Dr Chris Moore
Tips for Sensory Needs - Proprioception
What is the Proprioceptive Sense?
This sensory system is governed by our muscles and joints and is related to body awareness. It gives us vital information on the positioning of our body parts, the speed and force with which our muscles are stretching and how fast our entire body is moving through a space. This means that you can engage in lots of everyday activities - sitting down in a chair, bringing a cup to your mouth and staying on your feet whilst walking - without having to watch and consciously attend to each individual movement. Even as you are reading this right now, you are receiving proprioceptive information about how you’re sitting and the positioning of your hands and arms without having to look at yourself.
This sense is closely connected to the vestibular and tactile systems, in terms of planning our movements (e.g. catching a ball or co-ordinating our hands when tying shoelaces) and manipulating objects (e.g. gripping a pencil effectively or managing the weight of liquid in a glass). We get more proprioceptive input when we stretch and tighten muscles against the pull of gravity. This is often referred to as “heavy work”, such as lifting heavy boxes when moving to a new house or using resistance machines in the gym.
What happens when the Proprioceptive Sense does not function smoothly?
A child with poor proprioception has difficulty interpreting the sensations associated with body movement and positioning.
Over-responsiveness to proprioception can result in anxiety about weight-bearing activities and fast movements such as running, jumping, rolling and crawling. Some children can be reluctant to receive hugs or have their arms and legs moved by others. They may be labelled as lethargic or lazy, simply because they are more comfortable with smaller movements. Many children with Autism can be referred to as “picky eaters” and this may have a proprioceptive origin; some may lack the coordinated and forceful chewing actions needed for certain textures of food.
Other children are found to seek higher levels of proprioception. This can result in them presenting with more excessive movement, such as pulling or swinging off objects, throwing themselves around or crashing to the floor. They can crave tight hugs, being wrapped up in blankets and rough-and-tumble play. These sensory-seeking behaviours can unfortunately lead to perceptions of the child as disruptive or aggressive. They can also appear to be clumsy or uncoordinated in their movements. Some may engage in self-stimulating behaviour, such as head-banging or chewing and biting.
The next sections talk about ways in which we can provide proprioceptive input to help these children maintain a relatively calm and alert state. These are simply suggestions rather than an exhaustive list and it will be important to liaise with the child’s Occupational Therapist to construct a clear plan of activities. They will also need to be tailored to the individual child’s sensory profile. While “heavy work” will be gratefully accepted by the child who seeks more proprioception, those who are easily alarmed by body sensations may need a more gradual introduction of activities. These may need to be time-limited and modelled by a familiar and supportive adult first.
Proprioception in the Learning Environment
The child’s desk and chair offer some quick and easy ways to provide proprioceptive input. Consider having them perform chair push-ups, by using their arms to lift their bottom off the seat several times in succession. The Middletown Centre for Autism has a nice video demonstrating this exercise - https://www.youtube.com/watch?v=ecCgcqrH9l4. The use of therabands on the legs under the chair or desk can also give resistance for the child to push or pull against with their feet. A stress ball or fidget resource can allow the child to exert pressure on an object while listening to a whole-class discussion. For those children who require more stimulation of the jaw, we can offer safe chewy tubes, pendants on a lanyard or wrist bangles.
If there is a corridor, cloakroom area or quiet space near to the classroom, this could also be utilised for proprioceptive exercises. The child could place their hands on a flat wall and push in and out repeatedly. The space could also be used for quick bursts of activity, such as star jumps, hopping on one leg or jogging on the spot. For occasions where the child can receive one-to-one interaction with the class teacher or support staff, consider head and shoulder massages or tight hugs (with the child’s permission and a clear expectation of what will happen and for how long) as a means of giving the deep pressure that some of these children can crave.
Proprioception during Play Time and Physical Activities
Play time has lots of opportunities for proprioception. Activities which involve play dough and clay allow for pulling, pushing and squeezing movements. The child can use various utensils for digging and raking in the sand tray. Arts and crafts activities, such as drawing and painting, could be carried out on the floor using a big sheet of paper or card. Scheduling outdoor play before a period of sitting and listening can help the child to maintain a more balanced state. Pedalling a tricycle, carrying items in a wheelbarrow or going up and down a climbing frame in the playground are just some examples of providing additional proprioception.
PE can be difficult for children with Autism and sensory processing difficulties, given the increased noise, movement and various instructions and directions for them to process. But if these factors can be mitigated or worked around, the equipment and resources in PE offer natural avenues for proprioception. These might include running or crawling through an obstacle course, bouncing on space hoppers or trampolines and performing different stretches on a peanut ball. Incorporate visual markers, clapping routines or music to aid the coordination of the under-responsive child’s motor-planning and positioning. Team games such as musical statues or tug-of-war can provide rhythmic movement and greater input to the muscles and joints. Even giving the child the responsibility of lifting or dragging gym mats to different areas of the hall can offer proprioception. This brings us nicely on to the final suggestion.
Functional tasks which provide Proprioception
There are lots of ways to build in proprioceptive stimulation into more functional tasks throughout the day. This is undercover proprioception in a sense, in that the tasks blend into the normal routine and would typically be carried out by the majority of the children in the class at some point in the week. The child could be given responsibilities such as carrying and handing out books, tidying materials at the end of an activity or opening and holding doors when the pupils are transitioning from one area of the school to the other. Messages which need to be delivered to a nearby teacher or the school office also provide discreet opportunities for movement.
Jobs outside of the classroom environment can also be considered. These might include lifting and stacking furniture and equipment for assembles, brushing and mopping the floor after a practical Home Economics lesson or helping to wipe tables in the canteen. The seasonal weather can also allow us to be creative in offering proprioception. This may involve helping the caretaker to dig in the school garden, raking leaves in the Autumn or shovelling snow in the winter.