Sensory Processing Treatment for Individuals with Challenging Behaviors (Helping to take the mystery out of sensory processing treatment)

Created from materials from workshops taught by: Bonnie Hanschu, OTR Patricia Wilbarger, MS, OTR Bill Nason, LLP Acknowledgement and thanks also given to all the others (clients, families and teachers) who have taught us all so much

Revised 9/2008

OBJECTIVES: Participants will: 1. Gain increased understanding of basic neurology that supports sensory processing treatment theory. 2.

Gain increased understanding of how each type of sensory input calms down or wakes up the nervous system.

3.

Be able to recognized symptoms that might indicate POSSIBLE sensory processing difficulties.

What is Sensory Processing? • The way the brain organizes incoming sensation from the world (touch, smell, sound, etc.) so we can make sense of it.

• The registration and organization of sensory input into overall perception and understanding, which allows us to provide adaptive responses to environmental demands. • Effective sensory processing allows us to adequately access and respond to the demands of our environment.

Sensory Processing

Each sense provides valuable information. The brain integrates the senses together to provide overall perception and meaning.

• 80% - 90% of sensory processing, of EVERYTHING we do, happens automatically and below the level of consciousness. • If we have to do it consciously (“THINK” about it), it ties up those brain cells that we should be using to explore, pay attention, learn, remember, etc.

“Brain Drain”

• Having to consciously think about things/actions that should be automatic not only reduces a person’s ability to learn new things, it takes [up to] NINE TIMES more energy so they tire much faster mentally and physically.

Where does it happen?

Brain Stem

Sensory Deficits Can Lead To Two Different Types Of Problems 1: Problems with MOVEMENT (coordination). This is primarily “structural”, involving the neuron “wiring” in the brain.

2: Problems with AROUSAL (behavior). This is primarily chemical.

PROBLEMS WITH MOVEMENT/COORDINATION – STRUCTURAL

Newborn

6 months

24 months

Neurons (nerve cells) make up the pathways/”roads” that information travels on in the brain.

Neurons need to be well connected (have “good roads”) so that information travels fast and reaches the correct destination.

VESTIBULAR SYSTEM Vestibular Nerve

Semicircular Canals (filled with fluid)

Cochlea

Saccule (“Rocks” & “Hairs”)

Utricle

Receptors are in the inner ear Tells us where “down” is (registers gravity) Tells us where our head is in space (to protect brain) Registers movement of the head Provides baseline tone in anti-gravity muscles

“Poor roads” for vestibular input look like:

VESTIBULAR SYSTEM Vestibular Nerve

Semicircular Canals (filled with fluid)

Cochlea

Saccule (“Rocks” & “Hairs”)

Utricle

Receptors are in the inner ear Tells us where “down” is (registers gravity) Tells us where our head is in space (to protect brain) Registers movement of the head Provides baseline tone in anti-gravity muscles

“Poor roads” for vestibular input look like: • Clumsy • Poor/no protective response • Poor/slouched posture • Head wagging • Wide-based gait • Shuffling gait • Difficulty walking around objects/through doorways TREATMENT:

VESTIBULAR SYSTEM Vestibular Nerve

Semicircular Canals (filled with fluid)

Cochlea

Saccule (“Rocks” & “Hairs”)

Utricle

Receptors are in the inner ear Tells us where “down” is (registers gravity) Tells us where our head is in space (to protect brain) Registers movement of the head Provides baseline tone in anti-gravity muscles

“Poor roads” for vestibular input look like: • Clumsy • Poor/no protective response • Poor/slouched posture • Head wagging • Wide-based gait • Shuffling gait • Difficulty walking around objects/through doorways TREATMENT: Activities that move the head through space. Examples: Swinging Rolling on stomach on a ball Jumping

VESTIBULAR ACTIVITIES

Two purposes: 1. Building better pathways = better coordination. 2. Calm or alert the nervous system.

