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A new perspective

Today’s blog post was written by Lara Mather, who is currently busy with her Ayres Sensory Integration training courses through SAISI.

In honour of Autism Awareness Month

To all my beautiful children on the spectrum, thank you for teaching me that in order to gain an understanding, we must change our perspective.

 

“I wish things were different”

Don’t you ever say that

I’ve been given the greatest gift

A lens into unique interpretation

A different kind of connection.

A brief glance, a side smile or an almost undetectable touch

 

When I looked at you, feeling helpless, I realized

It felt like more than I could handle

When you appeared inconsolable and shut me out

I felt an overwhelming panic and despair set in

 

When people said that your behavior should be punishable

I ignored their advice

To create a safe space that supports your needs

To let you be you.

 

This was the biggest lesson I needed to learn

Understanding you

Was my greatest challenge

Accepting that our worlds look very different

I am still learning

Although I don’t think I am,

 

(now change your perspective and read it backwards)

I’m stuck! A case reflection on dyspraxia

Today’s blog post was written by Liani Austin, an ASI practitioner in a school-based practice in Pretoria and mom to two beautiful children.

“I am stuck” he said in a voice filled with panic. He desperately shook his leg, which resulted in him losing his balance. As if in slow motion his arm shot out, but it took a few split seconds too long and he missed the edge of the ball pit. Instead, his arm flailed next to his body and he ended up on his side, slowly sliding down the ramp, like a blob of jelly sliding off a spoon. “I am fine!” he bravely announced and got back up, his gaze diverted.

Well and truly stuck

I had lost him. Instead of trying to climb back into the ball pit, which he was so excited for, he stepped up onto a low structure, held onto the suspended rope in front of him and proclaimed that he was going to swing down. Full of confidence. Just like a superhero. Except, and I could see it coming, he wasn’t going to be able to swing like a superhero. You see, his hands were too low down on the rope and he was standing too far back on the structure. I remained muted while holding my breath. He moved his trunk, initiating movement, and flung his podgy little body forwards in full force. He had failed. Again. Just like every other day. Over and over again.

This is Johnny and he has dyspraxia. He is unaware of it, his teachers definitely have no idea and neither do his concerned parents.

Johnny is a bright boy who desperately wants to play with his peers, but his body won’t keep up. As his friends run with speed, he is simply too slow. As they climb up high onto the jungle gym, he lacks their agility. By the time he has figured out how to navigate climbing up the side ladder, they are already down again. I guess you can call him a loner. At break time, he tends to play on his own. Quietly. Lonely. Invisible.

At home, Johnny prefers flopping down onto the couch and his parents are becoming increasingly concerned about his apparent addiction to television. You see, watching TV doesn’t demand much at all. His body and neurological system can take a break after his challenging day at school. Johnny once overheard his granny telling his grandpa that his parents baby him far too much. But here is a school-going boy who, if his parents don’t dress him, sometimes even feed him, would never be on time for school. They have to help him. There is no way that his brain and fingers would be able to tie his shoelaces. They can’t even button up his shirt correctly.

Johnny can sense his teacher’s growing frustration. She knows he can do better. She is the kindest teacher that he’s ever had and he so desperately wants to please her, but he simply can’t. He is stuck. Stuck with an awkward pencil grasp. Plus, it is really hard to figure out what teacher just said; which book to open on which page, what to write and where on the page.

How can you run and be free when you are stuck? Stuck in dyspraxia.

I am here to help set Johnny free.

I remember when I first met Johnny. Johnny with the kind eyes, and quiet soul. He entered my OT room, any kid’s dream, and walked right past all my toys and equipment which begged to be played with. He concentrated hard on navigating his way down the steps and over the mattresses without falling, and flopped his body down onto the chair. He made it! Relief. I carefully placed a blank sheet of paper between us and invited him to draw a picture of himself. Instead, he started talking. His hand didn’t reach for the pencil nearby. I ushered the pencil closer. His hand stayed on his lap. Absolutely no desire to draw. When there was no more escape from my clear demand, Johnny drew a picture. Fast, no detail. A barely-there, sad-looking stickman figure.

I invited him to play. His body stood frozen, but his face smiled. Friendly little chap, I thought to myself. I asked him if he was scared of swinging or whether he liked it while I took down my “easiest” swing and hooked it onto its lowest point. Johnny looked unsure. Keen, yet cautious. The swing was ready. Johnny’s eyes sparkled, but he did not move. I demonstrated how to get onto the swing and stood back up again. “You want to have a turn?” I asked him. He nodded and I said “Come here, let me help you.” Let. me. help. you. These few words held a magnitude of power and trust within them. This was the beginning of our magical journey together.

Fast forward a year later. Many intense OT sessions. The changes were ever so gradual. So gradual that neither myself nor his parents noted much change. Yet we persisted, held onto our faith and gave it our all. Johnny played hard and OT became the highlight of his week. Once a week he could feel what it felt like to succeed as I made sure to provide just-right challenges. I gave help only when absolutely needed to ensure safety, and sneakily placed obstacles in his way. He had to figure out how to climb over them, or get around them or over them, moving his whole body through space. Johnny always carried on where he had left off the previous session. I peppered his neurological system with intense sensory input which he was unable to process before. Something awoke in him. His light began to shine. He stood up a little taller, he started to smile a bit wider and he started moving about more.

Johnny became visible to his peers and joined them in their fantasy worlds. His parents breathed a sigh of relief as Johnny was too engrossed with play during his playdates to even think about TV. His teacher beamed with pride when she wrote the final comment on his school report. “Johnny has made very good progress and is eager to read…”

I reminisced about the ball pit and swing rope incidents as I watched him climbing up a barrel, carefully balancing on top of it, before making a somersault into the spandex swing. He manoeuvered his body and limbs accurately, and with ease, which propelled him upwards and over into the next layer of the swing, all the way down to the ground. Like a feather. Like a superhero! Johnny was set free. Johnny was unstuck.

The joy of freedom and self-belief

 So what exactly is dyspraxia?

In everyday conversation, we often refer to dyspraxia as a motor planning problem. That makes sense to the human ear as we link motor to skills and planning to cognition. But motor planning is in actual fact a subtype of praxis.

Praxis is like the umbrella term underneath which we get ideation; to form an idea or plan, then motor planning; where we figure out how we are going to move our body using our senses, and then the final part; execution. This is where we perform our actual plan. Some children may struggle with only one aspect of praxis. Some struggle with it all.

Dyspraxia takes on many forms and is often a complex concept to explain to parents. As Sensory Integration trained occupational therapists, we especially consider two types of dyspraxia when working with children. Somatodyspraxia and Visuodyspraxia. Other types of dyspraxia of course also exist such as Praxis on Verbal Command and Speech Apraxia.

