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(Continued from page 3)
including dietary and environmental changes, specific to that individual and his/her goals. Most Sensory Integration therapists don't include nutritional recommendations - although in the case of autism spectrum disorders they might recommend consulting a nutrition specialist - nor does the school setting, usually, let them address light and/or sound stimuli, clothing fabric, class seating arrangements, and such. They probably don't introduce detox methods into their therapy plans. Like many occupational therapists, Certified HANDLE Practitioners provide instruction in how to fit "exercises" into a day's routines and, as with any other good therapy program, we conduct follow-up sessions to upgrade or modify the plan according to gains or other changes.
The crucial third distinction focuses on what happens between the instruction and the follow-up. All HANDLE therapy is home-implemented and requires only about half an hour per day. The activities are best interspersed throughout the day, as they fit into the family's routines. Some activities are recommended for bedtime, others when getting up in the morning. Some may be incorporate at mealtimes and others when your child sits on your lap to snuggle. It is with a familiar person assisting, in a familiar environment - which, unlike most treatment settings, can be modified - that the client's therapy occurs.
Fourth is that, in the
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HANDLE paradigm,
neuro- development normally begins with movement, and abstract or cognitive-level learning occurs in the body, first. That is, movement directs and facilitates the functions of the brain before the brain is integrated enough to direct movement. For example, conceptualizing boundaries is difficult for those who don't know where their body ends and something else begins. Similarly, grasping nonverbal language and facial expression is only possible if your body can do the same things.
Much of occupational therapy focuses on the development of "splinter skills," such as handwriting or self-care. Conversely, a Certified HANDLE Practitioner addresses impediments to the performance of such tasks. In fact, what made Sensory Integration so "revolutionary" thirty-five years ago, was its emphasis on vestibular foundations and perceptual integration for the skills prerequisite to learning tasks. That is, Sensory Integration backed away from teaching how to write, how to tie shoelaces, how to set a table, recognizing that the nervous system of the individual often didn't provide sufficient muscle tone or spatial organization to allow the task performance.
Where Sensory Integration left off, HANDLE continues. Cranial nerves and the autonomic nervous system, not just the central nervous system, need to be taken into account. Any of the body's systems - digestive, endocrine, etc. - plus social-emotional influences, plus auditory, visual,
olfactory,
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and tactile
hypersensitivities may impede performance.
When the prerequisite neurodevelopmental hierarchy organizes the brain for "higher" or more integrated functions, the body can perform its tasks. For example, when intact proprioception conveys spatial relations, the mind can grasp
math concepts. Or, when the vestibular system tolerates and supports movement in all dimensions, handwriting doesn't make the client dizzy. Or, when interhemispheric integration allows the matching of an image - stored in the right brain hemisphere - with the word - stored in the left brain hemisphere - language skills show up in all its forms.
To differentiate HANDLE from the standpoint of "psychosocial Occupational Therapy," this approach has demonstrated consistent success with bipolar disorder and obsessive-compulsive behaviors by addressing neurodevelopmental factors. Customarily, such "psychiatric" conditions are treated with some combination of pharmacology and behavior therapy. In contrast, HANDLE addresses the right-brain/left-brain/interhemispheric integration components to achieve the balance that changes behaviors. And it's behaviors that "define" the diagnosis.
Aside from the differences, because of shared goals, HANDLE and Occupational Therapy fit so well that many occupational therapists have turned on to what they can learn about this approach to treating individuals with functional and behavioral deficits.
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