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sensory

The Safe and Sound Protocol: Increase Self-regulation and Decrease Sound Sensitivity

By | NESCA Notes 2021

By: Julie Robinson, OT
Director of Clinical Services; Occupational Therapist, NESCA

NESCA is excited to announce that we now offer our clients the Safe and Sound Protocol (SSP)—a therapeutic listening program, designed to increase self-regulation and decrease sensitivity to sound. This new service is provided through our occupational therapy (OT) department and is facilitated by either Julie Robinson or Maddie Girardi, both of whom have been trained and certified in its administration. The process begins with an initial phone intake with Julie, who will help you determine if the program is a good fit for you as an adult, or your child. For new patients, we always initiate the program in the office for two to three visits. After this point, (if it seems feasible), you can transition to a home program. If not, we can continue through direct office visits until the program has been completed. In addition, we can offer the program as part of an existing OT treatment protocol.

Who is SSP appropriate for?

SSP is appropriate for anyone over two years of age through adulthood, who has the capacity to listen to music with over-the-ear headphones. It is ideal for patients on the autism spectrum, or individuals with sound sensitivity, sensory processing disorders, or difficulty with self-regulation. It can be used to facilitate more frequent calm and settled states of arousal for those under stress, or who have experienced trauma. It has been also observed to improve sleep and even feeding patterns in some of our clients who have difficulty in those areas. We have seen this carry over into improved behavioral control, independence, and focus in completing daily routines and academic work, as well as more availability for social interactions.

What if my child cannot tolerate wearing headphones?

Your OT will work with you to find an appropriate pair. In our experience, most children can learn to wear headphones with a bit of gentle coaxing and positive reinforcement. Sometimes we need to start with music, outside of the listening program, that a child is already interested in. Other times, we can start right in with the program and, bit by bit, build up increased tolerance.

What type of music is played in the program?

All programs are offered with both children’s music (common tunes from TV or movies, such as Disney programming) as well as adult-oriented songs (pop music or classical music).

NESCA offers two programs, each described below:

  • SSP CORE—This is the basic listening program, appropriate for most patients who are program, and what most individuals are ready to start with. This program has been used since 2017 as a mechanism to reduce stress and auditory sensitivity. It consists of a five-hour long listening protocol, that can be done ideally across five one-hour or 10 half-hour sessions, depending on tolerance levels. For some of our clients who cannot tolerate it as easily, listening sessions can be even shorter in duration. For clients who tolerate it well, and would be compliant, it can also be delivered as a home program after initial set-up through a clinician. It presents music that has been acoustically modified based on a specific algorithm that triggers physiological states of safety and trust. Calming the physiological state helps to promote social engagement and self-regulation, and further therapy can be enhanced or even accelerated. It has music with high frequency sounds gradually filtered in, allowing for slow and steady desensitization to auditory stimuli. It is suited for those who are accustomed to listening to music with headphones, those with subtle sound sensitivities, or those with general difficulties with self-regulation.
  • SSP CONNECT—SSP CONNECT is intended to be used as a less demanding introduction and foundation to the SSP CORE program, specifically for those who are not yet used to headphones, or who do not tolerate filtered sounds well. There is a classical music playlist—one for adults and another for children. It can be used for individuals who are highly sound sensitive, or very young listeners without high frequency filtering to get them ready for the CORE program. It also has five hours of listening time and is intended for use before the SSP CORE program, therefore resulting in a total of 10 hours of active listening time. The SSP CONNECT program should yield a sense of safety with the listening process and expectancy of what is to come next. It is important for the therapist and client to establish a strong rapport, with since there is a good deal of support from the clinician.

If you are interested in talking with a clinician who can determine if this would be a good fit for you or your child, please contact Julie Robinson, OT, Director of Clinical Services, at: jrobinson@nesca-newton.com.

 

About the Author

Julie Robinson is an occupational therapist with over 25 years of experience as a clinician. The work Julie does is integral to human development, wellness and a solid family unit. She particularly enjoys supporting families through the process of adoption and in working with children who are victims of trauma. Julie has extensive experience working with children diagnosed with an Autism Spectrum Disorder (ASD), or who have learning or emotional disabilities. She provides services that address Sensory Processing Disorder (SPD) and self-regulation challenges, as well as development of motor and executive functioning skills.

To book an appointment or to learn more about NESCA’s Occupational Therapy Services or other clinical therapies, please fill out our online Intake Form, email info@nesca-newton.com or call 617-658-9800.

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

Sensory-friendly Sunscreen for Tactile-sensitive Kids

By | NESCA Notes 2021

By: Madelyn (Maddie) Girardi, OTD, OTR/L
Occupational Therapist, NESCA

Our Sense of Touch

Tactile processing is our ability to sense and interpret information from our environment through our sense of touch. Information from our tactile system allows us to gauge everyday sensations such as light touch, temperature, vibration, pressure, or pain.

Tactile Defensiveness

Tactile defensiveness is a term used to describe an individual who is hypersensitive to touch. As occupational therapists (OTs), this is something we come across often on our caseloads. Sensitivity to tactile stimuli can interfere greatly with a child’s functional, day-to-day activities. It can impact one’s ability to tolerate certain types of clothing, perform self-care tasks (bathing, toothbrushing, hair brushing), or eat a range of foods. Another activity that may cause difficulty in the summer months is tolerating the feeling of sunscreen on the body. While we want our families to enjoy the beach, the pool, or spend time outdoors, this task can be daunting for tactile-sensitive kids. The anticipation of this event alone may elicit an aversive response, or, in many cases, the child may begin avoiding the task altogether.

(Movement Matters, 2020).