PROPIOCEPTION SYSTEM “Poor roads” for proprioceptive input look like:

 Receptors are in the muscles and joints

 Tells us where our body parts are (“the eyes of the body”)

Tells us how much force to use

PROPIOCEPTION SYSTEM “Poor roads” for proprioceptive input look like: • Don’t know where body parts are (EX: hits nose on drinking fountain) • Handles people/objects too hard / too soft / fluctuates • Difficulty centering self on furniture • Can’t put arm in sleeve or fasten button behind their back

 Receptors are in the muscles and joints

 Tells us where our body parts are (“the eyes of the body”)

Tells us how much force to use

TREATMENT:

PROPIOCEPTION SYSTEM “Poor roads” for proprioceptive input look like: • Don’t know where body parts are (EX: hits nose on drinking fountain) • Handles people/objects too hard / too soft / fluctuates • Difficulty centering self on furniture • Can’t put arm in sleeve or fasten button behind their back

 Receptors are in the muscles and joints

 Tells us where our body parts are (“the eyes of the body”)

Tells us how much force to use

TREATMENT: Activities that involve joint movement and muscles working against resistance. EXAMPLES: Lifting weights Climbing (hill, stairs, ladder) Exercises (chin-ups, pull-ups) Carrying weighted items (wear loaded backpack, pushing someone in a wheelchair) Tug-of-War Martial arts

PROPRIOCEPTION ACTIVITIES

Two purposes: 1. Build better connections = better coordination TRAMPOLINE

EXERCISE

2. Calms and organizes (if overaroused, brings down; if underaroused, brings “up”

WEIGHTED VEST

CLIMBING

TACTILE (Touch) SYSTEM “Poor roads” for touch input look like:

Two types of touch: light and deep/pressure

light touch is alerting (protective) Deep/pressure touch is calming Tells us where we have been touched and how much

Gives us our sense of self (what is “ME” and what is “NOT ME”)

TACTILE (Touch) SYSTEM “Poor roads” for touch input look like: •Can’t feel/touch enough •Like “trying to write or tell the difference between a dime and a nickel with gloves on” •Don’t know food is on your face

Two types of touch: light and deep/pressure

light touch is alerting (protective) Deep/pressure touch is calming Tells us where we have been touched and how much

Gives us our sense of self (what is “ME” and what is “NOT ME”)

TREATMENT:

TACTILE (Touch) SYSTEM “Poor roads” for touch input look like: •Can’t feel/touch enough •Like “trying to write or tell the difference between a dime and a nickel with gloves on” •Don’t know food is on your face

Two types of touch: light and deep/pressure

light touch is alerting (protective) Deep/pressure touch is calming Tells us where we have been touched and how much

Gives us our sense of self (what is “ME” and what is “NOT ME”)

TREATMENT: Activities involving tactile input. EXAMPLES: • Brushing skin with various textures • Massage •Finding objects buried in sand or rice

TACTILE ACTIVITIES

Two purposes: 1. Building better connections = better coordination 2. Calm or alert nervous system

• •

Light touch is alerting (protective response – what touched me and where is it?) Deep/pressure touch is calming

SECOND TYPE OF PROBLEM – AFFECTS AROUSAL MODULATION –A problem with the chemistry around the neurons/pathways. It is a problem with the “filter” and affects “Arousal (awake, alert, attending, asleep, and all the in-between states).

MODULATION DISORDER (continued) • •

Problem with the “filter” What do you see with modulation problems?

•

Can be overaroused or underaroused Need to change the chemistry in the brain Treat with a sensory ‘diet’

•

•

• TREATMENT: If overaroused: If underaroused:

MODULATION DISORDER (continued) DEFENSIVENESS Nervous system on “red alert” Hypervigilant Hyperresponsive

TREATMENT: Deep Pressure and Proprioception Technique (formerly called “Brushing & Join Compressions”) is the key activity in the sensory ‘diet’

ALL OF THE SENSORY ‘DIET’ BELOW WERE DEVELOPED BY OTRs WHO ARE EXPERTS IN THE FIELD OF EVALUATING & TREATING SENSORY PROCESSING DISORDERS. ANY SENSORY-BASED TREATMENT PROGRAM SHOULD BE DONE UNDER THE GUIDANCE OF A WELL-EXPERIENCED OTR

SUGGESTED READING • • • • • • • • • • •

•

“The Out-of-Sync Child”, Carol Kranowitz “The Out-of-Sync Child Has Fun”, Carol Kranowitz “Too loud, too bright, too fast, too tight”, Sharon Heller “Asperger Syndrome and Sensory Issues”, Brenda Myles “Sensory Perceptual Issues in Autism and Asperger Syndrome”, Olga Bogdashina “Raising A Sensory Smart Child”, Lindsey Biel, Nancy Peske “Building Bridges Through Sensory Integration”, Ellen Yakes “How Does Your Engine Run” Williams and Shellenberger “Unlocking the Mysteries of Sensory Dysfunction” Anderson and Emmons. “Fidget to Focus”, Roland Rotz and Sarah Wright. “Autism: A Sensorimotor Approach to Management” Huebner

Any of the “Tools” products (books and visual media) by Diana Henry, MS, OTR/L