Summary
In this episode, Megan Williams and Franchesca Cox delve into the two main categories of proprioceptive processing in children. They discuss children with hypersensitive proprioceptive systems, who avoid movement and struggle with postural control, and those with under-responsive systems, who seek out intense physical activity and have difficulty with body awareness. The conversation highlights how these sensory differences impact play, behavior, and social-emotional development.
Resources
The effect of interventional proprioceptive training on static balance and gait in deaf children
Motor speech interventions for children with cerebral palsy: A systematic review
The effect of interventional proprioceptive training on static balance and gait in deaf children
Episode Transcript
Franchesca Cox (00:00)
Hi there, I’m Francesca Cox, an occupational therapist based in Houston, Texas. Over the years, I’ve had the incredible honor of working with children who have neuromuscular conditions, rare genetic disorders, and developmental delays. Using approaches like DMI therapy and TheraSuit, I’ve seen firsthand the resilience and strength of these amazing kids and their families. Each day brings new lessons, and my passion is to empower families with the tools and knowledge to support their child’s journey.
Megan Williams (00:24)
And I’m Megan Williams, a speech language pathologist also based in Houston, Texas. I specialize in feeding therapy and I’m an MNRI core specialist. I’ve worked with children facing feeding challenges and sensory processing issues using reflex integration techniques to support the brain body connection and help children thrive.
My mission is to guide families through the often complex world of feeding and communication, empowering them to support their child’s growth with confidence.
Franchesca Cox (00:55)
are here to share insights, practical strategies, and heartfelt stories that can help you navigate the unique challenges and joys of raising a child with special needs.
Megan Williams (01:04)
We know every family’s journey is different, but our goal is to create a supportive space where you feel seen, heard, and equipped with the knowledge to help your child reach their fullest potential.
Franchesca Cox (01:16)
whether you’re looking for therapy techniques, expert advice, or just a sense of community, you’re in the right place.
Megan Williams (01:22)
Let’s explore this journey together filled with hope, growth, and endless possibilities.
Megan Williams (01:28)
welcome back listeners. Today we are starting a new series that we’re pretty excited about. We are going to cover all eight of the sensory systems. This is an important topic that…
I feel like we’re always talking about the sensory systems and we want to spend an episode breaking down each one and kind of talking about our experiences with working with the sensory systems and today we are covering the proprioceptive system which is one of the biggest if not the biggest sensory system that we work with or we are always trying to address.
Yep, it is described as the hidden sense. When we first think about, know, we’re usually generally taught that there are five senses and so proprioception is, our proprioceptive system is not one that we…
are taught, think unless you’re an OT or someone who works in the therapy realm. And so the proprioceptive system is important for coordination, motor planning, and even self-regulation, which I think that’s a huge piece that is kind of overlooked sometimes, right?
Franchesca Cox (02:25)
Yes.
For sure. For sure. Yeah. proprioception is easily one of my favorite things to work on. I am an OT, it definitely, everything that I do in the clinic, I kind of see through a sensory lens. And so I immediately, when a child comes to me, I’ve had several kids that have come and from the outside looking in, the child seems typically developing. But when we start to peel some layers back, we start to realize this child is maybe
past two, maybe upwards of 10, they can’t jump, running is a little bit uncoordinated, maybe they can’t ride a bike. And so I’ll start to see where their baseline is with their proprioceptive system. And so I noticed with the kids who can’t jump and we’d, and we’re talking about, we don’t have like cerebral palsy. We don’t have a diagnosis, maybe autism, but typically they’re just developmentally delayed. And when I start to do things with proprioceptive training, these
children are able to find where their body is in space and some of the research that we’ll talk about in a few minutes, it backs up what my theory is that if we…
fire that sensory system, that proprioception, those gross matter skills will follow. And so we’re pairing, we’re not taking away the strength training, but we’re combining those approaches, the proprioceptive training and the strength training. And some of the tangible things that I’ll do to help a child learn how to jump is putting a lot of input through the sole of their foot. So they might be lying on their back on the floor and I’m going to ask them to just push really hard into my hands, unilaterally, bilaterally, just getting them used to putting
force through those soles of their feet because we have thousands of receptors through those, the palms of our hands, but also the soles of our feet. And I’ll have also children that have a really soft high five and they think they’re just, you know, knocking you down, but I’ll do the same thing with their hands. And so it gives me a lot of information of how much force they think they’re putting versus what they’re actually putting out. And so I’ll do things with like a silk scarf. They’ll be in long sitting, bending their knees, and then I’ll have
Megan Williams (04:09)
Right.
Franchesca Cox (04:28)
them.
controlling their the environment through the soles of their feet so I’ll them slide back and forth. So it’s just a lot of fun. I’ll combine the sensory system so I’ll put like an auditory toy that when they jump or practicing jumping, they’re not going to just feel it, they’re going to hear it. So I like these little dog squeakers. And so I might just tape them to the floor with painters tape. And so they’re powering through and they’re hearing it and then they’re feeling it. And we know that
what fires together, wires together. So it’s super fun to see how that proprioceptive system is so important when we’re trying to achieve gross motor goals.
