Category Archives: Sensory Integration

To Avoid or to Expose: That Is the Question

To Avoid or Expose: That Is The Question

By Michaela Gordon, OTR/L

As occupational therapists, we spend a great deal of time thinking about how the nervous system receives, processes, integrates, and responds to sensory information.

 

For some individuals, ordinary sensory experiences can be overwhelming. A loud classroom, fluorescent lights, certain textures, movement, touch, smells, or visual stimulation may push the nervous system beyond what the person can comfortably manage. When this happens, we often make accommodations: we turn down the lights, reduce background noise, provide noise-canceling headphones, modify clothing, decrease visual clutter, or help the person move into a quieter environment.

 

These accommodations can be incredibly important. But there is another approach.

 

Rather than always reducing sensory input, occupational therapy can also work toward improving a person’s ability to process and integrate sensory information. Through carefully selected sensory experiences, graded challenges, repetition, and active engagement, we can sometimes help a person develop greater capacity to respond to sensory information.

 

So which approach is correct? Should we avoid sensory input, or should we expose someone to it? I believe the answer is both.

 

The more important question is not whether we should avoid or expose. The question is when, how much, and for what purpose?

 

The nervous system is designed to adapt. One of the most fascinating characteristics of the nervous system is its ability to change in response to experience.

 

Neuroplasticity refers to the brain’s capacity to change its structure and function in response to experience, learning, environmental demands, and sensory input. Research has demonstrated that sensory experience plays an important role in shaping developing neural systems, particularly during sensitive periods of development. Research has also found that sensory deprivation and altered sensory experiences can produce measurable changes in neural organization.

 

This raises an important question for sensory processing: If the nervous system can adapt to the sensory experiences it receives, what happens when certain sensory experiences are consistently removed?

 

There is a theory that when sensory input is provided at a certain level of intensity and frequency over a duration over time, the repeated sensory experiences may contribute to neuroplastic changes in the nervous system. In other words, the nervous system can learn from what it repeatedly experiences.

 

With carefully graded sensory input, we may be able to create opportunities for the nervous system to develop and strengthen neural connections and more efficient ways of processing and responding to sensory information.

 

This is one of the principles underlying sensory integration therapy.

The goal is not simply to expose someone to more sensory input. The goal is to provide the right sensory experience, at the right intensity, with the right frequency and duration, while keeping the challenge within a range that allows the person to remain regulated and engaged.

 

Over time, repeated experiences may support adaptation and more efficient sensory processing.

 

I am not suggesting that accommodations cause sensory sensitivity. The research does not establish that. But exposure is not the same as flooding. This distinction is critical.

 

If a child is extremely sensitive to sound, putting them into an extremely loud environment and telling them to “get used to it” with no defined beginning or end or support is not what I mean by therapeutic exposure.

 

In occupational therapy, we are often trying to find what I would call the just-right challenge.

 

The challenge needs to be meaningful enough to encourage adaptation, but manageable enough that the person’s nervous system can remain engaged. This might mean front loading the person so they know their system will be challenged and what to expect. This might mean starting with a very small amount of sensory input. It might mean changing the intensity, duration, or context of the experience. It might mean providing another sensory input that helps the person organize themselves. And it might mean using an accommodation while simultaneously working toward increasing capacity.

 

The goal is not to force tolerance, but to build options.

 

So what happens when we only accommodate? Accommodations are not inherently problematic. In fact, accommodations can be essential. If a child cannot tolerate the sound of a fire alarm, providing hearing protection may allow that child to participate safely in school. If fluorescent lighting causes significant distress, changing the lighting may allow someone to remain in a classroom. If a person becomes overwhelmed in a crowded environment, reducing the sensory load by limiting the amount of time in that environment may allow them to participate in an activity that would otherwise be inaccessible.

 

These are meaningful occupational outcomes, but I think we should also ask another question: Could an accommodation sometimes become the only strategy, when there is an opportunity to build greater capacity?

 

There is emerging research examining sensory accommodation in families of autistic children and children with sensory over-responsivity. Accommodation can reduce distress and help families function, but researchers have also raised questions about whether extensive accommodation can sometimes limit opportunities for coping and adaptation.

 

Again, this does not mean that accommodations are bad. It means that we should consider their cost and benefit.

 

-What is this accommodation allowing the person to do?

-What is it helping them avoid?

-Is the accommodation increasing participation?

-Is it reducing unnecessary suffering?

-Is it providing a bridge toward greater independence?

-Or has it gradually narrowed the person’s world?

 

These are very different questions.

 

We can learn something from sensory deprivation research. Research on sensory deprivation provides another interesting perspective.

 

We know from developmental neuroscience that sensory experience plays an important role in the organization and refinement of the developing brain. Severe deprivation during critical periods of development can alter the development and organization of sensory systems. Research has demonstrated that enriched and deprived sensory environments can produce different structural and functional changes in the developing nervous system.

