Primitive reflexes and RMT -What exactly is it ?

We all learnt about reflexes when we were in school- they were called as reflex actions.

Some examples of reflexes are

blinking of our eyes when something comes close to our eyes,
sneezing,
coughing,
Shivering
yawning

These reflexes are automatic and happen without your thinking-it is something on which you do not have control upon. They are protective in nature and they help us. Reflexes are also present in animals.

So what are Primitive reflexes?

· As you know the word primitive means crude or old.
· Reflex means something that happens without our conscious control like sneezing.
· And as I link the words together, a primitive reflex means something which is very crude and happens automatically which is not under your control.

In very simple terms, it means like using an old bulky slow computer of the 80’s in the age of sleek and fast processing laptops. Child is born with these reflexes until they mature by one year of age and the control of these primitive reflexes are released and the higher centers of brain take over. As the connections develop, the HOLD of the primitive reflexes on the body decreases. But if the connections do not develop, then these reflexes stay active and do not allow the other systems to express themselves.

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It is like many ministers of various states fighting to exert control. Each minister is in control of a particular state (part of the brain) which is assigned to them. These ministers have to be in sync and manage the functioning of the country (brain). But instead of working together to bring about efficient functioning of the country (brain), they all dominate their own self defined rules which makes it difficult for the country to prosper. To develop the synchronicity, these primitive reflexes need to be integrated and connections need to be established with higher centres. This happens when we do primitive reflex integration.

So what happens in primitive reflex integration?

It means allowing your child’s system to upgrade from old bulky slow computer of the 80’s to sleek and fast processing laptops. It also means that now all the ministers are in complete coordination with each other to bring about increased efficiency.

I am sure you will agree that the functionality is very different and so it will be for your child. You will be able to release the control of primitive reflexes of the lower brain centers through integration as the brain starts linking up. As the control releases, more independence and higher level control is achieved which leads to more of desirable behaviors by your child

You may be wondering how the retained primitive reflex manifests . So here it is

Fear Paralysis Reflex- This causes shut down of the systems when faced with stress or any kind of change. It causes mutism, shyness in social situations, depressions, constantly feeling overwhelmed, very fearful of any kind of change- fear of separation from a loved one, sleep and eating disorders.

Moro reflex – Retained Moro reflex causes rigid behaviour patterns, hypersentivity to light, sound, taste, touch or smell, resistant to changes or transitions, allergic to specific food substances, fluctuations from extreme hyperactivity to extreme fatigue, reading and writing difficulties.

ATNR – Retained ATNR causes difficulties in reading, writing and math skills. It also causes confused handedness – uses both hands for writing, eating etc.

SGR – Retained SGR reflex causes difficulties like bed wetting and wriggling behaviors ( like ants in the pants) which causes hyperactivity and fidgety behaviours making it difficult to pay attention.

TLR – Retained TLR reflex causes difficulties with space, understanding the relations of space such as up-down, right -left, difficulty in judging space and the speed of movement, toe walking, hunched posture and coordination difficulties.

What is RMT?

RMT is a short form for Rhythmic Movement training. It was developed by a psychiatrist Dr. Harold Bloomberg in 1980’s on the basis of work of Kerstin Linde when he saw that rhythmic movements had remarkable differences in his patients with psychiatric conditions. He also studies with other movement specialists. Moira Dempsey, an Australian Educational and Developmental kinesiologist became interested in the role of retained reflexes in learning and behavioural challenges in the mid 1990’s. Moira Dempsey met Dr. Blomberg in 2003 and started using the movements herself and with clients. She noticed remarkable results.

When the rhythmic movements are given, it helps to develop connections in the brain which were not developed before. These movements help in linking the different parts of the brain with each other which helps in efficient functioning of the brain. It also helps to integrate primitive reflexes.

If there has to be an analogy then, I see the rhythmic movements to be like water and fertilizers for the plant to grow. As the movements are done, new connections grow just like branches of a plant and help to synchronise the functioning of the brain.

The movements need to be planned by a therapist who is trained in RMT. Two or three movements are started initially and changed every 15 days to a month depending on how the body responds to them. Results can be seen within 10 days to a month. To maintain the results, the movements need to be done for a period of 12 -18 months. We combine RMT at khushi with other treatment approaches.

If there is a history of seizures the movements have to be very carefully monitored and done with neurologist’s opinion. Also, caution needs to be taken while doing it with kids with Downs syndrome.

When the brain starts linking up because of the rhythmic movements, the body starts releasing toxins and muscle tension. This causes side effects which may be physical or emotional in nature. These effects suggest that linking is happening and helping. However, if the side effects are not manageable, then you need to follow up with your consultant and change or decrease the movements as needed.

RMT is not necessarily to be done for kids but it can be done for anyone who has active primitive reflexes.

Reena Singh

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Lets understand Sensory Integration!

It is a term coined by the Occupational therapist Jean Ayres

Before we go into the theory of Sensory integration, lets read a story on how sensory integration helps in forming beautiful and wonderful memories of childhood!!!

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Ruhie is a little girl who has just come back from school and she jumps in the puddles. Sometimes the water in the puddles was lots and sometimes it was really mucky. Ruhie would sit into the puddle and dig her hands into the muck. With these hands, she pushed her hair behind as they came over her face. Enjoying the gooey muck, she knew how to zoom the lenses of her eyes and focus only on the swing in the midst of so many children running and jumping around, sometimes occluding her view of the swing. Her vision was sharp like that of the eagle’s who will grab her swing immediately as someone vacated it. Then she would sit on the swing and enjoy the movement till it was full for her. And then amongst the sounds of birds chirping and the children playing, she hears her mom calling. So Ruhie runs back home. As soon as she entered the house the smell of the yummy food pulled her towards the kitchen when she was asked to wash her hands and face. And then once all clean, she got to relish the delicious meal. She ends her day by finishing her homework.

