Sensory modulation & strategies Presenter: Emtia Bartlett Children s Occupational Therapist

Transcription

1 Sensory modulation & strategies Presenter: Emtia Bartlett Children s Occupational Therapist Sensory processing Disorder - Sensory modulation Behavioural analysis Sensory diet Classroom strategies Alert programme Specific difficulties Sensory Processing INFORMATION FROM THE ENVIRONMENT SPD (Sensory processing Disorder) Difficulty processing sensory information correctly Not currently a medical diagnosis in DSM IV or ICD PROCESSING IN THE BRAIN ACTION Proposed Nosology for SPD Sensory processing disorder(2007) The Sieve Mechanism over responsive under responsive SPD Sensory Modulation Disorder Sensory Discrimination disorder Sensory-Based Motor disorder SOR SUR SS Postural disorders Dyspraxia SOR = Sensory Over-responsivity SUR = Sensory Under-responsivity SS = Sensory Seeking/ craving Too much!! Not enough!! 1

2 Arousal Levels SOR Sensory over responsivity Extreme reaction to a reasonable sensory experience Often sound Often touch Textures tastes Sometimes movement Sometimes light Protective response flight or fight Helping over-responsive children Sit at the back or at the end of the line with back against the wall Predictability Careful not to touch hair or brush lightly against them PE/ assembly can be very difficult Allow an option to take a break Resistive activities Weight bearing on arms Animal walks Slow rhythmical movements Ear Defenders, hyperacusis white noise generators SUR Sensory under responsivity Delayed or reduced reaction to sensory input Touch Temperature Sound and speech Visual information Movement Helping under-responsive children Provide increased INTENSITY/ FREQUENCY AND DURATION of specific sensations Fast paced repetitive movement ( jumping, bouncing) Movement (acceleration and linear movement.) Trampoline Heavy work Chewing or crunching food Teacher s voice etc. Temperature in class SS Sensory seeking/ craving Frequently/always seeking sensations Movement Touch Noise Impact/tapping Tastes smells 2

3 Helping sensory seeking children Provide increased INTENSITY/ FREQUENCY AND DURATION of specific sensations with meaning and specific and clear boundaries Touch Movement Music and dance Heavy work Crash bump Chewies / drinking water Oral motor activities Sensory activities in the morning If they are not ready for learning they cannot access the lesson. ABC s of behaviour A Antecendent Special event Activity precedes the behaviour Environmental factors affecting behaviour Large room Unstructured tasks Poorly planned transitions Low adult ratio Proximity to others Noise, clutter Change in people place activity Boredom, lack of stimulation Excessive waiting time Warning signs C - Consequences, causes B Behaviour Define the behaviours Are behaviours linked? Do they occur in response to the same situation? Do the occur in a predictable pattern? Obtain Communication Attention Object, activity Internal/systemic Sensory - Productive - Nonproductive Primary cause Avoid-Escape Communication Attention/event Task event Internal/systemic Sensory - systemic/visceral Primary re-inforcers Preferred task Sensory based activities Food treats or drink Secondary re-inforcement Consequences Attention Avoiding task Habit Punishment Reprimand Eye contact Task avoidance Task analysis Task requirements Engaging/ stimulating Sensory feedback New task? Complex presentation? Skills analysis Motor skills? Sensory processing abilities ( discrimination planning etc) Developmentally appropriate Ability to work independently at expected level? Change in the environment? Teacher/content Emotional analysis Fight/flight? Self confidence? Fear of failure Over excited, mad, distressed Does the task seem overwhelming? Are the components clear? Avoiding auditory input Rate of speech Presentation of new information Complexity of language Similarity of words? Poor understanding of the context Short response time Open task and open structure Listening conditions Background noise of heating/ lightning/ventilation? 3

4 Primary re-inforcer self stimulating activity Obsessions numbers, letters, pictures Holding an object briefly MSITUA Autism consultancy Steve McGuinness Secondary re-inforcer Don t have inherent reward but children learn their value Praise Stickers Attention Toys If you want to change What is a treat for this child? What is their preferred activity? What do they choose in their free time? Sensory activities are good Motivators throughout the day Interest Profile Use key interests Use key interests range of football codes Participation (from simple turn taking to teams) where footballs come from leather from cows Pepsi bowling Thomas throwing Love of kicking football Visit where they make footballs shopping to buy footballs purchasing tickets and items Football games mapping to get there public transport to matches making supporters gear roller coaster throw pepsi can bowling 4

