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Health and Safety Fears Getting in the Way of Child Development

Ofsted has warned that some early years education providers have “undue concerns” about letting children play outside, climb and run around. These health and safety fears are hindering children’s ability to build up muscular strength and dexterity.

Without taking risks, children’s “natural inquisitiveness” is stifled, Ofsted’s annual report said, “In the early years, a crucial part of preparing children for school is developing their muscular strength and dexterity…

Read more in this article in the Telegraph

Ofsted is the Uk government’s Office for Standards in Education, Children’s Services and Skills. Ofsted inspects and regulates schools, services that care for children and young people, and services providing education and skills for learners of all ages. The full report is available here 

blur boots child childhood
Photo by Lela Johnson on Pexels.com
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The Shops are Full of Simple Christmas Crafts

The Christmas season is a fantastic opportunity to get our little ones involved in some Christmas craft activities at home. For those of us short on time or ideas the shops are full of templates and packs that you can put together at home… here are some lovely craft ideas that have been sent to us by some of our families this year, paper chains, both shop bought and homemade, and a beautiful Christmas llama.

Don’t forget there is still time for you to win a copy of Love Jean by entering our Christmas time book give away. Share your Christmas themed sensory ideas with our community… by leaving a comment on one of our Christmas themed blog posts or on our facebook page … before the 15th December 2018

love jean book

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Dyspraxia or DCD, what term and recommendatons do you use in your EHCP’s and why?

pexels-photo-1040427“Developmental co-ordination disorder (DCD), also known as dyspraxia, is a condition affecting physical co-ordination that causes a child to perform less well than expected in daily activities for his or her age, and appear to move clumsily.”

NHS Choices[accessed 1 July 2018] 

Sometimes the terms we use as therapists are disputed in EHCP meetings or tribunals. The following quotes have proved useful in defending my own use of the terms in reports, especially when I link the term I use to the specific assessment tool I have used to do my assessment and clinical formulation.

Gibbs and colleagues 2007 described that “the definition of DCD is very similar to dyspraxia. A survey of health and educational professionals showed widespread uncertainty about the definitions of, and distinction between, DCD and dyspraxia. Furthermore, the rationale for using one or the other term in the literature has been unclear. Therefore, DCD and dyspraxia should be regarded as synonymous.”

art assess communication conceptual

When I use the Movement ABC-2, I will tend to use the term DCD, as the tool and the research about it are clearly linked. As our local NHS paediatric services use the Movement ABC-2 for diagnostic purposes, despite its limitations.

For some referrals, therefore,  this is my tool of choice and the quickest way to ensure the child can access services because their condition is then officially recognised by teachers and the Local Authority. Thie example report is then how I report the results, ensuring I clarify the limitations of the tool, and that additional data and assessment has been undertaken to inform my clinical reasoning.

DCD Proforma

But when I use the term Dyspraxia, I am usually using it to refer to a pattern of praxis difficulties recognised in the research that we hypothesise interferes with participation in activities at home, school and out and about.

This pattern is typically identified by gathering a history of development and functional difficulties, Ayres’ Clinical Observations and the Sensory Integration and Praxis Test. I like the history form in Schaaf and Mailloux 2015 and the Sensory Processing Measure, or for adults the Adult/Adolescent Sensory History.

people in front of macbook pro

I will also use the COSA, OSA, SCOPE and MOHOST to gather information related to difficulties with participation in daily life and to set goals, and these can then also act as great subjective outcome measures. The impact of DCD/Dyspraxia on daily life is significant. Caçola 2016 described how Dyspraxia/DCD is considered to be “one of the major health problems among school-aged children worldwide, with unique consequences to physical and mental health.”

