -protective system with tactile (ex: startle from touch or pain) -systems must be balanced to respond appropriately -one part of the nervous system works with the other to prevent one area from over-reacting (inhibition) -tactile defensiveness = over-reaction to light touch -vestibular system interprets head position compared to the body (dysfunction = disorientation, imbalance, poor muscle tone or posture, etc.) -vestibular therapy = throwing, jumping, etc. -proprioception -motor planning sensory integration therapy allows controlled sensory input with tactile, vestibular, and proprioceptive input for proper functioning. Integration occurs when child actively wants to participate in these activities and applies meaning to them -ex: playing with shaving cream = tactile -ex: tactile and vestibular with swinging, then adding proprioception through pulling on an object to move self through space -ex: proprioception through firm pressure sensations (inhibits tactile defensiveness) -ex: slide down a ramp on a scooter on the stomach = holding head up and vestibular -ex: blindfolded, looking for objects in a tub of beads through tactile
Sensory Integration: this term can refer to:
-A theory (SI theory) -A functional pattern (normal SI abilities) -A framework (based on SI assessment) -A remediation approach (SI intervention)
SI as a treatment
-A type of intervention -Takes into account: •context •meaningful activities (just right challenge) •integration of sensory processing with other system functions (ex: cognition, emotion) -All of these are considered in formation of adaptive response
with mouth activities, consider...
-Action variables: What does the child like to do (chew?) -Quality variables: How it feels or tastes? (sour, spicy, salty, etc.) -Parent variables! Less sugar (sugarless gum); more vs. less nutritious -take dietary needs/preferences into account
3 components of attention
-Alertness -Selection -Allocation -alertness: choosing what to attend to and what not to attend to (pay attention to teacher ad not phone) -allocation: how much time attended to one stimulus and amount of effort required
Underlying philosophy of their program:
-All behaviors have meaning. What is the child trying to communicate on a sensory level -This program provides an opportunity to teach concepts of acceptance, cooperation, expression of needs, and respect for people's differences.
VIDEO: Texas retirement community
-Alzheimer's and dementia patients -Snoezelen rooms: for relaxation and calming, filled with sensory stimulation (light, touch, sounds, smell, etc.) -for: poor communication, frustration, etc. related to dysfunctions -both Snoezelen rooms and multi sensory environments are similar things, depends on the purpose (calming, de-escalation, population, etc.)
Interpretation of Evaluation Findings
-Analyze all of the 'data' from observations, interviews, and assessment findings -Determine if sensory processing is contributing to the child's presenting problems Identify: -If OT is recommended; -Estimate duration of OT (times a week, how long) (depends on setting usually) -Type of service delivery (individual, group, consultation) - will depend on type of setting -can get sample work from the teachers, talk to the teachers or parent, observe the child, etc. (have one hour, usually, to gather data; 30 min maybe in school)
Coping strategies for adults with sensory defensiveness
-Avoiding situations -Being controlling/perfectionistic -Mental preparation - getting ready for the stimuli -Talking through - making rationalizations -Counteraction - engage in activities to negate the effect of stimulus -Confrontation - identifying a plan to overcome the negative reaction -controlling = increasing predictability -how do we overcome it, cope, move on
What is SI dysfunction?
-Deficits in sensory integration result in conceptual and motor learning problems & functioning in everyday life
What can adults do?
-Develop insight into own sensory processing -Learn to self-advocate for needs (accommodations) -Engage in sensory and physical activities to help regulate Read about sensory defensiveness ◦Book by an adult w/ SD - Heller (2002) -evaluate and analyze reactions to sensory input -self-advocate = balance, know how to adapt -regulate = sensory diet -book: how to manage sensory defensiveness
sensory-based motor disorder: Postural Disorders
-Difficulty stabilizing body during movement or at rest in order to meet the demands of the environment or of a motor task -Individual with poor postural control often do not have the body control to maintain a good standing or sitting position •Vestibular-Proprioceptive Dysfunction - 2 types: -Postural-Ocular Movement Disorder -Bilateral Integration and Sequencing Deficits
Brain Gym
-Drink Water -Brain Buttons -Cross Crawls -Hook Ups 26 simple activities, shows whole-brain learning -4 of 26 listed -brain buttons = L with hand and place below collar bone, other hand on belly button, pulse/press both at the same time à increased blood flow to the brain -cross crawls = elbow to opposite knee = increased attention -hook ups = standing, right leg over left, right hand over left then clasp fingers together and loop hen place on sternum, deep breaths à decreased anxiety, improved mood
general goals
-Enhance functioning of child's nervous system to... -Enhance sensory processing to... -Enhance feelings of well-being and age-appropriate functioning in all occupational roles PERFORM IN ROLES: Student, player, friend, family member, etc.
Vision
-Evaluate eye tracking and overall eye pursuits -Note if child fatigues easily during visual tasks -Complete visual perceptual tests (MVPT, TVPS, Beery, etc) -Observe use of eyes during movement in environment and during fine motor tasks -*note unusual sensitivity to bright lights (visual defensiveness) -Behavioral optometrist -Behavioral optometrist - eye fatigue & eye tracking
17 Subtests:
-Form & Space perception (4) -Tactile Sensory Processing (4) -Vestibular Processing (2) -Praxis (6) -Bilateral Integration & Sequencing (5) There is a separate diagnostic worksheet that also groups scores by sensory system domain including: the visual system, vestibular processing, bilateral integration and sequencing, laterality, somatosensory processing, praxis, praxis on verbal command, and observations about arousal/modulation that are not standardized scores on the SIPT. -praxis = motor planning -bilateral integration and sequencing = using both side of the body to accomplish a task in a specific order/organizaiton (upper and lower body)
Over-responsivity: Vestibular Input
-GRAVITATIONAL INSECURITY •Fear reaction to non-threatening movement or to the position of the body in space where feet are off ground -grav = kids that avoid playground equipment, don't climb up or ride a bike, prefer sedentary activities (more emotional, fearful, anxious)
THERE MUST BE RULES
-Gum must be put in paper before thrown out -Keep mouth closed & quiet while chewing -Do not disturb others in room with fidget toys -Respect each other's unique sensory needs! -responsibility and maturity with methods
Person-Centered Crisis Prevention Tools
-Have consumer rate her/his perceived level of symptoms or problem-severity using a 0 to 10 rating scale -Help person learn to apply sensory input to either 'self calm' or 'alert' (How does your Engine Run Program) -Crisis prevention tools -Self-injurious behaviors
SI Evaluation: Focus on
-How child processes sensory information for function -How child manages environmental challenges -different environments -screening --> assessment --> evaluation
Outcomes of treatment
-Increase in frequency or duration of adaptive response -Increased complexity of adaptive responses -Improved gross and fine motor skills -Improved cognitive, language, or academic performance -Increased self-confidence and self-esteem -Enhanced occupational engagement and social participation -Enhanced family life -decreases in stress, can participate with peers -how to be social -parents are given a greater awareness and are able to understand their child's behavior more, given strategies to improve function, family routines and view of child improves
Sensory Perception: Proprioception
-Joint positions (Prop:JP) -Force (Prop:F)
Sensory Perception: Tactile Perception
-Localization (TP:L) -Designs (TP:D) -Shapes (TP:S, 3 parts: TP:S1, TP:S2, TP:S3, Oral Textures (TP:T)
Client Factors: Body Functions
-Mental functions -Sensory functions & pain -Neuromusculoskeletal & movement related function -Cardiovascular, hematological, immunological, and respiratory function -Voice and speech -Skin & related structure function Body structures = semicircular ear canals, skin, brain,
FOCUS of the program: Help children learn to -->
-Monitor -Maintain; and -Change their levels of alertness for different situations and tasks. -child's NS is less mature = having them sit still and attend for long periods of time is a lot harder for them
Olfactory and Gustatory
-Note any unusual responses to olfactory or gustatory input -Gags easily with non-noxious smells/tastes -May be cause of picky eating
Guiding Questions:Auditory
-Note responses to loud noises - fire drills, sirens, lawn mowers, vacuums, mixers, etc. -Loud cafeterias, hallways, pep rallies -could be one or multiple (variety)
Evaluation Strategies
-Observation of the child (p. 52-58) (Williamson & Anzalone reading) -Parent interview and questionnaires (p. 58 and 59) -Standardized assessment tools (p. 60-64) -Nonstandardized assessment tests Assessment is ongoing -goals/child may change, may find new things not originally identified -COPM helpful for goal forming (have the parents fill it out and find out what the parents want)
Guiding Questions:Visual
-Observe reactions to clutter or clear spaces -Reactions to various colors &/or amount of lighting -ex: how does their bedroom look
Ocular, Postural, and Bilateral Motor Integration
-Ocular motor and praxis (O:MP) -Postural control and balance (PCB) -Bilateral Integration (BI)
Sensory Perception: Visual Perception
-Orientation (VP:O) -Search (VP:S)
•UNDER-RESPONSIVE =
-Over-modulation of sensory input -Hypo-reactive to sensory input -Sensory seekers
Vestibular-proprioceptive dysfunction
-Over-modulation of vestibular input (seekers) -Under-modulation of vestibular input (avoiders) Vestibular = over (seeking, under responding to the input, NS not letting enough of the input in, hyposensitive) and under (hyperreactive, avoid, defensive to movement, ex: care sick easy)
Other essential guidelines
-Provide controlled sensory input to enhance CNS function in processing sensory input [*remediation*] -Educate parents, teachers and child about sensory processing abilities and impact on function -Modify the environment (including interactions) to *compensate* for the child's unique sensory processing abilities (in natural environments) -Adjust child's routines based on sensory needs (per Wilbarger) -ex: compensate = child wearing headphones instead of participating in a program -ex: remediation = slow integration into loud, public places, like recess -adjust = ex: don't speak too loudly when talking to my child
Purpose of EASI
-Provide inexpensive, electronically accessible, and practical instrument to evaluate SI functions in children ages 3-12 years old -Allow for comprehensive and feasible assessment (1-1.5 hours) -Ensure that scores provided by the instrument are reliable, valid, and relevant for the international populations served -Minimal influence of language/culture/experience -Standardization in 100 countries -electronically available --> everything can be made from a 3D printed without having to buy them (way of decreasing cost)
PURPOSE
-Provides a set of standardized tools for evaluating a child's sensory processing patterns in the context of everyday life and the impact of sensory experiences on the child's ability to function within the environment (school, home, community) -Looks at how children respond to a variety of commonly occurring sensory experiences -Provides a unique way to determine how sensory processing may be contributing or or interfering with participation. -Help determine a child's threshold for tolerating sensory stimuli found within the environment so parents, therapists and teachers can better understand the child's behaviors -Children's behaviors (especially those with disabilities) often reflect a desire to seek out or avoid sensory stimuli -child's sensory profile is a lot longer
What is SI treatment?
-Providing enhanced sensory experiences within the context of meaningful activity and promoting adaptive behavior results in enhanced sensory integration and in turn, enhanced learning
REMEMBER
-Response to sensory input builds up over time -Monitor level of arousal -Should repeat observations over time -Provide opportunities for choice -ex: child will dress and stay dressed the whole session, but responds differently at home -effectors: time of day, environment, threshold, arousal (sick or sleepy, etc.) -ex: when I am sleepy, some things bother me more
traditionally...
-SI evaluation & intervention was developed for children with learning disabilities (i.e. without "frank" neurological damage) and applied in a private, clinic-based context. -Sensory integration theory, evaluation, and intervention is also applied with other populations (i.e. autism, cerebral palsy, Fragile X, etc.) but must be modified based on the condition. -Sensory integration is also being applied in school settings but is adapted based on OT's role in school environments. -SI applied not 1 on 1 in a private setting = use sensory processing
documents helpful for midterm (in downloads)
-SI theory based observations -sensory diet revised -
OT Usage
-SIPT is used primarily in: -Outpatient clinics -Private practices -Hospitals (to a limited degree) -training through WPF services, stopped offering training (trying to move over to EASI)
Research that Supports SD & mental health
-Sensory affective disorder is secondary to sensory defensiveness (David, 1990) -Relationship between SD, anxiety, depression, and perception of pain in adults (Kinnealey & Fuiek, 1999) -Social and emotional issues of adults with SD (Oliver, 1990) -SI intervention helps adults with severe learning disabilities (Soper & Thorley, 1996) 1.) woman sexually abused 2.) SD and non-SD groups, those with SD had symptoms relating to anxiety and depression 3.) emotional and social well-being; tactile was eversion to tags, jewelry, hair cuts, meal prep, crowds, shaking hands, etc. 4.) intervention does help
2 "hidden" senses
-vestibular -proprioception -both significant -work together -contributes to body map/scheme -learn/develop through senses -nervous system processing all this -these 2 and tactile are the most important
Treatment sequence
-Set up environment -Prepare child's nervous system for session -Promote play that provides the sensory input that the child needs and that enhances adaptive responses -Continually assess... -Prepare for end of session and transition -Collaborate with parents ... •Transitioning smoothly is important to stay on track •Collaborate with parents = know treatment plan, what you are working on, the child's progression, etc.
Let's test your ability to attend
-Sit still, with both feet on the floor, & hands in your lap. -Do not wiggle or squirm -Focus on me and attend to what I am saying. -No eating, drinking or doodling!
Sensory Integration and Praxis Test (SIPT)
-Standardized in 1990 -17 subtests that assess praxis, tactile discrimination, bilateral motor coordination, visual perception, and lateralization -Will discuss in more detail Wed
strengths of SIPT
-Standardized nationally for 4 to 8 yrs, 11 months -Scored by computer to reduce error -Does not rely heavily on language -Can qualify children for the special services they need in school -Objective, skills-based assessment of SI abilities -population applicable for = greater reliability -a lot of movement-based tests and replications
Over-responsivity: Tactile Input
-TACTILE DEFENSIVENESS •Aversive or negative behavioral responses to non-noxious stimuli; inability to inappropriately interpret touch experiences -tactile = may avoid touch or certain textures, pull away from anticipated touch, stay away from contact activities, someone can hug them and they get upset, bathing can be an issue (ex: brushing teeth à accepting toothbrush in mouth can be difficult --> use vibrating brush), different textures of food can be an issue, light touch, may be aggressive with touch, increased stress when close to people (want to appropriately tolerate stimulation
Tactile processing dysfunction
-Tactile defensiveness -Poor tactile discrimination Tactile = defensiveness (negative behavioral response to tactile input, usually non-noxious stimuli, anxiety with stimuli, don't like being touched or being messy) and discrimination (problems in telling the difference between 2 things, ex: touching you with a feather or rock or on the shoulder and nose and not knowing the difference)
SI applied in Schools
-Tends to be more 'indirect' vs. 'direct'; 'push in' vs. 'pull out' -Equipment and materials embedded in school environment (classroom, playground); whole school approaches Focus of intervention à School function in both academic and non-academic areas -Remedial -Compensatory -push in = going into the classroom (ideal) -pull out = taking the child out of the class to work with them individually -academic = hand-writing, math, science, English -non-academic = socialization, participation, extracurricular activities
Open Access
-Those that are appropriately credentialed and trained will have FREE, UNRESTRICTED access to downloadable links for materials needed to administer and score the test. -Test materials need to be common objects or readily available internationally -Items are also 3D printed -still trying to figure out ways to decrease training strain (once trained à have access to all resources)
Post-Rotary Nystagmus (PRN) Test
-To assess the integrity of the vestibular system -Note the quality and duration of nystagmus following 10 rotations in 20 sec on a nystagmus board
•OVER-RESPONSIVE =
-Under-modulation of sensory input -Hyper-reactive to sensory input -Sensory avoiders -Sensory defensive
Administration & Scoring of SIPT
-Verbal instructions are standardized and must be followed exactly -Children with approximate average IQ ONLY Standardization of the score instructions - part of the reason that this assessment also requires that children have an approximately average IQ -booklet has all instructions for administration -decreased usability with IQ discrimination (usually use for autistic, etc. population = limited) -scoring takes at least 45 minutes
5 major senses
-Vision -Hearing (auditory) -Touch (tactile) -Smell (olfactory) -Taste (gustatory)
What is SI function?
