Occupational therapy in paediatrics uses participation in purposeful, age-appropriate activities that enable children to develop their sensory, motor and perceptual abilities. We aim to facilitate improved participation in a child’s areas of occupation including their activities of daily living (sleep, dressing, feeding, eating, toileting and bathing), play participation and academic performance. OT uses a child and family-based approach and works alongside other therapists and parents to provide the child with the skills to function as optimally and independently as possible at home, school or other social settings.
The children we often treat include those with developmental delays, learning difficulties, autism spectrum disorder, cerebral palsy and other genetic conditions.
INTRODUCTORY TO THE SENSORY SYSTEMS
We all know our basic 5 senses: Touch, Taste, Smell, Sound and Sight however we have another 2 senses that are less commonly known. These are our Vestibular sense, which is the movement sense and the Proprioceptive sense, which is our body sense. These two senses have their receptors in the ear and in the muscles and joints of the body. They help us with balance and gravity, as well as being an internal GPS for our bodies. It is important to note that often all of our sensory systems work together and it’s never just one sense working at a time.
The registration and interpretation of our sensory systems are so important for optimal functioning. The pyramid of learning below shows the hierarchy of how we develop and if there is a challenge in one area, how it can have an impact on all the skills that follow. For example, if we have difficulties with our visual system, it can affect our eye-hand coordination or body awareness. This is where OT comes in!
DEVELOPMENT OF THE VESTIBULAR AND PROPRIOCEPTIVE SYSTEMS
Introducing the Vestibular System (Movement).
This system is responsible for maintaining balance, ensuring we can adapt, and change based on our different postures to accommodate the different environments we enter, as well as assisting with our processing of gravity.
This system develops as early as 4 weeks in the first trimester of pregnancy when receptors in our inner ear begin to develop. At 11 weeks, the semi-circular canals in our ears start to develop and these assist us with balance. By 22 weeks, our vestibular systems are fully functional. The last 8 weeks in utero are filled with vestibular movement. Baby receives input from mom’s movements which activate our vestibular receptors and gets us used to this sense. After birth, the vestibular system helps us sort and relay incoming sensory input from other sensory organs and passes it onto our brain. An optimal vestibular system enables a child to feel secure and confident in their body, so they can move, pay attention to learning, and rest
Introducing the PROPRIOCEPTIVE System (Body).
This system is internal and helps us understand our body map, i.e. where are our body parts are in relation to each other, what each part is doing as well as how much effort is required from these body parts to do something.
This system begins to develop in utero when the baby first becomes active in the womb. Often when moms can feel the baby kick or turning, this is them learning about their body and its movements. This usually starts at around 18-22 weeks. Once a baby is born, their movement and interaction with the environment help them to develop a mental map of their body. Frequent proprioceptive learning comes from things such as kicking feet against something, playing on their tummies, exploring their face and body and just general movements during everyday tasks.
DEVELOPMENT OF THE TACTILE SYSTEM
The tactile system is the system responsible for touch. It is one of our first senses to develop in utero already developing at 8 weeks. This is when our tactile receptors begin to emerge, with the face sensors, primarily around the nose and lips, being the first ones to develop. Over the next few months the receptors for the rest of the body develop. At 22 weeks, the connection between the tactile receptors and the somatosensory cortex of the brain form and this is when baby starts actively registering the sensation of touch. Around the 30 week marker, this is when baby can start feeling pain and by 36 weeks, they can tell the difference between normal touch and pain. Interesting fact! Baby experiences tactile sensations now all over the body except the top of the head, which remains insensitive to touch until birth. Our touch system continues to develop after birth and provides us with a direct access to the external environment.