Sensory Modulation Traumainformed Care Tina Champagne M Ed

Sensory Modulation & Trauma-informed Care Tina Champagne, M. Ed. , OTR/L March, 2010

Sensory Experiences The experience of being human is embedded in the sensory events of our everyday lives (Dunn, 2001) Sensations are nourishment for the nervous system (Ayres, 1979)

Early Foundations: Sensory Integration Sensory processing disorders were identified in the 1960’s by Dr. A. Jean Ayres recognized the impact of neurological and psychiatric disorders upon the ability to play, learn and develop healthy attachments in children. Her early studies of early brain trauma in animals led her to believe that children may also have similar responses to trauma.

Sensory Processing The way the nervous system receives, organizes and understands sensory information - Includes information from within the body and the physical environment Sensory Processing Disorder *Sensory modulation disorder -Sensory over-responsivity -Sensory under-responsivity -Sensory seeking *Sensory discrimination disorder *Sensory-based motor disorder Lucy J. Miller -Postural disorders -Dyspraxia www. spdfoundation. net/research. html

Sensory Modulation “ …the capacity to regulate and organize the degree, intensity, and nature of responses to sensory input in a graded and adaptive manner. This allows the individual to achieve and maintain an optimal range of performance and to adapt to challenges in daily life. ” (Miller, Reisman, Mc. Intosh & Simon, 2001, p. 57)

Therapeutic Use of Self: Most Important Tool • Primary therapeutic attitude to be used in professional interactions: PACE • PACE: ü Playfulness: light, relaxed, exaggerated affect/cognition, smile, do unexpected ü Acceptance: non-judgmental, unconditional ü Curiosity: not-knowing, open, interested, act of discovery, surprised ü Empathy: feeling-felt, joined, in the world of the other; give attention/expression to affect vitality (Dan Hughes, 2004)

Evaluation & Treatment Process Evaluation Intervention Planning Intervention Implementation Re-assessment Outcomes D/C planning Treatment Teams & Communication Systems Champagne, 2007

Characteristics of Sensory Stimulation Calming Alerting Familiarity Novelty Slow paced Fast paced Soothing/relaxing Irritating Even beats/rhythmic Uneven beat Positive associations Incongruity Continuity/predictability Negative associations Mild intensity Unpredictability Simplicity Moderate to high intensity Low demand Complexity High demand

General Sensory Systems Proprioception Vestibular Tactile Auditory Visual Olfactory Gustatory

Proprioception Sensations derived primarily from receptors surrounding muscles, tendons, ligaments and in joint receptors; Movement against resistance Affords the ability to feel “grounded”/self-organized, contributes to spatial awareness, bodily boundaries, body image & movement sense (tone & control of effort). Where am I? What am I doing? Helps one feel “anchored. ” DEEP PRESSURE: Often helps to dampen over-arousal Examples: isometric exercises, pacing/walking, moving furniture, sports, playing on a jungle gym or rock climbing wall, weighted vest, tug of war, etc.

Proprioceptive Options §BOSU balance trainer: www. bosu. com §Exercise bands; exercise equipment §Exercise bike; treadmill §Yoga; Tai chi §Use of therapy/exercise balls §Stress balls/hand tools §Climbing, push/pull activities; sports §Jumping rope/hopping activities/stomping feet §Games with clapping; Pencil grips §Obstacle course; scavenger hunt; nature walk §Clay work/putty; hand exercisers Releases endorphins if input is strong and sustained

Vestibular Sensation derived largely from stimulation to the vestibular mechanism of the inner ear Vestibular Nerve (VIII Cranial Nerve - PNS) Stimulation occurs through changes in positioning and movement Contributes to a sense of body position in space - direction and rate of movements posture and muscle tone the maintenance of a stable visual field bilateral coordination provides a sense of equilibrium/balance gravitational awareness (Bundy, Lane, Murray, 2002) Caution: Watch for autonomic responses

