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Theoretical Frames of Reference | |||
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Founder's Vitae | |||
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Download Sensorimotor PDF form
On Line Sensorimotor form |
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Glenda Fuge, M.S. H. Ed, OTR is a cofounder of Developmental Pathways for Kids. She has a Master's Degree in
Health Education and a Bachelors Degree in Occupational Therapy. She received her occupational therapy degree from San Jose State University where she has been a clinical faculty member, teaching pediatrics with an emphasis in
sensory integration. Her 20 year career includes 12 years as coordinator of pediatric therapy services at Peninsula Hospital where she provided administrative services as well as direct patient care and consultation to
families, educational programs, and health care agencies. Glenda has extensive experience lecturing locally and internationally. Rebecca Berry, MS, PT, has been an active pediatric physical therapist on the mid-peninsula
since 1985, most recently as cofounder of Developmental Pathways for Kids, a pediatric therapy group. She received her Master's Degree in Physical Therapy from the University if Southern California. For over thirteen years,
she has provided physical therapy evaluation and treatment for infants and children with mild to severe developmental delays. In addition to direct patient services, Rebecca has served as coordinator of a multidisciplinary
pediatric team at Mills-Peninsula Hospitals and provided consultative services to schools throughout the Bay Area. |
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Sensory Integration The theoretical base of sensory integration affects all aspects of the Developmental Pathways for Kids program. It influences the children selected for participation, the staff composition and environment. |
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This theory guides intervention with its postulate that a child with deficits in sensory processing will have difficulty achieving optimal development. A child with
intact sensory processing can experience enhanced sensation during meaningful activities and have opportunities to plan and organize adaptive responses and therefore maximize her potential. The following are principles of sensory
integration theory and treatment techniques that are the basis of many of the decisions regarding the program (Ayres, 1972, 1979, 1985; Clark, Mailoux and Parham, 1985- Fisher and Murray, 1991; Parham and Mailoux, 1996).
Frames of Reference Although sensory integration theory provides the main theoretical base,
other intervention approaches are integrated into the DPK program. Neurodevelopmental Treatment The methods arising from NDT principles, which originally were developed by Bobath and
Bobath, often are used by occupational, physical and speech therapists with children having cerebral palsy. The overall purpose of this approach is to assist the child's acquisition of normal postural control and movement
patterns. The therapist facilitates these abilities in the child by skillfully "handling" the child during purposeful activities. Handling involves the provision of graded tactile, proprioceptive, and
vestibular input through key points of control (Bobath, 1963, 1967; Bobath and Bobath, 1964). Recently, therapists have advocated combining the treatment approaches of NDT and sensory integration (DeGangi, 1990" Blanch,
Boitelli and Hallway, 1995). These approaches may be helpful in addressing the aspects of a child's movement dysfunction related to alignment, postural stability and movement patterns.
Occupational Behavior and the Emerging Science of Occupation
The theory of occupational behavior based on the work of Mary Reilly (1974) emphasizes the importance of the occupational role. Occupational role can be considered as a developmental sequence of player, student, worker, and retiree. The period of childhood is seen as critical for learning, exploring, developing rules and skills about people, places, objects and abstract concepts. Through exploration, appropriate activities, and practice, the child develops competency. Play in its various forms provides a critical means by which developing children acquire the experience and knowledge necessary for competent interaction with people and objects in their world (Mack, Linnquist, and Parham, 1982). DPK emphasizes family involvement and promotion of various types of play within a peer group environment this supports the concept of play as a complex occupation having value as a therapeutic tool for many aspects of development.
Piagetian Theory The contributions of Piaget and associates to theories about cognitive development are incorporated in the DPK mode@. Piagetian theory stresses the importance of the child's active
interaction with her world (Gruber and Voneche 1977, Philips, 1969; Piaget and Inheider, 1969). The child learns through her sensory experiences and by her motor actions. During the child's sensory motor exploration of
her body and environment, she organizes and adapts her internal mental structures and external physical actions. Pragmatic Language and Natural Language Approaches The speech and language intervention of the DPK
program has also been influenced by the pragmatic and natural language treatment approaches. Pragmatic language theory stresses that there are both verbal and nonverbal components of language needed for social interaction
(Bloom and Lakey, 1978). The nonverbal elements include appropriate use of eye contact, gestures, posture, tone of voice, turn-taking, and words as well as phrases for social acknowledgement, requesting, answering, and
continuing a conversational topic. Natural language theory indicates the importance of facilitating expressive and receptive language within in the context of everyday events, including play (Hatten and Hatten, 1981).
