What is the therapist looking at during a sensory -motor evaluation?

When children are referred to us at DPK we go through an evaluation process utilizing a variety of tests:  Standardized Motor Scales, A Sensory Profile, the Sensory Processing Measure, Clinical Observations of Sensory Integration. 

Many parents ask us, “What are you looking at and how can you determine what is causing the problem?”

This is a very good question and requires a comprehensive answer!

In general, we are looking at how your child’s brain is spontaneously responding to sensory input (tactile, visual, auditory, vestibular, proprioceptive, multi-sensory).  We look at responses (called adaptive responses) and output behaviors to determine sensory processing ability.

All skills and functions that occur happen as a result of the Central Nervous System (CNS) processing and responding.

All behaviors and skills are a reflection of the state of the CNS. 

The level of organization or disorganization of the CNS is reflected in behavior.

There are 4 categories of OUTPUTS of the CNS:

  1. Motor Behavior
  2. Fine motor
  3. Gross Motor
  4. Visual Motor
  5. Oral Motor
  • Language Behavior
  • Receptive Language
  • Expressive Language
  • Pragmatic Language
  • Cognition/Academic Behavior
  • Academics
  • IQ scores
  • Psychosocial-Emotional Behavior 

*** This area is the primary area affected by self-regulation dysfunction

  • Ability to Focus, Attend, Interact and Engage
  • Self-Awareness
  • Ability to Relate to Others
  • Ability to Relate to Objects/Things
  • Self-Esteem and Self Control

The referral source to a therapist are children expressing behavioral dysfunction in one of the 4 areas outlined above.  During a sensory Integration based evaluation for Sensory Processing Disorder (SPD) we are looking at the output behaviors of the Central Nervous System to determine how the information is being processed and where in the brain the breakdown occurs. 

When the CNS is organized, a person is able to respond to the environment with appropriate motor or emotional “behaviors”.

When the CNS is disorganized, the responses be it motor or emotional are also disorganized.  A child’s poor behaviors may be a reflection of a disorganized CNS.

An adaptive response is defined as a spontaneous response to sensory input. 

A functional or successful adaptive response is one that results in efficient and effective use of the body in the environment as a result of intact processing of sensory information through the CNS.

A dysfunctional or maladaptive response is one where there are poor responses or inconsistent responses in one or more of the output areas (Motor, Language, Cognition, Psycho-Social).

Different types of processing disorders are related to different areas in the brain where the breakdown occurs – NOT to a specific sensory system itself.

Once we have completed all ofour testing, we can determine where the breakdown occurs and begin to develop atreatment plan based in a sensory integration approach which is targeted tochange the specific part of the brain that is not processing effectively.

Rebecca Berry, MS, PT, Clinic Director
Becky has been an active pediatric physical therapist on the mid-peninsula since 1985, most recently as cofounder of Developmental Pathways for Kids in 1997. She received her Master’s Degree in Physical Therapy from the University of Southern California. For over thirty years, she has provided physical therapy evaluation and treatment for infants and children with mild to severe developmental delays. In addition to direct patient services, Becky has served as coordinator of a multidisciplinary pediatric team at Mills-Peninsula Hospitals and provided consultative services to schools throughout the Bay Area. Her expertise and areas of interest include Autism Spectrum and Sensory Processing Disorders as they relate to peer socialization and play. She has completed research on the DPK Model Combining Sensory Integration and Integrated Playgroups and is a conference presenter throughout the United States. 

In her practice, she combines advanced training in NDT and Sensory Integration Theory and Practice as well as expertise in Integrated Playgroups, the ALERT Program, DIR/Floortime® and The Listening Program®. She has co-authored the book, Pathways to Play! Combining Sensory Integration and Integrated Playgroups and is the author of Hearts and Hands Together a story of inclusion

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Ideation

IDEATION

  

 

Do you know kids who:

  • say “I don’t know” a lot
  • copy the behaviors of other children
  • wait until another child offers an answer or idea and then agrees
  • appear a little reticent to play
  • rarely initiate
  • don’t suggest things to do or games to play in a highly engaging environment
  • have trouble sequencing simple steps to a project or physical activity
  • have difficulty remembering what they did last week or yesterday or this morning
  • cannot predict what will happen in a story as it’s being read


All of these behaviors exemplify children who have trouble with
ideation; a concept that plays an enormous role in all aspects of life.  

 

Ideation is the creative process of generating, developing, and communicating new ideas… Ideation is all stages of a thought cycle, from innovation, to development, to actualization.

It is the ability to visualize the action the child wants to take and how his body should move to do so.  This happens in both similar and new situations.  Ideation provides the goals for the motor action:  what does he want his body to accomplish?  For example, if he enters a room and sees a box of cheerios and a piece of string on a table, he can generate an idea of how to use them based upon his previous experience with beads and a shoestring.  If he should happen upon a box full of plastic nuts, bolts and screws but has never been exposed to the use of them, he could draw upon his past experience with beads and shoestrings and begin to stack the nuts and bolts upon the screw to create an object.  The collection of past experiences is automatic.  But the decision to put them into use is accomplished through his attention to the task.

 

Ideational challenges make learning, social interactions, and physical activity problematic and negatively impact self-confidence and self-esteem.

