Sensory – Active Play Therapies

30 Jun

Thoughts from a Therapist: Showcasing Sensory Clinic Spaces

Originally published on Sensory Integration Education on 28 June 2024.

In this month’s Thoughts from a Therapist blog, Anna Willis gives us a sneak preview of what she’ll be presenting at this year’s online SIE Conference. In her presentation ‘Showcasing Sensory Clinic Spaces’, she explores the creative side of designing and implementing sensory clinic spaces – from the basic “we’ve only got this space, let’s squeeze a swing in” to the Star Institute Treatment Clinic in Colorado!

I’ve had a busy month pulling together my presentation for SIE’s Conference in September. My presentation is Showcasing Sensory Clinic Spaces and I had a lot of fun revisiting old rooms, trawling through my old photo and video reels of work from years ago and visiting spaces to take videos of rooms in action.

I did wonder whether seeing therapy spaces would in fact be interesting to anyone else… and decided that, for me, I’m always so curious about where other people do their therapy, what it looks like, what their favourite pieces of equipment are and what they don’t rate – that I’m hoping there are lots of you out there too who are equally curious! It became a visual buffet of a wide range of sensory rooms from the basic “we’ve only got this space, let’s squeeze a swing in”, to, wait for it… the Star Institute Treatment Clinic in Colorado!

My mentor and sensory guru, Virginia Spielmann, very kindly let me quiz her all about sensory clinic favourites, regrets and advice, as well as giving me a host of videos I’ve merged together to show you all the wonders of what must be one of the best SI rooms in the world!

Whilst doing my research for the presentation, I realised the breadth of creativity there is in doing Ayres Sensory Integration (ASI). We often don’t have access to giant rooms with lots of fabulously sturdy beams just crying out for suspension points. And instead, we may have a water bed and a gym ball. Or a bus.

That’s right. A bus! I’ve come across a couple of buses kitted out as sensory gyms and they look fabulous. Bar the obvious challenges of available space, they can be made to be so versatile and flexible, whilst having the added bonus of being entirely mobile and rent-free (although I guess parking spaces may be an issue!) Although the bus didn’t make it into my final presentation, I certainly had fun exploring the creative side of sensory clinic spaces and I hope you enjoy my celebration of this at the SIE Conference later this year.

I hope I’ve inspired you all to go and buy a bus now!

Anna

Thoughts From a Therapist is a regular series written by Advanced SI Practitioner Anna Willis about something that piqued her professional interest or inspired her in some way over the last month. Anna, an occupational therapist and owner of Active Play Therapies, has over ten years of experience working with children and adults with a range of learning disabilities and autism.

30 Jun

Thoughts from a Therapist: What is Gestalt Language Processing?

Originally published on Sensory Integration Education on 28 May 2024.

In this month’s Thoughts from a Therapist blog, Anna Willis takes a look at Gestalt Language Processing, how this differs from Analytic Language Processing – where we build from single words upwards – and why Gestalt Language Processors are often misunderstood.

When I first started working with autistic children (which I discovered at a recent presentation was apparently 20 years ago. How did that happen?!), echolalia was often seen as a stim rather than as communication. At the STAR conference a few years ago, I heard about Marg Blanc for the first time and her work on Gestalt Language Processing (GLP). Now bear with me, because this is not my area of expertise, but it’s certainly something I’m interested in right now, hence deciding to write about it this month! This body of work started developing in the 1980s by looking initially at Natural Language Acquisition (NLA). For most of us, we acquire language word by word. This is called ‘analytic language processing’ – where we build from single words upwards. In GLP, language is learnt in ‘gestalts’ which are whole phrases and can be learnt from songs, stories, videos etc.

