Good morning, everyone. Thank you for joining today’s webinar. We’ll start in 1 minute.<OK it’s 12pm, let’s get started>
Welcome to our November Talks on Tuesdays webinar, “Sensory Processing in Infants and Toddlers: Now that I know about it what do I do about it?.” I’m Dana Childress from the Integrated Training Collaborative, and I’m joined by Tracy Miller. Tracy is the co-owner and director of Rehabilitation Associates, P.C., a private practice that provides early intervention, school system, and outpatient services throughout the state of Virginia. Tracy has participated in numerous post graduate courses in the area of sensory processing disorders. She is certified to give the Sensory Integration and Praxis Test (SIPT) and has expertise in sensory processing for all ages. We are delighted to have Tracy share her expertise with us today!
Before we get started, though, we want to familiarize those of you who are new to our webinars with the technology. We know that many of you have joined us before and are probably pros at this, but for those who are joining us for the first time, let’s go through a few quick housekeeping pointers. As you hopefully heard when you called in, we have tried to mute all lines to try to keep the noise level down during the webinar. We also ask that, if your phone has a mute button, please use it to mute your own phone too. We encourage you to make comments and ask questions using the chat feature that you’ll find to the right of your screen.
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Following this webinar, you’ll receive an email asking you to complete a brief survey to give us feedback. We really do value your feedback so please take a few moments and let us know about your experience participating in the webinar. This will help us as we improve future webinars and develop other resources for you. Once you complete the survey, you will then be given access to your certificate of completion.We know that many people participate in these webinars with colleagues huddling together around one computer. The survey email will come to the person in the room who registered for the webinar. That person can forward that email to his or her colleagues who can also complete the survey and receive a certificate. Okay, that takes care of the housekeeping. I think we’re ready to learn about sensory processing, so I’ll turn things over to Tracy.
So what is sensory processing? Lets suppose I walk into my kitchen and I am greeted by the smell of something baking in my oven. The smell goes through receptors in my nose up to my brain and based on my previous experiences my brain tells me that someone is baking chocolate chip cookies. I don’t have to actually see the cookies or taste the cookies to know what they are. Because I have previously experienced the sensations of seeing, touching, tasting, and smelling chocolate chip cookies, I am able to interpret the smell by smell alone. Change slides
So as a response to that sensory experience of smelling a chocolate chip cookie, I might saunter over to the kitchen and poor myself a glass of milk and settle in for a nice warm snack. Now if you were observing my behavior you would say that I made an appropriate response to that sensory input.Let’s change the scenario a little bit. Change slide
Now, I walk into the kitchen and perhaps I see smoke pouring out of my oven and I smell a burned acrid smell. Perhaps the smoke detector is going off. If I slowly made my way over to the refrigerator to pour myself a glass of milk and sat down in my comfy chair, you would probably say that I misinterpreted that sensory input and did not make an appropriate response. That is all sensory integration is.The ability to take information in through our senses, interpret it by our brain, and then use it to make an appropriate response. This ability begins in utero and continues to evolve throughout the lifespan based on sensory and motor experiences.For most of us it is a process we are not even aware of.
So think about two different babies
Take two different babiesMom and Dad are playing with the Abby and Sam on the floor. Dad picks up a bell and rings it. Abby ‘s eyes get wide and she turns to the sound of the bell. She quiets and smiles. It is a pleasant experience for her. Sam, hears the same ringing bell but it is an unpleasant experience for him. She closes his eyes, turns away from the sound and beings to cry. So how we process sensation varies from individual to individual. It is a continuum and we become concerned when we are at either end of the continuum and it interferes with our ability to participate in the activities that are appropriate for our age
Kindergarten we learned there were five senses. Taste, smell, sight, hearing, and touchIn addition there are two others. If you know what these are go ahead and put them on your public chat– Vestibular or our sense of movement and proprioception or our muscle senseEach of these seven senses have receptors that take the information to the brain for interpretation. So the eyes are the receptor for vision, our nose is our receptor for smell, etcALL of our senses are important but when we speak of sensory processing there are three that are stand out and are the building blocks for all others. They are our sense of touch (tactile), our sense of movement (vestibular), and our sense of our muscles (proprioception).We are going to take a moment to look at the individual sensory systems but remember that in reality these systems all work together at the same time. ‘
First system to function in uteroMost mature system at birthFetus responds to tactile stimuli as early as 8-10 weeks post conceptionDevelops in hands and mouth firstTop of head and shoulder region are less sensitive in newbornPain Reponses by end of second trimesterFirst two trimesters - avoidance responses to touchFull term respond to touch with approach responsesImportant for emotional development and attachment to the caregiverAvoidance responses in pre-term babies discourages bonding with the caregiverReceptors located throughout the skin, especially our mouth, hands, back of the neck, and genital areasDiscriminative touch or touch perception tells us about the properties of things (smooth, cold, hard, bumpy)Protective touch tells us when we are in dangerLargest sensory organ in our bodyLet’s look more closely at discriminative touch. When I have good discriminative touch I am able to go through the toll road and reach into the bottom of my purse and pull out a quarter instead of a nickel without looking. If I haven’t developed good discriminative touch, it is as if I had a rubber suit on. I am not able to feel or interpret information through touch. We would say that this child is Hypo – sensitive to touch. So take a minute to think about that and then on your public chat, list a few things you might observe in a child that would indicate there might be a problem in this area.Wait one minute then go to next slide
On your evaluation tools (Help or ELAP) these children may score low in the area of fine motor development and self help. So now I want you to think about the other function of touch. The protective sense. This part of touch tells us when we are in danger. Children who have difficulty with this are hyper sensitive to touch. Once again, list on the public chat, some things you might observe in a child who over responds to touch.