You must be wondering what Sensory integration has to do with all of the above- All that Ruhie did above was sensory integration. Read this along to know as I explain.

1. Proprioception and jumping in the puddles –
Ruhie could jump because she has an intact proprioceptive sense that helped her to decide how hard or gently to jump.
Proprioceptors are present in all the joints of our body. They help us to understand the position of body in space and also helps to grade the movement.

2. Tactile sense and Jumping in the mucky water-
Gave Ruhie the tactile input.
Tactile sense is the sense of touch which tells us what are we touching or where are we getting touched.
It also tells us the pressure of the input.
Touch helps us to understand the world.

3. Vestibular sense and swinging –
Helped Ruhie develop vestibular sense.
This is the sense which is present in our inner ears. It tells us about movement of body in space and also the kind of movement. So it tells us whether we are on a swing or a car or a roller coaster ride and guess what ….it also tells the speed.

4. Vision-
While Ruhie played in the muck or the mud, her eyes were glued on the swing.
This is the visual system which tells us how to focus on what we want and ignore other distractions.

5. Auditory-
While Ruhie played amongst the sounds of children shouting and screaming, crow cawing away, she was very clearly aware of her mom calling her!!
This means that we have the ability to separate ambient sounds from focal sounds.

6. Olfactory-is the sense of smell which helped Ruhie know what was cooked for dinner.

7. Gustatory- is the sense of taste helped her to relish the food.

8. Interoception- It is the sense responsible for detecting internal regulation responses, such as breathing, hunger-thirst, bowel bladder and heart rate cycle.

What else was happening
1. Attention- as you read all of the things above, it must be clear about how attention is a by-product or fruit of the 8 systems working effectively.
2. Motor planning- this was needed for Ruhie to grab her swing whenever someone vacated it- the speed and the coordination of her body to run quickly. Motor planning is needed to wash hands, feet and face after she finished playing. And also to complete her home work. So a lot of motor planning is needed in our day to day tasks.
3. State of arousal- Even though Ruhie was very tired after school, playing in the playground was something that she could not never miss out. She could SELF REGULATE and keep herself active in the playground. But once she was home, she was dull and lazy- she had control over the knobs of arousal which helped her to be dull or active.

All the 8 senses were integrated, Ruhie will grow up challenging her limits and exploring her surroundings. She will want to re-live it.

Now what happens when the senses are not integrated- lets consider Ruhie again. One thing to remember is that whenever there is a sensory processing disorder- the sense will work less(hypo), more (hyper) instead of just right (optimal).

1. Jumping in the puddle may not happen because of poor motor planning or there may be a big need to just jump irrespective of anything else.
2. Jumping in the puddle may be avoided because of the texture of the mud or water.
3. Touching mucky or gooey things may be just impossible because of tactile defensiveness. Or the child seeks just that irrespective of anything else. Because of the tactile sense of being more or less, tastes are either seeked or avoided making them into picky eaters.
4. Swinging may be avoided completely or it may be the only thing that is seeked.
5. Because the child gets absorbed into the input, attention suffers.
6. Visual attention or looking around and focussing on what is needed may be difficult because of poor filtering.
7. Listening to mom’s call or any sound directed towards the child maybe ignored because the child is again absorbed into one of the senses intensely seeking it or completely avoiding it.
8. Lot of smell seeking is there or child is completely oblivious about it.
9. And then I am sure by now, you know what happens to play and forming connections. Everything is broken and shattered because there is no integration of senses.
10. There is poor self regulation or regulation of arousal states making it really difficult to fall asleep – child may fall into patterns of no sleeping, difficulty falling asleep, irregular timings of sleep and so on.
11. And then you can imagine what it will be like to live with an interoceptive system which does not tell you when you are hungry and how hungry are you. How much to eat and when to stop eating? This system also signals when to go to pee and poop.

So, coming back to sensory integration- it is a process by which all the senses work together to make sense of the world – wanting to live and enjoy the world and seek and make connections.

And when the senses are not integrated, or when an individual has a sensory processing disorder, life is difficult !!!!

The good news is that Sensory integration can be facilitated by occupational therapists by providing “just right” opportunities and kids can have a lovely childhood with memories to cherish for lifetime!!!

Reena Singh

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So how exactly should I control my child’s screen time?

Do you remember your childhood days?
I remember playing till I was dead tired….just running around!!
Sometimes pretend play and sometimes board games!!!
Then there was exploring nature and climbing trees…
So many of those games where hands and feet were dirty with mud and muck…
Sometimes watching the birds go home and sometimes gazing at the stars…
I was so very connected and rooted to mother earth.
I got the precious memories of being rooted and embracing my mother earth!

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And here comes me today, coming back home in the evening to greet my son and getting back to my whatsapp (screen) or my facebook (screen) !!!
Oh yes! The emails (screen) need to be answered also and so many calls to be returned.
And then I think I should just chill and relax ..so I put on the TV( Screen).
And then you know I have my sacred book of scriptures on my ipad (screen) so I will pray too!
And when thats done and my son plays down, I can read some great books on my kindle (screen)!!

