Summary
Occupational therapist Franchesca Cox and speech-language pathologist Megan Williams, both based in Houston, Texas, discuss pediatric therapy on their podcast Little Brain’s Big Steps. They explore topics like the vestibular system, its role in balance, spatial awareness, and movement coordination, and its connection to other sensory systems. They highlight research showing vestibular dysfunction is common in children with conditions like cerebral palsy, autism, and traumatic brain injuries. They emphasize the importance of early intervention, therapy techniques, and educating families on how sensory processing affects daily life.
Resources
Wiggle Seat by A Busy Child
Use of Vestibular Rehabilitation in the Pediatric Population
Prevalence of Vestibular Dysfunction in Children With Neurological Disabilities: A Systematic Review
Episode Transcript
Hi there, I’m Franchesca 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.
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.
Together, Megan and I 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 meaning.
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.
So whether you’re looking for therapy techniques, expert advice, or just a sense of community, you’re in the right place.
Let’s explore this journey together, filled with hope, growth, and endless possibilities.
Welcome back, listeners.
This is another episode of Little Brains Big Steps podcast.
And today, we are talking about the vestibular system.
Last episode, we talked about the proprioceptive system.
And today, we’re talking about another big sensory system that interacts with our body to help us be able to have balance, good spatial awareness, and movement coordination.
And this is important for every area of development.
We know a lot about the vestibular system from adults.
A lot of adults have experienced vertigo.
And so there’s a lot of research out there and treatment protocols for that.
But today, we’re going to be focusing mainly on pediatrics, the components of the vestibular system, and how we see it working, and then sometimes how we see it not quite working efficiently.
So we’ll start off talking a little bit about what the vestibular system is.
So it is a system that works with our visual and proprioceptive systems.
None of our systems kind of work in isolation.
They all have to work together.
Yeah, that is so worth noting.
Yes.
No.
And I think in school, or when I’ve learned all of this stuff, I think about it in pieces and then it’s like, well, no, it all works together.
It has to.
That’s how our body works.
Yes.
So as far as the vestibular system, Franchesca, when did you start kind of learning about it, I guess, and kind of realizing how to look at it or see that as a part of a child’s development?
I think it became really clear when I was doing a lot of home visits at the time, and I would try to be working on fine motor or visual.
But the child had trouble crossing the midline, they had trouble with balance, and they didn’t have really an underline issue, maybe autism.
But I started to do a little bit of research with, I don’t remember how Sally, Sally Godard does some work with vestibular and primitive reflexes.
And she talks a lot about what you said, that the sensory systems worked in unison.
And usually if there’s a disruption in one, there’s a disruption in others.
And I know you’re fixing to get into some of the anatomy in a bit.
But if we look at the brain, we’re going to notice that different parts of the brain affect more than one sensory system.
And so I started to realize if I work on the vestibular system, we’re going to have better visual attention on like maybe school task or homework or tying their shoes.
Or, you know, it’s interesting.
A lot of it was research on my own after grad school.
So actually all of it was introduced.
Yeah, they introduced the system in school because they don’t have time to go deep, dive deep into a lot of things.
But it was definitely interesting to learn about that on my own.
Yeah, it’s like in school, you probably learn about all the anatomy and the systems and how it works.
But then you get out in the real world and practice and practicum.
And it’s like, oh, this is what happens when it’s not quite working.
And that also comes into play when you know your final goal as an OT might be like tying shoes or buttoning, you know, or doing fasteners.
But parents are wondering, why are you working on swinging?
Or why are you working on deep pressure?
And our goal is this.
And so they usually want to see you doing the task that they came to you for.
But we know it’s so much deeper than just not being able to button your pants or zip up a zipper or whatnot.
Yeah.
Yeah.
All these sensory systems that we take for granted that have to work together in unison.
Yes, for sure.
So in regards to the anatomy, we know that the vestibular system is housed deep within the inner ear.
It is innervated by the eighth cranial nerve, which is an important nerve because our auditory system is also innervated by the cranial nerve.
So they work together closely, and that’ll be a really important factor when we talk about possible reasons to work on the vestibular system and ways to work on the vestibular system.
We have our semicircular canals and the otolith organs deep down in the ear.
Now, the semicircular canals are really interesting because they help inform the brain about our vestibular system, our position in space, and our balance.
So if you think about the superior canal, that canal is going to be activated when we nod our head.
Yes.
So if I’m nodding my head up and down right now as I speak, I’m activating that superior canal.
Now, if I were to shake my head no, I have to do it very slowly or I get dizzy.
I’m activating my lateral canal.
And then if I’m going to try to put my ear on my shoulder on one side and then to the other side, I’m activating my posterior canal.
And so those three canals deep down, they’re teeny tiny in your inner ear, are all sending information to your brain.
And it’s interesting because the XYZ axis of movement, planes of movement with our body can also do those things.
So we have flexion and extension, rotation, and then side bending.
So a lot of times looking at, okay, the head can do it, can the body do it?
Right, right.
And is there balance, equilibrium in the body while the head’s doing it or the body’s doing it?
And you can see some really interesting, interesting responses to that when you have little challenges where you’re kind of looking at that.
Yes.
And I also wanted to mention a lot of the kids that we see, at least that I’ve seen in the past few years, they have frequent ear infections.
And I almost always notice that they have vestibular or balance issues.
And so it’s worth noting that we have that connection.
It may be impacting, you know, that much going on in the ear, that many, those many infections, it could be impacting their balance.
Yes.
Yeah.
Those eustachian tubes that are really responsible for helping clean out deep within the inner ear.
Sometimes if they’re, if your anatomy, just your eustachian tube is too flat, sometimes you will just end up being an unlucky recipient of lots of ear infections and possibly even issues with your hearing development too.
The brain regions that are responsible for the vestibular system are what’s in the brain stem.
There’s the vestibular nuclei, which is basically a specialized cluster of cells that process the raw balance signals and then talks to other parts of the brain like the cerebellum, which we talked about in the last episode, helps with fine tuning your balance and coordination and posture.
Our thalamus acts as the relay center there in the midbrain, so it directs vestibular information up to our cortex.
Kind of like, I’ve heard somebody say it’s like the mail post office kind of place where they send the letters and the information to the right places in the brain.
And then the parietal lobe, we also talked about is important for proprioception.
It’s also as a part of the somatosensory cortex.
It’s going to be, I think, the way that your proprioception of vestibular kind of interact with each other.
For sure.
That’s super interesting.
What does the research kind of say, Franchesca, about the vestibular system?
Yeah, I found a few articles that touched on it regarding pediatrics.
And there was one study that said, from 2019, Jennifer Christie did a study and she was studying vestibular dysfunction.
I think she was comparing vestibular dysfunction and in children separately, what the trajectory was.
And she concluded that when children have vestibular dysfunction, it tends to get progressively worse with affecting their gross motor skills as they get older.
Whereas with adults, they may recover.
Like when the adults suffer from vertigo, a lot of times there’s very direct therapies that can improve it over time.
Not 100% of the time, but they don’t usually get progressively worse.
She concluded that they can.
And she identified that tailored vestibular rehab programs were highly effective, but it would also have to include gaze stabilization, so it couldn’t just be doing vestibular movement.
She also concluded that you have to include a visual system to help coordinate the vestibular system.
She also said that you would want to work on balance, gross motor, and all the other things that vestibular system usually affects.
In 2019, another study talked about the vestibular dysfunction and how it affects children with neurological disabilities.
And they said that almost 50%, 48.4% of children with spastic CP showed that there was saccular dysfunction, and that’s that up and down movement that you were talking about earlier.
And we see that a lot.
You know, we have children in the clinic often with CP or CP-like symptoms.
And one of the main things that they struggle with is that sagittal plane, that up and down.
And so, if we don’t establish that sagittal plane up and down, we’re not going to get that trunk rotation, because the very first plane that you were talking about to develop in a child is that sagittal up and down plane.
And so, it’s interesting, I thought that was really interesting, that almost 50% children with CP or spastic CP suffer from vestibular dysfunction in that range.
It also said that 14, this is kind of broad, so I don’t think this is the best research for TBI, but it was anywhere from 14 to 81% of TBI patients that suffered from vestibular dysfunction.
And I think that goes back to which part of the brain was affected in their traumatic event.
So, that’s probably why there’s such a range there.
We have a lot of children that come through the clinic with autism.
And so, I wanted to see what the research was saying about vestibular dysfunction and children on the spectrum.
