Gretchen Kamke is an Occupational Therapist and DIR Expert Training Leader with the International Council on Development and Learning (ICDL) and is a Floortime coach in the DIR Home Program. While recording a segment for Season 1, Episode 4 of ‘We chose play‘, we decided to make a podcast about how a Floortime and Sensory Integration Occupational Therapist looks at a client in determining their sensorimotor profile, which is a large part of the ‘I’ in the Developmental, Individual differences, Relationship-based (DIR) Model.
Sensorimotor Profiles in Floortime
The Initial Meeting
I asked Gretchen what an Occupational Therapist (O.T.) who is Floortime trained is looking for when she meets a new client. Gretchen sees the ‘I’, Individual differences, as information about what we need to tailor to support success. As an O.T. she’s mostly looking at the sensory and motor profile. How does someone take in the information from their environment and process it? How does someone respond to the information that they’re receiving and use their body to interact with their environment.
She’s curious about what’s happening as information comes in, what goes on once it’s in, and how they use that information for output, then she’s concerned with a person’s sense of safety and what impacts that. Many people with complex individual differences can feel very uncomfortable with certain kinds of sensation. Then she thinks about how they’re using their bodies and if they look like they feel competent and whether they can accomplish the tasks they are looking to accomplish.
Gretchen describes proprioception, the sense of where your body is in space, as the awareness of where our muscles are and what they’re doing and how they’re talking to each other, which gives us the sense of where our hand is in relation to our leg, and how much force we’re using as we use our bodies. It helps us understand where our body is in relation to itself and the environment. Here’s the rest of the senses:
- Touch (tactile) which Gretchen did a fabulous presentation about at the recent 2021 ICDL International DIRFloortime Conference
- Sight (visual): how we use our eyes
- Hearing (auditory): how we take in sounds
- Smell (olfactory)
- Taste (gustatory)
- Vestibular: the sense of movement and our relationship with gravity and our balance
- Interoception: the sense of what’s happening inside your body
Senses don’t work in isolation, Gretchen explains. Our brains take everything in and our brain has to figure out what to do with it and figure out how to respond to it. Is it dangerous? Do we have to fight or flee? Or is it safe and we need to explore it? What’s important about this information and how can I then use that information and synthesize it for coordinated movements and precision. So it’s about safety, but it’s also about body control, Gretchen explains.
Supporting for Success
I described my understanding of my son’s sensory profile and how he is generally underwhelmed by sensation, while at the same time being overwhelmed by some senses such as not liking to be hugged. Whenever grandparents go to hug him, he turns his back towards them to get a hug. Dr. Porges had said that is a safer way to get tactile input for him. But while he’s underwhelmed in general, his norm is also to be upregulated. This is puzzling because we want to give him more input if he’s underwhelmed, but being upregulated we want to calm him down.
Gretchen says that the tricky thing about sensory processing is that it’s dynamic. It’s not the same all the time. All of the different senses coming in affect the balance. We have to think about which inputs we have control over, which ones we don’t, and how we support helping that individual find the right intensity to be able to be in the right spot for the activities they’re doing. Regulation on a playground looks different than regulation in a classroom, she explains. We’re not always trying to bring kids up or always trying to bring kids down. A sensory diet isn’t about being rigid.
We need our nervous systems to be able to move with ease through these different states. It’s about thinking about regulation as a whole and what are those inputs that support their regulation. We’re trying to figure out the balance and figure out what they need right now.
We’re trying to figure out the balance and where we are right now which is about attuning to the child in the moment, and about how we can use our Relationship and the knowledge that we have about what different sensation does to support regulation in each moment in each environment. It made me think about how while we are meeting the child where they are developmentally, ‘D’, in each moment, we are seeing how the ‘I’ impacts that. O.T. Robbie Levy talked about this in a past podcast and O.T. Keith Landherr talked about this important co-regulation piece in another past podcast.
O.T. Virginia Spielmann discussed how it’s not about a sensory diet, but about a Sensory Lifestyle. The goal is that we want our children to recognize how to regulate their own systems. I gave the example of Educator Jackie Bartell who said she doesn’t feel regulated unless she gets out for her run each morning, or O.T. Maude Le Roux who doesn’t feel regulated until she has her cup of coffee in the morning. Gretchen agrees, saying that we all ideally figure out how to regulate our nervous systems as we go through life. We can all be intentional to do things to support our own success and we can model this for our children.
I wondered while my son loved getting input by getting into small, snug places, he kicks off his blankets at night. While the former is about proprioception, I now realize, after seeing Gretchen’s presentation, that the latter is probably more about his tactile sense. Gretchen said it has her wondering about the texture and weight of the blanket. Does it wake him up when he feels the blanket as he moves? Does it need to be heavier for it to be relaxing? It does seem tactile and makes her wonder how that tactile input is not supporting what he wants to or needs to be doing, which is sleeping.
When Helpful Sensory Input becomes Dysregulating
I asked Gretchen what to do when you have contradictory sensory processing profiles such as needing to move, yet getting overly upregulated from it. Movement is so important, Gretchen explains. It helps us grow and mature our sensory systems. Parents say that their kids need to run and crash and they’re having such a good time, but then seemingly out of nowhere their child is suddenly overwhelmed or melting down. Gretchen thinks about matching the demands to the activity and asks how do we bring in more regulatory activities into the play. As the child is running, excitement can be dysregulating in itself.
