+ All Categories
Home > Documents > 30 Brownstone Schoen

30 Brownstone Schoen

Date post: 05-Apr-2018
Category:
Upload: bill-wong
View: 224 times
Download: 0 times
Share this document with a friend

of 28

Transcript
  • 8/2/2019 30 Brownstone Schoen

    1/28

    IMPROVING FUNCTION WITHA MULTI-SENSORY

    APPROACH

    Ann Brownstone, MS, OTR/L; SWCClinical Supervi soriLs Trainer

    Sarah A. Schoen, Ph.D. OTRAssociate Direct or of ResearchSensory Processing Disorder Foundation

    ANN BROWNSTONE, MS, OTR/ L; SWC

    Clinical Supervisor, Associated Learning andLanguage Special ist s

    Integrated Listening Systems Pract it ionerTrainer

    SARAH A. SCHOEN, PH.D., OTR

    Associat e Director of Research, SensoryProcessing Disorder Foundation

    Clinical Services Advisor, Sensory Therapies

    And Research (STAR) Center Assistant Professor, Rocky Mountain Universit y

    of Healt h Professions

  • 8/2/2019 30 Brownstone Schoen

    2/28

    OVERVIEW

    OT and iLs: a Mult i-Sensory Approach

    Neuroanatomy

    Key Components of iLs

    Clinical Applications

    Research

    Q and A

    WHAT IS ILS?A multi-sensory approach that

    provides input to the following

    sensory systems simult aneously:

    Auditory

    Vestibular

    Visual

    Proprioceptive/ Kinesthet ic wit h

    additional challenges for Language(receptive & expressive)

    Cognit ive skill s

    THE THREE PROGRAMS OF ILS

    AuditoryProgram

    VisualBalanceCoordinationProgram

    InteractiveLanguageProgram

    Usedsimultaneouslyorindependently

  • 8/2/2019 30 Brownstone Schoen

    3/28

    NEUROPLASTICITY

    TheBrainChangesThroughoutLife!

    Newneural

    connections

    are

    created

    through

    stimulation

    100billionneuronswiththousandsofconnections

    Neuronsthatfiretogether,wiretogether

    iLssoundandmovementprotocolsstrengthentheneuralcircuitryforsensoryprocessing:auditory,visual,balance

    Frequency,intensity,durationRepetitionoftheiLsprotocolfacilitatesfunctionalintegration

    HOW ILS WORKS

    iLsisaMultiSensoryIntervention

    Supportsandenhancessubcorticalprocessing(bottom

    upprocessinginthebrainstemandcerebellum)

    Subcorticalprocessingfacilitatesoptimalcognitiveprocessing

    Whensubcorticalfunctionisweak,tutoringandothercognitivebasedmethodsdonotstick aswell

    iLs keyingredientsforstrongfoundation:frequency,intensityandduration

    AUDITORY PROGRAM

    It all begins wit h frequencytransmission

    AuditoryTransduction

    Createdby&usedwithpermission

    fromBrandonPletsch

  • 8/2/2019 30 Brownstone Schoen

    4/28

    SOUND TRANSMISSION: BY AIR & BONE

    Soundvibrationspassviathesmallbones (ossicles)ofthe

    middleeartotheovalwindow.

    THE ROLE OF THE MIDDLE EAR

    Muscles of t he Middle Ear

    Two muscles (t ensor t ympani and stapedius) r egulat ethree bones which transmit sound to the oval window

    Most significant role is dampening volume to prot ect t he innerear

    Small est muscles in the human body regulatingthesmallest bones

    St riated (skeletal) muscles that can be st rengthened

    VESTIBULAR SYSTEM INNER EAR

    Thecochlea,semicircularcanalsandvestibule(utricleandsaccule)

    containacontinuousfluid;thevestibuleandcochleaareonesystem.

