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Developing a sense of well-being through adaptation
Today’s post was written by Stefanie Kruger, and first published on her website, Simply Senseable, after which she updated it for SAISI’s blog. Thank you Stefanie for reminding us to always look at the broader context!
This past year presented many events or situations that challenged our ability to adapt. The verb “adapt” can be defined as the ability to adjust someone (including oneself), or something to different conditions, a new environment; to fit, change or modify to suit a new or different purpose. In order to keep on growing and learning, we must be internally driven to actively participate in a purposeful activity, so that we can build on previous experience and gradually expand our skills repertoire and ability to adapt. Integration of sensations is critical so that we can react to the sensations from our bodies and environment in a meaningful way.
In her 1978 Eleanor Clarke Slagle Lecture, occupational therapy as a “science of adaptive responses” was proposed by Lorna Jean King. The adjustments made by an individual in the ongoing process of interacting with the environment were referred to as individual adaptation. Inherent in individual adaptation are adaptive responses, characterized by King as active, goal directed, integrated and self-reinforcing. The adaptive response is considered on a continuum of sequential and interdependent relationships to other human responses that serve an adaptive function. Authentic occupational therapy practice is concerned with eliciting an adaptive response, implying an action towards an external demand. King further suggested that Ayres’s phrase “eliciting an adaptive response” succinctly sums up what occupational therapists do (Kleinman and Bulkley, 1982).
Dr Jean Ayres was the first to recognize the role of sensory integrative processes in functional behaviour. She proposed that the manner in which a child’s central nervous system is able to process, integrate, and respond to sensation, influences the child’s cognitive, motor, emotional, regulatory, and adaptive behaviour. If the child’s integration of sensation is ineffective, the resulting responses are less than optimal, and may lead to a range of difficulties which may impact participation in daily life activities (Watling et.al., 2018).
In the context of occupational therapists with a special interest in Ayres Sensory Integration®, we are often dealing with terms and concepts such as adaptive responses and adaptive behaviour.
Ayres defined an adaptive response as an appropriate action in which an individual responds successfully or makes an adjustment to an environmental demand (Ayres 1979). It is a measure of the individual’s ability to cope with and successfully meet an environmental challenge (Roley et.al. 2001). The effectiveness of an adaptive response depends on the accuracy of our sensory perception and sensory feedback from our bodies. Adaptive responses imply that we are, or that we can do things, a little easier, better or more spontaneous than before. The tie between motivation and challenge is clear (Bundy and Lane 2020).
Ayres further added the term “adaptive behaviour” and differentiated between lower- and higher-level adaptive behaviours according to their complexity. A less complex adaptive response implies that the environment imposes itself on the individual. In a more complex adaptive behaviour, the individual initiates the interaction when he/she recognizes an invitation from the environment to act on it. Promotion of long-term adaptive behaviours leads to a healthy life due to the expanding repertoire of skills that enable people to achieve their goals in their own environment. Long-term goals leading to health through adaptive behaviours need to include assisting the individual to develop repertoires of nourishing occupations that help them maintain their optimal level of arousal, provide a sense of well-being and enable them to achieve their goals in society. Developing such a repertoire, the characteristics of the experience, the nature of the occupations and the temporal aspects of activities need to be considered. The characteristics of occupations that provide a sense of well-being include being enjoyable, intrinsically motivated and orientated towards the process, rather than the product should be considered. (Roley et.al. 2001)
In a therapy session, adaptive responses can be facilitated by means of creating the “just-right challenge”, not too easy, and not too difficult, bearing in mind the child’s unique level of skill (including strengths and vulnerable areas). The child has to exert some effort to get it right, in other words, a little out of their comfort zone. Some of the key issues in sensory integration therapy are that the child is in control as much as possible, the child is allowed to collaborate in activity choices during the course of a session, that activities are presented in the context of play and that there is a therapeutic alliance between the child and the therapist (Ayres 1972; Parham et al 2011). Shaping the just-right challenge can be difficult, as there may be some anxiety involved when having to perform a task at peak. Ayres indicated that these moments are “optimum-for-growth”. They allow a child to experience a sense of mastery over his/her environment, and are often embedded in moments of fun and moments of failure (Bundy and Lane 2020). An artful therapist has mastered the skill of finding the balance between when and how much support to give, and when to step back a little. Unlike in real life, a child in a therapy session is physically and emotionally safe to explore and make mistakes.
In life, individuals have to face challenges that are presented by their environment or people in their environment, without taking into considering each individual’s capabilities or emotional state, which can sometimes be a stretch too far. Some might be more effective than others, seeing that the environment in life is not necessarily adapted to suit the individual’s needs or skill level. However, an informed person can assist someone else in achieving success, and experiencing a sense of mastery over his/her environment by making subtle changes to an activity, breaking tasks down into smaller steps, or providing a little bit of support, until the individual (child or adult) can do things successfully on his/her own.
Adaptive responses can be observed on different levels (Smith Roley, Blanche and Schaaf 2001):
- Motor adaptive responses can easily be observed e.g. being able to hold on while swinging, or while being pulled/pushed, being able to maintain balance on a moving surface, being able to throw a ball into a basket, riding a bicycle over obstacles without falling off, being able to run and kick a ball, getting dressed independently, eating with utensils, or independent toilet routines.
- Organisation of behaviour in time and space can be observed when planning and packing for a holiday, or sports game the next day or the coming weekend.
- Emotional adaptive responses can be observed when someone is able to remain calm in a stressful situation. For a child it might be having fun without the presence of a primary caregiver at a playgroup or birthday party. For older children or adults, it might be coping with slightly less sleep, or dealing effectively with unpredictable change, or going to an unfamiliar place to do something without knowing exactly what is expected.
- Physiological adaptive responses can occur on an autonomic nervous system level which are not so easy to observe e.g. improved respiration and heart rates, digestive functions and sleep/wake cycles.
