Interview: Lona Otero-Nardone OTR/L on Sensory Integration Dysfunction
If you missed Tuesday's post, it featured the beginning of my interview with Lona Otero-Nardone, occupational therapist. Lona has been working in early intervention for over 8 years now and has become an excellent resource for her colleagues and clients on the topic of Sensory Integration Dysfunction (SID) in young children.
Today's segment is a continuation of the interview and will highlight an easy to understand list with effective strategies for parents and therapists to use when working with SID in young children.
Stephanie: Thank you for explaining sensory integration dysfunction. Let's continue on now and address ways in which parents and therapists can address sensory needs effectively with young children.
Lona: Much of the sensory integration activities and techniques that OTs use focus on the child being able to appropriately alert to, organize and respond to a variety of sensory stimuli so that he/she can function . There is no real "cookie cutter" recipe as each child and their response can be different.
Another thing I often tell a parent is that there is no "black and white" when it comes to SI, there is a whole lot of "gray area" and much trial and error. The effectiveness of treatment is based on watching how the child responds...Does he appear to attend or focus better? Are responses better organized and executed? Has distractibility or sensitivity diminished? Has desired or inappropriate behavior increased or decreased? These are just a few questions that I ask myself in order to tell whether or not the chosen method is working.
Many activities or techniques used in SI address three sensory systems: proprioceptive, vestibular and the tactile sense. These three systems are quite foundational to sensory processing. Difficulty in these areas often underlies or affects the other remaining sensory systems. They are also closely related and dependent upon one another. Therefore, most of the activities that I will provide when addressing sensory issues, deal with these three systems but can help all systems function more appropriately.
Here are some suggested activities to address sensory issues according to each system, but feel free to get creative with them modify as needed. You can also easily incorporate language/communication skills into many of these activities.
Proprioceptive: These activities are often considered to be calming and organizing and help to provide deep pressure input to the body.
- Allow for play that incorporates crawling, jumping or climbing. Create an obstacle course using tunnels, trampolines, pillows, etc. for child to maneuver through.
- Provide bean bag chair or weighted lap pad for sit down activities.
- Do push/pull activities such as vacuuming, shopping with cart, tug-a-war or a more resistive form of "Row- Row Your Boat" with partner.
- Provide deep pressure massage using lotions, vibration or brush (as tolerated).
- Have child perform activities such as coloring or puzzles while lying on belly.
- Incorporate rhythmical songs that include clapping, stomping or slow rocking.
- Have child roll up in a blanket (regular or weighted) like a hot dog.
- Allow child to "sandwich" themselves between pillows or bean bag chair. You can further provide deep pressure by pushing down on the outer surface.
- Provide great big bear hugs.
- Provide weighted or pressure vest (20 minutes on 20 minutes off or as instructed by OT).
- Have child do heavy work activities such as pushing in chair or carrying heavy object. This is especially helpful during transition times.
- Provide warm (calming) or cold (alerting) bath.
- Have child wheel barrow walk...if they are confident with this you can add objects for him/her to gather and put in container or play floor hockey using this position.
- Provide resistive materials to play with such as play doh, silly putty, kneading dough or pop beads.
- Bang rhythmically on therapy ball or drum - try altering patterns to see if they can imitate.
Vestibular: Always use caution with these activities, watch for changes in skin color, heart rate or breathing. Stop immediately if these occur. Never force a child if they are frightened.
- Provide swinging, which is always best if it is child directed. Slow linear swinging is calming, fast swinging is more alerting.
- Incorporate songs or games such as "Follow the Leader", "Simon Says", "Head Shoulders, Knees and Toes" or any other that requires changes in the position of the head.
- Do activities that require jumping, rolling or somersaults. (Avoid somersaults with those children whose joints are very lax such as those with Down syndrome.)
- Vary play by doing on scooter board, hippity-hop or ride-on toys.
- Bounce on trampoline or large therapy ball (seated).
- Do sit-ups or pull-ups.
Tactile: Never force a child to participate
- Provide weight bearing activities, brushing or deep pressure massage to hands/body prior to exploring and manipulating new materials to help decrease sensitivity.
- Play in tubs of beans, rice or macaroni, packaging noodles, etc. Hide items in materials for child to find.
