Therapy/Exercise Ball as a Sensory Integration Tool

相關網誌：
威爾巴格治療方案Wilbarger Brushing Protocol 感覺餐單Sensory Diet （澄5y9）

A Therapy/Exercise Ball as a Sensory Integration Tool at Home and in the Classroom






在自閉症光譜下( Autistic Sybetrom  )的孩子都有各自的感官調節異常問題SPD( Sensory processing disorder ),
每一個個案都不同, 職能治療師也會給予個別個案不同的幫助和治療。
而我家小BIE,很明顯有“觸覺防禦”，是對於碰觸的感覺有過度反應的傾向，對於環境中的觸覺刺激，感受過於敏感。

簡介職能治療中所運用的感覺統合治療理論和其原理。

1.何謂感覺統合治療?

何謂感覺統合治療?感覺統合理論是以神經醫學、神經心理學、神經生理學為基礎，發展出此一理論。此理論認為唯有基層的訊息傳遞良好，全面發展的大腦其高階層的功能才能加以發揮，而觸覺、本體覺、前庭覺為個體發展早期的最基礎的三個感覺系統，若發生障礙，則會影響未來更高階層的皮質功能。

身體處理來自外界各種的感覺訊息的主要神經構造為腦幹、下視丘等，在此處 感覺訊息被適當的加以統合，促使更高層的皮質功能發揮，使個體可以處於良好的狀態進行學習。

一般感覺統合治療適用的病患，通常是有感覺統合障礙的病人，感覺統合障礙所表現出來的行為缺失包括：姿勢控制不良、身體印象差、動作不協調、語言遲緩、視知覺動作障礙、動作計劃能力差、不專心、無法自我控制、缺乏自信、抽象思考能力或是慣用手未加以建立等。

主要的治療方式便是提供合宜的本體覺、觸覺、前庭覺的刺激活動，使病患能主動的與環境互動，進而產生適應性反應(adaptive response)。

 

2.何謂感覺調節問題?

感覺調節問題是指中樞性神經系統對於本身活動的規律、調節性，對感覺系統而言，感覺調節是指對於正在輸入的感覺刺激，適當的加以分級、定義，產生相關的反應，而不會對其反應過低或過度。對感覺的反應或一個人的警醒程度與定向感是平行的在一連續線的兩方，由低反應到高反應，由昏睡到清醒到過度警醒。

功能表現傾向於低反應的個體，被形容成是感覺註冊的功能不佳，因此可能會無法注意到一些會引起一般大眾注意的感覺刺激，而若是感覺調節的反應性過高，個體便會有感覺防禦的現象。因此對於一般很普通的感覺刺激，感到相當有壓力 ，覺得被衝擊到，十分的不舒服。

感覺註冊問題和感覺調節的問題(如觸覺防禦)在本質上不同，但在感覺註冊的概念被提出後，許多在感覺統合此一領域的專家們則主張感覺註冊和觸覺防禦是有關聯的，而且都是由於腦部邊緣系統來加以調節。

  

3.何謂重力不安全感?

重力不安全感是前庭覺過度反應所表現的一種行為，特別是內耳器官對在空間中的線性運動(如重力吸引造成的直線加速)所產生的感覺，兒童若是有這方面的問題，便會對受重力影響的一些須做動作的活動，感到相當不安全。因此在一般的活動中有極度害怕的現象，會有重力不安全感的兒童對於頭部位置和動作的改變感到相當的害怕，特別是在空間中向後和向上的移動，兒童會害怕高度，即使是離地面只有一點點的距離，對於重力不安全感的兒童更是一項相當難的挑戰。

有重力不安全感的兒童通常會表現出極度的害怕、焦慮或是甚至拒絕爬上樓梯 電梯，以及任何要爬到高處的遊樂設施，或任何無法事先預測的物體表面。有些兒童甚至會對只有一點點的高度改變，像是走在草皮的邊緣處，或是跨過一個積木，都感到非常的害怕不已。

  

4.何謂姿勢不安全感?

 姿勢不安全感和重力不安全感的情況類似。針對兒童會因動作方面的因素 而產生害怕的情況。姿勢不安全感的產生原因並不是因為前庭刺激輸入的過度反應 而是因為兒童缺乏適當的動作控制能力 因而無法維持自己在各項活動中的姿勢 會經常跌倒。所以 有姿勢不安全感的兒童 他們的動作表現經常是緩慢的 而且對 作出動作 這項要求 經常感到非常的害怕。兒童們的害怕、恐懼 便是根據他們動作遭受限制的真實情況反應。而這一個專有名詞 姿勢不安全感 便是指有這些情況的兒童們。

通常 我們不容易分辨兒童的焦慮是否是因為 感覺系統的過度反應或是動作控制的受限 因為這兩者的情況都可以造成焦慮的產生 而且這兩者的情況經常也同時發生在同一位兒童的身上。然而 有時候 這兩種情況的分辨又可相當的清楚。例如 有輕微痙巒的下肢型腦性麻痺兒童 通常會有姿勢不安全感 而非重力不安全感。他們會在攀爬活動時顯得很焦慮 但是當他們受到前庭刺激時 他們可能會顯出很喜愛前庭刺激的表情。像是頭在安全的保護情況下 往側邊或是各個方向傾斜 並且他們不須依靠自己的動作技巧 就可以維持在一個安全的姿勢。

  

5.何謂觸覺防禦現象?

觸覺防禦是對於碰觸的感覺有過度反應的傾向，若有觸覺防禦的現象時，則容易見到該孩童較一般人更易生氣、易怒，或是感到不舒服，讓一般人覺得其反應過度，尤其以輕觸(light touch)最容易令其感到不適。所以一般日常生活中，如穿衣、洗澡、刷身體、洗臉刷牙等活動，都容易引起觸覺防禦的現象。

由感覺統合觀點來看，有觸覺防禦現象乃是基於中樞神經系統的調節有問題，個體經由各種感覺傳輸進入大腦，進行各種感覺的註冊(sensory registration)，將各種感覺傳入後，加以調節整合，使大腦能進行更高階層的功能運作。但對於觸覺防禦的孩童，其觸覺註冊過程中有問題，對於環境中的觸覺刺激，感受過於敏感。

由於神經系統對於觸覺的感受過度反應(hyperresponsivity)，所以孩童對於一般正常人所感到的輕觸，會因神經過度反應而對該感覺感到不舒服，也因此，對於觸覺刺激，該孩童會有防禦，負向情緒出現，如生氣、發怒，由於不喜歡受到觸覺刺激，該孩童對於他人的碰觸也感到不適，因而可能不喜歡和他人一起遊玩，與他人疏離，甚至在人際關係上出現問題。

  

6.感覺統合建議訓練活動

一、                觸覺活動

1.      用大球或厚棉被在趴姿下滾壓其身體四肢，或坐在搖椅上可使安靜下來。

2.      在鋪地毯或毛毯的斜坡上側翻滾。

3.      手伸入觸覺箱內找尋玩具(觸覺箱內裝各式豆子、米粒、通心粉、玉米粒、種子等)。

4.      玩黏土遊戲，例如將黏土做成各種動物形狀。

5.      玩手指畫(可以顏料、醬糊、砂等當材料)。

二、                前庭本體覺活動

1.      溜滑梯(坐著溜下或趴著俯衝下來)。

2.      慢速規律性盪鞦韆。

3.      讓小孩坐在大球上，雙手扶住其腰部，幫他做上下彈的動作，或趴在大球上做上下彈。

4.      讓小孩趴在大球上，大人雙手抓住小孩的腿做來回向下俯衝動作。

5.      讓小孩趴在大球上，大人雙手扶住小孩的大腿或腰部，令小孩彎俯撿起地板的球或沙包，再抬起身將球或沙包投到籃子裡。

6.      趴在大球上做活動，如繪圖或拼圖。

　

三、                促進兩側統合活動

1.      袋鼠跳或小白兔跳。

2.      船行前進，即長坐在地板上，以手或腳前後移動。

 

四、                促進動作計畫能力

1.      大人手腳做出不同姿勢，讓小孩模仿。

2.      大人臉部做不同表情，或口部做出不同表情，令小孩模仿。

3.      大人以積木疊成不同模型，令小孩模仿。

4.      大人做出兩個(可依小朋友能力增加)步驟的動作，令小孩模仿。
http://web1.fyh.doh.gov.tw/depweb/Rehabilitation/unblock/teach/SI/SI.htm

