Case Studies

Case Studies by Students of the Brain and Sensory Foundations Course

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Case Study 2-Robby

By K.O., Occupational Therapist

[At the beginning of the school year]:

Robby is a six-year-old first grade student diagnosed with Autism. He is enrolled in our Autism program in a public elementary school which utilizes an ABA approach. Robby’s was a full term baby who reportedly met his developmental milestones until approximately 15 months per parent report. Robby is non- verbal, which affects his ability to communicate his needs or frustration. He is being introduced to PECS symbols to choose items that he wants in order to request, including toys, foods, all done and more from an array of two. Typically, Robby will point or take an adult by the hand and bring them over to get a preferred item. He will whine or protest when he does not get these items or when he is not able to tell others his wants and needs. Robby is beginning to make more sound vocalizations that include early developing sounds. Robby continues to demonstrated limited understanding of concepts receptively, including the identification of objects related to school and home environments and food. While Robby makes frequent eye contact as a means of requesting to adults, he does not consistently look in response to his name (about 50%).

Robby requires frequent sensory input to be comfortable and productive during his school day to regulate his body and his attention, including tactile, deep pressure/proprioceptive and oral input. He benefits from wearing a weighted vest and compression belt to provide this input to increase his ability to participate in seated tasks for educational and therapeutic activities. He frequently becomes physically dysregulated and seeks movement by running and yelling. Robby benefits from scheduled times to wear the vest and compression belt as well as other sensory activities to increase his participation and transitions between tasks. When his body is regulated and demonstrating a calm level of arousal Robby is able to sit and participate in fine motor or visual motor tasks for 2-3 minutes with consistent assistance. He demonstrates difficulty sustaining visual attention for visual motor and bilateral tasks and sustaining a 4 finger grasp on tools and manipulatives. He currently mouths non-edibles when upset/frustrated (intense chewing) or seeks to explore something orally. Robby is able to accept an appropriate oral motor tool to chew in most situations when he is seeking input by chewing inappropriate items in his environment. Robby exhibits several interfering behaviors which impact his ability to function in the classroom. He seeks out consistent sensory input (squeezes, ball being rolled over him) and is on a 30 minute fixed interval schedule with the weighted vest. He has limited body and safety awareness, and may run away from an adult or flop to the ground when distressed.

He demonstrates rigidity with regards to his schedule or preconceived notions of how things are “supposed to go”. When frustrated, Robby may flop to the floor, scream or cry and run in circles he can be very difficult to redirect. These tantrum behaviors average about four to five times a day.

Robby participates in routine gross motor tasks each day to help support motor planning development. He is able to follow 1 step tasks with repetition and physical assistance. For example, he is able to jump on the trampoline for varying repetitions but at times needs the motor plan demonstrated or physical assistance to initiate these movement opportunities.

Robby’s schedule is 5 days a week of 20 minutes of 6 varied motor stations that incorporate appropriate developmental movements and directed play activities. He is also seen twice per week for visual perceptual motor/fine motor tasks for a total of 40 minutes in all. He has the opportunity to participate passively in RMT exercises 5 days a week but has had a series of very slow introduction to the basic rhythmic movements due to his overall poor tolerance for touch.

I began very slowly introducing rhythmic movements to Robby as his touch tolerance was very low. We began with whole body deep pressure and slowly introduced the rhythmic movement in side lying of shoulders and hips. Robby could tolerate about 3-5 seconds and then roll onto his stomach where rhythmic movement of hips was introduced for a few seconds. We were able to introduce this method for 2-3 times a week as tolerated. Robby would then be introduced to a gross motor task such as using a riding car with his feet or jumping on the trampoline as these were tasks that he could motor plan and tolerate without periods of intense crying or screaming. He would ride to the motor room in a wagon using edibles to help maintain a sitting position. I felt that if we could proceed with a slow introduction he could greatly benefit as he was one of the most dysregulated children I have worked with in many, many years. Robby’s home situation is not one where I felt I could achieve any carryover of these movements.

After about three months Robby slowly began to develop tolerance a few times a week of deep pressure followed by 4 initial rhythmic movements for about 10-15 seconds. I started to incorporate opportunities to hug a large therapy ball as he lay over it to increase his body awareness. Also, hand reflex integration activities as tolerated during session to increase his grasp ability.

Now after six months Robby at this time is now tolerating about 1 minute of the each of the 4 basic rhythmic movements and is active in doing the windshield wipers leg movements with a touch cue. He approaches the mat and will lay down making eye contact consistently about 4 days a week. I have continued to expand his developmental movements/play activities each week/month to include tasks such as crawling through a cloth tunnel pushing a ball, sitting and scooting on a scooter board using his feet for movement as well as maintaining his grasp on a hoop to pull him about 20 feet at a time. He is now able to lie prone on a wedge and use large tweezers to pick up pompoms and release into a basket. We have been able to decrease Robby’s use of compression wrap and weighted vest to once per day.  

The changes we have seen in Robby this school year have been tremendous!

Robby is now able to sit at a table and work on concepts and fine motor activities for up to 30 minutes four to five times a day with periodic movement breaks. He is waving Hello and Good bye to familiar people. He is able to use a picture schedule to help anticipate his daily routine. He is vocalizing much of the day in a modulated volume making sing song noises, developmental sounds and uses approximately five words appropriately. Word use includes Hi, Bye, Go, Eat, No. He is able to sign all done and make an approximation of the words which he uses consistently. Robby is able to sit for circle time and listen to a story, he enjoys listening to music, he engages in “chase games” with staff coming towards making a go sound and looking for engagement. He is able to participate fully in motor group each day with cues for familiar motor tasks such as crawling through the tunnel, rolling a ball to another, jumping on the trampoline, using scooter boards, hippity hops, jumping with theraband holding the ends with both hands to name a few activities . The demonstration of new motor tasks enables him to engage in those activities, he is able to tolerate touch from familiar adults. This has facilitated a number of self-help skills such as buttoning buttons, zipping zippers and snapping snaps on his clothes and backpack. Robby used his finger for all eating at the beginning of the school year. He is now able to use a fork and spoon for foods such as macaroni and cheese, yogurt, etc. He has an upright posture and can wear his backpack to   walk down the hall. Robby is happy and smiling throughout most days. He anticipates his routine now and will follow simple commands such as “come here”, “sit down”, and “time to work”. Robby still chews many items but primarily it is now contained to chew toys and his back pack straps. At school, we have seen a significant decrease in his “tantrum behaviors “this has reduced to about once a week or less at this time. Robby is now able to wait in a noisy cafeteria to ride his bus home each day with a small group of children either sitting on a bench or in the wagon.

Parents report that Robby is much more settled at home and will engage in building tasks and cause effect toys at home. He is now on a more regular sleep schedule and they were able to take a vacation for the first time which involved “beach time”.

Overall I believe the combination of rhythmic movements, developmental activities and consistent approach each day have greatly contributed to Robby’s progress this year. He is a happy, smiling boy now most days!

 

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Submitted by Rachel G.

