Shotgun Therapy

I don’t shoot [Texan for handle guns]. But despite my urban upbringing, I know the difference between a rifle and a shotgun. A rifle shoots bullets. A shotgun shoots, or rather sprays a load of little pellets called shot (held in the cartridge by a wad - hence the saying that translates to using up all your resources…..I’m just sayin’…).

Sometimes it looks like a therapist just throws every technique and known-trick at a particular child – bang! 

Bang! 

Bang! 

And the child is covered in a weighted vest swinging on a bolster while an adult tries to rub a plastic surgery-brush over his forearms – shot all over the place.

Devotees of therapy to integrate the sensory systems of children with many (nearly every ambulatory) diagnoses will not like my implication that sensory integration therapy is implemented in a shotgun manner. Still, I’ve seen it many times, maintaining my skepticism for near-30-years.

A. Jean Ayres and her theories were cutting-edge when I was learning to be an OT. Well before her death  in 1988 and the formation of Sensory Integration International I was learning what was known as the Ayres Battery of tests for sensory integration. Conceptually her theories reinforced how the brain works and supported learning the intricacies of perception, response and emotion.

Briefly, if a child under-responds or over-responds to certain sensations or circumstances, she might be considered as having a sensory integrative disorder.

Here and there, I’ve gone to reference a particular question or principle of SI – tactile defensiveness, for example. Recommended SI treatment – deep pressure, joint compression, and vestibular stimulation. And then there’s the recommendation for the child who is constantly seeking tactile input – touches everything. Recommended SI treatment – deep pressure, joint compression, and vestibular stimulation.  Ahem.

I’m certain there is science – anatomy and physiology – that explains the changes seen in children who receive sensory integrative therapy. It’s not voodoo therapy.

A marginal amount of published research supports the effectiveness of SI therapy.

All the fun stuff – the swinging, the compression, the tactile stimulation – it just looks so good, everybody has got to have some! And that’s where I think a lot of SI therapy becomes shotgun therapy.  Easy to believe in, too. 

“Most of us have sensory issues.” Straight from a horses mouth [Texan for a valid reference].

I am mindful of my patient’s responses to sensory experiences, and I modify my treatment accordingly. OTs more-often get the sensory nuances of a child’s behavior than PTs. Powerful sensations are felt and potentially organized during movement. I believe in movement, er, exercise, near-same thing.

That part of Ayers theory that promotes the child selecting and controlling the sensory input they experience – that’s the powerful part of Ayers theory. Damn empowering for the child. The passive sensory techniques are worthy of a small part of what is effective in my book.

I see much less risk of harm in SI therapy than in chiropractic. The harm is in believing in something over a long period of time when in fact it may be less effective for your child than something else, or only better than nothing.

Better than nothing….a most-hopeless place for a parent of a child with a diagnosis. The parents in this place – I leave them there. I do not try taking away their hope after I offer them what I know, but I move-on myself.

I’m not above a bit of shotgun therapy myself, on occasion. The most-shotgun-technique I use is water, pool therapy, aquatic therapy. Sure I can be specific for requiring certain important movements in a pool, but why? Just being in the water brings into play all sorts of science – physics and biology combined – to make movement new, challenging, strengthening and, perhaps most important of all, fun. So I’m recommending swimming to every parent every summer that is no more specific than do all in the name of safety and fun.

Splash! instead of Bang! And be careful where you shoot your wad.

Comments

[mommy`dearest]

Excellent post, Barbara. My son has been a participant in the Wilbarger brushing protocol, as well as a barrage of other sensory techniques- mainly because if I didn't agree to them, I was considered a "non-compliant" parent.

I will say that he has shown marked improvement with a weighted/pressure vest, but it's only when he's receptive to it. It's like he knows when he needs that type of intervention/feedback, and I feel it's my duty as a parent, to listen to what he feels he needs. Many people think that makes me a lax parent, but spend a good amount of time with me son, and it's obvious he runs the show for a good reason.

Nice to hear a different approach on the topic.

Cheers!

[Trish @ Another Piece of the Puzzle]

We are just getting our son into swimming this summer now that he is potty trained and he is starting to love being in the water. We have used various sensory techniques with him, and the most effective things for him are jumping or sometimes he asks for a big squeeze hug!

Thank you so much for your comment on my birthday party post at 5 Minutes for Special Needs.

[aline]

That is really interesting actually, a lot to learn from your blog I say. I like the water therapy, it makes sense. I'd like to get into that myself, we all could use a little help. Not to mention, water brings out the kids in everyone!

[Stacey Harris]

I liked reading this post, I have been once again thinking about finding a weighted vest or blanket for my son... I just need to find somewhere I can try them out with him... to find what works...so I buy what fits his needs and not my "ideas" of what might work.