Part 1: Sensory Processing in Schools
Sensory health and wellness is not just a concept to be applied in the space of our homes - it is for the whole community environment, including and especially in our school settings. With insights into the impacts and need for active awareness and implementation of sensory health in our schools. we will delve into the importance of sensory health and how to better support sensory health for students with and without known sensory differences.
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[00:00:00.900]Thank you so much for having me.
[00:00:02.400]It's really an honor to be invited.
[00:00:05.760]I'm Virginia Spielmann.
[00:00:08.040]I am the Executive Director
[00:00:10.800]of STAR Institute for Sensory Processing
[00:00:13.170]based in Centennial, Colorado.
[00:00:15.030]But as you can probably tell,
[00:00:16.410]I'm a British trained occupational therapist.
[00:00:20.190]I did my undergraduate degree in occupational therapy
[00:00:24.210]at Oxford Brookes University in England.
[00:00:27.360]I've also done my master's
[00:00:29.160]at Mount Mary University in occupational therapy
[00:00:31.920]and my PhD in infant and early childhood development
[00:00:34.590]with an emphasis on mental health
[00:00:36.090]is from Fielding Graduate University based in Santa Barbara.
[00:00:39.480]I've been here for five and a half years, in Centennial.
[00:00:43.860]I apprenticed under Dr. Lucy Jane Miller.
[00:00:47.040]And prior to that I was working in Hong Kong
[00:00:49.650]where I ran a interdisciplinary
[00:00:53.370]children's therapy center called SPOT.
[00:00:56.040]Everything was all under one roof.
[00:00:57.330]It still is, it's just much bigger now.
[00:01:00.934]And prior to that I was living in Kenya,
[00:01:04.470]where I was working for a nonprofit.
[00:01:07.380]And the vision of that nonprofit
[00:01:10.770]was building families instead of building orphanages,
[00:01:15.150]which you would be probably not at all surprised,
[00:01:19.560]it's very hard to raise money for
[00:01:21.720]because people would much rather have a photo of themselves
[00:01:24.090]next to a building for something that they've donated to,
[00:01:28.440]than donate to families.
[00:01:29.520]So, you know, that was very interesting.
[00:01:31.980]Prior to that,
[00:01:33.133]I was working in the UK at a pediatric assessment center
[00:01:37.525]with some excellent people
[00:01:39.150]and getting some excellent experience there.
[00:01:41.520]And in schools for children with physical disabilities
[00:01:45.720]and special needs.
[00:01:48.044]I'm also a game designer strangely,
[00:01:53.130]but it's very specific to autism and neurodivergencies.
[00:01:58.440]And I designed a game called Critical Core
[00:02:01.560]with a group from Seattle, Washington
[00:02:04.830]based on Dungeons and Dragons.
[00:02:07.230]So it's a therapeutic tabletop role playing game.
[00:02:11.790]And it's really fun because adolescents and tweens
[00:02:15.990]who are some of the hardest people
[00:02:17.310]to sort of figure out motivation and play with, love it.
[00:02:22.260]And it's really, really fun.
[00:02:24.747]So I'm not sure what else I need to tell you
[00:02:26.970]about me right now.
[00:02:28.050]We'll probably here more as we go.
[00:02:29.730]I'm a mother, I have three children.
[00:02:32.855]My oldest is my biological son with my husband of 21 years,
[00:02:38.490]and he is neurodivergent.
[00:02:40.140]Our middle child is adopted and has type one diabetes
[00:02:45.660]and our youngest daughter is our foster daughter
[00:02:48.780]and also has type one diabetes.
[00:02:51.900]So we've got a lot going on
[00:02:53.520]and we've got lots of really mixed experiences.
[00:02:58.230]And so I speak as a student of sensory integration.
[00:03:01.860]I speak as a person with sensory integration differences.
[00:03:05.880]I speak as a mother of a family
[00:03:08.070]with lots of competing sensory needs
[00:03:10.290]and also someone who's worked a lot in schools
[00:03:13.260]around the world.
[00:03:14.093]I've worked in special schools, as I said,
[00:03:16.350]I've worked in mainstream schools,
[00:03:18.030]I've worked in private schools and Montessoris
[00:03:20.250]and international schools and so on.
[00:03:23.400]The topic of how our bodies integrate
[00:03:27.510]and process sensation is incredibly relevant
[00:03:30.060]to the school setting.
[00:03:30.990]But of course it's also relevant to every setting.
[00:03:36.354]It's relevant in prisons and in the workplace.
[00:03:39.630]It's relevant in the, on the sports field.
[00:03:42.780]You know, you see it at the Olympics,
[00:03:45.390]you see differences in doing integration and processing
[00:03:48.030]at the Olympics because you see exquisite,
[00:03:51.930]incredibly well developed sensory integration and processing
[00:03:56.400]from the ath there and so on.
[00:03:59.700]But what is it?
[00:04:00.630]And if we're gonna have this conversation,
[00:04:02.310]really want you all to be really comfortable
[00:04:04.710]with what I'm talking about, and I want it,
[00:04:06.930]I don't want it to feel like something nebulous
[00:04:10.350]or difficult to explain or abstract.
[00:04:14.730]Ask me questions as you go 'cause I can see the chat
[00:04:19.110]and I'm in fact, yeah,
[00:04:21.090]I'm just going to glance over at that occasionally.
[00:04:25.890]And then let's see how we go.
[00:04:29.940]So, the sensory integrative process,
[00:04:34.710]or sensory integration and processing
[00:04:38.760]is called lots of things,
[00:04:39.840]also called just sensory processing.
[00:04:41.690]It's called just sensory integration.
[00:04:44.340]There's a lot of,
[00:04:45.298]you know, variations in how we refer to this.
