SLK Study Group #2 transcript

Scott Baltisberger: Hello, everybody. This is Scott Baltisberger, Texas school for the Blind Outreach Department. With me here today is Sara Kitchen also with TSBVI Outreach. And we're here for -- this is session two of the Sensory Learning Kit study group. So, thanks everybody for showing up, again, and we'll go ahead and get started. We just wanted to go over our goals, the goals of this group. What we are hoping to do is learn more about the Sensory Learning Kit through shared experiences with a variety of students and become more proficient with the SLK assessment process. And also, an interesting thing; Millie Smith had originally talked about joining us for these groups. And she actually tried to participate last month, but was unable to because of technical difficulties. But we spoke with her again, and she said that... she would really prefer not to be part of the process, because her interest is seeing how the kit -- how easy it is for TVIs out in the field to use it. And so she really wants us to try it without her guidance; without having her 'on call' for us to go to whenever issues or whatever questions might arise; and be able to present those to her, so she can kind of get a good feel like how does it work out in the field; how easy is it for TVIs to use it; and she can make modifications to it as needed. So, we're actually helping Millie Smith out by doing this. Finally, the third goal is to build a strong supportive peer group of VI professionals who feel confident in their ability to use the SLK to assess learning media of students and design appropriate instruction for them. So we're really hoping that all of us work together and we... find the best way to use the SLK. So, remember that Scott and Sara are not instructors here; we are facilitators. We really, really are serious about you guys chiming in and getting your observations and your experiences; because honestly... I am not an authority on the SLK. I would like to become one... but I don't think my experiences -- it's very hard to do that just by reading the instructions on my own and trying to implement it. It usually works a lot better when I have people around me I can go to that are using the same... assessment or the same materials, and ask them what they're doing and exchange ideas. So, please share your experiences and observations. You can participate by voice. Remember to mute and unmute, so we don't get any unwanted conversations broadcast. You can also just participate by messages in the chat room, and Sara is monitoring that, and so she will let us know -- she'll break in with any news we need to cover. And what we planned to do, originally when we were designing this group, we thought about covering a different section of the SLK each month, that is, there are five main sections to it. And we thought every month we would hit one of those. But, really, now that we're getting into it, we're thinking that we might be spending more time than that on each section; and it really will depend on the feedback we get from you guys, as to whether we, you know, spend a couple of months doing one, or maybe combine a couple in a month; so we'll see what happens with that.

>> Sara Kitchen: Right, but we want to go at the pace that works for the group. We are not going to force a pace -- a training sort of pace on you. 

>> Baltisberger: The SLK -- I think it is a really nice way to address the learning media these kids with sensory impairments and multiple impairments. These guys are at a sensory-motor stage. I think -- I talked about last time, that when I was doing the learning media for some of these kids, when I was a TVI, I felt it was kind of hidden, yes; and a lot of the information I would put on the report was sort of anecdotal. You know, I would try to find ways to figure out what these kids -- the best way these kids learned, but I didn't really have a formal assessment. I didn't have a document that I could go to, and I think that's really the neat thing about the SLK, is you get an actual document that you can refer to when you are talking about the learning media. That would be an interesting question to ask, what have people been using for their learning media assessments for some of those kids that are, you know, say, age three and under.  

>> Kitchen: I know I have seen a lot of people using Jan Korsten's assessment, TEvery Move Counts, which has a real similar structure to Sensory Learning Kit. It really addresses preferred channels, but she doesn't come at it from the same background. Jane Korsten is a Speech Language Pathologist, and so, she worked with an Occupational Therapist to come up with that assessment, so it really does get at a lot of the same things. I think if people have [Background Noise] experience with Every Move Counts, they're going to find that experience will help them in looking at the Sensory Learning Kit. You know, one of the things, that when I'm talking to teachers and teaching assistants, I always go out and... say -- and talk about people having to wait for the kids' responses and interactions. This is kind of like that. Ok, let's see what Karen says...^* I have not used it at all. I was a little overwhelmed with the SLK -- unsure how to use it. Thank you, Karen. You are a new, new TVI. Yeah! OK. All right, that's really good input and thank you. And I wonder what kinds of questions, you know -- I know if you are overwhelmed it is even hard to think of a question, but if there is anything that pops into your mind, feel free to type that in -- what kind of thing we can do to help, right now, to help you get a little less overwhelmed.

