Category Archives: Self-Regulation

Safe & Sound Protocol

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:

  • auditory hypersensitivity
  • difficulties with auditory processing
  • behavioural outbursts
  • 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.

SSP Summary from Dr. Stephen Porges

Dr. Stephen Porges: What is the Polyvagal Theory

SSP Parent Testimonial

Therapeutic Listening

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:

  • poor attention
  • 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)
  • challenges with transitions or changes in routine

Here is a short video explaining more about Therapeutic Listening – Therapeutic Listening

Here are a few testimonials from parents that have used Therapeutic Listening – Therapeutic Listening for Parents

Here is some more information on the science behind Therapeutic Listening – Science Behind Therapeutic Listening

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

Visual Schedules

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

Here is an example of a visual schedule:

Morning Routine

Eat breakfast

Get dressed

Brush teeth

Brush hair

Put on coat

Put on shoes

Put on backpack

Heavy Work Activities

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
  • Pushing the cart while grocery shopping
  • Doing animal walks (crab, bear, bunny, kangaroo, elephant, etc.)
  • 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!

What do OTs do?

What do OTs (Occupational Therapists) do? Many people have no idea what an OT is when I tell them what I do! Many people think that we help people get jobs, but that is not the case (mostly anyways!). OTs focus on the areas of self-care, productivity and leisure. So depending where an OT is working they are helping people with very different things. OTs are trained in the areas of anatomy & physiology, neurology, child development, mental health, counselling, older adult disabilities, among other areas.

In acute care (hospitals) we focus a lot on self-care, helping people to be independent in their basic daily activities such as getting themselves dressed, having a bath, preparing a meal or moving around their homes/community. We prescribe equipment and provide education about how they can become more successful completing their activities of daily living in a safe manner. An independent study by health policy researchers published in Medical Care Research and Review (Rogers, Bai, Lavin, & Anderson, 2016) found that “occupational therapy is the only spending category where additional spending has a statistically significant association with lower readmission rates” for the three health conditions studied: heart failure, pneumonia, and acute myocardial infarction. Yay OT!

When working with children as we do at Bright Horizons OT, the focus looks very different. We use play as a means to achieving the child’s/family’s goals. In order to achieve the goals, we either use remediation (treating the underlying deficit) or compensation (adapting activities or environment) to make the child more successful in their everyday activities. The goals of OT can be many different things, here are some examples of general goals:


  • Increase ability to pick up small objects and release them
  • Increase ability to use both hands together (e.g. stabilizing the paper while writing with the other hand, holding a jar while using the other hand to twist the lid, etc.)
  • Increase handwriting legibility and/or speed
  • Increase accuracy while cutting with scissors


  • Increase core strength/postural stability in order to increase gross and fine motor skills
  • Increase the child’s support while sitting in a chair at school (proper seating in order to maximize their ability to complete school activities)
  • Making adaptations in gym class/sports/leisure activities to increase participation


  • Increase self-care abilities such as getting themselves dressed, doing up buttons, zippers, tying their shoes, etc.
  • Provide adaptive equipment/education to help make bathing independently or with assistance easier


  • Increase self-feeding abilities (using a spoon, fork, knife, open cup, straw cup, etc.)
  • Expand the number of foods a picky eater/problem feeder will eat


  • Decrease sensitivities to sensory input (lights, sound, touch, etc.) and/or make environmental adaptations to help them cope with these sensitivities
  • Increase the child’s ability to engage in hair brushing, hair washing, hair cutting, etc. for those that are sensitive to these activities
  • Make adaptations/find clothing that the child will wear without being bothered by tags, seams, fabrics, etc.


  • Increase on task behaviour in children who have attention difficulties (teaching self-regulation skills)

These are just some examples of the things that are addressed when you see an OT. One of the greatest parts of our job is we get to look at such a wide variety of areas!

Practical Sense in Sensory Integration Course

Over the past couple of months I have been focusing a lot on continuing education related to sensory processing. I came across Julia Harper’s online courses on sensory processing and was hooked immediately! Julia is a knowledgeable and dynamic speaker. She provides so much physiology to back her treatment, it makes me excited! I have completed part 1 (modulation) and part 2 (self-regulation) of her courses and I know I won’t stop there. Here are a few of the basics that I have learned:

  • There are four different types of sensory processing disorders:
    • Modulation – expressed behaviourally
    • Self-Regulation – expressed with inconsistent behaviour and skills
    • Postural & Discrimination – expressed with poor quality and/or quantity of skills
    • Integration & Praxis – expressed with skill refinement deficits
  • The type of sensory processing disorder is determined by where the breakdown occurs. That is, where the sensory information gets stuck and is not processed appropriately (lower brainstem, upper brainstem & cerebellum, midbrain & cortex).

I would highly recommend any Occupational Therapist working with children take Julia Harper’s courses. They are a good value for your money, especially since they are online and you don’t have to pay for flights and hotels!

The website is: Therapeeds