Articles for March 2014

SENSORY INTEGRATION – Not Just for Autism Spectrum Disorders – Part 4 of a 4 part series

Part 4 – Sensory Integration Interventions for Adults in Music Therapy

This is the final blog in a 4 part series about Sensory Integration. Three weeks ago, I defined sensory integration dysfunction as a neurological processing disorder that results in a disconnect in the internal sensory system(click here to read). The second post was about how sensory integration dysfunctions may present in children (click here to read). Last week I discussed a variety of methods to address sensory issues with children in music therapy groups (click here to read).

I have often said that I love being a music therapist. Being able to work with a variety of people in a variety of stages of life makes each and every day different. And being able to share in the joy of making music is truly a blessing.

While each individual is different, and how they need and respond to sensory input is also different, it is possible to address a wide variety of sensory goals in the music therapy group. There are a lot of similarities in the adults with sensory integration dysfunction as with children. Older adults with Alzheimer’s type Dementia exhibit many of the same types of sensory dysfunction behaviors as children. In addition to neurological processing disorders due to aging and dementia, many of these individuals have health issues such as decreased circulation which affects how they are able to move. On the memory units, I see many individuals that make repetitive hand motions such as stirring or tapping. Many of these people are at the end of life and have already lost much of their sensory functions. So it is important to provide as much sensory input as possible while at the same time being aware of limitations due to medical conditions.

I include a few minutes of movement in each group. I make eye contact and may hold hands with a resident and sway their arms in a wheelchair dance. Those that have the ability to move their legs and feet are encouraged to tap and kick and march in place.  I may give them scarves or ribbon streamers of varying colors and textures to move to the music. These can even be scented to add another level of sensory input. Parachutes, stretchy bands, balloons and beach balls are a great way to attract attention and get people to move to the music. Deep pressure stimulation isn’t appropriate with adults for a variety of reasons, but I have found that they need physical contact. As I pass out instruments or whatever manipulatives we are using, I gently place the object in the hand and help them grasp it. I also sing a closing song and go around the group and give a gentle handshake.

Auditory processing issues are different for adults in later stages of life because many of them have lost their hearing. They may not display auditory sensitivity issues like children, but they may not be able to understand what is being said, not only due to hearing impairment, but may have trouble comprehending what they are hearing. These same people, however, can sing entire songs with the correct words in music therapy, because the music centers in the brain trigger the long term memory.

I also do instrument playing and sing-along in every group. I use the cabassa for adults much the way I do for children (click here to read). This instrument is heavy so I give it to a couple of people that make repetitive stirring motions. For those that have the use of both hands I give guiros or claves. During the sing along, I try to have my music memorized so that I can move around the circle and make eye contact to help remind them to sing and play.

Sensory processing issues are seen in individuals of all ages and can be addressed appropriately in individual music therapy sessions or in the group setting.

What are your favorite techniques to address sensory processing issues for adults?

Please leave your comments and questions below.

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SENSORY INTEGRATION – Not Just for Autism Spectrum Disorders – part 3 of a 4 part series.

Part 3 –Music Therapy Interventions for Children with Sensory Processing Disorders

Two weeks ago, I posted my definition of Sensory Processing Dysfunction (click here to read that post) and last week I posted about some of the ways that children exhibit sensory processing issues (click here to read that post). This post will talk about some music therapy interventions that provide the sensory input that these children need.

When I first began working as a music therapist, I was working with children providing individual music therapy sessions in the child’s home. While a great majority of the children I worked with were diagnosed with Autism Spectrum Disorder, I also worked with children that had Cerebral Palsy, Down Syndrome and other developmental delays. In the 1:1 environment with a young child, I provided a regimen based on “the sensory diet” used by many Occupational Therapists. This was a program using deep pressure and joint compressions starting at the top of the head and working down the body. After all the compressions had been done, we would then jump up and down 10 times and do some nice squeezing (hugging) as needed. And because it is music therapy, we are singing songs, of course. By providing the deep pressure and joint compression at the beginning of the session, the child was then able to focus on other musical tasks. For many of the kids,

 the process needed to be repeated at intervals during the session. Ideally the child would learn how to calm himself and focus longer on tasks over time.

It is much more difficult to address individual sensory processing needs in the group setting, but it can be done. Although the goals for music therapy groups are generally written for the entire group and therefore oftentimes are geared toward social and educational goals, individual goals can be incorporated in the music therapy group by offering a wide variety of sensory experiences.

Auditory sensitivity issues are addressed in the music therapy group by building trust with the child. The first time I do a group, I let each child strum my guitar during the “Hello” song. It is a safe environment, a child that is afraid may need assurance that he only needs 1 finger or he may need hand over hand assistance. If a child is unable or unwilling to touch the guitar, they are given the option of putting their hand on top of mine while I play, to just listen or to be given a turn to try again after the other children have played. After about 2 weeks, I begin using different types of

perrcussion instruments during the hello song. Each week I bring something new that each child can play and then that instrument is incorporated into our group playing. In this way they understand what each instrument sounds and feels like individually and therefore it is less daunting during the rhythm band time. Children are never forced to play an instrument and a child with multiple sensory processing issues may not be able to stay for the whole music therapy group, or need more proximal space to be able to tolerate the sounds. Over time the child is encouraged to move closer to the group and participate for longer periods of time. Because the music therapy group and all the instruments and activities are very motivating, I have had some of the most auditorily sensitive children prefer the loudest instrument. The big gathering drum is 18” tall and 22” in diameter. It has a deep bass tone and a lot of vibrational input for sensory needy people.

