Monday, March 31, 2014

'Weighing' In On the Use of Weighted Items in Therapy

Deanna Macioce, MS, OTR/L

With so much discussion in the realm of treatment for Sensory Processing Disorder (SPD), we find that there is little research to support many of the techniques, protocols, or methods used.  If you are an occupational therapist (OT) you find that you use the methodology you were taught, enhanced by the things you have learned from attending continuing education courses, picked up ideas from co-workers, or just used your creativity to find something that works through experience to address a sensory need for a child. And you find it to be effective by the changes noted in the child's underlying neurological system, so you use it.  This is seen with treatments such as listening programs, spinning and brushing protocols, and the use of weighted items. It is known that if two individuals demonstrate issues in the same sensory areas, their needs, behaviors, and treatments are going to be different.  That is why OTs are known for using their little "tricks" be make treatment be successful, regardless of the research. If you are a parent, caregiver, or teacher you have seen the effects of some of these treatment techniques making a difference in the life of your child who is now more regulated, able to tolerate a movement he or she once couldn't, attend better in school, or even sleep better at night.

In regards to the use of weighted items, such as vests, blankets, or other items, we find that there is little research, and sometimes it is less than convincing that these treatment tools are effective. However as therapists we know that for some children the use of weighted items has been beneficial for calming, improving body awareness, or increasing alertness.  We have seen children increase their focus in school, sit better during circle time, calm when frustrated and be able to move into the sleep cycle with ease. Therefore, we have continued to keep these items as part of our treating repertoire, knowing that they may not work the same on every child.  Since these positive changes have been noted, we are able to find items from vests, to blankets, to hats, and so on because the use of weighted items can be effective in children.

Most often weighted items are used in therapy to address proprioception.  This is the sensory system that "senses the position, location, orientation, and movement of the body muscles and joints. Proprioception provides us with the sense of the relative position of neighboring parts of the body and effort used to move body parts"  (STAR Center).   And when we see improvements to the proprioceptive system, we see changes in body awareness, focus and attention, and calming.  We know that performing tasks the require heavy work and resistance are beneficial to work on the proprioceptive system, and weighted items help us obtain this.

The use of weighted vests are commonly seen in schools to help children sit and attend during activity.  In addition, the "just right" input could help these children remain regulated during play, interacting with peers or with transitions.  They are also beneficial to use during movement activities to help improve body awareness and position in space.  Lap pads and neck wraps are used during sitting tasks and are great for desk work.  Just a bit of weighted input helps children stay focused and attend while giving them the proper input to help keep their bodies seated.  Blankets are best to use when addressing a calming state.  They also help during stationary tasks to provide input over the body or during tasks performed in prone, such as playing a game or completing a puzzle.  In addition, weighted blankets have been found to help children calm and regulate their bodies for sleep, and provide good input to help them remain in the sleep cycle. Southpaw has recently worked to improve their weighted hat.  Not only do we now offer a trendy hat that can be worn by either males or females, we have improved the shape and size of the weights allowing it to be better dispersed.  Therefore, it is easy for children to wear it in a variety of settings, with ease during movement, and appear to have a common item on, versus a vest, lap pad, or neck wrap.

With the use of weighted items, or any type of sensory treatment method/protocol it is important to consult an occupational therapist to help determine wearing procedures, timing, and the proper needs to be addressed.  This will help establish an effective wearing program meeting the child's needs, while avoiding the child accommodating to having it on which in turn lessens the effect of using a weighted item.  It is also important to establish the right amount of weight with your therapist.  Typically is will range from 3-10% of the child's body weight.  But this is dependent on the item being used, the need trying to be met, and the overall weight distribution.  Also, it should be noted that it is important to use weighted items proactively, rather than as a reaction to when a child begins to meltdown as an attempt to calm.

Despite the research weighted items can be beneficial in a child's sensory program.  Therefore, whether you are a teacher, parent or therapist, it may be time to re-visit these "weighty" tools!

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