Have you ever had an ear infection or a blocked ear and felt slightly dizzy or off-balance? Do you know why you feel this way? Have you ever thought how it is that your body automatically knows how to move its limbs?
The answer is pretty miraculous, as all elements of the human body are. It has to do with how the central nervous system and the brain work together to interpret the world we encounter every day, and more specifically our vestibular and proprioceptive senses. First coined as a concept in the early 1960s and 1970s by occupational therapist and psychologist, Jean Ayres, the “neurological process that organises sensation from one’s own body and from the environment” is now referred to as “Sensory Processing and Integration” (SPI).
This blog primarily targets parents of preemies (though it is arguably relevant for all parents), focusing on how SPI may be important for your child’s development.
What is Sensory Processing and Integration and why might preemies have difficulty with it?
In my podcast interview with Jessica Tuohy, we briefly touched on sensory integration and why preemie babies who have had NICU stays might have sensory integration difficulties.
Typically, in early childhood, we unconsciously build the neural (brain) connections we need so that we automatically know how to respond to things we feel, taste, see, hear, smell, to where our body is in space and how to keep our balance as we sit or walk. Our central nervous system picks up signals from sensory receptors in our skin, muscles, ears, tongues, olfactory and visual systems, and sends these signals to the brain. The brain then processes the signals and enables us to respond appropriately to them.
An often-used example to explain this is brushing our hair. When we brush our hair, we automatically know that the brush is in our hands, and where our hair is to brush it. We do not necessarily need to look at our hair to find it, or know how to move the brush through our hair. Our sense of touch, and our knowledge of where our hand is in relation to our brain are automatic.
Children born prematurely may take longer to build the connections, and therefore may struggle to integrate all the information in an ordered way.
Jessica Tuohy spoke about how premature babies are exposed in a NICU environment to constant noisy machines and bright lights, how they tend to be held less, and how they probably move less than typical newborns would. She described in the podcast how it is common for these babies to have tactile/touch and movement sense integration challenges. For example, they can be cautious movers, they might startle easily, and need a lot of encouragement and gentle exposure to facilitate integration of these sensations.
Investigating Sensory Processing and Integration at an Early Stage
Based on our experience with my daughter Lily, I would highly recommend to preemie parents that you have SPI on your radar early and that you to speak to your occupational therapist about it (similar to other forms of early intervention, which I have discussed previously). The earlier you are aware of it, the sooner you can begin to identify whether your child may have SPI difficulties, and can help them deal with all the sensory stimuli coming at them very day.
According to Sensory Integration Education, the benefits of therapy can be both physical (e.g. help with balance, better hand-eye coordination, better motor planning, language development, sleeping patterns) and psychological (e.g. improving attention, building confidence, socialisation, dealing with frustration and emotional outbursts).
HOW SENSORY INTEGRATION HAS HELPED US HELP LILY
SIGHT, MOVEMENT, BALANCE AND REGULATION
The motor difficulties Lily has due to her cerebral palsy are compounded by proprioceptive and vestibular processing difficulties. Knowing about the impact of movement and balance sense has been especially helpful for understanding in more depth the additional challenges she faces when it comes to motor planning.
When Lily was 7 months old (corrected) we saw a fantastic OT in Johannesburg, South Africa, who educated me about how we could help Lily to develop her sensory system. She reminded me that preemies are fragile and that it would take time for Lily to adapt to, and to process all the different sensory stimulation she would experience.
THE VESTIBULAR SYSTEM
The vestibular sense is in our inner ear, where fluid in small canals moves whenever we move our heads. Receptors in the canals send the brain information to know which direction we are moving in. It is what helps us to balance whether we’re sitting, walking, or riding a bicycle. (When you have an ear infection, this sense of balance is impacted which is why you feel a bit dizzy.)
A premature baby who has spent a long time lying in an isolette in a NICU, may not move their head as much as a full term baby would, and therefore may not develop an optimal sense of movement and balance.
THE PROPRIOCEPTIVE SYSTEM
Our muscles and joints have receptors in them that tell the brain where our limbs and body parts are. The brain then automatically uses this information to plan movements and enable us to coordinate the use of our bodies.
As an example, little babies born full term and developing in a typical manner, will experience a myriad of different little movements, and when they are about 4 months old, they discover their feet by first feeling them and then seeing them. When it comes to sitting or crawling, their little brains automatically know where their feet are and how they can help them to move. Preemies, or babies with motor disabilities, may not experience the same range of movement and therefore need help to learn where their feet are – and then having discovered them, what feet can be used for or indeed how to coordinate their movement.
The first sensory area that our OT identified as a potential issue for Lily was sight. She recommended that we see a paediatric optometrist. It can be difficult to determine how much little babies see, but we saw an excellent specialist in Johannesburg who recommended that Lily immediately start wearing spectacles as she is very far sighted. This would help to ensure that Lily’s gross and fine motor development would not be negatively impacted by poor vision.
Secondly, our OT explained why the vestibular sense is important for a child’s development:
The third sensory area we were introduced to was the proprioceptive system. Per Jessica Tuohy’s explanation given above, proprioception is important for a child’s development because:
Pretty incredible really, something that most of us never know about or think about because it happens automatically.
For Lily, doing activities to develop the proprioceptive sense was important on two fronts. The first, she often got overwhelmed by overstimulation[i] (and sometimes still does) – too much noise, too many people holding her, or too much going on around her. When this happens, we learnt two ways to help her regulate her behaviour and calm down. 1) Remove her from the situation (take her to a quiet room), and 2) Deep Touch Pressure Massage – give her a big deep hug.
The second, it would help her to move with more confidence, and remove her fear of movement. Nicole Hilburn, another exceptional physiotherapist we have been lucky enough to work with, often talks about creating “scaffolding” for Lily (I believe this is a principle of Maes Therapy ). Simply, what it means is placing objects around her as reference points, whether it be a block, a wedge, a small table, a cushion. The idea being to help her to feel and realise where her body is, and therefore not be quite as scared to move. Otherwise she may feel that her body is in the middle of nowhere and it is hard to know what to do with it next.
STEPS YOU CAN TAKE IF YOU THINK YOUR PREEMIE MIGHT HAVE SENSORY INTEGRATION DIFFICULTIES
1. Ask your OT whether they have Sensory Integration Therapy training or can advise you. If you are Hong Kong-based, I highly recommend the SPOT Centre, or in Johannesburg, Marga Marloth is a fantastic OT.
2. Read up online to learn more, Sensory Integration Education is a good place to start.
3. Do an online course. I recently completed a very good online introductory course offered by Sensory Integration Education that is designed specifically for parents and carers, and provides very helpful insight into SPI and all the different sensory integration difficulties that can arise.
EXAMPLES OF ACTIVITIES TO DEVELOP THE VESTIBULAR, PROPRIOCEPTIVE AND TACTILE SENSES
(Note: Please exercise caution and seek professional advice from your occupational or physiotherapist before trying these at home. I include them here for illustrative purposes only.)
COMING UP NEXT BLOG
Two topics to look out for over the next little while: (1) Oral Motor and Language Delay, and (2) a podcast interview with Dr Gillian Saloojee, the founder of Malamulele Onward for whom SuperLily recently led an end-of-year-giving campaign. I will be talking to her about the role parents can play in CP kids’ development, and about a new project she is working for teenagers and young adults with cerebral palsy in South Africa.
[i] It is worth noting that under-stimulation or under-reactive responses to different sensations are also presented as sensory integration difficulties.