The Spastics Society of Tamilnadu (SPASTN)

OCCUPATIONAL THERAPY

In its simplest terms, occupational therapists and occupational therapy assistants help people across the lifespan participate in the things they want and need to do through the therapeutic use of everyday activities (occupations). Common occupational therapy interventions include helping children with disabilities to participate fully in school and social situations, helping people recovering from injury to regain skills, and providing supports for older adults experiencing physical and cognitive changes. Occupational therapy services typically include


•    an individualized evaluation, during which the client/family and occupational therapist determine the person’s goals,  
•    customized intervention to improve the person’s ability to perform daily activities and reach the goals, and
•    An outcomes evaluation to ensure that the goals are being met and/or make changes to the intervention plan.


Occupational therapy services may include comprehensive evaluations of the client’s home and other environments (e.g., workplace, school), recommendations for adaptive equipment and training in its use, and guidance and education for family members and caregivers. Occupational therapy practitioners have a holistic perspective, in which the focus is on adapting the environment to fit the person, and the person is an integral part of the therapy team.


Sensory Integration

SI is the neurological process that organizes sensation from one’s own body and from the environment for use in everyday life.
The theory of sensory integration was developed in the early 1960’s by Dr. A. Jean Ayres, an Occupational Therapist when treating children with cerebral palsy. Ayres noted that some children were not able to do motor task for reasons other than their existing neuromotor deficit. She hypothesized that in some cases inadequate sensory processing rather than inadequate motor control hindered the capacity of these children to function.
The five main senses are: Touch – tactile; Hearing – auditory; Sight – Vision; Taste – Gustatory; Smell - Olfactory
In addition, there are two other powerful senses:
A) Vestibular (movement and balance sense) - provides information about where the head and body are in space: and in relation to the earth's surface.
b) Proprioception (joint/muscle sense) - provides information about where the body parts are and what they are doing.
Sensory input is necessary for brain functioning. Certain types of sensory input are especially influential on.


•    Regulation of arousal (alertness) and attention
•    Formation of attachment and social relationship
•    Organization of actions in the physical world e.g. how to open the lid of a jar


The emphasis of Sensory Integration is on three senses viz., tactile, vestibular and proprioceptive system because:
•    Primitive systems
•    Early to mature
•    Relay information about the body and its boundaries

SENSORY PROCESSING DISORDERS

Sensory Processing Disorder is being used as a global umbrella term that includes all forms of this disorder, including three primary diagnostic groups:

•    Type I - Sensory Modulation Disorder
•    Type II - Sensory Based Motor Disorder
•    Type III - Sensory Discrimination Disorder

Type I - Sensory Modulation Disorder (SMD). Over or under responsiveness to sensory stimuli. Children, who are over responsive, typically avoid the stimulus e.g. dislike brushing the teeth. Children, who are under responsive, usually seek a stimulus e.g. thumb sucking to increase tactile feedback on hand and mouth.

Type II - Sensory Based Motor Disorder (SBMD). Shows motor output that is disorganized as a result of incorrect processing of sensory information. Children are typically clumsy, may have poor balance etc.
Type III - Sensory Discrimination Disorder (SDD). The child has difficulty in discriminating between the temporal and spatial qualities of a stimulus...

The following are some signs of sensory integration disorder (SID) (courtesy: Sensory Integration International (SII))
•    oversensitivity to touch, movement, sights, or sounds
•    under reactivity to touch, movement, sights, or sounds
•    tendency to be easily distracted
•    social and/or emotional problems
•    activity level that is unusually high or unusually low
•    physical clumsiness or apparent carelessness
•    impulsive, lacking in self-control
•    difficulty in making transitions from one situation to another
•    inability to unwind or calm self
•    poor self-concept
•    delays in speech, language, or motor skills
•    delays in academic achievement


How sensory integration therapy works?
During the session, the therapist works closely with the child to provide a level of sensory stimulation that the child can cope with, and encourage movement within the room. Sensory integration therapy is driven by four main principles:


•    Just Right Challenge (the child must be able to successfully meet the challenges that are presented through playful activities)
•    Adaptive Response (the child adapts his behavior with new and useful strategies in response to the challenges presented)
•    Active Engagement (the child will want to participate because the activities are fun)
•    Child Directed (the child's preferences are used to initiate therapeutic experiences within the session).


Children with lower sensitivity (hyposensitivity) may be exposed to strong sensations depending on the sensory system involved. Play may involve a range of materials or specialized equipments to stimulate the respective senses such as a platform swing, trapeze, play dough or puzzles.
Children with heightened sensitivity (hypersensitivity) may be exposed to peaceful activities including quiet music and gentle rocking in a softly lit room. The stimulus is graded and introduced in a non-threatening manner, so that the child can tolerate and later engage with them.