[00:04:49.080]But it is a,
[00:04:50.400]it is a fact of life.
[00:04:51.780]We all process sensation and then integrate
[00:04:56.520]what we have processed, what we have registered,
[00:04:59.610]and it is a big, big part of how we perceive the world.
[00:05:06.690]It is a big part of how we construct our reality
[00:05:12.090]and our perception of the world around us.
[00:05:15.863]even Piaget would talk about this
[00:05:18.987]and the importance of the sensory integrative process,
[00:05:21.930]particularly in the first seven years of life where we,
[00:05:25.560]we've been referred to as sensory beings
[00:05:28.530]or sensory motor beings.
[00:05:30.450]Because as you know, humans are born very, very vulnerable.
[00:05:37.850]And there's a evolutionary reason for that.
[00:05:40.860]The reason humans are born vulnerable
[00:05:43.530]is because experience is what helps the brain
[00:05:48.390]sort of finish cooking, if you like.
[00:05:51.120]In utero, we have three trimesters
[00:05:53.820]and a tremendous, miraculous amount of growth and change,
[00:05:58.110]which has wowed all of us at one time or another.
[00:06:01.050]But then the first three months of life outside the womb
[00:06:04.350]are called by some people,
[00:06:06.099]and this is something that we all say
[00:06:08.739]in the field in England is, the fourth trimester.
[00:06:13.170]And it's called the fourth trimester
[00:06:14.880]because there is this precocious alactricity
[00:06:20.420]or alcatricity, I know I'm not saying it right,
[00:06:23.250]but there is this precocious neuroplasticity
[00:06:26.580]that's taking place.
[00:06:27.750]And precocious means sort of unprecedented,
[00:06:30.660]never before seen and never again to be seen
[00:06:33.840]to quite that level.
[00:06:35.190]And as we experience the world in that fourth trimester,
[00:06:42.210]the brain just changes so, so very much.
[00:06:48.270]But it doesn't stop there.
[00:06:49.314]Our brains are plastic all the way through life.
[00:06:52.620]And what taps into that neuroplasticity
[00:06:55.350]is experience, motivation, and relationships.
[00:07:01.070]Those are the most powerful pieces there.
[00:07:05.250]So the sensory integrative process is,
[00:07:07.800]it's as inextricable from life, as respiratory processes,
[00:07:12.720]as cardiovascular processes are.
[00:07:15.330]We all do it, we all process sensation,
[00:07:18.360]and we have to use what we sense to make sense of the world.
[00:07:23.640]So when we talk about the sensory integrative process,
[00:07:26.220]we are talking about the mechanisms of how we feel,
[00:07:31.650]the neurobiological processes
[00:07:33.600]that are part of how we function.
[00:07:37.090]And it, you know, what we want is for ourselves,
[00:07:43.740]the children we're looking after, our partners,
[00:07:45.900]our loved ones, to experience sensation in an organized way
[00:07:50.340]so that it has an optimal effect
[00:07:52.680]and it actively organized and used by the individual.
[00:07:57.090]But sometimes that's easier said than done.
[00:08:01.860]the reason there's such a long preamble
[00:08:04.680]is because there's some myths circulating
[00:08:07.500]about sensory integrating
[00:08:08.910]and some sort of very rigid incorrect assumptions.
[00:08:18.444]One of the reasons for this, I believe,
[00:08:21.960]my hypothesis is that trying to get,
[00:08:27.622]there was a time when there was a big campaign
[00:08:30.300]and STAR Institute where I work was a big part of this,
[00:08:33.300]tried to get sensory processing disorder
[00:08:37.890]recognized as a standalone diagnosis in the DSM.
[00:08:42.960]It was not successful in getting its own piece of paper
[00:08:49.020]or place on the page,
[00:08:50.700]but it was included as underneath autism.
[00:08:55.509]What that meant was that the research interdifferences
[00:09:00.480]in sensory integration grew exponentially afterwards,
[00:09:05.460]but it also led a lot of people to say SPD is not real,
[00:09:11.007]sensory processing disorder is not real.
[00:09:14.280]And that's a gross overstatement
[00:09:18.330]because what we are saying then
[00:09:20.670]is sensory processing disorder
[00:09:23.280]is not recognized as a standalone diagnostic category.
[00:09:28.314]However, if there can be resp-
[00:09:35.340]if humans have respiratory systems that can be,
[00:09:39.893]vulnerable or strong and all of the places in between,
[00:09:45.281]you know, so can any system in the human body.
[00:09:49.710]The sensory integration process
[00:09:52.770]involves a lot of nervous system activity.
[00:09:56.670]It is a whole brain and body process
[00:10:00.420]with a lot of neurological underpinnings.
[00:10:03.000]And at any place in this complex system things can go wrong.
[00:10:09.060]There's tremendous vulnerability.
[00:10:11.280]There's also, of course,
[00:10:12.113]tremendous potential to develop these exquisite skills
[00:10:16.440]that might lead you into sports and other,
[00:10:18.600]and dance and other things.
[00:10:20.760]So, this idea that there's no such thing
[00:10:23.790]as sensory integration
[00:10:24.770]or I don't believe in sensory integration
[00:10:27.060]has come, I believe from this sort of one area
[00:10:31.320]and been overstated to the point of being reductionist
[00:10:36.810]and actually not logical
[00:10:38.520]when you think about how human bodies work.
[00:10:42.300]Another thing that people say
[00:10:44.790]and have said to me after presentations,
[00:10:46.800]although I haven't heard it in recent years,
[00:10:48.480]is, you know, but everyone processed sensation, right?
[00:10:51.150]And actually what they say is,
[00:10:52.770]everyone has sensory processing, don't they?
[00:10:57.070]Yes they do.
[00:10:58.770]Everyone processes sensation.
