The Safe and Sound Protocol (SSP) was developed by Dr. Stephen Porges. It is an intervention designed to reduce stress and auditory sensitivity while enhancing social engagement and resilience. By calming the behavioural and physiological state, further therapy is enhanced or even accelerated. The SSP is based on the polyvagal theory which was developed by Dr. Stephen Porges (see video below for more information).
The intervention involves listening to music that has been specifically processed so that the middle ear muscles are trained and exercised to focus on the frequency range of the human voice. The individual listens to a total of 5 hours of music over a period of time determined appropriate for the individual client.
The SSP targets specific features such as:
difficulties with auditory processing
inability to focus or sit still
anxiety in social situations
Bright Horizons OT utilizes the Safe and Sound Protocol as one part of our treatment with children who have a variety of needs. Please contact us for more information or to book an appointment.
For more information see the iLs website. There is also a facebook group that has testimonials and more information on the Safe & Sound Protocol.
Therapeutic Listening is an evidence-based auditory intervention intended to support individuals who experience challenges with sensory processing dysfunction, listening, attention and communication. Therapeutic Listening activates listening which is the process of detecting sound, organizing it and integrating it for use with information from other senses.
Therapeutic Listening involves listening to modulated music through specialized headphones twice a day for 30 minutes. The headphones are open air meaning the child can also hear others around them and can talk to others while listening to the music. The child can go about their daily activities while listening to the music (except for watching TV, playing video games and other similar activities). The time period between listening sessions must be at least 3 hours apart.
Therapeutic Listening is not a specific protocol but rather a dynamic process in which a trained therapist chooses modulated music specific to the child’s needs. The child will listen to each music album for a period of two weeks. After two weeks is up the child will be reassessed by a therapist and a new album will be recommended. There is no specific time frame for Therapeutic Listening, some children will benefit from listening to the music for twelve weeks and others will listen for 6 months plus.
Therapeutic Listening has been used to address:
difficulties with social interaction and play skills
abnormal responses to various sensory stimuli (e.g. sounds, touch, taste, pain)
poor timing and sequencing of motor skills
challenges perceiving and navigating space
struggles with sleep, bowel and bladder control, and eating
difficulty communicating (both verbal and non-verbal)
Therapeutic Listening is used along with many different OT activities to help children in these areas. Please contact me if you have any questions or would like to start exploring Therapeutic Listening for your child!
References: Therapeutic Listening – Listening with the Whole Body
Tactile defensiveness is the hypersensitivity to touch. Children with tactile defensiveness notice touch more than others. They react negatively to unexpected, light touch and even to the anticipation of light touch. The child may react with a fight or flight response by being hostile to those around them or by fleeing from contact with people, finger paints, playdough, etc. Some children will withdraw passively by avoiding the object and people that cause distress. The receptors of the tactile system are in our skin so therefore it is not just our hands that can be hypersensitive to touch but our whole body.
When our tactile system is functioning well we are able to filter out which tactile information is important and which is not. Those with tactile defensiveness have difficulty ignoring input that is not important (e.g. the way their shirt feels, the light breeze on their face, etc.) and may appear distracted. Many children who do not enjoy light touch may actually enjoy deep pressure touch, like bear hugs or heavy blankets.
Signs of tactile defensiveness:
Dislike brushing teeth or going to the dentist
Dislike getting hair washed or cut
Dislike wearing clothing or certain types of clothing, may prefer really tight clothing or baggier clothing
Withdraw from being kissed or from a light touch
Avoid playing with playdough, finger paints, etc.
Immediately want to wipe hands when they get dirty
Avoid playing in the dirt, mud, sand, grass, etc.
Suggestions when working with children who have tactile defensiveness:
Don’t approach or touch the child from behind
Avoid light touch
Use firm pressure when touching the child
Allow the child to have their own space during circle time (sit on their own piece of carpet or on a bean bag chair, rocking chair, etc.)
