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idit -> book (August 26, 2005 9:21:00 AM)

can anyone recommend me about a good book dealing with the subject Autism and physical therapy?
thanks 4 your help



srcase -> Re: book (August 26, 2005 10:28:00 AM)

The one I used on my clinical rotation was "The Out-of-Sync Child: Recognizing and Coping with Sensory Integration Dysfunction" by Carol Kranowicz. We saw patients with autism, but I can't remember if it was covered specifically in this book.
Sarah



tc -> Re: book (August 26, 2005 3:41:00 PM)

I agree with Sarah. With kids with autism, you're treating the problems, not that condition, per se. There are a lot of weaknesses and muscle imbalances that frequently correspond to kids with sensory integration disorder, which is extremely frequent in kids with autism. But it has to be handled very different, since they don't respond well to general PT handling. That book explains SI well, the different components of it and ways to work on them and it's very inexpensive. There's a follow-up book too that you can also find on amazon, something like the out-of-sync child has fun with basic to-do activities, which can be very helpful for home programs.
I have always found that the autistic kids respond very well to vestibular input, that is how you can get them to "interact" with you in a session, and those books explain why that is important and how to do it to get the desired results.
If you have a lot of kids with autism, you could attend an SI course. I have attended several and they were amazingly interesting. They tend to be targeted to the OT audience, but you can easily incorporate much of it into a PT treatment session.
If you are interested in learning about autism from a patient's point of view, I loved the book by Temple Grandin about her growing up with autism (she is high on the spectrum with Aspergers). It's called something like "learning in pictures". Fascinating stuff. She's a PhD at some university.
tc



Andrew M. Ball PT PhD -> Re: book (August 27, 2005 9:17:00 AM)

Although many (about 98%) of OT's will leap to SI in the treatment of patients with autism, the literature (especially the work of Patricia Rodie, PhD) suggests that may not be such a good idea. What scares me personally, is the SI for autism zealots who have never even HEARD of Dr. Rodie or her work!

Drew



tc -> Re: book (August 28, 2005 6:26:00 PM)

I am definately not an SI for autism zealot, and am not an expert in either area. I do believe the theories have some merit, however, and have worked in an SI clinic alongside some great OTs.
Drew - Do you have any links to work done by Dr. Rodie? I'd be interested to read them. I can't find any by looking her up on NIH or through the U of Rochester (which which where her link does come up through the UCLA autism research foundation). Thanks.
tc



winegirl -> Re: book (August 31, 2005 8:14:00 AM)

Her name is Patricia Rodier and you can find her information at the University of Rochester site. Most of her research is on possible neonatal teratogenic causes of autism, although her group is also doing some research on Applied Behavior Analysis. However, I don't see how any of her work that I've read would contraindicate using SI techniques for autistic children.



Andrew M. Ball PT PhD -> Re: book (August 31, 2005 5:12:00 PM)

"I don't see how any of her work that I've read would contraindicate using SI techniques for autistic children."

You're kidding right?

She found distinct neuroanatomical differences between normal and autistic children . . . . bigger corex, smaller cerebellum --- but most important for this discussion, a FUBARed brainstem. Consider that for a moment. What, if not something quite negative, would you suggest the effect of forcing sensory information through a neuroanatomically flawed brainstem would be?

Sensory integration theory depends upon cortical integration --- but sensory information processed and scattered through a flawed brainstem would more likely lead to cortical DISORGANIZATION than organization.

What then, is the "calming" effect we see? Just as likely to be a therapist produced post-traumatic shut-down response, as it is to be a positive integrative effect. I

Drew



winegirl -> Re: book (September 1, 2005 8:27:00 AM)

Sensory-based treatment is certainly not appropriate for all autistic children, but you are misrepresenting what is done when you describe "forcing sensory information through a neuroanatomically flawed brainstem"

Everyday life forces information throught that same brainstem. Sensory-based treatment is NOT forced! It is described very specifically by USC's OT department and WPS (who certify to perform the sensory integration and praxis test) as a child-directed approach.

