Investigate evidence-based sensory integration strategies and therapeutic tools designed to help individuals of all ages regulate sensory input, enhance emotional regulation, and improve behavior, attention, and participation across a variety of environments.
Jean’s thoughtful and thought-provoking seminar revealed some surprising documentation about adolescent mental health including the statistic that about 20% of children and adolescents in the US have been diagnosed with a mental health disorder that impairs their lives (NIMH, 2010; Perou, 2013). Jean provided a summary of supportive literature that indicates that a sensory-based approach to treatment promotes positive behaviors. Jean’s research using individualized sensory tool kits yielded statistically significant results in 6 areas, 3 of which affected all study participants including an increase in self perception of sense of occupational competence; an increase in daily number of hours in the classroom; and a decrease in the number of PRN medications.
Jean offered a rich array of ideas for creating individualized sensory tool kits that target all sensory areas, depending on the adolescent’s needs. She added cautions regarding some client-specific personal issues including: allergies to certain materials, olfactory experiences that may elicit negative memories in trauma victims, visual responses that may trigger seizures, and vibratory stimulation for hypersexualized adolescents. She advocated building the use of sensory toolkits into a client’s routine to help improve function, which means devising a way that the client has access to his/her toolkit whenever it is needed, i.e. during transition times that might cause an outburst, like going from school to a job. Some Therapro materials that she recommended included:
In addition to personalized tool kits for adolescents, Jean discussed some interesting examples of sensory-based coping skills groups. One example she gave involved playing “Sensory Hopscotch,” where the client throws a beanbag on a sensory square and then identifies the tool in their sensory tool kit they use in that sensory category and why they use it.
With our understanding of sensory processing, occupational therapists can have an important role in providing sensory-based treatment for young people diagnosed with mental illness. Jean provided us with a dynamic seminar, including interactive times for participants to share thoughts and problem-solve about tools that may be useful and accessible in their particular setting. Many offered helpful ideas on how to acquire those tools through creative funding. This seminar fulfilled all expectations for attendees who learned how to create and use personalized sensory tool kits with the adolescent population in individual and group settings.
Take a look at just a few of the positive remarks attendees made about this seminar:
A captive audience representing a broad range of disciplines attended Therapro’s September Saturday Seminar featuring Lise Gerard Faulise, MS, OTR/L, BCP. Lise is the founder of Rehab New England, a private sensory integration-oriented practice in Rhode Island, and co-founder of the Wolf School in East Providence, Rhode Island, designed for K-8 children with learning differences. Her presentation, Ready, Set, Learn: Tools to Build Self Regulation, provided a clear view of how self regulation develops from in utero and beyond, how dysregulation might occur, and how treatment can affect function.
Lise’s discussion of foundational skills that impact somatosensory experiences of a child before, during, and after birth was comprehensive. She led us through the developmental process where sensory and motor development are intimately linked, and showed how they help develop cognitive skills efficiently from the “bottom up.” She referred to the “Pyramid of Learning,” developed by Occupational Therapists MarySue Williams and Sherry Shellenberger, authors of the Alert Program – How Does Your Engine Run?, which teaches children how to identify and change self regulation using the analogy of an engine.
When there is a problem with self regulation, where the child either seeks or avoids sensory input, we may see behavioral changes in the child, which should raise red flags and further questions. Lise recommended the book, Is It Sensory or Is It Behavior? to help us examine if the behavior is intentional or whether it is a by-product. She suggested observing the timing of the behavior and whether it is limited to specific environments. For a child who experiences sensory modulation issues, Lise suggested providing the child with a large dose of sensory input activities so that behaviors don’t escalate and/or the child doesn’t feel threatened. For a child who experiences sensory overload, she suggested a quiet area or space at home and in the classroom that has things available that comfort the child, like a Cozy Caterpillar Sock, and comfortable clothing like Compression Clothing. She noted that oral or hand fidgets can help with self regulation as well. In addition, Lise identified somatosensory activities that involve deep tactile pressure, heavy work, rhythmical movement, music, breathing, and mindfulness as research-supported activities that are calming. Treatment materials to use may include scooter boards, Deluxe Peanut Balls, Rainy Day Playground: 2 in 1 Rotary Platform Swing, Heavy Work Bands, to name a few. When a child is self-regulated he/she is ready to tackle higher-level function.
