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Research into Practice: A study of safety and tolerability of rotatory vestibular input for preschool children

The answer to a question on SI4OT, a FB group for OT’s curated by our social media team, includes this interesting article.

This study was focussing on the vestibular system, and the researchers tried to work out the exact amount of vestibular input needed in therapy. The results strongly suggest that it is very individualised and requires direct therapist observation to know. This is exactly in line with Ayres’ teachings. There is no exact amount that can be prescribed

A study of safety and tolerability of rotatory vestibular input for preschool children

The use of sensory input to support function, health and wellbeing is an art and a science.

The science is knowing for instance that habituation of tactile input to Ruffini nerve ending is usually fairly rapid – eg light touch as we put arms in shirt sleeves while habituation to pain receptors will vary a lot and maybe ongoing after tissue damage we can’t always see.

The art is that our response to sensory input to sensory systems will vary greatly and is very individualised. This response is not just linked to immediate registration and perception of the input – meaning and memory need to be considered too.  Think about happy smells and songs that stay in your head all day. Think too about the response to trauma when a person smells their abuser’s perfume.

There is no recipe for how much to give and when. This is the art and science of ASI. So many factors impact on what a person needs and when to have an adaptive response.

This is why sensory input is not just something you can prescribe someone by saying;

“Give Jane 20 mins on a swing 3x a day” 

gray swing

Essential to practice is the person’s response to sensory input – Do they have an adaptive response?

“Ayres (1972b) described the adaptive response as central to praxis intervention. Adaptive responses are purposeful actions directed toward a goal that is successfully achieved, and the production of adaptive responses is thought to be inherently organizing for the brain. Ayres (1972b, 1985) further emphasized that SI intervention was a transaction among client, task, and environment.”

Bundy, A. and Lane, S. [2019], Sensory Integration Theory and Practice, 3rd Edition, [Philadelphia]. Available from: FADavis.

Watching and seeing this response to input, alongside feedback from the parents/family/person is what we do to understand each person’s unique responses and pattern. However, knowing and remembering that many things can impact on this, day to day and even minute by minute is essential. 

 

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Research Update: Novak Article Response published in AOTJ

We are delighted to announce this long awaited news, after Caroline got in touch with ASI Wise about the Novak Article at the end of September.

Caroline posted this to us in the wee hours of the morning:

I know people have been tweeting about the systematic review by Novak and Honan (2019) regarding sensory interventions for children with disabilities. We wrote a letter to the editor pointing out some inaccuracies in this review. Please share with colleagues

https://doi.org/10.1111/1440-1630.12623

You can read it here.

https://onlinelibrary.wiley.com/doi/epdf/10.1111/1440-1630.12623

Please Email caroline.mills@westernsydney.edu.au if you have any questions.

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Why ABA is not a good therapeutic fit for Occupational Therapists.

Novak’s Systematic Review (SR) of paediatric interventions in occupational therapy rates ABA as a green light intervention?? How and why would an OT SR even consider including ABA as a good fit with OT? Why?

We keep being told the article must be relied upon, as it’s a SR and these count more than almost all other research? Why?

While much of OT relies on science based research techniques, if we are truly holistic and believe Occupational Therapy goes beyond the medical model, then so must our research methods go beyond RCT and SR as evidence.

Narrative and lived experience must count. And, if we are to do no harm, then the common sense that so critical to our profession must prevail. This pragmatic common sense is grown in us as students to shape us and enhance our ability to help our clients find creative and very practical ways to live their often very tricky lives. The essence of occupational therapy.

Do we really need an RCT or systematic review of ABA practice before curtailing it?

Anyone fancy writing the ethics or grant application to get time off to write an article to stop something that should never be allowed to happen? Something that ignores the person’s every attempt to communicate, touches without consent and promotes child compliance with anything an adult demands?

I would love to see the ethics board member’s faces on receiving the application.

Please see this narrative and watch these videos. Read this parents common sense discussion about ABA.

Then please think about if ignoring communication and demanding compliance is in line with the values OT espouses? Is it about developing independence and promoting participation in daily life?

How much compliance is too much compliance: Is long-term ABA therapy abuse?

ABA requires daily therapy for years… where is the quality of life?

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Rapid onset sensory reactivity, movement difficulties, tics, mood changes and reduced attention may be PANDAS or PANS

Therapists practicing Ayres’ Sensory Integration should be aware of PANDAS and PANS as part of differential diagnosis.  Like Sydenham’s Chorea, the incidence of both these clinical presentations may be becoming increasingly more common as antibiotics are used more judiciously.

It is a possible differential diagnosis for a range of childhood neurodevelopmental and mental health difficulties including autism and rage/anger, and occupational therapists practicing sensory integration are likely to receive these referrals due to the sensory symptoms that may be a prominent marker of PANDAS, PANS and early-stage Sydenham’s Chorea, before frank ataxic movement patterns are observed .

A key symptom of this disorder is extreme sensory reactivity alongside development of tics, changes to participation in activity, altered movement patterns and fluidity of movement, joint pain and changes to mood, focus, attention and difficulties with emotion regulation. Intense extreme emotions and eating difficulties are also reported in the literature.

SYMPTOMS LIST from http://pandasnetwork.org/medical-information/

Symptom presentation and severity can vary from child to child. It can also vary in each exacerbation. Below is a list of possible symptoms a child may exhibit. Not all need to be present. Not all possible symptoms are listed.

OBSESSIVE COMPULSIVE DISORDER (OCD)

OCD can manifest in different ways in young children.  Learn more here.

RESTRICTIVE EATING
This includes selective eating and food refusal.There can a variety of reasons why the child experiences this, including contamination fears, sensory sensitivities, trouble swallowing, fear of vomiting or weight gain, and more. If restrictive eating is resulting in severe weight loss, call your provider immediately.

TICS
Tics are repetitive movements or sounds that can be difficult for a child to control. Motor tics can include eye-blinking, head-jerking, shoulder shrugging, nose-twitching, and facial grimacing. Some motor tics are a series of movements, performed in the same order. Vocal tics can include grunting, humming, throat clearing, coughing, repeating words or phrases. Some children are able to suppress tics temporarily, but doing so can cause extreme discomfort. Relief comes through performing the tic.

ANXIETY

EMOTIONAL LABILITY
Emotional lability includes not being able to control one’s emotional response such as uncontrollable crying or laughing. This is a neurological symptom.

DEPRESSION

IRRITABILITY AND AGGRESSION

BEHAVIORAL REGRESSION
This includes baby talk.

DEVELOPMENTAL REGRESSION

DETERIORATION IN SCHOOL PERFORMANCE
This includes deterioration in math skills, inability to concentrate, difficulty retaining information, and school refusal. School performance can also be a result of another contributing symptom, such as OCD or severe separation anxiety.

CHANGES IN HANDWRITING
This includes margin drifts and legibility.

SENSORY SENSITIVITIES
This can include being sensitive to touch, sounds, and noise. Simple touches may feel like they are hurting. For example: being unable to tolerate the way socks feel or the texture or temperature of certain foods. Sensory processing problems can also cause difficulty in finding an item when it is among a vast selection of items. For example, a child may have a hard time finding a shirt in a full dresser or finding words in a word search.

SOMATIC SIGNS
This includes sleeping difficulties, enuresis, frequent urination, and bed wetting.

HYPERACTIVITY

CHOREIFORM MOVEMENTS
Here is an example of Choreiform movements. The child is attempting to hold his hands straight out and is trying not to move his fingers.

SEVERE SEPARATION ANXIETY
Separation anxiety in an older child will present differently. For example, a child may be unwilling to leave the house or their bedroom.

HALLUCINATIONS
This includes both visual and auditory hallucinations.

FIGHT OR FLIGHT RESPONSE

DILATED PUPILS

RHEUMATIC PAIN OF JOINTS
Is often described.

URINARY PROBLEMS
This includes daytime wetting accidents and/or frequent urination.

Screen Shot 2019-12-08 at 10.51.16.png

Join the FB group here.

Parent Facebook group: This is a group run by parents only for parents of children with the illness PANDAS or PANS. Any medical advice should come from your child’s doctors.

Like Sydenham’s Chorea, the onset of PANDAS and PANS follows bacterial infection. However, without the clear cerebellar signs and choreic movements of Sydenham’s Chorea, PANDAS and PAN’s can be easily attributed to childhood developmental disorders, typical developmental changes and everyday environmental stressors.

See the references below for further reading about PANDAS and PANS.

Read this families story

 

Information Fact Sheet NIMH

 

http://bethalisonmaloney.com/books/
Childhood Interrupted: The Complete Guide to PANDAS and PANS by Amazon.co.uk Learn more: https://www.amazon.co.uk/dp/1492974862/ref=cm_sw_em_r_mt_dp_U_PKn7DbXA7K956

https://www.amazon.co.uk/PANS-PANDAS-Strength-Understanding-Educators/dp/1984056247/ref=pd_sbs_14_t_0/262-7890750-2033066?_encoding=UTF8&pd_rd_i=1984056247&pd_rd_r=6694cfe7-e40d-4366-a346-cffccbc7827c&pd_rd_w=kYPlh&pd_rd_wg=1A0Kh&pf_rd_p=e44592b5-e56d-44c2-a4f9-dbdc09b29395&pf_rd_r=XPAG74KZ915K6WC1GTE3&psc=1&refRID=XPAG74KZ915K6WC1GTE3
PANS / PANDAS Strength – Hope – Understanding: A Picture Book for Children, Family, & Educators by Amazon.co.uk Learn more: https://www.amazon.co.uk/dp/1984056247/ref=cm_sw_em_r_mt_dp_U_VKn7DbECJ6CQ3

In A Pickle Over PANDAS by Amazon.co.uk Learn more: https://www.amazon.co.uk/dp/1622879236/ref=cm_sw_em_r_mt_dp_U_RMn7DbDN53PFZ

 

Read more here:Screen Shot 2019-12-08 at 19.25.22

PANDAS and PANS Update

 

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Research Update:
Environmental Enrichment as a Therapy for Autism: A Clinical Trial Replication and Extension

Abstract

Based on work done in animal models showing that autism-like symptoms are ameliorated following exposure to an enriched sensorimotor environment, we attempted to develop a comparable therapy for children with autism. In an initial randomized controlled trial, children with autism who received sensorimotor enrichment at home for six months had significant improvements in both their cognitive ability and the severity of their autism symptoms (Woo & Leon, 2013). We now report the outcomes of a similar randomized controlled trial in which children with autism, aged 3-6 years old, were randomly assigned to groups that received either daily sensorimotor enrichment, administered by their parents, along with standard care, or they received standard care alone. After six months, enriched children showed statistically significant gains in their IQ scores, a decline in their atypical sensory responses, and an improvement in their receptive language performance, compared to controls. Furthermore, after six months of enrichment therapy, 21% of the children who initially had been given an autism classification, using the Autism Diagnostic Observation Schedule, improved to the point that, although they remained on the autism spectrum, they no longer met the criteria for classic autism. None of the standard care controls reached an equivalent level of improvement. Finally, the outcome measures for children who received only a subset of sensory stimuli were similar to those receiving the full complement of enrichment exercises. Sensorimotor enrichment therapy therefore appears to be a cost-effective means of treating a range of symptoms for children with autism.

Read more here