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sensory processing

Sensory-Based Motor Disorder

According to a leading paper on the topic, sensory processing disorders can be categorized into three basic patterns:

  1. Sensory Modulation Disorder, including sensory over-responsivity, sensory under-responsivity, and sensory seeking/craving.
  2. Sensory Discrimination Disorder
  3. Sensory-Based Motor Disorder

My post entitled What is Sensory Processing? defines Sensory Modulation Disorder and Sensory Discrimination Disorder. This is a follow-up post about the third pattern: Sensory-Based Motor Disorder.

Simply put, some motor coordination difficulties are due, at least in part, to faulty sensory processing. There are two sub-types of Sensory-Based Motor Disorder: Postural Disorder and Dyspraxia.

Spilled coffee on papers on desktop
If things like this happen to you often, you may have a sensory-based motor disorder.

Postural Disorder

To understand postural disorder, it’s important to first understand postural control. The terms for postural function vary somewhat among professionals and in the literature. Most experts agree, though, that there are two main functions of the postural control system:

  1. To keep you upright against gravity and help you maintain your balance, for which I prefer the term postural stability. This can be further broken down into static and dynamic functions. Static posture (meaning still, unchanging) is when you are upright against gravity without moving, and dynamic posture (meaning ever-changing) is when you work to keep your balance while moving.
  2. To keep the rest of your body still so you can use a part of the body to push, pull, reach and/or use force to complete a task. For this function, I like the term postural regulation. To conserve energy, you must be able to stabilize parts of your body and use isolated movements to carry out an action.
Image result for ulnar stability of hand picture
Keeping the pinky finger side of your hand stable while moving your thumb and forefinger to write and draw is an example of postural regulation.

Postural control is a lot more complex than just standing and sitting up straight, which is what many equate with “good” posture. In addition to keeping us upright, research has shown postural control actually prepares the body to move, which is referred to as anticipatory or feedforward postural adjustments. Postural control also contributes to your body schema or internal map of where you and all your body parts are in relationship to gravity. This is crucial for maintaining joint and muscle alignment as well as determining your center of gravity. Additionally, reflexive postural reactions help you recover when you are bumped, jostled, or otherwise knocked off balance. And, perhaps most complex of all, motor coordination relies on the combination of posture and movement.

Postural skills are largely subconscious, meaning you probably do not pay much attention to them. However, you rely heavily on your posture to complete every day tasks such as brushing your teeth or typing at a computer. Staying upright against gravity and coordinating your movements actually requires integration of multiple sensory systems. The sensory systems that contribute most to your posture include your: proprioceptive, vestibular, tactile (touch), and visual systems.

So, what qualifies a posture problem as a sensory-based motor disorder? Just like all sensory disorders, a sensory-based posture disorder is caused by brain wiring differences that are either developmental (present from birth) or acquired by a brain injury or disease. Therefore, poor posture due to poor physical fitness or health would not be considered a sensory-based condition.

Symptoms of a postural disorder may include:

  • Chronic muscle tension in the neck, shoulders, and back
  • Unusually loose or tight muscles at rest
  • Poor control of movements (i.e., clumsiness, poor body awareness)
  • Core muscle imbalance, resulting in rounded or slouched posture (see Figure 3)
  • Slow reflexes/reactions when knocked off balance (for example, you may not be able to catch yourself when tripping or falling)
  • Inefficient or excessive/extraneous movements (such as motor overflow) resulting in fatigue
Chronic poor posture can lead to chronic pain and inflammation.

Dyspraxia

Motor praxis is perhaps even more complex than postural control. In sensory integration theory, the term “praxis” encompasses all of the processes involved in performing skilled movements. Briefly stated, praxis includes:

  • Ideation–coming up with ideas; problem-solving; using the imagination to mime actions without objects (for example, “pretending” to brush your teeth)
  • Planning–deciding what to do
  • Sequencing–coming up with a logical sequence of actions
  • Execution–carrying out your plan of action
  • Feedback–reflecting on how well a plan of action is working

When a professional is assessing praxis abilities, some of the areas that may be examined are:

  • Constructional praxis–building or copying configurations of materials or shapes from a model or instructions
  • Oral motor praxis–coordinating the muscles of the mouth and jaw for speech production and facial expressions
  • Imitation of movements–watching a demonstration of a complex movement or a series of motions before doing the same movement/motions
  • Motor patterns–sustaining repetitive movement patterns (such as a rhythmic clapping pattern)
Image result for clapping
How many times can you repeat a clapping pattern before messing up?

