SAISI WEBSITE: Newsletter Vol...their jobs and especially sensory integration which made me even...
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Transcript of SAISI WEBSITE: Newsletter Vol...their jobs and especially sensory integration which made me even...
2 Volume 24 | No 2 | 2014SAISI WEBSITE: www.instsi.co.za Views contained in articles appearing in this newsletter do not necessarily reflect the opinion of the South African Institute for Sensory Integration.
ADDRESS TEL WORK TEL HOME FAX EMAIL EDITOR Rosa-Marié Olivier P.O. Box 17369 (011) 867 0015 (011) 867 0015 (011) 867 0015 [email protected] Randhart 1457EXCO CHAIRPERSON Ray Anne Cook 9 Wonderboom St (021) 976 2258 (021) 976 2258 (021) 976 2258 [email protected] Eversdal Heights Durbanville 7550 VICE CHAIRPERSON Riëtte Smit P.O. Box 668 083 3000 951 083 3000 951 riette.smit@kznatal Bethlehem, 9700 SECRETARY Ninette Visser P.O. Box 461 (011) 475 1449 086 697 6697 [email protected] Strubensvalley 1735 TREASURER Marica Botha P.O. Box 10536 082 335 6386 082 335 6386 [email protected] Aston Manor 1630 HEAD OF EDCOM Janine van der Linde P.O. Box 2559 (011) 717 3272 (011) 615 6900 [email protected] Potchefstroom 2520HEAD OF LIAISONS Magdaleen Stadler P.O. Box 7131 (041) 379 3318 083 328 1715 [email protected] Newton Park Port Elizabeth 6055 BOARD MEMBERS Stefanie Kruger P.O. Box 60750 (012) 667 3998 [email protected] Pierre v Ryneveld 0045 Sally Mackenzie 51 Wilson Street (044) 384 1536 (044) 384 1536 (044) 384 1536 [email protected] Hunters Home Knysna 6571 Annamarie van Jaarsveld P.O. Box 43218 (051) 401 2829 (051) 451 1782 (051) 401 3288 [email protected] Heuwelsig 9332 Corina Botha P.O. Box 32472 051 404 8942 (051) 522 5506 086 729 1476 [email protected] Fichardtpark 9317 Marié Greyling P.O.Box 25346 082 854 3382 (012) 460 2029 [email protected] Monument Park Pretoria 0105 Magdaleen Stadler P.O. Box 7131 (041) 379 3318 083 328 1715 [email protected] Newton Park Port Elizabeth 6055 Dana Katz P.O. Box 321 082 491 0314 082 491 0314 (021) 686 4264 [email protected] Bergvliet 7856 Celette Crafford 24 Dawn Close (021) 975 0286 (021) 975 0286 [email protected] Eversdal 7550Gina Rencken 3 Sanderstead (031) 260 7052 (031) 705 4784 [email protected] 97 Sander Rd, New Germany, KZN 3610Anneke Kruger P.O. Box 12637 083 447 5477 [email protected] Die Hoewes Pretoria 0163 Elze Pelser 3 Rietjie St (051) 432 4024 (051) 422 4197 [email protected] Pellissier, Bloemfontein 9301Amy Rode 21 Rokewood Ave 082 562 4147 (021) 887 9935 [email protected] Die Boord Stellenbosch 7600Nika Oberholster P.O. Box 539 082 372 7689 [email protected] Jeffreys Bay 6330 CO-OPTED MEMBER Elna Jooste P.O. Box 349 (011) 954 3626 (011) 954 3626 086 689 7747 [email protected] Paardekraal 1752 SAISI OFFICE Aletta Kietzman P.O. Box 14510 (012) 362 5457 086 651 5438 [email protected] Hatfield 0028 ADVISORY BOARD Prof André Venter P.O. Box 29864 (051) 405 3181 [email protected] Danhof 9310 Dr Lorna Jacklin P.O. Box 269 (011) 481 5192 Glenvista 2058 Dr Jackie Visser P.O. Box 29962 (051) 410 4000 083 263 7199 [email protected] Danhof 9310 Marguerite Monvoisin 33 Saffraan St 082 870 7213 [email protected] Loevenstein Bellville 7530 Suzanne Smith-Roley 15 Songbird Lane (949) 581-1380 (949) 581-1384 [email protected] Aliso Viejo California 92656
PORTFOLIOMANAGERS
CONTENTSSAISI NEWSLETTER VOLUME 24 NO 2 2014
4 Editorial Letter
5 Dear SAISI
6 Liaison News
7 Chairperson’s Report
18 Bilateral Integration & South African Children
21 A literature review: The neuro-biological basis of the vestibular and proprioceptive systems & the impact on motor control and bilateral coordination
33 VBIS Case Study: Adam (6yrs 3mnths)
36 Activity Ideas
40 Book Review
42 CPD Programme Questionnaire
Volume 24 | No 2 | 2014 3
SAISI BOARD
EXCORay Anne Cook Chairperson
Riëtte Smit Vice Chairperson
Ninette Visser Secretary
Marica Botha Treasurer
Janine van der Linde Head of Edcom
Magdaleen Stadler Head of Liaisons
LIAISONSAnneke Kruger Gauteng
Elze Pelser Free State & Northern Cape
Celette Crafford Western Cape
Magdaleen Stadler Eastern Cape
Sally Mackenzie Southern Cape
Gina Rencken KwaZulu Natal
Annamarie van Jaarsveld International Liaison
EDCOMEmmerentia Aldrich Course Facilitator
Stefanie Kruger Theory & Allied Health
Rosa-Marié Olivier SIPT & Clinical Observations
Riëtte Smit Interpretation
Janine van der Linde Protocols
Sally Mackenzie Treatment
Corina Botha Diverse Populations
Marié Greyling Additional Core Courses
OTHERDana Katz Ethics & SAQA Support
Sally Mackenzie Marketing
Corina Botha Website
Annamarie van Jaarsveld Universities, Research & SAQA
Ninette Visser CPD
Rosa-Marié Olivier Newsletter
Amy Rode Website Public Domain &
Newsletter Support
Nika Oberholster Standing Orders, Job Descriptions
& Newsletter Support
Riëtte Smit Policies
CO-OPTED MEMBERElna Jooste
ADVERTISING COSTSPRIVATE
3-4 sentences R 360.00
A5 R 496.00
A4 R 870.00
SAISI MEMBERS
3-4 sentences R 225.00
A5 R 385.00
A4 R 605.00
CLOSING DATE
Closing date for contributions to
Newsletter vol 24 no 3 2014 is 22 September 2014.
4 Volume 24 | No 2 | 2014
Editor’s Letter
... therefore we once again stick to the basics in this newsletter. Bilateral integration and sequencing difficulties remain amongst the most common problems OT’s face in practice, hence this follow-up on the previous newsletter. However, this time we dig even further down the basics into the neurobiology behind bilateral coordination.
The art and science of our profession urge us to understand the basic neurological background of the conditions we treat in practice. Thank you to Annamarie and Stefanie for their invaluable contributions to this newsletter!
Thank you to SAISI members for the positive and constructive feedback on the newsletter. We are committed to providing you with relevant, up to date information to assist you in maintaining a high standard of service to your clients. Therefore we invite you to communicate your needs, or to share your experiences with us. Please forward any suggestions or contributions to:
Rosa-MariéEditor
“You can’t change the world if you don’t know the basics” – Anonymous
Volume 24 | No 2 | 2014 5
Dear SAISIMy name is Tanita Smith, I graduated from UCT as an Occupational Therapist last year and I am currently completing my community service year at Frere Hospital in East London. I met Dana Katz as I was one of the student representatives for OTASA and I expressed that I was feeling concerned that I did not have enough practical experience with working with children and I was concerned about not knowing enough when going on community service in the following year. I also went to watch her work for 2 mornings earlier in the year and I really enjoyed the type of OT that she was doing. She kindly told me about the Kwela camp and she said that she thought I would really enjoy it and that it is a really fun and enjoyable way to learn about Occupational Therapy and working with children who have sensory integration needs. During my degree, I learnt a little bit about sensory integration, but I did not have the opportunity to learn about the practical side of sensory integration and in general my clinical practice with children was quite limited.
I attended Kwela camp at the end of 2013, at a time which was quite scary for me as I had recently finished my degree but I was feeling quite nervous about my community service year and that there were so many different areas in paediatric Occupational Therapy that I was still lacking. I was also so keen to learn because all the stress from completing my degree was over and now I was at the stage where I felt that I was truly able to learn and absorb as much information as possible. I was definitely quite concerned about the financial aspect of paying for Kwela camp, but the learning opportunity was just way too important for me to miss! So I managed to convince my parents to help pay for me to go and I promised I would pay them back when I started working. Kwela camp turned out to be so so much more than I could have ever hoped for!
There were so many great memories and experiences which truly stood out for me, from learning how to brush the children, helping the children out on the perceptual motor courses and playing in the sensory integration room as well as sharing and seeing their growth and development during the life skills sessions. I thoroughly enjoyed getting to know some of the individuals on a personal level and being there for them in
their times of need such as midnight toilet trips, making new friends, dealing with their anxiety and frustrations and the morning dance sessions. I really appreciated being part of managing their daily routines and took the role of token master terribly seriously and watching them grow so much in this area was very rewarding.
Another aspect of Kwela camp which I really appreciated was getting to know other Occupational Therapy students who were just as passionate about their studies as I was as well as qualified Occupational Therapists. I loved seeing how everyone was so passionate about their jobs and especially sensory integration which made me even more excited about my job and working specifically in this area of Occupational Therapy. I found Kwela such a supportive, non-judgmental and continuously inspirational learning environment which at times I really struggled to find at university. I was also at the same time able to learn a lot about myself and my own sensory integration needs and how I myself can work on these aspects.
Now that I am currently working with my own patients who have sensory integration difficulties, learning difficulties and a few who are on the autism spectrum I find myself continuously referring back to what I learned at Kwela camp. This has made me even more excited to return to Kwela and to continue to learn about sensory integration and how it can assist in the treatment of these children and my own personal development.
I would like to thank the SAISI board for assisting in making Kwela camp such a truly wonderful experience and for assisting with the financially where possible. I am looking forward to returning to Kwela camp and to continue my growth and learning in this area as and Occupational Therapist!
Kind Regards
Tanita SmithCommunity Service Occupational Therapist at Frere Hospital
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Liaison News
Submitted by Sally Mackenzie, Southern Cape Liaison
It is growing cold in the Southern Cape, with an early winter! What would us sensory seeking people do without winter – all that lovely deep duvet pressure, those sweet mugs of chocolate, the smell of a hearty soup, the gloopy feeling of a hot water bottle, candles flickering and warming your body by dancing to loud music!
The Southern Cape Group met for a fun Clinical
Observation morning in May. We discussed and
demonstrated all the items of the clinical observations, and
what we were observing and how you would interpret it all.
It was dynamic and generated much input from all sides.
An Ethics Workshop is planned for July, as sometimes it’s
difficult for therapists in outlying areas to get their ethical
CEU’s, so it attracts many different professions, which also
increases awareness of SI, and generates more interlinking
fingers!
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Annual Report
Saisi Annual Chairperson’s Report 2014Respectfully submitted with a honk-honk of encouragement by Ray Anne Cook
Our motto for the year was to fly like geese.
The V formation and thus the lifting power of many wings
can achieve twice the distance of any bird flying alone.
SAISI flew in formation this past year, sharing a common
direction, dropped back to help those who needed it and
then rejoined the formation and honked to encourage one
another. Thanks to all.
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SAISI is a non-profit organization and is purely run by the willingness of passionate therapists who shares their expertise, time and other personal resources.
When board members meet, the passion and dedication to
our occupation and sensory integration in South Africa is
contagious. SAISI has gained respect both nationally and
internationally.
MEMBERSHIPSAISI currently has 62 paid up members for 2014, this is
slightly down from last year. The latter is evidenced by the
international community’s request for SAISI’s presence
at the SIGN meetings. It is a privilege to be associated
with this dynamic group of people. We are proud of all our
members, both new and old who continue to practice a
high standard of clinical excellence. SAISI members have
a national presence, both in the government and in the
private sectors.
