Sensory Processing: Tactile System

Lacey Lubenow, MOTR/L, CLC

Purpose: The tactile system is responsible for receiving information from the environment through touch. It’s important in keeping us safe through the detection of potentially dangerous stimuli such as hot, cold, or sharp objects.

Function: The tactile system is composed of receptors that detect pressure, temperature, vibration, and texture in our external environment. The tactile system works alongside the proprioceptive system to communicate with the brain through sensory receptors throughout the body.

Why it’s important: As mentioned previously, the tactile system serves a lot of purposes, but none more important than safety. Without the tactile system, the body would be at risk of harm through things like heat exposure when cooking or bathing or cold exposure when outside in the elements. It also serves the purpose of emotional attachment (think skin to skin after birth), body position, and feeding and nutrition.

System Breakdown: Because the tactile sensory system is so vast, children who have difficulty with tactile processing may present with a combination of over or under responsive tendencies. Children who are over-responsive to tactile input may be resistant to self care tasks like hair brushing/cutting, nail trimming, tooth brushing, or face washing. They may have a hard time feeding, which can lead to picky eating habits. Children also may avoid or dislike messy play such as finger painting, sand play, or playing with food. Resistance to certain textures of clothing, socks, difficulty with tags or seams, or tight clothing can also be a sign of tactile over-responsiveness. Children who are under-responsive to tactile input may seek out various textures and use parts of their body that have more touch receptors including lips, tongue, and face to feel them. They may not recognize tactile input as easily and thus have a lack of awareness of when their face or hands may be dirty. They also may appear to have a high pain tolerance and seek out messy play opportunities rather than avoid them. Similarly to other sensory systems (proprioceptive and vestibular) children may also engage in active or rough play like running, jumping, or crashing into things.

OT Intervention: Every person is unique to their sensory processing needs. It only warrants intervention if it prevents participation in meaningful activities and impacts their quality of life. Regardless, tactile input is beneficial for children with and without sensory impairments. A sedentary lifestyle restricts the opportunity for engaging the tactile system and can lead to sensory processing difficulty purely due to a lack of exposure. Our sensory systems require frequent input to process information efficiently and effectively. Occupational therapists assist with creating a ‘sensory diet’ that is unique to each child’s needs to help them better process sensory information and promote improved regulation. Examples of activities that OT’s may use to promote exposure to tactile input include:

Water Play: Water is a great way to engage the sensory system without the feeling of being too messy.

Brushing Protocol: The Wilbarger brushing protocol is often used by OT’s to assist with desensitization of the tactile system using a specific brush on the skin. It can decrease over-responsiveness to clothing, food, and self care like hair or tooth brushing.

Deep pressure: A powerful tool that not only helps with regulation of the proprioceptive system, but the tactile system as well.

Exposing children to various textures through play over time will assist in desensitization of an over-responsive tactile system. If a child is under-responsive, providing and educating them with safe sensory opportunities that allow them to feed their sensory system through rough or messy play is equally as important.

May is Better Speech and Hearing Month

These days, every month seems to represent something different to celebrate and May celebrates better speech and hearing!

Our goal is to highlight the many different areas and specialties speech language pathologists play across the lifespan for our patients. Unless you have a personal experience with speech therapy or a speech pathologist, you may not be aware of all the “hats” we can wear.

Let’s focus on pediatrics, speech pathologists treat a variety of speech and language disorders including apraxia, articulation disorders, phonological disorders, voice disorders, traumatic brain injuries, intellectual disabilities, social communication disorders, late language emergence, auditory processing disorders, fluency disorders and written language disorders. We also treat feeding and swallowing disorders including dysphagia, picky/problem eating and orofacial myology disorders.

…Just to name a few!

Let’s dive into a few that are common for our therapists to treat at Gro.

Childhood Apraxia of Speech- or CAS is a neurological pediatric speech sound disorder where the precision and consistency of movements underlying speech are impaired in the absence of neuromuscular deficits (i.e. abnormal reflexes or tone). CAS may occur as a result of a known neurological impairment (i.e. brain damage) or independently. Think of it this way: the child knows what they want to say but has trouble coordinating the precise movements of the articulators to get the message out.

