In My Sensory Box!

                                                   

                                                  


A child with the Sensory Integration Dysfunction may find everyday experiences more challenging than any other typically developing a child. According to Dr A Jean Ayres, the founder of Sensory Integration theory, it is important to understand child’s needs and structure the environment accordingly since this process helps brain with poor processing to preserve stability and function properly.

Children with SI Dysfunction often display poor behaviour within the classroom and home setting. As per Dr Ayres theory, poor processing of brain leads to ineffective behaviour. She also concluded that SI dysfunction is not a disease that will get worse however, it impacts child’s life to a great extent. 

Children with SI Dysfunction may have learning difficulties and may often feel uncomfortable about themselves. It is difficult for them to cope with ordinary situations and can easily be stressed or anxious at home, classroom or public places.

Some issues like lack of focus within the classroom, handwriting difficulties, hyperactivity, impulsivity, inattentiveness, clumsiness, falling from chair frequently, difficulties in copying from blackboard are seen among SI dysfunction children within classrooms.

Sensory reactivity issues such as tactile defensiveness, sensory seeking behaviours (spinning, jumping, touching everything, not being able to sit still), disorganisation, sensitivity towards minimal noise, reading and writing difficulties, getting frequent headaches by end of day, are some of sensory issues that occur due to lack of brain’s registration and modulation.

To combat above stated sensory integrative difficulties and improve child’s focus within the classroom Occupational Therapists often set up sensory boxes having different sensory items that can be helpful for 

children.

 Items such as a weighted vest, lap weight, shoulder weight provides deep pressure to larger body part dampening the tactile defensiveness. Due to deep pressure proprioceptive receptors cause calming effect on body helping the child to stay focused within the classroom. Weighted items reduce the hyperactivity and impulsivity. Likewise, fidgets help the child to concentrate and reduce high levels of anxiety. 

 Concept Of Sensory Box

Sensory Box is a large container having different sensory items in it. These items support the child in being focused and engaged on given task, attentive and well-organised in his daily routine activities within the classroom.

This is a smart concept to simplify lives of everyone (pupil, teacher and parents) which involves utilising different sensory resources that support child’s self-regulation, learning, positive behaviour. These boxes help the child to provide sensory input needed to keep him alert, oriented and calm.

Weighted Items:

Shoulder and neck weights, lap weights, wrist, ankle weights, snakey weights,

weighted scarfs are weighted products for:

ü  Calming down child and works well to reduce anger, aggression

ü  Reducing impulsivity and hyperactivity

ü  Providing tactile-proprioceptive input, as the body gets consistent deep pressure.

ü  Supporting to stay focused on the task.

Pencil grips:

ü  Supports in improving handwriting legibility.

ü  Provides tactile-proprioceptive input. Resource

Sponge ball and other Fidget Toys:

ü  Stress Ball: Reduces anxiety levels in different environments such as a

classroom or shopping mall. Facilitates attention and concentration.

ü  Use of different magnetic balls can work as a fidget. They are quite handy and can be easily purchased from online retailers.

ü  Older kids can use paperclips, Blue Tac, or mechanical pencils. While sitting at a desk, manipulating, or linking paper clips together can work as the incentive in class.

ü  Doodling on paper is another way to keep oneself busy while focusing in the classroom.

ü  Making bracelets and fidgeting with that can be helpful too.

ü  Play -Doh can also work as fidget toy as it helps to improve hand strength too. 

ü  Other common fidgets can be giant nut and bolt, key chains, fidgeting fleece bags, finger squeezers, tactile balls (koosh ball), pencil Topper fidgets, sensory ruler.

Wobble Cushion and Wedge:

ü  Wobble cushion can be an important classroom tool for seating and focus.

ü  It provides tactile-proprioceptive input

ü  Encourages dynamic sitting which causes improved balance and postural control.

ü  Strengthens core body muscles and back pain.

ü  It improves the posture of child and reduces slouching

Weighted Vest:

ü  Provides Proprioceptive input and supports in calming down a child as the body gets consistent deep pressure.

ü  The steady application of pressure helps a child in reducing the self-stimulatory behaviour.

ü  Improves attention and concentration level.

ü  Reduces distractibility, impulsivity, meltdowns and emotional liability.

   Weighted Vest should be always prescribed by an OT as she is trained to understand how much weighted vest is needed by the child to provide just right amount of deep pressure depending on his age and level of sensory integrative difficulty.

Squease Jackets:

ü  Are inflatable vests meant for providing receiving deep pressure evenly across the torso

ü  They contain a hand pump which can be used for inflating and deflating the air pressure.