Gestalt Language Processors are often misunderstood because understanding the context to a phrase is crucial to making sense of it. I have worked with a young person for 10 years now. When I first met her, she recited the whole of a poem as she walked into our assessment room. However, she wasn’t able to answer our questions. Recently, I went to see her after a long break. She was in her room watching her tablet. She didn’t look up but I knew she’d registered me and she tapped on to a separate video (at incredible speed!) and I could see the subtitles of the video clip say “I miss your nuclear fusion”. I felt all warm and fuzzy! I may again have misinterpreted some communication but it felt like her way of telling me she’d missed me. It was such a tiny moment and would have been so easy to miss had I not been looking at her screen or if I’d been an outsider who could have presumed she hadn’t registered my presence.

Gestalts have meaning. We may not be able to understand them but that doesn’t mean it isn’t communication. We may have to do a lot more work to unpick, such as finding out the context of when and where they learnt the phrase (for instance, a gestalt could be “sit down now” which could mean “I’d like a snack” because that was the phrase they learnt and linked to having a snack).

Click here to access Marg Blanc’s website if you’d like to learn more about GLP.

Happy chatting!

Anna

Thoughts From a Therapist is a regular series written by Advanced SI Practitioner Anna Willis about something that piqued her professional interest or inspired her in some way over the last month. Anna, an occupational therapist and owner of Active Play Therapies, has over ten years of experience working with children and adults with a range of learning disabilities and autism.

30 Jun

Thoughts from a Therapist: Gear Shift to Secondary

Originally published on Sensory Integration Education on 23 April 2024.

In this month’s Thoughts from a Therapist blog, Anna Willis takes a look at the challenges students with sensory needs face when transitioning from primary school to secondary school and the role therapists can play in helping students navigate their way through this major transition.

In the UK, the transition from primary school (age 4-11 years) to secondary school (11-16 years) is a big leap. Children go from having the same teacher for most of the day to having a different teacher for each subject. They need to find their way around a big, noisy and often confusing environment to get from one lesson to the next and take a lot more responsibility for personal organisation of belongings, homework tasks and schoolwork. Despite this, children often get given less help at this time, rather than more. Often they don’t even get the same level of support (which was already required in a much less challenging environment).

Recently, speaking to a secondary school, a SENCO reflected that they often tend to take away the metaphorical rubber ring from primary schools and see who sinks and who swims. We reflected that perhaps it might be better to keep the rubber ring in place for this big transition and then gradually see what support can be taken away and what needs to be added in.

I’ve written before in a previous Thoughts from a Therapist blog about the differences I’ve observed between primary and secondary schools. This time, I’d like to focus on what we can do as therapists.

Something I’ve heard a lot about is the need to adapt strategies to secondary school-aged children: “That’s all well and good to have a big squishy fiddle toy/ ear defenders/ resistance band on chair legs in primary school, but what about now?”

At this age, children themselves often become a lot more self-aware (as well as in the upper half of primary school, aged 9 years +) and stop wanting to use the sensory tools that previously served them well. Equally, they can’t cart around a gym ball, wobble cushion and resistance band to put on each chair.

My approach in these situations is twofold. Firstly, find ways to meet the sensory needs that will absolutely still be there if they were there only a few weeks ago in primary school. Adapt this to what is now acceptable to the child. I talk about No Tool Strategies – things that can be done with no equipment. Examples include hand pushes and pulls, pushing down into the chair and arm stretches. All things that can be done in a seat without drawing any attention. I also spend time trawling the internet for age-appropriate fidgets (i.e., strategies that have Tools) that aren’t noisy or bulky, can fit in pencil cases, and don’t look conspicuous. Things like a black chew tube that fits over the top of a pencil, or a pea pod keyring that can attach to a pencil case and looks like a cute charm.

Secondly, I challenge schools to work on their culture. I discuss the concept of Equity versus Equality – making sure that staff and students alike all understand that we all have different needs and we all need different things. Just because one person needs a fidget toy does not mean the whole class has to have them, or that there should be a school-wide ban on them. Fostering a neuroaffirmative culture of acceptance and educating everyone about this is an important second strand here that works towards children with sensory needs being comfortable and able to express themselves.