Remember that we all make mistakes, but we try to learn from them. Please reassure children that it is OK to make a mistake, things do not have to be perfect or work out perfectly the first time. Guide them through possible frustrations by finding alternative solutions so that they can approach something differently to achieve success. There is more than one way to do something.
An important achievement for each family is to just try our best everyday, taking one day at a time. Today’s best may not be the same as yesterday’s or tomorrow’s best, and that is OK. Participating in movement activities, getting some fresh air and vitamin D from the sunshine is wonderful for everyone.
When attempting new activities, remember that each child is different in terms of interests, age and skills, so we have to make sure that we present them with a challenge that is not too easy, nor too hard for them, but just right – so that they can exert some effort and achieve success. And ultimately, have fun!
References:
- Ayres AJ. Sensory integration and learning disorders: Western Psychological Services; 1972.
- Ayres AJ, Robbins J. Sensory integration and the child: Understanding hidden sensory challenges: Western Psychological Services; 2005.
- Bundy, A., and Lane, S.: Sensory integration theory and practice 3rd edition (FA Davis 2020)
- King LJ: Toward a science of adaptive responses-1978 Eleanor Clarke Slagle Lecture. Am J Occup Ther 32:42943/,1978
- Kleinman M., Bulkley B. (1982) Some Implications of a Science of Adaptive Responses. American Journal of Occupational Therapy January 1982 vol 36 nr 1.
- Mailloux, Z., & Miller-Kuhaneck, H. (2014). From the Desk of the Guest Editors—Evolution of a theory: How measurement has shaped Ayres Sensory Integration®. American Journal of Occupational Therapy, 68, 495–499. http://dx.doi.org/10.5014/ajot.2014.013656
- Occupational therapy practice framework: Domain and process (3rd edition). American Journal of Occupational Therapy. 2017; 68(Supplement_1): S1-S48.
- Parham, L. Diane, Roley, S. S., May-Benson, T. A., Koomar, J., Brett-Green, B., Burke, J. P., Cohn, E. S., Mailloux, Z., Miller, L. J. and Schaaf, R. C. (2011) Development of a Fidelity Measure for Research on the Effectiveness of the Ayres Sensory Integration Intervention American Journal of Occupational Therapy, 65, 134 – 142
- Schaaf RC, Mailloux Z. Clinician’s guide for implementing Ayres sensory integration: Promoting participation for children with autism. Bethesda: American occupational therapy association. linda. linneanet. fi/F. 2015.
- Schaaf, R. Smith Roley, S. (2006) Sensory Integration: Applying clinical reasoning to practice with diverse population. Psychorp.
- Smith Roley, E. Blanche, & R. Schaaf (2001), Understanding the Nature of Sensory Integration in Diverse Populations. USA: Therapy Skill Builders.
SASIC 4 Online Course – A SAISI First!
Thank you to Elize Janse van Rensburg for sharing your thoughts with us today! Elize is the vice chairperson of SAISI, lecturer on SASIC3, owner of a a private practice in Bloemfontein as well as co-founder of Built to Bloom.
The year 2020 has been a year of many firsts for SAISI – from supporting members through lockdown regulations, hosting webinars and taking the first steps in telehealth in occupational therapy/sensory integration in South Africa, to hosting the very first online treatment course. If there is one thing that this year has taught us, it is that where there is a will, there is a way! And a will there was to make SASIC4 happen despite the unpredictability that has become part of our daily realities.
Preparations for the first online treatment course started months ahead of time and the team put in a formidable effort. Preparations started with ensuring that SAISI’s courses would still align with the standards set by the International Council for Education in Ayres Sensory Integration (ICEASI) in an online teaching format. While ICEASI’s standards require face-to-face contact for treatment courses, some of the requirements were altered amidst the global COVID-19 pandemic. Additional mentorship was added, and all course participants will attend at least three hours of face-to-face mentoring with an ASI® trained therapist following the course.
The SASIC4 lecturing team worked tirelessly to review and revise lecturing material under the leadership of Carina Taylor. Since treatment demonstrations could not be done “live”, the wealth of treatment videos collected during SASIC4 courses over the last few years provided invaluable learning opportunities. Marié Greyling must be saluted for the hours, days, weeks, months of work that she put into reviewing, selecting and editing videos for the online course. These have made all the difference and was evident in the feedback received from participants. In the words of one participant: “Using pre-recorded videos was an absolute plus as we could revisit sessions and learn factors or reasoning as they paused and spoke over them.”
Preparations for the course also included sending physical course packs to participants consisting of course notes, worksheets for practical sessions, some treats from SAISI, and lovely gifts from various “virtual exhibitors”.
The lecturing team consisted of Annamarie van Jaarsveld as course leader, and Marié Greyling as co-lecturer. Learning from these two masters of the science was captivating and inspiring! Elize Janse van Rensburg supported the team as course coordinator, seeing to the technical aspects and ensuring that the lecturers were well nourished and hydrated at all times. And, as always, Aletta Kietzman was keeping it all together in the background, surprising the team and participants with a beautiful personalised landing page each morning with memories captured from the previous day.
Participants and lecturers alike were apprehensive about the online environment, internet connectivity problems, load shedding issues, and all the “tech gremlins” that could potentially hamper the course. However, the “tech gremlins” (mostly) stayed away, and there were only minor glitches with quick recovery time and no significant impact on the course itself – for which all parties involved were very grateful. But as the COVID-19 saying goes… “Zoom fatigue is real”! For more than forty peadiatric occupational therapists, who are collectively much more comfortable crawling around on munch mats or cocooning in a spandex swing, spending almost forty hours in front of a screen in one week was quite a challenge – physically and mentally (this also goes for the lecturing team!). On the other hand, for many being in the comfort of their own homes was a big advantage that aided in combating the “con’s” of the online course format.
