Submitted by Elaine Kayhan, Occupational Therapist
| Before | After |
|---|---|
| Refused to wear underwear or long sleeves due to clothing sensitivities | Now more willing to wear a wider variety of clothes, even non-preferred items such as underwear |
| Required repeated direction when transitioning between activities | Requires fewer reminders to listen when transitioning between activities |
| Experienced tantrums and aggression | No more tantrums or aggression! |
Nanette is a 4 year old who I evaluated for OT due to concerns for clothing sensitivities, especially in the trunk area. This led her to refusing to wear underwear and also long sleeves. She also had an injury on her upper arm from a barbed wire fence a couple years ago. Some of the other issues I’ve observed include sensory seeking behaviors, decreased upper body strength, and decreased safety awareness.
At the beginning, I began with performing rhythmic movements [from the Brain and Sensory Foundations course] with Nanette because I had a suspicion that she had unintegrated reflexes. I tested for Spinal Galant reflex due to her clothing sensitivities and found that it was retained on both sides as her trunk was noticeably ticklish and twitched. She also had a retained Babinski reflex on both feet, which I suspected due to her poor balance as well as issues with many shoes. I chose to start with passive rhythmic movements and she seemed to become more relaxed each session in OT. After stimulating Spinal Galant reflex, I had her complete Spinal Galant reflex integration exercises. After stimulating the Babinski reflex, I would have her complete exercises [from the Brain and Sensory Foundations course]. I suspected that her TLR [Tonic Labyrinthine Reflex]is also retained because of her poor balance. and I’ve been trying to address this with a lot of prone play.
Nanette seemed to really take to the rhythmic movements and I noticed she was less stiff than in the beginning when we were first starting doing them. She also requested them to be very fast in the beginning and recently has asked for them to be slower. In therapy sessions, she was more willing to try on non-preferred clothing items. Also, her mother reported that recently she asked to wear underwear all by herself! Her grandfather at drop off also reported that he’s noticed her wearing a wider variety of clothes. Nanette was coming in with different shoes and when I asked her about the newer shoes, she stated they no longer felt uncomfortable! Overall, I noticed that Nanette was less impulsive in therapy sessions and was processing what I was saying more. I realized this because I was giving her fewer reminders to listen when transitioning between activities. The last session I had with her, I noticed too that her Spinal Galant reflex was much less noticeable (her trunk did not move much!). Also, in her feet I noticed that only her left foot now had a sign of retained Babinski reflex. The total length of time I treated her was 3 months.
Although I don't work with her anymore, my COTA is still working with her and the client's mom recently stated that Nanette has shown a drastic improvement in tolerance to donning novel clothing items. She also no longer tantrums or becomes aggressive. Nanette is also now able to wear loose fitting underwear more regularly during sessions and at home whereas previously she would not tolerate it at all.
(Edited, emphasis added)