THE AFFECTS OF REFLEXES AND SENSORY SYSTEMS ON GROSS MOTOR SKILLS.

Presented by: Amanda Pickett, DAPE Teacher, Sartell-St. Stephen Schools amanda.pickett@sartell.k12.mn.us Michelle Schluender, PT, DPT Benton Stearns Education District mschluender@bentonstearns.k12.mn.us

OUR SENSES
Near Senses
Taste Smell Vestibular Vision Hearing Touch/Tactile

Far Senses
Proprioception

A CHILDS VIEW OF SENSORY PROCESSING

http://www.youtube.com/watch?v=D1G5ssZlVUw

SENSORY
Sensory overresponsitivity
Too excited or over aroused to participate and engage in a productive manner

Sensory underresponsitivity
Too lethargic or unaware of internal and/or external sensory stimuli to participate in a meaningful manner

VISUAL:
Vision provides knowledge of the surrounding world and therefore informs us about our movement and position in space. It is one of the key components for postural stability. Poor visual- spatial processing: Shield eyes to screen or squints, has difficulty with eye gaze from the board to paper, omits words or numbers when reading or copying, orients drawings poorly on the page (writes uphill or downhill), confusing right and left, and has a poor sense of directionality .

VISUAL SYSTEM EXERCISES & CLASSROOM TOOLS

Eye Tracking/Crossing Midline Eye Tracking with a Flashlight Launch Board Flip and Catch Ball Wand catch Tetherball Hit a Balloon or Scarf Toss Bean Bags or Rings Mazes, Puzzles, Word Searches, Coloring Visual timer Visual schedule

AUDITORY:
How we process sound and filter sounds/ information through our ears for interpretation as a base for communication or when learning a new skill. Auditory Defensiveness: Hypersensitivity to noises and sounds not usually bothersome to other people. Sounds from vacuum cleaners, radios, or certain voices can range from annoying to painful. Students may cover their ears, become agitated, or display behaviors when becoming auditory defensive. A child with poor auditory- processing may: Be unable to pay attention to one voice or sound without being distracted by other sounds, seem unaware of sounds- may look around to locate where the sounds came from, misses verbal directions, and has trouble attending to, understanding, or remembering what he/she reads or hears.

AUDITORY SYSTEM CLASSROOM TOOLS

Headphones Talking Phones Music Game: How many sounds can you hear, eyes closed? I-pod Touch with music Awareness of Seating in the classroom- keep towards the front of the room.

TACTILE (TOUCH):
Awareness of where and how a person has been touched or can involve more discriminative touch as a base for the development of a skill. The child with poor tactile discrimination may: seem out of touch with his/her hands, be unable to identify body parts, be unable to perform certain motor tasks without visual cues (such as zipping, buttoning), puts on gloves or socks in unusual way, is a messy dresser (shoes untied, waistband twisted).

TACTILE (TOUCH):
Hypersensitivity (Tactile Defensiveness): Responds to light or unexpected touch as if it were uncomfortable or threatening. The child may object to having tags in the back of shirts, avoid wearing certain clothes, dislike having hair washed/brushed, or brushing teeth, avoid touching certain fabrics, surfaces, carpet, overreact when getting glue or paint on fingers. Hyposensitivity (Under-Responsiveness to Touch): Doesnt seem to respond to touch or has an unusually high tolerance for typically aversive stimuli (pain, temperature).

TACTILE (TOUCH):
For tactile stimulation the child may: need to touch certain surfaces and textures (like the wall when walking in the halls), seek certain messy experiences, enjoy vibration or movement that provides strong sensory feedback, rubs skin excessively.

TACTILE SYSTEM EXERCISES

Deep Pressure Body Paint Plastic Pool with balls Disappearing kid- sensory table Tenderfoot walk on different textures Sticker games- place stickers on body parts Cocoon Crawl Squish- play-doh or clay Palm Paint Goop

TACTILE SYSTEM CLASSROOM TOOLS

Koosh Balls Lotion Modeling Clay Hand Held Massager Silly Putty or Theraputty Crunch Paper Together to Throw in Trash Identifying Different Textures Read and Touch Me Books Shaving Cream Water or Sensory Table

ORAL ACTIVITIES:
Sucking (on hard candy or finger) is calming Chewing ( on candy or an eraser) helps the child to concentrate and organize his thoughts ) Crunching (on pretzels or a pencil) is alerting. Children seeking oral motor input may: Constantly be putting things in their mouth (toys, fingers, ), chews on their shirt or pencils

ORAL EXERCISES AND ACTIVITIES

Blowing and Sucking Activities Chewing Gum Straws Cotton Ball Races Drinking from a Water Bottle Kazoos or Whistles

PROPRIOCEPTION (DEEP PRESSURE)

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The awareness of ourselves gained through muscles and joints and through other receptors within our own bodies. A child with proprioceptive dysfunction (doesnt receive feedback through their muscles and joints like a typical student) may exhibit difficulties with; body awareness, motor planning, motor control, and postural stability. The child with low muscle tone may have a loose and floppy body, tend to slump in the chair, constantly lean her head on hand or arm, sit on the floor with her legs in a W.

