2011年12月16日 星期五

Movement, Rhythm, and Sensory Disturbances Affect Perceptual Reality - What Can We Do to Help?

An organized body leads to an organized mind! A person with severe, nonverbal autism often exhibits intense sensory, movement, and rhythm difficulties that affect all areas of development. The messages, the impaired sensory systems project are irregular and often confusing. In some cases, but not all, there are disrupted underlying thought processes, which cause difficulty organizing and categorizing thought. When movements (dyspraxia/apraxia) are not automatic, problems initiating and implementing motor skills including speech often occur. Central nervous system dysfunction may be the cause of this miscommunication among neurons, which renders someone with severe autism unable to think and move his body simultaneously. Initiating, stopping, and switching movement are all difficult.

If the person is unable to direct his body upon verbal request, or to imitate when provided visual cues, motor him through movement patterns. Repetition with a ramping down of motored prompts develops the neuron circuitry that allows the voluntary movement to become automatic. Break skills down into small units and keep language simple and direct. Use visual and gestured cuing as needed. Incorporate, backward chaining techniques, a process where the person is motored through the majority of the steps and then encouraged to complete the last step on his own. For example, when learning to zip a jacket, motor the person through the process of engaging the zipper and let him complete the last step by pulling it up. These strategies work well with self-help skills that require a series of steps. (I.e. tooth brushing, dressing, and shoe typing)

Dyspraxia/apraxia renders sign language difficult to learn; a poor choice for expressive communication; however, learning to understand signs and gestures as visual cues is effective receptively as many of these individuals are stronger using visual rather than auditory systems. When performing gross motor movements, motoring and repetition is key! Exercises that cross the midline and engage both hemispheres may have added benefit. (I.e. Brain Gym) Start early for the best outcome; however, it is never too late for improvement. Nature walks on uneven terrain encourage the individual to attend to a natural environment, and to respond automatically with appropriate movements. This lessens the inhibitory factor that often appears in artificial settings.

A nonverbal individual may appear to give priority to one sensory channel at a time. There is often a delay in auditory processing; hence, a visual stimulus may not be experienced simultaneously with auditory input. Some might demonstrate totally disconnected sensory channels. For example, an individual who responds correctly by selecting a correct response from a field of words or pictures may lose his accuracy in selecting a correct response if he has to get up and move. Is it just that he has difficulty thinking and moving at the same time or could it be more complex? A visual prompt, - picture, sign or gesture- will usually remedy the problem, but it does not wholly explain the break.

A person may indicate he understands and appropriately reply to a directive verbally, typing, using words/picture cards, but still not be able carry out the action. For example, ask the person, "Where are you going?" He responds, verbally or using alternative communication devices, " I'm going to hang up my coat." Instead of hanging up his coat, seemingly oblivious, he heads off in a different direction. Is it going from listening to thinking to moving that cause the thought disruption? A lost connection occurs when the student moves.

When working from a field of choices, a person may never look at the choices, not even a quick peripheral glance may be detected, yet, his selection of responses may be correct! It appears as if he is seeing and controlling his body from outside himself. A person, who has difficulty integrating sensory channels may easily match objects presented visually. (I.e. word to word, picture-to-picture, object-to-object) This process becomes more difficult when pairing visual material that varies from the concrete (object) to the representational (picture) to the word (abstract). (I.e. matching two words or two pictures is much easier than matching the word to the picture. Matching the word to the picture is easier than matching the word to the object.) Crossing sensory channels can be difficult. The person may be unable to match an object presented visually with an unseen object. For example, put a crayon, bottle of glue, scissors, and a ball, in a bag. Show the individual a crayon, and then ask him to reach into the bag and find the same. If he is unable to find the crayon, put one of the crayons in his hand, and ask him again to reach in the bag to find the other crayon. Repeat the activity, using the other objects. The person may be successful visual to visual or tactile to tactile, but not visual/auditory to tactile. After a good deal of practice, he may improve while another may continue to have difficulty.

An individual may appear to lack an internal rhythm. When young, parents should hold their child close, so he can feel the heartbeat/rhythm of the mother or father. An older child may be provided an external rhythm by alternately tapping the right and left hand, shoulder, or arm. Many of these individuals like rhythmic pressure to the sides or front and back of their heads. Listening to ocean waves, nature sounds, or music might help him attune to the rhythm of the earth. Moving to music or drumbeats might also help. An agitated person can be encaged in meditation by holding hands and breathing in unison with calm person.

Sight, sounds, smells, tastes, and textures may serve as sensory irritants. Eliminate aggravations when possible. One reason a student may engage in self-stimulatory behavior is to modulate unwanted stimuli. These repetitive behaviors might also help the person establish a rhythm to organize their movements. A person may also be trying to block out interfering thoughts and emotions of others or he might be stimmming as a strategy to return to his own internal world. Whatever the reason, instructors should encourage the person to stop when in the process of direct instruction since self-stimulation seems to enable the client to block the teacher, parent, or therapist. When not involved in instruction, let the individual re-engage in his preferred self-stimulatory activities as these activities may be helping him self organize and/or relax. If the self-stimulatory behaviors are dangerous or socially unacceptable, attempt to replace, rather than fade them.

Allow ample time for spinning, swinging or jumping on a trampoline for the individual student is the best judge of the type, intensity, and duration for vestibular and proprioceptive input over time. Each individual should determine what he needs. Brushing, deep-pressure massage, joint compressions, meditation, sacral cranial, reiki, and reflexology may help the person feel comfortable in his body. If comfortable, the person is more apt to stay present and attend to instruction. The importance of rhythm and movement is paramount in helping a person with severe autism reach his full potential.

Definition of Terms: apraxia/ dyspraxia: Impairment of the ability to execute purposeful, voluntary movement. binaural beats: Two different frequencies are presented, one to each ear, the brain detects phase differences between these signals. A perceptual integration of the two signals takes place. Vestibular: The system that sub serves the bodily functions of balance and equilibrium. It accomplishes this by assessing head and body movement and position in space, generating a neural code representing this information, and distributing this code to appropriate sites located throughout the central nervous system. Vestibular function is largely reflex and a€‥unconscious in nature. Proprioceptive: describes the ability of the to sense the movement and position of muscles without visual guides. It is essential for any activity requiring hand-eye coordination, awareness of posture, movement, and changes in equilibrium and knowledge of position, weight, and resistance of objects as they relate to the body. Resonant entrainment of brain waves: Because neural activity is electrochemical, brain waves can be influenced. Think of the tuning fork effect. Rhythm: a measured movement, the recurrence of an action or function at regular intervals. Subconscious: The part of the mind below conscious perception where subconscious joining or blending may occur. I speculate that the mixing of subconscious minds can exist without one's conscious awareness. This blending can be very helpful in helping the person understand and operate in "our" typical perceptual reality.

I have worked with a vast array of people with autism. Many of the ideas I present are based on experiences intuitively listening to what my students were trying to show and tell me. My ideas have also been influenced by information that I have read based on the work of others that has resonated with me.

Mary Ann Harrington MS


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