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Case Study

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by

Jennifer Wright

on 18 June 2014

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Transcript of Case Study

Background Information
Katie is a young girl who was referred to the children's Occupational therapy service in January 2012, aged 5 1/2 years, because of her difficulties with motor skills and co-ordination.
Previous assessment had been carried out by an educational psychologist.
Concerns that she was struggling academically in school.
Diffculties with movement and co-ordination were also impacting on Katie's functioning in activities of daily life- toileting, dressing.
Diagnoses as of December 2011-
mild learning disability (confirmed)
developmental co-ordination disorder (possible)
Sensory Integration Intervention
Key Principles of the Sensory Integrative Approach (Ayres, 1972)
Just Right Challenge
The therapist creates playful activities with achievable challenges; the activities incorporate a challenge but the child is always successful.
The Adaptive Response
In response to the Just Right Challenge, the child adapts their behavior with new and useful strategies, thus furthering development
Active Engagement

The therapist’s artful creation of challenging, yet playful, sensory-rich environments entice the child to participate actively in play; the methods of play incorporate new and advanced abilities that increase the child’s repertoire of skills and processing.
Child Directed

The therapist constantly observes the child’s behavior and reads their behavioral cues, thus following the child’s lead or suggestions. The therapist uses the child’s cues to create enticing, sensory-rich activities.
References
Ayres AJ. 1972. Sensory Integration and Learning Disorders. Los Angeles: Western Psychological
Services.
Ayres AJ. 1979. Sensory Integration and the Child. Los Angeles: Western Psychological Services.
Ayres AJ. 1989. Sensory Integration and Praxis Tests. Los Angeles: Western Psychological Services.
Bundy, Lane and Murray (2002) Sensory Integration: Theory and practice. Philadelphia, PA: F.A. Davis Company.

confident
realises that she is behind her peers
Katie has very supportive parents, but this may be affecting her independence. As she is struggling with ADLs such as dressing and personal hygiene, they are doing a lot of things for her which means she won't develop those motor skills in order to carry out the tasks independently.
Sensory Integration
Sensory Integration concerns how the brain organises the information we receive from our senses about the physical conditions of our body and the environment in order to form perceptions, behaviours and learning.
Sensory integrative dysfunction occurs when one has decreased ability to process sensation and may also have difficulty with praxis (motor planning)
Three main sensory systems
Vestibular System
Provides information related to movement and head position
Balance
co-ordination
eye control
attention
being secure with movement
language development
Receptors:
Otoliths (utricle and sacule)- respond to linear movement
Semicircular canals- detect changes in direction and speed of the head i.e rotary movements
Primarily sends signals to muscles that control our posture and structures that control eye movements.
Proprioceptive system
Perception of joint and body movements, position of body in space, ability to determine effort needed to grasp/lift objects
Sensory feedback mechanism to allow brain to send adjustments to muscles and joints in order to achieve motor control, balance and posture
Uses proprioceptors in the muscles which monitor length, pressure and noxious stimuli
Tactile System
Touch provides us with information about our environment that we use for social, emotional and motor development.
Functionally, all occupational roles can be disrupted by inadequacies in processing tactile input.
Difficulties with fine motor skills may be related to inadequate integration of input from tactile receptors responsible for discrimination.
Depend on proprioceptive information to know where your body parts are in order to plan movements- grading pressure, manoeuvring through space, knowledge of how to use objects
SI assessment and treatment
SI Treatment Evaluation
Observations from school visit:
slow processing instructions- vestibular
relies on peers for visual prompts- ? praxis problems
lethargic- ? underresponsive vestibular system
bumping into objects- ? proprioceptive problens
slow to dress after P.E, required assistance- ? tactile/ proprioceptive
limited peer interaction
Katie invited to attend Sensory Integration therapy sessions to improve her sensory processing.
Required sensory stimulation of the proprioceptive and vestibular system to improve arousal levels and build on poor postural control.
Then can target other difficulties e.g. bilateral integration
Observations of progress following intervention:
more focused and listening to instructions
no longer requires spinning for vestibular stimulation
posture and balance improved- able to maintain upright on platform swing holding heavy ball
Tripping less- increased equilibrium
Sensory Integration and Praxis Test
Standardized assessment designed by Ayres (1989).
Most comprehensive and statistically sound means for assessing sensory integration (Bundy, Lane and Murray, 2002).
4 areas of assessment:
form and space, visual- motor coordination and constrcutional ability
tactile discrimination
praxis
vestibular and proprioceptive processing
Scored from -3 to +3
Scoring of Katie's SIPT indicates tactile processing difficulties, visuopraxis and somatopraxis problems, insufficient propriovestibular sensory integration and bilateral integration and sequencing.

Functional implications:
In school, Katie's teacher reported a marked improvement in her attention and concentration since she started sitting on the exercise ball during class. Observed to be more alert and engaged in activities.
Paediatric Sensory Motor Team- Case Study
Full transcript