OTASASAISI supports OTASA in all respects and our constitution
is in line with that of OTASA. Riette Smit and myself
attended the OTASA Council meeting as representatives of
SAISI. At this meeting it was requested that SAISI has a
vote on the OTASA Council. The request was unanimously
supported by the Council. SAISI can now vote on the
OTASA Council. This will further improve our support and
relationship with one another and ultimately improve the
support of SAISI members.
Annual Report
CRITICAL SUCCESS FACTORS FOR THE 2013/14 PERIOD WERE:
CFS 1: TO ENHANCE OUR OPERATIONAL EFFICIENCY WITH REGARDS TO COMMUNICATION (BOARD AND MEMBERS) AND DATA MANAGEMENT:
KPA: Optimize the design and functionality of the website
KPA: Development of an efficient database to optimize information management and recordkeeping
CFS2: TO ADJUST AND EXPAND WORKSHOPS AND COURSES TO ACCOMMODATE THE DIVERSITY OF MEMBERS:
KPA: To present SIPT courses to KZN
KPA: To present core courses for advanced therapists – update on the new SA SIPT norms and interpretation worksheet
CFS 3: TO CONTINUE MANAGING THE INSTITUTE ACCORDING TO THE CONSTITUTION AND TO FULFIL THE PURPOSE OF SAISI:
KPA: Policy development to improve operational decision making and transparency
KPA: Development of work plans to ensure business efficiency, individual performance and reporting
KPA: Re-enforce values and philosophy of organization
Volume 24 | No 1 | 2014 9
By having more teleconferences and “bosberaad”
meetings and a board calendar, we have managed to
increase the operational efficiency of SAISI and improve
team work across the board. On reflection each board
member has played their role in the success of the above.
I am proud to say that we have reached our goals and
will be finalizing many of the plans at the meeting the day
before the 2014 AGM. Well done to all for flying together
and helping one another. The boards dedication and care
for the well being of SAISI and the members is rooted in
their passion for ASI®.
EXECUTIVE MEETINGSSix executive committee teleconferences were held during
the past year. Other board members were invited as the
need arose. EXCO could not have a better team and I
thank you all for your support, we could not do it with out
our board and members.
• Ninette, our secretary, a quiet thankless task of doing
our agendas, teleconferences, minutes and keeping
track of board reports, you are one skilled lady who
knows how to look after our needs.
• Riette you are a stalwart and your working memory on
SAISI matters astounds me. Your eagerness and
support as vice chairperson has no words to describe
how much you have meant to me, the board and SAISI.
• Marica you have taken over the treasurer portfolio and
have done a sterling task especially in our economic
times.
• Aletta, the backbone of SAISI who is always working
over time behind the scenes. As always you keep us
on our toes with your amazing working memory of all
SAISI ins and outs. Your “no problem” and then sort
out the crisis with ease attitude is invaluable, thanks
Aletta.
• Janine, as head of EDCOM you are a silent but
powerful force. You know just how to put answers
and queries into words. You keep us in the new world
of technology and teach us patiently.
• Emmerentia your dedication, strive for perfection and
keeping all fair is amazing. You keep the SAISI C1 to
C4 courses afloat. You are a true diplomat who knows
how to deal with all the tough situations with calmness.
FINANCIAL MATTERSThe treasurer, Marica Botha, is truly settled and handling
a daunting task (to most OT’s) with confidence and great
success. Success in this can be attributed to the superb
teamwork between, Marica, Riette and Aletta as well as
the board members. These birds flew in a V-formation and
have kept the flock of SAISI together financially.
The financial policies form the backbone of SAISI.
These policies have now been finalized. However, as we
grow new policies need to be developed. New claim forms
have been developed. When claiming ensure you become
the latest forms. A teleconference was held with the
liaisons to discuss the budgets of the workshops.
A comprehensive overview on the financial statements will
be provided at the AGM.
OFFICE MATTERSRunning the SAISI office is like the flock of geese, we all
need to fly in the V-formation to save energy and time.
Remember you as members are part of this flight for the
good of yourselves, our profession and our clients and
finally a tribute to Jean Ayres for her vision of ASI®.
The SAISI database is up and running and contains
important information regarding the running of our
C1-C4 courses as well as other workshops. The on-line
registration for courses and workshops is now efficient.
Please remember to let the office know if you have any
problems or if information is incorrect. Together we will
man the data base. Thanks goes to Aletta, Corina and
Riaan for their continuous hardwork. Riaan has managed
to explain all the intricacies to the board and works very
close with Aletta to maintain the efficiency.
Aletta is an early bird often corresponding at 7am in the
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Volume 24 | No 2 | 2014 9
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morning and even late at night. As chairperson I could not
do this task without Aletta, she is my working memory.
Thank you for always knowing what is going on and how to
solve a problem. Aletta always has the interest of SAISI at
heart. Her support for our vision and work as OT/SI is seen
in how she is always there for us.
How to fly in a V-formation for the SAISI office:
• Aletta is in the OT Office on a Monday, Tuesday and
Thursday 08:00 – 14:00. If no response to an email
within a week please send it again. If you need
to get hold of her urgently please contact El-lerisa
at the OT Office or send a sms to Aletta to respond
on 082 639 2585
• Online registration – Please READ and KEEP your
application form handy so you can know when you will
be notified about being on a course. The link will also
be on the SAISI website.
• Only workshop and course fees are to be paid into the
SAISI account. All membership fees must be paid
into the OTASA account. When making a payment
into the SAISI/OTASA account, the reference on the
documentation should be used, not the name of the
course as this then causes problems in allocating the
fees to the correct member.
• SAISI library now at the OT Office – updated list can
be obtained from the SAISI website:
www.instsi.co.za/documents.php
• All SIPT goods may be ordered through the OT Office.
A written request via email is requested:
• If you are an SI interest group, you can apply for CPD
points through SAISI, provided all the members
attending the groups are registered with SAISI.
All certificates re small groups done under SAISI
needs to be administered by SAISI as SAISI is liable
for all CPD applications done through the institution.
• Online certificates – a decision was made at the last
board meeting to do certificates online. The first time
you use this system you will need to register via your
cell phone (once off). You then only need to add the
‘access code’ supplied at the end of each workshop
course to obtain your certificate. All certificates can
then be printed off the CPD solutions website.
Record of all your CPD activities done through SAISI
OTASA/INSTOPP is then kept on this site.
Emmerentia and Riette, thank you for all patience time
and effort – “sal dit nie sonder julle kan doen nie”.
EDUCATION COMMITTEE(EDCOM)EDCOM continues to be the hub of SAISI and under
the leadership of Janine van der Linde they have worked
as a formidable team. EDCOM has developed SAISI’s
mission regarding the training of in ASI SA. Monitoring
the courses, workshops, lecturers and course content
remain a top priority. Lets continue to support one another
in our learning and strive for excellence. The way in which
Janine is currently developing our E-learning, updating and
developing all the documents for the website, developing
the SAISI dropbox and bringing SAISI into the new world
of technology. Janine is steering us more into the use of
technology, and manages to be patient with us “oldies”
during the learning phase.
The head of EDCOM and the course co-ordinator attends
the EXCO teleconferences to maintain communication
between EXCO and EDCOM.
EDCOM had 4 teleconferences during the year and
handled amongst other issues the following:
• Identifying and nominating lectures for the courses,
workshops.
• Handling queries, complaints and extensions at length.
These are taken very seriously and can be time
consuming and challenging at times. SAISI aims to
please and maintain our international standards. Can
Annual Report
Volume 24 | No 2 | 2014 11
members please try to take responsibility for their own
training process and check their facts. There is a query
form available to fill in when you have a query about the
C1 to C4 courses.
• Policies and procedures were developed and will be
placed on the website or dropbox according to who
needs to see it. This enhances our proficieny
immensely.
• The support of protocol markers and setting up
mentors for therapists writing their protocols has been
very helpful and effective and protocol workshops
were held in the various regions to ensure a high
quality of marking of protocols and discuss any issues
the markers have.
• Teleconferences for each of the various portfolios have
continued and kept the V- formation.
• The course structure is being reviewed with regards to
assessment following each course. From 2014 there
are now outcomes assessment after each course :
C1 – An online quiz
C2 – Peer review, 4 typical & 1 atypical assessments
C3 – Marking of SIPT scores, 1 mentoring session
paid by SAISI and writing the protocol
C4 - Fidelity measure
COURSE CO-ORDINATOR
Emmerentia manages to keep the flock flying in a
V-formation even when there is a storm she keeps flying till
she gets to the beautiful summer weather. Emmerentia has
run this portfolio since 2007 with tremendous efficiency
and hardwork. All the hardwork by Emmerentia and her
team has paid off. We are forever grateful for all that
Emmerentia puts into this portfolio. It is a mammoth task,
requiring efficient management, fairness, continuous
forward planning and networking. EDCOM plays a vital
supportive role in the identification of lecturers, venues and
educational decisions.
Some valuable information to note is:
• A previous decision of the board was that one of the
annual courses will be a course in collaboration with
SCU/WPS, if there is not a Congress or other courses
for which we will be sponsoring an overseas lecturer.
In 2013 we presented the Test Interpretation Course in
collaboration with SCU/WPS and thus not one in
2014.
• Online registration for courses is now running
smoothly. Attendance certificates and invoices are also
generated online. The standard of our courses
and whole training process is very high and we are
commended on this.
• Each faculty continues to update and improve on
their course content and presentation. The time
frame is still 5 years with a maximum of 2 years’
extension granted if motivated well enough. We still
have a group (those who started C1 in 2008) who
have 7 years to qualify and who may request an
extension. SAISI is still dedicated to present only ASI©
in our courses even though we recognize the worth of
other frames of references and treatment techniques.
• A policy for lecturers, that has to be signed each year
by the lecturers, was implemented during the last year,
to ensure that our lecturers keep updated and that all
of them get a chance to lecture.
• Following the C3 course in Durban, Dr. Susanne
Smith-Roley did a one day workshop on the Fidelity
Measure for the SAISI Board Members who were
present.
• SAISI presented 4 courses (C1, C2, C3 and C4)
The courses were presented in Durban (C1- C3).
C4 will be presented in Durban in June. SI has grown
exponentially in Durban with an enthusiastic group
of OT’s meeting frequently. We also did not struggle
to fill the courses in Durban. Thanks to our members
Annual Report
12 Volume 24 | No 2 | 2014
who travel to the various provinces for courses, in
this way we are spreading SI nationally for everyone.
We even have international attendees and this year
the courses received very positive feedback. The new
found venue in Gauteng is of a very high professional
standard, thanks Janine for finding the venue.
Course C4 C 3 C1
Treatment Interpretation Theory
Venue Gauteng Durban Gauteng Gauteng
Belle Vista School Blue Water Hotel La Widda Lodge La Widda Lodge
Date 8-12 July 7-11 Oct 10-14 March 24-28 March
Course Leader Carina Taylor Dr. Susanne Stefanie Kruger Rosa-Marié Olivier
Smith Roley
from SCU/WPS
Co-lecturer Mari Visagie Annamarie Riette Smit and Wendy Laubscher
van Jaarsveld Ray Anne Cook
Trainee Lecturer Stefanie Kruger C3 Lecturers None Marica Botha
attending: S Sims,
R Smit, RA Cook,
J vd Linde.
Co-ordinator Janine vd Linde Pippa Langley Janine vd Linde Janine vd Linde
Attendees 40 71 including lecturers 84 50
& board members
Annual Report
SAISI COURSES MAY 2013 – MAY 2014
Volume 24 | No 2 | 2014 13
FACULTY THEORYThank you Stefanie for the great task with theory and all
the hard work you and Sue van Rhyneveld have put in.
Riette and Ray Anne also enjoyed their first course as
theory lecturers, so the theory team is growing. Paulo from
Portugal’s 7 senses joined the theory course and was a
great help for the lecturers finding videos etc on the web
for us to use. The teleconference prior to the course was
very valuable.
