SENSORY STIMULATION IN RE-EDUCATION OF FINE MOTOR SKILLS IN CHILDREN WITH AUTISM SPECTRUM DISORDERS

Abstract

Mind and brain are in a perfect harmony. The feelings, thoughts and actions are only possible because of the complex actions of the brain. Any change that occurs in the brain can have a major impact on our feelings, thoughts and actions. Children with ASD look absolutely normal, but despite appearances, subtle areas of the brain are not functioning properly. Brain changes lead to behavior that confuses and frustrates them, they become aggressive or withdrawn when they are in a group or refuse to participate in various activities or sports games. These children usually have difficulty interpreting images, sounds, and the sensations of touch or movement, are disturbed by bright lights, and get upset if they are touched or moved unexpectedly. Also, the way they control, coordinate and use their muscles is ineffective. Sensory integration therapy, practiced by occupational therapists, uses play, designed to change the way the brain responds to touch, sound, sight and movement. Sensory integration therapy involves activities that have the role of organizing the sensory system by providing vestibular, proprioceptive, auditory and tactile stimuli. Through well-planned activities by the therapist, sensory integration therapy uses sensory stimuli in an organized and controlled way, depending on the child's needs. In each session the therapist "constructs" the characteristics of the environment in such a way as to create only "appropriate reactions" from the therapeutic point of view.

Headnote

Abstract: Mind and brain are in a perfect harmony. The feelings, thoughts and actions are only possible because of the complex actions of the brain. Any change that occurs in the brain can have a major impact on our feelings, thoughts and actions.

Children with ASD look absolutely normal, but despite appearances, subtle areas of the brain are not functioning properly. Brain changes lead to behavior that confuses and frustrates them, they become aggressive or withdrawn when they are in a group or refuse to participate in various activities or sports games. These children usually have difficulty interpreting images, sounds, and the sensations of touch or movement, are disturbed by bright lights, and get upset if they are touched or moved unexpectedly. Also, the way they control, coordinate and use their muscles is ineffective.

Sensory integration therapy, practiced by occupational therapists, uses play, designed to change the way the brain responds to touch, sound, sight and movement. Sensory integration therapy involves activities that have the role of organizing the sensory system by providing vestibular, proprioceptive, auditory and tactile stimuli.

Through well-planned activities by the therapist, sensory integration therapy uses sensory stimuli in an organized and controlled way, depending on the child's needs. In each session the therapist "constructs" the characteristics of the environment in such a way as to create only "appropriate reactions" from the therapeutic point of view.

Keywords: Autism spectrum disorder, fine motor skills, sensory stimulation.

Autism spectrum disorder, found in the Diagnostic and Statistical Manual of Mental Disorders (DSM - 5), is a neurodevelopmental disorder that affects communication skills, social interaction and behavior, sensory and motor areas.1

The scientific history of this disorder dates back to the early days of the 19th century, a century and a half before Kanner, when, in 1799, the first case was discovered and reported by Dr. Itard. Victor, the ‶wild man of Aveyron‶, had many common features with children who suffered from mental illnesses and triggered a multitude of polemics at the level of psychiatry of that era. Itard states that Victor was neither sensitive to cold nor to very strong heat, and showed very selective hearing: for example, the sound of a cracked nut or an edible item that was to his taste, made him turn around, and the sound of an explosion/loud noise produced no reaction from him.2

All this proves the similarity between Victor, the ‶wild child of Aveyron‶, and the children whom today science calls autistic.

Despite all the research carried out over decades, autism spectrum disorder has been and remains a controversial issue in every aspect. But one thing is certain: progress, speaking about it from all points of view, has guided specialists towards a better and better information about this disorder. Among the important researchers of autism, we can mention the Romanian Sergiu Paşca, a doctor originally from Aiud, professor and assistant of psychiatry and behavioral sciences at Stanford University. His research focuses on deciphering/decoding the molecular and cellular mechanisms of neuropsychiatric disorders, including autism.3

Over the years, have appeared various tools to assess autism spectrum disorders, such as: ADOS Test - Autism Diagnostic Observation Schedule, Carolina Curriculum Test, CARS evaluation scale.

Among the most common symptoms in autism are lack or loss of motor skills and sensory integration dysfunctions. They matter a lot to the development of the other skills of the autistic child, such as language development and self-service skills.

