Summary
In this episode, Megan and Franchesca explore the tactile system—our sense of touch—and its critical role in sensory development and MNRI work. They break down the three types of touch (discriminative, nociceptive, and proprioceptive), how touch relates to reflex integration, and the calming power of deep pressure. They also discuss how the brain interprets touch and its emotional impact, especially for children navigating trauma or sensory sensitivities.
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.
Franchesca Cox (01:28)
Welcome back to the fifth episode in our series about the eight sensory systems. Today we’re exploring the tactile system, how we process touch and how it affects everything from emotions to movement. We’ll talk about what makes up our tactile system, how our brain is involved and what happens when we have hyper or hyposensitivity in the tactile system. So Megan, what is the tactile system?
Megan Williams (01:47)
about today’s
really excited to talk about it. It’s okay I know you probably shouldn’t have a favorite sensory system but for me this is the one that is I guess the most interesting to me just I don’t know I guess I’m a big nerd I don’t know even more than auditory even I’m just really interested in
The tactile system plus it’s also what kind of got me into MNRI. it didn’t all really seem to matter to me until I took the tactile class and it just kind of put some things together about feeding and touch and all those kind of things. But yeah, I’m excited about today’s episode.
Franchesca Cox (02:22)
Yeah, I remember seeing that
course and that was what kind of sparked my interest in MNRI, that tactile course. And I thought, yeah, makes sense that this is your favorite. It’s very in line with MNRI.
Megan Williams (02:30)
Yeah.
Yeah, it is. And
you wouldn’t expect a lot of, I guess, reflex integration. Because at first I was like, I don’t understand what reflexes have to do with the tactile system. But once I took the class and started piecing things together about the sensory motor triangle kind of piece. So yeah, it started clicking for me.
Franchesca Cox (02:42)
Mm-hmm.
Megan Williams (02:54)
The simple definition of what is the tactile system? What are we talking about when we say that? It is the sense of touch, basically processed through our receptors in the skin. And of course our skin we know is the largest organ of our body. I mean, it’s the wrapping of our body. And we have everything from little hairs that are on our skin.
They transmit signals and information to our skin which goes to the brain and then it just gives us so much information about our surroundings. There are three specific types. Now this is according to Dr. Moskitova. I think some literature says there are two types of touch but Dr. Moskitova looks at three. So we have discriminative touch. So that’s just touch. Any kind of pressure and vibration.
It enables us to describe the texture and shape of an object without using our eyes. So I always think of like the little game where you put toys in a brown paper bag and you have a kid reach in and you have them grab something and maybe describe it or you You know, you can play variations depending on their language skills, but it’s using or when I’m Hopefully my husband doesn’t listen to this podcast when I’m driving down the road and I
Franchesca Cox (04:00)
Yeah.
Megan Williams (04:07)
elbow deep in my purse trying to find my favorite lip balm or whatever and I know exactly what that container feels like in my hands I don’t even have to look you know but I’m not focused on completely driving but and then once I find it I pull it out and I’m like yes I’m always like thank you tactile system and so that’s that discriminative touch and so those are processed through specific
Franchesca Cox (04:11)
Yup.
Yeah.
Yes.
Megan Williams (04:33)
receptors and I won’t go into detail MNRI you go into detail about all the Merkel receptors all these different the names of all of them but we won’t get into that detail and then we have what are called nociceptors those are what allow us to perceive pain, extreme temperatures, itch so that annoying mosquito bite that we get I get tons of every summer feeling the itch
response to the histamine and the bite and then of course tickling which is can be a hot topic sometimes because tickling is an activity that is usually a bonding activity but it can cross over into a threshold of pain so yeah.
Franchesca Cox (05:06)
You
Yeah, that’s so interesting to me.
Megan Williams (05:19)
Yeah, being someone who my mom, she just would love to always tickle me, like get right in between each rib and just tickle so hard till I couldn’t breathe. And it was always a thing where I was laughing, but then at some point I can remember it would cross over that threshold into like, I’m not breathing anymore, please stop.
Franchesca Cox (05:37)
Yeah, yeah, for me it’s like pure anxiety. Like I absolutely hate being tickled.
Megan Williams (05:42)
Yeah, yeah.
People will sometimes elbow, like they get defensive, they go into fight mode. And then the third type of touch is of course proprioception, which we’ve done a whole episode on in our sensory series. So, when a muscle stretches or a joint moves, so joint position,
Franchesca Cox (05:49)
Yes, yes.
Yeah.
Megan Williams (06:04)
And when tendons go under tension, those receptors deeper into our layers of our muscles and tendons, they’re sending information through proprioception as a sense of our tactile system. So it’s an example of how all of our sensory systems, I think we’ve said every time, all of our sensory systems all work together and it’s really hard to pick one that doesn’t work.
Franchesca Cox (06:22)
Yeah.
Absolutely.
Megan Williams (06:28)
at least with one or more. And so an important distinction to remember is that the pathway in our brain that sends discriminative touch information to the brain differs from the pathway that sends the information about pain and temperature. And it makes sense. You want that message that is relaying dangerous information about pain, so if you’re burning or
Franchesca Cox (06:30)
Yeah.
Megan Williams (06:53)
freezing or you know there you’ve had a laceration You want that information to travel faster to the brain and not have to jump multiple ⁓ Steps yeah to get to the brain. You don’t want to tap the synapse and fire on different levels You want it to get there quick? But discriminative touch is a different pathway and so it’s important really to remember that that
Franchesca Cox (07:04)
layers or signals. Yeah. ⁓
Megan Williams (07:18)
is that different distinction because they just like any sensory system they can be have wires crossed where the information that we think we’re sending could be like that discriminative touch but it actually could be firing on the pathway for pain and discomfort and so.
Franchesca Cox (07:25)
Right.
Yeah, and
I’m sure you’ve seen this, but a lot of times with brain injuries, they are crossed and children register things that are not pain as painful. And we have to slowly desensitize and retrain that brain saying weight bearing is not painful. And so especially when they haven’t been using a certain joint, like their palms or their feet. So that’s such a good, that’s a good distinction to make. It also made me think of like the times, cause there’s times that I use cold
Megan Williams (07:51)
Mm-hmm.