Megan Williams (05:06)
Yeah,
it’s really interesting that you say that you use the sound, you pair the sensory systems together. A lot of times whenever kiddos will come and have some stuff going on that I’ll work with them on and they may be in sports, they may be in recreational type.
settings, know, doing co-ed sports, but when you challenge them and have them close their eyes and try to do some type of proprioceptive challenge, it kind of falls apart. sometimes the child or the parent might be kind of surprised, you know, like, they’re pretty coordinated, but whenever you strip away kind of being able to rely on maybe visual or another system,
you start to see maybe that proprioceptive system isn’t as strong as it should be. The information isn’t quite clear to the brain. So yeah. And from a speech standpoint, proprioception really, you know, was not on my radar for a long time. We don’t learn about it in school. We don’t, you know.
Franchesca Cox (05:59)
Yes. Yes.
Megan Williams (06:11)
that’s just not a thing. But whenever you get out into the real world and you are, if you’re fortunate enough to work with OTs and PTs who are always willing to teach and help educate, it’s really important, I think, for a speech therapist to learn about proprioception too because proprioception is…
we need it in the muscles of our articulators, so our jaw, tongue, and our throat muscles, all those things. So proprioception is what helps a child develop from just making like this open jaw, sound when they’re trying to articulate all the way up to producing multisyllable words that have
vowels with a high jaw or open jaw posture, closed jaw posture, and then in between each vowel we might have lip closure sound or a fricative, like all these things that I did learn about in school, but nobody was putting the pieces together in school for me of your muscles have to have this ability to process the proprioception.
Franchesca Cox (07:17)
Yes.
Megan Williams (07:17)
And if you’re not adequately
processing proprioception, you’re going to have possibly some speech stuff happening, which we’ll talk about later kind of in the episode. And once I was at a place where I could start to understand this, I think that’s when my work really started to change.
Franchesca Cox (07:35)
That’s
amazing.
Megan Williams (07:36)
So let’s talk a little bit about what the proprioceptive system is. We know that the receptors are located in our muscles, the tendons, our joints, and all of the connections of our…
tendons, ligaments, and joints, they’re sending information to the brain constantly that helps our brain know where our body is in space. And so I think it’s interesting sometimes to explain to families and parents, you know, what this system is and…
where it is throughout our body. The proprioceptive system, like we said before, it usually works a lot. It wires and fires a lot with other systems in our body. So it works closely with the vestibular system, the tactile system, and it plays a big role in helping us feel grounded and stable and helping us continue to be grounded and stable.
you know, it’s job even when we lose our balance is to help us regain our balance, right? And just always constantly, I always say just constantly keeping us safe as humans. Yeah.
Franchesca Cox (08:39)
Yes.
Megan Williams (08:41)
And so it plays, like I said, a significant role in our postural control, our body awareness, and fine and gross motor coordination. So I feel like proprioception is, you know, anytime I have heard anybody explain it to a family, they go, you know, body awareness. And then families will sometimes, I don’t.
Franchesca Cox (09:02)
Okay.
Megan Williams (09:03)
I know where my body is in space. And so how do you like to describe it to parents, Francesca?
Franchesca Cox (09:06)
you
I describe it by telling them the proprioceptive system helps a child know just how much space they take up and where their body is in space. So a lot of times we have children that maybe have one side that’s weak. A lot of times they have poor awareness of where midline is. And if a child doesn’t know where midline is, meaning the middle of their body, they’re gonna constantly, you might see torticollis, you might see one side preference, you might see…
a discrepancy and using both hands by lateral integration, you might just you might see visual deficits and it’s all related to their proprioceptive system. So it’s so important that we have that foundation of where our midline is, which goes back to our proprioceptive system is. But that’s how I break it down. It’s a little bit more than body awareness is also how much force you’re putting out into the world.
Megan Williams (09:59)
So it’s a key piece in grading our force. And I think sometimes when you can use that as an example to talk to parents like, you know, how hard we push to push a door open or things like that. our brain is constantly getting feedback. Did we push hard enough? Did we not push hard enough?
Franchesca Cox (10:04)
guys.
Thanks.
Yeah,
there’s a range too. So we have people, kids who overdo it and they break pencils and they don’t mean to and then we have kids who are barely scratching the paper.
Megan Williams (10:24)
And so we know that the proprioceptors are in our body, but neurologically there are different regions of the brain that works to process that information. Sometimes sensory systems will work locally in one area of the brain, but I think just to talk about how big proprioception is, it’s actually…
It has multiple parts of the brain that are taking in and sending out that information. So we have in the parietal lobe the somatosensory cortex, which is what’s going to help us process the touch, our movement, any of the input from our proprioceptors.
it helps us know where our body parts are without looking. And so, like I said, whenever I do any kind of testing, if you take that visual piece out, cortex in your parotid lobe is really responsible for just having the awareness and knowing.
And then we have the cerebellum or the little brain. It is that little structure, it looks kind of like a walnut if you look at a picture. It’s kind of in the lower part on the back of the brain. It’s gonna help coordinate balance, posture, and your smooth movements. So its job is to help make sure.
Franchesca Cox (11:17)
Yes.
Megan Williams (11:36)
we move like a smooth operator and we don’t have really jerky or any kind of clumsy movements. Our basal ganglia, which is in our midbrain and the diencephalon, also works to regulate our movements and our automatic motor skills.
The basal ganglia is also, we know that with adults who experience Parkinson’s, when they start having a breakdown in the basal ganglia, their movements become less smooth and less controlled. And they’re getting less, yes, it’s not fluid movement. It becomes almost kind of mechanical and it doesn’t look natural.
Franchesca Cox (12:07)
We get that rigidity, right?