Articulation Disorders- these fall under the umbrella term “speech sound disorders” and focuses on speech errors in production of individual speech sounds such as distortions or substitutions of a sound.

Phonological Disorders- these fall under the umbrella term “speech sound disorders” as well but these are predictable, rule-based errors that affect more than one sound such as fronting (saying “tat” instead of cat), stopping (saying “dun” for sun) or final consonant deletion (saying “go” for goat).

Augmentative and Alternative Communication- or AAC is an area of clinical practice that supplements or compensates for impairments in speech-language production and/or comprehension including spoken and written modes of communication. AAC is an umbrella term that can use any equipment, tool or strategy to improve functional communication for people. Some forms of AAC include signs, gestures, line drawings, written words, picture communication boards and speech-generating devices.

Voice Disorders- occurs when voice quality, pitch and loudness differ or are inappropriate for an individual’s age, gender, cultural background or geographic location. Voice disorders are categorized under 2 main categories including Organic and Functional. Organic voice disorders include structural and neurogenic and are defined as a physiological voice disorder that is a result from alterations in respiratory, laryngeal or vocal tract mechanisms. Structural organic voice disorders are a result from physical changes in the vocal mechanism such as alterations in vocal fold tissues (i.e. edemas or vocal nodules) and/or structural changes in the larynx due to aging. Neurogenic organic voice disorders are a result from problems with the central or peripheral nervous system innervation to the larynx that affect functioning of the vocal mechanism such as vocal tremors, spasmodic dysphonia or vocal fold paralysis. Functional voice disorders are a result from inefficient use of the vocal mechanism when the physical structure is normal, such as vocal fatigue, muscle tension dysphonia or aphonia, diplophonia or ventricular phonation.

Traumatic Brain Injuries- or TBIs are a form of nondegenerative acquired brain injury resulting from a bump, blow or jolt to the head/body or a penetrating head injury that disrupts normal brain function. TBIs can cause mild, moderate or severe brain damage that can result in speech, language, swallowing or auditory processing disorders.

Intellectual Disabilities- or ID is characterized by the onset in the developmental period (before age of 22 years), significant limitations in adaptive behavior and significant limitations in intellectual functioning. The diagnosis of an ID is not made by a speech pathologist but children with IDs may benefit from speech, language and/or auditory processing therapy to help improve functional communication in the child’s daily life.

Late Language Emergence- this is often referred to as a “late talker” and is characterized by a delay in language onset with no other diagnosed disability or developmental delay in other cognitive or motor domains. Late language emergence is diagnosed when language development trajectories are below age expectations. Children may have expressive language delays only or they may have mixed expressive and receptive delays. Children with expressive language delays often exhibit reduced vocabulary and delayed sentence structure and articulation. Children with mixed expressive and receptive language delays will show a delay in oral language production and language comprehension.

Fluency Disorders- the most common fluency disorder is “stuttering,” which is an interruption in the flow of speaking characterized by specific types of disfluencies including the repetitions of sounds, syllables and monosyllabic words (i.e. “Look at the b-b-baby” or “Let’s go out-out-out”). Disfluencies can affect the rate and rhythm of speech and may be accompanied by negative reactions to speaking, avoidance behaviors, escape behaviors and physical tension.

Pediatric Feeding and Swallowing Disorders- This is an umbrella term so let’s break it down a little:

Feeding- is the process involving any aspect of eating or drinking including gathering and preparing food and liquid for intake, sucking or chewing and swallowing. A pediatric feeding disorder is defined as “impaired oral intake that is not age-appropriate and is associated with medical, nutritional, feeding skill, and/or psychosocial dysfunction.” It may be associated with oral motor and oral sensory function and includes behaviors such as refusing age-appropriate or developmentally appropriate foods or liquids, accepting a restricted variety or quantity of foods or liquids, displaying disruptive or inappropriate mealtime behaviors, failing to master self-feeding skills expected for developmental levels, failing to use developmentally appropriate feeding devices or utensils and experiencing less than optimal growth.

Swallowing- is the complex process during which saliva, liquids and foods are transported from the mouth into the stomach while protecting the airway. It consists of 4 phases: oral preparatory phase, oral transit, pharyngeal and esophageal. A swallowing disorder is called “dysphagia” and can occur in one or more of the 4 phases of swallowing and can result in aspiration (the passage of liquid, food or saliva into the trachea).