I've been working with a 3.5 year old boy with severe motor and speech delays for 6 weeks now, 1 session per week.
When I first saw him he was barely talking, did not have eye contact with anyone, wasn't toilet trained and was in total fear.
After 2 sessions the mother reported that he's saying many more words and he stopped drooling completely.
After 3 sessions he stopped wearing his cap which he never removed from his head for his security.
Now, after 6 sessions he's basically talking fluently (he still needs work on his clarity), makes proper eye contact, is almost fully toilet trained, is not scared of people or things and enjoys himself with his peers
He's also much calmer at home and enjoys playing on his own.

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Case Study

OD

Male, age 4

OD was referred to outpatient occupational therapy by his Speech Language Pathologist and parents. The primary concern was motor coordination for age appropriate skills, and apraxia of speech. A complete evaluation indicated fine motor and gross motor skills well below average, sensory processing differences, and delay in attaining independence in self care skills due to these skill deficits.

A home program was initiated to address postural control, head righting reactions, palmar grasp reflex, and spinal gallant. His home program incorporates movements and activities to integrate these reflexes. The activities and movements have included rhythmic movenents, hand reflexes activities, joint compressions, rocking on hands and knees, sequence of grasp hand positions, ripping and crumbing paper (had to start with tissue paper first), bottom walking, donkey kicking, roly poly, blowing activities, and core activation.

After initiating the home program, OD’s parents were amazed that he was willing to “wear pants again”. He had been refusing to wear any type of pants, and preferred to only wear a shirt. He was fully potty trained within 2 weeks, after trying on and off for 2 years. He began calmly and willingly climbing into his car seat and staying calm throughout all car rides.

His SLP was amazed that he is now speaking in sentences and has increased confidence in his speech abilities.

His teachers are reporting that his use of a scissors is better than any other children his age. Based on the progress and where his current skill level is at, his frequency for outpatient OT services has decreased to one time a week only. He will continue to utilize his home program and have it be revised during his once a week session.

OD is now an outgoing, playful, and inquisitive 4-year-old boy who once would only prefer to sit and watch TV.

Case Study submitted by A.H., Occupational Therapist

(emphasis added)

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Case Study: Oscar

By Jennifer Everett, OTR

I have been practicing OT for almost 25 years of which at least 20 of those years have been in pediatrics. I have attended many conferences/courses over the years. This course by far has been the most beneficial. It is the only course I have attended that some part can be applied to every student/client on my caseload.

Oscar is a 48-month-old boy who is in the process of being adopted into the family he had been with since he was 11 days old. There are two siblings in the home; one is a half sister who is 7 years (adopted into this home due to abuse by Oscar’s mother) and a brother who is 2 ½ years old. Baby sister is 4 weeks old. I will call his adoptive parents Mom and Dad as that is what they are and what he calls them.
Prenatal history: A lot is unknown. His birthmother was pregnant with Oscar when she abused his half-sister and while awaiting trial for the abuse charges. Oscar was to be relinquished to the state at birth. It is believed his mother did some meth and other drugs until the 4th prenatal month at which time the state started testing her weekly. It is known that she has problems controlling anger and is verbally and physically abusive to others. His biological father also used meth and has problems with self-esteem. So, we know during prenatal period, besides drug exposure, Oscar was in a “hostile “ environment with a lot of stress. He was a C-section baby and was bottle-fed.

Medical history: hospitalization for RSV at 6 weeks with continued asthma problems with upper respirator infections since then; three febrile seizures in two days at 12 months, none since; multiple ear infections with tubes placed at 18 months and removed at 3 years.

Mom believes Oscar met milestones on time. She cannot remember much about belly crawling or crawling, but he did not do much of this and learned to walk just as he turned 10 months old. He also talked early using vocabulary by 18 months that “surprised” people. He never liked to cuddle, had poor eye contact and was a very poor sleeper. He has always liked to chew non-food items including diaper lining, hair or fuzz from stuffed animals, hair from cats or dogs, crayons, etc. He wants to feel everything and especially likes to rub it on his face. He often has crayon or marker on his face. He used to smell everything, but became sensitive to smell at 3 and a half, frequently gagging due to smells. He uses noise-cancelling headphones and has extreme fear of going into public bathrooms without them. He also uses the headphones at zoos, when vacuum is on, and when Dad mows the yard (even if he is in the house).

Oscar frequently does not respond to name being called. He has hearing tested by audiologist with normal results.

Oscar has had social difficulty since age 1 when he was moved into a new room at daycare. Mom knows he was bit multiple times over the first 7 days in the new room and then he started biting, hitting, and shoving which has continued. In defense of Mom, she was not told of the biting until Oscar was being kicked out of this day care at age 3 and they reviewed his records with Mom. After two months at home, Oscar was placed in a half-day preschool but was removed after 5 days because he would ride the tricycle too fast, push others when playing chase, and would not “calm down”. Oscar was also aggressive with siblings at home and would shove or bite if they were near him- especially if siblings were moving quickly near him. He would say he did not know why he did this and seem upset with himself for a few minutes, but could not stop himself from the hitting and biting. He also liked to sit near Mom or Dad and feel their arm, then squeeze or scratch it. He was tense and anxious in public situations like parks, zoos, libraries, and stores and might bolt or have meltdowns. So Mom hesitates to take him many places. However, this same child could walk in the woods and by the lake for an hour telling stories, talking about the snails and animals, and stopping others walking with him so they would not scare a rabbit, turtle. He would listen to very detailed books on tape or read to him for at least 20 minutes at a time, but only had a 1 to 2 minute attention span for play dough, trucks, helping with chores, or even helping with mixing treats. He could add and subtract up to 5 in his head, knew numbers, letters, and sounds of letters. Everyone who meets him says, “He is so smart”. Mom knows he is “smart”, but he will have a difficult life if he cannot not get his emotions under control and enjoy life and learning more.

At 3 years 6 months, Oscar saw an OT who specializes in sensory processing disorder. He was diagnosed with Sensory Processing Disorder: Under responsive vestibular system with post rotary nystagmus of 0 seconds, Oral sensory seeker, delayed fine motor, retained ATNR and STNR. The OT had Mom do heavy work or activity every 2 hours at home. Oscar went to 2 months of weekly one-hour therapy sessions – each week behavior became worse at therapy and home. Mom stated that at therapy, Oscar was tense and “on-guard”. Therapies usually involved running, jumping, wiggling through tunnel with weighted toys then fine motor skills. Oscar would do a short amount of an activity- then try to run and hide. If mom or therapist grabbed his hand to bring him back, he would pull the hand to his mouth and bite. The running and jumping activities really made things worse quickly. It was decided that OT was not productive and it was stopped. At this point, Mom who is an educator (1st grade) was becoming very worried about how to help Oscar. She made an appointment with a behavior specialist and started researching more about sensory processing and problems with this. Move, Play, Thrive information was on the Special-ism website and Mom was interested in the Primitive Reflex Integration. Mom knew contacted me, as I am school therapist and asked if I knew anything about the course. I didn’t but after research the course felt like it would help my students so I offered to take the course and work with Oscar in the process.

