I attached 2 documents. One is the case where you have to answer all the questions and the other is a guide to help in the case.

Sensory Diet Activity

Guide Book

Cindy Chuan Occupational Therapist

yourkidsot.com

A "sensory diet" is a planned and scheduled activity program designed to meet a child's individual sensory needs (Wilbarger, and Wilbarger, 1991). It is related to activities that a child performs through their day to help them to "modulate" their bodies – It is not food related at all! Think about some of the activities you do to relax – Do you go for a jog? soak in a hot bath? go for a massage? drink a warm drink? Think of the activities that give you energy. The activities that might relax some people may actually energize others.

We live in a world full of sensory information and some kids have difficulty coping with the sensory information they receive in their daily lives (visual, auditory, vestibular, proprioceptive, tactile, taste, etc). Some kids can be seek sensory information and others will avoid it. This can change for a child depending on their environment or time of day.

A "sensory diet" aims to help a child level it all out and cope. It aims to prevent sensory and emotional overload by satisfying the child's nervous system. If you are concerned that your child may have sensory processing difficulties, contact an Occupational Therapist for an assessment. The assessment typically involves an interview and questionnaire completed by parents and teachers as well as observation of your child. This guide book is provided for those whose child's sensory needs have already been identified and is not a diagnostic tool.

This guide book is also written for occupational therapists looking for additional suggestions to help with the formulation of a sensory diet for their clients.This guide book provides examples of activities that may be included in a "sensory diet" in a home or school environment where specialized equipment may not be available. These activities are generally suitable for all children, however, professional advice should be obtained if you are uncertain (particularly with the vestibular system) about which activities or combination of activities to try. Consideration should also be made regarding your child's age and cognitive abilities.

Whilst the activities in this guide book have been categorized, all the sensory systems are connected so one system may affect another. After trialling the activities with your child, make note of the affect of the activities. Does it calm your child, arouse them, over-arouse them? It should be noted that whilst some activities may be calming for one child, it may alerting for another child. When creating a "sensory diet"; you will need to consider which activities are appropriate, when they should be carried out, for how long and how often.

There are over 100 activities that I have put together here so if you are overwhelmed don't feel like you need to try them all in one day. Not all the suggestions will be suited to your child. It is best to look over this list with your occupational therapist.

A Sensory Diet…

Cindy Chuan is a registered Occupational Therapist practising in Sydney Australia. She has two young children who are a constant source of inspiration and learning. Cindy loves working creatively to help children to reach their potential, finding opportunities in everyday living and making learning fun. Cindy is the author of the Occupational Therapy blog Your Kids OT (https://www.yourkidsot.com).

© 2018 Your Kids OT. Sensory Diet Activity Guide Book

© 2018 Your Kids OT. Sensory Diet Activity Guide Book.

Proprioception tells us about the movement and position of our bodies. Proprioception is sometimes called "position sense" or "muscle sense" as information from receptors in our muscles and skin help to inform us of where are body parts are in space, how they relate to each other, how much and how quickly they are stretching, the speed and timing of movement as well as the amount of force exerted. Proprioception helps us to be aware of our bodies and directs our motor control and planning.

Proprioception can be both subconscious (automatic) and conscious awareness of joint position we use in learning. This conscious awareness is also described as "kinesthesia".

Proprioceptive input can help to modulate arousal levels (ie. may help to increase arousal or may help to calm and organize sensory systems). Heavy work activities can provide proprioceptive input to the muscles and joints of the body. This may involve lifting, pushing, pulling objects and a child's own body weight.

Proprioception helps integrate touch and movement sensations (tactile and vestibular). The following activities are categorized into those that involve the whole body, hands and fingers or oral proprioception.