The Role of OT

Occupational therapists help children and families participate in meaningful daily activities. When a child is sensitive to certain stimuli, the therapist will provide an environment where controlled and guided exposure can take place. This process allows for ongoing positive interaction with the medium, often through play-based activities. The therapist can help the family find alternative solutions and to identify positive coping mechanisms that allow the individual to be successful in the given task.

Tactile Defensiveness and the Beach

As a pediatric occupational therapist, a question that often comes up in the summer months is: “What do I do if my child is having trouble tolerating the feeling of sunscreen on his skin?” The first thing you can do is consider the sensory properties of the sunscreen. Is it lotion? Is it thick? Sticky? Clumpy? Smooth? Does it absorb quickly, or does it stay on the skin? Is it greasy? Does it have a certain smell to it? Stick, spray, and powder options are great alternatives for children who may be sensitive to some of the less desirable lotions. Here are some of the most recommended, sensory-friendly sunscreen options:

      Stick options

  • Neutrogena Wet Skin Kids Stick *
  • Neutrogena Dry Touch Ultra Sheer Stick *
  • Aveeno Baby Face stick sunscreen

      Spray options

  • Babo Botanicals Sheer Zinc Spray
  • Banana Boat Light as Air

      Powder-based options – primarily for the face

  • Brush on Block Translucent Mineral Powder Sunscreen
  • Sunforgettable Total Protection Brush-On Shield

      Lotions

  • Neutrogena Dry Touch Ultra Sheer *
  • Supergoop Unseen Sunscreen
  • Biore UV Aqua Rich Watery Essence

(Evolution, 2021; No Author, 2018).

Additional Recommendations

As an occupational therapist, I am always thinking of other ways to adapt activities to make them easier for my clients. Beyond changing the actual sunscreen, here are some more ways to help make protection from the sun easier for our kids.

  • Coolibar Clothing – Limit the amount of skin that is exposed directly to the sun using protective clothing. This brand offers sun protective clothing options in shirts, hats, bottoms, and swimwear.
  • Make it a routine! – Like any other daily activity, such as getting dressed or brushing teeth, make it a part of the day! This way, it is familiar and expected.
  • Make it fun! – Play a game or sing a song while applying sunscreen. Use a timer so that the child can know when the activity is going to end.
  • Involve the child in the process as much as possible – As appropriate, have the child help with putting on the sunscreen. Use a mirror so that the child can see what is going on.
  • Proprioceptive input – Providing proprioceptive input prior to sunscreen application can help to reduce touch sensitivity. This is the sensory input one receives from the movement and force of muscles and joints. Some examples include massage/deep pressure to applicable areas, any pushing/pulling movement, use of weighted items, digging in sand, animal crawls, or wheelbarrow walks. Have the child rub down arms, legs, and back with a towel before applying sunscreen.

References:

Evolution, M. (2021, May 26). Sunscreen Ideas for Tactile Defensive Kids. Mommy Evolution. https://mommyevolution.com/sunscreen-ideas-tactile-kids/

No Author. (2018, March 31). Autism Inclusivity [Facebook page]. Facebook. Retrieved August 6, 2021, from https://www.facebook.com/groups/autisminclusivity

Movement Matters. (2020, May 3). Occupational Therapy ABC. https://www.movementmatters.com/

 

About the Author
Madelyn (Maddie) Girardi is a Licensed Occupational Therapist in Massachusetts with experience in both school-based and outpatient pediatric settings. Maddie received her undergraduate degree in Exercise Science/Kinesiology at The College of Charleston in South Carolina and  earned her Doctorate degree in Occupational Therapy from The MGH Institute of Health Professions in Boston.

Maddie is a passionate therapist with professional interest in working with young children with neurodevelopmental disorders, fine and gross motor delays and Autism Spectrum Disorder (ASD).

To book an appointment or to learn more about NESCA’s Occupational Therapy Services, please fill out our online Intake Form, email info@nesca-newton.com or call 617-658-9800.

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

Is It Sensory? Or Is It Behavior?

By | NESCA Notes 2021

By: Julie Robinson, OT
Director of Clinical Services; Occupational Therapist, NESCA

As parents or other caregivers of children with special needs, we can often find ourselves confused between what is a sensory response and what is behavior. Although this is often a complex question, and one without a straightforward answer, there are some tools of the trade that OTs use to help us determine just what is going on with these children. What makes this so complex is that each child is an individual, with their own unique ways of responding to sensory stimuli, to social interactions, and when out in varied settings in their community or with family. Children may also present differently from minute to minute or day to day, depending on sleep, hunger, and fluctuations in mood. But we can often look closely for patterns that may help to guide us in finding the answers.

When working with a child who seems to be in a meltdown, one of the best things you can do is take a quick scan of the environment. Is there a loud or distracting sound in the background? Did someone touch the child unexpectedly? Is the overall environment too busy and overstimulating, such as at party or a restaurant? Sometimes just naming or removing the stimuli, if possible, is enough to help get things back under control. If you know a triggering situation might arise that provokes a meltdown, see if you can give the child a warning and a plan of where to go for comfort. “We will be having a fire drill in 10 minutes, so when it happens you can hold _____’s hand, or we can get you some headphones to cover your ears to make you more comfortable” is one example. Find something soothing from a sensory perspective to help the child settle: a quiet corner with books, some tactile play or fidgets, calming music, a tight squeeze ( but only if tolerated and given permission to do so ). If you know you are entering a highly stimulating environment, it may be best to go in for short periods, with frequent breaks built in for your child every 10 minutes or so to take a walk, use the bathroom, or get a drink.

If you do not see something sensory in your environment creating the discomfort or the meltdown, then behavior and emotions are more likely at play. You child may feel confused about a social interaction, about expectations, or what may be coming next in a transition. Your child may feel a lack of confidence or anxiety in a situation, that although may be seemingly simple and straight forward to you, may not to him or to her. An academic task may feel misunderstood, and not knowing how to start can result in a meltdown for many of our children.