 

This does not mean that a child who wears headphones in a noisy classroom is experiencing “sensory deprivation.” That would be an inappropriate comparison. The situations are vastly different. However, these studies reinforce a broader principle: The brain develops and adapts in relationship to the experiences it receives; therefore having experiences is very important.

 

And that is one reason I believe it is worth asking whether we are providing enough opportunities for people to experience the sensory world in ways that are safe, meaningful, and appropriately challenging.

 

Sensory integration is about more than tolerating sensations. When sensory integration therapy is provided thoughtfully, the goal should not simply be: “Can I make this child tolerate something they don’t like?” The goal is much broader. The questions we can ask are:

 

-Can the child participate more successfully in school?

-Can they play with peers?

-Can they tolerate movement?

-Can they manage the sensory demands of getting dressed?

-Can they participate in family activities?

-Can they remain organized when the environment becomes more stimulating?

-Can they recover more efficiently when they do become overwhelmed?

-Can they develop greater flexibility in how they respond?

 

The answers to these questions determine the person’s occupational goals.

 

And recent research provides encouraging evidence for this approach. A 2025 systematic review of randomized controlled trials found strong evidence that Ayres Sensory Integration® supported autistic children in achieving individualized goals related to occupational performance, function, and participation. A 2026 systematic review of occupational therapy interventions using Ayres Sensory Integration® similarly concluded that there is good evidence supporting its use to improve participation in everyday activities for children with sensory integration and processing challenges.

 

Importantly, these studies do not suggest that sensory integration is a treatment for every behavior or difficulty. Rather, they support its use for individualized functional goals.

 

Therefore, the answer may be neither avoidance nor exposure. Perhaps the real answer is what combination of accommodation and direct intervention leads to the person’s best ability to adapt.

 

Sometimes adaptation means changing the environment. Sometimes adaptation means helping the person develop greater capacity. Sometimes it means both. For instance, a child may need headphones today, but that doesn’t necessarily mean they will need headphones forever. The plan may be that the child wears noise-canceling headphones during specific times of the day, but then engages in a therapeutic music program to improve their ability to process auditory input over a course of time.

 

There is no universal sensory prescription. The right approach depends on the individual.

 

We need to consider the person’s:

  • physiology
  • sensory patterns
  • developmental level
  • cognitive flexibility
  • emotional regulation
  • ability to communicate
  • adaptability
  • personality
  • environment
  • occupational demands
  • values
  • preferences
  • goals

 

Most importantly, we need to ask what the person wants and needs to be able to do.

 

If someone has no desire or functional need to increase their ability to adapt to a particular sensory input, perhaps there is no reason to make that a therapeutic goal.

 

But if sensory sensitivity is preventing someone from going to school, eating in restaurants, traveling, participating in family events, working, sleeping, playing, or engaging in meaningful activities, then expanding sensory capacity may be incredibly valuable.

 

The conversation should never be one-time. I think this is where occupational therapy has an important role.

 

We should continually ask:

-What is helping?

-What is limiting?

-What is this person ready for?

-What is too much?

-What might be a meaningful next challenge?

-What accommodations are necessary?

-And what capacities might we be able to build?

 

The answers can change.

 

A child who needed extensive accommodations six months ago may now be ready for a new challenge. A child who was tolerating an activity may suddenly become overwhelmed because the environment changed, their sleep changed, their health changed, or the demands increased. A person may need more protection during one period of life and more challenge during another.

 

So, should we avoid or expose? Maybe the better question is: What does this person need right now to participate successfully—and what might help them participate more fully in the future?

 

An accommodation can be a destination, but it can also be a bridge while we offer other types of therapeutic interventions. The art of occupational therapy is knowing the difference.

 

And sometimes, the most appropriate answer is not to choose between the two, but to use both.

 

References

Acuña, C., Gallegos-Berrios, S., Barfoot, J., Meredith, P., & Hill, J. (2025). Ayres Sensory Integration® with children ages 0 to 12: A systematic review of randomized controlled trials. American Journal of Occupational Therapy, 79(3). https://doi.org/10.5014/ajot.2025.051023  

Piller, A., Glennon, T. J., Andelin, L., Auld-Wright, K., McHugh Conlin, J., Teng, K., & Tarver, T. (2026). Occupational therapy interventions using Ayres Sensory Integration® for children and youth (2015–2024): A systematic review. American Journal of Occupational Therapy, 80(1). https://doi.org/10.5014/ajot.2025.051130  

Green, S. A., Hernandez, L., Lawrence, K. E., Liu, J., Tsang, T., Yeargin, J., Cummings, K., Laugeson, E., Dapretto, M., & Bookheimer, S. Y. (2019). Distinct patterns of neural habituation and generalization in children and adolescents with autism with low and high sensory overresponsivity. American Journal of Psychiatry, 176(12), 1010–1020. https://doi.org/10.1176/appi.ajp.2019.18121333  