I don't think a "post-traumatic shut-down" would explain the results of this study:
Brief Report: Autistic Children’s Attentiveness and Responsivity Improve After Touch Therapy (Abstract)
Field, T., Lasko, D., Mundy, P., Henteleff, T., Kabat, S., Talpins, S. & Dowling, M. (1997). Brief report: Autistic children’s attentiveness and responsivity improve after touch therapy. Journal of Autism and Developmental Disorders, 27(3), 333-338.



Andrew M. Ball PT PhD -> Re: book (September 1, 2005 2:34:00 PM)

Opinions vary, and your response is well reasoned. We just happen to disagree. My point, however, isn't with the efficacy of SI for children with autism so much as those PT's and OT's who push it without any knowledge whatsoever of the counterarguments.

FYI, a better argument that you may want to give next time is that NOT ALL patients with autism are of external agent eitiology (as Dr. Rodie studied), but some seem to be born of genetic strand origin (e.g. socially strange fathers). I have noted clinically that autistic children of genetic strand seem to respond much, much better to SI than those who don't seem to fit the genetic strand classification.

A serious, serious flaw, in my opinion, of the Field study is that it didn't at all tease that out. Furthermore, DPT's should begin thinking along the lines of why imaging rights might not be such a bad idea if it means differentiating kids with autism who would benefit from SI from those who will respond with sesnory shut down.

Furthermore, and I don't mean to evoke an emotional response on the part of those reading this thread, but children who are beaten tend to pay better attention too. We have to be very, very careful about interpreting these results. The ends may not justify the means, and it is my position that far too many PT's and OT's who use SI for this population focus on the ends, having less understanding and appreciation for the means than they probably should.

Drew



winegirl -> Re: book (September 1, 2005 3:13:00 PM)

I appreciate your response and agree wholeheartedly that latching on to SI as the "only" or "best" treatment for an autism-spectrum child is a huge mistake. I also agree that in the future it would be far more efficacious to differentiate btwn genetic vs. external agent autism.

My experience is similar that genetic-variety autistic children seem to be the only ones who I would attempt sensory-based therapies with and for these it has been effective. I know there is not enough evidence yet for most, I would like to see more too and it is my understanding that Lucy Miller is addressing that in her research.



srcase -> Re: book (August 26, 2005 10:28:00 AM)

The one I used on my clinical rotation was "The Out-of-Sync Child: Recognizing and Coping with Sensory Integration Dysfunction" by Carol Kranowicz. We saw patients with autism, but I can't remember if it was covered specifically in this book.
Sarah



tc -> Re: book (August 26, 2005 3:41:00 PM)

I agree with Sarah. With kids with autism, you're treating the problems, not that condition, per se. There are a lot of weaknesses and muscle imbalances that frequently correspond to kids with sensory integration disorder, which is extremely frequent in kids with autism. But it has to be handled very different, since they don't respond well to general PT handling. That book explains SI well, the different components of it and ways to work on them and it's very inexpensive. There's a follow-up book too that you can also find on amazon, something like the out-of-sync child has fun with basic to-do activities, which can be very helpful for home programs.
I have always found that the autistic kids respond very well to vestibular input, that is how you can get them to "interact" with you in a session, and those books explain why that is important and how to do it to get the desired results.
If you have a lot of kids with autism, you could attend an SI course. I have attended several and they were amazingly interesting. They tend to be targeted to the OT audience, but you can easily incorporate much of it into a PT treatment session.
If you are interested in learning about autism from a patient's point of view, I loved the book by Temple Grandin about her growing up with autism (she is high on the spectrum with Aspergers). It's called something like "learning in pictures". Fascinating stuff. She's a PhD at some university.
tc



Andrew M. Ball PT PhD -> Re: book (August 27, 2005 9:17:00 AM)

Although many (about 98%) of OT's will leap to SI in the treatment of patients with autism, the literature (especially the work of Patricia Rodie, PhD) suggests that may not be such a good idea. What scares me personally, is the SI for autism zealots who have never even HEARD of Dr. Rodie or her work!

