An OT and SLP Team Approach to
Educational Success
 2014 Georgia Organization of School-based Speech-
Language Pathologists
 March 6th, 2014
 Presented by Cindy Terry, Coordinator of Therapeutic Services
Gwinnett County Public Schools and
Doris Osborne, Supervisor of Related Services
Cobb County School District
What is a Related Service?
 Under part B of IDEA, OT & PT are related services for
eligible students, who, because of their disabilities,
need special education and related services. Related
services are support services that help the student to
“benefit from special education”. (AOTA)
??Eligible??
 A child does not become eligible for OT or PT. He or
she becomes eligible for special education. The results
of an OT or PT assessment or evaluation presented to
the IEP committee for consideration drive the need for
school- based therapy support.
What is “educationally relevant”
OT or PT?
 A student with a disability has a need for
improvement in his functional skills as related to
his performance in the educational environment.
The student may have an educational need as well
as a medical or clinical need. However, some
motor difficulties may not directly impact
educational progress and may not constitute
educational need. (CA DOE)
 School- based OT and PT services are performed
in the educational environment with educational
staff.
What is the GA Consideration Tool?
 Guidance tool for determining the need for educationally
relevant therapy and time required to support the IEP
goals/objectives
 Summary of educational considerations based on a review
of
 student records, evaluations, observations, progress
notes, parent/teacher information, and other data
 Visual aid to display the clinical reasoning process as
noted by AOTA & APTA Best Practices for school-based
therapists.
SLP and OT Co-Treatment
 Research in this area is limited.
 Studies reported most collaboration between school-
based SLPs and OTs are with students with ASD.
 1999 AJOT study reported SLP and OT with a 98%
collaboration during the evaluation 100% during
intervention for students with ASD
 2011 Study by Laura Czernik LEND Fellow found
advantages with the most common being increased
participation by the child
Leo Kanner- 1943
Coined the term “autism”
“biological impairment like physical and intellectual handicaps”
Noted perceptual difficulties and overreaction to loud noises and
moving objects.
50’s and 60’s- viewed as an emotionally based disorder resulting
from cold “refrigerator mother”
70’s- back to recognition as neurological impairment
Literature focused on social, communication, behavior and
cognitive issues. Attention to perceptual and sensory processing
difficulties (abnormal response to visual, vestibular and auditory
stimuli; disorder of sensorimotor integration; problems with
modulation of sensory input and motor output)
Occupational Therapy
 1970’s- Jean Ayers- behavioral problems associated with
inadequate sensory integration.
 1980’s Knickerbocker- behaviors exhibited by individuals
with autism may be related to hyper- or hypo- reactions to
sensory input. Planned sensory input provided through
specific activities could help normalize reactions to
sensory input and improve behavior.
 Autopsy studies of individuals with autism have found
developmental abnormalities in the cerebellum and limbic
regions of the brain. Significant roles within sensory
integrative process including modulation of sensory input.
 Adults with autism have written personal accounts of
sensory experiences- Temple Grandin, Donna Williams,
Zosia Zaks, Judy Endow, Sean Barron, Stephen Shore, John
Elder Robison, Larry Bisonnette & Tracy Thresher.
Examples of functional skills needed for school
 Hand function
 Visual skills/ visual
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perceptual skills
Handwriting
Attention span
Organizational skills
Sensory awareness
Sensory processing
Self care skills
Positioning
Social Skills
Motor planning
 Functional Mobility
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(walking or WC skills)
Stair climbing
Balance
Coordination
Oral motor skills
Gross motor skills
Fine motor skills
Assistive technology
Pre-vocational tasks
Leisure skills
“All learning has it’s basis in
sensory development.”
From Sensory Secrets.
Sensory Processing:
The organization of sensory input for adaptive
responses: learning, motor skills, perceptual skills,
behavior, social skills.
The brain locates, sorts and orders sensations
somewhat as a traffic officer directs moving cars.
When sensations flow in a well organized or
integrated manner, the brain can use those sensations
to form perceptions, behaviors and learning. When
the flow of sensations is disorganized, life can be like a
rush hour traffic jam.
