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SAISI Stress Ball Challenge

So being on Day 6 of lock down, and some of us having been at home much longer than that with kids, we decided you need a blog post that provides some comic relief as well as provides a challenge, both physical and mental.

Presenting: The SAISI Stress Ball Challenge

You might have received one of these stylish, multi-purpose items on a recent course.  These lovely green balls are worth much more than you think.  Not only are they helpful for releasing anguish while you write your protocol, but can be used for a multitude of sports challenges.  Here are our 25 ideas to get you started:

1.Bilateral sieve catch: toss the ball into a sieve

2. Kitchen cricket: using a wooden spoon as a bat

3. Passage golf (version 1): roll the ball down the passage and try to get it to stop on a bath mat

4. Passage golf (version 2): use a broom as your club and a cup on its side as the hole

5. For those of you dedicated members who have 2 or 3 stress balls: how about learning to juggle?

6. Tenpin bowling: roll the ball to knock over the Coke bottles

7. Egg and spoon race/relay: balance the stress ball on the end of one of your precious toilet roll inners

8. Family all stand in a line, first person holds the ball under their chin (touching neck between chin and chest) and then without using hands passes it to the next person under their chin continue until ball is passed to last person – can time it and see if you can beat your time or another team’s time.

9. Hand tennis or hand table tennis

9. Popcorn pong: bounce it down the passage into a container.  Level 1 : throw the ball into the container ( the lower and wider the opening, the easier it is).  Level 2: bounce the ball into the container.  Level 3: take turns and see who can get the most goals in a row.

10. Tube skittles: roll the ball through a pipe or down a ramp to knock down skittles of some sort

11. Galaxy bowling: stand with your back to the bottles and throw the ball between your legs.

12. Stingers

13. Robot zapping: stand with back to wall and a ball in each hand. Rotate on your axis and touch the ball (first to right, then to left) to touch target stickers placed on the wall behind you.

14. Lazy 8: sit or stand and roll the ball in a figure of 8 on the floor with two hands alternating. You can draw the 8 on the floor with chalk, or roll it around your feet and between your legs.

15. Towel toss:  2 players hold the corners of a towel.  Place the ball in the middle and throw it up into the air, and catch again.

16. Simon says: Mom gives instructions to roll/hold the ball with different parts of your body. Try under your chin, between your shoulder and ear etc, or jump like a  bunny/kangaroo with the ball between your legs.

17. Tray challenge: Hold a tray in both hands.  Count how many times you can roll the ball in a circle before it falls off.  Try make circles both clockwise and anticlockwise.

18. Bowls: see who can roll a ping pong ball closest to the stress ball (target).

19. Crawl with a stress ball in each hand, toes in the air.  Have a race!

20. Bilateral pass: sit back to back and pass the ball bilaterally to your partner

21. Sibling pass: stand in a line and pass the ball over head, then under/between your legs, or round the sides.

22. Toss the ball to each other without catching or letting it touch the floor. If you miss – the other person gets a free shot to throw it at you / you have to balance on one leg.

23. Bridge: stand like a crab.  See how long you can stay like that while someone else rolls the ball under you. Ideal for 3 players, one on each side to roll the ball and a crab in the middle.

24. Head hockey: place the ball in the toes of an old pair of pantihose.  Pull the pantihose over your head. Now try to knock over a plastic bottle by bending over and swinging the ball with your head, no hands allowed!

25.  Duster hockey: each have a broom and try to sweep the ball past each other.

And if you’d like to create a longer game, Ray-Anne Cooke created the game below in 5 minutes and using minimal stationery. Make spinners using 2 paper plates. Spin both and do what it says. You can have winner or just do it for fun. This example would be squeeze the ball in your elbow and spin 3 times.

Of course any ball will do.  These ideas were posted with a sponge stress ball in mind, and a heavier ball might make the challenge more dangerous (for people or precious decor).  As OT’s you know how to grade accordingly! Please post your own pictures and videos to the SAISI Stress Ball Challenge post on our Facebook page. And keep your eye on the ball!

Thank you to our hard-working Board members for their valuable contributions and for ensuring the physical and mental vitality of the sensory integration community and their families!  Special thank you to Elize Janse van Rensburg for the idea for the challenge.  Note: no husbands or children were harmed during the filming of the challenges.

COVID-19: To therapy or not to therapy?

Dear Therapists

We know you and your clients are stressed, maybe anxious, after Sunday night’s presidential address.  The now disaster status of COVID-19 in South Africa brings with it many questions and uncertainties, and we are here to help.

The basics

The corona virus causes COVID-19, the disease which has symptoms which develop gradually, so please make yourself familiar with the following timeline:

Day 1-3: Run a fever, mild sore throat

Day 4: Sore throat, hoarse voice, body temperature increases, anorexia, headache, perhaps diarrhoea.

Day 5: Fatigue, muscle pain and dry cough

Day 6: Mild fever, productive or dry cough, difficulty breathing, perhaps diarrhoea or vomiting

Day 7: High fever, cough with more sputum, body aches and pains, perhaps vomiting and diarrhoea

Day 8-9: Symptoms get worse, fever volatile, cough gets worse, difficulty breathing.

 

If you, or someone in your household, has any of these symptoms, please call 08000 29999 rather than going directly to your doctor to get tested.

You also need to look after you mental health: follow the link here https://www.bbc.com/news/health-51873799

But how do I handle my work environment?

There are many things to consider, so SAISI would like to assist you to take reasonable and responsible precautions and actions during this uncertain time. Based on the information provided by government, professional bodies, your practice will need to decide whether you want to or are able to continue face-to-face services at this time.  Here are some questions to consider:

  • Are you currently healthy?  Do you as the therapist have a runny nose / cough / fever?
  • Have you been travelling recently?
  • Has anyone in your immediate family shown any symptoms or been travelling or been in contact with anyone who has been diagnosed with Covid-19?
  • Do you work with children with compromised immune systems or chronic diseases?
  • Do you work with very young children or babies?

We know that children with Sensory Processing Disorders or Sensory Integration Dysfunction are most likely to struggle with changes in routine, or limited access to the sensory experiences you provide.  How can we maintain the health and functioning of these children and their families without going against the current recommendations, bans and guidelines?

If your practice has decided to continue offering face-to-face services for now, please let your clients know where things stand to decrease their anxiety and prevent unnecessary queries. Send out a statement and make sure that all therapists in the practice are on the same page. Here are our recommendations:

First and foremost are basic hygiene principles, making sure that your practice has adequate soap and sanitiser and that they are used.

Secondly, we need to consider our responsibility to keep ourselves and our clients safe and healthy, and “first do no harm”.  That means using your professional ethics and integrity to know when you should no longer be providing services.  If you, or your partner, or anyone else in your household, has come into contact with someone who has been diagnosed with COVID-19, you cannot provide contact services.  We work with children and vulnerable populations and have to take every measure possible to protect them, regardless of the financial implications that may have for us. Also, if you are immune-compromised in any way, suffering from a chronic disease or other, you will want to limit your contact with children.

In the days since schools were closed in the United States we have seen many therapists getting very creative in the ways they will try to help families during this trying time, including offering Skype consultations.  The HPCSA makes it very clear that we cannot do this, and you are referred to the Ethics Booklet 10, available on the HPCSA website, to read up further.  That said, we have to do everything in our power to help families.  You may not assess a child that you have never met over Skype, but it is possible to provide recommendations to a child you know, via a Skype or Facetime chat, or telephonic conversation.  Coding must be accurate and it is perhaps possible to charge a 66401 (Recommendations) code in the same way that you would be able to chat to a parent after a session.  Please note that you cannot charge therapy treatment codes for online assistance.  Any advice or recommendations regarding billing codes and procedures during this time of isolation will be posted on this blog as and when received from OTASA.

Our aim should be to relieve the stress and anxiety in the parents and children we deal with.  As sensory integration therapists we know that this time of isolation may manifest in less than optimal behaviour for the little people we work with.  Try to be the calm space for them and their parents, a sounding board, and a resource for coping strategies.  Use the time to update or create beautiful home programmes for parents.  The best home programmes are the ones that use everyday household items in creative ways, and don’t expect parents to go out and buy craft materials. Make use of what has been made available online or use your social media platforms to share your creative ideas.  Remember though, that when using public platforms your tips should be generalized (not for a specific client) and include a disclaimer.