Yep.
Franchesca Cox (08:05)
pads to try to bring some kind of discriminative touch feeling to this child so that we can start working on proprioception and so we can start working on weight bearing. And so you’re hitting kind of those nociceptors to eventually get some function. So that’s so interesting.
Megan Williams (08:12)
Mm-hmm. Mm-hmm.
Mm-hmm. Yeah,
it’s really whenever whenever I work with kiddos with brain injuries who are really deep into that trauma state if you just even walk by their table just the air even crossing over, know moving the hairs of the
on their skin or their arm, it can be really, you can notice that they’ll have like a fear paralysis response. And so that tells you immediately when you place your hands on them, like I have to spend up to about 21 seconds of giving deep, safe pressure and I can be standing and I can just be standing there for up to half a minute to a whole minute, just on one part. And so a lot of times it’s like, well, I got the, the embracing squeezes done to the
Franchesca Cox (08:51)
Wow.
Wow. ⁓
Megan Williams (09:04)
I got that done in 45 minutes and I think I finally you get to see them relax take deep breaths and it’s like It really requires you to slow down and think about how specific that information is that you have to give to their brains because they are
Franchesca Cox (09:04)
Mm-hmm.
That’s so
interesting. That makes me think of the kids who need deep pressure. So you’re saying deep pressure should be extended usually if we’re trying to calm, give that calming effect, not just a and then we’re done.
Megan Williams (09:31)
Yes.
Right, because on a typically intact neuro system,
It takes about seven seconds for a safe, safe touch to be perceived and then the brain kind of respond, tell the muscles to respond. Of course, like I said, it’s faster if it’s a dangerous or like the brain perceives it as danger. And so that deeper, slower amount of time gives
Franchesca Cox (09:54)
Right.
Megan Williams (10:00)
message of no this isn’t dangerous to the brain and it helps calm down that overly super active response and so I always say like multiples of seven so like
seven seconds on our sensory systems, well then maybe we need 14 for a system that’s maybe in higher flight and then 21 seconds for even more pathological functioning systems. Yeah.
Franchesca Cox (10:27)
Wow, that’s good information. Because
a lot of times, parents already know about the deep pressure, but there’s really no data out there that’s saying we need to do it for this amount of time for it to be giving you the result that you want to see. So that’s good information.
Megan Williams (10:43)
Mm-hmm,
you can feel the body kind of melt once it’s gotten to that safe level and you’ve reached that level where they’re and they take that just that first like And you’re just like I know I’m there with you buddy like that just they just feel so good and safe
Franchesca Cox (10:53)
Yeah.
Yeah, that’s
awesome. Well, let’s talk a little bit about the brain and how it relates to the tactile system.
So we know we have the peripheral receptors that you kind of touched on that sends the signals from the skin to the spinal cord into the brain. And a lot of times it goes back to the skin or back to those nociceptors, proprioceptors and all that. The somatosensory cortex is located in the parietal lobe and this process is an interprets touch. The thalamus is the relay station that directs sensory information. And the amygdala is involved in emotional reactions to touch,
protective and aversive. So we’ll see this more active with probably those nociceptors, perceiving pain, dangerous temperatures or aversive, even like tickling in some cases. The insular cortex connects the tactile input with emotional and body awareness. This is so interesting. It makes me think of maybe like we feel a hug from someone we love and so we are going to see this part of our brain probably lighting up. The cerebellum helps coordinate movement and balance in response to tactile cues and we work
Megan Williams (11:53)
Mm-hmm. Mm-hmm.
Franchesca Cox (11:59)
so closely with the cerebellum, of course all parts of the brain, but this is a huge part of our therapy goals, I guess, is to get this cerebellum working in conjunction with our sensory system. So what are some signs of some tactile processing challenges that we see, that you’ve seen in children?
Megan Williams (12:11)
Yeah.
So
we have kind of, just like the other episodes we’ve done, you can have hyper sensitivity or hyper responsivity. avoiding certain textures, disliking messy play, strong responses to even light touch. is too much information is being given to the brain when a certain texture. So I fall into this camp.
I don’t think I crawled enough whenever I was little and so the palms of my hands will There are certain textures of clothes that I’ll be even doing the work on adults sometimes and if they have Kind of a textured shirt on women sometimes come in with the blouses. I Will have I will sweat out my hands will get sweaty. I have sweating, you know
Franchesca Cox (13:01)
⁓
Megan Williams (13:04)
and my underarms and I, it is, it’s a response to tactile input to my hands. I’ve worked on myself a lot, it’s gotten better, I don’t get as sweaty, but it’s definitely something that I am aware of and that I’m always like, you know, trying to be. So when kids come in with their super like soft clothing, I’m like, I love your pants and the parents are like, like.
Franchesca Cox (13:05)
It’s an autonomic response. Wow.
Yes!
Megan Williams (13:30)
No, it’s just really soft. I really appreciate that. Thank you.
Franchesca Cox (13:31)
That
makes me think of like, okay, when I don’t maybe this is tactile, maybe it’s not, it’s probably a reflex. But if I’m standing in line and someone is right behind me, I will jump. Is that tactile or is that a reflex? ⁓
Megan Williams (13:45)
It
can be tactile and it can be because all reflexes have a component of sensory input. So it could be if they’re breathing on you, if they accidentally touch you, sometimes if someone accidentally elbows me in my side or my back when they’re in line because they’re too close. But yeah, it’s probably a little bit of both. I know, I know.
Franchesca Cox (13:56)
Yes.
That’s my thing, it’s like, nope, don’t stand near my back. That’s my,
oh, I don’t know, it makes me… Yes.
Megan Williams (14:10)
⁓ vulnerable space don’t be so
close behind me yeah I if someone standing close behind me and I can feel their breath like I’m the upper part of my like see
Franchesca Cox (14:19)
Yes.
Megan Williams (14:23)
I don’t know, C2 through whatever. Yeah, just thinking about somebody standing there breathing is making me wiggle. Exactly, your skin, that’s the response you have, a skin crawling response. So anyway, and then you can also have kids who we see a lot of times are hyposensitivity or low sensitivity, low threshold. So these are our kids that need excessive touch. They want to be buried underneath the
Franchesca Cox (14:25)
Yeah.