PROPRIOCEPTION

PROPRIOCEPTION: Whole Body Jumping on the trampoline Jumping from one stepping stone to another Jumping off the stairs onto the floor Jumping from a bench onto the grass Leapfrog over another child Swinging on the monkey bars Swinging on an overhead flying fox (zipline) Pulling wet clothes from the washing machine Pulling dry clothes from the dryer Tug-of-war pulling on a rope Pulling against a towel (someone else pulling back) Pulling rubbish bins to and from the kerb Pulling a garden hose Pulling toys (eg. wagon, sled, etc)

Animal walks (crab, bear, snake, etc) forward or backwards) Wheelbarrow on hands with someone else holding legs Commando crawling Crawling on knees Stamping feet Hopscotch Marching Vacuuming Rolling over a ball Wiping the table Wiping a whiteboard Running (forward, backward, sideways) Log rolling (body stretched out) Clean the windows Digging in dirt or sand with spade, hands or feet

© 2018 Your Kids OT. Sensory Diet Activity Guide Book.

PROPRIOCEPTION: Whole Body

Carrying heavy shopping bags Carrying heavy books Carrying a backpack with heavy contents Carrying beanbags on head Carrying sand/water in a bucket Carrying furniture around the house or classroom (appropriate size) Carrying pot plants Carrying watering can Carrying small pets Lifting furniture at home or school (eg. chair onto a table) Climbing up a slide Climbing over furniture or pillows Climbing up a ladder (suitable for child) Climbing on nets or frames at a playground Indoor rock climbing Chin ups on a horizontal bar Being wrapped in a blanket or towel and being squeezed (standing or lying on the floor) Being squeezed between pillows or mattresses (standing or lying on the floor) Using a weighted product (eg. blanket, vest, bag, toy) Being massaged by someone else Being squashed under a therapy ball or foam roller Giving or receiving a bear hug Hiding under heavy blankets on bed On the floor, pushing feet against a grown- up pushing their feet back (straight or cycle motion) On the floor, pushing feet against a therapy ball, wall, theraband, etc Chair push-ups (lift whole body up from a chair with arms straight)

Pushing a therapy ball up and down a wall Pushing a wheelbarrow (real or toy wheelbarrow depending on age) Pushing toys (eg. toy lawnmower, shopping cart, stroller, etc) Pushing hands against a grown-up who pushes back Pushing furniture Pushing a box of toys Pushing against a wall Push ups on the floor Pushing a shopping trolley Pushing arms and legs in a plank position Pushing arms and legs whilst lying on a scooter (prone) board. Pushing a laundry basket of washing Pushing a sibling in a stroller/pram Hanging washing on a line to dry

Many sports allow your child to receive whole body proprioceptive

and vestibular input. Here are a few examples:

Soccer Football Gymnastics Swimming Hockey Track and field Dance Horseback riding Martial arts Golf

Basketball Netball Table tennis Skiing Snowboarding Surfing Paddleboarding Canoeing/kayaking Cycling Scootering Tennis

© 2018 Your Kids OT. Sensory Diet Activity Guide Book.

PROPRIOCEPTION: Hands and Fingers

Cooking in the kitchen (eg. rolling, sifting, stirring, shaking, pushing, rolling, etc) Wringing a wet towel Squeezing a wet sponge Squeezing a soft toy Squeezing a squirting bath toy Squeezing a water pistol Squeezing a water spray Playing with a hand fidget Pinching pegs (clothespins) Playdough and theraputty play (squeezing, pinching, pulling, etc) Pulling theraband Pulling elastic bands (eg. loom bands) Playing "thumb wars" and other finger games Push pin poke drawing Usng tongs and tweezers to grasp and release

Finger play nursery rhymes and songs Finger puppets Finger push-ups on the table Finger painting Catch, throw and bounce a ball Clapping games Sharpening a pencil Punching a pillow or mattress Feeling "Mermaid" cushions Messy play with rice, cloud dough, kinetic sand, sand, etc Popping with fingers Q-tip painting

Many of these activities will also help with the

development of fine motor and bilateral coordination skills.