In simple terms, somatodyspraxia, which Johnny had, involves the “somato” senses. Somato means body. Here the brain struggles to correctly interpret touch and proprioceptive sensations. The touch receptors within the skin itself are intact, but impulses traveling through the spinal tracts to the brain are somehow not being interpreted effectively while they travel into the medulla, through the thalamus and end up within the end destination of the brain, the somatosensory cortex.

Likewise, with proprioception. The joint structures and tendons may well be intact, but feedback sent and eventually reaching the somatosensory cortex in the brain area is not processed effectively.

“Praxis is the basis for dealing with the physical environment in an adaptive way… dressing, eating with utensils, playing, writing, changing the physical environment to meet a purposeful goal, and making a living. To do these things one first needs the idea of doing them, then knowing how to do them. That is praxis” (Ayres, 2011).

The child with dyspraxia, according to Ayres, has less of a sense of his body and what it can do. “He doesn’t manipulate toys, can’t plan to play with them, and often is clumsy, accident-prone, and messy.” (Murray-Slutsky &Paris, 1953, p.22). This is such an accurate picture of our children who are referred to occupational therapy after which we discover, with the help of our Sensory Integration and Praxis Tests (SIPT), have somatodyspraxia.

Somatodyspraxia is a pattern associated with poor sensory perception and difficulty with motor planning. The main identifying features of this pattern are poor tactile perception and difficulty in imitating, planning or sequencing actions (also known as praxis). (Schaaf & Mailloux, 2015, p. 19)

When both the tactile and proprioceptive senses are affected, it leaves the child at risk for somatodyspraxia disorder. These are our everyday Johnnies who fight a hidden disability every single day, every single hour of their wakeful day. Hope lies in the hands of an OT applying sensory integration therapy. It is possible to get our Johnnies unstuck and let them fly!

References:

Mailloux, Z. et al., 2011. Verification and Clarification of Patterns of Sensory Integrative Dysfunction. The American Journal of Occupational Therapy, pp. 143-151.

Murray-Slutsky, C. & Paris, B. A., 1953. Exploring the Spectrum of Autism and Pervasive Developmental Disorders. United States of America: Therapy Skill Builders.

Schaaf, R. C. & Mailloux, Z., 2015. Clinician’s Guide for Implementing Ayers Sensory Integration: Promoting Participation for Children with Autism. Bethesda: AOTA press.

 

Spandex: It’s more than just a material swing

Today’s blog post was written by Robyn Turnbull (ASI® certified with Fidelity Measure) and she works in Cape Town.

For a session to be considered truly Ayres’ Sensory Integration® (ASI®), one of the criteria in the fidelity measure (Parham, et al., 2011) requires that there is a variety of equipment available and they list “spandex fabric” as one of these items.  This creates the feeling that spandex and sensory integration are somehow synonymous. But is it really that necessary in the therapy room? And how can you use it with the different clients who walk into your therapy rooms? In this post, I will briefly introduce to you the therapeutic benefits of spandex, how to suspend it and how the therapeutic value changes depending on the way in which it is suspended.

Leanne climbing through a spandex tunnel. This illustrates the quiet visual space inside spandex. This allows our sensory systems some reprieve from the noisy sensory environments we are so used to.

What are the sensory benefits of spandex?

Spandex offers a sensory-enriched experience of especially tactile, proprioception and vestibular input. The multi-directional stretch provides a full-body proprioception experience and as it surrounds the body it provides increased tactile input at the same time. As the person climbs inside, the spandex stretches down and around the body. This creates a visual quiet space, suddenly cutting out the visual noise from the environment.

Spandex also enables the full range of vestibular stimulation, depending on how you suspend it and move it.

Active movement inside the spandex challenges praxis, postural control and bilateral integration abilities. Therefore, when using suspended spandex, encouraging active movement will help integrate the skills.

How can we use it therapeutically in Ayres Sensory Integration?

Due to its rich sensory affordances, spandex is a versatile therapeutic tool. The affordances change depending on how the spandex is suspended. So, in order to understand the different affordances we will have to look at how the spandex is suspended.

Suspending from 4 points:

To suspend spandex from 4 points you will require either overhead beams or eyebolts secured into the walls. Some therapy rooms also have steel structures from which to suspend. Suspending the spandex from 4 points allows the child to move more actively in the spandex, increasing the proprioception, postural control and motor planning challenges.

Spandex suspended from 4 points creates a wider area on which to perform activities, but can be more risky.

Activity ideas in 4 point spandex:

  • Bounce it up and down, swing side to side or create a tornado by swinging wildly in all directions. Encourage the child to hold on to the sides of the spandex, and stop immediately if they let go. Spandex is a dangerous piece of equipment and children easily roll out, so make sure you have a lot of padding underneath them. And with padding, I mean pillows and mattresses and crash mats; gym mats won’t suffice.
  • Crawling and rolling from layer to layer as if ‘climbing a mountain’.
  • Build a tower or steps to climb into the spandex from the top.
  • Use the spandex as part of an obstacle course. Moving from one end to the other end and then walking over a beam, jumping on blocks, swinging from one point to the next or crawling through a tunnel.
  • Attach rope or bungee cord to suspension points and encourage symmetrical or asymmetrical pulling. This will enable the person to swing themselves. I often refer to this as rowing the boat.

Suspending from 2 points:

To suspend the spandex from 2 points you will need either an overhead beam or eyebolts secured into the wall. Spandex is very stretchy so you will need to have the suspension points approximately 1.5 times the length of the spandex swing (i.e. if you have a 2 meter long spandex, the suspension points need to be 3 meters apart). Suspending the spandex from 2 points enables a closed space which is visually quieter and provides more light tactile input from the spandex as it moves.

Activity ideas in 2 suspension point spandex:

  • Swing side to side, bounce or create a wild tornado by swinging it in all directions. Again, encourage the child to hold on the sides of the spandex when swinging.
  • If you have 3 or more layers of spandex, have the person lie in the 2nd layer from the top. Then scrunch up the top layer so the person can hold on it like a koala bear using arms and legs wrapped around the top layer of spandex. As the spandex swings or bounces, the top layer of spandex provides even more proprioceptive feedback into the limbs.
  • Climb in one end and crawl to the other end. Have mattresses underneath the spandex when doing these activities because any off balance movement will cause the spandex to throw the person out.

Suspending from 1 point:

This is the easiest way to suspend spandex as most therapy practices or homes have one point of suspension (i.e. from a tree branch or overhead beam). Suspending the spandex from 1 suspension point creates a closed, pod like swing. This forms a dark, closed visual space, and minimises the amount of moveable space inside. If you are looking to provide more passive vestibular input, then suspending spandex is a good option. However, if you are looking for more active movement and active vestibular stimulation then consider suspending the spandex from 2 or 4 points.