Poor praxis often means a person with little understanding of where their body is in relation to the world and so what to do next, making the plan and doing it becomes harder than for others. When this happens, our brain is unable to feel safe and secure, and so it is unlikely that the person can remain in a ‘calm and alert’ state.

children riding bicycle

For those who have poor praxis, a sudden increase in arousal often happens when a  new or unfamiliar task is presented, because the previous failures to achieve success on sensory-motor tasks will trigger and raise arousal levels. This often means the person’s body is on ‘red alert’  – reactive to the world and small confusing changes happening within their own body. This may mean they are more likely to make decisions in flight, fight or freeze mode, resulting in behaviours that challenge others. The underlying problem is the praxis deficit not sensory reactivity in response to a perceived threat. This is why thorough assessment is required.

Arousal and alertness, sensory modulation and praxis are interwoven with a complexity that is often missed by others and those new to learning about sensory integration theory and practice. Praxis difficulties that result in behaviours that challenge others are often labelled as sensory modulation difficulties, however digging deeper will often reveal praxis deficits underpin the dysregulated behaviours and attempts to get control. This is very true of our clients who have dyspraxia co-occurring with mental health difficulties. We ignore and disregard praxis at our peril. Left unaddressed, praxis deficits continue to interfere with participation in daily life, skill development and self-esteem unabated.

Watch this young person’s story about living with dyspraxia.

How is a diagnosis made?

For a diagnosis of DCD to be made, your child usually needs to meet all of the following criteria, in some areas of the UK this requires a score below a cut off on the Movement ABC-2 Test.

  • motor skills are significantly below the level expected for their age and the opportunities they have had to learn and use these skills
  • the lack of motor skill is significant and persistently affects the child’s day-to-day activities and achievements at home and at school
  • the child’s symptoms first developed during an early stage of their development
  • the lack of motor skills isn’t better explained by
    • a delay in all areas of development (general learning disability)
    • other medical conditions; such as cerebral palsy or muscular dystrophy

Usually, DCD is only diagnosed in children with a general learning disability if their physical coordination is significantly more impaired than their mental ability.

What about DCD/Dyspraxia and Autism?

In numerous studies, the links between autism and praxis skills have been reported.

In 2016 Cassidy published important findings from a study, showing that

kid s plating water on grass field during daytime

  • Dyspraxia/DCD is significantly more prevalent in adults with Autism
  • Motor coordination difficulties commonly co-occur with Autism
  • Dyspraxia is associated with significantly higher autistic traits and lower empathy in those without Autism.

These results suggest that motor coordination skills are important for effective social skills and empathy. This is clearly seen in children and young people presenting in clinics who struggle to know how to make friends, ask for the help they need and can’t understand others feelings and frustration.

What about DCD/Dyspraxia and Speech and Language Difficulties?

In 2012 Stout and Chaminade stated that “long-standing speculations and more recent hypotheses propose a variety of possible evolutionary connections between language, gesture and tool use. These arguments have received important new support from neuroscientific research on praxis, observational action understanding and vocal language demonstrating substantial functional/anatomical overlap between these behaviours.”

Listen to this Speech and Language therapist describe the links between speech and language concerns and tone, more general praxis and motor coordination difficulties.

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A Weekend of Learning at Abbot’s Lea School, Liverpool – Using Sensory Strategies for Mental Health and wellbeing Weekend Workshop

The ASI Wise lecture team have been at Abbot’s Lea School in Liverpool this weekend with a fantastic group of committed and enthusiastic occupational therapists, speech and language therapists and teachers exploring the use of sensory strategies and Ayres’ Sensory Integration therapy to support children, young people and adults mental and wellbeing health.

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Experiential learning opportunities, embedded into the course, help participants to understand their own sensory systems and to experience the challenges that the people they are working with face on a daily basis.

 

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With a mixture of classroom-based and hands-on practical learning, participants explored how to use the spaces and environment available in both school and clinic to support regulation and praxis. The workshop provided an opportunity to hear about the theory and practice of Ayres’ Sensory Integration, it’s application supporting those with autism, ADHD and dyspraxia,  with up to date research and evidence supporting practice.