Megan Williams (12:16)
Then we have in the brain stem, the reticular formation is one of the areas that filters sensory input and helps regulate our alertness level. And so that’s where the proprioception helps us regulate our…
awareness, our alertness level, proprioceptive input, such as heavy work, which can help and calm or alert the nervous system is working on that reticular formation. And then in the spinal cord, I think of it as the highway where the signals travel through the spinal cord to the brain and then reflexes and automatic adjustments to movements are processed. So that’s like
I don’t know, the Autobahn over in Germany where lots of information is just traveling really quickly. And so that spinal cord, those tracks need to be really efficient with sending the right amount of information and doing it quickly, really quickly.
Franchesca Cox (13:12)
Right, right. I think it’s also worth noting that some of the areas like the parietal lobe, it’s located right above the occipital lobe. So it’s so interesting that even though we don’t want to use vision to know where we are in space, it definitely affects our visual cortex because they’re so close in the brain. And so I thought that was neat. When I was looking at the brain earlier, I thought…
It’s real interesting that parietal lobe is located right above the occipital lobe. And a lot of times we see children compensating with their visual system to write themselves in space rather than using their proprioceptive system.
Okay, so I wanted to talk a little bit about what we found in the research about as far as proprioception, proprioceptive training, and how it affects children with special needs. The first study that I found was done in 2014, and it indicated that proprioceptive training in deaf children improved their overall balance. So this was done, I think, over a 12-session exercise program. They had a control group, and they had the experimental group.
There was 10 deaf children ages age of 14 and then another group with children who could hear. And they were compared, their balance and their walking abilities. And the outcome of that was that when they introduced proprioceptive training, and the study didn’t go into detail, but they did emphasize that it was proprioceptive training. I’m assuming it may have been administered by an OT or program that was designed by an OT.
they significantly swayed less. So their balance improved. What did not improve was how fast they walked. So it could be assumed that maybe with a little bit more different types of training could help that part. But we definitely saw an improvement in their balance with proprioceptive training. The next article I found really interesting.
In 2012, researchers found that proprioceptive training was more impactful and necessary for children with cerebral palsy to acquire balance
Bobath and Carr are referenced in this article to discuss the contrary theories on whether strength training is beneficial at all in children with CP, while it also highlights the impact that weakness and loss of skills is a true hindrance to function. The name of the article is Effectiveness of Proprioceptive Training Over Strength Training in Improving the Balance of Chilisbrubopalsy Children with Impaired Balance and we’ll…
link all of these articles in the show notes. But in this program, they also, I believe, worked over 12 weeks and they were assessed with the timed up and go test and the pediatric balance test to assess their balance. And so they, the one group did proprioceptive training and the other one did strength training. And the outcome for that was group A who did the proprioceptive training
showed significant improvements in both scores, both the TUG and the PBS scores, indicating enhanced balance and mobility. So this one was pretty cool. didn’t just hit balance. And also we had dynamic movement that was also positively impacted here. And the strength training group demonstrated improvements, but the gains were less pronounced compared to the group A who received proprioceptive training.
we can conclude that proprioceptive training is more effective than strength training and improving balance among children with CP. I will say because the TheraSuit program really emphasizes what we use in the clinic, it really emphasizes strength training for children with cerebral palsy. Like that is what it was designed for. So I kept thinking about that. But when I use and when we use the TheraSuit program, whether it’s the suit,
whether it’s the cage, even the UEU, where we were isolating muscle groups with weights, we’re combining proprioception. So we’re not just lifting weights, you know, we are definitely hitting that proprioceptive system, whether it’s with the bungees or with that TheraSuit There’s, I think I talked about it in the last episode, how that suit has so much proprioceptive information going into your body. So,
This was a really interesting study and it just confirmed what I’ve seen in the clinic when I combine proprioceptive training with strength training, especially with children with neuromuscular conditions, I see such a better improvement in the overall outcome and goals for the children.
Megan Williams (17:19)
Yeah, so to me it’s thinking about strength training. that’s like, I don’t know why I think of big muscles and you’re working that belly of the muscle to try to increase its strength and its mass versus the proprioceptive training is maybe more focusing on the ends of the muscles where those proprioceptors are. And when you can do both, that just seems like you’re covering a lot more.
Franchesca Cox (17:32)
Yeah.
Megan Williams (17:45)
parts that talk to the brain.
Franchesca Cox (17:47)
Absolutely, absolutely. Yes.
Megan Williams (17:49)
Yeah.
So I did, from a speech background standpoint, a little bit of research to see what’s out there about proprioception in the speech world. And I came across a systematic review. It’s called Motor Speech Interventions for Children with Cerebral Palsy, a systematic review. And basically, a systematic review is where people will look at the research that people have already done and they published for a certain number of years. They may start from there.
2000s till present or even further back and basically they compile all the information and then they look to see like okay if I’m going to compare these two methods which one is more of a gold standard. So this was a study published in January 2023 which I thought was really great that it’s really current. It was out of Australia. Johanna
Franchesca Cox (18:37)
Yeah.
Megan Williams (18:41)
Corkel-Laynen, I apologize Johanna if I am saying your name incorrectly, basically she and her team looked at eight specific therapy approaches that are motor speech therapy approaches for children who have cerebral palsy and who have specific types of dysarthria or apraxia related to their CP diagnosis. And of the eight,
Franchesca Cox (18:45)
Thanks.