>> Baltisberger: Looking at the structure of the SLK, you know, there are five main parts to it. The beginning -- the first part -- the one that we were attempting to do this past month was the Sensory Learning Summary, and that's really gathering existing information. The idea is, you take that information and then you go to do the ASP, Arousal State Profile which are observations of the student that you've chosen. In these observations you try to identify the times and places in a situation where you see a more alert state. Once you've got that -- you're aware of that, you can take the Sensory Response Record, which is where you are trying to find those stimuli, those things they respond to most readily.  

>> Kitchen: That can really give you a lot of information about the best learning Channel.  

>> Baltisberger: Right. I mean that's really what it is, and from that Sensory Response Record you come out the Appetite/Aversion List, which is sort of the likes and dislikes. A list of what motivates the student and what kind of...  

>> Kitchen: Irritates them... 

>> Baltisberger: What irritates them. [laughter] And then finally you've got the Levels and Strategies Guide, which is where you start to develop activities and take on data and what you're doing with that student to try to increase their interactions.  

>> Kitchen: I think just the Sensory Learning Summary, that's the only one we were looking at, last time. Even in looking at that, it's a pretty big and lengthy bit of information they're asking about. Oh, here is a review of it.  

>> Baltisberger: You're right. It is very lengthy. You know, you've got two main sections to it. One is just the medical needs, and the second being the sensory function needs. And those are further split up; medical needs into conditions, medications and issues, and the sensory functions into all of those parts. So Sara and I started working with the student here in Austin. There is just a lot of information... but some of it -- I wasn't real clear on where to get it. 

>> Kitchen: The thing that we encountered, too, is that our student is very young and so the documents we did have were not from the education field; they were more medical. Though it did give us a lot of information, but it had not been distilled by -- in the way we think of it. It was more of a medical model. And so we had to really, kind of -- we had to look up a lot of words, because we didn't know what they meant. A lot of it was from the doctors and nurses, or people -- they just had a lot of vocabulary we weren't familiar with. 

>> Kate Hurst: This is Kate. I just have a comment. I'm wondering if you all had access to talk to the parents about this information, gathering this information? 

>> Kitchen: We have an unusual situation, because Scott and I don't work directly with the student and we are not his TVI; and we just barely got the permission to look at his information last week. We really just got -- we met him. We met our student and we got some ideas, and we also talked to his nurse, but we really need to gather a lot more information from the people who are working with him now, because they're probably in the process of doing a lot of assessing. They just have a lot of information that hasn't been written down yet. 

>> Hurst: Well, I was just going to say, you know, in my experience the parents, when it comes to medical needs and medical conditions and issues and medications and stuff like that, they know it so by heart and they know this whole long medical history; that sometimes, I think, what is the record doesn't adequately reflect the information that the parents have. 

>> Baltisberger: Right 

>> Kitchen: Absolutely. There were a lot more people we needed to be talking to. But, yea, this definitely isn't something -- especially for the student who is very new and very young, you can get from paperwork entirely. So, we still have a lot of questions.  

>> Baltisberger: Yea, It is a very thorough summary of the student's needs. Two things that are kind of neat to me about it -- Millie said, when I spoke with her last, she felt very strongly that this should be done -- that the SLS should be done very thoroughly. She felt that -- on the one hand you might -- there might be some real medical conditions that could be affecting student. You might actually present something that could be harmful to the child. That can really happen. The medications that they're taking could be affecting what they are doing. You know, I think, our student's very young, so a lot of the information is not there. I think sometimes, people don't really look at the records as thoroughly as they should, and I think certain information becomes sort of assumed. It becomes, sort of like -- when we are looking at our student, the medications that he had been taking already, you know, he had already taken several medications, but at various times -- there were different ones tried. And I think -- I know I'm guilty of looking for looking and saying, "Oh now, you know, he's on this one -- he's on Keppra..." 

>> Kitchen: We had to go back and forth looking at, "What date is this?" To see when, "What is he on now?" 

>> Hurst: Well, and too -- with older children, a lot of times important information has sort of dropped off the map, for whatever reason. Maybe they moved and part of the record didn't come, or somebody was completing something else and didn't bother to put it down, and it is -- just going off of paper is pretty much, I think, impossible to get all the information you need.  

