How has the pandemic impacted our children? What is better? What is worse? Occupational Therapist Robbie Levy wondered how to enrich the lives of the families she works with. At the NYC 2021 DIR Conference in March, she presented, “Enriching Sensory and Motor Experiences During COVID to Enhance Relationships and Strengthen Capacities” which gave me a different insight into the challenges brought about in the last year. She then went through each sensory system and gave wonderful suggestions for activities we can do at home. I’m delighted to present part 1 of this two-part podcast today!
Robbie is celebrating 40 years this summer being a pediatric O.T. She is the Executive Director and Founder of Dynamic Kids NY, a multi-disciplinary pediatric practice that provides Occupational, Physical, and Speech Therapy services to children from birth through teens. They also provide enrichment groups such as music, art, yoga, self-regulation and handwriting. Robbie is very sensory- and pediatric-oriented and also just started a new company with another O.T. and an interior designer called Sensarooms which is a sensory-informed interior design company.
Sensory Ingredients and Dynamic Responsivity
A Lack of Physical Activity and Sensory Experiences
From March to September 2020, Robbie’s center was closed for in-person services, but they held Zoom presentations, Zoom classes, and Zoom therapy Tele-Health. When they opened back up, they noticed that many of the kids have had very limited movement and sensory experiences at home during the lockdowns. Although some families continued to go outside and walk or do outdoor activities, many kids didn’t leave their house for weeks at a time and had limited exposure to physical play and sensory experiences. I shared that my son would fall into that category because once the world shut down his father taught him how to play video games and he spent the next many months sitting for hours on end at that TV screen!
Meeting Families Where They are At
One thing Robbie says she’s taken from her years of experience is how to meet families where they are at in terms of their activity level and preferences. Some families are really into sports, some are into nature, and others are just not. Some are musical and others are not. It’s important to take not just the child’s preferences, but the family’s into account, she continues when assigning ‘homework’ or activities. There are some basic tenets, though, she offers, that we can take away from this pandemic with regard to physical play.
Following the Lead
Robbie suggests that physical activity doesn’t need to be going outside to play soccer. It can be as simple as just changing your position or moving from place to place. Take video games, for instance, she says. You can play standing up, laying down, on your side, or on your knees to change up your body position. It’s not as easy, but it challenges the body into different motor positions and strengthening different parts. She says that we may not come out of the pandemic stronger than before, but we don’t want them to come out weaker.
Robbie tries to meet the family where they are at, then use their interests and preferences to scaffold them to a place where they can participate in different movement activities or at least other positions. I compared this with my own physical activity from pre-pandemic to now where I went from regularly body building with heavy weights at the gym, to the gyms being closed and using resistance bands and lighter weights at home, to just stopping and doing nothing for months, then the amount of stiffness I felt from just starting to do a few exercises with no weights recently! If it’s like this for us, imagine our kids who are still growing and developing.
The Importance of Movement
Many of our kids not only are still developing, but a lot of them have neuromuscular differences anyway, Robbie explains, such as mild low tone, or hamstring tightness from toe walking. Many children need stretching, or range of motion, that they still need to do at home. If you’re really active it’s not as necessary because as you’re running around you get range of motions, but if you’re sitting all day, anyone will get tighter and stiffen up. With the neuromuscular differences, it’s compounded, she explains. Walking is always great, she says, and you can always include movement with sensory without making it too demanding.
What is 'Low Tone'?
I asked Robbie to describe ‘low tone’ because after 8 years of Occupational Therapy for my son, and having it explained to me by different people in different ways, I’m still not sure I totally understand it. I know that it’s when a child’s body is ‘floppy’, or they lay on their side to play with a car or train, or they slouch when they sit due to a weak core. Robbie says there’s a difference between ‘low tone’, ‘strength’, ‘endurance’, and ‘sensory seeking’. A lot of people use ‘low tone’ as an umbrella term when it is not really referring to muscle tone, but to endurance and strength, or even to co-ordination. You also have to tease out these from interest.
- Muscle tone is the muscle capacity at rest to move and be active. Those with low muscle tone have muscles that react slower to quick stretch. It should be diagnosed by a developmental pediatrician, a neurologist, or an orthopedist. Whether you have low, medium or high tone, it really doesn’t change all that much.
- Endurance Sometimes children have decreased endurance. If they don’t stay with an activity that requires a lot of core strength, it can be interpreted as decreased endurance when it’s really lack of interest in the activity.
- Strength It’s harder to have good strength if you have low muscle tone because you have to work that much harder to have strength, but it’s not impossible. In therapy, Robbie sees kids develop better strength.
- Sensory seeking What happens very frequently, is that kids who slouch or lean are doing it for sensory reasons. For example, if you’re not sitting up tall, it could be that your vestibular or movement system isn’t activated enough. Your movement system gives you a lot of extension. You get a lot of trunk extension from good vestibular movement, Robbie explains. After sitting for a long time, you might slouch from lack of vestibular input. Kids might also lean on the wall, or against their teacher in preschool and it looks like they are leaning because they aren’t strong and need support. They might just be seeking touch or proprioceptive input, though.
