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  1. 1. Needs Assessment-Creating a Sensory Environment Objective: ● To provide a needs assessment for FR to develop a multisensory environment to promote emotional self-regulation through sensory organization (modulation) Overview: ● Background on Sensory Integration theory ● Summary of literature supporting sensory integration techniques for children exposed to trauma ● Strengths of FR ● Reason for Sensory Corner ● Description of 7 senses ● Table summarizing recommendations ● Conclusion ● References Additional Resources: http://www.ot-innovations.com/content/view/49/57/
  2. 2. Introduction During the four weeks (July 9th, 2014-August 5th, 2014) while interning at Family Rescue (FR), Melina Marte, OTS, and James Oldenburg, OTS, conducted a needs assessment for development of a designated sensory area. The staff at FR approached the occupational therapy students regarding an area in which the children can de-escalate and regulate their emotions using sensory techniques. Below is a summary of the environmental and contextual supports that are already in place at FR. In addition, there are specific recommendations that may help to promote self-regulation in a safe and comforting environment, according to general sensory integration theory principles of modulation. Sensory Integration Overview Sensory integration is the neurological process that organizes sensation from one’s own body and from the environment and makes it possible to use the body effectively within the environment (Kielhofner, 2009). Sensory Integration Theory is a model of brain-behavior relationships and helps to explain why some individuals behave a certain way, plan interventions to address difficulties, and predict how behavior will change as a result of intervention (Bundy, 2002). Individuals may seek or avoid sensory input by interacting with their environment. The interaction between our sensory system and environment is largely an unconscious process the drives behavior to satisfy or regulate a system that is not in balance. For example, a person with light sensitivity may prefer a dimly lit room or a child with excessive energy may be constantly fidgeting in his/her seat. In addition, the Model of Sensory Processing helps to interpret a child’s behavior from a sensory processing perspective and proposes that sensory processing impacts functional performance. That is, an individual with a well-regulated system is able to meet the challenges of the environment and successfully perform his/her roles and routines; whereas, an individual with an unregulated system may have difficulty fulfilling requirements and managing responsibilities. In the context of a classroom, functional performance can be viewed as a child’s ability to attend to tasks, follow instructions, and adhere to classroom rules and expectations. If a child’s brain is able to control (i.e. modulate) its response to environmental stimuli then the child will be able to function within the environment. For example, the brain of a child that gets distracted by ambient background noises while reading is unable to filter out the unnecessary environmental stimuli, which then interferes with functional performance (reading). The child’s behavior in this scenario may take the form giving up on the assignment and distracting other students, fidgeting, or wandering around the classroom. The solution, in this case, may be to understand what is distracting the child and designing an intervention to improve participation. Two key concepts crucial to understanding Sensory Processing are Neurological Threshold Continuum and Behavioral Response/Self-Regulation Continuum.  Neurological Threshold Continuum: The neurological threshold is the point in which a stimulus triggers a response. An individual’s neurological threshold is located on a continuum that varies across all people. For example, a person with a low threshold for
  3. 3. noise may perceive the sirens of a passing ambulance as extremely unpleasant; whereas a person with a high threshold may not even notice the siren.  Behavioral Response/Self Regulation Continuum: Self-regulation refers to the strategies people use to manage their own needs and preferences (Dunn, 1997 - Sensory Profile Manual). The two ends of the self-regulation continuum are represented by: o Passive Self-Regulation - Children respond passively to their neurological threshold by letting things happen to them and may respond by complaining about unpleasant stimuli instead of withdrawing or retreating. Children on this end of the continuum do not actively seek to control their environment. o Active Self-Regulation - Children respond actively to their neurological threshold by attempting to control their environment by seeking or avoiding stimulation. For example, a child may actively try to add sensory input into his/her experience by skipping around the room and touching every object in the room. One the other hand, a student may withdraw or retreat from an activity to reduce the sensory input from the environment. How Trauma Affects Behavior: A Sensory Integration Perspective Literature suggests that young children exposed to early life traumas (early loss, disturbed caregiver systems, emotional abuse, neglect, sexual abuse, physical abuse, etc.) experience impairments across various developmental areas (Warner, Koomar, Lary, & Cook, 2013). Behavioral regulation, however, is the most severely impacted domain resulting in effects on other areas of development such as cognitive and social-emotional skills, among others. The Sensory Integration (SI) Theory has contributed to the treatment of mental health especially in the area of behavioral dysregulation through the use of sensory modulation. Many studies have used sensory-motor strategies to address arousal regulation manifested as behavioral dysregulation of children and adolescents who have experienced trauma (Warner, Koomar, Lary, & Cook, 2013). These studies consulted occupational therapists specializing in SI theory for individualized sensory-based treatment or to develop environmental modifications to residential facilities. Sensory rooms were developed for children to have the opportunity to learn new self-regulation strategies. By targeting behavioral dysregulation through sensory-motor input tools, children were better able to process traumatic experiences and disruptions within their daily lives. Strengths and Supports ● FR Employees ○ Values and Beliefs: Staff at FR are interested in learning more about sensory integration theory and how to incorporate these strategies into the children’s program. The staff has an understanding of the benefits of sensory input in order to foster healthy emotional regulation. Given FR’s belief in sensory integration strategies, they would value having an environment designated to the children’s sensory needs.
