Explaining Sensory Regulation in Layman's Terms

Therapists frequently ask "How do I explain these concepts to parents?" "What is sensory regulation?"

In order to participate in our every day tasks we need a background of alertness that is created in the brain allowing us to attend, think and participate. Different tasks require different states of arousal and alertness. The state needed to watch tv is quite different from the one required for playing soccer!

The typical nervous system has the flexibility and skills to adapt and move from one state to another with ease. Many of the children we work with have greater difficulty with this ability. For some reason their brains do not have the ease of connection to alter, regulate and organize the internal chemistry of the brain or the behavior that we see.

With practice of the right type of experience, the brain can learn to REGULATE and organize itself. When there is a match between the just right state of the brain and the demands of the environment, the brain goes "AHA" and the neural nets line up. This is called state dependent learning.

The goal of therapy is to help find the "AHA" so that the child can learn to SELF-REGULATE and use thinking, sensation and the environmen t to learn to change their own behavioral state.
In my mind self-regulation is the substrate for all learning, interaction and functional performance.

Connection, Fear and Sensory Processing

This is a topic near and dear to my heart!

Studying the brain has taught me how intimately connected the sensory systems are to the emotional centers (limbic system) and the rational centers (frontal cortex) of the brain. The bucket of chemicals that lives inside the amygdala (amy for short) does not know the difference between the sensory terrifying experience of fluffies in the socks from an earthquake! Each experience is interpreted through the perception of the individual.

When our clients are sensory defensive, their experience of sensations produce a dramatic neurochemical reaction of fear in the brain that becomes "engramed" or hardwired as an experience to be avoided. This is the case no matter how silly the behavior appears.

Because our nervous systems are wired for survival, fear responses occur very quickly and often subconsciously without time for rational thought to override the chemical reaction. The autonomic nervous system is triggered into fight, flight or fright, before a neuron in the frontal cortex has even registered the idea that fluffies are silly! This is especially true for young children who have a less mature frontal cortex.

Once a fear response is hard wired, it is hard to "talk" the brain out of its response. A titrated bridge of comfort is needed that dialogues with the subconscious and lower levels of the brain feeding in information that soothes the activated "amy" fear response. Such bridges as deep pressure, heavy work, soft music, rhythm, comforting touch and therapeutic connection send messages to the brain in conjunction with the fear inducing stimulus concomittantly helping the system learn to regulate and organize in a new way. The bucket of chemicals diminishes in intensity and the client learns that fluffies aren't so bad.

Therapists often ask "How do I explain this to the client?" Validating the child's experience is essential "I know that you don't like the feeling of your socks" "It is scary for you". "Let's see what we can do to help your brain change how those socks feel." Connection, reassurance and a new plan are in place.

The combination of therapeutic use of self, attachment and just right stimulation are a blend of intervention to change the channel of the "amy" from fear to organization.

What does Hypotonia have to do with Austim?

This is another wonderful frequently asked question! As you know there are so many variations to the theme of ASD and so really we are lumping a group of children together who someday may be differentiated like apples and oranges. Motor control issues are a prevalent aspect of challenge for many children with austim spectrum disorder and increasing research is helping to validate these observations.

Researcher Philip Teitelbaum of the University of Florida, has researched early signs of autism in infants through investigation of their motor patterns. In 1998, Dr. Teitelbaum, evaluated 17 autistic children aged 4-6 months through videotape analysis. The videotapes were tapes of children made by parents long before they had been diagnosed with autism. The movement patterns of these infants were compared to patterns observed in 15 typical developing children. Every single child in the study who was later diagnosed with ASD demonstrated a motor disturbance!

Disturbances were revealed in the quality of their motor milestones; demonstrating difficulties in movements requiring rotation (turning over from lying to side), difficulties in maintaining trunk control in sitting, asymmetries of posture and floppy muscle tone!

Dr. Eric Courchesne, neurobiologist and colleagues have also performed extensive research using neuroimaging on the brain of clients with autism. These studies have emphasized a morphological differences in the cerebellum, exhibiting a cerebellum that is smaller in size and different in cellular configuration. Suggestion has been made that these alterations may in fact contribute to the subtle motor control challenges experienced by this distinct population of clients.

Teitelbaum, P., Teitelbaum, O., Nye, J., Fryman, J. & Maurer, R. (1998). Movement analysis in infancy may be useful for early diagnosis of autism. Psychology, 95: 23, 13982-13987.