For paediatric therapists continuing with therapy:

  1. Insist that children with a runny nose or cough may not attend therapy. If they do arrive they will be sent home.
  2. Anyone with direct family that has travelled in the past 30 days should let the practice know in advance and make alternative arrangements for consultation.
  3. Anyone who has been in contact with a high-risk person should not come to the practice for 4 weeks.
  4. Wash your hands and client’s hands before, during and after every session, with normal soap, for at least 20 seconds.  This has been shown to actually break down any virus on your hands.
  5. Limit the time spent by clients in the waiting area. Space clients further apart to limit their contact with each other and request that they adhere to these times.  Ask family to wait in the car.
  6. No eating or drinking in the waiting area.
  7. No cellphones, laptops or cell phones in the waiting area.
  8. Pay specific attention to disinfecting shared items, bathrooms, access buttons and door handles
  9. Limit the use of ball ponds, hammocks, spandex or other tunnels and munch mats.  If you use spandex, take it down after seeing the child and leave in a box in the sun (>27 degrees celsius) and do not use for 12 hours.  You could place a PVC mat over the balls in the ball pond so that the children could still crash, and then it could be wiped.  Cover mats and equipment with PVC.
  10. Use disposable tactile play such as shaving foam, an onion sack, bubble wrap etc
  11. Allocate play dough to be used and once the session is over, give it to the client to take home.  Use air dry clay in the session and send it home.
  12. Be creative in using gloves, masks in play themes if needed e.g. super heroes, doctor doctor, fireman etc
  13. Spray and disinfect between clients, so leave enough time for a “reset” between clients.
  14. Get creative with spray bottles for fine motor use and cleaning surfaces and hands at the same time.
  15. Avoid closed and isolated places such as tents.
  16. Open air, flat mat crash so that you can clean easily after use.
  17. Use disposable climbing gloves with ropes and trapeze, and build it into your play themes.
  18. Fine motor and perception: use printed worksheets instead of actual games. That way you can send the end product home with the child, limiting transmission.
  19. Print out grids and cards to be used with each client to be used as disposables.
  20. Be creative while being hygienic and safe. Protect yourself first and maintain the safety of all your clients.
  21. If you are a practice that usually offers a sweet or surprise at the end of the session, allocate one per child and don’t let them stick their hands into a jar to choose.

Thank you to the North Gauteng Private Practitioners Group and Sensory Kidzone for sharing these ideas.

There is a Facebook group created by ASI Wise where therapists are sharing ideas for continuation of treatment.  You are invited to join the conversation and contribute to this initiative – let’s help each other out.  You can follow the link to join: www.facebook.com/groups/Covid19andsensoryintegration/ 

For those of you working in schools, the decision regarding continuation of therapy has probably been made for you.  There are some therapists who have shared lovely resources for those staying at home.  Feel free to use the links below and share these with parents:

  1. For seven OT-based packets: KidsMasterSkills.com and click on “Download your FREE Take-Home Packets here”. These include brain breaks, pencil control, kids yoga, scissor skills, writing practice, sight word practice and letter formation.
  2. TeachersPayTeachers: register and download various activity packs which have been made free for this period of uncertainty.
  3. Growing Healthy Children Therapy Services: Sensory Motor Activity Books downloadable at https://www.ghcot.com/sensory-motor-activity-books/ 
  4. A Facebook group by ASI Wise for parents: www.facebook.com/sensorystuckathome (You as therapists are also encouraged to contribute helpful ideas to this group)

Schedules and Routines

Being home 24/7 with your children, especially if they have special needs, can be a very trying time for parents.  Share routines and visual schedules with parents, highlighting the importance of routine and variety in their child’s day.  The one thing that we should all be wary of is too much screen time as we sit and wait for the time to pass. Try to include only one slot of screen time per day, whether that be used for academic (online learning), discretionary time, a reward, or social (e.g. Skype with friends or family). Include outdoor games, sports, bike rides and walks on a daily basis for gross motor activity, while reminding them to avoid communal play areas, restaurants, movies and ice-skating rinks.  We have the benefit of still enjoying the last days of a warm summer, and the virus is scared of heat.  What better reason to get out in the fresh air, let off some steam, clear our minds and chase the germs away!

The Star Academy shared a lovely colour-coded schedule which is available on SAISI’s facebook group, which helps parents schedule activities which are alerting (red), just right (green) or calming (blue).  You could use this to help parents understand how to select activities.

Items to include in a schedule: ADL tasks: make bed, eat, bath, teeth brushing etc, academic tasks (depending on age), fine motor games, fun time: board games, discretionary time, reading time, down time/ quiet time: after lunch; and outdoor time and movement/exercise.

In conclusion

We, as occupational therapists, have a unique perspective on the effect that isolation will have on the population, and children with special needs.  We have so much we can offer in terms of advice and support, but need to make sure that we

  1. Work within the limits set by the government during this time,
  2. Adhere to strict hygiene and social distancing protocols
  3. Stay within our scope of practice, and
  4. Work within the guidelines of the HPCSA.

Above all, we need to maintain the integrity and professionalism expected of us by the Health Professions Council of South Africa (HPCSA), the Occupational Therapy Association of South Africa (OTASA), and South African Institute for Sensory Integration (SAISI).  If you are in doubt as to whether something is an appropriate course of action, kindly contact the appropriate body and ask one of the board members for advice.

As new information we will share it here on the blog, or on our Facebook page. Please feel free to share your creative ideas, concerns or questions on SAISI’s facebook page.

Wishing you all good health, and some much needed downtime with your families to reflect, heal and reconnect.

SAISI Board

6 Researched and Real Dangers of Screen Time

Today’s blog post is written by Karen Powell, who is in private practice, is a member of the SAISI Board and has a special interest in the decline of the child’s occupation of play.

Screen time debate – some real facts

I think we all have come to a realisation that screen time is bad for us, and our kids.  Some people take it more seriously than others.  When we are confronted with yet another debate about screen time and device use, be it in our practices or the parking lot, it helps to have some facts to back up the claims.  This photo was taken recently in a popular retail shop in the Boys 2-8 years old section and is an indictment on our society:

The average child will see over 20 000 adverts on TV each year. Children between the ages of 6 and 17 spend about five hours a day in front of the TV or computer and only 15 minutes reading books. In Britain today, children by the age of 10 years have regular access to an average of five different screens at home. In addition to the main family television, for example, many very young children have their own bedroom TV along with portable handheld computer game consoles (e.g. Nintendo, Playstation, Xbox), smartphone with games, internet and video, a family computer and a laptop and/or a tablet computer (eg, iPad). Children routinely engage in two or more forms of screen viewing at the same time, such as TV and laptop. Viewing is starting earlier in life. Nearly one in three American infants has a TV in their bedroom, and almost half of all infants watch TV or DVDs for nearly 2 hours/day.

Across the industrialised world, watching screen media is the main pastime of children. Over the course of childhood, children spend more time watching TV than they spend in school. When including computer games, internet and DVDs, by the age of seven years, a child born today will have spent one full year of 24 hour days watching screen media. By the age of 18 years, the average European child will have spent 3 years of 24 hour days watching screen media; at this rate, by the age of 80 years, they will have spent 17.6 years glued to media screens.

Yet, irrespective of the content or educational value of what is being viewed, the sheer amount of average daily screen time (ST) during discretionary hours after school is increasingly being considered an independent risk factor for disease.

So what is the risk?

  • Radiation:

There’s a video you would do well to watch: “The truth about mobile phones and wireless radiation: what we know, what we need to find out, and what you can do now”.  It is presented by Dr Devra Davis. She details the effects and dangers of mobile phones and wireless radiation. She outlines the evolution of the mobile phone and smart phone, as well as global studies on the health consequences of mobile/wireless radiation, including children’s exposure and risks.  You can watch the video here.