PROPRIOCEPTION (DEEP PRESSURE)

Characteristics may include: difficulty positioning body to put on a jacket, or when trying to dress self, holds pencils tightly, produces messy work with large erasure holes, poor posture, slumps in a chair, sits on the edge of the chair to keep one foot on the floor for extra stability, fixate joint to decrease excessive movement during activity- example toe walk to fixate ankles or lock shoulders when running. 3 Ps Plop, Pop, Prop To gain feedback (deep pressure) the child may: stomp his feet on the ground while walking, crash on the floor or into walls, rub his hands on tables, prefers clothing to be tightly fastened, kicks heels against the floor or chair.

PROPRIOCEPTIVE SYSTEM EXERCISE

Pushing and pulling Lifting and carrying Jumping, hopping, skipping Moon shoes Hop jump or jump rope Weights Alternatives to desks Foot massage Rockerbaord Trampoline Climbing

PROPRIOCEPTIVE SYSTEM CLASSROOM TOOLS

Carrying Books for the Class to the Library Carrying a Weighted 3 Ring Binder during Transition Times Weighted Lap Pad Chair Push-ups Sharpening Pencils with a Manual Sharpener Arrange Desk in the Classroom Wash Desk and/or Chalkboard/Dry Erase Board Place Chairs on Desk of Day or Take Down at Beginning of the Day Pull a Weighted Rolling Back Pack Animal Walks Yoga Wrist Weights Weighted Pencils

VESTIBULAR (MOVEMENT):
System with receptors in the inner ear. It helps us respond to head position to help with balance and coordination. We get input from our eyes, muscles, and joints to keep us oriented to gravity and to how we maintain balance and move our bodies. Vestibular Dysfunction may cause difficulty with movement, balance, and posture: move in an uncoordinated way, easily loose balance when standing on both feet when eyes are closed.

VESTIBULAR (MOVEMENT):
Hypersensitive (Intolerance for movement): Increased alertness/arousal, motion sickness/nausea so they dislike playground activities such as swinging, spinning, and sliding. Hyposensitive (Increased tolerance for movement): need to keep moving, as much as possible, in order to maintain attention/function, craves intense movement experiences, and does not get dizzy after twirling in circles or spinning rapidly. Decreased postural tone, poor cocontraction, and poor rotational patterns.

VESTIBULAR SYSTEM
Flight- student may say, I need to use the bathroom or it is time to go yet. Fright- it is too hard, fear , tears, whinning Fight- hit, bite, yell We CANNOT work a student through the high arousal stage

VESTIBULAR SYSTEM EXERCISES

Spinning Rolling Swinging Rocking Sit and Move Hippity Hop Ball Scooter Board Jump Rope Hop Scotch Rocking Chair Therapy Ball Drive Thru Menus woodchopper, pendulum swing, paint your rainbow, pop up spelling, jumping beans, ants in my pants

VESTIBULAR SYSTEM CLASSROOM TOOLS

T- Stool Therapy Ball Sit and Move Tilt Board Drive Thru Menus woodchopper, pendulum swing, paint your rainbow, pop up spelling, jumping beans, ants in my pants Hop Scotch Rocking Chair Yoga Activities Brain Gym

THE LEARNING TRIANGLE

DNA Reflexive Patterns Learning Visual Auditory Tactile Vestibular Proprioceptive Performance Motor Skills Motor Patterns Motor Responses

KINESTHETIC AWARENESS
The unconscious understanding of our brain about our position in space or body awareness. This information comes from the muscles, joints, eyes, tactile, and vestibular systems. Movement Sense- some children need to see what they are doing Example: Finger to nose on the BOT-2 Example: lift the leg forward when standing on one foot or try to hold leg with a hand

Learning
Information our brain is gathering through the different systems and sensations all of the time.

Performance
Movement skills that are used to demonstrate what we have learned internally. Examples: speak, gesture, write to communicate our thoughts and ideas.

REFLEXIVE SYSTEM CLUMSY CHILD

Reflexes are God given movements that are stored in each of us. All movements are reflexive and are modified by influences of the brain. Those brain influences are what we call sensory systems: vestibular, proprioceptive, tactile, visual, and auditory. Children with poorly integrated reflexes may have issues with falling often, difficulty with catching a ball, difficulty with riding a bike, and difficulty with writing. Reflexes that persist: blink, gag, yawn and cough for safety reasons.

REFLEXES
ATNR asymmetric tonic neck reflex

STNR symmetrical tonic neck reflex

Labyrinthine prone flexion or supine extension

ATNR
Normal in infants up to 4-6 months of age and is integrated as the baby is learning to roll. Important to help infant reach for toy/object they are looking at and to assist with rolling Fencing Posture When the childs head is turned to the right, muscle receptors (proprioceptors) in the neck stimulate extension of the right arm and leg and flexion of the left arm and leg. Occurs in either direction. The response is usually stronger in the arms than the legs. Flexed side provides stability, extended side allows for mobility.

