blueballoon Health Services prides itself on building and maintaining competencies in established and evolving treatment techniques including but not exclusive to:

• Sensory Integration
• Cuevas MEDEK Exercises
• Neurodevelopment Treatment (NDT)
• Therapeutic Listening
• Feeding Techniques
• Assessment for Autism & Pervasive Developmental Disorders
• Cognitive Behavioural Therapy
• Astronaut Training

Sensory Integration

Sensory processing refers to the way in which a child registers and perceives sensory information through a variety of sensory channels including the visual, auditory, tactile (touch), proprioceptive (input to the muscles and joints) and vestibular (movement) systems. Sensory processing is important for all activities a child does. Sensory input provides the child with information about his environment in order that the child may respond purposefully and successfully to the demands of his environment.

Key Principles of SI Intervention

• Evaluating and modifying the sensory environment
• The context of play
• Active participation by the child
• Child-directed interactions
• Access to appropriate therapy equipment and tools
• Tapping the inner drive of the child - the child's engagement is its own reward

Sensory Integration and Praxis Tests (SIPT) - Ayres, 1989

The Sensory Integration and Praxis Tests (SIPT) is a group of tests that contributes to the clinical understanding of children with irregularities in learning, behaviour and development. This standardized test was developed for North American children after 30 years of research from occupational and physical therapists with the support of Western Psychological Services of South California. Due to the nature of the SIPT, clinicians need formal training in general theory of sensory integration and praxis and in the specific SIPT administration procedures and techniques before administering it.

This test is designed for children from 4 years to 8 years 11 months. No verbal response is required for the SIPT and sight is required for some tests. This advanced test is a great tool used in conjunction with clinical observations and other supplementary data, to identify the sensory integrative difficulties that some children may exhibit.

As Susanne Smith Roley, commented in her project proposal March 1998, how the SIPT helped a child with these words:

“Trevor, is a child who could be identified through observation as having immature development in several areas. He has been evaluated by psychologist, immunologist, neurologist, physician, speech and language pathologist, and teacher. None of these professionals were able to identify a possible explanation for this child’s difficulties. The SIPT profile revealed several areas of difficulty in processing and organizing information that might explain this child’s difficulties in his play and school performance.".

Cuevas MEDEK Exercises

Cuevas MEDEK Exercises (CME) is a treatment approach used to develop gross motor skills in infants and children with motor delay. Children whose birth history may place them at risk of gross motor delay (eg. premature birth), or those who have been diagnosed with Down Syndrome, cerebral palsy, hypotonia, global developmental delay or have an acquired brain injury, may benefit from CME.

The goal of CME therapy is to develop functional motor control in order to achieve the maximum level of independence in sitting, standing, and walking. However, in order to achieve these milestones, a child must first possess the ability to extend their body against gravity (antigravity extension) and to stabilize their body in space. Ramon Cuevas, creator of CME, believes that antigravity extension and stability are developed by maximally challenging the neuromuscular system. Therefore, in CME therapy, the therapist will use the most distal point of contact on the child’s body that is tolerated at each moment. By doing so the body segments are exposed to the influence of gravity and the brain’s automatic responses are stimulated in order to produce the desired reaction.

Several factors may influence the final outcome of therapeutic intervention using CME. One of these factors is the child’s age at the time that therapy is initiated. It has been well documented that development of the brain structures is influenced by activity, therefore early assessment and intervention is ideal. However, CME has been used to treat school aged children and therefore may be explored as a treatment option for older children as well. Other factors that may influence the final outcome of therapy include the degree of physical disability, the frequency of intervention and the level of experience and skill of the therapist.

In order to increase the frequency of intervention, a home program is taught to the child’s parents/caregiver. This home program consists of 6 to 8 exercises specifically chosen by the treating therapist to meet the needs of the child. Families are instructed to complete the home program on a daily basis. The acquisition and integration of a new skill requires practice, therefore repetition of the exercises is an important aspect of treatment. As the child progresses, the therapist will modify the treatment plan and teach new exercises to the family on an ongoing basis. Parents often comment that they appreciate the structured nature of the CME home program and the fact that the purpose of each exercise is discussed in relation to the therapeutic goals for their child.

Neurodevelopmental Treatment

Neurodevelopmental treatment (NDT), also commonly known as the Bobath Approach, is a problem solving hands-on approach that is used to assess and treat individuals with disturbances of function, movement, and postural control. NDT is typically used with individuals who have central nervous system (CNS) damage, specifically those that result in motor challenges (i.e. Cerebral Palsy, Cerebral Vascular Accidents, Head Injury). The current focus of NDT is to improve the quality of functional movements.

The two most frequent techniques that are used as part of an NDT intervention are as follows:

1. Handling, Inhibition and Facilitation: Handling is a technique where the therapist places hands at key points to control the client's body, inhibiting abnormal movement and facilitating movement and postural control.
2. Weightbearing and Weightshifting: Facilitates postural alignment and functional transitional movements. Joint co-contraction and improved proximal stability can also be facilitated through weightbearing and weightshifting.

Stimulation of muscle activity (specifically through the use of weightbearing, resistance, and sensory stimulation) is needed to enable individuals to have a sufficient basis for the training of functional tasks.

