Tips for Sensory Needs - Vestibular

This next series of posts will look at sensory issues and some simple tips for how these can be accommodated in the school environment. Difficulties with processing and integrating sensations from the body can be commonplace in children whose brains have been shaped by developmental trauma. Children with Autism and ADHD can also have similar needs.

The important theme, like my previous posts, is about looking underneath “behaviour” and understanding how to intervene. With sensory issues, this is particularly important as children can be over-responsive to a sensation or under-responsive. I will be talking about generic strategies – some children with more complex sensory profiles will require a more thorough assessment and intervention programme from an Occupational Therapist. This first post will look at the Vestibular Sense.

What is the Vestibular Sense?

The Vestibular Sense is connected to receptors in our inner ear. These register movement and help us to realise when we are moving or when we are still. The Vestibular system enables us to know where we are in space and detect the speed and direction of our physical actions and changes in our head position. It also generates muscle tone to improve the efficiency of our movements. This system has a crucial role in our fight or flight response.

What happens when a child is over-responsive to Vestibular input?

These children are very sensitive to movement, particularly fast actions or sudden changes in direction. They can be easily disoriented in response to turning their head, bending over or having to move their eyes from side to side. Travelling on the school bus may induce motion sickness and they can be distressed by vigorous movement involved in cycling, swings and mechanical rides. PE and sports at school will therefore be very challenging for these children. They may even be reluctant to join in with physical games during break and lunch.

How can we help children who are over-responsive to Vestibular input?

· As movements can be so daunting for these children, we may need to provide more communication about the beginning, middle and ending of a physical action. This can be achieved by timing the movements to a musical rhythm or using visual cues to help them anticipate the actions.

· We can help to ground them and provide calming input in order to support their tolerance of movement. This may involve providing firm touch (agreed with the child in advance) or providing a concrete object for them to hold and squeeze.

· Before using equipment and resources which are elevated, they may need initial practice with balancing on the ground. Consider modelling how to stand and hop on one leg, walk along a line and sit on a platform or ball with their feet flat on the floor.

· Having their feet off the ground can be uncomfortable. When sitting at their desk in the classroom, they may need a box or footrest to help them stay in contact with the ground. Such resources may also be necessary when they are sitting on the toilet.

· Slow and repetitive movements will be more comfortable for these children. Think about activities which allow for greater control and predictability. This can be as simple as throwing and catching a ball or beanbag with an adult. Going for walks in a familiar environment or participating in a treasure hunt can also be fun ways of exposing them to less distressing forms of movement.

What happens when a child is under-responsive to Vestibular input?

These children are often described as “on-the-go” within the classroom or playground. They engage in high levels of movement and can be seen fidgeting, rocking and spinning. During a learning task, it can be very difficult for them to remain seated or to concentrate for extended periods. They often have poor balance and coordination, which can lead to them tripping and falling more frequently than their peers. As a result of their craving for movement, some children may present with more impulsive and high-risk behaviour.

How can we help children who are under-responsive to Vestibular input?

· In the lead-up to learning tasks or routines which involve a period of sitting and listening, create opportunities for movement. These may include encouraging the child to jog on the spot for a few moments or perform push-ups on their chair or against a wall. Having therabands on the legs under their chair or desk can also give them resistance to push against.

· They should be encouraged to change position on a frequent basis. It would be self-defeating to expect these children to sit still or stop fidgeting altogether. Some benefit from a wobble cushion or a ball chair which provide additional stimulation while they are in a seated position.

· Movement breaks should be incorporated into the daily routine as a means of helping the child to recover from sedentary activities. These breaks may involve going for a run around the playground or going to the PE hall to do star jumps or bounce on the trampoline. In secondary school environments, scheduled times in the school gym could help them stay regulated over the course of the day.

· More discreet opportunities for movement can also be provided by giving the child physical jobs and responsibilities. For example, they could be asked to help hand out or collect books and materials from their peers or set up furniture and equipment for school assemblies and plays.

· We need to actively teach safe movement for those children who engage in more impulsive actions. Role-play or visual cues can help to model what is appropriate in a given context. For those children who are clumsy in close proximity to peers, they may benefit from a designated position when lining up or transitioning from one environment to the next.