Since I had just started this [Brain and Sensory Foundations] course when I first started working with Oscar, I tested his reflexes in the order of the video presentations. Oscar tested positive for TLR, ATNR, STNR, Babkin, Babinski, Fear Paralysis, Moro, and Spinal Galant.

At first, Oscar really resisted the brain tune up so just Rhythmic Movements were started and done daily by Mom for two weeks. Oscar really liked these when done to nursery rhymes and if there was a promise to tickle tummy after them. He tolerated 10 to 15 minutes of the exercises from the beginning, but when tickled he would grab and pinch or pull the tickling hand to his mouth to bite, yet he would request more tickling.

After two weeks, I tried the brain tune up again with Oscar. He still resisted, so TLR, ATNR, and STNR integration were added in the form of “play” as he could not participate in isometric integration. Balloon toss, pretending to be a puppy or kitty, crawling and looking side to side and up and down were some of the activities during therapy. He also liked to hold stuffed animal under chin and crawl to put it in a basket.

At the one month point Oscar was becoming dizzy when spinning on a disk swing or twirling himself. This was a new sensation for him. Mom was seeing short periods (5-8 minutes) where Oscar could play with siblings without pushing or biting. He still could not play on slides or climbing toys without immediately shoving anyone who got close to him. I started him on the fear paralysis tapping and the Moro rolly polly. Mom was also able to find a pre-school for him two mornings a week run by a speech therapist with a physical therapist on staff. There are only 3 children in his class, so they are able to work closely with each child.

After two months, Oscar was able to do ATNR integration lying on his back looking at stuffed animals and switching so this was added alternating days along with palmar and plantar integration. He now would do the brain tune up with assistance prior to exercise. His biting had decreased, but he still bit if face was touched or hand was grabbed. I decided to test his rooting reflex and found the left side of his face was ticklish and the right side stroking caused an immediate head turn toward right and biting action. So, rooting reflex integration was added, as the biting was a big social problem for Oscar. I did learn during this process it is wise to use something other than your finger for testing for rooting reflex! I could also see how closely linked the hand/feet/mouth reflexes were related while working with this child.

Two and a half months into the exercises, Oscar was much better with siblings with very few episodes of pushing or hitting and no unprovoked episodes of aggression. Biting had greatly decreased only two times in two weeks and both times he was overly excited. He no longer chewed on non-food items, but chewed gum daily. He still had trouble getting to sleep and would wake once in the night to go to the bathroom, but would go right back to sleep which was a big improvement

At this point the spinal gallant reflex was integrated, but we continued to work on it to be sure. The Palmar/Babkin and Planter reflexes were much improved, but still mildly present. ATNR was still present, but so much better and Oscar could track across midline with eyes both directions. STNR also was improved and he tilts head back for hair washing with eyes closed without problems.

Now three months into working with Oscar, Mom reports she is able to take Oscar more places without as much fear of his aggressive behavior. He is able to play about 20 minutes with others before he becomes too “wound up” and needs a break to calm down. He is still anxious in new settings and does not like crowded rooms. Preschool reports most days are good with only 1 or 2 time outs, but he can still be too aggressive with other children. We will continue working on all the reflexes and daily rhythmic movements along with daily bear hugs and tapping.

Mostly through this experience I have reaffirmed the need to be flexible and allow your client to be your guide. Take your cues from our client and modify exercises/activities based on there needs, comfort level, and interests while keeping the outcome of treatment in mind.

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Jayden, my 1st born, is a sweet, loving, creative sensitive 9 year old boy. He has a huge heart, and has so much compassion and kindness in him. We've had so many amazing moments with him, but it has been a hard 9 years. There have been moments where I was rocked to my core, not knowing how to go on, scared that my son was going to hurt himself, his younger siblings, or me, scared of what our life would be like over the years, as he got bigger and stronger.

Jayden had a rough birth, which lead to an intense and challenging infancy. He never crawled, hated being on his tummy, rarely climbed, rarely slept, and was delayed in several areas. He was highly sensitive to almost everything, especially clothing and touch, and often had several hour long tantrums in a day.

As he got older, we began to notice an increase in symptoms- his body was weak, he had poor posture, he was tired all the time, he wet his bed, tripped over things or ran into things, was not aware of the space around him, and did not like anyone, especially his siblings anywhere near him. He had little tics, like licking his lips, touching his face, and picking his scabs. He would flip out all the time and we could never predict what would lead to the next meltdown.

We became prisoners to his meltdowns, isolated, scared and alone. We tried changing his diet, took him to cranial sacral, worked wth a chiropractor and met with his school counselor. As he got older, around 2nd grade, the tantrums became more violent and he was always just so angry. We never knew when another explosion was going to happen In the Spring of 2nd grade, Jayden flat out refused to go to school, with meltdowns that lasted for hours. It seemed like our lives were spiraling out of control, we knew we couldn’t continue living like this.

It is so beyond painful to watch someone you love turn into an angry violent version of themselves. All the dreams you’ve had for them start to fade away. It affected all of us so much. And we felt so helpless. There were a lot of dark dark moments. Our family spent our days waiting for the next breakdown. Then, in May of 2016, we met our angel. Sonia came to speak at my son’s school and, thanks to my son’s amazing counselor who suggested I attend [Sonia’s Brain and Sensory Foundations] workshop, I found the key I’d been searching for for so long, and everything in our lives changed forever.

In the beginning of this work, I felt a extremely overwhelmed. How could we possibly add one more thing to our already busy life? I knew it was what I had been searching for, but this work,it’s a big commitment. These exercises need to be done daily, and, depending on how my son is feeling, it can take anywhere from 20 minutes to an hour. We began by doing only the rhythmic movements for all three of our children. These movements really seemed to calm my son’s system and helped him with his sleeping, which had always been a struggle.

My younger kids loved them too, and asked for them every night. Jayden was still throwing angry violent tantrums but it seemed to take the edge off it somewhat. He became more coordinated and more comfortable in his body. And, once summer came along, and the pressure of school was gone, things started to slowly get better. Jayden spent a lot of his summer alone, drawing or building legos. He started to explore moving his body, riding his bike and jumping on the trampoline, and enjoyed the slower pace of summer.

We focused solely on the rhythmic movements And just let his system have some time to relax and breathe. Towards the end of the summer, we knew we had to start introducing the reflexes and started by adding them one at a time, beginning with the Moro reflex. The most challenging part of adding a new reflex is the beginning phase, the tumultuous period which lasts for us anywhere from a few days to a few weeks, where everything seems to get way WORSE. For my husband a I, this was the hardest part, as we would be making progress and then, all of a sudden there would be a massive decline. I would immediately go into panic mode, thinking oh no, this isn’t working, we’re doing this work every day and its getting worse, and then, right when i wanted to give up, it would thankfully start to get better.

We started to see the pattern and then those moments became much easier to handle, as we knew it was only temporary. As time went on, we started to see massive shifts and would get these glimpses of how our lives could be, no longer controlled by these erratic violent eruptions. In October of this year (2016), Sonia came back to my son’s school and, re-inspired by her work, we began a nightly routine that included all of the reflexes for both my son and for me. It has been a long, hard road. But every week gets better.

