I plan to move into an adult practice during the next year. My husband and I are looking at a possible site for the clinic today. We will offer Interactive Metronome, Therapeutic Listening, Samonas Listening, psycho-therapy, and sensory integration therapy.
It is interesting for me to see and compare the difference in working with adults versus children. The poor folks who were sensory kids, but did not get therapy are now sensory adults who have self-adapted to the world around them and may still have a lot of difficulties in coping, adapting and interacting. The therapies that I use with children work with adults. The biggest problem is simply reducing the accumulated baggage that an adult has from years of dealing with physical, mental and sensory issues in the form of praxis, autism/Asperger's syndrome, and/or overall poor inter connectivity to the world and other people. Having access to psycho-therapy will help.
I am expecting to see fewer adult clients with autism than I do in my pediatric practice, but this will be offset by clients with traumatic brain disorder (TBI) and aging-related problems including stroke. I expect the same number of sensory-related issues and the issue of self-regulation will still play out strongly. For outcomes: those with auditory issues will be able to relax and be less volatile, those with vestibular issues will appear to be smarter and will probably act-out less. Those with social issues will lose fear of social situations and pay attention to social rules. Folks with TBI will find increased organization.
I'm not sure what to expect with teenagers. Probably a mixture of everything but stroke. And probably plenty of clients with autism.
My study of the adult parents of children with autism is near completion. There are still 2 post-tests to complete and then we can look at the results.
Sunday, June 22, 2008
Auditory Fight or Flight
A large number of my pediatric clients have auditory issues. For most, the noise of a cafeteria or gym is too much to handle and they are put into fight or flight movement with unexpected or loud noises. They have been known to scream, run and cry in response to everyday situations making them very unpopular with teachers. In addition, they may talk to themselves or make unusual noises (vocal tics for example) that drive classmates nuts. These poor children have a very hard time making and keeping friends.
These sensory kids may or may not have autism - and it seems that a lot of them are on a sort of continuum from "typical" to "high functioning autism". My first step is to give the children strategies to keep their cool. I recommend earplugs (with a pediatrician's approval), or headphones in noisy environments. There are chewy necklaces and pencil grips that can provide them with oral input and serve to limit the vocal tics. Then I discuss ways to self-calm using breathing and focus on breathing. With one bright child, I explained what fight or flight means and suggested that she provide herself with self talk by telling herself that she is safe and that her reaction to noise is just an over-reaction by her body.
These strategies help, but not all children can use them independently. My next stage of therapy is twofold - vestibular stimulation and a listening program. We have Therapeutic Listening at our clinic.
Vestibular Stimulation
Given that the vestibular and auditory "organs" are in close physical proximity, it is common for a child with auditory issues to have vestibular problems as well. I look for dizziness or fear, and treat it by finding the plane (lateral, vertical, horizontal) and type of movement (rotational, linear, stationary, head down, etc) that makes the child dizzy or fearful. I then acclimate the child to the difficult positions and types of movement by alternating them with safe movement (usually linear swinging). I count out loud so that the child knows when the movements will start and end. This helps to remove fear. I have them check themselves for dizziness, and report on progress. These types of vestibular problems usually heal in just a few 15-minute sessions. It is harder to accomplish with a child with moderate-severe autism because they may not pay attention to what I am telling them (or may not initially trust me) and so go into a state of fear. The trick with them is to go slow and back off if it looks like it's going to backfire.
Listening Program
I am still new to listening programs, but have seen progress with my kids and my colleague's clients, too. Therapeutic Listening (TL), as I mentioned in another post, has 4 classes of CDs: self regulation, time and space, praxis and connectivity (to the environment). I use the self-regulation CDs to help reduce the fight or flight response and the time and space CDs to help with correcting the auditory imbalance itself. After that, I move to the connectivity CDs to try and help re-integrate the child into his/her environment, with the hope that it'll help with social issues.
The self-regulation CDs appear to make a person more passive - which can be good or bad. I tried a week's worth myself and had a friend do so, too. We both became noticeably calmer, but more passive. I stopped standing up for myself. I certainly don't want that to happen with my clients. So, when I see that symptom, I move to a third stage - Interactive Metronome (IM). Perhaps not a full program, but certainly enough to break the passivity and induce a shot of confidence. With one client, I moved in and out of TL and IM in the hopes that he would find an easy place to settle. It appears to have worked and he is discharged. I'll check back in a few months to see if he is still doing well.
