Essential Questions for a Prospective Sensory Integration Therapist

If your child has been diagnosed with a sensory integration (SI) problem, finding the perfect therapist to suit his or her needs is not an easy process. Sensory processing disorder (SPD) is a complex and challenging field of therapy, and requires a professional who knows what he or she is doing. When meeting a prospective therapist for the first time, it can be very helpful to come prepared with a list of questions for him or her, including the following:

What is your training in SI?

Sometimes the simplest questions are the most helpful. A great first step in gauging whether a given therapist is right for your child is to get a sense of their knowledge of SPD, and training is a great indicator. There are several SI certification programs out there that your prospective therapist may have taken – one of the best-known is the Sensory Integration and Praxis Test (SIPT) which has been offered by Sensory Integration International in the past and in recent years by Western Psychological Services (WPS).  If the therapist is not certified in the SIPT, then asking what other coursework they have taken related to sensory integration can be helpful.

What practical experience in SI do you have?

So your child’s prospective therapist has degrees from all Ivy-League schools and a slew of professional memberships to boot? That’s all good and dandy, but there is no substitute for practical, hands-on experience treating children with sensory problems. This doesn’t necessarily have to limit your choices to veteran therapists with decades of experience – there are many fantastic mentorship programs for starting therapists that provide invaluable experience for use in a clinical setting. If your child’s prospective therapist is a bit behind in the clinical-experience department, ask if he or she has gone through any training or mentorship programs that included practical study (this might include fieldwork at a sensory integration clinic or an intensive mentorship program such as those offered by the Spiral Foundation) – the experience a new therapist can gain from these can certainly be enough to make up for a shortage of years in the clinic.

What other types of SI coursework have you taken?

Believe it or not, the best therapist for your sensory-impaired child may not be certified in SI at all! SPD can affect any of the seven human senses, and if your child is severely impaired in one sense more than another, a specialist who has taken SI-related coursework in your child’s area of sensory difficulty may be your best bet. For example, a child with extreme sensitivity to noise may make great progress while under the care of a therapist with heavy coursework on vestibular problems and sound therapy programs.

If you know a therapist who is looking for more experience and training in SI, be sure to refer them to the Sensory Integration Essentials Program here at the Spiral Foundation. This all-new course series for 2014 provides a solid and complete understanding of the ins and outs of SI and sensory problems, and includes hands-on clinical experience working with children with sensory difficulties. Our next course in the series, Essentials of SI Assessment, is coming up fast, so tell them to register today! As always, feel free to reach out to us any time at 617-969-4410 ext. 231 or courses@thespiralfoundation.org.

Sensory Tips for Parents and Teachers #2: Connecting with Children with Autism Spectrum Disorders Through Play

“All work and no play makes Jack a dull boy,” the old saying goes. If your child happens to have an autism spectrum disorder (ASD), that saying goes double for him or her. Playtime is crucial to stimulating the social, physical and mental development of children with ASD. Connecting in such a way with a child with ASD may seem challenging, but it doesn’t have to be! There are many deceptively easy tricks you can use to help stimulate your child’s development through play, including the following:

Limit Familiar Toys and Props

When parents see their children with ASD playing obsessively with certain toys, their first instinct is often to try to play along with them using said toys. However, this can be a challenge at times. Children with ASD tend to have very specific routines and habits when it comes to using their toys, and unless you can tap into their thoughts (scientifically impossible as of the posting of this blog) you may find it difficult to play with their toys the “right” way, as the child sees it. To avoid conflicts, use novel toys or games – such as Chase, tickle games (assuming your child likes these), or Hide and Seek – can be a great way to help your child build his or her play skills and connect with them in a way that is fun for both of you.

Maintaining Eye Level

This tip does not necessarily have to include eye contact, as most children with ASD tend not make direct eye contact anyway. What this tip does require is for your face to be clearly visible to your child at all times. This may require you to kneel, squat or even lie down, but your devotion to this can help your child pick up on certain facial expressions and start to associate them with corresponding emotions.