Tactile/Touch receptors: to touch or perceive being touched; pain, vibration, temperature Functions: protective & discriminative Skin is the largest sense organ Helps to discriminate between different kinds of tactile stimulation Contributes to sense of body boundaries Self-initiated touch Contributes to body image Alerts the system to potential threat(s)

Light & Deep Pressure Touch Protocritic System: Light touch, pain, temperature Epicritic System: Deep pressure touch, vibration Light Touch Deep Pressure Touch Picked up by receptors Receptors are further close to skin’s under the surface of surface/hair the skin Often a faster response Usually is in place Elicits attention; alerting longer; gives time for cortical appraisal: how May provoke strong much, how long, where emotional response Can be very calming

Weighted Modalities: We’ve come a long way…. Fun & Function

Tactile Items • Fidget items that vary in texture, material, pliability • Weighted blankets, lap pads, vests • Soft blankets & pillows; Art supplies; Games & puzzles

Tactile Stimulation Lotions or powders Hand/foot soaks Bean bag chairs Manicure/pedicure Weighted blankets Grooming activities Wrapping in a blanket/sheet Hand held massager Bath/shower Bean bag tapping Shower brushes Use of art supplies Hand hugs Therapeutic touch Pet therapy Shoe (gel) inserts Tactile manipulatives or Vibrating pillow Wikki sticks fidgets Pressure garments Manipulation of varied nature items Stereognosis activities Pen grips Champagne, 2008

Multimodal Although we may choose to focus on one or a few sensory areas, our experience is always multimodal!

Awareness: Practical Applications Helps us to better understand… • “Difficult” or odd behaviors • What to look for (symptoms & behaviors) How to support each client to foster success How to create sensory modulation spaces How to enhance programming Correlations with DBT and other programs • •

www. biocomtech. com/hrvscientific

Emotion Regulation Emotion Wise Rational Mind Linehan, 1993 Champagne, 2008

Trauma • National MH Initiatives: trauma-informed & recovery-focused care; restraint reduction (USDHHS, 2003; NETI, 2003) • Trauma-informed care is a therapeutic approach that incorporates: • Appreciation for the high prevalence of traumatic experiences among consumers • An understanding of the profound neurological, biological, and social effects of trauma and violence • Care that recognizes and addresses trauma-related issues, is collaborative, supportive, and skilled

Sensory Processing & Trauma Dysfunction Trauma Behavioral Responses Neurological changes SMD When you change the way you look at things, the things you look at begin to change. ~ W. Dyer

DESNOS Model • Luxenberg, Spinazzola, Hidalgo, Hunt & van der Kolk (2001) promote a three-phase guideline for working people with complex trauma and disorders of extreme stress NOS (DESNOS) • 3 Phases: 1. Stabilization 2. Processing & grieving 3. Integration & transcendence: deeper reconnection and reintegration with the world/ others Champagne, 2008

Sensory Defensiveness Case In Point: Sensory Defensiveness Highly explored phenomenon in OT There are many reasons for sensory defensiveness Genetic predisposition Developmental Influence Trauma History: different sources & types of abuse Neglect: sensory deprivation May occur in just one, several, or all sensory systems (Kinnealey & Fuiek, 1999; Kinnealey, Oliver & Wilbarger, 1995; Pfeiffer & Kinnealey, 2003; Smith, et al. , 2005)

Sensory Modulation Program (Champagne, 2006, 2008) Sensory Modulation Program: sensory focus is used during both assessment and treatment intervention: Therapeutic use of self Sensorimotor activities Sensory modalities Environmental modifications Assessment, exploring sensory tendencies and preferences, creating sensory diets (individual and programmatic), use of sensorimotor activities and modalities, modifying the physical environment, educating caregivers/community providers. http: //www. ot-innovations. com/content/view/38/28/

