Category Archives: Sensory Processing

Case Study: 5 year old female with Sensory Processing Disorder and PDD-NOS

Abby was a happy, energetic and friendly five-year-old female with Sensory Processing Disorder and PDD-NOS. She was adopted at 15 months and, according to the limited medical records available, may have had a minor brain injury or been sensorily deprived during her time at the orphanage. Since being adopted Abby received therapy services to address her sensory issues.

When Abby completed the REI Custom Program intake her issues were as follows:

  • Anxiety: Abby was anxious over transitioning from one activity or environment to another and afraid of loud and stimulating public places. She tended to lash out (scratching, hitting) others when over-stimulated or anxious. She would rock her body back and forth and engage in other repetitive behaviors to self-soothe. She was also notably fearful of the dark and of monsters.
  • Inattention: Her mother reported that Abby had difficulty focusing and staying on task. She was easily distractible and restless and fidgety when asked to attend to a task. She would often act impulsively, though she was not a thrill-seeker.
  • Language delay: Abby had difficulty expressing herself. She often repeated words or phrases, had difficulty with pronunciation and enunciation, often reversed her pronouns, and had problems finding the right words to say even if she knew them.
  • Sensory seeking behavior: Abby was a highly energetic child who would seek highly stimulating activities. She often craved pressure to self-soothe. She had difficulty with motor planning and didn’t know where she was in space, frequently bumping into others.
  • Sensory aversion: In spite of her sensory seeking behavior, Abby was also often sensory aversive. She was easily startled, reacted aggressively to light or unexpected touch, and disliked physical contact.
  • Social interaction difficulties: Abby prefered to interact with her family and had difficulty knowing how to engage with other children. She required prompts to interact unless it was a high-energy activity, such as playing tag.

Abby listened to her REI Custom Program recording once a day at various times based on her schedule. Times were generally between 8am and 10am or between 6pm and 8pm.

Many people ask about the best time of day to play their REI recording. In the long run it doesn’t matter – we can achieve the same net results as long as the current recording is played once a day. In the short run, the time of day you play the REI recording can have an impact on behavior for that day.

Abby’s varying schedule illustrates this concept really well. For example, she seemed calmed by the recording when it was played. In the evening this made the transition to bedtime easier. Even on the first day of listening, her mother reported that she was more compliant with her routine of brushing her teeth and putting on pajamas when she listened at 7pm.

When listening in the morning (8am) Abby also demonstrated calm from her REI recording. She dressed without complaint and allowed her mother to comb her hair without fidgeting. This calm effect seemed to last: According to teacher reports, Abby did a better job following directions and staying on task on the days she listened in the morning.

These immediate effects of listening can help you decide what time of day to play an REI recording. For most of our clients we recommend bedtime for three reasons:

  1. The evening transition is often difficult because the client is tired therfore is often more resistant. Calming can only help this resistance.
  2. Most of our clients have a hard time falling asleep. Turing on the recording when the light is turned off generally helps with falling asleep.
  3. The evening routine usually ends with some quiet time and it’s often easy to fit the REI recording into this time. 

Abby benefited well from the calming effect of her recording regardless of when it was played, so the best schedule for her was one in which her mother could find the time to play the recording.

After 2 weeks Abby showed improvements in:

  • Eye contact. This was noticed not only by Abby’s parents but also her teacher, who in one instance, remarked how Abby looked her in the eye and said she understood when her teacher explained that Abby could play with her friends after school if she followed directions during the day. She complied and was able to follow directions.
  • Transitions. She was less reactive/resistant to going to bed and school.
  • Language: Began using full sentences.
  • Sensory defensiveness. She was less bothered by having hair combed and would sit quietly rather than fidget or pull away.

Abby was clearly getting a fair amount of stimulation from her REI recording, which allowed for some good initial gains. On the flip side, she also craved more sensory input such as jumping on a trampoline and running around.

For her next recording we chose to address her sensory seeking behavior, knowing we would be slowing the progress of her language improvements, as sensory modulation and language development require two different types of REI stimulation. Her other issues, anxiety and attention, generally didn’t require this shifting focus since we can address them in each context. Over the remainder of her REI Custom Program we alternated the focus of Abby’s program between language/social and sensory.

This meant that each new track pushed one area forward while stalling, and some cases slightly back-tracking, the other. For example, during track #5 Abby showed significant improvements overall in her ability to appropriately interact with other children and her language showed improvement. While at the same time, she still needed to seek sensory input by jumping and swinging and she exhibited anxiety, particularly over loud noises, the dark, and monsters. 