My skin crawl.
Megan Williams (14:48)
crash pad and then lots of pressure they want a lot of input they crave it they also can have poor pain response so a lot of times when toddlers start crawl start walking if I am doing the interview with parents a lot of times they’ll say if I notice a lot of bruises and chin scrapes and things like that I’m like how do we respond
Franchesca Cox (15:07)
Mm-hmm.
Megan Williams (15:11)
to boo-boos? How do we respond to falling down and things like that? And they’ll go, you know what? They just get right back up and they keep going. And it’s like, okay. You know, and they’ll be like, that’s kind of odd. they would expect, you know, tears and whatnot. But some kids, if they have a low threshold, they don’t, they’re not aware of pain. And pain is supposed to be a roddily response to say like, hey, be careful.
Franchesca Cox (15:21)
Yeah.
Yeah.
Megan Williams (15:35)
Be careful, don’t do that again. Like that’s dangerous. And if we don’t acknowledge that then it’s another just like these reflexes that we have there. They are genetically encoded to keep us human, like human beings safe.
Franchesca Cox (15:37)
Right, it’s a warning.
Yeah.
Megan Williams (15:52)
And then we can also have mixed profile. So a lot of times we’ll see some kiddos who are are aversive to like walking in the yard barefooted, but then they love that deep pressure or they will run and tackle their
their siblings or parents. They’ll want to just get really rough and tumble and deep pressure. And so you can, it can be kind of like you have to become a detective to figure out why are they overly sensitive in some areas, but then they just can’t get enough of it in others. And then you can also see this outside of just the tactile system. You can see how the whole sensory system can have mixed. And I think that’s what really makes the sensory system such a head scratcher.
Franchesca Cox (16:28)
Yeah.
Megan Williams (16:35)
for practitioners and then people in other parts of the medical sphere where it’s like well is it really something because you know it just seems inconsistent but that’s that’s how we are that’s how our bodies are created so have you noticed with any of your family members like any oddities that
Franchesca Cox (16:51)
Yeah.
Megan Williams (16:57)
they crave or they stay away from.
Franchesca Cox (16:57)
So.
I
think so, yeah. Evelyn is my sensory kid. She is a seeker all the way. She loves just feeling the flower in her hand when she was younger. She loves dirt.
both my kids were, but she was way, and she was the one that loved squeezes. Like she would ask for them on her arms and it would just calm her down when she had to be quiet and she had to be still like in church. That was my thing. I would just squeeze her arms and people thought it was weird. I’m like, leave her alone. She needs it. And so yeah, she’s my sensory. She’s a seeker. Still to this day, like if she could walk around barefoot in her backyard, she would, cause she loves just feeling the earth and having it through.
Megan Williams (17:29)
Mmm. Yeah.
Franchesca Cox (17:40)
grounding component to it too but we have small snakes back there so she can’t go back with Merifit anymore but yeah she’s definitely the hyper…hyper…no no hyposensitive because she seeks it out yeah yeah I had to think about yeah
Megan Williams (17:41)
Mm. Mm-mm.
⁓ She wants as
much of it as she can take. Her body needs all that information. That’s interesting.
Franchesca Cox (18:01)
And I have to sleep with a heavy blanket.
Like it has to be heavy. So I need that deep pressure.
Megan Williams (18:06)
I think when
those weighted blankets became more commercially available like on Amazon and stuff I think a lot of parents really adults started figuring out like wow this is something that I kind of need ⁓ or like the the stretchy band type lycra
Franchesca Cox (18:20)
Yes.
Megan Williams (18:24)
You become like a little worm, it’s like a little sleeping bag and you can crawl in and cover your head with it. Parents are like, I like that. So they do and you can get them on Amazon. I don’t know what they’re called, but pretty smart. So we know that the tactile system is really…
Franchesca Cox (18:26)
Yes! ⁓
They make adult sizes now. Yeah.
Yeah.
Megan Williams (18:43)
important. So far we’ve talked about kind how it happens, what it looks like, how does it impact our cognition and motor learning?
Franchesca Cox (18:52)
Yeah, so touch just at
just isn’t about comfort or clothing sensitivities, it directly influences how a child thinks, moves, and learns. And this is really important at every stage of development, but it becomes more underlying when they’re in a situation where they have to sit still, where they have to be in school for six to eight hours a day, so it becomes a bigger deal. So it’s really important to catch it as early as possible and help them process these things. Some of the cognitive impacts of the tactile system on a child is
And the tactile input helps the brain form the body schema. So that’s like the internal map of your body that your brain is perceiving. And so it’s, I think it’s the homunculus. Homunculus is that word, right?
Megan Williams (19:30)
Mm-hmm. Mm-hmm.
Franchesca Cox (19:32)
And
so this is another word for it. That body picture, that map of where your fingers are, but it’s also the size of them. a lot of times people, children, we, sometimes we don’t have a correct size. Maybe we think we’re shorter than we are. This happens a lot with children as they grow, especially they’re growing so fast. So their body schema may not be fully formed or not, or maybe underdeveloped. This is very essential for spatial awareness, attention and self-regulation. This is really evident if you ever play like
Simon says with a group of kids you will spot out the kids that have a poor body schema because they may not have good lateral
left from right, directionality, know, up and down, sideways and all that, and also just the positioning of their bodies. So they rely heavily on their other sensory systems to tell them where their body is in space, and we’ll talk more about that in one of the research articles. But when a child receives consistent calming touch, it signals safety to the nervous system. This shifts them out of that fight or flight mode and into a state where the brain is ready to learn.
Kids with disorganized tactile input may show some distractibility, constant fidgeting, poor impulse control. They might be labeled the behavioral kiddos. They might need a little bit extra support or extra time or things like that. Accommodations in the school systems. They have trouble following directions, trouble focusing, and they might have anxiety in social or learning environments. If you think about, especially if you’re hypersensitive, you do not want to be in a crowd. That just makes you
unnerving because you know you’re going to bump into people you might touch you know clothing or fabrics or textures that you don’t want to touch and then not to even mention there’s going to be smells like if you have auditory sensitivities are not auditory I’m thinking of the word you can smell olfactory olfactory sensitivities you know when you’re around a lot of different people you just comes with it so
Megan Williams (21:11)
Old Factory.
