Lullaby and Goodnight (part 1)

baby sleeping with stuffed animal

baby sleeping with stuffed animal

If your child has difficulty sleeping, falling asleep, or getting a good night’s rest, she may have a sleep disorder. Most articles about sleep disorders and Sensory Processing Disorders center around children on the Autism Spectrum, or those experiencing ADHD, and other developmental disabilities. This article will offer suggestions for parents to consider in helping their child to sleep.

What is a sleep disorder?

Here is a short list of sleep issues that may signify a sleep disorder.

  • Problems related to sleep onset and maintenance
  • Irregular sleep-wake patterns
  • Long sleep latencies (how long it takes to fall asleep)
  • Nightmares
  • Night terrors
  • Irregular sleep patterns
  • Generally poor sleep
  • Early and night waking
  • Poor sleep routines
  • Shortened night sleep
  • Alternations in sleep onset and wake times

Questions to answer when assessing a sleep disorder

  • Are there any medical concerns that may influence sleep?
  • How many hours does the child sleep?
  • How many times does the child wake each night?
  • How long, on average, is the child awake?
  • Why do you think the child wakes up?
  • What is the child’s temperament when he/she wakes?
  • Does the child nap? If so, how many and how long?
  • Does the child sleep with any items?
  • What is the bedroom environment like?
  • What is the current bedtime routine?
  • What motivates the child?
  • What activities or items calm the child?
  • What is the child’s primary mode of communication?

If you consult your pediatrician about your child’s sleep issues, you might want to prepare a sleep diary or sleep chart to bring to the evaluation.

Sensory processing issues that may affect sleep

If your child displays other symptoms relating to sensory processing disorders, it might be beneficial to have him evaluated by an occupational therapist.  Here is a checklist of possible behavioral symptoms that may indicate a sensory processing disorder.

  • Address sensory problems associated with high arousal.
    • vestibular under reactivity-(think twirling and swinging)
    • Tactile Defensiveness or Over Responsiveness
    • noise sensitivity
  • Schedule a sensory diet with intense vestibular activity in the afternoon and avoid rough house and intense movement experiences after dinner. In the evening you can relax and calm your child with deep pressure activities.

For Part 2

Suggestions for promoting healthy sleep hygiene, and alternative approaches to addressing sleep disorders.

Resources:

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Sensory Dentistry

childrens dentistry sign

childrens dentistry sign

Going to the dentist can be a traumatic and emotional experience for a child.  Add the challenges of a sensory processing disorder and the issues are multiplied. Here are some pointers to help plan and implement a successful first visit with the dentist.

Inform the Dentist

Since it is almost impossible to find a pediatric dentist who has been trained in treating children on the Autism Spectrum or children who have sensory processing disorders, it is important for the parent or Occupational Therapist to communicate with the Dentist about that child’s special requirements.

  • Your Child’s Particular Sensory Sensitivity to touch, oral stimuli, taste, smell, sound, vibration, movement, and light must be addressed.
  • Sensory-adapted Dental Environment If your child is sensitive in any of these areas, your dentist must be prepared to make adaptations to the environment in the dental clinic (such as dimming the lights in the waiting room to make a more calming atmosphere.) This will decrease aversive sensory stimuli, and reduce anxious and uncooperative behaviors during oral care.
  • Dental Hygienist approaching with pick and mirror

    Dental Hygienist approaching with cleaning tool and mirror

    Adjust Schedule Routine by making the appointment time at a normally inactive period and allowing extra time for preparation and implementation of the sensory strategies.

  • Options for treatment include use of a mild anti-anxiety medication or (in severe cases) treatment in hospital under general anesthetic.

Occupational Therapist participation

An OT could accompany the child and parent to the dental clinic to facilitate sensory strategies, calm the child during the dental cleaning, and educate the dental practitioners.

Prepare before the actual procedure

  • A Social Story used in advance of an appointment with the dentist can prepare the child for the sequence of events that she can expect to occur during dental treatments. When accompanied by pictures (to facilitate the child’s understanding) social stories guide and teach appropriate behavior and reduce anxiety by explaining the routine and increasing the predictability of the experience with the dentist.
  • Dentist discussing procedure with child patient

    Dentist discussing procedure with child patient

    Acclimatization visit entails several trips to the dental clinic prior to the actual cleaning to establish a routine of going to the dentist and reduce the child’s anxiety associated with the dental clinic.

