Sensory-motor therapy: How much, when to begin?

Most clinicians recommend starting therapy as early as possible when a neurological diagnosis is confirmed or the child presents with obvious deficits in speech, motor skills, and behaviors. However, the glaring questions remain….

• ·       How much therapy i.e. how many sessions/week, how many months?
• ·      And more importantly, will the problems be solved or cured completely?

The following factors play a major role in deciding the frequency of therapy and how long will it be continued:

Age at which any intervention was first begun—most children with special needs undergo various therapies such as physical / occupational / speech therapy, and applied behavior analysis (ABA). The earlier you seek intervention as soon as you sense that all is not well with your child, better is the child’s prognosis.

Children learn through movement. When attention is brought to movement, the brain creates new connections about 1.8 million new connections per second. In the first 3 years of life, the brain grows four-fold, reaching 80 percent of its adult weight. The increase in size is due to an increase in number of connections between cells. From these connections, re-organization of the brain occurs in terms of body mapping, movement mapping, cognitive and emotional organization. At age 7 years, the brain of a child looks like an adult brain. Of course, it keeps modifying itself throughout life, but the maximum number of connections between neurons (brain cells) are developed and strengthened until age 6-7 years. Therefore, the need for sensorimotor intervention as early as possible.

In my long clinical experience, increasingly negative behaviors (defiance, reluctance, unwillingness to engage in effortful tasks) have been observed around age 4-5 years in children with autism and hyperactivity. This occurs not because the issues were not present earlier; but have surfaced with greater intensity because the child is placed on demand as he/she grows up. Therefore, it becomes an uphill task in therapy to get them to engage in meaningful work.

Other factors that go along with the diagnosis or deficits--- there are inherent features of every condition that are unlikely to resolve completely. For e.g. spasticity, severe hypotonia, athetosis (involuntary shaking), tightness/ shortening of muscles are seen in cerebral palsy. Deficits in spontaneous speech, echolalia, stimming behaviors are signs of autism. All of such signs and symptoms can be resolved to a large extent ‘if’ intervention has commenced early in life.

This treatment journey with your child is unfortunately a long and hard one; there are no quick fixes nor 'cure' despite the best treatment in the world. The underlying purpose for sensory integration and speech therapies is to improve the child's functional capabilities as much as possible. 

Typically, any child with special needs requires 1-2 years or even longer for therapy. The frequency of treatment would be 1-3 times per week based upon clinical findings as to how much potential is seen for improvement. During a phase when the child ceases to demonstrate adequate progress, therapy is discontinued with recommendations to continue with a home program.

Level of Cognition---is highly corelated with our comprehension of the world around us. If a child understands the verbal / nonverbal cues from another person, if he /she comprehends the affordances of objects in the environment, progress in therapy occurs at a faster rate.

It is crucial to remember that movement contributes to cognition and vice-versa.

Other concomitant therapies---Speech therapy received along with sensory integration (SI) works wonders for children with autism and ADHD. SI provides the groundwork for understanding the sensory stimuli around us, whereas speech therapy helps develop the tools to communicate. Even if the child is nonverbal and has minimum potential to develop speech, speech therapy still helps in comprehension of instructions and pictures. For a child who is already speaking only a few words but has deficits in spoken language, speech therapy helps in development of contextual speech that immensely boosts communication with others.

Support at home—parents need to follow the home program and strategies with the child as a carryover of therapy at home. Therapy sessions from all interventions amount to only 4  to 10 hours per week. This time is insufficient if we consider 12 hours of wake time X 7days = 84 hours. The brain is continuously modifying itself (neuroplasticity) based on opportunities and experiences that the child is provided with.

Accepting your child’s condition avails you of more energy and ideas towards the child’s progress rather than being in denial for a long time.

And finally, when you have doubts about the cost of therapy (time, money, effort), it is compelling to ponder about what would be the costs of not opting for therapy:

• ·       deficits in function
• ·       deficits in speech
• ·       deficits in learning
• ·       negative behavior issues
• ·       increase in restlessness or hyperactivity

Therapy will only ENRICH your child’s life!