The Safe and Sound Protocol (SSP) was developed by Dr. Stephen Porges. It is a five day intervention designed to reduce stress and auditory sensitivity while enhancing social engagement and resilience. By calming the behavioural and physiological state, further therapy is enhanced or even accelerated. The SSP is based on the polyvagal theory which was developed by Dr. Stephen Porges (see video below for more information).
The intervention involves listening to music that has been specifically processed so that the middle ear muscles are trained and exercised to focus on the frequency range of the human voice. The individual listens to the music one hour each day for five days consecutively.
The SSP targets specific features such as:
difficulties with auditory processing
inability to focus or sit still
anxiety in social situations
Bright Horizons OT utilizes the Safe and Sound Protocol as one part of our treatment with children who have a variety of needs. Please contact us for more information or to book an appointment.
Therapeutic Listening is an evidence-based auditory intervention intended to support individuals who experience challenges with sensory processing dysfunction, listening, attention and communication. Therapeutic Listening activates listening which is the process of detecting sound, organizing it and integrating it for use with information from other senses.
Therapeutic Listening involves listening to modulated music through specialized headphones twice a day for 30 minutes. The headphones are open air meaning the child can also hear others around them and can talk to others while listening to the music. The child can go about their daily activities while listening to the music (except for watching TV, playing video games and other similar activities). The time period between listening sessions must be at least 3 hours apart.
Therapeutic Listening is not a specific protocol but rather a dynamic process in which a trained therapist chooses modulated music specific to the child’s needs. The child will listen to each music album for a period of two weeks. After two weeks is up the child will be reassessed by a therapist and a new album will be recommended. There is no specific time frame for Therapeutic Listening, some children will benefit from listening to the music for twelve weeks and others will listen for 6 months plus.
Therapeutic Listening has been used to address:
difficulties with social interaction and play skills
abnormal responses to various sensory stimuli (e.g. sounds, touch, taste, pain)
poor timing and sequencing of motor skills
challenges perceiving and navigating space
struggles with sleep, bowel and bladder control, and eating
difficulty communicating (both verbal and non-verbal)
Therapeutic Listening is used along with many different OT activities to help children in these areas. Please contact me if you have any questions or would like to start exploring Therapeutic Listening for your child!
References: Therapeutic Listening – Listening with the Whole Body
Tactile defensiveness is the hypersensitivity to touch. Children with tactile defensiveness notice touch more than others. They react negatively to unexpected, light touch and even to the anticipation of light touch. The child may react with a fight or flight response by being hostile to those around them or by fleeing from contact with people, finger paints, playdough, etc. Some children will withdraw passively by avoiding the object and people that cause distress. The receptors of the tactile system are in our skin so therefore it is not just our hands that can be hypersensitive to touch but our whole body.
When our tactile system is functioning well we are able to filter out which tactile information is important and which is not. Those with tactile defensiveness have difficulty ignoring input that is not important (e.g. the way their shirt feels, the light breeze on their face, etc.) and may appear distracted. Many children who do not enjoy light touch may actually enjoy deep pressure touch, like bear hugs or heavy blankets.
Signs of tactile defensiveness:
Dislike brushing teeth or going to the dentist
Dislike getting hair washed or cut
Dislike wearing clothing or certain types of clothing, may prefer really tight clothing or baggier clothing
Withdraw from being kissed or from a light touch
Avoid playing with playdough, finger paints, etc.
Immediately want to wipe hands when they get dirty
Avoid playing in the dirt, mud, sand, grass, etc.
Suggestions when working with children who have tactile defensiveness:
Don’t approach or touch the child from behind
Avoid light touch
Use firm pressure when touching the child
Allow the child to have their own space during circle time (sit on their own piece of carpet or on a bean bag chair, rocking chair, etc.)
Have the child stand at the front or back of the line to minimize unexpected touch
Create a “quiet corner” (bean bag chair, tent, teepee or blanket draped over table) in the classroom or in another supervised room where the child can go if they are starting to feel upset or over-stimulated
Provide the child with deep pressure activities/movement breaks throughout the day (easiest to incorporate into daily class schedule as it is valuable for the whole class)
Weighted items such as a weighted lap pad or a weighted snake around the shoulders can be used to provide that calming deep pressure touch
Encourage the child to participate in sensory play activities
It is important to encourage the child to participate but do not force them into doing anything they don’t want to do, we want to gradually incorporate some challenging textures/touch while keeping it fun and enjoyable
The child may need to begin by just watching others take part in the activity, then move onto using a utensil (knife, paintbrush, rolling pin, cookie cutters) to play with the substance (fingerpaint, playdough, shaving cream, flubber etc.) and then finally to using their hands to play in it
Subtle, gradual exposure is the key to successful sensory play
The human body has 8 sensory systems which give us information about the environment and our place within the environment.
