Tina Champagne, M.Ed., OTR/L March, 2010 Sensory Modulation
& Trauma-informed Care Slide 2 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)
Sensory Experiences Slide 3 Early Foundations: Sensory Integration
Sensory processing disorders were identified in the 1960s by Dr. A.
Jean Ayres 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. Slide 4 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 Lucy J. Miller * Sensory-based motor disorder -Postural
disorders -Dyspraxia www.spdfoundation.net/research.html Slide 5
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, McIntosh & Simon,
2001, p. 57) Slide 6 Therapeutic Use of Self: Most Important Tool
Primary therapeutic attitude to be used in professional
interactions: PACE PACE: Playfulness: light, relaxed, exaggerated
affect/cognition, smile, do unexpected Acceptance: non-judgmental,
unconditional Curiosity: not-knowing, open, interested, act of
discovery, surprised Empathy: feeling-felt, joined, in the world of
the other; give attention/expression to affect vitality (Dan
Hughes, 2004) Slide 7 Champagne, 2007 Evaluation & Treatment
Process Evaluation Intervention Planning Intervention
Implementation Re-assessment Outcomes D/C planning Treatment Teams
& Communication Systems Slide 8 Characteristics of Sensory
Stimulation Calming Alerting Familiarity Slow paced
Soothing/relaxing Even beats/rhythmic Positive associations
Continuity/predictability Mild intensity Simplicity Low demand
Novelty Fast paced Irritating Uneven beat Incongruity Negative
associations Unpredictability Moderate to high intensity Complexity
High demand Slide 9 General Sensory Systems Proprioception
Vestibular Tactile Auditory Visual Olfactory Gustatory Slide 10
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.
Slide 11 BOSU balance trainer: www.bosu.comwww.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
Proprioceptive Options Slide 12 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 Slide 13 Tactile/Touch 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) Slide 14 Light & Deep Pressure Touch Light Touch
Picked up by receptors close to skins surface/hair Often a faster
response Elicits attention; alerting May provoke strong emotional
response Deep Pressure Touch Receptors are further under the
surface of the skin Usually is in place longer; gives time for
cortical appraisal: how much, how long, where Can be very calming
Protocritic System: Light touch, pain, temperature Epicritic
System: Deep pressure touch, vibration Slide 15 Weighted
Modalities: Weve come a long way. Fun & Function Slide 16
Tactile Items Fidget items that vary in texture, material,
pliability Weighted blankets, lap pads, vests Soft blankets &
pillows; Art supplies; Games & puzzles Slide 17 Champagne, 2008
Tactile Stimulation Lotions or powders Bean bag chairs Weighted
blankets Wrapping in a blanket/sheet Bath/shower Shower brushes Use
of art supplies Hand hugs Therapeutic touch Pet therapy Vibrating
pillow Wikki sticks Hand/foot soaks Manicure/pedicure Grooming
activities Hand held massager Bean bag tapping Shoe (gel) inserts
Tactile manipulatives or fidgets Pressure garments Manipulation of
varied nature items Stereognosis activities Pen grips Slide 18
Multimodal Although we may choose to focus on one or a few sensory
areas, our experience is always multimodal! Slide 19 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 Awareness:
Practical Applications Slide 20 www.biocomtech.com/hrvscientific
Slide 21 Champagne, 2008 Emotion Regulation Emotion Mind Rational
Mind Wise Mind Linehan, 1993 Slide 22 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
Slide 23 Trauma Neurological changes SMD Behavioral Responses
Dysfunction Sensory Processing & Trauma When you change the way
you look at things, the things you look at begin to change. ~ W.
Dyer Slide 24 Champagne, 2008 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 Slide
25 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) Slide 26
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/ Slide 27 Sensory
Modulation Program Goal #1: Self-awareness Assessment, increasing
awareness Self-rating & reflection Consider impact on roles and
relationships Goal #2: Self-regulation: Explore, Plan &
Practice (Skill Development) Continue to explore alternatives
Practice, practice, practice Establish sensory diet Goal #3:
Self-regulation & Positive Change (Habit stabilization)
Consistent use brings feelings of competence Goal #4: Repertoire
Expansion (Skill Enhancement) As mastery increases, re-assessment
and continued skill enhancement further develops Slide 28 Sensory
Modulation Program Identify what is calming and what is alerting
Intensity Determine when to use calming or alerting strategies
Anxiety/tension Triggers/cravings Dissociation The role of DPTS:
teach strategies people can do for themselves Grounding &
centering techniques Prevention & crisis intervention Sensory
Diet Creation 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 Slide 29 Champagne, 2008 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 de- escalation
purposes Slide 30 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 Slide 31 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 Slide 32 Sensory Kits
1. 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 Self-soothing KitSobriety Kit Slide 33 The Alert
Program www.alertprogram.com www.alertprogram.com How Does Your
Engine Run? Ages 8-12 High Low Just Right ( Williams &
Shellenberger, 1994) Slide 34 Champagne, 2008 Physical Environment
It is necessary to recognize the influence of the environment on
functional performance and to promote the 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
Slide 35 Sensory Room Umbrella SENSORY ROOMS SENSORY MODULATION
ROOMS SENSORY INTEGRATION (SI) ROOMS SNOEZELEN ROOMS or
MULTI-SENSORY ENVIRONMENTS (Champagne, 2007, 2008) Slide 36 Sensory
Integration Rooms Slide 37 Snoezelen or Multi-sensory Environment
Slide 38 Baystate Medical Center, Springfield, MA USA Slide 39
Sensory Modulation Room Cooley Dickinson Hospital Slide 40
Champagne, 2008 Sensory Mod Room - CDH Slide 41 Champagne, 2008
Program Evaluation Quality Improvement: SENSORY ROOM STUDY #1: 2003
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.
General Results: 89% reported: + results 1% reported: change 10%
reported: no change (Champagne & Stromberg, 2004) STUDY #2:
conducted in 2004: results very similar Slide 42 Sensory Carts
Slide 43 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 Slide 44 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:
[email protected]@chd.org Web:
www.ot-innovations.comwww.ot-innovations.com