  • 8/2/2019 30 Brownstone Schoen

    5/28

    VESTIBULAR SYSTEM INNER EAR

    Activated by gravity, movement and visual input(VOR)

    Support s balance, posture, motor development,muscle tone, body concept , awareness of 3-D spaceand visual spatial skills

    Processes input f rom all muscles (including extr a-ocular), j oint s, soles of feet and palms of hands

    90%of the cortex receives input f rom the vest ibularorgans

    Fully developed and functional at 14 weeks gestation

    CEREBELLUM: THE PROCESSOR

    Controls rhythm, t iming,processing speed, learningnovel skills and automaticity

    90% of incoming input issensory

    Only 10%leaves throughoutgoing pathways

    Pathways to f rontal lobeinfluence cognition, emotion

    AROUSAL: THE RAS

    Ret icular Acti vat ing System (RAS)

    Neural net i n the brain stem, wi th connect ions tothalamus

    Receives dif fuse input fr om all sensory systems: gatesor facilitates attending

    Prepares the brain t o receive and process specif icsensory input

    Regulates levels of consciousness and wake/ sleeptransitions

    Responsible for optimal stat e to be available tolearn

  • 8/2/2019 30 Brownstone Schoen

    6/28

    AUTONOMIC NERVOUS SYSTEM

    Sympathet ic System ( fight/ flight)

    Many clients are stuck here Acti vated by fear or percepti on of t hreat

    Parasympathet ic System (rest / digest) Produces calm, relaxation

    Vagus Nerve major inf luence on this system

    VAGUS NERVE

    Carries 75%of all parasympathetic activity

    Gates fight/ fl ight r esponse

    St imulat ed by sound

    Branches fr om external auditory canal

    Branches fr om tympanic membrane

    Controls heart rate, respirat ion, digest ion,homeostasis

    AUDITORY PROCESSING

    Audit ory Pathway is complex

    Seven relay stati ons fr om the cochlea to the primaryauditory cortex of the brain

    Errors in processing input at any one of t he relay

    stat ions may compromise sound/ language processing

    Superior Oli vary Nuclei f rom t his point, audit ory andvisual share pathways

    Inferior Coll iculus

    Superior Coll iculus

  • 8/2/2019 30 Brownstone Schoen

    7/28

    KEY PRINCIPLES THAT INFORM ILS

    The Ear is a Transducer

    The ear (outer, middle, inner) transforms soundwaves into electrical signals.

    Electr ical i mpulses are a battery t o t he brain.

    KEY PRINCIPLES THAT INFORM ILS

    Sound is a Nutr ient

    High fr equencies are alert ing

    Low fr equencies are grounding

    Low f requencies help us connect wit h our body

    Low frequencies, in excess , are fatiguing (e.g.,the drone of an airplane)

    KEY PRINCIPLES THAT INFORM ILS

    Listeni ng and Hearing

    Listening is activeand involves social motivation

    Hearing is the ability to perceive sound

    We hear in two ways:

    Air conduction

    Bone conduction

  • 8/2/2019 30 Brownstone Schoen

    8/28

    KEY PRINCIPLES THAT INFORM ILS

    Three Zones*(identi fied by Dr. Tomat is)

    Zone One: 0-750 Hz Sensory-Motor Zone

    Zone Two: 750-3000 Hz Communicat ion Zone

    Zone Three: 3000+ Hz Integrat ion Zone

    * based on years of clinical testing

    MUSIC CHOICES

    Most ly Mozart universal appeal; form & structure of compositions; broad

    dynamic range; rich in harmonics and overtones

    Orchest ral Music diversity of instruments provide broad dynamic range

    (symphonies, sonatas, serenades, etc. )

    Other compositions chosen for their frequency content, rhythm and dynamic

    range

    Frequency Fil t rat ion Sample

    FSM EHS FM 500 FM 1000 SM 0 - 2K SpL Chant

  • 8/2/2019 30 Brownstone Schoen

    9/28

    BONE CONDUCTION DELIVERY

    iLs delivers sound through both air and bone conduction

    A key therapeutic mechanism of sound lies

    in the natural f unction of the bones toconduct frequency

    Sound is conducted through the bones of

    the spine and skull t o the bony structure

    around the inner ear

    Lower frequencies conducted through bones Influence the

    vestibul ar system, improving balance, coordinati on, mot orplanning, spatial awareness, emotional regulation

    4PHASESOFILS PROGRAMS

    4PHASESOFILS PROGRAMS

    Each full-length program has 4 phases, in t his order:

    OrganizationThe initial period of full spectrum music, and SMbandwidths

    TransitionGradual removal of lower frequencies

    ActivationThe highest filtered music level of the program

    IntegrationThe gradual re-int roduct ion of the l ower frequenciesthat were removed during Transit ion Phase.

