Sensory Processing Screening Tool for Physical Therapists: A Case Study
As I began my busy week of physical therapy treatments this week, a baby and her mother came in for her third PT session. We will call her Sarah. Sarah is a 6 month old baby that came to me because there was a concern regarding head position and neck tightness with a preference for looking to one side. After the initial evaluation, I established she has a grade 2 congenital muscular torticollis (CMT) on the right. We began with some positioning, parent education for a home program, and manual therapy. She presented at the second session with significant improvement in her range of motion and resting posture and we progressed her therapy to include some developmental sequencing and improve her tolerance for tummy time. On Monday morning, Sarah demonstrated obvious improved CMT symptoms. However, mom expressed that she feels Sarah is stuck and cannot move. I began playing and moving her and attempting to facilitate rolling, side lying, and transition from sit to prone. Here is what I noticed…..
This baby presents with hypersensitivity to vestibular stimulation. How do I know this? And how will I treat this?
First, a basic understanding of sensory processing disorder (SPD) and its classification and categories is essential. SPD can be categorized into modulation disorder, sensory-motor disorder, and discrimination disorder. Visit the STAR Institute website to learn more about the evidence-based terminology we should all be using to address this disorder. https://sensoryhealth.org/ There are wonderful resources for professionals and therapists that include checklists and recent research on their site. As a physical therapist, I often see kids that present with sensory-motor disorder, which presents to us as postural insecurity and fixing patterns, clumsiness, poor motor planning, core weakness, poor balance, or decreased coordination. These are common to us as PT’s and we recognize them and often intervene appropriately. However, the modulation disorder is often missed by physical therapists, and babies presenting as this baby presented are good examples of why it is important to understand this category of SPD as a pediatric physical therapist. I have developed a screening tool to help identify these children. I will share the tool in this blog.
Sarah was stiff in her extremities while sitting. She resisted rolling by arching her back and refused to move her head from supine to side lying. When forced to roll, she cried and looked scared. When I attempted to help her transition from sitting to prone, she pushed back and seemed to have a protective reaction as if she was falling. Her body stiffened and she cried with position changes. She did not feel comfortable in supine or side lying and preferred to just sit or be held upright. I then proceeded to pick her up, rock her gently in different positions while holding her tight and keeping her feeling secure. I also put her on the platform swing while sitting and then in a prone position and swung her in a linear motion. I moved her in my arms into supine and side lying while rocking and swinging her. I sat her on my lap and tilted her in all directions while holding her tight. Following 20 minutes of vestibular stimulation, Sarah was more comfortable in supine, allowed me to roll her to side lying, and began to enjoy the transition from sit to prone and quadruped. I instructed mom in a home program rich in vestibular stimulation and head position changes.
Sarah clearly was defensive or hypersensitive to changes in head position. If I fail to recognize this piece of her presentation, I would find Sarah crying and stiff throughout our course of physical therapy. We would most likely encounter an obstacle to her motor development. Learning to identify this is crucial for all physical therapists in pediatrics. Kids and babies that do not move a lot often become over sensitive to movement due to lack of experience and possibly the presence of an immature vestibular system. It is important to incorporate these principles into physical therapy intervention early on. Below is the sensory screening tool I developed and we use in practice at Dynamic Solutions to identify these kids and babies. A well trained physical therapist is able to incorporate some treatment of the vestibular sensitivity into her sessions or refer to a sensory trained therapist if needed.
If a baby you work with or your own baby feels stuck and avoids or resists movement consider the sensory processing aspect of her development and sensory-motor system. Learn to identify and treat keeping this in mind. Educated parents about the importance of movement in general and how to help all families facilitate typical movement in their children in fun and safe ways.
Please contact me at firstname.lastname@example.org if you have any questions or need additional information regarding your child or a child you are treating. Below is the screening tool I developed. I have also linked another checklist and a guide to subtypes, I use from the Star Institute of Sensory Processing.
Sensory Processing Screening Tool for Physical Therapists
- The child demonstrates an overall resistance to movement or motion sensitivity and/or does not transition from position to position easily, may include a resistance or fear of head position change and orientation/ refuses head in the back position or upside down. The child may present with stiffness.
- The child does not tolerate physical handling and touch easily, may include grooming and daily care or being held by others not including the primary caregiver.
- The child avoids certain touches and textures.
- The child appears sensitive to noise or has difficulty with filtering auditory stimulation.
- The child appears sensitive to visual stimulation, may avoid eye contact and/or has difficulty staying regulated or attentive within a visually stimulating environment.
- The child does not actively engage with others, his environment, or toys and appears to have low endurance and low arousal for playing and activity.
- The child appears over aroused and in constant motion or cries and emotionally over reacts frequently.
- The child and caregiver struggle with feeding.
- The child is delayed in development in any area.
A score of 1 or 2 warrants monitoring and further observation during physical therapy sessions. A score of 3 or more requires further assessment, inclusion of sensory integration techniques in therapy or referral to a qualified professional for further assessment. The physical therapy intervention approach and plan of care should include some sensory goals and interventions with a score of 3 or more.
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