-Jean Ayers, 1979
The brain acts much like a
computer!
 Input goes in through the sensory systems…
 Which is processed in the brain…
 Resulting in an adaptive response…
 Which provides feedback/sensory input…
 Which is processed in the brain…
 Resulting in an adaptive response…
The process is cyclical.
Components of SP
Sensory Registration:
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Be aware of a sensory stimulus
Orientation:
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Pay attention to new information being received
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Determine what sensory input needs attention and what can be
ignored
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Utilize functions of inhibition and facilitation = modulation
Interpretation:
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Interpret and describe sensory input
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Allows for fight, fright, and flight responses (protective system)
Organization of a response:
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Determine if a response to a sensory stimuli is needed, and how:
cognitive, emotional, physical
Execution of a response:
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Execution of the cognitive, emotional, or physical response
Sensory Modulation
The ability of the nervous system to:
 Regulate, prioritize, and organize incoming sensory
information.
 Adapt to changes in the environment.
 Maintain arousal level appropriate to the task.
 Results in:
 Registration, arousal, self-regulation, attention, focus,
and behavior or emotional responses
Over-reactive to sensory stimulation
Under-reactive to sensory stimulation
Modulation disorders
Integration disorders
Difficulties with arousal levels-that “just right”
state for learning
Use sensory assessments to analyze.
The 2 Functions of the Nervous
System:
1. Protection: fright, flight, fight
2. Discrimination: for learning,
communication, behavior
Central Nervous System:
Sensory Processing Sets Foundation for:
Cognitive:
academic learning,
daily living skills, behavior
Perceptual-Motor:
auditory language skills, visual-spatial perception,
attention center functions, eye-hand coordination,
ocular-motor control, postural adjustment
Sensory-Motor:
body scheme, reflex maturity, ability to screen input,
postural security, awareness of the two sides of the body, motor planning
Sensory:
olfactory, Visual, auditory, gustatory, tactile, vestibular, proprioception
Sensory Systems:
 From eyes – vision
 From ears – hearing
 From skin – touch
 From nose – smell
 From mouth – taste
 From semi circular canals – vestibular
 From muscles/joints - proprioception
THE TACTILE SYSTEM
 Provides us with our sense of touch
 First sensory system to operate in uterus
 Rooting reflex, calming to neutral warmth
 Receptors in the skin provide information about
light touch, pressure, vibration, temperature, pain
 Feedback- development of body awareness, motor
planning
 Needed for ADLs including schoolwork, job tasks
Tactile cont.
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Protective tactile system- more primitive
Initially dominant
Informs us when dangerous contact is made
May be gently alerted or activate “fright, flight or fight”
response
 Discriminative tactile system- allows us to feel the
quality of the item we are touching
 Higher level- necessary for learning and brain
development
Tactile Dysfunction
 Hyper- or hypo- sensitive to touch
 Problems with tactile discrimination
 Sensory modulation- unable to screen out sensations;
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overwhelmed to point of not responding to other sensory
systems
Tactile defensiveness- (hyper-)regarded as threatening. Can
tolerate touch but not receive touch
Behaviorally- anxious, aggressive, controlling, inflexible,
unwilling to participate in activities
Hypo-low arousal levels require intense input
Body awareness, motor planning problems due to impaired
feedback
Delayed reaction to touch- may not realize injury
Seeking tactile input- constantly touching- social
implications
THE VESTIBULAR SYSTEM
 Provides information about movement, gravity, changing head
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positions
Tells us if we are moving, still, direction and speed of movement
Develops relationship to earth- body position vertical or horizontal
even with eyes shut
Balance, postural security, self- regulation and modulation
Receptors located within structures of ear( semi-circular canals, utricle,
saccule)
Influences development of eye movements- tracking, focusing,
maintaining upright posture
Influences muscle tone, “readiness” to perform work
Protective- reflexes to prevent falling
Discriminative- recognize going faster, slowing down, rotary
movements, rhythmical
VESTIBULAR DYSFUNCTION
 Hyper- fearful with changes in gravity and position
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gravitationally insecure- do not like heights, feet off ground
May feel discomfort, nausea, or dizziness with movement
No exploration of environment, no motor memory= poor
motor planning
Hypo- seekers, crave movement- climbing, jumping,
excessive movement to stay alert and organized
Problems with self-regulation- inconsistent responses to
sensory input , emotional instability, inappropriate arousal
levels, difficulty maintaining and shifting attention
PROPRIOCEPTIVE SYSTEM
 Unconscious awareness of body position
 How much force necessary for muscles to exert so we can
grade movements
 Receptors located in muscles, tendons, ligaments, joint
capsules, connective tissue
 Respond to movement and gravity- helps us make sense of
movement and touch experiences
 Position in space, body map- motor planning
 Regulate arousal levels (stretch, heavy work)
Proprioceptive Dysfunction
 Poor body awareness
 poor grading of movements- break items, writing too
hard or too light, may fatigue easily
 May use proprioceptive input to reduce
hypersensitivity to other sensations- intense rocking,
banging back and head against chair, jump on beds,
squeeze between furniture, hide under heavy blankets
Autism Sensory Processing
Sensory Quota System
according to Zosia Zaks
 “Say my brain has only 100 Sensory Processing Units.
