Bridging Sensory and Motor Components in Pediatric Therapy

Dr. Ushma Goradia discussed the critical importance of bridging sensory and motor components in pediatric physical therapy, emphasizing the pyramid of learning framework developed by Kathleen Taylor and a special educator. This framework identifies eight sensory systems as the foundation, with particular focus on the “power senses” of vestibular, proprioception, tactile, and visual perception, which work together to influence motor output, behavior, and cognitive responses in children.

The integration of sensory and motor components requires a holistic treatment approach where therapeutic activities like prone weight-bearing, trunk rotation, and gait training provide dual benefits by addressing both motor skills and vestibular function simultaneously. Physiotherapists must recognize that movement is crucial for development across multiple domains and should consider sensory integration when treating children with neuromotor impairments, distinguishing between sensory issues that show observable physiological responses and purely behavioral problems.

Parental involvement, particularly from mothers, emerges as a critical success factor in pediatric therapy, helping to build trust and comfort while addressing potential child discomfort due to touch hypersensitivity. Parents need education about therapeutic processes to support their children effectively throughout treatment. Clinicians should watch for specific red flags in conditions like hemiplegia and cerebral palsy, including asymmetrical posture, balance issues, body awareness problems, vestibular and proprioceptive concerns, and tactile defensiveness.

Treatment strategies for sensory processing issues involve gradual exposure to different textures, emphasis on movement therapy, systematic approaches to tactile defensiveness, and holistic methods that combine sensory and motor elements. The fundamental clinical insight is that physiotherapists must understand how sensory processing impacts motor development, as this connection is essential for creating more effective pediatric interventions that address the whole child rather than isolated symptoms -- Dr. KD Mallikarjuna, PT

Ushma ma'am, your emphasis on adding sensory integration gives the exact perspective to paediatric Physiotherapy needed. Humans are sensory beings. So taking into account all their sensory experiences and understanding their implications on therapy was well explained -- Dr. Vidhya Venkatesh, PT

Dilemma of the Dominant hand

The right hand holds a significant importance in Indian culture. Not only the right hand, but also the right foot. Giving money to a vendor or an autodriver, accepting ‘prasad’ at a temple, to making the first step in a new home are all done with the right side of the body. Some regions of the country call the right hand as ‘seedha haath’ meaning correct side and the left hand as the ‘ooltaa haath’ or the wrong side.

Being a physical therapist and having lived in the USA, the right hand being sacred and the left believed as unholy truly baffles me. The USA has a much larger number of people who are left dominant. In contrast, in urban areas of India, the left dominant child catches negative attention and is perceived as something wrong. My son is left-handed; he writes and eats with his left hand. During his preschool years, many people asked me to correct his dominance! But I taught my son to remain cool!!

A 7 years old girl was brought to my clinic due to behavioral and anger issues. (A diagnosis of autism was doubted by parents and past professionals at the time). She was also emotionally distraught in that she would cry without any reason, hit another child, and had poor sitting tolerance. Careful history revealed that parents were unsure about their daughter’s dominant hand. The child’s grandmother insisted that she use her right hand for eating, and hence the parents tried to insist on the same. Besides the sensory-motor therapy that was indicated for this little girl, my first priority was to educate parents on not forcing use of a particular hand and to let the child just ‘be’. In a few weeks, the child started calming down, following verbal instructions fairly well, and more importantly participating in fine motor skills and using the left hand for writing. Therefore, I strongly urge parents to not force your child into using the right hand only. 

I have had several children with delayed speech and poor fine motor abilities, who were forced to hold a crayon and eat their food using the right hand because the grandmother said so. 

Beginning at age 6 -12 months, a child uses 2 hands together and gradually shows preference for either hand around age 3-4 years. Dominance is generally established by 6 years of age. 

The other important point for parents to realize that we perform majority of tasks such as buttoning and tying shoelaces using both hands together in various ways (bilateral integration). Tasks such as opening or closing a bottle requires that you hold the bottle with 1 hand (non-dominant) and open or close with the other  hand which is the dominant one. You hold the paper with non-dominant hand and cut using the dominant one. So the non-dominant hand becomes the helping hand that provides stability, while the dominant hand is the working hand that performs the task. As you go through your day, try to consciously think when and how do you use your hands. 

I am trying to emphasize that development of both hands is crucial as the development of a child progresses from the first year of life to school years. As parents, offer objects to your young child somewhere in the center of their space and let them pick it up with any hand. Observe during many occassions as to which hand the child advances to pick up or pull something first. But do not force or insist on using the right hand only.