ces with autistic populations

CES with Autistic Populations

Renee Okoye, MSHS, SIPT, OTRBoard Certified, Pediatrics

1Dove Ministries for Children

Dove Rehabilitation Services

Sensory Integration specialists for primarily pediatric patients, Including:

• Attention deficit disorders• Autistic Spectrum Disorders

• Developmental Coordination Disorders

• Hypotonia

• Sensory Processing Disorders

Dove Ministries for Children 2

Diverse Autistic Population

• Traditional Autistics

• Asperger’s Syndrome

• Pervasive Developmental Delay

• Regressive Autism


Diverse Symptoms Among Autistics

Disorders of Skill• Auditory, visual,

somatosensory processing deficits

• Dyspraxia (Motor incoordination)

• Poor social reciprocity

Disorders of State• Under aroused

• Over aroused

• Self stimulable • Gross

disorganization


CES applications among Autistic populations

At our facility, CES has been used since 1984 within the context of occupational therapy treatment.

This is to say that the patient wears the CES device while engaging in functional activities that incorporate performance components that need to be improved


Each Treatment Involves

• A pre-test of performance for the day (given that Autistics typically have variable levels of performance on a daily basis)

• Identification of targeted skills and/or behaviors to be improved

• Application of the CES device

• Documentation of differences seen


Expected Outcomes with CES

• Used on a regular basis – At home, twice daily during structured

activities– At clinic visits, twice weekly during therapeutic

activities

• Differences between in pre-test and treatment performance can usually be noted within the first 90 seconds of the application.


Differences are Noted When

• Home program has been consistent

And

• Placement of leads is congruent with task demands

Examples


•Language tasks with leads placed trans-cranially on Wernicke’s and Broca’s areas•Motor tasks with leads placed trans-cranially on parietal and motor areas•WITH RED LEAD PLACED FOR DOMINANCE

CES Applications

With Autistic populations we have successfully used CES to impact

3.Disorders of state using the bipolar device

5.Disorders of skill using the monopolar device


Disordered State of Arousal

Physically and mentally over-aroused

Physically calm, but mentally active - ready for learning

sleep

Physically and mentally under aroused, poorly focused


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The Bipolar Device

Early research with assay of CSF showed that the bipolar device produced twice as much:

• Serotonin

• Dopamine

• Beta-endorphins

Neurochemicals for calming/organizing CNS state


When used with Autistic Populations, Clinical Experience

Has Shown

Modulate the disordered state of arousal

Address acquisition of discrete skills


Paul Shows Unwanted Behavior Due to Over-Arousal


9 year old Paul has difficulty transitioning into the clinic

He then darts into the gym and seeks to hide

Six weeks laterWith use of the Bipolar Device

Paul is better able to organize his behavior

• Transition into and out of activities without unwanted behavior

• Enter and sustain a more appropriate level of arousal (Alpha State)

• Focus attention on acquisition of skills


Disorders of Skill Commonly Seen in Autistic Populations

• Visual processing deficits (i.e. gaze aversion)

• Auditory processing deficits (i.e. hyper-sensitivities)

• Motor incoordination


Use of The Monopolar Device with Autistic Populations


Impacts skill acquisition in terms of:

• Social reciprocity and other social skills

• Decreased gaze aversion with emergence of more appropriate visual perceptual skills

• Improved language skills including listening, reading, and vocal inflection

• Improved fine motor skills

Use of the Monopolar Device for Skill Acquisition

13 year old Patrick shows poor gross motor skills involving reflex integration, balance, and bilateral motor integration.


His fine motor skills are impacted

• Oral motor coordination, impacting articulation

• Ocular motor coordination, impacting visual pursuits for reading and negotiating the environment

• Prehension patterns are compromised as shown by his 4 fingered pencil grasp


The monopolar device is applied

• Patrick uses a Monopolar Device daily at home with his speech therapist and SIET teacher.

• He uses it with each clinic visit at Dove.

• The site of application differs with the various therapies and types of activities he is engaged in


When the Monopolar Device is used during this visit


A bi-parietal application at Area 39 is used to enhance integration of visual, motor, and auditory influences (inner language to sequence motor output)

His balance is improved

He lands without stumbling

He spontaneously looks with intent to formulate a plan

Difference is also seen in

Fine motor skills as shown by:• Relaxed tone through his fingers• Individual finger function

• Emergence of a three jaw chuck pencil grasp

• Bilateral motor integration• Use of the left as a

stabilizing assist


Differences Were Noted

• The differences shown were noted within the first few minutes of the application

• We take this as an indication that the potential for higher levels of performance await additional input to the LEF’s (local electrical fields) within the neural pathways.

• CES appears to provide the boosted input


Do the Changes Last?

• Typically, initial changes fade quickly

• With daily use as prescribed, myelination of pathways appears to occur

• Sophisticated behaviors across all domains (social, emotional, motor skills, communication skills) begin to emerge and impact overall functional performance within the first month of daily treatment


For Further Information

Feel free to contact Renee Okoye directly at [email protected]


mailto:[email protected]

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