If it takes 95 units to decipher the sounds of a
conversation, decode the conversational signals that
indicate turns and innuendo, pick up the contextual
clues that impart social meaning, and modulate my
voice, I have just five units remaining to use for other
sensory sources.
 Since looking at someone’s face, decoding facial
expressions and coping with the pain of the fluorescent
lights requires (hypothetically) at least 75 units, in this
case I would not have enough Sensory Processing Units
to look at the other person, or even open my eyes, while
we conversed. This helps explain why most autistic
people are unable to look at someone in the eyes while
also talking, a characteristic behavior of autism spectrum
disorders.”
 When SPUs are used up:
 Sensory overwhelm or sensory meltdown
 Need to calm self ALONE
Scrambling- difficulty sorting sensory input into
meaningful chunks of information
Sensory cross-firing (synaesthesia)- experiencing a
sensation in one sensory system yet perceiving the
sensation in another modality
 Research continues to demonstrate that people with
ASD tend to have more issues with sensory processing
than the general population (Kientz & Dunn, 1997;
Watling, Dietz & White, 2001).
 Those with ASD demonstrate sensory symptoms
specifically indentified in taste, smell, tactile and
auditory processing (Rogers, Hepburn & Wehner,
2003).
 …people with ASD often over- or under-process
sensory input from the environment (Ornitz, 1989;
Wainwright-Sharp and Bryson, 1993) or have trouble
regulating sensory information (Lincoln et.al., 1993,
1995).
 BRAIN ACTIVITY
Be aware of your
sensory needs….
Be aware of the sensory needs
of your students!
Everyone has them!
Behavior
Everything we do.
Behavior may be learned,
a nervous system response to an environmental stimuli,
or both.
Behaviors have specific functions.
Functions of Behavior:
 Escape: avoidance of a person, task, situation, or
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environment
Tangible: desire for a specific item, activity or feeling
Attention: desire for positive or negative attention
from peers or adults
Sensory: desire for a feeling, taste, sound, or
environment to meet a sensory need or a fear or
avoidance of sensory input
Power/Control: desire for clout, authority, the last
word, influence over their environment
Problem Behavior:
 Student does not conduct himself properly for the
environment or situation.
 Student’s behavior does not match what we expect
from his peers.
 Student does not do what we want him to do, when
we want him to do it, or how we want him to do it.
Consider: Who’s problem is it?
Prioritize need for Behavioral
Change/Hierarchy:
1.
Behaviors that harm self.
2.
Behaviors that harm others.
3.
Behaviors that harm property.
4.
Behaviors that are disruptive.
5.
Behaviors that are distracting.
Behavioral Model
 Behavior is conditioned via external stimuli
 Based on the work of B.F. Skinner
When external stimuli are identified, they can be
manipulated and result in an increase, decrease or
maintenance of the behavior (used in ABA, PBS,
etc.)