-We take in sensory input from the movement of our bodies & environment and integrate it within the CNS to plan and organize behavior
discussion of checklist
-What do you use to increase arousal? Decrease arousal? -How do your arousal levels vary throughout the day? -Activities require various levels of arousal -increase ex: moving around, drink coffee, eat, fidget, doodle, twirl hair -decrease ex: calming music/sounds, darkness, hot tea, warm up
"To know your nervous system is to love your nervous system." Complete the "Sensorimotor Checklist (for Adults)
-as OTs, need to help the child understand their NS -understand your own engine before helping a child -checklist = goes through different activities (arrow up to increase alertness to accomplish, down to decrease, up and down to transition) checklist in folder
Postural-Ocular Movement Disorder
-associated with deficits in bilateral integration and sequencing •Symptoms: poor coordination, difficulty flexing neck in supine, hypotonicity of extensor muscles, poor proximal joint stability, inability to assume and maintain prone extension
Zones of regulation social skills Video
-blue zone = running slow, bored, slow, tired, sad, sick (skills to help you: drink of water, stretch, talk to teacher/counselor privately, eating a good breakfast) -green zone = ready to go, being organized, respect others, focus, listen -yellow zone = cautious, unfocused, hyper, silly, worried, frustrated (skills to help you: deep breaths, positive thoughts, be honest and open, drink of water) -red zone = loss of control, angry, mad, hitting, yelling, throwing (skills to help you: take a break, count to ten, go for a walk, breath, draw/write about your feelings)
Video: What is trauma informed care
-early trauma or ACE -repeated exposure to trauma can rewire the brain's response to stress -"what happened to you?" -TIC = integral for proper patient care (in tune with patient) -integration of TIC: build awareness, invest in a trauma informed workforce (training for all employees), create a safe and welcoming environment for all, identify and treat trauma
brushing
-every 2 hours -can do while sleeping -never do the face -press hard enough to bend bristles -do not do over thick clothing (thinner clothes acceptable) -avoid the spine -never do the same spot continually (down up down, W on the back) -try not to move the brush -follow with joint compressions (10 on each joint) -firm strokes on arms, legs, hands, feet, and back -helps to sing a song to them -for tactile defensiveness (perceive light touch as pain) -if they do not want compressions, have them jump or sit on a therapy ball, etc.
Sensory Inventory Stand up if you like what's on the following slide
-ex: jumping, a nice day, barefoot on grass, roller coasters, loud concerts, coffee, a hug, etc. -everyone has different preferences for different reasons (ex: I like coffee because of the stimulation it gives me of being awake) (ex: I like a nice hug because it makes me feel close and comforted)
SPD video
-how boy deals with SPD -when the messages your brain gets aren't organized -makes everyday life stuff difficult -can have it alone or with other things, like autism -under responsive = you are a large cup, keep adding and it never feels full -over responsive = you are a small cup; it only takes a little to spill over -can have a big cup for one sense and a little cup for others -activities to help your brain respond differently to sensory input
sensory-based motor disorder: Dyspraxia
-motor planning problems -Difficulty planning and performing novel motor tasks or series of motor actions -Often present with poor sensory discrimination -May occur with poor sensory modulation -Results in motor clumsiness -awkward, accident prone, break toys (don't understand strength or don't have awareness of hands), fine motor difficulties, etc. -struggles with ideation, etc.
Our engines need to run at different levels depending on the "road"we're on!
-need to be able to regulate engine/level of arousal based on activity we are to attend to -may have different engine at different points (watching a movie vs working out) -smooth hum = we need to change our engines throughout the day (ex: class, then lunch, then recess, then library, etc.)
•What enhances cerebellar function?
-proprioceptive input: coordination -vestibular input: ^^^ both help with balance, body awareness, coordination
How do we educate teachers, parents, & other school personnel about sensory integration?
-provide reading materials -refer them to websites (SPD star, sensory diet education, articles, etc.) -etc.
VIDEO: Multi-sensory environment
-sensory experience using light, touch, sounds for a relaxation response -teach them how to relax -happiness, joy -individual design -shows how mental healthcare has evolved (sensory input) -increases participation (enjoyment) (helpful for those with dementia/Alzheimer's)
Where is SENSORY PROCESSING addressed in the OT Framework?
-sensory processing is a body function or structure (client factor) -can affect occupations, performance skills, performance patterns -this is a bottom up course
What are the "traditional expectations" for attending?
-sitting still -both feet on the floor -hands in your lap and out of your mouth -eyes forward -not talking, good listening -this is difficult to do for extended periods of time
reading notes:
-tactile modulation dysfunction = depp pressure avoiding light touch -tactile discrimination = provide tactile experiences -defensiveness appearing during treatment of under-responsive children = improvement -not all clients with decreased sensory discrimination crave sensations they do not process effectively -vestibular discrimination disorder = trouble identifying upside down and right side up -proprioceptive discrimination disorder = distinguishing relative position or movements of body parts -
Video: Through our eyes: children, violence, and trauma
-trauma through eyes of those who have experienced it -trauma is a helpless event (damages perception of reality) -entire picture of what trauma is and what it does -witnessing or the victim -cannot think clearly or function -afraid, on edge -triggers amygdala = fight/flight = stress hormones -brain wired for danger = don't just get over traumatic event -cumulative trauma = changes the DNA -abuse in childhood --> range of long-term impacts (lack of trust, depression, anxiety, behavior problems, suicidal, etc.) -early intervention and education important (social-emotional based interventions)
APP for zones of regulation
-zones game (more interactive) -match the face (identifying, see the word and face and identify which zone it belongs in), count how many you get correct in a row -elated = overly excited (body out of control) = red zone -move character around to find different color circles, asks you questions and answering correct gives you points which you can use to get new perks in the game (a pet, new shirt, etc.) -going through the breathing = lazy 8 or six sides of breathing, tells you how to breath
Likert scale: Child Sensory Profile 2
1 = Almost Always 2 = Frequently 3 = Half the Time 4 = Seldom 5 = Almost Never -different scoring (switched)
Likert scale: Adolescent/Adult Sensory Profile
1 = Almost Never 2 = Seldom 3 = Occasionally 4 = Frequently 5 = Almost Always
Impact of Trauma on the Body
1) Changes neurological structures and functions 2) Results in difficulty integrating sensory information and regulating emotional stress
Sensory Modulation Programming
1) Help person recognize his/her sensory experiences and preferences ◦Evaluation - Sensory profile, interview ◦Identify sensory preferences and patterns of responding 2) Develop individualized sensory diet per Wilbarger's strategies or use ALERT Program 3) Modify the environment based on sensory preferences ◦Dim lights, less noise, weighted lap pads 4) Educate caregivers -ALERT Program: depending on cognitive level (can be juvenile if higher cognitive level) -Zones program: most adults -sensory diet = sensory breaks, tools that work for them (brushing not common in adults) -educate: sensory preferences, triggers, what to do during reactions/heightened emotional responses, sensory diet plan, etc.
SMD: 3 patterns
1) Over-responsivity -Undermodulation of input 2) Under responsivity -Overmodulation of input 3) Sensory craving/seeking
Sensory Diet Activities & Strategies
1) Specific time-oriented routines ("sensory tune-ups") 2) State changers or mood makers 3) Routines 4) Modify Interactions 5) Structure the Environment
What are the 5 components of Sensory Integration?
1. Sensory Awareness (eg. awareness of being touched) 2. Orientation (selective attention to new input) 3. Interpretation (integration of input across sensory modalities and attributing meaning) 4. Organization of a response (determination of a cognitive, affective, and/or motor response) 5. Execution of the response (performance of the cognitive, affective and/or motor response)
Alert Program fulfills these 4 needs:
1. Teach students, parents, teachers how to recognize the relationship between arousal states, attention, learning, and behavior 2. Help students recognize and define the self-regulation strategies they use in a variety of tasks and settings 3. Give therapists, parents, and teachers a framework (vocabulary, activities, and environments) to help students recognize and regulate their own arousal states 4. Help parents and teachers understand that behavior reflects both current level of organization of the student's nervous system and student's best attempt to respond adaptively and efficiently to the demands of a situation or task
Major Assumptions of SI Theory
1. The CNS is plastic 2. Sensory integration develops 3. Brain functions as an integrated whole 4. Adaptive interactions are critical for sensory integration 5. Inner drive to develop SI through participation in sensory-motor activities 1. Higher order functions over lower order functions (problem with sensory processing = lots of problems above it) 3. Depends on active participation
19 items:
1.Hyperactivity 2.Tactile defensiveness 3.Muscle tone 4.Eye preference 5.Eye movements 6.Ability to perform slow motions 7.Rapid forearm rotation 8.Thumb-finger touching 9.Tongue to lip movement 10.Cocontraction 11. Postural security 12. Postural background movements 13. Equilibrium reactions 14. Protective extension 15. Schilder's arm extension posture 16. Prone extension posture 17. Symmetrical tonic neck reflex (STNR) 18. Assymetrical tonic neck reflex (ATNR) 19. Supine flexion -muscle tone through MMT -eye preference through which eye they pick when given scope (cone or card with a hole, etc.) (test a couple times, in a different manner) -eye movements (saccades) -slow motions = record how long they prolong the movement -thumb-finger = oppositions with eyes open and closed -tongue to lip = show them how the tongue should move and the child should imitate (oral praxis) -co-contraction = resistance to passive movement -postural security = place them on an unstable surface, movement in all planes (ex: exercise ball) -background movements = weight shifting -equilibrium = different surfaces and positions -protective extension = push child in different planes (catch self) -arm extension posture = turning of head and observe arm movement (body map observation ) -prone extension = plank position (prone and push up and hold as long as possible) -ATNR and STNR = see if they have any reflexes that are not integrated (STNR = head and upper body perform opposite movements = extended head and arms --> flexed legs) -supine flexion = like holding a crunch (sustain 20-30 sec by 8 years old) -how is the CNS functioning, sensory abilities, body map information, etc. -when testing ex: if they child has dyspraxia, they should struggle in these areas (quadrant provided) VVVV
PROPRIOCEPTION/BODY MAP dysfunction
1.Poor muscle tone (low); limited cocontraction, poor prone extension, limited supine flexion 2.Abnormal Schilder's Arm Extension 3.Poor Postural Background Movements
BILATERAL MOTOR COORDINATION
1.Poor rapid forearm rotation 2.Poor thumb-finger touching 3.Poor ability to perform slow motions
VESTIBULAR-PROPRIOCEPTIVE
1.Postural insecurity 2.Equilibrium problems 3.Protective Extension problems 4.Schilder's Arm Extension - abnormal
Sensorimotor Strategies --> Five ways to change your Engine:
1.Put something in your MOUTH 2.MOVE 3.TOUCH something 4.LOOK; or 5.LISTEN Have the child begin experimenting with these sensory strategies and observe the effect on attending.
General guidelines for SI Treatment
1.Use controlled sensory stimuli based on accurate evaluation of sensory integration 2.Treatment is provided in an "enriched environment" with a variety of SI equipment -Suspended equipment, mats, inflatables, variety of play activities which provide tactile, proprioceptive, and vestibular input 3.) SI activities are play-oriented -Aim for a state of flow -Marks the "just right challenge" -See full absorption, repetition, & increased interest Treatment should be child-directed; OT does not impose sensory input -OT is the facilitator -Capitalize on child's inner drive -Requires more motor planning and CNS integration 4.) Environment must be SAFE -emotionally safe and physically safe -Don't want to give them random sensory input (provide what is needed by that specific child) -A lot of novelty -Min requirement: environment can be rearranged to meet motor needs, 14x14 room -ex: you're in a wind-storm (swinging on the swing) -ease the child into different activities, allow them to lead/actively approach the activity/task -obstacle course good for motor planning
TIMELINE
2014 - Initial test items developed 2015 - Initial field and pilot testing & analysis 2016-2017 - Pilot Testing; Item selection; Organization and training for normative data collection 2018 - Normative data collection; validity and reliability studies; item analysis 2019 - Writing manual and papers 2020 - EASI Available!!!! -7/20/20 Birthday Party for Dr. Ayres in CA -idea to release EASI assessment by 2020 (still haven't met ideal criteria) -article on BB on process of adjusting SIPT to create EASI
Adult Sensory Profile
60 questions in 6 areas: -Taste/smell processing -Movement processing -Visual processing -Touch processing -Activity level -Auditory processing Adult sensory processing is different than a child's
Integrating sensory and trauma-informed interventions
90% of people with severe psychiatric disorders are believed to have experienced abuse involving violence as a child and/or adult ◦This results in a plethora of MH problems which may include: anxiety, mood, behavioral, identity, eating disorders, substance abuse, and PTSD
what is trauma
A deeply distressing or disturbing experience Events that are considered traumatic are wide ranging ◦ What are some examples: natural disasters, military deployment, emotional/sexual/physical abuse, death of a loved one, war, torture, car crash/accident, illness, etc.
materials/tools
A pencil is required during the administration of this assessment as well as the evaluation form that is to be completed by either a caregiver, classroom teacher or school personnel depending on the selected form.
Sensory integration is
A theory, a framework for assessment, a type of intervention
Sensory Integration Theory
A. Jean Ayres •Ayres - an OT; began as a clinician working with children with subtle motor problems •She was dissatisfied with the approach at the time - focused on skill training •Doctorate in educational psychology in 1961; post-doctoral work at the Brain Research Institute at UCLA
CHART ON SLIDE 25 (SI Theory)
ASI -population = learning disabilities, ADHD, PDD spectrum (mild) -Terminology = sensory integration evaluation and intervention -sensory integration dysfunction -sensory integration assessments = clinical observations and SIPT -classical sensory integration = intervention 1:1, special intervention room, etc. Sensory Processing -population = everyone else including individuals with neurological involvement (CP, down syndrome, autism, spina bifida), mental illness, brain trauma, and elderly population -terminology = sensory processing dysfunction -assessments = all that address sensory processing, NOT SIPT -intervention approaches = varied -intervention examples = sensory diet --> Wilbarger, Dunn model of sensory processing, ALERT program --> Williams/Shellenberger, and Lucy Jane Miller -group in a therapy clinic wouldn't be ASI (not 1;1) = sensory processing -treatment = sensory processing -diagnosis = sensory processing (don't) or sensory integration (do) -integration if 1;1 -sensory processing intervention ... in next few slides
EASI based on
ASI theory and practice
1) Specific time-oriented routines ("sensory tune-ups")
Activities that have a modulating effect on the nervous system for a certain period of time. These activities include: -Deep pressure touch: "brushing program" -Vestibular & proprioceptive input
Which sensory system do you think would mindfulness affect most?
Affects the most: interoception (= mindfulness can be a good intervention)
TOUCH
Allow child to "fidget" with certain items -Koosh ball -Squishy hand balls -Silly putty -Stress balloon -Twisty toy -Kneadable eraser -might need touch to regulate fidgeting EVERYTHING, break things from always playing with something, movement with hands
Movement strategies
Allow movement breaks after school, during long homework periods or long class sessions How? Be creative! -Stand and stretch -Run errand to office -Exercise break (take a walk) -Play with pet -Sit on therapy ball or move-n-sit cushion -Stand alongside table -Arm wrestle -Rake leaves -Shovel snow -Vacuum -Play wrestle -Jump rope -Various sports - swimming, basketball, soccer, karate, etc. -make it purposeful -"heavy work"
Cognitive & Perceptual Functions in OTPF
Body functions -mental functions -specific mental functions -global mental functions -sensory functions
Clinical Observations
Analysis - Identify patterns of problem areas: -VESTIBULAR-PROPRIOCEPTIVE -DYSPRAXIA
Observation: Assess the 4 A's
Arousal -State of alertness? -Transitions? Attention -Maintain attention to task? Affect -Good range of emotional expression? -Predominant emotional tone? (fearful, anxious, defiant, flatness) Action -play behaviors? -Motor planning? -Aware of body? -are there different states of alertness you observe (ex: active alert to quiet alert) -do they need more effort, cuing, etc. more than typical peers -ex: happy when appropriate, or flat affect/no response -ex: spinning on the swing is discomforting (serious face or avoidance because of nervousness) -can they figure things out (problem-solve), are they participating in the same activities, do they complete activities, do they transition easily, do they avoid, do they need to be prepared, etc.
