Case Study: Auditory & Visual Processing, Bilateral Coordination, Depression

Associate’s Name & Discipline:
Lynn Schoeneck, Occupational Therapist

Name of Organization:
Porter Academy

Presenting Problem:
Auditory & Visual Processing, Bilateral Coordination, Depression

Therapeutic Goals:

• Improve auditory processing
• Improve phonemic awareness
• Improve bilateral and upper-limb coordination
• Improve social-emotional functioning

Background: (age, gender, diagnoses, previous therapies, etc.):
Gender: Male
Age: Pre-testing: 9-11; post-testing: 10-3
Concerns/Diagnoses: Auditory Processing, ADHD, Sensory Processing (low arousal, inflexibility), Depression (suicidal)
Previous Therapies: OT, Speech, Fast ForWord; no outside therapies during iLs program

iLs Program Used (program name, frequency, length, etc.):
Sensory Motor (full); 5 months, 1 hr/day, 5 days/week; integrated with playbook activities as well as teacher-created gross motor activities that focused on intense sensory input, bilateral coordination and mid-line crossing.

Other Interventions Used (occupational therapy, speech and language, etc.):
Group Occupational, Speech, and Music Therapy integrated into school setting; school for children with learning differences

Summary of Changes after 60-session Program (January-May):
Click here to view the summary in full-size table format

• Visual Perceptual sub-test of VMI: improved from 4th% to 65th% (standard score 74 to 106)
• Bilateral Coordination (BOT2): Scale score improved from 13 to 16 (mean of 15, SD of 5)
• Upper-Limb Coordination (BOT2): Scale score improved from 10 to 15 (mean of 15, SD of 5)
• Auditory Processing (SCAN:3-C)
  • Auditory figure ground (hearing target sound amidst background noise): improved from 0.4% TO 91%
  • Filtered Words (distorted speech): improved from 0.1% TO 25%
  • Time Compressed Sentences (fast speech): improved from 16% to 75%
  • Composite Auditory Processing: improved from below 0.1% to 19%
• His mother reports improvements in:
  • Sensory/Sensory Motor:
    • Endurance and participation in physical activity
    • Fine motor skills such as handwriting
    • Visual pursuits (doesn’t lose place as often when reading and is better able to find word/number on page during reading/math)
    • Ability to follow directions in a noisy environment
  • Auditory/Language:
    • Ability to recognize and repeat rhymes
  • Social/Emotional:
    • Temper, decreased irritability (from worst to best rating)
    • Frustration Tolerance (from worst to best rating)
    • Transitions
    • Ability to make and keep friends
    • Sleep (from worst to best rating)
    • Mood stability (from worst to best rating)
    • Independence and self-esteem
    • Maturity (from worst to best rating)
  • Organization/Attention/Cognition:
    • Ability to understand written instructions
    • Ability to plan ahead
    • Organize school assignments, belongings, schedule
• Pitch Perception Test: Demonstrated significant improvements in every zone for both ears. Most significant improvements were Zone 1 (0% to 80% Left Ear, 20% to 80% Right Ear) and Zone 3 (40% to 100% Left Ear and 20% to 100% Right Ear).
  • Teacher reports improvement in phonemic awareness
• Observational: Last year, he was always slumped in his chair, walked with his head down and shoulders slouched, quiet, demonstrated flat affect, low motivation to put forth best effort, impatient with peers, and worked very slowly. This year, he generally stands and sits upright, he is very animated, appears happy, he has become a leader during my OT classes – patiently coaching and encouraging the other students and helping them when they struggle with motor activities, and is very talkative with both teachers and peers.

Conclusions and Recommendations:
After one semester of adding iLs to his regular school program, this 10 year old boy demonstrated improvements in visual discrimination, moving up two statistical categories from the “low” range to the “average” range (4th% to 65th%), bilateral coordination and upper-limb coordination (improving from low-average to mid/high-average), and auditory processing: figure ground, moving from disordered to high average (0.4% to 91%); filtered words moving from disordered to high average (0.4% to 91%); time compressed sentences moving from low average to high average (16% to 75%); and  composite auditory processing moving from disordered to average (below 0.1% to 19%).

According to the iLs checklist, his mother reports improvements in endurance, visual activities, organization, and huge improvements in social-emotional functioning. This child also made huge improvements in his pitch perception (improving by up to 80%) and his teacher reports improved phonemic awareness. His teacher also commented that he is “a different child” now. Previously, he walked in with his head down, wearing dark glasses, and remained mostly solitary. Now he walks in with his head held high, the glasses are gone, and he maintains good social connections with peers and teachers.

This year, we are using an abbreviated Sensory-Motor Program and an abbreviated Reading/Auditory Processing Program. He listens to iLs during his occupational therapy class at Porter Academy three times a week (one hour each). We integrate PlayBook activities, sensory activities (swings, roller racers, scooter boards, trampoline), integrative exercises (yoga, Brain Gym, S’cool Moves), handwriting and written visual-motor activities with the listening.