The 2019 Therapro Saturday Seminar Series was launched by school-based physical therapists, Dr. Jennifer Colebourn, MSPT, DPT and Dr. Julie Goff, MSPT, DPT with their presentation: The Role of Motor Interventions in Autism Spectrum Disorder.

Jenn and Julie met at Northeastern University where they were pursuing their doctoral degrees. Jenn’s research focuses on motor interventions for Autism Spectrum Disorders. Her most recent work has been published in the journal, Pediatric Physical Therapy: A. Colebourn, Jennifer & C. Golub-Victor, Ann & Paez, Arsenio. (2017). Developing Overhand Throwing Skills For a Child With Autism: A Collaborative Interdisciplinary Approach In School-Based Therapy. Pediatric Physical Therapy. 29. 262-269. Julie’s research on improving gross motor skills in children with Autism Spectrum Disorders received Northeastern’s RISE award in 2016. In their practice, both therapists focus on a collaborative team approach to improving motor performance in children with ASD.

Attendees were given a comprehensive review of Autism Spectrum Disorder, including the DSM-V (2013) diagnosis as a Neurodevelopmental disorder. We learned that ASD is no longer classified on a “spectrum” but with levels of severity. The term “Asperger” is no longer used, but individuals with the characteristics formerly attributed to Asperger are now considered to be “high functioning Autism.” An alarming statistic they revealed was that currently 1.5 billion children in the US have an autism diagnosis. Jenn and Julie cautioned that diagnosing ASD is complex and in the past 5 years, neuroimaging has provided startling information about the difference in the brain of the child with ASD from a typical child, i.e. “neuro over connectivity” that impacts function.

Jenn and Julie addressed the fact that motor function of children with ASD is affected, usually with simple motor tasks being intact, but with complex tasks and motor planning being impaired. Motor difficulties are now considered a “Core Deficit.” Screening for motor deficits is important for all children with the ASD diagnosis. The PT’s role includes recognizing if a motor impairment interferes with function. Julie and Jenn cited a number of studies that examined how core deficits affect a child’s participation in physical activity across many dimensions. What we might see is a child who prefers simple, sedentary activities and who doesn’t participate in complex social activities such as organized sports. In summary, motor deficits affect a child’s ability to participate in play.

When providing treatment for the child with ASD, Julie and Jenn advocate strongly for a team collaborative approach that includes the child’s family members. They noted that the ABA therapist would be a strong, valuable ally because they can provide behavioral support to motor intervention. They discussed ways to design the environment and treatment sessions in order to help ensure success and motor learning. A few examples they gave were: promote positive transitions, simplify choices, and have a predictable space and schedule. A few materials they recommended include: Body Awareness Fun Deck, Upper Body and Core Strength Fun Deck, Magicatch Set, Rainbow River Stones, Learn to Move, Move to Learn!, and ABC Yoga Cards for Kids.

We are grateful to Jenn and Julie for sharing their passion and expertise for improving motor performance of children who have an ASD diagnosis. With improved motor skills, it is likely that other areas of function will be affected in a positive way as well. With the high incidence of ASD worldwide, Autism will affect us all. The need for continued research is critical to help our understanding and ability to treat children with ASD effectively.

Here are just a few of the attendees’ positive reviews of this seminar:

“Incredibly informative and relevant! Felt so empowered from the seminar. Helped to give me better direction in my practice as well as increased confidence in my recommendations to families & school staff.” – Laine F., Physical Therapist

“The two presenters were so knowledgeable in their area – facts were most interesting.” – Rolene K., Teacher

“Great overview of school PT and best practice for collaboration with all members of the team.” – Micaela M., Physical Therapist

“Presenters were professional presenting evidence based practice to help improve functional skills for students with Autism.” – Alice T., Occupational Therapist

Thank you, Jenn and Julie!

Filomena Connor, MS, OTR/L
January 12, 2018

Teresa A. May-Benson, ScD, OTR/L, FAOTA, is a pillar in the field of sensory processing disorder (SPD). She is the Executive Director of the Spiral Foundation (Sensory Processing Institute for Research and Learning), whose stated mission is “To Increase Understanding and Acceptance of Sensory Integration and Sensory Processing Dysfunction through Education and Research.” Dr. May-Benson is an esteemed educator and researcher as well as a clinician at OTA The Koomar Center in Massachusetts. At today’s Saturday seminar entitled: ASHs to A/ASPs: Comparison of Assessment Tools for Adolescents and Adults with Sensory Processing Disorder, she provided a comprehensive review of available assessments for the adolescent and adult populations with accompanying research, as well as a detailed overview of her tool, Adult/Adolescent Sensory History (ASH), published in 2015.

