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Sensory Modulation & Trauma-informed Care

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

2 Sensory Experiences (Dunn, 2001)
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)

3 Early Foundations: Sensory Integration
Sensory processing disorders were identified in the 1960’s 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.

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

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)

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)

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

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

9 General Sensory Systems
Proprioception Vestibular Tactile Auditory Visual Olfactory Gustatory

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. 10

11 Proprioceptive Options
BOSU balance trainer: 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 11

12 Caution: Watch for autonomic responses
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 12

13 Tactile/Touch Skin is the largest sense organ
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) 13

14 Light & Deep Pressure Touch
Protocritic System: Light touch, pain, temperature Epicritic System: Deep pressure touch, vibration Light Touch Picked up by receptors close to skin’s 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 14

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

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

17 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 Champagne, 2008 17

18 Multimodal Although we may choose to focus on one or a few sensory areas, our experience is always multimodal! 18

19 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

20 20

21 Emotion Regulation Wise Mind Emotion Mind Rational Mind Linehan, 1993
Champagne, 2008 21

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 22

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

24 DESNOS Model 3 Phases: 1. Stabilization 2. Processing & grieving
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 24

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) 25

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. 26

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 27

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 28

29 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 Champagne, 2008 29

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 30

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

32 Sensory Kits Help the person identify a theme Decorate/personalize it
Brainstorm what to put in it When to use it/what to do when it is not available “Sobriety Kit” “Self-soothing Kit” 32

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

34 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 Champagne, 2008 34

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

36 Sensory Integration Rooms

37 Snoezelen or Multi-sensory Environment

38 Baystate Medical Center, Springfield, MA USA

39 Sensory Modulation Room
Cooley Dickinson Hospital

40 Sensory Mod Room - CDH Champagne, 2008 40

41 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 Champagne, 2008 41

42 Sensory Carts

43 YOU, THE CLIENTS & CAREGIVERS
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

44 Contact Information: Tina Champagne, M.Ed., OTR/L OT Program Director Institute for Dynamic Living 342 Birnie Avenue Springfield, MA USA Phone: (413) Web:


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