Photo from Sensory Toyzone archives

Activity ideas in 1 suspension point spandex:

  • Person sits inside in the spandex which forms a pod or cocoon. You can then swing it linear, rotational or all over to provide Coriolis vestibular stimulation.
  • The person can stand inside and jump as on a trampoline. This provides a lot of proprioceptive feedback as the spandex is completely surrounding the person’s body inside.
  • Spin the spandex pod round and round until it is tight, and then let go to allow it to unspin itself. This is intense rotational input so should only be considered with people who have a high threshold for vestibular input. Also watch for signs of sensory stress such as flushing of cheeks, hiccoughs, giggling, dizziness and more. Counteract this sensory stress with proprioception such as drinking cold water through a long straw or rolling a large ball over the body with a lot of pressure.

How do I choose my spandex?

Spandex and Lycra are the same thing – Lycra is just a name which has been trademarked by a company called DuPont (Sarkar, 2013). But if you are choosing material there are some things you need to keep in mind:

1) The material needs to stretch both ways. If it only has stretch in one direction, it may be more likely to tear and changes the therapeutic input.

2) The thickness of the spandex material is key. A thickness from 195g/m2 and higher is most suitable for suspending spandex.

3) The design and colour of the spandex is key too. Lines create an optical illusion of movement so when swinging in a spandex with lines on, it can be overstimulating to the visual-vestibular system.  However, this does not mean we should be nervous of boldness. Remember, as much as we have clients who need calming input, we also need to consider the clients who need alerting input. Bold colours and engaging designs can be a huge asset in your practice.

With so much to offer in terms of therapeutic value – and such fun to use – spandex is a key tool in every sensory integration therapy room.

References

Cook, R. (2017). Spandex Ideas. Cape Town.

Parham, L., Smith Roley, S., May-Benson, T., Koomar, J., Brett-Green, B., Burke, J., . . . Schaaf, R. (2011, March / April VOL 65). Development of a Fidelity Measure for Research on the Effectiveness of the Ayres Sensory Integration® Intervention. AJOT, pp. 133-142.

Sarkar, P. (2013, June 30). What is the Difference Between Lycra and Spandex?

 

Through the looking glass – Foresight with 2020 vision

 

Today’s post was written by Stefanie Kruger, who holds the position of Head of Faculty for SASIC 1 and is lecturing on the SASIC 1 course this week.

We are all familiar with the phrase “Hindsight is 2020 vision”. It seems to have been printed for the first time in the early 1900’s and attributed to the film director Billy Wilder. This metaphor describes the perfect clarity of understanding from a distance, when we are looking back in time at a situation or event. Looking back at the year 2020, this phrase has a much deeper meaning now, and a very different perspective, even if it has been used for over a century by different people in different contexts.

15 March 2020 is a day we will remember for various reasons. It was my daughter’s 8th birthday party. We were relaxing and celebrating at the dam with friends, enjoying the outdoors, the children’s laughter and being in each other’s company. Little did we know of the president’s announcement that would come later that evening, and that weeks of Level 5 hard lockdown with strict regulations were to follow due to COVID-19, the pandemic that brought the whole world to a standstill, and possibly changed our lives forever. Can you remember where you were that day?

Many disappointments and challenges soon followed, including cancelling SASIC 1 2020, a week before the course. We expanded our vocabularies and learnt to include new words and routines like social distancing, masks and sanitizer on a daily basis. We also learnt new skills from baking, to brewing, to scheduling Zoom meetings, attending webinars and presenting telehealth sessions, to name but a few.

15 March 2021, exactly a year after lockdown was implemented for the first time, SAISI rolled out the very first hybrid SASIC 1, with a total of 113 participants. Not only is this the biggest SASIC 1 course to date (according to records available), but it is also history in the making having both face-to-face and live-streaming participants across South Africa, Namibia, as well as the United Arab Emirates. We are extremely grateful that all of this is happening, and to make it even more special, it is happening in SAISI’s 40th birthday year! It is indeed a time to celebrate friendships, opportunities and memories, but also a time to mark these momentous milestones and use the new knowledge and skills we gained in 2020 to move forward in a new way.

This historic hybrid SASIC 1 course would not have been possible without hours, weeks and months of dedication, planning and preparation of a passionate SAISI board, and the blood, sweat and tears of an incredible team of people working together and getting things done while juggling their family and work responsibilities. Let’s also pay tribute to the participants who are embarking on their journeys of sensory integration training, and showing their perseverance, even amidst uncertainties. Thank you to everyone for their contributions who made this course a reality! And now with the first hybrid SASIC 2 around the corner, we are definitely looking towards the future with humility, wisdom and the perspective of 2020, as well as the excitement of possibilities we could see being implemented early on in 2021.

When we look further back, there was a time where theory courses were presented in cold church halls, and where transparencies and faxes were at the order of the day. People’s names, numbers and addresses were printed in the telephone book, phones were plugged into walls, and the internet was something you had to dial into. There was a time (not too long ago) that the gross motor items were available on VHS, we received the SAISI Newsletter in the mail, and the small blue clinical observations booklet had the old SAISI logo. Times are changing, and we have to embrace the bittersweet impact of technology that is changing the rules and parameters of the game, of life.

Dr Jean Ayres was often described as a visionary before her time. She gave us the gift of solid theory, rooted with one foot in neuroscience, and the other in the art of play and connection. Ayres’ Sensory Integration® is an evolving theory, which keeps on evolving by means of rigorous research by her scholars and others following in their footsteps across the globe. This includes updating standardised assessments from the SCSIT, to the SIPT, and now with the EASI on the horizon, as well as providing evidence-based practice and intervention guidelines from the Fidelity measure. SAISI is striving to present courses that are up to date, and adhere to internationally recognised standards so that the courses are also keeping up with times and evolving requirements. This new generation of therapists is gearing up, to be able to support the children and families of the future in these everchanging times.

We had my daughter’s 9th birthday party the weekend before the course, and were very excited that we could be out again, celebrating with friends. But there is also a much deeper gratitude in this mixture of excitement and nerves: that soft voice reminding us that things can change quickly, that we have to learn to adapt and do things in a new way, and to appreciate the opportunities and special people in our lives in the present moment.

May 2021 be a year of growth, while moving forward with the clarity and simplicity of 2020 vision.

Best Practice in Paediatric OT – A little reminder from the Ethics Portfolio

Today’s post was written by Dana Katz, director of Rose Cottage, a special needs preschool in Cape Town, and she holds the Ethics portfolio on SAISI’s board.  Thank you Dana!

All I Really Need To Know I Learned In Kindergarten

by Robert Fulghum

“Share everything.
Play fair.
Don’t hit people.
Put things back where you found them.
Clean up your own mess.
Don’t take things that aren’t yours.
Say you’re sorry when you hurt somebody.
Wash your hands before you eat.
Flush.
Warm cookies and cold milk are good for you.
Live a balanced life –
Learn some and think some
And draw and paint and sing and dance
And play and work everyday some.
Take a nap every afternoon.
When you go out into the world,
Watch out for traffic,
Hold hands and stick together.
Be aware of wonder”

The following blog post is written as a reminder to us all of our responsibilities as occupational therapists (OT’s), as well as SAISI’s position on the assessment and treatment of children. It is not enough for us to just be good OT’s – we need to be good colleagues, good advocates for our profession and good to ourselves. We need to remind ourselves of who we are as professionals, why we do what we do and of what is expected of us as paediatric OT’s, specifically.

