Understanding Sensory Processing

Transcription

1 Understanding Sensory Processing Doreen Thom BSc.O.T., OT (C) Mary McMahon MA, OT (C) October 16, 2007 What is Occupational Therapy? O.T. s provide skills for the job of living Occupational Therapists are involved in promoting skill development and independence in all daily living activities. Learning Objectives To understand the basic concepts of sensory processing How daily functions may be impacted by sensory processing difficulties How to use practical tools to support a child with sensory processing issues 1

2 Outline for Presentation In the next 40 minutes, we will be discussing the following: 1) Define Sensory Processing Disorder and discuss the categories of Dysfunction 2) How OT s assess SPD s 3) The intervention strategies used by OT s Sensory Processing Disorder (SPD) Terminology used to describe sensory difficulties Miller, L.J. (2006). Sensational Kids: Hope and Help for Children with Sensory Processing Disorder (SPD). Penguin Group: New York, NY. Normal Sensory Processing Feedback Loop Stimulus Central Processing Feedback Response 2

3 Disordered Sensory Processing Loop Stimulus Central Processing Inefficient Feedback Response Stimulus- Sensory intake Central Processing-Analysis, Organization, Synthesis, Storage Response- Motor, language, emotion Inefficient Feedback- Attending, processing new information, remembering, interactions, learning How Common Problems May Overlap SPD (Sensory Processing Disorder) ADHD (Attention Deficit Hyperactivity Disorder) LD (Learning Disabilities) ASD (Autism Spectrum Disorder) Sensory Processing Disorder (SPD) Terminology used to describe sensory difficulties Miller, L.J. (2006). Sensational Kids: Hope and Help for Children with Sensory Processing Disorder (SPD). Penguin Group: New York, NY. 3

4 SMD Subtype1: Sensory Over-Responsivity (SOR) hyper-responsivity, hyper responsiveness, hyper-sensitivity, or over-sensitivity Responds to sensation faster, with more intensity, or for a longer duration than those with typical sensory responsivity. SMD Subtype 2: Sensory Under-Responsivity (SUR) Also known as hypo-sensitivity, hypo-responsiveness, or under sensitivity, aka spaced out People with SUR disregard, or do not respond to, sensory stimuli in their environment. Lack of initial awareness may lead to apathy, lethargy, and a seeming lack of inner drive to initiate socialization and exploration. SMD Subtype 3: Sensory Seeking/Craving (SS) People with SS crave an unusual or type of sensory input and seem to have a insatiable desire for sensation. They energetically engage in actions that add more intense sensations to their bodies in many modalities, eg. Spicy food, loud noises, visually stimulating objects, etc. 4

5 Sensory-Based Motor Disorder (SBMD) People with SBMD have poor postural or volitional movement as a result of sensory problems. There are two types: (a) Dyspraxia (b) Postural Disorder (PD) SBMD Subtype1: Dyspraxia Also known as DCD, Developmental Coordination Disorder, and poor motor planning. Dyspraxia is an impaired ability to plan, organize and sequence, to conceive of or execute new actions. People appear awkward and poorly coordinated in gross, fine or oral-motor areas. Visual-perceptual and visual-motor deficits are also common in this disorder SBMD Subtype 2: Postural Disorder (PD) Also known as hypotonic,or hypertonic muscle tone, poor core stability PD is difficulty stabilizing the body in movement and at rest to meet the demands of the environment or a given motor task. Inadequate control of movement, or inadequate muscle contraction to achieve movement against resistance 5

6 Sensory Discrimination Disorder (SDD) Identified by difficulties interpreting qualities of sensory stimuli Difficulties with recognizing similarities and differences between stimuli SDD can be observed in one or more of the following sensory systems: visual, auditory, tactile, vestibular, proprioception, taste and smell Assessment of SPD s Formal currently the most common instrument used is Winnie Dunn s Sensory Profile Informal OT s use clinical observations, Carolina curriculum, developmental checklists, unstructured play observations, clinical interviews (parents, teachers) OT s anlayze the data collated from the above measures with standardized tests to develop contextual intervention strategies The Sensory Profile Supplement Classification System 6

7 Dunn s Sensory Processing Patterns Foundations of Learning Academic Readiness Perceptual Motor Skills Perceptual-Motor Foundations Primary Sensory Systems Adapted from Stock Kranowitz (1998) The Out-of-Sync Child SENSORY MODULATION SENSORY OVERLOAD OPTIMAL RANGE OF AROUSAL LOW AROUSAL 7

8 Intervention Strategies based on the Sensory Profile When Registration is interfering with participation in daily life activities When Seeking is interfering When Sensitivity is interfering When Avoiding is interfering Sensory Diet Provide appropriate arousal or calming activities so that a child or person can participate effectively in all aspects of daily life. Helps regulate arousal levels Decrease distractibility Increase comfort in the environment Decrease self-stimulation or sterotypical behaviors Help decrease anxiety Support improved task performance Sensory Diet For Younger Children Daily Event Sensory Input/Accommodation Wake-up Fan, animal walk to bathroom Self-Care Flavored toothpaste, rough facecloth, cold Breakfast Crunchy foods, spicy, bland Arrival at school Fanny pack, playground equip. Midmorning Access to hideouts or quiet play Lunch Chewy foods, straws, playground equip. Mid-afternoon Rocking chair, nap, quiet space Arrival home Park, swing, hideouts, unplugged time Dinner Move n sit cushion, bland, brush teeth Evening activity Hoppity ball, climbing toys, chores (weight) Self-Care Extended bath, electric toothbrush, Bedtime Weighted blanket 8

9 Sensory Diet for Older Child Daily Event Sensory Input/Accommodation Wake-up Self-Care Breakfast Bus Ride Classroom Recess Lunch Arrival Home Dinner Evening Activity Self-Care Bedtime Dimmer switch, jump on trampoline Morning shower, massage brush Chewy/crunchy, straws, thick drinks Weighted backpack, fidget toys (attached) Study carols, movement breaks, chew gum Climbing apparatus, individual sports, Finger veggies, straws, thicker drinks Unplugged time, dance video s, trampoline Chair pushups, move n sit, crunchy foods Sport lessons, leisure activities, chores Bath brush or loofah, jumping, special soaps Heavy bedding, lights on a dimmer switch How to Use A SECRET A Attention S Sensation E Emotion C Culture R Relationship E - Environment T - Task Sensory or Behaviour? Identified SPD s require a sensory processing intervention and behavioral issues require a behavioral intervention. Understanding sensory processing issues is essential for understanding behavior, however multidisciplinary approaches are recommended to encourage the development of appropriate interpersonal skills. 9

10 How effective is OT Intervention? State of the art with Winnie Dunn s intervention strategies to date appear to be positive based on clinical feedback from caregivers and teachers Need to develop further research and collate more data, however, appear to be on the right track Questions and Discussion Open for 20 minutes 10