Thursday, November 12, 2009

Sensory Processing, Postural Sway, Anxiety - Better with Occupational Therapy

Interesting study that shows that the lines between sensory processing, emotional processing, and behavior are continuing to blur. As many parents of a child with significant sensory processing difficulties will tell you, anxiety and emotional dysregulation can be a huge part of what makes sensory processing disorders most difficult. A major reason for this, it is thought, is that sensory systems function to alert the body to danger, so that disordered sensory signals will trigger extreme danger reactions, like fear, anxiety, aggression, and escape.

But now more evidence from the psychological side point out the dangers of anxiety on sensory processing, spatial perception, and balance, informing us about the other side of the loop - sensory processing dysfunction not only makes anxiety worse, but anxiety makes sensory processing worse, so no wonder kids can quickly escalate into a meltdown or complete overload situation.

In the figure above, researchers found with surprise that an otherwise unselected group of children diagnosed with anxiety actually had unrecognized balanced problems that could be measured quantitatively on tests of postural sway. More balance problems were seen if the children had to concentrate on a memory tasks (divided attention), but the greatest imbalance was seen when kids stood on a compliant surface (foam) that required more active balancing, and this imbalance was even more severe when children were asked to stand with eyes closed.

The findings are quite startling, and the raise the question whether we're really treating a lot of cerebellar kids with balance problems with anti-anxiety drugs.

Now various groups have confirmed that spatial difficulties and balance problems are common among anxious people, but an Israeli group have take the observations a step further. In this presentation, researchers found that treating anxious children with balance training (OT) resulted not only improved balance, but also reduced anxiety and higher self-esteem. They also made the observation that commonly used physician screens for balance (standing heel-to-toe or neurological exams of the vestibular system) were not sensitive for detecting problems. The anxious children did complain of more dizziness and motion sickness than their matched controls though.

From an article in Science Daily:

“This is a breakthrough in the field of occupational therapy,” says Dr. Bart...“You can’t treat children with anxiety in a cognitive way because of their immaturity and lack of operational thinking. Working with the body may be the answer."

FYI, sensory processing guru Dr. Lucy Miller also has an article calling for more Translational research in sensory processing disorders in a recent issue of Frontiers in Integrative Neuroscience.

Postural Sway and Anxious Children
Impaired spatial learning in pediatric anxiety (abstract only)
Spatial perception problems in individuals with trait anxiety

1 comment:

  1. “Since the implementation of the "Back to Sleep" campaign, therapists are seeing increasing numbers of kindergarten-aged children who are unable to hold a pencil.”
    Susan Syron, Pediatric Physical Therapist

    “There are indications of a rapidly growing population of infants who show developmental abnormalities as a result of prolonged exposure to the supine position.”
    Dr. Ralph Pelligra regarding the impact of the Back to Sleep Campaign

    As it turns out, when the primarily back and side sleeping ALSPAC babies were compared to the primarily stomach sleeping Colorado babies used to develop the DDST the researchers obtained these results: 68% of the ALSPAC infants had abnormal scores at 6 months of age compared to the stomach sleeping DDST Colorado infants and 57% of the ALSPAC infants had abnormal scores at 18 months compared to the original stomach sleeping DDST Colorado infants.
    Summary of Alan Emond letter to BMJ in 2005 regarding ALSPAC data and a research project unrelated to Sudden Infant Death Syndrome.

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