When you see that the child you are caring for is beginning to ramp up, that is the best time to intervene. Once a meltdown has begun, language processing will be limited, and the child may not be reachable for a period of time in order to settle down. The best thing you can do in those moments, is to help the child to stop. I often use a stop sign to hold up in my therapy sessions, that cues the child to take a quick break from interacting with me when I see things starting to spin out of control. I limit my language, provide a calming sensory activity, then we can talk about the upset once I have the child back in my court.

Here are some things to think about and questions you might ask yourself to help guide your interactions and expectations when you, as the adult, are confused about whether this is sensory or behavior:

  1. What are the undesirable behaviors that my child observes when he or she is upset or uncomfortable? Are they different when there is sensory discomfort, in comparison to when he or she is upset with a person or a demand? Notice quality of voice, bodily tension, inability to stay still or focused, aggression, flight or an attempt to get away, shutdown or inability to interact. You may start to see patterns in behavior when you look at them in relation to a sensory event or something that is more emotionally-laden.
  2. What occurred just before this behavior appeared? Was there a sensory distraction or discomfort or was he or she upset with a person or a demand?
  3. How did the child behave during this episode?
  4. How did adults or peers interact with my child during the episode? Did it calm the child, or make him or her more agitated?
  5. List sensations that may have triggered a meltdown: tactile, auditory, visual, smell, taste, movement. Were they loud, distracting, uncomfortable? Was the child in a space that may have been too small or too large? Was the child able to get away from the uncomfortable stimuli, or did he or she feel stuck in the moment?

It will be beneficial for team members to share information and write these things down, perhaps in a format of a journal, so that the team can work together to uncover the patterns, find strategies that are successful, and provide consistency across the board. We all know consistency for these children is one of the most effective tools for learning, and although it may take some extra work up front for caregivers, the pay off on the other side is often so rewarding that it is worth the effort.

If you would like to explore this topic further with NESCA OT Julie Robinson, join us for a free webinar on this topic on September 13, 2021 at 10:30 am ET. Register in advance for this webinar at:

https://nesca-newton.zoom.us/webinar/register/WN_-edHNIwkRBKnjk0gq6-bUw

 

About the Author

Julie Robinson is an occupational therapist with over 25 years of experience as a clinician. The work Julie does is integral to human development, wellness and a solid family unit. She particularly enjoys supporting families through the process of adoption and in working with children who are victims of trauma. Julie has extensive experience working with children diagnosed with an Autism Spectrum Disorder (ASD), or who have learning or emotional disabilities. She provides services that address Sensory Processing Disorder (SPD) and self-regulation challenges, as well as development of motor and executive functioning skills.

To book an appointment or to learn more about NESCA’s Occupational Therapy Services or other clinical therapies, please fill out our online Intake Form, email info@nesca-newton.com or call 617-658-9800.

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

ADHD: Setting Up A Successful Environment

By | NESCA Notes 2020

Co-authored by: Lauren Zeitler, MSOT, OTR/L, NESCA Occupational Therapist; Feeding Specialist, and Lindsay Delling, OTS, Occupational Therapy Graduate Student

Before any assessments, treatment planning, or suggestions of adaptations take place, we must first understand what attention-deficit/hyperactivity disorder (ADHD) in childhood means, and how it may present and affect each individual child. The American Psychiatric Association defines ADHD as one of the most common neurodevelopmental disorders affecting children, with symptoms including, “inattention (not being able to keep focus), hyperactivity (excess movement that is not fitting to the setting) and impulsivity (hasty acts that occur in the moment without thought)” (2017). There are three different types of ADHD: inattentive type, hyperactive/impulsive type, or combined type, that come with specific criteria within each to provide a diagnosis. While some symptoms of ADHD are common amongst young children, such as difficulty sitting still or limited attention spans, the difference in children with ADHD is the inability to control it without external forces providing regulation for them. This blog post will outline the sensory systems and will provide environmental suggestions and adaptations for children with ADHD to help them succeed and increase focus!

It is estimated that 8.4% of children have ADHD; so, that being said, what can we as occupational therapists recommend to enhance attention and regulatory strategies in children with ADHD using the sensory systems as a guide?