FACULTY TEST ADMINISTRATION Rosa-Marie Olivier has taken over this portfolio with gusto
and precision and has led the team well.
A teleconference was held and the new powerpoint lay
out, file format, redoing the DC and MAC homework as a
final step in the process to create our very own SA course
content. Rosa-Marie is also currently working on the
clinical observations update.
FACULTY INTERPRETATIONRiette Smit has run this portfolio and has led her team of
lecturers with determination. After all attending the C3
course under our WPS/USC lecturer, Suzanne Smith
Roley, a bosberaaad was held in Bloemfontein together
with the clinical observations revision. A last bosberaad
will be held the Wednesday before the AGM to finalize the
new updated course/file.
FACULTY PROTOCOLSJanine has tackled the humongous task of getting the
protocol submission online via dropbox. This included the
following targets:
• To provide information and documents for upload
onto the website regarding the protocol process
• To update the database regarding the results of
protocols on a regular basis.
• Ensure Information management regarding protocols
in an electronic format for both therapists and protocol
markers. She even had to wrtite documents to tell us
how to do it.
• Management of protocol process.
There were 82 protocols submitted which is a record
and put enormous strain on Janine. Thank you to all the
markers who helped in marking more than they usually
do. A request is made that therapists rather send emails
than phone as phone calls disrupt her work. Due to many
protocols being submitted on the deadline Janine was not
able to answer phone calls immediately. SAISI request
that therapist be patient when and after submitting their
protocols. The implementation of checking the scoring
before submitting the protocols and the mentoring session
appears to have increased the pass rate. An updated
scoring sheet has been used with great success by the
markers.
Congratulations to the therapists who passed their
protocols and now meet the requirements to attend the
treatment course. Here you will truly understand the
concept of ASI®, and how to implement change a client’s
life. Well done to all of you! We hope that you will continue
to broaden your base of knowledge and strive to stay
abreast of the newest developments in sensory integration.
FACULTY TREATMENT Sally has continued to run Faculty treatment smoothly
and developed her team of lecturers. 2 DVD’s have been
submitted for the Fidelity Measure.
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14 Volume 24 | No 2 | 2014
FACULTY ADDITIONAL CORE COURSE CO-ORDINATORMarie Greyling has continued to develop this portfolio
and to ensure that all the regions get the core courses/
workshops that are suggested at the AGM. She liaises
very closely with EDCOM and the regional liaisons
ensuring that besides our C1 to C4 courses we consider
and fulfil the needs of our members. This has enabled our
workshops to run more smoothly. Where possible, the
AGM will be a platform for future workshops.
DIVERSE POPULATIONSCorina Botha has continued to prove her passion for
diverse populations and together with Mari Greyling
organized the SI and ADHD workshops which have been
run in all the provinces. SI in adults/adolescents and
psychiatry will be planned and Tharina Annadale has been
co-opted to help in this regard. The SAISI 2014 AGM will
focus on this.
REGIONAL LIASONSMagdaleen Stadler has taken over head of liaisons and led
a teleconference with all the liaisons to plan their year and
support one another. Thank you for so many therapists who
are willing to help during the organization of workshops
and courses in their region. ALL SAISI members in our
regions remain the backbone of SAISI, so support and
encourage one another. The regional workshops are
struggling to cover costs as often the attendance is poor,
and basic costs remain the same. We are aware that there
are many courses presented, but we need to keep our SI
knowledge up to date. This will be discussed at the board
meeting.
NORTHERN CAPE AND FREE STATETwo very successful workshops have been held. The 2012
AGM was also held in Bloemfontein and the next workshop
will be on ADHD and OTSI. Despite her health problems
Elze has continued to be an integral part of SAISI and to
be the regional liason.
WESTERN CAPECelette Crafford has taken over this portfolio and
is well known in the Western Cape as a SAISI course
co-ordinator. She organized a 2 day workshop on SI and
ADHD by Ray Anne Cook. It was a great workshop but
we were disappointed by the small number of attendees.
Thanks for organizing the protocol markers update
workshop. Celette has also taken on organizing the board
meeting and AGM in Cape Town this year.
SOUTHERN CAPESally Mackenzie has continued with this portfolio to provide
support for therapists in the Southern Cape. A clinical
observations workshop has been planned for May
EASTERN CAPEMagdaleen has continued in her role as liason and
motivated the therapists in the region to start with the SI
courses and writing of protocols. She organized a update
to SIPT interpretation and SI and ADHD presented by Ray
Anne Cook. An evening talk was also done for parents and
Annual Report
Volume 24 | No 2 | 2014 15
teachers on ADHD and SI.
4 SAISI interest group meetings have been planned.
Please contact Magdaleen for more details. A needs
assessment was done at an earlier OTASA meeting this
year. The Intro to SI and Clinical Observations was a
request from quite a few OT,s. Parents/teachers requested
that Ray Anne must do a follow-up on last year’s talk re the
life span of ADHD. A radio talk was done on the red flags
for sensory development.
GAUTENGAnneke Kruger continued to be our dynamic liason.
She organized an introduction to SI workshop in Centurion
in September 2013. Mandie Steyn was co coordinating
an intro to SI in Witbank-Mpumalanga, but unfortunately
this had to be cancelled due to the loss it would have run
at. Anneke also organized the protocol markers update
workshop. She compiled a ticklist document for liaisons
and course coordinators for communicating with the office
for organizing courses.
NATALGina has taken over the Natal liason. Workshops will
be planned for the second half of the year due to the
arrival of Gina’s first baby – congratulations. The planned
workshops are “The Alert Programme and Sensory Diets”
as requested after the last SI/ADHD workshop. Another
one planned is “SI and ethics” by Sally Mckenzie.
INTERNATIONAL LIAISONAnnamarie van Jaarsveld has continued her role as our
international liaison and this portfolio has increased
dramatically over the past year. SAISI continues to invest
in international collaboration and Annamarie handles all
the international queries and requests with diplomacy.
A meeting about the change in the structure and
management of USC/WPS was held in November 2013
and Annamarie went to USA to represent SAISI and was a
key negotiator for the needs of the international contingent
outside the USA. We and the international community
have received a document form UCS/WPS with the new
guidelines for international courses that has far reaching
implications. The positive in this whole situation is that
SA is the only country that can currently go ahead with
courses independently from USC/WPS. The negative is
that we do not want to isolate ourselves again from the
international community. South Africa has a pivotal role to
play as we are the only country who at present can run the
C1 to C4 courses independently. It has been requested
that SAISI be present at the meeting in Finland that will
take place between the 11th and the 13th of June 2014
in Naantali, during the 3rd European Sensory Integration
Congress. Although this process is cardinal for our future
as well, SAISI cannot, in this process, jeopardize our
current agreement with WPS regarding the provision of
SIPT materials and this becomes a possibility with the
new “rules” on the table. There is thus a lot at stake within
this new “internationalization” process of SI courses.
Annamarie will be attending the meeting on behalf of
SAISI.
UNIVERSITIES This is a new portfolio which Annamarie van Jaarsveld has
taken on to maintain relationships between SAISI and the
universities to promote SI as well as the use of the SAISI
clinical observations at the universities.
RESEARCHAnnamarie attended a symposium on “Occupational
Science and SI research: The way forward” in Los Angeles
in Nov 2013. There was a definite increase in requests for
research funding:
• Jacintha Geral: South African parent’s perceptions
Annual Report
16 Volume 24 | No 2 | 2014
and experiences of occupational therapy using a sensory
integration approach (OT-SI). She has passed and we look
forward to hearing her findings.
• Marica Botha: Sensory integration assessment of
infants: Parent report questionnaire vs clinician
observation report.
• Janine van der Linde: The development of a screening
instrument to identify sensory integration difficulties in
children from low socio economic environments
ACCREDITATION OF SAISI COURSES WITH SAQASAISI is still in the process of aligning with SAQA
accreditation. Janine and Aletta attended the first meeting.
Aletta and Annamarie has also become involved with the
accreditation of the SAISI courses. She has had several
sessions with Dr Nalize Marais who presented a proprosal
on a feasibility study which will be discussed and a way
forward will be decided at the board meeting.
ETHICSThis portfolio is managed by Dana Katz, thank you for your
commitment to this important portfolio. Many ethical issues
on the scope of SI come through and are dealt with.
CPD Ninnette is the SAISI CPD chair and together with Aletta’s
meticulous record keeping (ensuring that all course/
workshop feedback forms are kept for auditing purpose),
this portfolio is running smoothly. Please ensure that you
always sign in and fill in these forms.
NEWSLETTERRosa-Marié, with the help of Nika and Amy for the proof
reading, continues to provide an excellent newsletter of
the highest standards. The topics for each newsletter are
thought out well in advance and the focus has been
on “Back to Basics”. Three issues were printed during
this year namely Back to Basics, Somatodyspraxia and
Bilateral Integration and Sequencing. Feedback was
overwhelmingly positive, especially with regards to Activity
Ideas. We will consider giving more detailed attention to
more activity ideas. However, this is sometimes difficult,
because we try to refrain from giving “recipes” for
treatment activities. Thank you to all the therapists who
have made contributions to the newsletter. Rosa-Marie
eagerly awaits your contributions so contact her.
MARKETING Dana Katz has continued to be committed to this portfolio
and has helped check and develop various articles and
information pieces. For the OTASA congress Riette
and Rosamarie did a quick brain storm and organized a
wooden toy and booklet with the SAISI logo for the goodie
bags to promote SAISI to OT’s. The Flyers: A5 colourful
page of what sensory integration is, are available from the
OT office for R1 a flyer and have been handed out to OT’s
at various occasions. to promote ASI®. The public needs
to understand ASI® and what you as a trained SI therapist
do and the scope of ASI®.
SAISI has been asked again to man a station at the
Baragwaneth OT day.
WEBSITEThe website consists of 2 main areas the database and
the design. This has been a critical success factor for the
year and has received a concerted effort form all on the
board. Corina Botha has conintued to head this mammoth
Annual Report
Volume 24 | No 2 | 2014 17
task and with her team she has planned the process with
a task list which ensured all was done. Teleconferences
have been held as well as an onsite meeting in Cape Town
(Riaan, Liesl, Amy and Ray Anne).
The task team was:
• Database and Website Programmer - Corina
and Riaan Bezuidenhout
• Website Designer – Liesl Krumrey
• Office Administrator - Aletta Kietzmann
• Chair Person - Ray-Ann Cook
• Content Development - Amy Rode
• Marketing, Editing and Design - Dana Katz
• Design - Rosa-Marie Olivier
• Finances - Marica Botha
• Member Content - Riette Smith
Amy has been working tirelessly at the information for
the membership domain with Dana and Ray Anne proof
reading. Other boardmembers have also helped where
they could. Various documents especially the policies have
been worked on so that most of the information will be
ready to put on the website by the AGM. The website will
be launched at the AGM.
LIBRARYThe library is now managed by Alletta from the OT office.
True to form Aletta keeps her eye on which books are used
frequently and has thus requested SAISI to purchase more
of these for the members as they frequently use these
books when writing the protocols. SAISI purchased extra
and new books in February. If you have read any excellent
book you would recommend for the library please contact
Janine van der Linde as EDCOM recommends which
books should be bought. Go onto the SAISI website
and find the list of books, videos and tapes under the
“document” section.
JOB DESCRIPTION Nika has managed to pull all the board members together
to ensure the job description document is kept up to
date throughout the year and then a final check with each
member is done at the board meeting.
ADVISORY BOARD MEMBERSThe advisory board for this yeas was:
Prof André Venter, Ms Nicky Lash, Ms Jacky Visser, Ms
Nichi Casati, Sr Ann Richardson and Ms Marguerite
Jessop. As in the past, we would like to thank them for
their willingness to serve as advisory board members and
for supporting sensory integration in SA.
