- Associated Press - Sunday, February 28, 2016

WINCHESTER, Va. (AP) - In the lower level of an office building, there is a children’s paradise complete with a ball pit, a zip line, swings and mattresses lined up as a landing pad.

But don’t take the surroundings at face value. Serious work is done here by Terin Fetty, a licensed occupational therapist and the owner of Sky Climb Sensory Development Center, located at 2400 Valley Ave.

Much of Fetty’s work focuses on helping children with sensory processing disorder (SPD), formerly referred to as sensory integration dysfunction.

“Occupational therapy is so broad, but I feel like I have carved out a little niche in kind of making sensory integration my little area of expertise,” says Fetty, who is certified in sensory integration.

“A person with SPD finds it difficult to process and act upon information received through the senses, which creates challenges in performing countless everyday tasks,” according to the Sensory Processing Disorder Foundation’s website, spdfoundation.net.

The disorder can lead to clumsiness, anxiety, depression, behavioral issues and problems in school.

“I feel like my main job now is to help kids process their senses better so that they can reach high areas of learning in the brain and high areas of function,” Fetty said.

Most people are familiar with the five senses of sight, smell, taste, hearing and touch.

Children who have difficulty managing their tactile sense, or touch, either avoid sensations or enthusiastically seek them out.

“They’re going back and forth between two extremes,” Fetty said. One treatment is to rub a small plastic brush on a child’s skin.

In addition to the familiar five senses, humans also have proprioceptor, vestibular and interoceptor senses, Fetty said.

Proprioceptor receptors are in the joints. “They pretty much tell your body where you are in space without you looking at your body,” Fetty said. “Within that comes how much force to use.”

Children with proprioceptor issues might slam a door rather than gently close it. They might push too hard on their pencil when writing, run into things, bump into other children in line or they might feel “floaty” and need lots of sensory input to feel assured of their surroundings.

“A lot of kids, they don’t feel their body, so they seek an edge somewhere else,” Fetty said. “They will track the perimeter of a room because it gives them an edge, it gives them something to grasp on.”

The vestibular sense is related to the inner ear and affects “your ability to process where your head is in space,” Fetty said.

“Because that’s located in your inner ear, when we do treatment for that, we do kind of the suspended equipment because we can get your head in every different position.”

Some children are sensory-averse and reluctant for their feet to leave the ground.

On the other hand, there are seekers, children in a constant flurry of motion.

“I see a lot of (children) have really poor core strength,” Fetty said. “They can’t (hold) any one body position for any length of time, so they end up appearing very fidgety in school. That’s why I usually start with the core strength because it tends to be very, very weak.”

The interoceptor sense refers to the ability to know what’s going on internally, such as whether you’re hungry or thirsty or need to use the restroom, Fetty said.

Fetty believes many children she observes with sensory processing disorder have been misdiagnosed as having attention deficit hyperactivity disorder (ADHD) or autism.

And, while there is often an overlap in children with sensory issues and ADHD or autism, there are children who just have sensory processing disorder.

“There’s pretty much an acceptance out there it exists, but it’s really hard for people to do research on it because it hasn’t been labeled as a diagnosis,” she said.

Without a medical diagnosis, insurance companies often don’t want to cover treatment, Fetty said.

That’s an issue that Bonnie Riley, an assistant professor at Shenandoah University who is also an occupational therapist for Valley Health, has come across.

“We, in the last decade, have just become more able to measure it and understand it,” she said. “It still is not seen in the medical world as its own individual diagnosis.

“I think as our research becomes better, then the medical field will increasingly become more specific in their ability to diagnose.”

The senses most commonly out of sync are the vestibular, proprioceptor and tactile, Riley said.

Treatment depends on how those systems are effected, according to Riley. The patient could have a modulation issue - maybe a certain sense is turned up too high or too low.

Or, maybe it’s a discrimination issue, affecting their ability to know and interpret the information they’re receiving.

“Because the brain is plastic, (it) can rewire,” Riley says. “By giving specific, targeted activities and types of sensory inputs, the occupational therapist can work to rewire or create some habituation of the brain.”