[00:11:01.950]That is absolutely correct.
[00:11:03.780]That's not to say we don't all process sensation
[00:11:07.274]incredibly differently from one another
[00:11:10.380]and that there's tremendous variety and nuance between,
[00:11:14.460]from one person to the next in how sensation is processed.
[00:11:18.743]There's also another myth here.
[00:11:20.760]Sensory integration therapy is not evidence-based.
[00:11:24.390]We are gonna talk about that in a later presentation.
[00:11:27.019]It has reached evidence-based status
[00:11:29.850]for a certain population
[00:11:31.710]and there is emerging evidence in other populations too but
[00:11:34.710]and actually quite solid evidence by 2023 standards,
[00:11:39.270]especially compared to some other approaches.
[00:11:45.167]we're gonna talk about some of these other pieces as well.
[00:11:48.000]But really, what the most important place
[00:11:51.180]for us to start from
[00:11:52.440]is realizing that everyone processes sensation.
[00:11:57.270]It's incredibly complicated
[00:11:59.940]the way that sensation is processed.
[00:12:02.430]It's a system in a system, in a system, in a system.
[00:12:07.557]And it therefore has tremendous potential
[00:12:12.510]to support function or derail function.
[00:12:16.890]There's promise and peril
[00:12:19.020]when we talk about the sensory integration process,
[00:12:21.360]especially in early childhood.
[00:12:23.730]We're going to talk about the prevalence of differences
[00:12:27.540]in the sensory integration process in autism
[00:12:30.030]at the next presentation, but they're very, very high.
[00:12:34.080]And some would even say they're in the like 90% of people,
[00:12:39.300]of autistic people or people on the autism spectrum
[00:12:42.540]have these differences.
[00:12:44.610]And others say a hundred percent, you know.
[00:12:46.950]but I will share the prevalence data
[00:12:50.010]at the next presentation.
[00:12:52.410]What I really want you to just start off by understanding
[00:12:55.410]is that the sensory integration process
[00:12:57.780]is a tremendously important,
[00:13:01.410]a crucial part of the big picture.
[00:13:06.870]And it can, it can take your learning brain,
[00:13:10.830]your upstairs brain offline
[00:13:13.680]when your sensory integration differences
[00:13:16.800]are not being supported.
[00:13:18.720]And so, and there's so many other implications as well.
[00:13:23.757]How a person integrates and processes sensation
[00:13:29.457]really strongly influences
[00:13:31.801]their ability to make relationships,
[00:13:34.230]their ability to
[00:13:38.160]orient to social cues in their environment and so on.
[00:13:41.940]It is a huge part
[00:13:43.710]of being able to sustain focused attention.
[00:13:46.814]It is also a very, very big part of being calm
[00:13:53.520]and available or regulated.
[00:13:55.305]And we're gonna talk more about that later.
[00:13:58.650]The sensory integration process
[00:14:00.510]underlies almost every aspect of human function
[00:14:03.720]in one way or another.
[00:14:05.580]That's not to say it's a hundred percent of everything,
[00:14:08.573]but it's a massive contributor
[00:14:10.590]to how a person can engage in activities of daily living.
[00:14:16.920]I do want to say, and I probably should have led with this,
[00:14:21.390]but I tend to use identity first language.
[00:14:24.690]So I tend to say the autistic person
[00:14:27.690]rather than person first language,
[00:14:29.790]which I believe and feel is a little pathologizing.
[00:14:33.000]My, you know, when I meet a woman,
[00:14:39.450]I don't call her a person with femaleness.
[00:14:42.660]When I congratulate someone on their athleticism,
[00:14:46.860]I don't call them a person with athleticism.
[00:14:51.060]I call them an athlete
[00:14:52.050]and I recognize that part of their identity.
[00:14:54.780]Many people in the autistic self-advocacy community,
[00:14:58.590]and the vast majority of people
[00:15:00.600]have asked for identity first language.
[00:15:02.550]And so that's usually my default.
[00:15:04.740]My neutral ground for people
[00:15:07.830]because some people do find it offensive;
[00:15:10.590]they tend not to be autistic people, but that's okay,
[00:15:13.590]is to say people on the autism spectrum.
[00:15:15.900]That's a more neutral place for me,
[00:15:17.970]still feels a little pathologizing to me,
[00:15:20.400]but we can have that discussion later if you want to.
[00:15:23.430]Okay, so going back to the sense integration process,
[00:15:26.700]if we're thinking about,
[00:15:30.390]if we're thinking about understanding
[00:15:33.180]this incredibly complex integration process,
[00:15:38.040]the first thing we need to do
[00:15:39.330]is kind of organize our thinking.
[00:15:41.820]And so I want to talk about systems thinking for a second.
[00:15:45.570]Because one, what we're,
[00:15:47.730]one thing we are dealing with in our education
[00:15:51.480]and behavioral health and medical settings and so on,
[00:15:56.580]is a kind of siloed mentality.
[00:15:59.940]And this is actually in almost every space at the moment
[00:16:03.600]in the western world.
[00:16:04.650]So think about your adult life
[00:16:06.840]where you go to the gym to move
[00:16:09.300]and you go to the counselor's office
[00:16:10.980]to talk about mental health,
[00:16:12.870]and you go, you know,
[00:16:14.370]somewhere else to do something else.
[00:16:15.990]And we do things in these silos
[00:16:18.554]and we do the same thing with our children in therapy.
[00:16:23.820]We go to the physical therapist for X,
[00:16:28.830]the speech therapist for Y
[00:16:30.870]and maybe the OT gym for sensory and sensory motor.
[00:16:35.910]And really what we need is communication,
[00:16:39.810]sensory motor and posture.
