An occupational therapy assessment item involves having youth identify which finger I touch, with their eyes closed. It’s taken from the Miller Assessment for Preschoolers, and often doctors watching me evaluate youth are surprised I do it with high school students with typical intelligence and a history of PTSD, especially when they make repeated errors. I explain that I assess this 3-year old normed task as it is more common in people with PTSD and sensory discrimination disorders, because it is more difficult to use your hand if you can’t feel where your fingers are. People develop an internal working model of their fingers in their cerebellum that enable them to identify and write letters with their eyes closed.
When kids learn non-habitual “praxis” tasks (e.g., writing, key boarding, cleaning their room), they typically rely on their internal working model of their hands when developing internal working models of new tasks. Sometimes I’ll intervene in staff conflicts with kids who are “too lazy to clean their rooms”. I can clean my room with out even thinking about it because I have an internal working model of my hand and I’ve formed an internal model of the room cleaning task. However, for some adolescents with sensory and learning disabilities it’s like being told to “climb Mount Everest”. Once staff happily let me take over, I guide the youth in forming an internal working model in his cerebellum of clean my room.
First we learn to “get everything off the floor”. For a month he practices getting all the stuff off the floor onto the bed. When that is mastered, we proceed to stuffing all the clothes in the closet. Next, I teach him to individually place different types of clothes on particular shelves. In this way he develops an automatic ability (internal working model) of room cleaning.
When guiding praxis using a Sensory Integration/Sensory Processing framework, it is important to direct the progression of interventions. First sensory modulation is environmentally adapted to guide youth towards a more quiet alert state of responding to functionally relevant stimuli while screening out irrelevant information. Sensory modulation enables optimal responding to information. I use traffic lights and smells to teach youth about their unique interoceptive arousal levels and how their environment effects social skill expectations.
Once environmental adaptations have brought the youth towards a quiet alert state the next task is promoting sensory discrimination through facilitating body awareness. To promote body awareness it can be helpful to begin with then expand beyond using moderate pressure, deep pressure and joint compression. Sensory inputs involving light touch, vibration and joint traction (strategic separation of joints) can also be helpful, as are activities that naturally combine multiple sensory modalities.
Developmentally sequenced interactions like playing with classroom pets or caring for farm animals are natural inputs that enhance sensory discrimination. Embedding developmentally optimal sensory activities into the daily classroom routine is an effective way to improve student’s behavior (Mills et al., 2011). This functional environmental enrichment appears to improve school behavior (Weitlauf et al., 2017). In the horse grooming activity pictured above the student must combine the smell of the horse, light touch of horses hair, deep pressure of brushing the horse, and praxis of sequentially brushing from top to bottom. In addition, because it is a meaningful activity to the student he will try to complete it even when agitated because if he doesn’t complete brushing “the horse will feel itchy”.
It is helpful to initially try to achieve a foundational more quiet alert state through environmental adaptations, next work on body awareness, then address combined sensory discrimination integration before working on praxis or postural instability activities. Consider the task of writing “hat” on a white board to understand the benefits of an orderly session progression.
As the students writes hat they need to integrate the smell of the marker, squeaking sounds of the marker and any peers talking, touch of the marker in their hand, as well as the proprioceptive and visual-motor sense involved in writing the word. The nearer the student is to a quiet alert state and the better their body awareness the more prepared they are for praxis. As can be seen above these preparatory activities will help with them succeed in completing the praxis activity described above.
It is to prepare sequentially prepare students that I use the graph above describing the specific types of sensory disorders and my suggested progression for addressing them. It can be helpful to address sensory modulation first, sensory discrimination second, then progress to addressing the sensory based motor disorders of praxis and/or postural disorders. Try following this treatment progression to better address praxis and/or postural disorders.
References
Mills, C., Chapparo, C., & Hinitt, J. (2016). The impact of an in-class sensory activity schedule on task performance of children with autism and intellectual disability: A pilot study. British Journal of Occupational Therapy,79(9), 530-539.
Weitlauf, A.S., Sathe, N., McPheeters, M.L., Warren, Z.E. (2017). Interventions targeting sensory challenges in Autism Spectrum Disorder: A systematic Review. Pediatrics, 39(6).
More information on the Sensory Matching Strategy is given in my new book FAB Functionally Alert Behavior Strategies