When praxis is optimal, it has three main functions:

  1. Completing familiar motor tasks automatically, often using the same pattern of movements without much thought. For example, you may shower or fix breakfast the same way every day without making any decisions about what action to take next. You just “go through the motions.” This automaticity of movements saves a lot of mental energy, which frees up energy for your brain to use on newer, more interesting functions. This process occurs at the base of the brain in the subcortical region.
  2. Coming up with ideas, making plans, thinking of ways to get organized, and problem-solving for actions you will take in the future. This includes reflecting on recent experiences and processing what you thought went well and what you wish had happened differently. These processes happens in the top and front area of the brain, primarily in the frontal lobe of the cerebral cortex.
  3. Monitoring your performance in the moment to sustain actions or make adjustments to improve your accuracy or speed. This process combines both of the previously functions as well as additional cortical functions.

When praxis skills are not fully functional, one or more of the above processes are impaired. This impairment is called dyspraxia. The literal definition of dyspraxia is “bad” or “difficult” action. Some people use the term dyspraxia interchangeably with or prefer other terms, such as apraxia (which is literally defined as “without” action), developmental coordination disorder, or motor planning problems. In the United States, occupational therapists commonly use the term dyspraxia as an umbrella term for praxis problems.

Praxis abilities are based on the sensory processing functions of modulation and discrimination of inputs, as well as in the cerebellar functions of sequencing and rhythmicity. Praxis problems can be either developmental in nature (as in developmental coordination disorder), or caused by illness or injury (such as a head injury or stroke). It should be noted that in the United States, rehabilitation professionals tend to prefer the term apraxia for praxis challenges brought on by illness or injury.

Some symptoms of dyspraxia are:

  • Poor coordination, especially for complex tasks involving multiple body parts
  • Difficulty learning complex motor skills, such as driving a car
  • Struggling to come up with ideas or becoming distressed when answering simple open-ended questions, like, “What do you want to eat tonight?”
  • Difficulty with multi-tasking
  • Having trouble following multi-step instructions
  • Always doing things “the hard way” or in an illogical way
  • Having trouble planning ahead
  • Difficulty managing time
  • Poor organization
  • Being overly rigid with plans and routines

As you can see, sensory-based motor disorders can be quite complex and affect many different aspects of daily life. Currently, best practice for addressing praxis challenges is to teach clients bottom-up (body and sensory-based) strategies in combination with top-down (cognitive) strategies to manage symptoms and improve quality of life.

sensory processing

The Eight Sensory Systems

Your nervous system is a complex network of signals connecting your brain and your body. There are eight major systems that connect your sensory organs through collections of nerve endings that gather sensory information to send to your central nervous system (brain and spinal cord). These systems give your brain information about your body and the world around you.

The “Foundational” Senses

Your foundational or proximal sensory systems give you information about your body and are some of the earliest to begin developing in utero. They include:

Image of a hand on a green background
Tactile

Tactile (touch) – located in your skin, touch receptors provide information about the world and specifically about the shape, size and texture of objects. Your skin is your body boundary and helps you understand your surroundings, to feel safe or alert you to danger, and to bond with loved ones.

Image of a boy with orange hair doing a cartwheel on a red background
Vestibular

Vestibular (head position and movement) – located in your inner ear, your vestibular system provides information about movement, balance, and your relationship to gravity. It lets you know if you are right side up or upside down. It also communicates if you are moving or still, as well as how quickly and in what direction you are moving.

Image of an arm with pronounced flexed bicep muscle on a dark blue background
Proprio-
ception

Proprioception (joint and muscle activation) – located within each of your muscles and joints, your proprioceptive system provides information about the weight and resistance of objects, muscle relaxation, muscle contraction, stretch, and other movements of your body.


Image of a stomach on a light brown background
Intero
ception

Interoception (internal sensations) – with receptors in each of your internal organs, your interoceptive system provides information about your bodily functions and is linked with how you feel emotion. Examples of interoception are hunger, thirst, breathlessness, pain, temperature, heartbeat, muscle tension, and bladder/bowel pressure.

The “Functional” Senses

The functional or distal sensory systems give you information about the world around you. They include:

Image of an ear on a light brown background

Auditory (hearing) – located within your middle ears, your auditory system gives you information about what you hear.


Image of a blue eye on a teal background

Vision (sight)located within your eyes, your visual system gives you information about what you see.


Image of a mouth on a red background

Gustatory (taste) – located within your mouth, your gustatory system gives you information about what you taste.