Dr. May-Benson reviewed research studies conducted on adults with SPD and concluded that there is a paucity of research and more is needed. She outlined what we currently know about SPD in adults, including how it impacts all aspects a person’s life. A poignant example she described was a mother who is sensory defensive who had difficulty maintaining a family relationship with her child who is a sensory seeker. The challenge for therapists during the process of assessment is to explore what things are affecting the person’s ability to engage in life activities. Dr. May-Benson also cited the problem of an apartment dweller who is auditory defensive and lives in an apartment in between two apartments. Moving to an apartment end unit that has extra insulation from noise may be a good solution to explore with this client. These examples demonstrate the value of an interview as part of the assessment process because it helps the therapist gather information about the individual’s daily life experience, along with formal screening and direct assessment.

There are a number of tools available to assess SPD that Dr. May-Benson reviewed, discussing their positive aspects and their limitations. She cautioned that screening tools should be used only to determine whether a sensory-based problem is present that warrants further testing.

According to the Spiral Foundation, “The Adult/Adolescent Sensory History is designed as a self-report assessment of sensory and motor behaviors commonly observed in individuals with difficulties processing and integrating sensory information. The purpose of this assessment is to help identify adults and adolescents ages 13 to 95 who experience problems in sensory processing and integration as well as assist therapists in clinical reasoning when creating interventions for these individuals. Based on the conceptual model of sensory processing and sensory integration proposed by A. Jean Ayres, this measure is designed to identify difficulties in five key areas of functioning: Sensory Discrimination, Sensory Modulation, Postural-Ocular Skills, Praxis, and Social-Emotional Functioning.” The ASH has performed strongly on tests of reliability and validity. It is available at the Spiral Foundation www.thespiralfoundation.org This website offers many resources including webinars, courses, and free SPD education toolkits.

In her presentation, Dr. May-Benson provided the following implications for practice:

• Assessment of adults with SPD is complex and should be comprehensive.
• To determine sensory integration difficulties, assessment must include more than questionnaires.
• Be aware that different measures emphasize different aspects of sensory integration; be aware that we may miss vital information if we use one measure over another.
• Select measures with the particular client’s needs.
• Recognize that all measures are not created equal: some measures can provide better functional performance information than others and others may provide better psychometrics than others.

We were honored to present Teresa May-Benson’s seminar to spotlight her diligent work over the past 15 years to develop the ASH, which is a comprehensive, valid and reliable adolescent/adult assessment of SPD. Her research has illuminated the issues that clients with SPD as well as their families and practitioners face. Her research is ongoing and crucial.

Here is a sample of positive reviews about Teresa’s seminar:

“Excellent overview of Sensory Assessment tools.” – Teri B., Occupational Therapist

“I would recommend this seminar to a colleague if they work with an adolescent or adult population. The ASH appears to be a useful tool.” – Anonymous, Occupational Therapist

“Thank you for a well-organized and comprehensive seminar about the tools available for adolescent and adults with SPD. Teresa’s new assessment tool has great potential!” – Maria K., Occupational Therapist

Thank you, Teresa!

Filomena Connor, MS, OTR/L
December 15, 2018

Susan Little, OTR/L provided a fabulous seminar as part of Therapro’s Saturday Seminar Series on November 10th entitled: Handwriting Without Tears: Strategies for Success. She gave attendees a close look at a developmentally based curriculum for students from Pre-K through 5th grade and beyond, that uses a multisensory, fun approach to teaching skills for both printing and cursive. It includes three programs: Pre-K Early Learning, Handwriting Without Tears, and Keyboarding Without Tears (digital program). The program keeps expanding with additional products and trainings. The Pre-K program and elementary grade level programs include workbooks, journals, and Teacher’s Guides. Multisensory materials offer kinesthetic learning experiences for printing and cursive letter formation.

Susan is an experienced occupational therapist who has provided services to children aged birth through 21 years old in a variety of settings including school systems, early intervention, inpatient/outpatient rehabilitation, and neonatal intensive care units. As a certified handwriting specialist, she has worked extensively with children on penmanship instruction and remediation. She was first introduced to Handwriting Without Tears (HWT) as an OT student and found it to be a unique and targeted approach that meets the diverse learning styles of all students. Susan began working for Learning Without Tears in 2003 and now serves as Channel Sales Manager for the company. Her passion for educating others on the benefits of using the Learning Without Tears programs was evident in her presentation today.

