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An OT and SLP Team Approach to Educational Success


An OT and SLP Team Approach to Educational Success 2014 Georgia Organization of School-based Speech-Language Pathologists March 6th, 2014 Presented by Cindy Terry ... – PowerPoint PPT presentation

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Title: An OT and SLP Team Approach to Educational Success

An OT and SLP Team Approach to Educational Success
  • 2014 Georgia Organization of School-based
    Speech-Language Pathologists
  • March 6th, 2014
  • Presented by Cindy Terry, Coordinator of
    Therapeutic Services Gwinnett County Public
    Schools and
  • Doris Osborne, Supervisor of Related Services
  • Cobb County School District

What is a Related Service?
  • Under part B of IDEA, OT PT are related
    services for eligible students, who, because of
    their disabilities, need special education and
    related services. Related services are support
    services that help the student to benefit from
    special education. (AOTA)

  • A child does not become eligible for OT or PT.
    He or she becomes eligible for special education.
    The results of an OT or PT assessment or
    evaluation presented to the IEP committee for
    consideration drive the need for school- based
    therapy support.

What is educationally relevant OT or PT?
  • A student with a disability has a need for
    improvement in his functional skills as related
    to his performance in the educational
    environment. The student may have an educational
    need as well as a medical or clinical need.
    However, some motor difficulties may not directly
    impact educational progress and may not
    constitute educational need. (CA DOE)
  • School- based OT and PT services are performed in
    the educational environment with educational

What is the GA Consideration Tool?
  • Guidance tool for determining the need for
    educationally relevant therapy and time required
    to support the IEP goals/objectives
  • Summary of educational considerations based on a
    review of
  • student records, evaluations, observations,
    progress notes, parent/teacher information, and
    other data
  • Visual aid to display the clinical reasoning
    process as noted by AOTA APTA Best Practices
    for school-based therapists.

SLP and OT Co-Treatment
  • Research in this area is limited.
  • Studies reported most collaboration between
    school-based SLPs and OTs are with students with
  • 1999 AJOT study reported SLP and OT with a 98
    collaboration during the evaluation 100 during
    intervention for students with ASD
  • 2011 Study by Laura Czernik LEND Fellow found
    advantages with the most common being increased
    participation by the child

Overview of ASD
  • Leo Kanner- 1943
  • Coined the term autism
  • biological impairment like physical and
    intellectual handicaps Noted perceptual
    difficulties and overreaction to loud noises and
    moving objects.
  • 50s and 60s- viewed as an emotionally based
    disorder resulting from cold refrigerator
  • 70s- back to recognition as neurological
  • Literature focused on social, communication,
    behavior and cognitive issues. Attention to
    perceptual and sensory processing difficulties
    (abnormal response to visual, vestibular and
    auditory stimuli disorder of sensorimotor
    integration problems with modulation of sensory
    input and motor output)

Occupational Therapy
  • 1970s- Jean Ayers- behavioral problems
    associated with inadequate sensory integration.
  • 1980s Knickerbocker- behaviors exhibited by
    individuals with autism may be related to hyper-
    or hypo- reactions to sensory input. Planned
    sensory input provided through specific
    activities could help normalize reactions to
    sensory input and improve behavior.
  • Autopsy studies of individuals with autism have
    found developmental abnormalities in the
    cerebellum and limbic regions of the brain.
    Significant roles within sensory integrative
    process including modulation of sensory input.
  • Adults with autism have written personal accounts
    of sensory experiences- Temple Grandin, Donna
    Williams, Zosia Zaks, Judy Endow, Sean Barron,
    Stephen Shore, John Elder Robison, Larry
    Bisonnette Tracy Thresher.

