Pediatric Occupational Therapy Tips Gravitational Insecurity On February 8th, I shared how children with sensory issues can be classified as having sensory defensiveness, registration problems, modulation issues, and sensory integration problems. In that blog entry, I reviewed tactile defensiveness (sensitivity to touch), which falls under the category of sensory defensiveness. Today, I’m going to talk about another type of sensory defensiveness, specifically gravitational insecurity. A child with gravitational insecurity typically responds to movement activities with exaggerated emotional responses. This is because their vestibular system is not functioning properly. (For more information about the vestibular system, see the entry on Feb. 11th) Gravitationally insecure children prefer to stay low to the ground. You will typically find them lying down or seated, trying to prevent any possibility of movement. Children with this type of defensiveness avoid most active physical tasks and may get upset when movement is required of them. To get a gravitationally insecure child moving, it may be helpful to physically guide them during play activities such as climbing, sliding and swinging. I’ve gone down a slide with a child in my lap, and sometimes, this provides that extra security needed to tolerate the vestibular input. Also, role-playing can also be beneficial, tell your child, “watch me to this, or do it just it the way I do,” then provide demonstration. If you attempt any of the activities suggested in the Feb. 11th post, be sure to stop if your child fervently resists an activity. Always introduce new movement activities gradually and in small doses, and ALWAYS stop if your child appears to be frightened or over stimulated. If your child has extreme responses to movement activities, I would recommend that you pursue occupational or physical therapy. Vestibular Activities The vestibular system helps us know where our bodies are in space and provides a sense of balance and posture. As we move about, our eyes and ears take in sensory information and send it to the brain. The vestibular system is made up of 3 fluid filled canals, a “sack-like” structure, and a “pouch-like” structure, and all of these components work together to respond to movement, gravity, and changes in direction and in head position. The visual system works in conjunction with the vestibular system, allowing both eyes to work together and contributing to smooth eye movements. The proprioceptive system also plays a role in this process (which I will discuss in more detail in another post). As the brain coordinates all of this input, this provides a foundation for the timing and spatial orientation of our movements, allowing us to navigate our environment in a coordinated manner. In one way or another, this system influences everything we do. Think of the vestibular system as functioning like a switchboard, directing individual sensations where and when to go or stop. Considering all of the important functions of this system, it is quite apparent why a vestibular problem can lead to many problems that impact daily functioning. Signs of Poor Vestibular Processing include: Motion Sensitivity Clumsiness- difficulty learning to ride a bicycle, hopping, and stair climbing Low Muscle Tone Visual-Spatial Problems Poor Eye-Hand Coordination Fear of Heights Dizziness and/or Nausea Vestibular Activities: Movement experiences are very important for the vestibular system during development, especially those that are child-directed rather than passive. Here are some ideas to help with vestibular functioning: Encourage activities in which the child is positioned on the stomach, holding the head in an upright position Playground equipment – merry-go-rounds, slides, swings, teeter totter jungle gym, monkey bars Rides at amusement parks Jumping (games like leap frog), hopping, skipping Balance games- walking on a line, twister, skating and bike riding Spinning games- sit-n-spin, swing (never twirl or spin a child for prolonged periods of time as this can impact heart and breathing rates; let the child direct the spinning if possible) Jump rope games Tumbling- somersaults, rolling in all directions Slow rocking – over a therapy ball, in a rocking chair, on a rocker, rocking horse Obstacle courses that incorporate lots of head and body movements The Tactile, Vestibular, and Proprioceptive Systems I’d like to talk a little more about sensory processing disorders. In an earlier post, I briefly reviewed the senses, but I thought I go into a bit more detail about a few of the senses that most of us don’t know that much about. I’ll start with the sense of touch…. Tactile System: The tactile system is the sense of touch. This is the sensory system that helps us learn about our bodies and our environment. It is important in the development of a child’s body scheme (the internal map of our body and how we use our body to interact with the world around us). This system is composed of two subsystems: (1) discriminatory- allows us to know where we are being touched, (2) protective- lets us know if we are in contact with something dangerous. Tactile input is very important for the development of fine-motor skills, visual perception skills, and articulation of sounds. The Vestibular System: The vestibular system is the sensory system that responds to accelerated and decelerated movement. It is through the vestibular system that we learn directions and are aware of our body position in space. This input helps us to form a basic reference for all sensory experiences. This system has interconnections with many parts of the body and influences many different functions, for example muscle tone, postural control, balance, eye and neck muscles. The Proprioceptive System: Proprioceptive information is sensations from muscles and joints. Proprioceptive input tells the brain when and how muscles are contracting and stretching and how joints are being compressed or stretched. It helps us to know where our bodies are in space and how they are moving. Proprioceptive input provides a calming effect. It works along with the vestibular system. With sensory processing disorders, one, two, or all three of these sensory systems might be involved (as well as any of the other senses). An experienced therapist can evaluate and determine which systems are involved, allowing for more specific treatment planning, which leads to more effective treatment! In my next entry, I’ll share a variety of sensory activities that are