>> Baltisberger: And, the other thing... the other thing about it -- it being so thorough, is it can really give you some ideas about where to go, what type of assessments to make referrals for. You may not always consider, you know, have they done this or have they done that. I think she pointed out a lot of kids don't have audiology reports. People kind of assumed that must mean they hear fine. You know, it just means, a lot of times, they just haven't looked at it very thoroughly. That is something... that of course hugely impacts the kind of responses you're going to get. She also talked about whether the occupational therapy report addresses tactile defensiveness. And... a lot of them don't. So that's another thing that, you know, when you look at the information you gather in the Sensory Learning Summary, you can look and say this is a really important part we need to address with this student.  

>> Kitchen: I have a comment from Renee. She says, "In trying to gather the information on the Sensory Learning Summary for my student, the only information that was easy to find under sensory function was the vision. Unless therapists, who are skilled and knowledgeable of sensory integration techniques, there is just not information on school kids; on touch, vestibular, respiratory, olfactory and gustatory recommendations."

>> Hurst: Just as a side comment. I happened to sit in on this spectacular webinar on Friday, or Thursday -- can't remember what day -- from Carol Fletcher who is like an incredible audiologist, but also very much into the whole sensory integration stuff. 

>> Kitchen: Carol Fletcher? 

>> Hurst: Yea, I'll send her name -- I'll look it up real quick and put it up in the... in the chat. But anyway, she -- one of the comments she made about... was that, you know, this incredible percentage of any child that has any amount of hearing loss, also had vestibular issues -- which was brand new information to me. It was incredibly high. And, then, she also had, you know, information about the percentage of children who have multiple disabilities that have some degree of hearing loss. And I know that I had heard, and I can't tell you the source on this, but for kids that are multiply disabled, because they're often times not able to sit up, or they often times don't have good respiratory function, that there is a high percentage of those children that have continual middle ear fluid, and so they have conductive losses that may not be apparent to most people, but it is deeply affecting how they function.  

>> Kitchen: So in a sense, they are functioning like a person with deafblindness.  

>> Hurst: And a lot of times the doctors will say, "We can't get a good one unless we put them under for an ABR; and that's really not true anymore. You know, but... but even if that's the only way the local audiologist feels like they can go at it, there are, almost always for these children, times when they have to go in for medical treatment, and if there is some planning done ahead, they can do that ABR while they have them under for something else.  

>> Kitchen: What's did you say was the percentage, or she said a lot of people who have a hearing loss also have a vestibular...  

>> Hurst: Have problems with their vestibular system. A lot... a lot... The percentage was very high. I was very surprised by how high it was. 

>> Kitchen: I'm just surprised. I didn't know that people with Usher's -- I think there's 3 types of Usher's Syndrome -- I think 2 out of 3 of those sometimes experience vestibular problems that go with their hearing loss. I had no idea. I'm just wondering... not just with Usher's, but with other... 

>> Hurst: Well, Charges, almost always. That. But there's so many others that I hadn't really thought about. 

>> Kitchen: And it's not necessarily the sensory centers, it's because it's paired with this... with the hearing loss; with specific kinds of hearing loss? 

>> Hurst: With specific kinds of hearing loss; and she also said that it doesn't always manifest itself like dizziness, something like that, it shows up in other ways that have to do with their sensory integration functioning. So, It's just one of those things, that I think, we don't frequently -- we aren't good about checking regularly, the auditory function of kids that visual impairments. And it can be at progressive condition, too, you know. Unless you [inaudible] that there might be some progressive factor working -- that they're fine when you did the newborn screening, but two years later they're starting to lose significant hearing.  

>> Kitchen: I know a lot of kids have, you know, when they get a lot of input; like the whole multi-sensory thing, they get, you know -- their sensory system is overloaded and... if they have the dizziness thing going, too, that could also cause seizure activity. Andy if you've always been experiencing that vestibular thing going on -- you've never known what it's like not to have it; you might not have the same response to it. You might not feel dizzy because dizzy is your norm.  

>> Hurst: There's a lot to know. That is why taping your OT and PT, because they're the most likely to have, really, the ability to look at that, because it's so critical, I think. Like you said, if you're looking at all these subjects, you may not know it when you get the kid, but it sure points out an area of needed assessment.