The lecturing team worked together from Annamarie’s beautiful home in Bloemfontein. Visits from the local wildlife was a daily occurrence, and the “lecturing Zoom room” was one with a view which definitely helped to combat the Zoom fatigue. A big thank you to Annamarie for availing her house for the week. The lecturing team’s favourite session, however, was when they got to ‘play’ during the equipment practical on the Thursday afternoon. In the absence of children to demonstrate object affordances, Marié and Annamarie played their hearts out to make up for it. From hanging on to the bottom of a bolster swing, to playing with a “bilateral stocking bat”, it was indeed fun!
Feedback from the course was overwhelmingly positive and while many participants would have preferred a face-to-face course, the online format undoubtedly allowed for rich learning experiences. We take many lessons from this experience going forward, and we know that these lessons will help in SAISI’s continuous striving to doing it better every time!
Students adapt to their own COVID journey challenges
Today’s post is written by Karen Powell, private practitioner for infants, toddlers and children and SAISI board member.
“Life is neither static nor unchanging. With no individuality, there can be no change, no adaptation and, in an inherently changing world, any species unable to adapt is also doomed.”
― Jean M. Auel
While 2020 brought immeasurable change to the lives of health care practitioners, it could be argued that it brought even more to the lives of those on the cusp of completing their degrees. If the words “unprecedented” and “uncertain” were appropriate to be used in every news broadcast, then they were surely applicable to the students stuck at home who needed to complete their practical hours so that they could graduate at the end of the year.
Well necessity is the mother of all invention. And when the World Health Organisation (WHO) approved telehealth for use by occupational therapists as a result of the pandemic it opened the door for students to be trained in those same methods. After all, aren’t we preparing them for the real world, the one caught in a pandemic? Aren’t we training them to do what we do, and if we are able to assist families on a virtual platform, then they can too?
Under the guidance of Helga Lister and Stefanie Kruger, the University of Pretoria took on the challenge. As part of their community work hours, students would work under the supervision of therapists in private practice, treating children with a variety of diagnoses on virtual platforms.
I think it is fair to say that everyone was anxious and stressed. While some therapists and families were already quite well-versed in the telehealth processes, others were taking it on for the first time. There were so many things to consider, amongst others:
- Training of lecturers, therapists and students in new methods
- Accessibility to suitable platforms
- Connectivity, transfer speeds and access to data
- Coordinating the timetables of three or four individuals
- Finding quiet and private work space
- Limited access to resources
- Confidentiality and Non-disclosure Agreements
- Sharing of reports and videos
- Building therapeutic relationships over screens, and
- “Handling” children when you can’t use all the tricks you’re used to
There were also many new things to learn, including how to:
- Get and keep a child’s attention when you’re just a face on a screen
- Set up gross motor activities via “remote control”
- Handle printing and material costs
- Involve parents in the therapy, to be your hands on the other side, and
- Use what you’ve got available.
The students were up for the challenge. Thankfully, most of the therapists had been through various training webinars during lock down and had built up a big collection of resources that they were able to share with the students. The recorded SAISI telehealth webinars, as well as resources, activity suggestions and spreadsheets shared on the Whatsapp support groups proved invaluable. Therapists, lecturers and students also met via weekly webinars to train in the use of telehealth and discuss challenges, and a Whatsapp group for the therapists supported them along the way.
The students embarked on a 6-week long practical. Their sessions had to fit around outings to their community placements and they had to adjust to the programmes of the therapists and the children’s families. Not only that, but parents were also juggling changing return-to-school plans and their own work-from-home issues, sick family members and PUI’s in their companies.
Then enter another curveball: load-shedding. Always unpredictable, could be upgraded at any moment, always inconvenient. These students had to have back up activities, back up schedules and back-ups for their back-ups.
I think it’s fair to say that although in feedback they mentioned how stressful it was, they did not show it, always handling themselves professionally and overcoming obstacles with grace and maturity. The students were grateful for the opportunity, and for the most part feedback was upbeat and encouraging.
The first community block ended last week and I would like to commend all involved on a job well done. It struck me while completing the final work habits report that the COVID-19 crisis is not all negative. It has bred a new type of student – a more adaptable, flexible and throw-anything-at-me kind of professional. These young occupational therapists are going to fly through their community service years, knowing that nothing can stand in their way as they pursue their dream career.
“The measure of intelligence is the ability to change.”
― Albert Einstein
Locked Down in Level 5 with a Sensory Seeker
This week’s post was written by mental health OT and SAISI board member, Tharina Annandale.
Let me introduce you to my nine-year-old boy. He loves rugby and any form of rough play. He speaks loudly, likes to listen to loud music and never stops “running”. I always say that he started “running” at nine months. Yes, he started walking at nine months and hasn’t stopped “running” since, (or so it seems to a sensory sensitive mother).
He is a sensory seeker and does sports every day of the week. If he could play rugby every Saturday, he would be “in heaven”!
During the COVID-19 lock down my nine-year-old became unbelievably rebellious. Doing homework with him was such a nightmare. According to him, he “couldn’t do Maths without his friends”. I realized that he got his energy from social interaction and found it very frustrating to be limited by other people. He kept on verbalizing how angry he was with the headmaster of his school and even the president of the country! He was getting more and more irrational every day. I started wondering whether he did not have an anxiety disorder.
During the middle of lock down I had reached my limit. Having a sensory sensitive system and being in the presence of a sensory seeker, that did not want to leave my side or even allow me to attend virtual meetings, started to get to me. I realized that I had to do something, whether it was pushing the legal boundaries or not. The thing is, he was not satisfied with any craft activities and even started neglecting his pets. Although we have a large yard, he verbalized that he “was in a prison”. It was time for desperate measures!
I contacted someone that gave one-to-one horse riding lessons and I contacted his rugby coach. They both agreed to help him with an hour session a week. After two weeks his behaviour started getting better and even his school work improved. His participation in homework, knowing that he would go horse riding on Wednesdays and would play rugby on a Friday afternoons, made a huge difference in his and my life.