These sensory kids may or may not have autism - and it seems that a lot of them are on a sort of continuum from "typical" to "high functioning autism". My first step is to give the children strategies to keep their cool. I recommend earplugs (with a pediatrician's approval), or headphones in noisy environments. There are chewy necklaces and pencil grips that can provide them with oral input and serve to limit the vocal tics. Then I discuss ways to self-calm using breathing and focus on breathing. With one bright child, I explained what fight or flight means and suggested that she provide herself with self talk by telling herself that she is safe and that her reaction to noise is just an over-reaction by her body.
These strategies help, but not all children can use them independently. My next stage of therapy is twofold - vestibular stimulation and a listening program. We have Therapeutic Listening at our clinic.
Vestibular Stimulation
Given that the vestibular and auditory "organs" are in close physical proximity, it is common for a child with auditory issues to have vestibular problems as well. I look for dizziness or fear, and treat it by finding the plane (lateral, vertical, horizontal) and type of movement (rotational, linear, stationary, head down, etc) that makes the child dizzy or fearful. I then acclimate the child to the difficult positions and types of movement by alternating them with safe movement (usually linear swinging). I count out loud so that the child knows when the movements will start and end. This helps to remove fear. I have them check themselves for dizziness, and report on progress. These types of vestibular problems usually heal in just a few 15-minute sessions. It is harder to accomplish with a child with moderate-severe autism because they may not pay attention to what I am telling them (or may not initially trust me) and so go into a state of fear. The trick with them is to go slow and back off if it looks like it's going to backfire.
Listening Program
I am still new to listening programs, but have seen progress with my kids and my colleague's clients, too. Therapeutic Listening (TL), as I mentioned in another post, has 4 classes of CDs: self regulation, time and space, praxis and connectivity (to the environment). I use the self-regulation CDs to help reduce the fight or flight response and the time and space CDs to help with correcting the auditory imbalance itself. After that, I move to the connectivity CDs to try and help re-integrate the child into his/her environment, with the hope that it'll help with social issues.
The self-regulation CDs appear to make a person more passive - which can be good or bad. I tried a week's worth myself and had a friend do so, too. We both became noticeably calmer, but more passive. I stopped standing up for myself. I certainly don't want that to happen with my clients. So, when I see that symptom, I move to a third stage - Interactive Metronome (IM). Perhaps not a full program, but certainly enough to break the passivity and induce a shot of confidence. With one client, I moved in and out of TL and IM in the hopes that he would find an easy place to settle. It appears to have worked and he is discharged. I'll check back in a few months to see if he is still doing well.
Wednesday, June 18, 2008
Stay tuned
I have been incredibly busy the past few weeks - as all pediatric OTs certainly have been. I'll post updates and new material in the next several days and weeks. Lots to talk about!
T
T
Friday, May 16, 2008
Sensory Profile Score Gains
I had an opportunity to check gains in the sensory processing skills of a 7 year old girl who had undergone 6 months of SI. Her clinic-based OT consisted primarily of vestibular & tactile interventions was 1/2 hour weekly sessions with modulated music playing in the backgound. This was followed by 1/2 hour sessions with a music therapist. In addition, she received 6 weeks (so far) of Therapeutic Listening and a very good sensory diet program at her school.
She made significant gains in her parent's eyes and it also registered on the Sensory Profile (SP). She now accepts hugs from her family without tactile defensiveness (talk about huge!). On the SP, She gained 10 points overall (from 497 to 487). Her Touch Processing score moved from definite difference to probable difference and the Sedentary Factor moved from probable difference to typcial.
She made significant gains in her parent's eyes and it also registered on the Sensory Profile (SP). She now accepts hugs from her family without tactile defensiveness (talk about huge!). On the SP, She gained 10 points overall (from 497 to 487). Her Touch Processing score moved from definite difference to probable difference and the Sedentary Factor moved from probable difference to typcial.
Thursday, May 8, 2008
Tyler's Case Study
Here is an Interactive Metronome case study that I wrote up for IM. Thought I'd reproduce it here.
Tyler is an 11 year old boy with high functioning autism who attends regular education and special education classes. Before his IM program, he displayed low tone, poor motor planning, and poor attention and organization skills. He also demonstrated poor overall motivation. Tyler could not tie his shoes. He had difficulty playing the typical games of children his age that involved motor planning, rules and social interaction. Tyler had language skills but engaged in very little communication. For example, he did not acknowledge his mother when she asked him what he wanted to eat or requested that he clean up his toys.