That plasticity is where the sensory diet comes into play. Fetty gives her clients a set of exercises or activities to do each day to improve how they process sensory input.

“I feel like the idea is if you get the sensory input that you need every single day, that makes the biggest difference, and your nervous system gets used to it,” she said. “You’re in a more regulated state. The idea behind it is your brain starts to change. Between the ages of 4 and 9 is when you can change the most because your brain is most plastic then.”

Riley says parents might consider having their child evaluated for sensory processing disorder when they notice something is off, something beyond a behavioral issue.

Parents might notice their child likes extra weight on them, such as really liking being swaddled, Fetty said. Or they might be an extremely picky eater.

Some kids need to be in a perpetual state of motion. Or they might not want anything in their space and be very sensitive to touch. Maybe they have issues with their clothing, needing them to be either tight- or loose-fitting.

Everyone falls somewhere on the sensory spectrum, but those with a disorder can’t get through the day without disruption.

Fetty offers clients a series of 17 tests to measure sensory processing. The tests take two to three hours to administer.

From there, she can develop a treatment plan. It can range from six weeks to years.

Lori Barbe’s 5-year-old son, Brodie, has been working with Fetty for about two years. The Stephens City boy has autism in addition to sensory processing disorder.

“His sensory processing issues have changed a lot over time,” Barbe said.

When Brodie first started occupational therapy, he had core balance issues.

“He had a hard time perceiving safe situations from unsafe situations,” his mother said.

Now, Brodie craves sensory input.

“He thrives on a lot of jumping and a lot of activities that require a lot of strength, like pulling and hanging off of things that require a tremendous amount of upper body strength, and (Fetty) is helping him regulate all of these different cravings that he has,” Barbe said. Fetty “is his No. 1 superhero. He absolutely adores her. She has very high expectations for Brodie, and that’s a really good thing. She can incorporate so much play into what she’s doing that it’s really, really fun for kids.”

To do really good sensory integration treatment, you need suspended equipment, Fetty said.

Fetty’s office has a variety of swings and a zip line. She also has a large tire with poles to hold onto while jumping, dry-erase boards and a train table.

The zip line can be used for proprioceptor issues because it builds core strength and for vestibular ones because the child’s feet must leave the ground.

A climbing wall is for proprioceptor issues.

An exercise ball with spikes provides help for core strength.

Some of the young patients use the whiteboards or chalkboards for handwriting practice.

“The thing with handwriting, a lot of people think it’s just a fine motor issue, but it tends to be so much more than that,” Fetty says.

Core strength goes into handwriting, and it’s visual.

“The basic idea is to hit every sense that we can in here,” she says.

Winchester Public Schools provides sensory integration help for students.

“I think (children with sensory issues are) noticed in classrooms as either being over-responsive to something or under-responsive to the activities or the stimulation in the classroom,” says Christie McKee, behavioral specialist for the school system. “Usually, we see it affecting the motor skills, affecting them socially and then also their ability to have success in the educational setting as well.”

For instance, a child may not be able to maintain their own personal space, fidget, have difficulty with transitions or become disruptive.

Teachers will allow breaks from the stimulation or incorporate movement in the classroom to help the kids who have been sitting for a while.

A child-study team can meet and discuss the student’s needs.

Sometimes, the team will come up with interventions. If that’s not enough, the child can be evaluated for occupational services.

One strategy that can help students with proprioceptor issues is to incorporate heavy work into their day, such as asking them to pass out books or take something to the office.

Even if a child doesn’t qualify for an Individual Education Plan, other accommodations can be made, such as putting a strip of Velcro on the student’s desk for them to touch or have them take tests in quiet settings.

“I see these behaviors a lot in schools,” McKee says. “Whether or not it’s sensory processing disorder, I’m not sure, but we’re going to use the same interventions or strategies regardless of the label we’re going to put on the kids. I think we do a great job at the school level really working hard to make sure these kids are accessing education and succeeding.”


Information from: The Winchester Star, https://www.winchesterstar.com

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