Help: Challenging EI Patient


Linda Posts:

DEAR ERI COMMUNITY:I am an experienced OT (37 years) working in Early Childhood Intervention working in the home. Our program really wants us to use what is in the home and in the child’s natural environment. I have a 23 month old child who is in Spanish speaking family (so I work through an interpreter). He is extremely shy (fearful of all change)and will not interact with me at all. The way I treat is giving the mother ideas and then she tries them with him. The interpreter is an ECI Early Intervention Specialist who can also interact with the child and get him to do some of the things I suggest. He did not walk until 19 months. He never tolerated tummy time and even after he crawled he would not get on the floor to look for a toy under the bed, etc. He is an over responsive sensory avoider, extremely posturally insecure, moderate hearing loss, balance and motor planning are very poor. We have made lots of improvements and he will now get on the floor and look for a toy that rolls under furniture, get on a jumping horse and bounce, sit on a donut gym ball and play with toys, runs in the house but not the yard or playground, climbs on and off furniture, allows Mom and Dad to bounce him on their knees as long as it is not too aggressive and kicks a ball. I have left a few things in the home to work with (Rody Jumping Horse and Donut Ball). I am needing some new ideas in the challenging case.

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3 Responses to Help: Challenging EI Patient

  1. jackie sax says:

    How about trying some water or sand play inside the house. You can bring in a small tub or pool add some water and let him play with some toys . You can try to make the pool into a sandbox as well. Play inside first which is familiar and safe for him and then try to go outside with it. He might feel more comfortable if the mom went in the pool with him at first. jackie P.T

  2. Amy says:

    How about obstacle courses to mix things up a bit. Over pillows, through tents made of sheets, under chairs, stepping over items placed strategically (friendly sabotage). What about using a sheet to make a swing held by mom and dad that he can sit in. Use the sheet to make a parachute and play under and on it. Use pillows to kneel on and eventually stand on to work balance and core.

    • Teresa says:

      I too work in early intervention, and know that it can be challenging to come up with strategies in the home with “tough” clients!

      Since he has postural insecurity and poor motor planning, then I would provide strategies that include proprioception and deep pressure touch during the vestibular input. For example, have mom hold him firmly while rolling in the floor with him or have her hold him tightly while dancing with him or “lap play”. Many children with postural insecurity tend to tolerate a “sensory diet” that includes their body or feet on the ground while moving. Initially, this could be provided with items the family already has such as blankets, laundry baskets, couch cushions, staircase, & small playground sized balls, as well as the adults using their body to play in the floor with yoga poses (downward dog could be him pretending to be a bear (oso in spanish)). Then, he may build up to tolerating vestibular input that does not require his feet to be on the floor such as swinging at the park or swinging within a blanket as you and the Mom hold each end of the blanket.

      You could use an NDT approach, and with this analyze his equilibrium reactions, protective responses, and weight shifts in all directions, and where his muscle weaknesses are. Then, address those weakness specifically through fun activities. For example, if he is weak in his trunk, then maybe he could play while sitting on a stool with no back to it for short amounts of time during the day.

      If he is fearful of change, then I would try using a sensory integrative or Floortime/DIR approach in which you follow the child’s lead so that he is not suspicious of change, but yet it happens naturally; this should aid in motor planning and over-responsiveness because he will be at the “just right” arousal level which is where he needs to be for learning to take place. If you learn a few key spanish phrases or signs that he is familiar with this may help too.

      Buenas suerte (good luck)!

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