Long term consequences of feeding and swallowing disorders can include food aversion, oral aversion, aspiration pneumonia and/or compromised pulmonary status, undernutrition or malnutrition, dehydration, GI complications (i.e. motility disorders, constipation and diarrhea), poor weight gain, ongoing need for gastrointestinal or parenteral nutrition and prolonged feeding and swallowing problems into adulthood.

Orofacial Myology Disorders- or OMDs are patterns involving the oral and orofacial musculature that interfere with normal growth development, or function of orofacial structures, or call attention to themselves. OMDs can be found in children, adolescents and adults and can co-occur with a variety of speech and swallowing disorders. See our OFM blog post for an in-depth dive into this one 😉

That was A LOT!

Keep in mind that these are only a handful of disorders and diagnoses that speech pathologists can treat. Most SLPs have a passion for a few different areas but as you can imagine we can’t be experts in all of the areas so it’s important to find the right provider for you or your child’s needs!

(Reference: American Speech Hearing Association Patient Portal- Clinical Topics https://www.asha.org/practice-portal/clinical-topics/)

World Down Syndrome Day and Total Communication

Down syndrome or Trisomy 21 is a genetic syndrome marked by a 3^rd copy of the 21^st chromosome. This additional genetic material alters the course of development and causes the characteristics associated with Down syndrome (ndss.org). There are common physical traits associated with those that have Down syndrome including low muscle tone, small stature and an upward slant to the eyes. BUT it’s important to remember that each person with Down syndrome is different and may or may not possess these common characteristics, typically someone with Down syndrome carries more common characteristics with their parents and family members.

March 21^st is World Down syndrome day because it’s the 21^st day of the 3^rd month to signify the uniqueness of the 3 copies of the 21^st chromosome. On this day every year we celebrate those with Down syndrome, share awareness about all the things people with Down syndrome CAN do and fight for more opportunities and inclusion (i.e. quality education, good health care, a paying job, autonomy in making decisions and a voice).

I became a speech pathologist because of my experiences with people with Down syndrome, in particularly my youngest sister, Christina. I saw at a young age the importance of speech and language therapy in her life. Our family attributes Christina’s ability to communicate verbally to her speech therapist she saw from age 3-22 years old.

It’s important to remember that every child is different and comes to us with a unique set of skills and difficulties. Speech and language therapy looks different for everyone despite maybe having the same diagnosis. Typically, children with a diagnosis of Down syndrome may have feeding, swallowing, speech and/or language difficulties and can benefit from skilled speech and feeding therapy. It’s important to find a therapist that is trained and skilled in pediatric feeding and swallowing if there are feeding concerns and a therapist trained in pediatric speech and language disorders if there are speech or language concerns. Although both fall under the scope and practice of a speech pathologist, they are different and not all therapists have experience in both areas, it’s important to ask your therapist their level of experience if you have concerns!

Our main goal of speech/language therapy is to give each child the skills to communicate with their peers, family members and teachers. Each person has a voice with unique thoughts, dreams and aspirations even if they have difficulty communicating it. At Gro, our role is to use total communication strategies to help each person express themselves. This can look different for each person and we take time to develop communication skills, not just speech skills.

Sometimes this looks like verbal speech and other times it looks like augmentative and alternative communication (AAC) strategies. Our end goal for therapy is to give everyone an opportunity to meaningfully communicate with others despite their disability. There are many different forms of AAC, which will be explained more in depth in another post but common forms include sign language, writing, picture exchange communication systems (PECS) and a speech generating devices (i.e. applications that allow a person to communicate via electronic voice generation).

As a speech pathologist it is our job to help a family and child every way possible by providing a robust, language rich environment that supports language and communication development in all forms. No one uses verbal speech to communicate all the time (think of how often we communicate via text or facial expressions) and it’s important to support, nourish and develop ALL types of communication for our children.

In celebration of those with Down syndrome please join us in wearing your crazy socks today! The crazy or mismatched socks tradition is meant as a conversation starter, when people see your mismatched socks and ask why, you can take a minute to explain the significance and share acceptance and inclusion of people with Down syndrome.