The handwriting process was described in sequential stages beginning with pre-writing and finally handwriting. Susan identified the stages as follows: controlled scribbles; discrete lines, dots, or symbols; straight-line or circular letters; uppercase letters; lowercase letters. She focused primarily on early stages of handwriting, but also touched on the development of cursive and keyboarding skills using multi-sensory learning experiences.

The Print Tool is a comprehensive evaluation for students from kindergarten through grade 5 that includes student and school information, a review of school papers, and careful observation of the child’s physical approach and fine motor skills. Administered individually, the Print Tool evaluates uppercase letters, numbers, lowercase letters, and seven specific handwriting components: memory, orientation, placement, size, start, sequence, and word spacing.

A preschool student who is exposed to the Pre-K Learning program learns the readiness skills for handwriting (includes both letters and numbers). It consists of three components: 1.) Language and Literacy; 2.) Readiness and Writing; and 3). Numbers and Math. Susan identified some common struggles that occur at this level such as letter and number memory difficulties that might manifest themselves as omitting a letter, interchanging upper and lower case letters, or spelling phonetically. Another struggle a child at this early level may exhibit are letter and number formation problems including letter reversals, spacing, and sizing issues. Pencil grip is another area she discussed that may require simple modifications of posture or paper placement to build success. A fun fact Susan offered is that 50% of all 3 year olds have the ability to grasp a crayon correctly. LWT uses this fact by utilizing very small tools like pieces of chalk or Flip Crayons to facilitate development of the intrinsic muscles of the hands. Susan demonstrated a number of strategies and sequential activities to engage students as they transition to letter formation. The use of songs can help develop the motor plan for pencil/crayon use. Here’s an example:

Pencil Song
Pick up a pencil, Pick up a pencil
This is easy to do
Pick up a pencil, Pick up a Pencil,
I just tell my fingers what to do
My thumb is bent,
Pointer points to the tip, Tall man uses his side
I tuck my last two fingers in
And take them for a ride.

Now I’m holding it just right,
But not too tight,
Every finger knows what to do
And now I have a big surprise,
A big surprise for you
Let’s drop it and do it again!

Susan demonstrated a number of products that can be used in a variety of creative ways, including Capital Letter Kit to form letters in the correct order and position through teacher-directed play. It includes wood pieces and laminated cards that show the image of a letter on one side and activities on the flip side to help teach letter awareness and same/different discrimination. Roll-A-Dough Letters is a great companion to the HWT curriculum because it includes a multi-sensory tray that can be used to make letters in sand or shaving cream. Laminated letter and number cards and 12 oz. of modeling dough are included. The child learns the skills of size discrimination and visual integration. The Stamp and See Screen is a magnetic screen in a sturdy plastic frame. It includes 4 plastic magnetic letters to allow a child to stamp upper case letters. A tool that resembles chalk is used to trace or write letters. It can be used over and over because the slide eraser clears the board in one sweep. Blackboard with Double Lines helps teach placement on lines and spacing for uppercase and lowercase letters, and numbers. With repetition, a motor plan develops.

Handwriting Without Tears aims to maximize writing success for all students! This resource is fun and engages students as soon as it is introduced by providing the building blocks that are essential for handwriting in sequential steps. It is a rich program that takes into consideration the many components of learning handwriting skills throughout the school years and uses creative, engaging sensory activities. Be sure to check out the Learning Without Tears website for what Susan calls a “treasure trove” of free resources that includes screening and assessment tools: https://www.lwtears.com

Attendees had rave reviews about Susan’s seminar:

“As an OT student, I walked in with a limited knowledge of the topic. Walking out, I feel much more comfortable teaching handwriting skills and I am confident in the additional resources that were presented to me.” – Elizabeth W., OT Grad Student

“After 40 years of practicing OT, I wanted to be aware of other options I will try.” – Anonymous, Occupational Therapist

“I would recommend this seminar to a colleague because it provides the participant with the importance of the development of underlying components. Handwriting Without Tears is fun and brings back the joy of learning. It allows children to marinate in the learning process!” – Tara G., Occupational Therapist

“Lots of valuable information. Easy for students and teachers.” – Jenna R., Teacher

“I am an OTS and I believe this should be a required seminar. It was very informative and I feel as if I have a great resource to go to once I am an OTR.” – Tabitha C., OT Grad Student

Thank you, Susan!

Filomena Connor, MS, OTR/L
November 10, 2018