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Occupational Therapy

Auditory Intervention

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AUDITORY INTERVENTION

As part of working as an occupational therapist, and under sensory processing integration, we work with all of the 8 sensory systems. 

One of these is the auditory system. The auditory system is complex and many other sensory systems are connected to it as a multisensory functioning organ.  

So What is Auditory Processing?  

Auditory processing is the process of recognising and responding to auditory input. Auditory processing refers to the ability to discriminate between similar sounds, tune into a parent, teacher or friend to pick up important information, in order to communicate effectively with others. There are multiple skills linked to auditory processing including memory, sequencing, development of expressive and receptive language, academic skills such as association of sounds with letters or numbers, listening skills, communication skills, social skills, and maintaining attention.  One of the greatest skills needed is the ability to differentiate sounds.  Our ears are developed to interpret the different frequencies of sounds a world presents us. The frequency (Hertz- Hz) of sound is then determined by the way in which sound waves vibrate whilst travelling through our ear. Once sound waves reach our ear, they cause the membranes within to vibrate at varying intensities, causing the activation of certain musculature of the ear, which then allows us to hear!  There are varying frequencies such as:  

Low Frequency sounds (1000 Hz and below): This sound activates the outer ear muscles, moving slow as it passes through. This includes sounds like: 

  • Dog’s barking
  • Lawn mowers
  • Thunder
  • Vacuum cleaners 

Middle Frequency sounds (1000-3000 Hz): This sound activates the middle ear and where language and social skill development is primarily processed.

High Frequency sounds (3000Hz and above): This sound activates our inner ear, moving hard and fast as it passes through. This includes sounds such as: 

  • Women’s voices
  • Birds chirping

Challenges in Auditory Processing

Difficulties arise when the brain does not effectively or accurately interpret and respond to auditory information. This creates misinterpretation of information. 

There are two forms of difficulties with auditory processing: 

Hypersensitivity to sounds (Auditory Defensiveness) 

This is a child who is overwhelmed by auditory input and may present with the following: 

  • Easily distracted by sounds not noticed by others (clocks, fans, air conditioners)
  • Disliking sound of vacuums, hair dryers
  • Startled or distracted by loud or unexpected sounds- running away, crying, covers ears.
  • Frequently attempted to control sounds in their environment (asking people to stop talking)
  • Refusing to go to busy/ noisy places

Hyposensitivity to sounds (Under Registration) 

This is a child who does not easily register auditory information in his environment and may present with the following:

  • Does not respond to verbal cues or own name
  • Loves loud music or TV
  • Loves to make sounds or noises
  • Difficulty understanding or remembering what was said
  • Talks to self when completing a task
  • Needing directions repeated

At Explore and Soar, we are dedicated to understanding these sensory systems, determining ways to integrate and apply intervention approaches that alleviate these concerns. To do so, we engage in continued professional development and collaborative reasoning sessions with our senior OT’s.

There are many auditory interventions that can be supplemented into your sensory diet or OT home programming routine, presently at Explore and Soar, we utilise two intervention types; Therapeutic Listening and Quickshifts. In addition to these we have other auditory training and supports, which are tailored to each individual client where appropriate. 

Contact our OT’s to find out more information or  to see how we can help you. We will tailor an appropriate auditory intervention solution for your child. 

From a personal perspective, when I’m feeling like my mind is scattered or overwhelmed, I put on one of our quickshifts that emphasise the lower frequency sounds in order to ground me, to feel safe and to slow my heartbeat.

If I’m feeling slow, I’ll put on a track with shifts of high and low tones, and varying rhythms to invite movement to my muscles to activate and boost my energy levels to get going. 

When i’m really needing to concentrate and get work done, i’ll put on music with a constant rhythmic sound, that holds my attention in one space, it provides intensity with high and low sounds, with a fast but constant and non changing rhythm to allow my body to sync with the music and work to that speed. 

Our families at Explore and Soar know we love to put on music in sessions to add as much support to our kids intervention as possible. Whether it be through speakers or headphones, the impacts to the child’s regulation, engagement, social skills and communication is amazing to see. Some examples of these include:

Child one: A young boy who has high levels of energy. One of his biggest challenges was sharing space, regulation and holding attention to share engagement for more than 5 minutes. When putting on the QS space, you could instantly see the change in his body. He slowed his body and movements, he took a deep breath and paused. The music gave him time and space, it give him the support he needed, prompting safety and regulation. 

Child two: An overwhelmed child. He has challenges moving and communicating with others around him, to follow the lead of others, to transition between environments and settle enough for sleep. With persistence, through each day of our 5 day intensives, little by little, the boy that started the week was a completely different child by the end of the week. He stayed in the room for the whole 50 minutes, he could regulate and move through the changing of ideas, he shared eye contact, laughs and we beautifully transitioned out of the session with no crying or frustrations. 

Child three: With a confident personality, she loves to be in control of the things around her. She does so with constant attempts to change the activities that are new or tricky, tensing her body to try and stabilise movement or completely avoiding an activity all together if it means using both sides of her body together. Music had an instant effect on her body. She began to use both her left and right hand together during sit down fine motor tasks. The music prompted a huge smile and by moving with the rhythm of the music, she gracefully challenged herself throughout the activities.

Auditory processing is such an integral part of development. If you think your child may need some auditory interventions, please don’t hesitate to reach out and see how we can help!

Until next time,
Maddie

ORIGINALLY PUBLISHED SEPTEMBER 1, 2021

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Self Care

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SELF CARE

Self care is something we all do everyday. It includes activities which contribute to our basic needs, such as dressing, showering, going to the bathroom, brushing our teeth, sleeping and eating. 

As occupational therapists, we often refer to self-care skills as activities of daily living (ADLs) and it is an important milestone for children to develop. At Explore and Soar, our goal is to practice and strengthen skill development (at an age appropriate level) to enable independence in self care for all of our clients and therefore reducing stress on our parents and families. For many of us, these skills come naturally. However for many children, many of these tasks are complex and require high cognitive, sensory and physical capacity. This can cause challenges in getting ready in the morning, attending to hygiene or getting ready for bed at the end of the day.

Foundationally, self-care involves multiple complex skills including bilateral integration (the ability to coordinate both sides of our body), motor planning, balance, postural control and core strength. 

Additionally, higher executive functions are also important, such as sequencing, organisation and planning. It further involves our biological rhythms, being able to register when we need to toilet, hungry or full, and our sleep/wake cycle. Children with sensory processing challenges can have increased difficulty understanding where their body is in space, or be overly sensitive to textures on their skin or in their mouth. This can make tasks such as dressing, brushing hair and feeding particularly challenging and children can become avoidant.

We provide sensory diet strategies or sensory snacks to support our families in promoting self-care independence for our children. 

These can include auditory interventions through specialised music to help motivate, regulate, activate muscle tone and shift our brains into an optimal state to complete tasks. We also use strategies such as therapressure brushing and deep pressure to support regulation and internal grounding. Additionally, we think about what helps them to get moving in the morning, which may include heavy work activities or just jumping on the trampoline for 10 minutes to activate their body and sensory systems. Explore and Soar value multidisciplinary involvement and we often refer to chiropractic intervention to support biological rhythms.

Many of our referrals at Explore and Soar involve challenges in following routines and getting out the door of a morning. 

The morning routine involves multiple self care tasks. Planning outfits, dressing, brushing hair, preparing and eating breakfast, brushing teeth and packing school bags are common tasks necessary for children to complete before leaving the house. 

So often, children can find it difficult to remember and follow the routine in a timely manner, which can in turn cause stress on parents and family members. Occupational therapists can intervene by implementing the use of visual schedules and visual timers. Visuals are a great way for kids to see what step comes next and therefore support their independence and responsibility in self-care. The use of a visual timer can support their capacity to understand and stick to the expectations and can also incorporate a fun challenge for them to complete a task within a certain timeframe. Consideration of how our children learn and understanding their needs is important, whether using pictures, a list, or breaking each task down into smaller steps.

To help understand the complexity of self-care tasks, let’s break down the skill acquisition of dressing. This includes:

  • Higher executive functions: Before they even begin the task, organising and planning appropriate clothes is needed. Further, sequencing is required to move through each step of dressing in a timely manner.
  • Bilateral coordination: The use of both sides of the body working together to put on clothes, complete zippers, buttons and shoelaces.
  • Spatial and body awareness: understanding where our body is in space is important when putting arms through sleeves, legs through pants and pulling a shirt over our head.
  • Fine motor skills: utilised to complete zippers, buttons, shoelaces and putting on shoes and socks.
  • Trunk rotation: Being able to twist the body to put arms through sleeves of a jacket or shirt.
  • Hand eye coordination: controlling our arms and legs in relation to what our visual system is telling us.
  • Motor planning: Dressing requires coordination of both sides and our upper and lower body together, as well as executing motor movements. It also involves activating core strength, muscle tone and postural integrity to control our body. We have recently written about motor planning and the aspects involved.
  • Balance and core strength: Required when lifting one leg at a time to dress lower body.

If a child lacks competence in one or more of these areas, the dressing process will be more difficult, time consuming, and their capacity to achieve independence will be reduced. At Explore and Soar, when we assess clients, we make observations of these skills and then utilise play to develop and build on them in our sessions and home programs.

If you think your child may need some assistance with developing self care skills, please don’t hesitate to reach out and get in contact with us. Whether you’re a new or existing client, we can help!

Until next time,
Hannah

ORIGINALLY PUBLISHED AUGUST 4, 2021

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The Developmental Stage of Handwriting Skills

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THE DEVELOPMENTAL STAGE OF HANDWRITING SKILLS

The year is flying by! I cannot believe that we are already in July! 

Our winter school holidays are in full swing and we are now taking the time out to rest, recharge and perhaps even go on a small trip with our family! June brings about the halfway mark of the year and from here on we start thinking about what the remaining six months of the year will look like. We reflect on what has been achieved in the first six months of the year and set new goals for the months ahead. 

It’s also a time where we start to think about the transition to Kindergarten.

It’s about doing the preparation needed for a successful and stress-free leap into the next stage of life for both parents and children. It’s all about ensuring our children have the skills needed to make the transition. Reading back through our blogs over the years, we have detailed many of these including emotional regulation, sensory processing and gross motor skills.

A big question that is often asked by parents is how to prepare their child’s handwriting skills. How can we actually determine how well our child is prepared to learn how to write and are they ready for the transition to school?

To commence developing pre-handwriting skills, we spend time focusing on and developing our fine motor skills. You can see more information on fine motor skill development in a blog that we previously wrote here in July of 2020! 

The development of fine motor skills in relation to pre-handwriting skills begins with a focus on shoulder stability and control of whole arm movements including strength of the shoulder, upper arm and forearm, transitions to whole hand movements, positioning, grasping, whole hand coordination, finger isolation and finally finger movements.  

Once the development of fine motor skills has emerged and is strengthening, we then focus on the pencil grasp itself. 

Picking up a pencil: It may sound funny, but there isn’t just one way to learn how to hold a pencil. We first teach children a whole hand grasp, then onto a digital grasp, modified grasp and finally we transition to a tripod grasp. Through the early developmental years, forming these grasps is ideal in working towards a tripod grasp when engaging in academics. Each individual holds their pencil their own way, however, our aim is to ensure that they can each reach functional capacity and ease when completing all writing tasks. 

From the moment they pick up a writing utensil, our children draw, scribble, paint, colour and explore within the world of art. This can be in all mediums and is the beginning of pre-academic handwriting skills. This happens from a very young age and continues to develop over time. It plays such an important part in their development and not just with handwriting skills, but with their language, visual information, grapheme knowledge, word knowledge and developing symbolic representations of letters. 

Learning to write is a long term process and something that needs to be based on each child’s individual goals and skills. During our intervention and support, we scaffold and grade activities based on different developmental stages with pre-handwriting and fine motor activities. This allows for foundational skills to be set, whilst we support each of our clients emerging skills and ultimately preparing them to enter schooling

Learning to write can happen at different times for each child but as a guide and general rule of thumb, this is what most children are exploring / have the ability to do at particular ages:

At 15 months to 2 ½ months:

Random scribbling occurs, picking up their pencils and scribbling on anything they can get their hands on. Let’s face it, how many of our toddlers have picked up a writing utensil and scribbled all over our walls or doors without us realising! As frustrating as this may be, it’s a good indication that they are honing their fine motor skills. At this point in time it is about spontaneous circular shapes or scribbles with reduced clear direction. 

At 2- 3 years:

Controlled Scribbling over time with more practice and their hand muscles strengthening, scribbling drawing has increased in control, smaller drawings and creativity is becoming a part of their ability. They are starting to naturally move towards more controlled circular movements, vertical and horizontal lines, including multiple loops and spirals and shapes that resemble the letters ‘t’ and ‘v’.

Basic Shapes  (2 ½ years – 3 ½ years)

The development and understanding of being able to draw horizontal and vertical lines. Other shapes include circles and squares and shapes that may resemble the letters ‘t’, ‘v’, and ‘h’. 

This can then expand into curves, lines, scribbles that resemble writing and creating their own letters and words which is also helping their imagination, building upon letter recognition and developing drawings and ideas that have meaning, which they are excited to share. 

Pictures of objects or People (3 to 5 years)

This is when the development of distinguished drawing, such as drawing a person begins to emerge. From 3 to 4 years of age it is usually people with their arms and legs attached to their head, with expansion and development of head, body and limbs in appropriate places towards the end of 4 to 5 years of age. In addition, increasing details around the face, including eyes, mouth, nose, ears and hair. At this point your child will be able to tell you all about their drawings and what they represent but they may not always clearly represent the idea at hand. Children at this age will have an increased awareness of being able to draw two objects together, as well as beginning to expand on their subject matter, including trees, houses, vehicles etc. 

Letter and Word Practice (3 to 5 years)

In addition to the expansion of picture drawing, the child’s ability to draw and expand on pre-handwriting shapes also increases. This sets them up for increased letter representation and awareness, shapes expand from squares and circles to a cross (X), attempting triangles, diamonds and an interest in attempting letter development. 

All of these stages are fundamental in developing the pre-handwriting skills required prior to entering Kindergarten. Having these foundational skills allows for the awareness, skill and ability to make the shapes and lines required prior to knowing and beginning the correct letter formation. 

This significant part of development and fine motor skills can be lots of fun and can be completed in so many different ways through craft, play and art!  Being able to get creative, with finger painting, shaving cream, water play, colouring in and drawing are all ways that allow children to experience these skills in a playful way. It’s important to remember that play is the most effective way to learn all pre-academic and handwriting skills. Allowing the child to lead the play and explore their ideas with them will inadvertently assist you in naturally supporting and providing these opportunities to develop the skills needed. 

There is no one size fits all when it comes to developing handwriting skills! Remember that each child is different! 

What’s important for us as Occupational Therapists is coming up with creative and supportive ways to facilitate these learnings.

Berk, L. E. (2013). Child Development (9th Edition). Upper Saddle River, New Jersey: Pearson Education

Huffman, J. M., & Fortenberry, C. (2011). Helping preschoolers prepare for writing: Developing fine motor skills, Young Children, 66(5), 100-103.

Until next time,
Jess

ORIGINALLY PUBLISHED JULY 7, 2021

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Understanding Motor Planning and Coordination

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UNDERSTANDING MOTOR PLANNING AND COORDINATION

This month we are going to talk about motor planning and coordination.

Each child develops at a different rate and at Explore and Soar it’s our job to identify and offer intervention solutions to help that process. 

Developmental Coordination Disorder is what postural and motor sensory based disorders are diagnosed under, in the DSM-V. We use sensory based motor disorder definitions, information and research to help us identify behaviours consistent with this, as occupational therapists.

One of the most common reasons we find that children are referred to Explore and Soar is difficulty with gross motor skills. This could be concerns regarding poor coordination, appearing clumsy and falling over a lot, difficulty with crawling or an inability to jump with two feet at a time, to skip or to ride a bike. 

As part of our initial assessment process and during our intervention sessions, we pay close attention to how your child moves their body in various scenarios. This provides us with vital information regarding how your child is processing the varied types of sensory inputs around them.

Last year we wrote about Sensory Processing Disorders on our blog, how to correctly identify the warning signs and how to best assist your child. One of the types of sensory processing disorders that we only spoke briefly of was sensory-based motor disorders (SBMD) also commonly known as a developmental coordination disorder, as recently outlined in the DSM-V under the category of neurodevelopmental disorders.

In SBMD, we see children who have difficulties with “stabilising one’s body or thinking of/planning/sequencing or executing a series of movements based on sensory information outside and inside the body” (Miller, L.J., 2014, pg.14). SBMD can be categorised into two groups; Postural Disorder and Dyspraxia.

Postural disorder is seen in a child who has difficulty in maintaining the control of their body, to meet the demands of an activity. It involves our muscle tone, core strength and stability. It is the action part of all motor movements. 

Children who have difficulty with ideation (forming an idea in the brain), planning and sequencing (identifying what steps are involved) and execution of motor movements fall into the dyspraxia category. This can occur across all motor movements including gross motor, fine motor, visual motor and oral motor. This is known as the planning part of all motor movements.

Motor planning is an automatic subconscious process that occurs every time we seek to move our body. We tend to take this process for granted. It occurs with many common daily activities such as opening a door, putting a jacket on, writing our signature, or chewing our meals. Once acquired it becomes like riding a bike – once you know how to do it, it begins to happen without too much conscious thought. Everything we do can be broken down into steps that our brain automatically executes via motor movements for successful completion of the desired activity. Children who are experiencing difficulties with motor planning find such tasks difficult, awkward and exhausting because of the level of conscious energy they have to put into completing each and every task! 

One common result of motor planning difficulties is an impact upon the ability to form social connections and self-worth. This is often due to difficulties with oral motor (eg. speech), visual motor (eg. difficulties copying work from the board at school), fine motor (eg. difficulty with buttons, shoelaces) and gross motor skills (eg. difficulty keeping up with their peers at recess). 

So how do we address motor planning difficulties in OT sessions?

We practice all the steps involved – ideation, planning and sequencing, and execution – so that it eventually becomes an easy and automatic process for the child. We provide opportunities for the child to create their own ideas for an activity, we break skills down into smaller steps to achieve success and we provide high repetition rates to allow feed forward and feedback loops to develop around the sensory information the child receives from the world around them. This is where we apply our knowledge and skills of activity analysis as OT’s to coach and teach your child skills that allow them to increase their independence. 

This is not a quick process. It takes time to rewrite neural pathways in the brain for autonomic responses to sensory input. By addressing motor planning goals within intervention sessions, we are not only looking to increase a child’s skill level but also their self-esteem and confidence to complete activities that are meaningful to them, ultimately leading to a happier successful life!

If you have any questions around motor planning, please reach out to one of our therapists who will be able to provide more information to you.

Reference:
Miller, L.J. (2014) Sensational Kids: hope and help for children with sensory processing disorder (SPD). New York:Penguin Group.

Until next time,
Lori

ORIGINALLY PUBLISHED JUNE 2, 2021

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Health Promotion for our Families

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HEALTH PROMOTION FOR OUR FAMILIES

As occupational therapists we are trained to provide support to all our clients and their families, in order to increase their independence, grow their confidence and to live a happy and healthy life. 

More often than not, this is first done or activated when someone is starting to experience discomfort or challenges in certain areas of their life. For our children, self-care, play, schooling and their social interactions with their peers are where areas of concern often arise. As we’ve spoken about previously, when these challenges occur, they manifest in behaviours. For our children, the way in which they behave is in fact their method of asking for help. They are in turn telling us as adults, that something internally doesn’t feel right and they require extra help. It is then our role to determine what is going on and how we can provide effective support. 

But what if we could actually reduce these areas of concern and the amount of worry that comes along with them but being proactive rather than reactive? 