PROPRIOCEPTION: Oral Chewing on bubble or chewing gum Chewing on commercial silicon grade "chewy" products (eg. pendant, chewlery) Eating crunchy food (apple, carrot sticks, corn on the cob, rice crackers, celery sticks, dry cereal, pretzels, ice, froze ice blocks, etc) Eating chewy food (steak, fruit roll ups, etc). Chewing on bubble or chewing gum Poking out tongue Pushing tongue into cheeks Puffing up cheeks and squeezing out air Using a vibrating toothbrush (to brush teeth or for massaging mouth) Sucking water from a sports drink bottle

Blowing popper toys Blowing bubbles Blowing a harmonica Blowing a party blower Blowing a whistle Blowing up a balloon Blowing bubbles in water (eg. with a straw) Blowing a straw to push along a items (eg. pom pom, cotton wool ball, ping pong ball) Blowing a feather and keeping it up in the air Breathing in/out of brown paper bag Make silly faces Sucking a frozen ice block (popsicle)

© 2018 Your Kids OT. Sensory Diet Activity Guide Book.

TACTILE SYSTEM: SENSE OF TOUCH

Touch sensations can include light touch, deep pressure, skin stretching,vibration, movement and pain activated receptors.The tactile system may be classified into two components: discriminative touch (what and where touch occurs on the body) and defensive touch (fight or flight response).

The tactile system is closely related to the proprioceptive system (through deep pressure input to the skin, muscles and joints). Both the tactile and proprioceptive systems work to help with body awareness and motor control.

Many of the activities that are listed in the proprioception section of this reference sheet will also help those with difficulties with the tactile system. Some of these activities will need to be graded for those who are defensive to touch sensation.

The following suggestions relate to modification of the environment to assist with processing tactile input and then there are suggestions for exploration of different textures through touch.

TACTILE SYSTEM: Environmental Modifications

Make sure your child can see you before approaching or touching your child Avoid clothing fabrics which are irritating Consider "seam free" clothing When using guided physical prompts or instruction use firm touch Use markers to help designate personal space when sitting on the floor or standing in a line (eg. coloured dots) Provide a quiet space for your child to retreat to when required Try a progression of touching undesirable texture (eg. place progressively smaller objects on top of the surface) Try a progression of body parts to touch undesirable texture (eg. finger, hand, arm) Encourage your child to initiate touching when needed (eg. dance class, holding hands with another child to line up, etc)

Allow your child to say "no" when touching others is required (eg. dance or sports class) Allow your child to go first or last in the line to minimize tactile contact with others Allow your child to wear gloves when handling textures they are uncomfortable with touching Try tools made from different materials (eg. different grips on a pen, mechanical plastic pencil, wooden pencil)

© 2018 Your Kids OT. Sensory Diet Activity Guide Book.

TACTILE SYSTEM: Exploring textures

Provide different textures to explore with various body parts. This could be provided in a confined space such as "sensory bin or bucket" or a small portion affixed to a hard surface (eg. board, box). Try textures on hands, feet, arms, legs, backs, faces, etc.

Textures to try on a sensory board.

Textures to try in a"sensory bin".

Slime Packaging peanuts Salt Leaves Feathers Jelly Kinetic sand Cloud dough Shells Stones Dry pasta Dried beans Dry cereal Rolled oats Cooked spaghetti Shredded paper Mud Felt blanket pieces

Goop Jelly crystals Buttons Wood bark Sand Raw rice Water Pom poms Foam pieces Sponges Water beads Dirt Cotton wool Shaving cream Straw/hay Glass beads Scrubbers Bubble bath

Carpet squares Foam pieces Tuille Cellophane Shredded paper Sand paper Fake fur Felt Vinyl

Try different actions with the textures.

Pointing Touching with one finger Touching with whole hand Placing whole hand into sensory bin (immersing) Rubbing object between both hands Try applying different amounts of pressure placed on a texture Using short tool to touch Wrap body inside texture Rubbing object onto skin Step on texture Crawl over texture Jump on texture Roll over texture Climb on texture

Examples of Progression for Exploring Textures

1. Place a toy car on sand for child to drive 2. Half-bury toy car on sand for child to drive 3. Fully- bury toy car in sand for child to drive

Sequinned material Shells Rocks Feathers Wood bark Bbuttons Cotton wool Glitter material

Let your child be in control. Encourage your child to rub a variety

of textures against their own skin.

Try vibrating toys, massager and cushions for

tactile stimulation.

© 2018 Your Kids OT. Sensory Diet Activity Guide Book.