And I love that this study was so recent.
It was done in 2022, and they said that vestibular dysfunction is so common in children, that they said, that they reported that it could potentially be considered a core feature of autism spectrum disorder because so many of our children on the spectrum suffer from this.
We see a lot of times they’re avoiding swinging, they’re afraid of it.
We call that an OT, gravitational insecurity, just meaning they do not like movement that they cannot control.
And so, they will be happy to swing themselves, they’ll be happy to roll themselves around the floor.
But if you’re the one pushing them, pulling them, they just don’t feel regulated because they’re not able to control how they feel during those movements.
It said, according to this review, this done in 2022, they had 36 children on the spectrum, and I’m not sure what the age range was, but it was in children.
80% of them had abnormal balanced test results.
And so, 66% had irregular eye movement patterns affecting coordination.
And we know, which we’ll get into in the next few episodes, that vision and vestibular, they go hand in hand.
You cannot separate them.
If you have issues in one, you will most likely have some severity of dysfunction in the other.
This research matter, it just validates that, first of all, that vestibular dysfunction is happening in children.
It’s more common than we think, even in typically developing children, and that it can affect their daily life.
And so it’s worth exploring for parents that have these concerns.
You might have a child that’s maybe struggling with, you know, navigating the playground, going up and down the stairs, riding a bike.
And it’s worth just seeing, just getting them evaluated by a therapist that is a little bit trained with the vestibular system, knowledgeable about it.
Like we mentioned earlier, there’s not a lot of training in our undergraduate programs even with the vestibular system.
So it’s worth asking, you know, when you’re trying to seek out a therapist in the clinic, what training they have, what programs they have.
We do know that there’s astronaut program, and that’s a specific therapy program that I think PTs and OTs can take, and maybe even speech therapists.
It’s self-taught, or you can take the online class, and it targets that vestibular and visual system, both of those systems.
Other than that, I haven’t found a whole lot of specific vestibular rehabilitation like we have for adults with vertigo.
And so it would be interesting to see what comes up in the next few years, especially since we know that there’s a lot of research coming out, or newer research coming out, that children with autism are highly affected by this.
So hopefully there’s more campaigning in the future.
Yeah.
In our kiddos with CP, in the MNRI world, we talk a lot about terrestrial attraction, the understanding of how gravity pushes you down, and you have to use your muscles to push up.
And if a child doesn’t even have a clear awareness or understanding of what up and down is, or that’s flipped, that is like trippy to me to imagine what you’re trying to figure out, how you even are on this planet.
Exactly.
Exactly.
It’s just, it’s wild when you dive deep and you start exploring just how impactful the vestibular system is on a day-to-day function.
And these children live with it, and a lot of them are nonverbal, either because they’re too young or they just have never acquired that speaking capacity.
And so, it might come off as behavior, it might come off as fear, but it’s really just not comfortable for them.
Yeah.
And I’ll talk sometimes with families whenever I’m observing a child on the autism spectrum, and I’ll say, I’ll mention balance, and they’ll say, oh, their balance is amazing.
They’ll walk across the back of a couch.
And I’m like, okay.
So how are they about like standing on, or put a little circle floor marker down or whatever, that’s like 12 inches in circumference or whatever, and we’ll play a game where we see if we can be a statue and stand on that.
And their static balance is just, it’s not there.
They have to be in constant movement in any direction.
And so then I’ll kind of say, you know, help families see that like there are two different types of balance.
And, you know, we can be really overcompensating with one, if the other one is not so great.
Or as we’re about to kind of discuss, there’s hypersensitivity, hypersensitivity, and hyposensitivity to the two different kinds of balance.
Yes, I thought that, I think that’s absolutely fascinating because I have the same thing.
Parents will say, oh, they can run, or they can skip, or they can, you know, tumble and climb.
But it’s like you said, that’s static balance.
And I tell parents, it is easier to create spontaneous movement that is usually very uncoordinated, but it’s functional, than to create, than to create this static position because it requires so much, so many postural muscles that are working together for that core stability.
And that’s a lot harder for our children.
Yeah.
And so you may be kind of asking as a listener, what are some of the signs of vestibular processing issues?
So we have kind of just like with per perception, we have two different camps.
We have our people who are over-responsive, and then people who are under-responsive.
