Vestibular Dysfunction and Motor Skills

I participated in a multidisciplinary team meeting the other day where we were discussing how a particular regular ed child (diagnosed with ADHD) presents in the classroom.  His mom described him as having "poor fine motor skills," and that he often seems "uncoordinated."  He also has several sensory processing "red flags" in that he is a sensory seeker (very busy and fidgety) throughout the day (which gets him into trouble at times), and he puts all kinds of things in his mouth to chew on.  In the classroom, however, this child can have very good handwriting at various times.  He participates in regular phy ed, and does fine, although he is not the top of the class with gross motor skills.  Further information from the mom revealed that this child was a late walker, and took quite a while to learn to ride a bike.

What the mom sees and suspects is that her child has motor skill deficits and that something strange is going on with his "eating."  What an OT would suggest is that yes, this child presents as being uncoordinated in comparison to peers, but that there is likely an underlying (or a few underlying) issues at hand that are sensory related.  The one I would like to focus on here is that I suspect that this child (among other things) is having difficulty with his vestibular system processing.

Vestibular dysfunction is the inefficient processing in the brain of sensations received through the inner ear.  The child with a vestibular problem has difficulty processing information about gravity, balance, and movement through space (K. Stock Kranowitz, 2005).  Vestibular dysfunction can present in a variety of ways, and it would take too long to go into detail about it, but kids with vestibular dysfunction can present as craving movement experiences, as this little guy does.  They can have difficulty using the 2 sides of their body together and appear to be uncoordinated, fidgety and clumsy. They can appear to have poor fine motor skills and have difficulty using fine motor "tools" (such as a pencil, crayons, eating utensils).  They can have difficulty being organized and carrying out a sequence of movements or events.  So, friends, the motor difficulties may just be the obvious, but to improve some of these skills, you have to also address the underlying problem, and that would be to help improve the vestibular processing.

What could you do at home or how can you help a child that you are working with address these types of issues?

• Work on improving balance and movement
• Work on bilateral coordination (using the 2 sides of the body together)
• Work on praxis or motor planning (sequencing motor tasks or movement with their body)

You can read more about Vestibular dysfunction in the awesome book, "The Out of Sync Child," by Carol Stock Kranowitz, or you can check out her website at: http://out-of-sync-child.com/

The above referenced material was from:

Stock Kranowitz, Carol.  (2005)  The out of symc child, recognizing and coping 

     with sensory processing disorder.  New York, NY: Berkley Publishing Group.

This guy has good balance and coordination- his vestibular system is in good working order.
(and, you gotta love the boots he's rocking!)

This little gal really struggles with balance and motor skills-  note the posture of her
arms and body as she tries to maintain her balance.

Visual Tracking

Tracking is a skill that is necessary for reading, writing, drawing and playing.  It is what allows us to follow along a line when we are reading, or follow an object about the room with our eyes.  There are various eye movements that our oculomotor system directs, but I won't go into detail on that in this post. We talk a lot in OT about the integration of our vision with other systems.  Within the visual system alone, we also want there to be integration between our central vision (which tells us what we are looking at) and our peripheral vision, or our side vision (which helps us locate objects off to the side of us). When we are reading, our central vision is processing what we are looking at (letters/words) and our peripheral vision is looking down the line to see what's coming up next.  If the 2 systems don't work well together, then reading smoothly and tracking along the line when reading can be difficult. Smooth tracking typically develops around the age of 5.

Any activity that requires your child to visually scan can work on tracking as well as the use of both central and peripheral vision.  Here are some ideas for you to try to encourage visual tracking:

-have your child track an object or a light from side to side and up and down.  Don't forget to also practice doing so without moving his/her head to track.

-have your child locate various things around the room by shining a flashlight on them (you tell them what to find, and they look about the room to locate it and shine a flashlight on it).

-place various cards or pictures out on a table- have your child find and pick up the card or match the card or picture by scanning the table to find the card that they are looking for.  You can do the same things with having various objects placed on the table.

Matching lower case letters to upper case letters.

-play "I Spy"

-play a memory game with the cards spread out on the floor or table.

-participate in ball activities, bat a ballon back and forth.  Suspend a balloon from the ceiling with yarn and have your child practice batting it.

-Blow bubbles and have your child reach out and pop the bubbles as he/she locates them floating in the air.

-Look at a book with your child and have them point to or search for various pictures and items on the pages.  Look at "Where's Waldo" or similar books that encourage scanning the page.

An Olympics Must See!

THE BEST story regarding the Olympics~  Enjoy!  http://www.nbcolympics.com/video/alex-bilodeau-gets-inspiration-older-brother

The Importance of Upper Extremity Weight Bearing

I have a few little people on my caseload this year who, for various reasons, have had very little sensory/proprioceptive input to their upper extremity joints/hands as they have grown and developed. In a couple cases, the kids have had significant sensory defensiveness, and have not been able to tolerate holding anything or touching anything with their palms.  In another case, the child was developmentally delayed, and had very little to sporadic stimulation/intervention early on.

So, what are the consequences of kids not having had weight bearing experiences over time?  

• weak hands
• poor grasp patterns
• poor fine motor skills
• poor body awareness

**Prone activities (when babies/kids lay on their tummies and play), crawling, and weight bearing through the arms and into the shoulders are all important for fine motor development. 

Do you have a child or work with a child who has weak hands/grasp patterns, poor fine motor skills and/or decreased awareness of how his/her body works in space?  You should think about trying to encourage some weight bearing activities as a means of improving some of the above mentioned deficit areas.  

Here are some activities to encourage weight bearing:

-Have the child lay on their stomach on the floor while completing an activity, such as coloring, putting together a puzzle or playing a game

-Have the child complete an activity, such as a game or puzzle, while on their hands and knees (4 point position).  Have them try not to sit back on their heels, as this discourages having to bear weight through their arms.

-Laying on their stomach, roll over a therapy ball on to extended arms.  While in this position, have the child pick some items or toys up off of the floor and put them into a container.  Have them vary which arm they use, how far you put the container away or to which side you put the container to encourage weight shifting.

This little girl is a reluctant weight bearer, but seeks all kinds of deep pressure and tactile input
by slapping her hands hard on surfaces.  Loves to be over the ball, though.

Same little girl weight bearing while over a therapy ball- she is picking up small blocks
and putting them into a container.

-Wheel barrow walk, or do various animal walks (crab walk, bear walk, seal walk, etc)

-Have the child sit in a side sitting position and lean on an extended arm while doing an activity

-Have the child lay on their stomach on a scooter board and pull themselves along with their upper extremities

-While on hands and knees, have your child help you "clean" the floor with a sponge, or draw/color/play with sidewalk chalk

-When kids are sensory defensive and do not tolerate you assisting them or imposing weight bearing on them, you can get creative by setting up the environment or their play so that they are weight bearing all on their own (for example, put something just out of their reach while they are playing on the floor so that they lean forward on their hands to reach for it).

This child is not one to tolerate assistance with weight bearing through his hands- here he is leaning on a table to
reach at some items that I have placed across the table from him.

FYI, New Magazine from PACLA~

Found on Parenting Autistic Children with Love and Acceptance Facebook page:

The group Parenting Autistic Children with Love and Acceptance is putting out a call for submissions for a brand new magazine all about parenting Autistic children with love, acceptance and respect! If you'd like to be included in PACLA magazine, please submit your material to PACLAmag@gmail.com before March 5th, 2014!

We are also looking for artwork from Autistic artists of all ages for our magazine!

Please remember that we are an intentional community. PACLA Magazine will reflect those intentions and follow the basic guidelines of our Facebook community:

1. We love and accept our children as Autistic people.
2. We don't want to change our children.
3. We don't wish our children were not Autistic.
4. We do not speak over the voices of Autistic people.
5. We recognize that Autistic voices deserve center stage over our voices as parents of Autistic children.
6. We parent our children with an eye towards promoting neurodiversity and acceptance.
7. We do not subscribe to therapies/interventions which seek to change the nature of our children or utilize aversives.
8. We are open to learning from Autistic adults.
9. We foster our children's growth through respectful accommodation and support.
10. We do not tolerate the bullying of Autistic people.