[00:16:42.390]And you know,
[00:16:43.223]all of this all to be happening in each of those spaces
[00:16:46.260]because you can't really isolate out one aspect
[00:16:50.850]of someone's humanity and treat it as an island.
[00:16:55.920]And that's because that's how our brain and bodies work.
[00:17:01.880]one of the things that happens with the silo mentality
[00:17:04.350]is we kind of forget that the human being is an open system.
[00:17:10.226]It's not a self-contained unit.
[00:17:13.822]The human being is always exchanging energy,
[00:17:18.660]it's always interacting between the environment
[00:17:21.390]and other living things in the environment.
[00:17:24.840]And so that means it's an open system.
[00:17:28.110]So the human being is a system, contains lots of subsystems.
[00:17:34.350]The sensory integration system could be identified as one,
[00:17:40.110]but even within that are multiple, multiple subsystems.
[00:17:44.520]And they're not really defined by clear boundaries.
[00:17:49.110]They're open systems and so they influence one another
[00:17:53.670]and they have a flow of energy and information
[00:17:58.500]that is bidirectional and crossmodal.
[00:18:03.360]And so really important to just start with that.
[00:18:07.382]Siloed mentality has sort of led us
[00:18:10.830]to create ideas of like a sensory playgroup
[00:18:15.630]where we just do tactile play
[00:18:17.340]because that's what sensory is.
[00:18:18.840]But that's really just one sensory system maybe.
[00:18:23.460]Actually the tactile system's multiple,
[00:18:25.530]but it's not the big picture.
[00:18:27.750]So I want us to sort of start
[00:18:30.000]by remembering humans are complicated and that they,
[00:18:36.330]and that everything influences everything else.
[00:18:41.580]And so let's talk about the systems.
[00:18:43.980]Let's talk about the main systems we've identified
[00:18:47.700]when we talk about the sensory integration process.
[00:18:51.030]So, you know, classically at school,
[00:18:54.000]you get taught about five systems.
[00:18:57.900]You get taught about touch, taste, smell, sound and sight.
[00:19:06.030]And of course every OT in my field
[00:19:08.340]wishes that you would also be taught about the other systems
[00:19:12.180]so that when we start saying the sixth sensory system,
[00:19:15.725]for example, people don't think of a Bruce Willis movie,
[00:19:19.200]M. Night Shyamalan.
[00:19:20.550]They actually realize that there's a lot more going on
[00:19:24.900]in the human body.
[00:19:27.717]So these sensory systems are crossmodal.
[00:19:32.640]They all inform one another, some more so than others.
[00:19:37.830]And they all have multiple, multiple functions.
[00:19:41.695]They mature and operate independently.
[00:19:46.302]They develop asymmetrically and they rely on environmental
[00:19:52.350]and relational experience for the organization,
[00:19:56.840]for the structural and functional organization
[00:20:00.086]that occurs as a result of that experience.
[00:20:04.110]And again, what we want are organized experiences
[00:20:08.460]that the body can use
[00:20:11.580]to create even more organization to mature.
[00:20:16.050]And so that, you know,
[00:20:17.550]neural pruning can take place
[00:20:19.560]and nice neural networks can be laid down.
[00:20:23.640]Let's talk about some of the less well known systems
[00:20:27.178]so that you can get comfortable with them.
[00:20:31.110]And I really,
[00:20:32.100]I really want you to be able to explain them
[00:20:34.050]to someone else,
[00:20:34.883]and I really want you to be able to see
[00:20:36.360]how they underpin human function so foundationally.
[00:20:42.088]So the vestibular system is an incredibly important system
[00:20:48.030]and also, you know,
[00:20:49.620]therefore classically misunderstood quite significantly.
[00:20:53.370]But it's a system that supports
[00:20:56.280]our understanding of equilibrium.
[00:21:00.750]And so where my head is in relation to the sidewalk,
[00:21:04.402]where my head is in relation to gravity,
[00:21:07.814]it also helps me organize my eyes on the horizon,
[00:21:11.021]for example and so on.
[00:21:13.770]And so when I'm knocked and I experience disequilibrium,
[00:21:18.180]multiple sensory systems are involved in that process.
[00:21:20.790]But the vestibular system is key
[00:21:22.920]in helping me stay upright as well
[00:21:26.160]and help me develop.
[00:21:27.270]The vestibular system is really, really critical
[00:21:30.126]in the development of postural control,
[00:21:33.930]which you might also call the battle against gravity.
[00:21:40.500]And as we develop postural control in early childhood,
[00:21:43.950]we are hopefully winning the battle against gravity,
[00:21:48.300]but not all of us do so successfully.
[00:21:51.390]Now, I just want you to think about your vestibular system
[00:21:53.910]for a minute.
[00:21:54.743]And I love this picture.
[00:21:56.370]I'd love to know how many of you would get in this elevator.
[00:22:00.755]You know, when you've been in an elevator
[00:22:03.120]and there's been that moment of not being sure
[00:22:06.030]if it goes up and down and how alarming that is?
[00:22:12.087]And actually what happens that I always notice
[00:22:15.600]and think is so funny
[00:22:16.470]is when there are those kind of blips in the elevators,
[00:22:18.900]we all get social,
[00:22:20.056]but when the elevator feels safe, we all ignore each other.
[00:22:23.190]And I'm not totally sure what that's about,
[00:22:24.960]but I think it's very interesting.
[00:22:26.070]One of the things that happens is
[00:22:28.170]the vestibular system has a bat phone.
[00:22:31.050]It is hardwired,
[00:22:32.220]it has a direct line to our defensive systems,
[00:22:36.810]to our fight or flight systems,
[00:22:39.420]to our primitive self-preservation systems.
[00:22:45.930]Our alarm center has a bat phone
[00:22:48.420]straight to Commissioner Gordon's office.