The value of activity can never be underestimated. Taking someone out of a constant social environment twice a week contributes to their mental health. Even to the mental health of the sensory sensitive mother the sensory seeking child!
Praxis and Rolling with the Corona-Coaster
I am very excited to share this week’s post, written by Stefanie Kruger. She had an exciting interview this week with Dr Teresa May-Benson. Happy reading!
A roller coaster ride is known for its speed, intensity of highs and lows, unexpected turns, and even elements like flames or splashing through a water tunnel, adding more fun to the adventure. It is described by the thrill seekers as exciting. They will go back for more, or look for even bigger and faster rides. Some might choose simply not to get on a roller coaster ride, and for others it will be their worst nightmare.
The past couple of months have been compared to a roller coaster ride by various people due to the prolonged impact of the COVID-19 pandemic. Depending on our individual preferences, perceptions, and ideas, we have all had different experiences of lock down, as well as the ever-changing rules and regulations. Some are taking one day at a time, while others are able to care for their families and even beyond,supporting their communities.
The dilemma with this metaphor, is that a typical roller coaster ride is confined to a specific context such as a theme park. People have the choice (i.e. sense of autonomy) to go on them or not. It has a definite beginning and end. The external elements are controlled. There is some kind of protection from falling off (e.g. seat belt), and there are safety precautions to prevent the coaster from derailing. We can see it, and can form some idea of what is to be expected and around which exact corners the sudden drops are.
The Corona Coaster
With the proverbial Corona-coaster, it is probably like going on a roller coaster ride with a blindfold, a huge unknown. The unexpected twists and turns intensify the sensory event, never mind the risks involved when the proper safety precautions aren’t implemented.We do not have control over the fear-provoking elements, and there are so many news reports and critics, that we are not sure whose version to believe and which facts are accurate.
Illustration by Mies Jacobs
Imagine “carrying on with life” on such a roller coaster… with the environment being controlled by external forces…
Despite our individual differences, the past couple of months have certainly challenged our ability to adapt and to establish some sense of balance. We have had to form new ideas about doing familiar things in a new way, like getting dressed, going to the shops or preparing a meal, doing work or school projects, maintaining relationships and regulating our sensory and emotional needs. There has also been a significant financial impact on businesses and families, and no one could really have been prepared for what lay ahead. We also had to deal with the disappointment of events that got cancelled and the emotional strain of constantly solving problems or making new plans. The parameters were very different and often hard to measure, and then we had to change them at least once, sometimes several times before a plan could be implemented. And only then could the effectiveness of the plan be determined.
As occupational therapists with a special interest in sensory integration, we are familiar with concepts such as praxis. We know how important it is to regulate a calm-alert state for optimal performance, or how to make environmental changes to facilitate success, to feel good and to have fun. When we think of the components of praxis such as ideation, motor planning, motor execution, feedback mechanisms, language and theory of mind,one particular name comes to mind. Dr Teresa May-Benson is a well-known and respected clinician, lecturer, researcher and author on Ayres Sensory Integration® theory and intervention.She has written numerous book chapters and articles on praxis, and completed her doctoral dissertation on ideational praxis (from https://www.sensoryintegration.org.uk/Teresa-May-Benson) .
We are very grateful that Dr Teresa May-Benson was willing to answer a few questions. Here are her thoughts on Praxis and Rolling with the Corona-Coaster:
Question 1: Why are we feeling so exhausted, or even disorganized at times? Is it because of the cognitive effort we have to put in to THINK about doing the things that ought to be automatic? Or the lack of control we have? Or the energy we put into constantly adapting and adjusting, doing everyday life activities in a new way, or even not being able to do these activities at all?
Dr Teresa May-Benson: I think you hit the nail on the head and it is really the combination of all these factors. First, our routines and schedules have been disrupted, so we have to put energy into developing new ways of doing things from deciding when to get up and go to bed to deciding what to wear for the day and how to structure our daily time schedule. This is exhausting. As you noted, the cognitive attention we have been, and many people still are putting, into these decisions can be overwhelming. These are things that should be fairly automatic for us.
The lack of control is also a huge factor, along with all the changing demands that brings. Literally what we can and cannot do has changed nearly daily over the past five months. Something as routine and simple as going to the grocery now takes constant re-evaluation…can you actually go out today or have the rules changed overnight? Can you go with someone, like a spouse or do you need to go alone? How long will it take? Are there long lines to wait in? The constant lack of being able to anticipate and control our futures certainly takes a toll. All of these activities place demands on our praxis and related organizational skills that we are used to being pretty easy at this point in our lives. Now we are having to put tons of energy into basic life activities that most of us have not had to worry about since we became adults. Add in all the additional changes caused by work disruption, job loss, kids home from school and resultant demands on parents for home school and it can be overwhelming for the most capable person, let along any of us with praxis issues.
Question 2: Our ability to form ideas, solve problems and apply our practic abilities is certainly challenged by our perceptions of this pandemic on our lives and environment. Is it accurate to say that the flip-side could also be true: that our emotions could have an impact on our ability to effectively deal with all the changes and to apply our practic knowledge and skills?
Dr Teresa May-Benson: Yes, absolutely. When we are in a high state of arousal, emotional or sensory, that state interferes with our ability to process and organize information. Thus, interfering with our ability to access the praxis skills we have. Think about what happens to your ability to safely drive a car when you are upset. So in this covid situation, our emotions are high…for many different reasons…which then makes accessing our praxis hard. And we have already said that the praxis demands have significantly increased. For many people, this resulted in just shutting down and not being able to do much of anything for a while.
Question 3: We acknowledge that there are individual differences, preferences and experiences in everything in life. However, many people are experiencing some sense of uncertainty, increased fear or anxiety. In your opinion, what are the factors contributing to our emotional vulnerability?