Franchesca Cox (21:17)
This is to be, might be anxiety. of course our tactile system does impact our motor learning with our fine motor and our gross motor. Accurate tactile feedback allows children to hold pencils and utensils correctly. It helps them time their movements in space, like catching a ball, tying their shoes. So we usually think about catching a ball as a eye hand coordination, more of a visual, but it’s eye hand coordination. It’s the hands working with the tactile system, the proprioceptive
system, proprioceptive system and the visual system all working together for one task. that’s a lot. There’s a lot going on. Even cutting, know, cutting with scissors. need to feel they need to be able to coordinate that movement of opening and closing, tying shoes is all these little things are so complex when you try to break down and teach it to a child. Adapting a new motor challenge like climbing stairs or dressing. So the tactile system can impact all of these. And it’s really important to try to weed it out if it’s
Megan Williams (22:03)
Mm-hmm.
Franchesca Cox (22:13)
it’s
a tactile issue if it’s something else. Without clear tactile input, kids may avoid movement or appear clumsy. They may use too much or too little force and struggle to learn new motor sequences. Tactile feedback during movement is what helps the brain refine and memorize motor patterns over time. And think about how a child learns to zip their jacket, they must feel the zipper, coordinate both of their hands to do two different things and repeat it again and again and again. And touch tells the brain
yes, this is how it’s supposed to feel so the skill can stick and they don’t have to visually attend to something like buckling their belt, zipping their pants, opening a jar, things like that. So our tactile system is immensely important for daily skills.
Megan Williams (22:52)
Yeah.
It breaks it down so much more if you, cause I just think of touch and touch is just touch, like touching my arm or, but then when you really break it down and think, my gosh, all the amount of touch, like the amount of force that I need to use whenever I touch something hard versus something soft and modulating that. And then that ties into our proprioception And it, it’s so much to it.
Franchesca Cox (23:01)
Right.
It’s
complex and I see it a lot with children. You know, at the end of a session, I’m like, give me a high five. you know, they’ll be like barely tapping my hand. Some do not want to give force because they do not like that deep pressure. And some just don’t, they don’t, they don’t know how much force to put to make that clapping sound. And so that there’s a lot going on with that tactile system.
Megan Williams (23:27)
Mm-hmm.
Mm-hmm.
man, yeah.
And then in regards, the tactile system also plays a part in our speech, language and feeding. I mean, why would it just, why would it not? ⁓ So when we think about speech and feeding challenges, we don’t always think about touch, but it really is a huge role in helping a child develop their ability to eat, to speak, and even to understand properties of our environment for their language. So we know feeding
Franchesca Cox (23:47)
Yeah.
Yes.
Megan Williams (24:10)
development.
The mouth, the lips, the cheeks and the tongue, they are packed with tactile receptors. That’s why our babies, as soon as they have enough of ability to grasp, they are picking everything up and putting it in their mouth. Their tongue is giving feedback, their cheeks are giving feedback, everything about everything they come in contact with. And it’s almost reflexive because it is reflexive. There’s a reflex back in palmitominal because we have to know how to bring food to our mouth.
Franchesca Cox (24:24)
Yeah.
Megan Williams (24:39)
But babies don’t care when that reflex is super hyperactive as it should be They are putting everything to their mouth to learn about it because I mean you can tell if something’s hard something soft some things rough or you know hard all these different properties Babies also really rely on the receptors in their cheeks in the outer parts of their cheeks like the skin side To find the nipple or the bottle we have that rooting reflex where on a tiny
Franchesca Cox (24:48)
yeah.
Megan Williams (25:05)
infant you can just stroke their cheek and they’re already turning their head to find that source of nourishment. Coordinating their suck swallow breathing patterns. They have to be able to understand volume in their mouth and know when they can keep sucking and when it’s time to pause the suck to swallow and then breathe.
Tolerating different food textures when they’re transitioning to solids. I have seen so many families of children who have just, you know, been typically developing but had difficulty with transitioning from a puree to something that was even a meltable or was chewy or you know anything because anywhere in that development because of the tactile system on their tongue and in their mouth and it’s
If you look at what’s happening in the mouth, it’s usually an indication of what’s also happening like on the hands and most of the rest of the body. So yeah, but we don’t notice it until, you know.
Franchesca Cox (26:00)
Yes, yes.
Megan Williams (26:07)
it’s in the mouth and then you have to back up and zoom out of the picture and look at the whole body and then go well you know actually like they they don’t really you know enjoy doing this and this and and we don’t we don’t just give our little ones like boxes of sand and rocks or rice to play in and so we may not notice that ⁓ before they’re at that transition period when the tactile system is hyper
Franchesca Cox (26:08)
Mm-hmm.
Yeah.
Right.
Megan Williams (26:34)
sensitive, a child might gag or vomit just looking at, not even interacting with, but just gag with certain textures put in front of them. And then of course if we encourage them to touch it or even put it in their mouth, the gagging and vomiting can be so strong that…
they lose, you know, void what’s in their stomach. They may refuse to try new foods just if it looks even to have the, or feels like it has a different texture. They may avoid brushing their teeth or using specific utensils because all of the little receptors in our mouth.
Tongue brushing can sometimes be a thing for adults. You know, we’re always encouraged by our dentists for good dental hygiene. Brush your tongue, you know, as much as you can. Kill that bacteria, get it off your tongue. But for some people that is really hard to do. ⁓ When our system is under responsive, a child may overstuff their mouth. So, I haven’t even heard the term used recently, but many years ago it was called like chipmunk.
Franchesca Cox (27:21)
Yeah.
Megan Williams (27:34)
or squirreling where they would pack their cheeks full of food and just just continue to fill the mouth to the point where the parent would be like that’s enough you actually need to spit some out because you can’t chew that volume
Franchesca Cox (27:34)
Yes.
I’m bright.
Megan Williams (27:48)
Some children and adults may prefer extreme textures or temperatures because they need that specific information for their brains to understand what’s happening. maybe people who enjoy super like Carolina Reaper ghost chili pepper flavored chips and things like that. I don’t know. You know, that might be.
Franchesca Cox (28:09)
or like even really
hot, hot, hot coffee. I don’t know how people do it.
Megan Williams (28:11)
yeah, No, I don’t like burnt, the feeling of a burnt
tongue or roof of my mouth. That is an aversion for me. ⁓ And then some people may even, or children may be unaware that there’s even food left in their mouth. They may have it pocketed up sometimes between like the, their…
Franchesca Cox (28:21)
If for sure.
Megan Williams (28:34)
gum line in their cheek. Sometimes food will get pocketed up there or under the tongue. And parents will sometimes even have their child do like a mouth check before they can leave the table. And they’ll look and they’ll go, nope, still got some food in there. Take another sip of your drink and see if you can wash it down. Just cause they’re not registering that there’s something still in the mouth.
Franchesca Cox (28:43)
Yes.
Megan Williams (28:54)
For speech and language development, our tactile system gives the input that’s essential for building our awareness to…
producing sounds. So knowing where the tongue, the lips and the jaw are in space. So this tactile system is going to inform the proprioception proprioceptive system through development. So we have to have tactile awareness to produce clear articulation. So clear speech. So our kiddos who use sound substitutions, a lot of times it’s because their tongue is not in the right place. So when we have like a wuh for a la,
you know, we say, okay, put your tongue up to the top of your mouth, to the bumpy part, and the kids will do it, and it won’t go, luh, and it’ll go, wah, or yuh, and it’s just that tactile system maybe isn’t getting all that feedback. We have some techniques in the speech world of stimulating the little bumpy spot at the top of our mouth, but that’s an example of
Maybe, and this is not me saying that this is every child’s articulation issues stem from this. That is not always the case. But, you know, maybe sometimes they need a little bit more help because maybe they’re under responsive. And then sometimes some kids won’t make certain sounds because they don’t like the way it feels in their mouth because they’re over responsive.
Franchesca Cox (30:08)
how interesting.
Megan Williams (30:10)
Our breath control for longer phrases and sentences and longer parts of speech. We need coordinated movements for our speech and non-speech sounds. So, I mean, our tactile system…
is really big for speech and language. Children with reduced tactile awareness in the face and the mouth might drool excessively. They might struggle to imitate sounds. So they may watch mom or dad make the sound on their lips or make the sound with their tongue or however and then they just watch them and they’re not really sure what to do with their mouth. They may also have imprecise articulation. Their speech might sound
mushy or sloshy. Those have been some of the words that parents have used to…
classify their kids speech. And you know a lot of our articulation techniques will involve coming in and there’s controversy kind of in the oral motor realm of the speech world of you know if we come in with vibration like do we need to really actually wake up the tactile system? Do we need to do this? Things like that. My take on it is
Franchesca Cox (30:54)
Mm-hmm.
Megan Williams (31:17)
Yes but, it’s like any kind of sensory exposure to any part of the body or for whatever. Yes but it’s not a blanket thing. You need to know what you’re doing and why you’re doing it.
Franchesca Cox (31:25)
Right.
Megan Williams (31:28)
speech therapists need to have that awareness of the tactile system and you know just like all the other sensory systems we don’t get enough exposure to it in school and so children with tactile defensiveness they might be our kiddos who resist touch to the face or any kind of cues like touching sometimes I’ll cue to make the mmm sound we have to put our lips together and sometimes
Franchesca Cox (31:39)
Yeah.
Megan Williams (31:54)
Sometimes if I reach to place a finger under their lip, they’ll pull away because again that touch may feel like pain and not the discriminative touch. Some may have delayed babbling or speech development due to discomfort when using their mouth right now.
Francesca, you and I are working with a little guy in clinic and he is a seeker for deep tactile proprioceptive hugs. And one of the things he likes to do is when he gets in a hug, he will take his chin and he will push his chin into my cheek or my forehead as hard as he can. And he’s looking for that deep tactile pressure to
Franchesca Cox (32:23)
you
Yeah.
Megan Williams (32:41)
to his chin kind of…
And we have some oral facial techniques in the MNRI world to kind of reset the jaw. He holds his jaw out in posture a lot. And so if I can give him that input, even if it’s my forehead giving the input or whatever, because he doesn’t love when I reach over and place my hands on his face. ⁓ But if I can use whatever part of my body that’s safe or, you know, whatever to give him what he needs.
Franchesca Cox (33:06)
Right.
Megan Williams (33:15)
then I try to honor that and be aware of it.
Franchesca Cox (33:20)
Kind of along those lines,
have you noticed fingers facilitation versus other facilitation has different responses when we touch the children? So I try not to use my fingers as much because I notice the same thing, children just react differently. And so I feel like my palm is a little bit less aversive. I don’t know, but it’s interesting. I know what you’re talking about with that little boy.
Megan Williams (33:28)
Mm-hmm.
Mm-hmm. Mm-hmm.
Megan Williams (33:44)
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Franchesca Cox (34:49)
I have a question for you. So I know the palms and the feet have hundreds and hundreds and hundreds of touch and touch receptors, right? Does the mouth also have that many? Does it have just as many? Okay.
Megan Williams (34:58)
Mm-hmm.
Yes, so if you
look at that sensory homunculus you see he has giant feet, giant hands and a really pronounced mouth like a snout mouth. Yes, because that’s the representation of how much of our brain is dedicated to the sensory processing of that specific part of the body and so I remember I gave a
Franchesca Cox (35:09)
haha
Yeah, it’s like big lips, right?
Okay.
Megan Williams (35:26)
I I gave a speech in grad school for our project for our anatomy class and I remember talking about
I was talking about the the sensory cortex or whatever and I made a I made a passing joke about The OTs and the PTs thinks they think they have so much neuroanatomy they have to focus on it looks like maybe they haven’t looked at the sensory homunculus and it was just a bunch of speech my speech teachers and Students in the room and we all chuckled and so nobody was offended But you know, I still remember saying that cuz I was like, you know
Franchesca Cox (35:48)
Ha
Yeah. Yeah. Good joke.