Make Mistakes and Be Absurd

Lack of attention is often a major concern in children with ASD, but this unlikely trick is a great step in the right direction! Being absurd and using things in unusual ways at unpredictable times can greatly help catch your child’s attention and hone his or her ability to notice what’s happening around him or her. This is an invaluable skill with countless applications in life. Try putting on a bowl instead of a hat when you are getting ready to go out and wait to see your child’s reaction when he or she notices. You could also put your socks on your hands and gloves on your feet, put your jacket on backwards or anything else you think your child may notice. As an added bonus, laugh at the mistake with your child when he or she notices, and correct it with him or her watching – this will exemplify that mistakes happen, and they can be fixed when they do.

If you would like to learn more about helping children with ASD through play, be sure to register for The Spiral Foundation’s next webinar, Promoting Play Skills in Children with Autism Spectrum Disorders, on Monday, February 10, 2014. Our very own Sarah Friel, MA, SLP-CCC will be sharing vital information on this timely topic, drawn from her 23 years of experience helping children with ASD. Plus, you can earn contact hours! For more information on our other course offerings, reach out to us at (617) 969-4410 ext 231 or admin@thespiralfoundationfoundation.org.

Ahhh…That Exciting Cerebellum!!

As we learn more about the way the brain works and how that functioning relates to movement, we are learning more about the incredible influence of the cerebellum on so many of our daily functions.  Historically the cerebellum has been relegated to the functions of balance and timing of movements.  Today, however, we now know that the cerebellum not only controls these functions but also influences motor skills in the timing in oculomotor control, timing and prediction of the  motor aspects of speech; ataxia of gait, visuo-kinesthetic interactions of limb movements; and prediction and anticipation of motor action.

Even more exciting is the growing body of evidence which supports the role of the cerebellum in cognitive functions. One function that is particularly of interest for occupational and physical therapists working in the area of sensory integration, is the cerebellum’s role in encoding internal models of action which support and influence the development of mental representations in the cerebral cortex.  This is the vital role of sensory integration intervention…to create those internal models.  In addition, these models and cognitive mental representations appear to be vital for the child’s ability to generate ideas for actions and motor planning.

New information is also emerging which supports the role of the cerebellum in sensory acquisition.  Schmahmann postulates a theory he calls “Dysmetria of Thought” which states that the cerebellum is critical for the modulation of sensorimotor, cognitive, and limbic functions through the integration of internal representations with external stimuli and self-generated actions.  Wow!!  What a powerful thought.  In addition to these functions, the cerebellum is also now believed to influence traditionally cortical executive functions such as working memory, mental flexibility, perseveration on task, problem solving, expressive language, verbal fluency, emotional control, attention, and mental representations of visual spatial relationships.  All of which rely on our ability to represent, hold and access information.

Numerous resources are available to therapists on this topic.  I recommend the following for basic introductions.  These can be highly technical resources but are worth the read.  The articles are available as open access via Google Scholar.  Enjoy!!

* Kandel, E., Schwartz, J., Jessell, T., Siegelbaum, S., Hudspeth, A.J. (2012). Principles of Neural Science, Fifth Edition.

* Fatemi, S. H., Aldinger, K. A., Ashwood, P., Bauman, M. L., Blaha, C. D., Blatt, G. J., … & Welsh, J. P. (2012). Consensus paper: pathological role of the cerebellum in autism. The Cerebellum, 11(3), 777-807.

* Manto, M., Bower, J. M., Conforto, A. B., Delgado-García, J. M., da Guarda, S. N. F., Gerwig, M., … & Timmann, D. (2012). Consensus paper: roles of the cerebellum in motor control—the diversity of ideas on cerebellar involvement in movement. The Cerebellum, 11(2), 457-487.

