Tactile Defensiveness

Tactile Defensiveness is evident when an individual is extremely sensitive to touch or tactile experiences. They appear to over react to sensations most people don’t particularly notice. They seem to experience tactile sensations in a different way. For example, we might experience touching an item as smooth or soft, to them it can be almost painful. Think of the reaction you have when someone scrapes their fingernails down a black board.

Definitions:

Proprioception – The sensation from the muscles and joints. Proprioceptive input tells the brain when and how the muscles are contracting or stretching, and when and how the joints are bending, extending, or being pulled or compressed. This information enables the brain to know where each part of the body is and how it is moving.

Motor Planning – The ability of the brain to conceive of, organize and carry out a sequence of familiar actions

Tactile – Pertaining to the sense of touch of the skin.

Vestibular System – The sensory system that responds to the position of the head in relation to gravity and accelerated or decelerated movement.

Sensory Integration – The organization of sensory input for use. The “use” may be a perception of the body or the world, or an adaptive response, or a learning process, or the development of some neural function. Through sensory integration, many parts of the nervous system work together, so that a person can interact with the environment effectively and experience appropriate satisfaction.

Children who exhibit tactile defensiveness may

  • have difficulty interpreting sensory information and responding appropriately to it
  • withdraw from tactile experiences
  • have difficulty maintaining on task behaviour because they are so conscious of what is touching them or about to
  • throw anything placed within reach
  • react strongly to some stimuli
  • have better days i.e. the condition can fluctuate
  • have areas of their bodies that are particularly sensitive – the hands especially palms, soles of feet, mouth and tongue are usually most sensitive areas; this is why they will use fingertips to explore new materials
  • crave certain sensations that they find calming e.g. vibration, firm pressure, rocking etc
  • be tactile defensive
  • have difficulty with motor planning and knowing the position of their body in space
  • have poor balance and find it very difficult if they are required to take their feet off the floor

Assessments

  • Observation
  • Discussion with parents and teachers
  • Sensory Integration Inventory
  • Assessments found in “Sensory Stimulation Theory and Activity Ideas” by Susan Fowler
  • Standardised Assessment

Ideas for a Sensory Program

Firm Massage

  • Explain to the child what you are going to do.
  • Begin by rubbing the child’s back then gradually move down the arm and into the hand.
  • Talk to the child and tell them what part of their arm you are rubbing.
  • Repeat for the other arm starting at the shoulder.

Joint Approximation

  • Place your thumb in the child’s palm and encircle their wrist with your fingers. Place your other hand under their elbow, with their arm extended give ten to twenty firm pushes up through the arm towards the shoulder. This stimulates the nerve receptors in the joints and muscles, which react to stretch and compression. The receptors send messages to the brain, which reinforce the position of the child’s arm in relation to his head.

Vibration

  • Vibration also encourages messages to be sent to the brain via the receptors in the skin and muscles. It helps increase the child’s tolerance to tactile sensation and can be an alerting sensation.
  • Vibration should not be used of extended periods of time as the body becomes use to the sensation and so it is less effective.
  • It is more effective to provide the stimulation stop for a short time and them start again.
  • Frequency

    • The literature suggest that the massage program be undertaken at least 3 times a day for the first two weeks.
    • The program can be given to parents to use at home e.g. before mealtime
    • If tactile defensiveness is the child’s only problem then the more frequently the massage program is performed the quicker the results will be seen.

Activity Suggestions

Tactile

  • Use brushes that provide different types of light touch, e.g. paint brushes, scrub brushes, bathroom brushes
  • Use other equipment that provides pressure e.g. paint rolls, elastic bands, rolling child inside a sheet
  • Cover equipment with interesting textures: carpets, towels, velvet
  • Have activities that provide tactile input on the child’s entire body: container with balls or Styrofoam, sand, big soft pillows
  • When inside a container full of balls, encourage the child to move or change position by asking him to find a hidden object
  • Provide activities that encourage discrimination: objects inside bin full of beans, sand or Styrofoam
  • Use shaving cream, powder, finger paint, lotion, soap, gel and encourage fine motor coordination and tactile discrimination, by dipping fingers into substance and “writing” on the skin.
  • Pretend shaving face or applying clown make up and encourage the child to apply tactile input on his/her face.
  • Encourage localization of tactile input, use stickers on arms or legs and encourage the child to find them.
  • Have a box with the different texture that are easy to pull out and incorporate into other activities. Include vibrators, feathers and some of the materials mentioned above
  • Use tactile games e.g. tactile dominoes, noughts and crosses, tactile puzzles
  • Provide play doh that offers different textures and resistance e.g. homemade silly putty, therapy putty, slime
  • Play games which lead children through different textures e.g. small tunnel made with carpeted equipment
  • Use battery operated toothbrush, regular toothbrushes, different food consistencies etc. to provide tactile input in the oral area.

Proprioceptive/Kinaesthetic

  • Use weights during the session. Have a weighted jacket, bean bags of different weights
  • Use the opportunity to move the equipment, and ask the child to help pushing, pulling and lifting
  • Push and pull games: push therapist while she is sitting on scooter, tug of war
  • When riding a piece of equipment, provide uneven vestibular stimulation e.g. jerky, bumpy road so the child needs to contract
  • Have equipment the child needs to lean on or climb e.g. steep soft ramp against wall

Motor Planning

  • Simple motor activities e.g. pumping swing, walking up a ramp, climbing, getting in and out of equipment, jumping over a line
  • Whole body activities: rolling up a ramp, moving through boxes, obstacle course made with equipment
  • Games: Twister, follow a leader, find the treasure, following a map , follow instructions, Simon says, soccer, bumper cars,
  • Oral praxis activities: blowing bubbles, blowing cotton balls across a table, whizzles

Other Activities for the Sensory Program

  • Tubs of materials e.g. corn flakes, rice, noodles, wheat, brushes, balls of different shapes and sizes, flour, shredded paper, pine needles, feathers, autumn leaves, potpourri
  • cooking
  • painting balloons with paint or shaving cream
  • finger paint
  • painting with yoghurt
  • custard, warm and cold
  • foot spa
  • powder puff on skin
  • foot painting
  • putting feet into sensory tubs
  • grooming activities
  • sensory places e.g. Lilli Neilson Little Rooms
  • leaf fights throwing autumn leaves around
  • aromatherapy candles, oils
  • ball pit
  • texture mats for tray tops
  • bird seed bells
  • hair gel
  • corn flour and water

Things to be Aware of

  • avoid light touch as this can be aversive to the child
  • make the environment predictable and routine
  • instructions should be brief, simple and clear
  • explain what is expected of the child in each step of the activity
  • do not assume the child can imitate
  • prepare the child for changes in advance and introduce change slowly
  • be consistent
  • seat the child well with feet flat on the he floor, bottom well back on the chair and their back resting against the chair back
  • firm pressure can be very calming
  • epilepsy, medication, illness, anxiety, even hunger can make the defensive reactions more severe or cause progress to be lost
  • avoid using the vibrator on the head especially behind the ear

With thanks to Linda Anderson, Occupational Therapist, Diamond Valley SDS

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