Sunday, October 27, 2013

Sensory Integration: How to Calm a Hyper Child without Wearing Yourself Out.

Calming a hyper child can wear you out, unless you wear them out first. 

The child in this video is constantly in motion, it is very difficult to get him to focus on fine motor tasks and he is young so if the activity isn't fun, he isn't doing it.  This activity gives him deep pressure and heavy work and helps him to gain better body awareness and ends with him being calmer. 

The tube this child is playing in is a length of knit cloth from a fabric store that comes in a 'tube'.  You can also purchase body socks made of neoprene from therapy catalogs that do the same thing.

If anyone else has suggestions please share.


Sunday, October 20, 2013

ADA: Kitchen Design for the Deaf


The architect Robert Nichols (http://www.robertnicholsdesign.com) was kind enough to share this awesome example of accessible design for someone who is deaf. Enjoy.

The kitchen renovation and home remodeling project were completed in Bethesda, Maryland in March 2003. The plans and photographs of the project are placed to demonstrate how the accessible light system and other aspects of the construction simultaneously enhances comfort and safety using the following elements:

Friday, October 18, 2013

Finding the Right Sensory Channel for Learning

This post is how to teach an 8 year-old student with moderate to severe cognitive delays.  Our student, we'll call her Ashbury besides having cognitive delays also exhibits symptoms of cortical blindness and is hypersensitive to vestibular stimulation.  Ashbury has difficulty learning new tasks.  Many learning approaches have been attempted with Ashbury, the issue seems to be finding the right sensory channel to teach Ashbury.  By sensory channel I mean figuring out how Ashbury learns about her environment and working with her through that channel.

Vision:
Ashbury is able to match colors and can see but does not appear to utilize her vision as her primary sense to interact with her environment.
  • When Ashbury is putting objects in a container she does not visually search for the objects to put into the container, she uses her hand to feel around for the objects.  
  • When stacking blocks Ashbury does not look at the blocks she is stacking she 'feels' the blocks and tries to stack based solely on tactile input.  

Tactile: 
Based on how Ashbury does visually, you'd think she would be a tactile learner.
  • Ashbury is not able to feel simple objects (such as a ball) and then choose a similar object out of two objects (ball and spoon) presented based on tactile input (poor stereognosis.)
  • Ashbury is not able to feel the outline of a slot and orient a disc to the slot.
Kinesthesia:
  • Ashbury's movements are stiff and close to her body.  She exhibits gravitational insecurity and attempts to limit movement.
Auditory:
  • Does not follow verbal directions well.
  • Has very limited word phrases she utilizes.
  • Does not seem to be hyper or hypo sensitive to sound.
Olfactory:
  • Does not seem to react to scents.
Gustatory/Taste:
  • Food preferences unknown.
  • Tends to bite on things occasionally, more apt to bite on objects when frustrated.
The backpack:

Goal:  To put on backpack correctly independently every time. Ashbury continually has difficulty orienting the backpack correctly, it often is upside down or the straps are wrong.

Baseline:  Ashbury could put on backpack correctly independently 15%.

Progress: 
  • If Ashbury grabs the backpack by the loop at the top of the backpack we have developed a motor pattern so that she is able to put the backpack on correctly 90%.
  • Problem Ashbury is not able to identify or maybe understand where the loop at the top of the backpack.

Intervention:
  • As mentioned before, Ashbury is able to put her backpack on correctly 90% of the time, if she grabs the top strap with her right hand. However, she doesn't always find the correct strap and usually ends up with her backpack on incorrectly.
  •  In order to help Ashbury orient herself, we decided to connect a kush ball to the top loop. We thought that because she doesn't interact with her world primarily through her visual channel, that she could be compensating with her tactile senses. 
  •  The kush ball was unsuccessful and she continued to struggle with finding the correct strap. At this point it was clear that Ashbury's primary sensory channel is neither visual nor tactile. At this point we found a shiny silver piece of material that crinkles together. We decided to tie it to the correct strap for her next session. 
  •  The idea was that this material would be visually, tactily, and even auditorily stimulating. With this new material on her backpack, Ashbury is able to grab any strap and put it on correctly. I believe that Ashbury uses all of her senses when interacting with the world. When one sense fails her, she moves on to the next. She learns best when an activity engages at least three of her senses at once.

Sensory Integration: The Vestibular System and Handwriting Issues

The vestibular system, located in the inner ear, is made up of three major semicircular canals which are responsible for our sense of balance, spatial orientation, and our sense of movement. Fluid, located in the three canals, orients our head in space and provides feedback during movement.

When the vestibular system fails to process sensory information correctly, other senses such as auditory, visual, and proprioceptive integration can be skewed.

John:

Children with vestibular processing issues exhibit certain characteristics that affect their ability to play and learn in their environment. While working in a center based school.  I worked with a young 3 year old boy we'll call John. Along with other developmental issues, John presented with a hyperesponsive vestibular system.

John's reactions to sensory stimulation:
  • Tolerates up and down movements while bouncing on a peanut therapy ball.
  • Side to side movements on the ball upset John. 
  • While on the net swing, John was able to swing forward and backward slowly for a short time  but could not tolerate spinning or swinging in any other direction. 
  • While interacting with his environment, John would keep his head straight without turning or tilting out of midline. 
  • Instead of turning his head, he would move his entire body to face something he was interested in or to look at me during therapy. 
  • Very limited eye movements, cannot isolate eye movements and head movements.
  • Moderately defensive to tactile stimulation-reluctant to touch beans and rice, would touch lightly with finger tips only.
  • Will cross midline to participate in activities.
  • VERY brief visual attention to task.
John resists vestibular input, he displays issues with fine motor coordination, postural control such as trunk and shoulder stability, attention, and visual motor control.

These issues will significantly affect John's ability to develop the skills necessary for handwriting in the future.

Components of handwriting:
-visual motor skills
-visual perception skills
-fine motor skills
-trunk control and shoulder stability

When reading through the research, it is clear that we know a lot about the affects of vestibular difficulties and we know what is required for handwriting. However, there has yet to be a study to link children with vestibular processing issues to their ability to learn hand writing. As a profession, we need more research in many areas and we stand to benefit from understanding these effects.

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