What is Arousal?

A term that sensory integration therapists tend to use a lot is "arousal." What does it mean when we're talking about a
child, and why is it important?
Arousal is your level of alertness at any given moment. When you're lying in a hammock which is gently, slowly
swaying back and forth in a warm, sweet breeze, and the birds are chirping, you can hear the sound of the surf in the
background, and you're under the shade of a tree, you're very relaxed. Your arousal level is quite low, and you're
about to drift off into sleep.
Now imagine yourself sitting in the first car of a roller coaster, you're at the top of the highest curve, about to head
almost directly vertically downward. Very high arousal there!
Then there's everything in between. This is when we are engaged in an activity and still peripherally aware of what is
going on around us so that we can respond to it when necessary. For instance, think of sitting in the park, chatting
with a friend while watching your children play. You can easily flip your attention back and forth as required.
{Archie and Veronica fans: Jughead: low arousal. Laissez - faire attitude towards life, motivated by food and not much
else. Happy to be left alone, no particular interest in the opposite sex or in achievement.
Moose: High arousal. Always taking everything the wrong way, spoiling for a fight. Too wound up to do well in class,
but captain of the football team, where he gets to throw his weight around. Everyone walks around on eggshells when
he's in the room, afraid to offend him and risk an out of control reaction. His girlfriend's main function is to keep him
on an even keel.}
Our arousal levels dictate how able we are to pay attention and respond appropriately to what is going on around us.
For most of us, our senses and internal chemistry work together seamlessly to maintain correct levels of alertness
and arousal. When someone familiar touches us, our nervous systems don't interpret it as a threat. When the phone
rings, our hearts don't start to race. When the family cat jumps unexpectedly on our laps, we don't scream and shoot
up from our chairs.
And when we are sitting still, for example at a movie, we can stay alert enough to attend to what's happening on the
screen. When we are at work, sitting in front of a computer all day in artificial light, we can {mostly} stay focused on
the task at hand, be alert and present at meetings, and accomplish everything we are supposed to do.
All these levels of alertness are important because they are necessary for survival. When danger is imminent, high
arousal and hyper vigilance are what allow us to defend ourselves successfully against predators. Low arousal is
what allows us to transition into sleep so that we can rest and repair our bodies.
We unconsciously do little subtle things all the time, like stretching, chewing gum, and doodling, to adjust our arousal
levels so that we stay in synch with what is happening around us.
Some of what we do, like drinking coffee, is alerting, and some things are self soothing, like twirling hair. Some
things can be either, like chewing gum, depending on the circumstances and how a particular nervous system takes it
in and processes the sensory information it provides.
Many of the children whom we see in occupational therapy for sensory issues tend to live at one extreme or another,
functioning either too low or too high most of the time. Any attempts to increase arousal will cause them to shoot
straight into high gear. They don't seem to have a lot of middle range available to them, which is what is required for
most of the demands of modern urban life.
When a child has arousal difficulties, there may be many reasons why. One is chemical. The body's ability to
manufacture and utilize neurotransmitters, which transmit information and facilitate communication between brain
cells, is compromised. These chemicals are responsible for regulating, among other things, our attention, learning,
memory, alertness, mood, and motivation.
Another reason that a child may have difficulty keeping his arousal levels up has to do with the body's ability maintain
its upright stature against gravity. Many of the children I treat have low muscle tone. Their vestibular nerves, which
talk to the extensor muscles, need a lot more stimulation before they will fire and activate the extensor system, so
their extensor tone remains low unless they can move intensely, which they can't do when they're being expected to
sit still. This means that they are struggling just to stay upright, which is very tiring. {These are the children who are
completely frenetic the minute they get a chance to move, but as soon as they sit, they're lying all over their desks or