We all graduated from pre-school with many new lessons in our toolbox. We had taken our first steps into independence, started to develop self-confidence, learned how to be a good friend, to respect others and to follow the rules. As we grew older, these lessons grew more complicated and complex. We grew from preschoolers into adults without much choice in the process.

But, we consciously made the choice, however, to grow from adults into OTs; into professionals in our chosen field of practice.

Our professional qualification is empowering in many ways, but we need to remember that with power comes responsibility.  In this case, responsibility to our clients, to our colleagues, to our profession and to ourselves.

At times in our growth, we can grow so big, that we may forget our purpose, forget our responsibilities and forget the lessons we learned in preschool: to share, play fair, not to hurt people, not to take things that aren’t yours, to say you’re sorry when you hurt somebody (even if unintentionally), to live a balanced life, to learn some and think some, to play and work everyday, to hold hands and stick together.

When we forget these lessons, our professional practice runs the risk of becoming unethical.

The HPCSA’s Ethical Guidelines for Good Practice remind us of the Main responsibilities of health practitioners:

“A practitioner shall at all times:

(a) act in the best interests of his or her patients;

(b) respect patient confidentiality, privacy, choices and dignity;

(c) maintain the highest standards of personal conduct and integrity;

(d) provide adequate information about the patient’s diagnosis, treatment options and alternatives, costs associated with each such alternative and any other pertinent information to enable the patient to exercise a choice in terms of treatment and informed decision-making pertaining to his or her health and that of others;

(e) keep his or her professional knowledge and skills up to date;

(f) maintain proper and effective communication with his or her patients andother professionals;

(g) except in an emergency, obtain informed consent from a patient or, in the event that the patient is unable to provide consent for treatment himself or herself, from his or her next of kin; and

(h) keep accurate patient records.”

A client’s BEST INTERESTS OR WELL-BEING must always be our highest priority. Health-care practitioners should:

  • “Always regard concern for the best interests or well-being of their patients as their primary professional duty.
  • Honour the trust of their patients.
  • Be mindful that they are in a position of power over their patients and avoid abusing their position”.

Informed consent is one of the ways that we can show respect towards our clients. “A practitioner shall refrain from withholding from their patients any information, investigation, treatment or procedure the health-care practitioner knows would be in the patient’s best interests.” In our case, we need to decide what support and which treatment modality would be best for a client, as well as what should be prioritized according to what the client ultimately wants and we MUST refer accordingly. It is important to remember that a client has the right to choose the practitioner with whom they would like to work.

We need to ensure that we are sufficiently experienced in the treatment modality that we are offering or else we need to refer on to someone who is. “We may not impede a patient, or in the case of a minor, the parent or guardian of a minor, from obtaining the opinion of another practitioner or from being treated by another practitioner”.

When WORKING WITH COLLEAGUES we should: “Work with and respect other health-care professionals in pursuit of the best health-care possible for all patients. Not discriminate against colleagues, including health-care practitioners applying for posts, because of their views of their race, culture, ethnicity, social status, lifestyle, perceived economic worth, age, gender, disability, communicable disease status, sexual orientation, religious or spiritual beliefs, or any condition of vulnerability. Refrain from speaking ill of colleagues or other health-care practitioners and passing judgement on the professional reputation of colleagues.”

HPCSA Rule 12:“A practitioner shall not cast reflections on the probity, professional reputation or skill of another person registered under the Act or any other Health Act.

Do not make a patient doubt the knowledge or skills of colleagues by making comments about them that cannot be fully justified. Support colleagues who uphold the core values and standards embodied in these guidelines. Advise colleagues who are impaired to seek professional assistance.”

With respect to assessment and treatment in ASI®, the following is noted:

SAISI prescribes the use of reliable, scientific assessment instruments in order to obtain client information. Standardized assessment tools are to be used alongside collateral information and researched clinical observations to determine the strengths and therapeutic needs of the child. Treatment goals need to be appropriate and individualized to effectively support the therapeutic intervention process. This intervention process should address the development of functional occupational performance-based skills and adaptive behaviour.

SAISI currently promotes the use of the Sensory Integration and Praxis Tests (SIPT). Internationally, this test is recognised as the gold standard of assessment in the field of ASI®.

SAISI encourages the use of the Data-Driven Decision-Making process (DDDM by Schaaf & Mailloux, 2015). This process supports a standardized and objective, outcomes-based approach to the assessment and treatment of children.

ASI® assessment and treatment must be carried out by an occupational therapist qualified in Ayres Sensory Integration®.

Parents should be provided with information to enhance their understanding of the underlying sensory systems and processes involved in the holistic development of the child.

Therapists need to have face-to-face contact with parents and feedback on the child’s therapeutic programme and progress needs to be provided on an ongoing basis. Parents must, at all times, be recognised and included as part of the goal-setting and therapeutic process of the child.

Therapists may not assess, provide information on or work with a child without parental consent – this is specifically noted for practices within school settings.

SAISI does not prescribe the use of generalised, non-standardised checklists and screening tools as methods of obtaining clinical information regarding the developmental, functional and behavioural status of a child. 

In closing, I challenge you all to remember the lessons learnt in pre-school and apply these in your daily practice. Let these simple rules guide your complex daily interactions: let us work together, share, play fair and support each other in our endeavours to support our clients and always remember that “A client’s BEST INTERESTS OR WELL-BEING must always be our highest priority!”

The information quoted above is taken directly from the HPCSA’s Ethical Guidelines for Good Practice.

https://www.hpcsa.co.za/Uploads/Professional_Practice/Ethics_Booklet.pdf

A South African Sensory Perspective: Feels like home

Today’s blog post was submitted by Lara Mather.  Lara is an OT working in Hillcrest, KZN and is excited to start her ASI® journey on SASIC 1 and 2 this year.  Thank you Lara!

“Home is not a place, it’s a feeling”- Cecilia Ahern

Growing up, Ouma buttermilk rusks were the solvent of all of life’s problems. Not feeling well- have a plain rusk. Got your heart broken- nothing a rusk dunked in tea can’t fix. Sunday blues- here come the rusks! Our Ouma rusks tasted like home.

Picture: blikbeker and rusks - MMMM

A recent post on social media by Kath Smith from ASI Wise spoke to the sensory experience of eating a rusk, which got me thinking- is it the rusk, or is the sensory input provided by the crunching and the chewing of the rusk that brings about calmness and serenity that all of life’s problems have now been solved (1)?  Is the feeling of “home” in fact an experience that brings about self-regulation? Some literal food for thought!