  • Sensory Diet,Heavy Work Have your child do some physical activity just prior to the visit, such as pulling a loaded wagon, jumping on a trampoline or skipping.

Calming techniques during the procedure

  • Apply pressure to the child’s joints and large muscles; these “proprioceptive” activities can help decrease a child’s tendency towards overreaction to touch. Provide deep pressure through bear hugs, back rubs, or body  massages.
  • Place a weighted vest to the legs or torso to supply extra calming sensory input. You can fill the pockets of a vest or jacket with beanbags, or you can use a leaded X-ray apron if available in your dental office.
  • Use a handheld massager or a vibrating pillow to deliver relaxing vibrations. As a safety precaution, be sure that the child doesn’t put the massager on his or her neck.
  • Small child undergoing dental procedure while holding doll for comfort

    Small child undergoing dental procedure while holding doll for comfort

    Wrap the child’s arms, legs, or trunk with elastic bandage wraps. Be careful not to get the bandage too tight. Start with the wrist or ankle and wrap your way up the arm or leg. This can be turned into a fun game of “mummy” or “doctor.”

  • Familiar toy or fidget object for self-calming during the dental cleaning (think Linus Blanket).

Resources:

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Research, Therapy, and Special Education

child wearing EEG cap for brain study

child wearing EEG cap for brain study

What is sensory processing disorder? What causes it? Can it be cured? What are the best treatment protocols? These questions pertain to the actual condition.

There is another set of questions whose answers depend on the answers to the first set of questions above.  If my child needs special education, therapy and/or medical treatment for Sensory Processing Disorder, how do I get them from within the educational and medical system? Who decides which treatments and education are appropriate? Who will pay for this expensive special treatment?

Background

Sensory Processing Disorder and its underlying Sensory Integration Theory were born out of A. Jean Ayres work in the 1970’s.  Her program utilizes a therapeutic protocol that has been used for many years by occupational therapists providing improved occupational performance in children. She described sensory integration therapy as an approach used to help the brain’s ability to organize sensory input for use in functional behaviors. This therapeutic framework (also applied at home and school through training of other caregivers) provides the child with experiences rich in appropriate sensory input, in a guided manner, to produce an adaptive response (i.e., functional behavior) deemed more effective than previously observed behaviors. In a nutshell, Sensory Integration therapy produces results.

Enter the Psychologists (the world of Psychiatry)

Since behavior is the defining measure of results from sensory integration therapy, the psychologists have legitimate domain over the process of diagnosis and treatment. Many developmental disorders appear first as behavior problems to parents, and psychologists are consulted to correct them.  Autism, Down Syndrome, PDD-NOS, and other mental disorders, (along with Sensory Integration Dysfunction) become diagnosed by psychologists and psychiatrists through their diagnostic bible, DSM-5 Diagnostic and Statistical Manual of Mental Disorders

In 2013 DSM-version 5 was published and, for the first time it lumped behaviors seen as sensory integrative issues under the diagnosis of Autism, while excluding Sensory Processing Disorder per se. This produced a flurry of reactions and has clouded the once clear order of diagnosis, treatment, and special education for children experiencing Sensory Integration Disorders. Insurance companies have begun to react to this diagnostic transition and do not consistently pay for claims they once routinely acknowledged. School systems rely somewhat on the diagnosis to apply their required fulfillment of IDEA mandates on a child-by-child basis. A backlash has been felt by parents, teachers, and healthcare professionals of children who suffer these conditions.

Enter the Researchers

Child in MRI lab

Child in MRI lab

It is a well known fact that research concerning Sensory Integration and other brain functions lags far behind research in other areas of medicine. This is partly due to the complexity of the brain and central nervous system, partly to the mixed domain between brain medicine and psychiatry, and partly due to the available technology for performing these studies. Additionally, most people knowledgeable in A. Jean Ayres model of Sensory Integration are therapists in clinical practice and, “would rather be barefoot and playing with kids in a clinic than be stuck in a lab doing research.” according to Patricia Oetter, MA, OTR/L, FAOTA in a radio interview on  September 16.