CONCLUSIONSAISI is alive and flying in our V- formation as we strive
for excellence. We will continue play an important role in
South Africa and internationally. You can all be proud of the
part you have played in SAISI. May our clients continue to
benefit from our knowledge in ASI®.
Once again I am amazed and blessed at how the SAISI
board and members are cemented together like a family
and support one another. Thank you all for doing your part
without even being noticed.
Annual Report
Coming together is a beginning. Keeping together is progress. Working together is success.
– Henry Ford
“
18 Volume 24 | No 2 | 2014
Article
Bilateral Integration & South African Children
By Annamarie van Jaarsveld (M.OT UFS)
As a follow-up on the article of Zoe Mailloux on “The Vestibular Bilateral Integration Pattern” in the previous newsletter this article aims at providing an overview of research which is available on South African (SA) children and bilateral integration and how that relates to the research which has been done in the United States (US). A few South African studies have been conducted where
part of the research were focused or related to bilateral
integration. As Mailloux (2014) has stated in the article
on vestibular and bilateral integration patterns, Ayres
considered various bilateral integration patterns as they
were revealed in research which she has done. The
following are patterns which she has described, in order as
it is presented in the literature:
1. Postural Bilateral Integration
2. Vestibular Bilateral Integration
3. Bilateral Integration and Sequencing
Bilateral Integration and Sequencing is the pattern which is
also described and identified in the SIPT and SIPT manual
(Ayres, 1989). In reading and using results of studies that
have been done in other countries the question always
remain: “to what extend is this information/results true for
our SA population”? Due to more and more research being
done in SA within the field of SI, we are beginning to build
our own body of knowledge which we can start using and
refer to.
Four consecutive studies on the prevalence of SI
problems in children (including children from black- and
white cultures as well as from low- and high Socio-
Economic Settings) has been done on three- to five year
old children from Mangaung, SA (Van Jaarsveld, 2010).
Results indicated that 39% of black and 38.46% of white
children from low Socio-Economic Settings (SES) scored
within the risk and problem groups on the Bilateral Motor
Coordination section of the De Gangi Berk Test (Berk & De
Gangi, 1994). Data from the four studies were compared
and the results indicated that white children from high SES
scored significantly higher with regards to Bilateral Motor
Coordination than white children from low SES (p-value:
0.006) and black children from low SES (p-value: 0.002).
Black children from high SES also scored significantly
better on Bilateral Motor Coordination than white children
Volume 24 | No 2 | 2014 19
Article
from low SES (p-value: <0.001) and black children from
low SES (p-value: <0.001). There were no significant
differences between white children from high SES and
black children from high SES (p-value: 0.063).
These four studies, on the whole, indicated that children
coming from low socio-economic settings had a higher
prevalence of sensory integration difficulties than children
from higher socio-economic settings. Bilateral Motor
Coordination was the only section of the De Gangi Berk
test where a statistical significant difference between
children from low and high socio-economic settings was
found. Almost all the results indicated that children from
high SES tended to test better on the De Gangi Berk test
as a whole, than children from low SES. There were no
definite findings on whether culture can influence the
prevalence of bilateral motor coordination.
In a study on the patterns of SI dysfunctions in a sample
of SA children (Van Jaarsveld, Mailloux, Smith Roley
& Raubenheimer, in publication) patterns of bilateral
integration dysfunction, which are consistent with
those identified in US samples, have been found. In
this SA study, a convenience sample of 223 children
that experienced functional difficulties associated with
SI dysfunctions, and that have been confirmed with
assessment on the Sensory Integration and Praxis Test
(SIPT) (Ayres, 1989) were included. For a bilateral
integration and sequencing (BIS) dysfunction, moderate
to high statistical loadings on vestibular and bilateral
integration and sequencing test items of the SIPT needs
to be evident during a statistical process of factor analysis.
Test items were considered to load moderately on a factor
when the loading was >.35–.49 and strongly when the
loading was >.50
For the factor analysis, three factors emerged from
this study. One of these factors was identified as a
pattern of BIS dysfunction. Moderate to high factor
loadings were found on the following tests: Kinesthesia,
Graphesthesia, Oral Praxis, Sequencing Praxis, Bilateral
Motor Coordination, Standing Walking Balance and Motor
Accuracy. The loadings on these tests were, as already
mentioned, consistent with BIS patterns which were found
in previous research (Mailloux, et al., 2011).
The PRN test was the only test which did not load on
this factor due to the fact that this specific sample of SA
children included children with both high and low PRN
scores and thus had an averaging out effect. The averaging
out effect of the scores on the PRN test has also been a
challenge in previous research, except for the research
OPr .727 .684
SWB .657 .508
PRN .611 -.118
BMC .575 .665
MAc .573 .383
GRA .562 .565
SPr .462 .741
(KIN) (.330) .366
Table 1: Comparison of factor loadings on a BIS dysfunction pattern
USA LOADINGS SA LOADINGS
20 Volume 24 | No 2 | 2014
Bilateral Integration & South African Children
study done in 2011 by Mailloux, et al. They had a unique
sample of children where only 8.4% of the children had
high or prolonged PRN scores and the averaging out
effect was thus minimal. This particular study strongly
supported Ayres theoretical assumption that bilateral
integration difficulties are accompanied with an inefficient
vestibular system reflected by a very low or depressed
PRN score (Mailloux, et al., 2011).
When the results of the 2011 study (Mailloux, et al., 2011)
on the verification of patterns of dysfunction on a sample
of USA children and that of the study by Van Jaarsveld,
Mailloux, Smith Roley and Raubenheimer (in publication)
on patterns of dysfunctions in SA children, are compared
in terms of a bilateral integration and sequencing pattern of
dysfunction, the same tests of the SIPT had high loadings
(See Table 1). The only exception is the PRN test where
the SA sample had a negative loading due to the averaging
out effect, as already discussed.
The data from these two different studies confirms the
consistency of a dysfunctional sensory integration pattern
of bilateral and sequencing functions. The results of
this study also serve to confirm that the SIPT is a valid
diagnostic tool for use on SA children to identify a SI
dysfunction such as a BIS dysfunction.
REFERENCESBOOKS:
Ayres, A. J. (1989). Sensory Integration and Praxis Tests Manual. Los Angeles: Western Psychological Services.
Berk, R., & De Gangi, G. (1994). De Gangi-Berk Test of Sensory Integration Manual. Los Angeles: Western Psychological Services.
Mailloux, Z. (2014). The Vestibular Bilateral Integration Pattern:A Unique Contribution to Sensory Integration Theory & Practice. SAISI Newsletter.
Mailloux, Z., Mulligan, S., Smith Roley, S., Blanche, E., Cermak, S., Coleman, G., et al. (2011). Verification and clarification of patterns of sensory integrative dysfunction. American Journal of Occupational Therapy, 65 (2), 143-151.
Sensory Integration and Socio Economic Environments. (n.d.). SAISI Newsletter.
Van Jaarsveld, A. (2010). Sensory integration and socio economic environments. SAISI News Letter, 20, pp. 8-13.
Van Jaarsveld, A., Venter, A., Van Vuuren, S., & Joubert, G. (2001, August). Sensory Integration: The prevalence of sensory integration problems in three- to five-year-old black pre-school children in semi-structural pre-school programmes in Mangaung, Bloemfontein. Sout African Journal of Occupational Therapy, Vol 31(2), 3-6.
Van Jaarsveld, A., Venter, A., Van Vuuren, S., & Joubert, G. (2001, November). The effect of a sensoryintegration-orientated stimulation programme on three- to five-year-old black pre-school children in semi-structural pre-school programmes in Mangaung, Bloemfontein. South African Journal of Occupaitonal Therapy, 31(3), 9-13.
Volume 24 | No 2 | 2014 21
Article
A literature review:
The neuro-biological basisof the vestibular and proprioceptive systems and the impact on motor control and bilateral coordination
This article was inspired by some of the questions that were asked at the recent theory course. Thank you to a wonderful group with inquiring minds.
Please Note: The intention of the following article is to provide
a literature review of up to date findings in terms of the
neurological basis for sensory and motor processes involved
in developing and performing well coordinated rhythmical
movements and other bilateral tasks. The purpose is to guide our
understanding of what is relevant for OT’s working in the field of
sensory integration, despite the complexity of the neurological
structures and processes involved. A summary is provided from
(but not limited to) selected references.
INTRODUCTIONDr. A Jean Ayres developed the theory of Sensory
Integration in the late 1950’s and early 1960’s which is
now known as Ayres Sensory Integration (ASI®). Dr. Jean
Ayres, qualified psychologist and occupational therapist,
was able to make the link between the brain and behaviour
before modern scientific tools such as specialized brain
scans, were available. She was the first researcher within
the therapeutic field to acknowledge and investigate how
neurobiological processes impacted on a child’s learning,
emotions and behaviour (Schaaf & Smith-Roley, 2006).
It is within the context of ASI®, that we are looking at
Vestibular and Proprioceptive Bilateral Integration and
Sequencing (VBIS) difficulties as one of the patterns of
Sensory Integration Dysfunction (SID).
LEARNING AND BEHAVIOUR ARE THE VISIBLE ASPECTS OF SENSORY INTEGRATIONReview of some of the basic elements of typical functioning and performance:
Our sensory organs provide information from our
environment. The streams of electrical energy flowing
By Stefanie Kruger, B.OT (UP)
22 Volume 24 | No 2 | 2014
towards the brain are called sensory input. The spinal cord,
brain stem, cerebellum and cerebral hemispheres use the
sensory input from the receptors to produce awareness,
perception and knowledge. This knowledge assists us
to produce body postures and movements as well as
the planning and coordination of movements, emotions,
thoughts, memories and learning. Over 80% of the nervous
system is involved in processing or organizing sensory
input. Sensory processing is extremely complex, since the
different types of sensory input intermingle with each other
throughout the brain. This complex sensory processing
produces a message in the brain which the motor neurons
then carry to the body. It has been estimated that in a
single second, one impulse can spread out through up to a
million neurons in many different parts of the brain.
(Ayres 2005)
“Sensory integration dysfunction is to the brain what
indigestion is to the digestive tract. It can therefore be
concluded that sensation is food for the nervous system”.
(Ayres 2005)
SENSATION AND THE WHOLE BRAIN
When the activity of a sensory system becomes more
organized, or various sensory systems become more
integrated with one another, the nervous system functions
in a more holistic manner. When an infant crawls across
the room or a child masters an obstacle course, his entire
body works together as one balanced unit. When the body
and all the senses work together as a whole, adaptation
and learning are easy for the brain. The vestibular system
is the unifying system. It forms the basic relationship
of a person to gravity and the physical world. All other
types of sensations are processed in reference to this
basic vestibular information. The activity of the vestibular
system provides a framework for the other aspects of our
experience. When the vestibular system does not function
in a constant and accurate way, the interpretation of other
sensations will be inconsistent and inaccurate, and the
nervous system will have trouble getting started.
(Ayres 1972, 2005)
DEVELOPMENT OF NEURAL CONNECTIONS
A newborn baby has most of the neurons he will ever
have, and a few more will grow in the first few years of
life. However, at birth he has very few interconnections or
synapses between these neurons. As the baby interacts
with the parts of his body and the world, the sensory and
motor impulses flowing among his neurons cause the
fibers to grow branches and twigs reaching out toward
other neurons. Neurons must be stimulated to develop
interconnections. A sensory system can only develop if it
is exposed to the forces that activate its receptors. The
growth of new interconnections produces new possibilities
for neural communication which adds new elements to the
infant’s sensory perceptions and motor abilities.
A large part of a child’s capacity for learning is the ability
to integrate sensory information. It may look as though
the child at play is not learning anything, but actually, he
is...learning how to learn. Sensory stimulation and motor
activity during the years of early childhood, will mold the
neurons and interconnections to form sensory and motor
processes. (Ayres 2005)
Each muscle has many motor neurons and the electrical
impulses in the motor neurons cause the muscles to
contract. Many muscle contractions must be combined to
perform a task such as turning the head and eyes to look
at something, or move the hands and fingers to manipulate
an object, or move the body from one place to another.