Dr Teresa May-Benson: As we have discussed, I believe there are a variety of reasons why many of us are experiencing such emotional vulnerability. We are afraid of becoming ill, potentially dying, or having loved ones around us become ill. The media constantly bombards us with terrifying and conflicting information so it is difficult to know what to believe. All this uncertainty increases our arousal and makes it hard to know how to act or to respond. Many people have responded by becoming very rigid, others are rebelling. The increased practice demands and cognitive load we all are living with adds to the challenge. I believe much of our current civil unrest is related to this underlying emotional uncertainty we are living with right now. Individuals are acting out in a way that is allowing them to feel powerful or in some kind of control.
Question 4: To what extent is there interaction between how we experience the quality of our daily occupations such as the satisfaction of good sleeping and eating habits,and the impact of prolonged exposure to stress hormones e.g. on our digestive system or our ability to pay attention?
Dr Teresa May-Benson: We all know that increased stress results in increased levels of cortisol. High cortisol levels are detrimental to sleep, eating and emotional well-being, as well as our general health condition. When stress is high, we do not experience a good quality of life and completion of daily occupations of all sorts is disrupted. You mentioned attention as well. This is important as high cortisol levels result in decreased attention. It facilitates our flight or fight responses and we are constantly on high alert. This high alert state diverts blood flow from our gut to our muscles for flight so we are often not hungry, contributing to poor mealtime routines. Sleep is similarly affected and when you do not sleep you will be even more vulnerable to stress.
Question 5: From your experience, what has been the most helpful in dealing with these challenges and changes, and what positive life lesson(s) have you learnt?
Dr Teresa May-Benson: Wow, that is a tough question. My family is in the middle of making a major life move in the midst of this pandemic so we are dealing with both the pandemic issues as well as issues related to our relocation and job changes. That makes it harder to separate out what is originating from where. I have found that getting enough sleep, whether that means taking naps, using sleep aids, sleep and relaxation strategies, etc. is critical. Establishing some kind of a schedule and new routines which may be very different than before. For instance, getting up no later than 8:00, getting dressed in real clothes by 9:00 and then to work. Having dedicated space for work and for home and keeping those occupation spaces separate as far as possible helps. I go into my office to work. My husband works at the kitchen table but goes into the living room for leisure. Allowing myself to have “off” days when I just cannot function and being OK with that has been important. Making family time and re-establishing family relationships. My family has actually started cooking dinner and eating together earlier in the evening. Find things that are enjoyable for you and be OK doing them. Read a book, listen to an audio track, meditate, do yoga, go for a walk. It all sounds so easy, but can be hard to implement. I put everything on my calendar, just as I did when I went into the office. It makes all the overwhelming things to do easier and keep track of when they are put in a time frame on a calendar you can refer to and follow. I guess the major life lesson I have learned is that life goes on. As hard as this time is for us, others have had it harder and they managed. We will too, we will get back to normal eventually and by then it will be a different normal because our life circumstances will have changed anyway. Break down tasks into small steps. Be ok with accomplishing small things. Be kind to yourself, give yourself the space to rest and be OK with not being 100%. Be kind to others, they are as stressed and overwhelmed as you are.
Concluding thought: For me personally, I have learnt to appreciate the small things, which are actually the big things. Life is like a camera, point it to the beautiful things. We have a choice what we focus on.
https://me.me/i/life-is-like-a-camera-a-simple-vieus-focus-on-20865517
Acknowledgement: Thank you to Dr Teresa May-Benson for sharing your valuable insights and perspectives. We appreciate your contribution.
Impressions from Dr A. Jean Ayres at 100
On 22 July SAISI hosted Dr Susanne Smith-Roley (indicated as SSR below), a scholar and mentee of Dr Ayres (JA), to celebrate her legacy on what would have been her 100th birthday. The interview was facilitated by Dr Annamarie van Jaarsveld (AvJ), Gina Rencken (GR) and Ray-Anne Cook (RAC). I would like to share some of the impressions from the evening. Please note that these quotes might not be word for word as Dr Ayres said them, but I hope to convey some of the wonderful insight we gained into her career, as a clinician and a mentor.
Dr Ayres as a clinician
Jean Ayres treated children out of a trailer before opening a clinic, and worked 5 1/2 days a week. She was pragmatic and frugal, using what she could find that was either free or re-usable. We see these values carried through in the community service years we do in South Africa today. Dr Ayres was also always very hands-on with her students, with them in therapy rather than in her office.
She modelled collaboration with the child, handing the locus of control to them, either to do something they couldn’t do, or thought they couldn’t do. She provided scaffolding: “Sometimes scaffolding means waiting, even if it’s excruciating, to give the child that internal locus of control” – SSR. “It requires of us to expect a little more, within their capacity.” “Scaffolding is the stepping stone to an adaptive response” – AvJ.
Dr Ayres was a firm believer in explaining Sensory Integration challenges to the child as well as the family. She believed that when you reframed the problem, the solution was different. She explained that the clinician had to believe that the child was always trying their best within their capacity.
Dr Ayres as the creator of new equipment
Dr Ayres had an art degree, and was an elegant seamstress, leading to her dreaming up and creating much of her own equipment. She would ask herself, “What could I make that would give this child…[e.g. inverted rotary vestibular input]?” She used to ride on the scooterboard for 20 minutes each day, and believed the platform swing was the most versatile piece of equipment, as it has so many affordances for praxis. She could bring the ropes closer together to make it more unstable, or place a piece of carpet on it for incidental tactile input. She constantly trying to increase the influence of gravity during her sessions, as she felt the otoliths were easier to target than the saccule.
SSR felt that if Dr Ayres were still with us, she would have loved the affordances of lycra and spandex, and the multiple ways that they can be used. SSR mentioned that her three favourite items are lycra, a square platform swing with a tyre, and a big foam wedge.