We were engaged fully in Lise’s seminar and wanted to hear more as the two hours of her presentation evaporated. Her skills as a clinician, researcher, and lecturer in the area of sensory processing disorders were evident from her solid and inspiring presentation.
Attendees offered these positive remarks:
“What a pleasure! Great presenter and excellent information.” – Beth B., Occupational Therapist
“So much information that I can really use in my classroom. Clarified a lot! Could have been 2-3 classes!” – R. B., Teacher
“All educators should be equipped with tools to help children with self-regulation.” – Anonymous, Teacher
“Very informative and relatable to all disciplines.” – Amanda S., Behavior Analyst (ABA)
“Great seminar – loved the specific examples, backed by evidence-based practice.” – Marianne T., Occupational Therapist
Hippotherapy is a specialized treatment area used by occupational therapists, physical therapists, and speech and language pathologists. It involves utilizing the sensory-motor aspects of horses to achieve therapeutic goals such as improving sensory processing to tolerate touch and motor plan sequential movements. Although the horse functions as a therapy tool, it is obviously much more exciting than a swing or therapy ball, offering opportunities to develop an emotional bond, communication and social skills.
Let’s look at the basics of hippotherapy
Although the healing power of horses has been recognized for thousands of years (Hippocrates mentions it in ancient Greek writings), hippotherapy only developed in Europe in the 1960s and soon after in the United states as an adjunct to physical therapy. Therapeutic goals might have included improving the rider’s strength, postural control, balance and coordination. Hippotherapy’s versatility as a treatment tool gradually expanded as SLPs used it to improve communication skills. Occupational therapists recognized the power of sensory stimulation in promoting engagement and functional hand skills, such as manipulating fasteners. For example, this rider enjoys opening the zipper on my glasses case and then handing me the sun glasses. She loves to help out and make both the horse and me happy!
Hippotherapy is a type of Animal Assisted Therapy
Please note that “therapeutic riding” (TR) is a different type of animal assisted therapy (AAT) that is offered by certified therapeutic riding instructors who teach riding skills to people with disabilities. A TR instructor may or may not be an OT, PT or SLP. However, hippotherapy is ONLY performed by a licensed OT, PT or SLP practitioner. Training and certification requirements vary at facilities and many require that the therapist have certification in both TR and hippotherapy. As an OT, my goal is not to teach my client how to ride a horse, although frequently that is the result and many children transition from hippotherapy to do TR and eventually earn medals at the Special Olympics.
Why are horses special therapeutic friends?
Well, many animals are special in their ability to connect with people nonverbally and provide unconditional love. Cats and dogs also provide great heavy pressure and tactile sensory stimulation as they lie on laps and cuddle. However, a child with cerebral palsy may improve range of motion by straddling a horse and the repetitive, smooth vestibular movement can gradually reduce muscle tone. A horse’s gait is similar to the human gait in terms of timing. Clients who have never walked or have an abnormal gait can kinesthetically experience what normal pelvic movement feels like.
I have primarily worked with very young children who received services through their early intervention programs. Many had developmental disabilities, including Down syndrome and autism spectrum disorders. My goals often focused on decreasing sensory defensiveness while increasing engagement, postural control and hand skills. Of course, this involves using a variety of reaching, grasping and manipulation hand activities.
Hippotherapy Provides controlled and graded Sensory Simulation
Simply being on a horse provides sensory stimulation. Actually, as soon as a client enters the hippotherapy facility, they are impacted by happy sounds, smells and scenery. Bouncing on the horse while walking and bouncing even more when trotting provides heavy duty proprioceptive and vestibular sensory input. I control and grade the sensory input with choices such as whether to:
walk slow, fast and for how long before stopping
walk in straight, curved lines or in circles
walk uphill, downhill or only on flat surfaces
the child faces forward, sideways, and backwards or rides in a different position such as in quadruped or kneeling.
Using Sensory-Based Materials
Hipppotherapy horses are selected for many specific attributes including tolerance for riders who may hit, kick or scream. I also use a variety of sensory materials that must first be introduced when there is no rider so that the horse becomes desensitized to materials such as:
rings placed on top of a vibrating ring stack (see photo)
toys and sound puzzles that make funny sounds or vibrate
clothespins clipped onto or removed from the mane (this does not hurt the horse)
ball play, playing catch with toys like a Gertie Ball
The little girl in the photo is facing backwards while her hands bear weight on top of a vibrating cushion like a Senseez Vibrating Pillow. This helps to decrease her tactile defensiveness before asking her to engage in more complex fine motor tasks.