And our goal is to always help them be just in that just right range.
So our kiddos who are over-responsive tend to avoid the swings or slides or any kind of movement activities.
They have a fear of heights or even a fear of head movement.
So just being, even if they’re pushed outside of their like, their balance, if their balance is kind of pushed off.
If they have frequent motion sickness or dizziness, that could be a sign that they’re over-responsive.
Low tone or a slumped body posture, when they are speaking, they kind of just are kind of a blob.
Kids who have delayed speech or a flat kind of affect, so they don’t really have, they’re more monotone, over-responsive processors may have difficulty even pronouncing words or sequencing sounds, and that can be often a side effect of just having challenges with the vestibular system that we may not even realize that speech and language piece is connected to that vestibular system.
Yes.
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Franchesca, how have you seen some kiddos in clinic?
How are the over responders?
What do you usually see?
So in the clinic, I tend to see the kids that are over responsive.
They have a low threshold for vestibular movement.
And so I’ve seen children that are real scared to even lie down flat on their back for diaper changes.
They’re almost fearful of that movement.
And the bigger they get, the worse it gets because it’s just more body mass, right?
Yeah.
They’re fearful of swings.
I had one child, that was our goal, to get them comfortable swinging because on certain swings, you can get all three of those movements that you talked about earlier.
And that’s a very gentle and safe way, depending on what kind of swing you’re working with, to help them desensitize against that gravitational insecurity.
And also participate in purposeful play that most children really enjoy.
And children seek out vestibular movement on a day-to-day basis because they need it.
They need it for things that they’re going to need to do later in life.
And so it’s like Einstein said, play is the work of children, right?
I’m paraphrasing, but it is the most important work that they’re going to do.
And so I’ve also seen them fearful of heights.
So I have an older child in the clinic that comes twice a week, and he does not like to be laying down on the therapy table.
And yeah, and he knows if he falls off that table, it’s going to hurt.
And he realizes how big he is.
He realizes how high it is.
I also think there’s a visual component to that as well, but a lot of it’s vestibular.
He can’t control that because he knows, you know, his body’s not working the way it used to.
And so it was actually for him, the swing, and he’s a bigger guy.
They never grow out of that, but those are some of the ways.
What about you?
Yeah, so one of the things that I’m a people watcher, and anytime I’m in like kids playground areas or like, you know, the little playground places at shopping centers, parents will really encourage their kiddos, you know, climb the slide, go up the slide, and then the child will sit there and they’re paranoid.
And one thing I see parents do a lot of times that just kind of breaks my heart.
They will take the child’s feet and kind of lift their heels up and then give them a really an encouraging kind of pull.
But then, of course, that is knocking them off their center.
And I understand feeling like, OK, I’m just going to give you a little gentle pull, a little nudge to get you going down the slide.
And then that poor baby just is so scared.
Yeah, it backfires every time.
I know what you’re talking about.
Yeah.
Yeah.
And I’m always like, oh, yeah, that baby may need to have some vestibular testing done.
But yeah, those kiddos, I feel like are a smaller percentage of my caseload most of the time.
But yeah, just like with what we talked about, our kiddos who avoid proprioception or these same kids that avoid kind of vestibular movement, I feel like they’re very timid and afraid to take chances.
Yes, for sure.
And so our kiddos who are under responsive, so those are the friends who need lots of vestibular input.
Those are what I see maybe more commonly in clinic.
So they are the kiddos who are trying to find any way to spin, swing or jump on the surface, off a surface, into a surface.
They are constantly moving, sitting still and maintaining that static balance is really hard to do.
They have poor awareness of their body positions, so while they are seeking out all of this rotational movement or back and forth movement, they are clumsy.
Sometimes they will seemingly injure themselves, but they may not even realize it or, you know, it seems like their their falls should be pretty significant.
Then, of course, as they’re in constant movement, we assume that there’s poor attention or poor listening and then delays and following instructions because their body is in constant movement.
Right.
Right.
It’s hard to pay attention when you’re always moving.
It is.
It is.
That constantly needing that dynamic balance, so just constantly moving, which that wears me out.
I can’t imagine that being someone’s equilibrium.
Yeah, for sure.
For sure.
And it’s worth explaining that to parents, you know, if you work with children, that it’s not usually behavior.
It’s usually them regulating themselves.