Bengoetxea, H., Ortuzar, N., Bulnes, S., Rico-Barrio, I., Lafuente, J. V., & Argandoña, E. G. (2012). Enriched and deprived sensory experience induces structural changes and rewires connectivity during the postnatal development of the brain. Neural Plasticity, 2012, 305693. https://doi.org/10.1155/2012/305693  

Nwabudike, I., & Che, A. (2024). Early-life maturation of the somatosensory cortex: Sensory experience and beyond. Frontiers in Neural Circuits, 18, 1430783. https://doi.org/10.3389/fncir.2024.1430783  

Ben-Sasson, A., & Zisserman, A. (2025). Sensory family accommodation for autistic and sensory overresponsive children: The mediating role of parenting distress tolerance. American Journal of Occupational Therapy, 79(3). https://doi.org/10.5014/ajot.2025.050790  

 

Enjoying the Holidays With Your Neurodivergent Child

Enjoying the Holidays With Your

Neurodivergent Child

By Michaela Gordon, OTR/L

It is that time of the year again. Summer is behind us and we have entered the fall and winter seasons. The clocks have turned back and the weather has cooled. If that isn’t enough change, most of us celebrate 4 holidays up to the New Year! That is a lot of change! As much as we enjoy communing and celebrating, the holidays do come with some level of stress. This can be especially challenging for our neurodivergent children. Whether your child has ADHD, Autism, Anxiety or Sensory Processing Disorder, it is important to consider everyone’s needs as you make plans during this holiday season so everyone can enjoy themselves.

 

Here are some holiday suggestions so you can plan ahead:

  1. Try to stick with your self-care schedule as much as possible. Kids generally do best, when they stick to their daily self-care routines. It can be an anchor at the start and end of their day to re-center them. This means going to bed and waking up at the same time, eating balanced meals at regular times, and brushing teeth and bathing at regular times.
  2. Bring familiar items with you if you won’t be at your house. Again, the holidays come with a lot of novelty and this sometimes can overwhelm kids. You can consider bringing toys, blankets, books, food, or anything else that will make the child feel more comfortable while visiting friends and family.
  3. Share with your kids the events that will happen and also discuss what you don’t know to allow for some flexibility in their thinking about the novel events. It can be helpful to let kids know what activities they will be doing and who they will be doing them with. Showing them pictures of places and people can also be helpful. It’s really important to also let them know about the unpredictable by using “maybe” or “might” statements. Example: “We are going to your Aunt Margaret’s house for Thanksgiving. We are going to leave after breakfast and it will take 3 hours to get there. When we get there, you can go out and play in the yard and then we are all going to have dinner together. Some things might happen that we don’t know about. We might get stuck in traffic or it might rain. We will come up with a new plan if that happens.”
  4. Have an exit plan if needed. Sometimes things just become too much, even when we have tried our best to make sure the holidays as successful as possible. This means you may have to arrive a little later than expected or leave a little earlier to reduce the stimulation and demands that are becoming too much for your child. You can also go into a quieter room to do a preferred activity or go outside for some movement and fresh air.
  5. Know your child’s tipping point. Some kids can handle lots of treats, candy, screens, and high intensity play, and then return relatively quickly to a calmer state, while for other kids, that can send them right into a spiral, turning a fun event into a sad ending. You know your child best so even though it’s supposed to be a fun, care-free experience, you may have to put a limit on items and activities that historically cause overstimulation.
  6. Ask for support and help. You don’t have to do the holidays alone and bear through them. Ask the people you trust for help. It might be helpful to have a conversation before you arrive about what your child’s needs are so that family and friends can be prepared ahead of time. Whether it is making them special food, playing with your child while you socialize, turning down the music, or not insisting on a hug, asking for support can make the day a lot more enjoyable.

 

May you all be safe, healthy, and joyful this holiday season!

What is Dyspraxia?

What is Dyspraxia?

By Michaela Gordon, OTR/L

You most likely understand a therapist when they use the terms coordination, balance, and strength. However, do you understand the term praxis or dyspraxia?

 

Praxis can be broken down into three steps. Before a child can perform a motor action, two cognitive steps occur. The first cognitive step is ideation. Ideation is the ability to come up with new ideas for using your body and objects. In other words, is the child able to figure out what to do when they are presented with something new?

 

The second step is motor planning which involves planning out the sequence of motor steps to accomplish a task. Part of motor planning includes the timing of each step and getting the body into the various static and dynamic positions for each step moment by moment. In other words, now that the child has an idea of what they want to do, do they know how to put that idea into action in a timely and fluid way?

 

After these two cognitive steps have occurred there is then motor execution. Motor execution is the observable result of all these steps. In other words, was the child able to accomplish the task, and if so, was their performance within a range appropriate for their age?

 

The concept of praxis may be confusing for parents to understand if their child presents with high verbal skills or a vivid imagination but also presents with poor ideation in praxis. Ideation in praxis is specifically coming up with new ways to move or use the physical body in the physical world.

