Getting the Wiggles Out!

Promoting Participation with Assistive Technology Supports

Sue Mistrett & Johan deBesche

What We Know …

� Children grow + develop through participation in daily activities

� Disabilities present barriers to participation

Purpose of AT for Young Children with Disabilities

To promote development and learningthrough active participation in

everyday routines & activities in all of their natural settings

AT is…. by federal definition

“any item, piece of equipment, or product system, whether acquired commercially off the shelf, modified, or customized,

that is used to increase, maintain, or improve functional capabilities of a child with a disability.”

Assistive Technology is also services

“… that assist a child with a disability in the selection, acquisition, or use of an AT device.”

How Can AT Help a Child Participate?

MovePositioning + Mobility

Communicate Use Activity Materials What Else???

Full Participation? = Engagement Behavior!

� Focus and attend

� Self-regulate body and reactions

� Adapt behavior for different situations

� Follow rules

� Read/respond to social cues

� Remember steps of an activity

� Know the sequence of routines; what comes next?

� Understand activity and make choices

� What is sensory integration?

� How does sensory integration impact young children?

“Red flags”

� AT sensory supports for (participation) engagement

� Understand how, when, what will happen in daily activities

� AT visual supports for participation

Consider AT supports + strategies for ALL daily activities

Sensory Integration

� Our senses give us information about our own body + the environment around us

How many senses do we have?

Sensory Systems

Hearing

Taste

Smell

Touch

Balance

Body Awareness

Vision

Sensory Integration� Our senses give us information about our

own body + the environment around us

� Our brain organizes the messages from our sensory system in order to move, learn, engage, behave and function in our environment!

� Sensory integration “puts it all together”

Sensory Processing Disorder

Dr. Jean Ayres compares SPD to a traffic jam.

Sensory IntegrationChildren demonstrate their difficulty to integrate sensory information in different ways…..

� Over-responsive: greater response to input� Sensory-avoiding: 'fussy,' 'sensitive,' 'picky,’; difficulty

eating, dressing, bathing

� Under-responsive: less response to input� Sensory-seeking: 'behavior problems,' 'hyperactive,'

'difficult,’; actively seek out and crave sensory input

Sensory Reactions

Over Responsive?????Under Responsive?????

What Does Over-responsive Look Like?Visual Cannot tolerate bright or blinking

lightsAvoids eye contactBlinks, protects self from a ball even when trying to catch itIs distracted from tasks by other activityHides at parties or avoids them

Tactile Avoids ‘messy/sticky’ tasksPicky eater; gagsDifficulty standing in lineOverreacts to small bumps or cuts; fidgityFlinches or tenses when touchedTantrums during bath time, nail cuttingDislikes tight clothes, seams, new textures

Auditory Holds hands over ears when there are loud soundsBecomes distressed during large gatheringsDistracted by background sounds others don't seem to hear

Balance + Equilibrium (Vestibular)

Fearful of movement or heightsAvoids playground equipment; sportsDifficulty with balanceDoes not like to be off the groundVery cautiousDislikes tilting head back; gets dizzy easilyMay only walk on toes; dislike barefoot

Smell

Taste

Sensitive to smells (AVOIDS foods, perfume, lotion)

Sensitive to taste- texture (picky eater) Gags (oral system is overwhelmed)

Body Awareness (Proprioception)

(rare)

Over-responsive

Behavior characteristics

� Frequently tunes out or withdraws- “shuts down”

� Appears lethargic, disengaged

� Easily over-whelmed

What Does Under-responsive Look Like?Visual Has difficulty keeping

materials organizedEnjoys bright florescent colors, spinning objectsLikes bright, fast-paced TV shows

Tactile “Wild child”- always jumping, climbing, running, pushing, and roughhousing Touches everything and everyoneAlways sits close to children in a circleMouths objects or clothesUnaware of bumps or cutsUnaware of food on facePrefers tight clothing, vibrations

Auditory Needs directions repeatedUnaware of auditory changes, cuesMakes sounds throughout the day (humming, whistling)

Balance + Equilibrium (Vestibular)

Seeks out spinning and movementRocks while sittingConstantly movingBumps into things; Is awkward getting down/up, jumping, getting around toys and peoplePoor eye- hand coordination

Smell

Taste

Seeks out smells (smells hair, objects, food)

Seeks out input (suck, chew, crunch, blow) craves strong flavors

Body Awareness (Proprioception)

Seeks out falling, crashing, pushingDifficulty grading force when throwing or writingUnaware of body is in spaceComes too close to other people’s personal space

Under-responsiveBehavior characteristics

� Easily frustrated; cries easily

� Frequently acts out or tantrums

� Seems anxious

� Pushes, hits or kicks others

� Moves constantly

� Shows little or no reaction to heat, cold, pain and other sensations

‘Challenging’ behaviors ???