Image of a nose on a dark blue background

Olfactory (smell) – located within your nose, your olfactory system gives you information about what you smell.


Want to know more? Check out What is Sensory Processing? if you missed it! Also, stay tuned for Sensory-based Motor Disorders and Why You Should Care About Sensory Processing.

sensory processing

What is Sensory Processing?

In simple terms, sensory processing and integration are the ways your brain detects, prioritizes, and remembers:

  • External sensations from the environment around you
  • Internal sensations from within your bodies, and
  • Interactive experiences with the people and objects you encounter.
A funnel containing three balls labeled interactive experiences, external sensations, and internal sensations with a downward pointing arrow below the funnel pointing to text labeled Sensory Processing and Integration.
Figure 1. The Sensory Funnel. The way your brain processes information illustrated as a funnel.

Differences in the way your brain has developed gives you a unique set of filters through which you process the sensations you experience. Everyone has subtle differences in the way they process sensations, which are known as your sensory preferences. Here’s a quick overview of how sensory processing works.

Sensory Modulation

Sensory modulation is how your nervous system regulates your brain’s response to sensory stimuli. It is what allows you to perceive a sensation as being too much, too little, or just right. Sensory modulation is related to sensory gating, which is how your brain decides if something is worth paying attention to or not.

When functioning appropriately, sensory modulation alerts you to important information and helps you respond to dangerous situations quickly. However, problems with sensory modulation can lead to a wide variety of challenges.

Sensory Over-Responsiveness

Sensory over-responsiveness (SOR) is also sometimes referred to as sensory sensitivity or being highly sensitive to sensations. An over-responsive reaction to sensations may cause you to easily startle or become overwhelmed by sensations. Sensory over-responsiveness can affect individual sensory systems or the nervous system as a whole.

A small funnel overflowing with large, red orbs with a downward pointing arrow toward the words Sensory Over-Responsive at the bottom.
Figure 2. Sensory Over-Responsive. When you are easily startled or become overwhelmed by sensations.

Sensory Under-Responsiveness

Sensory under-responsiveness (SUR) is also referred to as low registration of sensory input. When you are under-responsive to sensations, you easily miss sensory information unless it is substantial enough to be noticed. Sensory under-responsiveness can affect individual sensory systems or the nervous system as a whole.

A large funnel with a few small blue orbs with a downward arrow pointing to the text Sensory Under-Responsive below.
Figure 3. Sensory Under-Responsive. When you easily miss sensory information unless it is substantial enough to be noticed.

Sensory Craving

Sensory craving (SC) is often confused with sensory seeking (which is usually an adaptive behavior and not a problem). Sensory craving is more mal-adaptive (addictive or risk-taking) in nature. When your brain cannot detect what or how much sensory input is needed, you are driven to seek out increasing amounts of input, even if doing so leads to negative consequences.

A large funnel with a hairline crack overflowing with yellow orbs and a downward arrow pointing at text Sensory Craving at the bottom.
Figure 4. Sensory Craving. When you are driven to obtain increasing amounts of input, despite negative consequences.

Sensory Discrimination

Sensory discrimination is how you filter and categorize sensations. It helps you identify what a sensation is (for example, a sound), determine its qualities (a quiet whisper to my left), and compare and contrast it to other sensations with refined detail (that sounds like my Aunt Mabel).

When functioning well, sensory discrimination allows you to pay attention to and process your experiences. It allows you to discard irrelevant information, catalog things of interest, and remember important details and their attached meanings. Sensory discrimination relies on efficient and reliable sensory modulation abilities, so when you have difficulties with sensory modulation, chances are you have some challenges with sensory discrimination as well.

Here are a few examples of sensory discrimination challenges:

  • May not notice how much is “too much” until too late—you may be overly rough with others, use too much force and break things, or over-stuff your mouth when eating. You may be slow to catch yourself when you trip and fall, talk too loud, or be unable to tell if food is spoiled or not. You may tend to overeat, wait until the last minute to use the bathroom, or not notice signs of hunger or thirst. You may overexert during exercise or yard work, talk excessively, or accidentally overfill containers.
  • May be unable to tell when something is “not enough“—you may tend to run out of things completely before buying more, not clean thoroughly, or use too little pressure when hugging or shaking hands. You may talk too softly, drop things often, or misjudge how much of something is needed when planning ahead or preparing a meal. You may not offer adequate information when communicating with others, not notice when a room is becoming too dark to see, or misjudge how much time it will take to complete a task.
  • May need extra time to form conclusions or come up with questions when learning something new—You may comprehend information on a surface level but have “aha” moments much later. You may ask someone to repeat themselves only to figure it out before the other person finishes repeating what they said. You may not fully understand the meaning of something until a later time. You may not appear to be listening but then surprise others when you say or do something later that demonstrates you were listening after all.

