Laurel Haack MS OTR
Boulder Valley Public Schools

Throughout the course of a day, our nervous system takes in and must respond appropriately to a wide variety and amount of sensory information. The brain helps register the type of sensory information coming in, filters out what is not necessary to pay attention to and organizes and interprets the most important input so we can respond accordingly. It is generally assumed that everyone has the ability to attend to all the important sensory input, filter out what is unimportant, interpret the input accurately and respond appropriately. This process is called modulation and is necessary to insure that a child (or adult) is able and ready to learn and control behavior. The modulation must be continual, throughout the day and does not occur easily or automatically in some children (or adults). Therefore, it is important to analyze what part of the process is breaking down and what can be done to help improve the modulation. For example, when we hear a smoke alarm, we are alerted to the auditory input and can respond appropriately to any danger. Likewise, we become calm when we read a book, watch TV or go to bed. However, if our nervous system does not process the sensory information accurately, it may alert and arouse to the wrong cues (attending to the activities of other children in the classroom, rather than completing your own work), it may become over aroused (to a TV commercial) or may fail to alert at all (by ignoring a teacher’s announcement that it is cleanup time). Our nervous system may also have difficulty calming down after a stressful or unexpected event.

Since everyone’s nervous system is unique and responds in different ways, each person may modulate sensory input very differently. Some children have a need for intense visual, auditory, movement or oral input. Examples would include: having toys or books all over and not being distracted by them, enjoying a loud radio, TV, or stereo while playing or doing homework, enjoying riding a bike up and down curbs rather than on a flat sidewalk, jumping off of playground equipment and chewing on clothes, toys or straws. While other children cannot handle that amount of input and may avoid it or limit their participation because of it. It is important to understand and be aware of what a child’s needs are, because if an adult tries to engage them in an activity without the appropriate level of modulation, they may not be able to respond well to the task. When the arousal level of a child is too low, the child may react less readily or more slowly to the input, affecting performance, learning and attending. If the arousal level is too high, performance can also decline. The trick is trying to keep the child at the "just right" level for learning, without shifting or staying at a too high or too low level; in other words, modulating their responses appropriately to the demands of the task.

There are certain types of sensory activities that can have an influence on modulation, resulting in more appropriate behavioral responses from the child. Deep pressure input, heavy work, rhythmic movements in a linear motion, vibration and oral motor activities can be organizing and also calming to the nervous system. These activities must be available and repeated throughout the day to help maintain an optimal level of modulation, particularly during transitional times, in stimulating environments and when the child is having difficulty maintaining attention. As children learn and grow, this process can become one of self-regulation, in which the child attempts to cognitively attain, maintain and change his/her arousal level appropriately for a task or situation. These activities are commonly referred to as a "sensory diet," which is generally designed by an occupational therapist for an individual child. The child’s response to the activities is monitored and changes are made as needed. Examples of the activities follows.

Deep Pressure Input

This involves any kind of firm input through the muscles, joints and skin. It is generally organizing, and unlike other forms of sensory input, rarely overloads the nervous system. Therefore, it is an excellent strategy to use to alert or calm down the body and helps develop body awareness at the same time.

• Wilbarger Protcol using brushing and joint compression (must be demonstrated by a therapist)
• Rubbing lotion on the body with firm strokes
• Using weighted blankets, weighted vests or wrist/ankle weights
• Utilizing a "pillow corner" in which the child can nestle, wrestle and cuddle in
• Wearing leggings, tights, or spandex, also ace wrapping the arms, legs and trunk
• Receiving firm hugs
• Rolling a large ball over the child with careful pressure when lying down
• Creating a small space with pillows or a barrel and climbing into it

This involves any type of activity that provides active pressure into the muscles through pushing, pulling, lifting and carrying. It is also useful in assisting development of body awareness and muscular strength.

• House work involving vacuuming, carrying groceries, carrying laundry, using a wheelbarrow or pushing the lawn mower
• Carrying and wearing a backpack filled with books or toys
• Pulling a wagon with another child in it
• Pushing the grocery cart
• Assisting in moving furniture, stacking chairs, scrubbing tables
• Push-ups or pushing against a chair seat, desk, table or wall
• Climbing stairs, using a stair master, pedaling a stationary or outdoor bike
• Playing with play dough or therapy putty
• Kneading bread, stirring baking mixes, using a rolling pin
• Jumping on the floor, mini-tramp or mattress
• Using playground equipment involving climbing and crawling
• Climbing up the slide portion of a slide, pulling self up with a rope
• Use of hand fidgets
• Using a "worry stone" that feels good to hold and rub on
• Attaching rubbing tubing to the backpack strap to pull on as needed

Movement

Movement that is slow, rhythmic and done in a linear motion is generally calming. Fast and more variable motion is generally alerting. Movement can also help improve muscular strength and balance.

• Riding a bicycle, roller blading and skiing
• Aerobics
• Playing on a trapeze
• Swinging and playing on other types of playground equipment
• Jumping jacks, running in place and stretching
• Using a rocking chair
• Utilizing recess time well
• Using hand fidgets
• Doing classroom errands
• Jumping on a mini tramp

Vibration and Music

Vibration and music can be stimulating to a child (depending on the type), but also can help to "center" or focus a child, as well as providing a calming effect.

• Electric or battery operated tooth brush
• Using a vibrating pillow
• Playing with a variety of vibrators
• Some musical instruments, especially electric or mouth blown can create vibration (harmonica, drums, etc.)

• Use music to help identify transitions and cleanup time

• Sing about activities as they are occurring in short, rhythmic phrases
• Teach concepts musically and with rhythm
• Listen to relaxation music and environmental sounds

Oral Motor

This provides "heavy work" input to the mouth that can help organize and calm the nervous system.

• Chewing gum, fruit leather, licorice, gummy bears
• Chewing on rubber tubing
• Using straws for thick drinks
• Using blow toys
• Playing games by blowing cotton balls across the table
• Sucking on popsicles
• Eating frozen grapes or frozen fruit
• Tooth brushing
• Sucking on hard candy
• Eating a crunchy snack such as pretzels or carrots