His mother’s stated goals for Tyler’s IM program were improved organization and motivation skills. Tyler’s personal goal was to be able to compete with family members when they played Wii. The IM long form pre-test indicated average to severely-below-average scores for Tyler. He was given a four-week, 12-session program with adaptations for low tone in his lower extremity (therapy ball), tempo modification and use of the visual mode. He began with 800 repetitions and by the twelfth session was able to maintain 1800 repetitions that included 30 minutes of continued focus.
Initially, Tyler showed poor motivation and tried to find ways to take frequent breaks. Introduction of a therapy ball during an early session increased his overall compliance. After 3 sessions, he independently taught himself in the space of one day to tie shoes. He also began to learn new gross motor skills in the gym. More important, he began to demonstrate a noticeable sense of pride in his accomplishments and to work diligently in the program. After two weeks, his mother said he was acquiring better focus, as well as improved attention, memory and sense of responsibility. He also beat his brother in a game of Wii. After three weeks, his mother said, “I was blown away. I asked him to pick some things up, and he said, ‘Sure, Mom, I’ll get it in a few minutes.’” She went on to say, “He had never done that before!” Tyler completed the program with above-average scores. Four months later, his gains including his newly-developed reciprocal communication skills remained intact and are growing.
Tyler is an 11 year old boy with high functioning autism who attends regular education and special education classes. Before his IM program, he displayed low tone, poor motor planning, and poor attention and organization skills. He also demonstrated poor overall motivation. Tyler could not tie his shoes. He had difficulty playing the typical games of children his age that involved motor planning, rules and social interaction. Tyler had language skills but engaged in very little communication. For example, he did not acknowledge his mother when she asked him what he wanted to eat or requested that he clean up his toys.
His mother’s stated goals for Tyler’s IM program were improved organization and motivation skills. Tyler’s personal goal was to be able to compete with family members when they played Wii. The IM long form pre-test indicated average to severely-below-average scores for Tyler. He was given a four-week, 12-session program with adaptations for low tone in his lower extremity (therapy ball), tempo modification and use of the visual mode. He began with 800 repetitions and by the twelfth session was able to maintain 1800 repetitions that included 30 minutes of continued focus.
Initially, Tyler showed poor motivation and tried to find ways to take frequent breaks. Introduction of a therapy ball during an early session increased his overall compliance. After 3 sessions, he independently taught himself in the space of one day to tie shoes. He also began to learn new gross motor skills in the gym. More important, he began to demonstrate a noticeable sense of pride in his accomplishments and to work diligently in the program. After two weeks, his mother said he was acquiring better focus, as well as improved attention, memory and sense of responsibility. He also beat his brother in a game of Wii. After three weeks, his mother said, “I was blown away. I asked him to pick some things up, and he said, ‘Sure, Mom, I’ll get it in a few minutes.’” She went on to say, “He had never done that before!” Tyler completed the program with above-average scores. Four months later, his gains including his newly-developed reciprocal communication skills remained intact and are growing.
Monday, April 21, 2008
Getting IM Training
A reader of this blog wrote and asked about getting IM Training. Here is some info for those who are thinking about getting started.
There are 2 modes of training: Interactive (alone) and Workshop (in a group). As usual, there are tradeoffs.
If you have access to the IM equipment, then doing the interactive training is a great option. For $225 (or so), you are sent an excellent training manual with 12 lessons, each 30-90 minutes in length, of hands-on training. Most people complete the training in 4-6 weeks. The beauty of doing this is that you will experience the effects of using the product 2-3 times per week for several weeks. The OTs in my clinic found that doing our own course of IM helped us to get our own gears in sync and allowed us to move forward with projects. (For me, it was my blog.)
The workshop is very vaulable for the instructor contact. (I'm sure I missed a lot by not attending the workshop!) and you learn how to facilitate IM in just 48 hours. (And of course, you can then do your own hands-on training later).
Be aware that the IM equipment costs over $3,000. For that price you get hardware (that hooks to your computer), software, headphones, and hand and foot triggers. In addition to the initial equipment cost, the company charges about $6-8/hr for use of the system. You buy blocks of time from IM so that you can treat your clients. In fact, the real cost for a client's session is much less than $6-8, because the IM clock runs only during active clapping.