Vestibular Stimulation and Seizures

The vestibular system helps us to understand the position of our head and body in gravity-bound space. It gives us information about which way is up and which direction we are going. It assists our body with balance, spatial orientation and maintaining a stable visual field, even when we are moving. Since movement is a part of everything that we do, the vestibular system is always working in the background.

Many children experience challenges in the processing of vestibular information. Some children seek out movement while others actively avoid movement experiences. Activities that assist the vestibualr system in learning balanced modualtion that contributes to daily function can be an integral component of a sensory processing program.

But what about children who experience seizures? This is a very common question asked by therapists. Typically, it is a moving visual array that can trigger seizure provocation and not necessarily the vestibular stimulation itself. Thereby, swinging, spinning and fast movement can create problems in that naturally the world is moving in relationship to the body. Rotation seems to be the greatest stressor on the nervous system and should not be used with clients who have known photic-evoked seizures, unless all of the light can be kept from the eyes. Children who seizure but do not experience a photic component to their profile can have controlled vestibular input introduced into their experience, but in a graded and slow manner that allows the therapist to carefully observe the child's reaction. Watch carefully for signs of sensory overload. These signs can occur even with the best observation and clinical reasoning. Examples of behaviors that signify overload are: yawning, changes in skin color, headache, changes in heart rate or respiration, pupil dialation, prolonged dizziness or nausea. Remember that vestibular stimulation is cumulative and that a reaction to the input provided during therapy can occur later outside of the session.

Offset over-stimulation with immediate vigorous, intensive, proprioceptive input. Such activities as

• Running, crawling or jumping vigorously around the room.
  
• Have the child place their hands on their head and press down while jumping in place. Combine with sucking vigorsously with lips sealed.
  
• Place ice cubes into the client's hands, at the base of skull and on the temples.
• Have the child push into a crash matt or wall with their entire body as hard as they can.
  
• Postion the child in prone on forearms and have them blow vigorously with resistance.

These activities are modulating in effect!

When in doubt discuss the use of vestibular stimulation with the child's physician!

Becoming A Detective

The tricky part about "reading" your patient's nervous system and their sensory needs is that this process keeps you on your toes! The difficulty with sensory diets or "programs' is that they don't always allow you to "read" the nervous system of the child in the moment. Questions like "what is the child's current state?" before you begin a sensory intervention is key in deciding which types of activities might be helpful in moving the child's state towards homeostasis. Too often when following prescribed activities, flexibility is limited in meeting the childs CHANGING needs.

Many children with autism experience fluctuations in their sensory processing. This means that their sensory needs are in flux. The effective sensory strategy on one day, can bomb completely on another day. "Being present" to the child's current state helps the therapist decide in that moment where the child may be in their overall state of arousal. Are they hypo? hyper? or over-stimulated? Remember that when children are over-stimulated, they often pass through a hyper arousal state (giggling, laughing, flushing, etc) on their way to an organized state. Perhaps calming activity needs to be continued for a longer period of time as the child passes through the hyper-aroused state transiently.

Children with autism may have a wide variety of sensory processing issues. They may have difficulty with the initial "registration" of a sensation; where the brain is unable to "notice" the feeling of that sensation. At times there is a delay in processing time of a sensation, where there is a 'kick back" or a long duration for the brain to notice the sensation. Often we continue providing a sensory experience beyond the duration necessary as we perceiving the child's sensory threshold to be high; whereas in reality, the threshold may be low, and have a long latency in time for detection. The three variables we can play with when providing an experience are frequency, intensity and duration of a sensory stimulus. How often do we provide an experience? For how long? and to what intensity? Sensory intervention is not as simple as providing a regime of sensory feedback!

Sometimes children with sensory processing challenges become excited when they are actually connected to themselves! The excitement or increased arousal that we observe may be about feeling present and in their body. This is an increase in emotional arousal resulting from experience rather than an arousal created by too much sensory feedback. Discerning this situation requires an especially fine magnifying glass. Children who seek to repeat and repeat and repeat an activity often are emotionally charged by the successful processing of the experience. "I like this feeling!"

One other situation that deserves consideration is that sometimes many different sensory interventions need to be combined together in order to "ground" the nervous system. For example, many children need to combine listening intervention with movement, deep pressure touch, heavy work and purposeful task in order for the sensation to "have meaning". Raw sensory data can "bounce around in the nervous system" without grounding or organizing the child's overall behavior. One stimulus at a time may not be sufficient to be organizing.

As ususal, one question leads to another like a road map or pieces of a puzzle. The nervous system of children with sensory processing challenges creates a wonderful opportunity to become a detective!