  4. 4. ● FR Environment ○ Social Support: The adult program provides a social support network for the staff at the children’s program given their shared interest in promoting healthy behaviors. Both services collaborate and periodically have meetings to discuss areas of improvement. ○ Social and Economic Systems: Given that FR is a non-profit organization, it is important to consider the resources available for improving the children’s program. The staff has demonstrated their commitment to investing resources on constructing a sensory environment. Information from this report may serve as a guideline for facilitating the process of drafting a federal grant proposal. ○ Culture and Values: The program at FR is intentionally designed to promote structure and a sense of safety throughout the day. The staff at FR values the social and emotional needs of the children and is committed to providing an environment for children to develop basic social and self-regulation skills. ○ Built Environment and Technology: The classrooms are located on the garden level of the facility. The built environment provides a generous amount of space for activities. The area proposed for the sensory corner is located in the northeast corner of the facility. A bank of windows that run on the east and, north, and south provide ample natural light. ● FR’s Impact on Child Performance ○ With the proper supports, children are able to develop skills necessary for gross and fine motor tasks, play, activities of daily living, education, and social participation. ● FR’s Impact on Child Participation ○ Children appear motivated to participate in the children’s program through their enthusiasm and positivity. The program provides many opportunities to support the children’s engagement through structured group activities, play, and community integration (field trips). General Recommendations Negative behaviors (aggression, defiance, obstinate, etc,) observed at the children’s program may be a manifestation of limited opportunities to obtain needed sensory input in order to self- regulate. These behaviors are then perceived as a hindrance to performance and participation in group activities, community outings, social engagement, and play. Providing opportunities to receive sensory input throughout the day may have an effect on observed behavior issues, thus improving performance and participation. In addition, a designated sensory environment may address some of these behavioral concerns by providing a safe environment for the child to de- escalate and regulate his/her emotions using specific sensory organization strategies. Below is a description of the seven sensory systems followed by a tabulated summary of recommended items. It is important to note that the following list is not an extensive representation of materials available but examples of how to address certain sensory needs. 1.) Vestibular Sensation (awareness of movement related to gravity)
  5. 5. ● Definition: Sensation coming from stimulation to the inner ear that is caused by moving through space (e.g. swinging or spinning) and moving one’s head in different directions (hanging upside-down). A healthy vestibular system helps with maintenance of vision and posture. Unmet vestibular needs may contribute to the behaviors listed below (Sensory Observations in table). Sensory Observations Recommendation Possible Solutions Availability/Cost Examples Children enjoy swinging on playground Provide linear, rhythmic movement as a calming vestibular input Harmony Kids Standard Rocker $55.65 Amazon.com Children seek being carried (e.g. piggy back rides, fly like superman) Provide input that elevates the body off of the ground or allows use of balancing skills Hanging Canvas Seat Swing Cost: $199.99 Fun and Function http://funandfunction .com/hanging- canvas-seat- swing.html Round Seesaw Cost: $164.69 Amazon.com Gonge Riverstones Cost: $58.99 Amazon.com
  6. 6. Seesaw Balance Board A or Circular Balance Board Cost: $49.99 Funandfunction.com Cost: $58.99 Funandfunction.com Children seek spinning sensation Provide continuous circular movement for arousing (fast) or calming (slow) input Tilt and Turn Cost: $139.99 Amazon.com 2.) Proprioceptive Sensation (awareness of body position in space) ● The sensation of one’s body in space and in relation to itself. The sensation comes from stimulation to muscle, and to a lesser extent, joint receptors, especially from resistance to movement. An example of proprioception would be with eyes closed, knowing the position of one’s limbs (e.g. hand is above head or arm out to the side). Children with underdeveloped proprioceptive systems have trouble controlling their body. Children may appear clumsy and have trouble using both hands to catch a ball or may like the feeling of running into doors/walls/people. Children with unmet proprioceptive needs may seek input into muscles and joints, which may take the form of behaviors (Sensory Observations in table) listed below. Sensory Observations Recommendation Possible Solutions Availability and Cost Examples