By the way, the trainees who purchase the Interactive course are given enough minutes to complete the course.
There are 2 modes of training: Interactive (alone) and Workshop (in a group). As usual, there are tradeoffs.
If you have access to the IM equipment, then doing the interactive training is a great option. For $225 (or so), you are sent an excellent training manual with 12 lessons, each 30-90 minutes in length, of hands-on training. Most people complete the training in 4-6 weeks. The beauty of doing this is that you will experience the effects of using the product 2-3 times per week for several weeks. The OTs in my clinic found that doing our own course of IM helped us to get our own gears in sync and allowed us to move forward with projects. (For me, it was my blog.)
The workshop is very vaulable for the instructor contact. (I'm sure I missed a lot by not attending the workshop!) and you learn how to facilitate IM in just 48 hours. (And of course, you can then do your own hands-on training later).
Be aware that the IM equipment costs over $3,000. For that price you get hardware (that hooks to your computer), software, headphones, and hand and foot triggers. In addition to the initial equipment cost, the company charges about $6-8/hr for use of the system. You buy blocks of time from IM so that you can treat your clients. In fact, the real cost for a client's session is much less than $6-8, because the IM clock runs only during active clapping.
By the way, the trainees who purchase the Interactive course are given enough minutes to complete the course.
Friday, April 18, 2008
More about Listening & Rhythm
I continue to be pleasantly surprised at the results of Therapeutic Listening (TL) in my practice. The kids get calmer, attention improves, meltdowns decrease and with that, comes real growth. One boy used the headphones for just 4 weeks, and then Interactive Metronome (IM) for another several weeks. Mom reports that he is calm (TL) and has confidence in himself (IM). I've noticed increaed postural control and motor planning, too. Unfortunately, not all children can use TL. Some children do not tolerate headphones or the music through them at all - whether this is due to actual hearing problems such as tinnitus (ringing in the ear) or perhaps a severe tactile issue isn't always clear with some of our non-verbal population.
Therapeutic Listening and Interactive Metronome have overlapping territory in the area of motor planning - although each product works in a unique way. There is rhythmic feedback with IM in which the person actively attempts to increase their rhythmic precision. (See my entry about this, or check out the IM site.) TL is a passive system in which the person receives modulated auditory stimulation through rhythm and music. The therapist can add active components to TL therapy in the form of sensory stimulation, play or exercise.
A third program I have checked into is Samonas. I'll devote a blog to this at some future date. It comes from Germany and is a very high quality listening program that would appeal to adults as well as to children. There are 5 levels of CDs offered. Levels 1-4 require direction from a trained therapist. An introductory set of CDs is available to the general public. The recorded music and nature sounds are gorgeous. I tried a level 1 CD for 15 minutes and felt some powerful broad effects that included auditory refinement, emotional release and energy. I was pleased with it. Samonas offers a series of Listening Programs for the general public specifically aimed at areas including emotional, social, communication, organization, motor planning, etc. The Samonas web site can be very confusing. You can find web-based training programs for professionals at this location. They will be offering live training classes in the fall in New York and Florida. I'll write more when I get the details.
Therapeutic Listening and Interactive Metronome have overlapping territory in the area of motor planning - although each product works in a unique way. There is rhythmic feedback with IM in which the person actively attempts to increase their rhythmic precision. (See my entry about this, or check out the IM site.) TL is a passive system in which the person receives modulated auditory stimulation through rhythm and music. The therapist can add active components to TL therapy in the form of sensory stimulation, play or exercise.
A third program I have checked into is Samonas. I'll devote a blog to this at some future date. It comes from Germany and is a very high quality listening program that would appeal to adults as well as to children. There are 5 levels of CDs offered. Levels 1-4 require direction from a trained therapist. An introductory set of CDs is available to the general public. The recorded music and nature sounds are gorgeous. I tried a level 1 CD for 15 minutes and felt some powerful broad effects that included auditory refinement, emotional release and energy. I was pleased with it. Samonas offers a series of Listening Programs for the general public specifically aimed at areas including emotional, social, communication, organization, motor planning, etc. The Samonas web site can be very confusing. You can find web-based training programs for professionals at this location. They will be offering live training classes in the fall in New York and Florida. I'll write more when I get the details.
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