Upon reading Kath’s post, I realized that as South Africans, we have many unique sensory experiences that the rest of the world may only occasionally encounter, ranging from the squawking hadedahs at 5am to the smell of a neighbour’s freshly lit braai wafting over the wall. Without even giving it a second thought, we often find ourselves seeking or even to some degree avoiding these sensory experiences in order to meet the demands of everyday life and keep ourselves regulated.

Over the years, South African drivers have built up a notorious name for themselves. A peak hour traffic jam is a perfect example. Picture this- cars jam packed bumper to bumper across all four lanes, moving at snails’ pace. Whilst most are law abiding citizens, we always have exceptions to the rule. For those select few a traffic jam automatically means making a beeline for the emergency lane. On a day when I have to encounter a situation like this, the constant stop, start, emergency breaking, hooting back and forth, I feel myself becoming completely unhinged and dysregulated and the day hasn’t even begun yet! A cup of something warm (Rooibos tea!) in hand often allows for much needed sensory input, bringing about a calm state in which I can function optimally. Each sip just feels like home.

South African’s are pretty adaptable beings- 14 years of load shedding really does that to you! One minute it’s light, and the next you are plunged into complete darkness- a completely unique sensory experience of its own! As inconvenient as the two-hour periods can be, they bring about an unusual calmness and serenity- no bright lights, no blaring TV’s, just the darkness. The hustle and bustle seems to grind to a halt and for a rare moment I can actually process my thoughts. A part of me is grateful for these forced moments of “down time” where I can remove myself from the sensory overload that is daily life. It gives me time with my family, who usually gather in one room waiting the two hours out together. It’s laughing, giggles, life advice and just general “togetherness” that we otherwise would probably never get. It’s home. Who would have thought that load shedding allowed for self-regulation? Who would have thought that load shedding felt like home?

Growing up in Durban meant that almost every home on our street proudly displayed their ever-blooming Jasmine that crept over fences and released the most beautiful scent. The sweet scent was identifiable from a couple of streets away, signifying that home was near. It only occurred to me recently that every single one of my perfumes contain Jasmine as an ingredient. Am I unconsciously self-regulating? A spritz and spray in the morning brings about the familiar scent that is grounding, familiar and calming- it smells like coming home.

Our beautiful country offers a myriad of unique sensory experiences that I could go on and on describing, from our incredible beaches to our midday electrical storms amidst mountains that seem to stretch far beyond what the eye can see. Each one holds a significant meaning for every one of us, helping us to centre ourselves and begin again. We encounter these unique sensory experiences every single day and we cope; we cope through engaging in small acts and experiences that allow us to self-regulate and bring us back on track. Home is not a place. Home is a sensory experience.

References

1.Smith K. Thank you Rusk and Co! [Internet]. 2021 January 25 [cited 2021 February 14]

Play and Discovery

Written by Karen Powell 

Happy New Year to you! To inspire you to have fun despite the pandemic level challenges we might be facing this year, we revisit the foundation and importance of play, and how it relates to the work we do.

Play and Discovery

In 2007 the American Academy of Pediatrics (AAP) published Clinical Reports on the importance of play.  Since then, newer research has provided additional evidence of the critical importance of play in “facilitating parent engagement; promoting safe, stable and nurturing relationships; encouraging the development of numerous competencies, including executive functioning skills; and improving life course trajectories” (1).

Living in the midst of a pandemic reminds us that fostering healthy relationships with those in your social bubble is vital, not only to further promote and encourage the healthy development of children, but also as a means to manage the underlying stress, for parents and children alike.

As occupational therapists (OT’s) we are well aware that an increasing societal awareness on school readiness has led to programmes which promote earlier academic results, even as early as preschool, with a corresponding decrease in playful learning (1).  The new Clinical Report, The Power of Play: A Pediatric Role in Enhancing Development in Young Children (2) by the AAP is very exciting, as it not only provides encouragement to paediatricians for the prescription of play, but provides research and evidence for what we as paediatric occupational therapists know to be true.

This article holds so much value.  You can learn from it, share it, motivate your therapy and causes. The full article is available here for your own review, but below are a few thought summaries to whet your appetite, perhaps a form of “highlight reel” of those issues most relevant to our area of expertise.

Relating to infant play:

  • “Caregiver infant interaction is the earliest form of play, known as attunement, but it is quickly followed by other activities that also involve taking of turns. These serve-and-return behaviours promote self-regulation and impulse control in children and form a strong foundation for understanding their interaction with adults” (2).
  • “By 9 months of age, mutual regulation is manifested in the way infants use their parents for social referencing” (3, 4).
  • “Uncontrollable crying as a response to stress in a 1-year old is replaced as the child reaches 2 to 3 years of age with the use of words to self-soothe, building on caregivers scaffolding their emotional responses” (2).

Relating to didactic learning:

  • “Early learning combines playful discovery with the development of social-emotional skills” (2). Children learn by playing with toys and looking at those around them.  Explicit instructions, however, limit a child’s creativity.  It is argued that we should let children learn through observation and active engagement rather than passive memorisation or direct instruction (2). “Successful programs are those that encourage playful learning, in which children are actively involved in meaningful discovery” (2).
  • Panksepp (5) went so far as to suggest that play deprivation is associated with the increasing prevalence of attention-deficit/hyperactivity disorder (6).

Relating to Sensory Integration, Outdoor Play and Risk

  • “Outdoor play provides the opportunity to improve sensory integration skills. Viewed in this light, school recess becomes an essential part of a child’s day (7).  It is not surprising that countries that offer more recess to younger children see greater academic success among the children as they mature (7,8).”
  • “Physical activity is associated with decreases in concurrent depressive symptoms” (9). [Outdoor] play decreases stress, fatigue, injury and depression and increases range of motion, agility, coordination, balance and flexibility (10).
  • “Rough and tumble play…enables children to take risks in a relatively safe environment, which fosters the acquisition of skills needed for communication, negotiation, and emotional balance, and encourages the development of emotional intelligence. It enables risk-taking and encourages the development of empathy because children are guided not to inflict harm on others” (11, 12, 13). “The goal is not to eliminate risk” (14).

Relating to scaffolding:

  • “A Russian psychologist, Vyygotsky, recognized that learning occurs when children actively engage in practical activities within a supportive social context. He was interested in what he called the ‘zone of proximal development’, which consists of mastering skills that a child could not do alone but could do with minimal assistance (15).  In the zone of proximal development, the ‘how’ of learning occurs through a reiterative process called scaffolding, in which new skills are built on previous skills and are facilitated by a supportive social environment” (2).
  • “According to Vygotsky (15), the most meaningful learning occurs in a social context, where learning is scaffolded by the teacher into meaningful contexts that resonate with children’s active engagement and previous experiences. Scaffolding is part of guided play; caregivers are needed to provide the appropriate amount of input and guidance for children to develop optimal skills” (2).