Examples of functional skills needed for school
  • Hand function
  • Visual skills/ visual perceptual skills
  • Handwriting
  • Attention span
  • Organizational skills
  • Sensory awareness
  • Sensory processing
  • Self care skills
  • Positioning
  • Social Skills
  • Motor planning
  • Functional Mobility (walking or WC skills)
  • Stair climbing
  • Balance
  • Coordination
  • Oral motor skills
  • Gross motor skills
  • Fine motor skills
  • Assistive technology
  • Pre-vocational tasks
  • Leisure skills

All learning has its basis in sensory
development.From Sensory Secrets.
Sensory Processing
  • The organization of sensory input for adaptive
    responses learning, motor skills, perceptual
    skills, behavior, social skills.

  • The brain locates, sorts and orders sensations
    somewhat as a traffic officer directs moving
    cars. When sensations flow in a well organized
    or integrated manner, the brain can use those
    sensations to form perceptions, behaviors and
    learning. When the flow of sensations is
    disorganized, life can be like a rush hour
    traffic jam.
  • -Jean Ayers, 1979

The brain acts much like a computer!
  • Input goes in through the sensory systems
  • Which is processed in the brain
  • Resulting in an adaptive response
  • Which provides feedback/sensory input
  • Which is processed in the brain
  • Resulting in an adaptive response
  • The process is cyclical.

Components of SP
  • Sensory Registration
  • Be aware of a sensory stimulus
  • Orientation
  • Pay attention to new information being received
  • Determine what sensory input needs attention and
    what can be ignored
  • Utilize functions of inhibition and facilitation
  • Interpretation
  • Interpret and describe sensory input
  • Allows for fight, fright, and flight responses
    (protective system)
  • Organization of a response
  • Determine if a response to a sensory stimuli is
    needed, and how
  • cognitive, emotional, physical
  • Execution of a response
  • Execution of the cognitive, emotional, or
    physical response

Sensory Modulation
  • The ability of the nervous system to
  • Regulate, prioritize, and organize incoming
    sensory information.
  • Adapt to changes in the environment.
  • Maintain arousal level appropriate to the task.
  • Results in
  • Registration, arousal, self-regulation,
    attention, focus, and behavior or emotional

Sensory Processing Disorders
  • Over-reactive to sensory stimulation
  • Under-reactive to sensory stimulation
  • Modulation disorders
  • Integration disorders
  • Difficulties with arousal levels-that just
    right state for learning
  • Use sensory assessments to analyze.

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The 2 Functions of the Nervous System
  1. Protection fright, flight, fight
  2. Discrimination for learning, communication,

Central Nervous SystemSensory Processing Sets
Foundation for
  • Cognitive
  • academic learning,
  • daily living skills, behavior
  • Perceptual-Motor
  • auditory language skills, visual-spatial
  • attention center functions, eye-hand
  • ocular-motor control, postural adjustment
  • Sensory-Motor
  • body scheme, reflex maturity, ability to screen
  • postural security, awareness of the two sides of
    the body, motor planning
  • Sensory
  • olfactory, Visual, auditory, gustatory, tactile,
    vestibular, proprioception

Sensory Systems
  • From eyes vision
  • From ears hearing
  • From skin touch
  • From nose smell
  • From mouth taste
  • From semi circular canals vestibular
  • From muscles/joints - proprioception

  • Provides us with our sense of touch
  • First sensory system to operate in uterus
  • Rooting reflex, calming to neutral warmth
  • Receptors in the skin provide information about
    light touch, pressure, vibration, temperature,
  • Feedback- development of body awareness, motor
  • Needed for ADLs including schoolwork, job tasks

Tactile cont.
  • Protective tactile system- more primitive
  • Initially dominant
  • Informs us when dangerous contact is made
  • May be gently alerted or activate fright, flight
    or fight response
  • Discriminative tactile system- allows us to feel
    the quality of the item we are touching
  • Higher level- necessary for learning and brain

Tactile Dysfunction
  • Hyper- or hypo- sensitive to touch
  • Problems with tactile discrimination
  • Sensory modulation- unable to screen out
    sensations overwhelmed to point of not
    responding to other sensory systems
  • Tactile defensiveness- (hyper-)regarded as
    threatening. Can tolerate touch but not receive
  • Behaviorally- anxious, aggressive, controlling,
    inflexible, unwilling to participate in
  • Hypo-low arousal levels require intense input
  • Body awareness, motor planning problems due to
    impaired feedback
  • Delayed reaction to touch- may not realize injury
  • Seeking tactile input- constantly touching-
    social implications

