Thursday 5 december 2013 4 05 /12 /Dec /2013 23:50

Lauren is a brave 15 year old girl with Cerebral Palsy. In October she gave a speech at The American Academy of Cerebral Palsy and Developmental Medicine. This was not an easy task for her, but she spoke clearly and bravely.

Lauren's grandfather John has kindly agreed to have this video posted. Please take some time to watch this moving video.



To read about Lauren's dream and her journey to raise awareness and funds for Cerebral Palsy (CP) please take a look at the following link:



By Sian Eckersley (
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Sunday 4 august 2013 7 04 /08 /Aug /2013 10:59


We all use our mouths in different ways throughout the day. We may use them to comfort ourselves (sucking a sweet, sucking your thumb, biting nails or just touching your mouth when stressed); to regulate and organise ourselves or to help maintain attention (chewing gum, chewing the end of a pen or pencil, taking deep breaths, blowing, whistling, biting your lip etc.). We also use our breath to help regulate and organise ourselves. The way we breathe in response to stimuli from our environment can help us to process the stimuli better. It can also assist in the activities we do daily.


Touch receptors (cells that give your brain information about the world around you through touch) are located all around your body. The lips and the fingers are considered to have the most concentration of touch receptor cells in the body. They correlate to a larger area of the brain that receives messages from the lips and fingers compared to other less sensitive areas of the body that correlate to smaller areas of the brain. More brain power is spent interpreting touch sensations from the lips and fingers than from other areas of the body that have touch receptor cells. Touch receptors help us to experience hot, cold, pain or pressure. Touch is an important sense because without it we would not recognise pain (e.g. from boiling water) and this would put us at great risk. Touch processing is very closely linked to emotional development which can also affect healing and the reduction of anxiety and tension. It has a great impact on a child's physical and psychological well-being.



It is natural to use our mouths in a variety of ways during the day. We also incorporate different uses of our breathing into this. We tend to have more of a shallow breath when angry or nervous. We take a deep breath before lifting something heavy or before raising our voice. All of this is dependent on the "Suck Swallow Breathe" synchrony (SSB "Out of the Mouths of Babes" S. Frick, R. Frick, P. Oetter, & E. Richter 1996). Our breath reflects our thoughts and feelings and can help to regulate us by calming and reorganising our systems. Our oral motor skills, touch processing skills and ability to vary breathing patterns all contribute to attention and organization of behaviour. The muscles used for sucking, blowing, chewing, swallowing, biting and breathing are the same muscles that help with good posture. Postural control needs strong neck, chest, stomach and back muscles. This in turn assists a child to be alert and attentive.

baby chewing on xylophone
Some children have difficulty with oral sensory processing and the Suck, Swallow, Breathe rhythm doesn't seem to flow of synchronise properly. These children will have difficulty with alertness and organisation of behaviour as well as some minor health problems, digestive problems, difficulty with speech, chronic colds, chronic constipation or diarrhoea, ear infections and problems with teeth. They may have some postural and motor development difficulties and would possibly have some visual issues (not watching where they are going or what they are doing, focusing on an object by looking at it from the side). These children are usually over sensitive to touch around the mouth (hyper-sensitive), or they do not receive the messages from the touch receptors well enough (hypo-sensitive). The oral sensitivity will need investigation and the right type of treatment activities to assist sensory processing.

A child with oral sensitivity may be hyper-sensitive or hypo-sensitive. The hyper-sensitive child (usually with oral defensiveness) will not like brushing their teeth, eating, or washing their face. They are often picky eaters and don't like foods with certain textures. These children tend to gag often when eating and may need to drink to help their food go down. They may use their teeth to remove food from the spoon or fork and they may have other tactile senstitivities throughout the body such as a dislike for touching messy object (paints, glue etc.) or sensitivity to different textures of fabrics and clothing.

The hypo-sensitive child is usually a messy eater who often leaves food in and around their mouth after a meal. They tend to over fill their mouth which can result in choking. These children can be observed drooling beyond the appropriate age. They may lick items and may prefer strong flavours. These children tend to have hypo-sensitivity on other parts of their bodies and may be found rubbing their hands on rough surfaces or different textures as well as enjoying lying under heavy layers of blankets and wearing layers of clothing on their bodies.

