Friday, 29 April 2016

Deep Pressure: Magic of Weighted Blanket!





                                                     
                                                  


John diagnosed Autistic at age of 6 years got admission in special needs school for progressive future. His parents did not inform school staff much about his maladaptive behaviours except being picky eater, impulsive and having tactile defensiveness. On first day to his school, he was introduced to classmates and support assistant (Ms. Johnson) by his class teacher (Ms. Winslet). As the day progressed, John seemed calm and settling within the classroom surrounded by some new friends.

During the lunch-time, Ms. Winslet told him about rules of eating in classroom and ensured that he is doing fine.  John without making any eye contact heard everything and absorbed all in (taking in too much information from new environment,resulting in sensory overloading) while eating his sandwich and nodded head.
All of a sudden, after fraction of seconds, everyone heard John shouting, being physically aggressive on child sitting next to him and crying without listening to anyone. He also bitten the support assistant who tried to stop him from hitting. Due to extreme kicking, hitting, pushing and biting behaviour (physical violence) he was restrained by two male staff members.

School OT intervened and he was taken to therapy room where she wrapped John in a weighted blanket (deep firm pressure) and rolled on floor until he calmed down.

Later, this little man mentioned that he got angry because child sitting next to him was eating crisps and making noise, that John didn’t like!!

Phew!! so, now we know why John behaved in such a manner.

Well, but what happened when he was wrapped in a weighted blanket? How so much angry young man (who needed male staff for restraining) calmed down so easily? Why didn’t he resist to weighted blanket?

This happened due to MAGIC of DEEP PRESSURE!!

   

Deep Pressure is a form of sensory input (touch) which involves hugging, stroking, squeezing and kissing. It is being used in therapeutic practice with the assumption, that it influences arousal regulation and sensory modulation.

It has been found to be effective means for calming down child or adult in any setting. According to Sensory Integration theory, deep pressure stimulates higher brain centres which results in sensory processing and sensory modulation of sensory information received through different senses (eyes, nose, ear, touch, movement) causing calming effects.

Temple Grandin has been the most outspoken advocate for using deep touch pressure to soothe special needs children, college students and animals. She devised a Squeeze Machine (Hug Machine), a deep pressure device to calm down hypersensitive individuals with Autism Spectrum Disorder. The machine was used to reduce significant amount tension and small decrease in anxiety as reported by American Journal of Occupational Therapy.

Commonly, children with sensory issues (ADHD, Autism or Sensory Processing Disorder) display difficulties with arousal regulation and sensory modulation due to which they are referred to OT clinicians.

Many OT colleagues have observed that children respond very positively to weighted items such as weighted vests, lap weights, shoulder weights and weighted blankets used at home and school settings.Their maladaptive behaviours reduce, attention span on given task improves, significant decrease in impulsivity as well as hyperactivity can be observed on consistent use of appropriate weighted items.

The best part is, that children are never reluctant to put on these weighted material in classroom setting since it gives instant calming effect if worn correctly and of appropriate weight. 

The tactile-proprioceptive input facilitates better concentration, organisational skills and appropriate engagement in social-emotional situations. Most importantly it works very well among aggressive kids too!!


Let's discuss weighted blanket in detail for better understanding!

Weighted blankets are non-invasive, non-pharmacological and convenient
mode of sensory strategy that is very beneficial for children and adults. 

Study done by Paul Gringras et.al (July, 2014) concluded that children and parents preferred weighted blanket over non-weighted blanket at night time. Parents reported that their child’s behaviour was much calmer and improved within a short periods of time.

Anecdotal reports from the some of the suppliers of weighted items suggests that weighed vests improves body position and awareness, balance, coordination, reflux maturity, spatial perception skills, fine motor and gross motor skills.

Pressure received through weighted items such as vest, blanket or ankle weights is found to be effective in supporting children achieve “just the right state” of being calm and alert.

The “prescription” or recommendation of weighted blanket is always made by qualified Occupational Therapist for an individual. She makes the complete evaluation of child and decides whether weighted material will help child or not along with appropriate weight needed and duration of wearing the vest or other item.

Basic Information regarding Weighted Blanket & other weighted Items:

  • Blanket’s weight should not be too heavy or light when purchased or made by hand at home.
  • Weight should be evenly distributed throughout the fabric so as to provide tactile stimulation and proprioceptive feedback across the body.
  • Weighted stuffed animals, dolls and other modalities are also available in market for little ones and toddlers.
  • Make sure that weighted item is washed properly at frequent intervals to stop infection issues.
  • Some people use it in state of crisis (as in case of John) whereas some people use it as Prevention. Most times parents are aware when and where their child can have sensory difficulties, anxieties or meltdowns. So using weighted item before situation goes out of control can lead to smart parenting as well as prevention or delay of bad behaviour.
  • The blanket should be more than 10% of person’s body (mass) weight for effective calming and relaxation. Too much weight can be dangerous and even fatal, so make sure it is 10% of person’s body weight. Olsen and Moulton (2004) conducted a survey of school-based occupational therapists using weighted vests. According to some of therapists 2% to 10% of child’s body weight was sufficient enough to be worn. The duration of wearing vest varied from 10 minutes to 45 minutes..
  • For every child weight of weighted blanket is different and which has to be adapted depending upon child’s sensitivities and type of input more needed (tactile, proprioceptive).

Health and safety concerns:

According to Autism Society, Canada (2008) certain ground rules have been written that should be respected. These are as follows:
  • It is MUST to involve healthcare professional and ensure, whether weighted item is suitable for child to wear or not. Consultation from Occupational Therapist is important to obtain.
  • Child should be willing to wear vest, belt, blanket or any weighted item before applying this sensory strategy. His/her consent is must.
  • Child should easily come in and out of blanket without any hassles.
  • Child should always be SUPERVISED while using any weighted item by an adult.
  • Rolling the child in blanket should be done under therapist’s supervision only.
  • Keep a check of vital signs while using blanket.
  • Child’s head should never be or be able to be covered in blanket.
  • Blanket should always be in proportion with child’s height and weight.