DAVAO DOCTORS COLLEGE 2015Anne Bernadette Barte, BSOT

PLAY

Types of play unoccupied, onlooker, solitary

Assessment developmental, skills (MPC), playfulness, social

participation

Elements environmental, novelty, challenge, friendly

competition

Barriers inhibited by caregiver, caused by condition,

environmental accessibility, sociocultural

Play diagnosis for precautions, development of age

Guidelines for therapists be playful, empower, structure the

environment, appealing, competitive, show how to play yet let him also play alone

Good toy safe, sturdy, no choking hazards,

attractive/interesting, popular, has a functional cost, age-appropriate, fad/trendiness (generic vs. trendy), packaging

SENSORY INTEGRATION

- by: Jane Ayres- organization of stimuli for adaptive responses- integrated by 8 to 11 years old through sensory experiences- affects CNS and behaviour- Han Siu simplified S.I. but today Jane Ayres principles has to be reinforced back- mild learning behaviour- 3 primary SI: TPV (tactile, proprioception, verstibular)

Tactile1. Discriminative – quality (i.e. how we are held)2. Protective – alerts from danger

Vestibular

through the ears, has an average of 8 hours effect

Proprioceptive through the mechanoreceptors, muscles,

tendon, joints

Sensory (brain) anterolateral – pain, crude sensation thalamus – pain, temperature reticular – arousal, consciousness posterior parietal lobe, areas 5 & 7 – new

sensations, visual inputs, tactile memory primary somatosensory, areas 3,2,1 – tactile

sensations hypothalamus – central center Limbic – emotion, learning, memory, sexual,

emotional

S.I. DysfunctionsI. Praxis Disorder

II. Sensory Modulation

I. Praxis Disorder- integrated at 3 years old- difficulty in planning

dyspraxic – difficulty in learning new tasks

apraxic – difficulty in learning new task and already learned tasks

a. ideational praxis – conceptualizingb. planning – intentionalc. execution – refinement of skills

Levels of motor planning:- in order for us to know what type of problems1. stable client-stable environment

example: kicking a ball2. stable client-moving environment

example: kicking a rolled ball towards you3. moving client-stable environment

example: run then kick the ball4. moving client-moving environment

example: run towards a moving ball

a. Bilateral integration sequencing deficits- mild- stable to stable- vestibular & proprioception

1 July 2, 2015Cornerstone Therapy Hub, Gusa, CDOLectured by: Thea Sheila Ocheda-Alonto, OTRP, MOH

DAVAO DOCTORS COLLEGE 2015Anne Bernadette Barte, BSOT

- do jumping jacks (7 yrs old)b. Somatodyspraxia

- severe- decreased PVT inputs- motor/execution memory- difficulty in feedback and feed forward- supine flexion (fetal position)- poor in-hand manipulation

II. Sensory Modulationa. Overesponsive

- neurologic- hyperesponsive – exaggerated, avoids- greater than normal people

b. Underesponsive- lesser than normal people- hyporesponsive – clumsy

c. Gravitational insecurity- fear of feet off the ground- aversive response to movement- generally sluggish

Use: Sensory Profile by Winnie Dunn, Ph.D., OTR, FAOTA

Treatment1. Sensory stimulation – indian milking, joint

compression2. Sensory diet – structured, few well-chosen set

of activities given on a daily basis3. Heavy work – number of muscles are used for

sensory input

BEHAVIORAL APPROACH

1 yr – single toy, plays for 2 to 3 mins, mother2 yrs – acitivity, plays for 5 mins, associative play3 yrs – group activities, plays for 20 mins4 yrs – cooperative play5 yrs – games with rules6 yrs – competitive play

Evaluate likes & dislikes, interview, performance &

progress review (teachers)

Behavior modification- managing behaviors

▪ Observe

▪ Identify problem▪ Realistic goals▪ Plan▪ Implement▪ Prioritze

I. Observe

II. Identify problemSensory - problems to touchBehavior - problems to communication

Inappropriate behaviorsa. Off-task/Out-of-seat behaviors: annoying,

inappropriate playb. Physical Contact: spitting, throwing, hittingc. Noise/inappropriate verbal communication: crying,

whinning, not responding

Classification systemsa. Conduct disorder: aggresion, disruptiveb. Withdrawn: isolation, lack of self-confidencec. Socially immature: not according to developmental

expectations, age-inappropriate toys

Considera. Intensity: minimaly needs support?b. Frequently: occur periodically?c. Duration: too long?d. Severity: does the behvaior interferes?

III. Realistic goalsSMART goals

IV. PlanBehaviors: increase or decrease frequency?

Use of reinforcementsa. Consistent - in all settingsb. Immediate - every after correctc. Congruent - everydayd. Clear - specific

Types of reinforcementa. Primary reinforcement - foodb. Secondary reinforcement - no intrinsic value (i.e.

money)c. Social reniforcement - engaging in desired actvity

2 July 2, 2015Cornerstone Therapy Hub, Gusa, CDOLectured by: Thea Sheila Ocheda-Alonto, OTRP, MOH

DAVAO DOCTORS COLLEGE 2015Anne Bernadette Barte, BSOT

When to give: during difficult? Or long time?Timing: everytime, how long, fix/variable length of time. Fading - gradual decrease when behavior has established (confirms the effectiveness of reinforcement)

Token economy system: behavior charts with stickers and stars; uses unconventional items

Contract setting: verbal/written

Modify environment: decrease distractions, organizational assists (routines), break down tasks

Stategies to develop new behaviora. Shaping - defining and reinforcing successively

closer approximately to desired behavior, gradation, no strict rules, prompting dependency

b. Chaining - break down into several steps, teaching one component separately, if done correctly are initially reinforced

c. Modeling - following other person, imitation and group situations

d. Prompts and cues - physical (HoHa), gestural (indicates course of action), verbal (reminder)

Strategies to decrease undesirable behaviora. Ignore/Extinction - for attention seekingb. Time-out/Negative reinforcement - remove from

activity; for 3+ yrs old; socially acceptablec. Satiation - reverse psychiatryd. Over-correction:

a) Restitutional Over-correction - modifies effect maladaptive behavior by restoring the environment

b) Positive Practice Over-correction - practicing appropriate behavior to prevent the inappropriate ones

Guidelines in behavior management1. Simple phrases and sentences2. Use gestures3. Physical promts4. Fade help5. Routines (CPR)

C - consistencyP - predictability

R - routine6. Tools: calendars, time tables7. Move to extrinsic to intrinsic motivation

Ultimate goal: Self-monitoringSelf-monitor through calendar, timer, lists, reminder notes, physical organization of tools

V. ImplementVI. Prioritze

3 July 2, 2015Cornerstone Therapy Hub, Gusa, CDOLectured by: Thea Sheila Ocheda-Alonto, OTRP, MOH