Wilbarger Brushing Protocol: What does BRUSHING do?
Brings about sensory summation -Increases the spatial &/or temporal discharge rates at the receptor level nerve cells to increase sensory thresholds and thereby decrease sensory defensiveness
Sensory avoiders
Avoid interoceptive input may eat more to avoid hunger pains, use bathroom more often because they do not like the feeling of a full bladder
Test development
Ayres developed & refined a group of perceptual-motor tests to assess sensory integration and normed them locally in CA -Became the Southern California Sensory Integration Tests (SCSIT) Because of the need for a test battery with more psychometric soundness -Revise and expand areas -Agreed to have SIPT normed nationally -Developed by Ayres for children with learning disabilities -You must be certified to administer these tests -normed = tested out -predecessor = SCSIT -now SIPT -will be EASI -not applicable for all disorders -usefulness -not complicated or difficult to administer, there is just a strict protocol (strictly standardized), tricky to interpret scores
Bilateral Integration & Sequencing (5)
Bilateral Motor Coordination -Measures ability to move both arms or feet together in a smoothly integrated pattern following demonstration -Oral Praxis -Sequencing Praxis -Graphesthesia -Standing & Walking Balance -BMC = following along with your movements
areas that are deficient in Bethany
Bilateral Motor Coordination -thumb-finger -slow motions Vestibular-Proprioceptive Function -protective extension back -arm extension Proprioception/Body Map -arm extension Praxis -thumb-finger touching -slow movements
EXAMPLE: Jessica has a difficult time catching a large ball and doing art activities especially those involving the use of scissors
Bilateral integration and sequencing deficit
Informal Observation of Sensory Processing
Can evaluate sensory processing in all children/adults Other diagnoses: -Autism -Cerebral palsy -Infants/preemies -Spina bifida -Down Syndrome -ask about occupational area of concerns (routine activities: like brushing teeth or dressing or leaving the house or having a meal, etc.) (informal observations) -Dr may recommend OT and the parent does not know why ^^^^ those questions help them realize
Sharing skills and services
Carryover by teacher, speech therapist, physical education teacher, parents This is what I am working on, collaborate with other professionals (IPE, PT, psychiatrist)
Expanding the role of sensory approaches in acute psychiatric settings
Champagne, 2005 Focus: ◦The co-creation and use of nurturing & sensory-supportive environments to support meaningful therapeutic interaction in acute care psychiatry ◦How does the overall intervention environment afford or constrain client's abilities to engage in meaningful interaction and occupation? -One of your readings -champagne = queen of trauma informed care -participating in sensory activities that improved emotional support (emotional problems)
Focus of Intervention: Compensatory
Change environment to enhance child's success in performance Change expectations of caregivers/teachers
Suggest school-based strategies
Choosing the best intervention strategy for a student can be accomplished only if flexible models of service are available -in the Natural Environment? -Small group sessions? -Individual sessions? "To create & promote healthy SI for all students, OT's can help develop school wide programs addressing basic developmental needs for movement and sensory input" (AOTA, 2003) -best to see the child in their natural environment because you can directly observe any obstacles and it makes it easier to integrate the child after intervention -group for more socialization -individual = more specific tasks
concepts of a sensory diet
Each person has unique sensory needs We all use sensation to maintain functional performance throughout the day
Formal Assessments: Non-Standardized Tests
Clinical Observations (Ayres) -Given to children with minimal motor impairment and who are suspect of having SI problems -Usually given along with the SIPT -Videos to be seen Monday and Wednesday Week 4
Evaluation
Collaborate with the person to gather important information -Complete a sensory history (interview) -Sensory Profile or Sensory Processing Measure
setting
Comfortable quiet room with a table to sit at
LISTEN
Consider individual needs for complete quiet or background noise -Quiet: sound deafening headphones; quiet, secluded area -Background noise: may prefer background music or noisier atmosphere
3) Routines
Consistent routines should be developed for daily activities such as waking up, dressing, mealtimes, bathing, bedtime, & transitions Prepare child for upcoming events -visual timer or visual schedule help
Crisis prevention tools
Consumer questionnaire identifying potential triggers, sensory and interpersonal strategies upon admission so that a crisis may be averted or minimized
Sensory seekers
Crave interoceptive input move fast, may not eat or drink as much because being thirsty or hungry feels good
Environmental Modifications & Sensory Rooms
Create and use nurturing & sensory-supportive environments to support meaningful interaction in acute psychiatry Make some suggestions ◦Tactile --> fidget toys ◦Proprioception --> weighted blankets
SI dysfunction
Deficits in sensory integration result in conceptual and motor learning problems & functioning in everyday life -ex: sensory defensive in tactile dysfunction = cannot stand icky things = work with shaving cream, etc. in therapy
Praxis (6)
Design Copying -Measures visual motor skills & graphic praxis -Draw geometric shapes Postural Praxis -Measures ability to imitate unfamiliar positions or postures demonstrated by examiner Praxis on Verbal Command -Measures ability to motor plan body posture from verbal directions without visual cues Constructional Praxis -Measures ability to relate objects to each other in space lDuplicate a model with blocks Sequencing Praxis -Measures ability to reproduce a series of planned hand or finger movements demonstrated by examiner Oral Praxis -Measures child's ability to motor plan oral positions and sequences of oral movements following demonstration of movmenets of tongue, teeth, lips, cheeks, jaw -DC = fine motor test -PP = examiner sees if child can copy movement without any additional cues -PoVC = ex: put your hand on your head -CP = box of pink blocks and they have to replicate a figure, then they have to replicate this big and complicated structure and measure their deviation with a ruler -SP = ex: tapping a rhythm and see if they can add onto the sequence -OP = ex: click your teeth, stick out your tongue (only doing, no verbal instruction)
Interpretation of Evaluation Findings
Determine whether SI dysfunction is contributing to the child's presenting problems Identify: -If OT is recommended; -Type of service delivery (individual, group; direct, indirect) -Estimate duration of OT
CLINICAL OBSERVATIONS of SENSORY INTEGRATION
Developed by Jean Ayres Clinical observations are a group of non-standardized procedures used to assess sensory integration Observations in 19 structured situations are made to assess the child's functioning in the following areas: -Muscle tone -Extraocular muscle control -Equilibrium reactions -Co-contraction -Vestibular function -Bilateral integration
LOOK
Dim lights to help children calm down Brighter light to "awaken" nervous system Lava lamps (calming; normalizing to system)
Effect of too little norepinephrine
Distractibility Need: new and novel stimuli
EXAMPLE: The teacher reports that Joey tends to bump into desks and trip frequently; she thinks he's clumsy
Dyspraxia
Developmental dyspraxia
Dyspraxia = motor planning problems (not just the execution, its being able to organize an idea, come up with the idea, and use the idea)
interpretation
Each question is rated on a 1-5 scale: 0= Does not apply; 1= Almost never; 2=Occasionally; 3=Half the time; 4=Frequently; 5=Almost always. After each section and question has been completed, the numbers are totaled up for each quadrant. The quadrants include; Sensory seeking/Seeker, Avoiding/Avoider, Sensitivity/Sensor, Registration/Bystander. The scores are classified depending on the sum of the scores for different sections. Those scores are placed into each quadrant into sections of; Much less than others, Less than others, Just like the majority of others, More than others, and Much more than others. This assessment also contains sensory sections and behavior sections for the scores.
indirect intervention
Education Consultation Environmental modifications giving teachers strategies to work on or environmental modifications, checking in to see how the child is doing, etc.
PHYSICALLY SAFE
Equipment & support structures are safe OT is near enough to promote safety and independence, but far enough away to allow child's independence -make sure all equipment is tested/approves for safety and its guidelines for safety
purpose
Evaluates a child's sensory processing patterns when considering the different environments of home, school, and community-based activities.
video on Bethany
Follow along on the Clinical Observation handout while watching the video on Bethany Write notes in blank areas if needed Use the score sheet and rate Bethany's response as best as possible as you observe her During video: Write down any questions that you might have about the purpose or administration of particular test items Refer to Interpretation sheet and try to fill it out Come up with a list of what you perceive to be Bethany's strengths and areas of concern
interpretation
For each properly imitated item one point is awarded. The test should be administered until there are three consecutive failures. To obtain a raw score, the number of items that are not successfully completed prior to this ceiling of three consecutive failures is subtracted from the ceiling (Beery et al., 2010). These scoring criteria and procedures apply to both Beery VMI forms, full and short.
interpretation
For each subtest the raw score is documented and then converted to normative scores made up of age equivalent, scaled score and percentile rank. Using the scaled score, one of 7 descriptive terms is applied ranging from Very poor through Average and up to Very superior. The subtest scaled scores are then used to form a composite score for Visual-Motor Integration, Motor-reduced Visual Perception, and General Visual Perception. The difference between the composite score of Visual-Motor Integration and Motor-reduced Visual Perception is calculated. This difference is then used to determine statistical or clinical significance. An average score in Visual-Motor Integration indicates the ability to perform complex eye-hand coordination tasks. A low score in this area could indicate poor eye-hand coordination or poor fine-motor development. The section of Motor-reduced Visual Perception is the "purest" measure of visual perception. A score of 90 or above in General Visual Perception means that the child demonstrates visual perceptual competence, meaning that they have accurate hand movements. These children tend to be good at a wide range of visual processing skills.
Structured Observations
Formal evaluations and adult-controlled situations -structured: ex: Denver II = have specific things for the child to perform, strict directions
Neurophysiological Processes: Modulation of sensation
Function: -Ability to modulate sensation Dysfunction: -Sensory Modulation Disorder (SMD) -sensory defensiveness or underresponsivity to sensation
Neurophysiological Processes: Discrimination of sensation
Function: -Ability to perceive qualities of sensory stimuli (duration, intensity) & allows for selective attention to input Dysfunction: -Poor sensory discrimination or poor attention to the input -Sensory Discrimination Disorder (SDD)
Neurophysiological Processes: Detection of sensation
Function: -Awareness of sensation Dysfunction: -Lack of awareness of sensation (not a specific area of SI dysfunction)
Neurophysiological Processes: Integration of sensation
Function: -Integration of input across sensory modalities and attaching appropriate meaning to it.SI allows for an appropriate cognitive, affective, &/or motor response to the input Dysfunction: -Sensory Integration Dysfunction: Various patterns that may include poor sensory discrimination, dyspraxia, or SMD
good for movement breaks in classroom
Go noodle on google -get them moving Drive through menus (good for movement breaks in classroom) -ex: its all in your head = massage your head in different ways -ex: pendulum swings = bend at the waist and swing your arms -ex: milkshakes -ex: desk push ups
www.ot-innovations.com
Great website Conferences Webinars Research information
Clinical Observations
Group of non-standardized procedures used to assess sensory integration Observations in 19 structured situations are made to assess child's functioning in the following areas: - Muscle tone - Equilibrium reactions - Bilateral integration - Cocontraction - Vestibular function - Extraocular muscle control - Primitive postural reflexes Given along with SIPT or alone....no items specifically evaluate tactile processing
Deep pressure touch: "brushing program"
Has a 1-2 hour duration Use soft surgical brush, brush with firm pressure on arms, hands, back, legs, & feet (NO STOMACH); follow with joint compressions -joint compressions follows brushing (2-4 hours)
Nervous System Hierarchy
Hierarchical or heterarchical? •Traditional SI - viewed brain functioning in a hierarchical system with higher levels in command of the lower levels and dysfunction theorized at brainstem level •Current theory - emphasizes more of a systems view of brain function; many areas of the brain contribute to SI Start at lower levels to build the higher levels -all the systems are working together = current
interpretation
Higher raw scores indicate greater severity of dysfunction for a child. There are three dimensions that are interpreted: scaled scores, item responses, and differences across environments. The normed scores in the manual are then compared to the scores of the child. The SPM can be used as a quick screening tool or as part of a more thorough evaluation. The scores can help determine what level of intervention the child needs. If the scores are higher, then the child needs more intensive therapy. This assessment tool can also help determine which specific areas need to be targeted and which areas should be prioritized.
SI Evaluation must be CONTEXT-SPECIFIC
Home -Observe in a variety of typical home activities -Mealtime, play, ADLs School -Observe in a variety of activities and contexts -Classroom, hallway, recess, cafeteria, physical education, restroom Clinic/Hospital -Usually limited to one setting that's "unnatural" -Behavior may not reflect true performance -ex: student overreacts in the cafeteria = cannot handle the intense auditory stimulation -differs where you are evaluating them/where you are observing the child
Adults with Sensory Defensiveness
How a person processes sensory input influences her/his emotional responses to everyday experiences. -May avoid certain situations, places or clothing -Quality of life may be limited -May be a relationship between sensory defensiveness and anxiety, depression, and social/emotional issues -more compensatory approaches usually -what stage are they in -have they had this their whole life? -ex: TBI, learning disability, autism, fetal alcohol syndrome, etc.
Sensory Approaches
How does the person modulate sensory input in order to self-regulate especially during a 'crisis'? "Crisis states" are dynamic processes of change and phase changes characterized by: ◦Acuteness, uncertainty, surprise, unpredictability, and the change of reorientation ◦Dynamic, longitudinal processes of experience "occupational crisis" - person facing an environmental perturbance Sensory approaches may include: ◦Direct or indirect sensory input, sensory-base activities, environmental modifications, & sensory diets In treatment, we can help person identify sensory-based activities that help self-organize during extreme levels of stress ◦Wrapping in a weighted blanket, biting into a lemon, deep breathing, isometric exercises ◦Wilbarger's sensory diet
Effect of too much Dopamine
Hyperactivity
Interpretation of Clinical Observations
II. Vestibular-Proprioceptive Function -Postural insecurity -Equilibrium -Protective extension -Schilder's Arm Extension III. Proprioception/Body Map Muscle tone -#3 muscle tone -cocontraction -Prone extension -Supine flexion Schilder's Arm Extension Postural Background Movements IV. Praxis -Ability to perform slow arm motions -Thumb-finger touching -Tongue to lip movement V. Bilateral Motor Coordination -Rapid forearm rotation -Thumb-finger touching -Ability to perform slow motions
Keep in mind ...Sensory strategies can either
INCREASE or DECREASE levels of alertness.
purpose
Identifies significant difficulties in the integration or coordination of visual perceptual and motor abilities (finger and hand movements). Indicates deficits in visual perception, fine motor skills , and hand-eye coordination
SIPT - Sensory Integration & Praxis Test (Ayres, 1989) PURPOSE
Identify SI dysfunction -Diagnostic & descriptive tool -Assess several aspects of sensory integrative abilities including processing of vestibular, proprioceptive, kinesthetic, tactile, and visual stimuli as well as behavioral deficits -only objective way to look at SP -vestibular functioning = sense of balance and ability to adjust to gravity (fluid and hairs in ear, movement of head in space) -proprioception = awareness of your body in space (pressure), joints and body position in space -kinesthesia = when you can feel and sense movement in space -tactile = touch sensation -visual perception = interpretation of visual acuity (ex: discern shapes, know what whole shape would look like even if a part was different, etc.)
Effect of too little serotonin
Impulsivity, out of control Stress -too little: depression, anxiety,
Sensory Modulation regulations in Massachusetts
In 2006, Massachusetts State Department of Mental Health passed a regulation requiring all state-licensed facilities to incorporate the use of sensory modulation interventions into care delivery of mental health services. -all states should facilitate this
Where can a "sensory diet" be applied?
In all aspects of life within any setting "Sensory diet provides structure for home programs" -every child is unique, have their own sensory diet
Summary
Increasing SEROTONIN helps improve all other problems ▫So you can give proprioceptive input when in DOUBT
•SI function
Individual take in sensory input from the movement of our bodies and from the environment and integrate it within the CNS to plan and organize behavior
What is the point of this pyramid? (slide 11)
Individuals w/ sensory processing problems have difficulties with higher levels of pyramid Sensory processing disorders had an impact on many aspects of person's life (performance and social interaction)
Sensory-Enriched Classrooms
Infuse sensory-rich activities into routines
Integrating SI Strategies in School Contexts
Intervention Strategies -Direct -Indirect
What type of interventions should be used to increase mindfulness?