>> Kitchen: How are you guys with your OT's, as far as like the OT's that you work with? Are they -- are most of your OT's -- cause I have heard some that say, "There is no such thing as sensory integration." [laughter] -- and I wonder what it is they do, then, exactly. What kind of experience have you guys had with your occupational therapists? Usually they're great! You know, they're a really great resources.

>> Hurst: While folks are typing, let me just also mention that -- I'm not going to go back to beat a dead horse, but... for those information, vestibular, gustatory an olfactory factors, I think, even if there's not been any formal sense of that -- if they do get a good audiological they'll know if there is a vestibular issue working. That is for sure. But, on the other two, you know, talking to those parents, they're often times -- they may not know to say that's what it is, but if you start asking about, you know, "Do they have a favorite scent?" You know, "Do they have a favorite food? Or is there something you think they really not like?" You know, that might be related to smell or taste. They're going to have so much terrific information. But even on vestibular things, you know, some of the questions to ask, you know, is if a child is... if they're at all, mobile. "Have you noticed them, like, when they were trying to crawl -- do the five-point crawl with their heads down, touching the floor. You know, there are some things like that, you know, some questions you can sort of ask generally, "Do you find them trying to lean on things?" You know, we see that in Charge kids all the time. It's that they really don't like to sit upright, and they prefer to either be laid out on the floor or they're leaning on you constantly; or leaning on a table, leaning on something -- It's like gravity is not their friend.  

>> Kitchen: A lot of them need to be attached to something in order to not feel that feeling. Renee says, "As far as OT's go, mine has been real good and tries to address the sensory needs they see." Marla says, "OT assigned to my campus has worked hard with my students. They actually go through the seminar, Through a Child's Eyes with VI staff to help understand. We understand what kind of vestibular can help or harm." That's so great. I'm so glad that you are working closely together. You know, it's so important that we get all that information, and 'wed it' to help our kids. 

>> Baltisberger: All right, I think it's... it may not be that common, those three, the vestibular and in particular gustatory and olfactory.  

>> Kitchen: If your student has to be tube fed. 

>> Baltisberger: Well, I think, you know, like some of the things like when we were looking at our student, he was on a ketogenic diet...and he has danger of aspiration. It's said that he... has a reflexive bite when his tongue is touched. And there's something about -- I guess he had eaten a short while, before he ... before they went to a G-tube. He had eaten for like a few months, he had been eating for a while, so I guess those are interesting things to know that could impact what you're looking at.  

>> Hurst: Well, also looking at, you know, [inaudible] Charge kids often times have little or no sense of smell, you know, and there may be other conditions, you know, that have some impact on those particular senses. And I think, a lot of times that's hard to find. Although, more and more, if you do a Google search on a syndrome online and often times, there's a government approved site, or MEDLINE; you can get some information, to at least know it might be a factor to pay attention to. 

>> Baltisberger: So, yes, there's a lot of good information addressed here. The VI report, that's probably one that is better covered, and we're all used to looking at that, and it typically should be looked thorough. But a lot of these things, just having to look at hydration, respiration, seizure activity or allergies, those are all really good things to have in a document that you can look at -- so better not do that... Well, this could be a factor if I'm trying to use this type of stimulus.  And I guess, the other thing, I guess we -- Sara and I were looking at in the information -- one of the things we ran across was this, it's called a FLACC scale. I don't have the acronym now, but it's basically whether it's on a scale of 1-3, and it's how much pain you're in. It was developed for people who are . It took us a while to figure that out, but we were thinking... we were thinking that maybe a good thing to have, -- nice thing to include in this information would be something about their communicative abilities, or, you know, their emotional state, because there's really nothing in here about that. Again, like you were saying, Kate, a lot of this stuff is not really going to be on a medical report... It will have something like the child is nonverbal, is not talking, but they won't really talk about how do they show displeasure. How do they show happiness? How do they show discomfort? I think, Sara, you were saying, that's like the first thing you want to know, with a new kid. "How do you know when he is liking something?;" because it's often very subtle or very atypical. You know those kids -- when you go to work with kids and you say, "How's that?. He's doing something -- he appears to be smiling." And they say, "No, actually he's grimacing." 

>> [laughter] 

>> Hurst: I want to throw that question out to Renee, because I know Renee works with a lot of kids who have significant medical issues, I'm just curious, you know, if the group of professionals she's worked with, and they've been doing it for years and years, if they have -- If you do Renee, if you have some tools, or information or ideas about how you might assess pain levels, or how you track pain? Or pleasure levels or anything, you know, great inside tips? 

>> Kitchen: Yea, that FLACC scale -- at first, when we looked at it, we thought, "Oh, this is how he shows this." But it's actually generic. 

>> Hurst: Yea. Yea. 

>> Kitchen: And we were -- I was like, "Oh, he does this and that was very insightful and he kicks his feet when" -- and it's generic. "Oh, this isn't helping." You know, I guess it is more of a reflexive thing; that, if somebody does this, it typically means they are having this level of pain. We did notice he was typically in the middle. Not pain -- never pain-free. He was [inaudible] for everything.  

>> Baltisberger: Yea, and that's kind of another... that would be another good bit of information to have... 

>> Kitchen: Stress! 

>> Baltisberger: Are they constantly stressed or constantly in pain? They do ask things like elimination, are they constipated, which can be another big factor. But just think about it, these kids, are they in pain all the time, or are they frequently in pain? That would be something that really affects the assessment.  
>> Hurst: Well, in kids, you know, oftentimes -- like a lot of kids who are multiply impaired have, you know, dislocated hips that are more dislocated than they are in place and there's -- or they have all this equipment on them, bracing and stuff like that., or they've been in surgeries. So it's just, you know, again, if you have a parent, they might know, but they don't always have access to those parents.

>> Kitchen: Renee says, "I can't think of anything I've seen that measures pain level. However, our observations of the kits we have, and knowledge of how they respond is our best guess on pain." 

>> Hurst: So it's kind of personal knowledge... 

>> Kitchen: Another thing it seems to really, you know, to clarify... because like, you know... a lot of times when I go into the schools, I meet little kids, or bigger kids, they -- somebody will think the child would do this move, and move his or her mouth, and then the teaching assistant will say, "Oh, he's hungry." And the VI teacher will say, "That means he's happy." And I'll be like, "Well, you know..." 

>> Hurst: Which one is it? [laughter] 

>> Kitchen: If that kind of thing can be pretty clear from the beginning, you know, if there was a way to record the communication kind of stuff on here -- I don't know if it belongs in the Sensory Learning Summary, but I certainly was looking for it, because, yea, it is the first thing I think about when I go in there. To have that more clear from the beginning, as a focus, you know, what is the child doing, you know, and of course, the parents would probably be the one to really know that. Other people interpret it differently later on, but hopefully they'll get that interpretation and it being passed down, we can try to start, or solidify it here. 

>> Hurst: Well, I do know a lot of parents who have developed, like a student portfolio, for their [inaudible] and that's one of the big things they include is, "When my child does XYZ, this means..." You know, they've made their kids very own personalized dictionary. And, if you can get a parent to do that, and take some time to sit down, because it's usually not, like 5000 things. It's usually a repertoire of 10, 12, maybe 20 things; the most important things. Again, if you can get to the parent and get it -- though it does take a bit of time initially, once it's documented, and like you say, the nice thing about this is there's a book that can travel with the kid and stay there. Then it sure saves the kid and future... future educators and nurses, and everybody a lot of headaches. It truly does.  

>> Baltisberger: Alright, and down the road when you get into the other parts of the SLK, the Sensory Learning Kit, and you do need to start documenting, like their response record and arousal state, you do have to figure out what represents being interested? Or what represents being motivated by this? So, if you've already got some of that information from the parent, [inaudible] that would help you along that way, perhaps.

>> Kitchen: What other kinds of things, in doing this Sensory Learning Summary, what kinds of things did you all come up, did you all think about? Where you all confounded by or just things you would like to share with the group, as far as trying to gather all this information? 

>> Baltisberger: There is one thing I wondered about when I was looking at this. When they talk about touch and they mention devices and equipment, and it's on page 53 of the SLS, and it talks about 'helpful', 'not helpful' under equipment, and that's under touch. So, I'm not really sure what that means. I mean... does that mean you've tried it? I would think if it's not helpful... you wouldn't be using it anymore. That was... a little unclear to me.  