And so let’s talk a little bit about how the vestibular system affects learning and development.
So we’ve touched on it quite a bit.
But when we narrow down to the cognitive and motor learning piece, we know that vestibular, the vestibular system, it supports postural control, especially when we’re doing static positions like standing in line, like sitting in your chair without moving.
And of course, in order to learn, you need to be in a still position, especially if it’s schoolwork or even trying to sing a song with a class.
You have to be still.
And that requires a regulated vestibular system.
If that child is constantly turning and hitting a friend, and they’re not even trying to misbehave or anything, they’re just trying to regulate their own bodies, but they’re going to have a difficult time paying attention.
Engaging is the last thing on their list because they feel so dysregulated.
And it really is a craving.
It’s something they cannot control.
They need that input, and we have to teach them ways that they can safely and socially acceptable way to put that in their bodies and give themselves that input.
I do recommend to families sometimes to, if they know that this is something that their children need, they can do like a swinging activity before school, even riding a bike, getting pulled on a wagon.
It’s something like we can pull you to school, you know, pull you in the wagon before school or get on the swing before school.
And they’re going to probably have a better day, especially if even like the trampoline can give that input as well.
But I’ve also seen that it does affect fine motor, not just the gross motor skills like running and walking with coordination, but they’re going to have difficulty with fine motor because fine motor is more of a precise skill.
So when you hold a pencil to write your name or sit down to play the piano, if you don’t have postural control, you’re going to have a more difficult time with the smaller muscles in your body doing the things that it needs to do in a coordinated way.
So a lot of times our children with vestibular dysfunction, they’re going to avoid fine motor activities.
They’re not going to want to tie their shoes.
They’re not going to want to button their own clothes.
They’re not going to want to even maybe use utensils.
They might avoid fine motor games like Legos and Puzzles because that requires so much control in their big muscles in their body, like their core, their back, their legs.
And it’s just they can’t move enough to do it well.
And so they’re going to avoid those fine motor activities.
And also, I mean, you touched on it a little bit with emotional regulation, but they are using it to regulate themselves.
And so we’re going to see more behavior when they’re not able to get that input.
And so it’s nice that some of some of the schools are starting to do adaptive seating and things like that, but sometimes it’s just not enough, you know, and sometimes it can be too distracting to have someone bouncing on a ball all day.
So there has to be a better solution.
I’m not sure what that is.
I did see a family about a year ago and I’ll put it in the show notes, but I think it’s called the wiggle seat.
And I think I told you about this before.
I don’t remember, but it’s a family, it’s a mom and a dad, and they had two kiddos that were very, you know, dysregulated in different ways.
And they put their little noggins together, and they created this brilliant idea, which is, it’s called the wiggle seat.
And it doesn’t look like anything special.
It doesn’t look like an adaptive seating or anything.
It’s a chair, and it literally, they can gently push themselves and rock themselves forward and back.
So they can’t go side to side or rotate, but it at least gives them that input forward and back.
And it’s not disrupting the person next to them.
And so I would like to see more of those kinds of seats in more common situations, you know, like daycares or schools.
Yeah, yeah.
I just think about emotional regulation, and I can remember on the playgrounds at school whenever I was little, like, we could not wait till we got to the third grade playground because they had the biggest, best swing sets that were massive.
And now you couldn’t pay me to get on one.
But they had the big chains and like the little sad wimpy plastic thing that you would sit in.
But you could go so high and be pumping your legs and just, oh man, and I was never mad or unhappy when swinging.
I feel like that was just such an emotional regulation, an upswing for me of like just being so happy.
And then, of course, trying to dismount from the swing at a very high, high, high altitude.
That was a terrible plan.
But that was what we did.
That was the ultimate, though, if you could land on your feet.
If you could do it, you could get a lot of praise and attention from that.
And the merry-go-round, I think the merry-go-rounds are just about extinct, but that was another wonderful, wonderful place to put them.
Sit to my stomach just thinking about those.
But yeah, that was fun.
See if you could hold on, pulling a couple Gs, not fall off.
Right, right.
So, tell me a little bit about how the vestibular system affects language.
I know you kind of hinted at it earlier, but can you give us a broader understanding about how the vestibular system affects language in children?
Sure.
So, when we talk about language, we have receptive language, so how that’s my understanding.
