#sensorysystem

What is The Proprioceptive System?

Another fundamental part of the sensory system is the proprioceptive system which is located in our ligaments, connective tissues, muscles and joints. This is the sense that detects and controls the amount of force and pressure we exert when moving around. The proprioceptive system is the only system necessary to develop body awareness. It is also the only sense that we experience before we are born since our first sensation is movement, which we experience inside of the womb!

The Importance of the Proprioceptive System:

There is a reason the proprioceptive system is also referred to as our hidden sixth sense. Proprioception is the internal sense that tells us where our body parts are at and what they should be doing, without having to look at them. If we had to consciously think about every physical movement we make during an average day, every time we got distracted we would fall down. Our internal body awareness sense relies on data gathered by receptors (called proprioceptors) in the skin, joints, muscles, ligaments, and connective tissues. The data is collected by detecting the pulling, stretching and pressure on the muscles and joints.

The information travels back to the brain through the central nervous system where it is processed, assigned meaning and stored in an unconscious area of the brain. This is how the unconscious area of the brain knows how much tension, pressure or stretching to apply as we move around during the day.

Proprioceptive Dysfunction Signs

We have covered that a normally functioning proprioceptive system allows us to move around freely without having to think about it. If the proprioceptive system is impaired life becomes more challenging, especially for children. The child has to make a conscious effort to both move around and sit still depending on what is being required of them. Often children struggling have a harder time mastering things we normally think twice about completing. This can cause a child t9 develop a short fuse and become frustrated easily.

There are three different areas a proprioceptive system can be impaired. Each of these different have different symptoms and interfere with life in different ways. Luckily, the way you treat and accommodate them are similar.

1.) Sensory Seeking

* Using too much force when trying to pick something up,

* Does not know how hard to press when writing- may often break pencils or tear through paper,

* Does not know their own strength- they may play too rough with others

* While sitting, they have to bounce or shake their leg

* Prefers tighter fitting clothing

* May be observed clenching jaw or biting inedible objects

* Feet stomping when walking around normally

*Bumps into things or people

2.) Poor Motor Planning/Control & Body Awareness

* Difficulty going up and down stairs

* Difficulty riding a bike

* Uncoordinated

* Seems unaware of their body

* Invades other peoples personal space

* Developmental delays with their fine motor skills

* Unable to gauge how hard to press when writing typically resulting in poor penmanship or tired crampy hands.

3.) Poor Postural Control

* May be observed slouching a lot

* Awkward gait

* Struggles with their balance

* Prefers sedentary activities

* Easily worn out

* Places head down on desk while writing

When the system isn’t working properly the brain cannot gauge how much tension, pressure or stretching is needed to go about different levels of activities in the day. If the brain cannot communicate how much tension or pressure is needed, then the child cannot apply the correct amount of force on things. Sometimes the force may be excessive which may lead to the child to accidentally breakthings. Other times the force may not be enough and your child will drop things and/or struggle with their fine motor skills.

Children with dysfunctional proprioceptive systems will typically begin engaging in self regulating behaviors such as crashing into things, excessive running, toe walking or flapping. These behaviors provide the child with the proprioceptive input that they are not getting throughout the day. There are much safer ways to help ensure your child gets the proprioceptive input that they are looking for.

Regulating Proprioception

Most people get the physical movement their proprioception system needs from their daily activities. Heavy work activities are anything that involves pulling, pushing, lifting heavy objects or any other tasks that involve providing heavy resistance and input to the muscles and joints. Heavy work is considered a sensory activity that helps jumpstart the child’s proprioception system ability to know where their body is at and what it should be doing.

Providing the child with heavy work activities each day can help reduce any symptoms associated with an un-regulated proprioceptive system. Heavy work activities can take place anywhere. Even bringing them to the grocery store and have them help push the cart and/or bend and lift the food into the cart. Taking the child to the park or asking them complete age appropriate chores around the house can provide them with the proprioception input they need.

Other ideas for proprioceptive input include:

* Bear hugs or being wrapped up tightly in a blanket

* Weighted vests or blankets (consult with a physician first because there is a formula involved that is based on weight to calculate just how much weight the child needs)

* Rolling around on the belly while doing push ups on top of an exercise ball.

