Did you think there were only five senses? Some neurologists believe that there are four times that many!
The senses help transmit environmental information to the sensory neurons and receptors in the body via the central nervous system to the brain to produce an adaptive response.
Proprioception is the sense that tells you how far down to squat when sitting in a chair. It’s the sense that tells your leg how far up to lift your foot to climb a staircase. If you hold a newborn baby, proprioception is the sense that helps you adjust the pressure in your hands to cradle that precious life.
When a police officer pulls over a driver to conduct sobriety testing, they are looking at the proprioceptive system as they ask drivers to walk heel-toe and alternate touching the nose with the index fingers.
Proprioception is the sense that tells your brain where all your body parts are, even if you’ve got your eyes closed, even when you’re upside down in a handstand, or folded in half cleaning something off the floor.
When you have efficient proprioceptive processing, you always know where your body begins and ends, where your fingertips and feet are.
HOW MANY SENSES ARE THERE?
You have likely always known that there were five basic senses – sight, smell, taste, touch, and sound. Most neurologists will test up to 9 senses, and some estimate that humans have as many as 21 senses.
The five basic senses can be measured as you interact with the environment; they are easy to test and understand.
Many occupational therapists will evaluate two additional senses that are “hidden” within the body – the proprioceptive and vestibular senses. We are even now learning that there is an 8th sense, known as interoception.
Let's quickly run through vestibular and interoception.
THE VESTIBULAR SENSE
This sense registers movement. It contributes to balance and response to gravity and motion; it supports motor coordination and even the eye muscles responsible for vision. You may see young children seek movement input to stimulate their vestibular system, by spinning in circles, rolling down hills, or swinging as high as they can on a swing set.
As we age and spend more time in upright positions, our vestibular system can become more sensitive; we are less tolerant of intense movement, may experience dizziness and loss of balance.
This sense involves the inner workings of internal physical processes that measure feelings like hunger and thirst. Other physiological feelings that this sense helps to regulate include heart rate, respiration, and elimination. The nerve endings in the tissues of the digestive and respiratory systems communicate with the nervous system to signal the brain that things are “off,” registering hunger/danger/etc. and promote the ability to produce an adaptive response - like taking deep breaths, finding a bathroom, grabbing a snack.
Now, what is the "sixth sense" called proprioception?
This sense is responsible for awareness of position and movement in space; it involves the communication between the joints and muscles of the body. It helps us sense the position of the fingers, arms/legs, and other body parts.
When working with the receptors of the skin, joints, and muscles, it helps the body adjust the amount of force exerted on an object. This allows you to adjust the amount of pressure to apply to a mechanical pencil, how to balance a full mug of hot coffee or how much of a push is needed to close a car door.
If you close your eyes, proprioception is the sense that lets you know where your body is in space; you could play Simon Says and know where all your body parts are to move them according to the leader’s verbal directions.
By the time we are adults, most of us have efficient proprioceptive systems that work in tandem with the other senses and get us through our day safely.
Some children have a very disordered proprioceptive system and struggle with some very basic tasks in their day. Dysfunction here can lead to emotional difficulty and learning problems over time.
DISORDERS OF THE PROPRIOCEPTIVE SYSTEM
Many children struggle with sensory processing difficulties, often with the proprioceptive system.
A child can be sensory seeking, always pushing and pulling objects with force, looking for activities where they can drag and pull things, jumping or stomping up and down staircases and hallways.
They have big, loud movements; you know they are coming towards you. They may unintentionally break pencils, knock over chairs when pulling them out from the table, or be too rough petting an animal.
Increased oral sensory seeking can be applicable here as well, chewing on pencils and clothing, mouthing non-food items. A child may want their clothing to be very tight, or heavy. They might always want to be under furniture, hiding in small spaces, trying to find the right amount of sensory information from their environment to feel regulated, or “just right.”
Motor planning/praxis and body awareness difficulties are also common. Motor planning is the ability to conceptualize, plan, and execute a new motor task. In a young child, you will see motor planning skills at their finest as they figure out how to get onto/off of playground equipment.
Body awareness difficulties can come into play if children are frequently bumping into others, have difficulty navigating a busy classroom, etc. Children that struggle with body awareness may resemble that visual term “bull in a china shop.” Bike riding, jump roping, and shoe tying are complex motor tasks that require an efficient proprioceptive system. Children struggling with sensitivities in the proprioceptive system might have a hard time on the stairs, especially on a moving staircase or escalator. Postural control is another area where difficulties in the proprioceptors can be seen.
Therapists learn that as humans we need stability before mobility. Motor development happens in patterns that begin proximal (close to the body) and move distal (towards the fingertips).
We know that a baby needs a stable core to balance in sitting before they can crawl. A child needs a stable core and trunk control to maintain a seated position for activities at their desk for writing, or when on the floor for circle time. You might see a child fall out of their chair, slouch forward, and hold their head in their hands.
On the floor, they may need to change positions frequently, lean on a classmate or nearby furniture for support, or feel like they have to lie down to attend and listen to the speaker. It's difficult to expect legible handwriting from a child that is struggling to sit up in a chair.
