Module III: Intervention of Sensory and Motor Issues in Individuals with Asperger’s Syndrome

Beth’s Intervention Program

Direct Intervention Services

When Beth first began direct intervention, she and the therapist established a strong and trusting relationship within her first couple of sessions. The therapist met with Beth’s parents and together they came up with goals and objectives for intervention based on behaviors they wished to see changed (Please click on the links below for a sample of Beth’s goals and objectives in either Microsoft Word or Adobe Acrobat format. You will need Adobe's Free Acrobat Reader if you choose PDF format.).
Beth's Goals and Objectives:
  

The therapist then worked with Beth to set up the “just right challenge” to reach her goals. This is the balance between the chosen activity being challenging and motivating enough that the client wants to put the effort into completing the activity but not too challenging that the client is overwhelmed or discouraged. The client needs to feel comfortable, safe (both emotionally and physically) and secure with the therapist and the environment.

The therapist used a variety of modalities in order to help Beth and her family achieve their goals. For example, to help Beth with her sensitivity to light touch experiences, including food sensitivity, the therapist used activities that provided strong, firm pressure to her whole body. These included a ball pit, a therapeutic brushing program following the Wilbarger Protocol for Deep Touch Pressure, large crash pillows made out of a soft material, and some oral motor exercises with straws, whistles, and toothbrushes. For more information regarding Patricia Wilbarger’s Brushing Protocol please see the following link: www.pbbkids.com/the_wilbarger_brushing_protocol.htm. ⁹

To help Beth with her fear of movement and carsickness, the therapist used a variety of swings hung low to the ground to allow her to receive vestibular or movement input in a linear and non-threatening manner; and climbing structures and jumping activities to help give Beth more information about her body and head position in space.

To work on decreased endurance, strength and body awareness, the therapist directed Beth toward activities that provided heavy work input to her whole body. These included jumping into large crash pads, pulling on ropes, carrying heavy objects such as large bean-bags, and jumping up and down on different surfaces such as mattresses and trampolines. These activities also helped improve postural stability and general over all motor coordination. Throughout intervention, the therapist chose activities that fit the “just right challenge” for Beth and graded them up or down appropriately. Beth’s responses to intervention were monitored during each session and recorded in therapy notes. The therapist would remark on any progress, regressions, and responses to the imposed sensory input or challenge. Overall progress was assessed every three to six months by Beth’s parents and therapist and new goals and objectives were formulated as needed. Beth’s parents and therapist continued to review progress until her goals were achieved and therapy terminated. For Beth, intervention lasted for approximately one year and she came to the clinic one time per week.

Parent and Teacher Education

Beth’s parents met regularly with the therapist at the end of intervention sessions to discuss progress toward goals and to educate them regarding Beth’s response to sensory input and how this affected her behavior. In addition, the therapist and Beth’s parents had formal meetings where they could bring up behaviors they may be seeing at home that needed explanation and assistance. At the end of intervention sessions, the therapist usually gave the parents an idea of what was helpful during Beth’s session and how they might carry intervention ideas on in the home. Beth’s parents read a lot about sensory integration as well and attended a lecture on sensory integration to gather more information about how to help Beth achieve her goals.

Beth’s teacher and occupational therapist at school were also in close contact with the therapist and shared information regarding certain behaviors they were seeing with Beth at school, what the possible sensory explanation could be, what they had tried in the past, and what they could now try to help her become more independent in the classroom. Together, the therapists, teacher, and Beth’s parents carefully monitored her improvements and changes over time.

Sensory Diet and Home and School Activities

The therapist also made accommodations for Beth’s family for use in the home and school. For instance, one of Beth’s difficulties was her very strong outbursts and reactions to unexpected and loud auditory input. The therapist suggested that Beth be warned before such noises in school, such as a fire alarm or the bell ringing. The therapist also suggested that Beth’s parents try to perform loud household activities such as vacuuming or running a food processor when Beth was not at home or in the room. Beth also had a hard time sitting upright in a chair for long periods of time due to low muscle tone and decreased postural stability. The therapist recommended that Beth use a stadium seat or wedge on her chair to achieve a more comfortable and upright position and to make sure that her seat was the appropriate height for the desk. She also recommended that Beth be given movement breaks every 20-30 minutes or so to help alleviate fatigue e.g. erase the board, hand out papers, bring books to the library, do short physical exercises the teacher put on the schedule for all the children to perform. The parents, therapists, and teachers all worked together in the home, school, and clinic to help Beth feel more comfortable with and better able to handle her environment.

With all parties working together, Beth made very positive gains in therapy by the end of the year. She participated appropriately on the playground and felt a lot more comfortable with climbing activities. She no longer had strong outbursts on a daily basis in school in response to loud noises and began to explore finger painting and new foods. Beth’s endurance and strength improved as well and she was able to sit for longer periods of time with fewer breaks needed during the day. Beth continues to experience some difficulties processing sensory input, however, she is functioning at an appropriate level with her family and support system in the school. Sensory diet activities and accommodations continue to be employed in both the home and school and Beth’s parents and therapist consult as necessary to make any changes necessary in her sensory diet. Beth’s teacher and therapist also consult occasionally to discuss any new behaviors that come up and how best to approach them. In this way, Beth continues to make gains in her ability to function comfortably and appropriately at home and school

When someone looks in on a sensory integration intervention session, at first glance, it may appear that the therapist is simply playing with the client using a variety of suspended swings, climbing structures, and pillows. The therapist may be guiding the client onto different swings and setting up different pieces of equipment for the client to climb on and explore. Since the major occupation of children is play, it makes sense that the therapist would use play to bring about desired goals. For example, let us say that a major goal of intervention is to improve balance for improved safety on playground equipment. To address this goal, the therapist would choose an activity that is motivating to the client in order to achieve the goal. If the child is very interested in movement, the therapist would choose a swing that is supportive enough to the child that he or she does not feel scared or that the child’s safety is compromised, but not so easy that the child would become bored or disinterested. The therapist would increase the challenge by moving to swings that were less supportive and adding other activities to the task such as throwing and catching and reaching for different objects.

To put the course objectives into action, here is an interactive way that you too can begin to formulate and implement a sensory diet. We first must look at the behavior we are dealing with, for example, hand-flapping. We then determine the sensory reason why the behavior is happening. Are they seeking this input for a certain reason, such as to help them focus to a task or improve body awareness? Once we determine why they might be doing the behavior, we try to provide more appropriate input to help them organize their sensory systems. So for the person who flaps their hands, we might suggest squeezing an appropriate object in his or her hand, engaging in heavy work activities throughout the day that involve pushing or pulling heavy objects, or providing a fiddle object to keep in his or her pocket to keep the hands busy. In this last section you will be able to formulate your own sensory diet based on a variety of different behaviors. When intervention is determined to be completed by both the therapist and the client (or caregivers), we come up with a sensory diet together that fits into the client’s lifestyle and will be easy to follow through with and maintain. A discharge summary is written up that discusses the course of intervention, progress made, and accommodations to aid in further development of sensory processing skills and functioning in the world in which they live.

 

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