Megan Williams (35:59)
But yeah,
Franchesca Cox (36:00)
That’s awesome.
Megan Williams (36:01)
it’s an example of the hands, the feet, and the mouth. They are big tactile receptors.
Franchesca Cox (36:04)
Yeah.
Yeah, I imagine there was, but the two things that I focus on a lot is those palms and the heels of the feet when we’re doing letter learning for different things. Well, let’s talk about some research. I know you found something. Do you want to talk about the first one that you found?
Megan Williams (36:22)
Yeah,
so I was just kind of looking. My search parameters were in the past, I think, 12 years. I wanted to know kind of what research was out there dealing with the population of children, teens, and adults with cerebral palsy. I wanted to know what kind of research was being done in the realm of the tactile sensory system. Like, are we, you know, just like what’s out there? What are we?
And so a lot of the research that came back, I was pretty stunned about. But one of the things that I thought was really neat, an article or a study that was done by Liang et al in 2023, they developed a tactile perception assessment specifically for the CP, individuals with CP populations. And I won’t get too
weighed down in the research with all the terms, but basically it turned out to be a pretty good test, retest, reliability showing that it is highly specific to what individuals with CP are experiencing. And so not only is it a good way to identify within the different kind of types of touch discrimination, what areas of weakness there are, you can also use it as
you know.
test, pre-test, and then after a few months just to see where they are, you can retest and see if there’s an improvement. So it’s kind of, and especially in the pediatric field, ⁓ there’s a gap, I guess, in the rehabilitation assessment world. And so it’s been kind of deemed as a reliable and valid tool for assessing tactile perception in people with CP.
Franchesca Cox (37:46)
Thanks.
Yeah.
a big deal.
The only one I ever knew was the Little Needles. I forget the name. It’s been a long time.
Megan Williams (38:07)
Yeah.
is it
the… Sims? Weinstein monofilament? ⁓
Franchesca Cox (38:16)
We’re doing discriminant. Yes. Yes,
Megan Williams (38:21)
touch threshold and then
Franchesca Cox (38:21)
the little.
Megan Williams (38:23)
I know of the two point discrimination. I’ve done that before and had that done. ⁓ But yeah, so it’s, they use those other tests that were the older tests to help build and figure out how reliable is this? And so yeah, I think it’s really cool. was, the study was published in the American Journal of Occupational Therapy. So hats off to OTs. Thank you all for doing that. And so yeah,
Franchesca Cox (38:25)
Mm-hmm. Yeah.
you
Megan Williams (38:48)
was published I guess in 2023 so I guess if you have access to that journal peer review journal and you’re really interested if you want to look it up on old PubMed I don’t spend any time there these days but yeah I that was a really cool thing because I always like when good high-validity tests are available for assessment that actually do something.
Franchesca Cox (39:14)
They’re easy,
yes, and they’re functional. They give us functional, objective results.
Another research article that I came across was kind of along those lines, but it’s more of a framework to guide clinical reasoning and future research for the tactile interventions available for children with cerebral palsy. So they were kind of looking at the gap, like what’s available to assess this and also what’s the best intervention. And so they came up with this theory, it’s called the apartment block theory.
And so they said there was three parts to it and I’m going to go scroll over. The first part was, so these are three different types, categories of interventions. The first one was pressing the buzzer repeatedly. So this is an analogy to get into an apartment and what typically happens, you know, we have a child in the clinic and
We know that they have tactile defensiveness or the reverse, you know, maybe hypersensitivity. But let’s imagine a child with hyposensitivity. don’t like they’re avoiding the touch. don’t like grass or food or whatever. And we’re working on the palms and the hands. And typically in the clinic, we’re going to see someone doing again and again and again, repeatedly trying to have this child touch something. But the research is showing that’s not an effective way, even though it’s the most common intervention that’s
happening.
We could because on a neurological level, we don’t even know if they’re processing anything that they’re touching. Because we know that something’s going on that that, you know, that tactile freeway in there from their skin to their brain, there’s something either broken, missing, under or underdeveloped, we don’t know. So that’s the first category of interventions, we just like if we have a goal to have them touch grass with their feet or their hands, let’s just get them outside again and again and again, no results, very little results.
Megan Williams (40:53)
Mm-hmm.
Franchesca Cox (40:55)
The second one is sneaking in the door and this is combining tactile input with motor output. So think of like constraint induced movement. There was another one that they mentioned, but it’s basically we’re combining our tactile goals with a motor component. we’re, we might have some like hemiplegia. One side is not processing that tactile information. So we’re going to restrain the good unaffected side so that affected, affected limb can have more function.
And so there’s some research that’s showing there’s a lot of research for CIMT obviously, it’s not as according to this framework research article,
Sneaking in the door was combining it with a motor component. The third one was connecting another way. And this reminds me of that phrase that we say almost in every episode with the sensory systems is what fires together, wires together. And they’re combining the tactile system, not with any other system, but.
Megan Williams (41:35)
Thank
Franchesca Cox (41:46)
targeted the visual system. So when the visual system is available for that child to use, when they combine it with the visual system, they’re seeing strong results in tactile processing. And so they, again, it’s called the apartment block theory. It’s really interesting, because they’re saying if you can help them not just see it, but do some
They called it visualization. There’s a whole thing on it. I thought it was really cool, but it’s not just looking at it, seeing it, but it’s also mentally closing their eyes, visually attending, either are processing it in their mind. So forming a picture even without their eyesight, that’s another form of visualization or using that visual system. So when they combined the visual system in one way, one of those ways, whether visually attending or visualization in their mind,
with visual eyes occluded and they were trying to do some kind of tactile goal they got better results those were that’s what the research is showing
and so the very one of the very last sentences in this article, it says, for now, though, the most critical component to realize is the need to continuously and consciously capitalize on vision and tactile training endeavors. So I just thought that was really cool. And it’s pretty recent. I think this was I think I told you 2017. And it was done by Megan Alden, Leanne Johnston. And I don’t know where what kind of therapists there are doctors there.
but I thought that was a really cool article just underlining and highlighting what we’ve been saying. All the sensory systems work together and another thing they mentioned was mirror therapy as far as part of that third category that’s highly effective. So mirror therapy is another really cool thing that we have used in the clinic before seeing really good results with it. So yeah.