Megan Williams (19:05)
They gleaned a lot of information, but the one thing I wanted to pull from this systematic review is that there was only one intervention that…
actually looks at the proprioception. So most motor speech therapy interventions for children with CP do not address proprioceptive input, but what did was the PROMPT, P-R-O-M-P-T, prompt method, because it was the only therapy that incorporates the proprioception directly, highlighting a significant gap in how
Franchesca Cox (19:21)
Well.
one.
Megan Williams (19:41)
the sensory motor integration is not being addressed in therapy. And myself, I am not prompt trained. I know a lot of therapists who are. And I’m including in our show notes a link. If you’re a parent and you’re curious about this therapy approach, you can click on the link and find a provider in your area. Because out of all these different approaches,
Franchesca Cox (19:46)
Right.
Megan Williams (20:04)
prompt is the only one that’s taking into consideration knowing where your articulators are in space. And so that was very surprising to me. And I really wanted to just highlight that how much the speech world in general is just maybe we’re a little slow, you know.
Franchesca Cox (20:21)
No, I
think there’s just across the board because we don’t have the time.
to co-treat, right? We have that missing link. Like, OTs know about sensory systems and speech therapists do their thing and the PTs do their thing. to, like we said earlier, to jump, it takes more than just let’s do it again and again and again. We have to hit that sensory system and it’s no different than speaking. That’s amazing to me. And when I have a child or a family who’s wanting a recommendation for a speech language pathologist who specializes in communication, I always
Megan Williams (20:27)
Mm-hmm.
Franchesca Cox (20:53)
refer to a prompt therapist because I know they get results. I couldn’t tell you why, but now I know why.
Megan Williams (20:59)
Yeah,
yeah, I mean
And from what I know of prompt, they are giving specific tactile and proprioceptive cues to different parts of the face. And so it is directly stimulating those proprioceptors to get a muscle response, which is a sound and articulatory posture in these children. so, yeah, it’s it’s on my list of things that I would really love
to sit down and become really educated in but until then yeah definitely referring to to those lifelong learner therapists that are doing all the good things. So let’s talk about what these signs of proprioceptive process issues what do these look like you know
Franchesca Cox (21:36)
Yep.
Megan Williams (21:45)
what when the system is maybe not functioning correctly.
So we have kind of two camps that children tend to, and adults tend to fall into. So we have our over responsive or hypersensitive proprioceptive systems. Those are people and children who avoid active movement. So they’re hesitant to climb, jump, or exert any kind of force on
on objects during play. They struggle with postural control. They often kind of slump in their chair or they may become
tired really quickly. They seem fearful of movement or they seem cautious. And I know when I work with toddlers, when they first come in and I, you know, try to just get an idea about their play skills, a lot of times I will watch and see if they will, usually I’ll have a trifold mat and see if they will step up onto the mat or step down off of the mat. Will they,
Well, they push a yoga ball to knock things down and and I do see a lot of kiddos who are very hesitant or you know heaven forbid if the ball comes their way and bounces into them they get really Nervous you can just see on their face. They’re like no, this is not fun. So those that’s kind of what I’ve seen
Franchesca Cox (23:06)
Right.
Yes. I would say this camp of kiddos, they’re
threshold for sensory information is very low. So they’re going to, like you said, they’re going to avoid activities that they cannot control because they just don’t, they don’t have that information coming from their brain to tell them how much force do I need to control that ball or to step off that, you know, step stool or whatnot. And so I find that they’re a little, like you said, they’re a little bit more fearful. They’re more clumsy.
the kiddos that are just barely scratching the surface of the paper with that pencil and they don’t realize it they’re giving you a high five and they’re barely touching your hand. It’s interesting to watch.
Megan Williams (23:45)
Yeah, and it’s always interesting their posture. They’ll play with toys, but maybe if they’re like doing cars, they’ll be on their side and they’re playing laying down and watching the cars as they move them forward and backwards, you know, and it almost looks like it just it’s taken a lot of energy for their muscles to work.
Franchesca Cox (23:59)
Would you?
Yes, yes. Would you say just from observation, I have no research to back this up, but would you say this camp of kiddos, they tend to be more low tone, a little bit on the weaker side versus our sensory, okay, because that’s my observation. My sensory seekers, which we’re fixing to talk about, they tend to be more high tone, high strung, highly energetic, not afraid of anything. Their muscle tone is just different. So it’s interesting that
Megan Williams (24:16)
Yes, definitely.
Yeah.
Franchesca Cox (24:31)
I think I just put that together. As you’re describing it, I’m like, these are the kids, like you said, they have a hard time sitting up upright. They’re the kids that will slouch on you if you’re behind them. That’s, yeah.
Megan Williams (24:33)
Yeah.
Yeah, and they are, they’re a lot, they seem outwardly a lot, what you would say calmer, but at the same time, it’s from a fear, you know, they don’t want to take chances or do any kind of play that is kind of like, like learning play. They don’t want to make mistakes. They don’t want to do anything that…
they could do wrong or whatever. So it’s really interesting to see how that kind of translates also with their social emotional side. Yeah. And then we have probably the kids I see more often. If I was to try to do a tally of, you know, kids we see in clinic, I feel like I tend to see more of I.
Franchesca Cox (25:08)
for sure, for sure. They’re not the risk takers, right? At all.
Megan Williams (25:24)
our kiddos who are under responders and so they are needing so much more proprioception for their bodies to even process it. So that looks like
you know, they’re the seekers. They’re looking for excessive movement. They love jumping, crashing, rough play. They cannot get enough of it. They are unsafe, for lack of a better word, because they have to keep pushing that threshold to find that level of…
Franchesca Cox (25:48)
Yes.