  • Provides information about movement, gravity,
    changing head positions
  • Tells us if we are moving, still, direction and
    speed of movement
  • Develops relationship to earth- body position
    vertical or horizontal even with eyes shut
  • Balance, postural security, self- regulation and
  • Receptors located within structures of ear(
    semi-circular canals, utricle, saccule)
  • Influences development of eye movements-
    tracking, focusing, maintaining upright posture
  • Influences muscle tone, readiness to perform
  • Protective- reflexes to prevent falling
  • Discriminative- recognize going faster, slowing
    down, rotary movements, rhythmical

  • Hyper- fearful with changes in gravity and
    position- gravitationally insecure- do not like
    heights, feet off ground
  • May feel discomfort, nausea, or dizziness with
  • No exploration of environment, no motor memory
    poor motor planning
  • Hypo- seekers, crave movement- climbing, jumping,
    excessive movement to stay alert and organized
  • Problems with self-regulation- inconsistent
    responses to sensory input , emotional
    instability, inappropriate arousal levels,
    difficulty maintaining and shifting attention

  • Unconscious awareness of body position
  • How much force necessary for muscles to exert so
    we can grade movements
  • Receptors located in muscles, tendons, ligaments,
    joint capsules, connective tissue
  • Respond to movement and gravity- helps us make
    sense of movement and touch experiences
  • Position in space, body map- motor planning
  • Regulate arousal levels (stretch, heavy work)

Proprioceptive Dysfunction
  • Poor body awareness
  • poor grading of movements- break items, writing
    too hard or too light, may fatigue easily
  • May use proprioceptive input to reduce
    hypersensitivity to other sensations- intense
    rocking, banging back and head against chair,
    jump on beds, squeeze between furniture, hide
    under heavy blankets

Autism Sensory Processing
Sensory Quota Systemaccording to Zosia Zaks
  • Say my brain has only 100 Sensory Processing
    Units. If it takes 95 units to decipher the
    sounds of a conversation, decode the
    conversational signals that indicate turns and
    innuendo, pick up the contextual clues that
    impart social meaning, and modulate my voice, I
    have just five units remaining to use for other
    sensory sources.

  • Since looking at someones face, decoding facial
    expressions and coping with the pain of the
    fluorescent lights requires (hypothetically) at
    least 75 units, in this case I would not have
    enough Sensory Processing Units to look at the
    other person, or even open my eyes, while we
    conversed. This helps explain why most autistic
    people are unable to look at someone in the eyes
    while also talking, a characteristic behavior of
    autism spectrum disorders.

  • When SPUs are used up
  • Sensory overwhelm or sensory meltdown
  • Need to calm self ALONE
  • Scrambling- difficulty sorting sensory input into
    meaningful chunks of information
  • Sensory cross-firing (synaesthesia)- experiencing
    a sensation in one sensory system yet perceiving
    the sensation in another modality

  • Research continues to demonstrate that people
    with ASD tend to have more issues with sensory
    processing than the general population (Kientz
    Dunn, 1997 Watling, Dietz White, 2001).
  • Those with ASD demonstrate sensory symptoms
    specifically indentified in taste, smell, tactile
    and auditory processing (Rogers, Hepburn
    Wehner, 2003).

  • people with ASD often over- or under-process
    sensory input from the environment (Ornitz, 1989
    Wainwright-Sharp and Bryson, 1993) or have
    trouble regulating sensory information (Lincoln, 1993, 1995).


Be aware of your sensory needs.Be aware of
the sensory needs of your students!
  • Everyone has them!

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  • Everything we do.
  • Behavior may be learned, a nervous system
    response to an environmental stimuli, or both.
  • Behaviors have specific functions.