WHAT IF YOU HAVE CONCERNS ABOUT YOUR CHILD’S SENSORY PROCESSING?
Occupational therapists have advanced training in sensory integration to evaluate and provide treatment for inefficient sensory processing. There is no specific “test” that will measure proprioception, but therapists can use their clinical observations of a child to identify weaknesses in sensory systems.
Additionally, there are questionnaires such as The Sensory Processing Measure or the Sensory Profile that can be completed by parents and teachers to help identify and quantify sensory difficulties, and categorize them as mild, moderate or severe.
Once identified with sensory processing dysfunction, occupational therapists will make a treatment plan that may involve a sensory “diet,” a home program or sensory-based routines at school. It is important to work as a team to help a child remediate sensory issues in all environments, beyond what might be addressed one on one in an outpatient clinic setting.
TREATING THE PROPRIOCEPTIVE SYSTEM
The proprioceptive system can be very effective in calming down the nervous system, for self-regulation. Think of how you feel if you’re stressed at work, home, or with life in general. Moving your body by lifting weights or doing yoga can all be regulating – giving your nervous system some input via the joints and muscles has a great impact on the brain. It’s a good starting place to get kids “ready to learn,” and the proprioceptive system is incorporated in most movement and brain breaks at school.
Heavy work – this term is commonly used when designing programs for kids, and it’s a literal translation, activities that provide resistance.
Activities can include:
- Carrying heavy objects for short periods – like a weighted backpack or a gallon jug of water
- Performing animal ‘walks’ – like a crab or bear walk, wheel-barrow walks
- Using resistance bands, medicine balls, playing catch with anything that has weight
- Having a pillow fight, playing tug-of-war
- Play with putty, Play-Doh, or clay
- Cutting cardboard or thick postcards/junk mail
- Use of a weighted lap pad, shoulder wrap, vest or blanket; this should be prescribed and monitored by an occupational therapist
- A pressure vest has a different protocol and wearing schedule than a weighted vest but can have similar results
Oral motor input – the cranial nerves that come from the brain down to the jaw are some of the shortest nerves (as compared to the nerves that go down the spine to the feet) and can have the most input. Heavy work to the jaw via food or other oral motor input has a quick impact.
Some ideas to target the proprioceptive system via the mouth/jaw include:
- Chewing gum, any crunchy or chewy snacks
- Using “chewelry” or chew necklaces to deter from chewing on clothes
- Drinking from a straw – the thicker the liquid (milkshake consistency) or thinner the straw (coffee stirrer), the more work the muscles do to move the liquid into the mouth
- Blowing bubbles and using whistles
- Consider a child’s water bottle – those with a bite valve or silicone straw provide additional oral input
Daily activities – it’s ideal to incorporate proprioceptive work into daily tasks, so that they are better integrated and don’t require being pulled away from social or learning opportunities as doing something “extra.”
Some suggestions include:
- Carrying a heavy book to transport to the library or school.
- Pushing the shopping cart, helping to carry groceries in from the car.
- Classroom chores like taking the chairs off the table in the morning, serving as the door holder for the rest of the class.
- Pushing the packages from the front doorstep into the house.
- Taking out the garbage, collecting recycling.
- Loading the washer/dryer, carrying the laundry basket.
- Vacuum, mop or sweep.
- Shovel snow, rake leaves, and other seasonal yard work.
After school sports/activities – be mindful of the sensory components that the activity offers or requires, ask your occupational therapist to help analyze a sport with you to determine its appropriateness for your child and his/her needs.
- Pulling a friend on a wagon
- Climbing up the side
- Practicing the monkey bars, and climbing structures
- Seasonal sports like soccer, swimming, gymnastics
- Team sports like football incorporate heavy work via their heavy “uniform,” dribbling a basketball
- Riding scooter boards - especially when on your belly pushing with the upper body
- Pedaling bikes, pushing scooters
- Coloring with chalk outside – the surface is very resistive
- Music lessons with drums, cymbals, sticks or anything heavy
Although it’s one of the “hidden” senses, proprioception can influence almost every motor task throughout the day. Children that have disordered proprioceptive systems can struggle to get through their daily tasks, tolerating the clothes that come with the change of seasons, navigating the school environment, sitting up and attending at school, and feeling good about themselves at the end of the day.
Activities that provide proprioceptive input can be highly organizing and a good preparatory activity before difficult times of the day like getting out the door to school, tackling homework, sitting at the dinner table, or winding down before bed.
Occupational therapists have advanced training in sensory integration to identify disorders of the sensory systems and help to remediate specific dysfunction. If you suspect that your child has difficulty with sensory processing, you can contact a local occupational therapist in your community or at your child’s school to help determine its impact on daily functioning and recommend services appropriately.
There are many activities that families can do at home and as part of their normal everyday routines to help a child organize their sensory systems, giving them the proprioceptive feedback that they need. It’s important for the adults at school and home to be on the same page when recommending sensory diets or home programs so that there is carryover throughout the day.