Proprioception and autism

(From Autism Parenting Magazine, By Kelly Beins, BHSc, OTR/L, January 2, 2024)

Our bodies naturally sense and position themselves in space through a system called proprioception, which involves sensory receptors in our joints and muscles.  Unfortunately, around 95% of children with autism process sensory information differently, affecting at least one of their eight senses.

 

What is Proprioceptive Input?

Proprioceptive input plays a significant role as a regulator in the body, acting like a natural calming mechanism for an active nervous system. When a child might feel overwhelmed or overstimulated by their environment, engaging in activities that provide proprioceptive input can help bring a sense of order and calm.

This sensory input can improve a child’s attention and focus, making it an effective strategy to prepare them for various activities throughout the day.

Parents and caregivers can create a supportive environment by incorporating proprioceptive activities into a child’s routine, such as activities involving:

• pushing,
• pulling, or
• heavy lifting.

Proprioceptive input activities aid relaxation, organization, and readiness for daily tasks and challenges.

 

How Does the Proprioceptive System Work?

Our joints and muscles come equipped with receptors that connect with the brain through the nervous system – which is why we know precisely what tasks our bodies are doing, even without paying attention to it.

There are three different sensory receptors called proprioceptors:

• Muscle Spindles: When we stretch our muscles, tiny sensors called muscle spindles sense the changes in length and speed. They send this information to our brains through a special pathway.
• Golgi Tendon Organs: Located inside our tendons, Golgi tendon organs attach muscles to bones and respond to tension.
• Joint Kinesthetic Receptors: Located in the joints, connecting bones to other bones. Joint kinesthetic receptors sense joint movement, telling our brains where our limbs are at – and what they are doing.

We are all too familiar with the five better-known senses – sight, sound, touch, smell, and taste. Proprioception is one of the three lesser-known ones.

 The other two are:

• the vestibular system (responsible for balance and equilibrium), and
• interoception – the least known sense, responsible for autonomic movements such as blinking and breathing.

 

Signs Your Child May Have Sensory Issues

More often than not, sensory input challenges are mistaken for behavioral issues. Children with autism perceive the world quite differently from many neurotypical people.

 

According to The American Journal of Occupational Therapy, they often struggle with proprioceptive difficulties, making them act challenging or hyperactive.

However, the opposite also applies. Lethargy and social difficulties are also signs to watch out for, possibly due to proprioception processing issues. Understanding these signs will help you support your child throughout this sensory improvement journey.

The most vital step is to be willing to remain open-minded and not mistake their struggles for tantrums. For practical purposes, we are going to divide all these signs into two different categories: perception and praxis issues.

 Perception Issues

Also known as sensory discrimination issues, they happen when the brain cannot interpret or give meaning to sensory input. Some examples include:

• Inability to touch their noses with their index fingers on the first try
• Struggling when self-feeding, commonly missing the mouth
• Looking at their own feet when walking (out of fear of stumbling)
• Struggles when coloring inside the lines
• When kicking a ball or trying to catch one, they often miss
• When asked where a specific body part is, they can’t point at it unless they are looking at a mirror.

All these struggles have one thing in common: an inability to associate a sensory input with its meaning or interpretation – it’s like doing the same thing repeatedly as if it were the first time.

 Praxis Issues

Praxis issues deal with unknown motor movements, something their bodies have never done before.

• When learning new skills, they usually struggle with poor posture and movement fluidity
• Underperformance in sports and athletic activities
• Usually, they require much longer to grasp a new movement
• Fails to remember the body posture associated with a new skill they learned

All of these behaviors tend to compensate for the sensory-seeking struggles these children are experiencing. Some adults with ASD even describe these feelings as if their bodies are numb and floating, with no awareness of where their bodies are at whatsoever.

 Engaging and promoting proprioceptive activities with your kids should help with the following:

• stimulating full-body awareness,
• improving self-regulation and balance, and
• relieving some of the stress caused by all these sensory-seeking challenges.

 

Proprioceptive Input Activities for Autism

While it’s true that most kids enjoy proprioceptive activities or at least participate willingly in them, there will be some in particular that children do not like. It is not advisable to force any form of sensory-seeking activity on children with ASD.

