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).

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Want to talk?

I’ll never forget a moment one of the moms from my work experienced and retold me. Her son has a severe developmental disorder. Parents said that he almost vegetated for the first 4 years: where you put him, that’s where he will stay. Later they started with sensory integration and communication and the boy lit up a little. I was working with him for over a year. Because of his state and inability to communicate practically in any way, parents used to talk about him in front of him. Until that one day! His mom started complaining about him and said how she felt to her friend while he was in the same room. The boy looked at his mom and started crying! Her heart was shattered. She felt so sad she hurt her son like this, but on the other hand she was so happy. She finally had a proof that her son understands language, that he understands and feels the same emotions, that he loves his mom. From then on, not only she stopped speaking about him negatively in front of him, but they doubled all of his therapies.

I was always careful not to speak negatively about a child in front of that child himself, but since I heard that story and felt that mom’s pain she has been causing her son for years, I changed, too. If I feel like I want to change the whole world for this child who has, by the way, grown to be such a happy and smiley boy, I can only imagine how his mom must feel.

Don’t take the risk of hurting your child no matter how sure you are they do not understand you and no matter what condition they had. It’s not worth it. Can you imagine science becoming so advanced that we can read their minds and souls and to find out our children understood every single negative thing and complain we made in front of them, can you imagine what pain we would come across? We all have to went at some point. Finding out your child is not of the health you dreamed of him to be is devastating enough. Not hearing his voice or words “mommy”, “I love you” or getting a hug and a kiss from your child is heart breaking. Grieving and talking about it is very good and healthy for the parents but choose an appropriate time, place and person to do it with. You never know if and when your child will start understanding you. When you finally figure it out, it might be too late.

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How to explain your kid’s sensory needs to family and friends?

It is not too complicated to explain sensory integration deficits to those who have never encountered this term before. But still, reactions of some people, especially those from an older generation, are quite interesting. They range from “But look at those cheeks, he looks so healthy!” to “You could not get away with this kind of behavior in my time.” Have you ever heard comments like that? So, what to do, how to explain to people that child who is throwing a tantrum over a glass of orange juice does not deserve punishment?

To answer this question, take into consideration that most of us have some sensory deficits and that we don’t even realize that some of our every day reactions are actually sensory reactions to the outside stimuli.

  • When sitting on a chair with one leg crossing over the other leg, some people start bouncing the upper leg. The brain did not have enough information about the position of the upper leg and had to move it around (or if you have some loose shoes, some people tend to play around with it). In this way, bouncing of the leg gives proprioceptive input from the joints to the brain about the leg and its position.
  • Some people find it very painful to walk on the pebbles, they have tactile hyper-sensitivity in the area of their feet.
  • Some people don’t like to touch wet sponges or wet hair.
  • You may throw some people off their balance very easily.
  • Some people will rarely manage to hit the shuttlecock as their hand – eye coordination is distorted.
  • When tired, some people become very sensitive to sounds or light (me!)

However, some of the kids and most of the healthy adults still manage to compensate these discrepancies on a cognitive level. We know dishes have to be washed or we have to sit through a boring class and while it won’t be the most pleasurable activity, we will still do it. Kids who have more severe sensory deficits will not be able to do that. They will only be seeking the needed stimuli or trying to avoid the stimuli they are overly sensitive to. What do you do when you get out of the house in summer – you cover your eyes or squint for a bit until you adjust. So, when you see a child throwing a tantrum over a glass of orange juice, check why that is happening (hint: pulp / temperature / sourness).

Thus, when you see that somebody does not understand when you tell them about your child’s sensory needs and behavior, try asking them some of these questions: do you bounce your leg after sitting with one leg over the other; do you mind the loud noises in the evenings; do you mind the mix of smells in the shopping malls; is the sun too bright for you when you come out of the dark room…They will feel much closer to the topic when they see that sensory integration is something within themselves, too but were never aware of it. They will comprehend the issue and its intensity / severity much easier.
Let me know if this was helpful!