Megan Williams (25:54)
information that they need. But then they also struggle with body awareness. So those are the kids who also may bump into things. They kind of appear clumsy. Maybe they have lots of little bruises and nicks and things on their knees and their lower legs, their shins from just walking into things.
Franchesca Cox (26:11)
Yeah.
Megan Williams (26:12)
whenever you’re doing play activities, you may be having them try to do graded movements where you’re like, okay, don’t do too hard or push the car a little bit and my gosh.
Franchesca Cox (26:21)
Yes, or like, don’t break the ice. I love that one for older children.
Megan Williams (26:27)
and they
can’t help it but it’s their turn and they get the first tap and they like plunge through the whole thing and you’re like I just took 20 minutes setting up don’t break the ice and you won? I don’t… yes. Yes, I’ve worked with a few of those friends and you know they’re trying really hard like they want to do it softly but
Franchesca Cox (26:35)
Thanks.
Yeah.
Megan Williams (26:49)
it’s like they cannot grade their movements. They prefer tight hugs, heavy blankets, some of these little… Yes. And I’ve had some families say, know, our kiddo will take off all of the couch cushions, you know, these cushion couches that have the big removable cushions.
Franchesca Cox (26:54)
They’re the biters too. Yes.
Megan Williams (27:07)
and they will climb into the sofa and put the cushions over them. It’s like they remake the couch with them in the couch and I’m like they have figured out how to make their own little cozy corner where they are getting a lot of proprioception and I’m like okay that’s really interesting. think it’s these kids have to be really
Franchesca Cox (27:13)
Yes.
Yeah.
Yes.
Megan Williams (27:31)
keen on how to always find that input, that level of proprioception that they need.
Franchesca Cox (27:36)
Mm-hmm.
Yeah, and almost it almost always goes hand-in-hand with self-regulation, right? As they get older, they are seeking it so much because they literally, their body craves it that they have to learn how to limit themselves. Like, okay, I can squeeze this person, but I shouldn’t bite them. Or I want to play, but I don’t need to break everything, right? So it’s interesting. There’s just a pattern there.
Megan Williams (27:55)
Yeah.
They’re constantly going, going, going, and at some point their poor systems have to just fatigue to the level of just constantly being 100%. These are also the kids who, whenever I do a little bit of manual muscle testing, I’ll say, I’ll put my hand up and have them put their hand, we’ll be palm to palm, and I’ll say, okay, I’m gonna give you a little bit of force. I’m gonna push about 25%.
And I’ll say, I want you to see if you can meet my level of force. And nope, they can’t. Get ready because they’re going to give 110%. And they, from a cognitive standpoint, you can really try to help them understand, but intrinsically they don’t.
Franchesca Cox (28:44)
You’re right.
Right. And that’s where we come in to give them those graded activities and home programs,
Megan Williams (28:52)
Yep.
Megan Williams (28:52)
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Megan Williams (29:58)
So what is the connection between the proprioceptive system and learning? I know, you know, a lot of times we can read about the proprioceptive system and why we need it, but specifically in regards to our learning and development, what makes it so important?
Franchesca Cox (30:08)
Right.
Right, so from a cognitive and motor learning standpoint, it’s essential, like I said, for things like jumping, things like running, riding a bike, learning to balance on an outdoor gym set.
walking even on uneven surfaces, you know, when we’re in those play areas outside, they’re usually like wood chips and stuff. And so proprioception is going to tell their body, okay, I need to move my ankle this way. So we don’t twist, right? We don’t twist my ankle. And so there’s uneven surfaces. So it’s navigating environments. proprioception is so important for safely navigating environments. Also,
Megan Williams (30:36)
Thank
Franchesca Cox (30:51)
supporting fine motor tasks like buttoning shirts, zipping up, you know, your jacket. And I have children on both ends of the spectrum, usually the ones that I’m teaching how to do, I guess, yeah, the the activities of daily learning or the ADLs, you know, those self care skills. It’s usually the kids that give too much force. So they’re just shoving the button through, you know, the fabric and they’re not patient enough to find the hole. And we need that proprioceptive awareness.
to use our fingertips to locate, you know, that buttonhole. And we don’t always have to see it, but they need those proprioceptors to find it on their on their jeans, on their button up jacket. Of course, there’s a lot of fastener free clothing these days, but and that’s great. But for those as they get older, especially they need that proprioceptive awareness to be able to take care of themselves, even brushing teeth. You know, think of the dentist always tells me I brush too hard, even though I try not to. But I can only imagine children who
Megan Williams (31:41)
Mm.
Franchesca Cox (31:43)
are on that end of the spectrum where they’re either not brushing enough, they think they are, or they’re brushing too hard and so we’re going to have problems on a hygiene standpoint. Of course, using scissors is such a complex task and you don’t know that until you sit down and try to teach a child how to cut with their scissors.
Megan Williams (31:59)
Hey, hats off to
UOTs who are like, yep, we’re gonna give this child a pair of sharp scissors and bless y’all.
Franchesca Cox (32:06)
Yeah. it’s, I mean,
it’s such a complex task that I took for granted before I started working with children.
as far as an OT. But what I love, there’s these little scissors, but on the end of them, it’s a scoop. And so I’ll link them here and it’s a safe way. It’s a really safe way to learn the skill, generalize it, and eventually start to snip the paper. But when you don’t have that and you just have the regular scissors that children use, I mean, you’ve got to be really careful because if they’re one of those sensory seekers, they’re going to just be chopping and not going to really be aware of what am I cutting.