falling out of their chairs.} The vestibular nerve also talks directly to the part of the brain responsible for managing
our state of alertness and arousal, so if it's not activated properly, it's not doing its job of regulating the arousal
centers in the brain.
If the child's senses are not taking in and interpreting things appropriately, he may be on high alert and stuck in a
state of chronic fight or flight.
Have you ever been in such a stressful situation, like a horrible medical procedure or receiving terrible, life altering
news, that you just left your body for awhile? A child who is sensitive to noise, light, or chaos, and has a hard time
sitting up, is going to spend a lot of his school day being tuned out as one way of coping with things that are hard for
him to deal with. These are the children who fall through the cracks, because they're not acting out. They're quiet
about the fact that they're not present and unable to learn.
The paradoxical thing about ADHD is that since the children who have this disorder have a hard time keeping still, we
think that their arousal levels are too high. The opposite is generally true; the child is coping with arousal levels that
are chronically too low to allow him to sit without his nervous system deactivating. A child who is perpetually on the
go is a child who is doing whatever necessary, trying to move, mostly -- to activate his nervous system and increase
his arousal. That's why stimulating drugs have such a powerful effect on attentional issues. They increase arousal,
and so they raise the brain's ability to attend.
One problem that children with arousal issues often have is the type of attention that is available to them. They are
either highly distractible and can't focus, or they become so overly focused on something that the entire world fades
away and it's difficult to rouse them out of that state. Again, this is problematic for functioning in school. Something
in the middle of those two extremes is what is required in a classroom. The child should be able to attend to the
lesson, but is not so lost to everything else around him that he is able to shift focus easily. He needs to be able to
concentrate on the task at hand while at the same time attend to what is going on around him. For instance if he is
concentrating on his work and the teacher makes an announcement, he should be able to look up briefly, take it in,
and go back to what he is doing without having lost his train of thought or spending a lot of time spinning his wheels
before he is able to return to the task at hand.
Helping the child learn to manage his body, and thus his arousal state, to live most of the time in that in-between
range is one of the goals of occupational therapy. This is what we call the "just right state for learning."
There is a wonderful program developed by occupational therapists called "How Does Your Engine Run?" that talks
about this in great detail. The authors liken the body to a car engine. Where does yours tend to idle, low or high? If
you think about the unconscious strategies you employ to help yourself during the day, you can get a sense of where
you fall. People who mostly do things that are self soothing in nature tend to idle too high, while people who do things
that are mostly alerting tend to idle too low. We all do a mix of these things, though, based on what we need at the
moment.
Sensory integration therapy assists the child in maintaining a better arousal state in a variety of ways. We can
improve the child's neurochemistry by doing things in the clinic that will increase the manufacture of dopamine and
seratonin, the "feel good" neurotransmitters. We can strengthen up his extensor muscles, integrate postural reflexes,
and improve the child's balance, which will help him sit for longer periods. We help the body learn to filter out
extraneous information that is distracting to the child, by changing the way the inner ear and vestibular nerve process
information, or by desensitizing the skin. We help the child become a better breather, so his oxygen levels are
improved and anxiety is diminished. We can teach strategies for managing low arousal that the child can employ
discreetly when needed. We can educate parents and teachers to recognize when the child is faltering and give him
an opportunity to rev up his engine before he tunes out or acts out.
Building more movement and fresh air into the child's day will certainly help him maintain his arousal at appropriate
levels. So will making sure that he gets enough sleep. Hydration is important, as is a diet low in processed food and
rich in protein. Breathing well is critical. If your child tends to be a shallow breather, his sympathetic nervous system
{which is responsible for regulating the fight or flight response} will be too responsive, and make his heart race and
flood his body with adrenaline at inappropriate times.
In another post I'll talk about some strategies I use to help children change their arousal levels during clinic time and
how they can begin to discreetly manage their arousal during class time.
Posted by Loren Shlaes at 8:38 AM

Go for more info

http://pediatricot.blogspot.com/2010/05/what-is-arousal.html

When a Child Can't Sit Still

One of the most common reasons why a child is initially referred for occupational therapy is that he can't sit still in
class. When a child simply can't stay put, it's vitally important for the grown ups to play detective and figure out why.
Children who can't sit still are children who are driven to move. Before we try to force them to be still, we need to find
out what is behind their restlessness so that we can begin to help them, either by fixing the problem that is driving the
behavior or by providing them with safe, appropriate opportunities to supply them with the movement experiences
they need.