ATNR
Children that do not integrate the ATNR reflex may:
When sitting at their desk writing and turns her head to see the board or respond to the teacher, her writing arm will flex or extend slightly, causing her to loose her place on the page. With experience the student will anchor her hand in place with a tight grip and/or pushing hard on the paper which can cause the paper to tear and the students arm to tire quickly. Difficulty catching a ball because the student may be afraid and turn his/her head away from the ball causing one elbow to flex and the other extend

STNR
Normal in infants 6-11 months of age and is integrated as the baby is learning to crawl. If the infant extends the neck lifting his head and looking up, his arms will extend and his legs and hips will flex. If the infant flexes his neck putting his chin close to his chest, his arms will flex and his legs will extent. This reflex contributes to the infants ability to develop a crawling position- rocking back and forth then eventually integrates and the child is able to crawl with a combination of flexion and extension of the opposite arm and leg

STNR
Children that do not integrate this reflex can be seen Bunny Hopping Falling on their face or elbows as they are unable to extend their arms when their neck is flexed Sitting posture at their desk will be flexed legs and extended trunk and head at the table or a flexed head/arms and extended legs.

TONIC LABYRINTHINE REFLEXES

Normal in infants birth to 4 months of age and is integrated as the baby is learning to bring feet to mouth or props on elbows in prone. Patterns are influenced by the labyrinths of the vestibular system. Prone Flexion: newborns curl into a flexed little ball when we place them on their stomachs Supine Extension: newborns in supine will extend their arms and legs and arch their trunk. Gravity provides stimulus to several systems to provide organization of muscle patterns to develop other skills.

TONIC LABYRINTHINE REFLEXES

Children that do not integrate this reflex may: Struggle with learning new skills because postural stability, stable head control and reorganization of muscle patterns are necessary for the child to reach and eventually complete other skills.

REFLEX INTEGRATION EXERCISES

SupermanLabyrinthine Reflex

Popcorn
Labyrinthine Reflex

Giraffe Stretch
STNR

Rocking Horse- ATNR Wall Lean- ATNR

REFLEX INTEGRATION EXERCISES

Exercises can be completed daily kids do not get bored with these activities Superman and Popcorn should be held for 20 seconds and repeated 3 times. If the student was unable to hold for 20 seconds, count faster to 20 and then slow down as they are able to hold longer. Giraffe Stretch should be completed 10 times
Place a poster on the wall for the student to look at.

Rocking Horse should be completed 10 times with head turned to each side

MODIFICATIONS
Superman
Start with only arms, then only legs Help hold arms for 3 seconds, then have them hold for 3 seconds and then rest Wedge

Popcorn
Wedge Start with knees tucked, then bring arms around knees Provide assistance to get full body flexion

MODIFICATIONS
Giraffe Stretch
Hold the cube position Provide assistance to hold head upright and rock forward Stand behind the student to prevent them from rocking too far backwards Bolster for positioning

Rocking Horse
Hold the cube position with head turned Provide assistance to hold to the side while rocking forward Provide assistance to keep elbow straight Place bean bag between chin and shoulder to maintain position Bolster for positioning

MIDLINE CROSSING
One side of the body is able to move into and occupy the space of the other side of the body. Children need to learn to use each side of the body independently and the brain must understand the function of the opposite side of the body to cross midline effectively. Faulty reflex integration will affect the ability of a child to cross midline.
ATNR STNR LR

MIDLINE CROSSING EXERCISES

Tornados Jumping Rainbows Horizontal Waves Spider Webs Vertical Waves Peanut Ball Trampoline

MOTOR PLANNING ACTIVITIES OR EXERCISES

REQUIRE THE COMBINATION OF OUR SENSES AND MOVEMENTS TO PERFORM A SKILL.

For example, collect several objects of differing size and weight balls to throw into a box from 5 feet away (tennis ball, weighted ball, rock, bean bag). The information from all the systems are recalculated and interpreted when processing the different textures, weights, force needed, motor planning in order to throw each item. Visual system- Did it land past the box? ( can I step and look at the box at the same time) Auditory system- Did it hit the inside of the box? Tactile system- How will this smooth ball travel? Vestibular system- How far forward should I step as I throw? Proprioceptive system- How heavy is this ball?

RECOMMENDED RESOURCES
Ready Bodies Learning Minds - http://www.readybodies.com/ Yoga Kids: Tools for Schools - http://yogakids.com No Longer a Secret by Doreit S. Bialer and Lucy Jane Miller The Out-of-Sync Child by Lucy Jane Miller Starting Sensory Integration Therapy by Bonnie Arnwine Sensational Kids: Hope and Help for Children with Sensory Processing Disorder by Lucy Jane Miller and Dorris A. Fuller Understanding Your Childs Sensory Signals: A Practical Daily Use Handbook for Parents and Teachers by Angie Voss Drive Thru Menus - http://drivethrumenus.net/