Interventions: yoga, deep breathing, calming music, breaks, imagination, swinging
Who developed Sensory Integration theory?
Jean Ayres
Tactile Sensory Processing (4)
Kinesthesia -Measures ability to perceive joint position & movement during "go visiting" game Finger Identification -Ability to identify which finger(s) are touuched by examiner with vision occluded Graphesthesia -Measures tactile perception/discrimination and translate into motor response -Child must duplicate design that was drawn on back of hand Localization of Tactile Stimuli -Measures ability to localize tactile stimulus applied to hand or forearm w/ vision occluded All 4 tests assess integration and interpretation of tactile (& proprioceptive) input from the body --go visiting game—child's finger is placed in given spot then moved to second location; vision is occluded; distance between where examiner placed finger and where child places finger is marked **In these tests, examiner watches for behaviors indicative of tactile defensiveness -K = lines on a sheet, move their finger along line to "house B" then move it back to home base, then have them replicate that movement pattern, mark where their finger landed and measure in cm how far their finger was from the mark (house B) -FI = shield up, touch the finger in different ways and patterns and have them touch their finger in the same way (ex: touch their pointer finger with 2 fingers on DIP and PIP, then have the child replicate it) -G = draw an imaginary picture on the back of the child's hand and the child must replicate it LoTS = put a dot on their hand/arms with an exact amount of pressure and have the child point to spot and hold it there while you measure (should be more accurate on hand than forearms because of a greater amount of receptors)
Sensory Perception: Auditory Function
Localization (A:L) -auditory function not touched in SIPT à added to EASI -localization = localize where sound is coming from in environment ad attend to it -response to auditory stimulation
Who coined the term "Sensory Processing Disorder (SPD)?
Lucy Jane Miller
Informal Observation Assessment Tools
Parent questionnaire Sensory histories -Checklists of sensory system functions -Sensory Profile is a standardized sensory history developed by Winnie Dunn (1999)
materials/tools
Materials used include the Examiner's Manual, Picture Book which contains items for the Figure-Ground, Visual Closure, and Form Constancy subtests, Examiner Record Booklet where the test is scored, Response Booklet which is used for the child's responses for the Eye-Hand Coordination and Copying subtests and Copying Subtest Scoring Template which is used to score the Copying subtest.
4) Modify Interactions
Modify parent/teacher/peer interactions based on sensory needs Modify touch -Avoid light, unexpected touch Modify voice quality -Whisper, soft voices Modify rate of speech -Less speech, slower rate Modify demands for eye contact
Vestibular & proprioceptive input
Movement & heavy work -bigger activities at once is better than a smaller one every couple hours (ex: have the child swing for a while in the morning before school rather than having them fidget throughout the day) -ex: heavy work = pushing a cart,
MOVE
Movement provides both proprioceptiveand vestibular input -Proprioceptive: Input to muscles and joints (received via "heavy work" - pushing, pulling, jumping, carrying, squeezing, etc.) -Vestibular: Input to inner ear through movement -heavy work = chores, heavy backpack, etc. -might benefit with movement when fidgeting, moving in chair, etc.
Intervention to increase norepinephrine levels
Need new and novel stimuli Need a challenge
EMOTIONALLY SAFE
OT demonstrates unconditional positive regard for the child OT fosters a trusting relationship Interactions are positive and rewarding -build rapport with child -accept the child for who they are -respect reactions to sensory input
sensory integration rooms
OT educated in SI, specific equipment for specific intervention (what we have talked about thus far), clinic, schools
Sensory Perception: Vestibular Function
Ocular reflex (V:OR)
5) Structure the Environment
Offer a few pieces of equipment to encourage self-selected and self-directed activity -Therapy balls -Crash pillows -Rocking chair -Trampoline -Swing -Secluded spaces -How is sleeping? Weighted quilt needed? -give them a choice -in home or in school -sleeping is hard with SPD (lotion, weighted blankets, etc.)
Clinical Observation analysis
PROPRIOCEPTION/BODY MAP dysfunction BILATERAL MOTOR COORDINATION -Once you do all 19 observations, see where the child falls (get as much information as you need)
What is Trauma-Informed Care (TIC)?
Organizational structure and treatment framework that involves understanding, recognizing, and responding to the effects of all types of trauma defined as "mental health care that is grounded in and directed by a thorough understanding of the neurological, biological, psychological, and social effects of trauma and violence on humans and the prevalence of these experiences in persons who receive mental health services"
EXAMPLE: A 5 yr old refuses to play on the slide and throws a tantrum when his Dad pushes him high on the swing
Overresponsivity to sensory input (vestibular = gravitational insecurity = doesn't like feet off the ground)
SP 2: Administration
Parents report the frequency their child responds to 125 commonly occurring experiences and they are grouped into sensory systems and behavior scores: Sensory System scores: -Auditory processing, Visual processing, Touch processing, Movement processing, Body Position processing, Oral sensory processing Behavior scores: -Attention, Behavioral, Social-Emotional •Added questions •Senses the same
SP 1: Administration
Parents report the frequency their child responds to 125 commonly occurring experiences split into the following categories: Sensory Processing -Auditory processing, visual processing, vestibular processing, touch processing, multisensory processing, oral sensory processing Modulation n-Sensory processing related to endurance/tone, modulation related to body position & movement, modulation of movement affecting activity level, modulation of sensory input affecting emotional responses, modulation of visual input affecting emotional responses and activity level Behavior & Emotional Responses -Emotional/Social responses, behavioral outcomes of sensory processing, items indicating thresholds for response 125 questions or short form—38 questions -now available online (helpful to give prior to first session)
Dysregulation - 'Red Alert'
Person experiences 'overwhelming sensory stimuli' flooding with multi-sensory stimuli as if trauma were happening again ◦Unwanted sounds, smells, bodily discomfort ◦feelings - may feel numb or frozen -affects interaction and social participation -can lead to outbursts/abnormal behaviors
Piolet studies
Pilot Study 1: Tactile Tests Pilot Study 2: Praxis Tests Pilot Study 3: Vestibular/Proprioceptive/Ocular/Postural/Bilateral Tests Pilot Study 4: Visual Test, Auditory Test, Sensory Reactivity Test -idea to release EASI assessment by 2020 (still haven't met ideal criteria)
Effect of too little Dopamine
Problems in initiating movement, low engines, Depression?
Vestibular Processing (2)
Post-Rotary Nystagmus (PRN) -Measures duration and regularity of nystagmus following rotation Standing & Walking Balance -Evaluates ability to balance on 1 or both feet, while standing and then walking, with eyes open and closed Plus clinical observations considered: -Ocular motor skills, prone extension -PRN = after you spin, an oculomotor reflex, the eyes should scatter (1 rotation per second on board, 10 times, stop and stare at blank wall and time how long it takes eyes to move back and forth and center again) (average 8-10 seconds, longer = over active response, shorter = under reactive and want to spin more usually) -S&WB = balance in different contexts and time how long they can balance without deviation from position -Pcoc = things not included in kit (sheet) (ex: supine flexion = how long they can hold it and if they can hold against resistance) (ex: watching movement patterns in pronation and supination) (ex: opposition, identifying cognitive effort) (Schindler's arm test = close eyes and flexion shoulders with extended arms and turn the child's head and observe if they move their whole body or just their head) (righting reactions) (wheelbarrow = watching for scapular winging) (visual tracking and pursuits = can they keep their head forward and follow and object with their eyes, sometimes there is a certain quadrant where they lose it, also look for convergence/crossing eyes) (visual saccades = looking back a forth between moving objects) (primitive reflex retention = have they integrated them in their ability to perform movement patterns, ex: walk like a duck or pigeaon and make sure their upper body doesn't move (invert or evert) like the lower body) (each related to specific sensory functions)
format
Preschool SENSE is a manual that includes easy-to-use charts and checklists, permission forms, sample introductory letters to parents and educators, and a reference section to compare typical and atypical responses to ordinary sensory stimulation.
setting
Preschool SENSE is a scan for sensory processing deficits that involves a questionnaire and checklist completed by the child's teachers. Teachers should have worked with the child for over a month. The teacher's observations of the child can occur in any setting familiar to the child, in order to assess the child's typical abilities in comfortable surroundings, over a period of several days.
description
Preschool SENSE is a screen intended to provide a framework for designing a collaborative program involving the child's therapists and teachers. The screen aims to identify children that should be tested by standardized assessments for sensory processing problems. The manual is broken up into three different parts; materials for the occupational therapist to direct the program, materials for educators to participate in the program, and reference materials for occupational therapists and educators to share. The various forms should be administered in a proper order outlined within the manual. Teachers may confer with one another when completing the questionnaire and checklist.
purpose
Preschool SENSE is an educational tool used to introduce preschool educators to Sensory Processing Disorder (SPD). It is not an assessment; therefore, it is not standardized or based on normative data. It is simply a scan designed to provide a quick look at children who may benefit from therapy to improve learning and behavior. Its purpose is to offer educators a way to understand sensory challenges, as well as the behaviors that result from those challenges.
interpretation
Preschool SENSE is intended for implementation by therapists with expertise and training in identification of SPD to ensure proper interpretation of results. Therapists collaborate to interpret the results of the completed Individual Child's Checklist forms. Using their expertise, therapists should make judgements on areas that may indicate therapeutic assessment of the child using appropriate tools. Therapists should use interpretations to consult with the school team, parents, and family physician of the child about formulating a treatment plan for the child with SPD. Therapists may also offer referrals to another therapist or multi-disciplinary team for a full assessment or offer their own services. Therapist may provide teachers with individualized suggestions for each child with SPD.
Intervention to Increase or normalize dopamine levels
Pressure touch, touch sensation
Intervention to increase or normalize serotonin levels
Proprioceptive input! -proprioceptive: exercising, walking, jumping
Focus of Intervention: Remedial
Provide sensory input to impact/modify nervous system, to diminish SI problems Some remedial can be done but must be incorporated into environment
SI treatment
Providing enhanced sensory experiences within the context of meaningful activity and promoting adaptive behavior results in enhanced sensory integration and in turn, enhanced learning -adaptive behavior increases sensory processing in the body
mindful practice is used for...
Psychiatric disorders •Anxiety disorders •Depression •Suicidality •Personality disorders •Eating disorders •Drug abuse & dependence •PTSD •Schizophrenia •Delusional disorders •Chronic pain •Stress •Anxiety •Cancer •Heart disease •Hypertension •TBI •Diabetes •Fibromyalgia •Urinary urge incontinence •Emotional regulation problems •ADHD •ASD •Trauma
What does brushing do physiologically?
Reticular Activating System (RAS) -or also called extrathalamic control modulatory system -set of connected nuclei in the brains of vertebrates that is responsible for regulating arousal and sleep-wake transitions -in your spinal cord, brushing provides stimulation to receptors, can change thresholds, influences neurotransmitters (affect arousal), decreases levels of substance P -defensiveness = too much substance P in their system (same neurochemical as pain) = same stimulation of pain when being lightly touched
Effects of Prenatal Stress on Brain Growth and Development
Rhesus monkeys - prenatal stress linked to ▫Decreased birth weight ▫Delayed self-feeding ▫Increased distractibility ▫Lower muscle tone ▫Decreased PRNT -stress in mother can effect infant
Guiding Questions: Smell & Taste
Reactions to smells in school - perfume, cafeteria Sensitivity to taste of foods - prefers bland foods or stronger tastes
Weaknesses of SIPT
Relatively expensive -$1,034 plus $30 for necessary forms for each child -Very large, heavy kit -Time consuming -Normed ONLY for 4 to 8 yrs., 11 mos -Training requirement for administration and interpretation
Drive Thru Menus
Relaxation -It's all in your head Stress Buster -Pendulum swings Attention -Milkshake Strength -Desk push-ups
SP 1: Results
Responses are grouped into 9 factors based on their responsiveness to sensory input -Sensory seeking -Emotionally reactive -Low endurance/tone -Oral sensory sensitivity -Inattention/distractibility -Poor registration -Sensory sensitivity -Sedentary -Fine motor/perceptual
https://sites.google.com/site/2020asivision/
SLIDE 15 -ASI 2020 page = tagline on looking up EASI -2020 is Ayres 100th birthday -listed papers of evidence on EASI -ASI 2020 Facebook page à pieces developed from 3D printer, questions, added on ideas to SIPT, etc.
Adult Sensory Profile: Results
Same 4 quadrants -Low Registration -Sensation Seeking -Sensory Sensitivity -Sensation Avoiding
EXAMPLE: Mother notices that Nicole (2 yrs) becomes irritable when she's at family reunions and at the mall and tends to become shy and timid in large groups
Sensory defensiveness or overresponsivity (auditory)
Therapist-Teacher Collaboration
Scheduled time for OT & teacher to problem-solve the needs of students in a special education class Embed strategies in classroom for the whole class -find strategies that could benefit the whole class
Classroom Options:
Seating Vestibular Proprioception Tactile Auditory Visual Oral sensory -bean bag, disco sit, cushion, cube chair, therapy balls, T-chairs (requires core and balance to sit in it) -trampolines, rocking chair, sit and spin -weighted vest, lap blanket, weighted stuffed animals, therapy bands -blanket, things with different textures, fidget toys, finger painting, shaving cream -calming music, headphones, metronome, rhythm band instruments, -visual timer (set time and red disappears with time, do activity until time is done/red is gone) (helpful with planning and transition), visual schedules -vibrators (z-vibe = mouth, lips, cheek, tongues), blow toys, straws, chew toys, gum/chewy food, chewies(chew toys)
Effect of too much norepinephrine
See perseverations (OCD) Need routine, sameness
format
Semi-structured interview for individual testing. There is a paper assessment booklet with a battery of tests and the scores from each individual sub-assessment is calculated in the paper booklet. There is only an English version of the assessment. The assessment is not standardized. The Interoceptive interview consists of 26 questions.
5 Components of Sensory Integration
Sensory Awareness Orientation Interpretation Organization of a response Execution of a response
Specific SI Intervention Strategies Appropriate for School Settings:
Sensory Diet Patricia Wilbarger, M.Ed., OT Tool Chest Diana Henry, OT (www.henryot.com) How Does Your Engine Run Program Williams & Shellenberger (ALERT Program) Zones of Regulation Leah Kuypers, M.A.Ed., OTR/L
Consultation for individual students
Sensory Diets & Sensory Breaks Small Group Sessions To work on specific sensorimotor opportunities -sensory break = getting up and stretching, moving, etc. -educate teacher on sensory diet techniques -finding environment best for what you wish to accomplish
•IF you are working with children without frank neurological dysfunction and using Ayres approach .....which term do you use? -Sensory Integration or sensory processing?
Sensory Integration
Four domains of EASI
Sensory Perception Praxis Ocular, Postural, and Bilateral Integration Sensory Reactivity
Widely used Assessment Tools
Sensory Profile (W. Dunn) - scales for infants through adults Sensory Processing Measure (D. Parham, D. Henry, et al) - more recent with heavy focus on sensory processing within school environments -Each of these is subjective, parent rating scale -sensory processing measure now looks at socialization (update)
Designing a "sensory diet"
Sensory diet is specific for person & is individualized for context BrainWorks www.sensationalbrain.com Sensory Smarts https://www.sensorysmarts.com/sensory_diet_activities.html -apps = give you examples or advice for stimulation/assistance, can track reactions to sensory inputs/environments/events, etc. -SENSORY DIET SHEET ON BB (her personalized form) (can take out, add in, modify) (lists everything so you do not forget anything)
How does Sensory-Based Intervention Help?