alerting, calming, etc. Sensory Processing Disorders Does your son freak out when it’s time for a hair cut? Do you absolutely dread clipping your daughter’s nails? Does you child complain about the tags in the back of his clothing? If you answered yes to any of these questions, you may have a child with a Sensory Processing Disorder (SPD). Sensory Processing Disorder, also called Sensory Integration Dysfunction, occurs when someone has difficulty taking in the many sensations from the environment and integrating them in order to respond appropriately to their surroundings on a daily basis. Professionals have estimated that somewhere between 5 and 10% of children have sensory processing problems. However, the majority of these kids go undiagnosed because many pediatricians and other medical professionals aren’t aware of the condition. Fortunately the medical community is wising up on the topic, and there is even discussion about including SPD as a diagnosis in a future issue of the Diagnostic and Statistical Manual of Mental Disorders, which is the official manual put out by the American Psychiatric Association for diagnostic purposes. However, for now, the DSM-IV does not recognize SPD as an official diagnosis, which causes problems when it comes to insurance reimbursement for therapy! In order to understand Sensory Processing Disorders, let’s begin by thinking about the five basic senses: sight, smell, taste, touch, and hearing. In addition to those, there are three additional senses: the sensory system that processes movement, the system that tells where our body parts are located in space, and the system that lets us know how we feel internally. As our brains receive sensory input from each separate system, that input must be interpreted, integrated, organized, and processed efficiently, so that an individual can react appropriately to the input. For example, let’s think about the haircutting example. In the case of a child with SPD, the nervous system is “wired differently” than with typical kids, so that the sensory input is not processed efficiently. When a little boy with SPD sits in the barber’s chair, the first thing that typically happens is that a cape is place around his shoulders. If his sense of touch is involved, it’s possible that the texture of the cape will unnerve him. Then the “clippers” are turned on, and the noise that he hears is much louder and harsher to his ears than yours. In fact, to his little auditory system, the noise can actually be painful. On top of that, the barber frequently touches him and runs the comb through his hair, adding to the bombardment of negative sensory input that he’s having to endure. No wonder the little fellow hates getting a haircut! The symptoms of SPD vary depending on which sensory systems are affected. Additional signs of dysfunction may include, but are not limited to poor sleep patterns, clumsiness, and over or under reaction to light, cold, or hot temperatures. Some children avoid certain food textures, and resist typical grooming activities such as hair washing, tooth brushing, or face washing. Many children also demonstrate an exaggerated fear of loud noises and crowds, while some little ones are extremely sensitive to touch and are fearful of playing on playground equipment. Avoiding messy materials such as play dough or finger paints and sensitivity to certain smells are also common. Children with SPD have also been described as having difficulty with transitions, and often complain about irritation from tags in the back of clothing or sensitivity to certain clothing textures. All of these issues can impact a child’s ability to interact with peers, and can ultimately lead to problems with social and play skills. If you suspect that your child has SPD, carefully consider whether or not the issue is affecting his or her quality of life. If so, treatment should be considered. If you decide on therapy, seek out an occupational or physical therapist who has completed coursework on sensory integration theory and has experience using sensory integration techniques. Why is treatment is necessary? As children are developing, daily sensory experiences are crucial. Kids with SPD usually don’t explore their environments as typical children do, and this lack of exploration can lead to delays with gross-motor, fine-motor, and possibly speech and language skills. Through a thorough evaluation, the therapist will identify where the specific problems are, and determine the sensory input that is most appropriate for each child. During therapy, children will gain the skills needed in order to more appropriately explore and interact with the environment. An experienced therapist knows how to provide controlled input to each of the sensory systems and guide the child in making appropriate responses. It is common for the therapist to work with a little one individually in therapy on a weekly basis, as well as provide a home program to be carried out daily, or every other day. Therapy can last from several months, to several years, depending on the severity of the symptoms and how well the child responds. It is best to begin therapy at an early age, because younger children respond more readily to SPD therapy; however, this does not mean that older children will not benefit from treatment. It only means that therapy may need to be more frequent and of a longer duration. How effective is SPD therapy? Most research on treatment of SPD has been conducted through case studies, and has been found to be effective. As an occupational therapist certified to administer the Sensory Integration and Praxis Test and 18 years experience providing therapy, I agree with the research, and I believe in SPD therapy. Admittedly, more research needs to be done on SPD treatment and its effectiveness, but personally, I have seen dramatic improvement in children who have received therapy on a consistent basis. Parents frequently share stories about how therapy helped their child better tolerate basic grooming activities, which made their day-to-day routines much more tolerable, and even pleasant. Personally, I love hearing how children that once resisted playing on the playground, swinging, or going to amusement parks are now in engaging in, and enjoying these activities. The sense of relief expressed by so many parents and the smiles on the kids’ faces are proof enough for me! Copied dari occupational therapy website ni, so many found for parents n professional use
Posted on: Thu, 20 Nov 2014 23:21:14 +0000
Trending Topics
© 2015