Sensation, movement and kids

posted in: Musings From My Lap Desk | 0

The way we make sense of the world is by integrating sight, sound, smell, taste, light touch, pressure touch, and inner ear signals. If any of those are hyper- or hypo- sensitive, it can become difficult to learn, focus, pay attention, coordinate movements.  

I got a hair cut today, and the woman cutting my hair started to talk about her daughter and how she only wears certain fabrics, and tends to hug too hard, and fears going to school some days. My pediatric physical therapy brain perked up and began to listen intently. “It sounds to me like she may have something called sensory integration disorder,” I said and began to describe the way touch, input from muscles and joints (proprioceptive) and input from the inner ear (vestibular) have to integrate in order to feel comfortable and move well in the world. The touch of clothing is not supposed to matter that much, its supposed to fade into the background so that we can stand to wear elastic, straps, tags, wool, cotton, polyester, whatever without losing focus on more interesting things like creating, thinking, reading, writing, playing. And a child who is hugging too hard may not be able to feel the input from muscles and joints until they are pressing too hard for most other kids to handle.

Other indicators of sensory integration disorder can be a dislike of being picked up or of swinging, dislike of paint or other slippery things on the hands, dislike of other kids standing too close, like around a sandtable in a kindergarten, dislike of different textures inside their mouths, fear of climbing up or being up off the floor, when young, difficulty climbing, when older, difficulty walking across an uneven surface or a shallow stream, clumsiness when everyone else in the family is coordinated. The hard chairs in classrooms can cause kids to squirm and not pay attention. Their clothes can bother them intensely. They can be easily distacted by sounds that no one else is paying attention to, like cars going by outside.

There are many other symptoms of sensory integration disorder. One or two are normal, we all have them, and we self-sooth to assist ourselves with handling our overstimulation and pay attention to what we are doing. I get overwhelmed with too much noise and hate the feel of a twist in the strap of my purse across my back.  I can’t stand turtlenecks or tags in my clothes.  One of my favorite sensations is to be held really tight and twirled with my eyes shut. Just twirling myself doesn’t do it, I feel sick. If I watch people closely, I see them self-comforting with behaviors such as stroking a moustache or rocking, jiggling a foot up and down, doodling or playing with a pen or their hair. These are comforting, orienting behaviors, what are yours?

Kids are trying to pay attention all day at school and then go out and deal with the world with their bodies, running, swinging, jumping, playing ball games. If their brains are not integrating all the information coming in, the output may be awkward and flawed, or the child might get depressed and wonder what the heck is wrong with them, feel different, be terrified of being picked to be on a team, be afraid all the time, nameless fears. As kids get older their brains frequently adapt to the disorder, but by then, self-esteem may be affected. My hairdresser had tears in her eyes as I was speaking. She said “I feel like you are describing me and my daughter. I always felt different, like I didn’t belong. I finally understand what was going on.”  

So, the good news is that sensory integration treatment really works. The theory is that stimulating a strong or normal feeling sense helps the weaker one, that a preference for fast spinning, for instance helps the brain to integrate the icky feelings from clothing or deep touch. Or getting off a swing and lying on the floor (lots of deep pressure along the back of the body) helps to integrate the vestibular overload. 

When I had my PT office, I’d watch the kids tell me what their strong and weak senses were. (I would also interview the parents and give the kids tests to identify these strengths and weaknesses). I had swings hanging all over the room, all different types: inner tubes hanging from elastic ropes, platform swings, hanging ladders, trapezes, bolsters hanging from two hooks. I would offer the room to the kids and they would choose. Some could not even climb onto a low swing with a platform, four ropes and an inner tube lying on it, 6 inches from the floor, even when they really wanted to get on. They would try to get on with one foot first…no sense of having to hold onto the ropes. Of course the swing would move away and they would fall or feel bad. The floor was covered with mats and beanbag chairs, so no one ever got hurt. I would place their hands on the ropes or demonstrate and I would say “hands first and then feet.” Something as obvious as hanging on was not natural to them but these kids were all walking around, most able to run and play games, albeit sometimes clumsily. They look normal, but they feel like they do not know where they are in space, where their bodies begin and end and where objects are going to be in the next minute. 

As kids with touch problems began therapy they might choose to lay under the heavy bean bag chair (from Robb’s pillows in Eugene, Oregon), to be rolled with thick paint rollars, to run their hands through big tubs of beans or rice and find small objects. I would help them get into a hammock swing with a featherbed inside and very gently rock them back and forth. This help was in the form of touching their hands, shoulders, leg or whatever part of their body they needed to feel and connect with. The initial goal was to have them handle this input and progress to enjoying it. If it was too much vestibular input, I’d have them get out and lay on the floor and mash them with the beanbag chair (deep pressure) or roll them with a thick paint rollar. From there they would progress to handling the input from a swing that made a big circle or a tight spin or they would bounce high holding on tight, or cling to a hot dog swing with very little seat. As their coordination (praxis) improved, their grips got stronger, they learned to make the swings move themselves, to climb on and jump off without falling. Their knees learned to bend and hold in order to hang upside down, they learned to hold on and pump and how to move a swing to get onto another one.

As kids got better they might chose to spin so fast it would make other people sick, or to hang upside down from the trapeze and fall into the beanbag or spin themselves with their hands on the floor. They might hang from the ladder swing and grab another as it goes by, or lay in a cloth trapeze on their bellies and grab velcro balls off a target as I swung them back and forth (at first many kids with S-I problems cannot lie on their stomachs and hold their heads up for more than a few seconds, neither can they lie on their backs and hold their knees in their hands and keep their heads off the floor). After awhile they could zoom down the hall on a scooter board and negotiate obstacle courses on a carpet. All of these activities had the added advantage of increasing their strength as well as their ability to use their eyes while controlling the input from their inner ear.

The advanced goal was to be able to move around the room going from swing to swing without touching the floor and at different speeds (I would hold the swings together, rope to rope), without me having to remind them to hold on or how to move their arms and legs. They would have to integrate vision, touch, vestibular, and proprioceptive information in order to make these complex moves. Their core strength would improve so that they could hold a prone (on belly) extended or supine (on back) flexed position for a normal amount of time (about 30 seconds). 

No therapy available? Listen to your kids and let them chose their clothes. Try yoga positions, and obstacle courses around the furniture. Have them roll across the floor without letting their heads touch the floor.Touch them more as they move on or off a climbing structure to help them know where they are in space. Also add touch if they are attempting somethng new like walking a curb or crossing a stream. Any touch will help, have them try a walking stick so they can feel the ground. Have them trail their fingers down a wall to walk in the dark.  Pick them up and squeeze and spin them at their directed speed, eyes open then closed. Have them jump into a bunch of pillows and then onto the floor, hold one hand if they need it at first. Walk on uneven surfaces, like couch cushions, always with a hand held first to add touch input. Have them lay under heavy blankets, tuck them in at night, if they like that. If you can find a park with swings, see if they can get off and on, touch their hands to the chains if they don’t do it first, have them slide their hands up higher if they are holding too low. Do not expect them to perform complex movements like climbing a jungle gym without added touch at first. Throw pillows or stuffed animals to train them to catch, nothing small or hard, progress to large soft balls, then smaller objects and stand farther away. Use lots of hugs, they are very calming.

Reseach Sensory Integration Disorder.

Call me, I’ll help. 541-6066473.

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