‘Help me explore it’ Incorporating Sensory Strategies into Conductive principles CYP information

Cerebral Palsy is the most common physical disability in childhood affecting individuals differently whom may also have associated learning, hearing, visual disabilities along with complex medical needs. As well as movement problems, many children with Cerebral Palsy have difficulties processing sensory information, for some these sensory processing problems can be as restrictive as the associated movement disorders. Talk about the students in class. Diverse complex needs. 2 CP 2 syndromes present similar symptoms and patterns as CP

Children with Cerebral Palsy often show signs of problems with integrating sensory information in combination with motor function. This may be due to the nature of the brain injury caused by lack of oxygen, but may be made worse by the lack of independent movement and absence of typical development that helps children to integrate sensory inputs. A child with CP is hindered in his/her ability to move against gravity, integrate primitive reflexes, experience tactile, proprioceptive and vestibular inputs. In addition to this these children often miss out on ‘rough and tumble’ play activities further reducing their ability to efficiently develop their efficiency and accuracy of sensory processing, and thus preventing quality sensory motor experiences.

“Tell me and I might forget Show me and I might remember, Involve me and I will understand” (Chinese Proverb)

What is Sensory Integration? “Sensory Integration is the organization of sensory input for use”. All information goes through our senses Input sight, taste, hearing, touch, smell, movement, proprioception Output Behavior, attend, learn, social interaction, express feeling, self-regulate, self-esteem

The three different types of behaviors 1-Over Responsive Does not like busy, crowded places Covers ears to block out noise Moving or tearing at clothes Covers eyes, squints Does not like messy play Picky eater Does not like walking on grass/sand bare foot 2-Under Responsive Not responsive to noise Clumsy (falling over things, dropping things) Not feeling hot/cold Does not taste bland food Being on the ‘sleepy’ side, does not engage in activities 3-Sensory Seeking Licking, biting, chewing Rocking, spinning Squeezing into small spaces Often looking for lots of sensory input to the point of over stimulation Likes big hugs, squeezes Likes rough and tumble play

Preparation for learning We need to teach the individuals appropriate sensory strategies for self regulation in order to be in the state of a ‘just right’ arousal level. We as conductors follow a sensory diet provided by OTs. Talk about post lunch, reduced attention. Body focusing on digestion …

Flamingo To improve arousal levels. Help us focus

Neuroplasticity Sensory diet activities help to lay down new pathways in a person’s nervous system over time so that he/she is better able to: Increase body awareness and spatial relations (motor co- ordination) regulate alertness and increase attention span tolerate challenging sensations and situations limit sensory seeking and sensory avoiding behaviours handle transitions with less stress

Sensory Diet Is very person specific because everyone’s sensory needs are different It resembles a personalized activity plan that provides the sensory input a person needs to stay focused and organized throughout the day. Activities can be stimulating or calming depending on the person’s needs It addresses the person’s main difficulties by looking at the behavior, and the sensory explanation of this behavior. It provides strategies to enable the individual to be at a ‘just right level’ of arousal in readiness to learn, play or take part in social situations. by OT Patricia Wilbarger We all have sensory needs and we all found our own individual ways of satisfying these needs to help us relax or focus. i.e. chewing our pens, clicking our pens, enjoy a relaxing massage

The twist How did this position made you feel? What were you aware of? What strategies did you use to keep your balance? i.e. previous experiences, our senses etc.