Tactile sensitivity issues are also addressed by introducing the instruments as described above because the instruments themselves have different textures. The cabassa is a cylindrical instrument with beads around the perimeter. It comes in different sizes but I prefer the large one for those that need tactile input because it is heavier so provides more weight in the hands, some kids are encouraged to rub it on their legs or feet as needed. The guiro is another excellent instrument for tactile input it comes in a variety of shapes but I generally use the tradition latin “fish shaped” guiro. It is a wooden rasp that is scraped with a stick so it provides both tactile and proprioceptive input.Josh plays the CabassaThe music therapy group setting is a perfect environment for children needing proprioceptive input. Dance and movement games are great to incorporate during the group. The school music therapy group setting is a perfect place for those children that need to rock, sway and move during the music.

What are your favorite interventions for sensory processing issues? Please put your comments and questions below. Come back next week when I will discuss Sensory Integration techniques for adults in the music therapy group.

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SENSORY INTEGRATION – Not Just for Autism Spectrum Disorders – A 4 part series.

Annie touches the guitar with one finger

Annie touches the guitar with one finger


Part 2 – How does Sensory Integration Dysfunction present in children?

Sensory integration issues are prevalent in individuals on the Autism Spectrum and often times is listed that a person has “autistic tendencies” that are related to sensory processing. In last week’s blog, I defined sensory integration as a neurologic processing disorder that results in a disconnect in the internal sensory system, (Here’s a link to last week’s post) so sensory processing functions may be affected for anyone that has any type of neurologic processing issues. Music therapy interventions can address a wide variety of sensory needs in individual and group settings.

A child with auditory sensitivity has difficulty with sounds, they may find any sounds disturbing, or only loud sounds. They do not perceive sound the way most people do. The example of “fingernails on a chalk board” is a good analogy. Although chalk boards are not used very often anymore most of us understand that this sound can be quite spine tingling. A person with auditory processing difficulty may be afraid to try new things (such as playing a musical instrument) because it may hurt their ears or be too loud.

Children with tactile processing issues are hesitant to touch new things, or they may need to touch everything. They may be at an oral stage and want to put everything in their mouth or lick it with their tongue. Some kids will put their feet on objects to get input on the soles of the feet. (I carry disinfectant wipes with all my instruments).

Many children will seek visual stimulation by squinting or rapid blinking of the eyes, or doing hand motions in the visual field. These kids may also exhibit some interesting facial expressions as well.

Proprioceptive processing disorders are often presented by repetitive motions such as hand-flapping, head movements, facial grimacing and toe-walking. These children have a very difficult time staying still or focusing on tasks for any length of time, they have a need to keep moving in order to seek the sensory input that their body needs at the time.

In next week’s post, I will give some ideas to us music and music therapy interventions to address sensory processing issues with children, in the meantime, please post your questions and comments below.

 

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SENSORY INTEGRATION – Not Just for Autism Spectrum Disorders – A 4 part series

SENSORY INTEGRATION – Not Just for Autism Spectrum Disorders – A 4 part series.

Part 1 – What is sensory integration?

Part 2 – How does it present in children?

Part 3 – Interventions for children

Part 4 – Sensory Integration for adults

 

Part 1 – What is sensory integration?

I first heard about sensory integration during my undergraduate studies more than 20 years ago.  A professional music therapist was coming into our class to present on the topic. She was very knowledgeable and had a lot of great suggestions, but I didn’t really understand what sensory integration was or why it was important. I have had the opportunity, over the last 20 years, to work as a music therapist with many children and adults with sensory integration issues.   I hope that through this blog series, readers will feel confident in addressing sensory integration issues through music therapy interventions.

We teach kids about our 5 senses – Sight, Sound, Touch, Taste and Smell, these are obvious sensory functions of the body and most of us understand how they work. We also understand that someone who is missing one or more of these senses compensates by relying on more acuity of the other senses. For instance, blind people may use their sense of hearing to make up for a lack of vision.

But there is another sensory system at work in our bodies. It is an internal sense of where our bodies are in space. Children love to twirl and spin and go upside down and each time they do, they are using this internal sense called proprioception. Most of us know instinctively where our bodies are and what we are doing. For example, I know that I am sitting up straight with my hands on my computer keyboard and typing.

So what happens when there is a disconnect in this internal sensory system? Dr. A. Jean Ayres identified Sensory Integration Dysfunction as “atypical social, emotional, motor and functional patterns of behavior related to poor processing of sensory stimuli.” In other words, the individual may be unaware of the environment around them and not able to respond appropriately to social or environmental cues. This can occur in any individuals of any age with neurologic processing disorders such as Autism Spectrum Disorder, Cerebral Palsy, Developmental Delays and Alzheimer’s disease and dementia as well as any type of Traumatic Brain Injury such as stroke. Music therapy is an effective rehabilitation and treatment model for individuals with sensory issues.

There are a variety of ways that individuals with sensory processing disorders may present themselves and I will post about some of the ways to identify sensory issues with children in part two of this blog series next week. In two weeks I will discuss effective methods to address sensory issues with children in the group setting and the series will finish with a discussion of music therapy interventions with older adults.

Do you have questions about sensory processing issues? Please ask any questions or make comments below. I would love to hear from you.

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