Have the child stand at the front or back of the line to minimize unexpected touch
Create a “quiet corner” (bean bag chair, tent, teepee or blanket draped over table) in the classroom or in another supervised room where the child can go if they are starting to feel upset or over-stimulated
Provide the child with deep pressure activities/movement breaks throughout the day (easiest to incorporate into daily class schedule as it is valuable for the whole class)
Weighted items such as a weighted lap pad or a weighted snake around the shoulders can be used to provide that calming deep pressure touch
Encourage the child to participate in sensory play activities
It is important to encourage the child to participate but do not force them into doing anything they don’t want to do, we want to gradually incorporate some challenging textures/touch while keeping it fun and enjoyable
The child may need to begin by just watching others take part in the activity, then move onto using a utensil (knife, paintbrush, rolling pin, cookie cutters) to play with the substance (fingerpaint, playdough, shaving cream, flubber etc.) and then finally to using their hands to play in it
Subtle, gradual exposure is the key to successful sensory play
Here are some suggestions for activities that will engage a child’s core muscles (back and front). Make sure the child is breathing and not holding their breath during these activities. Focus on good quality exercises rather than quantity. Be silly and make sure it is fun for the child! If the activity is too hard for the child think of a way to adapt it or find another activity that is the “just right challenge” for them.
Laying on stomach, lift legs and arms off the ground and hold that position
Laying on back, bring knees up to 90 degrees and lift upper body off the ground with arms across chest and hold that position until someone says “pop” and the egg breaks open
Laying on stomach, push up onto forearms or hands while keeping the body straight and hold
To make it easier go on knees, to make it harder go on toes
Keeping their shoulders and head on the ground, knees bent and feet on the ground the child will bring their bottom up and hold that position
Snake Curl Ups
Have the child lie on their back with knees bent
Pretend to play a magic flute or play some snake charmer music on YouTube and have them sit up until their hands are on top of their knees
Stop the music and start over
Hold their feet down if they are having difficulty
Crawling Through a Tunnel
Any crawling activity is great for engaging the core
Start with hands and feet touching the ground with bottom up (legs and arms straight)
Walk hands forward until the body is in a plank position
Then walk feet up to hands and start over
On hands and feet with bottom lifted off the ground walk around sideways
Most yoga poses are great for engaging the core, some ideas include boat pose, happy baby pose, downward dog, 3 legged dog, dolphin pose
Cosmic Kids Yoga on YouTube is great for kids
Child lays on their stomach and adult lifts up their feet
Child pushes up onto straight arms and walks around on hands
Make sure the child keeps their body as straight as possible
To make it easier, the adult can hold onto the child’s legs closer to their hips
Many children benefit from routine in their daily lives. A visual schedule is an easy way to provide a child with a visual reminder of what they can expect for their day. Many children experience less anxiety when they know what to expect before something happens. It is easy to find pictures to make your own visual schedule by searching Google. You can make very specific visual schedules (for example: getting dressed – put on underwear, put on pants, put on socks, put on shirt, put on sweater) or a more general schedule (for example a daily routine – get out of bed, eat breakfast, go to school, eat lunch, TV time, homework, supper, play time, bed time). Print the visual schedule you make and hang it close to where they will use it.
Some ideas to try:
Give the child a new paper with their visual schedule on it every time so they can check off the steps as they complete them
Laminate pictures of each of the steps and create a schedule with two columns (one column is ‘to do’ and the other is ‘done’), attach velcro to both sides and have child move the picture from the ‘to do’ column to the ‘done’ column when they have completed it
A pincer grasp is when you use your thumb and the tip of your index finger to pick up an object. As children develop they move from a gross raking grasp involving their whole hand to a more refined pincer grasp as seen in the picture below.