[00:22:50.940]And so if our vestibular system loses data
[00:22:57.288]gets data that indicates that there's a lack of safety,
[00:23:02.370]then that bat phone goes off in Commissioner Gordon's office
[00:23:06.600]and we get dysregulated because we go into a state of alarm
[00:23:13.560]and defense so that we stay alive.
[00:23:17.610]It's wired that way, it's designed that way.
[00:23:21.300]So your vestibular system,
[00:23:22.796]you might remember those incidences in the elevator.
[00:23:30.930]I wonder if you can think of other examples
[00:23:32.598]of when you've really tuned into your vestibular system.
[00:23:36.900]The hardware that gives you this information
[00:23:40.410]is in your inner ear, which is about here.
[00:23:43.230]If you can still see me,
[00:23:44.732]sort of just behind the cheekbones
[00:23:49.290]as you're going down past the part of the ear that can hear
[00:23:55.980]and then you get the vestibular apparatus, which is here.
[00:23:59.580]And the vestibular, I like this picture from this study.
[00:24:03.300]I think it's one of the clearer pictures
[00:24:05.250]of how the vestibular apparatus look.
[00:24:07.890]Now an important point to remember
[00:24:09.623]is that this is just half of the vestibular apparatus.
[00:24:14.581]So there's half in each side of, in each semi, sorry,
[00:24:20.310]in each ear.
[00:24:21.143]Your semicircular canals, half circle canals.
[00:24:24.890]They connect to one another.
[00:24:26.007]And that's what gives the big picture
[00:24:27.690]is the two sides of the head coming together.
[00:24:31.380]And the information you are getting
[00:24:32.820]from the semicircular canals, which is this,
[00:24:35.130]are these pieces here,
[00:24:40.710]is about planes of movement and rotational movement.
[00:24:44.970]So you're getting roll, yaw and pitch
[00:24:47.220]is one way of looking at it
[00:24:48.930]and how you move your head in those directions.
[00:24:53.070]And then in the utricle and the saccule which are here,
[00:24:58.110]you are getting movement
[00:25:01.140]about more about the pull of gravity.
[00:25:05.054]But if you tilt your head down,
[00:25:08.280]then what happens is the utricle and the saccule that this,
[00:25:17.370]this is the membrane here and the otolithic membrane
[00:25:22.860]and is pulled down by the weight of these crystals.
[00:25:28.394]And that moves the hair fibers here, these cilia,
[00:25:34.560]and that's what tells the nervous system
[00:25:36.570]about the direction your head is moving in.
[00:25:39.210]And so, if you're bouncing on a trampoline,
[00:25:41.820]that's gonna give you input here.
[00:25:44.460]And if you're tipping your head forward or back,
[00:25:46.231]that's gonna give you input here.
[00:25:48.548]And we have the utricle,
[00:25:51.450]I think is on this plane and the saccules on this plane,
[00:25:54.180]but now I want to look that up.
[00:25:57.900]And there's also constant pull of gravity.
[00:26:04.200]So even when you're static,
[00:26:06.330]your vestibular system should be sensing gravity
[00:26:10.680]and the pull of gravity.
[00:26:12.960]And that's one of the things that helps you with posture
[00:26:15.630]and with organizing your eyes so that they work together
[00:26:18.630]and don't move around like the eyes of a doll.
[00:26:21.540]And this is all really, really important functionally,
[00:26:24.672]there's a reason I'm telling you all of this.
[00:26:29.847]Then there's proprioception.
[00:26:37.590]is the detection of joint and limb movement.
[00:26:40.740]And the hardware for this is located in the joints
[00:26:44.340]and the muscle spindles.
[00:26:46.260]And proprioception is how when you close your eyes now,
[00:26:49.860]if you do that real quick,
[00:26:51.720]you can feel how bent your knee is, how flat your feet are,
[00:26:55.380]where your arms are and your hands are.
[00:26:57.900]It's how perhaps at nighttime when it's dark
[00:27:00.750]and you reach behind you to switch on the light
[00:27:06.390]or the, you know,
[00:27:07.223]nowadays we mostly say Alexa, turn the lights on.
[00:27:09.870]But it's how you know where your hand is
[00:27:13.050]in relation to that mental map you have of the light switch.
[00:27:17.580]Your proprioceptive system also is really important
[00:27:20.850]for telling you how fast
[00:27:22.913]or slow your muscles are contracting or expanding and so on.
[00:27:27.750]And the proprioception is a major facilitator
[00:27:33.720]of force regulation.
[00:27:35.580]So how hard or soft you open a door or a drawer
[00:27:38.970]or lift up a child.
[00:27:40.200]Remember lifting up a child
[00:27:41.231]and they're lighter than they look
[00:27:43.211]and you have to quickly adjust,
[00:27:45.120]otherwise you're gonna fling them into the air?
[00:27:47.610]And to the development of bodily self.
[00:27:52.042]And so the proprioceptors, as I said, they're here,
[00:27:55.560]they're in the joints,
[00:27:56.880]they're in the muscle spindles
[00:27:58.594]and the deeper layers of the skin.
[00:28:01.740]Now there's another part of sensory integration
[00:28:05.550]and processing that is being called
[00:28:07.860]the eighth sensory system.
[00:28:09.420]It is interoception.
[00:28:11.550]And the eighth sensory system is a bit of a misnomer
[00:28:15.330]because there's way more than eight for a start.
[00:28:22.680]there's all sorts of other things that are going on,
[00:28:26.757]thermoception and so on.
[00:28:32.730]However, I really think it's important
[00:28:35.880]that people are paying attention to it now
[00:28:37.800]the way that they are because it's,
[00:28:40.080]interoception is so critically mapped
[00:28:43.830]to the development of emotional self-awareness.