Research has become the ‘Holy Grail’ of the Sensory Integration model.  Its findings promise to provide a biological foundation for diagnosis and treatment of Sensory Processing Disorders.  This new approach to diagnosis eliminates behavioral considerations and returns to the physicians control over diagnosis, treatment (and thus special education).

In the past few years there has been a glimmer of hope.  Patricia L. Davies and others published results in 2007 of a small study using EEG brain mapping which validates the diagnosis of Sensory Processing Disorders.  In a groundbreaking new study(published Jul 6 2013) from UC San Francisco, researchers have found that children affected with SPD have quantifiable differences in brain structure, for the first time showing a biological basis for the disease that sets it apart from other neurodevelopmental disorders.

It is interesting to note that therapeutic definitions and categories used in distinguishing (and selecting) patients/subjects for research come from clinicians who evaluate and treat these clients–Occupational Therapists.

Tracing of flower used as the task for fMRI

Tracing of flower used as the task for fMRI

Additional findings are showing up in research conducted using Functional Magnetic Resonance Imaging of the brain.  In other words, brain scans are performed on selected patients/subjects while performing specific and repeatable tasks.  Similarities are showing up in the test population and differences in the control population.

Conclusion

Sensory Integration Research (mostly brain scanning) is beginning to catch up with Therapy and Special Education.  Diagnoses applied by therapists and Special ED psychologists help select the populations for research and also help correlate research findings. Until research claims victory, some Special Education and Therapy continues without benefit of DSM-5 and some therapy continues without benefit of insurance.

References:

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(not just) Music to Their Ears (part 4)

Sound Therapy is effective and enjoyable to children in OT

Sound Therapy is effective and enjoyable to children in OT

There are many sound therapy systems on the market today. Here is a brief overview of the three most popular ‘Structured’ systems in use by Occupational Therapists.  Whichever product you prefer, it is important to keep in mind it will also be used ‘at home’ for follow-up and maintenance applications. Information about other listening systems is available in the links under Resources list below.

Integrated Listening Systems (iLs)

Integrated Listening Systems is the most popular sound therapy program with all the bells and whistles. Its programs include acoustically modified classical music to provide enhanced or filtered sounds in certain frequencies. Loaded onto an iPod, this music is delivered to a pair of headphones that include bone conduction. With iLs you select from three programs (below). The audio content is pre-selected music that is in a set order (not selected by the therapist)

  • iLs clinic programs
    • 60-80 minutes/session
      • with 15-20 minutes allotted for the integration activities.
      • The balance of each session is spent doing creative and/or relaxing activities such as drawing, puzzles, fine-motor games, or just relaxing in a comfortable chair.
    • 20-40 sessions
    • 3 or more sessions/week
  • iLs school programs
    • 60 minutes/session
    • 40-60 sessions
    • completed over a 3-month period, i.e. within one semester.
  • iLs home programs
    • either 30 or 60 minutes/session
    • typically completed over 3-5 months

A study entitled “Effectiveness of the Integrated Listening System for Children with Autism and Sensory Processing Disorder” presented at the American Occupational Therapy Association Conference in San Diego, CA on April 25, 2013 concluded with:

These three studies provide diverse evidence that the Integrated Listening System (iLs) is an effective intervention for children with autism and SPD that may be used in isolation, in combination with a comprehensive OT program or in advance of individualized OT to promote improved functioning in a variety of areas including sensory processing, emotional regulation, social – communication interaction skills, and behavioral regulation . These studies contribute significantly to the science and practice of occupational therapy and suggests that iLs is an effective and efficient intervention to promote functional goals.

The Listening Program (TLP)

The Listening Program  has custom audio content created by a special ensemble of musicians. Each composition is specifically selected for its psycho-acoustic effects, including varied orchestration, tempo, octave, meter and simplification of lines. In addition to this special musical production, there is included in the program  a three-part workout called ‘ABC Modular Design™’  enabling listeners to effectively exercise the auditory processing system, providing “warm-up,” “workout” and “cool-down” phases. Also you have the option to select a delivery system that includes bone conduction.

TLP Level One trains auditory processing skills from a foundational to advanced level and contains the latest TLP program with exquisite classical recordings masterfully arranged and processed with ABT’s most advanced psychoacoustic modifications.

