Belief Makers

written by Rita Gendelman

Labels: rita gendelman, sensory. singing bowls

The importance of the vestibular system and its proper development cannot be emphasized enough. The vestibular system plays a critical role in our ability to be able to stand up right while safely and effectively moving through space. It is one of the very first systems to develop in utero and is fundamental to all future physical development. As human beings we are able to relate to the pull of gravity via the vestibular system and thus have power over our bodies and the surrounding physical environment.

The vestibular system as it pertains to all of the other systems in our brain plays a very similar role like a conductor to an orchestra. It is considered to be the orchestrator because it has its "fingers" or in other words neurological connections to all the other parts of the brain. Therefore all the other sensory systems (ex. touch, ears, eyes, proprioception- as it relates to body map, position, muscle force) must first match up with the messages of the vestibular systems upon taking further actions in order to function effectively.

All learning in the first fifteen months of life is centered on the vestibular system development. Our ability to maintain a sense of balance while sitting, walking, running, jumping; be able to tell a difference between specific sounds of a letter; and thus understand the different words that create our language; be able to use our eyes in relationship to the movement of our bodies is highly dependent on the proper functioning of the vestibular system.

Several factors may contribute to the disturbances in the vestibular system such as:

• Frequent ear infections
• Allergies
• Having been "shaken" as an infant
• Over growth of yeast
• Congenital birth defects
• Viral infections
• Lack of movement exposure in early stages of life

Children whose vestibular system is underdeveloped often become over-active or under- active thus have difficulty to focus, concentrate or pay attention. One of the major functions of the vestibular system is to be able to keep an appropriate level of alertness and organization in order to be ready for learning.

Labels: all blogs, autism, rita gendelman, vestibular system

As an occupational theapist, I have been working with special needs children, especially children with autism, for the past 7 years. A large part of my treatment is geared toward helping parents gain a deeper understanding of how to help their child. During this process of training the parents I am very often confronted with questions such as "Why do you think Autism exists? What is the root of the problem? What is the best way to help my child?" I always say the answer to this question is as diverse as the number of practitioners working with children on the spectrum. However, I do hold a perspective that allows my personality and a piece of my soul to express itself as I work with each precious child.

Much research has been done in an attempt to understand the root causes of autism. Thus far no concrete results have been found to explain this phenomenon. My perspective is two fold, which binds the spiritual and the physical realm of understanding on how to best approach a child with autism. When speaking about spiritual awareness and autism I am referring to an unconditional love and total perfection for the human soul. Secondly, when working with these children, I place a lot of emphasis on the crucial role the physical body plays in our development as human beings. I would like to share an excerpt from a book called "The Soul of Autism" by William Stillman, which further defines the importance of combing the spiritual and physical realms when putting the pieces together in relationship to these special children.

"In this particular passage, my dear friend Michael, then 15 years old, discusses his perception of being in the world as an autistic, what he defines as a whole soul being in a broken body as opposed to the commonest incarnation- a broken soul, in a whole body." Page 29

The above passage perfectly underlines the perspective I hold when working with autistic children. The notion of "A whole soul" allows me to see the perfection of the child and sets forth the possibility of a deep and loving relationship in the present as well as for the future, which we will both create. Furthermore, this attitude allows me to see the child as a direct contributor to his own growth and evolution.

Now I would like to say a few words about the physical reality, which is our bodies, and its relationship to children with autism. When the body is not synchronized with the functions of the brain and there is no damage to the neurological structure present, the resulting factor is children who exhibit the behavior we have come to know as autism.
The child’s inability to relate to the body and use it efficiently and effectively becomes an underlying factor that deeply influences all other areas of development. Here is an excerpt from a book called "Smart Moves" by Carla Hannaford who further explains the importance of the brain-body connection in relationship to our function as human beings.

"Thinking and learning is not all in our head. On the contrary, the body plays an integral part in all our intellectual processes from our earliest moments in utero right through to old age. It is our body’s senses that feed the brain environmental information with which to form an understanding of the world and from which to draw when creating new possibilities. And it is our movements that not only express knowledge and facilitate greater cognitive function, they actually grow the brain as they increase complexity. Our entire brain structure is intimately connected to and grown by the movement mechanisms within our body." (Pages 15-16)

We all have our own understanding of how to best help our children. I have shared my own way and continue to gain a deeper understanding every moment that I spend with an autistic child on the best way I can nurture the human soul, which is the essence of an autistic child, who wants to fully experience the sensation of a physical world.

Labels: all blogs, autism, rita gendelman

I am very excited to share with you my recent experience with a 12 year old autistic boy whose name is Kyle. Kyle is very unique. He is unique in regard to the sensitivity of his senses. He intensely reacts to smells, light, noise, touch and seeks lots of opportunities for movement. His heightened sensitivity affects Kyle's behavior in many different ways. One of the ways in which it impacts his behavior is expressed by his extreme vigilance and avoidance of people, objects and any new situations.

Through out the past 6 months my interaction with Kyle has been very limited, especially in the area of touch. Because Kyle is so defensive in the way he perceives touch sensation he is much more comfortable with touch input that he is fully in control of. In order to give him full control I have brought materials of different textures that he can explore on his own. I as well brought a vibration pillow and placed it in his favorite corner in order to expose Kyle to a variety of touch sensations. I am very happy to say that he has been experimenting more then ever with all the textures however he has still been very resistant to having me place my hands on his body, until yesterday.

Yesterday, when I walked into Kyle's playroom he was demonstrating his typical behavior. He was curled up in a ball on his bed while peeking at me from under his hands. I decided to play a peek-a-boo game with him since he was pretending to hide his face from me. As I was playing the peek-a-boo game Kyle began to smile and suddenly sat up on his bed with his feet hanging down. At this time he was much more open and connected to me in comparison to the beginning of the session.

So I decided to use the peek-a-boo game to transition into a game where I can touch Kyle's feet. I pretended that his toes were hiding from me. He loved the idea and kept smiling while wiggling his toes as I pretended to look for his toes all over the room. The sillier I became the more fun Kyle was having. Since we were so connected I decided that it would be a good time to finally find his toes as part of the game and start touching them. So I did just that. Bingo, Kyle was very accepting of my touch and gave me both of his feet to massage. After massaging his feet for some time I then asked Kyle's permission to touch his head, which he was very open to. I propped my self up behind him and asked Kyle to place his head on my lap. I was able to message his head for about 15 minutes. My next step was asking Kyle to allow me to touch his face. To my surprise he was opened to that as well and even pressed my hand into his chin with his hands. I was able to massage his jaw line and his lips for approximately 5-7 minutes. It was such a great experience. I felt his whole body fully relaxed and trusting of my touch. This was truly a miracle for a child who does not feel comfortable with any type of touch sensations.

As I was leaving, his mom knowing that I like apples offered me a nice green apple as I was heading out. Suddenly, Kyle ran up to me and whisked the apple out of my hands and vigorously started to lick it. I was very amused by his behavior and decided to let him have the apple since he seemed to really enjoy it. As I got home that day I found an email from Kyle's mom stating that he ate the entire apple by him self without having to cut it into little pieces. She said this was the first time he has every done that. She also attached a beautiful picture of him eating the apple with such joy in his eyes.

Writing this article I started thinking from a standpoint of an occupational therapist about the power of our jaw. First of all, the jaw and our mouth is one of the best connector points between the head and the body. It is very important to note that. Most of the children who have autism have difficulty organizing incoming sensations, which creates lots of chaos in the brain because the signals are not send to the appropriate place for processing. This makes it very difficult for the child to use their body effectively. Providing deep pressure touch/message to the jaw/mouth will open up channels of communications between brain and body. This type of input will allow the child to feel the muscles of his mouth and jaw, thus help with speech production, chewing, biting on hard foods, and allow for brushing of teeth for those children who are defensive to being touched in that area.

 As in the case of my little friend Kyle, giving him that extra sensation into his mouth, jaw area allowed him to connect and become aware of that area. Therefore, he was able to feel the muscles of his mouth and use them effectively for the first time to eat a hard big apple.

Labels: massage, occupational therapy, rita gendelman

As an occupational therapist I am very blessed to have the opportunity to work with a very wide range of children. Their diagnosis vary and include Autism Spectrum Disorder, Pervasive Developmental disorder, Cerebral Palsy, Down syndrome, Attention Deficit and Hyperactivity disorder.

Today I would like to share my extraordinary experience working with a 4.5 year old adorable little girl who is diagnosed with Cerebral Palsy (Cerebral palsy or CP is a neurological disorder that causes very poor development of movement and posture, causing activity limitation, often presenting with muscle rigidity and tremors). Caitlin is also diagnosed with a seizure disorder.

I began working with Caitlin 6 months ago. And even though I do have experience working with children who are diagnosed with CP, at first I was somewhat afraid to approach her. Caitlin has a g-tube attached to her stomach because she is unable to eat using the muscles of her mouth. She is also unable to move independently unless someone else is moving/repositioning her body. She is able to vocalize a lot of sounds that I have learned to identify as words she is using to communicate. Caitlin is highly sensitive to sound, touch and movement.

I work with her in her bedroom with the door closed however her ears are so sensitive that every sound coming from behind the door affects her. As she hears a sound she demonstrates a startle response as if she is in danger. Her muscles are immediately triggered, becoming very tense and impossible to move. One of the ways that I have been able to help Caitlin to be able to relax her body is by using her sensitivity to sound to her advantage. I have been playing "Sacred Drums" music CD during my sessions and she seems to respond beautiful. It is such a pleasure to watch her body process the music she is hearing. The CD starts very slowly with birds chirping and the sound of river floating. Her eyes begin to move back and forth helping her ears to focus and tune in to the music and the direction it is coming from. As the music gets a little more intense since the drums are beginning to play she lights up the room with a huge smile. I cherish these moments so deeply. Her smile is like a precious stone that you find only when you are really paying attention. The simple joy of life, such as a smile of this beautiful little girl, is a life worth living.

Caitlin receives lots of therapy among which are physical therapy and speech therapy. I have observed these well-intentioned individuals stretch her muscles and put her in positions that were causing lots of stress based on her facial expression and frequent crying. I have thought long and hard about the question "how useful is this type of rigorous therapy for her?". I have come to my own conclusion by experimenting with my own ways. I have learned that she responds beautifully to a very non-invasive, subtle type of touch, vibration, and stretch.

I have seen Caitlin this Saturday and had an amazing session. During this session I decided to experiment with vibration on her muscles, and joins. Her favorite part to be touched is her feet. Knowing that I first held her foot in my hand for about a minute without any movement. I was just thinking and feeling how much love I have for this precious girl. I then began to shake her foot in a very subtle manner, almost vibrating. I saw the vibration spread to all the joins and muscles of her body.

She let out a huge grin, a wonderful vocalization, followed by yet another huge smile. I continued to experiment by playing with the position of my hands and the subtlety of the vibrations. Caitlin and I were in this zone of total connection for the next half an hour. Through out the entire experience she was smiling and sighed with a depth that I rarely observe. She decided to let go and surrendered. I was in awe of how powerful this exercise was. In that moment I truly learned the power of subtle movement.

Labels: all blogs, rita gendelman

An Opportunity to Observe
A few weeks ago I had the pleasure of observing a HANDLE (Holistic Approach to Neuro-Development & Learning Efficiency) evaluation done by a HANDLE practitioner with Joe, one of the special children that I work with on a regular basis.

Following an in-depth observation in his natural environment (e.g. his home) and an interview with the mom, Jessica created a treatment plan that allows for the activation and integration of all the special Joe's systems (e.g. sensory systems, immune system, digestive system etc.,) to work in unison, thus significantly improving the his ability to engage with people in his environment in an empowering manner.

Prior to the evaluation, Jessica asked Joe's mom a few questions. The questions included Joe's sleeping and eating patterns over the last few weeks. Joe's mom stated that there had been no changes in his eating and sleeping patterns, saying that he consistently sleeps through the night without any difficulty.

In the Playroom, Your Child is the Boss
Following the conversation with Joe's mom, Jessica, Joe and I entered the playroom. Upon walking into the playroom Joe immediately began to climb on my back indicating that he would like to play the game that we often play during our sessions. I first introduced Jessica to him and then decided to play his favorite game in order to show Joe that he is still the boss even though there is a new person present.

After our game, Joe became very aware of Jessica's presence in the room and started looking at her more frequently. I then decided to step to the side of the room and become an observer.

In the Playroom, Actions Are Words
Jessica proceeded to set up the playroom for her evaluation. The first part of the evaluation required Joe to sit down at the table and pick one toy of his liking on the table in font of him. As Joe sat down and looked at the objects in front of him, he began to stare as if he was hypnotized. His eyes looked at Jessica; however, he seemed not to notice her as if she was not even there.

As Jessica continued to slowly explain to him what she wanted him to do, he continued to stare. He then slowly slouched over on to the table in order to support his body and finally slid off the chair onto the floor.

In a few minutes both Jessica and I heard intense snoring. Joe slept for the next two hours. Our attempts to wake him were unsuccessful. Every time we gently rocked his body or sang into his ear, he pushed us away and fell right back asleep.

Since both the HANDLE approach and The Son Rise Program teach that your child's behavior is his or her language of communication, Jessica and I discussed what Joe's behavior was communicating about the way he interacts with the world.

