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Occupational Therapy and Trauma

An introduction for mental health professionals to the place for OT in the treatment of people with a history of abuse.
by

Julia Bantimba

on 13 September 2013

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Transcript of Occupational Therapy and Trauma

Occupational Therapy
An Introduction for mental health professionals about the OT's place in treating people who have experienced trauma.
Occupational
Therapy is...

By the year 2017……We envision that occupational therapy is a
powerful
,
widely recognized
,
science-driven
, and
evidence-based
profession with a
globally connected
and
diverse
workforce meeting society’s occupational needs
OT Centennial Vision
Evidence Based
Theory Driven
Client Centered
Occupational therapy practitioners use literature from
psychology
education
public health
medicine, etc.
to inform their clinical reasoning and decision making.
References
American Occupational Therapy Association. (2008). Occupational therapy practice framework: Domain and process (2nd ed.). American Journal of Occupational Therapy, 62, 625–683.
American Occupational Therapy Association (2012). The road to the centennial vision. Retrieved from http://www.aota.org/News/Centennial.aspx
American Occupational Therapy Association (2012). About occupational therapy. Retrieved from http://www.aota.org/Consumers.aspx
Champagne, T. (2011). Sensory Modulation & Trauma Informed Care. Presentation at Boston University's Sargent College of Health and Rehabilitation Sciences.
Cohn, E. (2011). Sensory Integration: A.K.A. Sensory Processing. Presentation at Boston University's Sargent College of Health and Rehabilitation Sciences.
Anticipated Questions
what is the difference between SI and play therapy

What We Look At
Area of Occupation
Client Factors
Activity Demands
Performance Skills
Performance Patterns
Context &Environment
Areas of Occupation
Activities of Daily Living
Instrumental Activities of Daily Living
Rest & Sleep
Education
Work
Leisure
Social Participation
Client Factors
Body structures
Body functions
Mental
Sensory
Neurological
Muscular
Speech, etc.
Values
Beliefs
Spirituality
Activity Demands
The various aspects of the activity:
Objects and their properties
Physical space
Social demands
Sequencing & timing
Required actions & skills
Required client factors
(American Occupational Therapy Association, 2009)
Performance Skills
The abilities the client has while performing a task
Motor and praxis skills
Sensory-perceptual skills
Emotional regulation skills
Cognitive skills
"An orientation that honors the desires and priorities of clients in designing and implementing interventions" (AOTA, 2009)
(American Occupational Therapy Association)
Using "reason based on theory or empirical evidence, for using a particular intervention for a specific person" (Jacobs & Jacobs, 2009)
Performance Patterns
Behavioral patterns related to a clients habitual and routine activities.
Habits
Routines
Rituals
Roles

Performance patterns may also be applied to organizations and populations
Context & Environment
Context: "variety of interrelated conditions" both within and surrounding the client (AOTA, 2008)

Environment: the client's external physical and social environments in which their daily occupations occur

Context:
Cultural
Personal Temporal
Virtual
Environment:
Physical
Social
What is Sensory Integration?
Sensory integration is "the neurological process that organizes sensation from one's own body and from the environment and makes it possible to use the body effectively within the environment...
Sensory integration is information processing
" (Ayres, 1989, p.11)
When You Might See SI Problems
Autism Spectrum Disorder & other developmental disorders
Attention Deficit Hyperactivity Disorder
Prematurity
Cerebral Palsy
Dementia
Traumatic Brain Injury
Mental Health Conditions
Fetal Alcohol Syndrome
Learning disabilities
Trauma
Environmental deprivation
There is a
relationship between
the interpretation of sensation from the body & the environment and difficulties with daily functioning.
A. Jean Ayres hypothesized that
And that...
Sensory Integration Dysfunction is a problem with the way sensory information is received and interpreted by the brain.

This results in problems in occupational functioning.
Sensory Discrimination Disorder
Difficulty or inability to accurately interpret specific types & qualities of sensory stimuli
Difficulty or inability to identify similarities and differences between stimuli.
Sensory-Based Motor Disorders
Sensory Processing Disorder
Sensory Modulation Disorder
Sensory Discrimination Disorder
Sensory Based Motor Disorder
Poor postural stability, balance, and low muscle tone (Case-Smith, 2009)
Impact on Behavior
Slowness in completing daily activities
Difficulty with find motor and handwriting tasks
Difficulty with gross motor activities and sports
Decreased participation
Difficulties in conceptualizing, planning, sequencing and executing movement tasks
Sensory Modulation Disorder
Difficulty regulating and organizing responses to sensory input in an adaptive manner
Magnitude of responses to sensory stimuli do not match the magnitude of the stimuli, itself
What You Might See
Under-responsiveness
Over-responsiveness
Sensory Seeking
Sensory Defensiveness
oral, tactile, gravitational insecurity, auditor, visual, olfactory
Impact on Behavior
Avoidant
: over-anxious, fearful
Controlling
: stubborn, defiant
Impact on Behavior
Slowness in completing daily activities
Frustration
Anxiety
What You Might See
Vestibular
May crave enhanced sensation
Poor timing and sequencing
Somatosensory
Poor movement coordnation
Slowness in movement execution
Postural Disorder
Dyspraxia
Think about each step....
Make a peanut butter cracker
How Does Sensory Integration Relate to Trauma?
As infants and toddlers, typical children are exposed to a large amount of sensation
How? When? What?