  1. Touch – Children with ADHD may actually scientifically benefit from utilizing fidget toys to increase their attention to a task. This thought process comes from the fact that using a fidget toy, such as a fidget spinner or some putty, allows children to exert some energy while also keeping their hands busy. This then makes them more likely to attend to another task, such as listening to a teacher speak, because they have sustained alertness while working with the fidget toy and can therefore sustain attention to the overarching task. We have seen this in most people on a smaller scale as they twirl their hair or tap a pen while attending to a task; they are essentially using these items as fidget toys to enhance their alertness and sustain attention to the task at hand (CHADD, 2021). The same can be said for a wiggle seat cushion or chair to promote seated movement so the child can gain that sensory input of movement, while staying seated and attending to the task.
  2. Sight – Because children with ADHD exhibit hyperactive tendencies, this means that they are likely hypersensitive to lighting and types of lighting within environments, such as fluorescent lighting which is prevalent in many school systems. Providing children with ADHD breaks from this harsh light and allowing time for their eyes to relax is a great way to promote improved attention throughout the school day. Hypersensitivity in sight is also important to be aware of regarding any schoolwork a child may be doing. If there is a lot going on within the page, a child with ADHD can become easily overwhelmed and may be quick to abandon the activity due to overstimulation. Covering portions of the page so that the child can only see one activity at time may be helpful in keeping them focused and on track and will likely decrease frustration.
  3. Hearing – Due to the hypersensitive nature of children with ADHD, sounds can be very distracting for them when they are trying to focus on a task. One solution would, of course, be to find a quiet space for them to complete schoolwork and other activities. This, however, may not always be readily available or even an option. In that case, providing these children with other adaptations, such as noise cancelling headphones, while they complete their work or even just frequent noise breaks and allowing them to take a walk or play with a preferred item can be great alternatives in promoting sustained attention in a noisy environment!
  4. Smell – Just like the other senses, certain smells can also become overwhelming and even distracting for some children with ADHD. This can happen for many reasons, such as smells of food reminding them how hungry they are at school, smells that make them think of a certain memory that promotes daydreaming, or even simply gross smells that the child cannot seem to get their mind off of. To promote sustained attention and a calming effect with children with ADHD, essential oils can be a good option to trial! While they are not scientifically proven to directly help with symptoms of ADHD, they are proven to ease anxiety and stress, which can occur with ADHD. Scents such as lavender, vetiver, and chamomile are known for their stress-relieving abilities that promote relaxation and serenity within the body.
  5. Taste – Snacks…a fun way to wrap up this post! Similar to fidget toys, crunchy snacks can also provide attention-enhancing qualities when eaten during a time where sustained attention is necessary. The child will be focused on the task of chewing the crunchy item, such as carrot sticks, an apple, or some chips, and will therefore be present in the moment and better able to attend to the task going on around them. This strategy can be used in a variety of settings where eating is appropriate – school, home, tutoring, etc. And, it’s a fun contribution to the repertoire of strategies to enhance attention and self-regulation strategies!

As always, we recommend reaching out to your occupational therapist or getting an occupational therapy evaluation. Contact NESCA’s Director of Clinical Services Julie Robinson, OT, to learn more at: jrobinson@nesca-newton.com.

References

https://chadd.org/adhd-weekly/fidget-toys-and-adhd-still-paying-attention/#:~:text=Putty%2C%20squeeze%20toys%2C%20fidget%20cubes,classroom%20without%20becoming%20a%20distraction.

https://www.psychiatry.org/patients-families/adhd/what-is-adhd

 

Lauren Zeitler is a licensed Occupational Therapist in Massachusetts, specializing in pediatric occupational and feeding therapy. Ms. Zeitler joined NESCA full-time in the fall of 2020 to offer occupational therapy assessment and treatment for children of all ages, as well as to work in conjunction with Abigael Gray, MS, CCC-SLP, on the feeding team.

 

Lindsay Delling is a graduate student at Regis College working toward obtaining her master’s degree in occupational therapy. She previously completed fieldwork at Spaulding Rehabilitation Hospital in Charlestown and many school-based settings before coming to finish her fieldwork with NESCA. Prior to graduate school, Lindsay worked with children with disabilities in the Boston Public School system, as well as in a special education preschool setting in her hometown. Lindsay is open to working with many different populations once she completes her degree.

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

Mind the Gap: Why You Should Consider Summer OT and Speech Services at NESCA

By | NESCA Notes 2021

By: Julie Robinson, OT
Director of Clinical Services; Occupational Therapist, NESCA

It has been a challenging school year, with ever-changing schedules, routines, and unfortunately with a good deal of inconsistency in the provision of therapeutic services through the schools, due to the many impacts of COVID. Parents, caregivers and students have all experienced differing levels of anxiety about what progress has been and is being made, with many children experiencing some level of regression with regard to behavior, self-regulation, motor skills or language development. In anticipation of many of our children returning to school in-person in April, parents have expressed concerns that their children may be lagging behind or that they have not had ample support throughout the earlier parts of their school year to ensure they can keep up with the other children in their class. Over the months of April, May and June, we will all get to see firsthand where the gaps might arise. And then when school is over, many of us might be concerned that the gains of just a few short months will be lost again over summer. This is why those of us at NESCA perceive that the benefits of summer services will be an important part of ensuring progress and the ability to jump right back into learning – as we hope all school will be in-person again in the fall.

NESCA is available to provide summer services, as we do consistently for our weekly patients. In addition, we are offering short-term services to those children who may not qualify for them through their school systems, or for those families who would simply like to supplement what their children are receiving in-district to give them a boost before school begins again in the fall.

Our occupational therapists (OTs) can work on the following areas of focus with your child:

  • self-regulation and coping skills
  • how best to transition from the quiet of home to the multiple stimuli of a classroom full of children
  • how to cope with longer hours of wearing a mask
  • how to follow social distancing requirements, when they long for a closer physical connection with their peers

We can also help to ease the anxiety some children may have about becoming sick or how NOT to feel fearful of getting back into the classroom when sensory processing issues push them to feel uneasy. Our OTs can continue work on handwriting and motor development work started throughout the school year to ensure there is no regression or to improve the speed and automaticity of written expression and legibility. We can teach organizational and executive functioning skills to encourage kids to be independent, prioritize assignments and manage their time. OTs can address self-care skills of dressing, shoe tying, feeding and hygiene, which are likely to require more independence with social distancing requirements. While it’s summer, we help build outdoor skills, such as bike riding and greater self-confidence on the playground to elicit more social connections with peers. Our OTs are providing services in-person in our Newton and Plainville, Massachusetts clinics, by teletherapy or outdoors in the community as appropriate.

Our speech therapists at NESCA can also help to continue and supplement the hard work children have been putting in throughout the school year. They can work on social pragmatics and help with the skills needed to transition from so much time alone, to being in groups with their peers once again. NESCA’s speech therapists can support children on how to:

  • initiate play
  • find shared interests
  • be flexible thinkers
  • communicate with kindness and an appropriate level of voice
  • read gestures and non-verbal communication (especially while wearing masks, which can impede the ability to properly read another person’s mood, reactions or emotions)

We can continue to work on the established goals from school, regarding both expressive and receptive communication, language articulation and language as it pertains to written communication. Our speech therapists are currently providing all services via teletherapy while we work on a transition back to in-person therapy.

