What is A Sensory Diet?

                                                                         

A sensory diet is a carefully designed, personalised activity plan that provides sensory input to a child or adult who needs to stay focused and organised throughout the day (Occupational Therapist Patricia Wilbarger). It is developed by an Occupational Therapist specifically according to person’s sensory needs and abilities. It is developed to achieve particular goals considering child’s preferences, limitations, and available resources.

For example, a child having touch sensitivities will be given a sensory diet of activities which will have a calming effect since they support oversensitive children to decrease hypersensitivity towards sensory stimulation.Fast light- touch sensations increase arousal levels whereas slow sensations have calming effects (Schaaf and Roley, 2001).
Activities such as deep pressure massage, pushing-pulling, sucking hard candy or fruit, hand push-ups, rocking, swinging, running, obstacle courses are some of the generalised examples.

Heavy work (movement against resistance or weight) activities provide proprioceptive input. It helps to regulate arousal levels both the ways meaning in calming the child over-aroused child and stimulating the under-aroused child. 

Sensory Diet is similar to the nutritional diet of the human body. As food and water are basic requirements for body’s survival as well as functioning, similarly sensory diet is essential for reaching, maintaining and improving child’s ideal (optimal) level of alertness. The aim of sensory diet is to support the child in becoming more focused, organised, adaptable and skilful. It helps the child to perform a meaningful task in a successful manner.

A child with low arousal (under-aroused) levels needs alerting activities, whereas a child with high arousal (over-aroused) levels requires calming activities. Due to sensory reactivity or modulation issues, a child may have poor self-regulation and emotional regulation skills (Schaaf & Roley, 2001). Personalised sensory diet helps to improve attention span and concentration levels hence improving the quality of life and academic achievement.

According to the founder of Sensory Integration Approach, Dr A Jean Ayres (1972), the child should be actively engaged in activity or therapy session, and sensory experiences should be matched with a “just right” challenge that requires the child to give an adaptive response. For example, a child with hyperactivity and impulsivity can be given calming activities such as pushing the wheelbarrow or counted chair push ups as a movement break depending on his level of hyperactivity, age, and physique

                                                                  

Children with Autism, Attention Deficit Hyperactivity Disorder (ADHD), Developmental Coordination Disorder (DCD), Developmental Delay have difficulties in sensory integration and praxis deficits causing problems in reading writing, copying from the blackboard, listening and understanding instructions in the classroom. Minimal to moderate noise, an odour of different environmental objects, visual sensitivities towards fluorescent light are some of the examples that do not bother a typically developing child while working or sleeping. This happens since child’s body “tunes itself automatically” and gets adapted to environmental demands. However, in an atypically developing child “tuning” component does not work well, causing the child to struggle at each step and every moment since his body has to “tune itself manually” to get adapted to environmental demands.

Due to slow information processing, any instruction or command given will take the time to process the information and then respond. The child will answer correctly to what has been asked, however, it may take a little time and hence person has to be patient.


The purpose of the sensory diet is to provide sensory “tune ups” throughout the day so that child keeps on getting input needed for information processing correctly. The activities recommended in a plan should have long lasting effect on behaviour as diet is the group of alerting, organising and calming tasks.

The child with sensory integration dysfunction needs an individualised diet of tactile, vestibular, auditory and proprioceptive nourishment that means all the activities should be based on these three sensory systems. Careful planning is the key to perfect sensory diet.



  What is Sensory Integration?       

As first described by Ayres (1972), sensory integration is defined as “the organisation of sensory information for use” (p.1). It is a neurological process that enables us to make sense of our world by receiving, registering, modulating, organising, and interpreting information that comes to our brains from our senses.

Researchers and clinicians have explored many aspects of sensory integration in a variety of populations including typically developing children, children with learning disabilities, Autism, Aspergers, and attention deficit hyperactivity disorder (ADHD). 

Recently Ayres Sensory Integration© trademark denotes the adherence to the core principles of Ayres original theoretical framework. This copyright distinguishes it from other often applied clinical practices.  Mailloux, Roley, and Glennon (2007) have been working on Ayres Sensory Integration Fidelity tool which is correlated to trademark.

