OTS 26: Sensory Integration Treatment and Sensory Strategies in Schools Feat. Kelly Auld-Wright
- Jayson Davies
- Mar 18, 2019
- 38 min read
Updated: Apr 29
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Welcome to the show notes for Episode 26 of the OT Schoolhouse Podcast.
In this episode, Jayson interviews Dr. Kelly Auld-Wright, OTD, OTR/L, on how to go from sensory evaluation to treating a child using sensory integration and sensory strategies in a school setting (You know, without the whole gym setup). Kelly starts off right where Dr. Zoe Mailloux left off in Episode 25 and explains what type of patterns we should be looking for and what to do when we see those patterns.
Listen in to learn more about Kelly and how she uses sensory integration treatment and sensory strategies to benefit the students she works with.
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Episode Transcript
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Amazing Narrator
Hello and welcome to the otschoolhouse podcast. Your source for the latest school based occupational therapy tips, interviews and research now to get the conversation started, here are your hosts, Jayson and Abby. Class is officially in session.
Jayson Davies
Hey everyone. Welcome to episode number 26 of the otschoolhouse com podcast today, we are talking again about sensory integration, except we're going to talk a little bit more about the treatment side of sensory integration. Last week, we had on Dr Zoe Mayu. Definitely recommend that you go back and listen to that. Sorry. Not last week. Two weeks ago, that was episode 25 highly recommend that you go back and listen to that episode, because we talked a lot about sensory integration evaluation and well, I'm also going to, you know, pitch myself a little bit and say, Please do subscribe to the show so that you don't miss any future episodes. We do an episode every other week or so, and we really appreciate having you all around also. I don't know if you can hear it in my voice, but I have a little bit of a sore throat right now, so I'm going to try and keep this short and get us on to the interview. But first, I did have a few questions about how to access the show notes for the for each episode. And just to let you all know, you can simply type in otschoolhouse com, forward, slash episode and then the episode number to access the show notes. So you can do that on your URL address on any browser. So for instance, the show notes on this episode is going to be at otschoolhouse com forward slash episode 26 or you can actually go to our website and click on the podcast tab and find each episode on that tab, all right. Well, getting into today's episode, we have a very special guest here to talk about the treatment of sensory integration within the schools. And we're very lucky to have Dr Kelly, alt right. She has her OTD, and she's here to talk about how she uses the sensory integration model to treat students in schools. I have been very fortunate to work alongside her for the past almost year in our current position, and gotten to see a lot that she does within the schools to use sensory integration that some people may not be able to do because they don't have a clinic. She figures out ways to do this within the clinic, and it's really cool to see. I'm really excited that I've been able to learn from her a little bit this year, Kelly has done some research in sensory integration, and at Los Angeles Unified School District. She actually worked in one of their clinics and would work with other OTs and trained other OTS in how to use si within the school. So we're very lucky to have her, and I'm just gonna let this go into the interview, and you'll get to meet Kelly aldright. Here she is. Hey Kelly, welcome to the OT school house podcast. How are you doing this evening?
Kelly Auld-Wright
Hi, Jayson. I'm doing well. Thanks.
Jayson Davies
Great. Well, I'm happy to have you. I was just, I just kind of finished telling people how we work together now and how it's super cool to work with you. And, yeah, it's just pretty cool to have you as part of the podcast. So before we kind of dive into everything, give us a little bit of background about how you became or how you came into the world of OT, and what you've been doing in OT.
Kelly Auld-Wright
sure. Well, I grew up in a family with special education teachers. My dad was actually the principal of a school for special needs as I was growing up, so I spent a lot of time around children with special needs as I aged and in high school, I did a student project on cerebral palsy, and became really interested in some of those aspects, and looked at physical therapy with it. And I was actually pre med going into college, I was a neuroscience major, and I thought I wanted to be a doctor, and I realized that you had to give up a lot of your life in order to do that. And wasn't quite fitting with my you know, how I like to live. I like to have a good life, work, balance. And so my dad actually said, Why don't you look at OT and I can't even really remember how it clicked, but I looked and I thought, this is perfect. And I remember that first day of otschool thinking I really just found that right fit for me. So that's how I got into it. And I've always had a passion for working with children, especially children in the schools. Given my background growing up and I started out at pediatric therapy network in Torrance, where I got a lot of mentorship and training and sensory integration, and we worked in both school settings and clinics. So I got to see both. And then from there, I went to Los Angeles Unified School District for a number of years, and now I'm with you over at Gino.
Jayson Davies
Yeah, having a good time working together. And I think I actually might have reference referenced you in the past on this podcast, actually, because I remember, I remember, I think, talking about how I was super excited to be working at the school where I was going to be working with someone who had a lot of sensory integration background, as you know, kind of that, that kind of fell apart a little bit, and now we're back at different schools, but, at the same time, I think I actually referenced you some time ago, so that's kind of cool that. And again, I'm just glad we're able to do a podcast together. Super cool. So you obviously said that you've had some background at PTM with some sensory integration at Los Angeles Unified, they do school based services. Well, I mean, they're just so big, it can't look like any other school district, really. So can you explain a little bit what school based looks like in Los Angeles Unified?