And as my son plays around while I do all of the above,
I teach him that he is not supposed to watch too much TV!!
I teach him that he is not supposed to play on his ipad and that he should control himself and limit the time he spends on it!
I teach him that he is not supposed to see videos on my phone!!
I teach him that he is supposed to look at me and talk rather than answer while watching TV!!!

But is my son going to learn from WHAT I DO OR WHAT I TALK?????
I really need to think …
I know of all the ill-effects that screen time has on kids …
But is it not true for me????
Do I need to get back to my mother earth ?
Don’t I need to put a curfew on my screen time?
Don’t I need to stop all my screen work and look at him when he talks to me ?
Am I just blaming him or I need to be blamed?

I really need to think about this….AND WHAT DO YOU THINK?

Reena Singh

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Supporting kids with SPD during Diwali

Yay!!!!

The festival of lights has come….

So what is special about Diwali

  1. Vacations
  2. Lots of friends and relatives who come to us or we go to meet them
  3. New clothes
  4. Crackers and the noise of crackers
  5. Lots of homemade sweets and chocolates to munch on

While, I very strongly believe is that kids with Sensory Processing Disorder (SPD) should be “given opportunities” to participate in all the activities and create their own bank of memories for each event. However, in doing so, parents can play a key role to ensure that these memories are positive and not traumatic or painful. This can be done by understanding the needs of their kids and respecting their limits.

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Vacations:-

Kids with sensory processing issues need predictability in the midst of all the chaos that their body constantly presents them with. Routines help kids with SPD to establish predictability. During vacations, the routine is disrupted and also unpredictable which increases the stress levels for kids with SPD.  Increased stress levels make  children very vulnerable to meltdowns. The use of consistent approaches to daily schedules and carefully planned transitions can help a child adapt to daily expectations. This means that as a parent you need to ensure that you prepare and guide the child through the daily plan through pictures or text as per your child’s level of functioning. When the child is prepared for what is coming next, he will be able to flow through the day’s routine very easily even it is unpredictable.

Lots of friends and relatives who come to us or we go to meet them:

This helps because the child gets an exposure to meet new people and also learn from them. But if the child is not prepared for this kind of a situation, you may again experience tantrums and meltdowns. In such cases, a Social story on Diwali can help. Use of Visual Schedule will also help especially with a surprise card in the middle of the schedule which can be used when the visit of your guests is unexpected.

Also, when we attend to our guests, our kids feel ignored and they start engaging in unwanted behaviors to get attention. So, it will help if the kids get the attention and their presence is acknowledged while you have a conversation with your guests. Also, it is really important to make your child understand about how long the guests will stay. Some stay for days in which case it will be better to usecalendar and explain to the kids on the number of days that they would stay. In case, the guests will stay for an hour or so, then visual timers are very helpful. There are applications on iPad which have timers or even a simple sand clock timer would be good (which has 30 minutes or an hour). If your child can read time, then it will help to show them the analogue clock and explain the passage of time with the movement of the big hand on clock.

Doing these things will ensure that the kids have predictability in the middle of unpredictable situations.

New clothes:-

Most of the times kids have tactile issues which make it difficult for them to wear the Diwali kind of traditional clothes. In such a case, it will be preferred to respect their discomfort and allow them to wear what they are comfortable with. I am not meaning to say that this is how it will stay forever because most of these tactile issues can be worked upon but not at a time when everything else is also changing. It will be great if the traditional kurtas or the salwar kameez’s are tried at other times during the year while working on the tactile issues using Sensory integration.

Crackers and the noise of crackers:-

Many kids with SPD have sensitivity to the sounds and the sudden bursting of crackers makes it really worse because they are really unpredictable. The first thing to do will be to acknowledge that the reactions of the child due to the sound of crackers is real and not a tantrum. It can be taken care of by Therapeutic Listening. But when the sensitivity is not taken care of and you are already on the Diwali day, then other things can be done. Headphones and earplugs offer instant comfort and relief. Noise-canceling headphones are the most effective, because they replace irritating environmental noise by producing calming white noise. Earplugs are usually made of either foam or wax, and it is worth trying both types to determine which is more comfortable. You can take a break from your city and move to safe and quiet environments. You can show the child what the source of the sound is with small crackers such as gun rolls if comfortable. On several occasions, the anxiety of the child is because he does not know what the sound is and where is it coming from. I am sure you know the power of distracting your child. By giving them something like an iPad to focus on or an unusual privilege such as bringing along a favorite toy from home, it becomes possible to direct attention away from the offending noise.

 

Lots of homemade sweets and chocolates to munch on :

There are a lot of sweets that we eat during Diwali. It will be a good idea to give them in moderation to our kids. Research suggests that children are more sugar sensitive than adults, and the effects are more pronounced in younger children, according to Dr. Keith Conners, author of Feeding the Brain. This could be related to the fact that the brain grows rapidly in the preschool years, exaggerating the effects of sugar on behavior and learning. While studies show that activity levels go up in both hyperactive and normal children on high- sugar diets, the hyperactive children also become more aggressive.

 

Diwali is special and fun…so let’s make it fun for our kids as well….

Wishing you all a very happy Diwali…….

Reena Singh

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Occupational therapy and Children.

 

A lot of parents who come to meet me for the first time- ask me if I am an Occupational therapist? And when I answer yes – the question is “what do we do?” and what exactly is Occupational therapy?”

The main job responsibility of an Occupational therapist is to put the person back to his Occupation. Occupational therapists works with various strata of people right from schools to hospitals to geriatric care.