A pincer grasp is important for many functional activities such as zipping a zipper, picking up small objects, using a key, etc. Here are some activity ideas to help develop a pincer grasp:
Use tongs to pick up items
Set out a muffin pan and give the child small items to sort and place into the cups
Stickers – any activity that involves stickers helps practice the pincer grasp
Bigger stickers will be easier and small stickers will be more challenging
Hide small coins, beads, etc. in playdough and have the child get them out
Heavy work activities are activities that involve the big muscles and joints of the body (pushing, pulling, carrying, etc.). Heavy work activities help release a neurotransmitter called serotonin that helps calm and organize our brain and bodies. Below are some examples of heavy work activities:
Carrying heavy books from one room to another at school
Playing tug of war with a rope
Crawling through a tunnel
Pushing themselves around on a scooter board
Pulling another student that is holding a hula hoop and sitting on a scooter board
Pulling another child around on a sheet or blanket
Wall push ups – stand up with hands against the wall and do a push up
Popcorn – sitting in a chair push up on hands so bottom is off the seat, keep popping up and down like popcorn
There are so many activities that would be considered heavy work activities. Any activity that involves the large muscles of the body are great for organizing the brain to help the child be ready to learn. Use these activities throughout the day to help children stay on task and provide them with the movement their bodies crave!
The human body has 8 sensory systems which give us information about the environment and our place within the environment.
The 5 most commonly known sensory systems include:
Tactile – the sense of touch
Visual – the sense of sight
Auditory – the sense of hearing
Gustatory – the sense of taste
Olfactory – the sense of smell
The 3 less commonly known sensory systems include:
Vestibular – the sense of our head position in space
Proprioception – the sense of knowing where our body is in space, this information comes from our muscles, joints, tendons and ligaments
Interoception – the sense of the physiological condition of the body (hunger, thirst, pain, temperature, the need to go to the bathroom, etc.)
Today we are going to talk more about the vestibular system. The vestibular receptors are located in our inner ear. The receptors include the 3 semicircular canals (anterior, lateral and posterior) and the otoliths (utricle and saccule). The semicircular canals pick up rotary movement and the otoliths pick up linear movement.
The vestibular system answers 2 basic life questions:
Which way is up?
Where am I going?
Any movement of the head in any direction (up and down, forward and back, side to side, diagonal and rotary) activates the vestibular system. 25% of the vestibular information received goes directly to the cerebellum which is responsible for balance and posture. The other 75% of vestibular information goes to the brainstem via the vestibular nuclei which then connects to many other parts of the brain including:
Oculomotor nuclei – head orientation & stability for oculomotor (eye) control
Autonomic centers – gravitational impact on cardiovascular, visceral & respiratory control
Cerebral cortex – spatial orientation & body movement
Since the vestibular system has so many connections in the brain it is very important that the vestibular system is functioning well. In many of the children that we see in Occupational Therapy their vestibular systems are not functioning optimally. Many children have an under-responsive system or an over-responsive system. A child with an under-responsive system may be able to spin for hours without getting dizzy or sick. A child with an over-responsive system may get dizzy or sick with even the slightest movement.
In Occupational Therapy one of the goals is to help the vestibular system work optimally so that sensory information is processed correctly in the brain to allow the eyes to work well, the ears to work well as well as the many other areas that have been discussed above.
References: From Eyesight to Insight: Visual & Vestibular Assessment & Treatment
I have to admit that my daughter who recently turned 6 has not learned to tie her shoes. My mom tells me that when I was in preschool I was the kid tying other kids shoes under the table (not sure why we were under the table but thats besides the point!). I would have been four years old in preschool. It seems that kids these days are learning some of these skills later in life. Is it because of the invention of velcro shoes or are we just not teaching them these skills when we used to? Since my daughter is starting grade 1 really soon I thought now is the time to focus on teaching her to tie her shoelaces. Today I used the video below for the around the tree method and a lacing card I made (picture below) and she picked it up very quickly!
Here are some general tips and tricks I have compiled for children learning to tie their shoes or those that are needing some extra help learning:
Replace thin, round shoelaces with soft, wide (but not too wide) shoelaces that are easier to grip (also they stay tighter when tied)
Cotton or other natural fibres will be easier then slippery synthetic shoelaces
Use shoelaces that are designed for learning – half one colour and half another colour (can make them by cutting two different coloured laces and sewing or tying them together)
Try using a double starting knot to keep the shoelaces tight
Knot the end of each shoelace to prevent them from slipping through the loops
Have the child start practicing with the shoe on a table or on their lap so they are in a good, comfortable position
Help your child to make their own shoelace tying practice board out of cardboard
There are commercially available products to help with practicing (e.g. Melissa & Doug lacing sneaker)
Try out different methods to see which works best for your child: