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Top Tips for Sleep

In a Children’s Occupational Therapy practice, many parents tell OTs that they feel they could cope better if they just got more sleep. When I heard about Matthew Walker’s “Why We Sleep” book from a colleague on a course, I bought it and read it cover to cover. I then shared it with everyone in my life struggling with sleep because this book links sleep with mental health, physical health and sleep through the lifespan.

Here are “Why We Sleep” top tips for sleep hygiene from the appendix- is you want more information about why for any of these tips, go back to the book and dig deeper:

1)    Stick to a sleep schedule: go to bed and wake up at the same time each day as people have a hard time adjusting to changes.  Sleeping in on weekends can’t repay our sleep debt.

TOP TIP: set and alarm for bedtime

2)    Don’t exercise too late in the day: try to exercise 30 minutes on most days but no later than 2 or 3 hours before your bedtime

3)    Avoid caffeine: Coffee, cola, certain tea and chocolate contain stimulant caffeine and can take 8 hours to fully wear off.  Older teens may benefit from being cautioned that nicotine and alcohol also worsen sleep.

4)    Avoid large meals before bed: these can cause indigestion and having too many fluids might mean you need to get up to use the toilet

5)    If possible avoid medications that disrupt or affect sleep: over the counter and herbal remedies for cough, cold or allergies can disrupt sleep.  If you are worried, talk to a pharmacist or health care professional to see if any drugs you take might contribute to insomnia

6)    Don’t take naps past 3pm: Naps can help you catch up on lost sleep but if you nap too late in the day, it can be harder to fall asleep at night

7)    Relax before bed: don’t overschedule your day so you have no time to unwind.  Reading or listening to music could be part of your bedtime ritual

8)    Take a hot bath before bed:  Your body temperature will drop after getting out of the bath and this may help you feel sleepy and relaxed so you are more ready to sleep

9)    Have a dark, cool, gadget free bedroom:  Noises, bright light, an uncomfortable bed or warm temperatures can distract you from sleep.

10) Have the right sunlight exposure: Try to get outside in natural sunlight for 30 minutes a day.

11) Don’t lie in bed awake if you are still awake after 20 minutes or starting to feel anxious or worried get up and do some relaxing activity until you feel sleepy.  The anxiety of not being able to sleep can make it harder to fall asleep

 

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Research for Practice: Sensory Integration and Dyslexia.


Ayres’ published her research findings, making a case for emerging patterns of sensory integration dysfunction including;   

  • developmental dyspraxia – this pattern linking motor planning difficulties with deficits in tactile perception
  • difficulties with integration of both sides of the body; poor right-left discrimination, difficulties crossing the midline, and  reduced bilateral motor coordination – impacting on posture and postural control, thought to related difficulties processing vestibular input 
  • visual perception, form and space perception deficits impacting on visual-motor functions
  • difficulties with visual figure-ground discrimination
  • deficits in auditory and language functions.
  • tactile defensiveness and related sensory reactivity difficulties impacting negatively on attention 

A key feature of Ayres’ Sensory Integration is the adaptive response;  “an adaptive response is a purposeful, goal-directed response to a sensory experience … play consists of a series of adaptive responses that make the sensory integration happen. In turn, as sensory integration develops, better organization and more complex skills are possible” Ayres 2005.

In 2013, Viana et al reported that children with dyslexia show poor performance and variability while relating visual and somatosensory information. Children with dyslexia showed less coherent and more variable body sway;  suggesting difficulties in multisensory integration from sensory cues coming from multiple sources.

 

man in brown jacket holding a book

Studies with adults and children found that there is reduced neurophysiological adaptation in adults and children with dyslexia. In 2016, Perrachione et al published research suggesting that people with dyslexia are likely to have differences in sensory integration and processing, noting significantly reduced adaptation to speech from a consistent voice and less adaptation to the repetition of words, objects, and faces. They provide evidence to support the hypothesis that reading skills in dyslexia are related to the degree of neural adaptation.

In 2017 Wandel and Le confirmed the importance of the effective processing of multiple sensory inputs, including successful sensory integration for competent reading. 

“Successful reading involves the ability to efficiently integrate visual signals with the sounds of speech and the language system; thus, diagnosing the reading circuitry requires testing the cortical and white matter regions that carry reading information from the visual, auditory, and language systems. Reading impairment can result from problems within neural circuits that are used for multiple purposes, not uniquely reading (Rayner et al., 2012, Seidenberg, 2017). Hence, we advocate assessing the circuitry broadly, not just portions that are highly specialized for reading.”

In clinical practice, some children with sensory integration difficulties benefit more from the use of coloured overlays. Research from Kriss and Evans (2005) suggests that 

“Children with dyslexia seem to benefit more from coloured overlays than non‐dyslexic children. MIS and dyslexia are separate entities and are detected and treated in different ways. If a child has both problems then they are likely to be markedly disadvantaged and they should receive prompt treatments appropriate to the two conditions. It is recommended that education professionals as well as eye‐care professionals are alert to the symptoms of MIS and that children are screened for this condition, as well as for other visual anomalies.”

Read the full article: The relationship between dyslexia and Meares‐Irlen Syndrome

Read more here:

Dyslexia link to eye spots confusing brain say scientists.

Dyslexia and Sensory Processing, is there a link?

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Research Update: Sensory Modulation Disorder (SMD) and Pain: A New Perspective

Pain and sensory integration difficulties including sensory sensitivity are thought to be features in many disorders including CFS/ME and hyper mobility. Recent research and evidence is exploring the links.

Abstract “Sensory modulation disorder (SMD) affects sensory processing across single or multiple sensory systems. The sensory over-responsivity (SOR) subtype of SMD is manifested clinically as a condition in which non-painful stimuli are perceived as abnormally irritating, unpleasant, or even painful. Moreover, SOR interferes with participation in daily routines and activities (Dunn, 2007; Bar-Shalita et al., 2008; Chien et al., 2016), co-occurs with daily pain hyper-sensitivity, and reduces quality of life due to bodily pain. Laboratory behavioral studies have confirmed abnormal pain perception, as demonstrated by hyperalgesia and an enhanced lingering painful sensation, in children and adults with SMD. Advanced quantitative sensory testing (QST) has revealed the mechanisms of altered pain processing in SOR whereby despite the existence of normal peripheral sensory processing, there is enhanced facilitation of pain-transmitting pathways along with preserved but delayed inhibitory pain modulation. These findings point to central nervous system (CNS) involvement as the underlying mechanism of pain hypersensitivity in SOR. Based on the mutual central processing of both non-painful and painful sensory stimuli, we suggest shared mechanisms such as cortical hyper-excitation, an excitatory-inhibitory neuronal imbalance, and sensory modulation alterations. This is supported by novel findings indicating that SOR is a risk factor and comorbidity of chronic non-neuropathic pain disorders. This is the first review to summarize current empirical knowledge investigating SMD and pain, a sensory modality not yet part of the official SMD realm. We propose a neurophysiological mechanism-based model for the interrelation between pain and SMD. Embracing the pain domain could significantly contribute to the understanding of this condition’s pathogenesis and how it manifests in daily life, as well as suggesting the basis for future potential mechanism-based therapies.”

Read more here: Sensory Modulation Disorder (SMD) and Pain: A New Perspective

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Research Update: Sensory Over-Responsivity as an Added Dimension in ADHD

Anecdotally many Occupational Therapists who use Ayres’ Sensory Integration to inform assessment and practice report the close links between ADHD and sensory integration challenges. This article by expert Sensory Integration researchers Shelley Lane and Stacey Reynolds offers research evidence and neuroscience in strong support of the links between differences in processing and integrating sensory input for those who meet criteria for a diagnosis of ADHD.

Abstract “Years of research have added to our understanding of Attention Deficit Hyperactivity Disorder (ADHD). None-the-less there is still much that is poorly understood. There is a need for, and ongoing interest in, developing a deeper understanding of this disorder to optimally identify risk and better inform treatment. Here, we present a compilation of findings examining ADHD both behaviorally and using neurophysiologic markers. Drawing on early work of McIntosh and co-investigators, we examined response to sensory challenge in children with ADHD, measuring HPA activity and electrodermal response (EDR) secondary to sensory stressors. In addition, we have examined the relationship between these physiologic measures, and reports of behavioral sensory over-responsivity and anxiety. Findings suggest that sensory responsivity differentiates among children with ADHD and warrants consideration. We link these findings with research conducted both prior to and after our own work and emphasize that there a growing knowledge supporting a relationship between ADHD and sensory over-responsivity, but more research is needed. Given the call from the National Institute of Health to move toward a more dimensional diagnostic process for mental health concerns, and away from the more routine categorical diagnostic process, we suggest sensory over-responsivity as a dimension in the diagnostic process for children with ADHD”.

Read the full article here: Sensory Over-Responsivity as an Added Dimension in ADHD

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Neural Foundations of Ayres’ Sensory Integration.

Dr Susanne Smith Roley shared the draft of this with us when she teaching CLASI CASI M6 with ASI WISE in June. Lovely to see it in press and able to be shared! Thank you to all the authors! Just what’s needed to support practice.

Read it here: https://www.mdpi.com/2076-3425/9/7/153/htm