 

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A cranky baby? – behind the scene

  • “My baby cries a lot.”
  • “My baby doesn’t want to eat (solids).”
  • “My baby doesn’t like to get dressed.”
  • “It’s impossible to put my baby to sleep.”
  • “My baby doesn’t like to ride in a car.”
  • “My baby doesn’t like to spend time on her tummy.”

All of these are frequent examples of children’s reactions to sensory stimuli from the environment. To explain it a little bit: there may be many reasons for a baby to cry constantly or not to be able to sleep and it is up to us to find a pattern in the activities that preceded the negative reactions: e.g. bathing, dressing, feeding, going out in the sun etc. It can also be a reaction to an absence of a stimulus. For example: a baby or a child will not be able to fall asleep until he or she gets enough of proprioceptive stimuli (e.g. when we tightly hold the baby in hands). Children who have some oral motor and sensory difficulties will most likely have difficulties breastfeeding (sucking) or will have difficulties chewing their food, especially the solid, chewy items. Also, they might be irritated by the smell or the texture of the food. Furthermore, if a baby is hypersensitive to touch, she might cry while you try changing her clothes and might even be bothered by the etiquette or different materials in her clothes. Children who are hypersensitive to the vestibular stimuli most likely will not enjoy the car rides, while the children on the opposite side of the spectrum love the rides, swinging, walking on a beam (or couch armrest) and other unstable surfaces. Concerning the tummy time, if a child has a vestibular problem, they will probably not want to have their heads in a position towards the floor. If they have low muscle tone, they might have an issue holding their heads up or they might have a problem with their shoulder girdle.

Let me make this more clean with an example of a boy I worked with. He was 9 months old when he came to me and the reason his mom brought him was that he did not sit by himself. So, in our first meeting, I put the boy down on a mat and waited to see his spontaneous movements, reactions and motor skills. He did not want to turn to his tummy. I tried using the toys to get him to turn and stay like that, but he would immediately start to cry very intensely. Putting him into a side sitting position also scared him a bit and he would continue to cry. He didn’t even want to have his fists on the ground in front of himself. But, while he was on his back, he would hold a toy in his hands. After getting to know his motor skills, I took a look at his sensory profile since children until the age of 7 are very sensory oriented. I noticed this boy was hypersensitive to tactile stimuli on his fists and that was the reason he was not using the side sitting. The boy did not want to put his hands onto the floor which prevented him from getting and being in this position. Also, he did not want to have his head face the floor. While on the tummy or on all fours where head needs to be in that position tell us there might have been some vestibular difficulty. The vestibular system gives us information about the head position. When I realized what his sensory difficulties were, I started working with him on a swing – we would swing forward-backward as the linear swinging regulated him.This way we worked and played without any tears.

It is important to know what preceded some negative reaction your child had and look at the situation through sensory glasses. For example, if your child doesn’t like to get dressed and you only manage to put some clothes onto your baby while somebody is holding her or singing, take it as a clue that your baby needs more proprioceptive or auditory stimuli to get regulated. You can give your baby some deep pressures all around his body, especially the joints as if you were trying to reach their bones. Do not squeeze your baby or pinch or lightly caress, just give deep and relaxing pressure with your whole palm. Then, try to get your baby dressed. Any difference in his or her behavior now? If not, check if your baby has a preference in materials and textures or is she or he bothered by the etiquette on the clothes or if the clothes are too cold (after giving a warm bath, clothes can sometimes appear cold).

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Što se potencijalno krije iza bebinog negodovanja?

  • “Moja beba jako puno plače“.
  • “Moja beba ne želi jesti (krutu hranu)”.
  • “Moja beba se ne voli oblačiti“.
  • “Moju bebu je nemoguće uspavati“.
  • “Moja beba se ne voli voziti u autu”.
  • “Moja beba ne voli biti na trbuhu“.