So, if you work with secondary schools or offer training where secondary staff attend, do look at adapting things. Obviously this will benefit the children but it’s also vital to get staff on board.

Keep fidgeting!

Anna

Thoughts From a Therapist is a regular series written by Advanced SI Practitioner Anna Willis about something that piqued her professional interest or inspired her in some way over the last month. Anna, an occupational therapist and owner of Active Play Therapies, has over ten years of experience working with children and adults with a range of learning disabilities and autism.

30 Jun

Thoughts from a Therapist: Know Better, Do Better

Originally published on Sensory Integration Education on 26 March 2024.

Hot on the heels of Neurodiversity Celebration Week, in this month’s Thoughts from a Therapist blog, Anna Willis takes a look at the challenges we can sometimes face keeping up with the language around neurodiversity. Given the pace it’s evolving at, it’s easy sometimes to make mistakes and that’s when we may need some understanding that we will make them but that it’s better to try than disengage. And when we know better, we can do better.

Writing with confidence about neurodiversity used to be something well within my comfort zone. However, being asked to tie in my Thoughts this month to neurodiversity has made me pause. Whilst I have good intentions and want to be a good ally to my neurodiverse friends, colleagues, clients and families, I’m very aware that at times I do get things wrong.

The language around neurodiversity has developed at such a pace. A few years ago, I would have been writing about “ASD” (autism spectrum disorder). Now I know that the term disorder is no longer helpful or wanted by a lot of autistic young people and adults. So I refer to autism (dropping the word “disorder”) and use identity-first language i.e., autistic person, rather than a person with autism as it’s not something separate to the person but an integral part of who they are and as this is what the majority of the autistic community prefer.

For World Book Day recently, I shared my book recommendation for a fabulous graphic novel that has the word “Asperger’s” in the title and, quite rightly, someone commented that this terminology is outdated, particularly given Hans Asperger’s deeply disturbing links to Nazi regimes. This reminded me of the phrase “Know Better, Do Better”.

” Having open, honest conversation and being able to share with someone when they’ve said something accidentally offensive, whilst acknowledging their good intentions, is so valuable.”

And this is what I strive for. I feel it’s important for us to try our best, with good intentions, knowing we may make mistakes. There’s so much more I can learn. Only this week I was reading about how diagnostics of autism and ADHD are framed in language of deficits (or one opinion I read on ADHD spoke of how our preconceptions about it are based on distress patterns) and how different it would be if we instead looked at the strengths that these give people such as monotropism ((hyperfocus on one subject or task) and holotropic sensory gating (the idea of having “wide open” sensory gates and subsequently taking in all sensory inputs).

On the same day, I read about a mum saying if she came across one more person talking about autism as a superpower, she would scream! And I also totally get that. Her point being that autism just *is*. The same as someone having black hair or blue eyes.

I guess my point with all of this is that the landscape is complex and nuanced currently. It’s evolving at a pace and that makes it easy to make mistakes. But when we know better, we can do better. We need some understanding that we will make mistakes but that it’s better to try than disengage. Having open, honest conversation and being able to share with someone when they’ve said something accidentally offensive, whilst acknowledging their good intentions is so valuable. I sometimes witness other medical and health professionals stamping all over the invisible eggshells I’m trying hard to avoid and it can be difficult to raise – but that’s part of being an ally.

Sharing the mental load of educating, reframing and helping everyone move forward to a more neuroaffirmative world.

Thanks

Anna

Thoughts From a Therapist is a regular series written by Advanced SI Practitioner Anna Willis about something that piqued her professional interest or inspired her in some way over the last month. Anna, an occupational therapist and owner of Active Play Therapies, has over ten years of experience working with children and adults with a range of learning disabilities and autism.

30 Jun

Thoughts from a Sleep Deprived Therapist

Originally published on Sensory Integration Education on 26 February 2024.

In this month’s Thoughts From a Therapist article, Anna Willis, Occupational Therapist and Advanced Practitioner in Sensory Integration, looks at the sensory aspects of sleep and the emotional and cognitive impact on everyone involved.