This vibrating ring stack is made by inserting a motorized pen, like a Squiggle Wiggle Writer Pen inside a swimming noodle.
Adapting activities to vibrate is one of the many sensory strategies described in my book From Flapping to Function: A Parent’s Guide to Autism and Hand Skills.
Hand Activities to Develop Postural Control
Clients may work on postural control while reach to touch body parts on the horse or therapist. I like to offer sensory materials to pull or squeeze such as Panic Pete (AKA Martian Popping Thing) while the client maintains a quadruped or kneeling position. The child in the photo squats to take rings out of the bag and stands up while stringing them. He typically has difficulty visually attending but it is difficult NOT to focus and be in the moment when standing on top of a large animal!
The girl in the photo reaches for rings positioned in front of her before rotating her body to place them over a ring stack. This “ring stack” is actually a cat toy and the mouse on top of a spring squeaks when moved. The sensory aspects of this activity help her to visually attend while developing postural control.
Hand Activities that Develop Cognitive and Manipulation Skills
In my book – From Rattles to Writing: A Parent’s Guide to Hand Skills I describe many simple adaptations that make it easier for children with and without disabilities to develop manipulation skills. For example, lacing boards can be cut out of cardboard and made to have just a few, big holes and thick cord that are easier than string to control.
During a typical Hippotherapy session, I spend time walking and trotting, followed by stopping to complete a simple hand activity such as this lacing board. When finished I encourage the child to say or sign “go” to continue movement. Most children are eager to resume movement.
A horse’s rear end is wide and functions as a convenient work surface. I adapted this puzzle by attaching the pieces with Velcro to the box cover. I encourage the child to use one hand to stabilize the box lid while pulling them off. Of course, this activity also teaches children to identify animals and imitate sounds. The Pizza Party is another activity that would be fun to use in this position.
Creating Functional Hand Skills Objectives
It’s a good idea to create OT objectives to improve functional skills such as opening and closing buttons because:
occupational therapy is all about increasing independence
this skill is measurable
insurance companies prefer work on functional, achievable daily living skills rather than abstract goals such as improving coordination
Therefore, I provide activities such as:
opening and closing extra large fasteners
opening bags and other containers (like my sunglasses case)
putting the helmet and gait belt on and off
unbuckling and putting away the reins, neck strap or other equipment
The first video shows how I made and use the “Sensory Pull Toy” (that I designed) during Hippotherapy to develop:
reaching, balance and postural control
hand strength
visual attention
eye-hand coordination
color identification
This toy is made out of detergent bottles and a strip of fabric. It’s simple to use – the child pulls the handle while in various positions. It can also be used during non horse activities to work on many skills. Please check out my book The Recycling Occupational Therapist for many other easy to make therapeutic activities.
The second video shows a few of the exciting ways therapists can use hippotherapy to develop hand skills. It is truly amazing how motivated children are to focus and engage in challenging hand activities because they love being cowboys and cowgirls!
Guest Blogger: Barbara A. Smith.
Barbara A. Smith has worked with children and adults with developmental disabilities for over 40 years! She is the author of the Recycling Occupational Therapist, From Rattles to Writing: A Parent’s Guide to Hand Skills and From Flapping to Function: A Parent’s Guide to Autism and Hand Skills. Learn more about her work at RecyclingOT.com.
Jean MacLachlan, PhD, OTR/L’s November 4th 2014 Saturday Seminar was entitled: The Impact of Personalized Tool Kits on Adolescents with Mental Illness: How to Assess, Develop and Integrate into Daily Routines. A specialist in mental health and sensory processing, Dr. MacLachlan teaches at Salem State University, conducts research, and consults throughout the US. Her focus has been on the integration of sensory-based interventions into “non-traditional settings.”
Jean offered a rich array of ideas for creating individualized sensory tool kits that target all sensory areas, depending on the adolescent’s needs. She added cautions regarding some client-specific personal issues including: allergies to certain materials, olfactory experiences that may elicit negative memories in trauma victims, visual responses that may trigger seizures, and vibratory stimulation for hypersexualized adolescents. She advocated building the use of sensory toolkits into a client’s routine to help improve function, which means devising a way that the client has access to his/her toolkit whenever it is needed, i.e. during transition times that might cause an outburst, like going from school to a job. Some Therapro materials that she recommended included:
