Vol. 27 • Issue 3
• Page 10
Sensory processing includes perceiving, filtering and acting upon information given by the senses: sight, sound, smell, taste, touch, movement and pull of gravity.
Sensory processing disorder (SPD) can be described as an inability of the brain to process the information received from all of the senses at the same time while making meaningful and socially appropriate responses to this information. Sensory processing is critical in regulating one's activity level and emotional state.
Children and adults who are affected by this disorder, whether it is associated with autism spectrum, AD/HD, ADD, CP, mental retardation or other disabilities, can often benefit from deep proprioceptive and pressure touch input given by weight or pressure on the body, either by pressure on the shoulders or head when standing or sitting, or pressure on the whole body when supine or prone as in sleeping.
Individuals who demonstrate behaviors like repeated jumping, bumping into walls, pushing into things, and hitting their heads against things can be showing signs of wanting deep pressure from these objects. In extreme cases children will jump off dressers or other high places to get the pressure through their feet. Some people who experience restless sleep or insomnia will attempt to get this proprioception by piling many blankets on top of themselves or in extreme cases crawling between the mattress and box spring or under beanbag chairs to try to sleep.
When teaching about sensory processing disorder, I like to use this demonstration. I place a bright light bulb behind a running fan, tune a radio to loud static, turn on a vacuum cleaner and then begin to speak to the audience about autism. People begin to shuffle in their seats and have distressed looks on their faces because they are unable to concentrate on what I am saying. The visual distraction from the flashing light and the overwhelming noise from the radio and loud vacuum cleaner have disturbed their ability to focus.
I have found this to be a good way to represent a small part of what it may be like for a person with autism who has SPD to sit in a classroom with other children and pay attention to the teacher.
Fluorescent lights blink so rapidly that the individual with intact sensory processing may not detect it; but with the increased sensitivity to light, to the child with autism it can be like having a continual strobe light flashing, which would be difficult for any of us. The hypersensitivity to sound can be compared to standing at the end of a runway while jet engines are revving up for take-off and trying to listen to someone talking to you.
If you stop right now and list all of the sounds you are currently hearing you may be able to increase your awareness of the marvel of sensory processing, i.e.: running fans, car engines, fire sirens, horns blowing, dogs barking, spin cycle on the washer, water running in the shower, radio or TV on, children laughing, and a voice talking to you. You are able to let the less needed sounds take a lower priority in your attention while focusing on what is being said by the person attempting to converse with you.
Now add the smells of fresh cut grass, food cooking, garden flowers, a sea breeze. Add the visual aspects of bright sunlight, movement of a pet in the room, children running around. Your brain is taking in all these things at the same time and is able to filter a lot of it so you can concentrate on the task at hand.
There is a way to help at least some individuals with SPD to decrease their stimulation and increase their ability to relax and pay attention. Although I cannot explain how it happens, deep pressure from weighted products can be beneficial in calming and modulating the brain's ability to filter the overwhelming stimuli from the senses. Pressure through the use of weighted materials has been effective in helping people achieve that "just right" state of being calm and alert.
I would like to reiterate that weight does not work for all individuals, and it will take trial and error to decide if it will work for your clients. When it is effective, however, it does truly amazing things and can be life changing.
For the past 10 years I have been designing, fabricating and marketing weighted products through collaboration with an OTR who has 30 years of experience in the field. For weighted vests she instructs that weights should be placed as high as possible on the chest and back for the best input to the shoulders. The weight should be evenly distributed to prevent pulling the shoulders anterior or posterior. Five percent of the body weight is the starting place for deciding how much weight is needed. Using the least amount of weight that is effective in achieving the desired response.
The decision to use a weighted vest should be made by a qualified occupational therapist, parents, teachers and the individual after the OT assessment has determined that it may be helpful for the individual. A wearing schedule and the appropriate weight need to be determined and monitored by the OT.
As the years have progressed it appears that the thought process has become "if some weight is good, more weight is better"; but that does not appear to be a valid opinion, and I continue to use 5 percent as the rule of thumb.
The use of weighted blankets has proven to be a very successful intervention for sleep disturbances. When asked by parents how much weight their child will need, I always first refer them to their OTR. After that, if they report that their child is piling blankets on top of himself to get to sleep, I have the parent weigh himself and then weigh himself holding the pile of blankets, and this has been a very successful method of determining how much weight is needed.
For small children, five pounds is usually sufficient. For 7-12 year olds, eight pounds usually is enough. For teens and adults, 10 to 15 lbs is appropriate, depending on their height and weight. The 5-percent rule is not needed with blankets, as the individual can throw them off if the weight feels too heavy.
I had a request from the distraught parent of a 2-year-old asking if I could make a 20-pound blanket for her child. I said I had made 20-pound blankets, but would not do so for a 2-year-old, as it could harm the child.
It is important to state that too much weight can be dangerous, even fatal. In an e-zine article last year, I read about the following situation. A child in Canada who was disruptive in the class setting was placed in time out, rolled up hotdog-bun style in a 40-pound weighted blanket. The child slipped into a comatose state and died before he was discovered. In my opinion there is never a case that would require a 40-pound blanket with a child.
Weight should be evenly distributed throughout the blanket. On large or twin sized blankets, leaving the edges without weight is an added safety feature to prevent the individual from getting trapped under the blanket. The individual always must be able to easily remove the blanket. People with temperature regulation problems or circulation problems may not be good candidates for using weighted products.
In closing I would like to relate some feedback I received when I started making weighted products 10 years ago. I had an order for a vest and twin blanket for a 5-year-old with autism. I made the items and delivered them to the service provider. The provider contacted me about a week later and said the parents wanted to let me know what had happened.
Their child had never communicated with them in any way for the first five years of his life and slept only one hour a night during those years. He had been able to demonstrate only the classic repetitive behaviors of hand flapping, rapid running and speaking in unintelligible sounds. The parents had been unable to calm him down. He wore the vest the first day and settled down almost immediately. He slept for the first full night of his life and stayed asleep for 12 hours.
His parents checked on him each hour to be sure he was all right. He was fine, just sleeping. In the morning, for the first communication of his life, he went and got the vest and motioned, "Put this on me."
Over the years I have had many parents, therapists, teachers and case managers contact me with similar reports of the calming effect that weighted products provide.
Although they do not work for everyone, the individuals who benefit from deep pressure find weighted materials such as vests, blankets, lap pillows and stuffed animals to be very helpful in calming in the daytime hours and increasing sleep at night.
For more information on sensory processing I would refer you to the work of Winnie Dunn, PhD, OTR, FAOTA, professor and chair of the occupational therapy department at the University of Kansas.
Susan Hoffman, COTA/L, has been an occupational therapy assistant for 40 years, and is a seamstress for New England Adaptive Equipment, which makes weighted blankets and vests.