Upon completion of Level One, TLP Specialized Collection contains four categories:

tlp_abc_med

  • Full Spectrum
  • Sensory Integration
  • Speech and Language
  • High Spectrum

Therapeutic Listening (TL)

At Jenny’s Kids, Inc., we use Therapeutic Listening because it is the best product for the price, making it more affordable for parents to purchase for use at home as well as school. With Therapeutic Listening a child listens for 30 minutes 2 times per day, with at least 3 hours between listening sessions . Also the audio content from Therapeutic Listening is selected by the therapist (specific for each child based on her sensory challenges) and changes very 2 weeks. There are 3 different audio content profiles to chose from, depending on the severity of the child’s sensory challenges. (Policy Statement on Disclosure of conflicts of interest)

  • Profile 1
    • for severe sensory defensive and regulatory issues
    • 12 week program
  • Profile 2
    • for mild – moderate sensory defensiveness or regulatory issues
    • 10 week program.
  • Profile 3
    • for mild sensory issues and subtle regulatory issues
    • 8 week program

After children complete the regular program, they listen to fine tuning sessions, which follow a specific format depending the child’s profile.

 Comparison Summary iLs TLP TL
Custom Audio Content? no yes no
Bone Conduction?  yes  yes  no
training provided? yes yes yes
Relative Cost highest middle lowest
Listening duration see list above ?? 30min/2xper day
Audio Content Selection program fixed foundation program fixed 3 profiles/therapist selected

Resources

Other Structured Listening Systems

Informal Listening Systems

(Note: These informal listening systems use high quality recording methods or filtering techniques and musical structure, such as rhythm tempo and harmonics to decrease stress and enhance attention.  They are placed here as a courtesy and do not have OT applications for sensory integration.)

Credits:

Special thanks to The Anonymous OT for review and feedback.

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A Very Happy Birthday Party

Birthday girl age six

Ella opening presents

My precious Ella was nearly five when her anxiety levels unexpectedly shot through the roof with the start at a new preschool.  With her 5th birthday fast approaching in late September, Ella asked to have her friends over, but requested that it be only one person at a time. Ell suffered two major melt-downs in her small party of five kids.  She was completely overwhelmed despite efforts to structure the party in ways to minimize possible triggers and duress.

Her preschool teacher at the new school recommended taking her to the school district for a developmental screening.  In fairness, the first preschool teacher said it might be a good idea six months prior.  I finally listened the second time around.

Ella blowing out candles on her birthday cake

Ella blowing out candles on her birthday cake

During her developmental evaluation with the school (just prior to turning five), Ella passed all areas with flying colors.  Not one red flag.  In fact, she was reading the testing material while looking at it upside down from across the table. Did I mention Ella’s strengths such as reading proficiently at four and having a photographic memory?  Ell’s gifts in these other areas actually kept me from initially worrying too much or to further investigate.  There was that little voice in the back of my head saying, “I know Ella is super bright; so what if she is a little behind in a few areas?  She will catch up…”  It was impossible to dismiss the waves of anxiety, however.  My little girl was paralyzed by a fear I couldn’t see or understand.

Our journey towards a land I call “Better and Brighter” began with a call and evaluation by an OTR, initially for the coordination issues I could measurably see Ella struggling with.  That visit was the first time that terms like “proprioception,” “vestibular system,” and “under-responsiveness” were introduced to me.  As an educator of fifteen years, I had never heard much about sensory processing disorder, or one of the other pieces that we would begin to learn about through occupational therapy:  Dyspraxia.

Now the fear of something so tiny as one of Ella’s tiny curls in the bathtub (among a number of other sensory pieces) and doing things like running into parking meters started to make a little better sense, sort of.  Her inability to manage the completion of a simple instruction, carry on a conversation, get dressed independently or open a car door at five was yet another set of pieces to the puzzle.  Ella’s brain, while amazing in so many ways, wasn’t firing like a typical kid.  There was treatment though.  There was education.  There was hope.

OT every week.  Swimming for proprioception, piano for fine motor skills.  Therapeutic listening for three months. Speech therapy for pragmatic communication issues (another area where discrepancies became apparent).  The process to getting to “Better and Brighter” has been a journey, but it is an amazing road to be on, thanks to a team of loving professionals that have shared their knowledge and gifts.

