OT and SI Information Packet

What is pediatric developmental and sensory integration (SI) based occupational therapy (OT)?

Pediatric Occupational Therapy is the use of a childs occupations (play, school, home) to focus on how the child is functioning and developing their environments. When there is a delay in skills, poor attention, motor impairments, or other problems, OT can help a child gain greater independence in all areas of life through therapy.

Occupational Therapists collaborate closely with parents, Speech and Language Pathologists, Physical Therapists, and Teachers in order to effectively promote independent and successful performance.

At the Center of Development (COD), OT is a developmental & sensory based intervention that enhances the individual's ability to be the most successful they can be. Our team based treatment approach looks at the child as a whole, focusing on treatment techniques that help the brain process information correctly and/or adapting the environment to best meet their individual needs.

Occupational Therapy treatment starts with an evaluation of the child's capabilities which influence performance of tasks necessary to function in his/her environment. The evaluation will include standardized assessments as well as clinical observations to evaluate the child's specific strengths and weaknesses with respect to developmental milestones, sensory processing of vestibular (movement), proprioceptive(joint and muscle), tactile (light touch and deep touch), sensory motor skills, age appropriate developmental levels for fine motor, visual perceptual, self-care, play/leisure skills, and academic abilities such as handwriting, cutting, and classroom performance.

When therapy is recommended, it may be direct intervention weekly or consultation depending on the child's needs. Therapy sessions and consultations are individually designed to enhance the child's strengths and build on their skills, as well as develop new skills and better integration of sensory input from the environment.

Therapy may include accommodations in their school environment, home environment, positioning, adaptive equipment to help make tasks easier, and functional enhancement of sensory integration, motor responses, and fine motor abilities and manipulation to accomplish the daily tasks ("occupations") of living.

There are carefully delineated techniques for helping children with disorders of development or sensory integration.

Who needs therapy? Any child who is not displaying typical development in the areas of sensory processing, attention, fine motor, self help, play skills, visual perceptual, and academic skills related to these areas such as attention to task, handwriting, and/or focusing and attention in the classroom.

What is sensory integration (SI)?

All human beings receive information from their internal and external environments through the senses: vision, hearing (auditory), touch (somatosensory or tactile), taste (gustatory), smell (olfactory), vestibular (movement), and proprioceptive (joint and muscle). We respond to these stimuli automatically. The term sensory integration refers to the process by which we receive this information, the central nervous system directs the information to the appropriate parts of the brain, and the information is "integrated" or synthesized, so that we can respond to the stimuli in an adaptive manner.

• When there is a disturbance in this capacity to automatically integrate sensation and respond adaptively, the individual has a disorder of sensory integration. These disorders can have a negative impact on the child's capacity to learn, to function in socially appropriate ways, and perform the daily tasks of living.

• What is the purpose of a sensory integration (SI) assessment?

  The capacity to integrate information has an effect on the individual's learning, social participation, self-regulation and ultimately his/her self-confidence and self-esteem. When there are disturbances in SI these functional domains can be adversely affected. Examples of SI disorders include problems with tactile discrimination, touch acceptance or localization, filtering out extraneous stimuli, postural control, perception of body position in space, bilateral motor coordination, fine motor, self help, and social skills. SPD (Sensory Processing Disorder) affects all aspects of a child's life.

• There are a variety of assessments and clinical observations that can be utilized to identify and assess the degree of disturbance. This assessment, performed by a highly trained OT, is necessary prior to determining the appropriate intervention to assist in remediation of, or compensation for, the SI difficulties. The focus of the assessment and the intervention is to identify the underlying sensory disturbances that may be adversely influencing the child's ability to function adaptively in his/her environments.

What is Sensory Processing Disorder and how can it be treated?

SPD is a complex neurological disorder, manifested by difficulty detecting, modulating, discriminating or integrating sensation adaptively. It causes children to process sensation from the environment or from their bodies in an inaccurate way, resulting in "sensory seeking" or "sensory avoiding" patterns or 'dyspraxia," a motor planning problem, or commonly a combination of these.

SPD and Sensory Seeking

These children have nervous systems that do not always process that sensory input is "coming in" to the brain. They are under-responsive to sensation. As a result, they seek out more intense or longer duration sensory experiences. They often have difficulty with sensory registration and integration which manifests as a sensory craver or seeker needing an excessive amount of sensory input to get a normal central nervous system response and brain chemical release.

Some behaviors that can be observed are:

_ Hyper-activity as they seek more and more movement input (under registering input) Unable to stay in seat, fidgety, difficulty with test taking, working alone or in quiet room, needs hands on learning techniques.

