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Excelling in Out Patient Therapy Services

Seeking Input

Symptoms

Malky is an adorable four-year-old girl. Her mother is concerned because Malky is always bumping into people and furniture, falls frequently and occasionally even crashes into walls. Malky is always touching things as she encounters them and often lies down flat on the floor during meals or class time. Malky’s mother brought her to The Therapy Place to see if we could determine the causes of Malky’s unusual behaviors and help her function better.

Assessment

Malky has decreased body awareness. She is less aware of herself and where she is relative to her surroundings than most people naturally are. She needs extra input from her environment in order to gain the level of spatial awareness that most people naturally have. This causes her to display sensory-seeking behaviors.

Spatial awareness begins developing in infanthood. For example, when babies reach toward a parent’s face they may hit or miss – but through this exercise their brains develop a neural network that provides the awareness of depth and space. Eventually they learn to reach accurately, no longer needing the outside stimuli (banging into the object) to give them the information of where the object is. Their awareness of themselves relative where other things are develops to the point that they naturally know where their own body begins and ends and where other objects begin and end.

Malky’s sense of spatial awareness is underdeveloped. She is not intuitively aware of how close or far other objects are. She needs extra input to assess where she is at any given moment. She may bump into things because she didn’t know how close they were. She touches things as a way of establishing their location and her own location relative to the object.

Treatment

In order to develop better spatial awareness, we used therapeutic techniques to provide intense, repetitive sensory input. By tracing the same “path” over and over again, Malky would develop the neural pathways she was missing.

The therapist placed a sack of cool, heavy beans in front of Malky and guided her to bury her hands in the beans, move them around, feel the sensation of the weight through her fingers and over her arms. The therapist also brushed Malky’s arms with a sensory brush. During these activities the therapist talked to Malky, describing the feelings of the beans and brush on her skin in order to help Malky understand what her body was experiencing.

The therapist also addressed the vestibular system in order to help Malky develop better balance. The vestibular system is based in the inner ear and regulates balance. Since Malky’s vestibular system was underdeveloped, she fell often. To build the neural pathways that would develop better balance, the therapist had Malky swing repeatedly in specific positions. The goal was to bring Malky to that “click” moment when she would be able to sense where she was on her own, without relying on outside information.

By constantly challenging and encouraging Malky to develop her weak areas, we were able to establish those missing neural networks. By the end of her course of treatment Malky was no longer fidgeting with materials or crashing into walls. Malky had developed a typical sense of spatial and body awareness. Today Malky is a happy-go-lucky child who runs, plays and only crashes into walls as often as any of her friends.


You can submit questions via email at therapythoughtsnj@gmail.com. To schedule an appointment call 732-813-HAND today or visit our website www.thetherapyplacenj.org for more info.
Names and details have been changed. This case study may be amalgamation of different patients or symptoms. The purpose of this article is to educate about conditions that may be treated with occupational therapy.