And then motor planning, it just goes hand in hand. You’re not going to be able to put the steps together to do any kind of motor goal, crawling, walking, standing, running, skipping, any of the things without that proprioceptive awareness. And so they’re going to learn and they’re going to be not, they might lack confidence and like PE at school, or they might be left out of
group games because they’re the kids that are clumsy. They’re the kids that are just not, or maybe they’re avoiding it. They just don’t want to try. I read that somewhere in a research article when I was preparing for this episode and it said that a lot of times these children that don’t have this proprioceptive awareness or even any sensory system awareness, but it really comes out in the proprioceptive dysfunction and deficit that we see. They are avoiding tasks that they know they’re not going to succeed in. And so they’re…
And so they’re often left out of those group activities that require more agility, more coordination. And so they might be the kids that are not jumping rope and stuff like that. So it’s such a big piece of motor planning and cognitive learning.
Megan Williams (33:45)
Yeah, it can even carry over into their self-esteem during their teenage years, I think. Being chosen last to play kickball or wanting to find a sport area that they can fit in, but knowing that it just isn’t coming to them as easily as it is maybe some of their peers. Yeah.
Franchesca Cox (33:51)
Yes.
yes.
Absolutely.
What about from a speech language and feeding perspective? What do you see?
Megan Williams (34:12)
So we kind of talked earlier about how proprioception is really important for children to feel where their articulators are. So their jaw, their tongue, their lips, in space. Because when we speak and we produce connected speech, we are moving our articulators so quickly. It’s mind-blowing how fast we have to move.
all of our parts of our mouth. And so when you have a child who is probably having some…
they have that lower response of their articulators or awareness. They’re probably gonna have motor coordination issues and that’s gonna come across in their movements, so the way they play. And then it’s also gonna come across in their speech. And a lot of times, those are the children that are suspected of having childhood apraxia of speech, which is classified as having no
brain injuries, so if they do brain imaging, you don’t see any kind of damage. The brain looks completely normal, but there’s some kind of breakdown in the motor coordination piece. And those are the kiddos who need that motor-based speech approach, and that’s where Prompt comes in and really does a lot of really good for these kiddos. But then even in our expressive language, proprioception
Franchesca Cox (35:11)
Right.
Megan Williams (35:32)
is important for voluntary motor planning and symbolic expression. you know, speech testing we look at, are children able to gesture? Are they able to point? Are they able to, you know, before we’re even really looking for them to produce words, we’re wanting to see can they move their body in cohesive, coordinated ways. And a lot of times, if they are having trouble with that coordinated movement, it’s going be really hard for them to express themselves.
if they are a candidate for using AAC, augmentative alternative communication, if they are having trouble with motor planning for pushing different buttons on the screen, then it’s going to be really tricky for them to use some of the more advanced options that are out there.
We also need proprioception for things like our core stability for breath support, phonation, resonance, and volume control. So if you think about vocal singers and people who are trained on opera singers and stuff, all that kind of stuff, they have really amazing core stability and awareness of those perp receptors in their…
Franchesca Cox (36:32)
Right.
Megan Williams (36:39)
muscles in their their torso to be able to hold out those really long high notes or low notes or whatever. We have proprioception to help us with joint attention tasks and social communication because like we said earlier you have to be able to self-regulate and
Franchesca Cox (36:48)
Right.
Megan Williams (37:00)
know in proximity. like I have to know where my body is in space. I generally when I’m communicating with someone I will be an arm’s length from them. Maybe if they’re somebody that is a close friend or family member I may be a little bit closer but we have to know you know that social awareness of you know if I’m speaking with a parent I’ve never met before I’m probably not gonna be really really close to them in their personal space.
Franchesca Cox (37:26)
right?
Megan Williams (37:27)
And then of course with feeding it goes without saying that you you really need to have fine motor proprioceptive awareness of your tongue, your jaw, and your cheeks even to control the bolus while it’s still in your mouth before you go ahead and swallow because once you start to swallow, excuse me, it becomes involuntary and so
Franchesca Cox (37:31)
area.
Megan Williams (37:50)
A lot of our kids who have poor proprioception, if they’re trying to eat food that’s very piecey and trying to create a nice cohesive bolus, they may really struggle with those kind of mixed texture foods that requires a lot of yes.
Franchesca Cox (38:03)
yeah, like soup. That’s so hard. Yeah,
I thought it was so interesting. I never thought of volume control as a proprioceptive deficit. You you have children who are really loud or even really soft spoken and that is so interesting.
Megan Williams (38:20)
Yeah, and I know here on the podcast a lot of times my proprioception is poor and so I will get to talking and all of a sudden my brain goes, you need to take a breath because your volume, your lung.
Franchesca Cox (38:25)
you
Yes.
Megan Williams (38:33)
capacity
is not there but yeah like these these people who you know get up on stage and perform these like really beautiful pieces that they are locked in with their proprioception and awareness of how to project their voice and all that really cool stuff.
Franchesca Cox (38:48)
Yeah. So we’ve talked a lot about what the proprioceptive system is, what the research says, how it affects children on a day-to-day basis in different areas. Well, let’s talk about some of the things that we can do.