You can get more help here.

Many of the children I treat can't sit still simply because they need to move their bodies. In big cities like Manhattan,
children don't have the opportunity to run around freely, and their overscheduled parents don't make the time to take
them to the park. It often takes much convincing on my part that regular unstructured time spent out of doors, either
at a park, beach, or playground, is an essential priority for children, and that constantly strapping children into
strollers, car seats, high chairs, play pens, and anything else that prevents them from moving and exploring freely is
impeding their neurological and cognitive development.
I often go to schools for observations and leave with the feeling that the adults who are responsible for planning the
children's days don't always schedule activities with a realistic view of what is possible and what is not.
I recently observed a second grade classroom in which the children were required to sit quietly for 90 minutes and
write without a break. After about 30 minutes had gone by, the teacher was expending a lot of energy trying to get
her class to stay seated and focused. Ninety minutes for a group of seven year olds is a long, long time to sit still.
Another time I observed a classroom of six year olds being given a highly structured, rather uninteresting craft
activity to do. After about fifteen minutes, the teacher was working mighty hard to maintain decorum. The majority of
the children had long since finished their task, and were more than ready to move on, but they were required to sit
there for ten more minutes. The children got more and more restive and bored, and the teacher became sterner and
sterner as she tried to force the children to sit. It would have been much less toxic to give them a second task or to
give everyone a one minute structured movement break.
Something else I frequently observe is that circle time tends to go on and on and on. After about five or ten minutes
of sitting on the floor with nothing to do, the children are clearly restless and bored. The teacher is unable to do any
teaching at that point. All of her energy is directed towards trying to trying to convince them to sit still, when they are
obviously dying to get up and move their bodies.
When children don't have good, solid strength in their trunks due to low muscle tone, sitting in a chair is a struggle. If
a child is constantly rocking in his chair, wrapping his legs around the furniture, leaning his upper body against his
desk, or falling out of his chair during class, he does not have the strength to support himself, and is trying to
manufacture it by using the furniture.
Children who have a clinical condition known as auditory defensiveness, which is oversensitivity to noise, have a
hard time in school because they can't tolerate the noise levels. Their ears don't filter and dampen noise effectively,
and the sound waves from the other children's high pitched voices build up in their eardrums and can be quite painful.
A young child who moves around and around the periphery of a noisy classroom, can't settle down or demonstrate
any goal oriented behaviors during unstructured play or work time, is having difficulty coping with the sound levels.

If the child's eyes are sensitive to light, he is probably quite uncomfortable, especially if he is in an interior classroom
with fluorescent lighting. I see this quite often in New York: children in brightly lit classrooms painted a glaring, flat
white, with no natural lighting or ventilation. After a few minutes, I'm feeling sweaty and dull headed, and dying to get
out of there myself.
Tactile defensiveness, a condition where the skin is overly sensitive, can make it very difficult for a child to sit still
when his socks are bothering him, his underwear is bothering him, the tag in his shirt is bothering him, and other
children are sitting too close to him.
A child who is restless and reluctant to do table top tasks like writing, puzzles, coloring, or cutting may have weak
eye muscles. He may have quite a bit of difficulty controlling them to do things like copy from the board or pulling in
them in close enough to read or write. This is painful and uncomfortable and makes it extra challenging to attend to
close work. If a child squirms in his chair, rubs his eyes, and is resistant to close work, he may have trouble seeing
what he's doing.
Children who have a hard time sitting are often poor, shallow breathers. Chronic shallow breathing causes anxiety
by flooding the system with adrenaline and forcing the child to exist in a chronic low level fight or flight mode. Don't
believe me? Try panting shallowly for a minute, and notice the beating of your heart and the restlessness in the rest
of your body. The resulting agitation compels the body to get up and move, partly to survey the environment for
predators, and partly to discharge the large amounts of nervous energy that the floods of adrenaline cause in the
body.
A child who constantly seeks movement, spinning his body while standing in line, twirling around every light post he
passes, jumping on every bench and curb, very likely has an under responsive vestibular system. The vestibular
nerve is responsible for our levels of alertness and uprightness based in part on information it receives as the child's
body moves. When it isn't working right, the child is driven to move more frequently and intensely to make up for the
lack of nerve's ability to respond. His arousal levels are too low, and he's doing whatever he can instinctively do in
order to bring them to the level where he can focus and attend.
If a child has a very hard time falling asleep, and doesn't sleep well, his ability to sit and focus is greatly diminished. If
he is a seriously picky eater and subsists on junk food, he won't have the fuel necessary to help him keep centered
and focused. He may be suffering from gut problems, like undetected food allergies or yeast.
Posted by Loren Shlaes at 5:24 AM
4 comments:

reCREATEdonna said...
Thank you for this informative post. My daughter's teacher keeps their kindergarten class in circle for far
too long. She is convinced my daughter is ADHD...I completely disagree, as her behavior at home
doesn't reflect it. After reading this I think she possibly has auditory issues. Her hands are quick to cover
her ears and she constantly complians it is too loud in her class.
Thu Mar 17, 11:49:00 AM MST

Anonymous said...
Hi There, we have just been told that our son (3 years 10 months) does not stay still in class and is
always running around. The teacher has also indicated that he is very itelligent and can do activities very
easily. He is very active at home as my husband takes him out to the Park for an hour. At home as well

we cant get him to sit in one place and focus on sitting activity for more than 10 mins (like painting or
colouring or drawing, etc). Please do give me some pointers on how I may help my son. Thank you
Wed Jul 13, 01:31:00 AM MST

Anonymous said...
Thanks for the info! I can probably narrow it down to tactile defensiveness or poor shallow breathing for
my daughter. Both of those things fit my daughter. She said that she can't sit still cause she feels like
things are crawling on her so probably sensitive skin. I knew there was a reason for it but couldn't pin
point it. Very informative!
Tue Aug 09, 10:33:00 AM MST

Anonymous said...
My son is in 3rd grade and I was told today that it is very hard for him to sit still. I was told he is good for
about 15 minutes and that's about it. This has been brought to our attention since kindergargen but I've
witnessed him at home reading a book for a good 20 minutes.
Fri Apr 13, 03:31:00 PM MST

Twenty Four Reasons Why a Child Can't Sit Still

1. The child does not get enough exercise. Children require huge amounts of movement,
preferably outside, every single day. Movement and exercise is as essential as food for children
in order to stay organized, develop and mature their nervous systems, improve their
coordination, strength and motor planning, and to be healthy! So many of us live in cities now
and have just forgotten how vital it is for a child's health and development to go outside and
play. Bring the child to the playground for half an hour, or whatever you can manage, before
school starts, and let him play on the equipment, or have a game of touch football, statues, or
tag. If this is truly not possible, buy a trampoline or have him play an exercise game on his Wii.
And if his teacher takes away recess as a punishment, you must insist that she find another
way to help him manage his behavior. He is acting out because he needs to move more, not
less!
2. The child has poor postural stability, low muscle tone, and a weak trunk and spine. This
makes sitting physically exhausting, uncomfortable and painful. Circle time is especially
grueling since sitting unsupported is such hard work.
3. The child's chair/desk at school does not fit. I can't tell you how many times I've walked into
classrooms and seen children whose desks literally come up to their necks while their chairs are
so high that their feet are dangling on the floor. Could you sit and do your work like that?
4. The child is tactile defensive and his clothing bothers him. Or he is sitting in too close
proximity to others and his alarm system is clanging away, instructing him to flee.

5. The child is sitting with his back exposed and people are walking behind him, again setting off
alarm bells. He should be sitting with his back to the wall, preferably in a corner.
6. The child is auditory defensive and his ears hurt. A child who can manage in a quiet, low
stimulation atmosphere but can't control his behavior in a noisy environment is probably
suffering mightily in all of the chaos. Or he may not understand the teacher's instructions if she
is talking over many chattering voices. A good clue about auditory defensiveness: a child who
runs around the perimeter of the classroom, acts out, and can't engage in any goal oriented
behavior when the room is noisy.
7. The child is a poor breather. Shallow breathing sets up the body for fight or flight, and it's
very hard to sit still when every cell in your body is urging you to get up and check for predators.

