Staying Regulated amidst an uncertain world. Tools for regulation. Post by Irene Lestari, MS, OTR/L

Amidst the COVID-19 outbreak, our lives have been altered in many different ways. Disruptions of daily life and routines can cause our body undue stress. Stressful experiences or the presence of sustained stresses, such as during these unprecedented times, can wreak havoc on the nervous system. Amid school and extracurricular activities closure, children are deprived of their needs for sensory input.  Rather, they are stuck at home, with less than optimal sensory stimulation they were used to prior to this pandemic. Children react to stress differently than adults. They tend to somatocize their stress within their body and give meaning to emotions and feelings through their bodily sensations. It makes sense then to utilize their body and senses as vessels to alleviate any accumulating stress or discord in their body.  As such, their bodies and senses can be utilized to mitigate the effect of stress which subsequently fine-tune and regulate the nervous system. Engaging in sensory experiences can also activate and strengthen the vagal nerve by calming the autonomic nervous system through stimulation of the parasympathetic (calming) nervous system.
To glean upon the intricate interplay between sensory input and our capacity to regulate stress, it is useful to have some understanding of what sensory processing is and how our senses function. Sensory processing is the ability to take in sensory information, process that information, and then produce an output response to function efficiently and effectively in the environment. Efficient sensory processing allows the central nervous system to regulate such things as attention and activity level by enabling one to attend to salient stimuli, filter out irrelevant stimuli, and modify the amount of stimulation one is exposed to. Stress can have a direct impact on sensory processing capacity. During stressful situations, your child’s ability to process sensory input can be different from when they are in a calm/restful state. Deep tactile input, deep pressures as well as proprioceptive input are especially pivotal to restore balance to the nervous system. Deep breaths, humming, and singing is known to stimulate the vagus system, which can improve arousal state.
We all know the five basic senses: sight, smell, hearing, touch, and taste. These five systems are important to everyday well-being in everyone, two other senses that are less talked about, but are just as important. These are the vestibular and proprioceptive systems. The tactile or touch (skin) sensory system has many vital functions, including providing us with the ability to know what an object is without looking (tactile discrimination) and identifying temperature and pain.  Deep tactile input is calming and organizing for the body. It releases dopamine, which combats the effect of adrenaline and cortisol that is released when the child is in a high stress/fight or flight state.  Movement or the vestibular system consists of parts of the inner ear and related central nervous system structures that perceive and interpret changes in head position. It automatically coordinates movements of one's eyes, head, and body. Activities that provide vestibular input are activities that changes the position of the head in relationship to gravity. The vestibular system is the first sensory system to develop and is therefore the foundation for all other sensory systems. For children that are over-reactive to vestibular input, linear vestibular activation is the first type of movement provided as it is the least intense type of movement. It is important to follow all vestibular input with heavy work as this can help reduce any dysregulation that may occur as a result of vestibular input. The proprioceptive system provides information related to the muscular and skeletal systems and, therefore, the position of one's body. Proprioceptive input, or "heavy work" activities, are activities that challenge a child to move against resistance. These include pushing, pulling, climbing, carrying, log rolling, etc. Proprioceptive input provides organizing stimuli to the nervous system which can help with motor planning and body awareness, improve attention, and increase muscle tone. This calming and organizing input can also combat an aroused state. The regulating effects of 15 minutes of proprioceptive input can lasts 2- 4 hours depending on the child and the intensity of the input. Vision consists of both the motor function of the eye as well as perception of visual information. It is also a protective sense which offers information about what is happening around us. The auditory system consists of hearing, speech, and language, the child's response to sound, and their ability to perceive the spoken word and follow directions. 
Included in this blog are some simple sensory tools you can try to help regulate and decrease stress to the child’s nervous system. It is crucial to engage in multiple sensory systems' activities every 3 hours to notice their positive effects on the child's nervous system. Finding the most appropriate sensory experience at the right amount is the key. Examples of selected daily activities are included at the end of this blog.
 
Sensory regulation tools
Tactile/Touch

• Wilbarger Brushing Protocol

• Give deep pressure massage, back rub using comfort touch

• Have the child snuggle in a sleeping bag, bean bag chair, padded floor seat

• Give firm pressure and skin to skin contact

• Weighted blankets may decrease anxiety and arousal levels

• Sleeping under a heavy quilt

• Spandex fabric wrapped snugly around shoulders

• Foot or hand rollers

• Tactile adventures bin – corn meal, oatmeal water, sand, lentils, popping corn kernels, themed based bins

• With consistent pressure, roll and press a therapy ball up and down over the child’s body

• Wrap the child with a blanket and roll and a therapy ball up and down over the child’s body

• Forts/hide outs -- pillows, scarves, blankets, boxes and a flash light

• Treasure hunt – hide small objects in play dough or tactile bin to find with fingers

• Bath time – bubbles bath, soap crayons and back scrub brushes

• Foam soap or shaving cream – draw and blow

• Provide back rubs, bear hugs and massage with a towel in a predictable manner

• Employ vibration – use vibrating pillow, battery vibrating wiggle pen, toy massager

Proprioceptive

• Self-imposed body hugs or firm hugging by loved one.