That said, here’s a complete list of wide-range proprioceptive activities for all sensory input stimuli in children with ASD. 

1. Movements

Before becoming disengaged or lethargic, participate in a five-minute break of full-body movement with one of these ideas:

• Yoga
• Frog leaps
• Wheelbarrow walking
• Crab walking
• Gorilla jumping
• Stretching
• Somersaulting
• Jumping
• Rolling down a hill or on a mat

Trying a 7-minute HIIT emotional workout may be a good idea, too. For this workout, you will need:

• a timer,
• water,
• some sneakers,
• music,
• a yoga mat for children (optional).

All you need to do is a little room inside your house, shoving furniture to the sides. Results are best if done first thing in the morning because it sets the brain in a learning mood, ready to engage. 

If you’re familiar with the Tabata method, you’ll understand why this works so perfectly. Set the timer for seven rounds of 45 seconds of work, with an interval of 15 seconds of rest.

Ideally, do these exercises with your kid; be the model you want them to see. For 45 seconds, do as many reps as possible of the following drills. The goal here is to become truly tired, sweaty, and a racing heartbeat. 

Remember to play an upbeat song on repeat, one your kid loves! Here are some exercise ideas that you can try:

• R1 – Frog Jumps: Hop up and down, just like a frog
• R2 – Bear Walks: Looking down, hands and feet on the floor, at all times, with your hips as high as you can. Walk forward, backward, left, and right
• R3 – Gorilla Shuffle: Imitating a low sumo squat position (like a gorilla), use your hands to balance around the room, shuffling in all directions
• R4 – Starfish Jumps: Also known as jumping jacks
• R5 – Cheetah Runs: Imitate the fastest animal on Earth, but running still, in one place (like soccer players do)
• R6 – Crab Walks: Like crabs, put your palms on the ground behind you, lift your hips as high as possible, and crawl around the room
• R7 – Elephant Stomps: With the full weight of an elephant, march still in one place, stomping the ground as hard as you can

Once you finish with the drills, cool down slowly and dynamically. Don’t just lay on the ground, but pace around the room. As your heartbeat returns to normal, do some stretches and yoga poses with your child. 

Most importantly, have fun and be creative! The animal theme creates an excellent creative outlet, so make sure to make animal sounds and gestures and possibly even decorate your living room like a jungle to give meaning to the activity. 

 

2. Oral-motor Activities

Although they’re not as efficient as full-body movements, oral-motor activities are still pretty helpful in situations where you need to sit still with your kid, like a school meeting, doctor’s office, waiting rooms, etc. 

Our jaws come equipped with proprioceptors, and we can stimulate them by:

• Chewing gum
• Eating crunchy food, like celery or baby carrots
• Drinking a very thick milkshake by using a straw
• Chewing an oral massager 

3. Dynamic Activities

Unlike the first set of movements, which required only using the body, these activities will need props and objects to play:

• Pillow fights
• Rope jumping
• Bar swinging at the playground
• Trampoline jumping
• Tug of war
• Swimming 

4. Sports

Children with ASD are not usually drawn toward the collective aspect of sports since many aren’t comfortable socializing with other kids or with other groups.

However, it doesn’t mean you can’t engage in sporting activities with your child. You can try:

• dodgeball,
• kicking soccer balls,
• throwing footballs,
• throwing frisbees,
• playing catch,
• other one-on-one activities. 

5. Heavy-Duty Activities

These activities involve pulling, pushing, and lifting weights to stimulate the proprioceptors in the muscles and joints. Here are some ideas:

• Wagon rides: Ideal for siblings or that precious one-on-one time with your kid. Have them take turns pushing and pulling each other in a wagon
• Gardening: While you take care of your garden, make your kid help you by pulling weeds, digging some earth, watering the plants, and even planting some seeds
• Household chores: All children can benefit from activities involving some sense of responsibility, like helping out with the groceries. Sure, it’s a chore, but the positive reinforcement from helping along with the heavy work is an excellent way to stimulate sensory input
• Med-Ball: These balls are very versatile and all-around useful. They can roll, throw, carry, and squish each other too. Just make sure the weight is appropriate so that it won’t hurt them

 

Things to Consider Before Choosing Proprioceptive Activities

Before choosing which activities you will implement with your kids, there are some questions to ask and factors to consider. We are going to detail these below:

1. The Purpose

Will the activity serve the purpose of calming an over-responsive child? Or will it stimulate an under-responsive, sensory-seeking kid?