For these muscle contractions to be coordinated and
effective, the activity of the brain must be well organized.
When the functions of the brain are whole and balanced,
body movements are highly adaptive, learning is easy, and
appropriate behaviour is a natural outcome.
The more a muscle is used, the stronger it becomes, up
to a point. If it is not used, it becomes weak. Similarly, the
more a synapse is used, the stronger and more useful it
A literature review: The neuro-biological basis of the vestibular and proprioceptive systems and the impact on motor control and bilateral coordination
Our relationship with gravity is more essential to our well being than our relationship with our mother.
– Ayres 1979
“
Volume 24 | No 2 | 2014 23
becomes. As with a muscle, the use of a synapse makes
that synapse easier to use. Every time a neural message
crosses a synapse, something happens in the neurons and
in the synapse to make it easier for other similar messages
to cross that synapse in the future. (Ayres 2005)
It is therefore crucial to acknowledge that there are various
processes and structures involved at any given time in
order to successfully interact with our ever changing and
often unpredictable environment.
The vestibular and proprioceptive systems are constantly
interacting by processing sensory input from our bodies
in relation to gravity and our environment. They function
together in order for us to develop body scheme, have
good postural mechanisms, and coordinate movements.
“The vestibular and proprioceptive systems work together to provide a stable frame of reference against which other sensory inputs are interpreted”. (Nasher 1982 in Bundy, Lane and Murray 2002)
Inputs from the vestibular system could be used to resolve
vestibular-visual-somatosensory conflicts. The role of the
proprioceptive system is to provide the motor system with
a clear map of the environment and of the body (Matthews
1988 in Bundy, Lane and Murray 2002).
THE VESTIBULAR SYSTEMThe vestibular system is situated in the inner ear, on both
sides of the head. There are two types of receptor cells:
otolith organs (consisting of the utricle and saccule) and
semi-circular canals. The otolith organs are responsible
for static functions. The information processed by these
receptors is used to detect position of the head and body
in space and control of posture (Bundy, Lane, Murray
2002) The otolith organs consist of calcium carbonate
crystals attached to hair-like neurons. Gravity pulls these
crystals downward to press on and move the hair cells,
which then activate the nerve fibers to carry the vestibular
sensory input to the vestibular nuclei of the brain stem.
Because gravity is always present, these receptors send
a constant stream of vestibular messages to the brain.
The gravity receptors are sensitive to head tilts and bone
vibrations, which shake the crystals. (Ayres 2005)
The second type of vestibular sensory receptors, lies
in three closed tubes, filled with liquid and are called
semicircular canals. The semi-circular canals are the
dynamic components of the vestibular system.
These structures respond to movement of the head.
The semicircular canals respond to rotational forces in all
the body planes as well as acceleration and deceleration.
They provide information about the direction of movement,
or if a change in direction occurred (Bundy, Lane and
Murray 2002).
The vestibular system has approximately 20 000 nerve
axons on either side of the head that are constantly
receiving information about position and movement.
The vestibular receptors are the most sensitive of all the
sense organs and have a powerful effect on the brain.
This effect begins early in fetal life. In-utero, the vestibular
nuclei appear 9 weeks after conception and begin
functioning by the 10th or 11th week. By the 5th month
in-utero, the vestibular system is well developed and along
with the tactile and visceral systems provides almost all
of the sensory input to the fetal brain. Throughout most of
her pregnancy, the mother stimulates the baby’s vestibular
system with the movements of her body. Once the baby is
born, the baby has to develop his/her own relationship with
Article
The vestibular and proprioceptive systems have to be functioning optimally in order to successfully coordinate and integrate the two sides of the body.
“
24 Volume 24 | No 2 | 2014
gravity and in order to become comfortable with his/her
own body movements. (Ayres 2005)
Vestibular sensations are processed mostly in the
vestibular nuclei and cerebellum. They are then sent down
the spinal cord and into the brain stem, where they serve
a powerful integrating role. Some of the impulses are sent
from the brain stem to the cerebral hemispheres.
The impulses going up to higher levels of the brain, interact
with tactile, proprioceptive, visual and auditory impulses to
give us our perception of space, position and orientation.
Other impulses, going down the spinal cord, interact
with sensory and motor impulses to help us with posture,
balance and movement.
The vestibular system senses the movement itself, and
usually operates unnoticed to coordinate and calibrate our
every movement. Vestibular input seldom enters into our
conscious awareness, except after we spin in circles and
the input is so intense that we feel dizzy, and see the world
turn around us. Even when overstimulation of the vestibular
system creates a feeling of “motion sickness”, we feel the
uneasiness in our body rather than in our inner ears.
(Ayres 2005)
Since the effect of gravity upon our brains is constant,
we take it for granted. When the vestibular system works
optimally, the pull of gravity generates a constant sensory
flow of information to support our everyday functioning and
we can do things “automatically” without thinking about
how to do them.
Within the vestibular system, an individual may have
difficulty with one, or all, or any combination of sensory
receptors and processing. Disorganization within the
vestibular system may impact on: modulation and alertness,
eye and neck muscles, nystagmus, muscles, postural
control, equilibrium, postural background movements, co-
contraction, protective extension, emotions and behaviour,
digestive tract and academic learning.
(Ayres 1972, 1989, 2005)
THE MOTOR SYSTEMThe motor system consists of all our muscles and the
neurons that control them. It gives rise to our behaviour.
Behaviour requires the coordinated actions of various
combinations of almost 700 muscles in a changing and
unpredictable environment. The expression “running
around like a headless chicken” is based on the
observation that complex patterns of behaviour (such as
running around the barnyard) can be generated without the
participation of the brain. There is a considerable amount
of circuitry within the spinal cord for the coordinated
control of movements, particularly stereotyped (repetitive)
ones such as those associated with locomotion. Today’s
view is that the spinal cord contains certain motor
programs for the generation of coordinated movements
and that these programs are accessed, executed and
modified by descending commands from the brain.
(Bear, Connors, Paradiso, 2007)
Thus, motor control can be divided into two parts:
1. The spinal cord’s command and control of coordinated
muscle contraction is referred to as the peripheral somatic motor system: joints, skeletal muscle, and
spinal motor neurons and how they communicate with
each other.
2. The brain’s command and control of the motor programs
in the spinal cord is referred to as the central motor system. (Bear, Connors, Paradiso, 2007)
1. The spinal cord’s command & control of coordinated muscle contraction or Peripheral Somatic Motor System1.1 Sensory feedback
The sensory feedback originates from the muscles, joints,
tendons as well as from special senses inside the body
which dynamically adapts the locomotor patterns of the
spinal cord to the requirements of the environment. These
sensory receptors perceive the amount of pressure (stretch
or simply placement), direction of movement, speed and
velocity at which movement is occurring.
Article
Volume 24 | No 2 | 2014 25
There are two categories of lower motor neurons of the
spinal cord: alpha motor neurons and gamma motor
neurons. Alpha motor neurons excite skeletal muscles
and directly trigger the generation of force used by
muscles. One alpha motor neuron and all the muscle
fibers innervates collectively to make up the elementary
component of motor control, the motor unit (Sherrington
in Bear, Connors and Paradiso 2007). Muscle contraction
results from the individual and combined actions of these
motor units. Fast motor units contain rapidly fatiguing
white fibers, and slow motor units contain slowly fatiguing
red fibers. The collection of alpha motor neurons that
innervates a single muscle is called a motor neuron pool.
Graded control of muscle contraction by alpha motor
neurons assists us to exert just the right amount of force
during movements e.g. picking up an egg. Most of the
movements we make such as walking, talking and writing
require only weak muscle contractions. Now and then we
need to jog, or lift a pile of books which require stronger
muscle contractions. We reserve maximal contraction force
of our muscle for rare events such as competitive sprinting
or scrambling up a tree to escape a charging lion. The
nervous system uses several mechanisms to control the
force of muscle contraction in a finely graded fashion: (1)
varying the firing rate of motor neurons within the muscle
fibers, and (2) recruiting additional synergistic motor units.
(Bear, Connors, Paradiso 2007)
PROPRIOCEPTION FROM MUSCLES
Proprioception is derived from the Latin word “one’s own”
which informs us about how our body is positioned and
moving in space. This is the first source of synaptic input
to the alpha motor neuron. Muscle spindles are also called
stretch receptors. These receptors are components of the
somatic sensory system which is specialized for “body
sense”.
Muscle spindles are not the only source of proprioceptive
inputs from muscles. Another sensor in skeletal muscles is
the Golgi tendon organ which monitors muscle tension, or
the force of contraction. Golgi tendon organs are located
at the junction of the muscle and the tendon.
It is important to note that spindles are situated in parallel
with the muscle fibers, Golgi tendon organs are situated
in series. This different anatomical arrangement is what
distinguishes the types of information these two sensors
provide the spinal cord: activity from the muscle spindle
encodes muscle length, while activity from the Golgi
tendon organ encodes muscle tension information. (Bear,
Connors, Paradiso 2007)
PROPRIOCEPTION FROM JOINTS
A variety of proprioceptive axons are present in the
connective tissue of joints, especially within the fibrous
tissue surrounding the joint capsules and ligaments. These
mechano-sensitive axons respond to changes in the angle,
direction and velocity of movement in a joint. There are
many axons providing a lot of sensory information about a
moving joint, while there are only a few nerves encoding
the resting position of joints. We are none the less quite
good at judging the position of a joint, even with our eyes
closed. (Bear, Connors, Paradiso 2007)
1.2 Centrally generated patterns
Central pattern generators (CPGs) are biological neural
networks that produce rhythmic patterned outputs
without sensory feedback. CPGs have been shown to
produce rhythmic outputs resembling normal “rhythmic
motor pattern production” even in isolation from motor
and sensory feedback from limbs and other muscle
targets. (Hooper, Scott 1999, 2010) The spinal cord
executes rhythmical and sequential activation of muscles
in locomotion. (Cunningham, E.T., Sawchenko, P.E.,
February 2000). The central pattern generator (CPG)
provides the basic locomotor rhythm and synergies by
integrating commands from various sources which serve
to initiate or modulate its output to meet the requirements
of the environment. CPG within the lumbosacral spinal
cord segment represent an important component of
the total circuitry that generates and controls posture
and locomotion. This spinal circuitry can function
independently in the absence of descending input from
the brain to generate stable posture and locomotion and
A literature review: The neuro-biological basis of the vestibular and proprioceptive
systems and the impact on motor control and bilateral coordination
26 Volume 24 | No 2 | 2014
even modulate activity to match changing conditions (e.g.
stepping over obstacles). This capability improves with
training (spinal plasticity) and therefore it is believed that
the spinal cord has the capability to learn and memorize.
(Bear, Connors, Paradiso 2007)
Functional examples of CPG’s: locomotion (e.g. walking,
running, stepping), swallowing, chewing and breathing
are also observed in cats (e.g. running), birds (e.g. flying)
and water vertebrates (e.g. swimming). (MacKay-Lyons
M 2002; Bear, Connors, Paradiso 2007; Hooper, Scott
1999–2010, Van Emmerick 1998).
THE GENERATION OF SPINAL MOTOR PROGRAMS FOR WALKING
The crossed-extensor reflex, in which one side extends as
the other side flexes, seems to provide a building block for
locomotion. When you walk, you alternately withdraw and
extend your two legs. All that is lacking is a mechanism
to coordinate timing. In principle, this could be a series of
descending commands from upper motor neurons.
However, as we have concluded from the headless chicken
behaviour, it seems likely that this control is exerted from
within the spinal cord.
Different circuits use different mechanisms. The simplest
pattern generators are individual neurons whose membrane
properties endow them with pacemaker properties.