5 External motivators Claps and cheers may not reward- concrete will Draw picture Watch Thomas the Tank Engine video 1 2 Promote choice Sensory Diet A planned and scheduled activity program designed to meet the individual s specific sensory needs. (Yack et al., 1998) Assist the child in maintaining an optimal level of arousal Activities may be calming or arousing Sensory diet Short snacks through the day Aim to achieve optimum arousal level Seek appropriate activities to meet the sensory need Children need to feel how it feels to be the calm-alert state Deep pressure touch Vestibular ( 4-8hrs) Proprioception ( 2 hrs) Food much shorter Music Fidgets Proprioception Can be used to: 1. calm over aroused individuals 2. increase body awareness in preparation for learning The safe sense: It can be used for under or over responsive children It s a strategy for all senses 5

6 Proprioception Starting a sensory diet Make muscles work to provide proprioception! Include needed sensory input regularly in preparation for activities not as reward Active input is better than passive input animal walks wheelbarrows Climbing (monkey bars) press ups scooter board Some input added and some might be removed e.g. providing movement opportunities versus reducing noise by allowing quiet retreats Monitor child s response as activities should have a calming/organising effect tummy over a ball carrying heavy things riding on bikes Allow variety and choice to avoid habituation or boredom Choose a sensory break Activity ideas to be incorporated into the school day Joe arrives at school Good morning session Indoor play Outdoor play Snack time Do two animal walks Plays with vibrating toy Pushing pulling Tug of war Trampoline Sit on Movin sit cushion Activity ideas to be incorporated into the school day Strategies for the classroom environment Jenny arrives at school Good morning session Indoor play Outdoor play Snack time Runs outside for 5 minutes Heavy work for muscles Therapy ball activities Swinging Sits with a weighted cushion Sensory equipment that enables function Full class sensori-motor activities Positioning in the classroom Classroom layout (workstations, quiet areas, movement corner) 6

7 Sensory Integration Therapy Following an in-depth assessment by an Occupational Therapist who is trained in sensory integration. Blocks of therapy are conducted in the clinic setting. These are used in conjunction with activities recommended for home which help the child s functional performance at school/home. Alert Program To help the child identify how to self regulate their arousal levels How Does Your Engine Run is used as an analogy to apply the process Often used with older children [Approx.6 yrs] depending on their ability Wilbarger Brushing Protocol Intensive technique conducted at least 4 times per day Includes brushing the limbs then providing joint compression Should only be carried out if supervised by an OT Deep pressure/proprioception used to address sensory defensiveness Uses a specific surgical brush Listening Programme Therapeutic listening is a sensory stimulation technique which can be used as part of a child s sensory diet programme at home or school. involves the use of electronically modulated and filtered CD s the child needs to listen twice a day, for 3 to 6 months for initial gains promote organisation of attention, behaviour and movement. Some Factors That Can Affect Sensory Processing Poor health Medication Fatigue Stress Pain Diet Disruptions to routine Levels of anxiety Behaviors associated specifically with the condition, i.e. ASD. Specific problems Tactile defensiveness Picky eaters Mouthers Fearful of movement 7

8 Example Plan Behaviour Goal Hypothesis Management Plan John is hitting children at school John will not strike children at school John is tactile and auditory defensive. He is overstimulated in lines and a circle time Environmental adjustment -John to stand at back of line -John to sit at rear of circle time -John to be allowed 15 minutes in a quiet corner every 45 minutes Monitoring Method Teacher to collect data on number of times children report John striking or it is observed. This will be charted on a graph. References C Murray Slutsky, B. Paris, Is it sensory or is it behaviour? Behaviour problem identification, assessment and intervention Hammill Institute on Disabilities, Texas 2005 Dr L. Miller Sensational kids The out of sync child 8