Since I have explored my role of an Occupational therapist with kids, I would like to describe more about how we help the kids. Also, my explanation or description is only about my experience and it does not in any way limit what Occupational therapists do in various other setups in which they specialize.

 

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Do kids really have an Occupation ?

Does Occupation mean only working to earn money or it means constructively and independently engaging in activities which we love?

Some of the roles in a child’s occupation are

To play and make friends

To take care of his own self care needs

To be able to learn in school

To be able to participate in all events or activities that happen in his or her community.

Does the child need any skill to be able to do the Occupation of a child?

What does he need to play?

Early social play- this is the play which is mostly initiated by adults in the form of silly sounds, peek a boo etc. Infants as young as 6 weeks start learning and setting the base for later language development. Infants learn to pay attention, understand the use of language by adults and learn to read the intentions of the care givers. There is a lot of base being set in play for future development.

Exploratory play- Child is learning to explore the environment through the sensori-motor play by banging toys, mouthing them, throwing them, smelling them and feeling them. They are little scientists in making who need the inquisitiveness and the intrinsic motivation to sustain the exploration and to make that exploration fun. Main focus is on their own bodies. They are developing a large repertoire of sensory experiences and also laying foundations for body scheme which will be needed for motor planning or praxis. Lot of learning is happening till this time roughly from 6 months to around 15 months of age.

Constructive play – They learn about cause and effect, simple fixing, pulling and stacking from around 12 months of age. In doing so, they are training their postural muscles, attention skills and also gross and fine motor skills. They are learning to effectively use their body while they are playing. The play becomes more goal oriented and they learn to expect results of making a tower of cups or blocks or stacking rings and completing them. Their little brains are also developing social connections of getting praised for their attempts and also a lot of language development is happening.

Pretend play- this starts as early as one year of age where the infant is holding a remote to his ear and pretending to talk on the phone. They are trying to eat from a empty bowl with a spoon or drink from an empty cup. First words emerge with pretend where they learn the names of objects that they play with. When a sequence of play is done, they learn to understand two word sentences and even understand “first- then” relationships.

Parallel play- Children play next to each other and not with each other. They learn by observing their peers. Lot of imitation skills develop at this stage. Their own basic level of pretend play is expanded and extended by observing other kids. Their language skills also expand and they also learn to coordinate their actions with other kids. They are also learning to manage their own materials and toys.

Socio- dramatic play- This play emerges at around 30 months of age. They play simple doctor doctor, fireman, lift man or whatever that they are exposed to. So the play develops language which they use to convey their imagination to other kids. They also learn to mind-read whether the other child is interested in them or not. They start developing preferences for those who listens to them or understands them well. Inter-personal relationships start developing by now and whole big world of social development is now open for learning. They are learning to incorporate their friends ideas in their own play and thus learning what to and what not to imitate. They learn to act out their fears and adults help them to understand how to express and how to manage fears and anxieties. They are learning a very critical skill called self regulation. They are learning to manage their own toys and maneuver within space- not to wander away too much. They are also learning to organize their behavior through self regulation.

Games- Kids start this from 48 months of age and stay through life. Here is where the abstract language starts developing. Games such as hide and seek, stone, paper scissors start coming in.

So what exactly does a child need to perform the occupation of play?

I am sure by now you must be convinced that a lot of skills are needed in just playing and these skills lay the foundations for further learning and development. An Occupational therapist’s role is to help the child to play by checking where is he stuck in development because of what reasons and to take him from where he is stuck to restart the process of development that has stopped. All that is done is to provide the child with the right opportunities which he did not get and got stuck. Using activities to assist play is what an Occupational therapist will do to assist play.

Self care needs include

Eating – requires fine motor skills and good eye hand coordination, requires good integration of the tactile input so that the child is fine with messy food textures. The development of the oral motor system is also important as kids may stuff their mouth with food because of not being aware of food or become picky eaters. Kids also need to have developed interoceptive sense so that they know when they are hungry or thirsty and also to know when they need to stop eating or when they are full.

Dressing- This requires a good body scheme and also good coordination to be able to dress and undress independently. Tactile system also needs to be developed so that all fabrics are tolerated well.

Grooming and Bathing-Again tactile system and a very good body scheme is very crucial because kids have to be comfortable with brushing teeth, washing hands, wiping hands and so on. And when the body scheme is developed well, kids will be able to plan the actions well.

Toilet- Child needs to have good interoception so that they know when they need to use the toilet. Good coordination and body scheme is needed to clean themselves after bowels

Manage space and community mobility – how far they can go how safe is “safe”. They understand that it is safe to go to a neighbors house on the same floor but not safe to go to neighbour’s house on a different floor. They gradually expand their limits and start understanding that it is safe to go to a neighbour’s house in a different wing of the same building or a different building.

What do kids need to learn in school?

Visual perceptual skills

Attention

Fine and gross motor skills

Integrated primitive reflexes

Most of the above skills develop when the child gets enough opportunities to play while young. However, sometimes there is a scatter in development because of prolonged illnesses or a medical diagnosis.

What do kids need to be able to participate in the community activities or events?

Self concept

Self confidence

Self esteem

Inquisitiveness

The base of the skills is built on opportunities that the child receives when he is very young and playing.