* Yoga (improves flexibility, muscle strength and muscle and balance)

* Activities where your child has to locate body parts or be more conscientious of their body awareness. (Simon says, copying silly poses or dance moves, etc)

* Oral activities like chewy tubes or vibration sticks, sucking milkshakes or smoothies through a straw, blowing bubbles, etc)

Caregiver Advice:

What is a tactile system?

The skin is the largest organ and is constantly receiving tactile input. The tactile system is a necessary part of the sensory system. The tactile sensory system is the technical term used for the awareness and reaction to the feeling of touch throughout the receptors in the skin. The fingertips and lips have sensitive nerve endings that attach to pacinian corpuscles and meissner corpuscles cells. These cells are responsible for feeling vibration and the sensation of light touch.These cells play a large role in how the tactile system interprets touch.

There are two levels to the tactile system:

1.) The first level is where the brain begins interpreting tactile input data gathered from receptors on the skin. The data gathered by the receptors enable the brains sorting proccess. The brain sorts where on the body the touch was experienced and what qualities the touch had (temperature, texture, pressure and other tactile qualities).

2.) The second level occurs after the data is gathered and sorted. The next process take place in the emotional center in the brain. The information they gathered and sorted is then labeled as a pleasant or unpleasant experience. Once labeled, it is then stored in the receptors memory to make the body react accordingly the next time the tactile input is experienced.

Tactile Defensiveness Vs Tactile Seeking:

Tactile defensiveness is when the tactile system is over responsive to tactile input. Individuals with tactile defensiveness may be extremely sensitive to light touch and actively try to avoid it.

Tactile seeking is when the tactile system is under responsive to tactile input. It presents with people who have extremely high pain tolerances and who are seemingly unaware of their body in relation to space.

Tactile Seeking & Defensive Symptoms:

Tactile Defensive:

Poorly reacts to unexpected or light touch

Certain textures are upsetting to them when they come in contact with their skin. (Like clothing fabrics or tags on clothes)

Becoming distressed, anxious or unregulated anxiety when engaging in messy play. Or has a constant need to keep hands and face clean.

Difficulties walking barefoot on sand, grass or carpet

Difficulties with wet tactile experiences such as getting hair or face wet, shampoo, lotion, etc

Shies away from touch

Struggles to adapt in crowded or noisy places

Frequently anxious and overwhelmed

Avoids touching new objects or textures

Tactile Seeking:

The desire to touch and feel everything around them

Poor balance and coordination

Struggles with their body awareness. They may regularly bump into things or people

Invasion of other peoples personal space

lack of self awareness when their face is messy from food

Not reacting to stimuli that should feel painful

Seeks out messy play

Excessive jumping, spinning, swinging, crashing, squishing and other similiar movements.

Untreated Tactile Disorders

Tactile Defensiveness:

Delayed fine motor skills

Rigid clothing preferences

Oppositional response to getting dressed, showering or teeth brushing

Impaired physical boundaries

Avoidance of tactile sensory activities needed to develop necessary skills

Tactile defensiveness is not easy to manage. The behaviors that develop from tactile avoidence can delay certain developmental milestones. With the proper tools and techniques, you can help your child learn to cope.

Tactile Seeking:

Unintentionally rough during play

Self-injurious behavior

Inability to register temperature changes

Always feels the need to make noise to the point of annoyance

Unaware of parent calling their name

Puts their ears up right up against things that make sound as if they cannot hear it

Advice For Caregivers:

If you are worried that your loved one is experiencing difficulties with their regulating their tactile system, have a conversation with their doctor about getting a referral to have an occupational therapy evaluation. Most parents assume the behaviors they are observing is something their child is going to grow out of or adapt to. I have first hand experience with tactile defensiveness. If I experience light touch at any point during my day I get angry and struggle for hours (sometimes) to regulate myself again. This is something that if dealt with when the tactile system is still developing that can be resolved in a relatively small amount of time.

The activities I am going to recommend next are not meant to be used as a stand alone treatment plan. They are simply ways you can support and encourage your child in learning to cope with their tactile stimuli challenges.

