1. Sensory Motor Approaches with People with Mental Illness

2. Surprise!! Sensory motor approaches are not just used with children!!
There can be sensory motor issues throughout life
There can be sensory motor issues related to multiple illnesses and injuries

3. Sensory Systems According to Ayres
Primary Level: Three basic sensory systems
Vestibular (Ayres viewed this as the unifying system)and Proprioceptive:
facilitates gravitational security
Involved with balance, eye movements, posture, muscle tone
Tactile:
facilitates emotional bonding and attachment to mother
Can facilitate calming and comfort

4. Sensory Systems According to Ayres
Vestibular, Proprioceptive, and Tactile Systems:
Responsible for grounding the person and for giving him or her the necessary information needed to orient the self to the environment and prepare for an adaptive response

5. Sensory Systems According to Ayres
Second Level:
Three basic senses (vestibular, proprioception, and tactile) are integrated into:
Body precept (maps of the body stored in the brain)
Coordination of two sides of the body: allow bilateral work to accomplish tasks
Plan motor actions
Attention and focus: issues are reflected by hyper or hypoactivity

6. Sensory Systems According to Ayres
Third Level:
Impact of auditory and visual sensations make the following possible:
Speech and Language: begins with primary level sensory systems and builds on these
Eye-hand Coordination: begins with primary level sensory systems and builds on these with the visual system directing the hand
Visual Perception: intimately related to tactile and vestibular systems and is believed to be the end product of earlier sensory integration
Purposeful Activity

7. Sensory Systems According to Ayres
Fourth Level is resultant end products of sensory integration:
Ability to organize and concentrate
Self-esteem
Control and confidence
Academic learning ability
Capacity for abstract thought and reasoning
Development of dominance and hemispheric specialization

8. Sensory Systems According to Ayres
Beliefs
Adaptive Response or Self-Adjusting Process
Sensory Modulation: the brain organizes incoming sensory information
Brain inhibits or facilitates the flow of messages across nerve junctions and synapses
The repeated use of nerve pathways in a sensorimotor function creates a neural memory or map of that function
The brain can recreate the movement at other times

9. Sensory Systems According to Ayres
Beliefs:
Hierarchical View: Must work developmentally and sequentially
For example, don’t teach hand movement to improve eye-hand coordination unless you’ve started with integration of vestibular, proprioceptive, and tactile, the early systems

10. Sensory Integration Interventions
Goal of S.I. Intervention:
Improvement in CNS processing, specifically in production of adaptive response instead of isolated skill development
Treatment:
Sensory input within an environment that it can be modulated
Specific techniques to supply sensory input, e.g, joint compression, rotary vestibular stimulation

11. New Theoretical Approaches Since 1970s in Contrast to Ayres
Systems view of the brain in which the brain is an integrated, holistic system.
Sensory integrative dysfunction is due to multiple interrelated systems that are not functioning optimally
Trend is to combine S.I. with other approaches, like humanistic psychology
Ross: Incorporate neurodevelopmental approaches, e.g., NDT, with sensory stimulation

12. Sensory Systems According to King
Lorna Jean King’s (One of Jennifer’s and Robin’s favorites!) focus on Schizophrenics
Observed patients to determine sensory seeking
Linked vestibular system abnormalities with physical characteristics similar to Ayres’ children:
Poor muscle tone
Dislike of movement (fear of falling)
Lack of response to vestibular input
Limited mobility of the head
“S” curvature of the spine (lordosis)
Shuffling gait
Holding arms and legs in a flexed, adducted, and internally rotated position
Poor balance
Weak grip strength and atrophy of thenar eminence

13. Sensory Systems According to King
King’s hypotheses:Schizophrenic clients have:
Defective proprioceptive feedback mechanisms and under-reactive vestibular systems
Patient use sensory input effectively to determine position in space
Patients are unable to move fluidly
Patient limits movement and this causes more problems
This leads to decreased engagement in physical activity and discomfort in social situations
Movement and sensation play central roles in altering biochemical states and biochemistry in turn affects movement