  •  Blue light

Blue light, emitted from our devices, affects both our retinas and our sleep patterns.   Blue light is not necessarily even blue, as chemical compounds are added to make the light on our screens appear white, and therefore less strange to us. Blue light causes the cells of the retina to produce melanopsin, which suppresses the release of melatonin, a hormone which times your circadian rhythms – and affects when we feel awake and when we want to sleep.  Watching screens disrupts the release of melatonin, preventing us from feeling sleepy and tricking our brain into thinking it is day time. Disturbed biological rhythms have long term effects for children and adults, who not only struggle to fall asleep but also have poorer quality of sleep.

Blue light has also been found to damage the photoreceptors of the retina.  These cells do not regenerate, and thus increased exposure to screens accelerates the degeneration of the macular, which controls visual acuity, and results in poor eyesight.

  • Loss of play and the physical effects thereof

Research has found that children aged 4-7 are spending less time playing in the real and three-dimensional world, with less time exercising their gross and fine motor skills. This is  resulting in poorer hand function, in-hand manipulation, visual-motor integration skills and sensory processing skills.  One therapist described it as a decrease in three-dimensional hand skills (grips, arches and manipulation) while two-dimensional (flat) hand skills are exercised by interaction with screens (e.g. swiping, scrolling). The time spent on devices does not allow for the repetition required for the fine motor skills to develop before children enter Grade 1.

Not only hand function is poorer.  Therapists are finding that children with excessive screen use have decreased sensory processing skills, as they spend less time in the preschool years stimulating all the senses, and while the visual system is often overwhelmed and tired, children present with under-developed and poorly integrated vestibular (movement), tactile (touch) and proprioceptive (deep pressure, tension) systems.

  • Obesity, junk food and caffeine

As most screen time takes place in a sedentary manner, it has led to an increase in obesity in school-going children. Research has found that children and teens consume more junk food when watching television and consume more caffeine. If eating takes place in front of television, tastes aren’t noticed as well as satiety and we eat more than necessary.

  • Decreased interaction and atunement

When discussing screen time, we need to be aware not only of the effect of the screen on our physical bodies, but also the effect on our interaction and attunement.  Attunement is a term used to describe the phenomenon that occurs when mothers and infants appear to be coordinated behaviorally and/or are concordant physiologically during early interactions. This phenomenon was observed by Dr Edward Tronick in the Still Face experiment (watch it here), and is now being replicated with mothers looking at their phones instead of paying attention to the needs and communication efforts of their babies.

An old article in The Signal (WA-IMH), describes how babies attribute meaning and value to items that fulfil a need i.e. a cup only holds value for them when it contains milk.  When it is empty they toss it away.  In the same way, when a parent/caregiver does not respond to a baby’s repeated requests for interaction, they are taught that the relationship holds little value.  This is tragic and holds dire consequences for the parent-child bonding and future relationship.

  • Mental health

I think many are aware of the negative effects social media can have on our mental health, whether it be by “compare-and-despair”, inappropriate comments by trolls or a misinterpretation of real life.  Problems that need to be considered include peer pressure, secrecy, decoy apps, live streaming, addiction to “hits” and “likes”, and unrealistic mirrors, not to mention increased anxiety and suicide rates. Our teenagers are particularly vulnerable to the dangers of the internet, interacting with strangers and sharing of videos.  Cyber-bullying is a real threat and parents of teens have a responsible to seek counsel and advice on how to journey with their children through this quagmire.

As can be seen, screen time affects not just our eyes, but our minds, our physical posture and weight, our mental health and our relationships – with our spouses, children and friends.  We have to be so careful to be mindful of the amount of intrusion we allow it in our everyday lives.

Next time we will discuss practical tips for reducing screen time addiction – from adults to babies.  In the meantime, empower yourself your clients and family with facts.  An extensive reference list of the articles referred to in this blog is given below.

REFERENCE LIST

  1.  Screen time and sleep among school-aged children and adolescents: A systematic literature review; Sleep Medicine Reviews, Volume 21, June 2015, Pages 50-58;
  2. Young children’s screen time: The complex role of parent and child factors; Journal of Applied Developmental Psychology, Volume 36, January–February 2015, Pages 11-17;
  3. Taking Another Look at Screen Time for Young Children Journal of Pediatric Health Care; Volume 31, Issue 2, March–April 2017, Page 141;
  4. Effects of television exposure on developmental skills among young children; Infant Behavior and Development, Volume 38, February 2015, Pages 20-26;
  5. To watch or not to watch: Infants and toddlers in a brave new electronic world; Developmental Review, Volume 30, Issue 2, June 2010, Pages 101-115;
  6. Janne E Boone, Penny Gordon-Larsen, Linda S Adair & Barry M Popkin. Screen time and physical activity during adolescence: longitudinal effects on obesity in young adulthood; International Journal of Behavioral Nutrition and Physical Activity, Volume 4, Article number: 26 (2007);
  7. Thomas N. Robinson, Dina L. G. Borzekowski. Effects of the SMART Classroom Curriculum to Reduce Child and Family Screen Time; Journal of Communication, Volume 56, Issue 1, March 2006, Pages 1–26;
  8. Byron Reeves,Annie Lang,Eun Young Kim &Deborah Tatar. The Effects of Screen Size and Message Content on Attention and Arousal; Pages 49-67 | Published online: 17 Nov 2009 (Media Psychology);
  9. Mary L. Courage, Alissa E. Setliff. When babies watch television: Attention-getting, attention-holding, and the implications for learning from video material, Pages 220-238;
  10. Aric Sigman. Time for a view on screen time. Correspondence to Dr A Sigman, Office 444, 91 Western Road, Brighton BN1 2NW. Disease in Childhood, Volume 97, Issue 11;
  11. School, health and behaviour suffer when children have TV, video games in bedroom Date: September 26, 2017; Source: Iowa State University Summary;
  12. Centers for Disease Control and Prevention October 20, 2010 Television and Video Viewing Time Among Children Aged 2 Years—Oregon, 2006-2007 JAMA. 2010; 304(15):1662-1667. doi: MMWR. 2010; 59:837-841
  13. Namanjeet Ahluwalia, Steven M Frenk, & Stuart F Quan. Original article Screen time behaviours and caffeine intake in US children: findings from the cross-sectional National Health and Nutrition Examination Survey (NHANES) BMJ Vol 2 issue 1;
  14. Russell Jago, Simon J Sebire, Patricia J Lucas, Katrina M Turner, Georgina F Bentley, Joanna K Goodred, Sarah Stewart-Brown, Kenneth R Fox. Parental modelling, media equipment and screen-viewing among young children: cross-sectional study; BMJ Vol 3 Issue 4;
  15. S Bowring. Book: Set free childhood—coping with computers and TV.
  16. Brown, T & Stagnitti, K. Relationship between screen-time and hand function, play and sensory processing in children without disabilities aged 4-7 years: A exploratory study.  Australian Occupational Therapy Journal.
  17. The Signal (WA-IMH), Vol 3 No 3 Jul-Sept 1995.

Sensory processing, occupational performance and leisure

In Part II of the blog post on occupational performance, ASI-trained therapist Tharina Annandale looks at how sensory preferences affect leisure choice, which also has a close link to mental health.

 

Occupational performance can be defined as different aspects of a person’s daily living, like work, social participation, play and leisure, and sleep (Strong, S. and Rebeiro Gruhl, K.,2011 pp. 31-33).

We can consider leisure to be an occupational performance area.  An activity is regarded as leisure when it is experienced as rewarding or enjoyment is experienced during the activity.  Different people pursue different leisure activities, depending on their personal “needs” or idea of enjoyment.

In the previous article on “sensory processing and occupational performance at work” the different sensory profiles (Dunn, 1999) were considered.  Each individual has their own, unique sensory profile and there is always an unconscious experience of the sensory environment and sensory information during an activity.  In the pursuit of enjoyment and meaning, an individual will always do whatever addresses their unconscious sensory need.  Thus, all of us will have different interests in leisure activities.  Some people will prefer leisure activities like bungee jumping and free-falling.  Other people will prefer sedentary leisure activities, like building a puzzle or reading a book.

Some people are sensitive in their tactile (touch) systems and others are sensitive in their vestibular (balance and movement) system.  Of course you get so many sensory profiles that it will be impossible for me to give an example of each one, but I will attempt to explain it with the following case study.

Let’s consider the following child: A fourteen year old boy that prefers playing violin and singing in the choir.  He has never liked team sports or any form of contact sports at school.  He prefers being alone during break time and is regarded as socially awkward.  He has visited almost eight psychiatrists in his lifetime and one psychiatrist had diagnosed him with depression.  Most of the other psychiatrists have told the family that “they need to stop fighting” at home, then everything will improve.  Some have considered a diagnosis on the Autistic spectrum, but have not diagnosed him formally with Autism.  During the boy’s baby years he did not like to be put in his pram and he preferred to sit and play.  He got severe car sickness and had to sit in the front seat of the car at all times, otherwise he would even get car sick on the way to the local grocer.  His parents have thought it good to enrol him in gymnastics and the boy has been doing trampolining since he was eight.  However, the mother noted that in spite of the fact that a teacher recommended trampoline as a sport that the boy could participate in, because “a trampoline is good for children”, the boy is really irritated after he jumped on the trampoline, until seven in the evening.  When the boy is finished at his “trampoline session” he goes out of his way to irritate his younger brother, his father and his mother.  His mother explains that “he is in her space” and she only wants to “slow down” for the day.

Know, dear people, this is a typical example of two sensory profiles in conflict with each other and explains why the psychiatrists keep on saying “that the family needs to stop fighting”.  Rightfully so, the family need to stop fighting, but what is behind the conflict?  When we considered the fact that the boy started crying when he was put in his pram and that he gets car sick, the indication of a sensitive vestibular system is a possibility.  The sensory profile indicated a severely sensitive vestibular system and this lead me to one question: “Was doing the trampoline the best leisure activity for this boy?”

Let’s have a look at trampoline as a sport- the following systems are involved when doing trampoline as a sport:  Vestibular, proprioception, tactile and the visual system.  At a closer look, it was established that the gymnast will have to make 180 degree and 360 degree (which is a full circle) turns during this sport.  The position of the head is mostly upside down and the speed increases with each rotation.  Was this the ideal leisure activity for this boy?  The boy did not mind going, because “at least his parents will think that he is cool in something”.

However, the root of the conflict was analysed and an adjustment was made in terms of leisure activity and today this boy copes at school and at home.  He does not experience any “sensory overload” anymore and changed his leisure activity to squash.  Squash has less of a vestibular component, it is not a team sport and the proprioception that he gets from hitting the ball inhibits his tendency to experience vestibular information at a more intense level than other individuals.  The mother reports that she has put the boy in a school with smaller classrooms and he has adjusted his daily program and his leisure activities to accommodate his sensory profile.  The boy’s anti-depressants were stopped and he is socializing less awkwardlyJ.  This is a very good example of someone with a Sensory Processing Disorder that could have been diagnosed with Autism and on chronic medication for “aggressive outbursts” “irritating others” and “fighting” at home.  At this stage I would just like to make it clear that I am not saying that there should not be a diagnosis of Autism, but sometimes a very serious diagnosis is made that could have been different if sensory issues were sorted out.

Let’s have a look at other leisure activities and possible sensory profiles that might match the activities.

Leisure activity Main sensory systems involved Matching sensory profile
Horse riding

Proprioception

Vestibular

Tactile

Individuals that need a lot of proprioception to regulate.  Sensory sensitive people and people with low postural control can benefit from this

leisure activity.

Shooting

 

Proprioception and tactile

Auditory

Although this activity allows for proprioception at the shoulder joint, the auditory information might be too much for auditory sensitive individuals.  Luckily it can be done with ear protection to keep the sound less intense.
Rugby

Proprioception

Tactile

Vestibular

This sport has a range of sensory experiences, depending on the position that the person plays.  If he is in the scrum, the proprioception can either help with regulation or the tactile (fact that you have to touch each other) can be too intense in the case of someone with tactile sensitivity.
Long distance running

Proprioception

Vestibular

Long distance running has proved to be a very “good” leisure activity for people that have low postural control and that struggle with tactile sensitivity.  In some cases people struggle with poor motor planning, then long distance running is an activity that do not require extensive motor planning and can be used to improve self-concept.
Puzzle building

Visual When considering puzzle building, the person will have to be able to regulate visual information.  If a person tends to be more sensitive in the visual system, sensory overload might be a risk factor.

 

In the above examples you can see that there is literally a leisure activity that suits every sensory profile (Dunn, 1999).  Leisure activities can either enhance occupational performance or can have a negative impact on occupational performance.  Therefore, it is of utmost importance to allow children perform the leisure activities of their choice and to make sure that the leisure activity that they choose to do is not to impress a parent or any teacher.  If a person does a leisure activity that they don’t enjoy, it can have a spiral effect on interpersonal relationships, work, self-care and even sleep.

It is important to be sensory sensible when choosing your leisure activity.

Reliable and valid tests for assessing sensory integrative function

Today’s post was written by Riette Smit, an occupational therapist trained in ASI® , long term board member of SAISI and the 2017-2019 outgoing chairperson of SAISI.

As an occupational therapist I have often been faced with the question, “What makes our [occupational therapy] assessments different to assessments other therapists and teachers use?” Regarding sensory integration: What is the difference between tests such as the Sensory Processing Measure (SPM) and Sensory Integration and Praxis Tests (SIPT), and what distinguishes them from other tests measuring sensory integration function?

Some tests require training and a process of qualification for the therapist before she is a qualified test user. Other tests can be downloaded easily from the internet, without any prior training or learning attached to the test.

In any comparison of assessments it is important to establish whether the same parameters were measured, i.e.  “to compare apples with apples.”

The value, usefulness and reliability of the interpretation of any assessment are greatly influenced by the statistical reliability of the collected data.  This rests on four factors: standardization, reliability, validity and the adaption to the South African population.

Let’s have a look at the standardization of the Sensory Integration and Praxis Tests (SIPT) which is widely used by occupational therapists trained in Ayres Sensory Integration®.  The SIPT represents a culmination of Dr. A Jean Ayres’s lifework.  It is based on theoretical concepts and research that evolved over four decades. In the early 80’s extensive field and pilot tests were done in Southern California and Chicago.  The SIPT’s primary purpose is to provide information on a child’s sensory integrative and praxis function.  It provides an in-depth look at the child’s sensory systems functioning.  The test contains 17 subtests and takes about 2 hours to complete.  Therapists involved in the data collection process underwent training in the administration and scoring of the SIPT.  The 1980 US Census was used to ensure appropriate representation of the US population in the normative sample.  Variables considered were age, sex, ethnicity, and type of community.  The final number of children tested (normative sample) was 1997 children.  These children were selected from 9 geographic divisions.

Let’s have a look at the reliability of the SIPT.  The reliability of a test indicates the extent to which the outcomes are consistent when the test is done more than once or in different testing situations. Test reliability also includes consideration of error related to lack of consistency in human performance and test imperfections.  This means that trained SIPT therapists will get similar results when administering the SIPT.

Another important aspect we need to consider is the validity of a test.  Validity is the extent to which a test measures what it claims to measure.  It is very important for a test to be valid in order for the results to be accurately applied and interpret by the therapist. The SIPT has a very good validity within the subtests.

A very important consideration is how the test one is using, is adapted to the South African population.  There are pertinent differences in some areas of development when we look at children globally.  For example, South African children are found to have better developed motor skills than children in USA and Europe.  To what extent are these factors accounted for in assessments?  Research by Dr. Annamarie van Jaarsveld indicated which subtests within the SIPT needed to be adapted for the South African population.

In summary, when comparing assessments used by a variety of therapists and teachers, ask yourself  the following questions:

a) Is this test standardized? On how many children was it standardized? Is that a good representation of children regarding age, sex, culture and demographics? Is training for the therapist required in administration and scoring of the test to interpret results successfully?

b) Is the test reliable? Will the outcome of the test be the same should it be done in different settings and by other trained therapists?

c) What is the validity of the test? Does it test what it says it will test?

These are questions any parent can ask to determine the efficiency of an assessment as well as the accuracy of test results.

References

  1. Mailloux, Z. (1990). An Overview of the Sensory Integration and Praxis Tests. American Journal of Occupational Therapy, 44, 589-594.
  2. Ayres, A.J. 2004. Sensory Integration and Praxis Test Manual, updated edition. Eighth printing. Western Psychological Services, Los Angeles
  3. Van Jaarsveld, A, Raubenheimer, J & Smith Roley, S. 2011. Patterns of Sensory Integration Dysfunctions in South African Children. In process of writing up.

Sensory Processing and Occupational Performance at Work

Our blog post this week is written by occupational therapist and SAISI board member Tharina Annandale, who has a special interest working with adults with sensory integration and mental health difficulties.

Occupational therapy can be defined as the science addressing occupational performance through occupation (Strong S. and Rebeiro Gruhl, K, 2011 pp. 31-33).

Let’s have a closer look at what we can understand under occupational performance.  Occupational performance can be defined as different aspects of a person’s daily living, like work, social participation, play and leisure and sleep (Strong, S. and Rebeiro Gruhl, K.,2011 pp. 31-33).

When we consider work as a occupation, the importance of it can not be understated.  The lack of opportunity to work does not only have financial implications, but the psychological and social impact of not working can be equally devastating.  Thus, supporting the importance of work in our daily lives.  On average, people spend about 8 hours a day at work.  Therefore we can conclude that we spend about 70% of our lives working.  Work is also most typically distinguished from other areas of occupational performance, because of its role in facilitating identity and a sense of meaning in our everyday lives (Pitts, 2011).  According to Pitts (2011), work has the following benefits:

  • Employment imposes a time structure and routine
  • Employment implies regularly shared experiences
  • Employment links different goals of people
  • Employment defines important aspects of personal aspects of personal status
  • Employment enforces activity, demanding an action

As humans we function as holistic beings.  The Person-Environment Occupation Model (Strong, S. and Rebeiro Gruhl, K., 2011 pp. 31-33) describes the interaction between the person, his/her environment and occupation.  In this instance the “occupation performance” aspect will be “work” and therefore we will discuss the dynamic interaction of the person, work and his or her environment.  Environments, occupations and people all have limiting factors.  Factors that contribute to a decrease in productivity and therefore decrease in meaning within a certain role.  Thus, we can assume that a change in one of the aspects (person, occupation and environment) can contribute to more productivity and efficiency within the workplace.  Each individual (person) has individual qualities, which can compromise a work project or enable it.  We can also assume that the environment will have a direct impact on the person and the performance of activities at work.

When we look at the individual or a person, the person will comprise of a spiritual, social and cultural being.  Furthermore we can include the affective (what the person will feel), the cognitive (what the person is thinking or whether he/she is concentrating) and the physical (doing).  The spiritual component will involve what gives the person “pleasure” or “meaning” in life. Each person will also have a sensory system.  The sensory system will include the proprioceptive system (system that receives messages through the joints and muscle tension), the vestibular system (in the ear, contributes to balance and equilibrium), the tactile system (feeling something, located on the skin), the interoceptive system (feeling of being hungry or having to go to the bathroom), visual system, olfactory system (smell and taste) and auditory system (hearing).

Each person has an unique sensory system.  Some of us have a high tolerance for loud sounds and other have a very low tolerance for loud sounds.  No two people have exactly the same sensory profiles (Dunn, 1999).  According to Dunn (1999) a person can fall into one of four sensory categories: sensory avoidant, sensory sensitive, sensory seeking or low registration.  You can complete a sensory profile to find out more about your sensory system here.  This will assist you in understanding your sensory profile much better and incorporate this in your work environment.

Have you stopped to consider your work environment? Consider the smells, noises, feeling of your desk or the cushion that you are sitting on.  What is the distance between you and the person next to you? Are they in “your space”? Are you feeling tired or cold maybe?  How do you feel at the end of the day? I will like to explain how the sensory aspects of the environment at work can affect your productivity or positive work experience through the following example of a mechanical engineering department:

The mechanical engineering department at a university will be planned as follows:

1) The engineer trainees are all working from cubicles that are not separated from each other

2) All the trainees have a computer with a sound system

3) The level where the cubicles are situated is looking out over the workshop area

Now, let’s have a look at all the sensory experiences of the trainees in the environments mentioned above.

1) The trainees will be able to touch each other and look on the computer screen of the trainee next to them.  They will be able to hear the person next to them talk and they will be able to hear the sounds and smell the odours from the cubicle next to them.

2) The trainee will use his visual system to look on his computer screen, will hear his own computer or even talk on the phone. The trainee will experience touch when touching his/her desk and feel the heat or cold of his/her body.  The trainee will also taste certain tastes in his/her mouth or smell different body odours in the environment.

3) The sound of the workshop will be totally overwhelming.  The smells from the tools and the materials that they use will be in the air.  People will be working in close proximity to each other.

Keeping in mind that each individual has an unique sensory profile, imagine the impact that an environment like the engineering department will have on each individual.  People that are sensory sensitive will have tremendous difficulty coping and in the long term it could also contribute to anxiety or even a mood disorder; not even to mention the effect that it will have on productivity.  As mentioned, all people have different sensory systems.  While someone might seek noise due to a high auditory threshold, someone else might be auditory sensitive and even avoid “normal” noise levels.

When a person that is sensory sensitive is exposed to noise, they can easily become overstimulated.  Symptoms that they might experience could be headaches, nausea, dizziness, yawning, lower concentration levels or a “foggy” brain.  When people experience these symptoms, they are not as productive as they should be.  This also influences the productivity of the company that they are working for.  Unfortunately, in today’s world, everything is about money and time.  People are expected be more productive and they should be able to work fast and effectively.  If the environment is adapted to be a more sensory “friendly” environment, people will be more productive and companies will benefit in the process.

On the other hand…have you ever wondered why people choose certain jobs?  Have you ever noticed that jobs tend to attract people with certain personalities or even certain sensory profiles?  A person with a sensitive vestibular system will prefer a sedentary job, but someone with a vestibular system that has a high threshold might prefer a job that includes movement, like a soccer coach or even a gym instructor.  These decisions might be made on a subconscious level, based on the subconscious need that people have for certain sensory information.  Sensory thresholds can also vary according to the time of day, whether you had a good night’s sleep or whether you are consuming medication or even illegal substances at the time.

As an occupational therapist, I find it difficult to treat patients during the afternoons.  I have a sensory sensitive system and depending on the noise levels or the amount of touch that I have been exposed to during the morning, my fatigue levels will vary.  This influences my frustration levels and my level of productivity during the afternoon.  The positive side to the story is that I have learnt to cope through “quiet time” or “time-out”, as some people call it.  When I get home, I take a luke warm bath and this inhibits the symptoms of over-stimulation or sensory overload and helps me to cope for the rest of the evening.  This re-establishes my energy levels and decreases my level of frustration.  If I did not have the insight to manage my sensory systems, the worst might happen…unneccesary conflict situations, unproductivity, anxiety and burn-out.

Sometimes people are not well-matched with their jobs or work environment, and then tend to be unhappy at work.  This can be addressed by educating people about their sensory profiles and ways that they can adapt to cope better on a sensory level.  An occupational therapist that is trained in the use of sensory integration can be consulted to adjust the environment.  Sometimes it is only simple things that need adjustment and in most cases people need knowledge about sensory processing and the reason behind “not coping” or poor productivity.

All of us want to be as productive as possible and experience meaning and pleasure at work.  We have different interests, personalities, physical attributes and SENSORY SYSTEMS.  It is up to us to make our work experience as positive as we can.  I will like to end off with the following anonymous quote:

“Don’t be busy, be productive, be sensory sensible”

 

 

 

KWELA Camp celebrates its 20th camp!

Welcome back to all our readers and wishes for a prosperous and sensory-inspired 2020!  In today’s blog post we hear from a bunch of hard-working therapists who are bringing sensory integration to children in the Cape in a whole different way during the December break.