Dr Ayres as a mentor
Dr Ayres listened intently and was very sensitive to body language. She (JA) said “It takes every ounce of energy I have, to focus on everything I need to do, to do what I need to, for that child.” She helped the therapists under her supervision to pause, get quiet, and get out of the child’s way. She (JA) explained that children needed time to process, and that their therapists needed to give them that opportunity.
Dr Ayres motivated her students to pursue excellence in research, and tasked them to move forward to high level goals. Her graduates have gone on to continue her work in solid theoretical foundations, systematic data collection, publications and peer reviews. She planted seeds for them to nurture: giving lectures, publishing newsletters and establishing research divisions. She maintained that thorough testing was so important, as well as assuring access to adequate play spaces for all children. And she asserted the importance of Sensory Hygiene throughout the lifespan.
When asked “When should you start looking at Sensory Integration in the child?” she (JA) answered “At about 8 weeks gestation.” And when asked why, she replied, “Well, it takes a few weeks to figure out that you’re pregnant!”
There were so many “gems” throughout the webinar, and I hope that you will take the time to watch the full recording. SAISI would also like to extend our sincere appreciation to Dr Susanne Smith-Roley, for the way in which she has mentored, and continues to mentor, SAISI and its members over the years.
I would like to close with the following inspirational quote from Dr Ayres: “If you are willing to put in the work, the reward will be magnificent, because the children will change in front of your eyes”
Sensory Deprivation for the elderly in COVID times
By Sally Fraser-Mackenzie
Despite the fact that most of my work is based in SI and paediatrics, I’ve always had a strong passion for mental health and the elderly. I have been working closely with some elderly clients in the past few years. Through regular sessions, I have seen how gentle sensory integration can improve the quality of life in the elderly.
When the elderly are confined to their old age homes and have no relatives in town to take them out, their worlds become very small, limited and restricted. Gentle outings, such as a quiet drive looking at buildings or nature, and going down memory lane, can be so visually stimulating and an expansion of their day. A facilitated walk with a walking frame to a nearby coffee shop is the highlight of the month! A warm smile and a new activity can be enough for the day.
But what of COVID times? Many of my elderly clients have had extra lock down in their care homes, despite the easing of the Alert levels. They can’t manage smart phones and don’t have computers, so telehealth sessions are nearly impossible – unless a carer has a device and data, and is tech-savvy, and can be available to facilitate an appointment. Even then I have had a few instances of my clients falling asleep while I was talking to them on a video call, and no matter how I sang and danced, I couldn’t rouse them. Better sessions have included playing dominoes over a video call – “These are your dominoes, which one would you like to play?”, and memory games like Kim’s game which can be surprisingly effective. But despite all these efforts, my clients have deteriorated physically and mentally, becoming more sleepy, opting out of interactions, talking less, showing less interest and showing all the signs of depression. Their families are also struggling to communicate with them.
One old age home has claimed they will stay in lock down Level 5: no one allowed in or out, no walks around the block, relatives only allowed when they are on their death beds, for the next 2 years! Where does that leave an frail, elderly lady of 88 desperate to see her family? Well, it leaves me rather defiant, and determined to keep bringing her some quality of life, contact and smiles. But how? Between her carers and me, we have arranged illicit meetings on either side of the fence near the back compost heap! We sit about 4m apart, in a lovely patch of sunshine. I bring my camping chair, sometimes we both bring a cup of tea, and she smiles and chats a little. Despite the lack of contact and the big fence in between us, it works!
At another care home, I am permitted to see my client once a week briefly in the visiting bay through a Perspex screen where I can’t hear him very well, but it’s an outing for him in a way. He gets to go in his wheelchair up in the lift and to the conference room where the visiting bay is, which is something of a sensory expansion at least. The visitor’s bay is chilly, and I am almost sitting outside, while he is inside, so I usually dress warmly. Last week, I visited and they had double booked the visitors bay, so I was allowed right inside to his room. It was a cold day, and I had a spencer on, a top and my puffy jacket, and of course my mask. After multiple hand sanitizations, I had to then don a shield as well, a white synthetic coat with tight long sleeves and gloves. I was ushered into his warm room, and immediately started steaming up! I was completely overheating in all this but couldn’t take anything off, and we spent most of the session laughing at my claustrophobia, the steamed-up shield, and how crazy this all was!
Sensory Integration doesn’t have to be fancy paediatric equipment. It can also be the gentle world around us, the birds in the trees, fresh air or a breeze, the smell of roses and the movement of walking. These can be enough for our elderly, and through these difficult times, they are even being deprived of these, needing to stay shut in their rooms. My heart breaks for them as they have so little autonomy, little choice and minimal stimulation. As OT’s though, we can continue to be creative and inventive finding ways to overcome these barriers for the sake of the sanity of our elderly.
Back to work we go!
By Sally Fraser-Mackenzie
Post-COVID transitioning back to therapy
I’ve been back at work for 2 months and there have been the expected and necessary adjustments post-lockdown, and then other curve balls where I have had to make my own adaptive responses on the spur of the moment, which will be more interesting to read about!
Some of the expected changes that we have had to make include:
1) spending a small fortune on digital thermometers,
2) times between clients to spray and clean,
3) attendance and temperature registers set up,
4) writing up new COVID contracts pledging our commitment to a germ-free practice,
5) sanitizers,
6) cloths for each client to dry their hands,
7) clients being fearful and not coming,
8) clients being broke and unable to pay bills, and
9) a much more clutter-free practice with less surfaces to clean!
I put out a table with a basin of warm water for each client outside. We use all sorts of fun ways to wash when they arrive: kaleidofoam, glittery soap, squeezy foam soap that disappears after about 20 seconds, water toys, boats, and spraying activities. I’ve been presenting “cleaning” activities that serve my goals but are also fun on arrival. Then I spend the session keeping tabs on what’s been touched, putting away toys for a week that have been played with, and encouraging my clients to keep their masks on, often to no avail. During some vigorous somersaulting, a little boy’s mask slid over his eyes, and we both had a good chuckle!