What Sensory Processing Disorder looks like Causes of Sensory Processing Disorder Emotional and other impacts of Sensory Processing Disorder How Sensory Processing Disorder is treated Sensory processing (sometimes called "sensory integration" or SI) is a term that refers to the way the nervous system receives messages from the senses and turns them into appropriate motor and behavioral responses. Whether you are biting into a hamburger, riding a bicycle, or reading a book, your successful completion of the activity requires processing sensation or "sensory integration." Sensory Processing Disorder (SPD, formerly known as "sensory integration dysfunction") is a condition that exists when sensory signals don't get organized into appropriate responses. Pioneering occupational therapist and neuroscientist A. Jean Ayres, PhD, likened SPD to a neurological "traffic jam" that prevents certain parts of the brain from receiving the information needed to interpret sensory information correctly. A person with SPD finds it difficult to process and act upon information received through the senses, which creates challenges in performing countless everyday tasks. Motor clumsiness, behavioral problems, anxiety, depression, school failure, and other impacts may result if the disorder is not treated effectively. One study (Ahn, Miller, Milberger, McIntosh, 2004) shows that at least 1 in 20 children’s daily lives is affected by SPD. Another research study by the Sensory Processing Disorder Scientific Work Group (Ben-Sasson, Carter, Briggs-Gowen, 2009) suggests that 1 in every 6 children experiences sensory symptoms that may be significant enough to affect aspects of everyday life functions. Symptoms of Sensory Processing Disorder, like those of most disorders, occur within a broad spectrum of severity. While most of us have occasional difficulties processing sensory information, for children and adults with SPD, these difficulties arechronic, and they disrupt everyday life. Back to top What Sensory Processing Disorder looks like Sensory Processing Disorder can affect people in only one sense–for example, just touch or just sight or just movement–or in multiple senses. One person with SPD may over-respond to sensation and find clothing, physical contact, light, sound, food, or other sensory input to be unbearable. Another might under-respond and show little or no reaction to stimulation, even pain or extreme hot and cold. In children whose sensory processing of messages from the muscles and joints is impaired, posture and motor skills can be affected. These are the "floppy babies" who worry new parents and the kids who get called "klutz" and "spaz" on the playground. Still other children exhibit an appetite for sensation that is in perpetual overdrive. These kids often are misdiagnosed - and inappropriately medicated - for ADHD. Sensory Processing Disorder is most commonly diagnosed in children, but people who reach adulthood without treatment also experience symptoms and continue to be affected by their inability to accurately and appropriately interpret sensory messages. These "sensational adults" may have difficulty performing routines and activities involved in work, close relationships, and recreation. Because adults with SPD have struggled for most of their lives, they may also experience depression, underachievement, social isolation, and/or other secondary effects. Sadly, misdiagnosis is common because many health care professionals are not trained to recognize sensory issues. The Sensory Processing Disorder Foundation is dedicated to researching these issues, educating the public and professionals about their symptoms and treatment, and advocating for those who live with Sensory Processing Disorder and sensory challenges associated with other conditions. Back to top The causes of Sensory Processing Disorder The exact cause of Sensory Processing Disorder–like the causes of ADHD and so many other neurodevelopmental disorders–has not yet been identified. However, preliminary studies and research suggest some leading contenders. - from Sensational Kids: Hope and Help for Children With Sensory Processing Disorder by Lucy Jane Miller, PhD, OTR What causes Sensory Processing Disorder is a pressing question for every parent of a child with SPD. Many worry that they are somehow to blame for their child's sensory issues. "Is it something I did?" parents want to know. The causes of SPD are among the subjects that researchers at Sensory Processing Disorder Foundation and their collaborators elsewhere have been studying. Preliminary research suggests that SPD is often inherited. If so, the causes of SPD are coded into the child's genetic material. Prenatal and birth complications have also been implicated, and environmental factors may be involved. Of course, as with any developmental and/or behavioral disorder, the causes of SPD are likely to be the result of factors that are both genetic and environmental. Only with more research will it be possible to identify the role of each. A summary of research into causation and prevalence is contained in Sensational Kids: Hope and Help for Children With Sensory Processing Disorder (New York: Perigee, 2006). Back to top Emotional and other impacts of Sensory Processing Disorder Children with Sensory Processing Disorder often have problems with motor skills and other abilities needed for school success and childhood accomplishments. As a result, they often become socially isolated and suffer from low self-esteem and other social/emotional issues. These difficulties put children with SPD at high risk for many emotional, social, and educational problems, including the inability to make friends or be a part of a group, poor self-concept, academic failure, and being labeled clumsy, uncooperative, belligerent, disruptive, or "out of control." Anxiety, depression, aggression, or other behavior problems can follow. Parents may be blamed for their children's behavior by people who are unaware of the child's "hidden handicap." Effective treatment for Sensory Processing Disorder is available, but far too many children with sensory symptoms are misdiagnosed and not properly treated. Untreated SPD that persists into adulthood can affect an individual's ability to succeed in marriage, work, and social environments. Back to top How Sensory Processing Disorder is treated Most children with Sensory Processing Disorder (SPD) are just as intelligent as their peers. Many are intellectually gifted. Their brains are simply wired differently. They need to be taught in ways that are adapted to how they process information, and they need leisure activities that suit their own sensory processing needs. Once children with Sensory Processing Disorder have been accurately diagnosed, they benefit from a treatment program of occupational therapy (OT) with a sensory integration (SI) approach. When appropriate and applied by a well-trained clinician, listening therapy (such as Integrated Listening Systems) or other complementary therapies may be combined effectively with OT-SI. Occupational therapy with a sensory integration approach typically takes place in a sensory-rich environment sometimes called the "OT gym." During OT sessions, the therapist guides the child through fun activities that are subtly structured so the child is constantly challenged but always successful. The goal of Occupational Therapy is to foster appropriate responses to sensation in an active, meaningful, and fun way so the child is able to behave in a more functional manner. Over time, the appropriate responses generalize to the environment beyond the clinic including home, school, and the larger community. Effective occupational therapy thus enables children with SPD to take part in the normal activities of childhood, such as playing with friends, enjoying school, eating, dressing, and sleeping. Ideally, occupational therapy for SPD is family-centered. Parents are involved and work with the therapist to learn more about their child's sensory challenges and methods for engaging in therapeutic activities (sometimes called a "sensory diet)" at home and elsewhere. The child's therapist may provide ideas to teachers and others outside the family who interact regularly with the child. Families have the opportunity to communicate their own priorities for treatment. Treatment for Sensory Processing Disorder helps parents and others who live and work with sensational children to understand that Sensory Processing Disorder is real, even though it is "hidden." With this assurance, they become better advocates for their child at school and within the community. For detailed information about treatment for Sensory Processing Disorder, click here. http://www.spdfoundation.net/about-sensory-processing-disorder.html