  7. 7. Children enjoy movement activities including jumping and hanging Provide options for vertical movement to allow more input to joints and muscles Mini trampoline hopper balls Cost: $27.00 Walmart.com Aeromat Therapy Burst Resistant Peanut Fitness Ball 40 cm Cost: $26.00 Opentip.com Ball Bounce & Sport Fun Hopper Cost: $13.17 Amazon.com Children commonly burrow their bodies within objects (i.e. beanbags) or hide in isolated spaces Provide various weighted or resistance materials to provide deep pressure and receive more feedback from larger surface area Air Lite Barrel Roll Cost: $159.00 Amazon.com Body Pod Sensory Sock - medium Cost: $35.99 Amazon.com
  8. 8. Comfort Research XXL Fuf Chair Comfort Suede Cost: $99.00 Walmart Children throw, pull, and kick objects during positive and negative emotional reactions Provide safe objects and environment to push, pull, hit, and throw Big Time Toys Socker Bopper Power Bag Cost:$18.18 Amazon.com Skil-Care Crash Pad Cost: $150.00 www.mainstmed. com The Beam Store Royal Blue 2- Inch Thick Folding Panel Mat Cost: $148.99 Amazon.com 3.) Tactile Sensation (touch) ● Sensation derived from stimulation to the skin is referred to as tactile information. This information allows individuals to interpret physical contact with the external world. For example, using the hands to feel the textures on a leaf’s surface involves processing tactile information. As described below (Sensory Observations in table), children with unmet tactile sensations may demonstrate behaviors in which they touch objects constantly within their environment. On the other hand, children with difficulty processing tactile information may avoid physical contact with objects in their environment. Sensory Observations Recommendation Possible Solutions Availability and Cost Examples
  9. 9. Children are open to exploring new and familiar textures using hands within the natural and built environment. Some children are more resistant to new textures and dislike certain feelings on hands. Provide options for types of tactile stimuli to decrease tactile sensitivity and promote tactile exploration. Vibrations and soft textures for calming strategies. 1 lb weighted tactile beanbags - set of 5 Cost: $22.99 Amazon.com Tangle Creations Tangle Relax Therapy Cost: $6.62 Amazon.com Tactile cube (6 pc.) Cost: $188.99 Amazon.com Flashing Spikey Ball Light UP Party Cost: $2.99 each Amazon.com
  10. 10. Super Duper Frog Massager Cost: 15.95 +$7.99 shipping Amazon.com Senseez vibrating children pillows Cost: $39.99 Walmart.com Create homemade sensory bins with everyday items of various textures (e.g. rice, beans, sand, and flour). As a calming strategy, include a small cup inside for rhythmic pouring or small textured objects to find. Sterilite 16.5- Gallon (66- Quart) Latch Storage Box, Set of 6 Cost: $47.82 (set of 6) Walmart.com 4.) Visual Sensation ● Information entering through the eyes and processed by the brain provides visual sensation and interpretation. Visual input provides information about time and space from the environment. Children with unmet visual needs may have a higher interest in bright lights and colors, for example, and attempt to obtain this input in their natural environment. On the other hand, some children may experience sensitivity to visual input and present with behaviors such as avoidance, frustration, or disengagement. Sensory Observations Recommendation Possible Solutions Availability and Cost Examples
