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August 4 2013 1 04 /08 /August /2013 08:59


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 or synchronise properly. These children will have difficulty staying alert and with 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.

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.



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January 20 2012 6 20 /01 /January /2012 21:22


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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January 19 2011 4 19 /01 /January /2011 17:19

baby-eating-apple_thumb.jpgSensory Integration Disorder

The link between the way the brain works and a person's behaviour is sensory integration. This occurs naturally in most people. After receiving sensory information about things through your five senses as well as from pain or the position of your body, your brain captures this information and reacts to your environment correctly.

Difficulty processing information from the senses is sensory integration disorder or dysfunction. The brain puts information together incorrectly from the body's senses.

Sensory integration disorders typically appear in young children. Children with sensory integration disorder display problems in learning, development and behaviour.

Sensory Integration Therapy is a form of occupational therapy in which special exercises are used to strengthen the person’s sense of touch (tactile), sense of balance (vestibular), and sense of where the body and its parts are in space (proprioceptive). These 3 types of sensory input traditionally comprise the cornerstone of the SI approach.


Tactile is the sense of touch, and is especially regulated through the more sensitive skin areas such as the hands, feet, mouth and head. It tells us about texture, size shape and temperature and helps us distinguish between threatening and non threatening touch sensations.



Proprioception is an umbrella term for the sense of body position and is involved in body awareness in space, planning and coordinating movements. This is also connected to emotional security and confidence. Proprioceptive input is sent to the brain through receptors in the muscles, joints, tendons and ligaments.


The Vestibular system is made up of sense receptors in the inner ear, as well as the fibres of Cranial Nerve VIII (Vestibulocochlear) connected to the internal brain structures. This determines the quality of balance and movement. It provides information about gravity and space, balance and movement, and about our head and body position in relation to the surface of the earth.


The ability to modulate sensory input through these three systems has a powerful impact on the development of functional skills. They affect how we regulate our muscle tone, balance, motor control, postural stability, visual perception, visual motor control, auditory language skills and attention. Sensory Integration Therapy appears to be particularly effective for helping patients with movement disorders or severe under- or over- sensitivity to sensory input.


If we look at the vestibular system in particular we can see that people with vestibular sensory integration problems often have difficulties coping with their environment. Engaging children in simple activities for both the overactive and under active vestibular system allows them to grow up into healthy adults.


Certain conditions such as autism and attention deficit disorder respond well to sensory integration therapy and improve the life of a person with either of these conditions.
 A professional trained in this area should be consulted for the best outcome.



 The Vestibular System  

 ht vestibular system 0702-copy-1


 Our sense of balance is determined by vestibular sensations. The part of the ear that is not responsible for hearing make up the vestibular system. This system detects our orientation to gravity and our movement through space even in the dark. The vestibular system helps us maintain our equilibrium while we spin, rock, sway or bend.
Additional vestibular system functions include muscle tone, and language. Changing head positions, shifting your weight, and using both sides of your body develop a good vestibular system.



 Over Sensitive To Movement

Children with overactive vestibular systems prefer slow movement, avoid risk-taking (such as climbing frames in the playground) and avoid activities that require good balance and fast movement. They are fearful of falling, elevators, going up and down stairs and being tipped upside down. There are many activities that children can engage in to help an overactive vestibular system. Some of these include gentle swinging on a swing, moving heavy objects, ‘tumbling’ or rolling down a gentle slope, slow repetitive rhythmic movements such as Tai Chi, water aerobics or swaying in a rocking chair or rocking horse. Firm pressure on the body from hugs and compression devices also help (please seek advice from a trained professional).


 Under Sensitive To Movement

These children enjoy fast spinning and swinging. They are always jumping, running and moving. They enjoy taking part in dangerous activities and move whilst sitting.

Activities suggested for these children will help their brains organize and process information more efficiently and effectively by activating the vestibular system. This will help prevent them from falling, keep body parts properly aligned, and contribute to coordinated movement.

Outdoor and indoor swings give children of every age the vestibular activity they need. Rocking toys are calming and will help a child that becomes over active with movement and other stimuli. Bouncing on a large ball improves balance. Monitor the child during any vestibular activity. Watch for signs of over-stimulation.


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December 20 2010 2 20 /12 /December /2010 11:03



Some children are sensitive, I mean really sensitive. They won’t wear their socks because the material bothers them - it's too 'scratchy' (especially the seams at the toes). They can’t get comfortable and go to sleep because their sheets feel bumpy. They pull away from you when you try to hug them. They won't get their hands messy and feel very uncomfortable if they do. Some start to developing an unhealthy dislike of public places and crowds - won't go to the cinema or use public transport. Going to the dentist is a nightmare. On the other hand some children are really insensitive, talking and shouting too loudly, heavy handed and hitting too hard, pressing too hard when writing with a pencil so the tip breaks or goes through the page, accidentally hurting others or hurting themselves by bumping into things– not out of spite, but because they don't feel their own strength and force and they can't feel self inflicted bumps unless it hurts.


If this sounds like your child, you may have tried Sensory Integration Therapy as they may have been diagnosed with Sensory Integration Dysfunction. Sensory Integration is the ability to perceive, attend, and respond to sensory information from the environment. It is the organisation of sensation for use. Sensory Integration therefore needs effective intake and interpretation for an appropriate reaction to that particular stimuli. Sensory Integration Dysfunction is therefore considered to be a disruption in the brain’s ability to organize and respond appropriately to all the sensory input. It may manifest as hyper- or hypo-sensitivity (too sensitive or very insensitive) to touch, movement, sounds, smells or taste, or a combination of any of the five. Sensory Integration Dysfunction was first identified by Dr. Jean Ayres, an Occupational Therapist who noticed children struggling with functional tasks, but who did not fit into specific categories of disability commonly used in the 1960 - 1970's.

Sensory Integration Therapy has been proven to be effective in many ways - and for some children more than others. In my experience most children benefit from Sensory Integration Therapy and I have seen very good performance results through using this therapy method. There are, however, a very small minority of children that need more input and extensive therapy sessions. It may be useful to consider alternative therapy or educational approaches in these cases. There are some alternatives to Sensory Integration Therapy (if your child is one of the "others") that works in a completely different way. One of these approaches is the Learning Rx Brains in a Box.


Alternative - Learning Rx Brains in a Box:




The thinking behind Brains in a Box in relation to Sensory Integration has been explained by imagining a kitten, asleep in a box. If you touch the outside of the box with a feather, trying to wake the kitten he may not wake up. You then take a pen and poke the outside of the box, hoping to wake him, but he continues to sleeps. Next you try to hold a hot water bottle or an ice cube up against the box, but there is still no reaction. The final thing to do is reach inside the box and touch the kitten directly. That is when he wakes up.


The Brains in a Box suggest that children’s brains are like that kitten. Sensory Integration Therapy tries brushing all kinds of different objects against the “box” that is your child’s body, in order to wake the sleeping kitten. Many things may work and resolve, but some of the problems still remain or come back once the therapy is over.


Learning Rx claims to know how to wake the sleeping kitten with specially designed brain training procedures they say actually alter the connections in the brain that cause the dysfunction in the first place. "Once the connections are straightened out, the brain is able to interpret and respond appropriately to sensory input." Click here to learn more about LearningRx brain training.


sensory integration 

There are not many known alternatives to Sensory Integration Therapy that result in the desired sensory processing outcomes, however it is refreshing to see something that can claim to be as effective for children who take longer to respond to Sensory Integration Treatment.


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