Relating to stress:

  • “Play and stress are closely linked. High amounts of play are associated with low levels of cortisol, suggesting either that play reduces stress or that unstressed animals play more” (16).
  • “Children need to develop a variety of skill sets to …manage toxic stress. Toxic stress can disrupt the development of executive function and the learning of prosocial behaviour. Play supports the formation of the safe, stable, and nurturing relationships with all caregivers that children need to thrive. The mutual joy and shared communication and attunement that parents and children can experience during play regulate the body’s stress response.”
  • “Play also activates norepinephrine, which facilitates learning at synapses and improves brain plasticity” (2).
  • “Play, especially when accompanied by nurturing caregiving, may indirectly affect brain functioning by modulating or buffering adversity and by reducing toxic stress to levels that are more compatible with coping and resilience” (17,18).

Perhaps we should not overlook the importance of teaching parents to play with their children.  Play is not something facilitated only by the OT once a week in sessions, but is a vital part of every day.  Barriers to play with caregivers need to be removed so that children can experience more effective play interactions on a daily basis.

But it’s not all about the kids.  Play is great for adults too, and we can use this information to motivate parents to set aside uninterrupted play time with those in their charge.

  • “Parents learn to see the world from their child’s perspective and are likely to communicate more effectively with their child, even appreciating and sharing their child’s sense of humour and individuality” (2).
  • “To be passionately and totally immersed in an activity…and to experience intense joy” (2).
  • “Positive parenting experiences result in decreases in parental experiences of stress and enhancement in the parent-child relationship” (19, 20, 21).

 

And lastly,

“Play is not frivolous; it is brain building.  Play has been shown to have both direct and indirect effects on brain structure and functioning.  Play leads to changes at the molecular (epigenetic), cellular (neuronal connectivity, and behavioural levels (socioemotional and executive functioning skills) that promote learning and adaptive and/or prosocial behaviour” (2).

Wishing all SAISI members a playful 2021, for all the right reasons!

 

References

  1. Ginsburg KR; American Academy of Pediatrics Committee on Communications; American Academy of Communications on Psychosocial Aspects of Child and Family Health. The importance of play in promoting healthy child development and maintaining strong parent-child bonds. Paediatrics. 2007; 119 (1): 182-191.
  2. Yorgman M, Gardner A, Hutchinson J, Hirsh-Pasek K, Golinkoff RM. Clinical Report: Guidance for the Clinician in Rendering Pediatric Care. The Power of Play: A Pediatric Role in Enhancing Development in Young Children. Pediatrics. 2018; 412 (3): 1-18.
  3. Campos JJ, Klinnert MD, Source JF, Emde RN, Svejda M. Emotions as behaviour regulators: social referencing in infancy. In: Plutchik R, Kellerman H, eds. Emotion: Theory, Research and Experience. Vol 2. New York, NY: Academic Press; 1983: 57-86.
  4. Sorce JF, Emde RN, Campos JJ, Klinnert MD. Maternal emotional signalling: its effect on the visual cliff behaviour of 1-year-olds. Dev Psychol. 1985; 21 (1): 195-200.
  5. Panksepp J. Can PLAY diminish ADHD and facilitate the construction of the social brain? J Can Acad Child Adolesc Psychiatry. 2007; 16(2): 57-66.
  6. Christakis DA. Rethinking attention-deficit/hyperactivity disorder. JAMA Pediatr. 2016; 170 (2): 109-110.
  7. Murray R, Ramstetter C; Council on School Health; American Academy of Pediatrics. The crucial role of recess in school. Pediatrics. 2013; 131(1): 183-188.
  8. Pelligrini AD, Holmes RM. The role of recess in primary school. In: Singer D, Golinkoff R, Hirsh-Pasek, K eds. Play = Learning: How Play Motivates and Enhances Children’s Cognitive and Socio-Emotional Growth. New York, NY: Oxford University Press; 2006.
  9. Korczak DJ, Madigan S, Colasanto M. Children’s physical activity and depression: a meta-analysis. Pediatrics. 2017; 139(4): e20162266.
  10. Goldstein J. Play in children’s development, health and well-being: technology and play. In: Pellegrini DA, ed. Oxford Handbook of the Development of Play. New York, NY: Oxford University Press; 2011.
  11. Burghardt GM. The Genesis of Animal Play: Testing the Limits, 1st ed. Cambridge, MA: MIT Press; 2005.
  12. Pellis SM, Pellis VC, Bell HC. The function of play in the development of the social brain. Am J Play, 2010; 2: 278-296.
  13. Pellis Sm, Pellis VC. Play fighting of rats in comparative perspective: a schema for neurobehavioral analyses. Neurosci Biobehav Rev. 1998; 23(1): 87-101.
  14. Barry E. In British playgrounds, bringing in risk to build resilience. New York Times. March 10, 2018. Available at: https://nytimes.com/2018/03/10/world/europe/britain-playgrounds-risk.html . Accessed April 27, 2018
  15. Vygotsky LS. Play and its role in the mental development of the child. In: Bruner J, Jolly A, Sylva K, eds. Play. New York, NY: Basic Books; 1976: 609-618.
  16. Wang S, Aamodt S. Welcome to Your Child’s Brain: How the Mind Grows from Conception to College. New York, NY: Bloomsbury USA; 2011.
  17. Siviy SM. Effects of pre-pubertal social experiences on the responsiveness of juvenile rats to predator odors. Neurosci Behav Rev. 2008; 32(7): 1249-1258.
  18. Garner AS, Shonkoff JP, Siegel BS, et al; Committee on Psychosocial Aspects of Child and Family Health; Committee on Early Childhood, Adoption, and Dependent Care; Section on Developmental and Behavioral Pediatrics. Early childhood adversity, toxic stress, and the role of the paediatrician: translating developmental science into lifelong health. Pediatrics. 2012; 129(1). Available at: www.paediatrics.org/cgi/content/full/129/1/e224
  19. Berkule SB, Cates CB, Dreyer BP, et al. Reducing maternal depressive symptoms through promotion of parenting in pediatric primary care. Clin Pediatr (Phila). 2014; 53(5): 460-469.
  20. Weisleder A, Cates CB, Dreyer BP, et al. Reading is not just for language: promoting cognitive stimulation also enhances sosioemotional development. In: Pediatric Academic Societies Annual Conference; April 30 – May 4, 2016; Baltimore, MD.
  21. Cates CB, Weisleder A, Dreyer BP, et al. Leveraging healthcare to promote responsive parenting: impacts of the Video Interaction Project on parenting stress. J Child Fam Stud. 2016; 25(3): 827-835.

 

Knowledge is Power

Today’s post was submitted by Liani Austin.  Liani works in private practice at Therapy Factory and has two beautiful children.  She loves guiding concerned parents and educators, so that children can reach their full potential by means of a sensory integration approach.

“Knowledge is power.” We are all familiar with this quote from Frances Bacon, an English philosopher born in 1561. Interestingly, Francis is best known for his promotion of the scientific method, reveals a quick Wikipedia search.

