Friday, October 18, 2013

Sensory Integration: The Vestibular System and Handwriting Issues

The vestibular system, located in the inner ear, is made up of three major semicircular canals which are responsible for our sense of balance, spatial orientation, and our sense of movement. Fluid, located in the three canals, orients our head in space and provides feedback during movement.

When the vestibular system fails to process sensory information correctly, other senses such as auditory, visual, and proprioceptive integration can be skewed.


Children with vestibular processing issues exhibit certain characteristics that affect their ability to play and learn in their environment. While working in a center based school.  I worked with a young 3 year old boy we'll call John. Along with other developmental issues, John presented with a hyperesponsive vestibular system.

John's reactions to sensory stimulation:
  • Tolerates up and down movements while bouncing on a peanut therapy ball.
  • Side to side movements on the ball upset John. 
  • While on the net swing, John was able to swing forward and backward slowly for a short time  but could not tolerate spinning or swinging in any other direction. 
  • While interacting with his environment, John would keep his head straight without turning or tilting out of midline. 
  • Instead of turning his head, he would move his entire body to face something he was interested in or to look at me during therapy. 
  • Very limited eye movements, cannot isolate eye movements and head movements.
  • Moderately defensive to tactile stimulation-reluctant to touch beans and rice, would touch lightly with finger tips only.
  • Will cross midline to participate in activities.
  • VERY brief visual attention to task.
John resists vestibular input, he displays issues with fine motor coordination, postural control such as trunk and shoulder stability, attention, and visual motor control.

These issues will significantly affect John's ability to develop the skills necessary for handwriting in the future.

Components of handwriting:
-visual motor skills
-visual perception skills
-fine motor skills
-trunk control and shoulder stability

When reading through the research, it is clear that we know a lot about the affects of vestibular difficulties and we know what is required for handwriting. However, there has yet to be a study to link children with vestibular processing issues to their ability to learn hand writing. As a profession, we need more research in many areas and we stand to benefit from understanding these effects.

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