Sve su to česti primjeri reakcija na osjetilne podražaje iz okoline. Da ukratko obrazložim; može biti mnogo razloga za bebin konstantni plač ili nemogućnost spavanja te bi trebalo pronaći uzorak u tome što prethodi tim radnjama: oblačenje, kupanje, hranjenje, izlazak na sunce itd. Može biti i odsutnost nekog podražaja. Na primjer: beba, odnosno dijete, neće moći zaspati dok ne dobije dovoljno proprioceptivnog podražaja (npr. čvrstog dodira na površinu cijelog tijela kao kada bebu nosimo u naručju). Djeca koja imaju problem oralne motorike i senzorike, teško će sisati majčino mlijeko ili bočicu ili žvakati krutu, pogotovo žilaviju hranu. Također, možda ih smeta intezivan miris hrane ili njena tekstura. Zatim, ako je beba taktilno preosjetljiva, plakat će za vrijeme skidanja i oblačenja te će ju možda smetati i etikete ili neki drugačiji materijali. Djeca koja su vestibularno preosjetljiva neće uživati ili se brzo i lako opustiti za vrijeme vožnje u autu, dok će djeca hiposenzitivna na vestibularni podražaj uživati u vožnjama, ljuljanju, hodanju po gredi (rukovatu od kauča), nestabilnim podlogama itd. Što se tiče boravka na trbuhu, ako je problem vestibularni, onda neka djeca neće htjeti imati glavu u položaju prema podu. Ako je problem niskog mišićnog tonusa, možda im je teško držati glavu gore ili ima možda problem ramenog obruča.

Primjer: Radila sam s jednim dječakom od 9 mjeseci koji je došao na pokazne vježbice jer još nije samostalno sjedio. Na prvom sastanku s njim, kada sam ga stavila na strunjaču i pričekala da vidim spontane kretnje, reakcije i motoriku, nikako se nije okretao na trbuh. Koristeći igračke pokušala sam ga motivirati na boravak na trbuhu, ali nije se htio niti okrenuti, a kamoli boraviti dulje. Odmah bi počeo intezivno plakati. Postavljanje u bočni sjed ga je također dosta plašio te bi i dalje dječak jako plakao. Ručice nije htio držati ispred sebe u bočnom sjedu, ali dok je bio na leđima, ipak bi držao igračku u rukama. Nakon upoznavanja njegove motorike, pogledala sam ga i kroz senzoričke naočale jer su djeca do sedme godine života izrazito senzorička bića. Ispitujući dječakovu senzoriku vidjela sam da dječak ima hipersenzitivno taktilno odstupanje na šakicama te je to razlog njegove nemogućnosti da samostalno zauzme bočni sjed. Jednostavno nije htio držati ručice na podlozi, što je neophodno za ovaj položaj. No, problem je bio i u položaju glave. Dok je na trbuhu i u četveronožnom položaju gdje glava treba gledati prema dolje, možda postoji i vestibularno odstupanje. Vestibularni sustav nam daje informaciju o položaju glave. Kada sam otkrila koja su njegova senzorna odstupanja, krenula sam izvoditi vježbice i položaje na ljuljački koju sam ljuljala naprijed – natrag (linerano ljuljanje) koje je dječaka organiziralo i reguliralo te smo na taj način bez suza postizali sve položaje.

Važno je otkriti što je prethodilo nekakvoj negativnoj reakciji Vašeg djeteta i pogledati situaciju kroz senzorna načela. Na primjer, ako se Vaše dijete ne voli oblačiti i jedino kada Vam to uspijeva je dok bebicu netko drži ili pjeva, uzmite to kao znak da bebici možda treba više proprioceptivnog ili auditivnog podražaja za regulaciju. Možete bebici priuštiti duboke pritiske po tijelu, pogotovo po zglobovima, kao da želite prodrijeti ispod kože do kosti. Nemojte bebu štipati ili lagano dodirivati, samo dajte smirene i duboke pritiske cijelim dlanom. Nakon toga pokušajte s oblačenjem. Ako to nije pomoglo, pogledajte što je još prethodilo plakanju. Ima li razlike u ponašanju s obzirom na različite materijale odjeće? Smeta li Vašu bebu etiketa na robici, temperatura odjeće (npr. iz tople kupke u hladan bodi).

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