Vol. 27 • Issue 26
• Page 22
Occupational therapists in schools often work with students who experience sensory processing disorders (SPD). Frequently, the teacher will complete a Sensory Profile (Dunn, 2006) for the student, and the OT will use that information to develop a sensory diet. A sensory diet can include strategies to help a student self-regulate by jumping on a trampoline, swinging, or wearing a pressure vest.
The How Does Your Engine Run? Program, also called the Alert Program, teaches self-regulation for students ages eight to 12 with learning disabilities (Williams & Shellenberger, 1994). The Alert Program was designed to help students learn to monitor, maintain and change their alertness level, so that it is appropriate to a situation or task (Williams & Shellenberger, 1994). The program can be adapted for use in the classroom in collaboration with the teacher to help a student learn self-regulation during learning.
Repeatedly, when students have difficulties with expressing appropriate behaviors, teachers feel that it is a behavior issue and are not aware that the behavior is due to the students' inability to process sensory information from their environment and respond with appropriate motor output (Kranowitz, 1998).
Few teachers have heard of the Alert Program. A Powerpoint presentation developed to adapt the original Alert Program protocol provides visual cues to educate teachers and students about how to recognize and change their arousal level. This method has proven to be a time-efficient way to educate teachers and/or students about the Alert Program and recognizing their arousal levels.
What Do Feelings Look Like?
In the initial treatment session using the Alert Program, a student built a car using snap blocks. The student was instructed to push his race car across the floor and discuss how it feels when the car is running at different speeds and crosses the finish line.
At the next session, the student was instructed to look for pictures of faces in magazines and cut them out. Since the easiest facial expression to identify is smiling faces, the student, who was verbal, was asked what a smiling face means. The student answered "happy".
The pictures were then placed on a white sheet of paper to create a collage of happy faces. The student titled his first collage "Happy." At the end of treatment session, the occupational therapist and student discussed how a happy face can tell others how her emotional engine is just right to participate in tasks.
Treatment sessions that followed involved creating two other collages using faces. Facial expressions that demonstrated over-excitement, fear and crying were labeled "engine on high." Facial expressions that looked sad or tired were labeled as "engine on low." After the collages were made, a mirror was used to imitate facial expressions that described happy, sad and tired/sleepy.
The occupational therapist then showed the student how to make a car using a manila folder. The student colored and cut out the car and placed it on a board to identify where his engine levels were, using the high-low chart that was adapted from the program.
Student Jalen Moran with the author. ADVANCE thanks Beverly Motin
Making a Choice Chart
The occupational therapist collaborated with this student to discuss how engine helper choices can be used to change engine levels. The OT then discussed each of the five sensory areas, using the mirror and the collage of emotions to demonstrate how these activities can change one's engine level.
The student then picked activities she wanted to use to change engine level. The choices were compiled in visual form and laminated, and Velcro was placed on the back of each.
The therapy treatment sessions that followed involved choosing sensory helpers from the five senses to make one feel just right. The sensory helpers are the mouth, body (movement, touch), eyes and ears. The sensory choice cards are divided according to these five areas. Students should be encouraged, but not forced, to try a sensory experience that is challenging or new (Trott, Laurel, & Windeck, 1994).
The How Does Your Engine Run Program (Williams & Shellenburger, 1994) offers suggestions for activities in each sensory area:
Put something in your mouth:
• Eat crunchy food: pretzels, popcorn, apple, nuts (precaution if nut allergies).
• Eat chewy food: gum (check school policies for gum chewing), raisins, bagels, chunk of cheese.
• Eat sour foods: pickle, sour candy, lemon.
• Eat sweet food: fruit or candy (some schools are sugar-free schools).
• Drink from a sports bottle or suck through a straw such as a milkshake or slurpie.
• Take a slow, deep breath.
Move: (Student should try moving before doing seatwork)
• Do a wall push-up.
• Run in place.
• Run some errands for the teacher.
• Dance, do jumping jacks, or trampoline.
• Use a therapy ball.
• Play on playground equipment.
• Play fidget ball, or with a paper clip or putty.
• Rub gently or vigorously on skin or clothes.
• Hold a stuffed animal or bear hug oneself.
• Put bright lights on in the room if you are in low speed.
• Dim the lights if you are in high speed.
• Clear off the table you are working on if it is distracting.
• Listen to a classical type of music (even slow beat).
• Listen to music with drum beats.
• Avoid loud, noisy places if you are on high speed or it affect your concentration.
Creating a Sensory Folder
The Alert Program provides another high-low chart with "before" and "after" labeled on the chart. This chart is used to help students identify their engine levels before and after activities or sensory choices are made. The chart can be used in two ways; it can be placed on the board if the teacher is using the program with the entire class, or on the desk of the individual student.
The student used his car made from the manila folder and placed it on the chart to identify his engine level before and after an activity or sensory choice. The student was provided opportunities throughout the day to use the chart to identify his engine level.
It is important to provide students many opportunities to practice identifying their engine levels by using the before-and-after chart.
Benefits of Alert Program
Frequently, students have a difficult time expressing or controlling their emotions. The Alert Program helps them become independent in handling their own emotions, rather than trying to control the outcome (Trott, Laurel, & Windeck, 1994).
When students have difficulty processing sensory information, they can use sensory strategies to change their engine levels. The program can be adapted for all ages and used to collaborate with students to provide a client-centered approach to treatment in a fun, interactive way.
OT Link to the Alert Program
The OT in this program used communication management, education, play and social participation as approaches in this case. The therapist consulted with the classroom teacher regarding the Alert Program and how to identify a student's needs in order to change engine level by implementing sensory strategies.
The therapist encouraged play exploration as a game in order to give the student opportunities to practice identifying engine levels using the high low chart.
After several treatment sessions the student was able to express his engine level using the face collage and attempted to change engine levels with support from the therapist.
Adapting the Alert Program was successful in teaching sensory regulation strategies. It is important to consider the child's cognitive level and expressive language abilities when trying to collaborate and adapt the program.
Also, it is important to consider whether the student is a visual learner. It seems younger students respond better to pictures to express their emotions. Once the student is able to monitor his own behavior, the student is able to demonstrate better social participation with classroom peers and friends in the community.
References available at www.advanceweb.com/OT or upon request.
Beverly Motin, OTR/L, has worked for 15 years as a school-based occupational therapist who is currently working on her Post-Professional Masters in Occupational Therapy at Quinnipiac University.