Interpreting Actions as Communications
Based on what we both know about the different levels of "arousal" (a state of the nervous system, describing how alert the individual feels), we realized that Joe's system was asleep. His nervous system may be described as being in a state of low arousal. This means that for his brain to stay awake, alert and focused, he must be engaged in a movement activity other wise he falls asleep. He must be "on the go" all the time in order to send signals from his muscle and joints to the brain in order to know that he exists in a physical reality.

Identifying that Joe's system was in a state of low arousal is very significant since that allowed us to design a treatment plan based on his specific needs. The treatment plan is always geared towards helping Joe achieve a level of optimal arousal (getting him into the zone of optimal functioning). This is accomplished through a set of simple exercises.

Tuning Your Program to Your Child's Systems
Knowing the level of arousal of the nervous system allows you to choose appropriate exercises for your child. For Joe, we decided to pick movements that would promote alertness (waking up) integration and organization of his brain.

On the other hand, for a child whose nervous system is on high arousal, I would recommend a series of exercises that first and foremost promote calming affects on the nervous system as opposed to an alerting one.

Identifying the specific state of the nervous system of your child is one of the foundations from which you can begin helping your child to achieve a state of balance. If you would like to learn more about the different levels of arousal and how to identify your child's specific needs you may do so by using the book called How Does Your Engine Run? by Mary Sue Williams, OTR/L.

Labels: autism, handle, rita gendelman, son-rise

I am truly blessed....

Today, my day started with the most powerful connection with a very special autistic boy. No amount of words can describe the feeling of joy and love that I had the pleasure to experience. That is why I invite you to read this blog from your heart more then your mind since it's where I am speaking from and only then you might have a chance to experience a piece of my joy, my life.

It all started when Mark sat on his favorite corner of the bed while engaging in one of his favorite exclusive activities. Flicking his straw and sitting in a lotus position on the far corner of the bed while humming under his breath. His humming was very soothing, rhythmical and predictable. Mark was taking care of himself by stimulating his auditory system in order to regulate his body. Even though Mark was doing exactly the very best to take care of himself, I decided based on my knowledge of sensory processing to provide more intensity to his auditory system and incorporated drumming music into my session.

The moment that I turned on the Sacred Drums CD, Mark immediately looked up at me then at the music and started rocking back and forth to the rhythm of music. I decided to rock to the music just like him except in a more exaggerated manner. I was standing up while rocking and walking to the rhythm of music. I was looking at Mark through the mirror and saw that he was smiling and looking up at me frequently. I then decided to put a large Lycra sheet over my head and continued to walk and rock in a circle. When I stopped in the middle of the room Mark's and my eyes locked. He proceeded to watch me and then got up slowly and with caution came over and peeked in under the Lycra sheet that I was holding over my head. He was coming in and out, sometimes just came close to smell the sheet or touch it with his straw and then went back to his corner on the bed. His exploration of the sheet and I continued for the next 10 minutes. As he was exploring I did not make a sound and did not change the position of my body. I wanted to give Mark the space to just explore on his own without placing any more demands on his sensory systems. He then began to laugh and started rocking intensely back and forth while looking up at me. I started to rock with the same pace as him with the sheet over my head. He got up and started moving my arms back and forth very fast and with a lot of intensity. I quickly realized that he was watching the shadow that was created by the sheet.

Labels: all blogs, rita gendelman, son-rise

Imagine you have a headache and you are exhausted, or irritated. Imagine how that would impact your ability to engage with other people. In similar ways as how you are limited by your physiology imagined, children with autism who's sensory processing is compromised find it difficult to play games or engage with people until they feel a sense of comfort and ease in their own skin. All of their energy is used to regulate their body in order to just survive their environment. Since their level of arousal/alertness is in a state of imbalance, all their energy is used specifically to regain that level of balance, which leaves them unavailable to pay attention to anything other then themselves. Because of this very reason when I play with an autistic child or any child with special needs, I am first and foremost paying attention to their level of arousal.

To be able to determine your child's level of arousal all you have to do is to observe your child's behavior. I have noticed from my experience that most children with autism display a high level of arousal. This means that they are engaging in rhythmical, predictable and repetitious activities (e.g. jumping up and down, running in a circle over an over, flapping hands, making the same sounds, rocking back and forth over and over again, lining up cars, etc.). Sometimes the activity might not look like it is repetitious but if you look closely you will begin to notice that your child has put together several activities and that he/she is repeating the same sequence over and over in a very methodical manner.

Below you will find some techniques/ activities you can do to help your child achieve a state of balance when in a high state of arousal.
*These activities are only to be done if the child is open to them. A good technique to use to help a child be more receptive to these activities is to explain what you are about to do and then model it on your self or the child's favorite toy.