Ah, a good night’s sleep. Something I’ve been dreaming of (ironically!) since the end of pregnancy. My little one is now 15 months old and yet to treat us to sleeping through the night. It’s got me thinking about the sensory aspects of sleep and the emotional and cognitive impact on everyone involved.

Our health visitor is now starting to work with a sleep specialist for us. She showed me an image of a circus tent, likening the aspects needed for sleep as the ropes holding the tent up. One being ‘environment’ which as an OT, I have already spent a long time considering from a sensory perspective. The black-out blinds are up, the white noise is on (then off another night because maybe it’s too loud (?!), then on again the next and repeat), the heating is perfected to 18 degrees, the sleeping bag is tog matched to the chart, the routine is in place and I’ve perfected my dull yet reassuring “It’s sleepy time now” statement.

Oh, and the amount of money I have spent on gadgets that will get my toddler to sleep is verging on horrifying. I’m looking at you Sooth ‘n’ Snuggle Otter, Starlight Polar Bear, Wubbanub, funny mattress vibrating Zed thing, Merino wool sleeping bag, silky comfort blankets, a myriad of dummies (all of which are rejected), soft toys with the “right” squishiness, soothing sleep music apps…! So the environment has been well and truly OT-ed to the max.

Which has got me thinking. Of all the equipment recommendations we give. Of the information we impart. If sleep is involved – it’s a whole new level of desperation for it to work. And also a whole new level of brain fog for clients, parents or caregivers to cope with. Implementing new things on top of sleep deprivation is hard. Doing anything that may result in less sleep seems almost painful.

So if your clients mention poor sleep (which a lot of our sensory friends do struggle with), bear in mind if they or their caregivers are also sleep-deprived as a result, they are likely to need more concrete things to work on. Write things down. Keep it simple. And keep the equipment recommended as brief as possible to avoid them buying everything in desperation (ahem).

Right, I’m off to Google more things to buy that will guarantee me a good night’s sleep!

Sweet dreams,

Anna

Thoughts From a Therapist is a regular series written by Advanced SI Practitioner Anna Willis about something that piqued her professional interest or inspired her in some way over the last month. Anna, an occupational therapist and owner of Active Play Therapies, has over ten years of experience working with children and adults with a range of learning disabilities and autism.

30 Jun

Thoughts From a Therapist: The Role of Gaming in SI Sessions

Originally published on Sensory Integration Education on 19 January 2024.

In this month’s Thoughts From a Therapist article, Anna Willis, Occupational Therapist and Advanced Practitioner in Sensory Integration, looks at the role of gaming when planning Sensory Integration (SI) sessions for her younger clients.

Phew – the December chaos is finally settling into January freshness. I love Christmas but I also love the sense of a new start that the month of January brings. I have some exciting things coming up that I am looking forward to writing more about soon! However, for this month’s blog, I’ve been thinking about the role of gaming.

Screen time is such a divisive parenting issue. Sometimes it feels like it should be heavily policed and limited, with all sorts of scary stories about what too much screen time can do. However I’d like to speak up for gaming as a meaningful occupation.

As an OT, looking at children’s meaningful occupations is obviously a Big Thing I Do. So often, when I ask children now what they like playing, I’ll get a list of video games they play on an iPad, Switch, Xbox or Playstation. Old me would always be surprised as I’d be expecting a list of things such as ‘hide and seek’ or make-believe games! Mostly I have to go away after the sessions and Google all of these games.

When planning SI sessions and wanting to create fun, immersive play themes for children to fully want to engage in, I like to find characters and themes that link to their current interests, and often, this is game-based. A lot of children initially struggle to use their imaginations and motor skills (typically part of a larger picture of why they are coming to SI anyway!) to join in, but it does create a wonderful springboard into adventures in the SI room.