Fast forward a year….

September, 2013… Ella started kindergarten and was getting ready to turn six.  She made out her list for that birthday party that I was every bit unsure of.  Eleven kids this time; Ella’s call on that one.  I have to admit… I had no clue how it would go.  When you have a sensory kiddo, you kind of put yourself on high alert too.

For the week leading up to the party, Ell was EXCITED about her birthday.  We counted down the days, or in our house the “number of sleeps” until the party.

The big day came! Ella was filled with nothing but resounding joy. She was engaged, not overwhelmed.  She interacted with absolute joy as a part of the group.  She made people laugh at her “Mulan” moves in swinging at the pinata.

When it was time to sing “Happy Birthday,” she asked everyone to sing “not too loud,” and asked politely to be excused from the big table after the song/candles were done to go to a smaller table so it was less crowded.  From start to finish, I had a little girl who was on top of the world.

The only sad part for Ell was that her party had to end (transitions are still hard).  Even then, she quietly retreated instead of losing it, with only a few tears after everyone had gone.

The transformation in Ella over this last year has been mind-blowing.  She is healthier.  She is happier.  Her sixth birthday was a gift in so many more ways than just a marking of the day she was born.  It was a moment that will be unforgettable for our entire family.

Our journey continues, but with a greater understanding and many more smiles!

Thank you all for a healthier, happier little girl one year later!  Thank you for all that you have done for her and for our family!  Today was a true joyous moment that will be unforgettable for all of us!

Much appreciation for all of your gifts to an almost six-year-old girl!!!

Signed “Ella’s Mom”

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(not just) Music to Their Ears (part 3)

Toddler in OT with Sound Therapy

Toddler in OT with Sound Therapy

Sound Therapy improves sensory integration when used in connection with Occupational Therapy for sensory processing issues.  Since no two children are alike, each sound therapy program is customized to the needs of the child after a full sensory evaluation.  Testimonials provide a glimpse into the variety and effectiveness of sound therapy.

Max’s mother wrote this personal testimonial:

Max started OT in January 2012 at age 8 ½. We started OT for two separate reasons. One reason was for Max’s handwriting, which has improved but is still a struggle. The other reason was severe sensory defensiveness that had led Max to basically stop eating. Food was always too hot, too cold, too runny, too squishy, too tough, too bland, too spicy or it didn’t look like he had expected it to look or taste like he had expected it to taste. Meals were a HUGE source of stress in our house and Max had not gained weight or grown taller in almost two years.

During OT sessions, he learned to identify sensory stressors and tools to deal with those stressors. We learned that certain scents were calming. We learned that sour candy helped calm him. We learned that hand fidgets were helpful at keeping him focused, on task, and calm. We also learned how to incorporate “heavy work” into his daily routine. At home, we worked to integrate how to recognize stressors and how to calm himself during his daily routine. He also used therapeutic listening twice daily.

The therapeutic listening made a HUGE difference in his eating!  He has gained 32 lbs and 5″ in a year and a half and is now 50% for both height and weight as opposed to not even being on the growth chart before. More importantly we are able to sit down and eat as a family and actually enjoy ourselves! We ended up purchasing his favorite therapeutic listening music (“ez listening”) and when he starts to narrow his food choices, we restart the therapeutic listening for a few weeks and his symptoms improve.

Max still has difficulty with emotional regulation. I think he was in “fight or flight” response from the sensory defensiveness for SO long that he literally was in continuous survival mode. Now that he has discovered tools to help calm himself, we have been able to work on social skills and dealing with his emotions. All of these skills have helped turn him from a “behavioral problem” at school into a star student. His self esteem also has improved now that he knows he has control over these issues and they don’t have to control him.

We are still struggling with the school to get accommodations for his handwriting but other than that he is doing really, really well!

Grant’s mom provided this testimony:

Grant is now four years old.  I noticed problems with Grant’s development within six months after he was born. He was hypersensitive to light, sound, and visual patterns/movement, and did not respond to his name. When I had him evaluated at nine months through Tiny K (the state Infant/Toddler special services agency) they told me everything was fine.