Sensory input impacts on the structures of the nervous system in the following ways: ▫Makes dendrites grow in length & density ▫Enhances myelin
As a reference for assessment
Sensory integration is "the process of evaluating persons for problems in processing sensation" (Miller et al., 2007) -Standardized measurement and clinical observations
Sensory Processing disorder picture on slide 31
Sensory modulation disorder (SMD) -Sensory over-responsive -Sensory under-responsive -Sensory seeking/craving Sensory discrimination disorder (SDD) Sensory based Motor Disorder (SBMD) -postural disorders -dyspraxia -chronic and disrupt everyday lives -specifics next week -SDD = inability to discriminate or disccern different things or their locations -SBMD: motor planning -subtypes in each
Discussion of Adult Sensory Profile
Sensory sensitivity = degree to which you are anxious to input Sensation avoid = degree to which you are avoiding Low registration = degree to which you modulate/react to sensation Sensation seeking = degree to which you seek out sensory input -ex: I scored more than most people in low registration = I have a higher threshold to sensations, and regulate it passively (I have a greater low registration meaning I register stimuli more easily than most, ) -ex: more than most people in sensory sensitivity (I hate listening to loud music) -ex: less than most people in low registration = I need things repeated several times, proprioception: I am clumsy -ex: sensory sensitivity less than most = get car sick easily, anxiety with messes -ex: -high threshold = create sensory experiences -sensory sensitivity = high detection skills due to low threshold = cover ears, etc. -low registration = have to have input to react (ex: touch the child to have them respond) -dependent on harshness of yourself on answers
PRAXIS
Somatosensory-Based Praxis -Positions (Pr:P) -Sequences (Pr:S) Visual-Based Praxis -Tracing (VPr:T) -Designs (Vpr:D) -Construction (VPr:C) Language-Based Praxis -Following directions (Pr:FD) Ideation-Based Praxis -Ideation (Pr:I) -touch and body position on praxis -language = verbal commands
Various causes of sensory processing difficulties
Some people have sensory processing disorders which require more intense and frequent types of sensory input to help them function The environment itself can cause sensory processing problems: -Sensory deprivation results in disordered behaviors -Sensory overload produces stress -deprivation = not enough input -overload = too much input
ear canal
Sound waves --> tympanic membrane --> ossicles (middle ear) --> hair cells (organ of Corti; inner ear) --> basilar membrane --> auditory nerve --> CNS vestibular system -semicircular canal where vestibular system takes place
Form & Space Perception (4)
Space Visualization -Measures visual perception of stimuli composed largely of spatial elements (blocks & formboard) -Also looks at hand preference & crossing midline Figure Ground -Finding three shapes or figures present in an overlapping picture Manual Form Perception -Measures stereognosis; ID of shapes w/o use of vision; requires tactile discrimination Motor Accuracy -Measures visuomotor coordination in tracing over a long dark line with a red pen; assesses written accuracy w/ R & L hand -SV: put the peg in a specific hole in the shape, without thinking, must mentally manipulate the object in their minds and choose the shape with the correctly placed whole that will fit in the space -FG = pictures overlapping in the top of the book, then choose which individual figures the picture contains from a group of figures -MFP = shield held against chest to block vision of activity (feel shape in hand and point to picture of which shape they have à progress to board with shapes, selecting the correct shape on the board based on what shape was placed in their hand prior) -stereognosis = ability to "see" through touch -MA = must trace over a dotted line, mark where they get out of line, use map tool to identify how long they were out of line, use with both hands
nSummary Score Sheet
Split into 4 quadrants -Low Registration -Sensation Seeking -Sensory Sensitivity -Sensation Avoiding
3 Phases of Trauma Treatment
Stabilization Processing & grieving Transcendence Sensory approaches are used to foster safety, development, functional performance, & recovery -stabilization = personal safety (regulation of emotion, calmness) -processing and grieving = coping, mourning, moving on -transcendence = focusing on reconnecting with others, personally meaningful activities, healthy and fulfilling life, steps towards self-actualization and empowerment, developing independence -safety --> stabilization --> grieving and processing --> transcendence
Three stages of the ALERT Program:
Stage 1 --> Identify how your engine runs; Stage 2 --> Learn how to change your engine levels by using sensorimotor strategies; and Stage 3 --> Use sensorimotor input in order to regulate your engine for successful attending.
Training for SIPT
Strongly urged for accuracy for test administration and interpretation of results SIPT Training really is required to administer it, although recent discussions during SI conference panels may have blown that up a bit, especially in light of the new EASI development.
SP 2: Results
Summary Score Sheet Split into 4 quadrants: -Seeking/Seeker -Avoiding/Avoider -Sensitivity/Sensor -Registration/Bystander
Sensory Reactivity
Tactile -Defensiveness (TD) -Tactile registration problems (TRP) Auditory -Defensiveness (AD) -Auditory registration problems (ARP) Olfactory -Defensiveness (OD) -Olfactory registration problems (ORP) Vestibular -Motion defensiveness (MD) -Motion registration problems (MRP) -Gravitational insecurity (GI) -responses to tactile input -olfaction = added to EASI, response to different smells -MD = used to be gravitational insecurity
setting
Testing should be completed in an environment free of auditory or visual distractions. The person being tested should be calm and rested; due to this, it is recommended that individuals are tested earlier in the day. The examiner and examinee should be seated across from each other at a table or desk and the individual being tested should not be able to see the record form.
How does your engine run?
The Alert Program for Self-Regulation by Mary Sue Williams & Sherry Shellenberger Occupational Therapists (~$45.00) www.pdppro.com
description
The Beery VMI requires the test subject to look at an image and then copy it using a pencil and paper. The full form has 30 images to copy and the short form has 21 images - 1 point is awarded for each properly imitated/copied item. If the test subject is under the age of 5, start with imitation, #4 in the test booklet. If a child scores 1 or more points on imitation tasks, move on to #7 - copying printed images on the next page. If the child can not imitate, go back to scribbling #1-3. If a child does not scribble, stop the test. At functional age of 5 and above, test starts at #7, with copying the printed images (Beery et al., 2010).There are two optional supplemental tests, The Beery VMI Visual Perception test and the Beery VMI Motor Coordination test, that can be administered for those who wish to see pure visual and pure motor performance pictures in phone: big text booklet first --> if not passing use other smaller text forms
population
The age ranges for the Developmental Test of Visual Perception-3 (DTVP-3) are 4-12 years old. The test is used in pediatric/adolescent rehabilitation.
description
The DTVP-3 is compiled of five subtests and is used to test visual perception and visual-motor abilities. The first subtest is Eye-Hand Coordination-the child is required to draw a precise line within visual boundaries. Second is Copying-the child is shown a figure and asked to draw that figure in the box provided below the model. Third is Figure-Ground-the child is asked to identify the figures that are hidden in a complex background. Next is Visual Closure-the child is asked to identify the completed figure that matches the figure that is missing parts. Last is Form Constancy-the child is shown a figure and asked to find it in multiple other figures, the targeted figure can be a different size, shade, or position as well as hidden in a confusing background. For the Eye-Hand Coordination the raw score is recorded by determining if the child stayed in the boundaries and did not pick up their pencil. For Copying the Copying Subtest Scoring Template is used along with a scoring guide in the manual to determine the quality of the recreated figure. For Figure-Ground the Raw score is the sum of the correctly identified figures in each item of the picture book. For Visual Closure the raw score is the sum of correctly matched complete drawings. For Form Constancy the raw score is the sum of the correctly identified figures that include the original figure. For Figure-Ground and Form Constancy the child receives a 0 if they choose an item that is not in the original figure, even if the correct items are identified. The child continues through each item until the end or they receive a score of 0 on three consecutive items. These raw scores are converted to scaled and percentile scores. A scaled score of 8-12 is termed as average.
description
The MVPT-4 contains 45 visual stimuli that the individual will have to say or point to for the correct response choice. All directions are to be followed closely because incomplete administration may have an effect on scores.The examiner is able to see the directions on the plate book while facing the examinee and they should be read exactly. Casual conversation cannot take place once testing is started, because it may be an indicator of behavioral observations which need to be recorded. The examiner should remain emotionless during testing and examples in the booklet are given as needed. On the record form, the answer choice that the examinee states should be circled. If the examinee refuses to answer, use NR for no response. For scoring, the count of correct responses will be the raw score. The raw score is translated into a standardized score for age comparison.
format
The MVPT-4 is individually administered, with 45 visual stimuli presented and each stimuli is presented as a multiple choice question. To score, you count the number of correct responses to create a raw score, and then convert this to a standardized score using chronological age.
purpose
The MVPT-4 measures five types of visual-perceptual skills commonly used in everyday activities. The five skills are: spatial relationships, visual discrimination, figure-ground, visual closure and visual memory. This test can be used in clinical and research settings by occupational therapists, developmental optometrists, psychologists, neuropsychologists, rehabilitation therapists, educational specialists and others. The MVPT-4 is used for screening, diagnosing, and research. Its intent is to provide practitioners with an overview of visual-perceptual abilities, to better understand further impact on cognitive, motor, learning or daily living functions.
description
The SPM is an assessment tool that is used for children in kindergarten through sixth grade. It looks at behaviors and characteristics of the child's sensory processing, praxis and social participation. The assessment is composed of three forms. The first is the Home Form that is filled out by a parent, the second is the Main Classroom Form that is filled out by the child's teacher and the third is the School Environments Form that is filled out by a school staff member who has observed the child in various settings. The Home Form has 75 items, the Main Classroom Form has 62 items and the School Environments Form has 30 items. The Sensory Processing Measure assigns scores related to social participation, vision, hearing, touch, body awareness, balance, motion, motor planning and ideation. The form that is filled out has a carbon copy, so the responses are recorded onto a scoring sheet. The responses are tallied up in their respective locations for each section and then those scores are added up to equal a total raw score. The scores are then transferred to a profile sheet where a T score is calculated and a corresponding percentile rank is assigned.
format
The SPM is an observation-based rating scale. There are three forms: The Home Form (75 items- administered by a parent), the Main Classroom Form (62 items- administered by a teacher), and the School Environments Form (10-15 items per environment- administered by a school faculty member). This allows the child's sensory processing scores to be reflective of both individual and group settings.
population
The SPM is intended for children ages 5-12 years who are suspected of having sensory processing difficulties. This measure is based on a nationally representative sample of 1,051 children. In an additional clinical sample, data was collected from a total of 345 children.
purpose
The SPM reveals sensory processing difficulties that a child may have both in school and at home such as under and over responsiveness to sensory stimuli. Sensory processing disorders can appear differently in a variety of environments, so there is a form for several settings (a Home Form, a Main Classroom Form, and a School Environments Form). The SPM evaluates praxis and social participation as well as visual, auditory, tactile, proprioception, and vestibular functioning. This information will educate parents, teachers, and caregivers on the sensory needs of a child and how best to meet these needs. The age requirement for the Sensory Processing Measure allows for early intervention to occur.
What is your "engine"anyway?
The analogy of an engine is used to help children understand concepts of self-regulation "Your body is like a car engine. Sometimes it runs on high,sometimes it runs on low, and sometimes it's just right."
description
The Sensory Profile 2 evaluates sensory processing in children ages birth-14 years old. There are 5 different questionnaire types; Infant Sensory Profile 2 (25 items), Toddler Sensory Profile 2 (54 items), Child Sensory Profile 2 (86 items), Short Sensory Profile 2 (34 items), and School Companion Sensory Profile 2 (44 items). This questionnaire is to be completed by a parent and/or teacher based on their observations of the child's sensory processing. The person completing the questionnaire must be someone that has regular contact with the child. Each question is rated on a 1-5 scale by the parent and/or teacher. 5 being "Almost always" and 1 being "Almost never.'' The person completing the questionnaire can also put 0 for "Does not apply." This assessment can be completed with paper and pencil or online via Q-global.
materials/tools
The Sensory Profile 2 manual and score sheet is required for the pencil/paper version of the assessment. It can be ordered through the Pearson Assessment website. The manual and score sheet cost roughly $83 for a hard copy. The online version can be accessed through their website, the Q-global for a yearly subscription of $40.
materials/tools
The assessment administrator will need copies of the assessment forms which contain instructions on how to proceed with the assessment tool for the Interoceptive Awareness Interview and Caregiver Questionnaire. For the Assessment of Self-Regulation, 18 pictures are utilized to help the client identify their emotions.
setting
The assessment setting should include a table and seating that will allow for the administrator to reference the assessment booklet as well as record the answers of the participant.
interpretation
The five test areas have nine test items plus two unscored items which will allow the examiner to see if there are errors in the one or two task areas. The examiners may notice that raw scores tend to increase in early age and decrease in older age. This is normal for visual perception across development. The raw score is the correct number of responses and is recorded along with standard score, confidence interval, and percentile rank. The standard scores are based off of a mean, median, and standard deviation of 15. The precise measurement of the confidence interval is more likely to represent the person's true ability based on how small the interval is. This can be calculated by subtracting from the lower level score and adding to the higher standard score. When this test is discussed with parents or teachers it may be beneficial to mention test performance in comparison with percentile rank. This is better understood that way. Percentile scores are looked in comparison with population norms. Age equivalent scores, which are listed in a table, will be used for each chronological age or age range and may be used to document progress for the individual.
population
The full form of the test can be given to individuals ages 2-100. The short form of the test can be administered to ages 2-7 years. This test is often administered on children with suspected delays in visual perceptual and motor abilities and those who have been disabled by a stroke, injury, or Alzheimer's disease (Beery et al., 2010).
population
Used for children from birth to 14
materials/tools
The materials consist of a manual, a flip book with test plates, and twenty-five record forms.
What is a sensory diet?
The therapeutic application of sensory activity to: 1)Help a person attain & maintain optimal arousal states 2)Produce a change in sensory processing capacities 1 = compensatory 2 = more of a change -help meet the needs of those with SPD -analogy: every child has a bucket unique to them, they are either seeking to fill it or overflowing at different points of the day. So, a sensory diet can help fill their bucket or help prevent overflow
sensory processing
The way the nervous system receives messages from the senses and turns them into appropriate motor and behavioral responses
materials/tools
Therapist needs the manual for reference, the Introductory Letter to Parents/Guardians form, the Sensory Strategies for Preschool form, the Follow-up Letter to Parents/Guardians form, the A Sense of this Child form, the Individual Child's Checklist form, and the A Sense of My Whole Class at Work and Play form. All materials are reproducible with the exception of three forms.
description
There are three parts to the Interoceptive Awareness Assessment. The first assessment is an interview that describes and defines the participants' interoceptive experience and gives the administrator a descriptive and comprehensive perspective on the possible sensory processing needs of the participant. This section consists of 26 questions that follow a semi-structured, informal format where the administrator asks a question and then receives an open-ended answer from the participant. The next part of the assessment is the Assessment of Self-Regulation. This sub-assessment uses the eighteen pictures included in the package to allow the participant to reflect on the emotions displayed in the photographs as well as their emotions and what causes them to experience these various emotions. There is a scoring system for this section which grades the participant's ability to complete five self-regulatory skills. These skills are: identifying others' body state or emotion, identifying others' causes or triggers, identifying own causes or triggers, interoceptive awareness, and strategy identification and problem solving. The last sub-assessment included is the Caregiver Questionnaire for Interoceptive Awareness. This assessment is presented to the participant's caregiver and is used to identify Interoceptive Awareness of the participant observed by the caregiver.
setting
There is no specific setting the person has to take this assessment in. It is up to the discretion of the person. A quiet enough spot so the person can focus, do simple math, and thoroughly read each question is recommended.
Sensory Cell Discussion
Think about the entire cell, discuss in your group & use available literature (on Bb & web) to compile a list of modifications/adaptations for your assigned sensory system -Visual -Auditory -Olfactory -Gustatory -Vestibular -Proprioceptive -Tactile -sensory room at prison -what is appropriate in this room for the setting (restrictions in institution) -visual = dim lights, dimmers, softer colors, murals of nature, paintings, ceilings with clouds, declutter the room -auditory = noise canceling headphones, ear plugs, calming music -proprioceptive = weighted blankets -vestibular = rocking chair, small trampoline -olfactory = aromatherapy -gustatory = crunchy, sour, chewy *more of a sensory modulation room (calming, learn techniques)
population
This assessment can be used with any individuals from age 3 to late adulthood. Adaptations can be made to adjust the assessment to meet the developmental or other needs of the individual. The assessment is often used with individuals with various developmental concerns that affect sensory systems, such as: ASD, trauma, anxiety disorders, and ADHD.
format
This assessment is considered an individual-based questionnaire. It can be done through computerized administration/scoring or through a paper hard copy. Scoring is done using Q-global (web-based) or manual for paper and pencil version. This assessment is typically filled out by a caregiver or teacher, depending on the setting. All versions are available in Spanish.
purpose
This assessment is used to measure Interoceptive Awareness to determine areas where certainskills such as self-regulation can be improved in clients. This assessment tool analyzes the participant's individual interoceptive experience. The interoceptive experience includes anything felt by the participant that signals body states and needs.
interpretation
This is a non-standardized, qualitative assessment. The assessment scores could be used in the beginning of intervention to detail aspects of a client's interoceptive experience. For the Interoceptive Awareness Interview sub-assessment, higher scores (3, 4, or 5) indicate lower levels of Interoceptive Awareness (IA). In the Caregiver Questionnaire sub-assessment, lower scores (1, 2, or 3) indicate low levels of IA. Low or reduced levels of Interoceptive Awareness could point to IA difficulties that may require further investigation. The assessment could be utilized as a means of gathering a baseline for the individuals IA level and could be administered again upon completion of the intervention process to detect intervention outcomes and client progress.
population
This test is intended for a wide range of populations from 4-80+ years old. One of the limitations of this test is that it doesn't pinpoint specifics or identify causes for deficits, so developmental, physiological, medical and psychological factors can influence a person's score. The MVPT-4 is a first step in an evaluation of visual perception, it doesn't diagnose anything when standing alone. It was standardized from more than 2,700 individuals from ages 4-99. Testing was done in 85 different sites across the US and includes public, private and parochial schools as well as private practices.
purpose
This test is measuring vision and perception.
population
This tool is intended to be used on children (about 2.5-5 years of age) who may show signs of sensory processing difficulties.
Formal Assessments: Standardized Tests
Those developed by Jean Ayres for children with learning disabilities You must be certified to administer these tests -Post-Rotary Nystagmus (PRN) Test -Sensory Integration and Praxis Test (SIPT)
Those tests developed by other individuals to be used in identifying sensory processing problems:
Those tests developed by other individuals to be used in identifying sensory processing problems: -Miller Assessment for Preschoolers (MAP) -DeGangi-Burke Test of Sensory Integrative Functioning -Test of Sensory Integration in Infants (DeGangi-Burke) -Infant-Toddler Symptom Checklist (DeGangi) -Sensory Integration Inventory (Hanschu) -*Sensory Profile (Dunn & Westman)* -*Sensory Processing Measure (Parham, et al.)* -those in bold = most popular/common (constantly updated) -separate test for interoception
Receptors of Interoception
Tissues inside the body including organs, muscles and skin
materials/tools
To administer the Beery VMI the administrator needs a score booklet, pencil or pen (no erasers are allowed), administration manual, scoring manual, teaching manual, and a stopwatch
Sensory Approaches
To target the intense physical manifestation of trauma Provide "experiential" opportunities to help individuals 1) Recognize sensory experiences 2) Identify their sensory preferences 3) Begin to heal the mind through the physical sensation of the body (doing) -reduce emotional stress, calm organized state before communicating anything -sensory preferences = what their body needs, what calms them down -affecting brain functions, just talking about has limited success, participation in sensory input has proved success
purpose of adult sensory profile
To understand sensory processing of individual Assist with intervention planning -know awareness level (is it interrupting their lives)
2) State changers or mood makers
Use various sensory stimuli to modify arousal for the needed activity. These include: -Tactile (fidget toys) -Visual (dimmed lights) -Auditory (classical music) -Olfactory -Oral input (snacks) Just like "Alert" Program *Activities should be timed carefully and spread out throughout the day to help child maintain an optimal state of arousal
•IF you are: -Working with populations without frank (obvious) neurological dysfunctions
Using SI frame of reference •Use the term Sensory Integration (SI) -Using Ayres approach to SI as intended, fidelity to Ayres SI method/measures: ASI -if it is no neurological dysfunction = use sensory integration -IS a neurological dysfunction = use sensory processing
Pediatric Assessment Tools
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Preschool SENSE, Preschool Sensory Scan for Educators
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Review
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Sensory Diet
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Sensory Integration Intervention
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Sensory Processing Disorders
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Sensory Processing Measure-SPM
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Sensory Processing in Adults & Trauma-Informed Care
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Sensory Profile
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Sensory Profile 2
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The Beery-Buktenica Developmental Test of Visual-Motor Integration (Beery VMI)
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The Comprehensive Assessment for Interoceptive Awareness, Second Edition
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Sensory Integration and Praxis Tests (SIPT)
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Evaluation in Ayres Sensory Integration (EASI)
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Clinical Observations of Sensory Integration
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Developmental Test of Visual Perception-3 (DTVP-3)
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Motor-Free Visual Perception Test MVPT-4
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Sensory Integration Intervention: School Contexts & Sensory Diet
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Sensory Processing Evaluation
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Neuroplasticity and Environmental Input
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ALERT PROGRAM How Does Your Engine Run?
VVVVV this presentation will help you: -Become aware of factors that may influence attending behaviors -Analyze your own and children's unique sensory processing -Consider how to accommodate the environment in response to the child's unique sensory needs to enhance attending
Sensory Integration or Sensory Processing... Current Controversy
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Individual Ayres Sensory Integration ® (ASI) Intervention— "Classical SI"
What? SI intervention as described by J. Ayres -Controlled sensory input in an ... -'enriched environment' - space required and equipment & toys -Individual 1:1 sessions -Play-oriented (balance structure & freedom) -Active participation -Child-directed; foster inner drive -FOCUS is on 'remediation' -remediation = improving sensory system (no compensation) -give the child a choice (client-centered)
Leaders in this area:
Williams & Shellenberger - "How Does Your Engine Run" Program Otter, Richter, & Frick - MORE
Complete a daily engine analysis
Worksheet for child to fill out (slide 25) -visuals are helpful for them (helps them map out what their engine is like at different points during the day or with different activities)
Other Self-Regulation Programs
Zones of Regulation Emotional ABC's
Changes neurological structures and functions
a) affects hippocampus which influences learning and memory b) impacts multiple frontal-limbic structures needed to regulate emotional responses to stress and fear c) impacts the hypothalamic-pituitary adrenal axis that controls regulation of body processes and response to stress -impact the ability to make healthy attachments -regulation to constant fight or flight response -physiologically reactive to events -PTSD: experience trauma again
•Neural plasticity
ability of brain structure & function to change; SI intervention is hypothesized to change brain structure & function -plasticity always present through life (always changing)
SIPT Standardized on representative sample in US for
ages 4 - 8 yrs, 11 months Recall - what population was SI theory/intervention originally designed for? What do you think about the age range for this assessment? -important to know why and how it is standardized because it will only represent that specific populations (ONLY useable for those 4-8) (not a wide range, misses early intervention phase) -doing the test outside of age range = comparing them at best to an 8 year and 11-month year old (typically a lot of SP issues get resolved/better over time, so by the time they are older they have learned to adapt and compensate, so it might look more extreme of symptoms when you are comparing that 10 year old to an almost 9 year old)
SI theory provides
an important set of knowledge and skills for OT's world-wide
"Sensory integration therapy,
by providing specific sensory input to and eliciting a related adaptive response ... could influence the intercellular interactions that lead to synaptic strengthening, which in turn enhances the organization of the brain."
setting
can be administered as a group screening test or for individual assessment purposes. It is usually administered in a classroom or clinical setting by a teacher or therapist. The room should be well lit with minimal distractions and the test should be done while sitting at a table.
If your engine is high
cannot sit still, anxious, excited, aroused
Our senses allow us to
experience & respond to the environment
Vestibular
how does child respond to movement? Observe: -Behavioral response (limbic reaction) to variety of age-appropriate movement experiences (avoid or seek out) -Presence of equilibrium & righting reactions -Muscle tone -Extra-ocular control (focusing, tracking) -Gravitational security (how secure/safe child feels with movement; observe reactions to movement and feet above ground) -Note unusual cravings for or dislike of vestibular input -ANS responses to vestibular input (sweating, nausea, increased heart rate) .(ex: put them on a swing and they throw up)
Tactile
how does child respond to touch? Observe: -Note behavioral responses to various types of age-appropriate tactile input (during bathing, dressing, play activities, eating)—avoid or seek? -Any tactile defensive behaviors? (distraction when touched, pulling away from touch, scratch/rub where touched) -Evaluate for various forms of tactile discrimination (identification of where touched) a.) note behavioral responses to various types of age-appropriate tactile input (during bathing, dressing, play activities [finger painting, playdough, etc.], eating messy foods, etc.) b.) note any tactile defense behaviors (i.e. negative reactions to touch such as scratching or rubbing where touched, distraction when touched, pulling away from touch, etc.) c.) evaluate for various forms of tactile discrimination (identification of where touched, stereognosis)
EASI Test Authors
identified weaknesses with SIPT --> how to make it better
Unstructured Observations
individual child-directed free play, gross motor exploration, and activities of daily living -unstructured: are they able to do it independently, how do they do it, etc.
Interpretation
integration of input across sensory modalities and attributing meaning
Sensory Threshold
is the point at which the summed sensory input activates the CNS. Each sensory stimulus is cumulative in that it is added to sensations that came before it. Combined sensory input is processed and influences behavior We all process sensory Input a little differently and may vary in our overall threshold -High threshold = kids that are over modulated, under responsive, seeking input, easy going personality, NS not getting enough (need a lot of stimulus to potentially get a reaction) -Low threshold = high strung, over responding, avoiding, defensive, nervous system getting too much -most systems modulate systems in mid range, can experience high or low in certain situations, but dysfunction occurs when high or low threshold reactions are sustained and interfere with functioning
Unawareness
may take longer to potty train, may not eat as often because don't feel feeling of hunger or thirst, more frequent accidents
most people's response to sensory input
moderate responses to sensory input allowing for successful participation in daily life activities -5-15% of population have a sensory modulation disorder (disorder the neurological function for the brain to organize sensory information coming in, can be under or over responsive)
Snoezelen rooms
more for mild cognitive impairments, relaxation, social interaction
Zones of Regulation
need a break (blue), ready to go/happy, starting to get anxious (yellow), need to stop/overflowing (red) identify (this person is angry, what zone is that)
As a theory
neurological constructs explaining "how the brain processes sensation and the resulting motor, behavior, emotion, and attention responses" (Miller et al., 2007) •Also a cellular level of integration -sensory integration = brain processing information from all sensory systems, then your body is able toreact/respond (appropriately or inappropriately) -cellular level of integration
notes on The Comprehensive Assessment for Interoceptive Awareness, Second Edition
o Adaptations provided if disabled o Scoring interview 1-5 (5 = lower level of interoceptive awareness, 1 = high level) o Not standardized o Overall understanding/awareness of child's interoceptive awareness, or can be used to assess progress throughout rehab o First part: asks the client questions about how their body feels with different emotions (when you're angry, happy, etc.) § Harder to understand o Second part: do they ever... (feel a certain way, etc.) o Third: assessment of self-regulation = shown a picture (18 total) and asked the same questions for each of them § How does this person feel § What is making them feel that way § Have you ever felt this way o Fourth: caregiver questionnaire § Does your child have difficulties with... § Scoring 1-3 = lower level of awareness § Scoring 3-5 = higher level of awareness o Long assessment, child can get bored o Give words of how they are feeling (manual gives one option for an answer, scoring is strict) § Good IA answers and reduced IA answers provided in manual o Big score sheet for assessment of self-regulation, the rest are not transferred for scoring o Not a lot of research o Difficult to use/understand
notes on sensory processing measure
o Assessment for typically developing children, but mostly for those with exhibited dysfunction o School personnel fills out school environments, teacher for classrooms, parent/caregiver for home o Quick screening or more thorough evaluation (usually not used by itself) o Do they perform inconsistently, how is their balance, do they share things when asked, vision (do they like to switch light switches on and off repeatedly), auditory (do they like repetitive sounds) o Scoring = connect the dots to determine if typically developing (T score and percentile score) o Carbon copy paper under reported score sheet to make scoring a lot quicker (don't have to go back and forth) o Find environment difference by subtracting scores
notes on DTVP3
o Field perception and visual motor abilities o 5 subtests (gives specifics, helps guide intervention) § Eye-hand coordination: draw a line from first item to second item (point if staying in gray area and not picking pencil up, more points for smaller gray areas); copying figures (scoring template for measuring angles 0-3 on each figure) § Figure ground: identify the shapes that are in the top figure and receive a point for every correctly identified item (0 if picking one not in it) § Lined figures: pick dotted lined shape that is similar to the one above § Form constancy: identify targeted figure in the shapes provided below (0 if identifying one not in the figure) o Percentile score and scaled score § Scaled score gets descriptive term (very superior à very poor) § Above 90 score = visual competence and good, accurate hand movements o A little more thorough than the VMI (motor reduced and visual motor scores)
notes on MVPT-4
o Identify there are issues, not diagnostic o Standardized o Read the back of the book (standardized) and present the front to the child -Images given and provide answers from images on the bottom o Scoring: subtract number of errors by total items = raw score à standard score using manual (chronological age with raw score), standard deviation o Very long o Not allowed to give positive regard ("good job") o Takes away motor aspect, specifically visual perception
notes on Beery VMI
o No erasers allowed on the pencil used o Imitation = watching the therapist draw it and copying it o Copying = looking at the image and copying it o 3 trials o Raw score based on items correct o Conversion charts in the back of the manual for scoring o Spontaneous scribbling/marking if child cannot accomplish imitation o Get one stroke per image o If they make more than one mark, score the first one o 3 "NO SCORES" in a row (no point because task wasn't accomplished correctly) = finished o Take the highest score and subtract previous no scores = raw score --> convert to standard score (in manual) --> break down performance (in manual) o Green paper more calming o Start at the back of the booklet and work up (designed horizontally = open away from you) o Can observe more than just cognition of forming the picture (attention, handwriting skills, posture, etc.)
notes on Preschool SENSE, Preschool Sensory Scan for Educators
o Not standardized and not compared to normative data o No qualifications required for administration (but preferred) o 2 forms the therapist takes back from the teachers (can hand out many different forms if various teachers) o Sensory modulation abilities, sensory discrimination abilities, sensory based motor abilities (postural responses and praxis) o Scores: craver, jumbler, etc. in all senses o Ask teacher child's strengths, goals they want them to progress to, etc. (comes in the manual, a worksheet you give them) o Helps structure intervention more specifically o Limited research (not actually an assessment tool, is a screening) o Easy way for educators to identify sensory issues in students
notes on sensory profile 2
o Same as one we filled out, differences identified in ppt o Also contains sensory sections and behaviors sections for scores o Child: social emotional, attentional response, etc. -Sensory seeker, avoiding/avoider, sensitivity, ? o Interpretation: worry about much less or much more than others (extremes)
direct intervention
one on one
Execution of the response
performance of the cognitive, affective and/or motor response
If your engine is just right
ready to learn/attend, happy
vestibular
received in the middle ear, helps with balance, tells us if we are moving or still
sensory modulation rooms
promotes sensory modulation, ex: quiet space that is more sensory supportive (combo of Snoezelen and sensory integration), acute care, long-term care
Modulate
regulate, change, adjust—to respond appropriately to incoming sensory Input -over or under modulate -ability or dysfunction with each
•IF you are working with other populations and modifying Ayres' approach based on setting and the person's condition, then use
sensory-based or sensory-motor based approach or intervention -Can still use an SI frame of reference, but intervention is not necessarily SI or ASI -autism, TBI, CVA, cerebral palsy, etc. -do not call it SI or ASI anymore (treatment we use is updated) (can say using SI frame of reference)
Schema
sequencing, identifying the steps involved and organizing them into an appropriate sequence
setting
should be administered in a quiet setting at a table with adequate space to fill out the form. The individual filling out the form should be seated in a relaxed and comfortable position.
