Posted on November 4, 2024
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Ways To Integrate Proprioception Into Daily Routines
Add Weight to Integrate!
Proprioception – Ground Zero for Integration in Children with Low Muscle Tone
Proprioception allows us to know where our bodies are both in space and in relation to the environment. This incoming combination of pressure and position information is necessary for the brain to process the pressure and forces acting on our bodies in order to plan an appropriate motor response; praxis.
This sense directly affects our overall sensory integration (which in turn impacts visual motor integration and primitive reflex integration), as well as balance, coordination, fine motor skills, attention, focus, and observable “behavior,” to name a few.
Because proper integration for development can feel like a circular chicken and egg cycle, we need a point at which to intervene. For babies and children with Down Syndrome, normalizing proprioception is a great place to begin.
What, When, Where, and How
This is a basic diagram of the proprioception circuit. The Golgi Tendon Organs form a system of receptors in tendons that detect pressure and position. In addition, the space between the bones where they connect together in the joint also have specialized receptors to detect amount of force and pressure. It is an automatic circuit as you can see in the picture…it is mediated by the spinal cord. What isn’t in the picture are the pathways in the spinal cord that relay the information to the brain for processing.
What is this entire sensory system reliant upon? Muscles. If you reach in the fridge expecting a jug of milk to be full your brain knows how to plan in order to pick it up. If you grab the jug and it is actually empty, you automatically adjust your force even before your brain registers the information.
What happens when muscle tone is low? When the muscles are lax, they are not holding joints together compactly. When muscles and tendons are loose, the Golgi Tendon Organs aren’t Stimulated until the joint (in this case, elbow) is hyperextended.
We see this in our kids as “flexibility.” Our children with DS are able to fold over and sleep by resting their heads on their legs. Our children can often times bend their fingers all the way back to touch their forearms without issue. This is a huge problem because if our children can not reliably know where their hips, knees, ankles, and feet are until they are hyperextended, is it any wonder we see joint dislocations, poor motor plans like “butt-scooting,” walking with widely abducted legs, knees locked in extension, problems with fine motor tasks, slouched posture, and difficulty with overall praxis?
It is why a child wishing to place something accurately ends up smashing the object down, hitting instead of tapping when they wish to get someone’s attention, banging or throwing objects, foot slapping when walking, constantly chewing for sensory input to the jaw, or not being able to get in an out of positions correctly.
Unlike every other sense, the proprioceptive system does not feed information in from the environment, only from the body itself, and this is among the biggest systems impacted in our children with DS.
If you can’t feel where your body is or the forces acting on it, how can your brain plan movement?
The Point
Without proper proprioceptive sense everything goes off line. Jean Ayers, Ph.D. was an Occupational Therapist who developed Sensory Integration Theory. Sensory Integration and the Child, is a great book for those interested in a deeper dive. There are also tons of resources on the internet in the form of videos and tutorials. Ultimately, every OT is well versed in Sensory Integration by virtue of their formal education. As with everything else the knowledge is there, working together to apply the knowledge for true neurodevelopment is the goal. Combining your understanding of your child and a need for proper neurodevelopment with your Early Intervention OT can yield great results.
It is imperative that at no point in time can “That’s just DS” factor into plans for intervention.
Because it can take an extended period of time for all systems to begin integrating, traditional thought begins to focus on the time-based delays. When this happens, the focus becomes the sitting or the walking (for more on this: https://thenewdsap.blogspot.com/2024/07/a-means-to-end.html). Our integration mindset begins to take a back seat to compensation (braces, walkers, etc.) and modification (“Crawling with one leg straight out the side is fine,” or “It’s OK the child never achieves proper 4 pt crawl.”) in order to get the child to achieve the milestones.
10 Ways to Promote Continuous Proprioception Integration in our Children’s Daily Environment
Think Heavy!
1. Pushing
If baby is beginning to pivot, creep, or crawl around her environment, strategically place appropriately heavy objects in her way that she must push in order to get where she wants to go.
- Some books in a laundry basket or box
- Sofa cushions (*bonus for this one because baby will begin thinking about how to get over them!)
- Small ottomans
- Pile of toys
- Bags of canned goods
2. Pulling
Depending on where your baby is in development, the following can be adapted to different environments for a just-right challenge.
- Pulling a wagon with weighted objects in it like books, toys, etc.
- Tug-of-War – Gently and playfully pull objects from baby’s hands, for older children a game of Tug of War with siblings
- Hold a towel on the couch and let baby pull himself up
- Pulling Therapy band
- Bags with weight
3. Weight bearing
- Prone-prop on elbows, pushing up on hands while on belly
- side sit with weight bearing on one arm while crossing midline to play with the other
- playing on hands and knees, playing in tall kneel
- (when baby is able to get into stand via proper sequence) standing to play
- Plank
4. Hanging
**Be sure to clear these activities with your child’s PT or doctor.
- Hold baby’s weight and allow her to grasp a bar (monkey bars, pull-up bar, etc.). Gradually decrease the amount of support when you feel baby tighten her shoulders to accept more weight
- Monkey bars
- Swinging from hands
- Pull-ups
5. Crawling
That’s it. Crawling. Crawling is not a milestone, it is an intervention. Once baby perfects 4 pt crawling, they must crawl continuously. Crawl for distance – wrap play mats around the house and do laps – crawl, crawl, crawl. Even after baby can walk, keep going with crawling programs.
- Play a game of soccer on hands and knees
- A game of chase
- Crawling outside on the grass
- Crawling after pets
- Crawling over uneven surfaces such as sofa cushion obstacle course, etc.
6. Squatting
- Squatting down to pick up toys and standing up to place them
- Bunny Hopping
- Simon Says
- unloading dishwasher by grabbing dishes and standing to place them on the counter or hand to mom or dad
7. Standing– Only after baby can properly get there by himself with proper developmental sequence
- Standing at sofa playing
- Weight bearing and weight shifting on legs to cruise
- Standing on unbalanced surface such as sofa cushion, wobble board, balance board
8. Lifting
- A bag of books
- A box of toys
- Dumbbells
- Lifting and stacking cushions to build a fort
- A basket of laundry
9. Squeezing and Extending Fingers
- Squeeze and pinch Play Doh, slime, clay
- Wring out wash cloths, dish cloths
- Water play with sponges
- Roll out resistive putty and place around child’s fingers; have child extend and spread fingers
- Pushing a small peg into resistive putty with one finger (You are looking for the child to tighten finger to push and not allow it to hyperextend back)
10. Banging
- Hammering
- Pounding Clay
- Banging items together
- Throwing weighted objects like bean bags
- Jumping
- Hopping
- Stomping
As baby grows and develops, integrating proprioceptive work in daily routines becomes fun and functional. Doing Animal walks, obstacle courses, playground challenges, as well as chores including laundry, dishes, pushing or pulling with a large broom, shoveling, etc., are just some ways to input proprioception by creating daily targeting environments.
Providing proprioception through daily routines is far preferable than some “sensory activities to do as follow through.” By intentionally setting up the environment in which baby lives, you are combining the sensory work with intrinsically motivating activities that will provide continuous feedback instead of a few minutes of follow through activities that become tagged on to lengthy to-do lists.
Here’s to Having Fun with Heavy Work!
Best,
Geralyn