We are no longer walking on egg shells in our own home. We no longer have an angry violent son. He is back to being my sweet loving boy. He wakes up excited for school and gets himself ready in the morning. He has no more facial tics, and rarely throws tantrums. When he does get upset, the breakdown is more contained and no longer lasts for hours. He is learning to handle his emotions and is so much calmer. He is starting to see patterns. He has joy back in his life. He’s starting to dance and enjoy moving his body. He loves to read and write stories. He has lots of friends and is extremely social. He is excelling at school, and is enjoying his life. His posture has improved, and he’s no longer lethargic all day. When things don’t go his way he no longer breaks down. His artwork and creativity has exploded, and he seems more content and positive and happy to be alive. He has started doing martial arts and is becoming stronger and more at home in his body. He has an overall feeling of freedom and ease that I have never seen before.

Some days are amazing and some days are still challenging. But nothing like before. We have had some fallbacks due to a broken arm but have consistently been doing every reflex with him every day for more than 4 months. We know we still have a long road ahead of us, but it’s so clear to us that this is the work we need to be doing.

The biggest lesson I’ve learned from this journey is to never give up hope. When you have a child that becomes angry and violent, you start to feel a lot of shame, fear and guilt. I questioned, why was my son so broken? Was there something I did? Or something I didn’t do? As his explosions escalated, I feared for my son and for my family. I feared that this was our life and there was nothing we could do about it. I believed something must be broken and mourned the loss of the dreams I’ve had for my son and for my family.

But what I’ve learned is there was nothing wrong with my child, this behavior was not him. He was not trying to do this to get attention, not acting out because he was a bad kid. There was something off mechanically and his system was screaming out for help, something at his core was not lined up, but it is fixable. And, while this work has been a huge commitment to take on, it is so beyond worth it. We are so incredibly thankful to Sonia for the work she has done and to the amazing teachers at my son’s school who have been so supportive, accommodating and loving as we move through this. I hope my story can help others who are struggling and suffering to give you hope that there is a way out.

Thank you Sonia, we are forever grateful.

Lauren M.

Ashland, OR

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Case Study Submitted by Mary Bessenbacher, Occupational Therapist

Cash is a 2 year old boy diagnosed with autism that I work with in his home on a weekly basis. He displays very little eye contact, is non-verbal, prefers to play alone, and has trouble getting to sleep. He is delayed in fine motor skills and prefers vestibular activities such as swinging, jumping, and rocking on the exercise ball. Often, he would cry when I arrived and would attempt to run to the other room.

I began introducing the rhythmic movements with Cash because his delays in motor skills could likely be due to retained primitive reflexes. (Testing for them individually was not possible due to non-compliance.) He laid still for the first rhythmic movementE for almost one minute the first time I did it. His mom was in disbelief because he usually does not allow touch unless it is something he seeks out on his own. I also got eye contact during this movement. He did not lie still for the other three during our sessions. I did teach them to mom and told her to use them throughout the day and at bedtime.

Mom has used the rhythmic movements before bed and said that it helps him to lie still and relax. He especially likes the second one, lying on his side. I have noticed more compliance in our sessions since I have started the rhythmic movements. Some days he will not allow me to do them, but I have found that if I roll him on his back on the therapy ball for several minutes and then try to do the movements, he is more compliant. Since we have started, he has begun to babble, place shapes into a shape sorter with minimal assistance, clap his hands in imitation, and look at books with an adult. He was doing none of these skills a few months ago. 

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Adam is my four-year-old son who was adopted at 18 days old.   We began working with the neurodevelopmental movements because he saw me working with his sister and wanted to participate. He loved helping me with practice and though he has always demonstrated some sensory differences they did not interfere with his functioning so I began the movements not expecting anything to change. 

Adam has always been a poor sleeper and had difficulty settling at night or upon waking. When he became upset he was unable to calm himself and would cry for extended periods of time. We found that he was not capable to calming without adult assistance. He would also cover his ears with some loud noises and would scream, cry and run to me if my husband got out a drill.   Even recently he would be inconsolable until it was put away. He was also a tactile input seeker and always had his hands in my hair or touching things. He, like many boys, was a mover and crasher but didn’t appear to be doing it at a level that was concerning to me.  At this point we only do the rhythmic movements, the animal moves and wheelbarrow walking.   We are not as consistent with these because of my daughters needs but I have still observed positive changes. I have noticed that he is able to settle most nights without difficulty and will sleep through 80% of the time.   We went a few weeks without doing any rhythmic movement and noticed that he was waking more often in the night so it is felt that there is a correlation. What is most remarkable was the fact that he was able to “help” use the drill that instilled such terror in him to help build a toy boat. My husband and I have used the drill on several occasions with Adam casually saying “that’s loud” with no emotional reaction or needing to be held. Additionally, he no longer needs the added tactile input from putting his hands in my hair when he is being held. At this point we only see auditory sensitivity or crashing behavior if he is overtired or has eaten poorly.

N.K., Mother and Occupational Therapist

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Patient B is a 7 year old boy with Autism who had difficulty with speech, impulse control, sensory aversion, very little speech and was routinely dysregulated. His father repeatedly said "I just want my boy to talk to me." He frequently did not attend to therapist directives and wanted to participate in high energy activities that gave him the maximum amount of vestibular input available such as swinging on a trapeze bar upside down, jumping into the ball pit, or climbing the rock wall or monkey bars repetitively. He would only participate in therapist tasks for brief amounts of time; initially only up to 30 seconds. Upon our 4th session together I began using the rhythmic movements and activities [from the Brain and Sensory Foundations course] with him along with a brushing protocol. After the third session I noticed that he would allow brief eye contact with me which he had not done before or with any other therapist. When he and both parents arrived for our fourth session his parents came to me with tears and said he had been saying my name at home asking for me. By completion of our 6th session his father came back to me saying that his son purposely came to him and looked at him and said "Daddy, I want hug." His father stated this was the first time the boy actively sought him out and spoke to him in a direct manner with a specific request. He also stated that the little boy had increased attention span, played with his sister using kinetic sand and other sensory play tasks with no aversion.

 

Case study submitted by Heather Bowsher, COTA

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Submitted Dec 10th, 2015

Jim is my 12 yo son, and the reason that I took the Brain and Sensory Foundations course. He has been in school and homeschooled, both. We took him out of school because his behavioral issues were getting too frequent. He would make fun of other kids, disrupt class and steal sweets. He had issues at home too. He was unfocused, restless, at times hyperactive, loud, boisterous, and could get really angry. He was behind about 1-2 years in school, and behaviorally acted 2 years younger (or more). He was extremely picky about clothes and shoes and the way they felt. At times, he would make repetitive noises. He seemed to be trying to annoy people a lot of the time. His friendships were suffering. He was 12, and still had great difficulty tying his shoes. We think he is ADHD, but were unwilling to submit him to counseling or to put him on meds.

