Physical therapists and physical therapist assistants help individuals maintain, improve and restore mobility. In working with kids with challenges, physical therapists help them to continue to “Move Forward”. Dr. Joni Redlich shares valuable principles regarding the benefits of physical therapy in working with children on the spectrum or with Sensory Based Motor Disorders. Before we move into her insights, let’s first take a look at Sensory Processing Disorder in a nutshell.
Uncovering Sensory-Based Motor Disorders
Sensory Processing Disorder is more than an over- or under-responsivity and is a sensory craving that is part of one subtype: Sensory Modulation Disorders (SMD). SMD presents as a hyper- or hypo-sensitivity to the five main senses and difficulty with the additional senses of proprioception, vestibular and interoception.
Some children experience another sub-type known as Sensory Discrimination Disorder (SDD). Carol Kranowitz, author of The Out-of-Sync Child Has Fun, defines SDD as “a problem interpreting the characteristics of sensory stimuli and in differentiating among and between sensory stimuli.” Gwen Wild, OTR/L explains,
“Children with SDD have difficulty making sense of subtle qualities of sensory stimuli. For example, these children are likely to struggle with things like finding a specific slotted spoon in a utensil drawer, or a certain notebook amongst the other objects in a cluttered desk. Educationally, these children struggle to discriminate similar shapes (square vs. rectangle) or similar letters (p, b, d), and often have trouble recognizing differences in similar sounds which add up to making learning to read and write very difficult.”
A third subtype, often overlooked by concerned parents, is Sensory-Based Motor Disorders which includes Dyspraxia and Postural Disorders. Kranowitz describes sensory motor as “pertaining to the brain-behavior response of receiving sensory messages (sensory input) and producing an adaptive response (motor output)“. At a quick glance, Sensory-Based Motor Disorders may include some of the following issues:
Oral Motor Challenges
- oral defensiveness (tactile over-responsivity)
- feeding or eating problems
- speech and language difficulties
- attention and organization challenges
- social and emotional developmental challenges
Motor Planning (Dyspraxia) Challenges
- positional struggles
- trouble planning, organizing or sequencing
- difficulty with knowing where his body is in space
- self-help skills
- gross motor control
- eye-hand coordination
Bilateral Coordination Challenges
- body awareness
- gross motor (clumsy)
- difficulty with making hands and feet work together
- hand clapping may be difficult
- no hand preference by age 5
Crossing the Midline Challenges
- trouble tapping a hand on the opposing shoulder
- difficulty reading from left to right
- trouble with visual tracking
Autism & Motor Skills
Dr. Redlich brings awareness to the importance of early intervention in Autism and Motor Skills:
“An emerging area of awareness and scientific inquiry is the early identification of autism during the first few years of life. If differences in motor development can be observed in young infants later diagnosed with autism, then there is potential to detect autism long before a child is old enough to socially interact or to start speaking.“
Dr. Redlich elaborates on some areas of motor development where differences have been reported.
Dyspraxia is a term used to describe children who appear clumsy, have poor balance, and have difficulty performing activities in their daily lives, such as dressing, coloring, and playing on the playground. Children with dyspraxia often have challenges with visual perceptual skills, motor planning, and academic demands. Dyspraxia falls under the diagnostic term Developmental Coordination Disorder (DCD), but is also frequently seen with other developmental disorders, including ADHD, hypotonia and autism spectrum disorders.“
In Conquering the Motor Challenges, Dr. Redlich shares approaches to address dyspraxia.
Movement as a Tool
In Movement as a Tool, Dr. Redlich takes a strength based approach and discusses ideas to use movement to enhance overall development.
“Children with autism spectrum disorders often have movement as a strength. Perhaps the child cannot talk or doesn’t know how to initiate play with a peer, but they can typically walk down the block and climb the monkey bars. We’re not talking about the quality, variety, or skill level of movement because children with ASD often have significant deficits in these aspects of movement. We are so often focusing on what children with developmental disabilities can’t do and coming up with strategies to improve these areas. What if we flip it and look at their strengths? If we have identified movement as a strength, then how can we USE that strength to help a child learn, have fun and engage in social interactions?“
The Motor Connection
“Movement is an integral part of our social, emotional, and physical lives. Children with autism spectrum disorder (ASD) often cannot coordinate the myriad of movements needed to complete certain interactions… Motor differences are often due to differences in motor planning, sensory processing, reflex development and muscle tone. Motor planning challenges make it difficult for a child to time, sequence, and execute a movement, such as reaching for an object, crawling towards mom, or activating a toy. This can also lead to repetitive play. Sensory processing differences often cause children with ASD to take in misinformation from the environment. Low tone, or decreased stiffness of the muscles, requires the child to use more energy, can delay motor development, and will decrease sensory feedback a child gets from movement. The child with ASD will learn to roll, crawl, and walk, but the quality of their movement may be poor.”
Aquatic Therapy for Children: The Sensory Motor Benefits
“Water provides 30x more deep pressure to the body than air and it is uniquely a full contact input to the body. Many children who become adept at swimming underwater will find it a very calming and organizing place to be. Moving through water creates controlled vestibular stimulation in various planes. All of this enhanced sensory input helps with body awareness development and motor learning. In addition to swimming, children can walk, somersault, or do angels in the water when supported on their backs. The water is a natural environment for children to improve their oral-motor skills. Blowing bubbles in the water, blowing through a straw, or blowing ping-pong balls across the pool are fun ways to introduce blowing skills. The intense sensory input in the water will often increase language and lots of singing in the pool will further enhance those opportunities.“
Many children with sensory processing disorder can benefit from physical therapy to help provide a solid motor foundation in which sensory processing skills can occur and sensory discrimination skills can develop. Maximizing movement abilities will support the continuous feedback loops that occur within the body between the various sensory systems and the motor system, setting the stage for learning, social interaction and play.