I am finding many of the kids with whom I work have a difficult time coming up with novel ideas.  This has been happening in the play gym on novel equipment, when telling stories, when they are creating a structure with cranium builders, or when drawing.  Our Integrated Playgroups provide kids with ample opportunities to build this particular skill, but it can be difficult to help a child develop creative thinking.  Many times, when a child is given an open-ended directive, the outcome is often a repeat of a previous idea or activity, a copy of another child’s idea, or a repetitive theme.  When asked, “What should we add to the obstacle course?” sometimes we get an answer of, “I don’t know!”.  That’s when it’s time to “stop, think and choose!”  We have everyone “stop” and look at what is going on (“What will happen after you go on the zip line?  “Where will your feet land?”), then it’s time to think (“How can I add something to the obstacle course that works with the zip line?”) and choose (“Find something that will work!”).  This is the process of ideation – the ability to generate, develop and communicate an idea.  And for some of our kids this is hard work.

How can we help kids create ideas? During a conference I attended years ago on Building Praxis Skills, the speaker had suggested using the book “Not a Box” by Antoinette Portis as a fun way to promote creative thinking. I used this a number of times in a playgroup with great results.  First I read the book to the group and then gave each child a piece of paper with the same single-lined non-descript shape and told them to imagine what it could be and then add to the drawing.  After a designated amount of time, they passed their papers to the left and were told to add on to the previous person’s drawing.  Initially, when the papers were set before them, some of the novice players attempted to turn the form into what they had initially intended… a house, a truck, a treasure chest, a pool.  After some discussion, we tried round 2 giving each child a paper showing a new box.   We encouraged the kids to look at their friend’s paper when it was set down before them and to try to imagine what their friend was thinking about when they drew it.  Then, they should add to their friend’s drawing.  The goal eventually would be that the kids were able to take the perspective of their friends and create a novel addition to each picture that was consistent with the original drawing.  A huge side benefit was that the kids also learned to be flexible when their original pictures returned to them looking different than what they expected.

Here are a few other ideas we have tried with children in our Playgroups to build ideation:

  • Practice visualization.  Have the kids talk about and describe things that are familiar to them. For example, describe what your bedroom looks like (e.g. where is the bed?, what is on the walls?, where are your clothes?)
  • Tell a story without showing the pictures.  Have the kids describe the picture in their minds based on the words.  If the story is about a witch with stockings, what color are her stockings?  How old is the witch?  What does her hair look like?
  • Acting out stories is always fun.  Once a story is read, the kids can pick parts and picture where they will be acting out scenes and what they might use for props.  If they haven’t seen the actual pictures of the story, they will feel less like there is a “right” and “wrong” way and will be free to imagine and express themselves.
  • When kids are getting ready to transition from one room to another, take a moment to have them picture and describe the hall – what is in the hall?  Is anything on the walls or a rug on the floor?  What does the room they are going to look like?  Have the kids describe items and location of these items in the room with as much detail as possible.  Tell the kids where you expect them to go when they enter the room and have them visualize themselves going there and sitting down.
  • Before playing a familiar game, ask kids to close their eyes and imagine themselves playing the game.  What color is their piece?  With eyes closed, have them describe details of the game board.  The kids can then describe how to play the game – a nice sequencing activity.  While they are imagining themselves playing the game, talk about how they are cooperating with each other and having fun to reinforce the good sportsmanship.
  • Before asking a child to remember what activity they did last week or what they want to do this week, have them close their eyes while providing them with leading cues.  “Let’s see, we were in the front room with the rainbow swing last week and there were big blocks in the corner…” If they can visualize the environment, they may be able to “see” themselves there, giving them the context for the activity.
  • Make a picture using blocks. You can use different kinds of wooden blocks, legos, tinker toys and put all materials out on the mat.  Ask everyone to think of a scene that they want to create.  For example: “I want to create a rainbow tree with a girl eating an ice cream under it.”

Add stuffed animals or dolls to the scenes to make them come alive.

  • Practice “zigzags” of familiar games and activities.  Play tag and then have a child change one small thing about the game such as using a base or playing freeze tag or team tag.  When children with ideation challenges experience success in being original in this small way, their anxiety goes down and self-confidence soars.
  • Put something out of reach of your child and ask, “How can we get this animal back on the ground?”. Ask your child to “tell” you what he is going to try rather than “show” you. And then ask questions like “Is that a safe idea?”, “What would be a wacky idea?”, “How else can you solve the problem?”

A final thought I saw in an article on Ideation: “I know we are all sick of hearing about the negative impact of TV, computers and other technological devices.  However, if we don’t provide our young children the physical, mental, and emotional space and opportunity to create their own images in their heads, how will they develop the capacity for the creative process of generating, developing, and communicating new ideas”?

(Jill Perry MHA, M.S. OTR/L )

Rebecca Berry, MS, PT, Clinic Director
Becky has been an active pediatric physical therapist on the mid-peninsula since 1985, most recently as cofounder of Developmental Pathways for Kids in 1997. She received her Master’s Degree in Physical Therapy from the University of Southern California. For over thirty years, she has provided physical therapy evaluation and treatment for infants and children with mild to severe developmental delays. In addition to direct patient services, Becky has served as coordinator of a multidisciplinary pediatric team at Mills-Peninsula Hospitals and provided consultative services to schools throughout the Bay Area. Her expertise and areas of interest include Autism Spectrum and Sensory Processing Disorders as they relate to peer socialization and play. She has completed research on the DPK Model Combining Sensory Integration and Integrated Playgroups and is a conference presenter throughout the United States.

In her practice, she combines advanced training in NDT and Sensory Integration Theory and Practice as well as expertise in Integrated Playgroups, the ALERT Program, DIR/Floortime® and The Listening Program®. She has co-authored the book, Pathways to Play! Combining Sensory Integration and Integrated Playgroups and is the author of Hearts and Hands Together a story of inclusion

 

 

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