We were trying some natural solutions and diet changes at home, but they only showed minimal results. He was depressed, lethargic, and spoke of not caring if he was alive.

  • After 2 months of brain tune-ups, rhythmic movements and reflex stimulation/integration, homeschool is going MUCH easier for Jim and me. He is more cooperative, and focused.
  • I've been doing movement work with him 3x per week for 15-20 min per session. He really likes it and relaxes into it.
  • At first he could not do rhythmic movements #1 or #3 unassisted, but now he can sustain those for a little bit.
  • He baked flatbread entirely by himself and it came out great! Jim says he thinks the movements are working! He has far more energy, making lunch for the family, building forts outside.
  • I am seeing big improvements in focus during math and spelling, and therefore the lessons take less time. When asked in Spanish how he was doing, he replied "happy"!
  • I explained to him a bit of the theory behind all this. He told me that sometimes when he writes (which he has been very resistant to) his brain says one thing and his fingers write another (usually a letter or number).
  • I am happy to say that after 2 months of movement, Jim is a changed boy. His depression seems to be gone. He no longer says he's stupid. He is noticeably more confident and interested in things. He says this is the best year of his life so far. And that he used to not want to grow up, but now he's excited for it, because he can see all the possibilities. He's been learning to bake bread, repair engines, and play the bass. He does his school work far more willingly and with more focus. He has been more tired, so I have let him sleep in a lot. His behavior with his peers is far more mature. He has not stolen anything. He seems to have more self-control. He is less clingy and picky. We have not seen his scary anger in many weeks.

I cannot express my gratitude enough, Sonia. This course has been nothing short of miraculous for our sons. Our whole family is so much more harmonious and loving now.
Thanks from the bottom of my heart
MF

Update from Mother
March 15th, 2016

Hi Sonia,

Since [the previous report, our son], has been on an even keel, despite the fact that I have found little time to do any movement with him. His friendships seem more healthy as well. It's a testament to the method.
We have had 2 big trips (usually taxing for him) without incident.
We just returned home from another visit to Grandpa's. I did not find time or energy for movement, but I am amazed that my son continues to grow and thrive, it's like a door was opened. The one thing I notice in particular is that when he is frustrated or angry, he starts to get into his old patterns, but stops himself. He has not gone there, into his old patterns of anger and self-bashing, since last fall. And there continues to be no sign of his depression. He is in the habit of saying he's stupid, still, but it's a knee-jerk reaction that clearly has no meaning for him now. I think he says it now to hear me negate it. He's been happy, confident, and involved. He actually plays with his brother now, a relationship that I feared would never become close again. The whole family dynamic has changed, and we are all more happy.
I am definitely going to get back into doing the movements with both sons (and husband), I do think there's lots more work to be done.
So, of course you have my permission to use the case study. I hope it helps.
Thanks again for everything,


MF

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"Joey" is a child that I have been working with for a few months. He is 7 years old and has many of the developmental issues that I commonly see as an OT in an outpatient clinic. The biggest concerns that his mother brought up when I first began with him were related to his emotional regulation. He is a very anxious child, becomes upset and agitated easily, he's very rigid in his thinking, and has tactile and auditory hypersensitivities. Additionally he has a lot of difficulty with hand-eye coordination, many letter and number reversals, and most things requiring bilateral coordination.

I have noticed tremendous change him [after doing rhythmic movements and reflex integration movements]. His mom reports that he is in a better mood much of the time, that he is kinder and not so quick to become upset over trivial things. She said that he used to cry every time they went to the beach because he would be overwhelmed by the noise and irritated by the sand. The other week she said that they'd gone there over the weekend and she could barely get him to leave because he loved it! I have also noticed a significant decline in letter/number reversals when he's writing. Another huge change I saw in him last week was his catching/throwing abilities. He is still far behind his peers but when I first began seeing him, he had absolutely no trunk rotation. Even with a ton of assistance, he just could not coordinate stepping forward with his opposing foot to throw a ball overhand. The other day we were practicing this skill and I couldn't believe how much easier it was for him. He still needed some cueing but he was able to actually do the movement on his own. His mom has commented that he just seems more confident in his body overall. She sees him participating more with other kids at the park and he doesn't give up so quickly in gym class. It has been very exciting to see all the changes and I'm looking forward to the progress I know he'll continue to make!”

S.P., Occupational Therapist
August 2016

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My second client was a 6-year old boy with provisional autism diagnosis; called “Adam”. He had a history of reactions to vaccinations, febrile seizures, auditory sensitivity, tactile sensitivity, poor transitions, hair-trigger reactions to new environments, perseveration, and severe oral defensiveness.

Together his mother and I collaborated on a goal to decrease tactile sensitivity to clothes. As a pediatric OT, I focus on identifying goals that parents want to see change first. As it was the beginning of summer and Adam would only wear long-sleeves and jeans, it was imperative that Adam adapt to summer clothes due to approaching 100 degree heat. We began with Rhythmic Movement. I taught his mother the positions and requested she get 10-15 minutes daily. As he progressed we added Moro reflex integration after 3 weeks of Rhythmic Movement daily and in our sessions twice a week.

Adam had moderate adverse reactions in the first week of Rhythmic Movement positions in my sessions. He complained of dizziness/upset stomach and responded somewhat baby-like. By his second week, Adam had relaxed into them significantly and enjoyed doing them both with me and at home. He actively sought to move his head longitudinally. His mother reported that they enjoyed their time together at home. Within four weeks of Rhythmic Movement and introduction of Moro integration. Adam was attending sessions in short-sleeves and shorts. His mother was shocked that he would easily accept these clothes because in the past they triggered significant meltdowns. We are currently working on Moro integration to further decrease his sensory overreactions, but have been amazed to see this transformation this summer.

Jenny Jolley, MS, OTR/L
Founder & Occupational Therapist
Imagination Station & On-Track Therapy

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I worked with a 6 year old boy who came in with complaints of severe inattention and behavioral overreactions to various life experiences/sensory stimuli. He was treated with rhythmic movements, reflex integration, and brain gym/brain tune-up exercises. He was an excellent participant in therapy sessions. He received 3 months of therapy in total with great changes observed. I chose to use Rhythmic Movement and reflex integration secondary to observations of decreased rhythm with movements, decreased coordination and balance as well as positive signs and long term effects of the following reflexes: TLR, ATNR, Moro, FPR, and SGR. His mother was in the process of getting him diagnosed with ADD or ADHD. She began noticing changes in his behaviors and attention at home and in the community. I observed him listening with greater ease as therapy progressed, he demonstrated greater motor planning through various therapeutic activities, his mother no longer reported aggressive and emotional outbursts at home, and she stated that he began tasting non-preferred foods. By the time he was re-evaluated at 3 months, he presented with improved integration of the reflexes assessed that he initially tested positive for. He also showed marked improvements in his test scores for the Beery VMI test which assesses visual motor integration, visual perception, and motor coordination. He was able to be discharged from OT after 3 months of therapy and was no longer showing as many signs and symptoms of ADHD.