As he grew, Grant’s ‘symptoms’ increased and became more pronounced. He repeated sounds (echolalic speech), never expressed his needs like hunger or thirst, had a high pain threshold, toe walking, poor motor control, terrible sleep, increased hyper-sensitivity to small sounds and light, and hypo-sensitivity to smells, heat/cold. Socially he preferred adults to children and acted as if children in a room with him didn’t exist

Finally at age 2½ Grant was re-evaluated and began OT sessions through Tiny K. They helped me to start to understand a bit about ‘sensory’ issues (particularly visual and auditory) and how these related to many of Grant’s issues. I also learned how ‘poor motor planning’ was another key to many of Grant’s difficulties. The OT there worked with Grant once a week and addressed play skills that helped with creative play, washing hands-a big issue I was struggling with at the time (helping me to break down steps for him to be able to do this), fine motor skills (like putting a toy together), blowing/mouth games, etc.

When Tiny K exhausted its services mandate, I knew Grant needed to continue to receive OT (as we had JUST gotten started and it was a LATE start in my opinion, since his issues were visible before 2 ½ years old). So I went to Jenny’s Kids, Inc. where Grant restarted OT sessions  in June 2012 (age 3) that included sound therapy. There are so many activities that have helped Grant! I think Therapeutic Listening (2x/day-am and pm and we still do it almost every day with maintenance CD chips) has been very helpful for him. Ever since Grant was an infant, he has ALWAYS responded positively to music, so that may be why I feel he has responded well to the Therapeutic Listening. It seemed to make a difference almost immediately.

I can honestly say, without a doubt, Grant has progressed by leaps and bounds from his OT sessions, which have included TL from the beginning! His therapy included the entire gamut of sensory gym and ‘play stations’. He especially liked the hammock swing, ball pit, and crawling through the ‘tunnel’.

I can’t imagine where we would be with Grant if it hadn’t been for you Jenny! From the first day he started TL (Rhythm and Rhyme), there was a clear calmness and lack of overreaction to dropping a dish and it breaking. He would have had a complete tantrum- not sure if it was sound “deadening” of the ear phones or the TL music itself. Instead, he came over to me and said “Hug” and I gave him a hug! He’d never reacted this way before to something like that (instead he would scream and yell and run away)! We both cleaned up the mess calmly. It was amazing!

In that first 2 weeks, we saw all kinds of things. He was hugging more, playing with toys better and we actually saw him for the first time put together a train track!! Also, he commented for the first time on the SMELL of something! This was huge (you’d think I’d remember what is was but I don’t), but he had never commented on how something smelled before in his life-even BAD things! Since then, he now notices smells, both good and bad!

With Mozart Modulation, I remember for the first time I saw him waving at people and actually POINTING out things and talking about them when we were in the car (and he had TL on at the time.) He’d never really pointed at things since he was really young- he only did it a few times as a toddler. He also had fewer tantrums! While he still has some bad tantrums, they are far less frequent. He has become less rigid and more flexible!! While he still thrives on routine, he now requests that I take different ways home (vs. freaking out that I took a different turn or walked out a different door)! He is interested in going new places, where it seemed before he was anxious leaving the house and had started wanting to stay inside and not go places. This is life changing, as he has been able to experience being a kid without fear and instead experiencing JOY and FUN! He has improved in all personal skill areas, body awareness, crawling, tunneling, jumping, bilateral coordination, and dressing himself, better motor planning, improved attention span, and better social skills.

Overall we feel that the TL has improved Grant’s self-regulation. He has less tantrums and transitions easier. He also moves about his environment with better body awareness. I believe it has also improved his socialization skills with peers. I DEFINITELY feel that it has helped him to be less hypersensitive to environmental sounds (water running, airplanes, A/C/furnace, etc.)

(Note: Grant has had a weekly OT session from June 2012 to present.)

For Part 4

A brief review of the most popular Sound Therapy products and their advantages and disadvantages.

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(not just) Music to their Ears (Part 2)

Therapy for toddlers and infants includes sound therapy

Therapy for toddlers and infants includes sound therapy

In Part 1 I discussed what is sound therapy, some of the symptoms that have been helped with sound therapy and a brief anecdotal statement of its effectiveness.