Intrinsic pacemaker activity in spinal interneurons might
act as a rhythmic driving force for sets of motor neurons
which in turn command cyclic behaviours like walking, but
they are not solely responsible for generating rhythms in
vertebrates. It is the combination of intrinsic pacemaker
properties and synaptic interconnections that produces
rhythm. (Bear, Connors, Paradiso 2007)
To summarize this section: sensation and movement are
inextricably linked even at the lowest levels of the neural
motor system. The normal function of the alpha motor
neuron depends on direct feedback from the muscles
themselves, and indirect information from the tendons,
joints and skin. The spinal cord contains an intricate
network of circuits for the control of movement. It is
far more than a conduit for somatic sensory and motor
information. (Bear, Connors, Paradiso 2007)
Volume 24 | No 2 | 2014 27
2. Brain control of movement or Central Motor SystemThe brain influences activity of the spinal cord to command voluntary movements. The central motor system (referring to
what is happening in the brain) is arranged as a hierarchy of control levels, with the forebrain at the top and the spinal cord
at the bottom.
The motor control hierarchy is divided into three levels and is summarized as follows:
A literature review: The neuro-biological basis of the vestibular and proprioceptive
systems and the impact on motor control and bilateral coordination
Level of Motor Neurological Contribution to Motor Example: Considering a Control Representation Control tennis player about to serve to the opponent
1. Highest Level Association areas of Concerned with strategy: Strategy to move the body
neocortex and basal formulating a goal of from the current state to one
ganglia of the forebrain. movement, and a strategy in which a specific ball can
to successfully achieve be delivered to obtain a goal
that goal. (opponent missing the ball or
making a mistake) e.g.
considering options between
a fast/slow delivery, curve ball,
where on the court the ball
should land. Decision is
largely based on previous
experience.
2. Middle Level Motor cortex and Concerned with tactics: Making the decision to hit a
cerebellum. the sequences of muscle curve ball and issue
contractions, arranged in instructions to prepare the
space and time, required to body e.g. one hand throwing
smoothly and accurately the ball at the right height
achieve the strategic goal while the other hand prepares
above. to hit the ball at the right
moment and at the right
speed.
3. Lowest Level Brain stem and Concerned with execution: Coordinated movements
spinal cord. activation of the motor neuron of the shoulder, elbow, wrist
and interneuron pools to and fingers to play the desired
generate the goal directed shot, while keeping his eyes
movement and make any on the ball, without falling over
necessary adjustments of (postural adjustments), while
posture. his head and body move
about.
From “Neuroscience: exploring the brain” pg. 452 (Bear, Connors, Paradiso 2007)
28 Volume 24 | No 2 | 2014
Sensory information before a movement was initiated
is crucial to determine the starting positions of the limbs
and body and to anticipate any changes in resistance
during the movement.
Sensory feedback during the execution of the
movement is important to make any necessary
adjustments for improving subsequent similar
movements.
Article
PLEASE NOTE: THE ABOVE LEVELS OF MOTOR CONTROL HIERARCHY ARE NOT THE SAME AS THE COMPONENTS OF PRAXIS.
Levels of motor control explain how a specific movement is initiated and refined. Components of praxis explain an advanced ability to form new ideas in order to do something new for the first time, or something familiar in a new way. Praxis has to do with novelty, forming ideas and problem solving. Ayres referred to praxis as the bridge between cognition and action.
The components of praxis are summarized as follows:
Components of Praxis: Contribution to behaviour: Example:
1. Ideation and conceptualization The idea of what to do e.g. the idea of making a cup of tea
2. Planning a course of action Prioritizing and organizing the e.g. put water in the kettle, put the kettle on,
steps of how to do it: where to get a cup and spoon, get the ingredients
start and what is next (tea, milk, sugar)
3. Executing the motor action Doing the task e.g. measuring the right amounts of water,
tea, milk, sugar, putting it into the cup, stir,
and drink without spilling or getting burnt
“It is somewhat misleading to refer to execution as the final process of praxis, for there is a continual spiral of
ideation, sensory integration, planning, execution, sensory feedback, ideation etc.”
(Ayres 1985, 2011)
Ideation and planning distinguish praxis from a pure motor function. For the purpose if this article, the various neurological
sites involved in praxis will not be discussed.
A literature review: The neuro-biological basis of the vestibular and proprioceptive
systems and the impact on motor control and bilateral coordination
Volume 24 | No 2 | 2014 29
DESCENDING SPINAL TRACTS
Axons from the brain descend through the spinal
cord along two major groups of pathways: the lateral
and ventromedial pathways. This is how the brain
communicates with the motor neurons in the spinal cord.
The lateral pathways are involved in voluntary movement
of the distal muscles (e.g. fine movements of the arms
and fingers) and are under direct cortical control. The
lateral pathways include the corticospinal (also called the
pyramidal tract) and the rubrospinal tract.
The ventromedial pathways are involved in the control
of posture and locomotion and are under control of
the brain stem. These pathways include the following:
vestibulospinal, tecticospinal, and pontine and medullary
reticulospinal tracts. The vestibulospinal and tecticospinal
tracts control the posture of the head and neck. The
pontine and medullary reticulaspinal tracts control the
posture of the trunk and the antigravity muscles of limbs.
(Bear, Connors, Paradiso 2007)
PLANNING OF MOVEMENT IN THE CEREBRAL CORTEX
Goal directed movement depends on knowledge of where
the body is in space and where it intends to go, and on
the selection of a plan to get it there. It is also based on
knowledge about the objects (e.g. what the properties
are and what the object can do) that one needs in order
to successfully execute the plan. Once a plan has been
selected, it has to be held in memory until the appropriate
time. Then, instructions must be issued (from the brain to
the body) to implement the plan. These different aspects
of motor control are localized to different regions of the
brain where certain cortical areas are implicated in motor
planning. (Bear, Connors, Paradiso 2007)
BASAL GANGLIA
The basal ganglia is part of a motor loop where information
cycles from the cortex, through the basal ganglia and
thalamus, and then back to the cortex. One of the functions
of this loop appears to be the selection and initiation of
willed movements.
Increased inhibition (more than required) of the
thalamus by the basal ganglia leads to hypokinesia, as
seen in insufficient slowness of movement e.g. Parkinson’s
disease. Its symptoms include slow and poorly initiated
movements, rigidity and tremors of the hands and jaw.
Decreased (not enough) basal ganglia output to the
thalamus leads to hyperkinesia, which can be seen as an
excess of movement e.g. Huntington’s disease. The most
characteristic sign of the disease is chorea: spontaneous,
uncontrollable and purposeless movements with rapid,
irregular flow and flicking motions of various parts of
the body. People with Huntington’s disease also exhibit
changes in mood, memory and personality. (Bear, Connors,
Paradiso 2007)
INITIATION OF MOVEMENT BY THE PRIMARY MOTOR CORTEX
A view that has emerged from recent research is that
individual pyramidal cells can drive numerous neuron pools
from a group of different muscles involved in moving a limb
toward a desired goal. A burst of neural activity occurs
immediately before and during a voluntary movement to
encode two aspects of movement: force and direction.
(Bear, Connors, Paradiso 2007)
CEREBELLUM
The word cerebellum is derived from the Latin word “little
brain”. Although the cerebellum is physically much smaller
than the cerebrum, it actually contains as many neurons
as the both cerebral hemispheres combined. In contrast
to the cerebrum, the left side of the cerebellum is
concerned with movements of the left side of the body,
and the right side of the cerebellum is concerned with
movements of the right side of the body.
(Wolf et al 2009) The cerebellum has extensive
connections with the cerebrum and spinal cord. It is not
enough for the higher cortex to simply command the
muscles to contract e.g. throwing a curve ball requires a
detailed sequence of muscle contractions, each one timed
with great precision. This critical motor control function
belongs to the cerebellum. Lesions in the cerebellum can
A literature review: The neuro-biological basis of the vestibular and proprioceptive systems and the impact on motor control and bilateral coordination
30 Volume 24 | No 2 | 2014
be seen in uncoordinated and inaccurate movements e.g.
ataxia. The cerebellum is also part of another motor loop
which is involved in motor learning: it is a place where
what is intended is compared with what has happened.
When this comparison fails to meet expectations,
compensatory modifications are made in certain cerebellar
circuits. (Bear, Connors, Paradiso 2007)
CORPUS CALLOSUM
The name corpus callosum is derived from the Latin word
“tough body”. It is continuous with cortical white matter
and forms a huge bundle of axons (or an axonal bridge)
that connects the two cerebral hemispheres. The corpus
callosum consists of at least 200 million axons crossing
between the hemispheres. (Caminiti et al 2009) This
neural bridge is also the largest collection of white matter
within the brain, and it contains a high myelin content,
which facilitates quicker transmission of information. This
should not be confused with grey matter. The brain uses
grey matter for computation, thinking, memory storage
and more. White matter, like the corpus callosum, allows
different parts of the brain to communicate with each other.
(Fields, Douglas 2008).
In general, neural impulses from the body crosses over
in the brainstem. The right side of the brain receives
sensations from and controls movements of the left side of
the body. Similarly, the left side of the brain is concerned
with sensations and movements of the right side of the
body.
The purpose of the corpus callosum is to allow the
two sides of the brain to intercommunicate. It transfers
sensory, motor and cognitive information between the two
hemispheres. It promotes symmetry in the human body
e.g. language skills and handedness. It also promotes
eye movements, maintaining the balance of arousal and
attention, as well as tactile localization. Interestingly, the
front portion of the corpus callosum is larger in musicians
than non-musicians, as well as left-handed people.
(Witelson 1985) Musical training has shown to increase
plasticity of the corpus callosum during a sensitive period
of time in development (Levitin, 2007). The implications are
an increased coordination of hands, differences in white
matter structure, and amplification of plasticity in motor
and auditory ability. Corpus callosum size also correlates
positively with verbal memory capacity and semantic
coding (Kozlovskiy et al 2012). (Interpreting words and
making associations e.g. words, phrases, pictures from
memory). Research has also shown that children with
reading difficulties have a smaller and less developed
corpus callosum than their peers who can read well. (Von
Plessen et al 2002). Researchers have also demonstrated
that corpus callosum shape abnormalities at birth had an
impact on gender identity disorders (e.g. biological males
who self-identified as females and vice versa).
(Yokota et al 2005)
Lesions to the anterior part of the corpus callosum may
lead to akinetic mutism (lacking motor functions such as
speech, facial expressions and gestures), but demonstrate
apparent alertness or tactile object recognition (e.g.
stereognosis). Lesions to the posterior part of the corpus
callosum may lead to severe reading problems while other
language-related skills such as naming, oral repetition,
auditory comprehension or writing are typically intact.
(Behrmann et al 2001)
THE INFLUENCE OF MIRROR NEURONS ON LEARNING NEW MOTOR SKILLS
A mirror neuron is a neuron which fires both, when
someone imitates or observes the same action performed
by another. (Rizzolatti et al 2004). Thus, the neuron
“mirrors” the behavior of the other, as though the observer
is doing the action himself. (Rizzolatti et al. 1999).
The function of the mirror system is a subject of much
speculation. Many researchers in cognitive neuroscience
and cognitive psychology consider that this system
provides the physiological mechanism for the perception/
action coupling (Keysers & Christian 2011). They argue
that mirror neurons may be important for understanding
the actions of other people, and for learning new skills
by imitation. Some researchers also speculate that
mirror systems may simulate observed actions, and thus
contribute to theory of mind skills (Keysers et al. 2006),
Volume 24 | No 2 | 2014 31
while others relate mirror neurons to language abilities
(Théoret & Alvaro 2002). Neuroscientists have argued
that mirror neuron systems help us understand the actions
and intentions of other people and could explain the
neural basis for emotions such as empathy. (Lacoboni,
2005). It has also been proposed that problems with the
mirror neuron system may underlie cognitive disorders,
particularly autism (Blakeslee, 2006).
CONCLUSIONWhen considering the preceding sections on motor
control, it is evident that good bilateral integration and
sequencing is a product of various sensory-motor
mechanisms occurring on various neurological levels from
sensory tracts in the spinal cord, all the way up through the
brain stem, cerebellum, primary motor cortex and through
the corpus callosum. Ayres proposed that a sensory
processing disorder is made in the absense of frank
peripheral and /or neurological damage (Shaaf and Smith-
Roley 2006). Therefore it is not possible to limit VBIS
difficulties to one specific neurological domain, but rather a
difficulty in processing vestibular and proprioceptive input
effectively. Ineffective processing of sensory input can
be observed e.g. in inadequate motor performance and
development of functional skills.
