Have you ever heard of a weighted blanket? Or maybe a weighted vest? If your answer is “No”, these questions may conjure up visions of ancient torture apparatus, when in truth, it is quite the opposite. Body armor in the face of a battle would probably be a more appropriate visual, if you allow for a little latitude in your creative imagery.
There is a school of thought that pressure (most often deep pressure) may relieve anxiety in some people by regulating the sensory system when it has become overstimulated. Temple Grandin, PhD, tells how she actually invented a squeeze machine device as a teen to satisfy her need for deep pressure therapy to calm her “nervous system”. The use of deep pressure and weighted-somethings (covers, clothing, toys, etc) by people with autism, sensory integration disorder, and attention deficits is often recommended by occupational therapists who practice sensory integration therapy.
Like so many other areas of discussion related to autism, there is a significant amount of disagreement surrounding the relevance of using weighted devices as therapeutic tools. There are published reviews of the available research that maintain use of these items as an effective therapy is not scientifically supported, although widely accepted and promoted among occupational therapists.
This particular technique, just one of several in the field of sensory integration therapy, uses weight and/or pressure to provide information on a subconscious level instructing the brain and muscles to calm down and relax, and this calming effect is realized by the individual. It helps him reorganize and redirect the nervous energy created when he “loses himself”, as in the case of sensory issues where he has difficulty processing the “teroceptions”: exteroception – related to external stimuli, and interoception – related to internal stimuli.
According to the guidelines currently available, it is recommended that the use of therapeutic devices in the pediatric setting be determined by the therapist, with input from the child and family regarding their preferences. Items that are commonly used as weighted devices include blankets, quilts, lap pads, backpacks, vests, and stuffed toys.
Lia has several blankets at her disposal for her blanket therapy, with a range of sizes and weights. The blanket selected for therapy will depend on the situation.
When Lia is distressed it appears as though she doesn’t know what to do with herself because she doesn’t know where her ‘self’ is. She’s kind of like a sheet flapping in the wind and she’s all over the place with her behavior and her emotions.
Sometimes there’s a gradual build-up to “the change”, sometimes it strikes with no warning and she starts to cry or show signs of agitation. If distraction and redirection don’t work for getting her settled, we offer a blanket –
“Do you want your blanket?”
In this situation we will most likely opt for a heavy cotton blanket with tiny stitched squares (our version of a weighted blanket) that we snug around her shoulders and it calms her. If she isn’t able to answer, we gently drape the blanket over her shoulders and when she makes an effort to pull it closer around her we assist and snug her in, and then we wait for it to work its magic. The blanket helps her focus. It seems to give her a starting point that gradually spreads to the rest of her until she is calm and relaxed.
And then there are those days where we are preparing to sit and engage in an activity and Lia will often stop to grab one of her smaller fleece blankets to cover her legs. If she’s sitting in her favorite lotus position she carefully drapes the blanket over her folded legs, making sure the blanket touches the floor on all sides. When she stretches her legs out in front of her, she makes a little cocoon for them and then makes sure the edges are tucked all around, asking for assistance with her feet. She doesn’t stop adjusting the blanket until everything is covered ‘just right”.
Technically, when the healthcare provider is involved in the application of the blanket therapy, there’s a fine line between providing comfort and being considered abusive, regardless of the intent. It’s kind of like putting the side rails up on a patient’s bed to protect her from falling out, and failing to get a written physician order. There are rules to follow and lines that can’t be crossed. As healthcare professionals we must be acutely aware of the prudence of our actions, and ensure that we are in compliance with all legal and ethical standards. We must exercise extreme caution in the delivery of this patient care, and we must be precise in our documentation.
While there may be those who are inclined to see Lia’s blanket as a form of restraint, I can assure you that it isn’t. It is a source of calming relief for her when her world is spinning out of control. And a key factor is that she is able to remove the blanket any time she desires, as well as refuse it if she chooses to do so.
Lia’s blanket therapy is pragmatic rather than scientific. The theories and lack of definitive clinical research are of little consequence where she is concerned. Using the blanket works for her, and that is what matters in her time of need.