Megan Williams (43:16)
Mm-hmm.
Yeah, that’s amazing. And it definitely reinforces that idea
of when we can work all of these sensory systems together to support each other you’re going to get better results. you know, doing different tasks sometimes with older kids where I’ll have them lay in supine on their back and I will tap them on the
And I’ll say okay when you feel or I’ll give them the instruction when you feel me touch your arm or leg raise that arm or leg and of course they’re like All right, and so I’ll do it and they’ll raise their arm and they’ll just look at me because they’re like this What do you get now lady? I’ll say okay go ahead and close your eyes, and then when you take away that visual component a lot of times You know yes, I touched their arm they do it, but then whenever I increase I tell them I’m
Franchesca Cox (44:07)
Yeah.
Megan Williams (44:18)
we’re going to keep leveling up the better you do it’s going to get harder and harder and so if I’m touching like right arm left leg sometimes it starts to get muddy and they’re confused I’ll sometimes do it also with the hands so which finger do I touch I want you to raise that and then sometimes we’ll do multiple fingers on the same hand we’ll do a few on each hands and things like that and yeah a lot of times when I take away the vision
that they’re relying on. So yeah, if we can use what’s working for them and help them put these pieces together, I think.
Franchesca Cox (44:52)
Yeah, that’s super
interesting. It also kind of helps you weed out how heavily maybe those children are relying on their visual system to get through their world versus feeling it the way they should be.
Megan Williams (45:02)
Mm-hmm.
Mm-hmm, yeah.
Yeah, I always learn from kiddos. Every time I walk into a situation and I want to learn about their sensory systems, it gives me even more information back about what can be going on that we may not even have ever realized or thought about and going from there.
Franchesca Cox (45:11)
Mm-hmm.
Well, don’t you feel like almost every treatment session is like a new evaluation? Because I feel like I’m, like you said, I’m constantly learning about this child. And if we see children for any amount of time, they’re growing so much so rapidly and changing. And so always having a fresh pair of eyes, not assuming what worked yesterday will work today. You just never know.
Megan Williams (45:29)
Mm-hmm.
Mm-hmm.
Yeah, another
kiddo that you and I are both working with this week. I made a judgment error yesterday and jumped too high on a sensory kind of activity and you know, it took balance out of the equation in the activity, but it was a lot of vestibular and he became dysregulated and would not participate anymore and his family member was upset and you know, you’re disobeying, you’re disobeying and
I said, no, he’s telling me something that I am learning from. And I was like, he’s teaching me, showing me that I made an error in judgment. And I went over and I talked to him, you know, like, is this what happened? And I said, man, thank you for teaching me that and helping me understand. so. ⁓
Franchesca Cox (46:30)
what an opportunity
to build rapport,
Megan Williams (46:33)
Yeah, I told
him thank you for being my teacher today. then so today I saw him and I said, you know, I saw you were working with Miss Francesca and Miss Ashley. I said you were teaching two grownups. That’s a lot of work. Man. Yeah, they’re really they need a lot of teaching. And so I like to tell the kids that they’re our teachers. And I think it helps for some of the kids. Yes, because.
Franchesca Cox (46:36)
No.
We’re kind of hard-headed.
I love that. I’m sure he loved that too.
Megan Williams (46:59)
Yes, he
has strong opinions and I just love him. He’s adorable.
Franchesca Cox (47:04)
He
is. Well, let’s talk about some strategies to support the tactile system. We’ve talked about quite a few. I’ll shoot off a few and then if you want to jump in and just tell me what works for you with your line of work. I know whenever I have children that are hyposensitive, so they’re…
aversive to texture or whatever. I use a lot of weights. I use some deep pressure vibration plate on a low setting. I avoid light touch at all costs. So if I’m going to touch a child, it’s going to be pretty deep. So I do a lot of that kind of work. Heavy work. But if we’re doing vestibular, I know that I have to pair it with something heavy. So I’m going to make sure that either I’m holding the child on the swing, or maybe they’re they have a weighted vest on or
Maybe we reprime them with some kind of deep pressure work and then we get on the swing to help them not be as aversive. What are some of the things that you do to help and support the tactile system when we know there’s an issue?
Megan Williams (47:59)
Yeah, so
one of the first things I always like to try to do, whether the child’s ready to climb up on the massage table or not, if we’re sitting on the mat on the floor, if I can start working in some deep pressure, doing pieces of the MNRI neurotactile protocol where it’s that deep touch, safe touch, a lot of times I have to start at the feet because that’s like the furthest away from their face.
And a lot of times if people come to me for feeding things, they’re looking at me like you’re far away from the mouth. And it’s like, well yeah, because I’m not going to come straight at their mouth if they have tactile aversion. And giving them opportunities to, like we have, I have lot of blankets in our office. I have like stuffed animals and things like that. I also have harder surfaces that are like the foam.
and things like that. I will bring certain things around to kind of see, okay, if they don’t want my hands touching them, like can I use a yoga ball? Like will that touching them with deep pressure and then less pressure, will that help? And just always kind of being…
not thinking that I have to always use my hands, like knowing that I had one little girl, I was working on her back and she had a shirt on and she’s like, your hands are so hot. And I reached up and I felt my face and I was like, okay. And to me they weren’t that hot, but to her, like it must have been a lot. So knowing that.
your hands don’t have to always be the tactile workers. Sometimes the little stuffies that I, little stuffed animals will do a lot of the work because you know they can give hugs and so yeah that deep work but I try to almost always have some kind of piece of tactile work at the beginning of our session just because
Going back to that sensory reflex arc or triangle, we know that the sensory side is kind of what stimulates a reflex first. And so if I can calm down and regulate that sensory response to touch or use touch to calm down an overactive amygdala, then I’m gonna start with that always.