Listening is the active and motivated process of tuning into and filtering out sounds.  By emphasizing good listening skills and well organized intentional interactions with the music, sound therapies allow the child/client to process and integrate both sound and movement.  This connection between sound and movement is utilized during occupational therapy sessions by including sound therapy with other sensory-motor activities.

I use a holistic approach to sensory integration for my clients.  The implementation of central nervous system inputs (therapeutic activities) activate neural responses that, when repeated and reinforced over time produce adaptive structural changes in the brain and central nervous system and lasting remediation. Therefore, Sound Therapy is integral to the therapeutic process for those children identified through a sensory evaluation as having auditory system dysfunction. The modulated music listened to through the headphones has a powerful effect on the autonomic nervous system producing improved regulation that, when combined with intensive therapy and a sensory diet implemented at home and school, has had permanent positive changes to the nervous system in the children I have worked with.

Theory of Sound Therapy

Besides emphasizing various frequency ranges for specific purposes, the music is also modulated with somewhat random pulses of increased and decreased volume at certain frequencies throughout the therapy session.  This prevents conscious adaptive filtering to allow the inner ear muscles to strengthen thus improving their ability to filter out noise.  To this end the headphones for iLs program, (but not Therapeutic Listening program) also have (optional) separate bone conduction speakers which deliver sound directly to the inner ear through the skull without first being processed by the middle ear.  Finally the left and right speakers are separately balanced and modulated to provide specific left-right hemisphere brain connective adaptations (think left-brain for logic and sequence and right-brain for art and creativity) to improve reasoning  and communication.

There are three distinct frequency zones defined in the therapeutic listening process.

  1. The Sensory Motor Zone includes the lowest frequencies (sounds like kettle drums, bass notes, thunder, and animal growls)  and are used to stimulate the vestibular system and influence balance, coordination, and postural stability. These low frequency sounds also stimulate the nerves in the whole body producing increased body awareness and sense of security with regard to gravity.
  2. The Communication Zone includes middle frequencies that are heard regularly in speech and low quality audio music.  They are used to improve speech, language, vocal control,  attention, concentration, and memory.
  3. The Integration Zone includes high notes like flute, soprano voice, and bird song. These frequencies stimulate a greater number of neurons because there are more cells in the nervous system that respond specifically to these frequencies than all the rest of the sounds put together.  They send more neuronal pulses to the brain because of this and may improve alertness, energy, intuition, motivation, organization of ideas, speaking, communication, and active listening.

Case Examplesoundtherapy3

KP was three years old.  He was diagnosed with dyspraxia, developmental coordination disorder, and speech apraxia. Following his initial evaluation, there were numerous other issues which were to be addressed.

  • sensory modulation
  • behavior problems
  • delayed postural control
  • decreased muscle tone
  • poor balance, equilibrium, righting reaction
  • bilateral motor coordination
  • gross and fine motor delays
  • praxis difficulties
    • decreased ideation
    • organizing ideas
    • motor imitation
    • motor sequencing and execution
  • language delays
    • difficulties following verbal directions
    • poor articulation and intelligibility due to oral praxis problems

He received a total of 31 90-minute sessions of OT and Sound Therapy (using iLS) for sensory integration over a twelve week period.  The first several sessions emphasized postural control, body awareness, and gross motor skills using low frequency sounds and strong bone conduction.  KP improved in postural control, muscle tone, equilibrium, righting responses, body awareness, gross motor coordination, visual motor skill, and improved sleep.

Later sessions focused on oral motor activities, continued emphasis on praxis and higher level coordination activities by using mid level frequencies while OT was concentrating on communication, attention and memory. KP improved in verbal output and improved ability to coordinate total body movements such as dressing and playing on the playground.

Finally, higher frequencies were used in therapy sessions to emphasize ideation skills and sequencing.  His ability to follow multiple instructions improved. Also KP was better able to plan and sequence his own gross and fine motor skills.

Follow-up activities included:

  • collaboration with the school therapist to promote KP’s goals and achievements in the school setting
  • Additional home activities with Therapeutic Listening to continue work on his gross motor and praxis skills

After three months KP showed continued improvement in sequencing motor and language skills as well as better attending at school.  At this point KP began listening to informal music program CDs appropriate for unsupervised parent use.

In Part 3

A brief review of the various Sound Therapy programs and products with recommendations and (maybe) some parent testimonials.

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