Just a month ago, KWELA camp, the brainchild of Nita Lombard and Suzanne Olivier, celebrated its 20th camp in December 2019. The Kids With Energy Love Activity anagram rang true at camp, with 5 jam-packed days of activity. Robyn Turnbull, a Sensory Integration therapist at Sensory Kidzone and the KWELA camp coordinator for 2019 shares her experiences and thoughts with us.

KWELA camp is a unique specialized experience designed for children from 6 to 10 years. This 5-day intensive camp utilizes a Sensory Integrative approach, life skills, social emotional facilitation, observations for diagnostic purposes as well as training students and young therapists.

Daily life skills sessions introduced the lessons for the day, followed by craft sessions, perceptual motor and sensory integration sessions where the lessons from life skills were further instilled. These lessons encouraged our campers to practice turn taking, respecting others’ wishes and accepting that one might make mistakes – and that it is fine to make mistakes! Nothing teaches you to appreciate this lesson more than falling out of a spandex bridge onto piles of squishy mattresses. Mistakes can be fun too.

The theme and lessons from the movie Aladdin guided the planning for the life skills throughout the camp, with individualism being the key theme for the children to embrace. And did they embrace it! The concert evening held on the 2nd last day of camp is always a highlight for children and facilitators alike. With the hall set up like a theatre, the children performed a skit put together with their life skills group and were invited to perform individual acts as well. We were treated to singing, puppet shows, and even break-dancing. The courage of these children is enough to make the strongest of therapists emotional.

The 2019 camp welcomed the inclusion of hippotherapy. Patricia Hart travelled herself, two horses, games and tack all the way from Hout Bay to share the beauty of horses with us, and their therapeutic movement. The wordless, non-confrontational being of the horses brought a calmness to camp and instilled this calmness in the children who needed it.

The sensory integration session was a highlight for all children at camp. The opportunity to enter that room and climb on those swings got the children quite excited. At the new venue we had an even larger space in which to design and build the sensory integration lab – and nothing inspires a sensory integration therapist more than a large space and infinite suspension points! To date, the 2019 sensory integration lab was the biggest with the most individual pieces of equipment used in each session.

A new leaf of Kwela camp was turned as the decision to host the first optional-sleepover camp was taken, guided by the concerned parents’ “what if..”’s and “(s)he has never slept away from home.” Therapists were ecstatic at the response of children who changed their minds to join their peers in sleeping over at camp; considering that we had no television, cellphone or computer games on offer. The impressive nature of the children to seek out challenges for themselves, push their social boundaries and step up to independence was awe-inspiring.

Climbing the ‘KWELA mountain’ of planning, challenging oneself and growing was well worth it when parents gave feedback to state that their children: “can’ t stop talking about the activities from camp”, or “did not want to come home”, or said “they want to come again next year”. What better way to empower the children than through play!

Therapists and students also climbed their own KWELA mountains throughout the journey of receiving thorough training in the concept of a therapeutic community and specifically applying principles of occupational performance within a framework of Occupational Therapy.

We acknowledge and appreciate SAISI sponsorship in support of KWELA camp.

We thank the team of Taaibosch camp in Durbanville for their adaptability, and their willingness to meet the high expectations of the therapists.

We congratulate the parents who allowed their children to sleep over for the first time.

We applaud the therapists who gave 100% to the children despite their own struggles with change, limited hours of sleep, and year-end burnout.

I applaud the vision of the camp. And the people who drive its success.

Written by Robyn Turnbull – Kwela Camp Coordinator 2019.  Please visit their website here.

 

 

Travelling with SPD kids

Two weeks ago, Sally Fraser-Mackenzie shared some Tips for Trips to make our holiday journeys a little easier.  Today Dana Katz shares some ideas for travelling with children who have sensory processing difficulties which make those trips a little more challenging.  Enjoy the journey!

Some of my favourite memories centre around family holidays. Holidays are fantastic but getting to your destination can sometimes be quite an interesting, if not stressful and harrowing ordeal! Those of us with children know this only too well!

Travelling in a car or on a plane for hours on end can be extremely challenging for all of us. Not to mention tiring and perhaps even anxiety provoking for some. Maintaining a regulated, ‘calm-alert’ state is challenging when we have to sit still, have limited space and need to keep quiet. Our bodies need sensory input to stay calm and regulated. As adults we are generally able to override our sensory needs using top down strategies, such as cognition. We are able to tell ourselves to sit still for a while longer or not to kick the seat in front of us or not to shout out in frustration.

Alternatively, we are able to come up with other plans,  that are acceptable to those around us, to get what we need to stay regulated. Children can’t do this as effectively without some help. It is far more challenging for them to use top down strategies to stay in control of their bodies. They need input through their sensory systems; touch, movement, vision, hearing and taste to help them to stay in a ‘just right’ state of arousal. If they do not get the input they need, they may become overloaded or dysregulated, and you might see some of the following behaviours:

Irritability, restlessness, avoidance behaviour (covering eyes or ears, hiding away), anxiety, increased sensitivity, distractibility, flight behaviours (running away), crying easily, before a full meltdown sets in. Try to be alert to changes in behaviour that might be signs that your child is becoming overloaded and intervene with regulating input before a meltdown occurs.

As an OT mom trained in Sensory Integration, I decided to tap into my SI basket of tricks, to try and keep my sensory seeking children happy and regulated on our long journeys.

Here are some of the ideas that have helped me:

Preparation:

Being prepared and preparing your children beforehand is super important. Using a visual schedule (especially for younger children or children prone to anxiety) to help them to understand timelines can be very valuable. You can plot the number of days before you leave with a picture of your destination at the end, plot the time on the journey, including rest stops when travelling by car, if you are flying: airport and aeroplane schedule from arrival at the airport, check in, meals to landing and collecting bags.  The more they understand and are prepared for what is to come, the easier the journey will be.

Ensure that everyone (including Mom) has had a good night’s sleep before you leave. Being tired makes our nervous system more susceptible to sensory overload and resultant meltdowns.

Ensure that you have some regulating (sugar free) snacks, cold water and a few easy fidget toys in your bag at all times.

In the car:

  • Plan regular stops at spots that have child friendly areas to run and play.
  • Try to stop for meal breaks and not to eat meals in the car.
  • Use sippy cups / water bottles that can’t spill and keep snack food to simple finger foods, not sticky, saucy snacks that can ooze and drip.
  • Be aware of smells in the car – coffee, strong foods, these can also overload a sensitive system.
  • Use weighted blankets / weighted teddies to help calm or help them to sleep longer.
  • Block out overloading visual stimuli from the outside using a dark blanket / towel on the window (or some form of sun visor) so that the visual stimulus passing by doesn’t overload them.
  • Be aware of the noises in the car – aircon, music, talking, radio etc…that might become irritating.
  • Keep clothing soft and comfortable and unrestrictive. Try to eliminate zips, buttons and tight elastics.
  • Have a box of fidgets available using your child’s sensory preferences or special toys that they enjoy; play dough on a lap tray, squeezy toys, filled balloons (helium quality) with; flour, rice, cous cous, little beads etc… and have mini textured stress balls to play with (or buy some)water and oil timers, mini lava lamps, snow globes / kaleidoscopes to look at etc…
  • Mobiles / a balloon on a string attached to the back of the front seat can be fun.
  • Blowing bubbles
  • Books –
    • Touch and feel books.
    • Mellissa and Doug “Water Wow” books
    • Dry wipe books
    • White boards for drawing on
    • Card picture books (not paper pages that can be torn by accident or in frustration)
    • Spotting books
  • Music and ‘dance’ – favourite music and nursery rhymes, a few musical instruments – shakers, castanets. Sing fun songs and do action songs together. NB: Don’t have music on the whole time, regular quiet time is very important.
  • Provide regular snacks – chewy and crunchy are regulating, i.e. dried mango, savoury biscuits, rice cakes, fruit rolls, popcorn, biltong, favourite snacks (NB limit sugar intake).
  • Suck activities: milk / tea / water bottles, drinking yoghurt through a straw, dummies, ‘Squishes’, to help keep them regulated.
  • DVD’s / favourite cartoons / interactive Apps – for a short while or if you are desperate! Remember these are hard to take away once introduced.
  • Audiobooks are always a winner!
  • Blow Pens / “Sprayza Pens” (from Hamley’s) – to colour in pictures / shoot at targets on a page
  • Scratch and sniff stickers
  • Magnetic games

 

Ensure that all activities are easily accessible, so that you don’t have to dig around or struggle to get to them. Have a few plastic containers in the foot well filled with the things your child may need.