• Tug-of-war

• Heavy, sustained resistance exercises

• Joint compression and slow stretches

• Crawling through a Lycra tunnel

• Digging in the garden and pushing a wheelbarrow

• Safely push or pull heavy objects, such as large pillows

• Crawl through pillow forts tunnels or boxes on all fours

• Crashing into mats/bean bags

• Animal walks

• Yoga

• Catching/throwing – heavy weighted ball, bean bags, weighted animals, sandbags, cushions and pillow

• Swimming/extra bath time – swim weight can be added

• Wheel barrow walking

• Squishing between pillows, mat, bean bags chairs

• Heavy exercises – push up, sit-ups, hand sands, tug of war

• Pushing against a wall or another person, pushing or pulling one one’s own hands

• Belly breathing

• Use body pillow, weighted blankets, heavy quilts, compression vests or weighted vest to offer calming input

• In your home provide, offer hide out places, like bean bag chairs, small tents, pillow corners

• Wearing a weighted vest, compression vest, weighted bell, ankle or wrist weights

 Auditory:

• iLs Dreampad: The iLs Dreampad delivers gentle calming music and vibrations to provide gentle auditory and vestibular input to improve sleep patterns. It helps with both falling asleep and staying asleep, as well as reducing auditory defensiveness and sensory-seeking behaviors. It plays for 4 hours and then shuts off automatically. It should be used every day. It can be ordered directly through the website. You can order just the pillow system and use your own iPod to which you download the music, or you can order their mp3 system. All of the pillows are the same music system, the difference is only the pillow support itself. http://integratedlistening.com/products/dreampad/

• Quickshifts: Quickshifts, from the Therapeutic Listening app, can used as a tool to help restore a child to a calm regulated state when dysregulated.  Regulation 1,2 and 3 are especially useful to help change arousal state. Download Therapeutic Listening app at https://itunes.apple.com/us/app/therapeutic-listening/id836090895?mt=8

• Soft, slow and rhythmic music

• Classical, New age and Soft Jazz Music

• Repetitive sounds (ocean waves)

• Indoor fountains, and bubbling sounds

• Relaxation and meditation CD’s

• Humming and singing quietly

 Vestibular:

• If your child responds well to movement, engage him/her with slow and linear swinging on a hammock swing

• Rocking on a glider chair

• Perform slow swinging – back and forth – in a blanket

• Engage in slow rocking or swaying – rocking chair

• Slow dancing

• Recess games – hopscotch, ball catch, soccer, hockey, tag

• Climbing – on playground climbers, ladders, designated furniture

• Riding toys – trikes, bikes, scooters, roller blades, pedal less bikes

• Roughhousing/ Wrestling – swinging while someone pushes on legs

• Bouncing lightly and rhythmically on therapy ball

• Walking and strolling

Smell

• Lavender scent

Sight/Vision

• Natural or dim lightings

• Movement of fish swimming in an aquarium

• Lava lamps or bubble lamps

• Lack of clutter and simplified furnishings

Oral Motor

• Chewing gum

• Blow bubbles in water/bubble solution using a straw (make bubble mountains)

• Play straw games (for example, use a straw to blow poms poms/ cotton balls across the table)

• Blow out candles

• Vibrating toothbrush

• Chew toys

• Encourage to play with lots of oral motor play with whistles, harmonicas, kazoo

• Whistle or hum a song

• Blow up balloons

• Adding rhythm to activity through chanting, singing or rapping in time with child’s movement

• Drinking from sports water bottle

• Blow pen activity

• Tug of war with a rubber tubing

• Humming

General Sensory Tips/Tricks
 
Visual schedule as organization
·       Have a visual schedule. Visual schedules are an effective way to help children manage challenges with focus, task execution and transitions. A visual schedule would be helpful for the child to outline daily events and also to break down daily routines such as the morning and bedtime routines. A visual schedule can be an important component in regulation so the child can know what is expected and when, it brings a sense of order and predictability into the home. A good companion to a visual schedule is a tool to track time.
·       Provides a daily schedule to organize the child’s day. Start with one part of the day and make a list of 3-5 tasks that the child is required to do.
·       Adding pictures to be more specific about the task can improve accuracy and follow through.
·       Different tools for executive function tasks can be found here: http://efpractice.com/shop
 
 Other strategies for the home
·       Try to schedule calming activities in between more demanding activities to maintain the nervous system at a calm state.
·       Prepare auditory and visual materials ahead of time to assist in transitions. Timers, clocks with alarms, watches with a timer and concrete transitional objects may be helpful during transitions.
·       Modeling self-care and attunement to your own needs for sensory activities.
·       Keep a “sensory backpack” to use during “sensory emergency”. Fill the backpack with items such as massagers, different essential oils, headphones and regulating music, a soft weighted toy animal with different textures, a book with different textures, play dough, pipe cleaners, chewy toys, and pop beads.
·       Have an area in a house designated for a calming, quiet sensory oasis. Have it be a darker corner in the house filled with tactile activities (such as water beads, kinetic sand, theraputty, and weighted blanket).
·       Provide daily access to dry sensory play materials (make a bin filled with different tactile items).
 