8.The child has undetected visual problems. It's exhausting and frustrating to try to attend to
close work if you can't see what you're doing. His eyes may be so unstable that he is seeing
double, or seeing floaters, or visual images are shimmering. Or the light in his classroom might
be bothering him. In Manhattan many children are expected to sit all day long in inside
classrooms with no natural light or outside ventilation. I get headaches just thinking about it.
9. The child's inner ear is not functioning well. The inner ear tells us how alert/upright or at
ease we should be in response to movement. {Roller coaster: very alert and upright! Hammock:
very drowsy and relaxed.} If the child's inner ear is not registering movement very well, it's not
telling the body to sit up and attend. The child is driven to move in order to provide the intensity
he needs to stay upright and aroused.
10. The child's nervous system has not matured along with his chronological age. This means
that primitive movement patterns, which should be dormant, are instead active and present,
dominating the way the child responds to his environment. Primitive reflex patterns lower the
child's muscle tone automatically when he turns his head and body in certain positions. This
interferes with, among many other things, his balance, equilibrium, and vision. Or things that
would not even register to us, like a dog barking in the distance, can throw the child's system
into a startle, making it hard for him to stay grounded.
11. The child's metabolic processes are not functioning well. Does the child have undetected
food allergies, difficulty sleeping, leaky gut syndrome, candida, heartburn? Is the child
constipated? Is he subsisting on a diet of refined carbs, sweets, and processed food, and so is
inadequately nourished? Children need lots of high quality protein and complex carbs to fuel
their bodies for learning and attention.
12. The child does not get enough sleep, or the sleep that he does get is not resting him
properly. Can he transition well to bedtime? Does he get ten or eleven hours every night? Is
there good ventilation in his bedroom? Are the lights off in his room?

13. The child may be too young or too immature to be in a classroom. In my clinical opinion,
most three year old boys would be much better off waiting another year or two before starting
school. They simply don't have the emotional or neurological maturity to be handle all of the
rules and expectations of the classroom.
14. The expectations of the classroom are too much, and the child feels lost, inadequate, and
confused. Four year olds should not be expected to learn to write. They simply don't have the
internal stability, attention span, or visual discrimination required for such high level work yet.
Let them wait until they are developmentally ready. One of the very best schools in Manhattan,
the Rudolph Steiner School, does not start the children writing until they are seven. Their
children have beautiful handwriting and are exceptional scholars.
15. The child is hungry, thirsty, tired, or has to go to the bathroom.
16. The child is over scheduled. Children need lots of down time to recharge their batteries and
connect with their creativity. A child who has two or three activities every day after school and
on the weekend is expected to be "on" way too much. Cut back to just an activity or two a week
and use the time instead to take him outside to play.
17. The child is spending too much time in front of screens. This is especially true if the child
can't transition well to sleep after spending time on a computer. Is the child watching or playing
games with excessively violent content? Strictly limit time spent in front of televisions and
computers and use the time instead for creative pursuits {crafts, painting, writing stories, playing
a musical instrument, dancing, etc.}. Turn off the computer a minimum of two hours before
bedtime, or, better yet, allow the child just an hour or two on the weekend. It's just not realistic
to allow a child to spend all day Saturday and Sunday watching TV, playing video games, and
eating frozen waffles, and then expect him to be alert, relaxed, grounded, able to sit still for
hours at a time, and ready to learn on Monday. Don't you feel more clearheaded and able to
manage at work after you've taken a brisk walk?
18. His parents are going through a hard time, or don't get along. Strife at home will upset any
child's equilibrium. If parents are stressed out, rarely home, argue a lot, or are going through
their own issues, it will show up in the child's behavior.
19. The child's parents don't teach him to respond to adult redirection, so he thinks that obeying
grownups is optional.