These challenges, along with other similar difficulties with processing sensations are referred to collectively as sensory discrimination disorder (SDD). What is puzzling is that if you have SDD, you may often (though not always) be perceptive of details, but seem to have a hard time making meaning of the information taken in. It can seem like the “filter” in your sensory funnel is clogged. You take in information, and may even comprehend what you are perceiving, but you need time to form conclusions or questions about what you have learned. If you are required to take in too much information for too long, you may experience a form of shutdown that appears as though you are under-responsive to sensations. SDD may cause you to have difficulty prioritizing your responses to sensations, often missing or ignoring your body’s signals until the sensations become intense enough to register as urgent.

A large, wide funnel full of multi-colored orbs with shading at the bottom and a downward arrow pointing to text Sensory Discrimination Disorder
Figure 5. Sensory Discrimination Disorder. When it is hard to make sense of incoming information, as if the filter on your sensory funnel is clogged.

Want to know more? Check out The Eight Sensory Systems (that’s right–Eight!). Also, stay tuned for Sensory-Based Motor Disorders, and Why You Should Care About Sensory Processing.

sensory processing

6+ Self-Regulation Sensory Hacks

In a stressful world, all of us find ourselves in moments that are too much for us to handle. We start to “lose it” — our confidence, our cool, our train of thought. The good news is there are some easy ways to get re-regulated and get back in control. Read on to learn more about regulation and how to use sensory strategies to improve your life.

Regulation Basics

The most basic definition of arousal regulation refers to your energy levels and your ability to change your level of energy to match the situation you are in. A low arousal state (see Figure 1) occurs when you are tired, bored, and are either not able or not required to exert much energy. A high arousal state occurs when you are stressed, upset, and are exerting a lot of mental and/or physical energy. There are appropriate times to be in low arousal (first thing in the morning, late at night when it is time for bed). There are also times where it is appropriate to be in high arousal (in high-performance or dangerous, life-threatening situations).

An upside-down U-shape drawn within an x- and y-axis. The x-axis is labeled "arousal" with low (under-aroused) on the left and high (over-aroused) on the right. The y-axis is labeled "performance" with poor at the bottom and excellent at the top. Poor performance is indicated at the bottom left side of the U, maximum performance is indicated at the top of the U, and poor performance is indicated at the bottom right side of the U.

Figure 1. Arousal regulation performance curve. Based on the Yerkes-Dodson Law, also known as the Inverted-U Function of Arousal

However, when you drop into a low arousal state at the wrong time, such as during an important meeting or exam, you need to shift your arousal level to a more alert or regulated state. And, when you find your arousal getting too high at the wrong time, such as during a conversation with your partner, you need to know how to calm down and get re-regulated before you “lose it.”

Sensory Hacks

Finding the right sensory hacks takes time and practice. The best way to explore if the sensory strategies below are helpful is to try them when you are already fairly calm and relaxed. Some strategies may shift your arousal state right away. Some may have a delayed effect. You may need to try some of them several times to decide if they work for you. As you experiment, notice if the strategy tends to raise (increase) your arousal, lower (decrease) your arousal, or if it can do both depending on the situation. You may find that you already use some of the strategies below.

Hack #1: Get your head lower than your heart
This strategy works by initially increasing blood flow to the head, which signals your body to lower your blood pressure. This, in turn, is a hack to calm your nervous system and lower your arousal level.

Important Note: Do not attempt this strategy if you have high blood pressure. Keep your neck safe and protected and do not apply pressure through your head if you have neck problems. Stop immediately if you experience nausea, dizziness, light-headedness, or pain.

Some ideas: standing forward fold, inversions, child’s pose (from yoga); headstands, handstands, kneeling on the ground and touching your forehead to the floor; lying in prone (on your stomach) or supine (on your back) over a large exercise ball and shifting your weight forward onto your head and/or hands.

Bonus tip: If it’s not an appropriate time to get your head below your heart, try putting some gentle downward pressure on the top of your head or along your forehead, especially near the upper bridge of your nose, right above your eyebrow line. Both strategies tap into powerful bundles of nerves that send calming signals to the brain.