Therapeutic Listening

Recent research produced "encourage(d) findings to support the use of Therapeutic Listening as part of an overall sensory integrative approach to occupational therapy in elementary school-age children. Therapeutic Listening, along with sensory diet strategies, can be effective in reducing many behaviors associated with sensory integration disorder" (American Journal of Occupational Therapy: March/April 2007 special issue on Sensory Integration).

Therapeutic Listening is a method by which individuals learn to improve their processing, organizing and integration of sounds to make sense of what they are hearing, thereby improving "listening." Therapeutic Listening utilizes specialized music accessed through headphones to help individuals reorganize how they are orienting, locating and selecting sounds. It is often used in partnership with sensory based techniques (i.e. particularly movement based activities) although one can also use Therapeutic Listening while doing quiet activities a well. It utilizes a variety of CDs that vary in musical styles, types of filtering and levels of complexity. This electronically altered music then works to engage the orienting response which sets up the body for increased attention and active listening. The program runs twice a day at 30 minutes each time for a minimum of 8 weeks, and involves listening to a series of CDs carefully selected by a trained therapist.

For a detailed information aboutTherapeutic Listening provided by Vital Links, click here.

Feeding Techniques

Some babies or children may experience difficulty with feeding by mouth (oral feeding) and/or they may be receiving feeding via a tube and may need help moving from tube feeding to oral feeding; or progressing through different textured foods as they get older. Other babies or children may be struggling with gastrointestinal problems or have sensitivities to textures and smells.

The Occupational Therapist will complete an assessment to provide input regarding the contributing factors or problems and provide recommendations. Often times the Occupational Therapist will also collaborate with other team members involved with the client such as the client's doctors, nurses, nutritionists, etc. to help facilitate an improvement in oral feeding and swallowing. The ultimate goal is for baby or child to eat safely and efficiently and reduce the stress and anxiety often associated with feeding difficulties.

Depending upon the specific feeding issue, the Occupational Therapist will recommend feeding strategies such as alternative feeding positions or methods.

Assessment for Autism and other Pervasive Developmental Disorders (PDD)

A comprehensive autism diagnostic assessment at blueballoon would include several sessions with the family, in which informal parent interviews and child observation would be supplemented by the following formal psychological measures:

• Vineland Adaptive Behavior Scales, Second Edition (Vineland-II)
• Autism Diagnostic Interview (ADI)
• Cognitive Assessment using the Mullen Scales of Early Learning or Wechsler Preschool and Primary Scale of Intelligence (WPSSI)
• Autism Diagnostic Observation Schedule (ADOS)

Findings from the informal and formal measures would be integrated to inform a diagnosis. A detailed report will follow that includes a set of treatment recommendations. This report will be shared in a feedback session with the parents.

Cognitive Behavioural Therapy

Cognitive behavior therapy (CBT) is a well-evaluated form of psychotherapy aimed at reducing psychological distress and maladaptive behaviours. The underlying assumption of CBT is that there is a link between our cognitions (i.e., thoughts about and interpretations of certain situations), our feelings, and our behaviours (i.e., how we act in certain situations). There is much scientific evidence for the effectiveness of CBT in successfully treating a number of childhood disorders such as anxiety, depression, obsessive-compulsive disorder (OCD), and anger management.

The appropriateness of CBT to your child will be determined in our initial consultation in which we will explore the concerns you have and their possible underlying causes. In general, CBT is offered as a treatment block consisting of 12-15 weekly sessions with you and your child. Each session is divided so that 40 minutes are spent with your child and 10-15 minutes are spent with you. The goal of our meeting with you is to facilitate the generalization of coping skills acquired in your child’s session. After each session, your child will be assigned homework in which he/she will get an opportunity to practice the skills learned and discussed in the session. Your child’s progress will be evaluated throughout the treatment block.

Astronaut Training:  A Sound Activated Vestibular-Visual Protocol for Moving, Looking & Listening.

Our vestibular system helps us understand the position of our head and body in relation to gravity.  It tells us which way is up and where we are moving to; it is our "You are Here" arrow on the map.  It helps us with balance, spatial orientation, and maintaining a stable visual image - even when we are moving.  As human beings we move around constantly so it is vital our vestibular system is healthy.

Astronauts participate in extensive vestibular training so they can function without the earth's natural pull of gravity. Their vestibular system has to be particularly strong to cope with the disorientation of space travel and weightlessness. Research suggests that where a person's vestibular system is not sufficiently activated, vestibular training can significantly improve its functioning and ability to integrate information with the other sensory systems.

The Astronaut Training protocol harnesses the dynamic interplay between the vestibular, visual and auditory systems using specific play activities and exercises based on a space theme to improve functional performance.  The protocol was created by Sheila and Ron Frick, who brought us Therapeutic Listening, together with Mary Kawar.  Both Mary and Sheila are paediatric Occupational Therapists specializing in sensory integration.

Astronaut Training complements many other therapy programs offered by blueballoon, particularly the Therapeutic Listening Program.  For children completing an intensive or 12 week program of Astronaut Training, parents or caregivers can be trained to deliver the protocol as a home program under the supervision of an Occupational Therapist.   For further information, please contact us at blueballoon Health Services.