Gretchen wants to think about how we bring in more calming input such as deep pressure to slow it down. Maybe they’re running and crashing into pillows, and then we make a sandwich between them and the pillows, or maybe we’re running and playing and then we stop and we’re statues. It’s like taking their nervous system for a little ride, she says, by pushing the boundary of excitement, and then bringing it down. It’s helping the brain and nervous system practice regulation. Because we are there and being more intentional with movement and using attunement (such as saying slowly, “You are so excited“), we are co-regulating.
Sensory Modulation and Co-Regulation
Doing these things, Gretchen continues, helps them build more self-regulation skills, not because they’re upset, but because they’re so excited and it’s pushing the dysregulation. I gave an example of a girl who is generally sensory seeking at a recent birthday party who was upregulated by playing a game of pushing her little blanket dolly up into the ball machine and watching it fly up into the air over and over. Every time it flew up in the air she would scream. If someone tried to take it from her, she aggressively grabbed it back and wanted to keep doing it over and over again.
In Floortime, we want to use co-regulation in these play scenarios. Gretchen said she would be curious if the child is truly dysregulated or if this was just how she was expressing joy. She thinks about the power of the social engagement system that Dr. Porges talks about to connect and regulate. How can we be a part of that activity with her? Can she do that in connection with someone else? If she doesn’t want anyone around her, it makes Gretchen question the girl’s perception of safety and how we could be a play partner rather than a play interrupter.
Everything is easier to learn when it’s fun.
She might view the approaching person as a threat to her beautiful, wonderful game with her dolly. If this person is going to run that for her, she’s not going to let them in. But maybe if they make it more fun, I might let them in and connect and engage with them, which will help her regulate, Gretchen offers. I responded that it was so loud and chaotic, that it was hard to step in. Maybe if I had a dolly, too, then gave a fun glance and took a turn, maybe she might have responded and engaged in the play with me.
It’s hard to make inhibiting ourselves fun, Gretchen explains, when we have to stop and slow down. But Dr. Greenspan gave tips about how to help us gain that self control when he described sensory modulation games. Gretchen gave an example of playing music and freezing when it stops. It’s a playful way to practice a hard skill, which is that your body is going, going, going, and then you have to hit the brakes, and then wait until someone says to start again. When it’s playful, fun, and in relationship, it’s a lot easier. Knowing our child’s sensory system helps us know what they might like or not like. Just knowing a child loves to watch things move, Gretchen explains, helps us know to find activities that have moving parts that we can be a part of.
I asked Gretchen about how an O.T. works on sensory integration. She said that O.T.s that are trained in sensory integration often have environments where clients can engage in activities that can provide intense sensation. The O.T. thinks about the ‘just right challenge’ where the child has to respond to input in new and novel ways. It’s also about making the activity motivating enough for the child so they want to interact with that activity and find these small, tiny little challenges so the senses can communicate with each other as best as they can.
Sometimes kids who seem underwhelmed by sensation might not be sensory seekers as much as they’re just not able to process the sensory input well, Gretchen continues. An O.T. looks at if they need more of that input, or a type of intensity to help make sense of the input. This is where a thorough O.T. assessment comes in. They formulate a hypothesis and have things that they need to think about. But it all has to be meaningful to the child or client. It’s not about getting the child to do something, but about if it’s getting in the way of them feeling good about themselves so they can feel more confident, comfortable and competent in their own bodies.
In terms of children who are overwhelmed by sensation, Gretchen stresses that sensory integration is not desensitization. While there might be moments that might feel challenging, there should not be discomfort. For some kids having their hands in different textures is extremely overwhelming. When you force a sensation, you are just increasing stress in the nervous system, Gretchen stresses. When you have an overwhelmed nervous system struggling to take in certain sensations and force more of that sensation on a child, it doesn’t help and just makes it harder to calm and relax that nervous system to the point where they can explore things a bit outside of their comfort zone.
The goal of sensory integration is never to tolerate sensation, it’s to make sense of sensation. The client should never feel uncomfortable. You can’t force someone to participate in an activity for the sake of growth. Safety has to come first. Safety before exploration.
Development and Play
I heard a theme of development as well. The more my son kicks sand, the more he splashes in the water, and the more he throws balls of different sizes against different surfaces, different distances, he’s learning a lot about his environment and how to interact with it. Gretchen says that this is what being a kid is: figuring out what’s going on inside your body, in the environment around you, how to use your body to interact with it, how big or small are things, what do things sound like, how does something fit in to something else, etc.
Many children seek out womb spaces which are very regulating so kids will climb into toy boxes because they feel good, they feel safe, and there’s a learning experience about how big they are in relation to this space. This is why supporting playful interactions and opportunities supports the developmental process. Our whole childhood is about more opportunities to build our sensory, motor, cognitive, and relational systems.
This week's PRACTICE TIP:
This week catch let’s practice co-regulating with our child when they get very upregulated and excited by slowing down and adding in some sensory modulation.
For example (Slowly): “Oh… You are really excited about this” and slowing everything down. Let’s use ourselves as play partners to co-regulate the excitement of a fun game, staying very attuned in the moment.
Thank you to Gretchen Kamke for highlighting some important aspects into how a Floortime, Sensory Integration Occupational Therapist will wonder about a child’s sensorimotor profile, which will affect how the knowledge about our child’s profile is implemented. Did it clarify some things for you? If you 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. Have a very happy holiday season, and the next podcast will be in 2022!
Until next week, here’s to choosing play and experiencing joy everyday!