[00:28:48.720]And then there's this huge overlap isn't there between,
[00:28:52.080]like for example,
[00:28:53.250]the sensation of hunger can make you hangry.
[00:28:58.560]So that sensation of hunger
[00:28:59.880]can make you irritable and emotional
[00:29:02.190]and your emotional regulation goes out the window.
[00:29:04.500]But really it's this,
[00:29:06.180]it's a satiety cue that is making you feel that way.
[00:29:10.680]It's more of a sensory route.
[00:29:15.600]So included in interoception are all,
[00:29:19.017]are actually proprioception can be included
[00:29:23.160]under the title of interoception.
[00:29:25.212]Certain tactile inputs can be considered interoceptive
[00:29:30.630]it's generally about the,
[00:29:36.990]your state, your bodily state,
[00:29:42.003]your internal wellbeing, your internal equilibrium.
[00:29:46.290]And it's about maintaining homeostasis
[00:29:48.390]and all of these other pieces.
[00:29:51.324]And so, it's a complex body wide system
[00:29:55.080]of nerves and hormones.
[00:29:57.270]So in a way it's another category
[00:30:00.330]that would go more like this,
[00:30:02.040]where there's interoception, or my internal cues,
[00:30:06.210]and exteroception, or my external cues.
[00:30:10.200]And so just important to sort of remember this
[00:30:12.360]so that we don't get too simplistic
[00:30:14.310]in how we approach supports for people who have differences.
[00:30:18.840]One of the things we're really seeing
[00:30:21.090]is that differences in interoception,
[00:30:23.490]especially under responsivity to interoception
[00:30:27.510]map to the development of things like alexithymia,
[00:30:31.710]which is an ill ability to recognize
[00:30:34.950]my own internal emotional state
[00:30:37.110]and to separate emotions out from one another
[00:30:40.320]and therefore learn how to identify emotions in others.
[00:30:46.641]Here are some examples of interoception, just one aspect.
[00:30:50.730]And you can see that even just in the sense of gut wellbeing
[00:30:55.920]that comes from interoception,
[00:30:57.187]there are different types of receptors
[00:31:00.600]and mechanics going on.
[00:31:02.790]And so for example, on the aorta,
[00:31:06.450]there's a vagal neuron that can sense stretch
[00:31:09.900]and keep tabs on blood pressure,
[00:31:11.435]which is fascinating.
[00:31:12.780]In the larynx there's a hundred neurons in the mouth
[00:31:16.530]that detect chemical irritants.
[00:31:19.403]These are all interoceptive pieces.
[00:31:22.710]And so, interoception,
[00:31:25.347]the some phenomenological experience, long word,
[00:31:36.645]the sense of being alive,
[00:31:39.900]the state of the internal body, internal perception,
[00:31:43.440]these sorts of different things.
[00:31:44.760]And these are all different systems
[00:31:46.736]that could be included
[00:31:49.741]within this category of interoception.
[00:31:54.510]So, sensory integration
[00:31:58.140]and the role of the sensory integration process.
[00:32:01.080]It's everywhere all the time.
[00:32:04.620]Everyone does it.
[00:32:06.210]It has tremendous potential to do support function
[00:32:10.140]and it has tremendous potential
[00:32:12.840]to derail function when there are unsupported differences
[00:32:17.430]in the sensory integration process.
[00:32:20.280]Sensation is hugely important, for example,
[00:32:23.400]in the attachment process.
[00:32:26.190]And so I just want you to think for a second
[00:32:27.900]about that again, like those first moments outside the womb,
[00:32:32.010]what do we do with most children?
[00:32:34.230]We give them skin to skin contact.
[00:32:37.590]And is that,
[00:32:39.120]I want you to just think about if that's sensory
[00:32:41.880]or if it's affective, skin to skin with the parent.
[00:32:44.820]Is it sensory or is it emotional?
[00:32:47.730]Is it sensory or is it social?
[00:32:51.750]It's a hundred percent both.
[00:32:53.670]It's socio sensory, it's sensory affective.
[00:32:58.111]And that's tactile and it's olfactory.
[00:33:03.390]We know that new infants
[00:33:05.636]recognize the scent of mother's milk and gustatory.
[00:33:09.540]They recognize flavors that they tasted
[00:33:13.440]from the, their time in utero.
[00:33:16.620]And that all supports the attachment process, okay?
[00:33:21.570]So the sensory integration process supports attachment
[00:33:25.856]in the first years of life and throughout life.
[00:33:28.890]It supports acadec learning.
[00:33:31.320]As you experience your body in space
[00:33:35.190]and start to learn about spatial relationships,
[00:33:38.340]you can then apply that to more abstract concepts
[00:33:41.812]in pre-mathematics and mathematics.
[00:33:45.720]But it really supports the process
[00:33:48.065]when you experience it in your body first.
[00:33:51.364]Actually it's quite easy to map mathematical understanding
[00:33:56.220]to the sensory integration experiences of early childhood.
[00:34:01.260]Huge, huge piece of social learning as well.
[00:34:04.470]So much so that Simon Baron-Cohen
[00:34:08.490]wrote an article with Caroline Robertson
[00:34:12.450]even for coming up to four years ago now,
[00:34:15.240]where he said, actually,
[00:34:17.550]I think the sensory integration process
[00:34:20.667]and sensory motor experiences
[00:34:22.470]might be responsible for differences
[00:34:24.840]in social learning in autism
[00:34:26.400]rather than social learning itself
[00:34:29.400]being a core deficit in autism,
[00:34:31.770]which is a fascinating thing for him to say,
[00:34:34.620]especially as quietly as he said it.
[00:34:36.660]The sensory integration process is also hugely important
[00:34:40.890]in the development of regulation,
[00:34:44.130]co-regulation and self-regulation,
[00:34:46.170]which we're gonna touch on very, very quickly.
