Tuesday, March 27, 2012

Creating a Sensory Lifestyle through Proprioception

Occupational Therapy Corner

By Britt Collins M.S. OTR
We have eight sensory systems that affect our ability to function.  Tactile, visual, auditory, gustatory, olfactory, vestibular, interoceptive and proprioceptive.  Today we are going to focus on the proprioceptive system but if you have further questions regarding any of the other systems, please visit www.spdfoundation.net to learn more.
Proprioception is the input to our muscles and joints that tell us where our body is in space.  If I was to tell you to close your eyes and I placed your right arm straight out in front of you, would you be able to match your left arm to it?  You should if you have good proprioceptors.  We get feedback to this system by learning as infants how to roll, crawl, cruise etc.  We also receive input to our receptors by doing “heavy work” activities.  If you don’t know how much force to use when writing with a pencil you may break the tip.  Ifyou are not quite sure where your body is in space, you may fall out of your chair.
Many of us know children who have trouble understanding and processing this system.   You may also see these children have difficulties with organization of behavior, they may seek or crave deep pressure input, and they may need to constantly touch others or objects.  To best understand how to help a child process their proprioceptive system correctly we need to talk about the subtypes of SPD (Sensory Processing Disorder).  This will help determine what the best way to treat the child.
Dr. Lucy J Miller’s poses in her research, that SPD is broken down into 6 subtypes.
  1. Sensory Modulation Disorder
    1. Sensory Over-Responsivity (SOR)
    2. Sensory Under-Responsivity (SUR)
    3. Sensory Craving (SC)
    4. Sensory Based Motor Disorder
      1. Postural Disorder
      2. Dyspraxia
      3. Discrimination Disorder
        1. Visual
        2. Auditory
        3. Tactile
        4. Taste/smell
        5. Position/movement
        6. Interoception
Its best to try and explain each subtype and then relate that to the proprioceptive system as can be done for all systems so one can understand the reason behind the choice of treatment.
If a child is Sensory Over-Responsive, their bodies feel things too quick too fast and their system can go into fight, flight or freeze mode.  A child who shows signs of SOR in the proprioceptive system may refuse to jump, hop or skip and may not like the feeling of pressure on legs or feet.
Sensory Under-Responsive are children who are slow to move, the “couch potato” kiddo who is difficult to motivate.  They may choose sedentary activities over movement most or all of the time.  These children may appear withdrawn or self-absorbed.  In the proprioceptive system, they may show signs of weak muscles, slumping in their chair or having to lean on things to stand.
If a child is a Sensory Craver they actually “crave” the input to their bodies almost like an addiction.  These children seem to constantly need deep pressure input, constantly touching others, moving and crashing into things all the time.  You might see a kiddo who gives hard high fives, pets animals with too much force, always wants you to hug them really tight; they may have liked being swaddled tight as an infant.  These kiddo’s also may push down so hard when coloring they break their crayons, or tear the paper.
When moving into the second category of SPD we talk about Postural Disorders and Dyspraxia.  Children who demonstrate decreased postural control can be clumsy, uncoordinated, have poor posture and have trouble even maintaining a sitting position.  Children with Dyspraxia can have difficulty with coming up with new play ideas, sequencing a task, or motor planning how their body needs to carry out that new motor task.
The third category is Sensory Discrimination Disorder and a child can demonstrate difficulties in any of the 8 systems.  For proprioception, they may not know how much force to use when trying to pick up something heavy, they may not be able to discriminate the amount of pressure they use when writing or drawing.  You may see a child who has trouble judging how much force to use during motor tasks like kicking a ball, opening and closing doors etc.
When you notice a child having difficulties with any of the above listed sensory subtypes, they probably are having issues with multiple sensory systems.  As a clinician, you want to focus on following the child’s lead and building a relationship with them first.  Then as you gain their trust, you can slowly introduce them to more sensory stimuli through play activities.  You never want to force a sensory activity on a child.  If you are targeting their proprioceptive system, you may want to combine certain play ideas to help them activate several sensory systems at once.  For example, if the child wants to play a “fireman” game and they have a hard time in the area of Sensory Craving, you may want them to help you set up the game by pushing and pulling materials or equipment to set it up.  Have them carry over a heavy rope for the fireman to climb.  Maybe they have to create a swing obstacle course to get to the burning building up a ladder.  Have them participate in the heavy work activities while setting up the game for deep proprioceptive input to help organize them.  Then as they are going through, if they become too over-aroused and excited, slow your body and voice down and create a scenario where they have to stop and cognitively process how they are going to rescue the kitten from the burning building without getting hurt.  This will help slow down their impulse control as well.