When Should I Consider* Supports?

• Most young children experience some trouble with sensory integration at times

• If you or the family notice “red flags” with movement/balance, body awareness touch, auditory, and/or visual input

• If these behaviors are observed on a regular basis or during particular activities

• If the behaviors impact the child’s ability to function successfully in daily settings

• Supports should be embedded into everyday activities

*Contact an OT trained in Sensory Integration techniques…

AT Sensory Supports

AT is any thingthat helps

a child with a disabilitydo something

that s/he can’t do without it!

Consider AT Sensory SupportsPurpose:� Get ready to participate

� Calm/Stimulate

� Reduce/increase input

� Some supports help both avoiders + seekers!

Results with supports:� Improved focus, attention

� Body awareness + control

� Less distressed/frustrated,

� Happier- more cooperative

OBSERVE, OBSERVE, OBSERVETry, Modify, Document

Vision + Smell

Dream Lite Pets

Slow vs. Spinning toys

Vision

Sun glasses

Smell

Scented markers

Scented match up game

Aromatherapy Bear

Auditory Supports

Sound cancelling head phones

Ear plugs

Rainmakertoy

Voice magnifier

Ear covers

Toobaloo

REDUCE

ENHANCE

Tactile Supports

Use fidgit toys

Weighted items

Tactile/Vibration Supports

Combination:Weighted toy/heat, fragrance

wrapping snake or blanket

Massagers

Clothing� Soft, seamless � Compression

Soft + Seamlessclothing

Sleeves

Compression Clothing

Tight shirt

Bean bag chairs

Body Sock

Baby wrap

Pea Pod

Hammocks

MORE COMPRESSION

Body Awareness: Using Weights

Arm/leg bands

Weighted vest

Weighted blankets

Weighted lap belt

Chewies

BiteBands

Sensory Mittens

Oral

Vestibular…Balance + Move

Apps can help� Calming

� Non –messy drawing/writing Activities

� BooksBreathe, Think, Do

Letter School

Getting ready? Needing more input….

� Crash pads

� Ball pits

Carry heavy items)

Sensory Supports at Home� Get family input! Have families complete the Sensory

Checklist

� Consult with an SI trained OT

� Share successful supports/strategies used during similar activities in the center program with family � develop a plan- include how family can document� Add OT/SI services

� Check in with family on a regular basis

What Sensory Supports Have You Used?

Sensory Cube Activity

Sensory Cube Activity

Consider Visual Supports� Help a child focus….� Where things go� What comes next� Waiting � Transitions

� Help a child think about..� First… next….then� How it feels; how others feel� What to do; when to do it� How to play (rules)� Making choices + ideas

? ?? ?

??

? ?

… more SI Supports

Visual Supports at Home/School

Using a schedule of child’s daily routines/activities, ask if child needs help to understand ….

� where to find things and where they belong

� when things happen

� what to do and when to do it

� how to interact with others

� how to communicate thoughts + choices

Visual SupportsReminders: Keep hands to self….

What’s going to happen?

Where does it go?

Where’s mine?Calming down

More Visual Supports� TIMERS

� EMOTIONS

� SOCIAL STORIES

� VIDEO MODELING

Turtle TechniqueCFSEL

My Pictures Talk AppFlip books

iModeling app

DIY Visuals� Best to use photos + videos familiar to child:

objects, people + activities

� Involve families to contribute and use it!

� Modify as desired as experience and skill change

� Checklist:

Resources for Learning More About Visual Supports

• Head Start’s Center for Inclusion:(visual supports, social stories)

• Create visual schedules using the website.

• Center on the Social + Emotional Foundations for Early Learning (CSEFL)

Combine Sensory + Visual Supports

When is a support AT? it depends…....

When a child with a disability needs an item in order to participate- it becomes his AT

Selecting AT Supports� Identify participation outcomes

� Understand what is happening; what you see

� Select appropriate supports for a child

� Trial strategies: what, who, when how?

� Modify supports based on observed behavior

� Where else can you use successful supports?

How will you know the AT works?

What will you/the family observe? (see/hear)

� Have the child’s participation goals been met? Is s/he participating more?

� Is the child’s behavior different with the AT support?

� Does the child participate more willingly?

� Is the child calmer/less reactive or…

� More engaged with materials or activity?

Always Document What Works!!!

What Supports Have You Used?

Other Ideas???

New… Universal Sensory Supports- 2018

Sesame Place (PA) is the first theme park ever to be designated as a Certified Autism Center.

7 Theme Parks Supporting Sensory Needs with• Quiet rooms• Days with modified noises and lights

on rides• Weighted blankets• Soft toys• noise-canceling headphones • Lego building tables• Low sensory parades• Waterparks with water that can be

warmed for guests with sensitivities and waterproof wristbands

Let’s Participate! Projectwww.letsparticipate.org

A very special ‘Thank You!’ to Leaps and Bounds OT/SI staff

in Washington, DC

www.Leapsandboundsot.com

Considering AT Supports for

Participation…

Putting it ALL Together….

Participation Goal AT Supports + Strategies

Exploring all activity materials; getting “messy”

Participation Goal AT Supports + Strategies

Exploring all activity materials; getting “messy”

• Rub/brush hands briskly or “make fire” on carpet or on clothes before tactile activities

• Provide multiple options (glue stick, using paintbrush) until comfortable

• Reduce number of materials• Use apps with similar activities• Grade tactile activities: start with dry

beans/rice, then paint, then glue, then shaving cream

Classroom AT Tools

Desk easel

Multiple tools

Heated gel maze

Alternate activity

Spin Art App

Adapted spin art

Participation Goal AT Supports + Strategies

Keeping hands to self

Participation Goal AT Supports + Strategies

Keeping hands to self • Teach child to hug self; provide a visual cue (photo, picture)

• Give child something to hold in hands; weighted object

• Provide child with a designated area to sit or stand in

• Provide child with fidget toy to keep hands busy

• Provide child with a designated area to sit or stand in

• Define a child’s ‘work’ space with tapeor a tray

Supports to ‘keep hands to self’

Target: Carpet Squares

Weighted toyTray

“Hug Yourself”

Participation Goal AT Supports + Strategies

Self-regulating

Participation Goal AT Supports + Strategies

Self-regulating • Use a picture chart to help child identify body feeling as “too high” (excited, nervous, silly, frustrated), “too low” (tired, sad, bored), or “just right”

• Provide children with movement breaks

• Provide children with a quiet place to go when they are over-stimulated; add a cozy pod seat

• Provide a chewy necklace or object

AT Supports for Self Regulation

Participation Goal AT Supports + Strategies

Sitting still on floor

Sitting up in a chair

Participation Goal AT Supports + Strategies

Sitting still on floor • Provide child with a seat cushion or ball to sit on

• Provide child with a weighted lap pad or toy to place on lap

• Allow child to change positions (sit, stand, stomach)

• Use backjack chair

Sitting up in a chair • Make sure child’s feet can rest flat on floor and that the table is the correct height

• Turn chair around backwards while sitting at the table

• Use a seat cushion or a weighted lap belt

• Use stretchy bands to push against

AT Supports for Sitting

Seat cushionBackjack seat

Bouncy bands Weighted toyInflatable ball

Participation goal AT Supports + Strategies

Walking in line

Participation goal AT Supports + Strategies

Walking in line • Walk in a different way-backwards, sideways, animal walks, hopping

• Line position-front or back• Have child hold the door or carry

something heavy• Give a fidget to hold• Markers on floor (sticker dots or

tape lines) to stand on while waiting• Have young children hold onto a

rope with knots spaced 2 feet apart• Designated routes to follow• Line up two by two and hold hands

AT Supports for walking in line

Walking Rope

Participation goal AT Supports & Strategies

Transitioning easily

Participation goal AT Supports & Strategies

Transitioning easily • Use a visual schedule and go over it before changing activities

• Encourage child to learn the schedule; record steps on a device

• Visual – dim the lights; Auditory –whisper; “if you can hear me…”

• Use a timer (or timer app)• Incorporate movement activity into

transition (i.e. jump like frog, walk like a bear, etc); use an animal symbol

AT Supports for Transitioning

Picture schedule andAAC recorded

activities

Time timer

Symbol