INTERVENTIONS/THERAPIES: TECHNIQUES AND THERAPIES
Techniques and therapies discussed in this section include Music Therapy, Hippotherapy, Art Therapy, Augmentative Communication, The Picture Exchange Communication System (PECS), Occupational Therapy, Speech Therapy, Oral Motor Therapy, Physical Therapy, and Sensory Integration.
Art therapy is recognizing feelings and helping to identify them in oneself and others. The goals of art therapy are to move toward healing and growth. It is process oriented, it is self-expressive. It is therapeutic in that it is multi-sensory, involves visual-perceptual skills, requires coordination and fine motor control, teaches people to use objects purposefully, to follow directions, and build communication skills.
Augmentative Communication uses visual modes such as pictures, symbols and signs and promotes communication and language in children with severe communication deficits and poor verbal imitation skills. "Communication is based on the use of the individual words of our language. True communication is spontaneous and novel. When we cannot speak naturally, other methods of selecting words can be used. These methods have two parts: the language representation method and the physical selection technique. In some cases, such as with sign language, the communication may be direct to the partner. An electronic augmentative and alternative communication (AAC) system may include speech output which then transmits the words to the communication partner" (American Speech - Language Hearing Association).
Hippotherapy is a physical, occupational, and speech-language therapy treatment strategy that utilizes equine movement as part of an integrated intervention program to achieve functional outcomes.Equine movement provides multidimensional movement, which is variable, rhythmic and repetitive. The horse provides a dynamic base of support, making it an excellent tool for increasing trunk strength and control, balance, building overall postural strength and endurance, addressing weight bearing, and. motor planning. Equine movement offers well-modulated sensory input to vestibular, proprioceptive, tactile and visual channels. During gait transitions, the patient must perform subtle adjustments in the trunk to maintain a stable position. When a patient is sitting forward astride the horse, the horse’s walking gait imparts movement responses remarkably similar to normal human gait. The effects of equine movement on postural control, sensory systems, and motor planning can be used to facilitate coordination and timing, grading of responses, respiratory control, sensory integration skills and attentional skills. Equine movement can be used to facilitate the neurophysiologic systems that support all of our functional daily living skills. (American Hippotherapy Association).
Music therapy is a well-established allied health profession similar to occupational and physical therapy. It consists of using music therapeutically to address behavioral, social, psychological, communicative, physical, sensory-motor, and/or cognitive functioning. Music provides concrete, multi-sensory stimulation (auditory, visual, and tactile). The rhythmic component of music is very organizing for the sensory systems of individuals diagnosed with autism. As a result, auditory processing and other sensory-motor, perceptual/motor, gross and fine motor skills can be enhanced through music therapy. (American Music Therapy Association).
In its simplest terms, occupational therapists and occupational therapy assistants help people across the lifespan participate in the things they want and need to do through the therapeutic use of everyday activities (occupations). Common occupational therapy interventions include helping children with disabilities to participate fully in school and social situations, helping people recovering from injury to regain skills, and providing supports for older adults experiencing physical and cognitive changes. Occupational therapy services typically include an individualized evaluation, during which the client/family and occupational therapist determine the person’s goals, customized intervention to improve the person’s ability to perform daily activities and reach the goals, and an outcomes evaluation to ensure that the goals are being met and/or make changes to the intervention plan. Occupational therapy services may include comprehensive evaluations of the client’s home and other environments (e.g., workplace, school), recommendations for adaptive equipment and training in its use, and guidance and education for family members and caregivers. Occupational therapy practitioners have a holistic perspective, in which the focus is on adapting the environment to fit the person, and the person is an integral part of the therapy team. (American Occupational Therapy Association).
Oral Motor Therapy
"Oral motor" has been defined in a variety of ways. Many of the strategies of the 1950's and '60's were primarily stimulation techniques, such as brushing (pressure massage), icing (thermal stimulation), quick stretch (tapping), and vibration (manual and mechanical). These strategies have been used by physical and occupational therapists to prepare a muscle area for movement. These strategies cannot change the range of movement of a muscle or the strength of a muscle without additional muscle movement. Other oral motor techniques require the individual's cognitive cooperation to follow a command in order to complete a movement. But what if the individual cannot cooperate cognitively, or, due to significant motoric involvement, cannot follow the therapist's verbal directive to "lick your lips," or "move your tongue up toward your nose," or "round and spread your lips?" Many individuals with impaired oral motor skills are not able to follow a command for oral movement. To better serve such individuals, Debra Beckman has, since 1975, worked to develop these specific interventions which provide assisted movement to activate muscle contraction and to provide movement against resistance to build strength. The focus of these interventions is to increase functional response to pressure and movement, range, strength, variety and control of movement for the lips, cheeks, jaw and tongue. The interventions needed are determined by an assessment, the Beckman Oral Motor Protocol, which uses assisted movement and stretch reflexes to quantify response to pressure and movement, range, strength, variety and control of movement for the lips cheeks, jaw, tongue and soft palate. The assessment is based on clinically defined functional parameters of minimal competence and does not require the cognitive participation of the individual. Because these components of movement are functional, not age specific, the protocol is useful with a wide range of ages (birth to geriatric) and diagnostic categories. (Beckman).