ü  Provides the amount of deep pressure suitable to child’s needs.

ü  Easy to wear and operate hand pump.

ü  Helps in self-regulation. Resource

Ear Defenders:

ü  Helps to reduce auditory sensitivities and distraction.

ü  Improves concentration within a classroom

ü  Reduces non-attending behaviour such as getting up frequently from the seat and moving around in the classroom, fidgeting.Resource

Writing Slope:

ü  Supports inappropriate writing.

ü  Provides ergonomically correct posture, supporting hands and wrist.

ü  Reduces strain on neck and shoulder muscles as the child leans forwards.

ü  Aids in writing and holding tools correctly.Resource 

Massage Roller:                                    

     

ü  Provides proprioceptive and tactile input

ü  Good source of relaxation.

ü  Quickly calms child.

ü  Can be used while studying or while listening to teacher’s instructions. Resource 

Timers:

ü  Good source of organisation. Timers assists the child in keeping a check on time while completing any written task in hand.

ü  Digital times: Assists child in reading hours, minutes, seconds and milliseconds.

ü  Sand times: This resource is used as better visual support for young children who get confused with numbers and have time reading difficulties. Resource 

Thera-bands and Stretchy Tubes:

ü  Provides stretch release to the whole body                 

ü  Provides sensory input to joints and ligaments (proprioceptive input).

ü  Helpful for movement break.

ü  Good resource of exercise. Resource

Chewy Tubes:

ü  Prevents thumb-sucking

ü  Has calming, focusing and organising response.

ü  Reduces anxiety levels

ü  Substitute for nail biting and chewing

ü  Substitute for oral stimulation and sensory input (kids putting crayons, fingers, pencils, sweatshirt, cloth strings)

ü  Reduces self-stimulating behaviours (hand flapping, rocking, spitting)

ü  Provides sensory input (tactile, proprioceptive) to mouth which has a calming effect.Resource 

Sensory Strategies for Handwriting Skills

                                                 
                                                          

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Lewis is a 5-year old child who has recently joined pre-school. According to his parents he is very active, energetic and friendly boy who likes running in ground, spinning, jumping, watching Doctor Who and talking to everyone. After working with Lewis for a week, his class teacher discovered some unique habits, characteristics and behaviours of him which were as follows:

• While sitting in his chair or writing he slouches without him knowing about it. Likes wandering in the classroom and “always on a go”. He cannot sit for more than 10-12 minutes in his place.
• Doesn’t like playing with Lego or construction toys.
• Easily distracted by background sounds or outside noise (e.g., bird chirping or vehicle passing by)
• Gets confused with letters and numbers while reading and writing
• He is right handed but often uses left hand to write.
• While writing he goes out of space without realising it.

When these observations were discussed with school OT, she strongly recommended him for Sensory Integration assessment as all above stated features were part of sensory difficulties which were interfering in his handwriting, self-care, fine motor skills and day to day activities.

Handwriting is an important functional task for school aged children and primary way to express thoughts, ideas and knowledge, and emotions. Composing stories, expressing own emotions, copying numbers, from the blackboard, completing school assignments, writing formal letters, or applications all needs precise handwriting skill. 

According to Case-smith (1992), children began to draw and scribble on paper as soon as they are able to grasp a writing tool. The development of writing process in early years includes scribbling, drawing lines and circles.

During 7-8 years they learn to use the different functional tool such as

knife and fork, scissors, pencils, zippers, buttons, brooms. They learn to plan and sequence actions which are the important part of motor planning. 

Developing ideas, for building blocks, construction toys, Legos, sand castles, are taken enthusiastically. All these experiences of childhood enable a developing brain to work efficiently and organise incoming sensory information received from different sense organs.

However, for an atypically growing child these opportunities and playful scenarios are sensory challenges. They may experience stress in the case in the course of the day to day tasks related to fine motor, gross motor and handwriting skills.

These children are reluctant to write, easily tired, seen slouching in their chair, their desk is often disorganised, may drop things in hand and may display behavioural issues due to frustration, the anger of not being able to accomplish tasks in hand and other sensory difficulties.

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!!

Proprioception:The Position Sense

Apart from five basic senses (vision, auditory, touch, olfactory and gustatory), we have three more hidden senses called as Proprioception, Interoception (recently discovered) and Vestibular Sense. 
The following discussion is about our proprioceptive sense and how it works in typical and atypical children.Awareness about one’s own body position happens due to this sixth sense is known as proprioception.