Tactile Defensiveness Activity Ideas:

Below I’ve put together a list of activities you can do with your child to support their tactile system development. My advice would be to start slowly and never force any tactile input that your child resists. If you find that your child has absolutely no tolerance to new tactile experiences, I would advise you to reach out to your family doctor about a referral for an occupational therapy evaluation.

1.) Bins filled with rice, sand, beans or popcorn kernels and colorful dollar tree toys, numbers or letters are a great way for your child to be introduced to dry textures, If your child doesn’t want to use their hands to play in the sensory bin than you can provide them with shovels and cups for playing.

2.) Putting shaving cream on a hard surface and having your child play or finger draw with it.

3.) Playdoh, slime, putty, finger painting

4.) Deep pressure touches like massages, joint compressions, bear hugs

5.) Having your child identify objects with their eyes closed (such as coins, keys, marbles, shapes)

Tactile Seeking Activity Ideas:

1.) Anything that involves jumping. Jumping on a trampoline or even jumping rope

2.) Swinging isn’t just for outside. There are compression swings that you can make or buy that are great vestibular and tactile input for a sensory seeking child.

3.) Weighted blankets or vests, body socks, compression sheets or clothes, carrying around a weighted stuffed animal

4.) Games with lots of movement like tag, red light, green light, hopscotch, homemade obstacle courses, etc

What is the Auditory System?

The auditory system is a part of the sensory system that is responsible for our sense of hearing. The auditory system and the vestibular system work closely together to control balance, coordination and movement.

There are two components of the auditory system:

1.) The first component of our auditory system to develop is called the defensive component. Newborns get startled when they hear loud noises. Over time, our brains learn that not all loud sounds are threats. This knowledge is a precursor for the future development of comprehension skills. Truly understanding the meaning of the sounds that we help our sensory systems to become fully integrated.

2.) The second component of our auditory systems is discrimination. Auditory discrimination allows us to comprehend more details about what we hear such as sound location, ability to filter out background noise, associating sounds with prior experiences and remembering verbal instructions.

When the two auditory system components are functioning properly, our bodies react appropriately to auditory input we encounter in our surroundings. However, if the two systems are not working well together, our brains misfire and interfere with our ability to regulate our reactions. Malfunctioning auditory system components reduce our ability to fulfill even daily living functions and untreated will negatively impact our standard of living.

Auditory Processing Disorder:

As discussed above, when the components of the auditory system are not working properly, the next step is to consider consulting with a physician. Advocating your desire to get your loved evaluated for auditory processing disorder (APD). APD is the medical terminology used when referring to the brain struggling to comprehend speech or increasing or reducing how we percieve what we hear.

APD can impact individuals at any age and presents differently from one person to another. It is also important to note that APD has nothing to do with intelligence or the ability to hear sound. No matter how loud a person speaks, the individual with APD will sometimes have difficulty understanding what they are being told. They often need extra time to process what they hear.

In general, we can over respond, under respond or seek out auditory input:

Over responsiveness to auditory input will result in a person wanting to avoid hearing loud noises. It also results in the person becoming distracted easily by noises in their surroundings.

Under responsiveness to auditory input presents itself as a general lack of awareness to sounds that other people are aware of. They consistently do not hear their name being called. They often ask for things to be repeated and struggle to remember verbal instructions

For the individuals who seek out auditory input, it presents with the person speaking at a much higher volume than those around them no matter what environment they are in. They love noisy environments, loud music or having their volume high on the TV.

Symptoms of Auditory Processing Disorder:

Auditory Processing Disorder presents differently from person to person.  Many of these symptoms overlap with symptoms associated with other disorders, such as ADD/ADHD, Autism Spectrum Disorder and speech and/or language disorders.  Only about three to four percent of people are diagnosed with APD. Due to it being relatively rare, APD is not fully understood. What is known, people with an APD diagnosis often appear to have a combination of multiple symptoms.

Some of the most frequently reported symptoms of APD include:

Significant difficulty understanding speech, appearing predominately when paired in a setting with background noise

Difficulty following verbal multi-step instructions

Easily distracted

Difficulty staying on task in settings where required to listen to someone speak for long periods of time without a break

Difficulty comprehending and remembering information they receive verbally

Consistently performs below grade level in reading, writing and spelling

Trouble following abstract thoughts or ideas

Misunderstanding of jokes, idioms, and figurative language

Advice For Caregivers:

First and foremost, be patient and understanding. Always try to keep in mind that their responses are directly related to the traffic controller in their brain. Their responses to auditory input can sometimes come across as difficult behavior or poor listening skills. They just have a difficult time processing what they hear.