Amber Humphrey, OTR, MOT

www.opendoorpt.com

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I am a pediatric occupational therapist and the mother of two children who were adopted as infants with areas of concern. Annie is my 8-year-old daughter who has a variety of “invisible” issues in addition to her diagnosis of auditory processing disorder.   Her milestones were achieved in the later stages of what was considered “typical” and never was a proficient roller. She scooted instead of crawled and would have major meltdowns if I tried to get her to crawl. She did not walk until she was 15 months old.

She was (and is) a happy child for the most part but would go into sullen moods and refuse to talk about what was going on over what appeared to be minor issues. When questioned, she would yell “I DON’T KNOW”.   Additionally, she had a strong startle reaction and would have strong emotional reactions if she said something funny and people laughed suddenly or if she felt people were “yelling” at her.   She also demonstrated very low frustration tolerance and would give up before even trying challenging tasks. Additionally, she had difficulty with urinary incontinence during the day and at night.   Many times she seemed unaware that she was wet. Academically she struggles with math, multistep directions and needs more prompting to think things through. She was tested and showed average abilities but still struggled. She wears glasses and it was recommended that she begin vision therapy due to convergence and tracking issues. She complains of headaches and has overall higher muscle tone.

We started doing our exercises this summer under the cover of her “helping” mommy learn things to help her students. She enjoyed the 4 rhythmic movement positions and would ask for them every night.

We noticed an increase in her emotional lability for about 3 weeks but pushed through. One thing that she mentioned right away was a reduction in headaches and being able to flex her neck to work on tabletop tasks without having neck pain. Once things were more stable emotionally we began to work on her Fear Paralysis and Moro because I felt that this was causing the biggest problem in her life.

 

Positive changes that I have noticed:

Less noticeable startle reaction (she is even beginning to laugh at herself). More stable moods.

Urinary problems have resolved.

Less headaches, neck tension and more fluid reading out loud

She is more apt to persevere with difficult tasks- most noticeable is wanting to use Hearbuilder software where she would refuse or cry after a few minutes of working with it previously.

Prior to a choir concert that she was performing in we did the 5 step balance process.   After our integrative movements, she reported feeling calmer and was able to sing along with what looked to be confidence during the concert.

I am pleased with her progress and think that she notices as she is very compliant with the activities.


N.K., Mother and Occupational Therapist

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This is a young female aged 13 who attends a school that accommodates autistic, remedial and gifted children. In early childhood, her Epilepsy was misdiagnosed so she only started taking anti-epileptic medication from around the age of 5, but by then her speech other areas had been negatively affected by the mini seizures she had experienced. She is currently on anti-epileptic, anti-anxiety and ADHD medication. Her speech is unclear and her gross and fine motor movements are uncoordinated and unrefined. After receiving the appropriate permission from her parents and medical clearance regarding her epilepsy, I started a series of 22 rhythmic movement sessions with her. She did P.A.C.E exercises daily as part of her school curriculum. From observation while she was busy with P.A.C.E. I noticed that she wanted to rush through the cross crawl and her rhythm was completely off when she did cross-crawl. The first three Rhythmic Movement (RM) sessions only lasted about three minutes each as I was cautious to ensure the movements would not trigger an epileptic fit. She loved the RM from the start and was happy and content after each session.

By the eleventh session she was following the instructions clearly and could do the rhythmic movement actively with a very smooth and symmetrical movement pattern. She was very eager and happy while she did these movements and I encouraged her to hum instead of singing along with me as I found that she was so busy concentrating on the words of the song and the tune that she started tensing up which made smooth movements difficult.

By the sixteenth session she was coming out of her shell and chatting the hind leg off a donkey. With this new development, she also suddenly became quite stubborn and was not her usual compliant self. Her parents noticed that she was sleeping much better at night and also commented on her new-found stubborn streak. [Instructor comment: This sounds like the normal developmental stage of defiance coming out, which is a very good thing! She probably missed this stage as a younger child.]

By the twenty-second session her teacher had noticed that her fine-motor skills for writing and drawing had improved dramatically and the content of her free drawing had also increased in number and detail. Her movements were far smoother than at the start of the sessions and she had progressed from social caterpillar to social butterfly and was soon charming all around her with her wicked sense of humor.

I have been motivated by watching her these past twenty-two sessions emerge from her guarded and introverted self into a confident, expressive child delighting in her new-found skills and abilities. I am humbled and grateful to have been part of her initial journey and I can’t wait to continue this work in the New Year.

Submitted by

Nadia Roosendaal

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Overall the biggest benefit that I gained for myself from doing the rhythmic movements (from the Brain and Sensory Foundations course) is that I no longer get car sick.  When I first started, I couldn’t tolerate the rhythmic movements for longer than about 30 secs.  I quickly gained tolerance to several minutes.  I improved so much that I was able to help my sister study for an exam by reading her questions while riding in a car for 2 ½ hours while she was driving.  I was able to repeat this going home the next day.  I could never have tolerated even reading more than a sentence before.  That demonstrated to me personally how powerful these movements are.
L.H., Occupational Therapist, Ohio

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My son was diagnosed with several things - PDD-NOS, apraxia, and hypotonia at 18 months… but five years ago, at age 4, my son Jonah recovered from all of his diagnoses. However, because of these developmental difficulties he suffered as a child, he still struggled with attention, emotional regulation, auditory processing, and eye contact, among other things.

I then undertook an intensive reflex integration session with him daily, [using the neuro-movements from the Brain and Sensory Foundations course].

He has improved so much in a ton of areas. I’ll share with you just a few examples. For the TLR reflex, when I first asked him to do the integration reflexes, I had to be careful supporting his head because it was hard for him to lift and he looked as if at any minute he might drop it to the floor with a crash. After a few weeks of doing TLR every day (plus all the other reflexes) he one day did a complete sit up. He was so shocked he hollered with a big grin “watch mommy! I can do a sit up!!” He was 8 years, 11 months, and had never been able to do that before. He’s been working on TLR constantly, and now, for his sports team they have a contest of how many sit-ups you can do in one minute, and he’s been working on that a month. Yesterday he did 38 sit-ups in one minute!!! But just 6 months ago, before we did the program, he couldn’t do 1 sit up. It was a strain to lift his head up for 10 seconds.

Another area he is improving in is his pencil grip. We did both hand reflex exercises, which worked for us both. The hand exercises have really helped him not grasp the pencil with so much force, and his handwriting is looking so much better.

He used to have lots of emotional dis-regulation, now he’s calmer. His balance has improved. His eye contact has improved, as has his auditory processing and conversation skills. He used to have “leaking” accidents all the time during sports, now he never has a problem with that.

CD

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"I had the “Aha” moment that made me fully understand the power of integrating reflexes from a personal experience.  For years, when I play tennis, I bite my lips, and my mouth tenses whenever I swing the racquet.  When I power serve the ball, my often body tenses up and I hold my breath.  When this happens, the ball often goes into the net or a little wild.  I feel like I am fighting against my own body and have to mentally tell myself to breath and relax through the activity.  However, that changed that day after doing the han-mouth integration exercises.  I stepped up during warm up to serve the ball, and my body felt free to move exactly the way I intended for it.  This was a new sensation for me.  My serves were spot on.  I couldn’t believe it.  It felt so good, not to feel so bound up.  All my serves during that match felt free.  Better yet, we won our tennis match!"