Equipment and space
slide 7-10
Qualitative Observation Through
structured and unstructured observations
SI Assessment Involves...
systematic observation of 3 different contributors to sensory integrative function -The child -The physical environment -The social environment -and the dynamic goodness-of-fit among them -incorporate the parents and goals -ex: when does the child overreact to identify triggers -observe the child in different settings if you can (school, home, community)
These are the key mechanisms of neural plasticity which supports the basic premise of sensory integration -
that input from the environment has the potential to affect brain development
Zones of regulation: Green Zone
used to describe a calm state of alertness *OPTIMAL LEARNING!! (just right)*
Zones of regulation: Yellow Zone
used to describe a heightened state of alertness and elevated emotions; however, one has some control *WIGGLES* -almost out of control
Zones of regulation: Red Zone
used to describe extremely heightened states of alertness and intense emotions *OUT OF CONTROL*
Zones of regulation: Blue Zone
used to describe low states of alertness *BORED, LETHARGIC*
MINDFULNESS
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Proprioception
what kind of proprioceptive input does the child need to function? Observe: -Coordinated use of body -Assess awareness of body in space during activities -Ability to do tasks without an over-use of vision; observe how much child uses (over-uses) vision during daily activities -Informally assess kinesthesia (conscious awareness of joint position) -Note amount of pressure during pencil grip/writing -Note presence of clumsiness and dyspraxia -Note any unusual cravings for proprioceptive input (wrestling, jumping, pushing) (sensing of movement and body position) - assess awareness of body in space (body percept) during activities - ability to do tasks without an over-use of vision; observe how much child uses (over-uses) vision during daily activities - informally assess kinesthesia - note amount of pressure during pencil grip/writing -note presence of clumsiness and dyspraxia
sheet for them to fill out: When I Want to Keep My Engine Running Just Right
what works what bothers me
Sensory Processing Disorder (SPD)
www.spdstar.org "A neurophysiologic condition in which sensory input either from the environment or from one's body is poorly detected, modulated, or interpreted and/or to which atypical responses are observed" "is a complex disorder of the brain that affects developing children and adults. People with SPD misinterpret everyday sensory information, such as touch, sound, and movement. They may feel bombarded by information, they may seek out intense sensory experiences, or they may have other symptoms." Range from mild --> severe (decreased function, increased behavioral issues) -SPD = way our nervous system is receiving messages and how we are responding -disorder = not processing responses correctly (give slow sensory input, one at a time, to cope) -no fight or flight response when participating in sensory system (shouldn't be scared or anxious)
WHAT IS MINDFULNESS?
•"Mindfulness means paying attention in a particular way on purpose in the present moment and non-judgmentally." •Present-moment awareness •Paying attention to one's life experience in the here and now through the senses and the mind •"Being fully awake in our lives. It is about perceiving the exquisite vividness of each moment" Present moment awareness! •LIVING in the present moment (Not thinking about the present moment) •Open and friendly willingness to understand the here and now, what is going on in and around you -paying attention on purpose -thinking about how you are in that moment ("here and now") -we do a lot of multitasking in our days, mindfulness is the opposite of multitaskingWHY IS IT IMPORTANT?
underlying assumption
•"Since learning is a function of the brain, learning disorders are assumed to reflect some deviation in neural function." -studied integrative function of the nervous system -want to change CNS processing (neuroplasticity) -applied to all ages and populations
Hebb Synapse
•"neurons that fire together, wire together" ; repeated activation can strengthen synapse and increase intercellular connections
Sensory Processing disorder (SPD)
•A condition that exists when sensory signals don't get organized into appropriate responses •"Traffic jam" that prevents certain parts of brain from receiving info needed to interpret sensory information correctly •Person with SPD finds it difficult to process and act upon information received through the senses, which creates challenges in performing everyday tasks -Motor clumsiness, behavioral problems, anxiety, depression, school failure may result if not treated effectively •Lucy Jane Miller •Complex disorder of the brain that affects developing children & adults -Misinterpret everyday sensory information -May feel bombarded by information -May seek out intense sensory experiences -common self-injurious behaviors, ex: pain stimulation with head banging -sometimes the child could be overly medicated because the child was diagnosed with ADHD, but in reality, they just have SPD -can have ADHD and SPD and Autism, etc.
What IS sensory processing?
•A person's way of noticing & responding to sensory messages from their body and the environment •Nervous system processes sensory input -ex: autism, ADHD, psychosis, TBI, etc. -Processing = how your body knows that -why our brain processes sensory input: provides a general awareness for what keeps us aroused/attending and to help us determine and internal sense of awareness -these issues are interrupting their everyday life significantly à treatment
Attention
•Ability to focus selectively on a desired stimulus or task •Individuals may have sensory preferences in their attending abilities -ex: quiet input, sensory input, etc. (ex: have to have complete silence to read and stay attentive)
Arousal
•Ability to maintain and transition between different sleep and wake states appropriately for a given task •Arousal can be viewed as the state of the nervous system that influences how alert one feels -can vary depending on the types of arousal we are in -sensory stimulation can spark arousal
Sensory Craving
•Actively seek or crave sensory stimulation and seem to have an almost insatiable desire for sensory input •They tend to be constantly moving, crashing, bumping, and/or jumping •They may "need" to touch everything and be overly affectionate, not understanding what is "their space" vs. "other's space". •Sensory seekers are often thought to have Attention Deficit Hyperactivity Disorder (ADHD) and Attention Deficit Disorder (ADD). -sensory input provided not enough -overly affectionate -personal space issue -crashing into things -common with ADHD -what type of movement is the child seeking...? --> sounds, crashing, spinning, etc. -input they crave does not regulate them (hard to treat, can become more disorganized with input) -start with interoception --> regulation of emotions or awareness -can look like under-responsive until actually consistently supplying stimulus
Interoception
•Allows us to 'feel' our internal organs and skin and give information regarding the internal state or condition of our body •System helps us feel many important sensations •Helps us sense a variety of general and localized feelings •The awareness of our internal body state is the basis for how we view or feel emotions -Link between sensations and emotions •Interoception is a vital component to the emotional experience -ex: know when your hands are sweating that you're nervous -ex: I am giving a presentation in 2 days and I know I will be nervous -imperative component to emotional experience
The 4 A's & Sensory Processing
•Arousal •Attention •Affect •Action
Evaluation of Sensory Integration
•Assessment tools developed by Ayres -Post Rotary Nystagmus Test (PRNT) -Clinical Observations -Sensory Integration & Praxis Test (SIPT) •OBSERVATIONS of sensory processing -Sensory Profile (Dunn) -PRNT: vestibular, spinning the child 10 times in a circle with their eyes closed, normal response when stopping and opening = nystagmus (abnormal = eyes still) (test both directions of spinning) -hit it with them until their system can react -SIPT: must be certified to give it, -clinical observations = testing sequence of senses through child actions, not standardized, just observing -sensory profile = questionnaire, child infant school and adult versions, range from all the sensory systems (even emotional responses) -sensory processing measure (SPM) = preschool and child and school version, same assessment to parents and teacher then compare them and see where you are observing behaviors and if/when they change (increase or decrease)
Red Flags of SPD
•Attention problems - fixating, distractibility, perseveration •Difficulty maintaining an alert but relaxed state (hyperactivity or hypoactivity) •Avoidance of touch or movement •Self-stimulation (especially persistent self-stim. which interferes with daily activities) •Self-injury •Rigidity, inflexibility, or difficulty tolerating or adjusting to even routine changes that are a part of daily life •Unpredictable explosions of emotion •Disregard of, or impaired ability to interact with others (even familiar persons providing daily care) •Impaired learning, difficulty catching on, and/or giving the appearance of trying hard but just not quite "getting it".
RED FLAGS
•Attention problems - fixating, distractibility, perseveration •Difficulty maintaining an alert but relaxed state (hyperactivity or hypoactivity) •Avoidance of touch or movement •Self-stimulation (especially persistent self-stim. which interferes with daily activities) •Self-injury •Rigidity, inflexibility, or difficulty tolerating or adjusting to even routine changes that are a part of daily life •Unpredictable explosions of emotion •Disregard of, or impaired ability to interact with others (even familiar persons providing daily care) •Impaired learning, difficulty catching on, and/or giving the appearance of trying hard but just not quite "getting it". -want to look for clusters of behavior, one of these things might not necessarily be SPD (look at implications on occupations)
Sensory avoiders (counteracts threshold by withdrawing from input)
•Avoid sensory overload •Affect is often fearful or anxious •Includes children who are compliant or under-aroused May move abruptly from withdrawn to aggressive behavior -withdrawal from an area, aggression if forced
Tactile Dysfunction
•Avoidance of messy activities • Difficulty with touch discrimination resulting in difficulty mastering tool use. •Oral hypersensitivity •Under or over-reactivity to pain •Over-responsiveness = sensory defensiveness •Under-responsiveness or delayed reaction to touch may result from poor tactile discrimination. All occupational roles can be disrupted by poor tactile processing -oral hyper = gagging or vomiting -over = avoid -under = crave/seek
Bilateral Integration and Sequencing Deficits
•Bilateral Integration deficits have been linked with deficits in vestibular processing •Postural-ocular movement deficits associated with bilateral integration •More recently, deficits in bilateral integration were linked with deficits in sequencing •Symptoms: R/L confusion, poor bilateral coordination, poor sequencing of movements (catching ball, kicking ball, stepping over rolling bolster)
Sensory Integration Dysfunction
•Body's inability to properly take in and use sensory information A child w/ SI dysfunction has difficulty organizing sensory information to carry out everyday tasks, such as dressing, eating, or even playing. Some axs and social situations may be difficult for children with SI dysfunction. We all have difficulty processing certain sensory information.....but it is when it interferes with our ability to function in our daily lives, it can become a problem! -ex: don't like the texture of a toy
high threshold
•Children with DECREASED SENSITIVITY see 2 patterns of functioning: -Hyporeactive to input (acts in accordance with input) -Sensory seekers (counteracts threshold)
Low threshold
•Children with INCREASED SENSITIVITY see 2 patterns of functioning: -Hyperreactive to input (acts in accordance with input) -Sensory avoiders (counteracts threshold by withdrawing from input)
Population originally intended for...
•Children with LEARNING DISABILITIES •Now, applied to EVERYONE!
What population was SI originally intended for?
•Children with learning disabilities
Benefits of meeting sensory needs
•Decreased need to stimulate or injure self •Improved ability to pay attention, participate & learn •Increased independence in functional activities •Spontaneous expression of new skills and abilities •Decreased anxiety and fear •Improved social interaction •Improved ability to communicate •Improved ability to handle distractions and interruptions •Improved ability to adapt to change •Improved ability to experience joy and have fun.
Benefits of meeting sensory needs
•Decreased need to stimulate or injure self •Improved ability to pay attention, participate & learn •Increased independence in functional activities •Spontaneous expression of new skills and abilities •Decreased anxiety and fear •Improved social interaction •Improved ability to communicate •Improved ability to handle distractions and interruptions •Improved ability to adapt to change •Improved ability to experience joy and have fun. -increased participation to achieve these (inner drive beneficial)
Benefits of mindful practice
•Decreases anxiety, depression •Improves mood •Decreases stress •Improves quality of life •Effective dealing with conflict •Increases happiness with caregiving and in relationships •Improves immune functioning •Increases left brain activity (positive affect) •Increases self-awareness, balance in life
Adaptive Behavior
•Def. - purposeful and goal-directed activity that enables us to meet new challenges. •Adaptive responses help the brain achieve a more organized state •Ayres' promoted the use of purposeful and meaningful activity -want them to develop a more complex adaptive response --> enhanced SI --> more adaptive responses --> challenges diminish -remediation or adaptation approaches
Proprioceptive dysfunction
•Difficulty with body in space awareness •Clumsiness •Poor pressure control- too much/too little •Difficulty judging distance - in people's space, overstepping •Lacking the postural control needed to stay in one's seat •A need to seek heavy pressure to establish body boundaries and enhance body image -pressure ex: death grip on pencil -need to seek pressure = body sock
Vestibular Dysfunction
•Difficulty with eye contact and attention •Difficulty with balance and extensor muscle use •Sensitivity to specific movement patterns - linear vs rotary •Reading difficulties •Difficulty with visual figure ground and visual spatial tasks •Difficulty dealing with anti-gravity positions
Secondary Problems Related to Sensory Integrative Dysfunction
•Emotional impacts -Anxiety - Aggression -Depression - Low self-esteem -Other behavioral problems •Delayed motor skills •"difficult" temperament •Academic problems •Parent may perceive child as "different"
-Sensory seekers (counteracts threshold)
•Excitatory sensory input, attention is poorly modulated and brief, affect is variable, action is high and may tend toward risk-taking and impulsivity
Interaction between person and environment
•Harlow's work - deprived sensory input resulted in deficits in social behaviors Rodent studies: Environmental influences can change brain cytoarchitecture ... ▫Rats in enriched environments showed thicker occipital cortex, increased cell body size, and greater dendritic branching •Meaney - handled rodents - increased glucocorticoid receptors - helps organism adapt to stressful situations -sensory input is important for neural plasticity and brain development
Hyperreactive to input (acts in accordance with input)
•Highly aroused, difficulty focusing attention, negative affect, impulsive/defensive action •Children may seek out certain sensory input to help organize their behavior & manage hyperactivity (pressure touch, heavy work) •Includes children as sensory defensive, gravitationally insecure
•Important information detected by interoception
•Hunger or fullness •Thirst •Pain •Body temperature •Heart rate •Breathing rate •Social touch •Muscle tension •Itch •Sexual arousal •Nausea •Sleepiness •Tickle •Physical exertion •Need for the bathroom -social touch = holding hands, emotional response, not just touching something
Inner Drive
•Individuals have an inner drive to develop sensory integration through sensory-based activities •Children have an innate need to master the environment and explore -motivation to engage and function -ex: low functioning child = find what engages them initially and try to progress/chain from there
SPD: Populations Affected
•Individuals with autism •ADD, ADHD •learning disabilities •PDD (Pervasive Developmental Disorder) •Asperger syndrome •Fragile X Syndrome •multiple developmental disabilities •Anxiety disorders •TBI •Spina bifida
SPD: Populations Affected:
•Individuals with autism •ADHD (attention deficit hyperactive disorder) •learning disabilities •Asperger syndrome •Fragile X Syndrome •multiple developmental disabilities
3 axioms
•Intention = "on purpose" or focus •Attention = "paying attention" •Attitude = "in a particular way" or how you feel
Function of the Cerebellum
•Major function is INHIBITION ▫Allows for smooth, coordinated movement, thought •Enhances movement accuracy ▫Motor planning & execution •Balance, posture, & eye movements
treatment ideas
•Meditation •Concentration •Deep breathing •Body scan meditation •Guided Imagery/Visualization •Art techniques •Aromatherapy -body scan = how the body is feeling (individual parts)
simple exercises
•Mindful breathing •Mindful sound game •Mindful eating •Mindful walking •Mindful play •Mindful hunting in nature
WHY IS IT IMPORTANT?
•Multi-tasking has become a way of life •We talk on our cell phones while commuting to school or work, or scan the news while returning emails •In our rush to accomplish necessary tasks, we can often lose connection with the present moment. •We stop being truly attentive to what we're doing or feeling •Mindfulness is the opposite of multitasking •The idea is to focus attention on what is happening right now and accept it without judging.