If you are interested in seeking out summer services at NESCA, or any of our assessments and services, please contact NESCA’s Director of Clinical Services Julie A. Robinson. She can be reached at jrobinson@nesca-newton.org and will conduct a phone intake with you to help you best determine your needs.

 

About the Author

Julie Robinson is an occupational therapist with over 25 years of experience as a clinician. The work Julie does is integral to human development, wellness and a solid family unit. She particularly enjoys supporting families through the process of adoption and in working with children who are victims of trauma. Julie has extensive experience working with children diagnosed with an Autism Spectrum Disorder (ASD), or who have learning or emotional disabilities. She provides services that address Sensory Processing Disorder (SPD) and self-regulation challenges, as well as development of motor and executive functioning skills.

To book an appointment or to learn more about NESCA’s Occupational Therapy Services or other clinical therapies, please fill out our online Intake Form, email info@nesca-newton.com or call 617-658-9800.

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

The Benefits of Sensory-based Play

By | NESCA Notes 2021

By: Madelyn (Maddie) Girardi, OTD, OTR/L
Occupational Therapist, NESCA

The importance of play for child development

Play is considered an essential aspect of child development as it contributes to cognitive, physical, social and emotional well-being. As a pediatric occupational therapist, play is an integral part of my job. When children have opportunities to play, this allows them to build their creativity and imagination, resolve conflicts and learn self-advocacy skills. Through play, children develop new abilities that lead to enhanced confidence and resiliency, skills crucial for navigating day to day challenges. Play allows kids to practice decision-making skills, discover areas of interest and engage in passions. (Ginsburg, 2007).

 What is sensory-based play?

Sensory play can be described as any play activity that stimulates an individual’s sensory system. The sensory system includes touch (tactile), smell (olfactory), taste (gustatory), sight (visual), hearing (auditory), balance (vestibular) and movement (proprioception). Common examples include sensory bin or sandbox play, play with shaving cream, finger paint and/or food, use of a balance beam, ball pit, and/or swings, sound tubes, and so much more!

Why is sensory play beneficial?

While we know that play is a critical part of child development, incorporating a multi-sensory approach into play activities can be particularly beneficial. When activities are fun and meaningful – our senses are engaged – we learn best!

  • Promotes learning – children who engage multiple senses to accomplish a task are better able to remember and recall learned information.
  • Facilitates exploration, creativity and curiosity in children who may be seeking, or avoiding, certain types of stimuli.
  • Allows for strengthening of the brain pathways and connections that allow for efficient sensory integration.
  • Promotes self-regulation by allowing for interaction with different mediums that may be calming for the child (Educational Playcare, 2016).

What kinds of OT skills can be targeted through sensory play?

  • Sensory processing skills
  • Fine motor skills
  • Gross motor skills
  • Feeding skills
  • Body awareness
  • Motor planning
  • Visual perceptual skills
  • Communication and play skills
  • Self-regulation and coping skills

References:

Educational Playcare. (2016, October 27). Why Sensory Play is Important for Development.
https://www.educationalplaycare.com/blog/sensory-play-important-development/#:~:text=Sensory%20play%20includes%20any%20activity,%2C%20create%2C%20investigate%20and%20explore

Ginsburg, K. R. (2007). The importance of play in promoting healthy child development and
maintaining strong parent-child bonds. Pediatrics119(1), 182-191.

To learn more about Maddie Girardi, watch this video interview between NESCA Occupational Therapists Sophie Bellenis, OTD, OTR/L, and Maddie Girardi, OTD, OTR/L.

About the Author
Madelyn (Maddie) Girardi is a Licensed Occupational Therapist in Massachusetts with experience in both school-based and outpatient pediatric settings. Maddie received her undergraduate degree in Exercise Science/Kinesiology at The College of Charleston in South Carolina and  earned her Doctorate degree in Occupational Therapy from The MGH Institute of Health Professions in Boston.

Maddie is a passionate therapist with professional interest in working with young children with neurodevelopmental disorders, fine and gross motor delays and Autism Spectrum Disorder (ASD).

To book an appointment or to learn more about NESCA’s Occupational Therapy Services, please fill out our online Intake Form, email info@nesca-newton.com or call 617-658-9800.

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

Teletherapy at NESCA – Benefits and How It Works

By | NESCA Notes 2021

By: Julie Robinson, OT

Director of Clinical Services; Occupational Therapist, NESCA

Now that the second  COVID-19 surge is upon us, many families are again opting to receive occupational, speech-language and feeding therapy services through teletherapy. While COVID-19 is interrupting so many things in our lives, it does not have to interrupt important therapy services. Our clinicians at NESCA encourage teletherapy as a powerful tool to impact progress for your children and foster a smooth family dynamic.

It’s important to note that teletherapy IS covered by insurance, so just because you cannot or may not want to come into the office to be seen in-person, you do not need to put your services on hold.

While some people may not think teletherapy packs the same punch as in-person therapy, we’ve seen some unexpected and valuable benefits stem from this shift in how we deliver services remotely.