- Play in textured materials such as pudding, shaving cream, play doh, finger paints, corn starch and water. If child is resistive, do not force, offer encouragement or try offering a tool with a long handle and gradually decrease size of handle until comfortable enough to manipulate with hands.
- Encourage child to participate in meal preparation...could be cookies, pizza, preparing dough, peanut butter and jelly sandwiches, fruit salad, you name it! Also encourage tasting the end product, especially for those who exhibit sensitivity in the mouth.
- Do daily brushing protocol as provided by trained OT.
- Provide alerting foods to increase attention and oral motor awareness ...crunchy, chewy, sweet or sour, pretzel sticks, Twizzlers, Gummy Bears etc. (always supervise and take caution of possible choking hazards). Can also provide chew tubes or similar items to further increase input and awareness.
- Can massage around mouth area with cloth or vibration. Can also massage inside mouth with Nuk, Toothette, Z-Vibe or toothbrush (usually best if child directed and made into a game). Using firm strokes helps to decrease sensitivity and increase body/oral motor awareness.
- Provide child with quiet spot, try to eliminate extraneous, loud or unpredictable noises.
- Provide child with headphones or ear muffs to increase ability to attend to task and filter out noise. Can upgrade or downgrade ear coverings according to thickness of covering.
- Provide rhythmical classical - type music in background.
- Experiment with different intonations and vary loudness to see what the child tolerates the most and responds to better.
- Provide auditory information combined with other sensory stimuli such as verbal or visual cues.
- Use less descriptive and straight forward sentences when asking questions or giving directions. Use fewer words but quite clearly.
- Provide activities that have a repetitive beat or pattern to help calm and to organize auditory information being received.
- Incorporate prorioceptive and vestibular activities as these are also foundational to the auditory sense.
- Provide area with limited visual distractions such as a tent, tunnel, an area with a screen divider or a corner of the room.
- Increase lighting to help alert, decrease/dim lighting to help calm.
- Experiment with different types of lighting and shades (amber lights, fluorescent lights, incandescent lights, black lights, etc) to see what the child tolerates the most and responds to better.
- Provide sunglasses and hat if sensitive to bright lights outdoors (can be indoors too, if necessary).
- Always use caution when using flashing lights. They should not be used with a child with a seizure disorder.
- Use reflective materials or tape to increase visual awareness and attention.
- Use higher contrasting materials or backgrounds to help increase visual attention ability to visually discriminate or determine background from foreground.
Gustatory and Olfactory:
- Gradually introduce new smells and tastes to those who are hypersensitive. The smaller the better. Increase amounts as tolerated.
- Combine new tastes or smells with more familiar accepted ones or use those that are very similar to one another.
- Provide child with activities that incorporate strong smells or tastes...baking and cooking, or making scented and/or edible play doh are always fun activities.
- Provide child with scratch and sniff stickers and books.
- Provide child with his own special box of materials that he/she can chew or mouth. Direct the child to the box when you see them inappropriately licking or mouthing. Thoroughly clean items daily.
Stephanie: This is really great information! I know that I will be able to use all you have provided in my weekly sessions. So, now, let's talk more about your other roles and responsibilities as an early intervention OT. Tell us about the most challenging part of your job, as well as the part you like the most.
Lona: This is an easy question because the most challenging part of my job is actually the part I like the most, which is dealing with a variety of families and environments. It is what drew me to early intervention (that and a love of children and knowing what a significant impact early development has on life long skills).
When you deal with families, you are dealing with a lot of individual differences that you must acclimate to, adapt and accommodate for. You are constantly adapting based on each child's needs, family goals, family structure, beliefs, culture, language, home, socio-economic status, etc. It definitely keeps you on your toes but is what makes this job more interesting, fulfilling and challenging!
As previously mentioned, when using activities that are rooted in sensory integration, it is imperative to continuously monitor the child's response and to evaluate the effectiveness of the strategies that you are using. I hope these suggestions are helpful and remember to have fun with it! The more fun, the more motivated a child can get.
Stephanie: The "fun factor" is definitely an aspect that you have mastered. I know because I have seen you in action and know how the parents and children love and appreciate the work you do!!
Join us next Tuesday for the third and final part of our interview. In that segment, Lona will discuss the Speech-OT relationship and how it can work to create a mutually beneficial therapeutic experience for both professionals and the children we treat.