_ Unawareness of touch or pain, or touching others too often or too hard (may seem aggressive). Often touch everyone & everything. They are under registering the amount of pressure or proprioceptive input.

_ Engaging in unsafe behaviors, such as climbing too high (craving extremes), rough play, erratic swinging, running inside...

_ Enjoying sounds that are too loud, such as TV or radio volume (craving auditory input) or Nintendo or cartoons for visual.

SPD and Sensory Avoiding

These children have nervous systems that feel sensation too easily or too much. They are overly responsive to sensation. As a result, they may have "fight or flight" responses to sensation, a condition called "sensory defensiveness."

Some behaviors that can be observed are:

Responding to being touched with aggression or withdrawal (especially light touch from others, unexpected touch, messy activities, food aversions and picky eaters, bothered by tags in clothing, only wears cotton clothes, takes off shoes, or insists on leaving them on, gets upset in crowds or busy places such as gym or cafeteria)

_ Afraid of, or becomes sick with movement and heights (avoids vestibular input such as swings, stairs, moving toys, dislikes being picked up, doesn't play on playground)

_ Very cautious and unwilling to take risks or try new things, very clingy to parents, may play in corner or away from peers...

_ Uncomfortable in loud or busy environments such as sports events, malls, stores, cafeteria, gym, and in large open rooms

_ Very picky eater and/or overly sensitive to food smells

_ May be visual or auditory defensiveness as well with aversions to bright lights, flourescent lighting, or background noises as brain is unable to filter out background stimuli

_ Dislikes grooming, hair cuts, sometimes baths, nail cutting, etc.

_ Complains about clothing or bedding, may be itchy & red

_ Gets motion sick easily

_ Avoids crawling, weight bearing, or dislikes being on tummy

SPD and Dyspraxia

These children are often clumsy and awkward in their movements. They have particular problems with new motor skills and activities. They display difficulties with the registration and integration of sensory input, but may also fall under defensiveness and modulation disorders.

Some behaviors that can be observed are:

Very poor fine motor skills such as handwriting, cutting, motor planning skills

Very poor gross motor skills such as kicking, catching, throwing ball, sports are difficult

Difficulty imitating movements such as "Simon Says"

 Trouble with balance, sequences of movements and bilateral coordination

Children with SPD often display very specific sensory difficulties as follows and Occupational Therapy can help:

Auditory	Responds negatively to unexpected or loud noises Holds hands over ears Cannot filter out background noise Seems oblivious within an active environment
Visual	Prefers to be in the dark Hesitates going up and down steps Avoids bright lights Stares intensely at people or objects Avoids eye contact Self Stim behaviors Poor knowledge of left and right, reversals, and difficulty with reading skills are also visual perceptual delays

Taste/Smell	Avoids certain tastes/smells that are typically part of children's diets Routinely smells nonfood objects Seeks out certain tastes or smells Does not seem to smell strong odors
Body Position	Continually seeks out all kinds of movement activities Hangs on other people, furniture, objects, even in familiar situations Seems to have weak muscles, tires easily, has poor endurance Walks on toes
Movement	Becomes anxious or distressed when feet leave the ground Avoids climbing or jumping Avoids playground equipment Seeks all kinds of movement and this interferes with daily life Takes excessive risks while playing, has no safety awareness
Touch	Avoids getting messy in glue, sand, finger paint, tape Is sensitive to certain fabrics (clothing, bedding) Touches people and objects at an irritating level Avoids going barefoot, especially in grass or sand Has decreased awareness of pain or temperature
Attention, Behavior And Social	Jumps from one activity to another frequently and it interferes with play Has difficulty paying attention Is overly affectionate with others Seems anxious Is accident prone Has difficulty making friends, does not express emotions

Characteristics of Tactile Dysfunction

Hypersensitivity: heightened response to touch resulting in a flight or fright.

• React negatively and emotionally to light touch, unexpected touch, or certain textures. May act out, hit, rub spot touched, scratch skin, reject cuddling.

   

• May be fearful or act out in lines, when approached suddenly, or when touched when not seeing it coming.

   

• Reject all touch from others, especially if not mother or father.

   

• Rejects hand over hand assistance

   

• Prefers hugs over kisses, needs the deep pressure of the hug.

   

• Overreacts to bumps or bruises, or may be a hypochondriac

   

• Avoids touching certain textures, pulls away from touch to items, rubs and scratches when wearing tags, or certain fabrics (wools, polyester, non 100% cotton)

   

• Fusses about stiff clothes, appliques in clothes, tags, collars, elastic, turtlenecks, hats, gloves, scarfs, shoes and socks, prefer long or short sleeves.