 

The other variable that may be difficult for parents to understand is the difference between praxis and motor patterns. The reason this can be hard to understand is because your child may be able to perform and even sometimes excel at one or more motor tasks i.e. riding a bike, or playing tennis, but then may not be able to perform a new motor task, even if that task is easier than the other tasks they excel at. Praxis requires focused attention in order to conceptualize and plan the novel task. The child’s level of praxis will not be revealed until the child engages in a novel task.

 

A motor skill (or a motor pattern) is a task that is familiar and has been repeated many times to the point that the motor pattern has become programmed into their muscle memory. When this happens, the child can perform those motor patterns automatically. For some children, if an element of a familiar task has been changed i.e. a longer rope, a smaller ball, someone else joins in, the task is done in a new environment etc., this may be enough novelty where praxis is needed and the child may have difficulty performing the task or may simply refuse to engage in the task. 

 

One important contributor to the development of praxis is body scheme, which is a sensory-cognitive map of the physical self. Body scheme is developed through multisensory information with tactile and proprioceptive processing (sometimes referred to as somatosensory) being the biggest contributor to body scheme. Body scheme provides the child with physical safety to explore their environment, the ability to connect with the social world, to learn and develop motor skills, to refine movement, and influence regulation.

 

Issues with praxis may be referred to as motor planning issues or dyspraxia. Dyspraxia means difficulty with praxis even in the presence of normal intelligence and environmental opportunities. Somatodyspraxia means praxis issues that originate from issues with body scheme due to inefficient tactile and proprioceptive processing.

 

If praxis issues are present, it may take regular practice over a period of time to learn simple tasks and the child may need to re-learn the task on some level each time. Dyspraxia is easier to determine as occupational therapy services and programs are implemented since you often see this issue when the child is engaging in a novel task or engaging in tasks within a novel environment.

 

Dyspraxia can be addressed through sensory integration treatment and other sensory-based modalities.

Environmental and task modifications may need to be made at home and school to support the child while they build up their praxis skills. The child may also benefit from using cognitive strategies so they can better manage challenging tasks on their own. Lastly, engaging in a daily home program that supports the development of their sensory-motor skills is both important and helpful for long-term results.

What is Sensory Regulation?

What is Sensory Regulation?

By Michaela Gordon, OTR/L

Sensory regulation is the brain’s ability to turn sensory signals up or down to adapt and respond appropriately to everyday events.  

 

Similar to a thermostat, people tend to have a baseline that reflects their general energy levels. A person can tend towards a low, moderate, or high energy level depending on how their brain is regulating sensory information. This general baseline gives us an idea of the person’s ability to regulate sensory information.

 

Even though we all have different energy level baselines, that doesn’t mean we never shift into the different types of energy states. To be adaptable, you want to shift from one state to the other based on the situation you are in. For instance, if you are excited and social while at a party, then that would be an appropriate energy level for that situation. However, if you are trying to go to bed, then that higher energy wouldn’t be helpful to you.

 

For the person with a moderate energy level as their baseline, it’s easier for them to regulate sensory information and respond to daily stressors. However, if a person tends to have a lower energy level that doesn’t rise much or if a person tends to have a higher energy level that doesn’t lower much, that might affect their performance, their feelings about themselves, and their relationships with other people. If this is happening, then typically it would be good to see an occupational therapist to help them build their sensory regulation skills because their difficulty with sensory regulation is impacting their quality of life.

 

The goal of improving sensory-regulation skills is not to stay in an even energy state at all times. It is also not to change the person’s personality. The goal is to teach someone to monitor their energy levels as they go about their day and then use specific tools to return to an optimal state for the situation they are in while still being their wonderful selves. 

 

Another important note is that sensory regulation is just one piece of self-regulation. Self-regulation is the ability to regulate both sensory information and our emotions. Other parts of the brain help us regulate our emotions and help us make decisions. 

Sensory Processing: Your Online Brain Store

Sensory Processing: Your Online Brain Store

By Michaela Gordon, OTR/L

The brain is a complicated organ that we continue to study and understand. Sensory processing is a complex process that occurs in the brain. I wanted to come up with a simple way to explain the process.

 

To do this, let’s think of our brain as an online store, the sensory information as the products available to order, and the packages as what is sent out for delivery after an order has been made.

 

Normally on the store’s website, there are pages of different types of products made for different uses.  Some of those “sensory products” will come from our environment such as sight, sound, touch, taste, and smell. Some of the sensory products will be “store brand products” coming from inside the body such as movement from the inner ear, proprioception from the joints and muscles, and interoceptive input, which is the felt sense that tells you what’s happening in the body like temperature changes, hunger, thirst, needing the restroom, etc.

 

The sensory products are scanned and selected by the person as they go about their day. Some of these sensory products are hand-picked such as “you may like” while others are just there and you must shift through what is relevant for you and what is not.

