What’s the point?

A mother of a boy with autism asked me once right there in the middle of a session: “What’s the point of him swinging so much, I can do that with him in the park?” As I went deeper and deeper into explaining the concepts of sensory integration and why her son needed the vestibular input and how swinging would help him in school, a parallel train of thought started unwinding in my head. Does this lady see the big picture here? There she was, a gorgeous, polished and relatively young mother of this boy. She was always very polite and in the mood for at least a small talk. She rarely stayed in the sensory room but when she had questions, she would stay inside and I would take some time from the session to talk to her and make these concepts a little bit more close to her. So, after many years of explanations from my boss, and a couple of extra years of explanations from me, she kept asking the same question: “Why are you letting him swing so much, I can go to the park and let him swing there for free.” Now, let me just be clear about this, she was definitely not a stingy lady, just the opposite. So, for all those who can’t see the forest for the trees… What’s the point of sensory integration therapy?

Sensory integration has practically one ultimate goal, with small goals in between. The ultimate goal is to help children with any kind of developmental disorder or delay learn. When a child has sensory deficits, they find learning to be very tiring, tough, uninteresting etc. One very important goal that helps us getting to the learning process is the (self)regulation. This is a very tricky one. It is the one that is very individual and rarely you will find a nice and simple equation to get to the regulation and self-regulation point in a child. One day jumping and rolling on the floor will be a bingo, but tomorrow that might cause a tantrum.

Piaget nicely indicated that play is the work of children. They learn a lot better when actively participating as oppose to being told what to do. So, what’s a better way of helping children in their journey to the land of knowledge than the sensory smart play. I follow the child’s interests, observe their sensory appetite and I try using that to help them learn new things; whether a skill, or a word. Some children can only function and learn while getting their stimuli whereas some children are ok with being stimulated first and then afterwards successfully getting the task done. So, in order to get the cognitive tasks done which are on a higher level, we need to sort the basics that our body needs first.

http://www.zoneintraining.com/wp-content/uploads/2008/01/pyramid.jpg
http://www.zoneintraining.com/wp-content/uploads/2008/01/pyramid.jpg

I’ll try making this even more clear. In order to successfully learn, you need to be ok with your sensory self. You don’t need to be perfect and rarely somebody is. But people and children with a more substantial sensory disorder will find learning very tough. However, we can learn to compensate our sensory deficits to be able to function normally with every day challenges (taking a shower, putting clothes on and getting out of the house, getting a haircut, sitting in a class, having coffee in a crowded mall, cooking a spicy dish, reading a book, writing a paper, etc.). So, this is the big picture: settling the sensory basics for the higher cognitive tasks such as learning.

And just an FYI… If you ask me, sensory integration, yes, it can be a therapy, but I would rather if parents and adults used it as a lifestyle. Think, breathe and live (and play!) in a sensory way. Don’t wait for those one or two hours a week for your OT to work with your child and help them regulate. Talk to your child’s therapists, learn from them about your child’s sensory needs and implement them all the time: while the child is eating, when the child needs to brush his teeth and go to bed, on your way to the preschool, etc. I don’t think a parent should necessarily acquire a role of a therapist, actually better if not, if possible. But, hopefully you play with your child anyway, why not making it sensory friendly in your own home or a park. So, to answer the question that a patient’s mother asked: if I let your child swing as much as his brain needs, that will regulate him and thus he will learn better. And yes, I would love it if you would take him to the park to swing more, whenever the boy wants and needs (I only assume his biggest need would be before and after his classes).