Franchesca Cox (50:11)
Yeah,
yeah. I feel like you can’t access the limbic system, which is our center of joy and excitement and pleasure without calming them down first, right? Yeah, and we get the best results when we can reach them on that level. What about some approaches or interventions or ideas for hypersensitive children? I don’t see those as much. I see, I’m seeing one next week, but.
Megan Williams (50:21)
Mm-hmm. Mm-hmm.
Franchesca Cox (50:35)
And my approach, I guess, with those kind of children is just giving them what they want initially within their parameters that are safe, like whether that’s crashing or deep pressure and slowly trying to regulate them, giving them fewer or a little bit more demand and a little less time with the things that they are crashing into or whatnot. But what are some of the things that you do on your side for those kiddos?
Megan Williams (50:57)
So
our kiddos who are needing a lot of it,
Franchesca Cox (51:00)
Yes, yes.
interfering with school or listening or saying seatbelt or what not.
Megan Williams (51:08)
Yeah, so lot of times, so matching the heavy work with giving them that proprioceptive whatever they need, also helping them if they’re older child, helping them understand ways that they can get the same kind of information.
without the big movements. some kiddos, I even teach them how to do their own embracing squeezes where they’ll like take their arm and they can put it up and they just, have them put their hand on top of their arm and just lean over it.
and then relax. But if they’re kids who have no idea how their body works in space, it is a little bit more difficult where you’re watching for that threshold and you’re letting them have what they need, giving them access to what they’re needing until it becomes dysregulating and then trying to…
Yeah, come in with something that’s a little bit more appropriate and then letting them have that. I find that our kids who are seekers and cravers, those are the ones that are harder to bring to that normal, whatever normal is, yeah, versus our kiddos who are defensive.
Franchesca Cox (52:15)
homeostasis sort of, yeah.
Megan Williams (52:20)
That’s just creating opportunities for them to feel safe with exposure, feel like, versus when a body is needing so much.
Franchesca Cox (52:26)
I see.
Because their homeostasis tends to be higher, right? It’s different. so I feel like with the hyper sensitive kiddos, I keep getting those mixed up in my brain, but there’s a lot of caregiver education that’s needed because, right, there’s just some more hands-on with the family approach, maybe. I mean, they’re not all is, right? We teach all of the people that we, they’re families anyway, but I like there’s a lot that has to happen at home with our seekers. Yeah.
Megan Williams (52:33)
Yeah.
Yes.
Yeah,
and a lot of understanding why they’re doing what they’re doing, that it’s not just a behavior, why they prefer what they prefer, and then how the parent can come alongside the child and help them get what they need. As you are also decreasing that need for it, it’s not just stepping in and a lot of times
Franchesca Cox (53:00)
Mm-hmm.
Right.
Right.
Megan Williams (53:17)
That’s my thing about a sensory diet, like coming in and satisfying what the body needs is great, but at the same time, can we also regulate why the body needs that so much?
Franchesca Cox (53:29)
Right.
of these sensory diets are not reasonable whenever a child goes to school. You know, if they go to traditional school, even if they have an IEP, I don’t see most of the sensory diets being handed out a practical solution long term.
Megan Williams (53:35)
Yeah.
Franchesca Cox (53:45)
It’s practical when they’re three and they’re at home, or maybe they’re at daycare a few days a week, but it becomes more of a problem when they’re with teacher or the school for seven, eight hours a day. And now we have limited resources to help them function.
Megan Williams (53:54)
Mm-hmm.
Yeah.
Yeah. A lot of times I find the key to decreasing the amount and the intensity of input that they need is as a reflex starts to integrate and they understand inhibition and excitation at not not their conscious brain, but their their body understands that that’s an indication of
Franchesca Cox (54:17)
Bye.
Megan Williams (54:19)
that a reflex is working towards integration and that their body is getting closer to understanding homeostasis.
Franchesca Cox (54:27)
That’s interesting.
This has been such a fun episode. I’ve learned some things.
Megan Williams (54:30)
I’m telling you, I love me the tactile system, even though mine is kind of jacked up and I
understand what those tactile kiddos, I’m like, yep, I’m one of them. Hi, I’m there with you buddy. So yeah, some of our final thoughts and takeaways.
Franchesca Cox (54:45)
Yeah, for sure. For sure.
Megan Williams (54:50)
⁓ a child’s, struggle with certain textures, clothing, or messy play may be due to tactile processing differences. It might not just be a preference or a behavior issue. That’s, if that’s like the one thing I wanna engrave on a monument, put on a t-shirt,
and broider on a pillow for families to understand.
Franchesca Cox (55:13)
Yeah, it’s true though. And also the tactile system is foundational in how children interact with their environment, learn and regulate their emotions.
Megan Williams (55:21)
Speech and feeding are highly dependent on tactile input inside the mouth, so a child’s struggle with textures may also affect their ability to articulate words clearly or eat a variety of textures of food.
Franchesca Cox (55:36)
and small and consistent exposure to different tactile experiences can help them build tolerance and support sensory regulation. ⁓
Megan Williams (55:45)
Yes,
and I think the key there is supportive exploration. We don’t want to ever force. If it feels like you’re forcing, then it might not be.
Franchesca Cox (55:51)
Yes.
Megan Williams (55:56)
it could be pushing on that nociceptor pathway ⁓ and we don’t want we don’t ever you know we don’t ever want to be the cause of pain so
Franchesca Cox (56:00)
Right.
Megan Williams (56:05)
definitely keep that in mind when working with anyone with tactile issues. we have definitely enjoyed this episode. Thank you. We want to thank our listeners for tuning in to this episode. If you found this episode very interesting and maybe you haven’t listened to any of our other episodes in our sensory system series, go back and give them a listen. We have so far covered
Franchesca Cox (56:06)
down.
Yeah.
Megan Williams (56:32)
Third, proprioception, the vestibular system, vision, and auditory. So those were some really good episodes. If you want to go back and check them out.
Franchesca Cox (56:39)
Yeah, and
Megan Williams (56:42)
again, we thank you for joining us and until next time, take care and keep making those big steps forward.
Franchesca Cox (56:48)
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 (57:30)
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.