OT for Sensory Processing Disorder

I have a fever this morning, which isn’t atypical after a bad contamination, but usually with a contamination (rather than a virus or infection), my temperature is normal in the morning and only becomes elevated in the afternoon and evening. This pattern may continue daily for a week or two, with a return to baseline temperature overnight, remaining normal all morning, then proceeding to increase rapidly in the afternoon. Today, I’m already too hot and I had a fever when I woke up. I know I’m not sick though; this is all still a product of corn contamination. Still, it’s a sure sign I need to take it easy today; for better or worse, fevers naturally reduce my volitional activity.

This morning I feel proud and satisfied about the progress I’ve made with my self-administered occupational therapy (OT) in the past two months. I restarted a routine eight weeks ago and have been diligently performing the exercises for eight weeks. I no longer attend sessions at a facility with a trained therapist because there is nowhere to go in my area since we moved. I took a break from it all together last year, for essentially the whole year, because I had seen little improvement from it anyway, even with two to three sessions per week while I was living in Connecticut. With a $30 copay per session, this was adding up to high expense with little return on the investment. If anything, it seemed mostly like a fast lane to reach my sensory threshold on the days with my appointments, rendering me exhausted, headachy, and unable to do much of anything else productive for the rest of the day. The purpose of the exercises is to try to reset my working threshold for sensory stimuli tolerances and to improve my sensory processing and integration. Essentially, the activities are designed to build my tolerance for noises, visual stimuli (like moving images while driving), smells, and tactile sensations, and to help me discern the stimuli I detect (identify the source and direction of a noise, for example). Ultimately, if these purposes are met, OT should help reduce the discomfort of being so sensory defensive (easily and readily overloaded and uncomfortable).

In the ten months that I did OT with a therapist during official appointments after receiving my autism and sensory processing disorder diagnoses, I saw little improvement in my tolerance, thresholds, or processing ability with any of the senses save for an improvement in reading. Instead of the letters and words jumbling and jumping on the page much like they do for someone with dyslexia (and as they had my whole life), my eyes and brain can now work together more normally to track words in the order and arrangement in which they are written. This has decreased the burden imposed previously by reading (boy, this would have been helpful for all my many years of schooling!) and has made it much more enjoyable. I can actually understand a lot of what I read and I don’t get quite as severe of a headache in the process. However, it’s still a very physically taxing process for my eyes and mentally exhausting, actually much more so than before when I just couldn’t really read effectively. This is because my eyes and visual process isn’t “fixed” or “cured,” they are just more trained to function as they should. It’s not a natural process for me though, as it is (from what I understand) for most people without sensory processing disorder. Instead, my brain has to exercise each time I read to deliberately interpret the stimuli (words seen on the page) properly.

Although this is a welcome benefit, it wasn’t my primary objective with OT, and it hasn’t translated to any other visual processing skill outside of reading. Should the skill improvement have transferred to my driving comfort, I’d be more pleased. This has not yet occurred, and driving is still very taxing and difficult. Moreover, the biggest sensory issues for me are tactile and auditory processing issues. By “biggest,” I mean that they impact me the most significantly and frequently and my tolerance is appreciably worse than for the other senses. I’m extremely sensitive to touch and textures (tags, clothing materials, someone rubbing me, footwear feeling, blankets, movement of hair, etc.) and I’m unable to handle many sounds nor locate their source. These issues readily drive up anxiety and irritation. My occupational therapist in Connecticut included many specific exercises to address these issues such as a daily therapeutic listening program and the Walburger Brushing Protocol, which is designed to improve tolerance for tactile stimulation. We also did other sound-locating activities. I experienced no noticeable improvement in either area, and the regular brushing made me tense and testy. After ten months of work, I resigned to make peace with the fact that these issues were unlikely to improve, much like my therapist and the research cautioned. Particularly for adults, modifying tolerances in a favorable way, even with dedicated work, is not always possible.

Things have changed! After doing my own intensive work for the past eight weeks, five days a week minimum, my auditory processing has improved. I don’t think my tolerance or threshold for noises necessarily has gotten better, but my ability to locate the source and direction of a sound is so much better. I’d venture a wager that now I’m correct more often than not, whereas before, I’d rarely, if ever, guess correctly. This is pretty cool, and something I think most people without sensory integration problems take for granted. I can attest, however, that it’s an amazing gift because it makes me feel more relaxed and capable. There’s a reduction in the frequency of panic-inducing unknown noises and the worry that accompanies them when I fear the worst when I’m unable to identify the direction or cause of the noise. It’s very easy to assume danger (e.g., intruder, gunshot, rapist, bomb) when you’ve been attacked, are highly anxious by nature, and have no workable ability to pinpoint a noise. This situation is easily the epitome of catastrophizing. Now, with my acquired sensing, interpreting, and processing skills, I can more rationally identify the sound as whatever innocuous genesis it has. I feel like an increasingly competent hearing sleuth! I still am amiss about half the time, but I’m hopeful that this percentage will decrease with time. After all, the progress in the last eight weeks has been remarkable. Perhaps I should work on refining the system I’ve developed for myself and trademark it into a potential therapy for others!

No tactile improvements have yet occurred but frankly, I don’t do much in the way of touch-specific exercises in my home-spun OT program, so I’m not all that surprised. I have to spend some time experimenting and creating some options to test out and see if anything seems to move the needle in the right direction.

The secondary sense I address in my own OT is proprioception and balance, essentially the awareness of my body in space and my ability to control its movements. Deficiencies in these areas are the culprit in most of my falls, which range from mildly painful and embarrassing to disastrous and injury-causing. If I can attain a better command of my limb position and body’s position and balance, I can reduce the likelihood of random falls (those that occur because of perturbations in my center of gravity and inability to self-correct and those from clumsiness and obliviousness to where and how my body is moving in relation to my environment), I’ll reduce my injury risk many fold. This is exceedingly important, the older I get and the more bone mass I lose. It will also improve my confidence and decrease the anxiety I feel when moving about in public or in new or changeable environments, both of which are currently prone to inducing falls.

Although I’ve used my kinesiology background to design a proprioception and balance training program for myself and I’ve implemented it with the utmost dedication, the improvements seem transient. Some days I seem better, and others there is no change, or even potentially a decline in ability. I’m hoping it’s just too soon to see a significant gain in my skills, and that because I’m so grossly incompetent and have a thirty-year lifetime of reinforcing poor body mechanics and kinesthetic awareness, it will take major accumulated “positive work” to reverse the downward trend (declining ability) I’ve noticed in myself throughout adulthood. This is to say that my proprioception has always been awful, but it’s seemed particularly dreadful in the past five or ten years. Perhaps the sensory processing centers in my brain only allow improvement in one domain at a time, so right now, the focus is auditory. After a sufficient level of competency is mastered, the work going toward the next sense can be appreciated. (I recognize this silly hypothesis is unlikely, but I make it partly in jest and partly because there’s no saying how exactly my brain will respond to something.)

I’ll continue to tackle my OT exercises with optimism and an open mind. I’ll think creatively to develop alternatives to addressing my tactile issues and refine what I’m working on for the other sensory issues. I’m pretty excited about this project and that motivates me to continue pressing on.

 

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