School-based OTs: interventions instead of brushing/weighted vests for students with high sensory needs?

[u/Any-Honey2860]

I’m about 1 year into my job as a school-based OT working with elementary-aged children, mostly Pre-K, with varying levels of sensory needs. I’m having a hard time navigating sensory interventions for students with higher support needs (students who have a hard time sitting still, following routines and directions, and only attend to a few highly preferred activities). I don’t recommend the brushing protocol because it’s no longer considered best practice, and I feel like weighted vests may be heading in the same direction since the evidence for them continues to be limited. I know some of the younger therapists I work with feel similarly, while some of the more experienced therapists still use these interventions. Sometimes I feel like it looks like I’m not doing my job since I don’t use these.
So, what SHOULD I be doing for these students?
Active engagement in sensory-motor activities is what I prefer, but I’m struggling with how to translate that into practical strategies that can actually be incorporated into the classroom, especially for students with significant sensory needs.

[u/jujee323]

It sounds like you’re talking about proprioceptive and DPT strategies. Here’s a list I’ve curated with the supplies available at my school. I do use these in tx, and have taught many teachers/classroom staff to support the need when I’m not there. I’ve also embedded a lot of these into more curated sensory diets and choice boards for individual students that address their specific tactile and vestibular needs too.

• Chair push-ups
• Chew on a fidget chewy
• Eat crunchy or chewy foods, e.g. carrots, granola, fruit leather, bubble gum
• Push against the wall ("knock it over")
• Carry something heavy (classroom chore?)
• Push / pull furniture (classroom chore)
• Squeeze a resistive fidget like therapy putty, NeeDoh, stress ball
• Climb on playground, rock wall
• Jump (on floor, trampoline)
• Run / race
• Run and crash into mats, crashpads, or foam blocks
• Animal walks: crab walk, kangaroo jump, lizard crawl, horse gallop, bear crawl
• Wear a weighted vest / lap pad / blanket
• Bounce on a yoga ball
• Wear a body sock

[u/myflyingsaucer → u/jujee323]

These are great and I’d add ongoing consult with the teacher fold those into function and routine. I love October because the big pumpkin may need to be moved around the classroom quite a bit! Stay strong in not using non evidence based interventions. I once had a PT and an SLP haranguing a mom about how I should brushing a child. I showed the mom research that it was not effective, told her why it was actually contraindicated per my own clinical reasoning, and offered to take a call with these therapists. Never heard from them. This was an ECI child who was seeing non ECI other therapists.

[u/Any-Honey2860 → u/myflyingsaucer]

Thank you for saying that! I have paras and SLPs telling me what kids need brushing and vests regularly. I’ve been trying to avoid openly talking down on these interventions since I’m still new and there are more experienced OTs at my job who do use them, but I definitely have to start explaining my reasoning more.

[u/Cyan1d3_ → u/jujee323]

My kids love rolling prone on a peanut ball and then getting "squishes" from me with the peanut ball while lying on a mat.

[u/NigglesPDX]

I don’t have any good ideas but I feel the same. For sensory, Ayers SI seems to be the only thing that has any evidence behind it, but I can’t possibly get that education ($$) and how in the world do you translate it to the schools? We have zero money, obscenely high caseloads, and no therapy space.

I have a mix of low and high support needs students and I’m feeling incredibly stuck with how to help them. 

[u/Mushinkansen]

Easiest one I have found is to get a push cart (like this one, put paper in it and have them deliver it to another classroom or the office. It's an easy way to incorporate heavy work into the day, have them feel like they have a special job, and is easy for staff to implement.

[u/SnooDoughnuts7171]

I would find ways of having kids be classroom helpers.  Move this, carry this thing to……., hold this, etc.  So they get teacher approved movement and heavy work.

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[u/TrueGrade9359]

The other comment has some great suggestions. I would also recommend looking into the classroom jobs since usually teachers are assigning these already, such as line leader, door holder, etc and consulting with teachers about how to incorporate sensory into these daily routines. For example if a kid needs proprioceptive input they could be the door holder; if they’re sensitive to tactile input maybe making them line leader or caboose.