Sensory Processing Disorder

Does my child have sensory processing disorder? Do you wonder why your child is an excessive risk taker who jumps and crashes into anything they can? Or why they can’t do puzzles, write well, or find the coordination for riding a bike or hitting a ball? Why does my child cry or cover their ears with every loud sound, such as vacuums, toilets, and/or hairdryers? How come they don’t like to be touched or can’t be touched enough?

I wonder why my child will only eat pizza and macaroni and cheese? Why do they only wear certain clothes or need you to cut the tags out of their shirts? Why won’t my child put their hands in anything messy or use glue, Play Doh, or play with mud? I wonder why my child fears playground equipment or going upside down? Why do crowded stores bother them so much that it leads to public meltdowns? Do you wonder why you can’t seem to calm them down or get them to sleep?

Sensory Processing

So, did you answer yes to any of those questions (or all of them)? If so, your child may be having difficulty processing the sensory information in his or her environment. But what does this mean? Sensory processing (previously referred to as sensory integration) is the way the nervous system receives messages from our sensory systems and turns those messages into appropriate motor and behavioral responses.

Sensory processing is unconscious, which means it occurs without thinking.
Sensory processing organizes the information brought by our senses.
It gives meaning to our experiences by sifting through all of the information surrounding us and selecting what to focus on.
Sensory processing allows us to act or respond to the situation we are experiencing in a purposeful manner.
It forms the underlying foundation for academic learning and social success.

Sensory Processing Disorder (SPD)

SPD is an inability to process information received from our senses and generate an appropriate response. Therefore resulting in the decreased ability to respond to sensory information and behave in a meaningful and consistent way. This can make it difficult to use sensory information to plan and organize our body and make sense of the environment we function in. Sensory processing disorder can negatively impact your child in one or more of the following areas:

Daily functioning
Social and family relationships
Emotional regulation
Self-esteem, learning, and behavior

Also, children with difficulties in sensory processing may experience an inability to make friends or be part of a group, have poor academic performance, appear clumsy or have poor coordination, seem uncooperative, and appear disruptive and/or out of control.

Senses Affected by Sensory Processing Disorder

There are 7 senses that send messages to our nervous system that can be affected by SPD.

Hearing

Hearing – sensitivity to noises without a diagnosed hearing problem. Examples of sensitivity to hearing include:

Distraction by sounds not normally noticed by others
Running away, crying, or ear covering with loud or unexpected sounds
Enjoys excessively loud music or TV
Difficulty remembering/understanding what has been said
Requires directions to be repeated often, or will say “what” frequently.

Oral

Oral – taste and texture. Examples of sensitivity to oral input include:

Extreme food preferences
Difficulty with sucking, chewing, or swallowing
Refuses to lick envelopes, stamps, or stickers
Excessive drooling past the teething stage
Frequently chews on hair, shirt, or fingers
Constantly puts objects in the mouth after the toddler years

Smell

Smell – Examples of sensitivity to smells include:

Reacts negatively to or dislikes smells which do not usually bother or get noticed by others
Has difficulty discriminating unpleasant odors
Makes excessive use of smelling when introduced to objects, people, or places.

Vision

Vision – no diagnosed visual deficit. Examples of sensitivity to visual input include:

Difficulty keeping eyes focused on task/activity they are working on for an appropriate amount of time
Avoids eye contact
Has a hard time seeing “the big picture”, focusing instead on details or patterns within the picture
Difficulty locating items among other items: papers on a desk, clothes in a drawer, toys in a box.

Touch

Touch, or tactile sense, is input about touch, pressure, temperature, and pain. For example, kids with sensitivity to touch might experience fear, anxiousness, or even aggressiveness to light or unexpected touch, like to touch everything, or have an inability to identify what part of the body is touched when not looking at it.

Vestibular Sense

Vestibular sense is input from the inner ear about equilibrium, position changes, movement, and body position in space. For example, kids with vestibular sensitivity might dislike or avoid playground equipment, crave fast, spinning, or intense movement experiences, like swinging, frequent slumping, “W” sitting, or fatigue easily.

Proprioceptive Sense

Proprioceptive sense is input from the muscles and joints about body position, weight, pressure, stretch, movement, and changes in position in space. For example, kids with poor proprioception might have a preference for clothes to be as tight as possible, intentionally fall to the floor, or show difficulty understanding “heavy” and “light” movement.