Functions of Behavior
  • Escape avoidance of a person, task, situation,
    or environment
  • Tangible desire for a specific item, activity
    or feeling
  • Attention desire for positive or negative
    attention from peers or adults
  • Sensory desire for a feeling, taste, sound, or
    environment to meet a sensory need or a fear or
    avoidance of sensory input
  • Power/Control desire for clout, authority, the
    last word, influence over their environment

Problem Behavior
  • Student does not conduct himself properly for the
    environment or situation.
  • Students behavior does not match what we expect
    from his peers.
  • Student does not do what we want him to do, when
    we want him to do it, or how we want him to do
  • Consider Whos problem is it?

Prioritize need for Behavioral Change/Hierarchy
  1. Behaviors that harm self.
  2. Behaviors that harm others.
  3. Behaviors that harm property.
  4. Behaviors that are disruptive.
  5. Behaviors that are distracting.

Behavioral Model
  • Behavior is conditioned via external stimuli
  • Based on the work of B.F. Skinner
  • When external stimuli are identified, they can be
    manipulated and result in an increase, decrease
    or maintenance of the behavior (used in ABA, PBS,
  • Positive and Negative Reinforcement
  • Punishment and Extinction

  • Behavior Assumptions
  • Sensory Assumptions
  • Serves a function (obtain or escape)
  • Function is valid for the individual
  • Is learned and can be unlearned
  • Problem behavior is often viewed as a form of
  • Problem behavior results from a lack of basic
    social skills.
  • Problem behavior may be a source of internal
  • Problem behavior can be something a student does
    when he or she does not know what else to do.
  • (Alberto Troutman, 2009)
  • Problem behaviors may result from an underlying
    sensory processing disorder
  • Sensory behaviors serve a function
  • Sensory behaviors may be productive or
  • Productive- meet a regulatory need
  • Nonproductive- may be a source of internal
  • Sensory behaviors will be acceptable or
  • Sensory behaviors can be used for communication
  • (Murray-Slutsky Paris, 2005)

Some common misconceptions about negative
behavior and sensory concerns
  • Sensory strategies will reinforce negative
  • He enjoys it, theres a smile on his/her face
    the whole time.
  • She can do it, she did it beforeshe just
    doesnt want to.
  • Hes just being manipulative.

A-B-C Model
  • A- Antecedent Events that occur before
    behaviors and that may cue or set the stage for
    certain behaviors. (Who, what, when, where?)
  • B- Behavior of concern
  • C- Consequence Events that follow a behavior
    that determine whether the behavior will be
    repeated or not.
  • (Murray-Slutsky Paris, 2012)

Antecedent ControlSet the stage for success!
  • Environmental influences
  • Scheduling considerations
  • Activity considerations
  • Can reduce the need for specific sensory diets
  • or behavior plans as we manage behavior.

Environmental Factors that Impact Behavior
  • Behaviors are Less Likely to Occur
  • Small rooms
  • Structured tasks
  • One to One child-adult ratio
  • Engrossing, task
  • Stimulating, interesting activities
  • No waiting time
  • Quiet environment
  • Area free from distractions and clutter
  • Repetition, routine
  • Pre-planned transitions
  • Familiar People
  • Assistance Provided
  • Behaviors are More likely to Occur
  • Large Room
  • Unstructured tasks or schedule
  • Poorly planned transitions
  • Low child-adult ratio
  • Proximity of others
  • Stress or frustration
  • Environmental factors noise, clutter
  • Change people, place, activities
  • Bored, lack of Stimulation
  • Excessive Waiting

Environmental Influences
  • Promote an environment which facilitates
    sensory modulation. Utilize calming and
    excitatory influences throughout the day,
    depending upon the specific task and
  • Adjust lighting.
  • Utilize music or white noise when appropriate.
  • Utilize aroma therapy.
  • Offer an array of seating and positioning
    options, including those that offer movement.
  • Make weighted lap pads or snakes if possible.
  • Offer water bottles, gum, chewy or crunchy snacks.