Kelly Auld-Wright
Yeah, you know the OT program. Lisa test was really interested instrumental at LA Unified in developing the OT program there, and I think it's really unique in that we had, and I don't know how many they have now, but when I was there, there was at least 20 clinics that did that were at school sites where we did provide sensory, integrative based treatment. And what would happen is the school therapist would evaluate the child and would when they're they were deciding what the service needs were, they would they could consider clinic in addition to the school based and so if we thought the child required clinic, the child could go during the school day, and if the clinic wasn't at their site, they would actually take the bus to The clinic and get their service and then come back to school. And we had a lot of built in supports to make sure that system ran really well. I was a clinical advising therapist there, so I helped people make those decisions and really hone in on their evaluation to make those determinations. And we also had some embedded courses throughout the district called clinic to classroom to really help therapists learn about applying sensory in the school setting.
Jayson Davies
I want to dive more into that, because I know a lot of people. I get emails, and a lot of them are about types of in services they can do. So what are different types of in services you've done?
Kelly Auld-Wright
Oh, man, quite a few. So we've done some outside, you know, within our profession, at Otac, I presented with my colleagues at LA Unified about some sensory there, within the district. The course that we offered was for OTs, and it was usually when they were in their second to third year of practice, or new to the district, and we would go over, you know, basically, all the foundational things related to sensory processing. They would do a case study where they were looking at different their student and trying to just implement some sensory based treatment in the school setting, not the clinic, but the school itself, and then measure the progress based on that. And so we really tried to be data driven with it. We did do some in services to teachers and staff the you know. So that was we had that ability unified to to do that, and teachers could get paid on days off to come to end services, things like that. So yeah, we had, and there was a lot of time in our schedules that allowed for us to collaborate with the teachers, so they really understood what was going on.
Jayson Davies
Yeah, and it sounds like you were almost in the specialty realm where you really focus on the sensory side of things. Is that kind of true? Or did you?
Kelly Auld-Wright
I was a yes, we called them a clinical advising therapist, and it was really, I helped teach in that role. I helped teach the course. But then also I did help. When a therapist was like, help, I don't know what I'm looking at, and so I would come out and we might co treat, or I would help with their evaluation so we could make some recommendations that we thought were fitting related to that.
Jayson Davies
Yeah, and that's super cool because, I mean, it's not very often in a school district that I've seen or heard about where you get that type of mentorship. I mean, we Yeah, to hear that you had, you were providing an in service to other OTS like that doesn't happen in school districts usually, either they send us out to a training, you know, a full one day training, or they allow us to go to the OT Association of California conference. But it's not very often that you have an own, your own in house ot to kind of go talk to about stuff like that. So.
Kelly Auld-Wright
Yeah, it was a really, it's a really great for for new therapists, and just therapists we had. There was a lot of continuing education and support embedded within the model there. But there were also 100 and something OTS there. So there were, yeah, there was a need to kind of get us all on the same page.
Jayson Davies
That is true. It is a very unique program in the sense of how big it is. So,
Kelly Auld-Wright
yeah, yeah.
Jayson Davies
Alrighty, well, we're gonna kind of jump in now to our topic for today, which is really cool, because for the first time in the otschoolhouse, Comcast, we're kind of doing a part one, part two, because two weeks ago we had Zoe on Dr Zoe Mailloux, and. She talked about some of the evaluation procedures for assessing and sensory integration, and now today, we're going to talk a little bit about the treatment side of sensor integration. Before we get quite into that, I want to do a quick review. And if you could give us a quick take on the different senses that in sensory integration we really focus on.
Kelly Auld-Wright
So when we're looking at sensory integration, we really place a high emphasis on the taco probe and proprioceptive and vestibular systems as those form the foundations for all of our learning and behavior. So if you think of it like a pyramid, and sometimes it's helpful to just if you look, if you look up the pyramid from the Alert program. Actually, it's a really nice visual of what we're talking about. When we're looking at sensory integration on the bottom, you have that tactile, proprioceptive and vestibular input. I think you can even just Google sensory pyramid, and it will come up, and it's been used quite a lot. And then as those integrate, then you then you've put your layer on of the visual and auditory information. But when you're looking at it approaching an assessment and looking at from sensory you really want to do an adept in depth analysis about what's going on with the child's tactile system, their proprioceptive system and their vestibular system, because if one of those little blocks is off. The whole pyramid will be off,
Jayson Davies
Yeah, and we'll be sure to find that for everyone and link to it. But I think I've seen that before. And yeah, it's, it's a good one. So what a Where does Praxis fit into all all those sensations?
Kelly Auld-Wright
Well, if you can't feel your body, then you don't know quite what to do with it, right? So Praxis is an outcome of good sensory integration. It's a response to being able to move your body and figure out how it interacts with the environment. And so how I think of it sometimes is, you know, Praxis is just having the idea figuring out what to do and how to do it, but if you're not getting the right feedback from your body, you're not getting the right feedback from your environment, and interacting with your environment, then becomes much harder
Jayson Davies
when you're saying that. One of the things that kind of came to my mind was that whole sensory versus behavior, but we never use the word praxis, or very rarely, because it's not a key word, like sensory is how? How much do you think Praxis also plays into that? Well, it kind of looks like a behavior, but maybe it's poor praxis.