There are activities that an occupational therapist can recommend to help with sensory processing in and around the mouth as well as well as self-regulation through breath. The right amount of sensory input is needed to help the child regulate and process the stimuli in and around the mouth. This needs to be introduced gradually with a variety of pressure, vibration and textured items. Light and deep touch is used to sensitise and desensitise the child's oral structure. Various textured foods can also be used as part of the therapy as the child is taught how to take different sized bites and feel the food more appropriately in the mouth.

Stimulating the mouth can also have a positive effect on the nervous system that is often immediate. The activities tend to encourage deep breathing, which helps to organise and regulate the child. The following activities are an example of therapeutic tools and games that help:

1. A Volcano of Bubbles
Fill a large bowl about half full of water. Add a few squirts of dishwashing liquid. A few drops of food colouring may be added too. Give the child a straw, preferably a curly, crazy straw and encourage them to blow into the water. The child should keep blowing until the bubbles spill over the rim of the bowl. This is a fun activity to do with two children. Small plastic animals can be placed at the bottom of the bowl and the children can time how long it takes until the animals are completely hidden.

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2. Party Blower Target
Set up small animal figures on building blocks or cubes made of Lego. Ask the child to lie on their stomach in front of the figures. Using a large party blower (the ones that curl up and make a sound); the child can pretend to be a lizard or frog with a long tongue and knock down the figures. Lying on their stomach helps the child to regulate them and it is beneficial for proprioceptive feedback (see sensory integration). Other items can be used for the same game such as cut out cardboard figures.

3. Blow Pens
Blow pens are a good way to be creative whilst benefitting from a blowing activity. Pens are available from a variety of places in a variety of colours. Encourage the child to breathe deeply before blowing and watch that they don't become light headed. The activity should be stopped if they become light headed and tried again another day.
4. Bubble Blowing
Use bubble mixture to blow a variety of shapes and sizes. The semi-permanent bubbles are a fun way of creating a different atmosphere in a room as they last a while and the room can be filled with bubbles.

5. Chewing
Crunchy or chewy foods are organising and provide good sensory feedback for the mouth. Crunchy foods are alerting and chewy foods are organising. Observe the child's level of arousal or organisation and use the snacks throughout the day. Use them cautiously when doing movement activities.

6. Curly Straws
Long curly straws give the muscles around the mouth extra work when drinking. This makes meal and snack times fun whilst fulfilling a therapy aim.

7. Vibration
Vibration in and around the mouth will provide extra sensory feedback which will in turn help to balance the tactile responses. Use a tool like the Z Vibe or electric/battery toothbrush. This helps by desensitising an over sensitive mouth (use on low and slow vibration), or by stimulating an under sensitive mouth (using fast, high vibration).


The above activities are examples used in occupational therapy. These activities may not be suitable for every child as each individual child will need to be fully assessed by an occupational therapist to determine the degree and nature of their oral sensory processing difficulties. Using the above activities will not harm a healthy child, but it is recommended to have a full OT assessment to ensure the desired outcome.



By Sian Eckersley ( - Posted in: Sensory Integration
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Saturday 4 august 2012 6 04 /08 /Aug /2012 18:18


What is it?

Spatial awareness is the ability to be aware of oneself in space. It is an organised knowledge of objects in relation to oneself in that given space. Spatial awareness also involves understanding the relationship of these objects when there is a change of position. It can therefore be said that the awareness of spatial relationships is the ability to see and understand two or more objects in relation to each other and to oneself. This is a complex cognitive skill that children need to develop at an early age. Spatial awareness does come naturally to most children but some children have difficulties with this skill and there are things that can be done to help improve spatial awareness.


When a child is developing their spatial awareness they begin to become aware of their placement in relation to the things around them. They are central to this, and they need to understand their location as well as concepts like distance, speed and placement (over, under, behind etc.). Spatial awareness is part of our overall perception. The development of perception can be difficult for children with developmental co-ordination disorder (DCD), autism, cerebral palsy and many other conditions. As perception is the organisation and interpretation of sensory stimuli from our environment, the child would need to have adequate body awareness to be able to form the relationship of their body with the the stimuli and objects within that space. This is key to developing spatial awareness. Proprioception is the awareness of where our limbs are in space. This is developed alongside spatial awareness. For example, when a baby reaches for a toy it learns how far it needs to stretch the muscles in it's arms (proprioception) in order to reach the distance of the toy (spatial awareness). The next time the baby reaches for that toy it would have learnt something about the amount of muscle stretch needed and the distance of the toy. This can then be applied to a similar object at a similar distance another time. The child will eventually become familiar with where its limbs are without having to look at them. Distances, speed and placement will be integrated so that the child will know what they can reach and can't reach when they stretch their arm.