Noise cancelling headphones or ear plugs are extremely helpful for children (and maybe adults) who are going to be loud environments.

A person with APD is going to need extra time between instructions as well as a small break before you repeat any verbal instructions to avoid a sensory overload.

Reducing sound distractions in environments where they need to stay on task and focused.

Continue teaching coping skills and support their overall sensory regulation and mental wellness each day.

Ideas that are specific to those struggling with over responsiveness, under responsiveness and someone auditory seeking:

Over Responsive:

Always try to prepare your child in advance whenever they will be in loud environments or will be experiencing sudden loud noises such as fireworks or even a loud flushing toilet at a store.

Under Responsive:

Try to fill in whatever gaps they may experience from verbal auditory input by providing them with a written or verbal copy.

Auditory Seeking:

For those seeking auditory input, encouraging them to play an instrument or listen to music while they are doing their homework can help give them the auditory stimuli they are after.

How is it Tested?

Due to the complex factors associated with APD, there are several testing criteria that is REQUIRED before the child is eligible for testing.

A child must:

Be at least 7 years old

Have normal hearing

Normal speech and language skills

Not have an intellectual disability

In addition, there are some co-occurring conditions that prevent a child from qualifying for testing.

Common reasons that a child may not be eligible for APD testing include:

Autism Spectrum Disorder (ASD)

Down Syndrome

Developmental delays

Below average IQ level

Significant speech/language disorders, such as apraxia of speech, stuttering, etc.

Hearing loss

The diagnostic procedure for APD requires a very comprehensive review of the child’s past medical, educational, and developmental history. The test is several hours long, and the child is required to participate in listening test that assess different areas of their auditory system. Since the test is so in depth. the results typically are not available that day. The physician has to score the assessments, review the history and whatever notes they took during their interaction with your child.

My youngest daughter has been diagnosed with APD and our particular diagnostic process was a three-appointment ordeal. Each appointment lasted about 3 1/2 hours. The audiologist wanted to screen my daughters hearing, do a physical exam, send assessments home for teachers and caregivers and then perform the in-person assessment.

In our experience, there was a two weeklong wait before we had our follow up appointment. The wait was worth it. We received a very detailed report of what the diagnosis was, how she met the criteria and how teachers and parents can encourage the development of the auditory system moving forward. It was such a thorough and informative appointment and we left there with a game plan on how to support her in the most beneficial way.

Students who struggle with auditory processing can have difficulty with speech and language development and conversational skills. Since the auditory and vestibular systems are so closely related, incorporating movement into their everyday activities can encourage the development of their language skills.

How is it Treated?

Auditory Processing Disorder is not something to treat without the help from an audiologist. Depending on your families’ particular circumstances, the audiologist will come up with a customized treatment plan. If you think that your loved one may be struggling with symptoms of APD it is important to have them evaluated. If they indeed are diagnosed with APD, the diagnosis will be extremely important and beneficial to their education.

Since APD is considered a learning disability, it would qualify your child for an individualized education plan (IEP). An IEP is your tool to advocate for your child’s needs so they can qualify for and receive proper accommodations. The accommodations vary but some examples include extra test taking time, written and visual instructions to coincide with verbal instructions and if appropriate an IEP may significantly decrease the amount of work sent home with them.

Is there a cure for APD?

The answer to this question is a bit controversial. The areas of the brain that are responsible for auditory processing abilities continue developing until around thirteen years old. That is the average age the auditory system is considered to be mature. Due to the gradual rate of development, children diagnosed before their auditory system had finished maturing could “grow out of it.” Especially if they were receiving therapy and other services from a young age to improve their auditory processing skills.

For these reasons, it is recommended that children diagnosed with APD before age 13 be re-tested every 1-2 years until after their 13th birthday to monitor for any changes or improvements with their auditory processing skills. It may seem like an inconvenience, and you may wonder what the point would be to keep testing them instead of just waiting for the child’s auditory processing skills to improve?