 

The sensory order gets sent through the brainstem, which is the main delivery route for sensory products (except for smell which has its own special delivery), and then gets dispersed to the various departments of the brain store.

 

Once that sensory order has been placed, the brain then has to look at that order to see what’s on the list, determine what those items are, and what they mean. Special instructions are then created that will go into the delivery package with the sensory products so the person knows what to do with the products once they are ready to use them.

 

Now the brain is a very savvy business owner and committed to being environmentally conscious, so it’s not going to send you out one package at a time with one product. The brain is going to put all the products together with the best instructions on how to use these products in combination. 

 

Once you receive your package, you open it and use the products to take action. The items in the package along with their special instructions will help you to take action with your body, engage in daily activities, and socialize with those around you. In other words, these are the things you need to interact with your environment.

 

As you interact with the environment, you go back to the online store where you continue to browse, purchase, and use the sensory products. This is a continual cycle that keeps you hopefully living your best life!

 

Everyone has their own unique “online brain store” that will dictate what products are available and how efficient the brain store is with managing incoming orders, communicating between departments, and providing you with the best-delivered products with instructions possible.

 

Pediatric occupational therapists are trained to analyze an individual’s online brain store and how it is functioning so we can make sure their sensory shopping is a pleasant and effective experience!

 

 

 

 

Lessons From Zoey

Lessons From Zoey

By Michaela Gordon, OTR/L

If you asked me 3 years ago if I would be an author, I would have most definitely have said, “No way!” It started very innocently. A child I was working with was struggling with her friend. The more she tried to connect with her, the more her friend pulled away. We discussed that our energy takes up space, other people can feel our energy, and sometimes it can feel too much, even when we have the best of intentions. I explained that if she just made her energy a bit smaller, her friend might feel more comfortable, and they could spend more time together. 

 

I thought these points were important to understand. I often use books and activities to further explain concepts to the kids. The trouble was I couldn’t find anything explaining how our energy takes up space and how people feel that energy, so I wrote her a story. The child liked the story and it helped her. I had some other kids that I thought would also benefit from this concept so I read the story to them. They also liked it. A handful of parents mentioned I should publish the story and with enough encouragement, I decided to start the publishing process. 

 

From there, it was a long windy road to self-publishing. I had no idea what I was getting myself into! My years of being a novice occupational therapist were several decades behind me, but when it came to writing and publishing a book, I was right back at the starting line and the race to the finish line has not linear, but a course with winding roads, hills, and let’s be honest, sometimes I felt like I was climbing a mountain! Don’t believe me? Just take a look at the picture above and the final cover of my book and you can get a sense of where I started!

 

I bring up this point because it is important to know that something being hard and not being good at it right away, does not mean you shouldn’t do it or that you aren’t capable. Even if you never master that one thing you put so much effort into, there is something about challenging yourself and continually learning that can be highly valuable in discovering more about yourself. 

 

Here are things I learned from writing Zoey and Her Amazing Energy Bubble! and what I’d like to pass on to you:

  1. Let life surprise you! Every time I think I have life figured out, it decides to shake things up for me! Having no idea what I was doing during this process, I had to just trust the steps I could see in front of me, hoping the next steps would reveal themselves as I went along. I am still in the process as I approach the launch of my book at the end of the week and I navigate what happens next. I am not too sure you ever get to the end of anything, but maybe that is ok. What matters is that you are taking those steps forward!
  2. Expand your I am (fill in the blank). You are constantly discovering who you are through your experiences. Challenging yourself with new experiences keeps you open to who you could be. I am a writer. Even though I write all the time as a therapist, I didn’t consider myself a writer, but now I do! I never thought I’d be a publisher, but I am now! I didn’t think I could make and edit videos for social media. Now I can! I had no idea I had that in me. What do you have hidden inside of yourself?
  3. Look for your helpers. I had a mix of experiences along the way. Some people were so incredibly helpful and others were not. Although I don’t like to admit it, even the people who were not helpful to me, were an important part of the process because I learned important things about myself and it strengthened my discernment to make better future decisions. Of course, we love it when we find our village. Those people who understand us and support us in reaching our goals. I was so fortunate to have connected with some amazing people with whom without their help, my book wouldn’t have existed. Don’t let bad interactions stop you and keep looking for those helpers!
  4. Step towards your fears when you are called to action. At first, I wrote this story for one child. Then that turned into multiple children. Then I thought I would publish this book and then whoever happened to randomly find it, could enjoy it at their leisure. What I didn’t know was that it was time for me to come out of my comfort zone and speak up. I know for the energy bubble concept to be powerful, it needs to be learned by all kids. It’s time we start to teach the concepts and tools we teach to our neurodiverse children to their peers as well. It is time a time when accommodation is just not enough for many of our children. Inclusion can’t happen unless peers are helping peers. It is time we have books that explicitly teach social-emotional skills so that we don’t leave behind the kids who won’t get the hidden message in many children’s books. We can all help in our own ways to make the changes we wish to see in the world around us. Zoey is a vessel for me to be a voice for kids of all abilities on a level I couldn’t have imagined 3 years ago. When the opportunity comes, take action! If not you, then who?
  5. Be a good model. I ask kids all the time to do hard things and they tell me they can’t, all the time. It is so rewarding to watch them overcome obstacles and gain skills to become their best selves. I think it’s really important for us to show them through our actions that we too are doing hard things. Let’s talk about it, let’s work through it, and let’s celebrate each other as we navigate through the challenges we face in life!
  6. Use your gifts to help others. No matter your gifts and talents, they are needed. There is something about you that no one else possesses. Sometimes we take our gifts and talents for granted, assuming that everyone has them, but that is not true. It might not always be clear what we should be doing, but if it’s helpful and feels right, then pursue it. 
 