What if you had Sensory Processing Disorder? Imagine If…

You could see obstacles in your way, however, you could not make your body move to avoid them.
The different smells in this room made you utterly nauseous.
You felt like someone had given you a shot of Novocain in your backside, therefore you couldn’t tell if you were sitting in the middle of your chair and you fell off 3 times during this training.
You tried to drink a cup of water from a paper cup, however, you couldn’t tell how hard to squeeze it to hold onto it. Therefore, you squeezed it too hard and the water spilled all over you. After that, the next time you did not squeeze it hard enough and it fell through your hands and onto the floor.
Every time you tried to write with your pencil, you pushed too hard, consequently it broke repeatedly.

But Wait, There’s More

You couldn’t focus your eyes on me because everything and everyone in the room catches your attention, therefore, your eyes just go there instead.
Every time someone touches you, it feels like they are rubbing sandpaper on your skin.
You could only sit here for 15 minutes and then you had to take a run around the building or do 20 jumping jacks so you could sit for another 10 minutes before your muscles felt like they were going to jump out of your skin.
The tag in the back of your shirt makes you feel as uncomfortable as you would if a spider was crawling on you and you couldn’t get him off.
You wanted to write something down but it took you at least 5 seconds to form each letter. You can see the letter in your head, but your hand will not go in the right direction to write it.
The motion of the car makes you sick, subsequently you had to pull the car over three times on the way here.

How Can an Occupational Therapist Help?

These are just some of the ways that SPD can affect kids. As you go through these examples, you may think, “my child has a lot of these behaviors, he or she must have SPD” or “my child has some of these behaviors, but so do a lot of children.” What we are concerned with is how these behaviors and characteristics interfere with a child’s ability to function throughout the day and transition between activities. If you suspect your child might have SPD or if you have further questions, an occupational therapist can evaluate your child and assess how these behaviors are impacting his or her ability to function. An occupational therapist can provide activities to work on in the home to decrease behaviors and ideas on how to address the behaviors when they occur.

Baby Sign Language — Bridging the Gap

Sign language can be a fun and effective way to allow your baby to communicate prior to the development of verbal language. This is possible because a baby’s cognitive abilities develop at a faster rate than speech. Sign language bridges the gap between non-verbal and verbal phases by utilizing a baby’s faster developing hand-eye coordination. The idea behind the use of sign language for babies is that it will decrease frustration and tantrums because your baby can tell you what he or she needs. Can signing delay verbal language development? The American Academy of Pediatrics states that this is not a concern. In fact, they report that it shows your baby is effectively communicating.

To get the most out of your baby’s sign language experience, Mayo Clinic makes the following recommendations:

Set realistic expectations: Start signing with your child at any age, but remember that most children aren’t able to communicate with baby sign language until about age 8 months.
Stay patient: Don’t get upset if your child uses signs incorrectly or doesn’t start using them right away. The goal is improved communication and reduced frustration — not perfection.
Be consistent: Repetition is the best way to ensure your child’s success in using baby sign language. Encourage other caregivers to use the same signs.

Now that you have made the decision to start teaching your baby to sign, how do you start? Familiarize yourself with signs through books, websites, or a community class. Choose a few simple signs that will be part of your routine. Examples include mother, father, eat, drink, more, done, and please. The signs below are from mykidentity.com

Visual Perception — Not Just 20/20 Vision

Sight is the ability to see, but vision is something much more encompassing. Visual perception is our ability to understand, interpret, and respond to the information that we “see” with our eyes. Commonly we think that if we have 20/20 eyesight then we have good vision. This is not necessarily true. There are many more skills that the eyes must be able to master in order for us to have appropriate vision. When a child has not properly developed his or her visual skills, it can manifest as difficulty in school. Consequently, kids with visual perception problems are labeled as lazy, being a slow learner, dyslexic, working below potential, immature, “at risk”, having a behavior problem, or having attention deficit disorder.

Visual Perception Skills

Eye Tracking and Fixation: This is the ability to use fine eye movements to follow objects such as a line of print when reading and fixate on each object, letter, or word.
Eye Focusing: The ability of the eyes to focus on objects/words close to our face for extended periods of time and jump from close to far away and close again such as looking from the board to the desk during school activities.
Eye-Teaming: Ability of our eyes to work together to prevent double vision, visual fatigue, and poor attention.