Another side to gaming is the social connections. A lot of the children I see struggle with friendships face to face but when wearing a headset, immersed in a game they love, speaking to others who love and understand the game, they can connect in a way that doesn’t happen so easily. There’s no pressure for eye contact or to read body language. There’s a shared special interest already, with very clear topics to talk about – the missions being completed on the game!

There are clearly issues that need addressing, such as age limits, risks of speaking to strangers and the addictive nature of some games. However, in moderation and with proper safety nets in place, gaming holds a special role for some children to be able to access a playful side of themselves and also connect with others. If you don’t already – why not research your clients’ gaming interests and see if you can wind it into ASI!

Warmest regards

Anna Willis

Thoughts From a Therapist is a regular series written by Advanced SI Practitioner Anna Willis about something that piqued her professional interest or inspired her in some way over the last month. Anna, an occupational therapist and owner of Active Play Therapies, has over ten years of experience working with children and adults with a range of learning disabilities and autism.

30 Jun

Thoughts From a Therapist: Magic Expectations

Originally published on Sensory Integration Education on 19 December 2023.

In this month’s Thoughts From a Therapist article, Anna Willis, Occupational Therapist and Advanced Practitioner in Sensory Integration, looks at setting expectations at this time of year.

Ah, the festive season is upon us! Everywhere looks different, sometimes smells different and there’s lots of different activities going on. At this time of year in particular, we often have high expectations of making magical memories, only to realise that perhaps all the magic may instead be creating overwhelm.

For the families we support, often a large part of our role can be helping to reframe expectations. For example, if someone struggles with bright lights all year round, they may not quickly switch gears to enjoying all the sparkly lights at Christmas.

Equally though, some children surprise us with how they do cope, leaving parents perplexed at why. Usually, the answer is ‘motivation’. Going into a bright supermarket is different from going into a Christmas grotto knowing you’ll get a present!

Speaking of expectations, I visited a primary school recently who have reflected that their older students tend to regulate really well in the early years (reception, aged 4-5 years old) playground. So, we have been busy planning how to redesign their pastoral outside space with that in mind.

The school system seems to have an expectation that, after reception, the majority of children quickly lose the need for sensory play and environments tend to reflect that. However, we know that isn’t the case! So we’re introducing a mud kitchen, a swing, loose tyres, water and sand play, and maybe even a floor-level trampoline, so that pupils can continue to access these fabulous sensory activities all the way up to year 6. Next stop will be getting secondary schools on board with a slightly more grown-up version!

I hope you all have the chance to rest and cosy up over this mid-winter break and meet your own sensory needs for comfort.

Warmest regards

Anna Willis

PS You may also be interested in one of our recent Sensory Snapshot blogs which takes a look at what schools need to be doing to become more sensory-friendly. You can read the full blog here.

Thoughts From a Therapist is a regular series written by Advanced SI Practitioner Anna Willis about something that piqued her professional interest or inspired her in some way over the last month. Anna, an occupational therapist and owner of Active Play Therapies, has over ten years of experience working with children and adults with a range of learning disabilities and autism.

30 Jun

Thoughts From a Therapist: The Double Empathy Problem

Originally published on Sensory Integration Education on 29 July 2021.

This is a new regular series written by Advanced SI Practitioner Anna Willis about something that piqued her professional interest or inspired her in some way over the last month. Anna, an occupational therapist and owner of Active Play Therapies, has over 10 years of experience working with children and adults with a range of learning disabilities and autism:

“Recently I was asked to offer some social skills training. Until the other month, I would have happily entered into discussions as well as recommending and supporting interventions targeted at ‘improving’ social skills. However, listening to Dr Damian Milton talk about the double empathy problem has changed my thinking on this.

“The double empathy problem is the idea that instead of solely autistic people finding social communication difficult, it is actually a two way street – non-autistic people find it difficult to communicate with autistic people also.

“Crompton et al (2020) did an interesting study looking at information transfer – their study had chains of 8 people who needed to pass a story on, one person to another. The study found that non-autistic chains and autistic chains performed similarly in passing on the information. The difficulties arose with mixed chains sharing a lot less detail and reporting less rapport.

