Learning Disability and Special Needs

My journey as a mother of a special needs child with cerebral palsy and learning disabilities is what I try and encapsulate in my blog. The resources I have gathered along the way, the lessons I have learned, and the inputs and guidance that I have received over the years are all here. Finding myself in a good place now has enabled me to reach out to similar moms/caregivers like me.

My journey still continues… I also write at http://jokumar.blogspot.com/

Sensory Integration-handling sensory issues

This is something I have really researched not just to use for Anandita’s sensory needs but also to gather more understanding about it as a whole. I have written here chiefly focusing on my daughter’s issues but the area is so vast that it would be better to google it for more information.

Imagine this situation: My child is playing quietly in the dining room when the pressure cooker suddenly blows its whistle in the kitchen some meters away. My child is not just startled but becomes totally frightened and stiff with fear. Nothing can soothe her in that moment of anguish.

My child has a primal fear of climbing anything where her feet have to leave the ground. No amount of reassurance/encouragement can relieve her fear and gravitational insecurities. She will hold onto me for dear life if she is unsure where to walk say on the road/curb or even while climbing a stool. She can’t stand on one foot and has difficulty with any action that needs balance.
I find almost all her crayons and pencil points broken as she is unable to decide how much pressure is needed to be applied to the object. She is unable to gauge how much pressure is required to turn the pages of a book or to hold a cup of water.

If she has to fall down, her reflexes are slower to respond. Her poor body awareness is visible during activities. Even while helping her get dressed and undressed she does not know how to move her body. The difficulty is in motor planning here where she cannot conceptualize or figure out what each part of her body needs to do in order to move a certain way or complete a task (what is an unconscious sense to us, becomes an active, conscious, frustrating sense to them).

Each of the above is to do with our senses. Our sense organs are highly sensitive and extremely complex.

The above scenarios all come under the purview of संवेदी एकीकरण.
Sensory integration: What is it?

All of us receive information from our environment-internal and external through our senses-vision, hearing (auditory), touch (tactile), taste (gustatory), smell (olfactory, vestibular (movement), and proprioceptive (joint and muscle). All of us respond to these stimuli simultaneously. And the term ‘sensory integration’ is the process by which we receive this information. Our central nervous system directs this information to the appropriate parts of the brain where the information is integrated so that we can respond to the stimuli.

When we cannot automatically integrate sensations and respond in an adaptive way, we get a disorder of sensory integration. It is not just an ordinary disorder. This complex neurological disorder can have a negative impact on the child’s capacity to learn, function in socially appropriate ways, perform the daily tasks of living, and build self-esteem.

In the above instances, I have touched upon only those areas where Anandita lacks. The spectrums of sensory integration issues are many involving all of the senses. My concerns for her were due to her poor motor control, postural instability, auditory hypersensitivity, and poor hand-eye coordination.

During her annual assessment, it was recommended that she get a SI assessment done by a specialist Sensory integration therapist. I was asked to fill up a form that was so detailed and exhaustive that it consumed my attention totally. The questions asked were specific, some so relevant to me, and some unnecessary. I came to understand how many areas were covered under this issue. It had extremely specific questions on her Social interactions/Sense of sight/touch/smell/taste/vestibular/body movements/hearing. And I had to tick the fields under Always/Frequently/Occasionally/Never.
Usually, before a therapy session that involves the tilt board/obstacle play; my daughter is always fearful and scared. She keeps repeating the same things again and again that she is scared, will break her knuckles, and looks fearful. Soon after meeting the SI therapist, I understood two things-

(1) She has a PROPRIOCEPTIVE DYSFUNCTION. The proprioceptive sense refers to the sensory input and feedback that tells us about movement and body position. A dysfunction in the Proprioception system affects the child’s awareness of their body position in space Its “receptors” are located within our muscles, joints, ligaments, tendons, and connective tissues. It is one of the “deep senses” and can be considered the “position sense”. These activities are almost endless in choices. It refers to motor control and planning, body awareness, grading of movement (knowing how “hard” or “soft” to perform a task), and postural stability. If the proprioceptive sense is not working well, it will be difficult to move in smooth, coordinated, and properly graded movements. These children will have difficulty with both gross and fine motor tasks such as riding a bike, writing, walking, crawling, or playing sports. Some children also require additional proprioceptive input just to keep their bodies calm, organized, and arousal levels regulated.