1. Massage
a. Deep pressure massage on hands and feet preferably with lotion.
b. Apply firm pressure with your fingers around the jaw line, which lead to the back of the ears, as well as a firm head message if possible.
2. Snuggling in a bean bag, large pillows, sleeping bag
3. Giving firm hugs to your child
4. Finger hugs and tugs
5. Wrapping your child in a blanket
6. Putting heavy object on the child (e.g. your body, weighted blankets)
7. Encourage your child to suck on a straw (e.g. preferably a "crazy straw" it has many loops)
8. Create a corner or a small space where your child can climb, hide
9. Quiet music (white noise music, earthy drum music, chanting music)
10. Reduce lighting in the room
11. Provide a vibration pillow
12. Provide the opportunity to engage in rhythmical, predictable movement such as rocking slowly back and fort, swinging slowly back and forth, rolling slowly on the floor, pushing or pulling with resistance.

The behavior that you might notice when the child is in a low state of arousal is lots of lying on the floor without movement (be careful with making conclusions too abruptly because this might be a child who is so overly aroused that moving might be too overwhelming). It can also be that the activities the child does look very unpredictable, erratic, irhythmical (e.g. a child may suddenly smash into a wall, climb on a ladder, run, lye down, then jump).

Here are some activities you can do when your child is in a low state of arousal.

1. Turning up the lights
2. Fresh cool air
3. Fast swinging
4. Spinning
5. Drink cold/iced water
6. Sitting on an unstable surface (ball, air cushion)
7. Loud fast music
8. Startle-sudden noise
9. Visually stimulation rooms (e.g. lots of bright colors, moving objects)

Some children may fluctuate from a high to a low state of arousal. So the best thing to do is pay real close attention to your child's behavior in the present moment and then do the activity that you think might best help him organize and find a state of balance. I invite you to experiment because sometimes, especially initially, you might not be able to identify the specific state your child is in so just try something and then observe what happens. Allow your self to experiment without placing any judgment on what you are doing. There is really no recipe. We are always experimenting and staying with the present moment.

Labels: all blogs, autism, rita gendelman, son-rise

As an occupational therapist and Son-Rise Child facilitator, I have had the pleasure of working with many beautiful autistic children who presented with a very wide range of diagnosis and behaviors, biting them selves or others, intensely banging their heads, staring into space without movement, lying on the floor while licking the mirror, lining up objects, reciting all kinds of cartoons, and self stimulating, etc. My training has allowed me to look at these behaviors from a very empowering perspective, while most of the world sees them as unacceptable. I view these so called "bizarre" behaviors as a window in that child's world and in the process gain an in-depth understanding of how I can best help this child connect to his/her internal (body) and external environment and begin to see the world around him as a friendly extension of him self.

The sensory integration approach explains the brain-behavior connection (e.g. every atypical behavior observed in an autistic child or another special needs child is directly related to the state of his/her Central Nervous System - CNS). Even though every autistic child presents a variety of ritualistic and atypical behaviors, when you look close, you will start to notice that every child creates their own unique pattern, speed, and intensity of how they prefer to engage in their unique behaviors. For example: one child might decide to place all his cars near him and begin lining them up by gently placing one car next to the other while moving with caution in a very predictable manner; another child might be running to get cars from another side of the room, falling down, smashing the car into the next car and then adjusting the car to make sure it is in perfect alignment with the other cars, and still maintain a very predictable rhythm. So here we have two children seemingly engaging in the same activity. But are they really engaging in a similar activity? They are both lining up cars. However their unique behavior is a communication to us all about what kind of sensory input their body is craving in order to achieve a state of balance.

Noticing the specific ways our children engage in their activities will allow us as therapists, counselors, teachers, and parents become super sensitive to our children's needs and thus allow a doorway for these children to engage with us and motivate them to be a part our world.

I dedicate myself fully to observe each behavior of a special needs child as a meaningful and purposeful action on the part of that child. I look at the deeper meaning of why that child is engaging in this specific behavior (where is the break down in communication with in the CNS of that child) and finally then synthesize a treatment plan based on what I have observed and which will fit the program the child is following. During this process I ask myself: "what purpose is that behavior serving for that specific child?" The atypical behaviors of our children are a window in to their unique world, which provide me with the opportunity to design a very specific tailor made treatment plan for each child I work with.

Occupational Therapy and Son-Rise support each other and gives us a window into our children's unique world!

Labels: all blogs, autism, rita gendelman, son-rise