In cooperating sensory tools into self-care routine
Eating:

• Drinking through a straw

• Drink pudding/yogurt through a straw

• Eat crunchy and chewy snacks

Tooth brushing:

• Use Vibrating tooth brush

Sleep:

• Massage and/or joint compression prior to bed (you can use powder or lotion)

• Back rubs, bear hugs, and a rub down with predictable movement

• Making a small space for the child to squeeze into – some children like to sleep between the mattress and the box spring, or children may like their bed pushed against the wall so that they can push their body against the wall

• Have a predictable routine before bed

• Use the Dreampad (https://integratedlistening.com/products/dreampad/)

Washing:

• Wrap the child with towel after bath or shower

• Instead of walking, do wheel barrow walks

• A heavy face cloth and use pressure strokes on the body

• Use pressure and downward strokes with washcloth and towel

 Driving in the car
·       Listen to calm music (ex: light classical music, piano covers of Disney songs)
·       Play with a fidget
·       Eat crunchy snacks
·       Sit with weighted blanket and/or weighted toy
·       Carry a Sensory backpack during trips: massager, a soft toy animal with different textures, balloon, scratchy stickers, lavender, lemon and minty smell, silly putty or play dough, headphone and music, fidget stuffs: rubber coiled key chains, pipe cleaners, wiki sticks, chewy toys, stretchy band, coil shoe string, plastic pop bead, and koosh ball)
Example of daily sensory activities
 
Monday

• Body work (encourage long/deep breaths):

-Squeezing between pillows
- Animal walks

• Tactile activities

  • Make homemade play doh

  • Wilbarger Protocol brushing

  • Treasure hunt- hide small objects in playdough or tactile bin to find with fingers

• Oral motor:

- Blowing bubble mountain

• Auditory support:

  • Regulation 2

 

Tuesday

• Body work:

  •  Crawl through tunnels or boxes on all fours (place something with texture under the tunnels so the child is getting some tactile input)

  • Jump and crash into crash pads

  • Roughhouse– play wrestling and she needs to let out a big “argh” when the child falls or pushes

  • Calm vestibular – slow, rhythmic, linear swinging or rocking and bouncing on a ball

• Oral motor:

  • Blow bubbles in the bathtub with different wands and toys that you can use for bubbles.

• Tactile:

  • Brush body

  • Foot Massages

  • Tactile bin for the child to play with

  • Pretend bathing with different wash cloths (rub wash cloth on the child’s body)

  • Play with tactile bag – bits of fabric and small toys into a cloth bag. Children love the surprise factor of reaching in a bag and choosing items.

  • Messy play with shaving cream

• Auditory support:

  • Regulation 1

Wednesday

• Body work:

  • Massage or give parents massage

  • Magic carpet rides (the child sit on a blanket and gets a ride from the parent through pulling of the blanket)

  • Pushing something heavy (a big box filled with stuffs) around the house

  • Body socks while walking on crash pads and pillows

  • Silly animal walks

•  Oral motor:

  • Straw games

  • Suck and blow cotton balls/ping pong balls using a straw

  • Suck foam pieces with a straw

• Tactile:

  • Brush body

  • Back massage/squeeze

  • Fill balloon or gloves filled with things like corn, rice and flour.

• Auditory Support

  • Regulation 2

Thursday

• Body work:

  • Wheel barrow walk over various floor surface

  •  Crawl under piles of textured and weighted pillows/items

  • Catch /throw heavy weight ball, bean bags, weighted animals, sand bags, and cushions/pillows

• Oral motor:

  • Mosaic art project

  • Blow party blowers

• Tactile:

  •  Brush body

  • Draw in sand or salt

  • Massage

• Auditory support:

  • Regulation 1

Friday

• Body work:

-Massage or give parents massage
-  A magic carpet ride
- Push something heavy
- Play in the water or swimming or extended bath

• Oral motor:

  • Rubber tubing activity

  • Vibrating tooth brush

  • Blow pen activities

  • Mouth painting with sour food

• Tactile:

  • Brush body

  • Tactile treasure hunt (hide treasures in a bin or rice /flour/oats/beans for the child to find.)

• Auditory support:

  •  regulation 2

 

Saturday

• Body work:

  • Hop on balls and crash into pillows

  • Ball massage

  • Washing machine activity (place the child in a big pillow case or duvet cover, place different items in there like cloths or balls, then shake and drag the child around the house. Keep shaking/dragging until the child is “clean”)

  • Push against the wall/another person or hands together

  • Crawl through a Lycra tunnel while pushing a ball

  • Hang on adult hands/trapeze

• Oral motor:

  • Make bubble mountains with straw and bubble solution

• Tactile:

  • Brushing

• Auditory support:

  • regulation 1

 

Sunday
Outdoor play!

 
 
References
Moore, K.M (2008). The Sensory Connection. Self-regulation workbook. Learning to use sensory activities to manage stress, anxiety and emotional crisis. Franconia, NH: The Sensory Connection Program.
 
Yack, E., Aquilla, P., Sutton, S (2015). Building bridges through sensory integration (3rd edition). Arlington, TX: Sensory world.