(2) Although all obstacles play and tilt board climbing and balance activities are extremely vital for her, doing them consistently would certainly not help her overcome her fears. Unless she was taught certain calming techniques. Here calming techniques meant training her brain in such a way she would be able to overcome the fears gradually once her senses were integrated. Calming techniques are not learned overnight or in one SI therapy session. It is something that has to become a part and parcel of her day-to-day life.

Calming techniques:

(1) I didn’t know that heavy muscle and joint activities could calm and organize her body until I related it to myself. When I did yoga or hit the gym, there were days when I would end the session with the feeling of “just right”. The same applied to her too. Activities such as crawling, pushing, pulling, lifting, climbing, and “crashing” all provide inputs to receptors deep in the muscles and joints that provide calming input to the body. Children also get this same “ahh this feels right” feeling by doing play activities that give them this input. By providing this type of regular input it would be possible to feel “just right” throughout the waking hours. When in doubt, “move, move, and move!” Activities that one can include are trampoline jumping with assistance in holding, crawling through a tunnel, climbing, using a swing, wheelbarrow walking, bouncing on a large ball.
Swinging is the best technique to improve balance. For Anandita it was recommended that we could try different positions on the swing-face down, sideways sitting, even standing and along with this gradually introduce resistance activity. She could be asked to stretch and pull an object towards her while on the swing. The pace of movement should be changed every time, and the direction of the movement too.
A simple exercise that she did with Anandita was like this- Diti was face down/tummy down on the swing and swinging at a moderate pace and with her right hand she was asked to pull an object towards her. This combined two aspects – balance and resistance activity. Small gentle doses of swing activity are required for children with gravitational insecurity.

Walking on unstable surfaces is also important to enable the body to learn what it needs to do to maintain its balance. Body adjustments come with practice on different surfaces.
Teach the child to gently rock herself. Or opt for a rocking chair/rocking horse. The rhythm should be gentle, not overstimulating.

Essentially any activity that involves movement and joint action must be a part of this such as exercising to music- including walking, skipping, jumping, running, galloping, and hopping, whatever the child is capable of doing. Engage in activities that require pushing, pulling, squeezing, lifting, carrying, twisting, and lugging along. Even jumping activities like jumping rope or jumping on the trampoline, Playing catch with a variety of objects, activities that involve climbing, hanging from bars, walking on a balance beam.

(2) Another form of sensory modulation is “Deep Pressure” -Deep touch pressure is helpful for many problems with sensory integration, especially those involving the tactile and proprioceptive senses. It can mean simply rubbing your child’s shoulders or giving them a warm bear hug. I was asked to try and squash up Diti between 2 pillows or let her self-administer pressure on her joints by doing heavy work like lugging boxes, pushing and pulling a bolster, putting away therapy equipment like stools, and wedges in the right place.

It is often helpful to massage the child’s hands just prior to attempting fine motor tasks. The assistant can apply continual gentle pressure on the child’s hands with their hands as they are rolling out playdough or washing their hands. Having the children wear a weighted backpack or carry their workbaskets enables them to feel the weight on their muscles and joints. Fall into a beanbag chair. Jumping and rolling games. Slowly roll a ball or bolster over the child, applying pressure.

The Process
It’s important to determine which sensory systems are involved in the area of need. It is also essential to know where the child is developmentally. Make notes as to what the child is doing (don’t focus only on what the child is not doing) and any behavior patterns. Some children differ from one day to the next, having off days and ‘good’ days. Be sure to make note of this. The child with SD may have a difficult time reading cues in the environment (both verbal and non-verbal). If the child is receiving the sensory information, they might not have the ability to organize this information and produce an efficient response. For these children, everyday ordinary tasks are extremely challenging to perform and respond to.

Key facts during the implementation of the process:

For any SI session to be effective, the stimuli used should always vary. No set exercises/play for this session.

Use novel stimuli.

Use novel positions.

Use novel places-not just indoors, use the park, garden, and wherever possible.

When movement is used for them, say on a swing, the pace and the direction should vary.

No predictability here because with novelty, the brain also receives and responds to the stimuli in a more aware manner.

Always be patient. Suppose you want the child to reach a ball pool by crossing many obstacles (objects strewn along the path). Try not to prompt what the child needs to do or how he needs to use his body to reach there.

Always give time to the child to figure it out for himself/herself.

Proper intake and use of sensory input are absolutely critical to a child’s maturation process and the building of core, foundational skills.