Lilli Nielsen, Jan van Dijk, and Jean Ayres - 3 Great Gurus and What I Have Learned From Them

1. Lilli Nielsen, Jan van Dijk, and Jean Ayres - 3 Great Gurus and What I Have Learned From Them David Brown Educational Specialist California Deaf-Blind Services San Francisco State University The contents of this PowerPoint presentation were developed under a grant from the US Department of Education, #H326C080009. However, those contents do not necessarily represent the policy of the US Department of Education, and you should not assume endorsement by the Federal Government. Project Officer, Jo Ann McCann.

2. Common to all 3 gurus Child focused Child led Hands off Meticulous observation Meticulous interpretation Focus on guaranteed success (but with a challenge) Focus on the child’s positive self-image & self-confidence Recognition that sensory functioning depends upon many issues Opposed to received opinions of the time

3. Everyone can learn Active Learning is hands off Auditory primacy Work up to weight bearing Responsive environment Mix variety and constancy Emotional development involves mastery Learning by repetition - allow to fail Talk & reward at the end of play Limit input, wait for response 10 Basic Principles of Active Learning

4. My take on Active Learning & Lilli Nielsen • Hands off • Focus on self-image & self-esteem • TIME! • Close observation of the child • The concept of changing the environment to help the child to change • The concept of the Little Room and (especially) the Resonance Board • The concept of developmental stages in spatial awareness

5. Useful Websites • www.lilliworks.com • http://nationaldb.org/dbp • http://www.tsbvi.edu/outreach • www.visionkits.com

6. “Sensory Integration” means… • A neurological process • A theory developed by Jean Ayres • A treatment approach developed from Ayres’ theory

7. Jean Ayres defines Sensory Integration(1989) “..the neurological process that organizes sensation from one’s own body and from the environment and makes it possible to use the body effectively within the environment. The spatial and temporal aspects of inputs from different sensory modalities are interpreted, associated, and unified. Sensory integration is information processing…The brain must select, enhance, inhibit, compare, and associate the sensory information in a flexible, constantly changing pattern; in other words, the brain must integrate it.”

8. Ayres’ theory That the environment has a crucial impact on brain development, that the brain changes in response to external stimuli, and that experiences resulting from sensory inputs and the child’s responses to them affects brain development.

9. ‘A sensory integrative approach to treating learning disorders differs from many other approaches in that it does not teach specific skills… Rather, the objective is to enhance the brain’s… capacity to perceive, remember, and motor plan… Therapy is considered a supplement, not a substitute to formal classroom instruction… ‘ Jean Ayres, 1972

10. Examples of behaviors indicating possible sensory integration dysfunction in children with deafblindness (1) • repeatedly seeking strong stimulation through particular sensory channels. • sensory defensiveness. • abnormally low or high pain thresholds. • apparent variability or inconsistency in sensory perception abilities. • unusual postures. • distractibility.

11. Examples of behaviors indicating possible sensory integration dysfunction in children with deafblindness (2) • disturbed sleep patterns. • problems with regulating arousal levels. • postural & gravitational insecurity if moved by others, but pleasure in rhythmic movement. • inconsistent or inappropriate use of pressure when grasping, tapping, kicking etc.

12. The specific objectives of sensory integration therapy are: (Karen Nagel) • To achieve an alert, calm state. • To promote the organization of the Central Nervous System. • To enhance the child’s ability to regulate and adjust the sensations from their environment. • To increase conceptual development.

13. Key principles of Sensory Integration Therapy • The Just Right Challenge • The Adaptive Response • Active Engagement • Child Directed

14. Brushing Rhythmic joint compression Deep tissue massage Vibro-tactile input Objects to chew Sucking and/or blowing activities Textured bed sheets and/or heavy bed covers Lycra clothing or sleeve Swinging (forward & back or side to side) Rocking (forward & back or side to side) Weighted clothing Possible suggestions may include…

15. Sensory Issues Information may be missing, partial, distorted, or fragmented Over-sensitivity &/or under-sensitivity Processing time may be very extended Confusion & the need for consistency & predictability But…..think about consistency versus variety Fatigue Communication issues (receptive & expressive) Movement & postural differences Idiosyncratic behaviors & misinterpretation Developmental delay

16. The Senses and Deaf-blindness When there are multiple sensory impairments, it is important to consider the impact on the child’s: • Self-awareness • Body-awareness • Voluntary movement abilities • Health (especially pain and discomfort) • Attention • Memory, Prior Knowledge • Intentions, Tasks, Goals • Motivators • Emotion and Behaviour

17. “After air to breathe, postural security is our next most urgent priority.” Jean Ayres 17

18. Three important concepts • Sensory modulation, enhancing, inhibiting • Sensorydiet • Level of arousal

19. The 9 levels of arousal(Carolina Record of Individual Behavior) • Uncontrollable agitation • Mild agitation • Fussy awake • Active awake • Quiet awake • Drowsy • Active sleep • Quiet sleep • Deep sleep

20. [Self-regulation]… “is defined as the capacity to manage one’s thoughts, feelings and actions in adaptive and flexible ways across a range of contexts” Jude Nicholas, CHARGE Accounts, Summer 2007

21. Distance Senses Vision Hearing Smell Near Senses Taste Touch Vestibular Proprioception The Senses

22. My take on Jean Ayres & Sensory Integration theory & Therapy (1) The constancy & inter-relatedness of sensory inputs The senses connect the brain to the body Sensory inputs have a significant & direct impact on arousal levels Some senses may be more important than others Most children with deaf-blindness are not in touch with/do not feel their bodies very well

23. My take on Jean Ayres & Sensory Integration theory & Therapy (2) We all self-stimulate (all the time?) to maintain alertness, to wake up, to calm down, to maintain postural control, to keep/get comfortable, to occupy our minds, to self-regulate, to fight boredom, to maintain attention, to keep sane, and generally to improve our functioning to achieve our goals Sensory deficits and poor sensory perception make children with deaf-blindness self-stimulate in mostly normal ways – but often with more intensity, more persistence, and for a longer period of their lives than “normal”

24. My take on Jean Ayres & Sensory Integration theory & Therapy (3) For various reasons children with deaf-blindness may have poor social awareness, so self-stimulation behaviors may be more obvious Attempts to stifle and stop self-stimulation behaviors may result in worse self-regulation and generally less good functioning Observing how and when a child self-stimulates will offer invaluable insights into who they are and how they work, for assessment, teaching, behavior management, and relationship building

25. “Communication, communication, communication”

26. McInnes & Treffry Deafblind Infants & Children 1982 Communication can be summed up as our attempts to obtain information from and impose order upon the world around us

27. Communication with one’s own body ∨Communication with one’s immediate environment∨Communication with the wider world

28. Jan van Dijk (1966) “In the educational atmosphere I describe, the child holds the central position, the teacher ‘follows’ the child and, when the child responds, the teacher is present to answer the child’s request”

29. Van Dijk & Nelson “Principles of Assessment” (2001) • Make the child at ease • Determine the child’s bio-behavioral state • Determine the child’s interest • Follow the child’s interest

30. Van Dijk Approach to Assessment • Child-guided • Fluid • Looks at the processes children with multiple disabilities including sensory impairments use to learn & develop • Assessment is summarized in terms of strengths and next steps for intervention

31. Areas of the Van Dijk Framework • Ability to maintain & modulate state • Preferred learning channels • Ability to learn, remember & anticipate routines • Accommodation of new experiences with existing schemes • Problem solving approaches • Ability to form social attachments and interact • Communication modes

32. Assessment Questions D Brown “Follow the Child” (1997/2001) • How do you feel? • What do you like? • What do you want? • What do you do?

33. Van Dijk & Nelson “Principles of Assessment” (2001) • Make the child at ease • Determine the child’s bio-behavioral state • Determine the child’s interest • Follow the child’s interest

34. Van Dijk Approach - Evaluation challenges • No prescribed protocol • No specific implementation order • No set of testing materials • Each assessment is unique • No set interpretation scale

35. Van Dijk Approach - Quality indicators • Respecting the caregiver • Respecting the child • Following the child’s lead • Communicating with the child • Utilizing turn-taking routines • Creating of enjoyable routines

36. Van Dijk Approach - Fidelity • Utilization of stop-start within routines • Adding a mismatch with expectations • Returning to established routines in order to examine memory • Creating situations that allow for problem-solving • Utilizing varying sensory channels

37. My take on Jan van Dijk Follow the child Observe Identify & use motivators Time & pacing Credit behaviors with meaning Respect and seek the opinions of others The conversational approach The child’s preferred modes of communication BUILD relationships

38. This is normal viewing posture… …when you have no vestibular sense, upper visual field loss, poor tactile & proprioceptive perception, & low muscle tone.

39. davidb@sfsu.edu