* Koziol, L. F., Budding, D., Andreasen, N., D’Arrigo, S., Bulgheroni, S., Imamizu, H., … & Yamazaki, T. (2013). Consensus Paper: The Cerebellum’s Role in Movement and Cognition. The Cerebellum, 1-27.

* Ito, Masao (2011-08-01). The Cerebellum: Brain for an Implicit Self (FT Press Science).

Dyspraxia or DCD? What’s in a name?

For many occupational therapists the question continues to arise regarding how to label the motor organization and coordination difficulties we treat in children.  Popular terms include developmental dyspraxia, dyspraxia, and developmental coordination disorder.  As previously noted in this blog, there can be strong feelings among different groups regarding terminology.  At this time there continues to be a lack of consensus on which term is most appropriate.

I came across an article recently which may be useful.  While I don’t agree totally with all that is reported, it can provide a nice summary of the situation.  This article,Dyspraxia or developmental coordination disorder? Unraveling the enigma”  by Gibbs, Appelton and Appelton is open access and available for download.  These authors propose that functionally the terms DCD and dyspraxia be considered synonymous and that the best approach is to avoid labels at all and simply focus on describing the child’s motor difficulties.  This approach is probably the most useful for therapists and can allow more flexibility in perspectives.  Therapists who work from a sensory integration perspective can describe the perceived sensory foundations, while those working from other perspectives can concentrate on those skills most relevant to them.  Ultimately, the label is not important.  What is important is how we can treat the problem and improve the lives of our clients.

Sensory Tips for Parents and Teachers #1 – Those Winter Clothes

As we now head into fall with winter right around the corner, many parents of children with SPD are beginning their seasonal struggle to dress their child for the cold weather.  Many children with SPD experience sensory defensiveness, especially tactile defensiveness.  This tactile defensiveness manifests as an over-sensitivity to touch information.  These individuals often do not like light or unexpected touch, yet may crave deep touch pressure and heavy muscle work (proprioception).  Because of their sensitivity to light touch, clothing can be a problem.  We all know that friend that only dresses in soft, sloppy clothes because dress clothes are just too constricting.  The girlfriend that would not be caught dead in nylons or panty hose because she JUST CAN’T STAND THEM.  These friends probably have a bit of touch sensitivity.  In children with SPD this preference for certain kinds of clothing can be particularly strong.  The child may avoid wearing socks or underwear.  They may wear the same shirt or outfit over and over until it is way past too small or is worn thin from washing.  Seasonal clothing transitions from short pants to long pants and vice versa may be problematic.  In cold months, keeping hats, mittens, coats and scarfs on the child may be a challenge.  So what’s a parent to do?

Some Solutions:

1. Have your child be a part of the clothes finding process.  As adults we have total freedom in deciding what we wear and when we wear it.  This control allows us to feel more comfortable.  Don’t buy clothes for your child without them trying it on first.  Have them be an active participant in selecting items in their wardrobe.

2. Natural fibers tend to be easier to tolerate.  When selecting clothing, natural fibers, especially 100% cotton, tend to be easier for the defensive child to tolerate.  Avoid scratchy synthetics.  Go for soft knits and fleeces.

3. Avoid those tags and watch those seams. Try to get shirts that have printed tags rather than sewn in tags.  If you need to cut out a tag, be sure to get all of it and don’t leave sharp edges behind.  Also check seams for irritating tags and make sure that your child can tolerate the seams in any given garment.  Elastic waist pants can often be easier to tolerate than pants with zippers and waistbands.  Purchase socks that are seamless, these are much easier to find in stores like Walmart and Target these days or by Googling on the internet.

4. Prepare early for seasonal changes.  Weather changes can be unpredictable in fall and spring, but it behooves parents to start the clothing transitions earlier rather than later.  With the child select those long sleeved shirts and long pants in early September before the cold weather sets in.  If possible, on cooler days have the child wear the new clothes to get used to them, even if it is part of a day.

