Proprioception is a sense that tells us about the position of our body parts in relation to each other, other individuals and the environment. Proprioception also communicates information about how our body parts are moving. For example, how much force our muscles need to use for different activities, such as holding a paper cup as opposed to a plastic cup. 

Sensory processing for proprioception is the way our brains process information from our muscles and joints about the position of our bodies in space. Each child receives and processes proprioceptive information in different ways. Some children are hyposensitive and need constant input to feel where their body is in space or in relation to others. On the contrary, some children are hypersensitive to proprioception and may become overwhelmed. If a child has difficulties with receiving or processing this information, they may have trouble with body awareness or planning their body movements.

There are the four patterns of sensory processing: low registration, sensation seeking, sensory sensitive and sensation avoiding. 

Low registration: A child with low registration does not recognize or process all of the incoming sensory information, and they do not compensate by trying to gain more sensory input to meet their needs. They may seem uninterested, and inattentive to their surroundings.  

Sensation seeking: A child classified as sensation seeking does not recognize or process all of the incoming sensory information, but contrary to low registration, they actively try to gain this sensory input to meet their needs. They may be hyperactive, touch others often or engage in unsafe activities like jumping from heights. 

Sensory sensitive: A child classified as sensory sensitive feels overwhelmed by sensory information, but they do not actively try to avoid the overstimulation, instead they may just display frustration. They may be easily distracted, and irritable, cautious, and uncomfortable in loud or bright environments. 

Sensation avoiding: A child that is sensation avoiding feels overwhelmed by sensory information and will actively avoid the stimulation. They may run away from loud, busy environments, cover their ears when overstimulated by noise, or wear gloves to avoid touching certain materials such as paint. 

Hyposensitivity 

A child who has low registration or is sensation seeking for proprioception may require input to their muscles and joints to feel calm and to understand where their bodies are in space. 

If a child has a low registration pattern for proprioception they may: 

• Have difficulty navigating rooms and avoiding objects when moving around.
• Appear floppy and have difficulty with balance. They may have difficulties sitting upright in a chair or on the floor and keeping their head upright. The child may lean against people, furniture and walls for support.
• Stumble and fall more than other children their age.
• Have difficulty with some activities that require balance. For example, riding a bike.
• Have difficulty with activities that require a change in body positioning. For example, playing sports.
• Sit in a “W” stance on the floor.
• Hold onto items with a weak grasp and drop objects easily. For example, they may be unable to hold a marker tight enough to use it and they may often drop their toys.
• Have a limited sense of personal space. They may unknowingly stand too close to other individuals or objects.

If a child has a sensation seeking pattern for proprioception they may:

• Push or play roughly with other children or objects. For example, they may purposely bump or run into people or objects such as walls, tables and doorframes.
• Press too hard on paper when writing which may result in tears or holes in the paper. 
• Bang or hit their body parts. For example, they may hit their head with their hands, bang their hands together or bang their head on a wall.
• Prefer tight clothing. Tight clothing can give a large amount of proprioceptive input.
• Constantly be in motion. For example, they may constantly flap their hands and fidget and not be able to sit still. This may impact their ability to focus in class, as they may constantly be trying to gain proprioceptive input through movement instead of listening. 
• Prefer to run, jump or stomp instead of walking. They may walk very loudly, by stomping their feet on the ground.
• Walk on their tip toes.

Case example:

Ameer is a 5-year-old boy. You notice that Ameer gets tired very easily while standing or sitting for long periods of time. He tends to lean on tables and walls to support himself. Ameer’s friends enjoy playing games such as hopscotch and soccer. Ameer has trouble kicking a ball and balancing on one foot and consequently does not participate in these games with his friends. You try to practice some kicking and balancing skills with him at home, but you find that he just doesn’t know what to do with his body and often falls. 

Ameer has a low registration pattern for proprioceptive input. He has trouble supporting his weight while sitting and standing. He also has trouble with activities that use balance such as standing on one foot or kicking a ball.  

For children who are hyposensitive to proprioceptive information, try to provide them with activities that use their muscles and joints to calm the child and increase their responsiveness to sensory input.

Strategies to assist a child with hyposensitivity for proprioception:

• Incorporate activities that put weight on the muscles and joints such as crawling or push-ups. For example, games where the child needs to copy different walks such as a crab or wheelbarrow walks.
• Incorporate activities where the child does heavy lifting. For example, at cleanup time, you can ask the child to pick up a stack of books or bins of toys.
• Provide activities that use a lot of energy, such as running or jumping on a trampoline. Create obstacle courses for the child or have them bounce on an exercise ball. 
• Place a piece of TheraBand (large, stretchy elastic) on the legs of their chair and allow for them to kick the band while sitting. 
• Position furniture around the edge of the room to minimize the risk of falling and make navigation simpler.
• Provide the child with non-slip shoes to prevent falls. 
• Use deep pressure by giving the child hugs or a weighted/heavy blanket. This can be calming for children as it will give them their required proprioceptive input and calm their nervous system.
• Use fine motor activities in their daily routine. For example, encourage them to draw, build, or play with a fidget spinner. 
• Use an “arm’s length rule” or hula hoop to help judge personal space and reinforce them when necessary to maintain this practice. 

Hypersensitivity 

Children who are sensory sensitive or sensory avoiding for proprioception may be very sensitive to active movement and interacting with others. They may appear uncoordinated or be misjudged as lazy. 

If a child has a sensory sensitive pattern for proprioception they may: 

• Hold their bodies in odd positions or appear lethargic (tired and slow movements). They may become tired easily after standing for long periods of time.
• Appear stiff while walking or standing and walk with their legs wide apart.
• Have difficulty moving small objects around in their hand such as buttons or shoelaces. They may have difficulty turning doorknobs or opening/closing containers.
• Move their whole body, not just their head to look at something.
• Appear uncoordinated in their movements. For example, while catching a ball.
• Be hypersensitive to pain. For example, they may complain that their finger hurts after touching a pencil. 

If a child has a sensory avoiding pattern for proprioception they may: 

• Avoid wearing tight clothing.
• Avoid and refuse to participate in activities that require physical effort such as riding a bike, climbing or running.
• Be extremely sensitive to touch and avoid situations where others may touch them. This is due to proprioceptive input received by touch. These children may strongly dislike hugs and other signs of affection. Tactile and proprioceptive processing are closely linked.

Case example:

Alice is a 4-year-old girl in kindergarten. You notice that Alice tends to remain in the same area and avoids participating in activities with the other children. She gets tired very easily, even while standing. She often refuses to participate in any activities that require significant amounts of energy. She is also very selective with clothing. When her parents dress her in tight clothing for the day, she complains that she feels uncomfortable and will often take her clothes off. Alice has a sensory avoiding pattern for proprioception. 

For children that are hypersensitive to proprioceptive stimuli, strategies can be used to help them build awareness of their movements and body positions. 

Strategies to assist a child with hypersensitivity for proprioceptive processing:

• Use calming strategies frequently. For example, have them tightly squeeze an object such as playdough or a squeezy ball and then relax. 
• Incorporate activities that focus on fine motor skills such as beading, stacking, colouring or building with Lego.
• Slowly desensitize the child to varying body positions within their comfort zone. For example, you can practice animal walks with increasing difficulty. Start by walking like a bear and progress to walking like a crab on their hands and feet. This allows for the child to focus on their body movements in a controlled environment.
• Incorporate yoga stretches to move the muscles and joints in a relaxing way.
• Play games that increase body awareness, such as “Head and Shoulders” which can help to calm the nervous system and increase awareness of body parts. 
• Provide the child with a quiet, calm area to go to if they feel overwhelmed.