>> Hurst: So maybe that's a question we could, like, shoot off to Millie, and ask Millie to give us some feedback on it. 

>> Kitchen: And then -- Yea, if I were thinking about it, I'd be thinking about Active Learning a lot, and if I were thinking about that, of course, I would think about are they using AFO's while they're in the HOPSA dress or while they're in the support bench? And I would say, "Not helpful" Say, "Not helpful for that time." You know, but then they have different purposes. So, if you're going to be in a stander, a lot of times, you have to read the AFO's; but is the stander helping, working or not working? I mean... 

>> Hurst: That... that's just kind of an unclear question. It makes me want to look through my Millie notes and see if she talked about that specific item, to see what she might have said.  

>> Kitchen: I don't remember her talking about that. 

>> Baltisberger: Yea, [inaudible] 

>> [online participant] This is Renee...

>> Hurst: Hi Renee.

>> Renee: To me, one of the things that might affect the answer that, is like switch use; if you're using adaptive switches with the kids. There are, you know, some smooth top switches and there are bumpy switches and there are textures that a child likes. And if you're trying to get a child to push a switch, to activate a story or a song or something, then, you know, you want to find the types of switches that are helpful, or not helpful. The student I am studying, he doesn't have much movement in his limbs, but he can turn his head from side to side. And so I get him to turn his head to touch a switch... to access whatever. And so I've had to try to find what's the best way to touch him, to give him a signal, you know, that that's the way I want him to turn or that's the way I want him to push the switch. 

>> Kitchen: Oh, bringing up switches is a really good -- that's a really good point, because I wasn't thinking about switch use. There's a lot of unhealthy switch use going on, that I've seen. Such as... 

>> Renee: Also.... 

>> Kitchen: Go ahead. 

>> Renee: I was going to say on the Active Learning thing, you mentioned, when you try to find the object that you're going to put in the Little Room or on a mobile or in the tactile wall, if you know that the light touch stuff is... aversive to him, then, you know, you need to make sure you have things that when he grasps or when he hits it's not going to tickle and send him into a seizure or whatever.  

>> Kitchen: That's a really good point. 

>> Hurst: Sounds like we do need some clarification from Millie, for what she was going for... to see... 

>> Kitchen: Yea, I was thinking, also about, you know, a lot of times when kids have a reflexive -- they have a switch that's on their head, or near their head -- and they have a reflexive turn or they might be trying to look over here, but not necessarily press a switch. And the switch might be saying something that isn't necessarily what they would be saying? 

>> Hurst: Or it might distract them from whatever they were trying to do. 

>> Kitchen: I have seen a lot of kids, who have -- they're turning into 'yes' people. You have a 'yes' switch, and they're -- every time -- they get surprised and they hit it accidentally, cause they're not really hitting it on purpose. They say, "Yes. Yes." [laughter] I don't think this is right. 
>> Hurst: Well, also one of the things I hadn't been thinking about adaptive equipment and all, but the whole notion of, you know, the kind of intensity of touch, in terms of what you might use with them, but also how intensity of touch in the mechanisms that they're dealing with might impact their system. You know, cause touch is sort of like, how they received touch, but also how their sensors respond to -- see how they call it -- it's like internal touch, how they respond to things, to their own body's... sensors, and then it's how they respond to touch given to them. There's like two different pieces to that, and so... 

>> Kitchen: Also you could think about, you know, things like hand over hand use. That might be something that is fairly intrusive to most kids. It might be something that is not working for the most part, I would think.  
>> Hurst: OK, I want Millie to answer this eventually, for now. 

>> Kitchen: We need Millie. Millie! 

>> Hurst: Oh, and Renee said, "Maybe even how their wheelchair or seating system touches them." Yea. So we need some clarification on that one, Scott. 

>> Kitchen: Those are some good points. 

>> Baltisberger: Yea, there're a lot of different things about touch here. You know, they've got pressure, texture or temperature -- pacing. I thought that was kind of unique that she's got that in there. So... she does talk... about positioning needs and puts specific cautions for presentation of tactile stimuli. I know you talked about whether you use hand-under-hand with these kids, or if they've been exposed to a lot of hand-over-hand. Perhaps that's something that could be affecting them. So that might be a place to talk about that on the form.  

>> Kitchen: Yea, it might also be something that determines when they are alert, or not. 