The Picture Exchange Communication System (PECS)
PECS was developed in 1985 as a unique augmentative/alternative communication intervention package for individuals with autism spectrum disorder and related developmental disabilities. First used at the Delaware Autistic Program, PECS has received worldwide recognition for focusing on the initiation component of communication. PECS does not require complex or expensive materials. It was created with families, educators, and resident care providers in mind, so is readily used in a range of settings. PECS begins by teaching an individual to give a picture of a desired item to a “communicative partner", who immediately honors the exchange as a request. The system goes on to teach discrimination of pictures and how to put them together in sentences. In the more advanced phases, individuals are taught to answer questions and to comment. The PECS teaching protocol is based on B.F. Skinner’s book, Verbal Behavior, such that functional verbal operants are systematically taught using prompting and reinforcement strategies that will lead to independent communication. Verbal prompts are not used, thus building immediate initiation and avoiding prompt dependency. PECS has been successful with individuals of all ages demonstrating a variety of communicative, cognitive and physical difficulties. Some learners using PECS also develop speech. Others may transition to a voice output system. The body of research supporting the effectiveness of PECS continues to expand, with research from countries around the world. (Pyramid Educational Consultants).
Physical therapy (PT) uses therapeutic exercise and other interventions to improve posture, locomotion, strength, endurance, balance, coordination, joint mobility, flexibility and to reduce pain. Treatment may include active and passive modalities using a variety of means and techniques based upon biomechanical and neurophysiologic principles. (Blue Cross Blue Shield Manual).
Sensory integration is a specialty area of occupational therapy that is based on over 40 years of theory and research. The term “sensory integration” refers to: The way the brain organizes sensations for engagement in occupation; A theory based on neuroscience that provides perspective for appreciating the sensory dimensions of human behavior; A model for understanding the way in which sensation affects development; Assessments including standardized testing, systematic observation, and parent or teacher interviews that identify patterns of sensory integration dysfunction; Intervention strategies that enhance information processing, praxis, and engagement in daily life for individuals, populations and organizations. (University of Southern California Division of Occupational Science and Occupational Therapy).
Marlo Payne Thurman, USAAA Advisory Board Member, discusses "The Continuums of Autism: Cognition, Sensory Processing, and Behavior", and more specifically Sensory Modulation and Sensory Integration. "Children of higher intelligence take in more information than their peers of average cognitive ability. However, because the sensory skills of filtering, regulation and modulation mature with age, innately asynchronous sensory development in the gifted, twice-exceptional and high functioning autism and Asperger’s populations places our most intelligent youth at risk for academic, social and emotional problems. When compounded by learning disabilities, most asynchronous children simply cannot access enough cognitive energy to compensate and function successfully in their day-to-day lives. This, in turn, leads to cognitive and emotional fatigue, heightened physiological arousal and ultimately mental health symptoms. This paper will discuss the unique relationship between intelligence and sensory regulation, and will illustrate the impact of modulation abilities on learning, social and emotional function and the mental health diagnoses commonly seen in our most intelligent, yet out-of-sync populations".
"It is not at all surprising then, that in my experience with over 5,000 out-of-sync children, most have sensory arousal issues. Furthermore, I have yet to see an autistic child without severe sensory modulation difficulties. This is not necessarily the same however, as sensory integration dysfunction, although all kids can have that too. Let me explain. Sensory integration disorders are usually thought of as inaccurate registration of sensory information. Sensory modulation disorder however, is best described as the inability to filter and process only what is important."
When a person is unable to produce speech sounds correctly or fluently, or has problems with his or her voice, then he or she has a speech disorder. Difficulties pronouncing sounds, or articulation disorders, and stuttering are examples of speech disorders. When a person has trouble understanding others (receptive language), or sharing thoughts, ideas, and feelings completely (expressive language), then he or she has a language disorder. Speech Disorders may include: Childhood Apraxia of Speech, Dysarthria, Orofacial Myofunctional Disorders, Speech Sound Disorders: Articulation and Phonological Processe,s Stuttering, and Voice. (American Speech - Language Hearing Association).
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