20. The adults who care for the child spend inordinate amounts of time on their electronic
devices during their time together, or otherwise ignore him.
21. The child is expected to sit still for too long. I have so very often observed classrooms
where very young children were expected to sit for long periods without getting up, being given

a drink of water, or anything to eat. And if the child has endured a long bus ride to school, he is
at a disadvantage before he even walks into the building.
22. The child is bored. Many reasons why this could be -- the grownups don't have a realistic
idea about the child's attention span, the activity is too difficult or too easy, or the child expects
everything to be like television or the computer: loud, lots of chatter and images quickly passing
by, lots of novelty.
23. The child has sustained structural damage due to a fall or other accident, poor handling, or
birth trauma which affects cranial nerve function and would benefit from manual therapy.
24. The child may have issues with body/brain chemistry.
Posted by Loren Shlaes at 5:41 AM
5 comments:

Anonymous said...
Interesting post, this was really useful. thanks!
Thu Jan 05, 06:16:00 AM MST

Anonymous said...
Fantastic website you got here, best content yet!
Sat Jan 14, 04:02:00 AM MST

matthew Occupational Therapist said...

Always really interesting to read different OT blogs from around the world - keep up
the great work! Would love any feedback on our OT blog as well:
http://www.inclusion.me.uk/blog/
Thanks
Matthew
Mon Jan 16, 02:55:00 PM MST

therapydoc said...
This is just wonderful. I found you looking for DaMomma who links to both of us.
Now I have to figure out where she went. I'm linking to you right now.
Mon Jan 16, 05:39:00 PM MST

Barbara @ TherExtras said...

Very good list! I only disagree with no. 23 - the only one where you outright
recommend a specific therapy.
PS
The links do not work (at least not on my computer).
Mon Jan 16, 07:29:00 PM MST

Important!!!!!

Low Tone

As a therapist, I sometimes forget that civilians don't understand all of the professional jargon that my colleagues and
I use to communicate with each other. I try, when I write an evaluation of a child, to explain what each thing I assess
means, and most important, how it affects the way the child functions. But when I hand over a 12 page report to a
parent, I have to remember that not everything is sinking in all at once, and that the information I'm conveying has to
be absorbed, bit by bit, as the parent can integrate it.
"Low tone" is something we occupational therapists talk about quite often. But parents complain to me that they have
no idea what that means. Sometimes it's quite obvious -- the mother of one of the children that I treat just had a baby,
and she called me to tell me that the baby is so weak and floppy that it can't tighten its fist around an index finger
placed in its palm. Other times it's not nearly as apparent, and a child can appear to be quite athletic and still be
plagued by all kinds of problems associated with low tone.
Tone is the amount of electricity that courses through the muscles and allows them to do the jobs of extending the
body against gravity, contract themselves around joints for balance and stability, and work for long periods of time
without undue fatigue. An example of someone with plenty of tone is a professional athlete or dancer. I'll never forget
the time I met my favorite baseball player, Dennis Eckersley. He practically crackled, he had so much juice and
electricity flowing through his body!
As far as I know, there is no one definitive reason for low tone. Some people believe that it is a nutritional issue, and
that for some reason the body is not delivering, {perhaps because of dietary issues or metabolic difficulties} or the
muscles are not utilizing, the raw materials needed for maintenance and sustained use. The child's muscles don't
develop well, and so they tire easily.
An under responsive vestibular system can be a possible reason for low tone. The vestibular nerve is responsible for
many things. It tells us, along with our eyes and muscles, where we are in space. It also responds to how much and
what kind of movement we get, and communicates directly with the muscles that extend us against gravity and allow
us to be upright. It also talks to the part of the brain that is responsible for alertness, attention, and arousal. If the
vestibular nerve is not picking up and processing this information correctly, the result will be insufficient muscle tone
and chronic low arousal.