>> Baltisberger: Right. 

>> Kitchen: At times kids just go "Shhhooo," right into either overload, or they leave the room, you know, spiritually [laughter] even if not physically.  

>> Baltisberger: The other thing I noted under the vestibular/proprioceptive on page 55, there if information that cautions about moving the child. 

>> Kitchen: Yea. 

>> Baltisberger: And there's also question 20, "If the learner becomes fuzzy, agitated or withdrawn when moved, describe the physical conditions that triggers behavior." So that was a neat thing to have in there. Our student, he extended when he got moved.  

>> Kitchen: Reflex... And very... it looked like it was very uncomfortable for him; something very important. 

>> Hurst: Well again, that is where the PT, I would think, and your OT could come in with some better... transitioning strategies in terms of how you're going to manipulate that body, before you move it, and how you do the lift and stuff. It would make -- again, you could hold them in a way that you wouldn't get such a reflexive response, perhaps, or you can get them ready for that move, so that you're not as likely to get a reflexive response. It's just that these kids it becomes so very clear that you have to have everybody on the team kind of looking at it, and step in.  

>> Kitchen: Yea, I feel like we still need a lot of information. We began, but we still are just beginning to fill out that Sensory Learning Summary.  

>> Baltisberger: Well, I think there are two of us looking over it, and I think, if you're doing it on your own -- it helped to have two people there doing it. Because it is -- you have to wade through a lot of that medical information, and try and figure out what it is. We were looking things up online, and also trying to figure out where in the SLS does this go. There're a couple of things... You could go and say it's a movement, vestibular thing or maybe it's a touch thing, or maybe both. The other thing I wasn't really clear about was on page -- again looking at touch on page 56 -- it talks about question 22, "Modifications needed related to movement," and it talks about the direction or angle.  

>> Kitchen: Oh, I would think it would have to do with... I wonder if... We should ask Millie, but what came to mind for me is, you know, like if you're swinging, if you swing fast or slow, would you go  
>> Hurst: Back and forth, up and down, side-to-side...  

>> Kitchen: Or around and around. Can you spin? Do you not spin? And how long can do that for. You know, it could be the same thing with jumping. It could be the same thing with whatever kind of movement activity.  

>> Hurst: Did you say this was under touch, Scott? 

>> Baltisberger: This is under... let me be sure... No, it's under vestibular receptive.  

>> Hurst: OK. I would guess that's the direction of... whether it's rocking, back and forth, side-to-side, up and down, spinning -- all of that. 

>> Kitchen: Some kids like to go back and forth but not side-to-side. Some kids like to spin, but they don't like to, you know, bounce; something like that. It could be...  

>> Baltisberger: Some kids like those really big broad, broader movements.  

>> Kitchen: And some kids will throw up. 

>> Baltisberger: Yep, been there! Sara and I, I think, are of the mind that we... we really... that perhaps this takes more time than we had originally thought. And it is important. Like Millie said, she is very clear that you need to do this. Do not skimp on this. Get it done. And I think it's great, not just for the SLK, for that assessment, just looking at being a little more thorough, and having this document when we finish it being very thorough about this source of information.  

>> Kitchen: Well, I think it's worthwhile, then, to take more time with this. We want to do first things first. Our advice from Millie is to do this thoroughly, as Scott was saying. Let's not skimp on our first step. Renee says -- sorry to interrupt you, but I wanted to get this one in, "Sometimes you just have to dig in and use the SLK in order to fill in the assessment records." Yea, cause you're going to find out more about all these sensory channels, if you do try it. I think I would feel more comfortable using -- doing that, though, with students who are less medically fragile. But I'm -- I haven't had as much experience that students are medically fragile. Maybe Renee, you have, so you feel more comfortable reading all of those signals and signs...  

>> Baltisberger: So, we better wrap this up. The next meeting will be November 17, 3:00 to 4:00. If you would send me an e-mail, that is my e-mail, baltisberger-s at t-s-b-v-i dot e-d-u, so we can start that conversation online, like Sara said, by exchanging e-mails and questions and information. Be sure to register for the next webinar at our website, h-t-t-p, w-w-w, t-s-b-v-i dot e-d-u, slash, training events.  So thanks you everybody for attending and we look forward to hearing from you again next month.