How do I understand a language?
And then I have expressive language.
How do I use my language?
And when you divide it into two different categories, you can, of course, have higher or better receptive language skills.
They can be better than your expressive.
So, I am a non-native learner of Spanish, and my receptive language or understanding of Spanish is usually a lot better than my expressive.
In the same way, our vestibular system impacts both systems a little differently.
So, with our receptive language, our vestibular system needs to be really well regulated so that we can have the optimal arousal level, so I can stay focused and alert and taking in all the information from my teacher or whoever is in charge so that I can learn.
Children also need to be alert and still.
So, being…
that’s the big piece.
Can I be still, in a static position, not feeling overwhelmed or in need to shut down so that I can pay attention to the speech sounds, the tones that somebody is using, the words.
Those are all pieces that our kids are…
they need to have that regulation piece so that they can pick up on all these nuances and learn new vocabulary words and how to use them appropriately.
Then auditory processing is another piece of receptive language.
So, I mentioned earlier that the vestibular and auditory systems are closely connected because they share using the 8th cranial nerve.
So, if our vestibular system is not activating properly, sometimes our auditory system might also be impacted.
When our auditory system, those frequent ear infections or any issues that’s making it hard for us to hear, then learning is going to be really hard.
Any vestibular dysfunction can really interfere with sound processing.
When that happens, it’s harder for children to differentiate and comprehend spoken language.
So it goes back to, I have to be able to hear and learn how to say a new word or when to use that word properly.
And then for our head positioning, for listening.
So our vestibular system really teaches our head and neck muscles how to hold our head upright and to be able to turn our head in the direction of auditory information.
So that we can maintain our focus on a teacher who’s maybe walking towards the back of the classroom.
We have to have that vestibular functioning to follow them so that we don’t lose them, so to speak.
Right.
Difficulty with our vestibular system and our head positioning can reduce exposure to verbal cues and cause our receptive language skills to kind of be lower than our expressive language skills.
If we’re talking about expressive language, so how do I use my words and my knowledge of language?
And this is where we’re talking about requesting things, telling people yes and no, telling people what I like, what I don’t like, things like that.
We need to have, our vestibular system needs to be working so that our postural control can let us use good breath control, so I can get a big deep breath and say no or yes.
I have to have a stable core to activate off of, and this core is regulated by our vestibular system, and so if that’s not happening, I might not be able to fully use my words or poorly functioning vestibular system can lead to low tone or instability, which can impact our voice volume or pacing, even our articulation.
So sometimes if a speech therapist is working with a child for a while on articulation, and if they’re having issues with sounds that are voiced versus voiceless, and all of their sounds that are supposed to have a voice component are coming out with no voice, then it’s probably some kind of, I think it’s worth looking at that vestibular system and figuring out like, okay, what’s going on here?
Like what’s not working?
Why are they not understanding the volume control piece to it?
Right.
Motor planning for speech.
So that’s a big one we talked about with proper reception.
But whenever we are trying to motor plan words that come out of our mouth, we need to have good vestibular system functioning because if we are having trouble coordinating big movements with our body, then we are probably going to have trouble coordinating small movements with our mouth.
The vestibular system helps organize our sequential motor patterns.
And so a sequential motor pattern, if you are thinking about speech, one of the things we look at is, I don’t do it very often, but sometimes we will instruct kids to say three sounds.
We will say, puh, tuh, and cuh.
And then if they can do that, they will say it and they will say it.
Can you say it a little faster?
Can you say, puh to cuh?
And then you try to see if they can do it a little bit faster.
And I have not worked in a population where I have used that.
Gosh, in the past, I don’t know how many years, but that’s an example of a sequential motor pattern that’s what we’re doing with our mouth.
And so, I mean, the sheer number of kids that I’ve worked with, with vestibular issues, that is not going to be easy.
Thanks for the other time.
Yeah.
And then, of course, our confidence and willingness to speak.
Of course, all of our sensory systems play into our self-esteem and emotional identification of ourselves.
And so a disorganized vestibular system can create this internal chaos.
So your self-regulation, your emotional security, and social engagement feel like children’s who develop into preteens and teenagers who have an undiagnosed vestibular issue could probably be those kids who don’t want to participate in social activities.
And that’s got to be a challenge for them to want to interact, but just not have the skills.