Some of the benefits of teletherapy that we’ve observed are:

  • There’s less travel time and more efficiency of service delivery with teletherapy. There’s also more flexibility and scheduling convenience for both the parents and clinicians. We see so many families trying to juggle the responsibilities of remote learning, working from home and managing the needs of multiple kids. Teletherapy can offer the supports that are necessary in an easily accessible way to help families establish consistent and organized routines.
  • Teletherapy allows parents to be more involved in sessions with their child, also allowing the opportunity for clinicians to educate them about activities that can be done at home to facilitate progress. On top of the child receiving therapy, parents get 1:1 real-time training and consultation with a clinician. If parents cannot be involved in sessions, sitters, nannies and other caretakers can participate.
  • For parents who feel that their child is struggling with their experience in school since COVID-19, teletherapy can also be a way to supplement IEP services. Teletherapy as a modality provides more individualized attention to goals that have been established or can fill in gaps in services you feel your child may not be accessing as easily.
  • Clinicians are able to see your children at home—in their natural environment—and to even see some of the daily challenges experienced at home, right in the moment. This allows us to actively problem solve with parents around behavioral challenges and the difficulty their children are having in staying focused during remote learning. Via teletherapy, we can model responses and approaches right in the midst of real-life situations as they are unfolding.
  • Teletherapy allows our occupational therapists to do a virtual house tour with you to suggest modifications or accommodations to your physical environment/space to support sensory needs or motor development with items and areas you already have. Building a home program with our guidance helps to reinforce the work we do with them.
  • In all teletherapy sessions, the child must be present for at least a brief period. But in moments where a child is not able to stay engaged in the process, the clinician is able to stay in the session to provide parent consultation and problem solve.
  • When appropriate and agreed upon by all parties, your clinician can engage other children in the household into teletherapy sessions to incorporate social teaching and positive sibling interactions, as well as structured activity for the family unit.
  • Teletherapy has been a huge plus for our feeding therapists and their clients, as we can work with children in their own kitchens and with food that is typically available and prepared. We can also see how a child behaves throughout the mealtime process in their natural environment as they interact with family members. Therapists report that some of their feeding therapy clients have made more progress via virtual sessions than in their in-clinic sessions.
  • Because teletherapy gives occupational therapists a window into the home setting, we can work with our clients on self-care and hygiene tasks, support learning of chores and other daily household activities in a more natural setting to them.

How a teletherapy session works

Teletherapy is a little different than just showing up for a session in the office and does require some advanced preparation for both the client and the clinician.

  • Initially, your clinician will talk with you to gather information about your home environment, the setting for remote work, and what tools or equipment you may have around at home to incorporate into your sessions.
  • Each week, your clinician will send you an email with a list of items to get ready for your virtual visit, possibly a specific schedule or plan for the session, if needed. This will include a link to access your teletherapy session.
  • In most cases, parents need to be present to facilitate the process, or at the very least accessible to assist with any technology glitches that may arise during the session. We encourage participation from caregivers to ensure that they are educated about our goals as well as the things that can be done at home throughout the week to encourage progress.
  • We try to keep therapy sessions as play-based as possible, often engaging with visual supports or other tools that may help your child to focus and have fun.
  • There may be times when your child is overloaded with remote learning, before our session even begins, or there may be distracting factors in the household at any given moment that can limit their focus on therapeutic tasks. Therapists are able to maintain a flexible approach to end a session early, to give the child a break and talk to a caregiver instead, or to provide parent consultation instead of direct therapy activity. All are benefits to the child and family unit.

To learn more about NESCA’s new clinical therapy services, watch this video interview between NESCA’s Sophie Bellenis, OTD, OTR/L, and Julie Robinson, OT, who oversees the new clinical therapy offerings.

About the Author

Julie Robinson is an occupational therapist with over 25 years of experience as a clinician. The work Julie does is integral to human development, wellness and a solid family unit. She particularly enjoys supporting families through the process of adoption and in working with children who are victims of trauma. Julie has extensive experience working with children diagnosed with an Autism Spectrum Disorder (ASD), or who have learning or emotional disabilities. She provides services that address Sensory Processing Disorder (SPD) and self-regulation challenges, as well as development of motor and executive functioning skills.

To book an appointment or to learn more about NESCA’s Occupational Therapy Services or other clinical therapies, please fill out our online Intake Form, email info@nesca-newton.com or call 617-658-9800.

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

Movement Breaks – Part 2

By | NESCA Notes 2020

By: Julie Robinson, OT

Director of Clinical Services; Occupational Therapist, NESCA

In our last blog, we delved into ideas and suggestions to help preschoolers stay on track with remote and hybrid learning through movement breaks. In this week’s OT Tuesday blog, we move up to our elementary school-aged kids. How do we keep them focused on online learning throughout their long days at home in front of a computer?

Again, here are some suggestions that require minimal equipment, generally using things you can find around your home.

 

Gross Motor for Elementary-age Children

A movement break for 5- to 10-minutes every hour and a half to 2 hours is recommended.

Hopscotch – Draw with chalk or use painter’s tape and play this old school game! Begin by throwing a beanie baby, rock or bean bag so it lands in the first square. Hop over it and jump on all the other squares. At the end, turn around and come back and try to pick up the object while trying to balance on one foot! The next time, throw the object to square 2 and repeat through all the numbers!

 

Photo Credit: sciencebuddies.org

Homemade Hockey Sticks – Use a long wrapping paper roll or tape together paper towel rolls as the handle. Cut a long strip of cardboard and tape to the handle or use an old plastic water bottle. Enjoy playing this game with a balloon or tennis ball. Mark goals with tape, chalk or use empty cardboard boxes.

 

Stack the Cardboard Boxes – Got empty boxes? Have the child stack them up high and knock them over by running into them, or rolling/kicking a soccer ball into them. To make it a little silly, place a tennis ball in the leg of a pair of stockings and the waistband over your child’s head. Use the tennis ball to knock over boxes or cans, with their head upside down.

 

Photo Credit: Hands On As We Grow®

Stair Bean Bag Toss – Try to get bean bags to land on different steps. More points for the higher they land!