So, the role of an Occupational therapist is to check what is coming in the way of the development and what is stopping the child from performing his Occupation. Some of them are

Poor body scheme

Poor fine and gross motor skills

Poor visual perceptual skills

Poor pretend and imagination skills

Poor mind reading skills

Poor attention and concentration

Active Primitive reflexes

Inadequate development of postural or righting reflexes

Difficulty coping with academics because of poor handwriting, reading or spelling skills

Poor self help skills

Poor confidence

Low self esteem

No inquisitiveness

Poor self regulation

Poor management of space

Poor eating habits /picky eating

Delay in toilet training

Not understanding when to stop eating

Difficulty understanding Social skills or abstract concepts

Difficulty making friends

 

All of the above is developed by engaging the child in meaningful activities suited to their level of development and developing a Occupational therapy plan where the goals are decided monthly. Goals need to be revised monthly or quarterly and assessment needs to be done to check how much progress is achieved. Goals need to be modified if the child is not improving and all of this needs to be done according to how normal development happens for any other neurotypical child.So when an outsider sees an Occupational therapist work with kids, it just looks like play and fun…..But there is a lot of deeper work happening within the therapist to make that work look like fun and play!!!!

 

Hope I have done justice in explaining about what Occupational therapists do, fellow OT’s reading this, feel free to add more whatever that I have missed.

Reena Singh

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Autism and Therapeutic Listening

It was a long day at work in June 2013 and I was waiting to finish seeing the last child and go back home. And here came the Barbie doll who actually looked prettier than Barbie and had a cute smile on her face. After going through the papers, I found that she is in the spectrum of Autism and was referred to me through a parent.

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Barbie did not talk and was three and half years of age when I met her for the first time.

  • She had no receptive language and did not follow any instructions at all. The only way she communicated was by taking the person to the object.
  • She was not settling in the regular school and was extremely rigid in her behaviors.
  • She had a good eye contact.
  • She was not toilet trained and did not enjoy being with kids rather she did not even acknowledge their presence.
  • Parents were really concerned regarding her rigid behaviors.
  • She could sing songs and tunes but did not use her speech for communication.

We started her on Occupational therapy sessions thrice a week. We added Therapeutic Listening, Astronaut training and Sensory integration to her therapy program.  After 3 months of therapy, there was a long break because parents had to focus on the elder sibling who was getting left out because of Barbie’s therapy and they needed time to balance both. We saw Barbie after 6 months and there was just slow progress rather she was so rigid that therapists had a tough time to just settle her. There were a lot of sound seeking behaviors when parents decided to start therapeutic listening at home along with therapy. We did only modulation chips with her for three months.

I saw her now when she is going to turn 5 in two months. Parents were delighted with the changes. Her mom who was so dull and low when she met me for the first time and  was all glowing and had so much to tell me now. She was really not letting me talk. Her mom went on to say that Barbie is very communicative now and uses sentences to communicate for her needs. She has also started sitting in the class and following all the instructions given by her teachers. She has also started writing which was a major concern earlier.

With respect to her social skills, she has now started playing with kids. She still cannot maintain the conversation but her initiation and interest in kids has improved and she prefers to be with kids rather than being at home. She is very aware of everything and has also learnt to complain and tease. Barbie feigns coughing to get her favorite cough syrup. When mom smiles, she runs away. Barbie’s grandfather took her cup to have his coffee. She was furious and went straight to her mom and complained about it. Mom was in tears and so was her grandfather to see her complain in her own sweet way. Tutors come home to teach Barbie’s elder brother and she greets each and everyone and strikes a conversation with them in her own way. She is still not asking questions but started using “where” questions.

And here is another development with her play skills– Barbie can do pretend play now! After Raksha Bandhan, she puts the dupatta on her head, takes her plate and ties a string to her brother every other day. She takes her mom’s cosmetics and does her complete makeup. Mom was very angry and asked her what she was doing, to which Barbie cutely replied that she is a “dulhan” (bride). She wears new clothes from the cupboard and then asks mom to take her picture and then comments” beautiful” to herself.

I was really in awe after seeing the improvements that our little Barbie has shown and waiting to see much more.For more details on Therapeutic Listening Click here and check more case studies.

 

Reena Singh

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Communication and Autism

It’s been fifteen years that I have been trying to solve the puzzle of Autism. Since the last fifteen years, I have been getting trained to help out kids with Autism with some great success. However, there are many kids who teach me and inspire me for more learning and blending various treatment techniques.

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Here is this girl, Suraiya who had come to me when she was five years old. Now she is fifteen. She had come only for Occupational therapy and we did work on her sensory processing issues and also saw her in group therapy sessions to help her with social skills. At that point of time, I had got certified in PECS (Picture Exchange Communication System) and because Suraiya had no speech for communication, we started PECS for her. We made the folder and she used the pictures for her communication needs very well. We reached the Phase 3 of PECS.

Suraiya’s parents enrolled her for regular schooling and therapy stopped for her since they could not manage her school and therapy timings together. Suraiya was out of sight and out of my mind. Then suddenly, I see her when she is twelve years. By then, parents had really tried their level best promoted her, repeated grades till grade 3 hoping that she will cope with regular schooling. With six years of intensive work by the parents and no breakthrough, they thought that it’s really time that Suraiya’s sensory issues should be resolved and communication should be worked on.

I saw the twelve year old Suraiya again and now I saw that she was not using the PECS folder anymore neither was she communicating. The only way to communicate was by taking the person to the object that she wanted. At that time, I had done a lot of behaviour therapy workshops with Dr. Patrick McGreevy and also Dr. Duncan Fennemore who promoted the Verbal Behavior Analysis approach. Suraiya had beautiful imitation skills and was very good at planning. I wrote to my mentors and asked about what is it that I should do with Suraiya- sign language or PECS to promote communication. Most of them said that it is always better to use hands because then it’s easy to communicate without being dependent on a PECS folder. With the parents consent, we started using sign language (modified version of makaton). Suraiya learnt more than 100 signs in less than two months. We were really happy with her progress but the signs were not really being used. We had to ask her to sign even though she knew each sign very well. We were stuck….