I hope Zoey and Her Amazing Energy Bubble! has a positive impact on those who read it. I hope the concept helps them understand themselves better and helps them feel empowered to manage what shows up in their day. I hope this concept promotes healthy relationships with others and builds a sense of compassion for each other’s needs. Learning to co-regulate is one of the most important things to learn in life. When we can co-regulate, we can create healthy living with one another. 

 

 -Michaela E. Gordon, OTR/L

Cleaning up the facts about The Wilbarger Deep Pressure Protocol (Therapressure Protocol)

 

 

  At my first job, I remember seeing these white brushes. I knew they were for some sort of tactile stimulation, but I did not use them with students. I moved to CA and here, I would also find the white brushes! I was shown the protocol at an in-service. I didn’t fully understand the neurological underpinnings of the protocol, but I thought this was a great tool, so I started using it with clients.

 

I later realized after taking the class, it is really important to go to the training because you need to learn about the mechanism of pressure, which is difficult to conceptualize from verbal or written directions. Also, when I trained families in delivering the protocol, I typically had to review the technique with them 2-3 times before they could execute the procedure in an effective way on their own at home.

 

I was excited when Pat Wilbarger and her daughter Julia were coming to the area to teach the neurological foundations and the application of their protocol. Pat was one of the first pioneers in the field of sensory integration and she created this protocol to help children with sensory defensiveness. Sensory defensiveness is when the brain perceives non-threatening sensory signals as a threat, causing chronic, undue stress to the individual. During the class, Pat said something that helped me to truly to understand the importance and intent of the protocol. She said, “This sensory defensiveness is serious stuff! This is a matter of quality of life for these people so you really need to understand what you are doing.” It’s a matter of quality of life. I will never forget that. It’s a matter of being able to function in the world and being able to let others close to you. It matters.

 

There are lots of misconceptions about the Wilbarger Deep Pressure Protocol from its purpose to its details. I am hoping to clear some of these misconceptions up. First, the protocol is often called the “brushing protocol”, which sometime leads both non-trained professionals and non-professionals to miss the objective of the protocol, which is to provide pressure. Some individuals also confuse “brushing” with lymphatic dry brushing, which is surface, light-touch brushing with a different type of brush, which is counter-productive to addressing sensory defensiveness. Pat developed a specific brush where the bristles are a particular shape and texture as well as a rounded handle to ensure good delivery of deep pressure. This pressure is without scratch, tickle or itch.

 

Second, the purpose of the brush is to apply specific PRESSURE to the skin. It is not light touch or a massage. It is all about specific pressure. The brushing procedure is followed by joint compressions, which is also specific PRESSURE delivered to the proprioceptive (joint/muscles) system. Doing both is important so the brain can properly interpret and integrate the messages from the sensory signals. The tactile stimulation is given with pressure, but even so, can over-arouse the system. The joint compressions that follow are given to provide grounding input without overstimulation so the individual can benefit from both types of stimulation.

 

I often get complaints about the frequency the Wilbarger Deep Pressure Protocol has to be delivered, which is to be performed every 1.5- 2-hours throughout each day for at least 4-6 weeks or until symptoms resolve. I can assure you that this is not to torture you or your child. If you want to change physiology, the body needs consistent input that is delivered at a specific frequency and duration over time. So the more you can follow the protocol, the more likely your child’s physiology can shift.

 

Another missing piece is the sensory diet. This is Pat Wilbarger’s coined termed for providing other types of sensory inputs throughout the day along with the therapressure protocol. Again, we are looking to shift sensory input into informative data versus false alarms that puts the individual into distress. The person needs an opportunity to get organized input on their own in conjunction with the therapressure protocol that is delivered by an adult or themselves. Individuals with sensory defensiveness are often avoidant or distressed by daily activities so they do best with predictable, planned sensory activities. Over time, the person will be more likely to seek out and engage in a variety of activities that fulfill their sensory needs. However, until their physiology changes, they will need support and encouragement.