 

Tic Tac Toe – Make a big board with sidewalk chalk or painter’s tape. Use bean bags, frisbees, paper plates or crumpled up paper and throw into boxes for a fun spin. Get creative with items around the house – even food!

 

Photo Credit: OT Plan

Belly Catch – Have your child lay on their belly with feet or legs resting on a couch and hands on the floor (plank style). Roll balls or balloons and have them play catch with you, a great exercise to work on core and upper extremity strength.

 

 

 Fine Motor for Elementary-age Children

Photo Credit: Hoglets.org

Monster Feet – Grab some old tissue boxes or cardboard and make your own monster feet. Decorate the toe nails with markers, pom poms or however else you’d like! For an added challenge, try wearing them by using string to tie the child’s feet to them. Or tape their shoes to them and walk around like a monster!

 

Photo Credit: kidsactivitiesblog.com

Homemade Tennis Racquets – Cut slits in a paper plate or punch holes. String yarn through the holes and attach to a paper towel roll, spatula or wooden spoon/popsicle stick. Use it to keep a ball or balloon in the air!

 

Hangman! – Or for an added twist, play Melting snowman! Draw a snowman, and each time someone guesses a letter incorrectly, erase a part of the snowman until he is fully melted!

 

Make Your Own Quicksand – Mix roughly equal parts cornstarch and play sand. Add water until it is the desired consistency.

●       If you don’t have play sand, add 1 cup of water to a bowl and slowly add 1-½ cup of cornstarch and stir.

●       Put toys into quicksand and watch them sink!

 

Paint Pinecones – As the weather gets colder, collect some pine cones or rocks and paint them! Make kindness rocks by writing messages on them with a Sharpie. Leave them out along a wooded trail for others to find.

 

 

About the Author

Julie Robinson is an occupational therapist with over 25 years of experience as a clinician. The work Julie does is integral to human development, wellness and a solid family unit. She particularly enjoys supporting families through the process of adoption and in working with children who are victims of trauma. Julie has extensive experience working with children diagnosed with an Autism Spectrum Disorder (ASD), or who have learning or emotional disabilities. She provides services that address Sensory Processing Disorder (SPD) and self-regulation challenges, as well as development of motor and executive functioning skills.

To book an appointment or to learn more about NESCA’s Occupational Therapy Services, please fill out our online Intake Form, email info@nesca-newton.com or call 617-658-9800.

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

Movement Breaks – Part 1

By | NESCA Notes 2020

By: Julie Robinson, OT

Director of Clinical Services; Occupational Therapist, NESCA

Many parents are overwhelmed, juggling homeschooling, childcare and work from home. And now that the cold weather has arrived, many parents are looking for activities they can do indoors with their children as movement breaks to support online learning or just to pass some time and get the wiggles out. Here are some suggestions that require minimal equipment, generally using things you can find around your home.

In this week’s OT Tuesday blog, we provide suggestions on both gross and fine motor activities for preschoolers. In our second part of the blog series, we will offer ideas to target fine and gross motor activities for elementary school-age students during movement breaks.

 

Gross Motor Activities for Preschoolers

A 5- to 10-minute movement break is suggested every hour to hour and a half for children in this age group.

Balloon Games – Blow up and see how many times your child can hit the balloon in the air! Use a fly swatter or tennis/badminton racquet to mix it up a little.
Mazes – Use painter’s tape indoors or sidewalk chalk outdoors in the driveway to make mazes for your child to follow. You can even use the lines as a balance beam for added balance practice, draw feet to jump in, make curly lines to indicate twirling around, etc.! If you are looking for ideas, research sensory paths online. You can also draw crazy roads for toy cars or ride-on toys.
Bowling – Fill up old plastic water or soda bottles and have kids knock them over by rolling a ball towards them! You can add stuffed animals on top to make it more enticing.
The Floor Is Lava – Pretend the floor is lava and have the child walk around without touching the ground by walking on pillows and other objects!
Shape Games – Draw shapes, letters or numbers with sidewalk chalk or painter’s tape and try throwing stuffed animals into the shapes an adult calls out. Make it more challenging by increasing the number of shapes, throwing from further away or trying to balance on one foot while throwing.

 

Fine Motor Activities for Preschoolers

Hide Beads In Playdough! – Grab some putty or playdough and hide beads in it. Once all the beads are hidden, encourage your child to try to get them out! This is a great exercise to work on hand strength. It can also be fun to put raw spaghetti into the dough and “string” the beads onto them for working on fine motor precision.
Make Your Own Stamps! – Use household items, such as wine corks, water bottle caps, toilet paper rolls or anything else you can find. Dip them in paint and press onto paper. Enjoy the different shapes you create! For picky eaters, it can be fun to use foods, such as applesauce, yogurt or dips for paint.
Clothespin Activities – Use clothespins to pick up pom poms and put them in containers, such as an ice cube tray. This is a great activity for practicing a tripod grasp.
Shaving Cream Play – Use a tray or large plate and put shaving cream or other messy play materials on it. Allow your child to practice writing their letters with their fingers and have fun with it! To simplify, you can encourage your child to imitate shapes, letters or numbers after you have written them.
Noodle Necklaces – String noodles onto string to make a noodle necklace. Use noodles and put on a string or a pipe cleaner to make a necklace. Color or paint noodles, or soak cooked noodles in food coloring and allow them to dry for more interesting patterns.

 

About the Author

Julie Robinson is an occupational therapist with over 25 years of experience as a clinician. The work Julie does is integral to human development, wellness and a solid family unit. She particularly enjoys supporting families through the process of adoption and in working with children who are victims of trauma. Julie has extensive experience working with children diagnosed with an Autism Spectrum Disorder (ASD), or who have learning or emotional disabilities. She provides services that address Sensory Processing Disorder (SPD) and self-regulation challenges, as well as development of motor and executive functioning skills.

