getting the wiggles out! · down/up, jumping, getting around toys and people poor eye-hand...
TRANSCRIPT
Getting the Wiggles Out!
Promoting Participation with Assistive Technology Supports
Sue Mistrett & Johan deBesche
What We Know …
� Children grow + develop through participation in daily activities
� Disabilities present barriers to participation
Purpose of AT for Young Children with Disabilities
To promote development and learningthrough active participation in
everyday routines & activities in all of their natural settings
AT is…. by federal definition
“any item, piece of equipment, or product system, whether acquired commercially off the shelf, modified, or customized,
that is used to increase, maintain, or improve functional capabilities of a child with a disability.”
Assistive Technology is also services
“… that assist a child with a disability in the selection, acquisition, or use of an AT device.”
How Can AT Help a Child Participate?
MovePositioning + Mobility
Communicate Use Activity Materials What Else???
Full Participation? = Engagement Behavior!
� Focus and attend
� Self-regulate body and reactions
� Adapt behavior for different situations
� Follow rules
� Read/respond to social cues
� Remember steps of an activity
� Know the sequence of routines; what comes next?
� Understand activity and make choices
� What is sensory integration?
� How does sensory integration impact young children?
“Red flags”
� AT sensory supports for (participation) engagement
� Understand how, when, what will happen in daily activities
� AT visual supports for participation
Consider AT supports + strategies for ALL daily activities
Sensory Integration
� Our senses give us information about our own body + the environment around us
How many senses do we have?
Sensory Systems
Hearing
Taste
Smell
Touch
Balance
Body Awareness
Vision
Sensory Integration� Our senses give us information about our
own body + the environment around us
� Our brain organizes the messages from our sensory system in order to move, learn, engage, behave and function in our environment!
� Sensory integration “puts it all together”
Sensory Processing Disorder
Dr. Jean Ayres compares SPD to a traffic jam.
Sensory IntegrationChildren demonstrate their difficulty to integrate sensory information in different ways…..
� Over-responsive: greater response to input� Sensory-avoiding: 'fussy,' 'sensitive,' 'picky,’; difficulty
eating, dressing, bathing
� Under-responsive: less response to input� Sensory-seeking: 'behavior problems,' 'hyperactive,'
'difficult,’; actively seek out and crave sensory input
Sensory Reactions
Over Responsive?????Under Responsive?????
What Does Over-responsive Look Like?Visual Cannot tolerate bright or blinking
lightsAvoids eye contactBlinks, protects self from a ball even when trying to catch itIs distracted from tasks by other activityHides at parties or avoids them
Tactile Avoids ‘messy/sticky’ tasksPicky eater; gagsDifficulty standing in lineOverreacts to small bumps or cuts; fidgityFlinches or tenses when touchedTantrums during bath time, nail cuttingDislikes tight clothes, seams, new textures
Auditory Holds hands over ears when there are loud soundsBecomes distressed during large gatheringsDistracted by background sounds others don't seem to hear
Balance + Equilibrium (Vestibular)
Fearful of movement or heightsAvoids playground equipment; sportsDifficulty with balanceDoes not like to be off the groundVery cautiousDislikes tilting head back; gets dizzy easilyMay only walk on toes; dislike barefoot
Smell
Taste
Sensitive to smells (AVOIDS foods, perfume, lotion)
Sensitive to taste- texture (picky eater) Gags (oral system is overwhelmed)
Body Awareness (Proprioception)
(rare)
Over-responsive
Behavior characteristics
� Frequently tunes out or withdraws- “shuts down”
� Appears lethargic, disengaged
� Easily over-whelmed
What Does Under-responsive Look Like?Visual Has difficulty keeping
materials organizedEnjoys bright florescent colors, spinning objectsLikes bright, fast-paced TV shows
Tactile “Wild child”- always jumping, climbing, running, pushing, and roughhousing Touches everything and everyoneAlways sits close to children in a circleMouths objects or clothesUnaware of bumps or cutsUnaware of food on facePrefers tight clothing, vibrations
Auditory Needs directions repeatedUnaware of auditory changes, cuesMakes sounds throughout the day (humming, whistling)
Balance + Equilibrium (Vestibular)
Seeks out spinning and movementRocks while sittingConstantly movingBumps into things; Is awkward getting down/up, jumping, getting around toys and peoplePoor eye- hand coordination
Smell
Taste
Seeks out smells (smells hair, objects, food)
Seeks out input (suck, chew, crunch, blow) craves strong flavors
Body Awareness (Proprioception)
Seeks out falling, crashing, pushingDifficulty grading force when throwing or writingUnaware of body is in spaceComes too close to other people’s personal space
Under-responsiveBehavior characteristics
� Easily frustrated; cries easily
� Frequently acts out or tantrums
� Seems anxious
� Pushes, hits or kicks others
� Moves constantly
� Shows little or no reaction to heat, cold, pain and other sensations
‘Challenging’ behaviors ???
When Should I Consider* Supports?
• Most young children experience some trouble with sensory integration at times
• If you or the family notice “red flags” with movement/balance, body awareness touch, auditory, and/or visual input
• If these behaviors are observed on a regular basis or during particular activities
• If the behaviors impact the child’s ability to function successfully in daily settings
• Supports should be embedded into everyday activities
*Contact an OT trained in Sensory Integration techniques…
AT Sensory Supports
AT is any thingthat helps
a child with a disabilitydo something
that s/he can’t do without it!
Consider AT Sensory SupportsPurpose:� Get ready to participate
� Calm/Stimulate
� Reduce/increase input
� Some supports help both avoiders + seekers!
Results with supports:� Improved focus, attention
� Body awareness + control
� Less distressed/frustrated,
� Happier- more cooperative
OBSERVE, OBSERVE, OBSERVETry, Modify, Document
Vision + Smell
Dream Lite Pets
Slow vs. Spinning toys
Vision
Sun glasses
Smell
Scented markers
Scented match up game
Aromatherapy Bear
Auditory Supports
Sound cancelling head phones
Ear plugs
Rainmakertoy
Voice magnifier
Ear covers
Toobaloo
REDUCE
ENHANCE
Tactile Supports
Use fidgit toys
Weighted items
Tactile/Vibration Supports
Combination:Weighted toy/heat, fragrance
wrapping snake or blanket
Massagers
Clothing� Soft, seamless � Compression
Soft + Seamlessclothing
Sleeves
Compression Clothing
Tight shirt
Bean bag chairs
Body Sock
Baby wrap
Pea Pod
Hammocks
MORE COMPRESSION
Body Awareness: Using Weights
Arm/leg bands
Weighted vest
Weighted blankets
Weighted lap belt
Chewies
BiteBands
Sensory Mittens
Oral
Vestibular…Balance + Move
Apps can help� Calming
� Non –messy drawing/writing Activities
� BooksBreathe, Think, Do
Letter School
Getting ready? Needing more input….
� Crash pads
� Ball pits
Carry heavy items)
Sensory Supports at Home� Get family input! Have families complete the Sensory
Checklist
� Consult with an SI trained OT
� Share successful supports/strategies used during similar activities in the center program with family � develop a plan- include how family can document� Add OT/SI services
� Check in with family on a regular basis
What Sensory Supports Have You Used?
Sensory Cube Activity
Sensory Cube Activity
Consider Visual Supports� Help a child focus….� Where things go� What comes next� Waiting � Transitions
� Help a child think about..� First… next….then� How it feels; how others feel� What to do; when to do it� How to play (rules)� Making choices + ideas
? ?? ?
??
? ?
… more SI Supports
Visual Supports at Home/School
Using a schedule of child’s daily routines/activities, ask if child needs help to understand ….
� where to find things and where they belong
� when things happen
� what to do and when to do it
� how to interact with others
� how to communicate thoughts + choices
Visual SupportsReminders: Keep hands to self….
What’s going to happen?
Where does it go?
Where’s mine?Calming down
More Visual Supports� TIMERS
� EMOTIONS
� SOCIAL STORIES
� VIDEO MODELING
Turtle TechniqueCFSEL
My Pictures Talk AppFlip books
iModeling app
DIY Visuals� Best to use photos + videos familiar to child:
objects, people + activities
� Involve families to contribute and use it!
� Modify as desired as experience and skill change
� Checklist:
Resources for Learning More About Visual Supports
• Head Start’s Center for Inclusion:(visual supports, social stories)
• Create visual schedules using the website.
• Center on the Social + Emotional Foundations for Early Learning (CSEFL)
Combine Sensory + Visual Supports
When is a support AT? it depends…....
When a child with a disability needs an item in order to participate- it becomes his AT
Selecting AT Supports� Identify participation outcomes
� Understand what is happening; what you see
� Select appropriate supports for a child
� Trial strategies: what, who, when how?
� Modify supports based on observed behavior
� Where else can you use successful supports?
How will you know the AT works?
What will you/the family observe? (see/hear)
� Have the child’s participation goals been met? Is s/he participating more?
� Is the child’s behavior different with the AT support?
� Does the child participate more willingly?
� Is the child calmer/less reactive or…
� More engaged with materials or activity?
Always Document What Works!!!
What Supports Have You Used?
Other Ideas???
New… Universal Sensory Supports- 2018
Sesame Place (PA) is the first theme park ever to be designated as a Certified Autism Center.
7 Theme Parks Supporting Sensory Needs with• Quiet rooms• Days with modified noises and lights
on rides• Weighted blankets• Soft toys• noise-canceling headphones • Lego building tables• Low sensory parades• Waterparks with water that can be
warmed for guests with sensitivities and waterproof wristbands
Let’s Participate! Projectwww.letsparticipate.org
A very special ‘Thank You!’ to Leaps and Bounds OT/SI staff
in Washington, DC
www.Leapsandboundsot.com
Considering AT Supports for
Participation…
Putting it ALL Together….
Participation Goal AT Supports + Strategies
Exploring all activity materials; getting “messy”
Participation Goal AT Supports + Strategies
Exploring all activity materials; getting “messy”
• Rub/brush hands briskly or “make fire” on carpet or on clothes before tactile activities
• Provide multiple options (glue stick, using paintbrush) until comfortable
• Reduce number of materials• Use apps with similar activities• Grade tactile activities: start with dry
beans/rice, then paint, then glue, then shaving cream
Classroom AT Tools
Desk easel
Multiple tools
Heated gel maze
Alternate activity
Spin Art App
Adapted spin art
Participation Goal AT Supports + Strategies
Keeping hands to self
Participation Goal AT Supports + Strategies
Keeping hands to self • Teach child to hug self; provide a visual cue (photo, picture)
• Give child something to hold in hands; weighted object
• Provide child with a designated area to sit or stand in
• Provide child with fidget toy to keep hands busy
• Provide child with a designated area to sit or stand in
• Define a child’s ‘work’ space with tapeor a tray
Supports to ‘keep hands to self’
Target: Carpet Squares
Weighted toyTray
“Hug Yourself”
Participation Goal AT Supports + Strategies
Self-regulating
Participation Goal AT Supports + Strategies
Self-regulating • Use a picture chart to help child identify body feeling as “too high” (excited, nervous, silly, frustrated), “too low” (tired, sad, bored), or “just right”
• Provide children with movement breaks
• Provide children with a quiet place to go when they are over-stimulated; add a cozy pod seat
• Provide a chewy necklace or object
AT Supports for Self Regulation
Participation Goal AT Supports + Strategies
Sitting still on floor
Sitting up in a chair
Participation Goal AT Supports + Strategies
Sitting still on floor • Provide child with a seat cushion or ball to sit on
• Provide child with a weighted lap pad or toy to place on lap
• Allow child to change positions (sit, stand, stomach)
• Use backjack chair
Sitting up in a chair • Make sure child’s feet can rest flat on floor and that the table is the correct height
• Turn chair around backwards while sitting at the table
• Use a seat cushion or a weighted lap belt
• Use stretchy bands to push against
AT Supports for Sitting
Seat cushionBackjack seat
Bouncy bands Weighted toyInflatable ball
Participation goal AT Supports + Strategies
Walking in line
Participation goal AT Supports + Strategies
Walking in line • Walk in a different way-backwards, sideways, animal walks, hopping
• Line position-front or back• Have child hold the door or carry
something heavy• Give a fidget to hold• Markers on floor (sticker dots or
tape lines) to stand on while waiting• Have young children hold onto a
rope with knots spaced 2 feet apart• Designated routes to follow• Line up two by two and hold hands
AT Supports for walking in line
Walking Rope
Participation goal AT Supports & Strategies
Transitioning easily
Participation goal AT Supports & Strategies
Transitioning easily • Use a visual schedule and go over it before changing activities
• Encourage child to learn the schedule; record steps on a device
• Visual – dim the lights; Auditory –whisper; “if you can hear me…”
• Use a timer (or timer app)• Incorporate movement activity into
transition (i.e. jump like frog, walk like a bear, etc); use an animal symbol
AT Supports for Transitioning
Picture schedule andAAC recorded
activities
Time timer
Symbol