Prepared But Not Anticipating

How do you handle going into a session with an injurious Speller??

Here’s the thing: there might be times when you have a student, maybe a child or sibling, that is impulsive and injurious. We KNOW they do not want to hurt you or themselves, but they get an overwhelming impulse to act.

Impulses can be a challenge for Spellers, families, and Communication Regulation Partners (CRPs). These impulses can present in a variety of ways, and it can be helpful to understand where they stem from. There are four types of motor: Reflexive, Impulsive, Purposeful, and Automatic. Impulsive motor is unplanned. It is non-cognitive, non-thinking, and stems from the subcortical region of the brain – specifically the limbic system and amygdala. This is where our fight, flight, or freeze responses come from. Impulses can be in response to basic drives like hunger, sleep, or safety but also in response to big emotions (both negative and positive). Once an impulse gets triggered a few times, it can quickly become an automatic response in a variety of situations.

What can you do? Be PREPARED, but don’t ANTICIPATE. What I mean by this is, go into a session with everyone’s safety in mind but leave the anxiety of the possibility of injurious impulses happening at the door. We are working with our Spellers to build new PURPOSEFUL neuronal pathways – we help them practice pausing these impulses and gaining control over their bodies. This process is not a quick one, but with time and practice, the ability to put forth those purposeful motor actions over impulsive motor actions will become easier and easier. Your Speller is also gaining access to effective communication, which can help with that emotional output that has been pent up over the years.

We DO NOT want to take away someone’s chance of achieving communication because they have uncontrolled impulses due to their Apraxia. So we need effective strategies!

First strategies needed? Those for your own self REGULATION! It is understandable to be anxious about getting hurt; we have our own fight, flight, or freeze instincts, BUT our Spellers feel that. What strategies can you use to let those feelings and instincts go? Take a deep breath, don’t perseverate on previous injurious sessions, believe in your heart that it is not purposeful and that they don’t want to hurt you, and talk it through with a Practitioner or other CRP without betraying the confidence of your Speller to get ideas or comradery with someone who understands, be prepared.

Of course, learn your Speller’s motor and sensory profiles for regulation. Not just what helps them return to a regulated state but what helps them stay regulated in the first place? However, keep in mind that what works in one moment or one day may not work the next, so have a mental toolbox of strategies ready to go. Even think about what input their body may be seeking, and see if you can replicate it in a safe way. If you know that it is a potential that a Speller will be either self or outwardly injurious, ALWAYS have someone in the room with you.

Some things to try if:

Your Speller hits or kicks
– Stand up while they sit to spell: this allows you to step back easily and keep your head out of the strike zone.
– Use a rolling chair: super easy to push your feet onto the floor and roll away when needed.
– Set up so you are around the corner or on the other side of the table from the Speller while you read and write and just come close when it is time to do the actual spelling. (hint: rolling chairs make this easier, too)
– Have them keep something soft in their non-spelling hand to soften the blow to either you or themselves.
– Use a larger room to give everyone some space.

A pencil becomes a weapon, or they bite or break them easily:
– Try a silicone straw
– Check out these flexible pencils on Amazon

They are a grabber or pincher:
– Be conscious of what you are wearing: try a sweatshirt or make sure you aren’t wearing dangling earrings or other jewelry.

They throw things:
– Clear the room of unnecessary items.
– Keep your boards stacked and in your hands when not in use. (I like to use a clipboard for my transcripts so I just stack the boards under the transcripts while I am writing or reading and keep them in my hands)
– You could even try having only soft items in the room if fulfilling that impulse temporarily helps, but you’ll be redirecting it to something safe.

With practice, you will start to gain control over your flight, flight, or freeze instincts in this environment to allow yourself to stay regulated even during an injurious moment. We want to try our hardest not to act hurt or point out that we are hurt. This is because the Speller will likely have some continued big emotions (like guilt) after accidentally injuring you, and as you can probably guess, this could lead to a spiral of even more injurious impulses. We want to reassure them that we are fine, that they are fine, and that you will work through it together. Once your Speller is regulated and safe, then step out momentarily if you need to. Remember, our goal is to keep EVERYONE as safe as possible.

I will give you an example of something that happened in one of my sessions. I had a Speller that would become grabby and hit/push a bit when they became dysregulated. In this particular session, I had dangling earrings in. I was on the ground beside him to spell when he reached out and pulled my earring. I calmly reached up, realized I was bleeding, quickly closed my hand to hide the blood, reassured him I was ok, and helped him regulate. I then told him and his mom that I would be right back. I stepped out; someone helped me clean and bandage my ear and I took a deep breath and walked right back in to finish the session successfully. I did have to go to urgent care to get it properly closed up, which left a bandage on my ear. So, as a preemptive way to assist with regulation in the next session, I wore my hair in a low braid to cover my ear so that the Speller wouldn’t see it and be reminded of the incident. I also did not wear dangling earrings in those sessions anymore, but these were my strategies for being prepared but not anxious in our following sessions.

I know that these can be complex scenarios for everyone, but if you choose to be someone’s Communication and Regulation Partner, you MUST learn to support them in their individual needs so that they can gain robust communication and autonomy. You need to be honest with yourself about your own regulation status and find strategies that help you and the Speller succeed. You are not alone in this journey! We are all here to support each other, to brainstorm strategies, to be a confidant, and learn from each other. Communication is a fundamental human right for everyone, including those in impulsive bodies.