To book an appointment or to learn more about NESCA’s Occupational Therapy Services, please fill out our online Intake Form, email info@nesca-newton.com or call 617-658-9800.

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

The Ideal Remote Learning Workspace

By | NESCA Notes 2020

Co-authored by: Sophie Bellenis OTD, OTR/L and Jessica Hanna MSOT, OTR/L

Designated Space for Schoolwork – Make sure to set up a workspace with intention. While it may be easy to have children hop on the couch or sit at the kitchen table, having a space that is specifically used for academics will help them to compartmentalize and associate the space with focus and learning. There should be a concrete difference between a place to work and a place of rest. Ensure that this space is distraction-free and set away from the hustle and bustle of the home. Give your child some autonomy by allowing them to decorate their space and take ownership. A small desk, a card table in a quiet corner or a small bedside table set up in a private space are all options for workstations that children can make their own.

Remove Distractions – Take a moment to sit down at your child’s workstation and note any potential distractions. Some will jump right out, such as a TV or box of enticing toys within their line of sight, but some may be less obvious. Are they near a window facing a busy street or a dog park? Is there a substantial amount of visual clutter around their desk, such as busy posters or a family photo collage? Is their desk covered in mail, knickknacks, or arts and crafts supplies? If removing items is not an option, consider creating a physical barrier between your child and any environmental distractions by using a desktop study carrel/shield. Taking these distractions away will help a student to focus their energy on attending to school, as opposed to ignoring it and resisting distractions.

Organize Materials – Depending on your child’s age, they may need help organizing their workspace to be prepared for the day. For our young students, consider using toolboxes or tabletop organizers to hold their materials. A toolbox may have crayons, markers, scissors, pencils, erasers and glue sticks. If your child benefits from sensory supports, consider a toolbox with manipulatives, as appropriate per occupational therapy (OT) recommendations. Children are often very visual learners and may benefit from color-coded or designated folders for each subject or class they are taking. If a workspace is shared, keep your child’s personal materials all in one location, such as a personalized storage container that is easily portable, accessible and organized. Finally, remember to consider digital organization. Students are often told how to label and save documents by teachers at school. With the move to remote learning, children may need assistance organizing documents, folders and classwork on their computer so that they can easily find everything in the moment.

Adequate Lighting – Assess the lighting in your student’s workspace by checking to see whether there is any glare from the sun on the screen, whether they could benefit from a desk lamp to better illuminate their paper and determine whether there is a specific location with good natural light. If natural light is preferred, it’s best practice to position your electronic at a right angle to the light so the light is neither in front nor behind the screen. Avoid fluorescent light bulbs whenever possible. One more thing to consider is the fact since this past March, students and professionals alike have noticed an increase in headaches and visual fatigue due to spending substantial portions of the day in front of a screen. Technology is visually straining. Consider investing in a pair of blue light-reducing glasses, a newly popular solution to this problem that has shown promise for improving adolescent sleep, mood and activity levels (Algorta et al., 2018).

The Rule of 90 Degrees – When sitting at a table, children’s hips, knees and elbows should all be positioned at 90 degrees. Feet must be firmly planted on the floor. This helps to create a solid foundation. When children have a strong foundation and postural stability, they are set up to freely and accurately use their fine motor skills. Being grounded allows for easier writing, typing, cutting and manipulation of all the tools necessary for learning.

Appropriate Furniture – To meet the Rule of 90, it is important to consider the furniture that your student is using. Furniture needs to be the correct size or be modified to help children fit comfortably. If a desk/table is positioned too high, it will cause extra strain and fatigue. If your child’s feet do not reach the floor, consider using a step stool or fortified box for their feet. With regard to the chair itself, avoid options that spin and slide around as they are often distracting and make it difficult for children to pay attention.

 

 

 

References

Perez Algorta, G., Van Meter, A., Dubicka, B. et al. Blue blocking glasses worn at night in first year higher education students with sleep complaints: a feasibility study. Pilot Feasibility Stud 4, 166 (2018). https://doi.org/10.1186/s40814-018-0360-y

 

About the Co-authors:

Dr. Sophie Bellenis is a Licensed Occupational Therapist in Massachusetts, specializing in educational OT and functional life skills development. Dr. Bellenis joined NESCA in the fall of 2017 to offer community-based skills coaching services as a part of the Real-life Skills Program within NESCA’s Transition Services team. Dr. Bellenis graduated from the MGH Institute of Health Professions with a Doctorate in Occupational Therapy, with a focus on pediatrics and international program evaluation. She is a member of the American Occupational Therapy Association, as well as the World Federation of Occupational Therapists. Having spent years delivering direct services at the elementary, middle school and high school levels, Dr. Bellenis has extensive background with school-based occupational therapy services.  She believes that individual sensory needs and visual skills must be taken into account to create comprehensive educational programming.

 

Jessica Hanna has over 10 years of pediatric OT experience in conducting assessments and providing treatment of children and adolescents with a broad range of challenges and disabilities, including autism spectrum disorders, sensory processing disorders, visual impairments, cerebral palsy, executive function deficits and developmental disorders of motor function. Prior to joining NESCA, Jessica trained and worked in a variety of settings, including inpatient and outpatient hospital settings, private practice, schools and homes. She has served on interdisciplinary treatment teams and worked closely with schools, medical staff and other service providers in coordinating care. In addition, Jessica provided occupational therapy services at Perkins School for the Blind and Spaulding Rehabilitation Hospital pediatric inpatient unit, where she conducted comprehensive evaluations and interventions for children with a broad range of presentations.

 

To book an appointment or to learn more about NESCA’s Occupational Therapy Services, please fill out our online Intake Form, email info@nesca-newton.com or call 617-658-9800.

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.