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   Signs and Symptoms

As spatial awareness develops the child will learn the concepts of direction, distance and location. They will understand that when they walk to an object the object will become closer to their body. they will know that objects that are far away appear smaller because of the distance. They begin to appreciate the space around themselves and the proximity of others around them. As they grow older their movements become more controlled and constrained around others as they are more aware of their personal space.


Children with poor spatial awareness tend to have visual perceptual difficulties as well. They may appear clumsy and may bump into others. They often stand too close or too far away from the people or objects that they are interacting with. In the classroom they may have difficulty with presentation of written work and may find it hard to structure and organise such work. These children often find it hard to tell their left from right and they confuse positional language i.e. over, under, in or out, left or right. This makes it hard for them to follow directions that use such language. They may have difficulty with PE, team games and games that use apparatus.


In the classroom the child with spatial awareness difficulties often finds mathematics hard. This is due to the abstract concepts of the subject especially where shapes, areas, volume and space is involved. They will have problems reproducing patterns, sequences and shapes. Their strengths, however, are with the more practical and concrete subjects. These children will often find that they excel at using a multisensory way of learning. They tend to have good auditory memory skills and have strength in speaking confidently whilst being able to listen well. They tend to have good verbal comprehension skills and their strength is usually in verbal and non verbal reasoning.


Developing Spatial Awareness

In order to be able to relate ourselves to objects in a given space, we need to have an accurate body schema. This is a sense of where your body is in space and where it is in relation to the whole of you. For example we need to know the exact location of our arms in relation to our trunk. The body schema develops through our muscles and touch receptors (proprioception and tactile senses combined with other senses). This gives us a map or image of the way we perceive ourselves to look and is linked with our body awareness. Asking a child to draw a picture of a person will give a trained therapist a very good indication of the child's body schema and it will provide the therapist with information on the child's spatial awareness. The therapist can also detect spatial awareness difficulties in a child's handwriting. A child with poor spatial awareness may leave out the spaces between words, start the sentence in the middle of the page, have difficulty keeping on the line or write diagonally instead of horizontally. These are visual perception problems that are related to spatial awareness.


An occupational therapist will also be able to identify a child with spatial awareness difficulties when observing their gross motor skills. The difficulties may be seen during team sports such as football where the child needs to judge distance and speed of a ball coming towards them, as well as the distance between themselves and the person they need to kick the ball to. They may also appear clumsy, move into spaces that they are not meant to be in during the game and often bump into team members.


Spatial awareness develops naturally when children have the ability to freely explore their environment. Babies learn about themselves and how they relate to their surroundings naturally. They learn to manipulate objects as they become mobile and learn about distances and sizes when they are able to move towards the objects. There are, however, situations that interfere with or prevent the natural development of spatial awareness. The child may have some developmental difficulty or a disability that results in poor spatial awareness. In other circumstances there may have been a lack of opportunity for the child to freely explore the environment during it's early developmental stages. The child may have been ill at key developmental points or may have missed opportunities for other reasons.



Occupational therapists work closely with parents and schools to provide suitable remedial exercises for a particular child with spatial awareness difficulties. The activities may involve games that work on judging distance and placement such as throwing beanbags into hoops, buckets or over lines (target games). They may use obstacle courses to involve the body and help the child to be aware of where they place their limbs in relation to the obstacles. Music and movement helps with placement, co-ordination and use of space. Games such as bowls or marbles help the child to develop a judgement of space.


At home parents can help to develop spatial awareness in the following manner:

  • By discussing locations of objects i.e. the kettle is in the kitchen on top of the counter to the right of the toaster. 
  • An object may be hidden in the child's bedroom and instructions given to the child of where to find it. 
  • Parents could discuss which objects are closer or further away from the child and compare the relationship of the distance between several objects and the child.
  • They could play the "Robot Game" where the child pretends to be a robot and the parent gives directions such as "turn left" or "stop at the door" or "turn right".
  • Playing games such as "Simon Says" helps with spatial awareness as well as using equipment such as tunnels to crawl through or outdoor climbing frames.
  • Use jigsaw puzzles, tessellation games and arranging 2D and 3D shapes.
  • Model making using pictures as a guide to build the models.


