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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

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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

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Occupational Therapy and Trauma 2: Using meaningful occupation in the healing of trauma.

“It is so important not to be defined by tragedy,  to be shaped by it but never defined by it” Amanda Holden – Britains got Talent 

How can meaningful occupation and occupational therapy be useful in healing and recovery from trauma? and why should occupational therapists be trauma-informed?

This morning I was sent this video by a friend, I found it really powerful because not only is the story in itself one of beauty and empowerment but also because it ties together everything I have learnt this year about the use of meaningful occupation in both physical and emotional healing.

This incredibly moving dance routine was choreographed to pay tribute to the victims of the Manchester bombing.

The video tells the story of Holly whose aunt was killed in the attack. Like so many of the children who were at the Manchester arena that night, Holly has experienced both physical and emotional trauma. Physically, Holly broke her right knee, he left leg and foot was broken, she suffers from nerve damage and must use a splint to be able to walk. Holly has already had eleven operations to help her recover physically.

An occupation that had been meaningful to Holly before the attack came to play a central role in her recovery. Only a couple of days after it happened Holly was asking the medical staff…”When can I go back to dancing?” Dancing is meaningful to Holly, her mum describes it as being “everything to her”.

Because of the damage to her legs, returning to dancing may have seemed like an impossible goal for Holly. Through returning to dancing Holly has been empowered to shine, to show incredible bravery facing what, I can only imagine, are her worst fears in returning to a venue similar to the one where the attack happened. Social isolation is a real risk for survivors of trauma and those with physical disabilities, however, through grading and adapting the occupation and a desire to keep Holly dancing as part of the team the choreographer has done an incredible work in valuing Holly’s presence and contribution. It is a beautiful example of the importance of meaningful occupation and social inclusion in both physical and emotional healing.

For me, this video summarised the answer to a task I was given this year by my lecturer Sarah Bodell (OT)…

“Find a way to explain how occupation links to health and wellbeing, I want you to tell them this…What you do affects how you feel...”   

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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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Research Update: Early alterations of social brain networks in young children with autism

In this study, the researchers were able to suggest that there are “frequency specific alterations in the driving of information flow from brain areas implicated in social information processing during the viewing of naturalistic dynamic social images in toddlers and preschool with ASD” and that these occur in the early stages of ASD. These findings support the clinical experience of OT’s and others doing ASI with this client group, that early intervention is critical. The study continues to recommend further studies into social orienting skills as a way of perhaps remediating social brain development while neural plasticity is most optimal.

Wouldn’t it be great if the results we see in clinical practice of ASI, helping children better orientate, attend and respond to sensory input including social cues, studied as a possible intervention in response to this study?

Here is a copy of the abstract and link to the full article.

Social impairments are a hallmark of Autism Spectrum Disorders (ASD), but empirical evidence for early brain network alterations in response to social stimuli is scant in ASD. We recorded the gaze patterns and brain activity of toddlers with ASD and their typically developing peers while they explored dynamic social scenes. Directed functional connectivity analyses based on electrical source imaging revealed frequency specific network atypicalities in the theta and alpha frequency bands, manifesting as alterations in both the driving and the connections from key nodes of the social brain associated with autism. Analyses of brain-behavioural relationships within the ASD group suggested that compensatory mechanisms from dorsomedial frontal, inferior temporal and insular cortical regions were associated with less atypical gaze patterns and lower clinical impairment. Our results provide strong evidence that directed functional connectivity alterations of social brain networks is a core component of atypical brain development at early stages of ASD.

https://doi.org/10.7554/eLife.31670.001