2. The Time

When dealing with anxious children, first identify the trigger points for anxiety. These could vary from a playground, a school assembly, lunchtime, etc.

Once you’ve identified these triggers, introduce the activity before they can become anxious, helping them remain calm during such events. If successful, incorporate them into their timetables or visual schedule.

Likewise, with under-responsive and sensory-seeking children, you need to identify the lethargy trigger points when they become disengaged and distracted. Usually, these triggers happen either before or after sitting independently to work on a personal task.

3. The Frequency

Identifying trigger points will help you determine how often you should implement an activity. Every child is unique, as are their sensory needs. Focus on short activities rather than long ones.

Monitor how long it takes for your child to sway from lethargy to re-engagement or stress to calmness. This time interval will determine the duration of the activities.

4. The Place

It’s essential to know your surroundings and understand the correct place where the activity needs to happen. 

Some tasks are available without leaving their seats, such as:

• pushing hands,
• doing chair push-ups, or
• squeezing objects.

Others are still doable within a room, for example:

• doing wall pushes,
• doing star jumps, and
• wiping surfaces.

There are also outdoor activities, such as:

• stacking objects,
• jumping on a trampoline,
• climbing structures, and
• completing circuits.

 

Fostering Confidence Through Proprioceptive Input

There are numerous benefits to promoting proprioceptive input in children with ASD. From everything we already discussed, arguably the most important one is confidence-building and awareness of their bodies and their surroundings.

Children with autism perceive the world differently than some of us. But they sense it, nonetheless. Helping them understand how the world around them works and how they also belong here is a critical step in their development. Ultimately, promoting these sensory input activities should help a child with special needs reach their full potential and get ready to tackle the world.

 

References:

The proprioceptive senses: their roles in signaling body shape, body position and movement, and muscle force. Physiol Rev.
https://pubmed.ncbi.nlm.nih.gov/23073629/

A set of Full-Body Movement Features for Emotion Recognition to Help Children affected by Autism Spectrum Condition, University of Genova
http://fdg2013.org/program/workshops/papers/IDGEI2013/idgei2013_4.pdf

Supporting Children with Sensory Processing Needs in the Early Years, Cumbria County Council
https://www.cumbria.gov.uk/elibrary/Content/Internet/537/1459/7037/18016/4450511357.pdf

Sensation-Seeking. In: Volkmar, F.R. (eds) Encyclopedia of Autism Spectrum Disorders. Springer
https://link.springer.com/referenceworkentry/10.1007/978-1-4419-1698-3_191

Sensory Integration and Praxis Patterns in Children With Autism, The American Journal of Occupational Therapy
https://research.aota.org/ajot/article-abstract/69/1/6901220010p1/5958/Sensory-Integration-and-Praxis-Patterns-in

Neurophysiological hyperresponsivity to sensory input in autism spectrum disorders. J Neurodevelop Disord
https://jneurodevdisorders.biomedcentral.com/articles/10.1186/s11689-016-9162-9

Kinesthetic Inputs. In: Pfaff, D.W. (eds) Neuroscience in the 21st Century. Springer
https://link.springer.com/referenceworkentry/10.1007/978-1-4614-1997-6_31

Approaches to the Teaching Exercise and Sports for the Children with Autism. International Journal of Early Childhood Special Education
https://dergipark.org.tr/en/pub/intjecse/issue/8653/107971

Effect of yoga on children with autism spectrum disorder in special schools. Ind Psychiatry J. 2022
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9678151/

Addressing Sensory Needs for Children With Autism Spectrum Disorder in the Classroom. Intervention in School and Clinic, 2022
https://journals.sagepub.com/doi/abs/10.1177/10534512221093786