Finding hidden objects in rice, bean, or button binFinger paints - pudding, shaving cream, paintToys with different textures
On your evaluation tools these children may score low in social emotional areasI think of these children as always being on their fight or flight system.
Avoid unexpected touchUnderstand that what the child perceives is real (nail cutting)Help families develop a quiet calm householdHelp families understand that these children benefit from predictability and routineUse natural lighting when possible as some of these children are defensive to visual inputDo not impose touch (don’t force playing with textures or playdoughetc)
Receptors are located in our inner earTells us how when we are moving and how fast we are moving.Tells us if we are right side up or upside down. Contributes to bilateral motor coordinationThe system influences our muscle tone and posture. (atypical development)Can calm us up or calm us down. So fast movement is alerting to us and slow movement is calmingMature in the full-term neonateActively stimulated in intrauterine space by own movementsPassively stimulated by mother’s movementsVestibular input promotes maturation of other systems, especially motorPre-term baby experiences much less vestibular input in the uterusPre-term babies experience less movement after birth which further compromisesHigher incidence of gravitational insecurity in the pre-term infantSo just like our tactile system, children can be hypo-sensitive or hyper-sensitive to movement. A child who is hypo-sensitive needs more input for it to register in the brain. On your public chat list something you might observe in a child that is hypo sensitive to vestibular input
The child who under-responds may score low in the areas of gross motor, fine motor and you may see some high activity levelsOver respond – social emotional, gross motor, self help
These children need lost of movement opportunities.Mini trampPlayground equipmentMovement gamesYoga etc
Examples gravel to grass, adjust legs when sitting too longIt is how you can tell me the position of your feet without looking at them or how you can ride a bike and pedal without your vision.May score low in gross and fine motor areasI have personally never seen anyone who over responded to proprioception but we do see people who under respond. Once again, list on your public chat what you might observe.
A child may show red flags in one area or any combination of areas but there must be red flags in these areas In order for us to hypothesize that what we are seeing has a sensory basis.Let’s suppose you are working with a family and you see some red flags. What are some things that would be safe and appropriate for you to try.
Heavy work activities – anything that works our muscles and jointsWearing a back packMoving furniture, carrying booksPlay ground equipmentChewy foodsHeavy toys
We’ve talked about things you can do with individual children but many early interventionist are going into preschools or daycares and some programs also run classes for children in their centers. So let’s take a few minutes to discuss what you can do to make your environment more sensory friendly for all children. The benefits include improved ability for children to participate, better transitions, less frequent meltdowns, improved social interactions.
The examples I have given you are safe and just child friendly activities that ALL children will benefit from. With children who have some mild sensory processing issues, providing these types of activities and help families to set up the environment that will support the child may be all you need. However, children who are way out on the continuum and whose sensory issues are interfering with the child’s and the families ability to participate in life activities should be referred to an occupational therapist with experience in treating sensory processing disorders.
Sensory Processing in Infants and Toddlers: Now that I know about it what do I do about it?
