IM training, Loading and SPD

Question:

I am an SLP doing vision therapy and I am fairly new to IM. I have a patient whose scores initially were not bad (Both Hands – 172ms). Her scores are now in the 20s and 30s, which is great, but I’ve noticed that I have to place heavy cognitive loads on her to get the good scores. She has ADHD characteristics and at the beginning of vision therapy I could not even get her to attend to our vision activities so I started doing mostly IM in our sessions. Her scores dropped the most when I put her on a very challenging balance board; then, I flashed pictures at her to name. Since then, I load with heavy balance, visual tracking and whatever else I can think of.

Unfortunately, what I find now is that this level of loading no longer keeps her attention; she needs more novelty and more loading to keep the good scores. She does great with background distractions. The problem is that I have run out of ideas to put more cognitive demands on her. She is so distractible that if I’m not loading her constantly, she is off task and looking around the room. I haven’t experienced this with any other patient. Maybe this is all normal, but I’m not sure when to dismiss or what to try next. I think there has been some improvement in her distractibility at home (not sure about school) but not a great deal. She’s had a total of 16 IM sessions, with 6 sessions of 20-30 min and 3 sessions of over 30 min. I’d appreciate any insight.

Answer:

You may find this research paper applicable to this and other clients in your practice:

Sensory Integration, Sensory Processing, and Sensory Modulation Disorders: Putative Functional Neuroanatomic Underpinnings

These suggestions for your client from an OT trained in sensory integration may also be helpful:

If your client needs loading to participate and integrate the IM related information with attention, I think you need to pinpoint which sensation is providing her “modulation.” Based on your reporting, I would say that it’s either proprioception, vestibular stimulation or a combination of both. Either visual or auditory stimulation is contributing to her inattention and distraction, or both perhaps. To help integrate the visual and auditory processing I would try and isolate the modulation activities. Try the following in isolation or together:

Proprioception:

1. Wrist weights
2. Weighted book bag
3. Medicine ball or other heavy object to carry

Balance:

1. Standing on one leg
2. Try standing on one and hitting their side with her opposite hand
3. Sitting on a ball or standing on a trampoline
4. Try some IM prep with loading; yoga (sun salutation)
5. Try some inversion – hand stands or rolling over a ball backwards
6. Brain Gym; Cross crawls – right elbow/left knee, then left elbow/right knee