Living in an abusive or neglectful environment can lead to:
Inadequate opportunity for sensory exploration
Decreased cognitive ability
Various mental health problems
Sensory seeking/avoiding behaviors
Sensory Deprivation
Sensory experiences can lead to
A sense of safety & stability
Support, build relationships
Support development
Regulate emotions and behaviors
Contribute to overall health & well being

Think about what you do when you are upset? angry?
Why Use Sensory Approaches?
Calming
Familiar
Slow
Soothing/relaxing
Rhythmic
Holds positive associations
Continuous & predictable
Mild intensity
Simple
Low demand
Consistent
Two Basic Classifications of Sensation
Alerting
Novel
Fast
Irritating
Uneven beat
Holds negative associations
Unpredictable
Moderate/high intensity
Complex
High demand
Incongruous
Our
Seven
Senses
Auditory (hearing)
Visual (sight)
Gustatory (taste)
Olefactory (smell)
Tactile (touch)
Proprioceptive (body awareness)
Vestibular (movement & balance)
Specific Sensory Stimuli
Touch
We have receptors all over our bodies & skin to sense pressure, light touch, vibration & temperature
Senses function to protect us from harm. When working correctly they let us know when we may be in danger.
Tactile Dysfunction
Poor tactile discrimination
difficulty distinguishing between types of touch
Hypersensitivity to touch
overly sensitive to touch
does not like to be touched or touch "messy" things
Hyposensitivity to touch
under sensitive to touch
touches people and things often
unaware of touch unless it is seen or intense
poor body awareness
chews on toys, objects
invades others' personal space
uses excessive force
Body lotions/powders
Bean bag chairs, cushions
Weighted blankets*
Swaddling in blankets
Bath or shower in warm water
Body socks*
Hand/foot massage (deep pressure)
Getting hair done
Brushng*
Tactile manipulatives
Pressure garments
Vibrating pillows/chairs
Sandwhiching in mats*
Tactile Stimulation
*Starred items should be done only in therapy by therapists who are certified sensory integration specialists.
Deep pressure is sensed by proprioceptive receptors and is often associated with a feelings of grounded-ness and calmness as well as a greater sense of the body's boundaries
Deep Touch-Pressure
It can be provided by:
Hugs
Carrying a heavy backpack
Moving heavy furniture
Swaddling
Sitting or laying on the floor (as opposed to in bed or a squishy chair)
Massage
There are receptors located in our muscles, tendons, ligaments and joints that allow us to determine the location of our body parts (without looking).
Proprioception
People who have difficulty relating to proprioception may:
Have difficulty locating their limbs in space without looking at them
Bump into things
Appear clumsy
Proprioceptive Dysfunction
The organs that sense balance are located in the inner ear. A series of small tubes filled with fluid allow us to locate the rate of movement and the position of the head.
Vestibular System
Vestibular Dysfunction
Hypersensitivity to Movement
Insensitive of movement, reacts emotionally to movement (i.e. sports, play grounds, etc.)
Fearful of heights, stairs
Easily motion-sick
Hyposensitivity to Movement
Craves fast, large magnitude movements (swings, spinning, jumping, etc.)
Clumsy
Leans against things, holds self up with furniture, etc.
Weak grip
helpingpsychology.com
compliance.vpr.okstate.edu
web.stagram.com
write down link of video and have open in separate window
http://www.ehow.com/how_17381_hang-tire-swing.html
Hopefully this presentation has:
Given you a new lens through which to look at your clients
Increased your understanding of the implications of sensory processing difficulty and disorders
Increased your knowledge of the OT scope of practice
Implications For You
(Cohn, 2011)
Not a Disorder!
Children and youth
Health and wellness
Mental health
Productive aging
Rehabilitation, disability and participation
Work and Industry
Emerging areas
Driving
Bullying
Obesity
Prevention
Veteran's affairs
etc.
Areas of OT Practice
OTs help people across the life-span participate in the daily activities they want to do and have to do through the therapeutic use of occupation (AOTA, 2012).
What Occupational Therapists Do
Occupational therapy typically consists of
Initial evaluation
Individualized intervention
Evaluation of progress and planning for discharge
Swings
Jumping games
Running games
Moving up and down the stairs
Wagons, scooters, etc.
Car rides
Rocking chairs (either for the child/person or while holding a baby)
Vestibular Stimulation Can Be Provided By:
Thank You!
Julia Bantimba, MS, OTR/L
A Better Way, Inc
Boston University
Sargent College of Health and Rehabilitation Sciences
Full transcript