Sensory Processing in Infants and Toddlers: Now that I know about it what do I do about it? Please Call 1-866-842-5779 Enter Code: 463 661 9330#Webinar provided by the Integrated Training Collaborative, with funding support from the Virginia DBHDS, American Recovery and Reinvestment Act (ARRA)
Dana Sensory Processing in Infants and Toddlers: Now that I know about it what do I do about it?Tracy Miller
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Sensory Processing Réhabilitation Associates. P.C. Tracy Miller 10
Key Concepts• Learning occurs when a child experiences sensation, the brain interprets it, and then uses that information to plan and organize behavior.• A deficit in the processing or interpretation of the sensation impacts conceptual and motor learning• Our central nervous system (brain and spinal cord) can improve in the ability to process and interpret sensory input Rehabilitation Assocates. P.C. Tracy Miller 11
Two babies same input Rehabilitation Assocates. P.C. Tracy Miller 12
Sensory Processing Allows Us• Explore and Play• Complete daily chores• Complete self-care tasks• Complete school and work tasks• Maintain focus and attention• Manage our emotional states Rehabilitation Assocates. P.C. Tracy Miller 13
Causes of Sensory Processing Dysfunction (SPD)• Appears to be a genetic connection• Possible causes include pre and post- natal environments• 12-30% of the population• Boys 3x as likely as girls• Boys may be diagnosed more often because of disruptive behavior
Our Senses Rehabilitation Assocates. P.C. Tracy Miller 15
Touch• Receptors located through out the skin• Discriminative touch tells us about the properties of things• Protective touch tells us when are in danger Rehabilitation Assocates. P.C. Tracy Miller 16
Red Flags Poor Touch Discrimination• Hypo- sensitive• Mouth objects past normal• Touch hungry• High pain tolerance• Doesn’t notice their shoes ate their socks• Not aware they have food on their mouth• Hyper vigilant visually• Poor speech articulation• Poor fine motor skills therefore poor play skills Rehabilitation Assocates. P.C. Tracy Miller 17
Red Flags Poor Protective Touch• Hyper-sensitive• Tactile defensiveness/sensory defensiveness• Babies arch away from caregivers• Distressed over hygiene and grooming• Do not like messy play• Babies may crawl with fisted hands or curled toes• Picky eater• High frequent meltdowns• Irritable, fussy, whiney miserable Rehabilitation Assocates. P.C. Tracy Miller 19
Vestibular• Receptors located in inner ear, semi-circular canal, the saccule, and the utricle• Tells us if we are right side up or upside down• Contributes to bilateral motor coordination• Helps us manage our level of alertness, our state of arousal Rehabilitation Assocates. P.C. Tracy Miller 21
Red Flags Vestibular Hypo sensitive• Sensory seeker• Poor safety awareness• Lack of fear• Poor muscle tone and joint stability• Difficulty with balance and protective responses• Difficulty with activities that require bilateral motor coordination Rehabilitation Assocates. P.C. Tracy Miller 22
Vestibular Hyper-sensitive • Gets car sick easily • Avoids things that challenge balance • More passive, clingy children • Dislikes playground equipment • Doesn’t like changes in head position (diaper changes) • Afraid of open stairs, escalators • Lots of frequent meltdowns and falling apartRehabilitation Assocates. P.C. Tracy Miller 24
Embedded Intervention Hypersensitive to movement • Go slow • Linear movement is more tolerable than any other. • Do not impose Rehabilitation Assocates. P.C. Tracy Miller 25
Proprioception• Receptors located in tendons and joint, and muscles• Tells us where our body parts are and what they are doing by sending information to the brain every time we move• Provides us the feedback we need to modulate our force Rehabilitation Assocates. P.C. Tracy Miller 26
Red Flags of Proprioceptive Dysfunction• Break toys, crayons, etc. as they cannot grade their force• Clumsy• Crash into objects or persons• May seek great quantities of jumping and crashing• Bull in a china shop• Have difficulty doing things without looking Rehabilitation Assocates. P.C. Tracy Miller 27
Embedded Intervention Proprioception Rehabilitation Assocates. P.C. Tracy Miller 28
Benefits of developing sensory friendlyenvironments for all children• Improved ability to• Play, participate, and learn• Make transitions and go with the flow• Experience fun and joy• Decreased fear and anxiety• Improved independence in functional activities• Improved social interactions Rehabilitation Associates
Activities that increase alertness• Movement – Playground, sit/spin, animal walks, stretches• Tactile – Finger paint, light touch, shaving cream, squiggle pens, washing face with cool cloth• Oral Motor – Crunchy foods, drinking through a straw, cold foods Rehabilitation Associates
Activities that calm • Movement – slow rocking • Reduce lighting – natural lighting • Allow fidget toys • Provide “womb” space • “heavy-work” activities • Sucking – pacifier, hard candy, slurpee • Back rub • Soft music Rehabilitation Associates
Activities that organize• Chewy foods – granola bars, licorice, cheese, dried fruits• Hanging from chin-up or monkey bars• Infants – flexed and swaddled• “heavy-work” Rehabilitation Associates
Preschool or home strategies• Keep room organized and • Allow variety of positions clutter free for circle time• Avoid visual clutter • Provide security of routine• Well defined work areas and predictability• Natural lighting if possible • Structure transitions• Experiment with calming • Pay attention to appropriate music behaviors• Provide “womb” space • Provide support for circle or• Morning routine to organize group time (fidgets, sitting and calm support – Yoga, stretching and bending, jumping jacks Rehabilitation Associates P.C. 33
When to call anoccupational therapist Rehabilitation Assocates. P.C. Tracy Miller 34