Before starting any therapeutic intervention, there are two very important steps: correct assessment and setting clear goals.

In the case of motor problems, among the objectives that can be established are: stimulating the formation of the correct perception of the body scheme, stimulating the development of lateral dominance, stimulating fine motor skills and motor skills, stimulating the development of rhythm and movements' coordination.4

Sensory stimulation can also be achieved at the same time through fine motor reeducation games.

The goals of sensory integration therapy focus on improving sensory modulation related to behavior and attention, increasing skills for social interactions, improving academic skills and personal autonomy. The sensory stimulation activities carried out by occupational therapists are intended to improve the modulation of the nervous system, to integrate information from the environment in order to result adaptive responses.5

A very important component of autism is the difficulty of sensory modulation and discrimination, motor planning and discrimination of the sequence of actions.

Most children with autism show unsatisfactory regulation of ordinary sensations. Some children will always have difficulty regulating tactile, visual, auditory and movement stimuli.

One of the most well-known autistic people in the world, Dr. Temple Grandin, reported both in his books, ‶The Autistic Brain″ and ‶Thinking in Pictures″, as well as in his numerous articles published in specialized magazines in the USA, the ordeal of sensory stimulation. An eloquent example he describes is the agony of receiving hugs from other people. To satisfy this need, however, she built herself the famous ‶hug machine″, and in this way she could relax in very tense moments.

One question many may have is about the connection between this sensory desynchronization and fine motor skills. How can we work on sensory stimulation and fine motor skills at the same time? What is their connection and importance?

There is certainly a very important link between sensory stimulation and fine motor re-education. Starting first from the difficulties of children with autism spectrum disorder, looking at these two very closely connected areas, we can say that a sensorially desynchronized child encounters obstacles when handling ordinary tools, such as cutlery, scissors or even a pencil. Let's think about the children who go to kindergarten and school: they are certainly discouraged by these dysfunctions, unable to handle the tools and complete the tasks given to them. Children with these disorders generally do not have developed self-care skills, make a mess when they eat, and their language shows immaturity.

Fine motor skills are of fundamental importance in the overall development of children with autism and is a multilateral process that involves the participation of several portions of the cerebral cortex: sensory areas, motor and association areas, forming the basis of the neuro-musculoskeletal function used in all precise movements. The word "psychomotricity″ means that the development of motor skills has a strong connection with progress in the areas: intellectual, social, affective.

So, in the case of people with autism, the connection between fine motor skills and sensory stimulation can be complex. Difficulty in fine motor skills can be related to the delay in the development of the central nervous system, which can affect the control and coordination of fine movements. Also, people with autism can have a sensory desynchronization that can affect the way they respond to certain fine motor activities. For example, a sound or texture that is unpleasant for them can lead to avoidance or rejection of the activities that involve fine motor skills.6

Starting from here we will also look at the many advantages of these forms of therapy. But first let's understand what they are.

Sensory stimulation is a form of therapy that involves developing the way the child relates to his own senses: sight, hearing, smell, taste and touch, all this in order to make progress in improving cognitive, emotional, motor functions.

Fine motor reeducation means therapy to recover fine motor skills, such as writing, drawing, cutting and manipulating small objects.

Understanding the connection between motor dysfunction and sensory desynchronization is very important for developing effective therapy programs.

The benefits of these therapies to children with autism spectrum disorder are many. They can improve communication skills, the development of social relationships, physical and cognitive skills such as memory and concentration. Both sensory stimulation and fine motor reeducation can be achieved through games, activities, objects, hand coordination exercises, as well as exercises for improving hand and finger strength and flexibility.7

Benefits of sensory stimulation:

* Improving communication skills through exposure to different sensory stimuli. Children with autism spectrum disorders can learn to respond to external stimuli and improve their communication skills;

* Reduction of repetitive behaviors, which are common in children with autism;

* Increasing attention and concentration. Learning to relate normally to external stimuli will increase attention to everyday activities;

* Decreased anxiety;

* In general, sensory stimulation can improve the quality of life of children with autism and is a useful way to decrease specific behaviors.