So they may be withdrawn, less likely to initiate speech when their bodies don’t feel safe or grounded.
So yeah, so that’s something to really think about.
That’s crazy, that’s crazy, how the vestibular system affects speech so much.
I never really thought about it in depth because I’m not a speech therapist, but I can tell you in the DMI training, they tell us when you’re doing these movements, we are actively and purposefully activating that vestibular system.
And they didn’t go into detail why, but they said you might get untargeted results from these exercises, such as speech, as fine motor, such as vision.
And none of those are our target goals, but I have seen, even in the Universal Exercise Unit, the Spider Cage with DMI, I’ve seen when I’m doing the swinging motions, more when I’m doing the swinging, like I’m rotating the child in the air, I am putting them in that swinging, I think you’ve seen it, that they kind of just lay prone on their bed.
And I’ve heard new verbalizations, and mom or dad has confirmed, I’ve never heard that sound before.
And they may not even repeat it, but when you were talking about how postural control is affected by that vestibular system, that’s what made it click.
And it’s just so neat, they all work together.
And so, do you know if, as a whole, speech therapists are aware how important that vestibular system is for speech production?
I think it’s a growing, I think it’s starting to take hold in the speech world back in, gosh, 2011, maybe, I think, when we were living in Arkansas, I had a student who was working in our clinic to get her graduate hours or whatever, communication disorders.
And she had this idea just from shadowing me and helping me out.
She’s like, what if we put this specific kiddo in a swing for 15 minutes, and then go to your office and do some language activities, some games?
And I was like, well, they love the swing.
And I think that this could really be interesting.
Yeah.
And she had the idea of like, is there a link here with the Vestibular System?
Because we so often will go take a kiddo, if they want to go to the gym and swing, we’ll put them in the swing.
And we hear them just talk, talk, talk so much more than being seated in a chair trying to play games, you know?
And so that’s kind of what she had picked up on.
That’s very perceptive.
Yeah, she tracked this child’s behavior, like speech behavior before, and then there were some days that we wouldn’t go.
And of course, I’m sure there are a lot of faults in the research study, so to speak, but it was a very interesting, just early look at it.
And that was the first time I ever thought like, there really could be something here.
Yeah.
And then fast forward to now where I’m like, yeah, there’s absolutely something.
And I think more speech therapists are picking up on that.
That’s super exciting.
Yeah, there definitely needs to be like an overlap.
Vestibular can’t just be for OTs.
And I’ve been in a few, quite a few sessions where the parents super excited and I’m like, but I don’t know what to do next about speech.
So, you know, it’s just such a cool moment.
We weren’t really looking for that, but we got it.
And man, that’s when I really wish we had, you know, a little bit more therapists, or maybe you may not have been in the clinic.
And I just like, man, what do we do next?
How do we recreate this scenario, you know?
But it’s neat.
It’s neat.
I wanted to talk a little bit about how the vestibular system affects bilateral integration.
Because as I know, we’re usually looking at, that’s usually one of the big goals for occupational therapists.
We’re looking at being able to use two hands at the same time for one task.
And a lot of times that’s really difficult for children.
And we’re talking about maybe pushing a cart, pushing a laundry basket, carrying a laundry basket, carrying something with two hands, riding a bike.
And it takes, like you were saying, that postural control, that stability, that static posture to be able to complete a bilateral task.
And we know looking at an infant’s development, that they initially, probably for a good three to five months, they’re using their body unilaterally.
So they might grab a toy with whatever hands closer.
They’re not going to reach over and cross that midline until they’re closer to six to eight months, and they’re able to sit up closer to sitting independently.
Some children will do it at a different point, but that bilateral integration starts to come on as they start to pass that year mark.
But we know that it requires a regulated system to be able to use two hands for one task.
And so it definitely affects that bilateral integration.
And we know that bilateral integration requires that cross lateral communication in the brain.
So we’ve talked about a lot of the brain anatomy as far as the vestibular system is concerned, and it’s all over.
We know that bilateral integration requires cross lateral communication in the brain between both hemispheres for complex and simple tasks for children.
Absolutely.
So complex speech and language structures requires that cross hemisphere, cross lateral communication.
So yeah, it definitely adds up.
Yes.
Yes.
What are some ways that we can support the vestibular system as a speech therapist?