  • 8/2/2019 30 Brownstone Schoen

    10/28

    ILS FOCUS PROGRAMSSensory Motor 60 hours

    Balance, Coordinat ion, Muscle Tone, Spati al Awareness,Laterali ty as well as for those with significant delays in

    reaching developmental landmarks and those on thespectrum

    Concentration & Att ention 40 hours

    Concentration, Attention, Ability toFocus, Memory, Moti vati on

    Reading, Audit ory Processing 40 hours

    Reading, Language, Speech, Art iculati on, Audit ory Processing

    Optimal Performance 2 versions of 24 hours each

    Concentration, Performance & Productivity, Energy, Mood,Enthusiasm

    INTEGRATING VISUAL AND VESTIBULARINPUT

    Playbook a guide for activit ies

    Balance board

    Adjustable tr acking ball

    Racquetball

    Bean bags

    *optional use for i n-clinic OT practice;recommended for home

    BREATHING, BALANCE & CORE

    SAMPLE ACTIVITIES

  • 8/2/2019 30 Brownstone Schoen

    11/28

    VISUAL MOTOR

    SAMPLE ACTIVITIES

    VISUAL TRACKING/ MOTOR PLANNING

    SAMPLE ACTIVITIES

    HEMISPHERIC INTEGRATION

    SAMPLE ACTIVITIES

  • 8/2/2019 30 Brownstone Schoen

    12/28

    OTHER ACTIVITIES WHILE LISTENING

    Keep it f un

    Quiet acti vit ies: puzzles and games

    Creative activit ies: drawing, coloring, fi nger painting,molding clay

    Start session wit h movement act ivi t ies

    Adults oft en like yoga, st retching, r elaxing

    INTERACTIVE LANGUAGE PROGRAM

    (OPTIONAL)

    Functional Language & Engagement, Reciproci ty

    Loaded onto the iPod Touch

    Children songsVocal production: i.e. humming, single & mult iple t ones

    Repeating words, phrases, tongue twistersWords filt ered w/ high-pass fil ters (consonant practice)

    w/ low-pass filt ers (vowel practice)Auditory memory

    Auditory figure groundDichotic listening

    INTERACTIVE LANGUAGE PROGRAM

  • 8/2/2019 30 Brownstone Schoen

    13/28

    ILS DIFFERENCES Integrates an auditory program with vestibular, visual, and

    functional language exercises

    Delivers sound through both air and bone conduction: addedvesti bular stimulati on and calming eff ect

    Individualized f or each child; combining cli nical reasoningwith easy-to-understand methodology

    Gentle, gradual program design: begins gently and graduallyincreases information

    Clinical & Equipment Support : available by phone or e-mail;advanced clinical support available with Ron Minson, MD

    Professional Development: fr ee webinars; case study seriesand newslett ers monthly; repeat tr aining at discounted r ates

    CASE STUDY

    11 y/ o wit h Agenesis of t he Corpus Callosum,Congenit al Atrophic Cerebellum

    Challenges: balance, contra-lateral movements, eyeteaming, apraxia, self-care dependent

    Program: Zone 1 and 2 (body and cognit ivefunct ioning), 30 sessions over 12 weeks, no st ructuredexercises

    Results: Improved balance (5 steps on balance beam),independently dressed himself aft er 15 sessions,improved handwrit ing, eye tr acking, oral motorarti culation, self expression

    PILOT STUDY: COCHLEAR IMPLANTS

    Cochlear implants, BAHAs, Hearing aides

    Audiology, OT, SLP

    Sound localizati on, f il tering background sound,decoding, sequencing, audit ory memory

    Sensory Profi le, Peabody, VMI, cli nical observati ons,self-care report

    March 2012 September 2012

  • 8/2/2019 30 Brownstone Schoen

    14/28

    5420 S. Quebec St., Suit e 103

    Greenwood Village, CO

    303-221-STAR (7827)

    www.starcenter.us

    INTENSIVE MODEL

    In town clients

    3 to 5 t imes per week for 10 weeks

    Out of town clients

    5-10 times per weekfor 1-10 weeks

    Break if possible

    PROGRAM STRUCTURE

    Intake

    Evaluation: comprehensive OT or expanded multi-disciplinaryteam evaluation

    Feedback: based on three priorities

    Orientation: goal setting session (relationship building and GAScale)

    ~30 OT Treatment sessions; may also include DIR/ Floorti me,MD, LSW/ MFT, SLP (wit hin 30 sessions or added on)