14. Interventions According to King
Pleasurable, noncortical activities: Start subcortically by doing activities that increase proprioceptive and vestibular input, e.g., dance
Goal is to normalize movement patterns, strengthen upper trunk stability, and increase flexibility
Changes in these areas will lead to improvements in body image, self-confidence, attention, social skills
Changes are the foundation for building cognitive and daily life skills

15. Problems with King’s Theories
No standardized assessment tools to evaluate S.I. in adults
Lack of evidence-based practice: studies were inconclusive

16. Sensory Motor Strategies
Consider alerting versus calming sensations
Control the amount of sensory input within the environment
Therapist’s role is to be directive, yet, have fun and be spontaneous

17. Goals of Sensory Motor Treatment
Provide sensory stimulation and opportunities for adaptive responses
Focus on muscle tone, posture, and motor planning
Provide motivation to participate through sensory input
Start with lower cognitive skills to build higher ones
Provide multiple opportunities for practice of functional tasks
Reinforce achievements

18. Proponents and theorists: Winnie Dunn and Catana Brown
Developed Adolescent and Adult Sensory Profile
Brown-found individuals with schizophrenia had higher scores on low registration and sensation avoiding, and lower scores on sensation seeking than people without a mental illness
schizophrenia

19. Alert Program
Williams and Shellenberger – developed in 1996, use with children 8-12 with learning disabilities
Purpose – teach to develop self-awareness of their bodies, a vocabulary, and self-regulation sensorimotor strategies to maintain appropriate arousal levels to improve participation during activities.
Self-regulation is defined as “the ability to attain, maintain, and change arousal appropriately for a task or situation” (Williams and Shellenberger, 1996).
Williams and Shellenberger- developed in 1996, use with children 8-12 with learning disabilities.
Purpose- teach to develop self-awareness of their bodies, a vocabulary, and self- regulation sensorimotor strategies to maintain appropriate arousal levels to improve participation during activities.
Self-regulation is defined as “the ability to attain, maintain, and change arousal appropriately for a task or situation” (Williams and Shellenberger, 1996)

20. Taylor/Trott Pyramid, 1991

21. Top Down vs. Bottom Up Bottom Up Top Down
assume that if foundational motor skills are developed, motor control will emerge and task performance will be improved. Taylor/Trott Pyramid would be an example of bottom up approach.
assume that the motor requirements for any task are variable, motor control for a particular task becomes more efficient when one understands what is expected. Often referred to as cognitive approaches since the emphasis in therapy is upon assisting one to identify, develop and utilize cognitive strategies to manage daily tasks more effectively.
Put what it is
Why top down vs bottom up
Some people will not have cognition to learn to self-regulate so it is important to train the caregivers

22. Alert Program
There are three orders of self-regulation that develop throughout the lifespan (Williams & Shellenberger, 1996).
The first order, the most primitive, involves the autonomic, reticular, and limbic systems – primal, first to develop.
The second order of self-regulation is developed throughout infancy and childhood. Infants develop and use sensorimotor strategies to attend to a desired task, such as sucking, swallowing, and breathing, to adapt to their environments and self-organize.
The third order of the Arousal Theory requires abstract problem solving skills and insight. The Alert Program® uses the third order of self-regulation to teach clients become aware of their sensory needs and use second order strategies to self-regulate (Williams & Shellenberger, 1996).

23. Research First study Clark, Pritchett, Vandiver……
Does the AP increase communication and interaction skills with adults with CPMI
Community mental health program – day Peer support
Started with 12 participants, ended up with 8
Did a pilot study to establish procedures, parameters and inter-rater reliability
AP adapted protocol was implemented 2x weekly for a total of 6 sessions (with baseline and post-test)
Dx:

25. Research Second study Link, Parkman, and Frame
Effects of the AP on the communication and interaction skills of adults with DD that display atypical sensory processing during group activities
Community-based day program for adults with DD
14 participants
Did 2 small pilot studies to establish procedures, parameters and inter-rater reliability
AP adapted protocol was implemented 2x weekly, for 7 weeks, total of 14 sessions
THE EFFECTS OF THE ALERT PROGRAM® ON THE COMMUNICATION AND INTERACTION SKILLS OF ADULTS WITH DEVELOPMENTAL DISABILITIES (DD) WHO DISPLAY ATYPICAL SENSORY PROCESSING DURING GROUP ACTIVITIES