Reeducation of fine motor skills also has many advantages:

* Fine motor skill development focuses on improving the control and accuracy of fine hand and finger movements. Through specific exercises and techniques, children with autism can improve skills such as grasping, manipulation and coordination of fine movements;

* Improving autonomy and independence, which is one of the main goals of therapy in children with autism: fine motor skills have an essential role in daily activities such as dressing, feeding, drawing, using school tools. By reeducating fine motor skills, autistic people can gain more independence and autonomy in these activities and thus achieve increased self-confidence and self-esteem and automatically a better, less anxious state of mind;

* Improving school performance: a better level of fine motor skills is essential in the process of writing and drawing, skills needed in the school environment. Students with dysgraphia need this kind of therapy, thus learning to write, developing clearer and more fluent writing, better handling of writing instruments and thus increasing academic performance.

* Promoting cognitive development and learning: Fine motor skills and cognitive development are closely related. Exercises that involve fine motor skills stimulate neural connections and promote the development of cognitive skills such as attention, memory, logical thinking and problem solving.

Occupational therapy in sensory stimulation and fine motor reeducation is an approach focused on improving the daily functioning of children with autism spectrum disorders. Occupational therapists using this approach are able to identify sensory and motor difficulties and develop strategies to manage them and sensory stimulation can provide visible progress in communication skills, social skills and also improve fine and gross motor skills for the patient to learn step by step to organize and plan their daily activities.

Each recovery program is individualized according to the child's needs, the degree of impairment and the potential he can achieve. Therapy programs and goals are established after a very strict assessment using assessment tools and scales. To evaluate these areas we are talking about, the following can be used: the Gessel development scale for the sensorymotor area, the Oseretzski motor development scale, the Mira Stambak facial motor test.

Physiotherapeutic assessment in autism aims to assess motor capacities, coordination and physical development, and some key aspects are as follows:

* Motor control, balance and muscle strength are examined;

* Motor development and the evolution of movements from early childhood to the present age. It is analyzed whether there are significant differences in motor development compared to chronological age;

* The ability to carry out activities of daily living such as dressing, undressing, feeding, personal hygiene is assessed depending on age, and is examined the level of independence:

* Motor behavior is assessed in different contexts and situations;

* It is observed if there are sensory dysfunctions. Although the physical therapy assessment focuses mainly on motor aspects, it is important to observe how the autistic child reacts to external stimuli, what skills he has in terms of socialization and communication, because all these are connected to each other in recovery programs.

Occupational assessment. This is usually a pleasant experience, carried out by the occupational therapist in his office. Here are some areas that the occupational therapist can perform an assessment:

* The level of development of fine and gross motor skills;

* Visual-motor integration (by solving a puzzle, copying shapes, etc.)

* Visual discrimination;

* Neuromuscular control (balance and posture);

* Reactions to sensory stimulation (tactile, vestibular and proprioceptive);

* Bilateral coordination;

* Praxis (motor planning);

Fine motor skills' reeducation through sensory stimulation involves the use of specific techniques that improve both sensory integration and fine motor skills. These techniques include occupational therapy and physical therapy activities: play therapy, music, art, movement therapy and massage techniques.

Based on the results of the assessment, an individualized intervention plan will be developed to address the specific needs of the person with autism. These plans may include various games, activities, exercises, among which we can mention:

✓ Prehension exercises: These involve using and training the small muscles of the hand and fingers to grasp and manipulate small objects. Examples of exercises may include: grasping and transferring beads, using a brush to draw, object sorting games;

✓ Hand-eye coordination exercises: These help develop and improve coordination between hand movements and visual information. The patient may be involved in activities that require chasing objects and grasping with the hands such as ball games or puzzles.

✓ Play with modelling clay or dough - these can be used as part of a sensory diet and can also improve fine motor skills. The child is encouraged to squeeze, pinch or form snakes with the dough or modelling clay in his own hands, thus developing the coordination of the two limbs.

✓ Play with water - we need a cup in which we put about a quarter of water, an empty cup, a pipette or a clean syringe. We ask the child to try using the syringe or pipette to transfer the water from one cup to the other by dripping or splashing. Thus, motor coordination and sensory processing will be worked on. We can also give the child several cups and add dyes to the water, from which we can do a colour mixing experiment.

✓ To improve tactile discrimination - finding hidden toys in a ball made of therapeutic plasticine;

✓ Techniques to improve hand strength and endurance: using the hands to compress a sponge or ball for hand recovery, performing grip exercises and moving small weights.