Assumptions regarding vision can result in visual perception impairments being overlooked. These assumptions include¹:

Parents assume their child has perfect vision if they passed a vision screen or test or if they have 20/20 vision.
Teachers assume that if a student can see letters on the board easily then they should be able to read letters in a book for extended periods of time without difficulty.

Currently it is estimated that 1 in 4 kids have vision problems that interfere with learning.¹ Complaints may include:

Seeing double
Loss of place when reading
Highlighted words are easier to read
Words go in and out of focus on a page
Words and letters disappear when reading so I have a to blink a lot and I lose my place

Symptoms of Poor Eye Tracking ¹

Easily distracted/poor attention during work times
Avoids near-point work
Poor reading posture
Head tilting during reading/writing
Holds book too close to eyes
Reading homework takes a long time
Loses place when reading and/or uses a marker to keep place
Moves head when reading
Omits or re-reads words/letters/lines
Repeats letters within words
Reads big words, but misreads/misses small words
Difficulty copying from chalkboard
Avoids reading out loud or enjoys being read to but avoids self-reading
Poor reading comprehension and/or comprehension worsens as reading continues
Misaligns numbers in math

Symptoms of Poor Visual Perception ¹

Letter reversal (b, d, q, p), number reversals, word reversals
Repeatedly confuses left and right
Grips pencil too tightly/poor grip
Poor handwriting or writes uphill or downhill
Deficient orientation of handwriting/drawings on the page
Poor shape recognition or difficulty copying shapes
Confuses similar words or fails to recognize the same words multiple times
Difficulty with sports/poor motor skills

Social Observations ¹

Difficulty with sports/poor motor skills
Short attention span, frequent day dreaming
Low self-esteem, poor self-image
Temper tantrums
Class clown or extremely shy
Frequent crying or behaviors when tasks are hard
Frustration or angry emotions come on quickly
Clumsy or has difficulty with sports
Often appears confused
Mixed dominance or lack of hand preference
Developmentally delayed

References

Remick, K.M, Stroud, C.A.,& Bedes, V. (2000). Eyes on track: A missing link to successful learning. Folsom, CA. JF’s Publishing.

20 Healthy New Year’s Resolutions for Kids

Preschoolers

I will clean up my toys and put them where they belong.
I will brush my teeth twice a day. I will wash my hands after going to the bathroom and before eating.
I won’t tease dogs or other pets – even friendly ones. I will avoid being bitten by keeping my fingers and face away from their mouths.

Kids: 5- to 12-years-old

I will drink milk and water three times each day. I will limit soda and fruit drinks to once each day.
I will apply sunscreen before I go outdoors on bright sunny days. I will try to stay in the shade whenever possible. I will wear a hat and sunglasses, especially when I’m playing sports.
I will try to find a sport (like basketball or soccer) or an activity (like playing tag, jumping rope, dancing or riding my bike) that I like and do it at least three times a week!
I will always wear a helmet when bicycling.
I will wear my seat belt every time I get in a car. I’ll sit in the back seat. I will use a booster seat until I am tall enough to use a lap/shoulder seat belt.
I will be nice to other kids. I’ll be friendly to kids who need friends. For example, someone who is shy, or is new to my school.
I will never give out personal information. This includes my name, home address, school name or telephone number on the Internet. Also, I will never send a picture of myself to someone I chat with on the computer without my parent’s permission.

Kids, 13-years-old and up

I will eat at least one fruit and one vegetable every day, and I will limit the amount of soda I drink to one glass daily.
I will take care of my body through physical activity and nutrition.
I will choose non-violent television shows and video games, and I will spend only one to two hours each day – at the most – on these activities.
I will help out in my community – through volunteering, working with community groups or by joining a group that helps people in need.
When I feel angry or stressed out, I will take a break and find constructive ways to deal with the stress, such as exercising, reading, writing in a journal or discussing my problem with a parent or friend.
When faced with a difficult decision, I will talk about my choices with an adult whom I can trust.
When I notice my friends are struggling or engaging in risky behaviors, I will talk with a trusted adult and attempt to find a way that I can help them.
I will be careful about whom I choose to date, and always treat the other person with respect and without coercion or violence. I will expect the same good behavior in return.
I will resist peer pressure to try drugs and alcohol.
I agree not to use a cell phone or text message while driving and to always use a seat belt.