    Parents only educat ion ~ every 5th - 6th session

    Break after ~ 60%of sessions (if indicated of 3 weeks to 3months)

    Post-testing & recommendations

    Boosters as needed

  • 8/2/2019 30 Brownstone Schoen

    15/28

    TREATMENT BASED ON CLINICALREASONING

    (Incl udes Many Frameworks And Models)

    Integrated List ening Therapy

    DIR/ Floorti meSOS Approach t o Feeding

    Cognit ive Behavioral St rategies

    Interactive Metronome

    Kawar Ast ronaut Program

    Wil barger Prot ocol

    Wii

    Kinect

    And more

    INTRODUCTION TO STAR CENTER

    Differences from traditional OT model

    1. Intensives, short term

    2. Signif icant parent education

    Famil y is also a focus of t reatment

    Famil y part icipat ion in child s tr eatment session

    Focus on teachi ng play to parents

    3. Arousal modulat ion, relati onships & engagement,using sensory and motor acti vit ies

    4. Clinical reasoning; process not acti vit y based

    5. Sensory li festyl e (not a sensory diet )

    INTRODUCTION TO STAR CENTER6. Turning over magic moments to parents

    7. Focus on Joie de Vivre as well as physiologicsymptoms

    8. Theme-based approach t o t reatment

    9. Organizat ion of the session is done by child whenpossible (visual schedule)

    10. Transit ions into and out of tr eatment are part ofintervention

    11. Acti ve (vs. passive) use of sensation

    12. Balance bet ween success and chall enge (so thatevery task is hard but scaffolded)

    13. And iLs with many of our clients!

  • 8/2/2019 30 Brownstone Schoen

    16/28

    STAR CENTER TREATMENT MODEL

    & BEST PRACTICES

    BEST PRACTICE USING THE STAR CENTERMODEL

    Build Arousal Regulation for the Child & FamilyEngagement and Relat ionship is Pri marySensory integration and clinical reasoningTap the Child s Inner DriveParent educat ion and empowermentRe-enact the Problem AreaActive Participation to Control Arousal LevelChild - Selected Thematic PlayTherapist - Guides Session OrganizationIntensives - Parents Part icipation Fosters Model t hen Coach

    Challenge must be j ust rightEnjoy YOUrself , Have Fun!!

    SENSORY PROCESSING DISORDERTAXONOMY

    SensoryModulation

    Disorder (SMD)

    SensoryBased Motor

    Disorder(SBMD)

    S OR S UR SC Dy sp rax ia P os tu ralDisorder

    SensoryDiscrimination

    Disorder (SDD)

    SOR=SensoryOverResponsivity

    SUR= SensoryUnderResponsivity

    SC= SensoryCraving

    Visual

    Auditory

    Tactile

    Taste/Smell

    Position/Mvmt

    Interoception

  • 8/2/2019 30 Brownstone Schoen

    17/28

    SENSORY MODULATION DISORDER

    In Sensory Over-Responsivit y:

    Emotionally Fearf ul, Anxious, or Angry

    Behaviorally:

    Hostile

    Aggressive

    Withdrawn

    SENSORY MODULATION DISORDERCONT.

    In Sensory Under-Responsivi t y

    Emotionally Depressed

    Behaviorally:

    Flat Aff ect

    Paucit y of Interactions

    Hyperf ocused: can t shift att ention

    SENSORY MODULATION DISORDERCONT.

    In Sensory Craving

    Emotionally errati c (fr om exuberant t o out ofcontrol)

    Behaviorally:

    In your face and in your space

    On the go

    Decreased att ention, distractibl e

    Disorganized

  • 8/2/2019 30 Brownstone Schoen

    18/28

    SENSORY-BASED MOTOR DISORDER

    In Postural Disorder

    Poor body scheme

    Balance difficulties

    Dif fi culty crossing the midl ine

    Ocular problems

    Weak muscle tone

    Poor endurance

    SENSORY-BASED MOTOR DISORDER

    In Praxis

    Arousal, Rhythmici ty and Sequencing

    Ideation

    Motor Organization

    Planning (t houghts and actions)

    Bilateral Coordinati on

    Projected Action Sequences

    Execut ion and Feedback

    Problem Solvi ng and Organizat ion of Behavior

    USE SENSORY MOTOR PROGRAM

    Sensory Modulat ion Disorder

    Sensory Over-Responsivi ty

    Sensory Craving

    May manipulate bone conduction to fit needs of child

    Wit h SOR can turn down BC

    With SUR can turn up t o +1 if tolerat ed

  • 8/2/2019 30 Brownstone Schoen

    19/28

    WHAT HAVE WE LEARNED USING ILS?

