pictured: Madame Valerie Drouot, Tomatis voice specialist, (alive and well and living in Paris who teaches twice a year at the Spectrum Center)

 

.......Tomatis Topics

T oday's auditory listening evaluations indicated that Willard presents with an underlying sensory integration and listening disorder. Also associated with this is an auditory processing disorder that is resulting in abnormal auditory perception

A. Auditory Listening Evaluations

Today's auditory listening evaluation revealed an auditory processing disorder. Willard demonstrated difficulty with various auditory closure skills, auditory figure ground skills, dichotic listening tasks, and phonemic processing. In order to improve higher order based tasks, it is important to first improve the lower order perceptual skills. Willard presents with an auditory processing disorder that is associated with an underlying sensory integration disorder. A weak vestibular system, which has already been documented is providing insufficient support for higher level auditory processing or cochlear functions. The vestibular system is anatomically joined with the cochlear system as they together comprise the inner ear. The two systems lie closely together throughout the nervous system, allowing for many close neuronal associations between auditory processing and vestibular functions. Research has found that therapy that improves the function of the vestibular system can also improve auditory processing, organization, and attention. Good sensory integration mechanisms between the vestibular and cochlear systems are needed in order to provide a stable foundation for auditory processing.

Today's evaluation revealed that Willard presents with a disorder of the vestibular system. The vestibular system detects motion and gravity and provides us with our sense of balance. The system develops early in utero and through its many connections with the rest of the brain, is believed to provide the foundation for many other functions. When the influences of vestibular stimuli fail to reach their natural destinations, they cannot adequately contribute to sensory integration.

Today's evaluation also indicated that Willard demonstrated a breakdown in interhemispheric communication associated with an underlying disorder of the vestibular/auditory systems. The vestibular and auditory systems provide opportunity for the two sides of the body to communicate on the brain stem level, and support the development of bilateral coordination, or the ability to use both sides of the body in a coordinated manner. This in turn influences the development of laterality and the specialization of skills on each side of the body and allows for the coordination and specialization of the visual (both eyes) and auditory (both ears) systems. Sensory integration and listening training are excellent therapeutic tools for impacting and improving brain stem function and enhancing bilateral integration of sensory information. Both the vestibular and the auditory system have many crossed pathways, and stimulation to both of these systems helps to establish improved integration between the hemispheres.

The type of sensory integration and listening disorders that Willard presents with could also contribute to a child's low self esteem and anxiety. Individuals with this problem are aware that they are not doing as well as their peers. However, because it is a hidden disorder they may see themselves as dumb, not realizing that they are working twice as hard to compensate for their difficulties. The cost of compensation may be a sense of frustration and awareness that their bodies are unable to keep up with tasks that their good minds are able to conceptualize.

Testing

V estibular Integration Evaluation.

Today's evaluation indicated that Willard presents with a motor planning disorder known as motor apraxia. Motor planning, or praxis, is the ability of the brain to conceive, organize, and carry out a sequence of unfamiliar actions. Motor planning weaknesses are evidenced by a reduced ability to carry out nonlearned movements, despite adequate motor and conceptual capacity. Tactile, kinesthetic, and vestibular sensory information are registered from the body and organized into neuronal models. This neuronal map, known as body schema, permits the effective programming of action sequences that involve the whole body and are required in motor behavior. Praxis involves three components: 1) the ability to ideate or envision what one wants to do; 2) the sequencing of the actions required to accomplish the task; and 3) the motor control needed to execute the task. Motor planning difficulties impact many areas of development that require the ability to ideate, sequence, and organize.

While motor planning difficulties can manifest in the acquisition of motor skills, they can also manifest on a larger scale, as individuals try to organize their environment and themselves in that environment. This is an area that is particularly difficult for Willard. Learning routine and how one fits into that routine may also prove difficult. Individuals with motor planning problems may perform slowly, or may not be able to perform at all when asked to follow multi step directions. They may require longer exposure to a new activity in order to learn it. They may use trial and error until they can generate a motor plan about how to approach a new activity. It was observed today that Willard is compensating for underlying motor planning difficulties. This causes him/her to work twice as hard as other people to accomplish the same skill.

A motor planning disorder, or apraxia, also appears to be affecting Willard's auditory processing abilities, because motor planning and sequencing skills are combined with the ability to follow directions. We must first process the instructions we are given (auditory) and then organize and sequence how to execute the instructions (motor planning). Today's evaluation would suggest that Willard has difficulty in both of these areas.

Participation

A motor planning disorder, or apraxia, also appears to be affecting Willard's auditory processing abilities, because motor planning and sequencing skills are combined with the ability to follow directions. We must first process the instructions we are given (auditory) and then organize and sequence how to execute the instructions (motor planning). Today's evaluation would suggest that Willard has difficulty in both of these areas.

Benefits

B ased on today's vestibular and auditory listening functions evaluation it is highly recommended that Willard attend the combined sensory integration/listening training program that is offered at the Spectrum Center. The difficulties described in today's report are secondary to an underlying physiological disorder that involves poor processing within the sensory systems. This is resulting in general motor apraxia and abnormal auditory perception. Therapy should be initiated to improve the many foundational skills upon which higher skills are dependent.

Goals

1. Improve motor planning to provide the foundation for improved organizational skills.

2. Improve auditory perception and processing to improve performance on auditory/linguistic based tasks, auditory sensitivities, and attention.

It is important in Willard's case to normalize the neurologically based functions of the sensory systems in order to provide him/her with a better foundation for higher level skill development. Tutoring and training approaches that work in the skills themselves cannot always be as effective as desired unless the underlying causes of the child's difficulties are remediated. With improved underlying sensory integration and listening, we believe that Willard will be able to benefit more from his/her education and any additional services HR receives.

Researchers have found that it is best to administer sensory training very intensively in order to adequately affect the sensory system. The recommended breaks allow for the use of new processing abilities in the child's regular environment before proceeding to make any more changes. A variety of formats have been tried and the above format has been the most effective. Without sufficient intensity, we do not make the changes that we hope for, and without breaks, the children become overwhelmed.

Thank you for the opportunity to evaluate Willard today.

_______________________ Valerie Dejean

First Part of Evaluation