Family- Centered Care One of the major reasons for development of the DPK program was to provide greater opportunities for the staff and families to work together as a team. Family-centered care is the
provision of services in such a way that the parents and/or other family members are an integral part of the service team (Grady, 1989; Hanft 1989; Vincent, 1989). We believe that the family unit has a major influence on the
efficacy of intervention services. Significant support for family-centered early intervention services was gained by the passage of the Education of the Handicapped Act Amendments of 1986, Public Law 99-457. This
legislation added Part H, which provides limited funds to those states that have chosen to create and expand comprehensive services for infants and toddlers experiencing or at risk of experiencing developmental delays. In 1990,
Congress passed additional Education of the Handicapped Act Amendments, Public
Law l0l-476, which changed the name of the act to the Individuals with
Disabilities Education Act (IDEA). Part H , which covered early intervention
services, was implemented in October 1993 in California. IDEA was reauthorized and amended in 1997 with the passage of Public Law 105-17. The section governing the provision of early intervention services was retained
but now is Part C of this law. |
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Many atypical children encounter problems entering into imaginative and social play activities with other children. These children demonstrate a restricted number of
activities and interests and lack the social sophistication necessary for pretending and coordinating play with other children. Peer play experiences are seen as especially critical for acquiring social knowledge. While
playing with peers, children develop friendships and learn a variety of key social strategies that are affiliated with increasing social competence. The Integrated Play Program© allows guided participation in play with "expert players" (normally developing children) and "novice
players" (children who participate in therapy services at Developmental Pathways). Redeemer School children are invited to be the "expert players". All children will be grouped into small groups with two
experts to one novice and under the supervision of an occupational therapist, physical therapist or speech and language pathologist. The children involved in the Integrated Play Program have the opportunity to work on functional
fine motor, gross motor and communication goals during a facilitated peer play experience. Functional carry-over and generalization of skills is our primary goal. Currently, there are over 45 play groups scheduled for
Developmental Pathways clients 5 days per week. For additional
information about Integrated Play Groups©,
click here! And
for more detailed information, contact us at Developmental Pathways for Kids. |
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The September/October 1999 American Journal of Occupational Therapy (AJOT) contains 3 articles on
occupational therapy (OT) and its application to children with autism. The article entitled Current Practice of Occupational Therapy for Children with Autism
looks at current practice patterns of OTs treating children with autistic spectrum disorders. Through the use of a mail questionnaire, investigators sought the answers to the following questions:
1. How do OTs experienced in serving children with autism describe their current practice? 2. What assessments and intervention techniques are used by OTs who are experienced in serving children with autism? 3. What education and training do OTs who are experienced in serving children with autism consider most important to their practice?
In regards to the first question, the questionnaire clarified that 1:1
intervention was the most prevalent service model for providing OT services. Prior research in this area supports these findings in early
intervention programs and behavior programs. However, the efficacy of 1:1
intervention model in OT requires further research. The questionnaire revealed that OTs worked in collaboration with other professional when
providing service to a child within the autistic spectrum. Noteworthy results were also found regarding evaluation areas examined by OTs. Across the board, OTs looked at the fine motor skills, coordination, attention,
behavior, and sensory processing of their clients with autism. OT intervention, the study revealed, centered on the acquisition of skills in behavior management, endurance building, sensory processing and play.
The article entitled, The Effects of Occupational Therapy with Sensory Integration Emphasis on Pre-school Age Children with Autism, was a more thorough investigation of sensory integration (SI) as an OT
intervention. Due to difficulties using standardized testing procedures with this population and the wide variation in presenting behaviors, the study utilized a single-subject research design. Ultimately, the study
revealed that SI enabled participants to make significant improvements in the areas of mastery play, decreasing incidents of non-engaged behaviors, and adult interaction. However, the study showed no improvement in peer
interaction. The authors explained this to be a product of unrequited attention given by the typical peer. Given the inability of the autistic child to respond to a peer, the peer soon loses interest and no longer
attempts interaction. When viewing Developmental Pathways for Kids (DPK) in light of the first article reviewed here many similarities present themselves. Typically, DPK uses the 1:1
intervention model with children in
the autistic spectrum. Also, the approach taken by OTs at DPK is very collaborative by nature. Occupational therapists speech therapists, physical therapists, teachers, principals and parents work together to design an
effective individualized program for the client. When evaluating the client, all areas traditionally examined by OTs are considered but the most attention is given to sensory processing, modulation and play. DPK uses SI
combined with peer modeling as its primary practice pattern and it is interesting to review the results
attained by authors of the second article with this in mind. Stated again, this study found no change in peer interaction
when utilizing SI. Although no formal studies have been conducted it seems that clients at DPK do make progress in the area of peer interaction. Fusing SI with peer play groups may provide a framework from within which
the autistic child can explore social experiences safely. The SI helps to organize the central nervous system and neurologically prepares the child for receiving stimulus. However, without modeling the autistic child
has no understanding of peer interaction. Thus, it becomes crucial for the typical peer to "teach" the autistic child what it means and how it looks to "play." The pairing of these two strong
interventions is perhaps the next direction research in this field must go in order to learn how we can best serve children with autism. |
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BALANCING THE ACT |
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Occupational and physical therapists play a valuable role when they enhance the play and social experiences of children with special needs on the playground
(Nabors & Badawi, 1997). Fidler (1987) stated, " There is an accumulation of significant data to support the thesis that the drive to action, transformed into the ability to "do", is fundamental to ego
development and adaptation." (p 76). When one's sense of competence is given value by others, one's efficacy and value as a human being is confirmed.