Scheduling Considerations
  • Intersperse all sitting and concentrating
    activities with movement or heavy work activities
  • Use visuals to communicate schedules so students
    can prepare for changes and transitions
  • Verbally prepare students in advance when
    non-typical activities will occur, i.e.- fire
    drill, outings, visitors

Ways you can help..
  • Routine
  • Provides student with understanding- gives
    confidence and security
  • Gives sense of predictability
  • BUThave to help with what happens when changes
    occurprepare, prepare, prepare
  • First/ Then routines
  • Individual Schedules
  • Use photos, icons, words
  • Length of schedule
  • Various ways to use them
  • For the days events
  • For specific routines in the room

Activity Considerations
  • Give choices when possible
  • Mix non-preferred with preferred
  • Make tasks short manageable, especially if
  • Use reinforcers
  • Make expectations and consequences/rewards clear
  • Reduce the Anxiety
  • SCHEDULE DOWN TIME- will melt down if have to
  • Sensory Input- determine function, use tools-
    nubby seats, balls, tramps, velcro, pressure,
    sensory diet
  • Fidgets
  • Students with ADD/ADHD may exhibit improved focus
    by allowing them to hold fidget

Principles for Using Sensory Strategies
  1. Make sure strategies are not used to reinforce
    negative behaviors- be proactive, not reactive
  2. Provide a sensory diet- schedule frequent breaks
    (movement/ stationary), heavy work throughout
    day, use strategies that can be used during
    learning tasks. When in doubt- use
  3. Utilize strategies to regulate arousal level,
    teach self-regulation mouth, hands, move,
    auditory, visual
  4. Teach the student to communicate needs.

  • Based on information gathered, the therapist
    collaborates with teachers and parents to design
    an intervention plan to address the child's
    sensory processing problems.
  • The goal of a sensory based approach is to
    provide the just right amount of input in order
    to help the child regulate his sensory system and
    adapt to improve attention and focus for learning
    to occur.

Sensory Diet
  • Term coined by Patricia and Julia Wilbarger in
  • Individualized, planned and scheduled activity
    program developed to help a specific child meet
    his/her sensory needs.
  • Combination of alerting, organizing, and calming
  • Dynamic- Adapts with the childs sensory changes
  • Everyone has one.

Sensory Diet
  • Metaphor- nutritional diet. Sensory diet requires
    the right combination of sensory input to keep an
    optimal level of arousal throughout the day.
  • Sensory snacks short term
  • Sensory entrees last longer, very powerful
  • Powerful behavioral tool!

Sensory Diet ConsiderationsHandout
Sensory Diet
  • Over-responsive/ hypersensitive
  • Schedule sensory activities throughout the
    childs day to modify arousal levels to fit the
    childs needs.
  • Activities with intensity and long lasting
  • Be proactive to keep child calm and organized.
  • Deep proprioceptive activities are calming and
    organizing heavy work, wall push ups, weights,
    climbing, pushing, pulling
  • Tactile deep touch pressure, massage
  • Vestibular Proceed with caution beginning slowly
    with proprioceptive activities. Jumping on
    trampoline, swinging

If your student is overly sensitive to or overly
stimulated by sensory input
  • Touch Use firm pressure. Always approach from
    the front. Ask permission to touch. Allow to be
    in front or rear of lines.
  • Noise Keep classroom noise to a minimum. Try
    using white noise. Try using earplugs,
    earphones, or cotton balls in ears when in noisy
    environments. Always prepare in advance of a fire
    drill. Muffle your classroom speakers. Position
    desk on outer periphery of classroom and away
    from doorways/hallways.
  • Vision Keep classroom and walls uncluttered.
    Have student keep minimal items on his/her desk.
    Use simplified worksheets. Use a reading or
    writing window. Position desk in front of
    classroom and away from doorways. Try using a
    study carrel or an office. Use sunglasses
    outside if needed.