Proprioception is also called as “position sense” since it tells us, where we are we sitting, standing, lying or walking in relation to any object or surrounding. The word Proprioception comes from Latin word, “proprius” meaning “one’s own”. This sense supports a child to regulate their responsiveness to sensations. 

This sensation occurs when our muscles move or work.Consequences of poor proprioceptive functioning are the poor academic achievement, lack of self-care skills, difficulties in self-regulating emotions, attention and stress.

To know more about proprioception, let’s consider a simple example.

Suppose, you are blindfolded and asked to ascend and descend stairs you have never seen. Now your eyes do not have any experience or measurement of these stairs.The depth of every stair is unknown that can actually help your body to go up and down without falling or tripping. It is obvious that your balance will lose while doing this activity.

So what role does body play to protect you?

To be careful and protect you from falling, your hands will try to search and hold railing or any other external support. 
Your dominant foot will step forward slowly and attempt to judge how much is the height of the first stair so that you can climb the second step easily, with a swift movement. 
As you will climb further, your body will be confident enough to take steps confidently and instantaneously with controlled balance. 
Moreover, descending stairs will be easier for you now since the body can easily judge and feet can measure the steepness of staircase.

So how does this all happen?

This all happens because of our Proprioceptive sense! It is a hidden sense, that carries sensory information telling us about our own body’s movements and positions. It allows the brain to understand body's position, posture and place in relation to surroundings and other individuals.
Whether we are standing under the tree, over the bed, in the sand or on the top of the cliff, this unconscious awareness happens due to this sense.

Being able to walk in the dark room without losing balance control, typing without looking at the keyboard, driving a car without looking at brakes and other components, or performing ballet will not be possible without this sense.

This sense is the foundation for our body postures and actions. It makes us feel where are we sitting standing or lying in relation to our surrounding.

Consider, while sitting on the chair, how does our body know, where it has to sit? How much our knees need to bend according to chair’s height? Is chair comfortable or not?This all work is done by Proprioceptive sense.

It informs body about direction, velocity and force needed by one’s body

for doing any task. Finely graded movements, body coordination and body scheme are some of the areas that are affected due to lack of proprioception.Heavy work activities are calming for these children.

The functions of proprioception are to increase body awareness and contribute to motor control and motor planning (praxis). Children with poor proprioceptive sense have poor body awareness which causes difficulties in carrying out a gross motor and fine motor activities such as playing football, get dressed, zipping a jacket, buttoning a shirt or doing handwriting tasks.

Characteristics of poor prop (short form used by OTs) sense can be easily observed within the classroom or home setting among SPD (Sensory Processing Disorder) children such as, they would slap feet on ground while walking, or hold pencils too tightly to make a clear impression, or that the points break, there can be erasure holes on sheet producing messy work.

Unlike typical children, atypically developing children are not able to judge space around themselves. They might bump into other people or objects.  They may enter into other person’s intra-personal space which is considered weird and uncomfortable by most of the people. Such a child might be considered strange however reason behind this action is not his intentional bad behaviour but the lack of body awareness. 

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People's strange reactions cause anger,depression and emotional liability in the child since he is not doing all this deliberately or intentionally but indirectly trapped by his own body.

The perception of judging ordinary tasks such as the weight of a coffee mug, holding a pencil efficiently in order to write, poor balance while standing, tripping while walking, difficulties in planning actions are some of the examples of poor proprioception. 

Moreover, children with poor proprioception usually slip from their chairs while sitting in classrooms or other settings. These children have affected body positions and difficulties in organising their sensations therefore falling is usual. Providing Wobble cushion or wobble wedge provides combined tactile-proprioceptive input helping the child to sit appropriately. Moreover, it helps in preventing slouch and increases attention on the task. These resources can be purchased from different websites such as Amazon  at cheaper prices.

Other weighted items such as weighted vests or weighted lap pad provide calming effect on the child. They support child to stay in place and focus well

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on given task.

Other classroom activities to can be Brain Gym and yoga exercises to improve child’s focus in academics. Mediation has very calming and long lasting effect.

Sensory Diet designed by Occupational Therapist is essential to be incorporated in child’s schedule specifically to meet the needs of the individual's own nervous system.  Its purpose is to help the person become more focused, adaptable and skilful.  It is the combination of alerting and calming activities that helps in organising child’s behaviour and needs.

Home activities can include jumping on a trampoline, riding scooter or bicycle, participation in running, jumping, hopping activities, obstacle courses, sand play, hopscotch play, gymnastics, horse riding.

                                                                   

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