By now, Suraiya had started intensive therapy sessions with us and I still thought on the same principle that a sign would be easy because there is no dependency on a PECS folder or a fear of pictures falling off and getting lost while traveling. But we were still stuck and Suraiya was using very basic signs for communication.

Suraiya had a little speech where she could speak what she wants in words but in whispers which were barely audible. We started her on Therapeutic Listening and we saw that she was a little louder but not confident of talking or even audible. The worst thing was that she was not using her little speech or the large repertoire of signs. It was getting really frustrating with her. Most other kids responded well to therapeutic listening or signs or PECS but here we were stuck, really stuck!!!

Then there was this forbrain device that we ordered which enhances specific patterns of your voice, delivering your voice directly via bone structure hoping that this would help Suraiya to talk a little louder. We tried it for three months and there was some great difference in her speaking and labeling and she was audible though she still spoke in whispers. But again none of that speech was being used for communication.

Now, we added RMT (Rhythmic Movement Training) with Suraiya really hoping for some magic or miracle to happen. Three months of RMT passed by and mom was reporting some positive changes. We were doing Moro reflex balance with Suraiya and the mother reported decreased frustration and anger levels in her. She was at peace with herself and also more flexible with changes. She was showing willingness to communicate. She used to get really bothered by her brother crying but now, it did not bother her at all.Not just that, she was finding new ways to pacify him.

Suraiya was also good at sight reading and during the Occupational therapy sessions, she was getting frustrated sometimes when she wanted a break. The Occupational therapist working with her suggested we use “break” and “help” cards for communication because Suraiya does not say them even if she can speak. So we started PECS again with sight cards. Two weeks passed by and she was using the cards when she wanted but not really consistently. One new therapist had come to our centre for observation and she was observing Suraiya work with her Occupational therapist. My Occupational therapist was working on ideation and asked Suraiya to complete a task which she really found difficult. Suraiya did not like this in front of the observing therapist. She flung out of her place and frantically started searching for her cards everywhere in the room, found them and gave the “help” card to my therapist. It was a Eureka moment for all of us…..She used the card on her own at the right moment without any prompt…..Hurray!!!

Now, after four months of RMT (Rhythmic Movement training), the mother reported that Suraiya is now using a lot of speech for communication very spontaneously. This was another EUREKA moment for us…..

Now Suraiya’s speech is coming like a spring which we have been digging since the last three years……………..we are hoping much more …….I am very strongly feeling that she needed a combination of various different therapy modalities to reach to where she is now…….

Reena Singh

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Stress in special needs parents and EFT

I have been seeing this child Shubho, 8 years old for therapy sessions. He has a synostosis of the radius and the ulna (fusion of the bones of the forearm). He also has a history of absence seizures. He attends Occupational therapy for his sensory processing issues along with behavioral challenges. Parents reported lots of impulsivity and hyperactivity and complete dependency in his self help skills.

Shubho attended therapy with one of my assistant Occupational therapists and met me once in a month. At the end of the month, the therapist reported beautiful changes in Shubho and lot of self regulation that had developed. I was really happy and keen to meet the parents for the follow up anticipating wonderful and amazing developments to be reported by them. Only the parents turned up for the appointment and didn’t get their child. I was keen to know why. I started asking about how is the child doing and was surprised to know that the parents noticed absolutely no changes in the child.

I was trying to discern about what might be the cause. I explored more and found that there are lots of family issues happening in front of the child. Mother had developed severe pain in the neck, shoulders and her back. She was really feeling vulnerable and experienced frustration and self-pity because she was fed up of the medicines and the medical procedures that she was going through. All the stress of ill-health and the inability to manage the child was released unknowingly on the husband and so he was also equally down and depressed. I told the mother to attend EFT session for herself. I generally spoke of the improvements that my assistant therapists had seen in Shubho and his parents affirmed in unison about the progress while still reiterating that there is no progress. I was feeling really sad for them because they really were extremely confused and desperately needed help.

After a week, I met Shubho’s mom for her EFT session. She was very happy and had come to me thinking that tapping will help her remove all the stress and her pains in just a session. I had already explained that 3-4 sessions may be needed and that a lot of self work will be needed at home. She was really defensive and guarded. She was not happy at all about coming for more sessions. I told her that it is completely her decision to attend and I am not going to force or ask her to come if she feels its not helping. Through the session, she realized that it was her need to feel significant and prove herself right which was always coming in her way and leading to arguments and verbal exchange of harsh words with near and dear ones. All of this almost always happened in front of Shubho. But she was still not ready to open up completely and also ensured that she interrupted me every time I wanted to explain something. I stopped explaining and very politely ended the session because her need to over power me and the situation was really strong.

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I was feeling really sad that I could be of no help to her and that the session was a waste of my and her time. I was so very sure that she will never come for EFT or get Shubho for therapy. The sense of ego was so strong and the sense to be always right really empowered her.