TACTILE SYSTEM: Fidget Tools

Fidget tools are used for children who seek sensory input from their hands to help them to focus on other tasks. Fidgeting may occur with a child moving their own body (eg. wiggling, interwining fingers, tapping fingers, scratching, twirling hair etc.). Generally a child does not need to look at the item that they are fidgetting with as it is an automatic response to a need for tactile input.

When a child can not get enough tactile sensory input, then an external "fidget tool" may be used. These tools should not distract the child from the main activity of focus and should not distract others around them.

In recent years, mainstream shops have sold "fidget toys" which offer tactile input for children. Fidget tools are not toys. They should not be "played with" as the fidget is used to help focus on the main activity.

A child will often need to trial several fidget tools to find what best suits them and if it is needed to help with attention and focus. There are usually other signs of fidgeting observed. A child may only need a fidget tool for short periods of time. If they are fidgeting throughout a whole lesson or over a long period of time, then other sensory systems may need to be addressed.

Fidget Tool Rules

1. Fidget tools should be held with my hands. 2. Fidget tools should help me to focus on a task or my teacher. 3. Fidget tools should be discreet. They should not distract me or other children from a task. 4. Fidget tools should be used for short periods of time. 5. When I need my hands for other activities, I don't need a fidget tool. 6. Fidget tools should not be noisy.

Blue tak Velcro Feather Elastic band Screws/Nuts/Bolts Paperclip Dice Small stone Eraser Coin Small zipper Stress ball Pom pom

Here are some objects that you may have in your home or classroom that may be used as

a fidget tool.

Beaded necklace Craft stick Paint brush Qtip Bangle/bracelet Buttons Pencil

© 2018 Your Kids OT. Sensory Diet Activity Guide Book.

VESTIBULAR SYSTEM: Sense of Gravity, Movement and Balance

The brain processes vestibular sensations received through the hair receptors in the inner ear. These inner ear receptors are stimulated by gravity. The vestibular system tells us about our head and body position in relation to the earth and sends information to our central nervous system about balance and movement. The vestibular system also tells us whether we or objects around us are moving or standing still. It tells us about direction and speed of movement too.

The outer ear and cerebral cortex also help to process precise vestibular and auditory sensations through the sensations produced by vibrations of movement and of sound.

The vestibular system has been described as necessary for the entire nervous system to function effectively (ie. to help with the interpretation of other senses such as vision and the feedback from the muscles and joints through proprioception).

There is a self-protective (defensive) component of the vestibular system that matures as a child grows. As a child grows they can coordinate their body movements together with visual information, learning to discriminate what they see and how they move.

Vestibular movement can be described as linear (up/down, forward/back and side to side movements). Slow and low linear movements can have a soothing affect and often parents introduce this to their babies in the form of rocking or gentle bouncing. Linear movements which move in a bigger or faster arc may be more stimulating.

Vestibular movements can also be rotational (spinning around) and are enjoyed by most children as they stimulate the vestibular system and feel good.

Vestibular movements may involve a child being upside down (defying gravity).

Encourage but never force vestibular movements. Experiment with different speeds. Vestibular input will change for one activity depending on the child's head and body position (for example: sitting vs lying prone).

© 2018 Your Kids OT. Sensory Diet Activity Guide Book.

Linear Movement: Side/Side

Swinging on a hammock Rocking/Swaying from side to side Dancing Side steps Crab walking sideways Adult hugs child's torso whilst rocking child from side to side

Zip line or flying fox Swinging at the park sitting or lying over the seat Swinging on a rope or tyre swing Scooter board activities (sitting or prone) Rocking forward and backwards on a rocking horse Skate boarding, riding a bicycle, or scooter Roller blading, roller skating or ice skating Sliding down a slippery slide (forwards, backwards, lying down, sitting up) Jogging or running Relay races Crawling through a tunnel

Linear Movement: Forward/Backward

Spring see-saw Ball hopper Bouncing on a grown-up's leg Bouncing on a gym ball Zip line or flying fox Jumping Skipping with a rope Trampolining Pogo stick Piggy back ride

Linear Movement: Up/Down

VESTIBULAR SYSTEM: Linear Movement

VESTIBULAR SYSTEM: Rotational Movement

Spinning Movements

Spinning self in circles Adult hugs child's torso whilst spinning child Sitting on a swivel chair and spinning around Scooter board spinning on stomach rotating with hands to push Twisting around on park swing and then untwisting Merry-go-round or spinning playground equipment Sitting on a spinning toy (eg. Sit 'n spin, Wobbel360 or Bilibo) Rolling activities (eg. log roll, forward roll, rolling down a hill)

© 2018 Your Kids OT. Sensory Diet Activity Guide Book.

