It is going to be another great day in the office. On the schedule is a six year-old child with chronic ear infections coming to you as a new patient. Unbeknownst to you, this child also struggles with attention issues and frequent aggressive outbursts. In the last issue of Practice Insights, we brought a glimpse of what a neurodevelopment practice might look like. We also mentioned Sensory Processing Disorder (SPD) and promised to bring you more on this unique population group.
I would first like you to partake in an "out of body experience" with me. Try and forget who you are and that you have ever been inside your office before. You are now this six year-old child coming to your office for the first time. When you open the door to your office, what do your eyes tell your brain, is it too bright and distracting? Is there a lot of movement and chaos? What about your ears, is it noisy? What does your nose smell, chemicals or other toxic elements? Are there toys that you can touch that your brain may enjoy? Is there seating that is warm and inviting that may help keep you grounded while you anxiously wait for your appointment? Was all of the initial paperwork received ahead of time or do you have to try and sit still while your mother or father fills everything out?
With the numbers drastically on the rise, it is imperative that our profession better understand this population group in order to provide them with the most optimal care. In this article, we will discuss environmental strategies as well as chiropractic strategies to help individuals struggling with sensory processing issues.
What is Sensory Processing Disorder?
Sensory Processing Disorder is the inability to take in, organize, analyze and integrate information the brain receives from the senses and then respond in a meaningful and appropriate manner. In essence, sensory input does not lead to proper motor output. The neurological disorganization resulting in SPD occurs in three different ways: 1) the brain does not receive messages due to a disconnection in the nerve cells, 2) sensory messages are received inconsistently, or 3) sensory messages are received consistently, but do not connect properly with other sensory messages. When the brain processes sensory messages poorly, inefficient motor, academic or emotional output is the result. A 2009 study in the Journal of Abnormal Child Psychology suggests that one in every six children have sensory issues that impede their daily functioning, socialization and learning. It is important to know that SPD is not restricted to children only. Adults with Sensory Defensiveness are thought to have higher rates of anxiety and depression as a result of trying to apply coping mechanisms in order to handle the abnormal sensory input to their brain.
The Eight Senses
The sensory processing system is comprised of five far senses: auditory, visual, tactile, taste and olfactory. This is information we take in from the outside world. In addition, there are three near senses: vestibular, proprioceptive and interoceptive. This information is received from our internal self. The vestibular system is thought to be the "chief regulator" of sensory processing with the ability to "ramp up or tone down" information coming into the CNS from all other sensory systems. Interoceptive sensation is that received from our internal viscera and organs and is primarily regulated via the Vagus Nerve.
Autonomic Regulation
The neurological underpinning within this population group is that of autonomic dysregulation. A person struggling with sensory issues may be hypersensitive to stimuli and deemed "Sensory Defensive." They are often in "fight or flight" with the sympathetic nervous on full throttle most of the time. These individuals experience otherwise non-noxious sensation as being harmful, painful or distracting and may not habituate to or cannot function effectively in their presence. As chiropractors, we must be mindful of potential vertebral subluxations in the parasympathetic nervous system when it comes to the sensory defensive (also known as sensory over-responders) patient. The adrenal glands will most likely be taxed with these individuals; thus, we will also see signs of adrenal fatigue and immune compromise. In such cases, support with dietary counseling and proper supplementation is imperative in conjunction with the adjustment. It is thought that approximately 56% of those with Autism Spectrum Disorder (ASD) and approximately 69% with ADHD are said to be sensory over-responders.
Sensory under-responders are just the opposite of their hyper counter-parts. They require intense, prolonged and changing/novel sensory input in order to respond effectively. These individuals often appear as though "the elevator isn't going all the way to the top." With these particular individuals, we should be paying close attention to possible subluxations within the sympathetic nervous system so as to up-regulate input to the CNS.
As with any condition, it isn't all that cut and dry. Those with SPD can either by hyper-sensitive, hypo-sensitive or both. To make it even more complicated, they can change from situation to situation. Therefore, knowing some of the signs will help you better work with them in your offices.
Practice Pearls
Below are some tips to help identify if a patient may have sensory issues and some practice pearls to help facilitate achieving a better adjustment (these children may be difficult to adjust due to their hyper-sensitivities). Chiropractic care MUST be a cornerstone of treatment with these patients as it has the most profound influence on regulation of the autonomic nervous system!
Hyper-auditory patients may not like the sound of cavitation from an osseous adjustment or the "click" from an activator. The sound from drop tables may also be alarming. When trying to adjust them, they may tighten up in defense and anticipation; especially with cervical adjusting. These children often times have a history of chronic ear infections.
Pearl: Keep room noise to a minimum; avoid clocks, music, etc. Have only that patient in the adjusting room so as to minimize noise from others. If you practice open adjusting, have a separate quiet area to work with these individuals. Allowing them to wear ear buds with an iPod playing their favorite music may be helpful.
Hyper-visual patients may appear hyperactive and easily distracted; they may have difficulty relaxing when getting adjusted. These children are often misdiagnosed as having ADHD.
Pearl: Minimize visual chaos with dimming lights (avoid fluorescents if possible) and too much wall art. If you practice open adjusting, screen off one area to minimize movement from others about the area. Allow the use of sunglasses if necessary to relax.
Hyper-tactile patients will not like touch and may attempt to pull your hands off of them and/or tighten up in defense. Again, this is common when attempting to adjust the cervical spine. Often times, children will cry in anticipation of touch. These children often appear anxious and controlling. (Note: Hypo-tactile patients may appear to have a high pain tolerance and areas of concern may be overlooked as pain may not register with palpation or movement.)
Pearl: Deep pressure tends to me more soothing than light touch to these patients, perform some deep joint compression or massage prior to adjusting.
Hyper-vestibular patients may not like head movement; therefore, they do not like their cervical spine adjusted. These children often appear fearful of gravitational challenges and head movement. (Note: Hypo-vestibular children often need movement in order to pay attention; therefore, appear hyperactive.)
Pearl: Have the patient perform some self-regulated vestibular exercise prior to getting adjusted. Such as balancing on a wobble board or balance cushion and/or performing head flexion/extension and rotation maneuvers.
Hyper-proprioceptive patients often have poor posture as they fatigue easily. These children often have aggressive outbursts and are easily frustrated.
Pearl: In addition to adjusting, give exercises that require resistance against gravity; especially in a prone extension position.
Other office pearls:
- Have paperwork filled out in advance to avoid wait time.
- Have sensory inviting chairs such as bean bags and rocking chairs.
- Avoid using chemicals to clean in your office.
- Avoid scented perfumes, lotions and candles by you or your staff.
- Set-up a calming environment.
Dr. Monika Buerger, a 1991 graduate of Life Chiropractic College West, is the owner of Eagle Canyon Wellness & Sensory Development Center in Ammon, Idaho. She is a teacher, international lecturer, author, and the founder of Intersect4Life Educational Seminars and developingMINDS certification program in childhood and adolescent neurodevelopment. For more information, visit www.intersect4life.com and www.devmindsu.com.