 

It must be noted that Pat Wilbarger figured out something remarkable. While working with her friend and colleague Jean Ayres, she realized that some of these children were avoidant of treatment versus naturally gravitating towards sensory stimulation that met their needs. Pat was also able to determine that the timing of sensory input was important. Her clinical findings indicated that children generally needed to be engaged in sensory input every few hours in order to keep the integration process going. Due to this discovery, she realized that it wasn’t enough to treat a child just in a clinic, but sensory stimulation needed to be continued in homes and schools. That is why it is important for parents, therapists, schools and other adults in the community working with the child to communicate in order execute the sensory diet and therapressure protocol. As they say, “It takes a village!”

 

So do the sensory diets and the therapressure protocols require some planning and effort? Yes. Can it feel stressful and at times tedious? Yes. However, I think the missing link is that parents, teachers, therapists etc. may not have gotten the message I received and that is, “This sensory defensiveness is serious stuff! This is a matter of quality of life for these people so you really need to understand what you are doing.” I think when we keep the intent of what we are trying to achieve out in the front, it keeps us on track. We do the best we can to deliver consistency to the defensive/avoidant individual. We do our best to come up with a plan that can be realistically implemented. It doesn’t need to be perfect. The goals just needs to be clear and we have to keep working at it.

Pat Wilbarger has absolutely left her mark on this earth. Both she and her daughter Julia have gone all over the world delivering their knowledge and expertise on sensory defensiveness. I have seen with my own eyes the difference this method can make for individuals with sensory defensiveness. They regain confidence and joy. They begin to understand themselves and connect with others.

 

A thank you to Pat and Julia Wilbarger for all they have taught me and the rest of the OT community.

“Never doubt, that a small group of thoughtful, committed citizens can change the world; indeed, it is the only thing that ever has.” -Margaret Mead

Michaela E. Gordon, OTR/L

You Don’t Know How It Feels To Be Me!

 

 

    Do you ever hear a kid say, “You don’t get it. You don’t know how it feels to be me!” That is the truth. We don’t know what it feels like to be them. We can only empathize and try to relate based on what we are experiencing. When it comes to sensory defensiveness, children are over responding to sensory input, which causes a fight, flight, or freeze response. It is not necessarily the actual stimuli that is the issue, but rather the way the sensory signal is being processed when it reaches the higher level pathways of the brain.

 

 

We all have some degree of sensory preference and sensitivity. And some sensitivity is good. If you were walking across a street and noticed that a car was both close and coming at you, it is a smart move to run as quickly as you can! However, if you are walking across the street and you hear a car way off in the distance, but your brain says, “Run, you are about the get hit!” when that is not the case, then the brain has just sent you a false alarm, which can be confusing and distressing. If the brain is constantly misinterpreting  non-threatening sensory input as a danger, this can impact the child’s confidence while interacting with the world and can give them a sense that the world around them isn’t safe and at the very least, uncomfortable.

 

 

Here are the types of sensory defensiveness one might be feeling:

 

      1. Tactile defensiveness. This is the most recognized type of defensiveness. These children have strong reactions to touch information. They may complain about hygiene routines. These complaints can include brushing their teeth or hair hurts, bathing is uncomfortable, clipping their nails or getting a haircut is painful. These children complain about their clothing, refusing to put on their socks and shoes or only wanting to wear a specific piece of clothing. These children may also have difficulty with accepting touch from others so they avoid hugs or they will report that others have hurt them because normal touch felt like a push or some other assault.
      2. Auditory defensiveness. This is also a widely recognized sensitivity. These children put their hands over their ears to block loud noises. They may refuse to go into public places or use the restrooms because of loud sounds like music or the toilet flushing. These children may be bothered by everyday sounds at home and school so they avoid situations, have meltdowns, or become aggressive due to the noise.
      3. Movement defensiveness. In the OT world, we call this gravitational insecurity where the child develops great anxiety when experiencing movement. These children do not feel comfortable moving through space, especially if their feet leave the ground. In babies, they may be fearful to stand or walk. In toddlers and children, you might see them avoiding riding their bikes, climbing playground equipment or using swings. These children usually crawl upstairs versus standing. You will often seem them keeping both their hands and feet on the ground when scared or unsure. They often cling onto parents and teachers for dear life and can’t bring themselves to go enjoy play with the other children.
      4. Visual defensiveness. These children are often sensitive to light. They may ask to turn the lights off or you’ll see them squinting or rubbing their eyes.  Their parents may need to put a screen up in the car to block the sunlight. These children may become overwhelmed with fast moving environments or fast moving television shows. These children can be easily startled by visual stimulation, especially peripheral stimulation they weren’t expecting.