Plasticity of Brain Development
•Myelination continues throughout life •At birth, the brain is ¼ the size of an adult brain
PRAXIS leads to the development of motor skills
•Needed to plan & carry out unfamiliar tasks •Need less motor planning once a skill is learned •3 aspects of praxis: -ideation -schema -motor execution
Sensory Processing
•Neurological process of detection or orientation to a stimulus, interpretation or CNS processing of that stimulus, and then responding to the stimulus •Includes modulation of the response -Appropriate level of arousal •"Sensory "processing" rather than sensory "integration," when used for the diagnosis of sensory-based processing challenges, distinguishes the disorder from both the theory" -ex: has ADHA = use sensory integration -ex: cerebral palsy = use sensory processing
CHARACTERISTICS OF MINDFULNESS
•Non-judgmental observation •Acceptance •Impartial watchfulness •Awareness of change
Intervention is 1:1
•OT controls environment; child controls self •OT balances structure and freedom •Intervention is fun •"Just right challenge" -master environment, inner motivation, exploration, interaction, -give them some control and say about what they do in therapy
Treatment for Under-Responsivity
•Objective: Help child notice input so responses are influenced by a convergence of equally reliable sensory input •Strategies: -Use huge doses of 1 type of sensory input in the sensory areas under-responsive -Obtain optimal arousal and then engage in more complex SI activities
Treatment for Over-Responsivity
•Objective: help child appropriately interpret non-noxious sensory input without a "fight or flight" response Strategies: -Strong doses of pressure touch (brushing) followed immediately by quick compressions (Wilbarger approach) •Administer at 2 hour intervals during awake hours -Provide sensory diet that includes GM ax, heavy work, & sensory input -Controlled desensitization within the context of meaningful activities -Self-regulation programs (ALERT and Zones of Regulation)
Remember your roots
•Occupational therapist delivering interventions using an SI frame of reference -Often referred to as OT/SI •You are NOT an SI therapist -This does not exist! •Contexts, child-driven, engagement in meaningful activities (occupations) are key, and this is OT
Sensory Integration Dysfunction
•Original term used by Ayres Diagnostic subgroups within "sensory integration dysfunction" encompass "immense individual differences in detecting, regulating, interpreting, and responding to sensory input" -can be called sensory processing disorder currently
HOW is SI intervention provided?
•PLAY on simple, specialized equipment •FOCUS on vestibular, proprioceptive, & tactile input -play based -ex: tiger swing (bounce) (picture on the left) (tactile, vestibular, and proprioceptive) -evaluate if over or under responsive in sensory system à use tools to correct
SPD Facts
•Parent surveys, clinical assessments, and laboratory protocols exist to identify children with SPD. •At least one in twenty people in the general population may be affected by SPD. •In children who are gifted and those with ADHD, Autism, and fragile X syndrome, the prevalence of SPD is much higher than in the general population. •Studies have found a significant difference between the physiology of children with SPD and children who are typically developing. (brain size, synapses, etc.) •Studies have found a significant difference between the physiology of children with SPD and children with ADHD. •Sensory Processing Disorder has unique sensory symptoms that are not explained by other known disorders. •Heredity may be one cause of the disorder. •Laboratory studies suggest that the sympathetic and parasympathetic nervous systems are not functioning typically in children with SPD. •Preliminary research data support decades of anecdotal evidence that occupational therapy is an effective intervention for treating the symptoms of SPD. -not typically functioning sympathetic and parasympathetic systems
Proprioceptive system
•Perception of joint and body movements, position of the body, sensing direction and velocity of movement •Determines grading or effort of movement •Muscle spindles, mechanoreceptors of the skin, centrally generated motor commands, (joint receptors)
symptoms of dyspraxia
•Play, Developmental, & Educational Limitations -Clumsy, delayed gm skills & sports, probs with constructive and manipulative play, handwriting delays •Behavioral -Disorganized approach to tasks, avoids "doing" and new tasks, prefers to talk and socialize to stall ax, low self-esteem from frequent failure experiences and frustration in doing tasks •Clinical observations -Poor supine flexion -Difficulty with finger touching -Poor diadochokinesis -supine flexion = can't hold a crunch --> dyspraxia -finger touch = finger to nose -diadochokinesis = coordination in alternating between prone and supine really fast
tactile processing
•Pressure* •Also temperature, pain and vibration that contribute -homunculus
Sensory Discrimination Disorder
•Problem in interpreting the temporal and spatial characteristics of sensory stimuli (e.g. stereognosis) •Poor tactile discrimination -Inability to perceive and organize incoming discriminative touch information for use Symptoms: •Difficulty knowing where one is touched •Impaired stereognosis •Inefficiency in how one tactually explores an object or environment •Fine motor problems •May see motor planning problems -ex: vestibular = can I tell when I am walking backwards, etc. -steareogenosis = able to identify an object without vision (ex: can I tell the difference between a quarter and a penny when reaching into my purse) -may take extra time to process sensory stimuli -can occur in any sensory system -treatment: bean or rice box with hidden objects and having them use stereogenosis skills to find an object
Sensory Modulation Disorder
•Problems in regulating and organizing the degree, intensity, and nature of response to sensory input in a graded and adaptive manner -Over-responds -Under-responds -Sensory craving •Demonstrates poor ability to regulate arousal, which is needed to orient, attend, and focus on meaningful sensory events •There are 3 patterns seen ----->>> -3 ways of reacting (over = responding too much, soon, long) (under = unaware, responses delayed or notthere) (craving = seeking stimulation, trying to obtain more sensory stimulation)
Si treatment
•Providing enhanced sensory experiences within the context of meaningful activity and promoting adaptive behavior resulting in enhanced sensory integration and thus, enhanced learning -remedial approach -improve self-confidence, learning, social and personal skills, etc.
What happens if taste/gustatory gets disorganized?
•Receptor - tongue taste buds and taste receptor cells •Under or over reactivity to taste •Tendency to gag (taste and or texture) or vomit -smell food and gag or taste it -salty, sour, bitter, sweet -mixed sensitivity on tongue (taste buds) -front of tongue = lingual nerve -back of tongue = -throat and pharynx =
The Vestibular System
•Receptors (hair cells) in the semicircular canals (dynamic) and otolith organs (static) in the inner ear •Vestibular nuclei also receive information from visual system, ocular-motor system, only sensory system with direct connections to cerebellum
What happens if smell/olfactory gets disorganized?
•Receptors - in the nasal cavity -Hair cells called cilia •Under or over reactivity to odors •Atypical processing of food tastes •Sensory seeking/avoiding -not as common -common with feeding
What happens if the sight/visual system gets disorganized?
•Receptors are in eyes (photoreceptors; rods and cones) •Hypersensitive to light, processing, figure ground information, identifying shapes and forms, matching visual elements -finding something in a busy background = figure ground information (ex: where is Waldo or finding something on the shelf at a grocery store) -light sensitivity = put pastel paper over lights or give assignments on duller paper
What happens if auditory processing gets disorganized?
•Receptors in the inner ear (hair cells) •An impairment in the ability to process or interpret sounds which may affect the ability to correctly discern the source or location of sound; distinguish selected sounds from background noise, distinguish between similar sounds, identify sounds. •Hypersensitivity to certain sound frequencies can result in anxiety, fatigue and aversive responses to sounds in specific environments. •Auditory processing functions can be tested in children 5 and older.
World Map
•Remember auditory, visual, taste, and smell help us develop a world map by giving us info from environment •Map is disrupted when any of the systems are affected -Uses all the sensory systems
Under-responsivity(Overmodulation of input)
•Responds to sensation in a less than typical way •Fewer or flattened responses (hyporesponsive) •Tends to under-respond to proprioceptive & vestibular input •Demonstrates low muscle tone •Tends to be "sluggish" until they get moving •Tends to have motor planning problems -quiet and passive -disregard stimuli or not respond at all -seek out movement -want to wrestle, be aggressive, run into things, hug people, etc. -may be labeled as mean or bad -crave senses, participate even if inappropriate -passive observer (watch before participating) -may not perceive hot or cold, pain, etc. -motor planning problems, body awareness
Autism
•See major structural problems in cerebellum •Whole cerebellum is 20-30% smaller in 80% of individuals with autism •This explains why we see difficulties in "inhibition" ofincoming input (and therefore sensory defensiveness) •See a delayed attention shift of about 5-10 sec •See immature axons (poorly formed neurons) with compromised myelination (Accounts for problems in delayed processing and "scrambling" of sensory input)
Sensory Processing for Parents video
•Senses help us orient ourselves •How well we respond based on how CNS regulates stimulation •Sensory processing •Speech and motor coordination dysfunction •Sensory defensiveness •Difficulty with self regulation •Can have one or more sensory processing difficulties •Sense of touch and movement have the most effect (key senses used to overcome sensory problems) •Brain is plastic throughout life (change is always possible) •Fit sensory needs (ex: taking trash out to the curb if need for proprioceptive input) •Routine is helpful •Make sensory time for child (let energy out) •Sensory strategies used to create independence and responsibility in child (what they can do to help themselves) (ex: I was going to hit my brother, but I jumped on the trampoline instead)
III. Sensory Integration
•Sensory Input provided during meaningful activity is shown to strengthen synaptic connectivity •Hebb Synapse •Long-term potentiation
SENSORY PROCESSING FRAMES OF REFERENCE
•Sensory Integration (Ayres) •Sensory Defensiveness & Sensory Diet •ALERT Program for Self-Regulation •SPD Foundation
Sensory Nourishment
•Sensory input is necessary for optimal brain function •Brain malfunction occurs with too little or too much stimuli -ex: childhood trauma --> malfunction (developmental issues, etc.)
Interoception dysfunction
•Sensory seekers •Sensory avoiders •Unawareness
Video: Applying sensory integration principles where children live, learn, and play
•Skills through play •Sensory integration: early sensory experiences are important for normal development (FOR) •Ayres •Behavioral theory •Humans depend upon sensation to experience their world, achieve comfort, and acquire skills •Touch movement and gravity in early life •Early experiences à sensory perceptions •Experiencing sensation is not enough, doing new things in new ways (successful interaction) for adaptive responses •Imitation of facial gestures, reaching, molding to another body = early adaptive responses •Fun and success motivate children that shape lifestyles •Intrinsic motivation most beneficial (inner drive to explore and create) à sustain attention and participation --> attempt in more complex challenges and cooperate •Play creates inner drive •Play with others = take turns, socialize, desire for further engagement, learning from others, etc. •Just right challenge •Every child is unique, developing in their own way •Sensory integration guides professional processes that guide learning and behavior (typical development vs abnormalities) •Primary natural environments •Intense sensory experiences in therapy, so the child doesn't have to inappropriately participate in them in their natural environment (e.g. it is okay to climb up the ladder in the clinic, but not okay to climb up the chalkboard) •Touch = interact intimately and comfortably •Vestibular = movement and gravity, ability to hold self upright •Proprioceptive = knowledge of how and where the body Is moving (navigation) •Praxis = novel action plans (motor and sensory) •Sensory modulation = tolerating and adjusting to environments and movements •Quiet rooms for those who are hypersensitive to sound •Suspended equipment (swings) provide a variety of vestibular sensations •Each child has an individual set of sensory needs (important for learning) (ex: different chairs available for different needs) •Calm down through deep pressure •Too calm = use a yoga ball to wake them up •Sensory integration at home à organization, self-care routines, household chores, etc. •Clinic, school, home, and community
Hyporeactive to input (acts in accordance with input)
•State of arousal is decreased, flat affect, passive or sedentary actions
Action
•The ability to engage in adaptive goal-directed behavior -Action involves motor abilities as well as perceptual and cognitive processes. An important aspect of action is PRAXIS. -Sometimes the goal of action is to regulate the other A's. Sometimes we fidget to increase our arousal for learning. -praxis = plan it out and execute it -ex: sometimes we fidget, which would be the action part of our attention -how attentive, happy, etc. can affect your action
SI is a Complex Process
•The brain must select, inhibit, compare and associate sensory information in a flexible and constantly changing pattern -Select what is important; inhibit what is not -Compare and association to add meaning and to achieve the goal -body is comparing senses (what does this feel like compared to this) -can inhibit senses (ex: tactile with clothes on your body, hunger, the sounds of keyboards typing while listening to lecture)
Affect
•The emotional component of behavior •Children with problems in sensory processing may have atypical, heightened or depressed affective responses to sensory input -overly excitable without cause, loud laughing/affective crying, or zoned out/flat affect
SENSORY PROCESSING & MINDFULNESS
•The relationship between sensory processing styles and mindfulness was examined •Surveyed healthy adults (150) •Results: Low registration and sensory sensitive processing styles were significantly negatively correlated with mindfulness scores •Conclusion: Individuals with sensory processing styles characterized by passive self-regulation strategies were less mindful in daily life •**Reduced awareness of sensory information affects the ability to mindfully engage with the environment -low registration and sensitive = not much mindfulness in their lives
Terminology: SI vs SPD
•Theory is referred to as "Sensory Integration theory based on the work of Jean Ayres" •Diagnostic label is Sensory Processing Disorder (SPD) •Assessment terminology include either the term "integration" or "processing" •Intervention label used only with therapy that is based on Dr. Ayres' original principles •Recommended that the intervention description include both the discipline and the frame of reference -"OT using principles of sensory integration" -"OT using a sensory integration frame of reference/approach" -1:1 = SI -group = sensory processing treatment -*client is diagnosed with SPD based on an SI or SP assessment. OTs use principles of SI theory to provide sensory integration treatment in a clinical setting (1:1)* -diagnoses always SPD and theory always SI, but intervention varies based on setting
What is this course about?
•This course is designed to teach the sensory and cognitive integration body structures and functions of a person at the knowledge, comprehension, and application levels. It also introduces, applies and analyzes theoretical frames of reference used by occupational therapists to address evaluation and intervention of the sensory and cognitive integration areas of function. The course lays a foundation for use of these functions at higher levels of all three learning domains and in a more integrated way in later courses.
Goal of mindful practice
•To become more aware of one's own mental processes, listen more attentively, become flexible, recognize bias and judgments, and thereby act with principles and compassion -emerging in OT
Sensory Systems
•Visual •Gustatory •Olfactory •Auditory •Proprioceptive •Vestibular •Tactile •Hidden 8th sensory system: Interoception
We are all unique sensory beings
•We each respond to everyday sensory events in individual ways •Resulting in unique sensory preferences that are reflected in - what we eat, wear, and do; how and where we socialize -ex: I don't like to wear jeans because they are restrictive -some preferences might interfere with your day (ex: child overreacting about sleeves coming up while putting on a jacket = won't leave the house) -children's sensory systems are still maturing = can grow out of things, but adult's sensory preferences are usually permanent
activity in class: SENSORY TREATMENT IDEAS FOR DIFFERENT ENVIRONMENTS •Swimming Pool •Airplane •Recess •Cafeteria •Beach •Hayride •Birthday Party •Hotel •Church •Playdates •Long car ride •Mall/Grocery store •Amusement park/County fair
•What sensory input does each environment receive? •What are sensory activities you can do in that environment or before? •Visual •Vestibular •Proprioception •Tactile •Auditory •Olfactory •Gustatory •Interoception
What is neural plasticity?
•ability of brain structure & function to change - greater dendritic branching - greater synaptic connections - greater size of brain tissue
Long-term potentiation
•in the hippocampus - controlled bursts of stimulation across synapses produces increased synaptic efficiency
Impact of Sensory Input on Neurotransmitters: Serotonin
▫"master modulator"; influences all other NT ▫Modulates our arousal; gives us a "feel good" feeling
Impact of Sensory Input on Neurotransmitters: Dopamine
▫Activates us; helps get us moving in morning -dopamine: pleasurable reward, sleep, cognition, addiction, etc.
Impact of Sensory Input on Neurotransmitters: Norepinephrine
▫Allows us to have selective & sustained attention ▫"fires" with novel stimuli ▫When serotonin goes down (with stress), norepinephrine goes up (see aggression)
Brain development involves
▫Neurogenesis (formation of neurons) ▫Synaptogenesis - establishment of their connections ▫Synaptic elimination (pruning) - allows for efficient cortical processing ▫Synaptic overgrowth (synaptogenesis) ▫Synaptic elimination (pruning)
TIC Addresses the Relationship Between:
◦Environmental/subjective triggers ◦Perceptions of danger ◦Distressed neurophysiologic states ◦Functional & behavioral problems (affect) Acknowledges how trauma has impacted the person's perception of emotional and physical safety, on sensory perception and behaviors. -educating them on what TIC is
goal of TIC
◦Help person restore a sense of personal control, safety, & stability using individualized strategies to reduce emotional distress and bring about a calm and organized state to foster engagement -everyone has their own strategy -participate and engage in what they want to -address physical state before cognitive approach (sensory --> coping/cognitive)
Self-injurious behaviors
◦Often used by people with trauma histories to manage distress, negative thoughts, traumatic memories and flashbacks may result in an 'orienting effect' that may be alerting or calming, or help escape their thinking by causing a physical or emotional numbing. OT should try and find out how the person feels that this helps and brainstorm alternatives (eg. sensory diet strategies might work).
Results in difficulty integrating sensory information and regulating emotional stress
◦become neurophysiologically reactive to events/situations