So we have heavy work activities and if your child is in therapy you may have heard of this term and that just we referenced it earlier but it’s just pushing, pulling, carrying weighted items. One thing that I saw was you could have a children help you bring books like pass out books to the class or something and that’s going to give them that proprioception activity that heavy work activity. A lot of times our sensory seekers are going to love this activity but it also
them grade their power especially if it’s a it’s a
goal-directed task. So go take this or push the basket to the laundry room. They’re going to be a little bit more focused if they have a goal in mind. Of course, having something heavy in there so they can feel it. Animal walks like bear walks, crab walks, things like that to provide deep joint compression and hanging like hanging from monkey bars, climbing, anything like that. Wall push-ups, you can modify those and even do like a wall sit.
and so that might give them a little bit different input. You can also do, like at home, can do pillow pile jumps and just like we were talking about earlier, getting those cushions off the couch or just getting a bunch of pillows and instead of being in a cocoon, know, jumping on them.
vacuuming, sweeping for older kiddos, even if they’re not actually cleaning, just giving them that input. Like today I vacuumed upstairs with our new carpet and it was so much work. A lot of heavy work. We just put carpet up a little bit ago and then put the vacuum up there. I needed it. Oh my goodness. Talk about proprioception . And you feel it, you feel it. So vacuuming is definitely a good one. Carrying groceries is another one.
Megan Williams (40:18)
haha
Franchesca Cox (40:32)
We talked about the bear walks and the crab walks, but like at school, chair pushups. So you can teach them how to just be in their chair and hold onto it and then push themselves up and then let go and push themselves up. Stacking the chairs, weighted backpack, you could even do, I think we’ll get into weighted activities, but those are some of the heavy work activities that I saw. A wheelbarrow walks is one of my favorite, especially for if we need that sensory input, we need to…
maybe desensitizes the palms of the hands. Wheelbar walks are wonderful.
Megan Williams (41:00)
Yeah, that’s a lot of really good things that kiddos…
School can do to be good helpers because I know a lot of times those kiddos the seekers tend to kind of stand out Maybe in certain classrooms because they’re constantly needing that input and if we can help them Be a helper that can help with self-esteem and giving them a goal Or a job, that’s cool We also have giving deep pressure
Franchesca Cox (41:07)
Yes.
Redirection, right? Redirection. Yes.
Megan Williams (41:30)
or we call it deep perp receptive input. So weighted blankets and compression vests are, I find them a lot, I feel like they’re on the market and they’re becoming even more like less quote unquote sensory.
labeled things because I think families and parents even are finding that that weighted blanket and it doesn’t have to be significantly heavy. I think it’s a certain percentage of a child’s total body weight, you know, and so we are using this weighted pressure to give deep input to the body when we are
Franchesca Cox (41:50)
you
Right.
Megan Williams (42:06)
resting or the compression vest that I find a lot of times is good to have when your child’s in therapy and needing that extra help.
with their to their torso. Of course, big firm hugs or like kind of a lot of time, rough, rough play is a good way that family members find to give this kind of input to their child. And it can also be activities that bring them together. So like kind of a bonding exercise. Kids love being rolled up like a burrito. Sometimes I say a sushi roll.
Franchesca Cox (42:16)
Yes.
Mm-hmm.
Megan Williams (42:45)
They get to pick which one they want to be and using just a standard throw blanket having them you know lay still and they get to choose do they want arms in or arms out or whatever and they get to roll up into a nice tight little kind of cocoon.
Franchesca Cox (42:48)
This is like.
Megan Williams (43:01)
and they like that a lot of times, especially at our clinic, our rooms get kind of cold and so sometimes they really love that. If you’re in a setting where you’re able to offer snacks, sometimes if we can give kids crunchy food or food that’s got a little bit of a resistive texture to it, so this of course is for children who don’t have any kind of oropharyngeal dysphasia but need that
Franchesca Cox (43:06)
There we go.
Megan Williams (43:31)
type of special food to help provide proprioception to their jaw. So maybe popcorn or pirate’s booty, veggie straws, anything that’s really crunchy is going to give them that input. And it’s also going to give them auditory input as they crunch into the food. Things like carrots, little baby carrots, or bagels, sometimes even twizzlers or jerky.
Franchesca Cox (43:49)
Yeah.
Megan Williams (43:59)
can sometimes offer that kind of chewy texture that they like. Some kids, know, schools are all, they all have different feelings about gum, but if a good sugar-free gum option is good, that can help kids continue to get the oral per-perceptive information that they seek out. You just have to have a discussion about where that gum goes whenever they’re done with it.
Franchesca Cox (43:59)
yeah.
Yes, yes, absolutely. As far as giving support when it comes to fine motor skills.
Especially when you’re learning to write, the child’s learning to write, you can use resistive writing tools. I’ve seen these vibrating pens that are super fun. So they’re not super functional, but they’re fun and the child can feel that pen. I also tell families to get the big, the fat markers or the jumbo crayons because that child’s going to be able to hold it a little bit easier. They’re going to be able to, you know, grasp it and feel it a little bit.