The following week roughly after 10 days, we had a parent training on EFT. I was very happy that new parents will get benefitted. I was shocked to see Shubho’s mom in the parent training session. Anyhow, we started the session and when asked if some parent would volunteer, Shubho’s mom came !!! I was determined to achieve a breakthrough this time while also respecting her limits and boundaries. We started and she was accepting and opening very warmly to every question that was asked by me as we did continuous tapping . We achieved a real breakthrough. Not just that, the pains of her neck and back also reduced while the session was in progress. I was myself surprised and excited to enable and witness this transformation. The session ended and then came another major surprise. She came to me and declared that -on the day we had our EFT session, she was crying and sobbing for the full day. She took a lot of time to accept that she could be a reason for the arguments at home .But now she was completely ready to take full charge now. I was feeling proud of her and absolutely admired her courage to speak out. She said that it took her time to ACCEPT that things are happening because of her and that she has the power to change the way she sees the situation. She also mentioned that she is ready to do all the tapping at home. She was also not very hassled about Shubho’s issues like before while still strongly determined to work on him and provide therapy to equip him with skills. I was really happy because the change had started happening- there was a difference in her perception about herself -from being helpless and a victim to being empowered and confident.

I am really touched by this incident and feel great about the difference that will now come in the lives of Shubho and his parents. It really helps when help is more holistic ………..feeling blessed!!!

Reena Singh

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Rimzim’s journey with Learning Disability

UNI53626I was very happy to meet one parent who came to me today and that feeling is still keeping me floating like a happy balloon moving with the wind in any direction that it takes me.

I was seeing this child Rimzim who is seven years old and who was diagnosed with learning disability and had a significant discrepancy in the verbal and the performance IQ. In the draw the person test- the results showed that she is very anxious and believes in fantasy rather than reality satisfaction and also had feelings of inadequacy and dependency. There was also a lot of restlessness and hyperactivity. Her visual motor age was 5 years.

She came across as a very small tiny bony girl who didn’t make eye contact and wanted to just hide behind her mom. I wanted to discuss about the concerns with the mother but not in front of her. She was very very shy and extremely compliant. We gave her a puzzle and asked her to play in the room outside. Rimzim had changed two schools in two years because she was not able to cope with academics and used to get easily frustrated and angry in the class. She was receiving counselling at school for a year and help for academics from a special educator but behaviour was worsening with each day. Mother also said that she cannot copy from the board and also made a lot of spelling mistakes. The major complaint that the mother had was that Rimzim would hit all her classmates and did not make friends. She had a lot of motion sickness even while traveling in auto rickshaw. Even though she is seven, she still did bed wetting every single night.We called Rimzim inside and she was still shy and anxious about what I would ask her. We just had a general conversation and evaluated her.

She had

  • Sensory processing disorder
  • Poor Vestibular tolerance  and also had
  • Presence of Primitive Reflexes -TLR (Tonic labyrinthine Reflex), ATNR ( Assymetric Tonic Neck Reflex), SGR(Spinal Galant Reflex) and STNR (Symmetric Tonic Neck Reflex)

Some reasoning in Rimzim:-

  • The presence of TLR affected her eye movements and did not give her a stable visual field. Presence of TLR is also an indication of immature vestibular system.
  • The cerebellum coordinates the signals from the vestibular and the visual systems and because of the immature vestibular system,TLR and ATNR,  the messages given to the cerebellum and those received by the body did not match. This resulted in motion sickness and visual perceptual problems.
  • The presence of SGR affected her sitting and she constantly changed her position and wriggled in the classroom which coupled with TLR and eye movements made it difficult for her to focus on the blackboard. The presence of SGR also resulted in bed wetting and difficulties with auditory processing.
  • Auditory processing affected her ability to blend,discriminate and sequence sounds and thus her spellings suffered and reading comprehension was also slow.
  • The presence of ATNR affected her planning and bilateral integration skills.She had difficulties in crossing the midline which made handwriting very difficult- her eye tracking was also laboroius when it involved crossing midline. Because the  entire task of copying from the blackboard was not automatic, and completely done by the cerebral cortex, the ability to comprehend slowed down because of overload on the cortex.
  • Presence of STNR affected her  posture because the tone of  the upper and the lower body were dependent on the position of the head. It also affected her speed of accomodation which affected copying from blackboard. (accomodation in simple words is the automatic ability to converge and diverge for near and far objects). She avoided eating by herself because it is messy in the presence of active STNR.
  • The cerebellum uses the postural reflexes to acheive smooth coordinated movements and when the above mentioned primtive reflexes were present, they didn’t allow the access to postural reflexes. Thus there was a general slowness and clumsiness in everything that Rimzim did.
  • Rimzim had a very intelligent brain which was compensating for the above mentioned challenges but at the cost of falling grades . Since she is intelligent and can see the effort she was putting and the results that were coming out, she had temper tantrums and hyperactivity and undesirable behaviours.
  • Rimzim also stammered at times which is because of the immature functioning of the cerebellum. The cerebellum coordinates the speed of the thought and the speech which if uncoordinated led to stammering in Rimzim.

So, we started with

  1. Sensory integration
  2. Astronaut training to work on her vestibular system.
  3. Therapeutic Listening to manage her sensory processing issues
  4. RMT to integrate the presence of active primitive reflexes.
  5. Behavior therapy- we added token economy and ensured that she was praised for all her efforts and not for the end results.

She came for sessions twice a week and the mother did RMT every day at home.

She met me in March after a month and there was no difference in her at all. I was really sad and was wondering what is going wrong. Her mom was also quite upset with no difference. Then we changed her therapy targets but worked along the same systems as above. She took a break for the month of April because of exams and was out of town in May for a few days because of which the therapy was irregular. I was very sure that the meeting in June would also be the same as March and it was actually what I predicted. Now, we decided to really continue for just a month and see if things get better or we decide the course of action and also changed some of the therapy targets.