L.H., Occupational Therapist, Ohio

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I suffered from two both emotional and physical ailments. On the emotional side, I experienced high levels of sudden-onset emotional dis-regulation, high levels of stress, among other things. Physically I had extraordinarily severe, debilitating lower back pain and vertigo (plus lifelong motion sickness), constant and severe shoulder and neck tension and pain, and I held a pencil with a crazy-hard-death-grip. After testing my own reflexes, I realized that I had many, many unintegrated reflexes. This all made logical sense to me as I was in an incubator for a couple weeks after I was born, I was only 4.5 lbs at birth (a twin).

Although the bulk of my attention has been to my son, and because I have nobody to do the reflex integration on me, I’ve only been able to do a few things consistently: rhythmic movement and hand integration. But with both of these two things, I have had amazing improvement. By doing the rhythmic movement daily over the course of 2 months, I found that my back pain is 80% better.

Before I started the rhythmic movement I was told that I needed surgery, and I knew they were right because I was in constant pain 24 hours a day. After the rhythmic movement my pain is 80% gone… it only bothers me when I’ve been sitting for a prolonged time or I lift something heaving. I am at a point now when I don’t need to think about surgery! I also found out that holding my steering wheel was triggering in me my hand reflexes. I found that as soon as I gripped the wheel my arms automatically straightened and locked, and the muscles of my entire neck and shoulder and arms were permanently tightened. I spend 10+ hours a week driving my son, and during that time he needs to do his homework in the back of the car. I found that I was responding to him with high levels of impatience, stress, and anger as a result of my hand reflexes being constantly triggered. Once I started the hand reflexes, I found my stress and fatigue from driving greatly diminished, and my emotions better regulated.

CD

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My client is a 5-year girl who required surgery one week after birth to correct a deformity. She had extensive early intervention of PT & OT to addressed delayed milestones and sensory processing. When she came to me, she had ‘plateaued’ and discharged about a year before. Her mother’s concerns were irrational behavior easily triggered with minimal stimulus, difficulty with transitioning, hypermobile joints, fearful/wallflower reports from pre-school, lengthy melt-downs that were very difficult to calm down, and her greatest concern: bowel incontinence. Megan had daily complaints from her preschool about bowel-movements in her underwear, no appropriate reporting to the teacher and the same occurred at-home. Although, she was above-average intelligence, she had no concern for bowel accidents and would justify them with “I’ll just change my panties”. Her family was very frustrated.

When I started with her, it was actually before the Online Brain and Sensory Foundations course; so our focus was on overall-strengthening to reduce joint mobility and gentle exposure to sensory input to improve her sensory processing. Megan made excellent progress in strengthening, but she continued to have irrational fears, meltdowns, and no gains in bowel-training. I began taking the Online Brain and Sensory Foundations course four months into her treatment and began using the rhythmic movements with her for 15 minutes a session.

I continued to faithfully complete all positions for 15 minutes a session two times a week.
Initially, Megan would resist the direction to do Rhythmic Movement , but within two weeks, she was happy to participate in the movements both actively and passively. She began to transition between activities easily and had lessened ‘tantrums’ when she was overwhelmed or didn’t get her way. She began to be a much easier child to work with. The most profound change occurred after 4 weeks of Rhythmic Movement, only two times a week for 15 minutes (At this time here was no home movement program being done for Megan). She became bowel-trained. Her mother reported the last two weeks before she discharged: she had no accidents.

Jenny Jolley, MS, OTR/L
Founder & Occupational Therapist
Imagination Station & On-Track Therapy

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I recently took this class and was amazed! I have four children, ages 2 to 11, one of which has had significant difficulties due to sensory processing disorder and many food sensitivities. All of my children have been poor sleepers until at least the age of 5 or 6. The information Sonia presents in this class has been SO helpful and has provided huge insight into each of my children's ways of interacting with the world and many of their difficulties

We started with the rhythmic movements before working on reflex integration, and after doing them consistently for a while, sleep improved for my 2 year old - we went from him waking and calling for me to help him re-settle 6-10 times a night to only once or twice a night. He even sleeps through occasionally now. He had also had a mild speech delay, and within two weeks of beginning the rhythmic movements, he started saying many new words and expressing himself much more clearly. He's been extremely clingy and needy for me since birth, and has also made great strides in this area also - able to play independently or with other kids for long stretches of time without needing to have me right next to him and even comfortable going to his class at church and going with his grandmothers and other friends while l leave him! This has been so freeing for me! He had also been asking for comfort nursing at least 15 times a day, and has gone to only asking to nurse at waking and bedtimes with very infrequent comfort nursing.

My 9 year old with sensory processing disorder has been significantly helped as well through the rhythmic movements and reflex integration. Both his sensory seeking behavior and hypersensitivities became greatly diminished. We used to get only small chunks of time when he was 'in the green' (nervous system well regulated and operating with the appropriate level of alertness for the situation, not hyper or wild nor sluggish). With regular rhythmic movement of a few minutes every night (with four children, it's been impossible to consistently make it happen twice every day) and working on his Moro/startle reflex and feet reflexes, he's been spending more and more time 'in the green' until it's become his regular way of being! I feel like we are finally getting to spend time with the amazing boy I've always known was 'in there' somewhere!

In the class, Sonia explains the possible long term symptoms of each reflex being unintegrated. Of about 20 symptoms of Moro/startle unintegration, my son has had all but 4 of them - and almost all of them have disappeared or greatly improved since starting the movements. Just to mention a few that have improved: his motion sickness has completely disappeared - he used to feel sick every time we were in the car and would throw up if we drove longer than 30 minutes, he's no longer overwhelmed all the time, he has hardly been sick at all this past few months and when he has, it's been mild (as opposed the last year when he had 12 significant illnesses in a four month period), he's much less reactive with his siblings, he's better able to pay attention visually to what he wants to focus on, and he had also needed a regular dose of melatonin every night to be able to settle down for sleep, and has decided on his own to wean himself off with complete success!

My oldest son needed open heart surgery when he was three months old, and the information in the class about trauma or surgery causing reflexes not to integrate or to become unintegrated was so eye opening! It explains so much about what we thought was his personality, but I see now is related to the fear paralysis reflex and others. He is 11 now and has always been fearful of and very resistant to anything new (including participating in this therapy!), but after seeing the changes in his brothers, he sheepishly asked me to start working with him. We have only worked with the rhythmic movements so far (not yet begun the reflex integration), but already he is more confident and less fearful - more at home in the world.

I can't thank Sonia enough for sharing this life-changing information! What a gift to our family!