Science. Evidence. Facts. Research. These come to mind first. But what about philosophy? Dreams. Hope. Goals. Expansion. Improvement. These two terms, seemingly on the opposite ends of the spectrum, yet gently and subtly connected by the human brain.

I believe occupational therapists are some of the kindest, wisest souls on planet earth. The everyday “Mother Teresa’s and Florence Nightingale’s” of the world. Most of us are naturally drawn into the philosophical side of life, in which we can (as clichéd as it sounds) express our deep yearning to help others. Perhaps waking up at night, fretting about the child who is falling apart at school. Or blinking away tears when triggered by a song in the car and feeling the pain of your stroke patient whose whole world came tumbling down today.

“If you don’t move forwards, you move backwards” (author unknown). I eventually learned this as I navigated my way through my early days as an occupational therapist. Now I have to be honest, studying occupational therapy straight after giving it my all for years at school, felt like it took its toll on my learning tank. I remember the feeling of freedom during my community service days. Relief that filled my heart when I returned home after a rewarding day at the hospital and plopping down onto the couch instead of opening a textbook. I was a little bit over studying… There, I’ve said it.

So when the HPCSA implemented stricter measures on tracking CPD and everyone around me was being “audited”, I rolled my eyes in despair. But I complied and made sure to go on a few courses, workshops and seminars.

It happened slowly, but one day, I suddenly realised, that what I had previously rolled my eyes at, became part of the highlights of my year: attending seminars, learning, and best of all, the feeling of complete inspiration afterwards.  I wasn’t necessarily able to explain perfectly in words what I had learnt, but I could feel it in my hands and heart during therapy the next day. It made me a better OT.

When SAISI put forward the awesome idea of structured journal clubs, I jumped at the opportunity when I was invited by Stefanie Kruger. The name of our journal club in Pretoria East? “Sensory Inspiration”. How fitting!

I love meeting therapists in the area, putting smiles to names, and my favourite part of journal club is the bits of discussion and brainstorming in between. We share ideas,so that next time we will look at a situation from a different angle. Not even Covid-19 lockdown could deter us as we continued our monthly meetups online via Zoom.

I’m sure everyone has their individual favourite topics, and for me my ears prick when we discuss articles about sensory modulation and linking this to behaviour. A few standout articles for me were:

  1. Atypical Sensory Modulation and Psychological Distress in the General Population, Bar-Shalita & Cermak (2016).
  2. Sensory Integration Therapies for Children With Developmental and Behavioral Disorders, Zimmer & Desch (2012).
  3. Sensory Over-Responsivity as an Added Dimension in ADHD, Lane & Reynolds (2019).

No one has ever failed (or not that I know of in any case) the quick multiple-choice questionnaire completed after each article discussion.

Journal clubs are an easy and cost-effective way, to not only get loads of CPD points, but also to keep up with the latest research, especially in the field of Sensory Integration. Plus, we stay connected to our colleagues. After all, isn’t a journal club really like a book club (with or without wine)? We make friends, we chat, we listen, we connect. Oh yes, and we learn!

Time to sign up. Free to SAISI members.

What you need: 3 like-minded SAISI members / 6 hours per year / you can meet in person or over zoom.

What you get: earn up to 18 CPD points for the year / time to reflect with colleagues / expand yourself as and ASI ®️ therapist

Contact the SAISI office saisi@instsi.co.za

References

Bar-Shalita, T & Cermak, SA 2016, ‘Atypical Sensory Modulation and Psychological Distress in the General Population’, American Journal of Occupational Therapy, vol.70, 7004250010. (http://dx.doi.org/10.5014/ajot.2016.018648)

Zimmer, M &Desch, L 2012, ‘Sensory Integration Therapies for Children With Developmental and Behavioural Disorders’, Section on complementary and integrative medicine and disorders council on children with disabilities pediatrics,  vol. 129, no. 10. (http://pediatrics.aappublications.org/content/129/6/1186)

Lane, SJ & Reynolds, S 2019, ‘Sensory Over-Responsivity as an Added Dimension in ADHD’, Frontiers in Integrative Neuroscience, vol. 13, article 40.

 

 

Goodbye 2020

And just like that we bid farewell to 2020.  SAISI board would like to thank you for your ongoing support and engagement through what has been a very challenging year.  For some the challenges were health-related, for others financial, emotional, or personal.  We see you and we acknowledge how our members have made the most of the situation and supported each other through it.

The year with its ever-changing restrictions has also challenged us, especially technically.  Both younger and older members have felt the the push to improve their tech skills.  It has been a year of firsts, including:

  1. First online board meeting in June
  2. First online SASIC 4 course
  3. First webinar series to support members through all the changes, and
  4. Whatsapp groups for member support

I think the overarching theme of the year has been one of support.  We can all agree that SAISI members have pulled together, helped each other, shared ideas, sourced PPE and equipment, supported each other when the rules and restrictions didn’t seem fair. While all the messages and mails may have been overwhelming, I feel there has been a shift in our profession, from competition to collaboration.  What a wonderful acknowledgment of the kindness of our fellow OT’s, knowing that we pull together when it counts, for the good of our clients and each other.

Wishing you all a very blessed festive season with your families, wherever that may be.  Though you might not be able to go to the beach or see all the family members that you miss, we know that as resourceful OT’s you will make the most of the difficult situation.

Sit back for a while, recharge with your families and pat yourself on the back for surviving the year.  Be thankful for all the good that has come out of the year.  Acknowledge those who helped you through it.  Look for an opportunity to give back.

We have lots to share with you when we come back in 2021!

The Essence of OT-ness

Today’s blog is written by Stefanie Kruger, private practitioner at Simply Senseable, and SAISI board member, who decided to conduct some of her own research into the loss of “OT-ness” in this year of the pandemic.

Vanilla essence  is a delectable scent. It infuses anything it is mixed with, whether it is a milkshake, cookie dough, tea or soap, with that unique vanilla flavour. However, a spoonful on its own is rather bitter. For any young baker, that is often a surprising discovery: the secret of balance on a very concrete level. By adding “just the right amount” (not too much, and not too little) to the other ingredients, one would get the desired flavour. On a more abstract level, the term ‘‘essence” can be defined as the intrinsic nature or indispensable quality of something, especially something abstract, which determines its character. This may be the reason why it is so hard to describe the exact character or essence  of hands-on occupational therapy, especially when we have a passion for the Ayres Sensory Integration (ASI®) approach. What is that indispensable, often intangible, quality or abstract “thing” (or probably mixture of things) that we miss when we cannot see our clients in person? It is that special something-ness that is so hard to compensate for over a screen e.g. for those who provide therapeutic support via a telehealth platform as well as those who did not see clients at all during lockdown earlier this year.