Drew



tc -> Re: book (August 28, 2005 6:26:00 PM)

I am definately not an SI for autism zealot, and am not an expert in either area. I do believe the theories have some merit, however, and have worked in an SI clinic alongside some great OTs.
Drew - Do you have any links to work done by Dr. Rodie? I'd be interested to read them. I can't find any by looking her up on NIH or through the U of Rochester (which which where her link does come up through the UCLA autism research foundation). Thanks.
tc



winegirl -> Re: book (August 31, 2005 8:14:00 AM)

Her name is Patricia Rodier and you can find her information at the University of Rochester site. Most of her research is on possible neonatal teratogenic causes of autism, although her group is also doing some research on Applied Behavior Analysis. However, I don't see how any of her work that I've read would contraindicate using SI techniques for autistic children.



Andrew M. Ball PT PhD -> Re: book (August 31, 2005 5:12:00 PM)

"I don't see how any of her work that I've read would contraindicate using SI techniques for autistic children."

You're kidding right?

She found distinct neuroanatomical differences between normal and autistic children . . . . bigger corex, smaller cerebellum --- but most important for this discussion, a FUBARed brainstem. Consider that for a moment. What, if not something quite negative, would you suggest the effect of forcing sensory information through a neuroanatomically flawed brainstem would be?

Sensory integration theory depends upon cortical integration --- but sensory information processed and scattered through a flawed brainstem would more likely lead to cortical DISORGANIZATION than organization.

What then, is the "calming" effect we see? Just as likely to be a therapist produced post-traumatic shut-down response, as it is to be a positive integrative effect. I

Drew



winegirl -> Re: book (September 1, 2005 8:27:00 AM)

Sensory-based treatment is certainly not appropriate for all autistic children, but you are misrepresenting what is done when you describe "forcing sensory information through a neuroanatomically flawed brainstem"

Everyday life forces information throught that same brainstem. Sensory-based treatment is NOT forced! It is described very specifically by USC's OT department and WPS (who certify to perform the sensory integration and praxis test) as a child-directed approach.

I don't think a "post-traumatic shut-down" would explain the results of this study:
Brief Report: Autistic Children’s Attentiveness and Responsivity Improve After Touch Therapy (Abstract)
Field, T., Lasko, D., Mundy, P., Henteleff, T., Kabat, S., Talpins, S. & Dowling, M. (1997). Brief report: Autistic children’s attentiveness and responsivity improve after touch therapy. Journal of Autism and Developmental Disorders, 27(3), 333-338.



Andrew M. Ball PT PhD -> Re: book (September 1, 2005 2:34:00 PM)

Opinions vary, and your response is well reasoned. We just happen to disagree. My point, however, isn't with the efficacy of SI for children with autism so much as those PT's and OT's who push it without any knowledge whatsoever of the counterarguments.

FYI, a better argument that you may want to give next time is that NOT ALL patients with autism are of external agent eitiology (as Dr. Rodie studied), but some seem to be born of genetic strand origin (e.g. socially strange fathers). I have noted clinically that autistic children of genetic strand seem to respond much, much better to SI than those who don't seem to fit the genetic strand classification.

A serious, serious flaw, in my opinion, of the Field study is that it didn't at all tease that out. Furthermore, DPT's should begin thinking along the lines of why imaging rights might not be such a bad idea if it means differentiating kids with autism who would benefit from SI from those who will respond with sesnory shut down.

Furthermore, and I don't mean to evoke an emotional response on the part of those reading this thread, but children who are beaten tend to pay better attention too. We have to be very, very careful about interpreting these results. The ends may not justify the means, and it is my position that far too many PT's and OT's who use SI for this population focus on the ends, having less understanding and appreciation for the means than they probably should.

Drew



winegirl -> Re: book (September 1, 2005 3:13:00 PM)

I appreciate your response and agree wholeheartedly that latching on to SI as the "only" or "best" treatment for an autism-spectrum child is a huge mistake. I also agree that in the future it would be far more efficacious to differentiate btwn genetic vs. external agent autism.

My experience is similar that genetic-variety autistic children seem to be the only ones who I would attempt sensory-based therapies with and for these it has been effective. I know there is not enough evidence yet for most, I would like to see more too and it is my understanding that Lucy Miller is addressing that in her research.



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