Specialties – Vestibular Integration

Visual-Vestibular Integration, Auditory Integration Therapies, and Astronaut Training

The vestibular system is our most important sensory system, as it is intricately connected to all other sensory systems. The vestibular sensory organ is a uniquely designed structure located in the middle ear. The primary function of the vestibular system is to detect movement, and gives us an understanding of where our head and body are in space in relation to the pull of gravity. However, efficient functioning within the vestibular system is essential to balance, bilateral coordination, muscle tone, posture, coordination of eye movements, and the ability to maintain an optimal level of arousal.  

Children with vestibular processing dysfunction may have poor motor coordination skills, be fearful of movement, awkward, clumsy, fall and bump into things. These children may have poor balance.  They may appear to be “squirmy” or “fidgety”, be described as the child who “doesn’t stop moving”, or appear “rigid” and avoid movement, especially imposed movement, all together. Children with vestibular processing dysfunction may appear to be “lost in space”.  Their actual experience of movement and changes in his/ her perception of gravity may feel similar to the sensation astronauts feel when gravity is eliminated.

The vestibular system has a direct impact on our proprioceptive and visual systems. For example, movement stimulates the muscles that support the vertical axis of our body.  A strong center is required as a stable support in order for us to use our eyes effectively. A strong and stable core allows us to hold our eyes steady on a target while moving our body through space. Without our eyes working properly in conjunction with our vestibular system, visual information is not interpreted properly. This in turn makes it difficult to read, write, throw and catch a ball, and participate in many activities that are vital to proper childhood development.

Sensory integration therapy requires active participation by the child, and is not achieved via passively providing sensations (i.e. pushing a child on a swing, providing massage, etc.). In addition, sensory integration therapy is play-based and child-directed, as motivation is essential to new learning. Sensory integration therapy incorporates suspended equipment (one or 2 suspension points, horizontal or vertical connectors), therapy balls, scooterboards, inflatables, climbing structures, ramps, etc., which influence our vestibular system via altering our perception of gravity. Utilizing these special apparatus’ in conjunction with specific visual target tasks, facilitates visual-vestibular integration. Incorporating  verbal directives, external rhythms via music or a metronome, facilitates visual-vestibular-auditory integration. Incorporating resistance, weights or textured toys facilitates visual-vestibular-auditory-proprioceptive-tactile integration.

Astronaut Training is a treatment protocol for improving visual- auditory- vestibular integration. Developed by Mary J. Kawar MS, OTR, Astronaut training is a child friendly approach to vestibular training which incorporates therapeutically imposed movement, in conjunction with visual activities and auditory support, to facilitate efficient integration of these 3 senses.

Using music through auditory integration therapies (i.e. iLs, Therapeutic Listening, The Listening Program; music modified to enhance high and low frequencies to impact sensory processing) and the Astronaut Training protocol facilitates sensory integration through our auditory system. Input to our auditory system has the ability to activate our vestibular, tactile, and proprioceptive systems, and the rhythm inherent in music has the ability to affect our body rhythms (sleep/ wake cycle, heart rate and breathing rate, timing for motor planning, etc.). Sound is essentially just vibration at different frequencies. Very low frequencies can be felt as vibration, and may stimulate our tactile, proprioceptive and vestibular system, telling our bodies “you are here”. This is why music with a lot of bass in it makes you want to dance. Low frequency auditory input activates the muscles surrounding our core.

Higher frequencies, such as a siren, or a voice, are easy to localize, facilitate attention, and tell you about the space around you. This is why children may run into a gymnasium, or other large open space and scream. The echo feedback provides information about the spatial surround. Similarly, with our vision occluded, we are able to tell whether we are in a large or small space, and where someone is standing when speaking to us, in relation to our own body, based on what we hear.

Also, sound is basic to our survival, in that it has a strong influence on our “fight/flight” response (i.e. think of a startle reflex in an infant). Some children with sensory processing delays demonstrate a retained startle reflex, may exhibit sensory defensiveness, or may spend a lot of time in “fight or flight”.  Sound should always elicit an orienting response.  An orienting response activates the postural muscles that enable us to bring our bodies into an alert, upright position.  This allows us to turn our heads and our bodies if necessary, and then visually locate the source of sound in a precise manner. With efficient sensory integration, it is then that we determine if we are faced with a “fight” or “flight” situation. During our day to day activities of daily living, all parts of the vestibular-visual-auditory triad are required to function at optimal levels.  All systems working together will properly provide us with a strong understanding of ourselves, as well as the “spatial envelope” in which we live.  Without efficient integration of all systems, the sensory information received may be interpreted in a fragmented way that does not make sense, or may make filtering irrelevant sensory input extremely difficult. 

In children with sensory processing disorder, using the auditory system as a window to impact the tactile, proprioceptive, vestibular, visual and auditory is an extremely powerful means of facilitating sensory integration. 

Sensory Integration Therapy is not a cure, but depending on the child’s response, when SI is provided by a trained and experienced therapist, there is a chance this type of intervention may provide some relief and functional progress for the child, and if nothing else, greater understanding by the parents. Sensory Integration Therapy provides the child with therapeutically guided opportunities to receive the appropriate type of sensory stimulation deemed necessary. Under these conditions, it is the therapist’s hope, that the child’s central nervous system will have a chance to experience positive sensory stimulation in a context that is neither threatening or limited, and his or her brain will integrate more healthy messages along their own “electrical circuit”.