    Most childr en wit h SPD start wit h t he Sensory MotorProgram or t he Calming/ Prep Program

    Be careful of overload when combiningvest ibular-based act ivi t ies and Bone Conduct ion

    Some children may use supplemental program:Calming/ Preparatory wit h or wi thout chant

    NUMBER OF SESSIONS PER WEEK

    Younger childr en

    3 sessions per week

    Middle aged children

    5 sessions per week

    Older children

    5 sessions 1-2 ti mes per day

    Consistency is key!

    PREPARATORY PROGRAM W/ OR W/ OCHANT

    Use wit h

    High anxiety

    Sensory Over-Responsivi ty

    Emotional dysregulation

    Aut isti c Spectrum Disorder

    Comprised of f ull spect rum music alt ernating wit hsensory motor

    Signif icant bone conduct ion

    Two versions: chant and musical

  • 8/2/2019 30 Brownstone Schoen

    20/28

    CALMING PROGRAM

    Useful wit h:

    Children on the autism spectrum

    Children wit h modulat ion disorders (SOR/ SC) Fullspectrum music for calming and relaxing

    Can be preparatory pr ogram for

    Children/ adolescents/ adult s

    Wit h high stress or anxiety

    TREATMENT BY SUBTYPE: SMD

    Sensory Over-Responsive:

    Only use Sensory Motor Program OR

    Delay using iLs unti l aft er OT intensive OR

    Begin wi th Calming Program

    Use more humming and toning to decreasearousal

    Especially i f emoti onall y reactive

    SMD

    Sensory Under-Responsive:

    Extremely under-aroused children may needhigher f requencies sooner

    St il l start wit h Sensory Motor program andobserve result

    May benefit from actives early on

  • 8/2/2019 30 Brownstone Schoen

    21/28

    SMD

    Sensory Craving

    Most of these children are over-aroused

    Myth: r elat ed to SUR continuum

    Start with Sensory Motor Program

    SENSORY BASED MOTOR DISORDER

    Postural Disorder

    Simi lar to SUR, needs acti vation

    Try using some higher bandwidths in betweenSensory Motor program and watch caref ull y for over-arousal

    Try more bone conducti on if i t is tolerated (up to+1)

    SBMD

    Dyspraxia

    Benefit fr om iLs during OT

    Benefit from iLs as a follow-up after OT ispaused/ stopped

    Especially if they have trouble organizing theirthoughts; or word r etri eval problems

    With language delays same applies

  • 8/2/2019 30 Brownstone Schoen

    22/28

    Sensory Discrimi nation Disorder :

    iLs and OT during same ti me span but at separat etimes or on alternating days

    Modify/ simpl if y your language signif icant ly if iLs andOT used together

    SENSORYDISCRIMINATIONDISORDER

    IN SENSORY DISCRIMINATION DISORDER E.G.,READING/ AUDITORY PROCESSING DIFFICULTIES

    Use Reading/ Audit ory Processing Program

    Intro period of full spectrum & sensory motor

    Rapid t ransit ion phase

    Focus is on

    Zone 2 for language and communication

    Zone 3 for reading comprehension and highercognit ive functi oning

    WE HAVE OBSERVED

    Low SI bandwidths are more calming and increaseregulation

    Propriocept ive and heavy work compliments theSensory Motor Program

    Use of bone conducti on helps postural cont rol improvemore quickly

    e.g.,children with low tone who drool oftenincrease in tone in the oral region with lowbandwidths

  • 8/2/2019 30 Brownstone Schoen

    23/28

    INTERACTIVE LANGUAGE PROGRAM

    Pil ot data show an increase in physiological arousal when

    children anticipate and start use of microphone withInt eract ive Language Program

    Consider Int eract ive Language Program for SensoryUnder-responsive and Postural Disorder earl ier inprogram than you would for dysregulated children

    CONCENTRATION/ ATTENTION PROGRAM

    May be useful wit h the fol lowing diagnoses:

    ADHD wit h co-morbid SPD (40%)

    ADD wit h co-morbid SPD

    Obsessive Compulsive features?(to assist wit h dividingattention)

    ELECTRODERMAL ACTIVITYDURING A 50 MINUTE OT SESSION

  • 8/2/2019 30 Brownstone Schoen

    24/28

    Ball

    Pit

    Swinging

    Tunnel

    Trampoline

    LycraSwing

    Wagon

    Time(Hours:Minutes)

    ElectrodermalActivity(microsiemens)

    ChildsSkinConductanceduringTherapySession

    EDR: 50-MINUTE OT SESSION IN WORDS

    Speakinginto Mic

    WIRELESS CONTINUOUS RECORDING OF EDA

    Using wireless continuous recording of EDA, 77 usable treatment sessions weremonitored for arousal

    Rosalind Picard Scd

    MIT Media LaboratoryAffective Physiology

    UNDERSTANDING AROUSAL CHANGES DURINGTREATMENT

    Potent ial use during iLs:

    Treatment studies need object ive markers

    Wil l EDR be a useful marker of changes in the autonomicnervous system during and aft er intensive intervention?

  • 8/2/2019 30 Brownstone Schoen

    25/28

    CURRENT AND PREVIOUS RESEARCH

    73

    HISTORICALLY, EFFECTS OF MUSIC

    Listening to music can improve

    Spatial t emporal reasoning

    Mathemati cal abil it ies

    Result s evident in cl ini cal groups ranging from

    Healthy adults and children

    St roke patients

    Dyslexia

    Insomniacs

    EFFECTS OF MUSIC CONTINUED

    Additi onal posit ive eff ects include

    Decreased stress

    Greater relaxation

    Improved memory and attention

    Bett er sleep patt erns

    Improved phonological and spelling skills

    Less fat igue

  • 8/2/2019 30 Brownstone Schoen

    26/28

    ILS RESEARCH

    Universit y of New Mexico

    64 students (kindergarten 2nd grade)

    Listening therapy plus art therapy

    3 months of i ntervention

    3 t imes a week

    Average improvement i n reading ~ 2 years

    EFFECTS OF PROCESSED MUSIC

    Controversy exists

    Mixed result s in t he lit erature

    Lack of consistent fi ndings

    Due to met hodological weaknesses

    Programs not comparable

    Samples not homogenous

    Inappropriate met hods used

    Few studies conducted using iLs

    THERAPEEDS CLINIC

    28 chil dren wit h auditory processing disorder

    Age 7-14

    Interventi on = OT combined wit h iLs

    30-60 sessions

    2-3 times a week

    Changes noted in post rot ary nystagmus, ocular mot orskil ls, and audit ory processing

    7 childr en wit h ADHD discont inued meds

  • 8/2/2019 30 Brownstone Schoen

    27/28

    CONTINUED . . .

    Auditory Brainstem Response

    Binaural summation normalized following

    intervention

    measures the t ransmission of sound from the ears tothe low, middle and high port ions of t he brainstem.

    This is an obj ecti ve measurement which tell s us ifthe ears are coordinating with each other.

    DENVER ELEMENTARY SCHOOL

    20 childr en, ages 5- 9 years

    Diagnosis of learning disabilities

    iLs Focus System 30 sessions, 3x per week i n school

    Improvements included:

    transitions from special education to regulareducation

    having an IEP removed or

    overcoming other emotional, behavioral oracademic defi cit s

    ILS AND SPIRAL FOUNDATION

    New studies: Effectiveness of iLs for children with Autism

    Single Case Study

    18 subjects

    6 weeks of baseli ne, no t reatment

    12 week int erventi on (5x per week) and playbookactivities

    Outcome measures: standardi zed assessments andparent-report

  • 8/2/2019 30 Brownstone Schoen

    28/28

    ILS AND SPD FOUNDATION

    SPD Foundat ion r esearch proj ect on eff ecti veness of i Ls

    Using mult ipl e case study methods we wil l t est

    children, obtain baseline data, do an 8-week iLsprogram, 5 days a week (4 at home)

    Measure 10 children pre-post (Physiological changese.g., elect rodermal activit y; Scan 3C, BASC II, ABASand Sensory Processing Scale

    Measure each week EDA duri ng session (wirel esssensors) and Visual Analog scale of f ive goals parent shave for their child


Recommended