It is our role as occupational therapists working within the
field of sensory integration to make use of all available
assessment data e.g. from the SIPT, structured and
unstructured clinical observations, as well as functional
difficulties reported by the caregivers and teacher in order
to make the correct diagnosis. We have to understand the
underlying sensory processes and functional difficulties
in order to design an appropriate treatment plan and to
ultimately improve the occupational performance of the
individual who has vestibular and proprioceptive based
bilateral difficulties.
Playing, exploring and having fun is part of every child’s
development. They are curious by nature and want to do
things for themselves. It is important for children to explore
sensory properties in a safe environment, be actively
involved, do things for themselves and to have fun. For
children with sensory processing difficulties, life is not easy
and learning is not fun. We therefore have the responsibility
to help them to things a little better than before to make
their lives a little easier and more fun.
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2. Ayres, A. J. (1972) Sensory California Sensory Integration Test Manual, Los Angeles, Western Psychological Services.
3. Ayres, A. J. (1975) Southern California Post Rotary Nystagmus Test Manual. Los Angeles, Western Psychological Services
4. Ayres, A. J. (1989) Sensory Integration and Praxis Test Manual. Los Angeles: Western Psychological Services
5. Ayres A.J. (2005) Sensory Integration and the child - 25th anniversary edition, Los Angeles, Western Psychological Services
6. Ayres, A. J. and Cermak, S. A. (2011). Ayres Dyspraxia Monograph - 25th anniversary edition. Pediatric Therapy Network, California
7. Bear, M. F., Connors, B. W. and Paradiso, M. A. (2007) Neuroscience: Exploring the brain 3rd edition. Lippincott Williams and Wilkins
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11. Case-Smith, J. (2001) Occupational Therapy for Children 4th Ed, Mosby: Philadelphia
12. Cohen, H. S., Burkhardt, A., Cronin, G. W. and McGuire, M. J. (2006). Specialized Knowledge and Skills in Adult Vestibular Rehabilitation of Occupational Therapy Practice. American Journal of Occupational Therapy 60 (6) Nov/Dec 2006
13. Cunningham, E. T. and Sawchenko, P. E. (February 2000). “Dorsal medullary pathways subserving oromotor reflexes in the rat: implications for the central neural control of swallowing”. J. Comp. Neurol. 417 (4): 448–66
14. Davies, P. L., and Tucker, R. (2010). Evidence review to investigate the support for subtypes of children with difficulty processing and integrating sensory information. American Journal of Occupational Therapy, 64, 391–402
15. Fields, Douglas (March 2008). “White Matter”. Scientific American 298 (3): 54–61.
16. Fischer, A., Murray, E. and Bundy, A. (1991). Sensory Integration Theory and Practice, F.A. Davis Company: Philadelphia
17. Hooper, Scott L. (1999–2010). “Central Pattern Generators”. Encyclopedia of Life Sciences. John Wiley & Sons
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– Ayres 2005
“
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32 Volume 24 | No 2 | 2014
18. Keysers, Christian and Gazzola, Valeria (2006). “Progress in Brain Research” (PDF). Bcn-nic.nl.
19. Keysers, Christian (2011-06-23). The Empathic Brain (Kindle)
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Volume 24 | No 2 | 2014 33
VBIS Case Study: Adam (6yrs 3mnths)
By Stefanie Kruger, B.OT (UP)
REASON FOR INITIAL REFERRALAdam was still switching hands at the age of 5 years,
struggling to draw and cut, struggling with fastening
buttons and zips. He was emotionally immature and threw
tantrums when not successful. He struggled to learn new
motor skills, and to keep up with the work pace in class.
Adam was experienced as a pleasant and popular boy
who enjoyed the company of friends. He had a poor sitting
posture, was slouching at the desk, showed exaggerated
postural background movements, and supported his head
while working.
Information gathered from parent questionnaire and sensory profile:• Born at 39 weeks by means of natural induced labour
• weighed 2.9kg, no complications
• bottle fed
• irregular sleeping patterns
• sitting at 6 months
• crawling at 10 months
• walking unaided at 12 months
• started saying words at 10 months
• potty trained at 3 years
• good relationships with parents and friends
• struggling to put clothes and shoes on the right way
• messy eater at times
• loves swinging and being tossed in the air
• protrudes tongue while doing fine motor coordination
tasks
• struggling with rhythmical tasks such learning to ride a
bicycle without training wheels
• had stitches in lip after falling
• takes excessive risks during movement or climbing
activities that compromise safety
• seeks opportunities to fall without regard to personal
safety
• tires easily
• appears clumsy
• accident prone
• excessive emotional outbursts when not successful at
a task
• poor frustration tolerance,
• cries easily
• not completing tasks
• seeks all kinds of movement (fidgets, “on the go”)
• rocks unconsciously
• twists clothing on body while talking
• leaves clothes twisted
Observations during SIPT testing:• impulsive, talkative, fidgety
• postural fixations in his neck, eyes and trunk as well as
exaggerated arm movements
• clowned about, fell down between tasks and was very
giggly and visually distractible
Article
VBIS Case Study: Adam (6yrs 3mths)
34 Volume 24 | No 2 | 2014
• avoided crossing midline, sitting on edge of chair,
poor posture
• wrist instability, shoulder fixation, increased pressure,
thumb wrap
• slow and segmented movements with poor rhythm
and timing
• many incomplete sequences were noted
• movements appeared haphazard with little fluidity
between the left and right side, possibly indicating
poor reciprocal movement patterns
• sequences performed segmentally, being rigid and
disjointed and were either incomplete or executed
with additional movements.
• poor dissociation of fingers and increased pressure
when tapping on the table
• PRN: Struggled to maintain upright posture during
rotation, fell off the board after rotation, enjoyed the
movement and was eager to continue spinning.
No nausea was noted.
• Tactile section: very distractible, appeared to want to
use a large amount of visual cues, trying very hard to
cheat and see what was going on underneath the shield,
riding the chair. No obvious aversions to touch.
Additional clinical observations:• Difficult to sustain postures against gravity, fixating,
hyper-extended elbow joints, scapulae winging, lordosis
and locking of his knees in standing. Poor endurance
and quick execution of gross motor tasks.
• Poor equilibrium reactions, poor trunk rotation
• Difficulty in executing movements in a smooth and
controlled manner.
• Poor head eye dissociation was noted, convergent gaze
stability, tracking (particularly across the midline) were
noted.
• Obvious difficulty with catching balls. Used increased
pressure and force when executing movement
sequences, particularly when executed bilaterally.
• Difficulty performing tasks such as jumping, hopping,
skipping with rhythm and timing.
• Struggled to start and stop movements.
Adam’s scores were adapted according to Annamarie van Jaarsveld’s research based on the South African population and
are indicated in the blue in the graph below:
Space Visualization Figure-Ground Perc.
Man. Form Perception
Kinesthesia Finger Identification
Graphethesia Loc. Tactile Stimuli
Praxis Verb. Command (-0.26) Design Copying
Constructional Praxis Postural Praxis
(-0.19) Oral Praxcis Sequencing Praxis
Bilateral Motor Coord
(11.21) Stand & Walk Balance (-0.63) Motor Accuracy Postrotary Nystagmus
0.28 1.83 1.61
-0.60 0.59
-1.40 1.02
-0.30 0.24
0.99 0.88 0.31
-1.15 -0.33
-0.71 -0.13 -0.62
SD LOW
3 3210-2 -1
AVERAGE
PERCENTILE
HIGH
0.5 1 5 10 25 50 75 95 95 99 99.5
VBIS Case Study: Adam (6yrs 3mths)
Volume 24 | No 2 | 2014 35
Occupational Performance Goal: To facilitate the quality of motor control in order to successfully participate in tasks
that require the integrated use of the two sides of his body
Environmental Context: Home, school and during leisure activities
Current Performance: Clumsy, accident prone, switching hands, poor motor output, struggling with
rhythmical and sequential tasks, temper tantrums if not successful
ASI objectives related to 1. To promote trunk control and ability to maintain postures against gravity
sensory processing within 2. To facilitate trunk rotation in order to use his preferred hand without switching
the vestibular and hands across his body midline
proprioceptive systems: 3. To promote balance and equilibrium reactions so he can perform movement
sequences with better rhythm and timing
4. To participate in free play activities with his peers during motor tasks where he
can engage with more confidence and less emotional outbursts
Session Target: 1. To satisfy the child’s need for enhanced sensory feedback in order to promote
stable background movements and a realistic body scheme so he can have more
control over his body and participate in motor tasks without hurting himself;
2. To build his skills repertoir and self-confidence while having fun and experiencing
success during a “just right” motor challenge.
Grading: • maintaining postures during dynamic activities (semi-circular canal activation)
(within current session or over • maintaining postures against gravity (otolith organ activation)
more than one, depending on the • stable base - moving base (challenging balance and equilibrium, bearing in
mind base of support) child’s participation)
• ipsilateral - contralateral motor challenges (challenging trunk rotation)
• symmetrical vs reciprocal movements UL vs LL combinations
• level of complexity e.g. one motor task at a time building towards an
obstacle course
(Remember it is always child directed: provide intended opportunities to challenge
and develop the individual’s skills, NB control what you make available for him to
“discover”)
Integration of skills to facilitate • at home: fastening buttons, zips, eating without making a mess
desired adaptive behaviours: • at school: drawing, cutting without switching hands
• during play: playing on the jungle gym with his friends during break time,
successful participation in at least one structured sport offered at school,
riding a bicycle* with his friends in his neighbourhood
(* participated in 94.7 children’s race in 2008 and 2009)
Goal setting suggestions summary:BILATERAL INTEGRATION AND SEQUENCING DIFFICULTIES
(Under responsiveness resulting in discrimination difficulties in the vestibular and proprioceptive systems)
36 Volume 24 | No 2 | 2014
The activities are divided into 3 groups:
1. Activities to enhance symmetrical functioning
2. Activities to enhance alternating functioning
3. Activities to enhance midline crossing
Part 1 and 2 was published in the previous SAISI
newsletter, vol 24 no 2 2014. Following is part 3:
Activity ideas
Suggested Activities for the Improvement of Bilateral IntegrationBy E. Steenekamp, E. Jooste & C. Dureux
This article was first published in the SAISI Newsletter of May 1986
ACTIVITIES TO ENHANCE MIDLINE CROSSING
1. BOLSTER SWING
• Neck righting reaction:
Child lies prone on the bolster with arms and legs
hanging relaxed down the sides. Child turns head
alternatively towards the right and the left while the
bolster is moving slowly.
• Crossing through head, eyes, shoulders, hands:
- Swing bolster forwards and backwards. Child holds onto bolster with one hand,
while other hand throws bean bag at a target on the opposite side, or hit a
suspended ball on the opposite side.
- Child sits astride on bolster swing and hit a suspended bag full of balls with a large
rolling pin with handles on both sides, or a medium size ball, big enough to hold
with both hands.
- Child swings forwards and backwards on bolster while holding onto a stick with
both hands. The therapist throws a ball alternatively to the right and left sides, and
the child has to hit it back.
Volume 24 | No 2 | 2014 37
2. JUNGLE GYM
• Integration of leg movements
- Child moves sideways on the frame.
• Total body rotation (advanced level of midline crossing)
- Make a cranky pathway through the jungle gym with a rope, which the child has to
follow. Ensure that this pathway has many turns and bends and requires the child
to turn his body to be able to follow.
3. INNER TUBE
• 5-7 small tubes tied together:
- Neck righting reaction: The child rolls while lying within the tube “tunnel”.
The movement is inisiated by turning of the head. It may be necessary to put a
pillow with the child in the tubes.
• Medium size inner tube lying flat on the floor:
- Child stands on all fours on tube and draws a half circle around himself, or build
a puzzle etc.