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Positive and Negative Reinforcement
Punishment and Extinction
Behavior Assumptions
Sensory Assumptions
 Serves a function (obtain or escape)
 Problem behaviors may result from
an underlying sensory processing
disorder
 Function is valid for the individual
 Is learned and can be unlearned
 Problem behavior is often viewed as
a form of communication.
 Problem behavior results from a
lack of basic social skills.
 Problem behavior may be a source
of internal pleasure.
 Problem behavior can be something
a student does when he or she does
not know what else to do.
 (Alberto & Troutman, 2009)
 Sensory behaviors serve a function
 Sensory behaviors may be
productive or nonproductive
Productive- meet a regulatory need
 Nonproductive- may be a source of
internal pleasure
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Sensory behaviors will be
acceptable or unacceptable
Sensory behaviors can be used for
communication purposes.
(Murray-Slutsky & Paris, 2005)
SESNORY BASED LEARNERS
Handout
TASK AVOIDANCE
Handout
Some common misconceptions about
negative behavior and sensory concerns:
 Sensory strategies will reinforce negative behavior.
 “He enjoys it, there’s a smile on his/her face the
whole time.”
 “She can do it, she did it before…she just doesn’t
want to.”
 “He’s just being manipulative.”
A-B-C Model
 A- Antecedent: Events that occur before behaviors
and that may cue or set the stage for certain behaviors.
(Who, what, when, where?)
 B- Behavior of concern
 C- Consequence: Events that follow a behavior that
determine whether the behavior will be repeated or
not.
(Murray-Slutsky & Paris, 2012)
Antecedent Control:
Set the stage for success!
 Environmental influences
 Scheduling considerations
 Activity considerations
Can reduce the need for specific sensory diets
or behavior plans as we manage behavior.
Environmental Factors that Impact Behavior
 Behaviors are More likely to
Occur
 Large Room
 Unstructured tasks or
schedule
 Poorly planned transitions
 Low child-adult ratio
 Proximity of others
 Stress or frustration
 Environmental factors: noise,
clutter
 Change: people, place,
activities
 Bored, lack of Stimulation
 Excessive Waiting
 Behaviors are Less Likely to
Occur
 Small rooms
 Structured tasks
 One to One child-adult ratio
 Engrossing, task
 Stimulating, interesting
activities
 No waiting time
 Quiet environment
 Area free from distractions
and clutter
 Repetition, routine
 Pre-planned transitions
 Familiar People
 Assistance Provided
Environmental Influences
Promote an environment which facilitates sensory
modulation. Utilize calming and excitatory
influences throughout the day, depending upon the
specific task and requirements.
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Adjust lighting.
Utilize music or white noise when appropriate.
Utilize aroma therapy.
Offer an array of seating and positioning options,
including those that offer movement.
 Make weighted lap pads or snakes if possible.
 Offer water bottles, gum, chewy or crunchy snacks.
Scheduling Considerations
 Intersperse all “sitting and concentrating” activities
with movement or heavy work activities
 Use visuals to communicate schedules so students can
prepare for changes and transitions
 Verbally prepare students in advance when non-typical
activities will occur, i.e.- fire drill, outings, visitors
Ways you can help…..
 Routine:
 Provides student with understanding- gives confidence
and security
 Gives sense of predictability
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BUT…have to help with what happens when changes occur…prepare, prepare, prepare
 First/ Then routines
 Individual Schedules
 Use photos, icons, words
 Length of schedule
 Various ways to use them
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For the day’s events
For specific routines in the room
Activity Considerations:
 Give choices when possible
 Mix non-preferred with preferred
 Make tasks short & manageable, especially if frustrating
 Use reinforcers
 Make expectations and consequences/rewards clear
 Reduce the Anxiety
 SCHEDULE DOWN TIME- will melt down if have to earn
 Sensory Input- determine function, use tools- nubby seats, balls,
tramps, velcro, pressure, sensory diet
 Fidgets
 Students with ADD/ADHD may exhibit improved focus by allowing them
to hold fidget
Principles for Using Sensory Strategies:
1. Make sure strategies are not used to reinforce
negative behaviors- be proactive, not reactive
2. Provide a sensory diet- schedule frequent breaks
(movement/ stationary), heavy work throughout
day, use strategies that can be used during
learning tasks. When in doubt- use
proprioception!
