Saturday, 30 March 2013

Placement Day 3


Today I decided to miss the first half of my first class and join an Occupational Therapist (OT) during their morning warm up session. There was a group of three primary school children aged nine all with forms of autism. One particular student had a form called childhood disintegrative disorder... The children were non-verbal and displayed volatile mood swings.

The session was in a slightly smaller hall with a vestibular swing in the corner. A pupil was already enjoying rocking in the swing under supervision. The pupil was also enjoying being squeezed on the hands and feet, when the OT explained to me that a few of the students enjoy the use of deep pressure, another area I had studied and was interested in its use with special needs children, and that being squeezed helps them to feel calm and less irritable. This is why the OT had planned the specialised session in the morning so that the children were less likely to suffer mood swings throughout the day. Another example of this was the use of two crash mats, where pupils could lie on one to be gently squashed by the other like a sandwich. The OT told me that this is an effective method for relaxing the students of this class and that they only did it on the students terms.

Another student in this class was a visual learner. They enjoyed watching one of the  TA’s bounce a green plastic ball or sometimes a red one. The student could catch the ball in the air whenever they wanted to switch balls, showing good hand-eye coordination. This student showed particularly sensitive moods, occasionally banging their head on a wall, hitting their head, and chewing. I also noticed they had an item tied around their neck which they chewed as well, the only difference was that the TA encouraged this one. I asked what the item was and I was told that it was called a chewy gem, made of soft plastic and suitable for chewing. If this student grew frustrated and tried to chew something or someone, the TA’s turned the student’s attention to their chewing gem, to appease their desperate urge to chew on something.

This was a great session to use as an example of sensory therapy for children with special needs; it was something I had touched upon during my research period and was interested to see how it may be used in a school environment. In this session there was a good implementation of vestibular, pressure, and visual therapeutic approaches and could be something I integrate into my training plans.

End of Lesson 1 - Class A
When I walked into the end of class 1, a collection of mats was laid on the floor with all pupils rolling on them. They were learning different rolls, a log roll, and a side roll. A couple of students had a few moments where they struggled to focus on the tasks and ran away from the matted area. PE teacher A and I stopped them and directed them back to the area in which they were supposed to be working in. They then went on to perform a cat pose, on their hands on knees.

Lesson 2 - Class B
This class was continuing tennis skills practice, but this session was planned to be more competitive. PE teacher A told me that almost 50% of the skills this class will learn will go as soon as they enter an anxiety provoking environment, so it was good to get them use to a little competition so they can get better at performing skills they learn under pressure. 
The class began by bouncing a tough ball on the floor; the class was informed that they would not be practicing this skill for long as they had done it in previous lessons. This encouraged the students to get on. 

The pupils were then placed into teams by coloured cones in preparation for a relay race. The students had to balance the ball on their racket, run to a coloured cone at the other end of the hall and come back to pass it onto the next team member. This encouraged team cooperation and positive encouragement among peers. The next task was another relay race, but this time the students had to bounce the ball on the floor down the hall to the cone and back again to pass to their team mates. 
The Teacher gave clear demos in between races.

The students then had the challenge of playing tip tap, where they chose their own pairs and had to hit the ball to each other without it bouncing on the floor. This was the most difficult task the students were given so far; a couple of students particularly struggled and needed reminders.

At the end of the lesson, the teacher told me they wanted to leave the students on a high and finished with something slightly easier. They had a game of rallies in their pairs to see how long they could last, this was something they had done before and enjoyed. This too was intended to have a competitive element, but the teacher decided  to eliminate that element as some of the students had struggled with the previous task. A gold coin was even given out.

Lesson 3 - Class C
In this lesson Pupil 5 suffered a petit mal seizure. I was on the trampette with Pupil 2, encouraging him to bounce on his own by standing him up and holding his hands for a while before trying to let go. But Pupil 2 gets extremely nervous when standing upright unsupported and held tightly onto my hands to prevent me from letting go. I also assisted him sitting down on the trampette by bouncing him with my hands on the springs; I was told by PE teacher A the week before that there was a rebound instructor with this class, which is different to a trampoline instructor. Today I had decided to ask her what the role of a rebound instructor was and she told me that children with mobility issues can benefit from being bounced gently to engage their vestibular system. It also helps them to engage postural muscles such as core and back muscles when propped upright. After learning this I decided to integrate it into my own practices with the children, in today’s case Pupil 2. He responded well to the treatment I was delivering on the trampette, laughing and occasionally bouncing by himself. I was delighted to work with this student and continued to coax a completely independent bounce whilst standing, but this was not achieved today.  I was also told that Pupil 2 was able to walk and could even do squats with someone holding his hands; this is something I would certainly like to see in the future and perhaps come up with similar exercises to squats to help this student gain strength and stability in the appropriate muscles for standing and walking.