because it’s bigger. You can also put a fidget, you can you know just make it a little bit heavier with a fidget toy or an eraser. That’s what I meant like an eraser on the end. The ones that are really fun you know that might be a bumblebee or something and you just stick it on the end so it’s going to give it’s going to be a little bit more weighted so they’re going be able to tell where it’s at. Even those giant pencils you know the ones that are a foot long just to give them that information. They might use two hands but they’re still using this
Megan Williams (45:16)
you
Franchesca Cox (45:20)
fine motor skills, especially if they’re under five and they don’t really need to have a dominance yet, just getting them acquainted with that, with using their hands to control a riding device. That’s super fun. Activities like Play-Doh, squeezing stress balls, using resistance bands. They’re really good for building hand strength and giving them that proprioception. And also I like to emphasize when we’re trying to gain fine motor skills and we know
proprioception is issue, making sure that the child has contact not just with their fingertips but more importantly with their palm because in our palm we have the intrinsic hand muscles and we have to strengthen those before we can fine-tune. So in other words, if I can’t sit up I’m not going to be able to play the piano at the bench. So you have to start proximally and closer to the center of the body meaning so we have to think about that proximal part of that hand strengthening that palm in one
to do that is with a pegboard. And most kids, mean all ages, I even have like a 14 year old now that he’s got some underlying fine motor issues and he loves the pegboard. It’s brightly colored, they’re easy for him to find. He’s got other things going on so they’re easy to spot and he can push down with that palm and you can, it’s just really satisfying. Another one I thought of was like stomping on crunchy leaves. It’s so much fun. It’s so sad, or stomping on pine cones. So fun. I love doing
Megan Williams (46:36)
Mm-hmm. Mm-hmm.
Franchesca Cox (46:40)
that. Maybe I’m a seeker, I don’t know.
Megan Williams (46:42)
Yeah, it’s fun going on walks in the fall when you have the acorns and the leaves and the pine cones, all the things that are falling out of the trees. there’s lots of sensory stuff in our environment to explore.
Franchesca Cox (46:51)
Yes.
Megan Williams (46:56)
And so if you’re looking for ways to to kind of work This these supports into your child’s day. That’s definitely something talking to your therapist about and you know How can how can we give our child what they need if they’re seeking or how can we? Encourage them to explore things that are going to help
build up their proprioceptive system. So when we’re doing chores at home, we can always make sure that we delegate those chores to kiddos who need the heavy lifting, the carrying, the pushing. I can’t get over how many times during the day doing normal chores, just trying to carry a full, close basket to the washer and dryer, you know, how…
Franchesca Cox (47:40)
Yes.
Megan Williams (47:40)
tired I get, but that’s going
to be a good activity for maybe a kiddo in the family that needs that. And then also making sure that educational systems provide movement breaks during learning activities. So making sure that their programming allows for a recess or allows for some time in the classroom to get up and do specific types of movements.
and things that are gonna, you know, it’s gonna support their learning. So it’s not wasted time. It’s actually gonna, you know, help their brain be more attuned to what they’re learning or they’re trying to.
Franchesca Cox (48:12)
ready.
Thanks.
Megan Williams (48:18)
pick up on. I’ve noticed, I haven’t been in the school system as a speech therapist in millennia, but I feel like there are more programs that are allowing children to maybe like to tie like a resistance band around the legs of their chair so that they can like put their feet against it and kind of bounce or get whatever they need while they’re still seated. And I think that’s amazing that
systems are really leaning into it instead of, you know, back in our day maybe saying like, no, just sit still, you control it. And so, yeah, also wiggling, wiggle cushions, standing desks, it’s good to see that schools that have it in their budget to be able to provide these kinds of, these tools for our kiddos.
Franchesca Cox (48:50)
Yes. Yes.
Absolutely,
So.
Some final thoughts and takeaways from this episode. know that proprioception is a crucial but often overlooked sense that helps children navigate their environment, control their movements, including speech, and regulate their emotions. It touches all the things about child development. Research supports proprioceptive training as a beneficial tool for improving balance, coordination, and body awareness in children with various challenges, including hearing loss and cerebral palsy.
recognizing that proprioceptive challenges, both hypersensitivity and hyposensitivity, can help parents and educators better support children who struggle with movement, coordination, and self-regulation.
Megan Williams (49:47)
We know that practical strategies like heavy work activities, deep pressure input, and fine motor exercises can strengthen that proprioceptive processing and in turn support the learning of motor development and emotional regulation. We also touched on some simple daily activities that can be kind of sprinkled in throughout the day using weighted tools and other activities to naturally integrate that proprioceptive input.
into your child’s routine to make it easier to support their sensory needs.
Franchesca Cox (50:19)
Yes, yes, this has been such a fun episode to discuss and to research for. It’s just been super fun and I hope y’all learned something and we would love to hear from y’all if you have any questions.
Megan Williams (50:31)
sure.
If you suspect that maybe your child has some underlying proprioceptive needs, definitely reach out to your local therapy providers. Check out our notes from today’s episode and or shoot us a message and we can always kind of help guide any families in any direction that they need.
Franchesca Cox (50:52)
Yes. Thanks for joining us. Until next time, take care and keep making those big steps forward.
Franchesca Cox (50:57)
We’re so glad you joined us for Little Brain’s Big Steps podcast. Please remember information provided on this podcast, whether from the hosts, sponsors, or guests is for informational purposes only, and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult with your child’s physician and therapist before making any changes to their medical care. Take care, and we can’t wait to chat with you again next time.
We’re so glad you joined us for Little Brain’s Big Steps podcast. Please remember information provided on this podcast, whether from the hosts, sponsors, or guests is for informational purposes only, and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult with your child’s physician and therapist before making any changes to their medical care.
Franchesca Cox (51:39)
Thanks for joining us on the Little Brains Big Steps podcast. We hope this episode provided valuable insights and support for your journey. If you know a parent who could benefit from this episode, share it with them today. Be sure to visit our podcast website for show notes and additional resources. Until next time, take care and keep making those big steps forward.