Occupational Therapist's Role in Planning Sensory Diet:

Sensory Diets are planned by Occupational Therapy practitioners who use sensory integration therapy for intervention purpose. They are mostly trained in Sensory Integration which enables them to work precisely with children and adults having mental health issues. Due to the better understanding of child’s sensory processing difficulties and requirements they can formulate reliable and achievable goals along with intervention strategies. All the activities are aimed at enhancing the child’s ability to participate in the day to day chores within the school, home and community.

                                                                   

Referral: Occupational therapist receives a referral from  GP,  SENCO/ head teacher depending on Borough as each borough has different systems.On getting the referral, OT  communicates to family and makes observations from SI point of view.
OT efforts to discover child's strengths and areas of weaknesses as he assesses sensory challenges (e.g.- touch, smell, vision, movement, hearing) and motor difficulties such as  poor body awareness, handwriting difficulties, right and left discrimination and then  plans  activities according to child’s needs and abilities on discussion with child, parents or caregivers following the client-centred approach.

Comprehensive Assessment : The assessment and information gathering involves taking histories, structured interviews. The main sensory integration assessment involves touch, movement, sight, hearing, smell, pressure, and taste. Along with these areas, behaviour, body awareness, motor coordination, learning in a classroom, attention, emotional liability is also assessed within different settings. 
Sensory Checklists: Occupational Therapists carry out clinical observations in structured and unstructured environments, follow sensory checklists and  use the standardised assessment tool called as Sensory Integration Praxis Test (SIPT), SPM, and Sensory Profile. The OT should be trained and certified to administer SIPT assessment.

Education: Educates child and family about sensory Diet plan and how it works.

Setting Goals and Outcome Identification: Therapist sets achievable, flexible and systematic goals for the child. He selects and schedules activities according to child’s abilities and deficits. Therapist set’s appropriate goals which are compatible with family’s beliefs, ethics and religion. They should work well within a family routine.

Activities Selection & Sensory Diet Planning: Activities are planned in correlation with goals. Mainly activities involving three sensory systems - tactile, vestibular, and proprioceptive are chosen since they are baseline systems for all behaviours. For example, child doesn’t like to be touched or hair washed, happens due to deficits in touch system, likes too much of movement or rocking happens due to deficits in vestibular system (sensory seekers), lacks body awareness, happens due to proprioceptive difficulties or is a picky eater happens due to oral hypersensitivities.So the activities are planned depending on sensory system deficits and careful planning is the key to sensory diet.

Follow-up: After a period of time therapist re-analyses effectiveness of intervention Plan. Activities are changed as the child able to accomplish the "just right" challenge. Activity modification and task gradation while measuring the outcome of the intervention is an important part of therapy plan. 

Video Description Credit: Unique Prints

                                                                     

Bridging the Gap: A Sensory Friendly Classroom

                                                 

A classroom is an important practice environment where pupils improve their learning skills and develops a better understanding of life and the community. They get equipped with education to follow their future dreams, however, interference of sensory processing difficulties can hinder a child’s learning abilities and self-esteem to a great extent. 

At the same time inclusion of child within the school brings opportunity for teachers and members of staff to support one more child in becoming independent to her maximal potential, though, it also brings unseen responsibilities on class teacher to understand child holistically from diverse perspectives which may or may not be the part of academic teaching and learning process.

As an Occupational Therapist in a special needs school, I realised that educating and supporting teachers along with other members of staff, regarding the inclusion of Sensory Smart classrooms and related strategies is an indispensable part of my job role.

Often, teachers welcome sensory strategies and sensory integration tools within their classroom settings, suggested by Occupational Therapist in the first place, however feeling themselves ill-equipped to understand the appropriate utilisation of sensory tools, the sensory intervention is discarded or evaded very soon, considering as a waste of time or not their area to work in.

It is imperative for an occupational therapist to reassure, assist and collaborate with teachers in designing sensory-friendly classrooms and implementing sensory strategies among children. Educating and supporting the whole staff regarding sensory environment will aid in developing knowledge for sensory needs and behaviours are often seen among Autistic, ADHD, and Sensory Processing Disorder (SPD) children.

Modifying tasks and classroom environment can make significant changes in child’s learning potential and behavioural patterns. The classroom affords enormous amounts of sensory stimulation and distractions which lead to “sensory overload”. 