[00:34:48.510]And of course developmental milestones.
[00:34:52.140]So in summary,
[00:34:54.120]it is a whole brain body nervous system process.
[00:34:58.410]It is an amalgam of numerous subsystems
[00:35:01.186]and importantly each of these 8, 9, 10, 11, 12 systems,
[00:35:06.450]however you want to categorize them,
[00:35:09.013]provide partial data towards the whole.
[00:35:12.981]And the whole, the big picture,
[00:35:15.600]is different for me than it is for Annette,
[00:35:18.900]than it is for Megan, than it is for you.
[00:35:24.720]And Anil Seth even calls our personal big picture
[00:35:28.020]our hallucination of the world because it is so,
[00:35:32.250]it is so personal and it is so much about interpretation.
[00:35:36.671]When we've created this big picture of the world,
[00:35:39.570]which is a temporally continuous process,
[00:35:42.780]we're never done processing sensation
[00:35:45.008]and we're never done constructing our big picture
[00:35:48.630]of the world.
[00:35:49.706]But as we're doing so, we need to respond to the world.
[00:35:54.600]And in sensory integration theory,
[00:35:56.370]that's called the adaptive response.
[00:35:58.920]It's your response action.
[00:36:00.780]Here are all the things I'm sensing,
[00:36:03.090]here's how I'm prioritizing them,
[00:36:05.730]here are the things I choose to react to
[00:36:08.550]and here's what I think the reaction needs to look like.
[00:36:11.730]And so when I'm knocked and I get that disequilibrium,
[00:36:15.570]my reaction will be to right myself.
[00:36:20.520]When I'm in the elevator,
[00:36:22.140]and I don't know if it's going up or down,
[00:36:24.510]my response action actually is to seek social reassurance
[00:36:28.740]from other people in the elevator
[00:36:30.720]that we're not all gonna die,
[00:36:32.490]but to check, right?
[00:36:33.600]To check if we're all safe.
[00:36:36.570]And there's other examples here of the response action
[00:36:39.360]or what we might call the adaptive response
[00:36:41.190]if we're using sensory integration jargon.
[00:36:43.980]One response action that I want to just highlight
[00:36:46.710]would be the child who's dropped something in the classroom
[00:36:51.180]and has to bend down to pick it up.
[00:36:54.370]If that child has an over-responsive vestibular system,
[00:36:59.580]that movement of picking up the object from the floor
[00:37:03.750]could send them into a state of high arousal, for example.
[00:37:08.340]So these things are ever present every day.
[00:37:15.030]And every sensory system's primary
[00:37:17.970]and most primitive responsibility
[00:37:23.040]is to keep you alive and safe.
[00:37:25.740]And that's that bat phone situation
[00:37:28.320]to Commissioner Gordon's office.
[00:37:30.450]Every single sensory system is,
[00:37:34.798]that has a hot wire, a bat phone.
[00:37:40.530]The vestibular system probably has the most efficient one,
[00:37:45.060]the most direct line.
[00:37:46.530]But their job for all of them is to keep you alive.
[00:37:51.060]And that means that they are among the fastest
[00:37:54.990]and most powerful triggers of your fight flight system,
[00:37:58.770]your fight, flight, fawn, freeze system.
[00:38:03.688]And of course,
[00:38:05.550]a sensitive stress response often looks like behavior,
[00:38:12.090]what we describe as behavior.
[00:38:15.270]So, we aren't gonna talk about how differences present
[00:38:20.220]in detail today, but just as an overview,
[00:38:23.640]differences in the sensory integration process
[00:38:26.250]are much more than just being over responsive
[00:38:29.220]and under responsive.
[00:38:30.930]You can also,
[00:38:32.490]you can be responsive to the appropriate degree
[00:38:38.010]but not able to discern the meaning of the sensation
[00:38:42.240]So, if I'm over-responsive to touch and someone touches me,
[00:38:47.062]I will be hyper responsive and I will react in a way
[00:38:52.241]that doesn't seem proportionate to the touch I received.
[00:38:56.400]And so we might call that overreacting,
[00:38:58.440]of course it's somewhat in the eye of the beholder.
[00:39:01.230]If I'm under responsive to touch and someone touches me,
[00:39:05.700]I may not register that they've touched me
[00:39:08.640]for a really long time
[00:39:10.830]or until the touch intensity increases,
[00:39:15.630]and there's other scenarios as well.
[00:39:18.120]But if I can register that I've been touched,
[00:39:20.370]but I am struggling with discrimination,
[00:39:23.730]then it may be that I know I've been touched,
[00:39:26.850]but I'm not sure where.
[00:39:29.010]Or, I know I've been touched, but I'm not sure what by.
[00:39:33.668]Or, and more importantly, I know I've been touched,
[00:39:39.780]but I don't know if it's a threat or not or if it's loving.
[00:39:44.730]And then that hotline to Commissioner Gordon
[00:39:48.900]to our alarm systems goes off
[00:39:51.171]and in the classroom, for example,
[00:39:55.500]we might lash out in response to touch
[00:39:57.750]because we cannot discriminate
[00:39:59.790]whether or not that touch is life threatening or safe.
[00:40:03.900]The sensory integration process, as I also said,
[00:40:06.840]supports the development of posture,
[00:40:08.550]which includes breath
[00:40:10.260]and the coordination of your eyes in your head.
[00:40:13.109]And the development of motor mastery
[00:40:17.340]relies on the sensory integration process.
[00:40:21.294]So that would be my body map, my body scheme,
[00:40:24.661]my capacity to move in increasingly refined ways
[00:40:29.400]with muscle synergies that are increasingly efficient
[00:40:33.390]that I can cause an effect with my body.