On the Aeroplane:

Prepare them before boarding

  • Brushing and joint compression protocol
  • Deep pressure massage / squashes
  • Let him jump and run (up and down an incline would be best)
  • Carry a heavy backpack / push the trolley etc…
  • Board last
  • Seat them last – let them move around for as long as possible
  • Tie seatbelt quite tight
  • Have a schedule of events from boarding to landing – try to find out from the airline and print visuals
  • Can use ‘Rescue Pastilles’ to help with calming.

On the plane

You can use all the car ideas above on the aeroplane too. Here are some extra ‘aeroplane specific’ ideas!

  • Ensure that they drink enough water.
  • Have chewy sweets, gum to suck for take off / landing – if you have a baby, let them drink a bottle – to help equalize pressure in their ears.
  • Have a few surprise treats packed that are new and novel, that can be used as incentives / reinforcers.
  • Massage hands / feet to calm
  • Squash him under a pillow or use a weighted blanket or weighted teddy
  • Sit on a deflated beach ball / move ‘n sit cushion
  • Bounce them on your lap while hugging tight
  • Give regular (15 – 20min), varied calming sensory input while awake.
  • Take him for short walks, play games, i.e. “Simon Says”, balancing on one foot, push ups, at the back of the plane / air hostess’s area …. find a spot that vibrates / shakes and let them sit there for a little while.
  • Look out of windows etc…
  • Plan a scavenger hunt and let him find things around the plane.
  • Vibrating massagers (handheld) / toys / pens / toothbrush

I hope that some of these ideas will be helpful and will make travelling to your next holiday destination fun, happy and relatively stress free!

Happy Holidays!!

Dana Katz

Dana is a mom to 2 sensory seeking kids and an SI OT with 20 years’ experience in paediatrics. She lives and works in Cape Town where she runs an inclusive preschool and an SI OT practice.

 

 

The Show Must Go On

“The Show Must Go On” is a popular phrase we are all familiar with. The well-known hit song by Queen, “The show must go on”(1991) has a catchy melody, but when we listen closely to the lyrics, it is tainted with anguish and suffering.The phrase was first coined by a circus back in the late 1800’s. Although there is no record of which circus used it first, the phrase caught on and was used by other circuses. It was used by the ringmaster when there was an incident, such as an animal getting loose. It was an effort to keep patrons calm and reassured. “The show must go on“ was printed in the Evansville (IL) Daily Journal on September 12, 1866 and in The Morning Republican (Scranton, PA) on December 13, 1875. In the 1900’s, the term spread to all of show business as a catch phrase meaning keep the show going regardless of what interferes. The expression soon applied to any kind of “show,” even a political show. (Quora.com) “The show must go on” became a proverbial phrase widely used in quotes and in various contexts since the 1800’s, and is still current today in the 21st century.

My circus, my monkeys, my responsibility

I was assisting backstage at my 7-year old daughter’s ballet show, when I felt the reality of the cost for the “show to go on”. The cost in this context does not refer to the sacrifices in terms of time or money, but the sensory and emotional strain on children and their parents, the impact on relationships and family life, and even the way how (we think) other people perceive us, can influence our decisions and behaviour.

 

As I sat there watching the hungry, thirsty, tired, excited ballerinas, bouncing in the heat backstage with flashing lights and loud music, waiting for over two hours before it was their turn to go on, the penny dropped. It was a sensory disaster, and we chose to take part in this show. Proverbially speaking, this was my circus, and I was responsible for these little monkeys. Life can be a bit like a theater performance sometimes, and the things we have to handle and cope with “backstage” so that the “show can go on”, can be debilitating and exhausting. I had to ask myself, are all the hours of preparation and emotional turmoil really worth the few minutes on stage?

 

The sensory struggle is real

Weeks before the show the schedule was finalised, amidst the end-of-year rush, with extra rehearsals on Saturdays. In the week of the show building up to the weekend, there were two additional compulsory dress rehearsals at the theater in the city center. Then the highlight of the year’s hard work: three scheduled theater performances, one on Friday evening, and two on Saturday, with a photo shoot in between. This implied that the ballerinas had to be fully dressed in their costumes for all the performances, with perfect hair and make-up. As a mother, I felt frustrated as my daughter so desperately wanted to dress-up and take part in the show, but at the same time it was a complete sensory nightmare and our relationship was suffering. Routines and habits were disrupted, and we just survived from moment to moment with less than optimal sleep and food. At times I felt a bit helpless as I could see how everything escalated, but did not know how to do it differently. We were late for the 10h30 rehearsals as the tears, anticipation and resistance already started when she woke up at 6h00. I was not allowed to open the curtains, the elastic of the skirt was too tight, the leotard pinched her skin, the strings in the ballet shoes could not be tucked away properly, the soles of the shoes were too dirty, the tights were too itchy, the hair bun was too big/small, the colour of the elastic was not right, the hair clips were pokey, the hair products smelled bad, she wanted to do her own make-up as I was not doing it right, breakfast was not right, and she did not need the toilet (which implied undressing and dressing when we arrived at the rehearsals, already late). Needless to say, this was a challenging and exhausting time, and yet, regardless of the struggles, we managed to find a way to pitch for the rehearsals, even if it meant arriving a few minutes late without tights and a perfect hair bun. She persevered and learnt that if she wanted to take part in the show (which she insisted she did), she had to deal with the demands that go with it.

As I was sitting in the end-of the month, black Friday city-center traffic on the way to the first performance at the theater, the words of Dr Ayres dawned on me “when the flow of sensation is disorganised, life can be like a rush-hour traffic jam”.1,2 I felt relieved that there were words and an explanation for what we were experiencing and a weight lifted off my shoulders as I understood better, and knew there was something we could do to cope better. This is probably what was happening to some degree in the brain stem of every ballerina and parent: a complete sensory overload resulting in frustration and various survival mode behaviours.3 As an OT trained in sensory integration, it took a while for my brain to kick into gear as I (an adult and parent) was also trying to cope with my own sensory issues like the loud music, the heat, dealing with my daughter’s emotions, as well as my own, and making sure everything was packed and ready so she can show up, despite the traffic.

As with life, the show had to “go on”, despite all the difficulties and challenges. However, the one thing that could not be ignored, punished, bribed or avoided, was that the sensory issues and struggles were real. VERY REAL. And if they were not acknowledged and dealt with at the right time and in the right way, became worse and we got stuck in the proverbial sensory traffic jam, and ended up in tears and smudged make-up.

 

The difference with life is, even though we have a choice, some things are compulsory, like we have to eat, get dressed, get enough sleep, and hopefully enjoy the activities we choose to participate in. Some of those things we can control e.g. what we eat, what we we wear, what time we go to bed and what we choose to participate in. On the other hand, some things we have to handle as they come e.g. the unpredictable responses of others, unexpected changes in our plans, and the “volume and intensity” of life.

Keeping the context in mind

In life, the “show” can be anything from keeping it together at school during the day (especially assessments), or with friends at a birthday party, a school prize giving evening, year-end party, or simply just dealing with the sensory and praxis demands of simple every-day things.It also happened that my daughter’s class was being renovated two weeks before the holiday, and they had to be divided into the other classes with children they may or may not know. In hindsight, of course, I could recognise that all of the above happened to my daughter in the weeks before the show, contributing to the after-school and Saturday morning meltdowns.