To find out more about our courses and learning here

 

 

We are so grateful to Abbot’s Lea School who have allowed us to use such a beautiful spacious venue. The three lovely well-lit rooms allowed us to create a pop-up sensory clinic, where participants had space to move about; extra room to break into groups supporting learning and the sharing of ideas. The school staff and local therapist volunteer support team have been incredibly welcoming and supportive, helping the workshop to run smoothly. As a bonus, the sun has shone all weekend which has allowed us to use the outdoor spaces, we have spotted a few daffodils and blossom trees around the city – it feels like spring is on its way.

Thank you to our volunteer therapists who helped to make the weekend such a success.

 

 

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Sensory Ladders

The first Sensory Ladders were made in 2001 for adults with sensory integration difficulties receiving help with mental health difficulties in Cornwall. Influenced by the paediatric Alert Program, they offered therapists a way to combine Dialectical Behaviour Therapy and Ayres’ Sensory Integration, addressing the development of the person’s self-awareness in collaboration with ward staff on an acute psychiatric inpatient unit.

The need to start with the person where they are at, before introducing learning about new ways of being, including the development of new skills, made it necessary for the Sensory Ladder to remain a very individualised and personalised journey within a close safe therapeutic relationship.

Both Ayres’ Sensory Integration(ASI) and Dialectical Behaviour Therapy(DBT) share a common understanding that development and change can only occur within a safe environment. The DBT idea of balancing safety and challenge reverberates strongly with Ayres’ concept of the ‘just right challenge’.

Creating a Sensory Ladder is about creating opportunities for an adult or child to learn to become aware of themselves in a new way – to explore and discover new things about mind, body and brain. It allows the therapist and person to do “curious wondering” together, and for the person to try new things – creating and promoting active but informed risk-taking; testing how we might feel and experience something when we do it differently; new ways of being – new ways of responding.

Making and using a Sensory Ladder is about the journey together within a safe therapeutic relationship. It’s about getting to see and know someone in a very different way, getting underneath the skin of behaviours that are perhaps being described by others as tricky or challenging.

The Sensory Ladder facilitates the reframing of behaviour that are a result of sensory integration challenges, providing the first step of acceptance of the behaviour necessary before strategies and therapy support development and change to happen.

To see more Sensory Ladders, visit our Sensory Ladder FB Page

Pokemon Sensory Ladder copy

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Ayres’ Sensory Integration and the great outdoors

The “just right challenge: for this plucky young lady. She clearly likes the sensory input these activities are providing to her body and brain. These are exactly the outdoor sensory system challenging opportunities afforded by climbing trees and jumping streams that  Jean Ayres’ wanted to recreate in her therapy spaces. For those of us lucky enough to live in rural areas and near great parks and other outdoor spaces, do we think about these natural spaces and resources enough.

I will be sharing this with every family I work with for Easter half term when it is a great time to start to once again out and about, now the snow has gone.

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Ayres’ Sensory Integration and the great outdoors

The “just right challenge: for this plucky young lady. She clearly likes the sensory input these activities are providing to her body and brain. These are exactly the outdoor sensory system challenging opportunities afforded by climbing trees and jumping streams that  Jean Ayres’ wanted to recreate in her therapy spaces. For those of us lucky enough to live in rural areas and near great parks and other outdoor spaces, do we think about these natural spaces and resources enough.

I will be sharing this with every family I work with for Easter half term when it is a great time to start to once again out and about, now the snow has gone.

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CLIMBING TO THE TOP: HOW LEARNING A NEW SKILL CAN STRENGTHEN OLD ONES

As a Healthcare Professional, we are encouraged to practise reflective learning; thinking more deeply about a critical incident to support or challenge how a situation we find ourselves in went well or if our response could have been better. I intend to use reflective learning to discuss how a very meaningful learning exercise I undertook was successful, using learning topics from this course.