5. Pre-wash and soften new clothes.  Pre-wash and soften up any new clothes.  Take advantage of that early preparation and wash the new clothing several times before expecting your child to wear them.

6. Find a coat the child will tolerate.  OK, easier said than done, right?  Think about coat choices and have your child help select one.  Avoid wool coats.  Will your child handle a puffy fiber-fill jacket or would he or she do better with a thinner fiber?  Is a waist-length jacket better or does your child prefer a longer hip or knee length coat?  Is a double-breasted button-up too much fabric?  Is a zipper easier to manage?  Will your child wear a hood or is that too much irritation on their head or neck?  Also think about whether your child will or will not layer up on clothes.  A somewhat lighter coat may suffice if the child will wear a warm sweatshirt or sweater on a regular basis under it.

7. What about those hats, scarves and mittens?  The need for hats, scarves and mittens may depend on the jacket or coat preference of your child.  If he or she has a jacket with a snug collar and a hood, does he/ she really need a hat or scarf?  Again, think of the fabric of these items.  There are also options in the hat and scarf lines.  A cowl style may give warmth and be able to be pulled over the head without being constricting.  Ear muffs or head bands may provide sufficient warmth versus a full cap.  Will a ball cap be enough cover for most days?

For hand covering, consider mittens over gloves.  Can you attach mittens to the sleeves of the jacket.  Are the jacket sleeves long enough the child can pull their hands in the sleeves rather than wearing mittens?  Again check the tolerability of the fabrics of the mittens.  You may love Aunt Susie’s home made mittens but they may drive your child crazy.  Consider washing mittens as well to soften them up.

Clothing changes with the seasons can be hard on both parents and child but some preparation and respecting a child’s clothing preferences as much as we respect our own can go along way to making the transitions easier.

Spiral Foundation’s NEW!! Book Club

In our ever-growing attempts to provide resources and materials to professionals and parents, the Spiral Foundation has partnered with Amazon to bring you our NEW! A-Store.  In our A-store/ Book Club you will find recommended reading for parents, professionals and children.  By purchasing your books…paper or Kindle versions alike!…through our store, you not only get a great recommendation, but also help support research and education activities in sensory integration.  So make us your first stop for your sensory-related resources!

Today for professionals we would like to highlight two wonderful MUST HAVE resources by Dr. A. Jean Ayres.  If you want to know more about praxis pick these up today!  Click on the pictures to go to our store.

 

Ayres Dyspraxia Monograph, 25th Anniversary Edition

Ayres Dyspraxia Monograph

This monograph is THE resource on beginning to understand the complexities of praxis.  This updated version includes bonus information by praxis expert, occupational therapist, Dr. Sharon Cermak as well as a new extensive bibliography of praxis references.

The Adaptive Response

The Adaptive Response

This classic DVD is the only resource from Dr. Ayres fully explaining adaptive responses in sensory integration intervention and detailing the various levels of adaptive response.  This resource is a MUST HAVE for every therapist practicing in the area of sensory integration or mentoring other therapists or students in sensory integration.

Happy reading and viewing and watch this blog as well as our Facebook page for more great resources.

In Memorium – Jane A. Koomar, PhD, OTR/L, FAOTA

Jane KoomarMany people are already aware that our beloved friend and colleague, Dr. Jane A. Koomar, passed away this year on February 23, 2013 after a three year battle with breast cancer.  Jane was the heart and soul of her private occupational therapy clinic, OTA The Koomar Center (previously known as OTA-Watertown).  She was an icon in her field and changed for the better the lives of thousands of children, parents and therapists.  The Spiral Foundation deeply mourns her loss but endeavors to continue her work with our research and education activities.

To see  a lovely memorium written by OTA and Spiral Foundation staff please visit our website, http://www.thespiralfoundation.org, or by clicking here.

Donations in Jane’s honor may be made to the Spiral Foundation to support research in sensory integration.