On the other hand during track #4, when we focused on the sensory processing, Abby showed improvement in sensory seeking activities such as running and jumping and engaged in more quiet activities including pretend play. Her langauge, however, regressed. She returned to repeating words and phrases, something she stopped doing once she began her program. Her mother felt that some of the vocal perseveration was due to anxiety over her school situation – there was a new student in the class that was impulsive and loud – but this behavior matches the give and take that can happen when switching the focus of an REI Custom Program.

Over the next several months Abby made progressive gains across the board from this alternating pattern in REI stimulation levels. Most notable from the start of the program were:

  • Language: She was now using pronouns properly more consistently. The fluidity and composition of her sentences also improved significantly.
  • Social: She was interacting more appropriately with other children. She was more talkative with them and was able to engage without needing prompts from adults.
  • Anxiety: Overall Abby was less resistant to transitioning to and from school and with her bedtime routine. She still exhibited some anxiety when she was tired or over-stimulated.
  • Attention: Abby was more compliant with directions from her parents, therapists and teachers and was better able to attend and stay on a task asked of her.
  • Sensory seeking behavior. She was less compulsive about seeking sensory input from running, jumping or swinging. During the last three tracks of her program she exhibited some self-stimulatory behaviors, such as rocking and jumping, but the timing of this matches with her returning school where there are other children who are anxiety provoking to her (crying and screaming)
  • Sensory Aversion. This area improved most notably in her reduced resistance to having her hair combed. She was also better able to handle noisy environments, though she could still get over-stimulated by them if she is tired.

Abby continues to listen to REI recordings as we adjust her recordings to further her progress.

REI for Sensory Processing: Two helpful resources

Most of our clients have sensory processing issues, whether its hyper-sensitivity to sound or poor grading of movement (or a host of others). In this blog post, I share two great resources for understanding how REI can help with sensory processing.

1. Video. Here is a video on how we approach sensory processing using complex drumming

2. Article: A Look at Rhythmic Entrainment Intervention by Its Creator

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Published in: Insights into Sensory Issues for Professionals: Answers to Sensory Challenges, edited by Kathleen Morris. MS CCC/SLP. 2010.

by Jeff Strong

Director, Strong Institute

Auditory rhythm has a long history of use for affecting neurological function, with the earliest uses being documented tens of thousands of years ago. These original techniques are some of the most pervasive therapeutic practices known to man, existing on every continent even among people who had no contact with one another (Harner, 1990). As an ethnomusicologist I was fascinated by the commonality in the techniques within such disparate cultures. I spent over a decade trying to understand how the same basic therapeutic approaches developed when so many other aspects of these societies were vastly different.

The answer, it appeared, was that the physiological mechanisms at work are so powerful that experimentation by each culture resulted in a common finding: You can affect consciousness, cognition, and behavior by employing only two specific rhythmic techniques. One consists of a repetitive pulse while the other employs complex rhythmic structures.

Discovering such commonality among traditional therapeutic rhythm practices prompted another, perhaps more important, question: Can these therapeutic effects sustain themselves outside of the cultural context in which they developed? I believed so, but many of my colleagues did not, believing instead that the rhythm was secondary to the rituals they were imbedded in (and is often attributed to the placebo effect). This led to an odyssey that began in 1992 and has continued to this day, culminating in the development of Rhythmic Entrainment Intervention™ (REI).

REI is a music-medicine therapy (Spintge & Droh, 1992) that stimulates and synchronizes the listener’s brain. REI is available as some generalized CDs (Calming RhythmsFocusing Rhythms and the SI Series CDs), and the REI Custom Program™. This is a custom-made, program that optimizes neurological function.

Auditory Rhythm to Stimulate the Brain

REI is unique in several ways. First, REI employs auditory rhythm to directly stimulate the listener’s brain. Other auditory programs use modulated frequency (Tomatis, 1992), binaural beats (Oster, 1973), or simply classical-based music (Rauscher, Shaw, and Key, 1993).

Auditory Driving

As I developed REI, my first step was to identify the core mechanisms of the traditional techniques. It turns out that these mechanisms are simple, powerful, and easily understood. First, human consciousness can be directly affected by an auditory stimulus. This is called “auditory driving” (Goldman, 1992). Auditory driving states that a listener’s brain wave activity will synchronize with the pulsation of an auditory rhythm (provided certain conditions are met).

Traditional practitioners would employ a four-beat-per-second rhythm, which would in turn facilitate a corresponding four-beat-per-second pulsation in the listener’s brain, resulting in bilateral neurological synchronization and a shift in consciousness to a theta state (this is a meditative state)(Maxfield, 1994).  With REI we double the tempo to synchronize a listener’s brain into a relaxed neurological state called alpha. This is the state of consciousness where sensory processing is optimized.

Complex Rhythms

The second core mechanism involved in traditional therapeutic rhythm techniques consists of using complex rhythms to activate the brain (Scartelli, 1987; Shatin, Koner, Douglas-Longmore, 1961; Parsons, 1996). Here complex auditory rhythms stimulate the Reticular Activating System (RAS), a part of the brain that controls sensory input (Scartelli, 1992). Applying rhythm – especially complex rhythm – to activate the brain is one level of the stimulation provided by REI. As we conducted research we discovered another dimension to the rhythms: One that appears to be more important than just complexity. It seems that each rhythm produces a different response.

Once the core mechanisms were discovered the next step was to determine the best way to deliver the correct stimulus to aid in the areas in which I was interested. Traditional practitioners performed the rhythms live for each person and adjusted their rhythms based upon the responses they saw in their patient.

Daily Listening for Long-Term Change

This is where I started — the first 1,000 people that REI was used for experienced this one-on-one, live stimulus. They also listened to a recording of one of their live sessions daily in their home. Daily listening was a departure from the traditions, but I felt that people needed the stimulation repeated consistently for a length of time in order for any long-term change to be expected.

One of the first children that I worked with in this manner was a seven-year-old girl on the autism spectrum. In this case, the girl, let’s call her Stephanie, was referred to me because of extreme anxiety. This anxiety impacted every aspect of her life: She wasn’t able to sleep in her own room and needed to be in constant contact with her mother; transitions and even minor changes in her environment were a point of crisis for her throughout the day.

She also had significant language and social delays. Her language consisted largely of repeating rote words and phrases. Although she had a large vocabulary, she was unable to communicate beyond her basic needs and desires. Socially, she lacked eye contact and wasn’t able to interact appropriately with her peers.

She calmed down within minutes during the first live session, and after the second session she remained calm and was able to sleep in her own room from that night on. Stephanie listened to a recording of her third live session everyday for eight weeks. At seven weeks she spontaneously described events in proper sequence for the first time. She was also developing social connections and had begun making friends.

She was mainstreamed at school (she was in a classroom with non-autistic children and had a one-on-one aide) and at 10 weeks the school psychologist evaluated Stephanie in her classroom and noted that she was “indistinguishable from the “normal” children in the class.” She continued listening to her recording for several more months and eventually no longer required her one-on-one aide.

Universal Calming Effects

This, and many other cases studies, led to a formal study conducted in a public school setting (Strong, 12). This study consisted of 16 children from age 6 to 12 who were on the autism spectrum. The results of this study showed almost universal calming effects (only one child was not calm most of the time, and this child ended up not being on the autism spectrum).

Long-term change was significant for anyone who heard the recording at least four times per week.  This study caught the attention of several prominent autism professionals and led to a paper of this study being presented at several professional research conferences (including one organized by The Center for the Study of Autism led by Dr. Stephen Edelson, who went on to design all of our double-blind, placebo-controlled studies).

At this point my interest in exploring the therapeutic application of auditory rhythmic stimulation techniques deepened. I formed the REI Institute with Beth Kaplan with no intention of creating a “therapy” that would be available outside of a research environment.  Our goal was simply to try to understand how auditory rhythmic could be used to enhance neurological function.

Over the next 10 years the REI Institute conducted numerous studies and presented dozens of scientific papers on what we were learning. Two of the key discoveries of this period were that synchronization was universal when certain techniques were applied and that each rhythm used elicited a definite, observable response over time.

Specific Rhythms’ Observable Effects

In other words, we found that we could introduce specific rhythms to have a pre-determined effect on each listener. To date, we have documented over 600 rhythms that seem to correspond to symptoms and combinations of symptoms. As a result we found it was critical to use just the right rhythms for each person in order to have the greatest positive benefits for that person.

During the 1990s, the REI Institute conducted a series of double-blind, placebo-controlled studies to try to understand the best approaches to take in balancing auditory stimulation and synchronization. What we learned in a nutshell was that the custom-made CDs are more effective than CDs created for a broad user base.

Custom-made, Revisable CDs

This leads to the second unique aspect of REI: The REI Custom Program™ is custom-created for each person based on his unique characteristics. By custom-making each CD we can ensure that the correct level of stimulation is used for that person. In the event that we aren’t seeing the results we’ve come to expect, we also revise the CDs until we see the results we are looking for. The practice of revising the custom-made CDs is the third unique aspect of REI.

Because the REI Custom Program™ is created for each person, we are able to focus the CDs on the three or four main issues someone faces. As a result, everyone responds differently to his CDs, but we see the most significant benefits in some general categories. These include anxiety, sleep, self-stimulatory behaviors, language skills, sensory sensitivities and defensiveness, socialization, attention and focus, and aggressive or oppositional behaviors.

Another example of the results with the REI Custom Program™ (and one most relevant to this article) can be seen with a 10-year-old boy with severe sensory issues. Gerald, as I’ll refer to him, saw significant improvement within just a few days. Before he began the REI Custom Program™ he refused to wear shoes or socks, covered his ears whenever music was played, couldn’t tolerate headphones, and socially isolated himself from others, often retreating to a dark, quiet room.

Within the first week of listening to his CDs, Gerald was more tolerant of everyday sounds. He also spontaneously joined his extended family outside and began  interacting with them. By the second week he was interacting with his siblings and cousins much more frequently, and by week four, according to his REI Provider, “… He is wearing socks and tennis shoes every day. He now not only allows mom to listen to music in the car, he often goes to his room and ‘rocks out’  to his own pop music.  He has been more interactive and engaged in activities as well as initiating appropriate play with other children.”(Strong, 1996) He was also able to tolerate headphones for the first time.

Open-Air Environment

This leads to the fourth thing that distinguishes REI from other auditory programs: REI is designed to be used in an open-air environment. That is, we don’t use headphones for the implementation of the therapy. The CDs simply need to play quietly in the background once a day (with the exception of the third week where the CDs are used twice a day). Having the stimulus in the background while the rest of the sensory input of life goes on forces the brain’s RAS to work hard to decipher the pattern in the stimulus while also ensuring that the listener doesn’t become over-stimulated by the rhythms.

In 2004 we began offering REI Custom Program™ through trained providers -– we now have hundreds across the U.S. This represented a monumental shift after 22 years of research — research that simply started from my desire to understand why traditional therapeutic rhythm practices were so prevalent around the  world.

In spite of our growth and the expansion of REI beyond just research, I am still personally involved in the creation of all the REI Custom Program™ CDs that leave our office and am still impassioned by learning more about how auditory rhythmic stimulation can impact individuals with neurological issues.

References
Goldman, J. (1992). Sonic entrainment. In R. Spintge & R. Droh (Eds.), MusicMedicine (pp. 194-208). St. Louis, MO: MMB Music, Inc.
Harner, M. (1990). The Way of the Shaman (3rd ed.). New York: Harper San Francisco.
Maxfield, M. (1994). The journey of the drum. ReVision, 16(2), 157-163.
Oster, G. (year, month). Auditory beats in the brain. Scientific American, 229, 94-102.
Parsons, L. M. (1996, October). What components of music enhance spatial abilities? Paper presented at the VI International MusicMedicine Symposium. San Antonio, TX.
Rauscher, Shaw, & Key (1993, October 14). Music and spatial task performance. Nature, volume, pages.
Scartelli, J. (1987, November). Subcortical mechanisms in rhythmic processing. Paper presented at the meeting of the National Association for Music Therapy. San Francisco, CA.
Scartelli, J. (1992). Music therapy and psychoneuroimmunology. In Spingte & Droh, (pp. 137-141).
Shatin, L., Kotter, W. L., & Douglas-Longmore, G. (September 1961). Music therapy for schizophrenics. Journal of Rehabilitation, 27, 30-31.
Spintge, R., & Droh, R. (1992). The International Society of Music in Medicine (ISMM) and the definition of MusicMedicine and music therapy. In Spintge & Droh, (pp. 3-5).
Strong, J. (1996, October). Rhythmic Entrainment Intervention (REI) as applied to childhood autism. Paper presented at the VI International MusicMedicine Symposium.
Tomatis, A. (1992). The conscious ear: My life of transformation through listening. Barrytown, NY: Station Hill Press.

Reducing Sensory Overwhelm with This REI Drumming Video

In this video, I play REI rhythms to calm your sensory system so you aren’t so overwhelmed by sensory input.

Learn more about REI for sensory issues here: reicustomprogram.com
Learn to play the drum for healing here: drumhealing.com
Listen to more of my music for free here: brainshiftradio.com

Jeff Strong on How I Create REI Rhythms from Ceremonial Polyrhythms

In this video, I show you how I create a composite rhythm from a ceremonial rhythm composed of 4 drum parts. I also describe why it is important to vary a rhythm, no matter how complex it is, to influence the brain and behavior within the alpha state of consciousness.

learn more about REI at: https://www.stronginstitute.com/
Learn to play the drum for healing at: http://www.drumhealing.com/
Listen to my music for free at: https://brainshiftradio.com/

Jeff Strong: How I Use REI Drumming for Sensory Processing

In this video Jeff shows how he approaches the three types of sensory processing issues – hyper-sensitivity, hypo-sensitivity, and sensory discrimination.

He plays examples of various drumming rhythms to influence these sensory responses and describes how hyper and hypo sensitivity fits into an REI Custom Program.

Learn more about the REI Custom Sensory Processing Program here: https://www.stronginstitute.com/blog/sensory-processing-program/

Explore my music for free at https://www.brainshiftradio.com

REI Creator Jeff Strong Speaking at USAAA Conference in Tucson July 30th

Jeff Strong is presenting at the 2015 US Autism & Asperger Association 10th Annual World Conference in Tucson, AZ July 30-August 1, 2015

Based upon his recent memoir, Different Drummer: One Man’s Music and Its Impact on ADD, Anxiety, and Autism, Jeff will speak about calm, anxiety reduction, and the development of REI.

He writes, “When I began my exploration of therapeutic drumming in 1983, I was fortunate to study with a teacher who showed me how to calm aggressive behavior with fast, complex drumming. This experience became important years later when we were doing a study with adults on the autism spectrum.”

Jeff is joining a distinguished line up of presenters including Temple Grandin, William Shaw, and Stephen Shore. Here is a breakdown of the conference schedule

If you are attending the conference, please seek us out and say hello.

If you are unable to make it to Tucson, parts of the conference will be streamed live. Learn more about this here.

REI Helps Sensory Processing: An Excerpt From Different Drummer Book

DD-Front-cover-25This article is an excerpt from REI creator Jeff Strong’s book, Different Drummer. You can learn more about the book here.

Sensory processing issues are common among the people I work with. In fact, sensory challenges are part of nearly everyone who falls into the developmental disability spectrum, including people with ADHD and autism. Sensory processing issues come in three basic forms: sensory-defensive, sensory-seeking, and poor sensory discrimination.

Sensory defensiveness is characterized by being easily overstimulated by sensory input. This is the child who recoils to touch, won’t wear shoes, covers his ears in response to loud noises, gets dizzy easily, or throws up in the car.

Easily overstimulated people constitute most of my clients with sensory issues. I work to reduce their sensitivity to stimulation by giving their brains more stimulation.

“What do you mean by stimulation?” Laurel asked. “Emily is always overstimulated. Why would you add more, and how could it calm her down?” This was one of the first questions she asked me after I began to work with her daughter, Emily.

You can read the entire excerpt here

You can order the book and read reviews from amazon.com here

REI for Adult Autism, Sleep and Bipolar – A Case Study

Even though the REI Custom Program is implemented at the listener’s home and we create the recordings based on a comprehensive intake questionnaire, I still occasionally get to play live for a client before they start their program.

In this case study, I met with the subject, Russell, in the group home where he was living and played for him twice before making the REI recordings. Russell was 38 years old and had been at this facility since its inception 11 years previously. Prior to then he was cared for at home by his family.

According to records, Russell was diagnosed with autism and bipolar disorder. He had very limited communication skills and was functionally non-verbal. The facility staff described that his communication consisted of mostly pointing, directing and vocalizing (mostly with grunts and other non-language cues). He also exhibited severe often self-injurious, self-stimulatory behaviors, the most significant of which were head-banging, anal-digging, and forehead-scratching.

The issues they were most concerned about, and the reason for wanting to do the REI Custom Program, were his self-injurious behaviors and his bipolar symptoms including, poor sleep and a starvation/binge-eating cycle (where he often gained and lost up to 10 pounds through his cycles).

Read the Rest of the case study here