Halogen lights, front wall decorations, much written information on the white board, cluttered desks and surroundings, background noise or poor acoustics, children moving around are some of the physical environment factors that don't allow the child to concentrate well and pay attention to task in hand. Taking too much of information within can lead to flight, fright and freeze reactions.
These strategies can be recommended by school’s Occupational Therapist according to child’s primacies and requirements. Sensory Diet which is a personalised activity strategy plays a pivotal role in child’s academic achievement, learning, and positive behaviour. It should be planned in collaboration with class teachers to achieve the potential outcome from the sensory diet plan.

A child’s future depends on team collaboration, effort, and coordination within a learning institute. It will be injustice with the pupil and the parents who establish their trust in school system believing that their child is in right hands and being armed with best quality education, environment, and social ethics to face the challenging world and live a

OT recommended strategies for Sensory-friendly classroom.

Sensory Box:

It is a large container having different sensory items in it. These items support a 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 resulting in increased self-esteem. For example, use of ear defenders helps to improve engagement and attention span on the task in hand within the classroom or home setting. 

It reduces various sources of auditory distractions (e.g., classroom noise, outside classroom voices, birds chirping, children shouting in the playground) that can be the potential threat to children as learning. 

These distractions will hardly bother anyone without Sensory difficulties, however, do have a great impact on the child with auditory hypersensitivity.

Sensory Diet:

It is a carefully designed, personalised activity plan that provides sensory input to a person needs to stay focused and organised throughout the day. It is developed by an Occupational Therapist specifically according to person’s sensory needs and abilities. It is developed to achieve particular goals considering child’s preferences, limitations and available resources. 

For example, a child having touch sensitivities will be given a sensory diet of activities having a calming effect such as deep pressure massage, heavy work, pushing-pulling, sucking frozen candy or fruit, hand push-ups, rocking, swinging, running, obstacle courses. Moreover, activities will be devised depending upon child’s choice and developmental age. 

Sensory Diet is similar to the nutritional diet of the human body. As food and water are basic requirements for body’s survival as well as functioning, likewise sensory diet is essential for reaching, maintaining and improving child’s ideal (optimal) level of alertness. The aim of sensory diet is to support the child in becoming more focused, organised, adaptable and skilful. It helps the child to perform a meaningful task in a successful manner.

Handwriting:

Children with handwriting difficulties should be given proprioceptive input

by utilising different positions, pen grip alternatives and related modifications. Here’s the link for handwriting strategies.

Homework Alternatives:

Provide homework printouts or give assignments in writing and not verbally. Most times it is better to post homework on school website so it is easier for parents and kids to understand the given assignments. Most of ADHD kids have difficulties in copying from whiteboard of blackboard due to distractibility and inattention to focus

Writing Slope:

• Supports inappropriate writing.
• Provides ergonomically correct posture, supporting hands and wrist.
• Positions reading and writing text inappropriately.
• Reduces strain on neck and shoulder muscles as a child leans forwards.
• Aids in writing and holding tools correctly.

Movement Break Activities:

• Star Jumps: These are good to involve whole body coordination.
  
• Animal Walks: Walking like bear, elephant will improve body sense
• Marching: This also involves coordination between both sides of the body, can be difficult. Initially start with feet marching, once mastered, then include arms.
• Play Hopscotch: This will give distance and space judgement
• Commando Crawling: Involving both hands and feet.
• Body Paint: Ask the child to paint his particular body parts such as a right-hand or left-hand index finger.
• Body Image: Ask a child to draw around his partner’s body on the large sheet and label body parts.

Colour coding:

It is best to colour code each and every subject and study material. For example, all maths folders, binders and handouts can be colour coded with red or green. Similarly, DT can be blue or yellow. This will help the child to organise and manage papers easily and conveniently. 

Moreover, it saves a lot of time and energy from being wasted which can be drained in locating one assignment sheet or revision paper. It is better to involve child when doing colour coding of the particular subject since he may have different perceptions about varying colours. 

Logically, colour coding gives visual stimulation and a clue to the brain regarding reference subjects.