Sensory Modulation Program • Goal #1: Self-awareness • • Goal #2: Self-regulation: Explore, Plan & Practice (Skill Development) • • Continue to explore alternatives Practice, practice Establish sensory diet Goal #3: Self-regulation & Positive Change (Habit stabilization) • • Assessment, increasing awareness Self-rating & reflection Consider impact on roles and relationships Consistent use brings feelings of competence Goal #4: Repertoire Expansion (Skill Enhancement) • As mastery increases, re-assessment and continued skill enhancement further develops

Sensory Modulation Program Identify what is calming and what is alerting Determine when to use calming or alerting strategies Grounding & centering techniques Prevention & crisis intervention Sensory Diet Creation Anxiety/tension Triggers/cravings Dissociation The role of DPTS: teach strategies people can do for themselves Intensity Safety kits, back packs, etc. Integrating other treatment modalities/protocols Prevention & crisis intervention techniques Help consider environmental modifications for the unit, home, school, therapy & work

Sensory Diet Term coined by Patricia Wilbarger, OTR/L that refers to those things we all use/do throughout each day to help ourselves self-regulate and engage in meaningful life roles and activities. Used for: prevention, maintenance & crisis deescalation purposes Champagne, 2008

Sensory Diet: Daily Schedule & Transitions Examples of Considerations: Daily Flow of Events Daily structure/schedule Before activities of daily living Before &/or at the end of each class The timing of transitions (change of class, change of shift) How these transitions occur Preparation prior to transitions Add isometrics/“heavy work”; Use of music/movement Distraction techniques/activities Use of sensory room or cart items Visual charts; use of music or movement activities

Sensory Diet: Strategic Planning Programming Sensorimotor Activities Relaxation Techniques Weighted modalities Art Therapy Brushing or Tapping Music & Sound Therapy Sports/exercise activities Pet Therapy Aromatherapy Playing an instrument Use of items in the sensory room

Sensory Kits Help the person identify a theme 2. Decorate/personalize it 3. Brainstorm what to put in it 4. When to use it/what to do when it is not available 1. “Sobriety Kit” “Self-soothing Kit”

The Alert Program www. alertprogram. com How Does Your Engine Run? Ages 8 -12 High Just Right Low (Williams & Shellenberger, 1994)

Physical Environment It is necessary to recognize the influence of the environment on functional performance and to promote therapeutic and skilled use of environment to enable participation in meaningful life activities (Letts, Rigby & Stewart, 2003) Environmental Enhancements: Examples of environmental considerations include: Safety Complexity Functionality Aesthetics Population Specific Champagne, 2008

Sensory Room Umbrella SENSORY ROOMS SENSORY MODULATION ROOMS SENSORY INTEGRATION (SI) ROOMS SNOEZELEN ROOMS or MULTI-SENSORY ENVIRONMENTS (Champagne, 2007, 2008)

Sensory Integration Rooms

Snoezelen or Multi-sensory Environment

Baystate Medical Center, Springfield, MA USA

Sensory Modulation Room Cooley Dickinson Hospital

Sensory Mod Room - CDH Champagne, 2008

Program Evaluation Quality Improvement: SENSORY ROOM STUDY #1: 2003 n Random data collection recording the effects of sensory-based treatment delivered in the sensory room with 46 people with varied diagnoses and cognitive abilities, over a total of 96 sessions. n General Results: n n n 89% reported: + results 1% reported: – change 10% reported: no change (Champagne & Stromberg, 2004) STUDY #2: conducted in 2004: results very similar Champagne, 2008

Sensory Carts

People may not remember exactly what you did, or what you said, …but they will always remember how you made them feel. - Unknown "Never doubt that a small group of concerned citizens can change the world. Indeed it's the only thing that ever has. ” - Margaret Mead YOU, THE CLIENTS & CAREGIVERS ARE THE CULTURE CHANGE

Contact Information: Tina Champagne, M. Ed. , OTR/L OT Program Director Institute for Dynamic Living 342 Birnie Avenue Springfield, MA USA Phone: (413) 439 -2170 Email: TChampagne@chd. org Web: www. ot-innovations. com