The 5 most commonly known sensory systems include:
Tactile – the sense of touch
Visual – the sense of sight
Auditory – the sense of hearing
Gustatory – the sense of taste
Olfactory – the sense of smell
The 3 less commonly known sensory systems include:
Vestibular – the sense of our head position in space
Proprioception – the sense of knowing where our body is in space, this information comes from our muscles, joints, tendons and ligaments
Interoception – the sense of the physiological condition of the body (hunger, thirst, pain, temperature, the need to go to the bathroom, etc.)
Today we are going to talk more about the vestibular system. The vestibular receptors are located in our inner ear. The receptors include the 3 semicircular canals (anterior, lateral and posterior) and the otoliths (utricle and saccule). The semicircular canals pick up rotary movement and the otoliths pick up linear movement.
The vestibular system answers 2 basic life questions:
Which way is up?
Where am I going?
Any movement of the head in any direction (up and down, forward and back, side to side, diagonal and rotary) activates the vestibular system. 25% of the vestibular information received goes directly to the cerebellum which is responsible for balance and posture. The other 75% of vestibular information goes to the brainstem via the vestibular nuclei which then connects to many other parts of the brain including:
Oculomotor nuclei – head orientation & stability for oculomotor (eye) control
Autonomic centers – gravitational impact on cardiovascular, visceral & respiratory control
Cerebral cortex – spatial orientation & body movement
Since the vestibular system has so many connections in the brain it is very important that the vestibular system is functioning well. In many of the children that we see in Occupational Therapy their vestibular systems are not functioning optimally. Many children have an under-responsive system or an over-responsive system. A child with an under-responsive system may be able to spin for hours without getting dizzy or sick. A child with an over-responsive system may get dizzy or sick with even the slightest movement.
In Occupational Therapy one of the goals is to help the vestibular system work optimally so that sensory information is processed correctly in the brain to allow the eyes to work well, the ears to work well as well as the many other areas that have been discussed above.
References: From Eyesight to Insight: Visual & Vestibular Assessment & Treatment
What do OTs (Occupational Therapists) do? Many people have no idea what an OT is when I tell them what I do! Many people think that we help people get jobs, but that is not the case (mostly anyways!). OTs focus on the areas of self-care, productivity and leisure. So depending where an OT is working they are helping people with very different things. OTs are trained in the areas of anatomy & physiology, neurology, child development, mental health, counselling, older adult disabilities, among other areas.
In acute care (hospitals) we focus a lot on self-care, helping people to be independent in their basic daily activities such as getting themselves dressed, having a bath, preparing a meal or moving around their homes/community. We prescribe equipment and provide education about how they can become more successful completing their activities of daily living in a safe manner. An independent study by health policy researchers published in Medical Care Research and Review (Rogers, Bai, Lavin, & Anderson, 2016) found that “occupational therapy is the only spending category where additional spending has a statistically significant association with lower readmission rates” for the three health conditions studied: heart failure, pneumonia, and acute myocardial infarction. Yay OT!
When working with children as we do at Bright Horizons OT, the focus looks very different. We use play as a means to achieving the child’s/family’s goals. In order to achieve the goals, we either use remediation (treating the underlying deficit) or compensation (adapting activities or environment) to make the child more successful in their everyday activities. The goals of OT can be many different things, here are some examples of general goals:
Increase ability to pick up small objects and release them
Increase ability to use both hands together (e.g. stabilizing the paper while writing with the other hand, holding a jar while using the other hand to twist the lid, etc.)
Increase handwriting legibility and/or speed
Increase accuracy while cutting with scissors
GROSS MOTOR/CORE STRENGTH:
Increase core strength/postural stability in order to increase gross and fine motor skills
Increase the child’s support while sitting in a chair at school (proper seating in order to maximize their ability to complete school activities)
Making adaptations in gym class/sports/leisure activities to increase participation
Increase self-care abilities such as getting themselves dressed, doing up buttons, zippers, tying their shoes, etc.
Provide adaptive equipment/education to help make bathing independently or with assistance easier
Increase self-feeding abilities (using a spoon, fork, knife, open cup, straw cup, etc.)