Common terms found in the literature when defining play are intrinsic motivation and joy or enjoyment. According to Piaget, primitive play begins with a set of sensory motor behaviors (1962). Play
is the strategy that children use to develop sensory, motor, cognitive, communication, and social competence. Development in one domain directly affects development in another; it is called secondary circular reactions
(Piaget, 1962). A key assumption from a criterion-based reference is that play is internally motivated, free of reality, and internally controlled. From a developmental reference, play may be viewed in terms of
performance components such as sensorimotor, social, cognitive, and emotional. In addition, play provides the foundation for later roles such as student, friend, and so forth (Royeen, 1997). In therapy, the most effective,
enjoyable, and productive environment for working with children is one in which the atmosphere is relaxed and mutually supportive. Activity based intervention is distinguished by several important characteristics: it is
engaging and integrated; it acknowledges the importance of play; it emphasizes functional skill development and generalizations. Most importantly, activity based intervention involves creating a stimulating, responsive
atmosphere and then following the child's lead (Coling & Garrett, 1995). A Frame of reference that emphasizes play as a means as well as an outcome include the sensory integration approach. Ayres (1979) believed that
sensory integration occurred primarily in early play experiences. She described sensory integration developmentally and said that the child organized behavior through successful adaptive responses to sensation. Bundy (1991)
describes the role of play within sensory integration framework as a powerful tool for treatment. Therapy using the principles of sensory integration may be very helpful in facilitating the development of play if it is
carefully planned and conducted. Likewise, play as a part of well orchestrated treatment plan can result in improvements in sensory integration (Bundy, 1991). Ayres (1972) defined sensory integration as the
organizing and processing of sensory information from different sensory channels and the ability make an adaptive response. Sensory integration disorders are also classified as modulation or discrimination disorders.
Under reaction, overreaction, or fluctuation between the two extremes in response to sensory input is the outward manifestation of a modulation disorder (Bundy, 1991). Many children with autism and
attention difficulties
are unable to process and organize sensory information effectively. According to experts in the field, a disturbance in response to sensory stimuli is a behavior often seen in individuals with autism (Freeman &
Ritvo, 1984). Sensory integration assists children in processing and responding to information so that they can maintain an optimal arousal state for functional tasks. By utilizing a sensory integrative treatment
approach, therapists can determine how children are processing sensory information and provide them with sensory input that is a just right challenge, which is organizing to the system. When therapists are able to
facilitate play skills in their clients with the partnering of typical peers, there is an added benefit. Research suggests that incorporating structured play using two typically developing peers with one atypically developing
peer into play-based therapy sessions, can produce more diverse forms of play and maintain higher levels of play on their own. In addition, the children's advances in play generalize to other peers, activities, and settings
(Woldfberg, 1995). As school based therapy moves more and more into the full inclusion model, it seems appropriate to revisit play as a tool for intervention. One of the best ways for young children with special needs to
practice using newly acquired skills is in a play format. The use of child initiated learning experience capitalizes on the child's attention and motivation. Play is the accepted learning mode for nearly all
children with special needs (Widerstrom, 1995). Dr. Pamela Wolfberg, lecturer, facilitator, author, and researcher describes play as an opportunity for expert players (typical children) to model appropriate behavior to novice
players (atypical children). As therapists, we know children have an innate, drive to move, explore, and learn through pleasurable experiences. A poster developed by Sensory Integration International explains, "Play is
the work of the children. Through play, children learn about themselves and the world around them". By providing play opportunities on site as part of a therapy session, therapists can meet the needs of all the children...it is a
win, win situation.. At Developmental Pathways for Kids, we have successfully combined physical and occupational therapy with Integrated Play Groups© during regular scheduled therapy sessions. Our treatment approach utilizes a variety of methods of stimulation (vestibular, tactile, proptioceptive, visual, auditory, gustatory, and olfactory and provides building blocks for functional skills. These skills are not taught but are allowed to emerge spontaneously as foundations develop. Therefore, play is the adaptive response to the just right challenge. Play becomes a balanced partnership when sensory integration and Integrated Play Groups© are the supporting foundations! |
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