I met Rimzim today and saw the posture of the mother, it was upright and straight and she looked at me with a tinkle in her eyes. I sensed that something good has happened and was really curious to know what it was. We started filling the follow up form and here is what she said

  1. Rimzim has started sleeping well and has sound sleep because of which she can focus better (earlier she had disturbed sleep)
  2. She had started eating on her own completely whereas earlier she was fed by her mom.
  3. Her temper tantrums and impulsive behavior had reduced by 50-60%.
  4. Her motion sickness has gone away which they noticed when they took her out of town and had to travel in cars and buses. In fact, she also sat on the merry go round which was initially something that her would not even dream of.
  5. Her books are complete; she has started copying from the black board. She has started writing fast. She has stopped hitting her class mates and not just that-she has made friends!!
  6. Her stammering which was seen when she was angry has reduced by 60%.
  7. Self regulation or in simple words –controlling her own behaviour which used to take 30 minutes earlier- now happens in just 2-5 minutes.

She still makes spelling mistakes and we are working on auditory processing but we have come a long way in just three months. Bed wetting is less but still there.

I have been feeling happy after meeting them and floating around like a happy balloon and also feeling extremely satisfied and blessed!!! Brain is neuro-plastic and we can change the way it functions-feeling really optimistic!!!

 

 

 

Reena Singh

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Vestibular System

So where is this vestibular system? And what does it do? Why is it so important in the sensory Integration approach?

Vestibular system is present in the inner ear and plays a very important role in detecting movement of head in relation to the rest of the body. It works very much in unison with the visual and the auditory system.

So, what does that mean? In simple terms-you may close my eyes and make me sit on a swing or in the car or in the roller coaster ride or a revolving chair or think of anything that moves, this system will tell me where I am and in which direction I am moving and the speed at which I am moving. All this complex information with just the vestibular system. Amazing !!

So from the example above, it is very clear that the vestibular system will sense movements

  1. In a vertical plane like jumping or bouncing on a ball.
  2. In an angular plane-like sitting on a swing.
  3. In an orbital plane- sitting on the merry go round which goes round like earth around the sun.
  4. In the horizontal plane- sitting in a car or riding a bicycle.
  5. Rotation –moving around in rotations as we used to do when we were kids –go round and round and round till the world goes round and fall down and still see the world moving.

Also, we are very clear with our body and also very accurate about which direction feels comfortable and what speed is comfortable. When my son plays down on the swings and I swing him fast, he tells me –“So do you want me to fall off the swing?” or when I go slow, he would say “Am I a baby?” So you can see how well the vestibular system checks speed and also knows what speed is comfortable and which is not.
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Another amazing thing that it does tells me when it is enough – so I went to my sisters house and she had a swing in the living room. I kept swinging and chatting for more than an hour and then I can sense and alarm inside telling me to get off the swing and that it was enough for me. This is the body’s way to protect the system.

Vestibular system has very strong connections with

  1. Eyes – have you noticed that the world moves round and round after we go round in circles-so it is not actually the world moving but the vestibular system moving the eyes-telling us “Ok, you have stimulated me enough!! Just stop now”. Technically, it is called as Nystagmus.
  2. Brain – we feel giddy after we go round in circles – the vestibular system tells the brain – “come on dear! It’s enough for me for now”. This is its way to stop excessive input and to prevent what is technically called as “Vestibular Overload”.
  3. Autonomic nervous system – How many of you have felt nausea after going round in circles or feel some “weird” feeling in the stomach? This is one more connection that it has to stop excessive input.
  4. Muscles of the back – Have you noticed that we sit on a swing- we automatically get erect. This is one more connection by which this system maintains the tone in the postural muscles.
  5. Strong connections with the cerebellum – This is how the vestibular system helps us to balance. So, when we are giddy after a lot of spinning, we lose our balance.
  6. Proprioceptors – The vestibular system has strong connections with the proprioceptors and they work like hand in a glove.
  7. Reticular activating system – This is like a switch which either makes us alert or dulls us down.

So why do we need to know so much about this VESTIBULAR SYSTEM??? Until now we spoke of what the vestibular system does and now what if it is not doing what is meant to do????? CHAOS!!!!!

One important thing about this system is that the imbalance of the vestibular system effects is felt in other systems.

  • Visual spatial map – which in simple terms means an understanding of the world and the space around us is distorted. They will have difficulty learning movements or actions that require timing and sequencing.
  • The child will also have a difficulty in moving in dark places because he relies on vision for the map. There will be an underlying anxiety and depression.
  • A person with sensory processing issues will have difficulties with visual perception, words are all scrambled, spellings do not make sense. Sequence of spellings is difficult to remember and retrieve giving an appearance of learning disability.
  • Child may go round in circles and will not get a signal when to stop so the protective mechanism to protect the brain is not working which will lead to overload symptoms such as headaches, nausea, vomiting, changes in heart rate and respiration, yawning and changes in skin color.
  • Feeling of fatigue and very low stamina or not sensing that the body is tired and needs rest so they seem to be filled with lot of energy.
  • Some kids may completely avoid movement to some others who would always seek movement. They may rock themselves.
  • Movements of the kids would be very clumsy and uncoordinated.
  • But, we can work and improve the functioning of the vestibular system and help these individuals.

Isn’t it really amazing to understand how big a role this little vestibular system plays in our life!!!

Reena Singh

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