Another issue that interferes with the child's ability to function is delays in the maturation of spinal reflexes. When a
child is born, its nervous system is immature, unlike a horse's -- a pony can get up and walk shortly after birth.
Humans start out instead with nervous systems that respond by increasing or decreasing muscle tone in response to
certain stimulation, and then go on to refine themselves through movement and play until voluntary control is
established. Then the reflexes disappear. If they don't disappear and are dominating the nervous system, the child
will have difficulty working his body against gravity.
If your child tires easily, complains that he doesn't have any energy, can't sit up while he's writing, is a chronic
slumper, or has a hard time sitting still or sitting on the floor, chances are his tone is low, even if he appears to be
athletic. I've seen plenty of boys who could pitch a ball like Roger Clemens -- but their core strength was so weak that
they couldn't do a single sit up or lift their chests and thighs up off the floor when lying on their bellies.
Children with low muscle tone have an especially difficult time of it in school, because their bodies don't have the
effortless uprightness against gravity that allows them to sit still. If they are struggling to stay upright, they're using the
mental and physical energy to sit that they should be applying towards attending to the lesson. I once went to school
to observe a little boy who acted out a lot, especially during circle time, when all the children had to sit cross legged
on the floor. The day I saw him, during circle time, he sat with his legs straight in front of him and his hands behind
his back on the floor, using his arms to brace himself. He simply was not able to sit in the traditional "criss cross
applesauce" position, and needed the additional support from his arms, and wide base from his extended legs, just to
stay upright. I saw immediately that he was so uncomfortable sitting this way, and that it was so much effort, that he
couldn't sit on the floor and attend to what was going on at the same time. He didn't have enough sophistication in his
language to tell anyone what the problem was. His only recourse was to refuse to stay there for very long, and this
was viewed as disruptive behavior. I suggested to his teacher that he either be allowed to sit in a chair or that he be
assigned a place against the wall so that he could sit with his back supported. He was much happier after that, and
he was much more able to attend.
Low tone affects many aspects of function, which I will address in future posts. Meanwhile, if your child has low tone,
no amount of yelling at him to sit up straight will help. Try incorporating activities to strengthen the trunk, like sitting on
a therapy ball while doing homework or watching TV, doing sit ups and push ups, wheelbarrow walking, wrestling
matches, and playing with whistles, bubbles, and blow toys to your child's daily routine. Spinning is good for
vestibular activation, if your child likes to spin. Or take your child outside and play tag or ball, or organize a game of
statues or red rover with other children in the neighborhood.

Posted by Loren Shlaes at 7:23 AM

5 comments:

silvio soprani said...

Loren, is the electricity in the muscles you are referring to related in any way to that clip that the nurse
puts on one's forefinger (while taking blood pressure) to measure one's "oxygen level" ? I don't
understand how a clip can measure oxygen, but I am learning so many new things from your blog, I
thought I'd ask.
Mon Apr 19, 12:56:00 PM MST

Anonymous said...
My daughter was diagnosed with hypotonia/low tone. She didn't begin walking until about 18-19 months
old. She is 27 months old now and she has difficulty with climbing stairs, especially down. She also does

not jump at all yet. We still find it hard to break her of sitting in the W position as well. Any suggestions?
She was seeing a therapist until about October of last year when my insurance decided it was no longer
necessary. What can we do at home to help her? Thanks so much!!
Tue Apr 20, 09:36:00 AM MST

Scarehaircare said...
a friend of mine sent me an email about your blog. You have great information, here! I am looking
forward to learning from you. My daughter recevies OT at school and then we turn to a private practice
over the summer.
Wed Apr 21, 05:53:00 AM MST

Anonymous said...
Thank you for the clear presentation of information. If I may ask, are there different degrees of low tone?
How can you tell the difference? Thank you
Wed Jul 21, 04:52:00 PM MST

Anonymous said...
My Son was referred to OT + PT aged 3 / 4 after I highlighted delays with his motor skills. Prior to this his
nursery teacher had described him as per the child above. He received OT + PT for approx. 1 year and it
was decided that he has no medical problem and that he had largely caught up. Hence, discharged.
During this time the PT mentioned that he had low core tone.
My Son is now nearly 8 and still won't entertain riding his bike, his scooter or anything else with less than
3 wheels.:( HE struggles to straddle railings, fences, play equipment and descend the other side. I'm torn
as to what to do: go mt best to teach him these things with love + patience or march back to the Doctor's
office?
Sat Aug 07, 01:13:00 AM MST