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The “just right challenge” is not just about equipment and activity, it’s about our therapeutic use of self – as OT’s doing ASI we need to be shapeshifting chameleons.

The skillful therapist is like a chameleon – able to shapeshift and turn their hand to any and all presentations; artfully engaging with, weaving and drawing out magical cooperation; making it fun. The art of both assessment and therapy are to make sure whatever we do, it is the “just right challenge”. Whether it’s just the right way of being to connect to a child, preparing a room for the initial visit with a swing or ball pool that’s likely to entice play and engagement, aiming for the “just right challenge” is essential.

Doing parent training in a school recently reminded me again how important it is that we ensure what we do is the “just right challenge” for parents and teachers too. While we are very good at simplifying what we do to make it understandable and accessible for all, sometimes parents need to trust us because we have knowledge and skills beyond what they can read in books and on social media sites.

The “just right challenge” is critical to the therapeutic relationship; too much or too little challenge and too much or too little safety, and we don’t create the right brain chemistry for engagement and participation. Remember last time you were frightened and scared, in an interview – How was your performance, were you able to be who you usually are?

This includes making sure we choose the right assessment tools and therapy activities, the therapist ensuring the ‘just right challenge’  – not too tricky, but also not too easy.

I explained the Sensory Integration and Praxis Test, Clinical Observations and the Sensory Processing Measure to a group of parents, and why we won’t always use the same test for each child, because each child is unique.

Critically, not every child can be assessed with a standardised norm-referenced test like the SIPT or Movement ABC, some assessment can only happen in a different way – with equipment and games, through play – play and assessment served up with artful skill so that the assessment can happen unnoticed by the child.

I was reading a report written by another OT, and her artful use of self to get a thorough clear assessment in a situation just like this. It reminded me about what is special about being an OT. We are trained to problem solve and think outside the box  – perfectly placed to creatively choose from the many tools we have in our toolboxes and mix and match them to each person’s unique needs.

Each child is so unique and different – some are clearly children with obvious sensory integration patterns that link to their Autism, just like the research predicts. Some children have had trauma, some have genetic differences, and their patterns are more complex, needing different lenses, and a skillful combination of assessment and therapy approaches. Others need us to wear different hats, combining what we know – Neurodevelopmental Therapy interwoven with Ayres’ Sensory Integration or ASI woven with just the right amount of attachment theory, or just a cognitive behavioural approach coupled with backward chaining to learn a new skill. Skilled experienced therapists know the “just right” combination.

 

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It’s not about our own stress, it appears stress can be catchy too.

Is your stress changing someone else’s brain? A research study by Jaideep Bains and a team at the Hotchkiss Brain Institute (HBI), at the University of Calgary, has suggested that stress can be transmitted from one person to another, changing the brain of the other person too. The study shows that social contact by female mice reverses the effects, but not for male mice.  

A full article “Social transmission and buffering of synaptic changes after stress” can be found at https://www.nature.com/articles/s41593-017-0044-6.

 

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Scientists have discovered that stress transmitted from others can change the brain in the same way as a real stress does.
 https://www.sciencedaily.com/releases/2018/03/180308143212.htm
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What happens when I take my child to have Ayres’ Sensory Integration Therapy, what can I expect?

Do you want to find out a bit more about what happens when your child attends a therapy session with an occupational therapist, Physiotherapist or Speech Therapist doing Ayres’ Sensory Integration therapy?

Ayres’ Sensory Integration therapy is highly specialised and deeply rooted in neuroscience.  Before therapy can start, it is essential that a thorough assessment is undertaken. Thorough assessment saves time and money, as when therapy is purposefully targetted as a person’s own sensory difficulties, then it is most efficient and most effective. The art of a good therapy is that the therapist can engage with your child in a playful and motivating way, while directly targetting your child’s sensory challenges.

Watching from the outside, the play may appear unstructured, relaxed and just a lot of fun. However, the therapist will have planned specific goals with you that they will work on, determined by the assessment. The therapist will interweave these with your child’s ideas and choices of activity, incorporating ways to address the sensory challenges identified in your child’s assessment. This is the exquisite art of ASI therapy – it should, for the most part, look effortless.

Each sessions therapy aims will have been chosen to support the ability of your child’s sensory systems to register, process and integrate sensory input for use, to support improved participation in activities of daily life. The therapist will offer your child a ‘just right challenge’ – enough of a challenge to extend their skills, while safe enough so that your child feels comfortable and not overextended.  The OT will be closely monitoring your child’s reaction and arousal levels during the therapy session.

Ayres’ Sensory Integration Therapy is very individualised to every child and relies upon the close therapeutic relationship your child has with their therapist. The therapy is not about a set of repeated exercises, and every therapy session will look slightly different, with different equipment and story themes, enticing your child on that day, in the moment. However, the therapist will keep in their head overarching goals and aims, these drive the deliberate choices about what equipment to use.

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You can read more about what Ayres’ Sensory Integration therapy is on Sensory Integration Global Network’s website 

Below is a video from Ann & Robert H. Lurie Children’s Hospital of Chicago which gives a fantastic example of what Sensory Integration Therapy might look like for a child.