Pump up child’s proprioceptive system

These are some of the things you can do with your child to bring his/her proprioceptive system closer to the regulated state:

  • utilize your home:
    • lay mats of different thickness and softness onto the floor (information coming from the joints)
    • put some mats or safety sponges onto the walls (for children who like to run and bounce themselves off of the walls)
    • have Pilates kind of balls in the space (child can roll on the ball on their stomachs or you can lightly massage them with the ball on their backs or squeeze them in between two balls, or have them jump on the Pilates ball while catching some other small objects)
    • big cushions (take a duvet cover and fill it up with pillows, Styrofoam or small soft balls and have your child jump on it, cross over it, crawl on it, lay down on it etc.)
    • fill up the crib with small plastic balls to make a ball pit.
  • have fun out in the streets:
    • pass each other a ball, small stone, pine cone
    • pick up pine cones or stones into buckets of different sizes (thus different weight)
    • try walking and running with small weights around the ankles
    • walk around in a vest with some weight in it
    • walk in deep snow, through puddles of water, sand, in high grass, in mud, different surfaces
    • walk up or down the steep streets
  • other creative activities:
    • make a dough out of water and flour. Some can be smooth and soft, some you can make rough by adding seeds and some you can make a little dry. Ask your child or show them how to pull a little bit of dough with their fingers, make a small ball and paste the ball onto a piece of paper. For older children, you can make a line or a shape on that piece of paper and they should paste the dough balls onto the lines. This is also great for tactile regulation
    • jump on the trampoline in a rhythm

 

 

Kako senzorički opremiti kuću?

English version

Jeste li vi među onima koji imaju prazan podrum koji k tome nije vlažan te je savršen za senzoričku sobu? Ja nisam! Mi živimo u stanu. Imam doduše garažu, ali ne odgovara ovim kriterijima. Prljava je, vlažna i puna stvari. Također je i dva kata niže. Svakako nije namjenjena za senzoriku. Moji roditelji imaju podrum, ali je također vlažan, prepun stvari i ima veliku škrinju. Ne odgovara našim potrebama. Dobra vijest je da vam ne treba zasebna prostorija. Jedna super strana senzorne integracije je što nas traži da budemo vrlo kreativni. Djeca i roditelji s kojima radim inspirirali su mnoge moje ideje, igre i trikove.

Dakle, što možete učiniti da vaš mali, skučeni dom bude senzorički povoljan? Počnimo razmišljati u 3D! Iskoristite svoje zidove, plafon, podove, vrata itd. Sve može biti korisno. Ali najprije pogledajte koje su potrebe i mogućnosti Vašeg djeteta. Jesu li potrebe Vašeg djeteta više proprioceptivne, vestibularne ili možda vizualne? Imajte na umu sva osjetila, ali u prostoru imajte malo više stvari koje podražuju ono osjetilo koje Vaše dijete najviše treba. Ne morate imati svu tu opremu i pomagala cijelo vrijeme nasred boravka i po cijeli dan. Mijenjajte raspored i opremu prema želji odnosno potrebi djeteta. I svakako imajte djetetovu sigurnost na prvom mjestu.

Za propriocepciju:

  • stavite strunjače različite debljine i mekoće na pod (informacije dolaze iz zglobova)
  • stavite i strunjače ili zaštitnu spužvu na zidove (poglavito za djecu koja se vole “zabijati” u zidove)
  • imajte pilates lopte (dijete se može ljuljati na lopti na trbuhu ili ga možete masirati loptom po leđima; malo ih stisnuti među dvije lopte kao u sendviču; mogu skakati na lopti dok hvataju neki drugi manji predmet)
  • veliki jastuci (uzmite plahtu od prekrivača i napunite ju jastucima, stiroporom za igračke ili malim lopticama da djeca mogu skakati po tome, puzati preko tog velikog jastuka, prelaziti preko njega ili pak leći na njega)
  • napunite krevetić ili vrtić malenim platičnim lopticama da stvori bazen s lopticama.
baby in the crib
http://community.babycenter.com/post/a41331646/ball_pit_time_pic

Za taktilno:

  • napravite taktilne ploče kod kuće (mogu biti jednostavne poput ovih kvadratića na slici niže dolje ili možete otići korak dalje i napraviti brojeve i slova od različitih materijala i tekstura, pa čak i PECS kartice u 3D!) i stavite to na zid. Ako imate veći neiskorišteni zid, možete ga obući u neku tkaninu ili materijal.
pecs
http://www.pinterest.com/genrescue/pecs-non-verbal-communication/
0021154
http://www.specialneedstoys.com/can/discrimination/504-tactile-board.html
  • stavite različite materijale na pod i najbolje bi bilo da dijete boso hoda po njima, ako je moguće. Možete imati jedan kut sobe, ili kut od kauča popunjen jastucima različitih materijala i tekstura (mekani, tvrdi, izrezbareni, vuneni, krzneni, glatki, bodljikavi) te nekoliko jastuka koji izgledaju isto, ali su različite težine, te i treću kategoriju jastuka koji izgledaju isto ali su različito punjeni – grahom, sterilnim mačjim pijeskom, perjem, kamenčićima ili stiroporom)
  • bojanje i pisanje također može biti zabavno (zeleni kaktus je kemijska olovka te ako ste toliko kreativni kao ovaj dječak sa slike, možete popiti i malo mineralne vode (“pikave vode”) iz kaktusove posude).

IMG_0020 IMG_0021

  • Kupanje: voli li Vaše dijete vodu? Ako da, kupa li se u kadi ili ga tuširate? Voli li jaki mlaz ili slabi? Možete se igrati pjenom za brijanje dok se dijete kupa te staviti po licu i tijelu, namazati i patkice. Također dodajte i taktilne podražaje popust krupne soli ili šećera u pjenu i namažite na djetetove ruke ili tijelo. Bolje da se sami namažu. Možete dodati i jestivu boju za vizualni podražaj. Time možete namazati i igračkice za vodu koje su bodljikave, spužvaste ili glatke).
  • Oralno: dijete su može prati zube i trljati jezik i desni četkicom – postoje klasične četkice, no i one za bebe i od NUKa. Možete i svojim prstom masirati oko usta i obraze. Također i desni i jezik ako vam dijete dopusti. Moj sin obožava tu masažicu uz pjesmicu “Wheels on the bus”. Puno se smiješi na to.

Za vestibularno:

  • stavite ljuljačku u kuću (neki roditelji su instalirali mrežu za ljuljanje iznad svog bračnog kreveta pa bi se djeca popela i skakala na krevet – pazite na sigurnost!! Možete instalirati ljuljačku na plafon, a na susjedni zid stavite konop pa kada se ljuljačka ne koristi, samo ju zaglavite između zida i konopa da ju ne morate uvijek skidati. IKEA ima jednu ili dvije koje ja svakodnevno koristim. Dijete se može ljuljati u različitim pozicijama (dok sjedi, na trbuhu, na koljenima ili dok stoji) i u različitim smjerovima te možete kombinirati i druge aktivnosti skupa s ljuljanjem poput hvatanja lopti različitih težina (proprioceptivno) ili materijala (taktilno).
  • možete imati balansne ploče ili jastuke. One samo da daju vestibularni podražaj nego su bodljikavi pa daju i taktilni podražaj.
  • jedna majka s kojom sam radila je okrenula kauč naopačke i koristila ga kao tobogan za svoju kćer. Ja sam koristila velike jastuke za naslon te sam ih stavila niz kauč pa su se nećaci na tome spuštali kao niz tobogan.

IMG_1745

Za vizualni:

  • zapravo svi materijali i oprema već imaju nekakvu boju i oblik. Ako je Vaše dijete osjetljivo na vizualni podražaj, pojednostavite Vašu opremu. Također smanjite i broj svjetala u prostoru. Za one koji su na drugom dijelu kontinuuma, možete uvesti više boja, oblika i veličina.
  • uzmite rotirajući reflektor s više boja

IMG_0301

  • ako stavite strunjače različitih visina (boja i tekstura) na pod kao što sam napomenula u dijelu o propriocepciji, to je izvrsno i za vizualni sustav.

