DAVAO DOCTORS COLLEGE 2015
Anne Bernadette Barte, BSOT
PLAY
Types of play
unoccupied, onlooker, solitary
Assessment
developmental, skills (MPC),
playfulness, social participation
Elements
environmental, novelty, challenge,
friendly competition
Barriers
inhibited by caregiver, caused by
condition, environmental accessibility,
sociocultural
Play
diagnosis for precautions,
development of age
Guidelines for therapists
be playful, empower, structure the
environment, appealing, competitive,
show how to play yet let him also play
alone
Good toy
safe, sturdy, no choking hazards,
attractive/interesting, popular, has a
functional cost, age-appropriate,
fad/trendiness (generic vs. trendy),
packaging
SENSORY INTEGRATION
- by: Jane Ayres
- organization of stimuli for adaptive
responses
- integrated by 8 to 11 years old through
sensory experiences
- affects CNS and behaviour
- Han Siu simplified S.I. but today Jane Ayres
principles has to be reinforced back
- mild learning behaviour
- 3 primary SI: TPV (tactile, proprioception,
verstibular)
1
July 2, 2015
Cornerstone Therapy Hub, Gusa, CDO
Lectured by: Thea Sheila Ocheda-Alonto, OTRP, MOH
Tactile
1. Discriminative quality (i.e. how we
are held)
2. Protective alerts from danger
Vestibular
through the ears, has an average of 8
hours effect
Proprioceptive
through the mechanoreceptors,
muscles, tendon, joints
Sensory (brain)
anterolateral pain, crude sensation
thalamus pain, temperature
reticular arousal, consciousness
posterior parietal lobe, areas 5 & 7
new sensations, visual inputs, tactile
memory
primary somatosensory, areas 3,2,1
tactile sensations
hypothalamus central center
Limbic emotion, learning, memory,
sexual, emotional
S.I. Dysfunctions
I.
Praxis Disorder
II.
Sensory Modulation
I.
Praxis Disorder
- integrated at 3 years old
- difficulty in planning
dyspraxic difficulty in learning
new tasks
apraxic difficulty in learning
new task and already learned
tasks
a. ideational praxis conceptualizing
b. planning intentional
c. execution refinement of skills
Levels of motor planning:
- in order for us to know what type of
problems
1. stable client-stable environment
example: kicking a ball
2. stable client-moving environment
example: kicking a rolled ball towards
you
3. moving client-stable environment
example: run then kick the ball
4. moving client-moving environment
example: run towards a moving ball
a. Bilateral integration sequencing
deficits
- mild
- stable to stable
- vestibular & proprioception
- do jumping jacks (7 yrs old)
b. Somatodyspraxia
- severe
- decreased PVT inputs
- motor/execution memory
- difficulty in feedback and feed
forward
- supine flexion (fetal position)
- poor in-hand manipulation
II.
Sensory Modulation
a. Overesponsive
- neurologic
- hyperesponsive exaggerated,
avoids
- greater than normal people
b. Underesponsive
- lesser than normal people
- hyporesponsive clumsy
c. Gravitational insecurity
- fear of feet off the ground
- aversive response to movement
- generally sluggish
Use: Sensory Profile by Winnie Dunn, Ph.D., OTR,
FAOTA
Treatment
1. Sensory stimulation indian milking,
joint compression
2. Sensory diet structured, few wellchosen set of activities given on a
daily basis
3. Heavy work number of muscles are
used for sensory input
BEHAVIORAL APPROACH
1 yr single toy, plays for 2 to 3 mins,
mother
2 yrs acitivity, plays for 5 mins, associative
play
3 yrs group activities, plays for 20 mins
2
July 2, 2015
Cornerstone Therapy Hub, Gusa, CDO
Lectured by: Thea Sheila Ocheda-Alonto, OTRP, MOH
DAVAO DOCTORS COLLEGE 2015
Anne Bernadette Barte, BSOT
4 yrs cooperative play
5 yrs games with rules
6 yrs competitive play
Evaluate
likes & dislikes, interview,
performance & progress review
(teachers)
Behavior modification
- managing behaviors
Observe
Identify problem
Realistic goals
Plan
Implement
Prioritze
I.
Observe
II.
Identify problem
Sensory - problems to touch
Behavior - problems to communication
Inappropriate behaviors
Off-task/Out-of-seat behaviors: annoying,
inappropriate play
b. Physical Contact: spitting, throwing,
hitting
c. Noise/inappropriate verbal
communication: crying, whinning, not
responding
a.
Classification systems
a. Conduct disorder: aggresion, disruptive
b. Withdrawn: isolation, lack of selfconfidence
c. Socially immature: not according to
developmental expectations, ageinappropriate toys
a.
b.
c.
d.
Consider
Intensity: minimaly needs support?
Frequently: occur periodically?
Duration: too long?
Severity: does the behvaior interferes?
III. Realistic goals
SMART goals
IV. Plan
Behaviors: increase or decrease
frequency?
a.
b.
c.
d.
Use of reinforcements
Consistent - in all settings
Immediate - every after correct
Congruent - everyday
Clear - specific
Types of reinforcement
a. Primary reinforcement - food
b. Secondary reinforcement - no intrinsic
value (i.e. money)
c. Social reniforcement - engaging in
desired actvity
When to give: during difficult? Or long
time?
Timing: everytime, how long,
fix/variable length of time. Fading gradual decrease when behavior has
established (confirms the
effectiveness of reinforcement)
Token economy system: behavior
charts with stickers and stars; uses
unconventional items
Contract setting: verbal/written
Modify environment: decrease
distractions, organizational assists
(routines), break down tasks
Stategies to develop new behavior
a. Shaping - defining and reinforcing
successively closer approximately to
desired behavior, gradation, no strict
rules, prompting dependency
b. Chaining - break down into several steps,
teaching one component separately, if
done correctly are initially reinforced
c. Modeling - following other person,
imitation and group situations
d. Prompts and cues - physical (HoHa),
gestural (indicates course of action),
verbal (reminder)
July 2, 2015
Cornerstone Therapy Hub, Gusa, CDO
Lectured by: Thea Sheila Ocheda-Alonto, OTRP, MOH
DAVAO DOCTORS COLLEGE 2015
Anne Bernadette Barte, BSOT
Strategies to decrease undesirable
behavior
a. Ignore/Extinction - for attention seeking
b. Time-out/Negative reinforcement remove from activity; for 3+ yrs old;
socially acceptable
c. Satiation - reverse psychiatry
d. Over-correction:
a) Restitutional Over-correction modifies effect maladaptive behavior
by restoring the environment
b) Positive Practice Over-correction practicing appropriate behavior to
prevent the inappropriate ones
Guidelines in behavior management
Simple phrases and sentences
Use gestures
Physical promts
Fade help
Routines (CPR)
C - consistency
P - predictability
R - routine
6. Tools: calendars, time tables
7. Move to extrinsic to intrinsic motivation
Ultimate goal: Self-monitoring
Self-monitor through calendar,
timer, lists, reminder notes,
physical organization of tools
1.
2.
3.
4.
5.
V. Implement
VI. Prioritze
