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.

                      

SUPPORTING A DYSPRAXIC CHILD

                                                

Our body’s ability to conceptualise (think), plan and execute a movement in the correct sequence is called as praxis. Learning a new task and following all its sequential steps happens due to our motor planning ability. It requires person’s attention to highest level.In simple the terms, Praxis is "Doing".

We can frequently see infants doing motor planning to achieve developmental milestones. A child perceives, holds, and explores a rattle at 7 months, mouths it at 8 months and bangs it on different surfaces (table, floor) to hear various sounds after achieving successful grasping skills. 
Here brain first learns to hold the spoon then to put it in to the mouth and later banging. All these tasks need attention. More child learns to move his or her body in different directions, better is the motor planning which all happens during foundation years.

Consider, when we try a new recipe for the first time, how much attention is needed to follow all steps. We are conscious about ingredients, water, salt, baking duration and all the other aspects to make the perfect dish. 

The way we react towards above process is called as praxis. Our brain is learning a new task, therefore, we need to pay more attention as compared to doing it for a second or third time.

Planning involves conscious attention, therefore, praxis is connected to analytical and logical functions.

Different daily chores that we perform without thinking much demand

a lot of attention during childhood learning phase. Putting on clothes, holding knife or spoon, making a cup of coffee, doing laces or ties, time-telling are some of the examples of tasks which a person learns in early years with much focus, concentration and practice, however, once understood and practiced it becomes a neural memory for future times. On repeated practice, this task becomes Motor Skill.

However, a child with poor praxis will have difficulties in processing information, formulating ideas to planning, and execute any task on his own. A child with consistent poor praxis may be diagnosed as be Dyspraxic.
Features like clumsiness, avoidance of motor activities, lethargic behaviour, difficulties in learning new tasks, poor balance and postural control are prominent in children with Dyspraxia. 

An occupational therapist plays a vital role in completing the full assessment and planning direct intervention strategies for the child to overcome functional difficulties in day to day activities such as self-care, handwriting, dressing, PE). Encouragement, supervision, and consistent practice are key to teach any tasks, such as tooth brushing. Following all the steps in a sequential manner is important for the child to learn this task.

Children with dyspraxia often display difficulties in figuring out and remembering how to carry out a task physically. They may face challenges while performing an activity having a number of steps. Putting together steps is tough for them. Often children with sensory issues involving proprioception, vestibular, tactile and visual sense display praxis inabilities. Proprioception sense contributes in balancing, postural control, motor planning, motor skills. Children with sensory modulation issues face challenges in performing simple and complex tasks.

Let’s contemplate an example of poor motor planning, during one of my OT sessions, I asked a pupil to take off his shoes and sit on the mat. 

I got engaged in other tasks and observed him from another corner of a room. He untied the laces with hit and trial method and then stopped. 

I asked, “you okay Andrew?”

He politely responded, “what do I need to do now?”

The poor little lad did not have had the idea, to how to take off his shoe from the foot. His brain couldn’t do the planning, sequencing and execution of actions at all. The "doing part" needed for untying laces, pulling off the shoe from feet, and standing was missing.

Climbing and descending stairs needs complex motor planning and children with poor skill show anxiety to use staircase or escalators. Fear of falling or tripping makes them avoid stairway. Doing practice on climber frames is one of the ways to reduce anxiety. Making staircase of different size mattresses can be safe, appropriate and fun ways.

RELATIONSHIP BETWEEN MOTOR PLANNING AND BRAIN'S FUNCTIONING

Our brain has body “maps” which carry information about every body part

and its relationship to each other.

These maps help’s person to feel how his own body feels like when vision is blocked. It also tells what it is doing without looking at different body parts. For example, scratching our back when it itches or wiping face when it has dirt on it. Our proprioception receptors update these body “maps” (precepts) which helps the brain in sending messages to needed body part for further actions.
In above, face wiping example, the brain sends messages to elbow so that specific muscles can contract and relax to bend elbow joint and hand can go up to face to clean the dirt. Related hand muscles also contract and relax.