Expand the number of foods a picky eater/problem feeder will eat
Decrease sensitivities to sensory input (lights, sound, touch, etc.) and/or make environmental adaptations to help them cope with these sensitivities
Increase the child’s ability to engage in hair brushing, hair washing, hair cutting, etc. for those that are sensitive to these activities
Make adaptations/find clothing that the child will wear without being bothered by tags, seams, fabrics, etc.
Increase on task behaviour in children who have attention difficulties (teaching self-regulation skills)
These are just some examples of the things that are addressed when you see an OT. One of the greatest parts of our job is we get to look at such a wide variety of areas!
In the past year I have been going full steam ahead in my continuing education! My latest education has been on Auditory Processing Disorder (APD). I completed the TheraPeeds “Treating Auditory Processing Disorder” course and I loved it, just like I love all of Julia Harper’s courses. I’m starting to sound like a groupie! Haha. But she uses physiology to back up all of her assessments and treatment which I love.
What is APD? Auditory processing is what we do with what we hear. Children with APD do not have a problem with their hearing, they have a problem with how the sound is processed in their brain. “We don’t hear with our ears, we hear with our brain.” Sound information comes into our ears, moves through the outer, middle and inner ear to the lower brainstem, to the upper brainstem, to the midbrain and finally to the cortex. In children with APD somewhere along that pathway the information is not processed as it should be. The type of APD depends on where the breakdown of processing occurs in the brain. Most of the time the breakdown occurs sub-cortically or below the cortex (i.e. lower brainstem, upper brainstem or midbrain).
Audiologists are responsible for diagnosing APD, along with information from SLPs and Educational Psychologists. Then you may be wondering where does an Occupational Therapist come in? Well one of our areas of specialty is sensory processing. Auditory information is sensory information. As OTs we can use our sensorimotor knowledge to help treat APDs.
Treatment for APD focuses on sensorimotor and auditory (sound) activities. Since most of the APDs occur below the level of the cortex we can use sensorimotor activities to ensure that the proper wiring is set up in the brain to allow the messages to get through.
Please contact me with any questions or if you are interested in learning more about how OT can help your child with Auditory Processing Disorder.
Over the past couple of months I have been focusing a lot on continuing education related to sensory processing. I came across Julia Harper’s online courses on sensory processing and was hooked immediately! Julia is a knowledgeable and dynamic speaker. She provides so much physiology to back her treatment, it makes me excited! I have completed part 1 (modulation) and part 2 (self-regulation) of her courses and I know I won’t stop there. Here are a few of the basics that I have learned:
There are four different types of sensory processing disorders:
Modulation – expressed behaviourally
Self-Regulation – expressed with inconsistent behaviour and skills
Postural & Discrimination – expressed with poor quality and/or quantity of skills
Integration & Praxis – expressed with skill refinement deficits
The type of sensory processing disorder is determined by where the breakdown occurs. That is, where the sensory information gets stuck and is not processed appropriately (lower brainstem, upper brainstem & cerebellum, midbrain & cortex).
I would highly recommend any Occupational Therapist working with children take Julia Harper’s courses. They are a good value for your money, especially since they are online and you don’t have to pay for flights and hotels!
Do you have a child or know a child who loves to chew on everything? There are some kids who love to chew on anything they can get their hands on – shirt collars, shirt sleeves, hair, nails, pencils, erasers, papers, toys, power cords, you name it and I’m sure there’s a kid who’s chewed on it! Often these children don’t even notice they are doing it. They naturally gravitate to these items and put them into their mouths without even thinking about it. It can be calming to children (and adults) to chew so you may notice that they do it when they are in difficult or stressful situations or when they are tired at the end of the day.
Mouthing objects is a part of the normal developmental sequence. One of the reasons babies and toddlers put objects in their mouths to learn about them. As children get older many of them will stop mouthing objects but there are others, especially those with Autism, developmental delays or sensory difficulties, that will continue. As children get older it becomes less socially acceptable to mouth objects and can be a hazard to their health if they are chewing on dangerous objects.
Here are some tips to help curb chewing on everything and maybe save some clothes!
Gum – if the child is old enough allow them to chew gum as it can provide the same calming effect
Chewlery/Pencil Toppers – provide the child with jewellery or pencil toppers that are made to be chewed on
Do you struggle to get your child dressed every morning because they refuse to put anything on? Does your child hate tags, seams and uncomfortable fabrics? I’ve compiled a list of online stores that cater to kids that are sensitive to clothing. All of these stores either have Canadian retailers or will ship to Canada.