From Jessica,

Mother of Four from Southern California
Posted June 13, 2015, less than 5 months after the start of the 8 week Brain and Sensory Foundations online course. See www.facebook.com/MovePlayThrive

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The reflex assessment and integration I have used more specifically with 1:1 clients. When they do the work, changes happened very fast. I can think of 2 clients I worked with particularly on the foot reflexes - their stability, balance and confidence changed along with their gait.

For one, within a few minutes of stimulating then integrating his foot reflexes it helped him make more of a connection of his feet belonging to his body - it seemed like his feet were almost disassociated from his body due to a condition 20 years back for which he received chemo and radiation, which damaged nerves or connections in his feet. He watched as his toes were able to bend again! I was so shocked too at how quickly he got movement and sensation back. He continues to work on the foot reflexes himself at home, and now I have noticed that he even is beginning to have better movement in the the ankles too…it’s working its way up! It was astounding. He was very shocked. I was thrilled for him.

In my yoga classes, I have incorporated rhythmic movements in every class. Comments after doing the rocking/rhythmic movements include:
"I feel so relaxed",
"I could go to sleep",
"I feel more alive and awake in a good calm way"

And what is most interesting is that even the people who attend my classes whom I have not seen for 1:1 yoga therapy that includes reflex integration, even those people are seeing shifts in their body. The yoga therapy movements have remained the same. The only different factor in my group classes since June are the rhythmic movements. I know in my being that this is the piece that is changing these people. In one lady, her knots have disappeared completely (she is SO HAPPY - she’s had those knots for several years!), or function becomes better, or pain decreases … it is contributing and enhancing the therapeutic yoga work that I do and it’s truly obvious and amazing.

Sue Kruszewski,
Certified Yoga Therapist and Yoga Teacher

Elements in Motion
Yoga & Movement Therapy
elementsinmotion.ca

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Case Study by Mansi Bhagwate, Occupational Therapist, MS OTR/L, CPH
Submitted April 28, 2016

Adam (name changed) is a 4 year old boy who I have been working with since December 2015 and introduced reflex integration in March 2016. His mother reported that he is a hyperactive boy with a fleeting attention span. He is always on the go and is easily distracted by surroundings. He was born full term and his mother had an uncomplicated pregnancy which is why she was surprised when he didn’t talk until he turned 3 and was ‘clumsy.’ When I started working with him in December, I too noticed that he was hyperactive and needed a lot of sensory input in form of heavy work and brushing to help him focus for 1-2minutes after which he was off again. Safety was also one our concerns as he was literally bouncing off walls, sofa and TV in his ‘free’ time. He could barely play with toys. He was so strong that sometimes he exerted too much pressure when playing or writing and would break things. He didn’t know how to approach peers or adults for play and ended up hitting them, fighting with them or having a tantrum. He didn’t show hand preference and switched hands all the time. He had a fisted grasp while coloring. Motor planning was also a problem as he couldn’t figure out an obstacle course and would just trample everywhere, all the while laughing. He also drooled quite a bit especially when concentrating on activities. He seemed to have a sensory processing disorder.

I first introduced P.A.C.E warm ups. Immediately I noticed that he couldn’t do cross crawls and hookups, especially arm crossing. So we practiced passively. Next, we did the 4 basic rhythmic movements passively. I also had mom practice those on herself and on Adam. He kept on asking for more and we ended up doing those in the entire session. Immediately, he appeared calm and completed entire 6 piece puzzle by himself as I sat next to him, observing. Next, I used the reflex pattern and rhythmic movement assessment and found that he had at least TLR, Moro and palmar/babkin reflexes still unintegrated. We then started doing isometrics for TLR. We also played neck flexion extension games like pushing balls back and forth etc. He loved participating in those games and also said he would play them with his cousin. He also really liked doing cat-cow poses. We continued with rhythmic movement. His attention span was now improving. He completed 3 desktop activities (cutting, tracing lines, play-doh) which lasted for 10-12 minutes, the most he has ever paid attention for anything. He was still drooling when cutting, so I changed focus to integrating palmar/babkin. For the next few sessions we did brushing palms, isometrics, oral-strengthening exercises. In my last session, drooling wasn’t there anymore. It was more like a wet mouth. His mom reported that since she has been doing rhythmic movements with him, he has been sleeping through the night without waking up and didn’t fight with his cousin over the weekend. I noticed that he didn’t switch hands while writing/coloring and used his right hand with a 4 finger grasp. We have moved onto integrating the Moro as he tends to get scared with loud noises and sudden change of position. He loves doing Roly-Poly, jelly fish and monkey hugs with a body pillow. I also use therapeutic listening with him when we do Moro integration.

Since March 2016, I have completed at least 6 sessions with Adam with rhythmic movements, isometrics for TLR, palmar/babkin, Moro and PACE tune ups. I am noticing a drastic change in this boy’s demeanor. Where at first, I saw an immature, hyperactive boy with a lack of safety awareness and delay, today I see a calm, self-regulated child who follows adult directions, completes activities asked of him, shows an active interest in academic activities, can sit down for task completion, is showing a hand preference with a proper grasp and doesn’t drool anymore when concentrating. He has come a long way in a short time.

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Case Study submitted by Jessica Ullmann, OT, Colorado

G is a five-year old preschool student who started on my caseload at the end of last year when his teacher and parents became concerned that he lacked the skills needed to continue on to kindergarten in the fall. Some of the challenges that G has include: very limited attention span and focus, impulsivity. Even in play G will spend limited time on any one activity and will quickly move from one thing to the next. He demonstrates mixed dominance, decreased fine motor skills, avoids activities that involve tool use (pencils, crayons, scissors), and has decreased core strength and motor planning.

I choose to introduce movements from the Brain and Sensory Foundations course. We did rhythmic movements to help him mature his brain stem so that he can improve his impulse control, focus and attention and help him to be able to learn and succeed in his preschool environment. I also wanted to help develop a good foundation for his reflex integration. I choose the TLR, ATNR and hand reflexes to focus on because of his difficulties with comprehension, poor fine motor skills, tense pencil grip and trouble forming basic shapes and letters in his name, and to help him develop a dominant hand for tool use.

In the beginning G had a very difficult time nodding his head along with the first rhythmic movement. He kept his head and neck stiff, and they would move as a unit. G liked helping to determine the speed of the movements and which song we sang. When he returned in the following weeks,  G would request rhythmic movements right away. His head is moving more freely now, and he is able to assist with the head nodding for brief periods. For the reflexes I am providing the stimulation followed by the playful developmental movements, I have not introduced the isometric activities for TLR and ATNR due to his age.

He has been able to do the isometric hand reflex activities. Participating in these activities has begun to increase G’s ability to focus and participate in his fine motor activities, and he is much more willing to come and sit at the table. He continues to need verbal cues to stay in his seat, but is needing much less of them. He also has been noted to be using his right hand more consistently when writing and using scissors. For the 5 Step Balance G wanted to draw a picture. After acting out the drawing of a picture for the second time G stated that it was “fun” and then he wanted to draw a real picture. From this experience I learned how rhythmic movements and reflex integration activities can help improve a child’s attention and participation in play and learning.

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