Upside Down

Walking or crawling on unstable surfaces will require a child to adjust their body as they move. Try a sandy beach, playground suspension bridge, grassy field, waterbed, foam filled mattress or path of pillows.

T-Stool Walking/crawling on unstable surfaces Sitting, kneeling or lying on a gym ball Standing on foot pods Walking on a balance beam Balancing rope courses Move n sit cushion Balance boards Hopping games Climbing on rope ladders

Balance challenges

VESTIBULAR SYSTEM: Gravity Challenges

Forward and backward somersaults Handstands supported by a wall Handstands unsupported Cartwheels Hanging upside down from a horizontal bar Wheelbarrows on hands Lie backwards over a gym ball and roll so head tips backwards Lie backwards with legs on sofa and head on the ground Sitting on chair then look for something under the floor

You could also try having your child pass things over and under their heads whilst looking at it.

© 2018 Your Kids OT. Sensory Diet Activity Guide Book.

VISUAL SYSTEM

A child uses their eyes to see in a variety of ways. These visual skills include acuity (details), adjusting from bright to light, focus and accomodation as well as detecting movement around them. Children use their eyes together (binocularity) to form a single mental picture that the two eyes see separately.

Children also use their eyes in combination with motor skills (ocular-motor) and this includes fixation (steady attention on an object), saccades (movements from one point to another) and smooth pursuits (tracking a moving object).

At a higher cognitive level, children use their vision to discriminate and refine what they see. These visual perceptual skills are discussed in more detail in the Your Kids OT "Visual Perception Reference Sheet".

Visual-motor skills include eye-hand coordination, eye-foot coordination and eye-ear coordination.

A child's visual discrimination and visual-motor skills are closely related tot he other sensory systems (especially tactile, vestibular and proprioceptive). Visual dysfunction may involve poor movement, posture, body awareness or coordination with motor skills. When a child is experiencing visual discrimination difficulties which are not related to movement then it is unlikely that this is caused by sensory processing issues.

VISUAL SYSTEM: Environmental Modifications

Reduce clutter Wear sunglasses Wear a cap or visor Present one item at a time Remove unnecessary information from a whiteboard Position a child at the front of the classroom Use coloured paper rather than white Provide multi-sensory learning techniques so the child does not rely only on their visual system for learning

Multi- sensory learning uses more than one "sense" to teach a child a concept or a motor skill. This may involve seeing and touching an object, moving through space with this object and listening to instructions.

© 2018 Your Kids OT. Sensory Diet Activity Guide Book.

Some children rely on their visual system to help them to organize and plan. These children can use their vision to guide their other senses. Here are some ways to use the visual system to guide behaviour and organization.

VISUAL SYSTEM

Social stories Visual schedules Colour coded timetables Checklists Maps Writing plans Calendars/diaries First/then visual prompts Visual timers Desk strips Placemats Posters Scheduling apps Clock or watch

VISUAL SYSTEM: Using this strength

Some children will need to have visual information

highlighted or exaggerated so that they can respond. Mirrored ball

Strobe lights Neon lights Disco ball Ocean Waves Fingers Glitter wand Lava lamp/timer Sand timer Kaleidoscope

Some children find watching and gazing at objects to have a calming affect on their overall sensory systems.

Provide a tactile prompt to help with writing on the line. Highlight the left hand margin on a writing page. Use two coloured shoe laces on the one shoe Try different coloured paper for worksheets Use a ruler or finger to track words when reading

© 2018 Your Kids OT. Sensory Diet Activity Guide Book.