Kelly Auld-Wright
It's huge. It's huge. Because what happens if, if I sit you in a room with this, with the subject content, that's very hard for you, you know? You try to figure out ways to get out of it. You know, I am not somebody that likes to learn about the mechanical aspects of things. And so if you sit there and start talking to me about how to put a computer together, like I'm going to start having a lot of different kind of behaviors. It's, you know, I don't know what you're talking about, and it doesn't work for me that way. But, you know, I think really when you're looking at sensory or behavior, you know, one thing that really gets overlooked in the school system is really looking at the sensory perception pieces. Is, how is, how does the child actually perceive and feel tackling or vestibular input or proprioceptive input, we get a lot of referrals for that reactivity or modulation to the kid that looks hyper, the kid that's running around that kind of stuff. And I went to a training last weekend, and it was with Suzanne Smith Rowley, who's just amazing, if you ever have a chance to hear her speak on sensory integration. But she was talking, she put it in a really good visual for me to understand in terms of, you know, and I not that I didn't understand, but it's just, I think it's a good way of explaining and teaching. This is that when you're looking at your tactile, your visual, your proprioceptive, your vestibular, auditory system, so you have those senses that you're looking at. And so if I take away your sense of touch and you're sitting in the classroom, what might you do? JC, to get information about your environment. If I take away your sense of touch.
Jayson Davies
I would think a, either I would touch nothing because I just don't feel it or B, I would, if I had a little bit of sensation, I would go touching everything, just to kind of see what something that feels like, right?
Kelly Auld-Wright
So you might be trying to touch everything. You might be compensating with your other systems too, right? You might have to use your vision too,
Jayson Davies
Yeah.
Kelly Auld-Wright
You might have to use your proprioceptive more to push on your body to feel where it is in space. You might use your sense of movement more to tell you about where you are in space. So you take one of those senses away, you know, just as somebody who's blind, who has really good hearing, your other senses start to try to compensate, to give you the information you need about that environment. So if you take it. Child's, you know, tactile or proprioception, their sense of their body away, they might start moving a lot, because they're trying to get some information that tells them where they are in space in general. So I always go back to when I do an evaluation is looking at the perception pieces first, because if one of those is off, it's easier for me to to target and treat, I think. And if you think about it, if you didn't look at that, and then you just hand the kid a fidget, you know, and you say, well, sensory didn't work, you know, you didn't really do sensory justice in that, in those occasions. And I think that's what tends to happen. We just throw a sensory strategy at them without an assessment. And, no, it didn't work. All right, move on.
Jayson Davies
Yeah, absolutely. And that's why our last podcast was Zoe was so important. Everything she said was spot on, and where we kind of left off, I think, was after we're doing the evaluation, a sensory integration type of evaluation. How do you go from there? Like, what do you find out from that evaluation? What are you able to pull away from that that then helps you to to start treating?
Kelly Auld-Wright
you know, I look at so I'm sure Zoe talked about the sensory integration and Praxis tests, because those are the gold standard for for doing it. And to me, if you can have a sip, if you can do a sip, that's like having a blood test. You know? It really tells you details about what's going on. If you're using other tests, you have to do more of a piecemeal approach. Understanding the SIFT really helps you understand the theory and the application. So the sipped patterns that were identified, and most recently in the article by Doctor Mayu and others in 2011 has the patterns of sensory dysfunction that come out of the sip. And these are patterns that time after time after time again when they've run these factor analyzes on the Sith, these patterns turn up. And so the patterns we look at are visual Praxis difficulties with visual praxis, difficulties with stomatal praxis, difficulties with vestibular and bilateral integration and then tap reactivity issues usually linked to tactile defensiveness. So those are the categories. And I always, when I'm trying to teach and learn about sensory I say, learn it in the boxes first, and then everyone's going to deviate from it eventually. So you know, as you're learning something, try to put try to put the things that you're seeing into these boxes and see where you're getting the most hits in terms of the patterns that you're seeing. So if you don't, you know, if you have a sip, you can kind of, you can look at the clusters on that, which will help you lead you the way. If you don't, then you're going to take your information from your various assessments and try to pull it together. So if you're not using a sip, you should definitely be using clinical observations of sensory function. And so you're looking at, you know, sequential finger touching. You know, are they able to touch their fingers to their hands? If they can't, then you might be wondering if there's some tactile and proprioceptive perception issues because or they have to look at their hands in order to do it. Those, you know, if they can't put the the sequence together, you might put it with sequencing or Praxis issues. So you kind of have to piecemeal. And one thing I found interesting over the weekend at the course I was that is that people were presenting the the sips that they did, but they had also given the bot with it. And I had always kind of looked at manual dexterity, for instance, is as a test that would tell me a little bit about some tactile perceptions. Because my hypothesis would be that if you don't feel your hands well, you're not going to be able to manipulate items well with your hands. And what I found interesting is that they had some issues turning up on the SIFT that were really analyzing the sensory function. But the bot was coming out average, except for bilateral coordination. Bilateral coordination was actually more would always show up on the bot as an issue. So it made me kind of think, okay, like, that's, that's why you kind of want the more information, you know. And I think a lot of us will give the bot, and we won't give those other, you know, you'll give the the fine motor integration, manual dexterity, then we just kind of stop.
Jayson Davies
Yeah, I was just thinking the same thing.
Kelly Auld-Wright
But when I was at PTM, when I was first learning about sensory in the schools, you know, they would always say, give the whole give the whole thing. You know, not necessarily the strength part, you know, that running part, but the bilateral coordination and balance is a piece that we often omit that is very interesting to look at, especially because the balance has. Some eyes open, eyes closed, that really tell you more about the body and space, if you if they're consistently doing worse with their much worse with their eyes closed. Or, you know, how do they move when they try to balance those kinds of things? So I understand that a lot of people don't have access to a zip or don't have the training. So I get it. I'm in the schools, and I do it too. I have to piecemeal what I'm doing and make my best educated guess about what pattern I think the kids falling into. But that's where you start, you know. And as you start to treat the kid, then you might see, are they making changes using the approach that you're using, or are you seeing some other things and other systems that you think you need to target a little bit more. And that's, that's therapy, you know,
Jayson Davies
Absolutely.
Kelly Auld-Wright
We get kids in for visual motor, and then you're like, Oh, this is a visual motor. This is that, you know, there's something else going on here, you know, yeah. So I always say to, you know, you just do your best to make those clusters and figure it out from there.
Jayson Davies
So you talk about these clusters, and you kind of gave them a name, but if it's possible to kind of quickly go over them, what would visual Praxis kind of look like?
Kelly Auld-Wright
Someone with difficulties with visual praxis? So it's kind of how you take the visual things in your environment. Could be 2d or 3d and how you organize them in their respective space. So, visual praxis, packing your suitcase, getting all your things into your thing. So organizing your desk, being able to put the books on the left the other things on the right, being able to, you know, just draw geometric figures, if you're looking at the design copying, which would be most, most akin to, you know, like VMI, or the those things building so if you you know kids who can't imitate block structures, putting those things together, those kinds of navigating your space in general, you know, knowing what's up on top, under, over, around. So that would be more visual praxis, putting those visual things together and how they orient in space. The Somato somatospraxia is really, that's, that's the outcome of your tactile and proprioceptive systems, and it's related to praxis. So kids with Somato dyspraxia always uses the head that looks a little bit clumsy. They might push too hard on their writing tools because they need more feedback. They have a hard time figuring out how to form a letter imitate body movements, you know, just follow regular classroom routines, even, and novel routines. If something's novel, it's just lost, you know. And you know, in there, those are the kids who might kind of appear slightly rough in their play, because they don't have that good perception of where their body is, sometimes vestibular proprioception, bilateral integration and sequence. That's a mouthful, vbis, as we call it, for sure, these are your kids who are under responsive to movement, and it's impacting their postural skills, how they can sit upright in a chair, as well as their ocular motor skills to follow and track items. So somatodyspraxic Kids tend to have be more apparent often, you know, and the kids with the five vestibular issues sometimes tend to be more subtle, so they have a hard time copying from the board tracking with their eyes and their reading. They might get lost a lot. So they might be able to say, do two or three jumping jacks, but as the pattern continues, you'll see that they lose that kind of sequence and rhythm. So keeping like the rhythm with things is difficult. Anything bilateral, select, cutting might be difficult. Obviously, sitting upright in their chair, it's like, I kind of explain these kids sometimes look like gravity is just weighing them down. It's really hard for them to stay upright in space and say, and then they're just kind of propping their they don't have the postural skills so their elbows on the desk, and it's like their hand is just holding up their poor little head to gravity. Gravity is just too heavy for them.
Jayson Davies
Yeah.
Kelly Auld-Wright
Don't want to put a weighted vest on those kids.
Jayson Davies
What's that?
Kelly Auld-Wright
You do not want to put a weighted vest on those kids?
Jayson Davies
Well, since you you brought it up, weighted vest. Who? When is it? When do you use a weighted and or more the proprioception type of vest?
Kelly Auld-Wright
I prefer the pressure vestibular insulin. I think it's an more even pressure around the body. And so, you know, I think they're really more warranted if you're looking at a kid who has some pro. Receptive difficulties or tactile and because you know then that they are not feeling their body in space, and so you're giving them this strategy to feel, to help them feel their body a bit better, which can then lead to less of some of the seeking behaviors you see in the classroom. The other reason you might use it is a kid who has tactile defensiveness and those that's the another pattern, one of the patterns, which is the reactivity pattern, and is that tactile defensiveness is highly, highly tied to difficulties with attention. And you can imagine if you are so defensive that anytime your shirt moves, it alerts you that it's going to be hard to pay attention you're that sensitive to that input, so the weighted vest, or as I prefer, the pressure vest with those children, might be more effective. But I think that's why, if you actually look at the research out it's not really, it doesn't show any like strong effects, especially with kids with autism, you know, and I think that's because they're just taking, well, this kid has autism, and let's try the pressure that you're not tying it to that underlying sensory system, of why they might need that specific tool. And so then the studies come out, but saying they're not effective because I think, to me, it's actually a sample here, because they didn't have the right assessment to make those determinations.
Jayson Davies
Yeah.
Kelly Auld-Wright
The other thing though, the research is showing, though, that the weighted vests, the more effective ones, have been with children with ADHD, and so that it actually gives them that that deep pressure input to relax their nervous system a bit more. So that's one area that you know, if you have a kid with ADHD, I mean, they tend to have some proprioceptive issues.
Jayson Davies
Make sense, yeah, yeah. And, and last week, I referenced to a study. We didn't talk about that specifically, but there was one study that I referenced to In last episode, and so I'll repost that, that specific study that does talk about how pressure vests have been shown to work with kids with ADHD more so than autism,
Kelly Auld-Wright
yeah.
Jayson Davies
All right, so we kind of got our patterns down. Now, how does that guide us? First? Let's kind of start with right now. You have a sensory clinic at the school that you're at, so if you do have an actual clinic that you can use with swings and all that good stuff, what does treatment look like?
Kelly Auld-Wright
Well, if you're if you have a clinic, I would refer you to the fidelity measure
Jayson Davies
we talked about that last week. Yes, a little bit
Kelly Auld-Wright
Really, to follow those principles of fidelity to air, sensory integrative intervention. And so if you're using a clinic setting, then you want to try, you know, and you're using that sensory integrative approach that that, that's your, you know, formula there of what you're doing. And I think that's kind of its own advanced area of practice. But I think where most of us are suppose we don't have a clinic. And so in that, in those situations, you have to be more creative with you with your tools, and what we call the affordances that that tool allows you. And so a scooter board offers you many different affordances, right? They can sit on their bottom and scoot on their bottom. They can lay on their stomach and pull with their arms. You can lay them on the back and have them pull a rope. And so if you go back to actually, one of jeannie's original works, the sensory integration and learning disabilities, she has a chapter in there about teaching treating Somato dyspraxia, which is rooted in tactile and proprioceptive perception issues, and she lists 30 different activities you can do on a scooter board. So
Jayson Davies
Wow.
Kelly Auld-Wright
We can get a scooter board. We can find some space on the playground, in the auditorium to use a scooter board. So there's no reason you can't apply her theory, you're not doing fidelity to air, sensory integration and intervention in terms of having that clinic setting in the environment like that, but you can do most of those treatment principles with a scooter board. If you look at it, you can still be child directed. You can still provide multiple areas of sensory input. You can still get an adaptive response. You know, these kids can still get input to their bodies that get them more organized their play, can expand their posture, can look better, all that stuff. So I think don't get bogged down with that. You need a clinic. Because you can do, you can be very creative in what is, what the tools will allow you to do with them. Absolutely, yeah, and that kind of ties right into where I wanted to go. A little bit is like sensory integration versus sensory integration based resources and interventions. I mean, we all as school based therapists, sensory diets. You know, we kind of do stuff like that. We help collaborate with the teachers, give them ideas of what they can do in the classroom. It seems like everyone now in schools, not just the OTs, like, just attached to this word sensory. And it's crazy, because we're, we were the ones that kind of started with sensory, and now, like, sensory has just taken over in the schools. How did, like, how do you think that happened? Well, I think people are looking for answers, you know, and oftentimes, you know, it's sensory so vague to a lot of people that they just want to, you know, throw it out there, and different people use it different ways. So a behaviorist talks about sensory and stereotypical, you know, behaviors and those things in different ways, and the psychs in different ways than how we talk about it. And so I think that the way to start is having that evaluation when you're at an IEP and really breaking it down and explaining what you were looking at and what the theory looks like. So I think we just have to be a lot, really proactive in our education about it. And you know, when we are at the table at the IEP meetings, do a better job explaining what we're looking at and why.
Jayson Davies
Yeah, and so we talked a little bit about the scooter board using the pressure vest. What other types of SI based interventions do you incorporate into your practice?
Kelly Auld-Wright
And I love a therapy ball. You can use it for a child who has vestibular postural issues. So I might start with them prone on a ball. And we all kind of people will do prone on a ball to get puzzle pieces or but it's how you vary the intensity of how you're using that ball. So if I have a child who's under responsive to vestibular input, we're not just slowly rocking back and forth on the ball as we get that puzzle piece. You know, I might be oh, we're gonna blast off, you know, 10, nine, eight, and really intensely pushing them forward and pulling them back and starting to to get them to use their body too. Can they push off the ground with their arms to get it back? Can they do I have a pillow? Can I roll them off of it, into it to really get that kind of intense input for that vestibular system, the more intense if a child will handle it, going backwards, over, over the ball. So, you know, putting a puzzle piece on a chair behind them, having them sit on the ball and rolling completely upside down to reach that and come back. And I'm just saying puzzle piece, because that's, I don't it all depends on what the child's interests are. We're still occupational pieces. Yes, you know that it kind of, you know, I think we all have one, but so you you know, I've taken the ball and stabilized it between my legs and had the chub jump on it, you know, I've had them. You know, you can do the bouncing on the ball, especially for the kids who with their vestibular systems, where it's really the otoliths which respond to vertical movement of gravity. So giving them that quick changes in that vertical movement, you can see the child who is sometimes hunched over immediately get that, that nice extension that they need against gravity. So doing a lot of vertical bouncing, kind of activities while they're targeting or, you know, whatever other needs they have, if they have fine motor needs, I'm a huge close pin person that's bringing those into my sensory based activities to work on the fine motor in the context of that Dizzy disc is something that I used to love to have. I left mine. Mine had to go get returned to LA Unified. But we all got dizzy discs there. And you know, so you could, well, you could do the spinning. If you don't have a dizzy list, you can use the office chair if you're trying to really get that rotary movement. And you know, you always want to be careful with it. I have a pretty good idea of how intense I can spin or not spin, because I've looked at their post rotary nystagmus. So if a child after you spin them 10. 10 times in 20 seconds, their eyes, or the reflex, is only there one to two seconds. You know, you know that you can go pretty intensely on that spinning because they're not really feeling that movement. But if you spin them around, and their eyes are going back and forth, back and forth, anywhere, for me, anywhere from six seconds and above, then I'm a lot more careful how intense I'm spinning them when I'm doing that, because I know that they're going to register get dizzy and possibly sick. But we have, most of my kids don't feel it, and I can go pretty intensely on that. And I think therapists, especially when I was at my previous district, in my role, when I would go out to see how they were incorporating that vestibular in their school based treatment, they were afraid to go intense. And so yes, you have the ball, you have the scooter board, you have the Dizzy disc or whatever. But it's not just slight thing, it's intensity varying how intense you're giving that input while they're on there, and spending, if you have a 30 minute session, spending 25 minutes in those sensory based activities before you, and then five minutes at the table, you know, just really, really working on that consistently. And to be honest, I can work with, you know, a lot of kids, I don't get the behaviors I don't get, you know, because you're giving them that input their body needs. And, um, you know, they sit all day in the classroom. So, you know.
Jayson Davies
Move, yeah, yeah.
Kelly Auld-Wright
Figure out how that body works, you know,
Jayson Davies
Yeah. And so I want to touch on that. But first, the other day, in an IEP, I was sitting there, and yes, I have some sensory integration background, but I don't know it as well as you know other people do. And so I had the parent ask me, and I did do a PRN post rotary nystagmus, and it was basically absent. I did it on the office chair, and I was explaining that, that to the Father in the IEP. And the father's like, Yes, I know that. But if he closes his eyes, he gets dizzy. And so, you know, I was, I was explaining, I mean, I did it 1020 spins, and he was just like, more and more. And obviously I didn't being limited in my si experience, I didn't really do a whole lot of eyes closed activities with him, but the dad had a question about that, and I didn't exactly know how to answer. And from your point, does that eyes close position affect the the PRN, or even just the vestibular at all.
Kelly Auld-Wright
Um, it's, you know, it's a reflex. So, no, it shouldn't. If they're, you know, closing their eyes or not. I'm wondering if, when his eyes are open and you're spinning him, though, if he's fixing them on something,
Jayson Davies
that's funny that you say that, because that's the other thing that I think the dad brought up is like that. You can almost see him looking out the corner of his eye, fixating on something,
Kelly Auld-Wright
Yeah. So in that case, he's he this is, to me, a child who probably has a really, really strong visual system, and he's using that to override the vestibular, you know. So here, so you know, if you, for instance, ice skaters, when they spin, they're fixing their eyes on something so they're not coming out dizzy because they're, oh, they've learned to override that system. So I think if he is really getting dizzy, you know, and you could try eyes closed and see if he gets up and looks dizzy. But, yeah, I guess the question is, was what? What was the functional, you know, you obviously in isolation? PRN, no. PRN, whatever, you know, yes, yeah, you know how, what was the end point that you were?
Jayson Davies
There's a lot of this kid, oh, I mean, he couldn't catch a tennis ball. He's a six year old, and couldn't even, like, attempt to catch a tennis ball. There's some bilateral stuff definitely going on. And so I definitely recommended some services for this kid to work on some vestibular bilateral stuff going on. But everything that you just said, like when I brought up that limited information, what you said was kind of exactly even the dad actually said he had done research, and he said the same thing about ice dancers, about how that's what they do. They fixate on something, and that's what he noticed also in his son, that he was fixating on something. So thank you. You just helped me.
Kelly Auld-Wright
Yeah, but it's the PRN isn't the only measure, right? You know, because that's a really volatile measure. It was, you know, it's, it's hard to get it doesn't? It's not always quite accurate, you know, I always look at it as a judgment, but you're also looking at other physiological responses. And then the other thing. He's like, with him, you know, what was his posture like? What were his bilateral skills? Like you mentioned the ball, that's feed forward skills. Being able to catch a ball is a direct outcome of, you know, your vestibular system and its ability to tell you about your body and space and time. And so those are the, you know, if that was my school kid, you're putting those into that, that pattern, right?
Jayson Davies
Yeah, absolutely. And that's kind of think that's what I came kind of came to, but that whole fixating on something, I didn't realize that and, and that's something that, if a kid can pick up on you, like you said, you may not see the PRN, but that doesn't necessarily mean that there isn't a PR, and it just means that that kids learn to adapt,
Kelly Auld-Wright
Yeah, and that's why you can't use it, any of these things in isolation, right? When you're when you're looking at it, you have to have multiple observations that lead you to that hypothesis of what's going on. And I always say appears to, seems as if you know my hypothesis, I believe you know, seems to have issues. You know, because it's not, it's not conclusive. You know, we're making it. And I always tell parents at meeting, you know, I'm using this information to make an educated guess about what I think is going on. And it may be right and it may not, you know, and so, but we're going to try to treat it this way for now and see what happens, you know, yeah.
Jayson Davies
All right, so taking one step back, one of the things we were still kind of on was si based interventions, and I kind of want to touch really on sensory diet. Do you work with teachers to build sensory diets. Or do you prefer more of kind of a general teach the teachers general strategies that they can use with all their kids?
Kelly Auld-Wright
Um, I think you're always doing a little of both. You know, the follow through for a sensory diet is never really great unless the child has a one on one, you know, and that's just, you know, the nature I think, of the beast. So, you know, you do want to work with the teacher on embedding strategies into their classroom, and those, you know, self regulatory strategies that all kids could benefit from. You know, there's a lot of asking for sensory diets, and not a lot of research, or any that you could really find about a sensory diet. I don't know how often I've seen it be that effective, because I, you know, so I actually like, I hate to write them, but I will do them if I have to, because, you know, but I think it needs to, you know, there's, there's some theory, you know, there's a lot of people that believe that if you are doing a sensory diet, then you need the OT should actually be following up weekly on that to see What strategies did you Use last week? How did it work? You know, what should we do that? Because, like, as we know, one strategy doesn't work all the time. It changes. And so you can't just say, after five minutes of work, he needs to go do this. After 10 minutes he should do this, you know, because it's different. And so when I do write a sensory diet, I tried to educate the teacher and the aides in the classroom about the students arousal level that you're really looking trying to look at their arousal, are they too excited, or are they too sleepy, or are they just right, you know? And then I tried to pair the sensory strategy that they could use for that arousal level. And I try to pick points of their day. So if you're in centers and the child has a low arousal level, you could have them stand up and jump as they're reciting the time stables, or spin around in 10 circles. And you know things. And I think we need to be better about how helping the teachers incorporate movement with learning in those aspects, you know. So I almost Sometimes I wish I could just be a co teacher with right, you know, and just sit in the center and say, hey, oh, okay, it's time for times tables. Everybody up, you know, jump 2468, you know.
Jayson Davies
Wouldn't that be so cool? Like, honestly, I want to totally pause on this conversation that we're having. I am not even gonna lie. I have thought about, like, if I could, you know, just almost be like a paraprofessional in a classroom, yeah, like, you know, just kind of be an OT but be in one classroom, just like kindergarten classroom, like all day, every day, to help the teacher out with, like, incorporating movement and and regulating arousal, basically, like, that'd be so cool. But anyways, kind of cut off there. But I think that is so cool. And I think. Right on. I personally also, I like to give the general strategies, kind of like what you're talking about, teaching the the teacher, how to look for the arousal level, and not just always going with the same movement activity at the same time every day. Because often that's yes kids will, they'll be like, Oh, well, he had PE, yeah, but PE, maybe at the same time every day, rather than being, Oh, I see my class is like, all about to fall asleep, let's get up and do some movement. Yeah. And so I find that the general strategy, slash teaching them about how to kind of look for the signs of low and high arousal and and judge from themselves, judge for themselves on that and go from there.
Kelly Auld-Wright
Yeah. And it's also getting them comfortable with alternative seating options, which tend to, I think, sometimes have more impact in terms of if you can get the kids to go on a peanut ball instead of the floor during circle, or those things, and the rocking chairs that are that Virgo has and things, and the teachers knowing that, yes, they're going to move, you're giving them something to move. Their body needs to move, you know, but they're going to settle into it too. So like, you're going to see a couple weeks of just a lot of movement, exploring, exploring, and then hopefully you'll see them kind of settle in and just use it when they need to. So that's, you know, one, and you know the those. But again, it's also coming back to your assessment. So I'm not going to put a kid with vestibular postural issues on a ball. Because they have vestibular postural issues, you know, they have to be a little more creative in how we're giving them their movement information, you know. And eventually, maybe one day they can sit on a ball, but.
Jayson Davies
you're going to work with that kid individually on that task, so that one day they might be able to do it right, versus you're saying you're saying you're not just going to let them sit on it in the classroom. However, during therapy, that may be something that you're actively working on.
Kelly Auld-Wright
Yeah, and, you know, tying the you know, we're not, we're not good about taking the data related to our strategies that we put in. So how are we seeing differences with the pressure vests or that? And one strategy I found effective when I'm taking data is giving the teacher this option that more of a reflection for them. So if I have them on a different using a tool, for instance, during centers or circle time after circle time, what we do is kind of start with the baseline of in describing what the child's participation looks like at baseline, and then the data is more of a reflection on, You know, on Monday, did they perform better than baseline, you know, worse than baseline or the same, you know? And that's a way to start, you know, are we consistently seeing the child? Do have better participation? And that's something easier for the teacher to reflect on, you know. Like, oh, you know what? Today he during centers, wow, he did all his work. Like, yes, he did better, you know. And I think it's not overwhelming for them, and we you can actually get some some more meaningful data out of that. So I think, like, really being careful with that and tying it together. Um, helps, but it is hard. It's really a lot of work, and when you have a full caseload to have all that stuff in order and ready to go, I mean, I understand why things get the way they do, you know, because I've got a full caseload too, and you're just trying to help the kid that you don't have enough time To sit and have those discussions and provide the data and sit in the classroom with them as much as you would like. So you're really trying to do the best you can, you know, and so it's hard, and I think that's why a lot of us just take hearing the word sensory sometimes it's cool because it's a lot of work.
Jayson Davies
Yeah, yeah, that's true, yeah, yeah. So talking, we just kind of got into a little bit about the data. Of course, as school based OTs, we all have to come up with goals and take data on that. How do you go about developing a goal that is a measurable but also incorporates, like that sensory aspect, keeping it functional, but also clearly a sensory goal. Like, do you kind of have a formula or way that you do that?
Kelly Auld-Wright
I don't think something has to be clearly a sensory goal. So if you're talking about a child with somatodyspraxia Who doesn't feel their body right, yeah. Cutting is going to be hard. You can still have a cutting goal, but it's related to somatosta You can, you know, or it's related to how they form their letters and hold the pencil, you know. So your fine motor outcomes are the things we work on in school. Fine and visual motor or bilateral coordination, are all outcomes of proper sensory perception, integration and praxis. So you don't have to have this wild sensory bowl that he's going to do an obstacle course. It could still be cutting, you know, like your approach to it is different. You know, you're not doing us skills based, you know, tabletop work. You're doing full body work to get to the cutting and you know, sometimes therapists do do their obstacle course and then they go to the table. But I would challenge you, if you do that kind of model, to look at your child and decide, well, he has more vestibular based issues. So this obstacle course that I'm doing, or this sensory motor activity needs to heighten the movement vestibular pieces, or if this is so this child somatostaxic. So I'm going to have a lot more kind of tactile based heavy work kind of activities in our sensory motor warm up before we do the tabletop. So, you know, a lot of the research says sensory motor doesn't work, right? You know, the study. So again, that's another issue that they're not tying it to the underlying sensory issue. So, yeah, I don't write like I will in my present level, describe what's going on with their sensory system and how I think it impacts their fine motor skills, but it's still a fine motor goal?
Jayson Davies
Yeah, absolutely, yeah. That's great. How you describe that? Because, well, I won't go too much into detail, but I will sometimes, like write a student will display improved bilateral integration in order to do cut something or whatever. So that might be kind of how I put that sensory in there a little bit. But even then, it's not really, it doesn't say sensory. It just says that it's a skill that they need help with. And the sensory is more the treatment model that I may use.
Kelly Auld-Wright
Yeah, you know. And then so those are, like the perception, I think is easier to tie to one of those functional school things. I think the harder goals to write well are goals around those reactivity issues that impact their you know, attention. But I urge everybody to stay away from the word attention. Stay away from the word non preferred, because non preferred is not OTS. Nobody wants to do anything non preferred.
Jayson Davies
No.
Kelly Auld-Wright
That's, you know, what behavior say. That's not what OTS do. So what I try to my ideal with, with, with those kinds of things, is to find out what kind of goal the teacher already has, or is writing for attention and participation, and ask them if it's okay if I add using sensory strategies as needed to that goal. So that way, I am flexible in being able to support that student on that goal, but I haven't taken ownership of attention because attention is so dynamic. There's so many things that go into it, and sensory is a piece of it, and we do want to share our knowledge of how that impacts their attention. But what I found is year after year, you end up with this kid who has this attention goal, and it's never quite really being met, but then you can never really drop, you know, you know. And then the parent gets really stuck, because the OTS they were going to fix their intention, not fixing their attention. Yeah, right. So I try to always kind of veer that way. If I do have to write the goal. I might look at something about them, you know, it maintaining engagement in their classroom activity for, you know, five minutes without excessive sensory seeking, if they were the kid that was up and seeking input to their body by running around the classroom and that kind of stuff. That's the other reactivity piece. We didn't quite go over, but you have the tactile defensiveness that leads to attention issues. But then, besides vestibular perception issues, you do have reactivity issues where a child is over or under responsive to vestibular input, which also impacts their arousal and their attention. So. Yeah, yeah, that's a whole. Confusing for people in that regard. But that have a kid, you know, the over responsive kids with vestibular issues are your kids who are really sensitive to movement and avoid it, and they're always kind of because it's scary. Be in the world like that, and then your under responders are either running around the classroom because they need more of it, or they're just really sleepy. Yeah, turtles, though, that's another piece that you that you do look at, but yeah,
Jayson Davies
All right, well, we've been going on for a while, so I think I'm gonna stop us here. Well, I'll have to have you on another time, because I know there's so much information you have, but real quick, everything that we talked about today was obviously a very, very small snippet of sensory integration and treatment. And so where,what what was that?
Kelly Auld-Wright
Person in the schools.
Jayson Davies
In the schools, in the schools, particularly, yes. So where can people go to learn more about sensory integration, in the schools and or out of the schools, if that's what they care for?
Kelly Auld-Wright
Yeah. You know, I suggest, if you really want to learn more is to start with a good course that teaches you about the theory. And there's several different courses I am affiliated with, the collaboration for leadership in air sensory integration, the clasi. And they have a course series that you can find at CL dot, sorry, CL dash asi.org and so they have a nice, nice hybrid series of in person and online modules. But there are, of course, other courses. I think there was a article put out by Annie Baltes Mori describing the different courses available. So there's the clasi, there's also spiral foundation USC, as well as I'm blanking the sensory, sensory processing disorder in Colorado, Lucy Miller's courses, so I'm butchering that. So you know you have to find that, find what fits your learning style and your your structure. You know of how you want to learn. And we do hope that the clasi will soon have a school based course. Specifically, it'll probably be an add on after you learn the theory. So I would say, if you're interested in that, get started in the theory.
Jayson Davies
Yeah, and that's the course I'm currently taking right now. And very appreciative of that being able to go back and look at that. So yeah. Well, Kelly, thank you again. So much for coming on. It was great to have you. I'm so glad that I get to work with you and that we can, you know, have discussions like this for podcasts every now and then. So appreciate it. Thank you and have a great rest of your evening.
Kelly Auld-Wright
Bye, thanks. You're welcome.
Jayson Davies
Take care.
Kelly Auld-Wright
Bye.
Jayson Davies
All right. Well, that was Kelly, alt right, talking about sensory integration in the schools and what it is and how you can kind of treat it. So with that, my throat turning a little bit, I'm gonna go get some rest. I will see you all next time here on the otschoolhouse podcast, take care and be sure to stay healthy. Bye. Bye.
Amazing Narrator
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