   

• dislikes grooming touch such as washing and cutting

   

• Avoids messy play in paints, sand, glue, mud, etc.

   

• Hurries to wash off hands, rubs hands on clothing when touched with mess

   

• Avoids going barefoot

   

• Walks on tiptoes, doesn=t crawl

   

• Resists oral touch: toothbrushing or food textures

   

• Temperature preferences

   

  Hyposensitivity: under responsive to touch

   

• touches others very hard and firm, is rough with objects and people

   

• Unaware of messiness on face or hands, may crave messy activities

   

• High pain tolerance

   

• Unable to identify body parts touched without looking

   

• Unable to perform some fine motor tasks such as fasteners

   

• difficulty holding tools, writing utensils, eating utensils

   

  For stimulation (either calming or alerting) they may:

   

• Touch objects repeatedly such as stroking hair, favorite blanket or toy

   

• bumps into others, bumps walls, touching others excessively

  rub or even bite self

   

• prefer strong tastes in foods (salty, sweet, spicy)

   

• Use mouth to explore more than hands (more intense sensation from the mouth)

   

  May cause difficulties with body perception, body awareness, motor planning:

   

• unable to coordinate body movements (stand on one foot, balance beam, crawl

   

• Difficulty with bike riding, cutting, handwriting

   

• Poor eye hand coordination and visual perception

Characteristics of Vestibular Dysfunction

Hypersensitivity:

• Dislike playground activities that move: swinging, spinning, sliding

   

• Gets carsick easily

   

• Hesitates to take risks, doesn't like to try new movement activities

   

  Gravitational Insecurity:

   

• Primal Terror to falling off something above ground

   

• Avoids walking on curbs, steps, holds on for dear life when above ground

   

• Feel threatened when head is inverted, tilted, or spun

   

• Fearful when moved, sliding chair from someone else

   

  Hyposensitive:

   

   

• Needs to move all the time to function, trouble sitting still or staying in seat with feet on the floor

   

• Shakes head, spins, runs, jumps, moves all the time

   

• Craves intense movement: jumping, climbing, spinning, head upside down

   

• Does not have post rotary nystagmus after spinning, does not get dizzy

   

  Muscle tone is affected by vestibular input:

   

  Low tone:

   

• loose and floppy body, poor posture, slumps in chair, humped when standing

   

• prefers to lie down, slump over desk, lean on hands or head

   

• W sits, hard to wheelbarrow walk on hands

   

• difficulty with tools, utensils, loose grasp, too light of pressure or too hard to

   

• compensate, tires easily with handwriting or cutting

   

• Difficulty catching self when falling

   

  High Tone:

   

• Too tight of muscle, seems tense and hyper

   

• Tight grasp, white knuckles, breaks pencil lead or crayons easily

   

• Stiff in movements

   

  Poor Bilateral Coordination and Visual perceptual skills:

   

• Did not crawl as a baby, early walkers

   

• Clumsy, poor fine motor skills, poor coordination of right and left

   

• Difficulty with crossing midline

   

• Difficulty with using one side of body to assist the other side, poor dominance

   

• Poor rhythm, can't keep a beat

   

• No established hand dominance at 4-5 years, switches hands a lot

Child with Proprioceptive (muscle and joint receptors) Dysfunction:

• Poor muscle tone: either too high or too low

   

• deliberately runs into people, objects, jumps, dives into stuff, tackle people

   

• stamp or slap feet onto ground while walking, walks with a bouncing gait

   

• Kick his feet or heels against chair or floor, or desk

   

• Bang sticks or objects on wall while walking, rubs against the wall

   

• Rubs his hands on everything, bite or suck fingers, crack knuckles

   

• Likes to be touched, hugged, rough and tumble play, swaddled, rolled into bedding tightly

   

• Chews on shirt, cuffs, strings, pencils, toys, and gum a lot

   

• Poor motor planning, body awareness, position in space

   

• Holds pencils or crayons too tight or too loose

   

• messy eater, messy work

   

• "Bull in a china shop"

   

• Uses too much force, breaks objects frequently

   

• Poor posture, slumps, sits on edge of chair with foot for support

   

• Unable to balance on one foot

Poor Visual Spatial and Perceptual Skills:

Please contact us ASAP so we can help with all of these issues!  Education is EMPOWERMENT!  

• Closes or covers one eye, squints, leans into work, leans head to one side

   

• Complains of seeing double, tilts head, headaches

   

• Difficulty with losing place when copying from the board, loses place on worksheets, reading, math is unorganized on paper

   

• Fails to comprehend what they are reading, loses interest

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