AUDITORY SYSTEM

The hair cells in the inner ear process information about both sound and movement. Therefore the auditory and vestibular systems are closely linked. The auditory system is required to process what and how something is heard.

Babies develop a startle defensive sense of sound, reacting to loud or unexpected noises. As they grow their auditory system develops so that they realize not all sounds will hurt them. Over time children develop an understanding of where sounds are coming from (localization), the ability to follow a sound (tracking), remember and recall sounds they have heard before (auditory memory), place sounds in a logical order (auditory sequencing), compare and contrast environmental sounds (discrimination), distinguish between foreground and background sounds (figure-ground and the ability to relate to unfamiliar sounds (association). All of these skills are then drawn together to find meaning to what is heard which they can label with a name when speech has developed.

Auditory dysfunction may be due to a physical issue (eg. ear infection). A child's hearing may be functional, however they may have difficulty with processing the information heard.

Therapeutic Listening is an evidence-based auditory intervention intended to support individuals who experience challenges with sensory processing dysfunction, listening, attention, and communication. Further information about therapeutic listening should be sought from a trained professional.

Here are some suggestions to assist with developing auditory skills and some environmental modifications for those who are sensitive to auditory input.

Play commercial listening games (eg. Cock-a-Doodle Moo) Play listening games with sounds from the environment (eg. garbage truck, siren, bell, clapping) Find soothing sounds for your child (eg. music, waves, white noise, etc) Listen to audio books (with or without headphones)

Help your child to manage unpleasant sounds by anticipating them (eg. turning on the vacuum, counting before using hand dryer at shops or hair dryer) Use headphones to listen to instructions and block out other noises Find a sanctuary in a noisy environment if possible (eg. lift, library) Reduce the sound in a room by placing carpet or a rug Seat child away from possible sources of noise (eg. fish tank, clock)

Listening activities Try these at different volumes, with

headphones, in a small space (eg. car).

Environmental Modifications

© 2018 Your Kids OT. Sensory Diet Activity Guide Book.

Whilst an overall "sensory diet" is not food related, the oral system is an important sensory system. The mouth is the gateway to eating and many children who are fussy or picky eaters may have difficulty with sensory motor experiences. They require coordinated oral motor skills such as sucking, swallowing and breathing. An over responsiveness to tactile sensations in the mouth (oral defensiveness) can make eating uncomfortable and unpleasant. An oral desensitization program might involve increasing deep pressure to the jaw, lips, cheeks, tongue and mouth.

If your child is a picky eater consult with a therapist trained in the SOS (Sequential Oral Sensory) approach to feeding. This approach to feeding addresses the whole child, their physical, oral motor, sensory, digestive and psychological needs when it comes to feeding. It is an approach that works on increasing exposure to improve acceptance and then increase dietary repertoire / quantity. It is a life skill building therapy.

Some children find the mouth a way to seek sensations to help with calming and organizational skills through biting, chewing, sucking and blowing. They may chew inappropriate objects (eg. pencils, shirt collars, etc).

ORAL MOTOR SYSTEM

Bundy, Lane and Murray (2002) recommend providing infants and young children with deep pressure to the roof of the mouth or gums with the therapist's fingers or other soft rounded object (eg. Nuk toothbrush). They also suggest that older children and adults may be taught to provide deep pressure to their own mouths using a variety of oral motor toys (eg. using whistle, biting on knotted rubber tubing, blowing on a rubber strip).

Oral Desensitization

Apply firm pressure symmetrically to the area outside the child's mouth (from the forehead to the chin and mouth) using hands or different materials. Encourage your child to apply pressure (massage) to the roof of their mouth and gums (with their finger or a soft, round object). This may begin with placing the child's finger on their lips and then by rolling the finger inside the lip. Encourage the child to dip the end of the toothbrush into a small cup of water and brush their tongue, teeth, inside of the cheeks and roof of the mouth. Additional input with an electric toothbrush may provided. When the child is coping well with touch to their face and inside of their mouth, further oral motor activities may be introduced involving sucking, blowing, biting, crunching, chewing or licking.

The Paediatric Occupational Therapy Department from Abertawe Bro Morgannwg University Healt

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