SENSORIMOTOR APPROACHES TO OT GROUPS

Focus/Premise:
-Approaching the central nervous system in a systematic way can facilitate learning or relearning of motor skill. Body structures, body functions and the environment interact to produce best performance in occupations

-Many theorists with different emphasis but sensation, practice and feedback are important in all of them.

Sensorimotor Approaches
Trombly
Task Oriented Approach
Motor Learning Theory
Motor Relearning Program by Carr and Shepherd
Trombly
Occupational Functioning Model Hierarchy Table 9-1
Goal is to develop a sense of self-efficacy and self esteem
Task Oriented Approach
-Functional tasks help organize motor behavior
-Meaningful tasks are graded and sequenced
-All behavior is interpreted as an attempt to achieve functional goals
5 Principles of Task Oriented Approach
1. Client centered focus
2. Occupation based focus
3. Person and environment
4. Practice and feedback
5. General treatment goals see Cole p 251-252
Motor Learning Theory
-“set of processes associated with practice or experience leading to relatively permanent changes in the capacity for producing skilled action” (Schmidt, 1988, p. 346 as cited in Cole, p. 252)
– Neural Plasticity
Neural Plasticity
ability of the whole nervous system to become more efficient at the cellular level and neural connection level
Motor Relearning Program by Carr and Shepherd
-Emphasis is on teaching how to use feedback to modify performance.

-The feedback given can be oral, visual demonstration, manual guidance, and accurate and timely feedback.

-Graded activity demands are used to elicit specific motor response patterns

-The movement category of reach and grasp with passive stretch prior to is the activity mentioned as most applicable for group format.

Standing and sitting
Walking
Reaching and manipulation
Neurophysiological Approaches
Rood
Bobath
Brunnstrom
Ayres
Margeret Rood
Bobath (Couple)
Sensation of movement important,
Cidney Brunnstrom
Reflex
Jean Ayres
255-258
Neurophysiological Approaches
used to be taught in depth, but are now controversial due to conflict between the idea of reflexive or functional tasks. Read it and have a general idea, but don’t use time to memorize stages or know in depth. You will get more info on these in later courses.
Regarding SI:
Sensory Integration approaches remain controversial.

The term, “Ayres Sensory Integration” has been trademarked.

www.siglobalnetwork.org is an attempt to preserve SI in its original form

www.spdfoundation.net links research on autism, Asperger’s and learning disabilities to research

More re SI
Has a number of standardized tests that are used

Is no longer thought of primarily as a hierarchical model

Is now a systems view

You will learn much more about this in other classes (do not memorize the levels now)

Dunn’s Sensory Processing Model
A sensory processing model not a sensory integration model (like Ayres SI)
3 categories of sensation:
1. Chemical such as taste and smell
2. Body senses such as tactile, proprioceptive and vestibular
3. Environmental senses such as auditory and visual
Dunn (Cont) 4 Sensory processing patterns
Sensation seeking
Sensation avoiding
Sensation sensitivity
Low registration

Tool, The Sensory Profile is used to determine the above

Sensory Processing Disorders in Adulthood:
-Based on idea that those with undiagnosed and or untreated conditions such as autism, or ADD grow up and learn to cope with their sensory issues on their own. Often have developed anxiety, depression and defensive reactions.

-They need to learn self advocacy and sensory modulation to prevent social problems

Lorna Jean King
(right here in Phx!) studied the work of Ayres and applied to work with people with schizophrenia, noticing their faulty vestibular and proprioceptive process. Emphasis is on gross motor movements to normalize patterns of flexion, adduction, internal rotation. Attention must be centered on an object or outcome, not the motor movement and be pleasurable. Typically used parachutes, scooter boards, hammocks, balls, blankets, balloons, beanbag chairs.
Ross
extended use of SI to those with Alzheimer’s, neurological patients, chronic elderly
Ross 5 stage groups
1. Acknowledge, introduce, establish purpose, explain, capture attention.
2. Maximum exertion, gross motor stimulate, excite
3. Perceptual motor, judgment, purposeful task, finish in 30 min, calm and focus.
4. Cognitive Stimulation, memory, cortical control, attentiveness
5. Resolution and termination, summary, sense of peacefulness (Cole, 2012, p. 261-262)
Function/dysfunction
“when a person is able to learn and use all of the adaptive skills characteristic of his or her age” (Cole p. 262 )
Change
Brought about by:
-Physical activity
-Sensory stimulation and repetition of movement
-In a specific sequence in hierarchy according to some traditional theories
-Or repetition in varied contexts and environments which form alternate neural pathways (motor learning)
Role of the OT in Sensorimotor Approaches:
-Directive leader
-Knowledgeable about neurodevelopment, neurophysiology, sensory integration
-Able to plan activities that match the level and be the ‘just right challenge”
-The OT controls and limits sensory input
Goals of the Sensorimotor approaches
-Develop adaptive responses
-Develop skill in sensorimotor performance and sensory integration
Improve muscle tone, posture, motor planning
-Motivate and promote possible imitation and self initiation of activity
-Develop higher level cognitive responses
-Provide multiple opportunity for practice of functional and meaningful tasks
-Achieve mastery and well-being
Types of Groups that are Typical
New Games
Parachute
Bioenergetics (expression of feelings through movement)
Exercise, dance, movement, possibly using music to calm or alert

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