Occupational Therapy -with an SI approach

John is attending OT (occupational therapy) two times a week right now at Casa Colina Rehabilitation Hospital.  The therapists working with him are working with a SI (Sensory Integration) approach.  To understand this a bit more, I thought I would define SPD (Sensory Processing Disorder), the treatment, and how it all affects behavior, emotions, social skills, and motor skills.


What is SPD?
First, to understand SPD, we need to look at what Sensory Processing (sometimes called Sensory Integration) is all about.  According to the Sensory Processing Foundation, sensory processing is our nervous systems way of receiving messages from the senses and turning them into appropriate motor and behavioral responses.  If you touch something that is too hot, your nervous system interprets that touch and you react accordingly, realizing it is too hot.  If you hear something that is too soft, you are able to react by turning the volume up because the nervous system interpreted the sense of hearing and sent the message that the volume was too low. 

SPD, or sensory processing disorder, is when the signals do not get interpreted correctly and therefore, responses are not organized appropriately.  The brain receives the sensory information incorrectly and inappropriate responses in behavior, emotions, motor planning, social skills, etc. 

Some people with SPD may over-react to one of their senses, while others under-react.  Some people are bothered by textures, tags on their clothing, certain foods, loud noises, bright lights, etc.  Some people with SPD have poor posture, low motor planning, low muscle tone, appear klutzy, etc.  Others crave sensations in what appears to be "overdrive", where they can't seem to get enough of a particular texture, swinging on a swing, spinning in circles, etc.

MANY PEOPLE THAT HAVE SPD GET MISDIAGNOSED FOR OTHER PROBLEMS BECAUSE THE BEHAVIORAL, EMOTIONAL, SOCIAL, MOTOR PLANNING, ETC. ARE AFFECTED AND CAN APPEAR AS SOMETHING DIFFERENT.

There have often been times throughout our journey where I have wondered if the "at risk" for autism diganosis or the PDD-NOS diagnosis for John was really just SPD.   Children on the Autistic Spectrum have Sensory Processing problems, so oftentimes, both SPD and an Autistic disorder are present.  I hit a point a long time ago where the actual label didn't matter to me anymore.  I know what John's current needs are and I'm addressing those as they come up.  About 3 months ago, it was obvious that he needed OT above all other help.

OT with an SI (sensory Integration) approach is when an occupational therapist works with the child in a "sensory rich" environment in an OT gym.  The therapist will guide the child through play activities that challenges the child in areas where he/she need improvement.   For John, they are currently working on fine motor skills (buttoning buttons, writing, hand games), motor planning (using yoga positions to challenge him to manipulate his body to match a photo and hold position without falling, using obstacle course where he crawls through tunnels, climbs over obstacles, hits a baseball, kicks a soccer ball, bounces on a trampoline, jumps in a ball pit, swings on a trapeze bar, etc), stengthening posture by having him use his upper body more (this week they had him lying on his stomach on a skateboard and had to use his hands, arms, and upper body to move the skateboard through the bases of baseball).

John has a problem with organization in his brain.  There are days where he becomes over-stimulated through  the day and can no longer organize his body, his responses, etc.  There are times you will see him slumped over in a chair---standing facing the chair, with his head in the chair--- constantly moving to get comfortable or he might appear "tired" where he wants to be carried and slumps over ones shoulder like a young infant.   He sometimes throws his head back and shakes his head so his eyes move back and forth.  These are all signs that his brain is "disorganized" and he can't appropriately focus or react to what is going on around him.    Occupational Therapy teaches him how to regulate himself when he gets that way, as well as helps him learn everyday activities through play therapy.

Childhood Apraxia of Speech

Apraxia is a neurological disorder that results from poor motor planning.  Physical therapy, occupational therapy, or speech therapy can help kids with Apraxia.  Developmental Apraxia of speech interferes with the child's ability to produce different sounds needed for intelligible communication. 
 The child may know what he/she wants to say, but the area of the brain cannot "motor plan" appropriately to make the muscles of the jaw and mouth move appropriately to make the sounds.    Even when trying to correct them, the child cannot figure out how to make the correct syllables and sounds.  Some signs of apraxia include children who have very limited sounds they can make, intelligible speech that doesn't "clear up" with time, inconsistent speech errors, frustration with speech correction attempts, ability to say short words but can't string a series of words together, drops ending off of words, can imitate sounds better than plan them on their own, etc.

The information below is taken directly from www.aprakia-kids.org.

What is Childhood Apraxia of Speech?

Childhood Apraxia of Speech is a motor speech disorder. For reasons not yet fully understood, children with apraxia of speech have great difficulty planning and producing the precise, highly refined and specific series of movements of the tongue, lips, jaw and palate that are necessary for intelligible speech. Apraxia of speech is sometimes called verbal apraxia, developmental apraxia of speech, or verbal dyspraxia. No matter what name is used, the most important concept is the root word "praxis." Praxis means planned movement. To some degree or another, a child with the diagnosis of apraxia of speech has difficulty programming and planning speech movements. Apraxia of speech is a specific speech disorder.
The act of speech begins with an intention to communicate.  Next, an idea forms, outlining what the speaker wants to say.  The words for the desired message are put in the correct order, using the correct grammar.  Each of the words are comprised of a specific sequence of sounds (also called phonemes)and syllables that must be ordered together.  All of this information is translated from an idea and information about order of sounds into a series of highly coordinated motor movements of the lips, tongue, jaw, and soft palate. 
The brain must tell the muscles of these “articulators” the exact order and timing of movements so that the words in the message are properly articulated. Finally, the muscles must work properly with enough strength and muscle tone to perform the movements needed for speech.
In typically developing speech, children make word attempts and get feedback from others and from their own internal systems regarding how “well” the words they produced matched the ones that they wanted to produce.  Children use this information the next time they attempt the words and essentially are able to “learn from experience.”  Usually once syllables and words are spoken repeatedly, the speech motor act becomes automatic.  Speech motor plans and programs are stored in the brain and can be accessed effortlessly when they are needed.  Children with apraxia of speech have difficulty in this aspect of speech.  It is believed that children with CAS may not be able to form or access speech motor plans and programs or that these plans and programs are faulty for some reason.

How Is CAS Different Than A Speech Delay?

A true developmental delay of speech is when the child is following the "typical" path of childhood speech  development, although at a rate slower than normal. Usually this rate is in pace  with the child’s cognitive skills. In typical speech/language development, the child's receptive and expressive skills increase together to a large extent. What is often seen in a child with apraxia of speech is a wide gap between their receptive language abilities and expressive abilities. In other words, the child's ability to understand language (receptive ability) is broadly within normal limits, but his or her expressive speech is seriously deficient, absent, or severely unclear. This is an important factor and one indicator that the child may be experiencing more than "delayed" speech.  In the case of such a mismatch in skills, the child should be evaluated for the presence of a specific speech disorder such as apraxia. However, certain language disorders may also cause a similar pattern in a child. A gap between a child's expressive and receptive language ability is insufficient to diagnose apraxia.