If a parent is concerned about their child's spatial awareness they should seek advice from their child's GP, school or health care professional.



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By Sian Eckersley ( ) - Posted in: Co-ordination
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Sunday 10 june 2012 7 10 /06 /Jun /2012 00:00


The Asymmetrical tonic neck reflex (ATNR) is a primitive reflex that is found in new born babies and normally remains until around 6 months. It emerges in utero at around 18 weeks after conception and is usually identified and seen within the first 3 months after birth. The reflex is initiated when the head is turned to the left or the right whilst the baby lies on its back. The turning of the head causes the arm and the leg on one side to extend, whilst the limbs on the opposite side flex. If the head turns to the right, the right arm and leg will automatically extend whilst the left arm and leg both flex. It is often called the "fencing" reflex due to this pattern.      


The purpose of the ATNR is to provide stimulation for developing muscle tone and the vestibular system whilst in the womb before birth. It also assist with the birthing process by inhibiting limb movement and slowing it down so that the baby uses a "corkscrew" movement through the birth passage. ATNR helps with eye-hand co-ordination and serves as a precursor to this skill. A retained ATNR can have a significant impact on a child's development and it is often thought to have a major effect on the child's physical, cognitive, social and emotional progress, thus affecting their ability to function well in school. The retained reflex will continue to influence limb movement every time the head is turned and will have physical influences that impact on all other areas.



The ATNR will interfere with a baby's ability to centralise and reach things within the mid line position of their body. Once this reflex is integrated (around 6 months) the baby begins to reach and have functional ability within the mid line of their body. A strongly retained ATNR will affect this ability so that the baby finds it difficult for hands, feet and eyes to cross the mid line. Visual tracking and eye pursuit of an object becomes difficult and this later results in difficulty with reading as the child can not easily make the rapid forwards and backwards eye movements (saccades) that are essential for reading. Writing will also be difficult due to this as well as due to the reflex causing the hand to involuntarily extend as the head is turned towards the hand. The child will find it difficult to maintain a pen grip and may compensate with a lot of pressure in a tight grip, causing cramps and making their writing messy and illegible. The child may also find it difficult to copy written work as their eyes will follow their hand and not the text.




The retained ATNR prevents a baby from developing certain physical cross pattern movements such as rolling over, crawling and later marching using alternative leg and arm. As they grow older the child may have atypical movement patterns and may draw circles backwards, clap downwards, use one hand more than the other whilst clapping, or may be very single handed in most activities. A strongly retained reflex in the legs can also affect balance as the child looks from left to right. Walking, running and other physical activities can be uncoordinated and the child could have difficulty with symmetrical movements of the hands and feet.  A strongly retained ATNR may eventually cause physical problems in the child's bone development. It may affect joints as well as the skeletal structure. It is often seen in children with scoliosis (curving of the spine).





When assessing and identifying a child with a retained ATNR, therapists will look for key features that indicate the child has retained the reflex. It may be mild and difficult to detect, or strong and obvious. If the child displays three or more of the following symptoms, further investigations should be conducted:

  • Difficulty with visual tracking and crossing the mid-line.
  • Difficulty with reading and following a line of text. Easily losing their place when reading. Difficulty reading small print.
  • Listening skills and attention skills are difficult to develop.   
  • Difficulty with binocular vision so that images are blurred. Double vision as two eyes can't work together well.
  • Poor handwriting and difficulty copying written script. Tight pencil grip.
  • Difficulty with spellings.
  • Poor eye-hand coordination.
  • Difficulty with bilateral coordination.
  • Poor sense of direction.
  • Difficulty catching and throwing balls. Often using one hand to throw.  
  • Poor gross motor coordination and balance.
  • Difficulty with swimming, especially breast stroke.
  • The child finds it hard to tell their left from right.
  • Poor short term memory and difficulty following verbal instructions.
  • Impulsive and emotionally immature for their age.


The retained ATNR is often thought to be associated with dyslexia and attention deficit disorder. If a child is having marked difficulties with the above areas they would need an assessment to determine if the ATNR reflex has been retained. Occupational therapists use a variety of methods to test for the reflex. This ranges from a quantitative rating scale that indicates the degree of integration of the ATNR in normal first and third grade children for comparison; to Sensory Integration clinical observation assessments as well as observations of the child performing daily functional activities.