Meanwhile, Pupil 5 had been having a petit mal seizure. I had barely noticed anything was happening until towards the end of the lesson when I overheard someone debating giving him medicine. I asked if the pupil was okay and I was told what was actually happening. Admittedly surprised that Pupil 5 was not writhing, I decided to approach closer when the other students had begun to leave and offer any help. It was then that I could see Pupil 5’s eyes rolling into the back of his head with eyelids fluttering; despite being a concerning event, I couldn’t help but appreciate the wealth of observance and understanding the TA’s clearly had to recognise immediately this petit mal seizure. Eventually Pupil 5 recovered and was placed back in his chair and taken to class, his meds taken closely alongside incase the seizures initiated again.

While packing equipment away I asked PE teacher A for more details: he told me that what happened was an instance of a petit mal seizure and it does not necessarily involve fitting. A petit mal seizure, or absence seizure, occurs when there is an irregularity or failing of electrical signals crossing over synapses in the brain, resulting in a staring spell that can exist while a person is standing. PE teacher A explained to me that fitting, rhythmically contracting and relaxing muscles, is a symptom of seizures and that you cannot fit without having a seizure, but you can have a seizure without fitting. PE teacher A also said that seizures is probably something I would have to get used to while being at the school, as every week numerous students undergo them. He briefed me on the standard procedure taken when seizures occur and told me that there was a poster in the staff room that I could look at also explaining the procedure, which I looked at later that day.

(Below is a poster similar to the one in the school staff room, giving a procedure to perform in the event of seizures)

Lesson 4 - Class D
Just before this lesson I told PE teacher A about my idea to create a picture book tailored to particular exercises that could potentially be implemented during or after my project in schools. He said the idea was brilliant, and may help to teach certain fitness or sport concepts, like utilizing team members or space, to children with autism. He also mentioned  the use of social stories in schools, which were a similar concept but were designed to help children with special needs to understand social situations rather than get them interested in physical activity. He liked the idea and said he could find a way with helping me with a picture book in the future.

Class D had been practicing tennis, and today they were going to practice more skills, similar to Class B’s. This session however, was a slighter version of lesson 2 as this class are younger and have more trouble with fine motor skills like racket control and technique. The exercises were written on the whiteboard and before PE teacher had begun the lesson, students were attempting to read from it with little success; noticing this lack of reading skills within the group, I wondered how I may use the whiteboard in the future, if at all. This is a class that I thought could potentially be responsive to my lessons with visual aids, and that using pictures on the whiteboard may be an interesting way to help teach these students.

The class started with a simple exercise in hand-eye coordination: bouncing the ball up and down on the racket as many times as they could. Students were asked to keep count of there own scores and be honest about them when PE teacher A asked afterwards by a show of hands who got what number or more. The students reacted to this well and did not call out any numbers, they are clearly a well-behaved class that still listen to authoritative figures. However some students needed to think hard before raising their hand, so adding this simple numerical element of keeping your own scores was clearly suitable for this class.

The class went on to bouncing the ball high and trying to catch it on the racket; this looked like a much more acute exercise in motor function control and timing, the students also seemed baffled that the task was even possible and I realised then they may struggle with this one. Indeed they did, barely one student managed to perform this task but nonetheless still appeared in high spirit and in a high level of concentration to perform. This class has scarcely played up since my time here and they listen to instructions well, I think this may be an enjoyable class to teach.

Lesson 5 - Class E
The final class of the day also practiced tennis skills; it was interesting for me to see the same lesson and sport used with different classes and seeing their abilities cary. Class B are clearly the most physically able, enjoying a sense of independence, and never staying on the one task too long. Class D are quite mixed, they listen beautifully, but some skills like coordination and reaction time seem more of a struggle to refine. I was curious to see how this class would get on as some members appear physically able, but there are also two wheelchair users.

Tennis was something that everyone could do in this class; the session started with students traveling around the hall, rolling the ball around the rim of the racket, which some students picked up straight away and claimed it was too easy. These students called out asking to do something more challenging and the teachers simply reassured them they would moving onto something more difficult momentarily. As a differentiation for the wheelchair users, they were given small volleyballs which they simply had to keep on the racket while driving around. They still needed assistance from the TA’s though, suggesting some wrist strength is yet to be developed, particular on one side of both users bodies.
The class went on to bouncing the ball on the floor and another game of tip tap, which most students enjoyed and got on with, but the wheelchair uses struggled to react in time with the ball. Nonetheless their TA’s were patient and fed encouragement like “good try, just a bit quicker.”

Live life to the full.


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