[00:40:35.943]And then if they start to predict
[00:40:38.370]what my movement is going to do in the environment,
[00:40:41.070]as well as sequencing long and complex chains of movement,
[00:40:44.820]as well as responding to novelty with my best guess
[00:40:50.490]at the appropriate adaptive response.
[00:40:54.120]And what I mean by that,
[00:40:55.770]and I hope you can relate to this,
[00:40:57.720]when I lived in Hong Kong, you know, there was always,
[00:41:00.360]always a new restaurant to go to.
[00:41:03.030]And I lived in Hong Kong for a number of years
[00:41:05.069]and sort of towards the end of living there
[00:41:07.800]about six years ago,
[00:41:09.330]these new restaurants would have the most bizarre, funky,
[00:41:13.920]sometimes cool restrooms.
[00:41:16.410]And you'd go to the restroom and you would have to predict
[00:41:21.630]to the best of your ability how to engage with this faucet,
[00:41:26.760]this sink, this tap or this even this toilet successfully.
[00:41:32.340]And so that like dealing with novelty like that
[00:41:34.890]in the environment successfully relies very, very heavily
[00:41:38.760]on the sensory integration process
[00:41:40.860]and on a childhood and lifetime
[00:41:45.300]of successful sensory integration experiences
[00:41:49.470]so that you have a nice database to pull from.
[00:41:53.310]Because of all of this,
[00:41:55.192]the sensory integration process
[00:41:57.540]and self-regulation are not separable from one another.
[00:42:01.436]Now regulation is not self-control,
[00:42:05.280]it's not self-management, it's not choosing to behave well.
[00:42:11.280]That comes later and is dependent on regulation.
[00:42:15.450]Regulation really refers to
[00:42:17.100]a sort of nervous system state arousal.
[00:42:21.872]And it starts at that level.
[00:42:25.080]And in early infancy
[00:42:27.300]really relies on the caregiver for development.
[00:42:31.380]what we see in MRIs of infants and their caregivers
[00:42:35.175]are that they are synchronous
[00:42:41.250]and that it's almost like the adult lends
[00:42:44.520]their nervous system to the infant.
[00:42:46.980]They loan it until the infants upstairs brain comes online
[00:42:51.503]more and more and more and they can do more themselves.
[00:42:55.985]But you're never really self-regulating
[00:42:58.410]in complete isolation.
[00:42:59.910]That's very, very rare.
[00:43:00.930]Most of the time there's lots of things happening
[00:43:04.740]that support regulation
[00:43:05.841]and a number of those things are social.
[00:43:11.072]And you know,
[00:43:11.997]you should be able to relate to that
[00:43:14.580]because often when you're stressed or scared
[00:43:17.190]or anything like that,
[00:43:19.230]you'll call a friend or you'll contact someone.
[00:43:21.690]And that social reference, just like in the elevator,
[00:43:25.099]is one of the things that helps you co-regulate.
[00:43:28.305]So, so state regulation
[00:43:31.260]is my ability to be calm and alert and available.
[00:43:35.670]It's expending right amount of energy for the task at hand.
[00:43:41.850]It varies from context to context
[00:43:43.980]and it's very, very relational as well.
[00:43:46.757]So you could call it nervous system arousal.
[00:43:50.070]You can see why we don't use that word a lot, arousal.
[00:43:53.880]Physiological state regulation homeostasis
[00:43:58.200]is also wrapped up in there.
[00:44:01.590]And then as the brain and body develop
[00:44:04.560]additional sophisticated self-regulation processes
[00:44:08.130]come online and then you sort of get this spectrum
[00:44:10.170]that goes, leads into executive function.
[00:44:14.250]But always subject to self-regulation.
[00:44:16.620]And think about how stressed you get.
[00:44:19.650]Think about something that really stresses you out.
[00:44:21.600]Being late for work, the coffee's spilled,
[00:44:23.643]the dog's doing something over there.
[00:44:26.730]You know, someone's fallen through
[00:44:30.752]on a promise that they made,
[00:44:32.670]your clothes aren't quite dry
[00:44:34.980]or they smell like they were left in the dryer for too long,
[00:44:37.290]which is like the worst thing ever.
[00:44:39.000]And then, you know, your tax attorney calls.
[00:44:42.090]You're not going to be regulated enough
[00:44:44.580]to have that conversation
[00:44:45.633]and hopefully you would be able to recognize that and say,
[00:44:49.200]I need to have this conversation later.
[00:44:51.510]So there are lots of bits and pieces
[00:44:53.040]that contribute to regulation,
[00:44:55.680]regulate and can cause dysregulation.
[00:44:58.679]We've been using the image of a coffee cup
[00:45:00.960]for years and years and now I decided just for today
[00:45:03.813]that we needed to have a boba, cup of boba.
[00:45:06.570]So into our cup of boba
[00:45:08.100]goes all of these different stressors.
[00:45:11.430]And some stress is good, right?
[00:45:13.740]But if there's too many and we don't have the resources
[00:45:18.750]to cope and there's a mismatch,
[00:45:22.260]then we will get dysregulated
[00:45:24.690]and our arousal will go too high,
[00:45:27.150]or we might shut down
[00:45:28.590]and our arousal will go very, very low.
[00:45:31.680]So all of these things are going on all the time
[00:45:36.000]and every person has a different profile
[00:45:39.030]and there are multiple places,
[00:45:42.210]probably too many to count, where this process can go awry,
[00:45:46.890]leading to perhaps disorder,
[00:45:52.410]a mismatch with the environment, disability and so on.
[00:45:56.426]Not all differences have to,
[00:45:58.620]but that is something that does happen a lot,
[00:46:01.380]especially in the rigid environments in which we operate.
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