3. Utilize strategies to regulate arousal level, teach
self-regulation: mouth, hands, move, auditory,
visual
4. Teach the student to communicate needs.
Interventions
 Based on information gathered, the therapist
collaborates with teachers and parents to design an
intervention plan to address the child's sensory
processing problems.
 The goal of a sensory based approach is to provide the
“just right” amount of input in order to help the child
regulate his sensory system and adapt to improve
attention and focus for learning to occur.
Sensory Diet
 Term coined by Patricia and Julia Wilbarger in
1991.
 Individualized, planned and scheduled activity
program developed to help a specific child meet
his/her sensory needs.
 Combination of alerting, organizing, and
calming activities.
 Dynamic- Adapts with the child’s sensory
changes
 Everyone has one.
Sensory Diet
 Metaphor- nutritional diet. Sensory diet
requires the right combination of sensory
input to keep an optimal level of arousal
throughout the day.
 “Sensory snacks” – short term
 “Sensory entrees” last longer, very powerful
 Powerful behavioral tool!
Sensory Diet Considerations
Handout
Sensory Diet
Over-responsive/ hypersensitive
Schedule sensory activities throughout the child’s day to
modify arousal levels to fit the child’s needs.
Activities with intensity and long lasting effects
Be proactive to keep child calm and organized.
Deep proprioceptive activities are calming and
organizing: heavy work, wall push ups, weights,
climbing, pushing, pulling
Tactile: deep touch pressure, massage
Vestibular: Proceed with caution beginning slowly with
proprioceptive activities. Jumping on trampoline,
swinging
If your student is overly sensitive to or overly
stimulated by sensory input:
 Touch: Use firm pressure. Always approach from the front. Ask
permission to touch. Allow to be in front or rear of lines.
 Noise: Keep classroom noise to a minimum. Try using white
noise. Try using earplugs, earphones, or cotton balls in ears when
in noisy environments. Always prepare in advance of a fire drill.
Muffle your classroom speakers. Position desk on outer periphery
of classroom and away from doorways/hallways.
 Vision: Keep classroom and walls uncluttered. Have student keep
minimal items on his/her desk. Use simplified worksheets. Use a
reading or writing window. Position desk in front of classroom and
away from doorways. Try using a study carrel or an “office”. Use
sunglasses outside if needed.
 Sensory Diet: Under-responsive/ hyposensitive
 Sensory activities to “wake up the systems”. Intense to
increase registration, awareness, overall processing.
 Be proactive to keep child alert, awake, organized, engaged.
 Modify environment to alert: bright colors and lights,
animation
 Proprioceptive: weights, pushing, pulling, carrying & lifting
heavy objects. Combine with vestibular: jogging, climbing,
monkey bars
 Tactile: sucking, chewing, massage, vibration, sand table
activities alternating sand, rice, beans; putty
 Vestibular: jumping on trampoline, swinging, bouncing on
ball
 Sensory Diet: Sensory seekers
 Schedule sensory activities throughout the day to modify
arousal levels. Assure availability of activities.
 Select 1 or 2 powerful activities to maintain optimal alert
state.
 Intense, long lasting effects
 Be proactive to keep child calm and organized.
 Proprioceptive: activities for calming, organizing. Heavy
work, wall & chair push ups, climbing, monkey bars,
pushing, pulling, weights
 Tactile: deep touch pressure, massage
 Vestibular: Linear movement, bouncing on ball, jumping
on trampoline, riding bike
Sensory Strategies Used in Schools
Activity or Equipment
Sensory
System
Purpose/criterion
Weighted vest
P,T
Calming, organizing, attending.
Adhere to protocol
Weighted lap-pads or
snakes
P,T
Calming, organizing, attending
Pressure vests
P,T
Calming, organizing, attending. Offers
sustained input
“Wiggle” cushions
V, T
Facilitates attending. Allows
movement while remaining in seat.