26. Findings
Clinically significant but lacked number of participants to give enough power for statistical significance
Increased interactions b/t peers
Voiced she is more alert, but not hyper, after trying the movements
Noted that the voices he hears have gotten better due to techniques
Client stepped out of room because he felt too calm and others were getting on his nerves. Stated “this is finally something that makes me calm” during touch protocol
Scores highest during mouth, then move, then touch and lowest for look and listen (repeated measures ANOVA) to determine which protocol has most impact on ACIS scores.

27. Findings/Field notes
Mouth protocol was the favorite within the group and had the most affect on the ACIS scores
Second favorite was touch, which had the second most affect on ACIS scores
Per field notes, touch had the most calming response overall
Sour worms/sweet candy-more engagement with one another
Crunch foods were calming for clients
Participants that chewed gum during check-in appeared more alert and attentive.
Few participants wanted to try the beach balls or exercise balls as they were scared the balls would pop
Turning lights on/off made * sick.
Participants enjoyed the floor lamps rather than the overhead lights

28. Feedback from consumers included:
What do you feel is different from now than before?
I feel more alert
I listen to music now
I now take a pen and paper to church with me so I won’t fall asleep
I feel more calm now because of the techniques
I’m dealing with stress better
I’m being more positive

29. Research Second study Link, Parkman, and Frame
Effects of the AP on the communication and interaction skills of adults with DD that display atypical sensory processing during group activities
Community-based day program for adults with DD
14 participants
Did 2 small pilot studies to establish procedures, parameters and inter-rater reliability
AP adapted protocol was implemented 2x weekly, for 7 weeks, total of 14 sessions
THE EFFECTS OF THE ALERT PROGRAM® ON THE COMMUNICATION AND INTERACTION SKILLS OF ADULTS WITH DEVELOPMENTAL DISABILITIES (DD) WHO DISPLAY ATYPICAL SENSORY PROCESSING DURING GROUP ACTIVITIES

30. Findings
13 participants displayed an increase in skills during the data collection period;
12 participants had predicted results of future communication and interaction skills;
11 participants showed an increase in skills over the predicted period;
7 participants had statistically significant results
Used SPRE- single-subject semiparametric ratio estimator design. Used as it measures participants’ performance over time then determines a change point so that predictions of future outcomes may be made (Weissman-Miller, Shotwell, & Miller, 2011)

32. Reason chose AP-gave me a language and tools to make this accessible to clients, caregivers etc

33. Move- Vestibular/Proprioceptive
Yoga – stretching, positioning, body alignment, balance, breath (also under Tools for the Mouth)
Brain Gym
Dancing
Exercise
Rocking
Swimming
Chores (raking leaves, mopping)
Anything that makes the head move in space

34. Tools for the Mouth
Action: Chewing, sucking, licking, biting, pulling, blowing
Feel/Taste: resistance, crunching, taste, temperature
Breathing
Smoking
Bubbles
Straws
Taste (spicy, sweet, sour, salty)

35. Look Sunglasses Eliminating florescent lighting/dimmers Visor/cap
Cozy shades
Aquarium/oil and water
Elderly and lighting intensity (soft white, warm)
Glare screen

36. Listen Experiment with different genres of music Playing instrument
Reduction/elimination of sound – headphones
White noise

37. Touch Weighted items/garments Textured bins Wilbarger
Clothing-texture and weight of clothing
Light touch/heavy work
Fidgets
Pets

38. So what do you do now? Educate caregivers on language How to implement
Build strategies into functional activities

39. Precautions Seizures Down Syndrome Trauma
Use caution when using lights, rotary movement, and aromatherapy with known history of seizures
Down Syndrome
Weighted items
A1-A1 instability
Trauma
Smells can elicit trauma
Follow vestibular input with proprioceptive input
Pure oils