OT in statement - has anyone got sensory integration provision

[loueytbg]

Has anyone successfully got sensory integration treatment in their DC's statement??? We have a good report stating he needs weekly OT and sensory integration therapy. The LA are saying that if he needs treatment offsite, then its not an educational need. He needs vestibular stimulation with swings etc which cannot be provided in schools (and certainly not in his current nursery). My argument is that without it, he can't sit still and his attention span is very poor. Plus he will try and escape - can't see why that is not an educational need.

I have said that I thought some LA's paid for children to have SIT off-site but she had never heard of that before. I am going to speak to his private OT to see if she can write (another) letter/report and the SEN officer has said she will take it to panel but I just thought someone might have experience of this.

I'm curious as to why you think that 'vestibular stimulation with swings' will improve his memory and help him to sit still.

There is no doubt that sensory integration helps my DS to stop undesirable sensory seeking behaviour and calm down enough to sit on the carpet and listen...sadly getting it written in to statement was impossible for us-it was enough of a struggle to get standard OT sessions built in (based on the educational need argument). We rely on DS 1-1 support carrying out aspects of DS sensory diet at intervals during the day...would be fascinated to know whether you win this one..

OT is a borderline educational need, unlike SALT - that's established in case law, so far, anyway. My son has OT in the Statement, in Parts 2, 3, 4 and 5, but for fine motor skills mainly, because his writing is so poor. This = educational need but SIT is more health-focused, I think. Sorry.

Neither-I am interested in what the op thinks and believes.

btw, my son did have NHS SIT which was very good for his gross motor skills and balance (and good for showing me what exercises to do with him) but I very much saw it as an extra.

moondog - he is sensory seeking (like oddgirls ds) and because his vestibular, auditory and proprioceptive systems are out of sync he seeks out movement at any opportunity. This means he doesn't sit still for very long and is distracted by every little thing around him.

Both his NHS and private OT have recommended doing some active work (vestibular or proprioceptive) before he has his focus time at nursery because it helps him to concentrate for longer. It also means he doesn't play (as much) with light switches, taps and doors because his senses are more in balance. In terms of getting vestibular input, the best things are swings although there are other bits of equipment that help (like trampolines for example). The only way to improve his vestibular sense is to provide movement which stimulates it (hence the sensory integration treatment). I probably haven't explained it that well (or possible entirely accurately) but you get the gist. So the only way to integrate his senses is via SIT and that will have a direct impact on his education and what he is able to achieve.

oddgirl we may end up having to go to tribunal - but if he gets into the ASD unit attached to the school then he will get OT on site. They have a fab sensory room with swings etc and an OT for 25 hrs a week. So it just shows they think it is necessary. We have to assume that he won't get in though hence my question.

We already have time in the statement for implementing a sensory diet and doing exercises as set out by the OT but sadly little to none actual OT time.

'The only way to improve his vestibular sense is to provide movement which stimulates it (hence the sensory integration treatment).'

How do you know this? I'm wondering how or/and why you came to this conclusion?

That's what the OT told us. Although we are doing some auditory integration therapy over the Christmas holidays and we've been told that might help as well.

Should have added moondog that by no means am I an expert in any of this so if you have some advice/knowledge feel free to post it.

I'm no expert either.
I'm a SALT and focus on those issues when I post here but I am very interested in O/T, work with some very good ones and research aspects of it because so much of it is relevant to the children I work with.

I have no wish to cast aspersions on what you feel works for you but I would point out that there is very little evidence for this sort of stuff (I attended a comprehensive review of O/T provision in an academic setting a few months ago).

Additionally, I have my doubts about programmes (of any sort) that involve a lot of expensive or out of the ordinary resources. Someone out there is getting very rich out of kitting out 'sensory rooms'.

If you want to imporve a skill, you need to do the skill you want to improve more. So if it is sitting still that is your focus, you need to practice that for increasing lengths of time. I can't get my head around the logic that recommends doing something completely different.

I had someone ask me the other day if Brain Gym would help with spelling. The way to improve spelling is to do more spelling. I like to run. I get faster if I run more.

Either way, the only way you will know if your chosen approach works is to have a baseline measurement before treatment and one after. I hope you can get the O/T to agree to this.

Moondog - my DS's vestibular and proprioceptive has been vastly improved by doing retained reflex therapy - which is essentially daily OT.

DS couldn't sit still before becuase he didn't know where he was and always felt like he was going to fall off the chair.

Now that we have improved his vestibular / proprioceptive systems he doesn't need to move, he can just sit still like everyone else.

If you can treat the underlying problem, that is vastly better than just training him to put up with the problem.

Brain Gym is also based on the same principles of retained reflex therapy.

If you found it works for you, then that is great.
I am pointing out that there is little evidence for these interventions.
This, combined with the fact that it may not be possible to attribute any perceived improvements to the therapy requested,means the chances of getting it on a statement are slim at best.

'Brain Gym is also based on the same principles of retained reflex therapy.'

What does 'principles' mean.
My kitchen is run on my culinary principles.

I've just had a look through Brain Gym's 'research review' on the website. It's a joke. A few unpublished Master's theses and artcles in their in house journal are not research.

It's important to ask questions and to demand the best for children with SN, based on sound scientific evidence.

The Brian Gym guy can also be heard in the background, tinkering with his cutlery while his 'research review' presentation runs.

We got OT written into Part2 and 3 of the Statement but nothing that you can really pin them down on. Eg. Impt that ds's sensory needs are catered for in a structured way to enable him to function in school in Part 2. Part 3 is just as wishy washy - all adults working with ds will be alert and appropriately responsive to his sensory needs. Deep pressure and whole body awareness activites will be freely employed etc etc.

However, got OT (NHS) to come into school and talk to teacher and said how important it was, that ds should have movement breaks between work eg. at least 3 times/hr. etc so that he can concentrate. Then I negotiated it into his IEP.

Am probably going to tribunal if I don't get placement ds needs for his education and think with above concession, I can probably push them for more. Unfortunately, NHS OT won't commit herself in writing to frequency. However, I think someone told me she got Sensory Intergration Therapy written into her ds's statement at the tribunal. She also paid for a solicitor and barrister for her tribunal though.

Its a fascinating discussion and all I can add (NOT an expert at all-just a mummy!) is that no amount of "practice" would have helped DS to sit still-I would liken that to telling a blind person"if you just practice seeing, I am sure you will be able to". ie for DS it is a PHYSICAL cause for his inability to sit still-hypermobile joints and low tone (diagnosed by a bona fide paed!). Therefore a behavioural approach just didnt work...my evidence?? A year of trying such techniques with timers/behavioural charts all to no avail. 3 months of sensory integration to improve feedback to those muscles? A child who can sit still. I am not disagreeing with moondog and can see why being taken for a ride is easy...I would still reiterate for me, sensory integration worked.

oddgirl our DS's sound very similar. DS1 also has very low muscle tone and hypermobility and some of the OT work has involved exercises which strengthen his upper body. I agree that for him, no amount of teaching him to sit still is going to work because he simply has to move around to sense where he is in space because of his proprioceptive difficulties. That coupled with his vestibular and auditory sensitivity means he doesn't really stand a chance of sitting still without therapy.

moondog I only really learnt about SIT over the summer so its all a bit new to me. However, DS1's portage worker had been saying for sometime that we needed an sensory trained OT and that most of his problems were caused by sensory dysfunction. Then his NHS OT referred him for SIT over the summer (first session this morning) without any input from me. So I had (maybe naively) assumed that if the NHS thought it was worth doing then there was evidence that it worked?? This morning at his first session there, DS1 was hyper and it took some time to calm him down but what did calm him down was bouncing on the trampoline (stimulated his vestibular and proprioceptive systems) and it was really very noticeable that after he bounced for 5 mins he was calm.

keepyourmouth we already have some reasonable wording in part 3 about how much OT he should have per week (but given by the TA). It is fairly specific because they actually took it from the independent OT's report. Unfortunately they haven't taken the wording about how much direct OT he needs, hence the current battle I'm having. Currently it just says that he will receive 4 sessions of SIT and then it will be reviewed. So the principle that they can put SIT in the statement is clearly not an issue. The problem is that those 4 sessions will be finished by the time the statement is finalised and I know we won't get any more SIT (or indeed any more NHS OT contact) unless its in the statement. Our current private OT has a contract with Berks schools to go in there and do OT so I am hoping that they can give me some advice about the best approach.

I think part of the difficulty with this is the language we use to authenticate it.

Why do we call it 'sensory integration therapy' and 'stimulation', etc?

Also, I think that we can view the same event from many angles.

So 'what did calm him down was bouncing on the trampoline (stimulated his vestibular and proprioceptive systems) and it was very noticeable that after he bounced for 5 mins he was calm.'

The premise there is "the trampoline stimulated his vestibular and proprioceptive systems; therefore he is calm."

But, you could argue that 'the trampoline was enjoyable, so he was able to focus after', or 'excercising for 5 mins expended excess energy so he was calm' or 'being quiet for 5 mins while trampolining cleared his mind and he was calm'.

The difficulty is that unless research is done, and by that I mean controlled trial, data driven research, then all you have got is theory, and speculation, which unfortunately for the most part earns 'specialists' a lot of money.

Excellently put Lougle.

It's an interesting issue isn't it though, namley which difficulties are caused (for want of a better word) by a deeper problem (often unresolvable) and which are maintained because of insufficient opportunities to work at addressing them?

Absolutely, Moondog.

To bring the thread back on topic, loueytbg, have you experimented with other movements that are more simple? Something like 'roly-polys' or floor-based activities? Have you observed what happens if your DS is asked to run backwards and forwards between two points for 5 minutes, for example? People tend to recommend what they know. But your child is an individual. You might find that the principle is an intense period of physical activity using gross motor skills, and that the actual activity is less important?

So, LAs don't like sensory OT cos it's expensive. The NHS is happy that there's little research as low evidence base means no obligation to provide. Various private providers are getting lots of cash for building sensory rooms.

In the meanwhile, those whose kids seem to have done well with sensory OT say that running, jumping, spinning, swinging, bouncing, being massaged, tickled, blown on, and encouraged to do messy activities has enormous benefits. And these generalise to other areas.

So why do we need a statement specifying sensory OT for schools to do what a good pre-school (or your gran) would consider cheap, effective and readily available?