Quiet or safe area in
classroom
Designed to
target 1or
more systems
Allows student to control need to regroup, chill-out, prepare for
unscheduled event. Favorite calming
act.
Sensory Input
Calming
Alerting
General
Characteristics
Mild/Soft
Slow/ Rhythmical
Simple/ Familiar/ Expected
Low Demand/ + Assoc.
Strong/ Pronounced
Fast/ Jerky/ Non- rhythmical
Complex/ Busy
Unfamiliar/Unexpected
High Demand/ - Assoc.
Movement:
Slow rocking, swinging
Heavy work: pushing, pulling
Fast rocking, swinging
Bouncing/ Jumping
Tactile
Firm, steady pressure or weight
Student prepared
Warm neutral
Soft/ Smooth
Light or erratic touch
Student unprepared
Cold/ Stiff/ Scratchy
Auditory
Soft/ Slow
Classical, soft rock, some jazz
Static/ White noise
Loud/Fast/Non-rhythm
Hard rock/ Rap
Visual
Neutral or soothing colors
Simple/ Soft lighting
Bright or loud colors
Busy/ Bright lighting
Smell
Soft pleasant smells
Strong or noxious odors
Taste
Sucking/ Sweet/ Bland
Crunchy/ Cold/ Bitter/
Spicy
Vestibular, Proprioception/
Kinesthetic
Sensory Supports
 Sensory stories
 The Alert Program
 Drive Thru Menus Exercise Programs
 Stickids
 Sensational Brain
 Equipment- tramps, pressure vests,
weighted vests, blankets, fidgets, swings,
dynamic seating, etc.
Great Resources…
• You’re Welcome: 30 Innovative Ideas for the
Inclusive Classroom
– Patrick Schwartz and Paula Kluth
• The Incredible 5-Point Scale
– Kari Dunn Buron and Mitzi Curtis
• “Just Give Him the Whale!”
– Paula Kluth and Patrick Schwarz
• Practical Solutions to Everyday Challenges for
Children with Asperger’s Syndrome
– Haley Morgan Myles
 Building Bridges Through Sensory Integration:
Therapy of Children with Autism and Other Pervasive
Developmental Disorders
 Ellen Yack, Paula Aquilla, Shirley Sutton
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Shawnee Mission, Kansas: Autism Asperger Publishing Co., 2006.
Quirk, Norma J. and Marie E. DiMatties. The Relationship of Learning Problems and Classroom Performance
to Sensory Integration. 1990.
Self-Calming Strategies: 16 Strategies on Cards and Posters to Encourage Self-Calming Skills. Schaghticoke,
NY: Your Therapy Source, Inc., 2010.
Tomchek, Scott D. and Jane Case-Smith. Occupational Therapy Practice Guidelines for Children and
Adolescents With Autism. Bethesda, MD: The American Occupational Therapy Association, Inc., 2009.
Willis, Clarissa. Teaching Young Children with Autism Spectrum Disorder. Beltsville, MD: Gryphon House,
Inc., 2006.
Additional
Resources
S’cool Moves for Learning: Enhance Learning Through Self- Regulation Activities
Wilson, Debra Em and Heiniger-White, Margot C.
More Minute Moves: Seven Weeks to Classroom Management Success
Wilson, Debra Em
www.schoolmoves.com
Too Loud, Too Bright, Too Fast, Too Tight: What to do if you are Sensory Defensive in an
Overstimulating World
Heller, Sharon
Sensory Secrets: How to Jump-start Learning in Children
Schneider, Catherine Chemin
Oh Behave! Sensory Processing and Behavioral Strategies: A Practical Guide for Clinicians,
Teachers and Parents
Trott, Maryann Colby
Self- Calming Cards
Crary, Elizabeth and Katayama, Mits
Sensory Challenges and Answers
Grandin, Temple
 Building Bridges Through Sensory Integration: Therapy of Children with Autism and
Other Pervasive Developmental Disorders
• Ellen Yack, Paula Aquilla, Shirley Sutton
Need assistance locating these or other resources, contact Cindy Terry @
cindy_terry@gwinnett.k12.ga.us.
Or Doris Osborne@ doris.osborne@cobbk12.org