- Vestibular input is needing to move, but specifically it’s about taking a sensory break to do something powerful with movement. Walking is ok, Robbie says, but something more powerful like mini sprints where you run and stop, run and stop, run and stop, is better because it’s more energizing to the vestibular system than just plain movement.
- Proprioceptive input I asked about bouncing on a big ball. Robbie says that gives more proprioceptive input which is to your joints, muscles and ligaments. It’s still movement which gives input to your vestibular system, but it doesn’t have the reactivity to it.
How your Brain Registers Sensory Input
It’s important for your brain to notice input. It does this when input quickly changes. When you’re walking you are getting movement, but it’s the quick and unpredictable start/stops that helps the brain register that input and alert to it and make it more powerful, Robbie explains.
Even if you’re done with Occupational Therapy, it’s still important to have an O.T. attune to your child and provide recipes for you so that the sensory ingredients are still coming in to your child’s body and brain so they can get a maximum benefit from their sensory system.
I told Robbie about my podcast with Dr. Ira Glovinsky where we discussed Dr. Lisa Feldman Barrett’s research on how the amygdala responds to novel sensory input, rather than being the ‘fear centre’ of the brain as believed in current popular opinion. When Robbie discharges a child it might be that the child hit a plateau and their services aren’t the most important anymore. The child might need more of a focus on academics or speech and language, for instance, but it’s always good to have a good O.T. on the team to consult with who will say, “This is what I see. What do you think? How can we make this better?” to make sure the child is still getting in the registration necessary from their sensory input. They do a lot of this kind of consulting at Dynamic Kids, Robbie shares.
I shared how my son was constantly seeking vestibular and proprioceptive input as a toddler and still does to this day. I mentioned a lap pad. Robbie gave a great example about how we acclimate to smell quickly and similarly, our brain gets used to the lap pad quite quickly so that it is not really having an impact anymore after a short amount of time. Same thing for a weighted blanket or wearing a compression vest. It will lose its effect quickly unless you take it off and put it on over and over again so the brain registers that something is different.
Robbie also cautions that you don’t want the input to be too alerting, though, otherwise it’s dysregulating. If it’s the right input, it will kind of ‘reset’ you to a state of homeostasis. This can be disrupted, though, if the child is having gastrointestinal issues, is tired or hungry, or if there are emotional changes due to traumatic experience or a change in the family system, for instance.
Sensory responsivity is not static.
Robbie says that these issues could be temporary or longer lasting, but her point is that our homeostatis is not static. What they aim to do is to have their clients ‘hover’ around a range of homestasis. The younger you are, the bigger that continuum is for you, Robbie says. It’s typical for younger children to become dysregulated, she says, but the question is do we have supports in place for them to recover, and how long does it take for them to recover?
In her NYC DIR conference presentation, Robbie also said that vestibular affects relationships, emotionality, and arousal level. When she started teaching about the vestibular system, she had in mind a defensiveless newborn and how all their movements are reflexive. When they fuss, we pick them up and move them around. However, we don’t necessarily know the baby’s sensory profile and if they don’t like all that movement, they can’t really let us know but to cry or fuss. Instinctively, we all rock babies, but that doesn’t give the start-stop that the vestibular system might need, Robbie explains.
It’s very common where Robbie is to provide wiggly school children with wiggle cushions to sit on, but she notices is that they don’t make kids stop wiggling. They keep wiggling. What makes you stop wiggling is the more quick start-stops, she explains, so you can get your input, reset your neurology, and then be able to sit for a longer period of time. It really mimics how we support development in DIR/Floortime by challenging and expanding rather than doing the same thing over and over.
Robbie says it’s a similar concept for motor planning as well. If we do the same thing over and over, and the child develops the movement pattern to do that, it doesn’t really expand their motor planning capacities. It’s novel activities that expand your motor planning. Just like in Floortime, it doesn’t have to be something drastic for the expansion. Robbie says it can just be one new colour, texture, or character in the role playing you’re doing. We just need these little pieces to scaffold and nudge them along, Robbie explains. And I added that you can be working on the new expansion for a long time, even months. Robbie agrees and offers that sometimes newer therapists will change it up too frequently.
This week's PRACTICE TIP:
This week try to break up your child’s screen time (and your own!) with start-stop movement breaks!
For example: Schedule in breaks with a timer every 30 minutes and make a fun activity where your child has to sprint to the other room to get something or high five you before returning.
Thank you to Robbie Levy for sharing this valuable information with us and stay tuned for part 2 next week, where we’ll get into specific sensory activities you can do with your child at home and hear about Robbie’s new sensory interior design business! If you enjoyed and found it useful and helpful, please do share it on Facebook or Twitter and feel free to share relevant experiences, questions, or comments in the Comments section below.
Until next week, here’s to affecting autism through playful interactions!