Another example may be if a child has difficulties with Dyspraxia and completing new motor tasks, you can challenge them to a game where they can’t touch the hot lava on the ground as they cross over the jungle.  The child may struggle with grading their movements appropriately and knowing how hard or fast to move their bodies to get to the next obstacle in the jungle.  You can have them help set up going through a tire, over a bolster, climbing onto a swing and timing a jump to a crash pad all pretending these are part of the jungle and if they fall into the hot lava they have to start over again.  You may need to help them physically with some of the obstacles especially if they have poor body awareness.
There are many examples of how to use proprioceptive input to help a child organize their sensory systems, but we really want to embed it into a play theme so the child doesn’t realize they are “working”.  Other tips you can do with a child for a home program could be:
  • Eating crunchy and chewy foods help provide proprioceptive feedback to the mouth and jaw and can help calm and organize.
  • Drinking a smoothie or applesauce through a straw
  • Chewing on a chewy tube (if age appropriate) to help get input (can help decrease teeth grinding)
  • Chewing gum if appropriate
  • Fill a laundry basket up with heavy toys and have the child push it along the hallway (a relay race with siblings)
  • Have your child help re-arrange the furniture
  • Create an obstacle course in your living room with the couch cushions, tunnel, pillows, crawling under chairs etc.
  • If you have a mini trampoline they can jump and then crash onto a homemade crash pad or a pile of pillows while practicing saying the alphabet or math flash cards
  • Wrapping them up in heavy quilts or blankets for a calming affect (always leave the head out)
  • When sleeping, they may like deep pressure of body pillows, create a small space, push the bed against the wall, line it with pillows for a cozy sleeping place
  • Create a tent in their room with bean bags and weighted blankets if they need a place to go when they get upset
  • Playing with thera-putty or play-doh can help give input to the hands and wrist
  • Wheelbarrow walking
  • Wall pushups, chair pushups
  • At school have the child help put all the chairs up at the end of the day
  • Teach them how to give themselves squeezes on their arms and hands if they have trouble keeping their hands to themselves
There are plenty more ideas, but this is a start.  If you have further questions regarding a child and you are not sure which subtype they fit into or they could be demonstrating difficulties in several different subtypes, please visit www.spdfoundation.net,www.sensoryparenting.comwww.starcenter.us and www.otdvds.com  for more information.
Featured PediaStaff Columnist:  Britt Collins, MS OTR/L
Pediatric Occupational Therapist, Britt Collins, graduated from Colorado State University and since graduating  has worked tirelessly on OT and Sensory Integration awareness, research and application.  Britt has worked in a variety of settings including pediatric hospital inpatient, ICU, rehabilitation, outpatient clinics, homes, school s and skilled nursing facilities.  With her award-winning OT DVD series and newly released book, “Sensory Parenting,” she’s among the cutting-edge leaders in the field.  Her book is receiving enthusiastic reviews from Dr. Lucy Jane Miller and Lindsey Biel, M.A., OTR/L, and she’s presented nationwide alongside experts Temple Grandin, Paula Aquilla, Diane Bahr and Carol Kranowitz.
Britt is the co-creator of the OT DVD series including; OT for Children with Autism, Special Needs and Typical; OT in the Home; OT in the School and Yoga for Children with Special Needs.  These were created to be a visual learning tool for parents, caregivers and professionals to help implement OT and sensory integration into the home, school and community.  They are a tool that is easily used as a home program from your current OT or therapist.
Britt’s professional specialties include: applying creative approaches to sensory processing disorders, incorporating innovative sensory treatments in the home, school and clinical setting, and providing practical solutions to managing different types of behavior.  Britt is also has vast knowledge and experience working with children with special needs, their families, and their intervention teams in order to achieve optimal results for the child.
Currently, Britt is practicing at the STAR Center in Greenwood Village Colorado as she nurtures her non-profit organization, Special Needs United, which provides OT products and equipment to lower income communities.  For more information on Britt, please visitwww.SensoryParenting.comwww.otdvds.com, and www.SpecialNeedsUnited.org.

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