- Child crawls in a circle on the tube, while collecting “trash” from the outside of the
tube and throwing it on the “garbage dump” (inside of tube).
- Child sits astride on tube and takes rings from the inner circle to throw over a
target (traffic cones) outside the tube.
4. HAMMOCK with 2 corners tied together
• Child lies prone on pillows (prevent lordosis) and hit a target or throw a ball on
opposite side. (The target should be low to prevent excessive head extension.
Do not elicit the ATNR.)
• Put traffic cones in a circle around child. While lying prone, rotate the child and let
him hit the cones with a stick.
• Child spins himself around.
5. FLEXION SWING
• Child sits on swing, facing towards one side, while the opposite hand pushes with a
stick on the floor (extension movements) behind the back to move around in a circle.
• Child throws objects to the different sides.
• Child sits on flexion swing, holding onto trapeze while therapist moves the flexion
swing around to create rotational movements.
• Child kneels on flexion swing en walks sideways, or stands and crosses legs to walk
around middle axis of swing.
6. MATTRESS or TRAMPOLINE
• Neck righting reaction:
- Child rolls, inisiated by neck flexion. Resistance can be given at cheeck / shoulder.
- Child rolls over rope, rolling the rope around the child.
38 Volume 24 | No 2 | 2014
- Roll child up into a blanket and roll quickly out again.
• Crossing of head, eyes, shoulder and hand:
- Put mattresses downhill and let child roll up and down to “transport” bean bags.
- Child lies supine with slight head flexion. Hit a ball sideways over midline, or
move objects from one side to the other while keeping hips steady.
• Total body rotation:
- Child rolls, inisiated by hip / knee against resistance.
- While kneeling, catch a ball with a scoop held by both hands.
- Child sits with straight legs on trampoline and turns himself around through
shoulder, arm and trunk movements. This can also be done in kneeling, kneel
sitting and all fours positions.
- Put a rope in a straight line on the trampoline, or draw a line with chalk.
Child stands on all fours with line between his hands. Let him jump with knees
sideways across the line.
7. SCOOTER BOARD
• Crossing of head, eyes, shoulders and hands
- Child lies prone while being pulled forwards while hitting targets to the left and the
right. This can also be done in sitting and kneel-sitting position. Example of targets:
small tins with shapes on (e.g. hit all the triangles etc.); throwing rings over traffic
cones etc.
- Child holds onto stick / rope / hoola hoop that is being pulled by the therapist.
He turns himself in different directions and all around while “driving” through
different obstacles. (This might give an indication of which side does cross
the midline.)
- Child moves himself forward by “rowing over the river” with a stick held with
both hands.
• Integration of leg movements
- Child sits on scooter board with feet on the floor. He turns himself all around
with his feet. This can also be done while lying prone.
8. CUBIC FOAM BLOCKS
• Crossing of head, eyes, shoulders and hands:
- Put blocks against each other in a line, or build steps. While crawling over the
blocks with support from the therapist, the child picks up objects from the blocks
and throws it sideways, crossing the midline.
Activity ideas
Volume 24 | No 2 | 2014 39
9. OTHER MIDLINE CROSSING ACTIVITIES
• Work on an upright standing blackboard Prevent splinter skills.
• Clapping patterns, swinging flags or “Simon Says”.
• Kneel-walking, pushing a small wheel-barrow on a winding pathway.
• Animal walks
• Phoning numbers on a large telephone disc. (Bear in mind that this was written
in 1986, adapt to modern day technology! Ed.)
GRADING OF MIDLINE CROSSING ACTIVITIES AND VARIATIONS TO FIT OTHER GOALS
1. The size of the ball / bean bag can be graded from medium size to smaller.
2. The size of the target can be graded from large to small.
3. The height and distance of the target is easy to adapt.
4. The weight of the ball / bean bag, or the hitting aid (stick, rolling pin, bat etc)
can be graded. Weights can be attached to the child’s wrists if necessary.
5. The level of skill can be graded: it is easy to throw with a bean bag, but more difficult
to use a ball. A ball can easily be hit with another bigger ball, while it is a bit more
difficult with a stick held in both hands and even more difficult with a bat held in
one hand.
6. Grading of movement from shoulders to fingers: shoulder and elbow movements are
involved when hitting a ball with another big ball held in both hands; pro- and
supination are involved when using a bat or racket; and wrist movement is involved
in carpet bowls, or hitting tennisballs off stands during scooter board activities, or in
throwing darts.
Suggested Activities for the
Improvement of Bilateral Integration
40 Volume 24 | No 2 | 2014
Book Review
THE AFRICAN COLLECTION Stories about Sensory Integration Difficulties by Sally Fraser-Mackenzie (B.Sc.Hons OT; B.Sc.Hons Psychology)
Sally Mackenzie published the first of the books in this
series already in 2002 and has since added more stories
to her series. These remain a wonderful resource for
therapists, psychologists, teachers and parents. She
created a series of illustrated books for children, using
animal characters, to help explain different difficulties they
may be experiencing. The book Nyabile’s Sports Day,
specifically focusses on the child with BIS difficulties. It
follows the story of Nyabile (meaning clumsy in Xhosa), a
giraffe who struggles with bilateral coordination and ends
up disheartened by her inability to participate in activities
her friends can all do. The book leads the reader to fully
understand why she is experiencing these difficulties,
with the help of some other animal friends with difficulties
of their own, and provides practical strategies to help
them. On the back page of the book, she provides a
clear description of what bilateral integration difficulties
encompass and provides easy to implement but effective
activities and intervention strategies. The series also
contains 8 other books addressing other developmental
and Sensory Integrative dysfunctions. For parents and
teachers these books are also a tool to assess whether
a child is presenting with a difficulty and gives some
guidelines for assisting in the management thereof. For
the Occupational Therapist, these books can be used
in individual therapy by either reading to or with the
child (depending on age and reading level). In group
intervention it can be read, where after the story’s meaning
can be discussed. Although some of the terminology and
concepts may be difficult for the younger child to grasp,
these books are interactive and the stories written so that
the child will relate to the characters in each story. By
providing information, it empowers the child with sensory
integration difficulties and will also assist in addressing
the significant socio-emotional difficulties our children
often struggle with. The stories are now available in a 105
page full colour book, containing all 9 stories as well as
Afrikaans translation cards.
THE SERIES INCLUDES:
• Nyabile’s Sports Day
a story about Bilateral Integration Difficulties
• Sensitive Squelch’s Hideout
a story about Sensory Defensiveness
Resources to Assist with Bilateral Integration Difficulties
Compiled by Anneke Kruger, B.OT (UP)
Volume 24 | No 2 | 2014 41
Book Review• Verget’s Monkey Problems
a story about Low Muscle Tone
• Asteracea’s B’s an D’s
a story about Perceptual difficulties
• Frumpy Gets in a Knot
a story about Motor Planning Difficulties
• Wise Words form Zoë
a story about a warthog with Cerebral Palsy
• Bizzie and Ant’s Great Adventure
a story about a bee & an ant with Attention
Deficit Disorder
• Phalala’s Best Flying Area
a story about a hadeda with Sensory
Processing Disorder
• Biscus Makes Friends
a story about a tortoise with Autism
OT MOM LEARNING ACTIVITIES by Tracey le Roux
In our digital age, information and aids for Sensory
Integration difficulties are readily available on the internet
through many organisations and private enterprises. It
is often overwhelming due to the volume and variety
of e-books and web-sties accessible. In my search for
scientifically sound resources, I came across “OT Mom
Learning Activities”, created by South African, Tracey le
Roux, a home schooling mom and a qualified Occupational
Therapist with a background of paediatric occupational
therapy (OT). Other than the easy to use and informative
website – especially for parents and teachers – she
created a series of OT Mom Learning Activities E-books.
The series contains 5 activity-based books, addressing
Bilateral Integration, Shoulder Girdle exercises, Core
exercises, Fine-motor and Scissor cutting skills. The books
are mainly aimed at ages 5 years and up (Grade R and
primary school) but many of the activities can be graded
for younger pre-school children as well. The activities were
inspired by her work in private paediatric practice but also
at low-income schools where resources are limited. Thus
activities are designed to be low cost (use of everyday
resources and basic equipment) and easy replicable in
the home, school and therapy environment. The activity
book for Bilateral Integration contains a short introduction
on Bilateral Coordination, activities (16 pages of
photographed activities), additional information on midline
crossing and hand preference as well as an activity planner
section assisting in successfully implementing activities at
home. Activities included specifically focussed on Bilateral
integration are for: Hands and Arms; Feet and Legs; Arms
and Legs Together; Trampoline Exercises; Ball Activities;
Kitchen Activities; Activities with a Jungle Theme ; Ribbon
Activities ; Play dough Exercises.
These e-books are easy to use, especially for the
Occupational Therapist working within the community or
school setting where children are often treated in groups,
with limited time and financial resources. It can aid in
designing programmes to be implemented by assistants,
teachers and also parents in these environments. It could
assist the less experienced therapist in developing her
knowledge base but also for the skilled therapist assisting
parents and teachers implementing home and school
programmes. The books are available to download in a
PDF format, individually as well as in a bundles, single-
copy use or for organisations (up to 10 copies).
42 Volume 24 | No 2 | 2014
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ANSWER ALL QUESTIONS TRUE (A) OR FALSE (B)
QUESTIONNAIRE 35.1 (a24474) Bilateral Integration and South African Children
by Annamarie van Jaarsveld, M.OT (UFS)
1. Ayres considered various bilateral integration patterns, which include Postural Bilateral Integration, Vestibular Bilateral Integration and Bilateral Integration and Sequencing.
2. Three consecutive studies were done on bilateral integration difficulties in South African children.
3. Results of SA studies indicated that 39% of black and 38.46% of white children from low Socio Economic Settings scored within the risk and problems groups on the Bilateral Motor Coordination section of the De Gangi Berk Test.
4. Data from the four studies were compared and the results indicated that white children from high SES scored significantly higher with regards to Bilateral Motor Coordination than white and black children from low SES.
5. There were no significant differences between white and black children from high SES.
6. Culture has a significant impact on the prevelance of bilateral integration difficulties, while the socio-economic setting of the child does not have an impact on bilateral integration.
7. Consistent patterns of bilateral integration dysfunction have been found amongst SA and US children.
8. The sample of SA children included children with low PRN scores only.
9. Ayres made the theoretical assumption that bilateral integration difficulties are accompanied with an inefficient vestibular system reflected by a very low or depressed PRN score.
10. It can be concluded that the SIPT is not a valid diagnostic tool for use on SA children.
QUESTIONNAIRE 35.2 (a42574) A literature review: The neuro-biological basis of the vestibular and proprioceptive systems and the impact on motor control and bilateral coordination by Stefanie Kruger, B.OT (UP)
1. Only 20% of our nervous system is involved in organizing and processing sensory input.
2. When the activity of a sensory system becomes more organized, or various sensory systems become more integrated with one another, the nervous system functions in a more holistic manner.
3. Vestibular sensations are processed mostly in the vestibular nuclei and cerebrum.
4. Today’s view is that the spinal cord contains certain motor programs for the generation of coordinated movements and that these programs are accessed, executed, and modified by descending commands from the brain.
CPD Programme Questionnaire
CPD Programme Questionnaire
Volume 24 | No 2 | 2014 43
5. Motor control occurs in two parts: in the spinal cord itself as well as from the brain.
6. Proprioception is the first source of synaptic input to the alpha motor neuron.
7. Graded control of muscle contraction by alpha motor neurons assists us to exert just the right amount of force during movements.
8. Central pattern generators (CPGs) are biological neural networks that produce rhythmic patterned outputs without sensory feedback.
9. The crossed-extensor reflex, in which one side extends as the other side flexes, seems to provide a building block for balance reactions.
10. Increased inhibition of the thalamus by the basal ganglia leads to hypokinesia, as seen in insufficient slowness of movement, symptoms include tremors of the hands.
CPD Programme Questionnaire