This is an area that as occupational therapists we are so very passionate about. Through health promotion we can bring awareness, education and support to all families and communities about child development, patterns to look out for and access to support services when you have questions. This should be readily accessible to every person in each of their communities. By having access to services that offer advice and support, promoting health and wellness for both the parent/carer and their child, inadvertently increases well being and reduces the risk of mental health. 

From an OT perspective; the definition of health promotion from the World Health Organisation is “the process of enabling people to increase control over and to improve their health. To reach a state of complete physical, mental, and social well-being, an individual or group must be able to identify and realise aspirations, to satisfy needs, to change or cope with the environment. Health is, therefore, seen as a resource for everyday life, not the objective of living. Health is a positive concept emphasising social and personal resources, as well as physical capacities. Therefore, health promotion is not just the responsibility of the health sector, but goes beyond health lifestyles to well-being.” (1986, para.2). 

Something that we do as a company outside of providing intervention strategies and support to our clients and their families, is also providing them with a range of essential health promotion strategies to positively influence, empower and educate in order to further reduce the inequalities in our health industry. Therefore, significantly supporting positive interactions and emotional connections in our client’s support networks. 

Each of our OT’s provide strategies and supports to our clients, such as:

  • Teaching positive ways for your child to move their body that feels good for them, to increase control and awareness.
  • Teaching them to feel safe and comfortable sharing their emotions and sitting within their feelings.
  • Providing as many possible positive social interactions with other peers who are presented with similar challenges in group program settings.
  • Conducting skill based training for self-care so that children can be successful on school camps or overnight trips.
  • Teaching your child how to plan, organise and sequence activities or thoughts together, to help with positive inclusion in school – this makes them feel clever, smart, successful and allows them realise their worth. 
  • Providing strategies and support to be successful and confident in navigating their local communities.

Additionally, each of our OT’s provide strategies and supports to our clients parents/caregiver’s such as:

  • Providing connections and relationships within the Explore and soar family; other families, clients or health professionals.
  • Taking into account every parent’s well-being when working with their children, giving them emotional support, and interventions that are based both on the child and the parent, so as not to overwhelm and contribute to more stress.
  • Running parent groups, where like minded parents are present to talk about their own situations, so that they feel heard and they are able to build connections around them without feeling isolated, increasing their support network outside of health professionals.
  • Utilising parent coaching strategies to teach them how to do the interventions; positively reshaping their confidence in order to be able to manage all aspects of their lives with their children. 

Within Explore and Soar, we support and provide strategies to our local communities for health promotion such as:

  • Education nights at preschools for the parents and their educators. This is a regular offering as a part of our service to build awareness and health promotion for development – it’s one of the most consistent things we do. 
  • Work within our local schools; teacher professional development courses that support them in the classroom and the playground. This differs from early education nights, as rather than identifying areas of concern at a younger age, it’s more about working with difficulties that have already been identified and enveloping the right strategies.
  • Remaining very community orientated by sponsoring and supporting sporting events or team members. We do so, so that the community knows there is a point of access, that if information or support is needed, there is a place to ask questions. We always seeking to create a presence in the community to bridge the gap and get people openly talking about behaviour, emotion or social skills.
  • Promoting safe access within the community, so as to eliminate anxiety and stress.

This brings us to an exciting event happening at the end of this month in support of the Hunter Region! We are participating in the Hunter Disability Expo this May! We participate in local expos in the community to bridge the gap and bring awareness to the support that is offered.

The Hunter Disability Expo is open to anyone that would like to attend and it is on Friday 21st and Saturday 22nd May at the Newcastle Entertainment Centre. 

Participants get to see all the different supports and companies within the Hunter that offer assistance to our kids, all the way through to adulthood, from allied health professionals to general support services. 

On a personal note, growing up, this level of awareness, education and events to support our local communities and families simply weren’t available. This is often still the case in our regional communities. So participating in events like this to share with others within a safe space, is and will always continue to be a passion of mine. 

So, if you have time and want to see us and many other local health professionals, join us at the Hunter Disability Expo and don’t be afraid to say Hi! We would love to see you there. 

Until next time,
Jess

ORIGINALLY PUBLISHED MAY 5, 2021

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