Journal

isic 2018

Resources for Practice in Mental Health and Trauma-Informed Care: improving self-regulation to eliminate control and restraint aka TMAV

On our courses, we teach staff from CAMHS and adult/older adult mental health services how to use Ayres’ Sensory Integration to inform care including for those who have had early trauma.

On our in-house courses, we regularly teach mixed staff teams including Mental Health Nurses and Healthcare Assistants, CPN’s, OT’s, PT’s, SLT’s and Therapy Support Staff, Complementary Therapists, Psychologists and Psychiatrists. Working with staff teams from forensic, secure, acute and longer stay units, our lecturers help teams to develop and implement sensory informed care pathways. This includes working with sensory providers to develop secure safe sensory rooms for safe self-regulation and sensory-rich movement activities suitable for secure and forensic environments, where ligature risks mean traditional swings and other equipment cannot be used.

The use of Ayres’ Sensory Integration to support health and well-being has grown across the UK and Ireland.

The research and evidence base is expanding across the globe, with more clinical audits and studies being published that report that Ayres’ Sensory Integration is

  • improving self-awareness
  • improving self-regulation
  • promoting participation in everyday life
  • increasing clients ability to engage with others, with therapy

this means that there are significant reductions in

  • days in secure or acute care
  • deliberate self-harm
  • the use of PRN medication
  • the need for the use of physical support aka TMAV

We’d like to thank Tina Champagne for pointing us in the direction of this resource which fits so neatly alongside the resources and tools we teach on our courses.

Tina ChampagneTina is a critical friend of ASI WISE and wrote several chapters in this free online resource about developmental trauma and practical ways to institute trauma-informed care.

Resources for Eliminating Control and Restraint aka Therapeutic Manage of Aggression and Violence 

https://www.mass.gov/files/documents/2016/07/vq/restraint-resources.pdf

 

 

 

Resource for Practice: Sensory Approaches to Mental Health – AOTA

As it is Mental Health Week, here is a great resource for practice…

This handout Sensory Approaches to Mental Health is published and available free from AOTA
— Read on www.aota.org/Practice/Mental-Health/Emerging-Niche/Sensory.aspx

Mental Health Awareness Week 2018: Millennials feel more stressed in the workplace than older colleagues, study finds

Mental Health Awareness Week 2018: Millennials feel more stressed in the workplace than older colleagues, study finds
— Read on www.google.co.uk/amp/s/www.independent.co.uk/life-style/millennials-stress-workplace-higher-baby-boomers-mental-health-awareness-week-2018-a8350631.html?amp

 

Supporting Practice – Your Questions Answered: Why did Ayres’ not consider the visual system?

So I was just asked “Why didn’t Ayres consider and put more importance of the visual system? I was a bit perplexed and so explored this further with the therapist asking the question. The OT explained that she has been taught that Ayres did not consider the visual and auditory systems and that this means that for School OT’s where many difficulties link to visual processing deficits, learning the SIPT is not a useful and that therapists should instead use other tools linking vision to motor skills like the Bruinicks or Movement ABC alongside TVPS or VMI to ensure they understand and consider visual deficits.

This OT is not the first person to ask this question, so here is a bit more information about the visual system in Ayres’ Sensory Integration, and her understanding about the impact of sensory integration difficulties on academic learning.

” Those of us who study the overt behavior of children with academic deficiencies, and, at the same time, try to keep informed on related neurological research, are making an effort to interweave both approaches to knowledge into a theoretical structure which may be used as a provisional basis for treatment of children with learning problems.”

Ayres 1964 re-printed in Ayres 1974

The Sensory Integration and Praxis Test(SIPT) has 2 tests that are motor free and directly assess visual skills; Space Visualisation (SV) and Figure-Ground (FG), and 4 more that further explore visual skills in conjunction with other sensory systems and contribution to function; Manual Form Perception (MFP), Design Copy (DC), Constructional Praxis (CPr) and Motor Accuracy (MAc).

SV         5                    Motor-free visual perception; mental rotation

FG         2                    Motor-free figure-ground perception

MFP       14                  Recognition of forms held in hands; visualization

DC         4                    Visuopraxis; two-dimensional construction

CPr        3                    Three-dimensional visual space management

MAc       6                    Eye-hand coordination; somatopraxis

Jean A Ayres’ absolutely understood the importance of the visual system, her papers, books, and the SIPT manual make clear reference to this. Ayres did not consider vision just in terms of assessment, but also in how she recommended intervention approaches that would address deficits in the visual systems ability to support participation in daily life.

“Visual perception of the external world is at least partially dependant upon adequate perception of the construction of one’s own body or body scheme. The ability to perform complex motor tasks is dependant on mastery of the ability to do certain basic motor planning. Acquiring these two kinds of ablities occur sumultaneously and the acquisision is mutually dependant…

…any child who is severaly deficient in visual-motor function should begin…by learning to roll over, initiating motion by looking at a bright object placed at the side. This is an early step in ocular control…

…a recreational game through the ingenuity of the supervisor of the activity…

…The use of the eyes along with the body is essential, for it is the beginning of the dvelopment of one of the fundamental uses of the eyes – the guiding of total body action.”

Ayres 1961 in Ayres 1974

Research data from the SIPT and its predecessor, the SCSIT clearly showed the emergence of a pattern linking visual and movement difficulties called visuo and somatodyspraxia;

Read more here:

Verification and Clarification of Patterns of Sensory Integrative Dysfunction

Patterns of sensory integration dysfunction in children from South Africa

Correlational study between structured clinical observations and the Sensory Integration and Praxis Test

In her seminal work, Sensory Integration and Learning Disorders, Ayres 1972 discusses the importance of the development of Form and Space Perception, summarising the significant work of the time by Goins, Punwar, Frostig, and others. She describes the underlying neuroanatomy of visual perception, and it’s development in man. Ayres concluded the chapter exploring theories of dual modes of vision, advanced by Trevarthen, Gibson, and Held in the late 1960’s, before describing treatment approaches to develop form and space perception.

“…it is appropriate to close a therapeutic session which emphasized somatosensory and vestibular stimulation with task that focus on visual form and space perception. It is anticiapted that the earlier treatment enhances the capacity for visual perception and that sitting still while engaged in visual perception tasks helps quiet the child before he leaves the therapy area.”  Ayres 1972

from Chapter 15 – Sensory Integration and Visual Deficits, including Blindness in the book Sensory Integration with Diverse Populations written by Smith Roley, Blanche and Schaaf published in 2001.

Our Special Needs Kids on TV, Something Special and Pablo

Submitted by guest blogger Ruth OT

Our daughter recently appeared on a UK Kids TV show called  Something Special. I was ridiculously excited CBEEBIESabout it and told lots of people who never usually watch CBeebies, the BBC children’s channel, that they just had to see her.

Filming was brief but exciting. We got to meet Justin briefly (one child was very disappointed Mr Tumble wasn’t there too) and the team were genuinely very lovely.
Some of the people who would never normally watch CBeebies were surprised there is a programme which exclusively features children with special needs and/or disabilities, they felt that pointing out the difference wasn’t kind and the kids should be encouraged to blend into a typically developing world. This was a good opportunity to explain how the show “Something Special” had helped other children to understand the way our girl supports her speech with signing and to not be phased by her difference. We’ve often heard comments like…“oh look! She signs like Mr Tumble does!”.
Then a friend asked what I thought of “Pablo”, another CBeebies programme about a little autistic boy and the imaginary world he creates to navigate the confusing things around him. Of course, I had to investigate. I watched a little video of the autistic boy who plays Pablo explaining that he thought it was important for other children to understand autistic children so that they would want to play with them and that Pablo helped that, and I was ready to investigate.
So, I sat down with four kids to watch. The 8 and 10-year-old exclaimed in unison “Oh, I love Pablo!” so of course, I asked them what the show is about “a little boy with a really good imagination who draws stories about things”. Fair enough. And so we all sat and watched the show together…

In the episode, Pablo and his mum are going about really everyday things (cleaning a bin in the first one we watched) and Pablo’s mum uses a phrase he doesn’t really understand to explain what she’s doing. He knows he mustn’t touch the “smell gobbler” but doesn’t understand why. Pablo draws his fears, in this case, he is concerned that the “smell gobbler” might eat his own familiar safe smell which he likes and then what would he do? He and the cartoon characters that represent aspects of him, problem solve it and trap the “smell gobbler” under the laundry basket. Mum comes back and is amused to find her air freshener trapped.

I actually loved the show. The kids who told me they loved Pablo hadn’t spotted that he’s autistic (the 8-year-old is usually quite a diagnostician) and yet they loved that he has such a really good imagination. watching the show together opens up a way to talk about autism with her and how her autistic sibling and friends might see the world a bit differently. It touched on the sensory differences that can come with autism and the importance of sameness for people with autism and modelled a useful way for children with autism to reason through problems and confusions they encounter.

I have a speech therapist friend who is very keen on creating comic strips with children as a method of problem-solving and reasoning through PABLOsituations before they happen. I could do that or I could just let my kids carry on enjoying a funny cartoon about “what if we really meant exactly what we say?”.

It’s my job to watch what my kids are watching and use it to start those conversations with them. I’m so glad these programmes give us a platform to start that.

 

 

 

 

Crawling, Sensory Integration and Child Development

Submitted by guest blogger Ruth OT 

I meet so many parents who are concerned about their children’s motor or sensory processing skills who tell me their child never 4-point crawled, or did so only briefly. They proudly tell me how their child was ahead of their motor milestones and walked early, and never realise how important crawling is.

What is so special about crawling?

In crawling, the baby supports their weight on their hands and arms, this works wonders for developing shoulder girdle stability and proprioceptive awareness of the hands and arms which is foundational for fine motor skills like handwriting, fastening clothing, threading, sewing, crafting etc. Crawling also requires the baby to hold their core flat and stable off the ground, developing core stability against gravity. It also puts the baby’s neck into extension (ie bent back so that the baby is looking forwards not at the ground), this activates areas of the brain stem and supports baby’s developing understanding of their relationship with gravity and thus vestibular processing.

But what good is telling you all this now if your baby wasn’t a crawler? My youngest child was a very proficient bum shuffler, he could get anywhere over any surface (but not steps!) very quickly shuffling along on his bum. If I put him into the tummy time position, he just laid there and cried until I sat him up. I knew crawling was important for his development and that bum shufflers are late to walk, but I couldn’t make him do it once he’d learned a really efficient way to get where he was going!

So now that he’s a confident walker, we’re going back to crawling activities, and I thought I’d share some of the activities we do without any extra equipment at home to get those crawling benefits…

Going back to crawling…

  • Climbing! There’s a lot of motor planning and problem-solving in this as well, depending on where you climb. Over rocks, up muddy hills, up slides (you will get looks from other mums), in soft play, anywhere where they need to use their hands to support their movement is good by me crawling 1
  • Cars and small world toys- some kids I know will squat down on their feet and use their hands to play, if this is your kid try setting up a small world where the kid has to reach far enough that they have to support their weight with their hands to reach the middle.
  • Big floor art, floor puzzles etc. We love messy art at the best of times, but if you can get a roll of lining paper on the floor to do your art on, you can work on shoulder girdle stability, prone extension and motor planning while you do it.
  • Tunnels, those pop up tunnels you can get for kids are great for encouraging crawling (you can’t bum shuffle through one, we speak from experience!)
  • Ball pools, he loves falling face first in them and then crawling back to standing up.

Ditch the train tables, lego tables and tuff tray stands. I know they make tidying up easier and are more comfy for parents, but playing on the floor is about so much more than the game.

crawl 2

Research Update:Dark Chocolate May Boost Brain Function, Immunity, And Mood

Chocolate as therapy? Two small studies may provide more evidence for dark chocolate’s health benefits. And at reasonable doses.
— Read on www.forbes.com/sites

Supporting People with Anxiety, Using Sensory Integration and Other Strategies

Submitted by Guest authour Jane OT

As I read the recent article “14 Phrases Kids Said That Were Code Words for ‘I’m Anxious from The Mighty, It felt familiar – like I had met every one of these responses to anxiety and not just from children.

 “What’s wrong with me?”… “I’m tired.” … “Can’t we stay home?”

“I don’t feel well.”

Anxiety affects so many people and they are not all confident naming and talking about it. Some may know they are anxious but be embarrassed about telling people, for others, it may be that long-term anxiety is new to them and they haven’t really grasped that the physical symptoms are related to their anxiety.

So how does anxiety play out in real life and how can we help?