“The Therapist Neurodiversity Collective have a helpful poster around what they think are helpful skills to teach: self-advocacy, self-regulation and perspective taking. Narrowing it down to those 3 skills really helped me. I’ll be making my recommendations much more targeted and inclusive, and trying to be mindful of my own part in the two-sided nature of communication, as well as a bigger focus on supporting clients to self-advocate when possible.”

30 Jun

Thoughts From a Therapist: In Suspense For New ASI Space

Originally published on Sensory Integration Education on 29 August 2021.

This is a new regular series written by Advanced SI Practitioner Anna Willis about something that piqued her professional interest or inspired her in some way over the last month. Anna, an occupational therapist and owner of Active Play Therapies, has over 10 years of experience working with children and adults with a range of learning disabilities and autism. This month, Anna discusses her excitement about a new ASI space.

“Whilst scrolling on Facebook one day, I did a double take at a photo that set off my SI Geek Alarm. Suspension points!

“Since having to close my clinic space due to maternity leave, and then COVID-19 pushing services online, I have been mainly focusing on sensory assessments and emotional regulation. However – since restrictions eased, I’d started wondering about renting a space out, investigating the local village halls. But here was a different opportunity – a gymnastics hall renting out evenings to an aerial fitness business who had installed suspension points! I called the owner and went to visit.

“Wow – SO many sensory opportunities! It had a sprung floor, sunken trampolines (including a runway style one!), a foam crash pit – as well as 3 suspension points already in situ, load tested and maintained. Financially though, the cost of renting the facility was just unfeasible for one therapist and one family. But it was too good an opportunity to miss – so this Autumn term, myself and another Advanced ASI Practitioner are going to be using this fabulous facility together, seeing two families in the space at once to provide ASI-OT.

“I’m also running a CPD session for the gymnastic coaches after speaking to the owner about the 8 sensory systems and praxis! It is a giant facility so plenty of room for multiple families, but it isn’t something I’ve tried before. In America, it’s more common to have a couple of children in a sensory gym at once – but I haven’t heard of it happening so much in the UK. I’m excited to see how this works – and shall report back on our progress!

30 Jun

Thoughts From a Therapist: The Virtues of Virtual

Originally published on Sensory Integration Education on 29 September 2021.

This is a regular series written by Advanced SI Practitioner Anna Willis about something that piqued her professional interest or inspired her in some way over the last month. Anna, an occupational therapist and owner of Active Play Therapies, has over 10 years of experience working with children and adults with a range of learning disabilities and autism. This month, Anna considers the virtues of virtual therapy:

“As I’m now getting ready to going back to face-to-face ASI (Ayres Sensory Integration), I’ve been reflecting on the virtual world I found myself thrust into in 2019. A lot of my skill set is not reliant on verbal communication. As SI OTs we set up opportunities in the environment to encourage fun, novel physical interactions. Without being face-to-face, this was quickly lost. I found that I was hesitant to offer online sessions to many of the children I’d worked with face-to-face as I felt the demand to sit in front of a screen, listen and talk was potentially setting up some of these children to fail, compared to the relatively low verbal demands of face-to-face sessions.

“Instead, I offered parent consultations and assessment through video calls and video review. What I found was invaluable. The video clips I was sent by parents and carers opened up a whole new world of observation. As OTs, we want to see how people are functioning in their environments but so often, when I went to observe, parents would comment “Oh, they wouldn’t usually do that. It’s because you’re here!” and clearly it was a different experience to the child’s daily life to have a therapist lurking in the corner!

“The videos I received showed me snapshots of normal daily life: typical interactions and performance without the added variable of a stranger’s presence. I could rewind and re-watch tiny fleeting moments many times, observing things that I would have missed in person.

“Using video is certainly not new to COVID-19 – however, using it as extensively throughout my assessments is, and that’s something I’ll be taking forward. For now though – I’m excited to be back to getting on the swings!”