Strategies for coping and conquering “backstage”

We all have different coping mechanisms, and should have compassion and empathy for everyone’s perspective and experience. We have to familiarise ourselves with the challenges that go with the rules and expectations of the show or game e.g. dress code, make-up, and try to identify “backstage” coping mechanisms that are crucial for keeping things together e.g. getting enough sleep, taking sensory breaks (time away or out of the situation), healthy snacks (chewy and crunchy), taking those itchy stockings off, and letting their hair down (literally and figuratively speaking) to allow for recovery time between the shows in order to go on. The insight and sensory strategies were not nice to haves, they were critical for our survival during a challenging event. We are so often not aware of the blood, sweat and tears behind the scenes for someone to just keep things together in ordinary everyday events. In the end, what matters is that we did not sacrifice our relationships for the sake of the “show to go on”, but that we supported and encouraged each other, and experienced joy and satisfaction in what we accomplished together, with a bit of help of friends and family.

For my daughter, the victory dance at the finale and the smile at the end when the curtains went down, was priceless. She did it, and she loved it, which made it all worthwhile. She did not only take part in the show with a smile on her face, she also endured all the backstage challenges and conquered many unseen backstage mountains that were not part of the show. That in itself, was a victory. We can learn from our children that it is not just about the show that “must go on”, it is about accomplishing something, despite the challenges, and feeling good about it afterwards.

 

 

December holidays and Christmas season

Everyone is looking forward to a much-needed break. Now it is our responsibility to find a balance between the things we do for fun so that we can also relax during the holidays, and not a need a holiday to recover from the holiday. We have to give ourselves permission to slow down, rest, ask for help and let our hair down when we need to. We have to implement strategies so everyone can be OK during the holidays and Christmas season such as anticipating meltdowns and be prepared, whether it is for a long drive, long rainy days, hot and windy days on the beach, noisy restaurants, dinner parties, or festivities at busy public places. We have to be sensitive to and have compassion for our children’s sensory needs, as well as our spouses’ and our own, especially in a time when our habits and routines are disrupted. Let’s respect each other’s experiences, that it is REAL to them, choose our activities and company so that we can be energised at the beginning of the new year, that the “show can go on” without too many sacrifices and that we can enjoy the time together. Happy holidays everyone!

 

  1. Ayres AJ. Sensory integration and learning disorders: Western Psychological Services; 1972.
  2. Ayres AJ, Robbins J. Sensory integration and the child: Understanding hidden sensory challenges: Western Psychological Services; 2005.
  3. Bear MF, Connors BW, Paradiso MA. Neuroscience : Exploring the brain. 3rd ed. ed. Philadelphia, PA :: Lippincott Williams & Wilkins; 2007.

 

Thank you to Stefanie Kruger for her beautiful metaphor shared in this post.  Stefanie is an OT trained in Ayres Sensory Integration, SAISI Board Member and lecturer on the SASIC courses.

Tips for Trips

As we head into the holiday season, with many families planning their annual holiday, Sally Fraser-Mackenzie (OT, passionate road-tripper and mother of two busy boys) gives us some do’s and don’ts to prepare as we set out eagerly for our various destinations, so that we don’t arrive battered and bruised but ready for some real R&R.

 

General Principles of Travelling with small children:

  1. Plan petrol and loo stops carefully – fill up with petrol before the trip. Synchronize sleep time away from stops for food, loo, road work areas (road blocks and stop-and-go’s).
  2. Leave early – all family members are generally better in the morning, rather than the afternoon.
  3. Try and drive away from the sun – west in the morning and east in the afternoon.
  4. Stop for a long healthy, hearty breakfast. Preferably somewhere where there is a large area to run, trampolines, or a touch farm.
  5. Alternate which side of the car the child sits on if possible, so that the seat belt doesn’t keep pressing on the same side of their body for such a long time.
  6. Peg the seat belt higher up so it doesn’t squash their shoulder and irritate them.
  7. Line the car seat with a soft blanket, sheepskin, or pillow (those kids car seats can be really hard).
  8. Use some form of sun visors if necessary, even if just a towelling nappy in the window.
  9. Always have 2 or 3 towelling nappies available in the car. (Sun visors, plate to catch crumbs for Dad’s sandwiches, vomit cloth, soaking up toilet accident, wiping up yogurt, tug of war, cleaning the windscreen, wiping anxiety sweat from your brow!)
  10. At road blocks, if possible, get out, move, visit your neighbours… make friends…
  11. Monitor the children carefully. Change activity BEFORE they get irritated and “go over the edge”. Keep them regulated and settled. Do not, DO NOT let them get beyond themselves and unable to calm. (I speak from the bad kind of experience…)
  12. Approach the trip as an adventure, and something positive and exciting. Don’t let the kids get wind that you are terrified! (It does get better with age!)

What NOT to do:

  • Activities with small parts (potential for: choking hazards; lost forever; jam up the air-vent/seat belt)
  • Sticky juices (stick to water).
  • Yogurt (gets everywhere)
  • Sugary snacks (if your child responds badly to sugar).
  • Sugary snacks (if you do regular long trips).

GOOD Activities to do:

  • Having boxes or bags of various activities to pull out at different stages.
  • Box of fiddles: bubblewrap, scooby wire, pipecleaners, elastic bands, Prestik.
  • ZipLoc Bag (sealed with tape) or something stronger filled with rice and small objects (beads, plastic bugs, paperclips, matches, etc), then child must find the objects. Some children will tend to make holes and push small bits through and make wonderful mess.
  • Balloons on sticks. Balloons off sticks. Balloons on a string.
  • Squashy squeezy stress balls – Commercially available or you can stuff balloons with play dough, rice, seeds, maizena, flour, sand, cotton wool. Can put another balloon around the first for extra strength.
  • Shop at Crazy Stores (Or Mr Price Home) before trip for bits and bobs – bringing out a novel toy may save the day. Keep a few surprises.
  • Buy them a new small toy animal, vehicle, man to play make believe with, make a story with.
  • Books – touchy feely ones are always good.
  • Music – sing-a-long songs, action songs, bring out a few musical instruments – shakers, castinets. (Don’t have music on the whole time. Put it on in bursts, have it loud, enjoy it, then turn it off).
  • Wrapping up all these kinds of things you would give them anyway (snack, toy, book), then when they have to find e.g. a windmill, then they can open one thing.
  • Sticker books
  • Snacks – popcorn, chewing gum, carrots, pickles, cucumber, dried mango, savoury biscuits, rice cakes, fruit rolls, liquorice, wine gums, jelly babies (try and keep sugary snacks as last resort).
  • Thread an Otee/Cherrio necklace, then eat one by one.
  • Magnetic drawing boards
  • Blow activities: noiseless whistles, mouth organs
  • Suck activities: long straw with a Yogisip
  • Weighted blankets to help calm them, or help them sleep longer
  • Attach a polystyrene bag on their laps as a work station so they have something to put their sticker book on.
  • Simple games – “I spy” with colours

For the older ones:

  • DVD’s (works particularly well for children who don’t have TV at home, like mine – as it is such a treat! – we did a 900km trip through the Karoo (7 movies) and they didn’t even ask when are we going to get there!)
  • Ipods (especially if your kids are different ages, and have different needs)
  • Audio books
  • Verbal Games – I spy, find the next red car, etc.
  • Magnetic board games – noughts and crosses
  • Activity pads with wipe off markers
  • Etch a Sketch
  • Library books they haven’t seen before
  • Where’s Wally, or puzzle books
  • Sing-a-long Music (Queen played very loudly is a firm favourite in our car, and James Taylor!)

To Prevent car sickness and vomitting

  1. Don’t let them scream so much they vomit. Stop the car. Get out, have a break, anywhere. It is worth it! (I know)
  2. Ginger helps – Ginger teas, ginger biscuits, candied ginger.
  3. Ice blocks held in the palm of the hand or rubbed on soles of the feet.
  4. Suck an ice block (don’t choke on it).
  5. Heavy pressure to the head – Joint compressions through the neck.
  6. Let the child sit on a booster seat in front to watch the road. Or in the middle at the back.
  7. Choose your activities so child is not looking down.
  8. Play lots of “I spy” and talking about the environment, and listen to music.
  9. Sea bands – available from pharmacies.

And lastly – if these don’t work – maybe consider a staycation 🙂

With thanks to Jenni Saunders, Kate Bailey, Michelle Luyt, Ray-Anne Cook and Janet Michaelides – some creative and inspirational mothers and therapists!