The unexpected curve balls are interesting. A sibling of a client came to visit at the end of the session, then chaos reigned and everything got touched, played with, and I could no longer keep track. I needed to write the mom and dad a diplomatic email saying I understood that the sibling would so love to play, but during these times, I simply can’t allow it, and then listing the reasons. Of course, they were very understanding, but I still felt sad for that sibling.
Another little 4 year old girl arrived and took absolute fright at the thermometer gun. She even refused to let me take my own temperature. The new goal for her therapy suddenly became desensitizing this aspect of COVID, as she will be exposed to this when she goes back to school and at shops. We spent the next two sessions playing doctor-doctor with dolls, and in the end she loved taking their temperatures. We are still working on taking her own!
Previously angelic children are now more inclined to say “no” and show belligerence and refusal. They’ve been at home, watching screens and sometimes having either no or undivided attention from adults. So gently revisiting manners and boundaries is necessary.
Some of our clients (often with ASD or highly sensitive) are loving this new and gentle world. No insult to the senses, no other children rattling their cages, just quietly staying at home doing the odd zoom call. Academics can soar; individual time can be spent on aspects they struggle with; learning at their own pace suits them better. The prospect of returning to school has been hard and many parents are opting for home schooling in the future.
I will be looking for COVID-related stories for our SAISI Newsletter later in the year, so if you have any stories, or interesting case studies, please start documenting them and get in touch with me. We live and work in interesting times indeed!
Thank you Sally for sharing your experiences with us. Anyone who would like to contribute their stories to the newsletter please email saisi@uitweb.co.za. We’d love to hear from you!
Ode to the OT’s of 2020
Today’s blog post is a creative outlet. Maybe you identify with part of it. Maybe it inspires you to reflect on your own journey through this pandemic. May it give you hope!
It started off with disbelief.
We were sent home, to the quiet, the questions and the calm
It felt like an early holiday to some, to others – financial ruin.
Which side were you on?
Did you Netflix all day?
Did you bake bread, make jam, lounge at the pool?
Did your case load shift to hours of zoom?
Or did you spend your days anxiously cleaning every room?
Did the kids drive you crazy, with noise and incessant snacking?
Or were you alone, isolated, craving company and family?
Were you grateful for the extra time with your babies?
Were you panicked by interrupted meetings and daily changes?
A time of tons of new rules, regulations.
Face masks, and hand washing and sanitisation
Did you find a way to play via screen?
Read bedtime stories? Online magazines?
We’ve drafted consent forms and practice plans,
Opened windows, disinfected handles,
Packed away excess,
Covered with plastics,
Bought expensive thermometers,
Put up screening charts and posters,
Banned water bottles and shoes
And high-5’s, the list feels endless
Hours of cleaning to be able to welcome
Those precious little people we miss so much
Their smiles hidden behind visors and masks
Be safe! Don’t sneeze! Don’t touch!
What are they thinking? How do they feel?
Do they know it’s me? Are they keen to play?
Some eyes betray their childish confidence
Some seem oblivious,
Dive into the safe space they’ve missed
How will this affect them? What are we teaching them?
That the world is dangerous? That a cough can hurt them?
That hugs and kisses are only for family?
That being yourself, spontaneous, is potentially damaging?
For toddlers and preschoolers and older kids too
This monster steals away playtime, friends are few
What far-reaching consequences will affect their mental state?
What strange new normal can we try to mitigate?
Come on! We’re OT’s! Our toolboxes are HUGE.
We’ve got approaches and devices,
Webinars and mentors,
Skill sets,
Research bases,
Support systems in various places.
Adapting, being flexible is what we do best.
We’re advocates,
Frontline fighters,
Activists,
Programme writers.
Looking back, hindsight’s going to be 2020
We’ll acknowledge this year came with lessons aplenty.
Did you work through the discouragement?
Did you give yourself a breather?
Are you ready to come back
Stronger together?
An introduction to the legacy of Jean Ayres
You may or may not know that on 18 July 1920, Dr A. Jean Ayres was born, making 2020 what would have been her 100th birthday. As we gear up for celebrations in July 2020 and 2021, we take a look at some of the organisations, groups and congresses focused on continuing her work, ensuring her legacy and promoting education and research in the field. The following information has been taken from each organisation’s respective websites. You can click on each link to learn more, or join their Facebook pages/groups to stay up to date with their events. Many of the organisations have wonderful resources, as well as online learning opportunities during lock down. So here’s our list of “ASI’s”:
SAISI (South African Institute of Sensory Integration)
The South African Institute of Sensory Integration’s vision is to provide training and education in Ayres Sensory Integration® of an internationally accepted standard in order to provide a service of excellence to the ultimate benefit of the client. Our mission includes:
- To equip occupational therapists with basic as well as advanced up-to-date Ayres Sensory Integration® interpretation principles and treatment techniques.
- To promote awareness within the multi-disciplinary framework in order to play a leading role in the application of Ayres Sensory Integration® theory and practice in South Africa and in the rest of the world.
- To make Ayres Sensory Integration® accessible to the network of individuals (including caregivers, parents and teachers) involved in the context of the client.
ICEASI (International Council for Education in Ayres Sensory Integration®)
ICEASI came together in 2008 to both develop and safeguard the standards of education in Ayres Sensory Integration®. The members represent organisations with national profiles of providing training and education in Ayres Sensory Integration®. ICEASI meet every year around the European Congress of Sensory Integration (ESIC).