Perhaps we can also ask similar questions when it comes to presenting or attending training sessions or webinars over a virtual platform. However, for the purpose of this blog we will focus on hands-on OT intervention with a special interest in ASI®. That could be another topic for another blog 😊

As OT’s with a special interest in ASI®, we are all familiar with concepts such as the art and science of intervention, as well as the requirements according to the Fidelity Measure (Ayres 1972, 2005; Parham et al 2011). It is interesting that about half of the process criteria of the Fidelity Measure pertain to therapy as play and the therapist as a skilled playmate,  the promoter of play as well the person responsible for being able to create the just-right challenge and developing a therapeutic alliance (Bundy and Lane 2020). By using this playful approach in intervention, the therapist often infuses  imaginative play and creative themes so that the child loses track of time and effort. It allows the child to become engaged in challenging activities that might not otherwise be possible (Schaaf and Smith Roley 2006).

It is evident that play is the essence  of childhood, and of ASI® intervention. Play is intrinsically motivating, it relies in on the child’s inner drive, and allows the child to be and feel in control. Play, in the context of intervention, involves a careful balance of freedom of rules and the constraints of reality, with some subtle and unobtrusive structuring and framing by the therapist. Being playful with children and watching them flourish through play with us, is what makes our work so enjoyable, satisfying and effective. Providing structure and support for adaptive responses is one of the key issues for collaboration in activity choice and for the therapist to create that just-right challenge (Bundy and Lane 2020).

What gives an OT-session that unique character, or OT-ness which makes activities in a “real-life” session different than over a screen?

When we think about the idea or concept of an OT-session, and how to use different pieces of equipment, one of the terms that comes to mind is affordances. This implies knowledge of objects, actions, and appropriate object-action interactions. Dr Teresa May Benson mentioned that praxis has to do with our library of motor possibilities: when we make an adaptive response, we put a new book into our library to interact with the rest of the library. She further added that action-semantic fields link with the total experience of a sensory-motor input, and that we encode these books in our library as pictures (generic images) and not just with words. Arnheim (1966) stated that his mind in its “ordinary operations, is a fairly complex picture gallery, not of finished paintings, but of impressionistic notes”. When we think about the characteristics of a cat, we can describe its body parts, diet and perhaps its habits. But what are the action-semantic fields and encoded images, which give a cat, its total experience of cat-ness? We could probably add that our perception is based on our interactions and previous experiences with a cat. (Based on workshops notes presented by Dr Teresa May-Benson 2015: Assessment and intervention for ideation and praxis).

 

Survey feedback

Thank you to everyone who completed the online questionnaire for this blog. We received 56 responses of which 78.6% presented telehealth sessions this year. It truly was amazing to tap into the wisdom of this crowd in an attempt to capture what the “essence of OT-ness” is from our personal experience. It was even more exciting to find the supporting evidence to support our perceptions with up-to-date literature.

 

  • From your perspective, what did you miss the most by not being able to see your clients face-to-face? (irrespective if you did telehealth sessions or not):

Human connection, personal interaction, touch, being hands-on, sharing in the small joys and successes, subtle support and adaptations within activities, gauging the child’s non-verbal cues, therapeutic relationship, tangibility of working in real-time and space, spontaneity, natural flow of a session (being more flexible e.g. in terms of planning and preparation), being able to control / manage the environment and equipment within.

 

  • In your opinion, the “essence of OT-ness” is a:

Feeling (67.9%)

Physical therapeutic space (50%)

Having a variety of equipment available (44.6%)

Other (28.6%)

Click on the link to open the chart: Chart 1

“Other” included:

Being together in the moment, combination of who we are and what we know, adaptability, balance between art and science, facilitating problem solving as it happens

 

  • Which statements describe the “essence of OT-ness” the best?

The following options were given and the results are indicated in the bar graph below (click on link to open):

  1. Sharing space (e.g. not necessarily in conversation, but just “being” together or doing something meaningful together)
  2. In-tune with the client’s needs in the here-and-now (e.g. able to subtly adjust grading quickly in the moment or as needed)
  3. Intuition (e.g. able to read non-verbal cues and support client’s needs such as emotional and sensory regulation)
  4. The joy of having fun together
  5. Dynamic exchange of ideas and trying out different things
  6. The satisfaction of seeing the client succeed (ability to scaffold, tweak and adjust challenges)
  7. Empathy for the client (e.g. when something goes wrong or not according to plan)
  8. The freedom of being creative within a session while still keeping goal-setting in mind
  9. Spontaneity (e.g. the flow of a conversation, or within activities)
  10. Types of activities and grading that can be presented by the therapist (e.g. not limited by what parents have at home)

Chart 2

It is indeed fascinating to see that the following items were the top five (5) descriptions of the essence  of OT-ness from the 56 responses that were received:

  1. Intuition (98.2%)
  2. In-tune with clients’ needs (85.7%)
  3. Satisfaction of seeing the client succeed (80.4%)
  4. The freedom of being creative within a session (75%)
  5. Spontaneity and the flow within the session (62.5%)

 

  • Describe the “essence of OT-ness” in one word, phrase or sentence:

Fun, play, adaptable, collaborative, flow, small moments of joy, engage, connect, synchrony, empowering, meaningful, creative, available to child, intuition with skill, the feeling of sharing space and time, therapeutic use of self.

Finding balance between the art and science of OT – creating a sensational palette

The most effective intervention reflects a partnership between art and science, where the relationship is fluid. Science is explicitly concerned with knowledge and theory, and crucial for clinical reasoning, effective goal-setting and targeted intervention. Science allows us to situate a session in the proper constructs of ASI® theory. Art on the other hand is more intuitive, almost ethereal. Art is fluid, and allows for that “ever-adapting activity required to meet the moment-to-moment needs of a child”. “The artist’s mission may not ever by reduced to words or rationally understood, but its invisible magnetizing presence will infuse an artist’s work completely” (Alex Grey 1998 in Bundy and Lane 2020).

Peloquin (1989) indicated that art is the soul of occupational therapy practice. (Bundy and Lane 2020). Peloquin (2005) further stated that effective practice is artistry and science together “Grains of sand and waves of sea together make seaside. Seaside would not be if one were gone” (Bundy and Lane 2020).

Let us go forth in the ever-evolving future and strive to balance the science and art of OT intervention, so we as therapists, as well as the people we work with, may experience the soul of OT in its totality.

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)

May-Benson TA, Blanche E, Schaaf R. A theoretical model of ideation. Understanding the nature of sensory integration with diverse populations. 2001:163-81

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

Roley SS, Blanche EI, Schaaf RC. Understanding the nature of sensory integration with diverse populations: Pro-Ed; 2001.

Schaaf RC, Mailloux Z. Clinician’s guide for implementing ayres sensory integration: Promoting participation for children with autism. Bethesda, md.: American occupational therapy association. linda. linneanet. fi/F. 2015.

Schaaf RC, Roley SS. Sensory integration: Applying clinical reasoning to practice with diverse populations: PRO-ED, Incorporated; 2006.