  11. 11. Children notice colorful or bright items in environment Provide some visual stimuli using cause and effect relationships as well as tactile input Playvisions Light Up Molecule Ball Cost: $6.43 Amazon.com Some children display aversion to bright lights Provide an enclosed space or eye covers to reduce visual input Explorer Dome - small tent/dome Cost: $21.99 Funandfunction. com Dream Zone- Earth Therapeutics Sleep Mask Cost: $8.99 Amazon.com Children’s energy levels change with lighting Allow the option for limited/dimmed lighting to reduce visual stimulation. Consider modifying natural lighting as well by opening/closing window blinds Starry string lights - 20 ft. Cost: $24.99 Amazon.com 5.) Auditory (Hearing) Sensation ● Auditory sensation comes from sounds entering the ears and is then interpreted by the brain. This sensation, like visual input, provides information about time and space in the environment. Children with unmet auditory needs may seek objects that create different sounds or may produce noises with their mouth such as humming, singing, whistling. On the other hand, children with sensitivity to auditory information may have an aversion to certain types of sounds (i.e. loud, high pitched noises) and may exhibit avoidance behaviors such as covering ears or becoming emotionally upset. Sensory Observations Recommendation Possible Solutions Availability and Cost Examples
  12. 12. Children’s high energy levels may be modulated with music or instruments Slow music for calming and relaxation effects. Can be used as ambient noise while exploring other sensory stimuli within environment. I Can Relax! A Relaxation CD for Children Compact Disc: Cost: $17.99 Amazon.com Digital Download: Cost: $9.99 iTunes 120 Nature Sounds Digital Download: Cost $9.99 iTunes 20" Chilean Cactus Rain Stick Musical Instrument Cost: $12.00 Amazon.com 6.) Olfactory (Smell) Sensation ● The sense of smell comes from receptors in the nose that are processed in the brain. Children with unmet olfactory needs may use smell to interact with people/objects or fail to notice unpleasant odors. Some children experience olfactory sensitivity, in which they react strongly to smells and are easily bothered by certain odors. Sensory Observations Recommendation Possible Solutions Availability and Cost Examples Some children are sensitive to unfamiliar odors and others enjoy various scents (i.e. coffee, perfume, aerosols) Provide natural or artificial odors that promote calming sensations. If natural odors are prefered, consider making a potted garden with scented flowers. Aromatherapy Sleep Lavender Vanilla Body Lotion (6.5 fl oz) Cost: $11.26 Amazon.com
  13. 13. Aromatherapy oils (Lavender) Cost: $10.99 each Amazon.com Wallflower fragrance plug and Wallflower fragrance refill (pack of 2) Cost: $4.50 Bed Bath and Beyond and Cost: $6.50 Bed Bath and Beyond 7.) Gustatory (Oral) Sensation ● Gustatory sensations provide information from the mouth to the brain about taste, pain, temperature, feeling, and movement. Children with unmet oral needs may prefer certain textured food items or constantly have items in their mouth (i.e. pencil, gum, toy). Children who experience difficulty with oral sensations may avoid certain food textures, gag easily, or dislike tooth brushing. Sensory Observations Recommendation Possible Solutions Availability and Cost Examples Children often feel urged to place items in mouth constantly (toys, unfamiliar food-like materials) Provide children with an item that will promote oral stimulation and oral-motor activity (chewing, biting, sucking) for soothing Red chewy tube (other types/textures available) Cost: $8.53 ea. Amazon.com
  14. 14. sensations Flexible Straws (in a jar) Cost: $1.25 (50 ct) Walmart Office snacks Sugar-free Pops (or other candy) Cost: $24.60 Walmart Conclusion The use of sensory strategies can be beneficial in the recovery process of children exposed to traumatic experiences. These techniques offer the opportunity to self-regulate in a moment of emotional disturbance, as well as other moments throughout the day. It is important to provide a safe, comforting environment where children can de-escalate. A designated multisensory environment will allow children to have a sense of control in how they explore and obtain sensory needs. The occupational therapy students would like to thank Family Rescue for providing the opportunity to apply our current educational background in order to suggest recommendations for a sensory environment. We hope that you will find this information useful and valuable as you continue the process towards developing a sensory environment. Signatures
  15. 15. References Warner, E., Koomar, J., Lary, B., & Cook, A. 2013. Can the Body Change the Score? Application of Sensory Modulation Principles in the Treatment of Traumatized Adolescents in Residential Settings. Journal of Family Violence, 28 (7), 729-738. Retrieved from http://link.springer.com/article/10.1007/s10896-013-9535-8#page-1.