Cortex Limbic System Brainstem Thinking Memory and emotions can affect response depending on previous experience Sorts and filters incoming senses of sight, touch, balance, hearing, taste, smell and proprioception

Vestibular Activities Effects can last between 4-8hrs Rhythmical and predictable vestibular activities are organizing and calming (linear movements on a swing, slow rocking, slow movements) unpredictable vestibular activities are arousing (spinning, roller coaster) Some people find vestibular activities very challenging (gravitational insecurity)

CE high arousal levels

Swinging in prone

Sitting on the swing

Examples of alerting vestibular activities Fast erratic movements on a swing, using the roundabout, position changes where the individual takes part in, rebound, up down ramps in chairs/on foot Driving/walking over bumpy ground

LA before arousing activity Low tone and low arousal levels often go together

LA during and after arousing activity

LA on trampoline

LA sitting up on trampoline

Proprioception and deep pressure Effects can last up to 2hrs They always have an inhibiting, calming effect on the nervous system Charlotte brushing and joint compression

Example of proprioceptive and deep pressure activities Roll up in a blanket, “Sandwich” between pillows Heavy work activities, pulling and pushing, help with gardening Vibrating toys - pens, balls, use Vibrating mattress, vibrating pillows, vibrating toothbrush Swaddle, Bear hugs Backscratch, Scrub with washcloth/scrubby Joint compressions, Therapy brushing Hydrotherapy, Rebound Fall onto “crash pad” Log rolling Weighted blanket, vest, lap pad Mix bread dough, kneading, use Play-doh, clay etc

C walking deep pressure required

Touch Can be alerting and or calming depending on activity and sensory needs of the person and the type of touch Some people have a very low threshold to tactile stimulation, we refer to them as tactile defensive. Others need to touch objects all the time or do not notice touch, they have a high threshold (tactile seeking and poor registration) Seeking deep pressure, massage/pressing/shaking parts of the body we are working on.

Low threshold to tactile stimulation Modify environment to produce calm, safe and predictable surroundings with controlled sensory stimulation Avoid touching or approaching the person from behind. Make sure the person sees you before giving instruction or asking for responses Use firm touch, allow the use of weighted vests, etc gradually incorporate a variety of tactile experiences in play, eating, bath time, etc. Demonstrate on yourself and make it fun. Encourage active exploration. Do not force participation. Needs a very specific programme to address sensory defensiveness, need training to implement i.e. introduce one new experience at a time Supplement by calming experience before during and afterwards

High threshold to tactile stimulation Messy play opportunities throughout the day – use lots of tactile activities as part of a multisensory curriculum Allow fiddle toys to aid concentration Use deep touch to organise sensory system to allow for better concentration Remember: sensory need has to be addressed before you expect optimum performance - do not use it as a reward

Vision Visual input can often be too much and hard to cope with by somebody with sensory processing issues Some individuals have a low threshold to visual information – they are easily distracted by environmental influences Others need more intense visual experiences to engage in play or learning Sensory room

Strategies for visual regulation – low threshold Remove clutter from class rooms, cover shelves etc. in plain coloured curtains Have floor areas that are plain coloured (no textured rugs, carpets etc.) Position person away from areas that are visual distractive (either at front of class or at the back)

Strategies for visual regulation – high threshold Use high contrast to draw visual attention to desired object Use person’s favourite colour for folders, toy chest etc Use light up toys or ball that lights up to engage child and help person to maintain visual attention

Auditory stimulation People with a low auditory threshold find it hard to cope in noisy environments like the dinner hall or a busy street. They also have difficulties blocking out background noise when listening to a speaker People with a high auditory threshold appear not to listen to what was said

Strategies for low auditory threshold Warn person before a loud noise Allow to leave class early to get accustomed to noise in dinner hall Provide quiet space to withdraw to when it becomes too much Use calming techniques before exposure to loud environments (deep pressure, head phones with calming music) Wear ear defenders

Strategies for high auditory threshold Use one step instructions in clear language Give lots of time to respond Do not whisper – use a projected voice when calling Use a visual or tactile cue to gain attention

Sensory processing difficulties stay with the person for life, but the person is able to manage them through a sensory diet or other sensory strategies Difficulties only need addressing if they are interfering with the persons day to day functioning Everybody is different and has different sensory preferences That’s why sensory diets are individually tailored to the person On-going observation/re-evaluation of individual’s response to the sensory stimuli is key The diet part means it has to become a component of every day life

In memory of Judit Blake (Delicsany) (1954-2014) Liora Abrams (1999-2014)