The elderly lady who has had a reduction in her mobility now feels sick when she goes in the car (but her doctors can’t find anything physically that would cause this), may not understand that her body and brain has become accustomed to less movement and so is less able to integrate vestibular stimulation with other sensory stimulation hence she feels sick now avoids leaving her chair for fear of some as yet unidentified illness but is embarrassed to say she feels scared. Her fears about illness then generate yet more anxiety symptoms e.g. Feeling sick racing heart and more, confirming that she really has got some mystery illness that the doctors are missing, so she avoids leaving her chair whenever she can. This leads to a further loss of integration between her senses as she is not moving much (vestibular) and she is not using her muscles much (proprioception) and will eventually lead to loss of function.

Or that friend who is always tired or busy when you want to go out (there might be other reasons) and cancels at the last minute. But to be honest, as a mother to a lovely but anxious young lady it is the young people who concern me most

My concern for young people is driven adult-cute-face-female-41522by the knowledge that the young brain is primed to learn (Jenson 2015)… And learn it will – either good things or less good things, so if like the elderly lady the young teen avoids activities there is a good chance that these coping strategies will become an ingrained life pattern.

So what can we do to help?

  • First get to know the symptoms of anxiety there are numerous self-help books and Web pages e.g. The NHS Web site, Web MD, mind etc.
  • Second help the young person to choose activities that are likely to reduce anxiety… From a sensory integration perspective, these are likely to be ones that involve heavy muscle work and muscle stretch (proprioception) and ones that make the young person think like Martial arts, dance, rock climbing gymnastics etc. Will be better than just proprioception alone. We do dance and acrobatics.
  • Consider 1 to 1 tuition if they need to gain skills to catch up with their peers… But if you do this it’s good to plan to reintegrate the young person into group lessons… So that they can deal with social anxieties. We went to a group lesson and it was clear my daughter had a lot to learn so we had a year of individual lessons (and still supplement the group lessons with the occasional individual lesson). But then we went to group lessons, it took half a term but now she is enjoying doing acrobatics duets which brings me to my next point.
  • Make sure the young person attends regularly and on time for a good chunk of time…..
    Be prepared for ongoing anxiety and be firm that they go… My daughter frequently tells me on the way home “oh sensory mum you’re right I do feel better.
  • Try to avoid surprises… We have a wall planner for the term and all activities are written on it… And I have noticed my daughter (and I am) much calmer knowing what needs to be done and when.
  • Discuss and consider professional help… Some Ayres’ Sensory Integration trained occupational therapists use other techniques in conjunction with their sensory integrative therapy, others will work alongside mental health professionals and for some people, Ayres’ Sensory Integration therapy will be enough on its own.
  • You may also decide to work through a self-help book and this can be a good option… But if in doubt always consult with your GP or/and any other health professional who is working the young person.

So what about those adults… Its a little different to the young people but listening and understanding or trying to understand is a good first step. Giving them information about sensory integration and mental health issues can also be helpful. Then asking them what they want you to do and staying in touch with them even if it’s difficult. And always remember it’s never too late for someone to get help.

what anxiety loks like

Reference The teenage brain by Frances Evans Jenson. L

Occupational Therapy and Trauma 3: A Tool for considering the physical environment in children’s residential homes to address sensory processing issues in trauma-affected children

This article by Clinical Psychologists Christopher Robinson and Alicia Madeleine Brown in the Scottish Journal of Residential Child Care includes a lovely environmental checklist (adapted from Simpson 2009) used in considering the physical environment in three children’s residential homes.

Abstract: Sensory processing issues are generally considered to be clinically significant in children who have suffered abuse and trauma and much has been written about the possible neurological correlates of such sensitivities (De Bellis and Thomas, 2003; van der Kolk, 2014). Comparatively little focus has been given to the functional aspects of these sensitivities, and particularly how these might interact, in context, with a child’s underlying neurological vulnerabilities. In this respect, the environment surrounding the child is a neglected area of significant, perhaps critical, importance. In terms of potential hypersensitivity to environmental stimuli, children with Autistic Spectrum Conditions (ASC), although with different aetiological correlates to trauma affected children, are known to face profound environmental challenges. Children with ASCs have received a wealth of attention in the literature with regard to these sensory challenges, whereas, in contrast, trauma affected children have received very little direct attention at all. It is the aim of this paper to focus on the environmental aspects of sensory processing in trauma affected children, specifically in relation to the physical environment of children’s residential homes.

from the Scottish Journal of Residential Child Care 2016 – Vol.15, No.1 Scottish Journal of Residential Child Care ISSN 1478 – 1840 6

Read the full article free here.