I intend to describe a learning experience and then discuss how it can be applied to serve as an example of the following three topics:

  • transfer of ideas and concepts from one areato another
  • focused and diffuse modes of thinking
  • lifelong learning and broadening my passions

My story begins when I had been an Occupational Therapist for a few years and worked in a Neurological Rehabilitation unit. My main patients were adults who were trying to recover lost skills due to any number of misadventures that had befallen them. I worked with a very skilled team, but it could be difficult to convince patients to trust our assessment of their ability to shift weight through a leg with hemiparesis for example so that they would be able to step and walk. I was teaching physical skills but the patients who did best were those who got interested in learning about their learning.

climbingAt the same time, a friend invited me to try out a climbing wall and I embraced the opportunity to learn a new skill. What I didn’t realise at the time, was how powerfully the acquisition of that skill would transfer to other areas of my life, namely to my OT practice. It was a real shock to be on a rope, halfway up a wall at an indoor climbing centre and hear a climbing partner shout “okay, transfer your weight through your left leg so you can step up to that ledge with your right foot” and hear myself shout down “I can’t! I’ll fall!” This “I can’t, I’ll fall!” was what my patients told me when I asked them to try skills within their grasp.

Two things quickly became obvious to me, through transfer of ideas and concepts from one area of learning to another. The first was a lightbulb; “This is what my patients feel!”. We have heard in video lectures that the most powerful lessons are tied to the sensory memories we create, and the fact that I still remember looking down from up high, feeling the fan blowing cool air against my skin, hearing slight impatience with my refusal to progress, and feeling the tension in my arms as I clung on for dear life – and the fear in the pit of my stomach certainly backs this up.

I remember learning what it was like to feel how scary it is to trust others to see your way through a challenge. The second thing I knew was, if I was right every day, when I encouraged patients to achieve, then my climbing friends encouraging me from the bottom of the climb must also be right. I learned to trust my climbing partner and their assessment of a climbing problem, and I had to learn this over and over again. Trust was a whole new skill again when I had to lean out and trust that the hold my partner could see and I couldn’t, was really there. But I did learn, well enough that I could teach it to others and transfer it to being a crucial part of how I understood setting and achieving rehabilitation goals with my patients.

Climbing is actually a brilliant sport to discuss the interplay between focused and diffuse modes of thinking. Of course, when if you are working out a particularly hard climbing problem, all your focus is diverted to that. Sometimes trying to follow the route you want to take is frustrating. Like other problems in life, sometimes it’s best to let things become more diffuse so that your body can automatically do movements that your brain might not consciously choose. When you are just enjoying a climb, your mind can wander to earlier learning and try to make those connections that cannot be learned in focused mode. The connections that were made weren’t limited to learning how to climb and it also seemed especially easy to develop new insight when the topic might involve anatomical or functional knowledge. It seemed that earlier questioning about my range of motion to reach a hold might lead me to think about biomechanics or something related. Lastly, just as Dr. Sejnowski described with his running, my diffused focus might shift to make connections about other learning topics.

I dread to think that none of this learning would have occurred without embracing lifelong learning and broadening my passions. It has become my belief that if I am going to teach others how to meet physical challenges, I need to keep teaching myself the same lessons. In that spirit, I have embraced adult gymnastics, yoga and kickboxing. There is nothing like feeling new muscles working to take you back to an anatomy text so you can be precise about training muscles and their antagonists and not just by using the ‘trick movements’ that we all use to get things done. Every new activity I try teaches me something different about myself, something about learning and something about teaching. New skills keep me engaged in my life and also give me treats to strive for when I have completed those pomodoro tasks.

I will always teach physical skills, but lately, I have started to work in schools as well. Naturally, it was important to see what “going back to class” would teach me about learning how to learn. I first discovered free online classes through the Coursera platform in neurology and behavioural economics, and then moved onto ‘learning about learning’ to help me to discover and work towards correcting some of my learning errors and give me insight and empathy to help others learn.

My new academic passion is the work I am putting into an MSc with specialising in understanding sensory integration. Like my Coursera experience, I am discovering a fantastic supportive network of friends and mentors who have now involved me in a new way to share my learning, blogging to all of you.

I hope my reflections on learning have reflected or renewed your own enthusiasm for learning and continued professional development. Warm wishes to you all.

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