Kroz cijelu kuću: ponekad je teško zadovoljiti dijete kada je vani -30 stupnjeva C. Parkovi nisu najbolja opcija ne samo radi hladnoće i jer su mokri od snijega ili kiše nego i jer se u Hrvatskoj vrlo brzo zamrači po zimi, već oko 16 sati. Iz nekog razloga, kod nas u večini parkova nema ulične rasvjete. Ali ima nešto što možete učiniti i unutra. Iskoristite cijelu kuću ili barem dio za poligon: rasprostrite jastuke, strunjače, stolove, balansne ploče, lopte i sve što Vam se čini zgodno u niz prepreka. Ako Vaše dijete može pratiti upute, dajte mu i nekakvu igračku koju na cilju mora staviti u košaru. Cilj može biti i toliko jednostavan kao i poljubac mami. Preko nekih prepreka dijete može puzati, hodati, provlačiti se ili čak preskočiti. Evo kako je kod nas:

IMG_0011
Gurati jedan drugoga u autiću.
IMG_0162
proći kroz tunel
IMG_0362
Možete uključiti i kućne ljubimce ako su raspoloženi!
IMG_0396
Mogu proći i kroz otvor za pećnicu od dječje kuhinjice.
IMG_0726
Ima li Vaše dijete brata ili sestru? – udružite ih! Neka jedan drugome budu prepreka ili most kroz koji se treba provući.
IMG_0840
Vojničko puzanje
IMG_0859
Neka dobiju dopuštenje za iduću prepreku nakon obavljenog kognitivnog zadatka.
IMG_2105
neka pužu ispod stolića
IMG_2107
i na kraju, na cilju, neka ubace igračku u košaru ili kao ovdje na slici, u vrećicu.

Budite kreativni i zabavite se!

Making the house sensory friendly

Croatian version

Are you among those lucky ones who have an empty basement which is not humid, perfectly convenient for a sensory room? I’m not! I live in an apartment. I do have a garage though, but it does not fit any of these criteria. It’s dirty, cluttered and humid. And it’s two floors down. Definitely not suitable for a sensory room. My parents have a basement, but it’s again humid, terribly cluttered and has a big freezer. Again, very unsuitable. Good news is, you don’t need a special room! One of the great things about sensory integration is that it makes you be very creative, it makes you think outside of the box. Children and parents I work with inspire me and are responsible for many of my ideas, games and tricks of the trade.

So, what can you do to make your small, often congested home sensory friendly? We should start thinking 3D! Use your wall, ceilings, floor, doors etc. Everything can be useful. First what you need to look at are your child’s needs and abilities. Are your child’s needs more proprioceptive, vestibular or perhaps visual? Having in mind all other senses, put a little extra of those your child needs the most. Also, please note that you don’t have to have these things in your living room the whole time and every day. You can change the setting as you wish, or per child’s needs. Have your child’s safety in mind at all times.

For proprioceptive:

  • Lay mats of different thickness and softness onto the floor (information coming from the joints)
  • Put some mats or safety sponges onto the walls (for children who like to run and bounce themselves off of the walls)
  • Have Pilates kind of balls in the space (child can roll on the ball on their stomachs or you can lightly massage them with the ball on their backs or squeeze them in between two balls, or have them jump on the Pilates ball while catching some other small objects)
  • Big cushions (take a duvet cover and fill it up with pillows, Styrofoam or small soft balls and have your child jump on it, cross over it, crawl on it, lay down on it etc.)
  • fill up the crib with small plastic balls to make a DIY ball pit.
baby in the crib
http://community.babycenter.com/post/a41331646/ball_pit_time_pic

For tacticle:

  • make tactile boards at home (they can be as simple as these squares below, or you can take it a higher level and make numbers and letters out of different materials, maybe even PECS cards in 3D!) and put them on the walls. If you have a bigger empty wall space, you can “dress” your wall into some fabric or some material.
pecs
http://www.pinterest.com/genrescue/pecs-non-verbal-communication/
0021154
http://www.specialneedstoys.com/can/discrimination/504-tactile-board.html
  • put different textiles, materials on the floor and keep your child barefoot if possible. You can have one corner of your room, or corner of your L-profile couch filled with cushions of different materials (soft, rough, spiky, woolen, furry, smooth) and a few cushions that look the same, but are of different weight and third category, same looking cushions filled differently – with beans, kitty sand (sterile), feathers, small stones, Styrofoam etc.)
  • even coloring and writing can be fun (the green cactus is a pen and if you are as creative as this little guy, you may even use the pot to drink the sparkling water from)

IMG_0020 IMG_0021

  • Bath time: does your child like the water? If yes, in a bath tub or sprayed on him/her as a shower? Strong pressure or mild? You can use shaving foam to play in the bath, put on child’s face and body, put on the swimming ducks – also incorporate other tactile stimuli here (put some sugar or grains of salt into the foam and spread on child’s body – better if they do it themselves, put some food coloring into the foam for visual stimulus, get some other toys that are spiky, rough, silky etc.)
  • Oral: you can have your child wash their teeth and also brush the tongue, lips, gums around etc with a regular brush or for babies or from NUK. Also, use your fingers to massage the space around the mouth and cheeks. You can also massage child’s gums and tongue if they allow you. My newborn loves this along with a “wheels on the bus” song. Makes him smile a lot :)

For vestibular:

  • implement a swing in your house (some parents had a net installed above their king sized beds and had a child climb on it and jump or drop down onto the mattresses – please consider safety here! – same you can do with a swing. Also, you can attach a swing on your ceiling and put a rope on a side so you don’t have to take the swing down each time, but just tuck it in between the rope and the wall or just keep it aside. IKEA has one or two nice swings that I use on daily basis. You can have your child be on the swing in different positions such as sitting, on their stomachs, on their knees or standing and implement different activities while swinging: catching some items that look the same, but are of different weight (proprioceptive) or material (tactile)
  • you can have different objects that react when stepped on such as a balance board, or these balance pillows. Not only do they give some vestibular input, but they are spiky on their surfaces so play as a tactile input, too.
  • one of the mothers I worked with flipped her couch upside down and used it as a slide for her daughter. I used big tight pillows down the couch for my niece and nephew

IMG_1745

For visual:

  • practically, all of the materials and equipment listed above as ideas for proprioceptive, vestibular and tactile come in some color and shape. If your child is sensitive to visual stimuli, keep it simple. Also, don’t get many reflector lights into the space. For those who are on a hypo side, you may have these things in different colors, shapes and sizes.
  • get one of the colorful rotating reflectors

IMG_0301

  • if you implement the mats of different heights (and colors and textures) on your floor that I mentioned was good for the proprioceptive system, it is good for the visual, too.

Throughout the house: sometimes it is very hard to keep the kids sensory and otherwise happy when it is -30 degrees Celsius outside. Parks are not only unavailable due to the possible snow or cold, but at least here in Croatia it gets dark so fast (around 4pm) during the winter and for some unknown reason, parks are not equipped with the street lights. There’s something you can do indoors. Use your whole apartment or house, or at least a few rooms and a hallway, for this exercise: spread cushions, mats, tables, balance boards, balls etc. into a line of obstacles. If your child can follow instructions, you may give him a toy or a ball that they need to carry through the obstacles and put into a basket in the end (have some kind of a goal – may it be as simple as a kiss to mom). Some parts they should crawl on, crawl under, crawl through, some walk over, some jump through and so on. Here’s a visual:

IMG_0011
Push each other in a car
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Go through tunnels
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You may include your pets, too. If they are eager to participate :)
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Go through an oven opening in the children’s kitchen
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Your child has siblings? – involve them! Use each other as tunnels or obstacles to cross.
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Soldier crawl
IMG_0859
Getting an assignment done to go to the next obstacle
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crawl under the table
IMG_2107
in the end, have a goal and put a toy in the basket or bag on the door handle.

Put your creative hat on and have fun!