                      

25 Tips for Sensory Smart Classrooms!

                                

                                   

    Classrooms need to be Multisensory for better learning!!

         

A.  Instructions should be simple, clear and short for the child to follow easily.

B.   Be precise and slow while giving instructions. One step at a time since brain’s information processing is slow.

Fidgets 

C.   Encourage the child to learn and practice the task. Practice! Practice! Practice makes a lot of difference.

D.  Keep Fidgets handy! They reduce anxiety levels in different environments and facilitate attention on a task in hand. Use of different magnetic balls, paper clips, blue tac, or mechanical pencils can work well too. Other common fidgets can be giant nut and bolt, key chains, fidgeting fleece bags, finger squeezers, tactile balls (koosh ball): Resource: 

E.   Let child do heavy work activities such as jumping, chair push-ups, wall push-ups, clearing cluttered desk,carrying the heavy bag.

F.   Give verbal instructions with visual demonstrations where ever possible. Showing child how to do activity is better than telling him about it. Demonstrate how to do the obstacle course and then let him perform.

Carrying heavy books has to calm effect

G.   Give extra time in the classroom to complete written work. Teachers need to have patience and calm!

H.  Remove visual distractions from the classroom. All wall decorations, notices should go on the back wall. Whiteboard should be clear (except when teaching!) with a date in the corner.

I.   Use colourful marker pens for teaching particular topic or concept.

J.   Child should sit near to teacher’s desk and in front of a classroom.

K.   Organise child’s desk, textbooks, supplies. Label different folders. This makes a lot of difference.

Supplies should be adequate

L.   Keep the supplies and textbooks in the good amount within a classroom.

M. Introduce and encourage calming music.

N.  Let child submit written assignments rather than hand written since handwriting can be illegible or messy.

O.  Labelling and Categorisation: Use sticky tags for labelling folders such as work done, work to be done, notices, to be read and other labels can be made according to requirements and relevance. It supports the child to distinguish and different folders and binders as well as subjects.

Sticky Notes for Organisation & Labelling

P.    Lighting: Use of Halogen lighting system is considered better than fluorescent lighting system in classrooms.

Q. Homework Print Outs: It is better to post homework on school website so it is easier for parents and kids to understand the given assignments.

R.   Visual Reminders: These can be in the form of picture posters, sticky notes, widgets or coloured writing on the board.

S.  Sensory Diet: A sensory diet is a carefully designed, personalised activity plan that provides sensory input to a person needs to stay focused and organised throughout the day (Occupational Therapist Patricia Wilbarger). It is developed by an Occupational Therapist specifically according to person’s sensory needs and abilities

Credit

T.   Movement Breaks: A child should be given a break for 2-3 minutes’ maximum. This for stress release and reassure that child can re-focus well on topic again. Doing deep Breathing or Stretching exercises can be beneficial. Going to an office to hand over paperwork is one example of movement break.

U.  Pencil Grips: Children respond well to pencil grips as it improves handwriting, legible and provides tactile-proprioceptive feedback. Resource: 

V.   Wobble Cushions: Good for ADHD kids especially. Keeps good posture and maintains focus.Resource:

W.                Ergonomics for Seating:

a.    While sitting on chair hips, knees, and ankle should be perpendicular to each other.

b.   Back should be straight and ninety-degree angle should form at an elbow.

c.    Wrists should be in resting position.

d.   Table and chair should have appropriate height.

e.   The seat back should be angled at 15 degrees.

f.    The child should lean forward with body weight supported by the floor with feet on the ground.

g.   Provide slanting desk or tilt table desktop for achieving ideal reading and writing angles for vision and spine.

h.   Elbow rests prevent straining of shoulders and neck muscles.

i.     Reading angle should be about 60 degrees from horizontal.

j.     Writing angle should be about 10-20 degrees.

X.  Introduce Theraband Stretching exercises or Deep Breathing as a part of Daily morning routine to concentrate well in a classroom.

Y.   Weighted Items: Use of appropriately weighted items should be done within the classroom on discussion with Occupational Therapist. Shoulder, Shoulder and neck weights, lap weights, wrist, ankle weights, snakey weights, weighted scarfs are weighted products for Calming down, reducing impulsivity, hyperactivity, and aggression. Resource