In children with poor motor planning skills the relationship between body actions and these “maps” do not work well. Due to poor functioning of body percept, a brain is not able to plan actions leading to poor motor planning.

This is the reason children with Dyspraxia are disorganised, forgetful and clumsy. Their brain is not able to do motor planning causing them not being able to judge speed, weight rate, the direction of any object or task. 

Moreover, these maps also contain memories related to environment such as gravity. For example, while sitting on swing we know our upper body is on swing however legs are swinging. Another common example is while swimming whether our body is in deep or shallow water. In both the situations, body maps help the brain to plan the movements according to the state of the body.

In conclusion, it is essential to understand child's difficulty zone, create child-friendly strategies and provide sensory, playful opportunities which involve her imagination abilities, creativity and motor planning skills.

INTERVENTION STRATEGIES FOR DYSPRAXIA:

A. HANDWRITING STRATEGIES: -

Handwriting is an important functional task for school-aged children and the primary way to express thoughts, ideas and knowledge, and emotions.

Here are some significant handwriting strategies with proprioceptive input.

Hand strengthening activities:

·        Use hole punch

·        Make orange juice using a hand juicer

·        Playdoh activities such as pinching pulling, hiding items in playdoh, kneading

·        Finger extension and finger spread exercises.

·        Hand Exerciser

·        Ask the child to write on a vertical surface followed with a horizontal surface.

·        Wax pencil

·        Games like bed bug,operation can be useful for young children

·        Use clipboard while writing for stability or clip the paper to a desk.

·        If the child moves the whole arm, shoulder, and elbows while writing than practice while lying on the stomach.

·        Propelling pencil can be used if children apply too much of force while writing. This may break the lead but wouldn’t create holes in paper.

·        Vibrating Pen

·        Use non-slip mat under the book to prevent slipping of paper.

·        Use reading ruler if child is dyslexic to reduce visual stress and as reading tracker

·        Thick (fat) pencils can be used as they make holding and writing easier

·        Sitting Alterations: If child has poor posture which is difficult to improve, try following options: -

·        Allow child to sit on floor

·        Wobble cushion

·        Wobble wedge or Wedge Cushion

·        Bean bags

·        Workstations

·        T-stools: Should be prescribed by an OT as she knows how to make ergonomic changes and take measurements according to child's height and weight 

B. SELF-CARE STRATEGIES:

For the competent dressing skills at the age of 5-6 years onwards, a

reasonable sense of proprioception and body awareness are essential features along with an adequate sense of touch (tactile feedback).

It will be better to start with warm up exercises such as push- pull games, bouncing on the therapy ball, jumping on a trampoline, rolling on a mattress to increase sensory feedback.

Label child’s clothing drawer so that he can easily access clothes and garments.

Use large textured buttons for easier manipulations

Ask the child to see the mirror for visual feedback.

Place the clothes in a sequence night before school keeping garments on the top of other clothes.

Use bathroom checklists or visual checklists for ease.

Add a ring to zipper fastener so as to make it easier to grab hold of.

C. OT APPROVED GAMES FOR MOTOR PLANNING:

Go Fishing

The Twister Game

Fine MotorSkills Tricky Peg Tree Game

LearningMinds Mega Lacing Shapes Tub - 48 Pieces

Fine motor skills peg domino game

D. BALANCING ACTIVITES:

A child with Dyspraxia commonly display poor standing and walking balance as their sensory systems ae not supportive. Having inefficient proprioceptive, vestibular and visual systems can cause poor posture and balancing issues. Different activities such as walking, hopping, sidewalk, jumping, kicking a ball, running, dancing or riding a bike can be difficult tasks to carry out.

Activities:

• Obstacle Courses.
• Walking along a narrow beam or line marked on the ground – forwards, backward, sideways
• Walking on different surfaces such as grass, concrete, foam, mattress.
• Doing activities on balancing board or equilibrium board
• Walking in a straight line.
• Play hopscotch
• Walking on toes and on heel
• Follow a wriggly line – walk on the line or feet either side
• Tunnel Games: Crawling in the tunnel is a fun activity.
• Climbing Activities: Climbing frames, monkey bars, ladders, ropes or slopes.

                                                                   

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.