CLINICAL TREATMENT STORIES
The Manual for the Sensory Connection Program contains many stories that demonstrate the effectiveness of sensory activities. Since there was not enough room for all of the powerful stories collected over my years of practice I decided to post some of them on this website. All of the activities used in this clinical story are described in detail in the Sensory Connection Program Manual and Handbook.
Carlos's Story
DEMONSTRATING THE POTENTIAL OF A SENSORY BASED TREATMENT APPROACH WITH PROBLEMATIC BEHAVIORS
This story demonstrates the effectiveness of a sensory approach with a client admitted to our Adult Psychiatric Developmental Disabilities Unit due to problematic behaviors and placement difficulties.
Carlos came to this country with his mother when he was about 6 years old. He was diagnosed with Autism and his mother had been diligent in learning about his condition, and she had developed marvelous ways to handle his behaviors. When he became a teenager he resided in a group home but visited his mother every weekend. One day his mother was assaulted by a group of teenagers who left her for dead; she ended up in a coma. Carlos could not understand why he was no longer able to go home on weekends. He began to be very assaultive. His behaviors were so difficult to manage that he was transferred to a hospital and eventually to a program that used "aversive therapy" to deal with problematic behaviors. Each behavior that was considered inappropriate was punished. His mother came out of the coma and was finally allowed to visit him during the excessively restricted visiting hours. He was dismayed by her at first because she was so severely disfigured. His behaviors were becoming increasing worse. The facility wanted to transfer him to a more intensive level of behavior management. Despite her compromised cognitive capacities due to head injury, his mother realized that this particular treatment approach was not working for her son. With the help of a lawyer she was able to secure a place for him in another facility. Before admission the facility wanted him evaluated. Carlos was transferred to our Acute Psychiatric Developmental Disabilities Unit.
Our staff found this young man engaging and very manageable. He did indeed have little hand to mouth rituals and was easily upset. He responded well to the quiet predictable environment and to calming sensory input. According to our occupational therapist he had many sensory issues and she began doing some brushing and other sensory interventions that he tolerated well. A rocking chair was brought to his room but he resisted using it. With great encouragement he began to use it to rock and calm himself. Rocking had apparently been a behavior that was punished as part of the aversive therapy. His mother was so happy to be able to spend time with him that she would cry. During one visit he started to escalate a little so she put him in a body wrap by crossing his arms in front and holding his hands tightly at his side. He immediately calmed down. She intuitively used a strategy that our staff uses to calm agitated patients.
Carlos stayed on the unit for almost two weeks. There was only one small incident of problematic behavior. Our therapist was able to contact his new facility to make arrangements there for the occupational therapists to continue her work with sensory interventions. He was transferred without incident. It is unknown if the therapists were able to follow through with the recommended treatment.
ANGELA'S STORY
Demonstrating the Need to Treat the Body Before the Brain
When patients are totally disorganized and non-functional, therapy must begin with concentration on the body and physical responses.
We had a nineteen-year old college student come to our acute mental health unit with symptoms of severe psychosis. Angela was one of the sickest individuals I have ever treated. Initially she was so psychotic and confused that she could not even organize herself enough to go to the bathroom. She would just sit and stare at her food. She would become upset and shake her head if we tried to take the food away, so we knew she was hungry. For almost a week we had to hand feed her. She was labile and agitated and would wander out into the unit where she was very vulnerable. Consequently she was put on one-to-one supervision, meaning a staff person was assigned to be with her 24 hours a day.
Her parents were frantic. Days before the admission, their child was an active college student who worked hard to keep herself on the Dean's List. She was a young lady with many friends who called her regularly to discuss activities and boyfriends. Angela was independent and tried to support herself in college by working as a waitress. She came home every other weekend, and it was late at night on one such weekend that the parents found her crying, screaming, and hallucinating. Not knowing what else to do, they brought her to our hospital Emergency Mental Health Clinic. She was admitted soon after to our unit.
I went to Angela's room several times a day to try to establish a therapeutic relationship with her. She just looked at me with wild frightened eyes. Her mumblings were incomprehensible. I just sat beside her and acknowledged her fear while assuring her that we would take good care of her.
For the first few days the only people to whom she would respond were her parents. They were supportive albeit frightened and upset seeing their daughter in such a state. They took turns being with her for most of the day. They liked to walk her around the unit. At first staff members were skeptical because clients on one-to-one status are usually room restricted. I felt she needed the physical stimulation of walking as well as the cognitive stimulation of the unit milieu. The treatment team agreed to let her continue with her walking routine.
It was almost a week before I could even approach Angela for treatment. At that point she had some recollection of being a college student and that she worked as a waitress. Responses were still slow but intelligible. She agreed to try some beanbag tapping but wanted to tap herself. We threw the Koosh around for a while as I slowly increased her need to move around in order to catch it. As she sat on the bed I taught her foot flexes and several other exercises out of the music and movement routine. I hoped that by introducing her to these movements she would tolerate the group more easily. We did some Exercise Band Rowing together. It reminded her that she had been on the crew team.
It took a while for Angela to relax and smile. Her mother commented that she almost cried when Angela smiled; she was afraid she would never see her daughter smile again. Angela's strength was poor, as was her ability to pay attention. I had to keep reminding her to pull or tap harder. When I talked with her mother after the treatment session, her comment was, "Such simple things, and yet I can see the difference in her." I left the mother with the Koosh and encouraged her to toss it around with Angela several more times during the day. I also asked her to do some foot flexes with her. Besides the fact that it was good for Angela, I wanted the parents to feel that they were helping with their daughter's treatment.
The following day when I started out treatment by tossing the Koosh, Angela was able to communicate to me that she had been tossing it around the night before with her sister. Again we performed some of the exercises from our group movement routine. After our treatment session, she sat at her table with her breakfast and actually opened all of the cartons and sliced the bagel.
That afternoon she went quite willingly to the Sense-ability Group. I sat right beside her in case she had difficulty but she tolerated the group very well. She followed the movement routine completely. During the beanbag tapping she tapped with out cueing and with good intensity. She engaged in the target games and was able to name two other participants at the end of the name game. The skill building activity was purposely simple and she was able to take her turn appropriately. When the group was over, I asked her if she enjoyed it and she nodded her head yes. She continued to progress nicely and was attending two groups by the next day and all four groups by the end of the week when she was discharged.
Clearly Angela's treatment needed the initial emphasis on physical activities due to her primitive state, lack of body schema, and total disorganization. Her story exemplifies the usefulness of a Body-Mind approach, when the brain is severely compromised fortunately the body can be used to mend the mind. Not all of Angela's progress was due to her sensorimotor treatment. She was also starting to respond to her anti-psychotic medication. I do believe the sensory activities brought her to a functional level more quickly. Activities that provided strong sensory input such as beanbag tapping and exercise band rowing helped to organize Angela and helped to orient her to her own body. The simple activity of throwing the Koosh ball helped orient her to others and to her environment. Because she was more oriented, she was less frightened and labile. Through the carefully orchestrated activities of the Sense-ability Group she was able to graduate from movement activities to target activities and on to socialization and simple problem solving activities.