  • Sensory Diet Under-responsive/ hyposensitive
  • Sensory activities to wake up the systems.
    Intense to increase registration, awareness,
    overall processing.
  • Be proactive to keep child alert, awake,
    organized, engaged.
  • Modify environment to alert bright colors and
    lights, animation
  • Proprioceptive weights, pushing, pulling,
    carrying lifting heavy objects. Combine with
    vestibular jogging, climbing, monkey bars
  • Tactile sucking, chewing, massage, vibration,
    sand table activities alternating sand, rice,
    beans putty
  • Vestibular jumping on trampoline, swinging,
    bouncing on ball

  • Sensory Diet Sensory seekers
  • Schedule sensory activities throughout the day to
    modify arousal levels. Assure availability of
  • Select 1 or 2 powerful activities to maintain
    optimal alert state.
  • Intense, long lasting effects
  • Be proactive to keep child calm and organized.
  • Proprioceptive activities for calming,
    organizing. Heavy work, wall chair push ups,
    climbing, monkey bars, pushing, pulling, weights
  • Tactile deep touch pressure, massage
  • Vestibular Linear movement, bouncing on ball,
    jumping on trampoline, riding bike

Sensory Strategies Used in Schools
Activity or Equipment Sensory System Purpose/criterion
Weighted vest P,T Calming, organizing, attending. Adhere to protocol
Weighted lap-pads or snakes P,T Calming, organizing, attending
Pressure vests P,T Calming, organizing, attending. Offers sustained input
Wiggle cushions V, T Facilitates attending. Allows movement while remaining in seat.
Quiet or safe area in classroom Designed to target 1or more systems Allows student to control need to re-group, chill-out, prepare for unscheduled event. Favorite calming act.

Sensory Input Calming Alerting
General Characteristics Mild/Soft Slow/ Rhythmical Simple/ Familiar/ Expected Low Demand/ Assoc. Strong/ Pronounced Fast/ Jerky/ Non- rhythmical Complex/ Busy Unfamiliar/Unexpected High Demand/ - Assoc.
Movement Vestibular, Proprioception/ Kinesthetic Slow rocking, swinging Heavy work pushing, pulling Fast rocking, swinging Bouncing/ Jumping
Tactile Firm, steady pressure or weight Student prepared Warm neutral Soft/ Smooth Light or erratic touch Student unprepared Cold/ Stiff/ Scratchy
Auditory Soft/ Slow Classical, soft rock, some jazz Static/ White noise Loud/Fast/Non-rhythm Hard rock/ Rap
Visual Neutral or soothing colors Simple/ Soft lighting Bright or loud colors Busy/ Bright lighting
Smell Soft pleasant smells Strong or noxious odors
Taste Sucking/ Sweet/ Bland Crunchy/ Cold/ Bitter/ Spicy
Sensory Supports
  • Sensory stories
  • The Alert Program
  • Drive Thru Menus Exercise Programs
  • Stickids
  • Sensational Brain
  • Equipment- tramps, pressure vests, weighted
    vests, blankets, fidgets, swings, dynamic
    seating, etc.

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Additional Resources
  • Scool Moves for Learning Enhance Learning
    Through Self- Regulation Activities
  • Wilson, Debra Em and Heiniger-White, Margot C.
  • More Minute Moves Seven Weeks to Classroom
    Management Success
  • Wilson, Debra Em
  • Too Loud, Too Bright, Too Fast, Too Tight What
    to do if you are Sensory Defensive in an
    Overstimulating World
  • Heller, Sharon
  • Sensory Secrets How to Jump-start Learning in
  • Schneider, Catherine Chemin
  • Oh Behave! Sensory Processing and Behavioral
    Strategies A Practical Guide for Clinicians,
    Teachers and Parents
  • Trott, Maryann Colby
  • Self- Calming Cards
  • Crary, Elizabeth and Katayama, Mits
  • Sensory Challenges and Answers
  • Grandin, Temple
  • Building Bridges Through Sensory Integration
    Therapy of Children with Autism and Other
    Pervasive Developmental Disorders
  • Ellen Yack, Paula Aquilla, Shirley Sutton
  • Need assistance locating these or other
    resources, contact Cindy Terry _at_
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