Submitted by Kendel Knudson OTD, OTR/L
| Before | After |
|---|---|
| Trouble sleeping; had to be with mom and sitting up, frequent wake-ups | Now falls asleep at a normal hour, in her own bed, and sleeps through the night |
| Hypersensitivity of all senses | No longer bothered by smells; no longer startles at loud noises or light |
| Anxious, particularly going to school | Able to speak in front of the class and participate in group activities without anxiety |
| Frequent meltdowns and difficulties transitioning between activities | No more tantrums |
This study is on a 5 year old girl who came to me with an order for “Abnormal sensation of the skin”. For this study we will call her Sarah.
History: Mom had a high risk pregnancy due to being pregnant with triplets. However the other two passed away in Utero. Sarah was born via a vaginal water birth 2 weeks after her due date. Prior to this, mom had undergone a retroversion due to Sarah being breech. Mom states this was very traumatic for her. Mom began to deliver while no one was in the room.
Sarah was blue and without oxygen when the doctor came in and the doctor had to put her upside down and slap her back to get her to breathe. Mom reports feeling traumatized by the whole situation. Sarah had jaundice, extreme colic, and lactose intolerance as a baby. Mom reported Sarah never slept as a baby. Sarah met all of her milestones extremely early (i.e., rolling at 2 weeks, talking at 7 months) and had hypersensitivity of all of her senses.
Primary Concerns:
When Sarah came to see me, mom’s primary concerns were :
• Sleep: Sarah had to be sleeping next to mom, sitting up right, on the couch, and would often still not go to bed until 12am and then would wake frequently during the night
• Hypersensitivity of all senses: Could not sit with the other kids at lunch because the sound bothered her. Mom and Grandma had to talk quietly around her. Often had difficulties being in the room with other individuals due to the ability to smell their body odors (just normal odors, nothing outside the norm). Sarah had difficulty tolerating certain types of clothing. Constantly mouthed non food objects. She also had difficulty tolerating outdoor sunlight.
• Anxiety: Sarah had difficulties going to school or being in public due to anxiety. She would startle frequently when mom turned on the lights.
• Had frequent meltdowns and difficulties transitioning with activities. Had difficulties being in the school environment and had to switch to a private school. Sarah was given a diagnosis of Autism Spectrum disorder and Sensory processing disorder.
Treatment
I began seeing Sarah about one month before beginning this course. I first started with diet. Sarah was still consuming dairy products despite having the vomiting and diarrhea from milk. Mom was providing lactose free milk thinking it would help. After the first treatment session mom eliminated all dairy products from Sarah’s diet including the lactose free milk.
Sleep was the next area addressed. Modifications were made to her bedtime routine and screen time was eliminated after dinner time.
While both diet and routine helped Sarah in her ability to sleep, it wasn’t until the rhythmic movements [From the Brain and Sensory Foundations course] were recommended that we started seeing bigger changes.
Sarah showed signs of all of her reflexes [unintegrated as] discussed in this course.
Treatment integration first began with the Rhythmic movements [From the Brain and Sensory Foundations course]. Due to her high level of anxiety and previous rapport with me, we worked on the moro and fear paralysis [reflexes] next. Mom was very compliant and understanding of recommendations and so the isometric exercises were recommended at home. During treatment sessions developmental movements and play-based therapy were utilized with occasional integration of isometrics. We next addressed TLR [Tonic Labyrinthine Reflex] , STNR [Symmetrical Tonic Neck Reflex] and ATNR [Asymmetrical Tonic Neck Reflex] and then moved through the rest of the reflexes.
As Sarah became more comfortable at therapy we decided to try a 5-step balance process in order for her to be able to sit and eat lunch at school with her friends. Sarah was hesitant to participate in the balance process but opened up once she got going. When she first acted out her goal she required encouragement and was very shy. We participated in play and performed moro and TLR isometrics, the puppy stretch, as well as a lot of crawling games and a lot of swinging for vestibular input. Sarah did well with the re-patterning sequencing and only had difficulties with turning in a circle with cross crawl. When Sarah was asked to act out her goal she giggled, went and sat at the table and sat quietly with a smile on her face. She appeared much more calm and comfortable in her own body.
I was surprised by how quickly [Fear Paralysis Reflex from the [Brain and Sensory Foundations course ] was able to integrate and we were able to see improvements in anxiety and sleep. The Moro however took a bit longer. I felt that once these reflexes were integrated it was much easier to move through the rest of them. I chose to work on ANTR and STNR kind of simultaneously through the sessions and I felt that she responded well to that. I have seen a big improvement in her bilateral coordination and less hyperactivity as a result. The feet reflexes were the last to work on because while they were present, I felt the other ones were impacting her more. Sarah still shows only minimal signs of a plantar reflex now and is much less ticklish.
Conclusion:
I saw Sarah this last week and she is doing wonderfully! She makes great eye contact and is always super excited to see and greet this therapist (compared to the anxiety she used to have). Sarah now goes to bed and falls asleep at a normal hour, sleeping in her own bed, on her back and sleeps through the night. Because of this we have seen improvements in her behavior and regulation during the day. Sarah is doing wonderfully at school (She is still in summer school). Teachers have noticed a huge difference to the point that they have made comments to mom. Sarah is able to stand up in front of the class, state her name and participate in group activities without anxiety. She is now able to sit and have lunch with peers without any difficulties and is no longer bothered by smells. Sarah no longer startles with loud noises or light and appears much more calm in her body and her environment. Mom states that although she has an extreme sense of smell and hearing, she seems less bothered by it. Sarah is now a much happier child and able to engage with her environment without anxiety, tantrums, or over stimulation. Sarah is doing so well that we are planning to discharge soon!
[Edited for length and clarity; emphasis added]