CLASI (The Collaborative for Leadership in Ayres Sensory Integration®)
CLASI provides innovative and customized partnership, scholarship, and mentorship opportunities for mastering, applying and advancing knowledge in Ayres Sensory Integration® (ASI) theory and practice in order to support and develop leaders, promote knowledge development, disseminate evidence-based information and facilitate learning and skills. Co-founded by first-generation students of Dr. A. Jean Ayres, CLASI is committed to following her tradition of excellence and research in practice. CLASI offers educational programs online and in more than a dozen countries around the world. Course materials are derived from Ayres’ original publications and subsequent research in basic and applied science related to sensation and the impact on human function. CLASI is a member of the International Council for Education in Ayres Sensory Integration (ICEASI) which provides global standards for education in ASI.
ASI-WISE (Ayres Sensory Integration – Wales, Ireland, Scotland, England)
ASI-WISE is a not-for-profit organisation established in 2017 to provide affordable, accessible hands-on education and CPD about Ayres’ Sensory Integration for occupational therapists, physiotherapists and speech and language therapists across the UK and Ireland. Kath Smith and Ros Urwin have led the development and application into older adolescent and adult/older adult clinical populations including trauma since 1999 in the United Kingdom, supporting and developing this awareness and teaching into Europe and further afield. Through the Sensory Project, ASI-WISE are building a community of support, mentoring and collaboration to equip and empower practitioners in Ayres’ Sensory Integration, enabling them to deliver the best possible, evidence-based therapeutic interventions to each individual.
SIGN (Sensory Integration Global Network)
In March 2004, during the yearly Research 2000 (R2K) conference series on sensory integration and related research, 20 people from North and South America, Asia, Africa, and Europe who are practicing and teaching Sensory Integration in the tradition of Dr. Ayres, gathered in California for an International Networking Meeting. At this meeting these individuals founded an organizational body to promote and protect Ayres’ theory and it’s applications in practice: the Sensory Integration Global Network (SIGN).
SIGN is made up of a group of volunteers who are dedicated to protecting the integrity and promoting the work of Dr. A. Jean Ayres in Sensory Integration Theory and Intervention. The originators of this group include former co-workers and students of Dr. Ayres, who are now among the leading experts in the field, and occupational therapists committed to providing occupational therapy services from a sensory integrative perspective in a manner consistent with Ayres’ core principles. In addition to the support of the Successor Trustee of Dr. Ayres’ estate, who now holds the trademark term Ayres Sensory Integration® (ASI), participation at the ground level has also included businesses who manufacture tests and equipment related to sensory integration.
ISIC (International Sensory Integration Congress)
The very first International Sensory Integration Congress was hosted by SAISI in Cape Town, South Africa and opened by SAISI’s own Dr Annemarie van Jaarsveld, a real research leader in the field. Twenty four countries were represented, and the latest research in ASI® was presented. In 2019, ISIC was hosted in Hong Kong, and a very special celebration was planned for Rodondo Beach, California for July 2020. ISIC 2020 had to be postponed unfortunately, due to the COVID-19 pandemic, but we look forward to the celebrations in 2021.
ESIC (European Sensory Integration Congress)
The European Sensory Integration Congress is an event that joins therapists and specialists from worldwide that are interested in sensory integration. The first meeting was held in a castle near Vienna in 2003, in a meeting titled “Sensory Integration Original – Today” and hosted 100 participants from 10 countries. SAISI was represented at the congress in 2013, 2014, 2015 and 2017. The 6th ESIC (2019) took place in Thessaloniki, Greece and we were proud that Shanna Louwrens represented South Africa in her presentation on SI profiles in children with cerebral palsy. Previous venues have included Algarve (Portugal), Naantali (Finland), Birmingham (United Kingdom), and Vienna (Austria).
As mentioned above, the year 2020 marks what would have been the 100 year birthday of Dr. A. Jean Ayres. In commemoration of this milestone, the following vision is proposed as part of the Ayres 2020 Vision:
Ayres Sensory Integration® will have a strong, international presence with demonstrated scholarship, means for valid, comprehensive assessment and pathways for training to ensure the ongoing development, standards of excellence and effective implementation of this important work.
The following goals have been established by the international community, in keeping with things that would have mattered to Dr. Ayres, aimed at achieving this vision:
1) Promoting Scholarship in ASI®: Dr. Ayres was committed to the scientific method in building her theory and ensuring ongoing evolution of this important work.
Goal: 100 papers that further the understanding and evidence for ASI®, will be published in peer reviewed journals (start date January 2013) (must reference or be consistent with Ayres Sensory Integration®)
2) Ensuring Effective Intervention through Comprehensive Assessment in ASI®: Dr. Ayres developed highly valid and reliable methods for evaluating comprehensive sensory integrative functions that have stood the test of time. We value these tests and encourage ongoing training in their use, as well as in theory and practice in ASI®. However, there is a need for a valid and reliable set of tests of key sensory motor functions that is accessible to therapists all over the world so that they can identify, understand and treat sensory integrative dysfunction.
Goal: a set of tests with demonstrated reliability and validity will be developed and internationally normed in 100 countries and made available at low or no cost.
Update: We are very excited about the International Normative Data Collection for the Evaluation of Ayres Sensory Integration (EASI) that is currently taking place. South Africa has made a great contribution, testing over 300 children for establishment of norms and diagnostic patterns.
3) Facilitating ongoing development and implementation of ASI®: Dr. Ayres mentored a generation of therapists, educators and researchers who have followed the road map she left for implementation of ASI®. It is time to ensure that leadership and pathways to excellence in the ASI® approach are in place for future generations.
Goal: Sensory integration training that includes clearly defined pathways for demonstrating competency in ASI® will be developed and available in 100 countries.
As you can see, Ayres Sensory Integration® has a worldwide presence, and there are many therapists and scholars dedicated to the continued study and furtherance of her work, as well as protection of the integrity of the name of Ayres Sensory Integration®.
Please join SAISI on 20 July 2020 for our Ayres 100th Birthday Celebration Bash, as we look back on the development of ASI®, and look forward to the future! More information can be found on our Events page soon.