Sensory Motor Planning

Jennifer had an early session today so she could overlap with Karin. One of the things discussed in our last Team Meeting was Raquel's limited motor planning and how the ABA Team could help develop this during their sessions. Motor planning is part of occupational therapy, so they needed Karin's input.

To help with her motor planning, Karin recommended that they do a few things during their sessions:

• Increase the proprioceptive input by doing the jumps, crashes, crawling out of the beanbag, etc.
• Increase vestibular input to help strengthen Raquel's muscle tone by primarily doing the fitness ball bouncing, but to only do this AFTER giving her the proprioceptive input. The timing is important.

A few other general recommendations from Karin were:

• PECS. She wants the ABA Team to help develop Raquel visually cross midline. So, if Raquel picks up the PECS with her right hand (which she is consistently doing), Karin wants their hand to be on the left so she'll have to reach over to the left. I guess this whole "crossing midline" thing doesn't fully develop until age 3. This is when a hand dominance typically takes effect. Even though Raquel is behind - I try to think of her as a year younger developmentally - it's not a critical thing to have this develop by her 3rd birthday. However, based on Karin's observations, she feels that certain tasks are becoming just a learned pattern and not a hand preference. Raquel consistently - and accurately, mind you! - throws with her left. If she has something in her right hand, I am never on the defense about getting hit because I know she doesn't throw right handed. But, she eats, drinks, and brushes her teeth with her right hand. She draws with her left. PECS, as mentioned, is a right handed thing.
• Keep Sensory Items - Sensory: Lately, the ABA Team have been using the ball bounces at times for both her interverbals and verbal immitation programs. They bounce her while singing a song that they want her to fill in with words or to make immitations of sounds they are demontrating. Karin recommended that they keep sensory related items strictly sensory, and not associate it with the working part of the session. She said to try to give her the sensory input first, then target all the verbals afterwards. We'll have to see how it goes.
• Less Time For Stimulating Items: I've posted many times about how Raquel loves the spinning tops. It's one of her biggest reinforcers. Today, she was having table time and playing with them, and Karin asked Jennifer to take them away because she noticed she was getting really wound up. The same thing happened a little later with the play phone. It appeared that the longer she was allowed to play with these items, the more overstimulated she would get.
• The "Song": If the song is needed during a session, Karin suggested that it be Raquel's break from therapy. She said that Raquel has associated the song to her self-calming, and to try to force her to work while the song is playing will only bring out behaviors. I could sense that today. Karin asked me to play the song at one point and Jennifer continued with her session. Raquel was arching her back and doing everything she could to get away from her. Once she was allowed to escape, she walked over to the radio and sat and listened. When the song was over, she came back and joined us.

Another fascinating day in regards to the sensory thing. I'm always so amazed at how well Karin is able to read Raquel.