Hack #2: Hum
Humming, especially non-melodic, long, and low sounds produced deep in your throat creates strong vibrations that work to internally massage and soothe your nerves.

Hack #3: Bean bag tapping
Any soft, small, weighted object will work for this strategy. A sock filled with rice, a TY Beanie Baby, or a cornhole bean bag all work well.

Standard Cornhole Bags from AllCornhole.com

Hold the bean bag (or other soft, weighted object) in your right hand and gently but firmly tap from your left upper back/ shoulder, down the outside of your left arm, up the inside of your left arm, across your collarbones/ upper chest, then switch hands. Repeat the process across your right upper back/ shoulder, down the outside of your right arm, and up the inside of your right arm. You can continue this cycle back and forth or move to your lower body.

To tap your lower body, hold the bean bag (or other soft, weighted object) in your right hand and gently but firmly tap from your left hip down the outside of your left leg, across the top of your left foot, and up the inside of your left leg. Switch hands, and repeat the process beginning at your right hip, down the outside of your right left, and up the inside of your right leg. You may find it helpful to tap along your lower back and buttocks one side at a time, or, hold a weighted object in each hand while standing, twisting side-to-side, allowing the weight of the objects in your hands to alternately tap your lower back and buttocks as you twist.

Hack #4: Put pressure on the “button” on the roof of your mouth
There is another powerful bundle of nerves on the roof of your mouth. You can press on the roof of your mouth or increase the pressure on the inside of your mouth by sucking while pressing upward with the tongue. A small, hard candy, such as a mint or lollipop can help you apply even more pressure, but is not necessary. This is why many young children find thumb-sucking or sucking on a pacifier so soothing.

Hack #5: Acupressure
Acupressure has traditionally been used as a healing methodology provided by trained practitioners. It usually involves applying sustained pressure to sensitive points along the energy meridians of the body. However, sustained pressure in any tender spot of the body (especially the hands and feet) can be a powerful way to ground you in your sensations and calm racing thoughts. Self-administered acupressure has also shown promise as a way to reduce deliberate self harm in some patients.

To do acupressure on yourself, you can either use a variety of self-massage tools or simply use your thumb(s) and/or finger(s) to apply pressure. The key to using acupressure is to feel around until you find a tender spot and then apply gentle but firm pressure to that spot for several seconds. Some spots to try:

1. The soft space between your thumb and first finger, about a half-inch into your palm.
2. The nail bed and/or cuticle of your fingers and toes.
3. The webbed spaces between your fingers and toes.
4. The base of your thumb where it meets your wrist.
5. The middle of your forearm about three fingers-widths away from your wrist.
6. The back of the neck where your skull connects to your spine.
7. The ears.

Hack #6. Exercise.
This “hack” is probably not a surprise. Exercise has been shown to be an excellent way to boost your mood or recover from stress. But what you might not know is how much intensity matters. What I am referring to is not the amount of calories you burn, but the strength of the sensation(s) provided by various forms of exercise.

When the intent of exercising is to change your arousal level, you will find that engaging in exercise that provides you with strong, enjoyable sensory input has the most impact on your regulation. Some examples of forms of exercise that can provide a lot of body-based sensory input are:

1. Chin-ups, monkey bars, or hanging on a bar or door frame from your hands
2. Leg presses, lunges, or squats
3. Lat pull downs, rowing, or butterflies/pec flies
4. High-intensity interval training, CrossFit, or Orange Theory routines
5. Hot and Yin-style yoga classes
6. Running, swimming, or cycling

Bonus Sensory Hacks
There are many ways you can use your body to tell your brain you are okay. Below are several more ideas of ways to tap into sensations to adjust your arousal throughout the day.

  • Mindful movement
  • Dance
  • Isometrics
  • Deep breaths
  • Rock
  • Massage
  • Take a big yawn
  • Chew on something (give your jaw a work out)
  • Aromatherapy
  • Stretch
  • Sing
  • Cry
  • Sleep
  • Fidget
  • Squeeze something
  • Lie down
  • Close your eyes
  • Bounce or jump up and down
  • Shake body parts (head, arms, legs) or all of your body
  • Use weighted objects (blanket, lap pad)
  • Go outside for a change of scenery, some sunshine, and fresh air
  • Find a small space or lean against something like a wall, door frame, or piece of furniture
  • Swing
  • Listen to music (or better yet, make music!)
  • Seek out cold or warmth
  • Take off your shoes (and socks!)
  • Touch an interesting texture with your hands or feet and really notice what you’re touching