Reproduced with permission from the American Academy of Pediatrics

Topics in Physical Therapy: Plantar Fasciitis

What is Plantar Fasciitis?

Plantar fasciitis is inflammation in the thick tissue (plantar fascia) of the bottom of the foot. The plantar fascia connects the bone in the heel to the bones of the toes which helps to form the arch of the foot.

What Does it Typically Feel Like?

Tightness and/or pain on the bottom of the foot
Pain that is worse in the morning or after being in one position for a long period of time
An initial slow decrease in pain with activity followed by increases in pain when activity continues throughout the day
Pain when lifting the big toe up
Tightness in the calf muscles

What Are Some Common Causes?

Repetitive microtrauma over many years with a gradual onset and no specific injury
Excessive pronation (rotation inward, flat foot)
Sudden increase or decrease in activity level
Heel spur

Risk Factors for Developing Plantar Fasciitis

Certain lifestyle and environmental factors may put you at an increased risk of developing plantar fasciitis. Firstly, participation in edurance sports increases your risk. This is due to the increased stress placed on your feet. However, prolonged sitting or standing which may cause decreased ankle flexibility, can also lead to plantar fasciitis. Changes in lifestyle or activity level may have an impact as well. Lastly, obesity or sudden weight gain can increase your risk as well.

Treatment for Plantar Fasciitis

Anti-inflammatory medication as well as PHYSICAL THERAPY treatment

How Will a Physical Therapist Treat Plantar Fasciitis?

Physical therapists may be able to treat plantar fasciitis. They are able to stretch the plantar fascia and calf muscles which therefore improves pain. Therapists can also provide soft tissue mobilzation as well as provide exercises to strengthen the intrinsic and extrinsic muscles to support the arch. Physical therapists are also able to provide education to those suffering from plantar fasciitis. This involves teaching individuals how to reduce the amount of stress they place on the bottom of their foot. Furthermore, they can provide shoe recommendations or modifications if necessary. Lastly, physical therapists can help with providing orthotics or night splints which may help with pain and inflammation.

Topics in Women’s Health: Considerations After a Cesarean Section

The cesarean section (c-section) rate in the United States continues to rise. Statistics for 2010, show that one in three women gives birth by c-section. With numbers that high, it’s necessary for physical therapists to understand the complications of this surgery.

Infections and Cesarean Sections

The first consideration is the rate of infection at the incision site. It’s also important to consider inflammation in the womb (or metritis). Infection occurs in approximately 5-8% of women. The occurrence of post-cesarean metritis is 10-20%. Physical therapists can screen for infection and inflammation. Screening includes inspection of the skin and tissue around the incision. It also consists of taking the patient’s temperature, and feeling for pain in the area.

Affects of Scarring

It’s also important to consider the scar/incision after c-section. Large amounts of scar tissue can affect how the abdominals function. If there is too much scar tissue, these muscles may not work properly. Proper function is important after childbirth because these muscles are necessary for childcare tasks.

Appropriate Exercises

What can mothers lift after a c-section? Mothers are not advised to lift anything heavier than her baby. This recommendation stays in place for up to six weeks after a c-section.

Physical therapists can help! They can provide training on how to lift properly and how to apply an abdominal brace (if needed). This is beneficial to prevent over straining. It’s also helpful to teach mothers how to perform core exercises. Specific exercises help to protect ab muscles and the spine.

Allow six weeks for the incision to heal. Seeing a physical therapist may be beneficial if pain, discomfort, tightness, or swelling is still present after six weeks. A visit to the physical therapist may also be useful if scar tightness persists.

What Will Physical Therapy Include

Physical therapy after a c-section consists of a full non-invasive examination. This includes an assessment of incision site and lower extremity function. It also includes assessing posture, and overall strength. The physical therapist will perform a more specific evaluation of the incision site if there is pain in that area. This will determine if there is too much scar tissue as well as if there is decreased scar mobility.

Therapeutic massage techniques can improve these problems. Massage is specific to the scars. Other tools such as the therapeutic ultrasound can also be used. Other impairments can also be addressed in the appointment. After the initial assessment, a home exercise program is developed. These programs are based on patient’s needs.