The ATNR can be integrated with therapy in which a series of exercises, specific games and activities are used. The activities involve movements which replicate the early reflex movements and therefore lay down the neural pathways that will enable the child to overcome the retained reflex. With young babies over 7 months a simple exercise would be to work with them on their stomach (prone position) reaching for toys in front and to either side of them. With young children, games can be used that involve e.g. crawling with their head turned to one side (tuck a bean bag or small soft ball under the chin between the shoulder). This can be done as a race. Simple exercises can be done with older children such as one handed wall push ups (standing sideways to the wall) with one hand on the wall and the other hand on the hip as the child faces away from the wall.



 Once the child has integrated the ATNR improvements in classroom performance will be noticed providing there are no further underlying conditions or difficulties. Progress is different for each child and the activities should be done under the supervision of your therapist to ensure success and desired results.












By Sian Eckersley ( - Posted in: Development
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Friday 20 january 2012 5 20 /01 /Jan /2012 22:22


imagesCA1ZTRS8-copy-1.jpgIt is difficult for anyone who is not on the spectrum to understand the daily barriers that affect a person with autism. These barriers are due to their perception and experience of the world which can be so extreme as to prevent them from leading a normal life.  


The National Autistic Society describes autism as:


"Autism is a lifelong developmental disability that affects how a person communicates with, and relates to, other people. It also affects how they make sense of the world around them. It is a spectrum condition, which means that, while all people with autism share certain difficulties, their condition will affect them in different ways." 


Autism will not only have an impact on the way the person communicates and relates to others, it will also have a profound affect on the way the person responds to and interacts with the environment. This often manifests in their behaviour. It is a complex neurodevelopmental disorder that has multiple symptoms that begin before the child is 3 years old. These include:

  • Difficulty understanding other people's mental state and emotions, so not being able to respond accordingly.
  • Difficulty with verbal and non verbal communication.
  • Repetitive behaviour (words and actions) with rigid rule governed rituals.

These symptoms are variable in their severity from one individual to another. This results in the use of the term "spectrum".


Children with  autism have difficulty making sense of the world. This is mainly due to them having difficulty processing the sensory stimuli from their environment which can cause them a great amount of anxiety. the world is a confusing place for them and they are often over loaded with sounds, smells, sights, tastes and sensations that may appear vivid and extreme, disjointed, or even lacking in some way. These children will try to create some sort of order for themselves so that they can gain a feeling of security in the total chaos they experience daily. 



The difficulty they have in processing daily sensory information is referred to as Sensory Processing Disorder. It can cause a great amount of stress and anxiety as well as inappropriate or difficult behaviour. They may feel physical pain at times and find that they are unable to express this in words. They often either shut down, or react to the over load of stimuli. Sensory Processing Disorder can result in the person being hypersensitive or hyposensitive to stimuli whereby they can over react or under react to e.g. sound, touch or light.


The main areas of processing difficulties are seen when a child is hypersensitive or hyposensitive to the seven senses which are sight, sound, touch, taste, smell as well as balance (vestibular) and body awareness (proprioception) - see previous posting on Sensory Integration (1 and 2). The results of these sensitivities are seen in the person's behaviour. For example, a child with hypersensitive vision may see fragmented images, or their vision may be distorted where objects and bright lights appear to jump about. They may find it easier to focus on one spot of detail rather than take in the whole scene as this could be too overwhelming especially if it is distorted, too bright and fragmented. the child may not want to look directly and people and may often find it difficult to have eye contact. They may avoid certain rooms due to the lighting, wall colour, or objects in the room as it may heighten their sensitivity to a very uncomfortable level. The resulting behaviour often appears unrelated to anything obvious within the environment and this can result in parents and carers remaining confused and unsure how to help their child. This is an example of one of the senses, but there is often a combination of processing difficulties involving two or more senses. 




There is no cure for autism, however, there are several treatment and management approaches that can help to make a difference to the child's life. These range from simply adjusting the child's diet to a combination of therapies, behaviour interventions and self help tools. The approach taken will depend on the individual and their level of needs. Before deciding on any approach it is essential to gain sufficient knowledge of its aims. The approach needs to be positive and motivating, whilst building on the child's strengths. It should enable the child to reach their full potential for a better quality of life.






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By Sian Eckersley ( - Posted in: Sensory Integration
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