Transcript The Somatosensory System/ Praxis

Touch – Deep Pressure System – Motor Planning
The Somatosensory
System/Praxis
The Somatosensory System
• The Somatosensory system is comprised of the touch or
tactile system as well as our deep pressure system, also called
proprioception.
• This system is a crucial foundational building block for motor
and emotional development.
• An under responsive system can be as equally devastating as a
hypersensitive system in regards to the building of essential
praxis skills which influence executive functions such as
multitasking, language formation, speech formation and much
more.
Importance of Tactile Input on
Emotional Development
In animals and
humans:
Contact comfort of
the infant is critical
in psychosocial and
emotional
development
Touch
•
•
•
•
Sensations from the skin
Influences Body scheme
Emotional development
Skills associated with:
– tactile perception
– motor planning
– sequencing
– organization
– visual perception
Proprioception
- ‘proprio’ is Latin for “one’s
own”
- one’s sense of body position
and movement
• of limbs and trunk
• of the relationship of
body parts to each
other
Problems with Proprioception
may result in:
• Lack of fluidity in movement
• Decreased muscle tone or stiffness
• Difficulty with co-activation around a joint
• Poor grading of muscle force
• Tendency to lean or look for support outside
oneself
• Craving activities that provide proprioceptive
input
Proprioception may also function
as
• An Arousal Modulator allowing the child to
experience the sensations of daily life while
maintaining adequate arousal level
• Organizer/regulator of sensation
• A component of motor control
Proprioceptive Seeking
• Crashing
• Banging
• Biting/chewing on
non-food or hard items
• Jumping
• Taking risks in play
• Hitting/punching
• Hanging
Deep Pressure Seeking
• Squishing self between
couch pillows or in
other small spaces;
• Squeezing others
• Needs heavy blanket to
sleep even in hot
weather;
• Smooshes body against
others or into small
spaces
Problems with Proprioception
may result in:
• Lack of fluidity in movement
• Decreased muscle tone or stiffness
• Difficulty with co-activation around a joint
• Poor grading of muscle force
• Tendency to lean or look for support outside oneself
• Craving activities that provide proprioceptive input
Assessment of Proprioceptive
Dysfunction
• What types of difficulties in the child
experiencing in daily occupations?
– Poor posture, body awareness, decreased tone, lax
joints, etc
• If seeking input, what type and why?
• Can proprio help child organize actions in
environment
• Is there evidence of a modulation or
discrimination problem?
Proprioceptive Activities
• Resistive
• Active
• Fun
Activities that Offer Therapeutic
Proprioceptive Input
• Any activities that
require weight bearing
or co-contraction
– wheel barrel walking
– Prone or quadruped
activities
– Tug of war or “push” of
war
Activities that Offer Therapeutic
Proprioceptive Input
• Use weights during activities to increase
resistance and thereby heavy work
– Weighted jacket or vest
– Backpack
– Weighted bean bags
• Encourage child to move, push, pull, lift
equipment
Activities that Offer Therapeutic
Proprioceptive Input
• Facilitate weight shifts during activities to
activate muscles
• Use trapeze
• Use hula hoop or trapeze to have child pull
another child on scooter
• Fine motor manipulatives that offer resistance
such as play dough, rice, therapeutic, popoids
Activities that Offer Therapeutic
Proprioceptive Input
• Use tire inner tubes as bumping cars.
• Create a pulley with weights in it.
• Climbing equipment such as ramps, ladders,
ropes to climb.
• When child is on moving equipment, provide
uneven movement stim (I.e. bumpy road) so
that the child needs to co-contract to
maintain balance.
Kinesthesia / Kinesthesis
- “Kines” means movement
- a special kind of
proprioception where you
can feel - and thus are
aware of -- how your body
parts are moving/ how your
position is changing
The Somatosensory System:
Clinical Observations
• Stereognosis: the ability to perceive the form of an object by
using the sense of touch with the vision occluded. It requires
a combination of tactile perception and visual imagery to
identify the object.
• Localization of touch: the ability to correctly identify the
placement of tactile stimuli to the dorsal and ventral surfaces
of the upper extremities while vision is occluded.
Observations of Tactile
Discrimination
Stereognosis
• Place a visual shield over
the client’s hand.
• Choose 5-6 small objects
to place in the client’s
hand.
• Have them manipulate
one object at a time to
determine what the
object is.
Localization of Touch
• With his/ her eyes closed,
touch points on the hands,
forearms, and upper arms
of the client in random
places.
• Request that the client
touch the spot that you
just touched.
• Observe the proximity of
the client’s touch to where
you touched.
Research
on Touch
Massage Therapy:
wt. gain in
preterm infants
2. reduces stress
hormones
3. Facilitates
homeostasis (VT)
4. reduces pain
5. improves immune function
6. alters EEG in the direction of
heightened awareness
Tiffany Field
The Touch Institute
1.facilitates
A hierarchy of movement skills
PRAXIS
Praxis
• Praxis: the ability to conceive of, organize (plan), and
carry out or execute an unfamiliar motor activity.
• Many individuals with dyspraxia display the following:
struggling to accept change, become comfortable with
strict routines, have difficulty with transitions, avoid
being challenged by new and novel experiences, all of
which, over time, restricts his/her activity preferences
to a greater and greater extent.
Praxis: Hierarchy of skills
• Ideation: the ability to conceive a motor plan relative
to the demands of the environment
• Motor planning/ sequencing: ability to determine
which action needs to be done in what order to achieve
the end result
• Motor execution is dependent upon adequate postural
control, balance, body awareness / scheme, visual
spatial skills, bilateral integration, and tactile
discrimination.
– It is the act of “doing” the motor movement.
Praxis: Hierarchy of Skills
Bilateral Integration
• Dependent upon the ability of the left and
right side of the body to work together as one
unit
• Begins with the skills of crossing midline as a
baby and trunk rotation for rolling over.
• Also pertains to the ability of our upper and
lower body to work together
Praxis: Clinical
Observations
Ways to assess an individual’s praxis ability:
• Ideation: Have the individual come up with as many ideas as
possible of what to do with a single piece of equipment (i.e.
barrel, bean bag, etc.).
– If the ideas start flowing readily, ideation is intact.
• Sequencing: Observe the client completing daily tasks such
as grooming routine; complete multi-step craft activity; have
a child complete a multi-step obstacle course at least 5 times.
• Execution: Observe skills such as jumping jacks, skipping,
hopping, and doing the “Itsy Bitsy Spider”.
Praxis: What to consider
• Is the individual able to generalize and adjust a motor plan
based on the changes that occur within the environment?
• Is the individual able to fluidity move through a motor
action?
• How is the timing of the individual’s movements?
• Is the individual able to use feedback from the environment to
adjust his/ her motion?
• Does the individual look clumsy or awkward?
• Could the individual maintain the action?
Rhythmicity and Timing
Development
 Message through temporal lobe
mostly auditory and related to
rhythmicity and timing.
 Rhythmicity and timing found to be crucial in the
development of language
 Also overlap between rhythmicity and timing into limbic
system as well as in active working memory