CONCLUSIONS

It is important to note that young patients with autism spectrum disorders generally show hypersensitivity or insensitivity to certain sensory stimuli such as sounds, smells or textures. Some cannot tolerate wearing certain materials on their skin, cannot wear clothes with labels or seams, others cannot touch different textures, hugging or cuddling can mean real torture for some of them, and others can only eat certain textures, tastes or flavours. Also hot, cold, spicy, sweet or sour food can be real problems for children with autism.

These dysfunctions usually lead to difficulties in handling small objects, difficulties in writing, self-service or others that involve precise movements.

Awareness of the effectiveness of sensory stimulation in fine motor retraining is essential as it contributes to the improvement of fine motor skills through the central and peripheral nervous system.

Sensory therapy involves different techniques such as massage, light or sound therapy, or sensory exercises and games.

Fine motor retraining exercises can be done through games and activities that involve handling small objects, writing or drawing.

Sensory stimulation improves neural connections and develops fine motor skills. For example, games that require the use of the fingers to feel different textures or recognize objects by touch can improve tactile sensitivity and manipulative skills.

Correctly done, together with a well-designed therapy plan, sensory stimulation and fine motor reeducation can do visible progress in the overall development of children with autism spectrum disorders: a child who can only feed himself with help or who is fed by parents because he cannot handle the cutlery, can come to handle the cutlery and to eat by himself, a student with dysgraphia, lack of attention and concentration, distracted by any stimulus around him will be able to complete his school tasks and in this way his mood will improve, he will no longer be frustrated and embarrassed in front of his colleagues. A child who cannot eat and thus his diet is very poorly diversified may have deficiencies or other health issues. Sensory stimulation therapy will also be able to improve this dysfunction along with fine motor retraining.

Sensory stimulation in fine motor reeducation is an effective way to encourage healthy behaviors in children with autism spectrum disorders by creating an environment that motivates them to engage in positive activities. This approach is based on the idea that they are influenced by their environment and that a stimulating environment can encourage a behavior that the child needs to acquire.

Improving the precision of motor control through sensory stimulation provides multiple advances in all areas of development for children with autism and in this way they will become more independent, able to socialize, have functional play, academic skills, better mood and self-esteem, increased self, increased tolerance to external stimuli and a much more effective adaptation to the environment.

Footnote

1 C.S. Baron, The Pattern Seekers: How Autism Drives Human Invention, Publica Publishing House, 2021, p. 105.

2 S. Bignell Simon, Autism, Asperger's & ADHD: What You Need to Know. A Guide for Parents, Students and other Professionals, Derby, My Child Services Publishing, 2018, p. 89.

3 C. Mureşan, Infantile Autism. Psychopathological structures and complex therapy, Clujeana University Press, 2009, p. 37.

4 C.S. Baron, The Pattern Seekers: How Autism Drives Human Invention, Publica Publishing House, 2021, p. 151.

5 J. Beaney, Autism Through a Sensory Lens. Sensory Assessment and Strategies, Taylorand Francis LTD Publishing House, 2020, p. 189.

6 L. Wing, Aspects of Autism. Biological Research, Oxford, Alden Press, Gaskell Psychiatry Series, The National Autistic Society, 1987, p. 99.

7 R. Duffus, Autism, Identity and Me: A Practical Workbook and Professional Guide to Empower Autistic Children and Young People, Taylor and Francis LTD Publishing House, 2023, p. 201.

References

REFERENCES

Baron, C.S., (2021), The Pattern Seekers: How Autism Drives Human Invention, Publica Publishing House.

Beaney, J., (2020), Autism Through a Sensory Lens. Sensory Assessment and Strategies, Taylor and Francis LTD Publishing House.

Bignell, S. (2018), Autism, Asperger's & ADHD: What You Need to Know. A Guide for Parents, Students and other Professionals, Derby, My Child Services Publishing.

Duffus, R., (2023), Autism, Identity and Me: A Practical Workbook and Professional Guide to Empower Autistic Children and Young People, Taylor and Francis LTD Publishing House.

Mureşan, C., (2009), Infantile autism. Psychopathological structures and complex therapy, Cluj, University Press Clujeana Publishing House.

Wing, L., (1987), Aspects of Autism. Biological Research, Oxford, Alden Press, Gaskell Psychiatry Series, The National Autistic Society.