So for speech therapists who are in a setting where they have access to a therapy gym, I think knowing the child and knowing if they’re over or under responder, being able to identify those pieces and then know accordingly kind of what activities to engage them in to support that vestibular development.
So not pushing them past their threshold or vice versa.
You know, on the other side, we don’t want to dysregulate them because they love the swing so much.
So just knowing that how to encourage a child who is an over responder by challenging them in safe ways to take that small step to engage in vestibular activities, and then also knowing not to just let the under responder just go crazy in a swing because you don’t want to drive them to the point of dysregulation.
You’re not probably going to get as successful of a speech therapy session, but finding that just right balance there so that you’re making a positive impact on their vestibular system, and by default, their language.
Yes, yes, absolutely.
Some of the activities that I do as an OT in the clinic is a rock roll and swing.
If they’re small enough, like maybe under 40 pounds and way smaller, rocking side to side, rolling, like stimulating a rolling laterally.
And then also just swinging, so going more of a rotational move.
And that gives them that vestibular input automatically in your arms.
So that’s something simple.
So a lot of times when kids are just losing it, as soon as I start doing that rock roll or swing or all three, they just instantly calm down.
Yeah.
In the clinic, I will often give them just a minute or less of that vestibular input, and they automatically calm down.
In that regard, we automatically know that that vestibular system just needed a little bit of input.
If they’re a little bit bigger, you can do balance activities like standing on one foot, walking on a balance beam, or encouraging movement breaks.
So if they’re in the classroom or they’re in a setting where they need to be regulated and calm to learn, making space for those movement breaks will get you so much further in a learning environment.
There’s a lot of free stuff on YouTube.
There’s a yoga channel, I’ll find it, but they have really cool, fun yoga breaks for children, and that you can just pop on a screen and have them simulate.
Yeah, and being able to incorporate that into the educational system in places where you have that ability to take a pause and let everybody in the classroom benefit from maybe a mini yoga break or maybe helping more than just the child that you can identify with vestibular issues.
Right.
One of the techniques that I will use sometimes on myself, it’s not always the most functional with kiddos because kiddos can be very protective of their outer ear, so their ear canal.
So you can take your fingers and if you’re holding on to, if you want to just call them like your ear flaps, your ear canals, you’re going to take your thumb and your pointer finger and you’re going to hold and then you’re going to pull upward.
So you’re going to take your penna, your outer ear, and you’re going to pull upward to activate one of the semicircular canals.
You hold for about 7 seconds and then you pull downward.
So kind of like where ladies wear their earrings, you’re going to pull that area downward for about 7 seconds, and then you can activate the third semicircular canal by holding and pulling your outer ear kind of outwards towards the right and the left.
That’s wild.
About 7 seconds, if you ever are feeling dizzy or just like you’ve taken in too much vestibular information, maybe visually or through movement, that is one of my favorite ways, because like I said earlier, my vestibular system used to be so much better.
And these days I find that I need to sometimes help myself out.
So that’s a tip for parents, and you’re welcome to attempt to use it on your child, but like I said, sometimes kiddos are very overly protective of their ears, and that’s sometimes not fun for them.
I cannot wait to try that.
I cannot wait.
That’s awesome.
That’s so easy to apply to.
Yeah.
All right.
So let’s recap what we’ve discussed for today’s episode.
Yeah.
So we know the vestibular system is needed for good balance, body awareness, motor coordination, internal regulation, and the development of our fine and gross motor skills.
Yes.
And we know the vestibular system is…
And we know the vestibular system informs the overall muscle tone in our body since it switches on the muscles that will serve as flexors and extensors.
Vestibular processing is foundational for attention, learning, and communication.
And we know that recognizing the signs of vestibular dysfunction can help support a child’s development and learning.
We know that simple activities can be used to help regulate and strengthen the vestibular system.
And we’re excited to cover the visual system next week and tell you just exactly how the vestibular and the visual system work really well hand in hand together.
And what happens when they don’t work so well together.
Yep.
Yep.
And next time, and we will be talking so much about the visual sensory system.
Until next time, take care and keep making those big steps forward.
We’re so glad you joined us for Little Brains 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 Brains 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.
Thanks for joining us on the Little Brains Big Steps Podcast.
We hope this episode provided valuable insights and support for your journey.
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