    If you are someone without defensiveness, these scenarios may not make sense to you. Perhaps you are a good integrator of sensory stimulation, but your child or student is not. Instead of the sensory signals informing the various parts of the brain in a rational way so the child can learn, play, and relate, these signals are heading right to the watchdog of the brain, the amygdala. The brain tells the child, “Danger, danger! You must protect yourself!” These constant false alarms can be overwhelming over time and can impact the child’s emotional well-being and their ability to participate in everyday life tasks. It can take a toll on relationships and make the child feel like there is something “wrong with them”. So when a child says, “You don’t know how it feels to be me,” you may want to answer, “You’re right, I have no idea how it feels to be you AND we are going to figure out how make this better.” In other words, we are going to figure out how to get your brain and body working in a more integrated manner.

     

     

    Here’s the good news! We know that using sensory integration treatments and tools, we can retrain the brain to better understand the sensory signals so they are correctly informing the child as they interact with the world. Several things need to happen in order for this to be accomplished. The right tools need to be identified, the tools need to be implemented with frequent consistency, and the child needs to want to participate on some level. If that can happen, it is amazing how the nervous system can shift and the defensiveness can either be reduced and in some instances completely resolved.

     

     

    It is an honor to help children overcome these challenges. It can really have such a positive impact on their quality of life, yielding to a more comfortable and confident child. If your child or a child you know presents with sensory defensiveness, I encourage you to get them to an occupational therapist.

     

     

    “Dwell in possibility.” Emily Dickinson

    Michaela E. Gordon, OTR/L

     

    Craniosacral Therapy

     

     

           When I was younger, I attempted to run from my brother as he dragged his feet across the carpet and touched my arm, giving me an electric shock. It amazed me that in seconds he could just zap me with his finger! Another childhood memory was having sleepovers with my friends. We would all wake up with our hair standing straight up from the static from our sleeping bags. Later in life, I was training for a marathon swim. I was with a group and we swam about 1 mile off shore. A storm quickly moved in, with thunder soon following. I was concerned about what was to come as I knew people in water and lighting was not a good combination! We luckily arrived at shore with no time to spare. Lighting was cracking directly over the water and we were thankful not to be the conductors!

     

    In 2011, a chiropractor had given me a craniosacral therapy book and a massage table and said, “Here, I think you’d be really good at this.” I hadn’t a clue what craniosacral therapy was, but after briefly looking through the book, I thought it was interesting so I decided to take a class.

     

    What I learned was that craniosacral therapy is a hands-on technique that uses light touch to access the membranes around the spinal cord and brain to release restrictions and improve the circulation of cerebral spinal fluid. Improving the function of this craniosacral system can positively influence the functioning of the whole body, which results in better health, reduced inner stress, and access to your body’s own inner wisdom.

     

    Initially, I was apprehensive about the technique because it was so light and the measurement of change is more qualitative than other techniques I had learned over the years. However, as the instructor reviewed the structure of the body, the power of the nervous system, and the electrical exchange between the therapist and the client, I started to realize the what I had naturally experienced in the past, and the information that was being provided during the course, are really one and the same.

     

    I think what I found most interesting about craniosacral therapy is the idea that you access change through electromagnetic fields. There are an estimated 100 billions neurons (nerve cells) in the human brain. The human body conducts electricity. Everything that conducts electricity has an electromagnetic field. The human body has over 50 complex electromagnetic fields. The hands have 13 picoamps of electricity that can come off of them at one time. If electricity comes off the hands, then we can energetically influence other things we conduct with, including other humans. That is pretty mind blowing if you ask me! As a human and as a practitioner, I felt compelled to explore the possibility of influencing the nervous system through this hands-on approach.

     

    Can we create changes in the nervous system through light touch on parts of the body, specifically the spine and skull? I do believe we can and I have clinical observations and client feedback that support this belief. The results I have seen have been effective and positive. Children with hyperactivity have been able to transition to a state of calm. Children and adults with anxiety have been able to manage everyday stressors with better success. Children with decreased coordination have demonstrated improved motor skills. Babies with poor latches, colic, and physical restrictions are able to eat, interact, play, and sleep with greater ease. In one instance, a child with a seizure disorder had cessation of seizures according to pre and post testing by the neurologist and with no other new treatments occurring at that time.

     

    As humans we innately want to connect and to interact with others and the things around us. When an infant, child, or adult presents with a dysfunction within the nervous system, it influences their choice of interaction and their experiences. The dysfunction can lead to a whole host of issues impacting quality of life or perception of life. Cranial sacral therapy is just an example of how we can help nurture a person’s nervous system as a means of improving quality of life and understanding one’s self. Some individuals may find these types of therapies abstract as they are not commonly heard of in the general population. However, when we can connect these abstract concepts to common experiences such as electric shocks from touching something after rubbing your feet on a carpet or avoiding water when lighting storms are approaching, we can allow ourselves to open up to the possibility that a therapeutic, hands-on technique could create positive influences within our bodies.

     

    As Albert Einstein said, “ Everything is energy and that’s all there is to it.  Match the frequency of the reality you want and you cannot help but get that reality.  It cannot be any other way. This is not philosophy. This is physics.”

    -Michaela E. Gordon, OTR/L