1. Somatodyspraxia
Understanding the complexities of touch as it relates to sensory, praxis and emotional adaptive responses
Do not use or distribute without written permission.

2. Defining it
Ayres (1989) – Sensations from the body, especially during purposeful activity, provide the means by which a neuronal model or percept of the body is established.
Woodward (2009) – association between somatosensory perception in praxis – investigated how infants begin to understand and anticipate the actions of others through their own actions.
Do not use or distribute without written permission.

3. Presentation
Associated with deficits in processing of tactile, vestibular, proprioceptive sensations
Tactile discrimination deficits thought to form a foundation for somatodyspraxia
Feed-forward and feedback difficulties
Also be impacted by somatosensory modulation difficulties
Do not use or distribute without written permission.

4. Includes Exteroception (sensation from outside the body, e.g., touch)
Proprioception
Kinesthesia
Interoception (visceral sensations)
Poor planning of both anticipatory, feed forward dependent movements and actions that depend on sensory feedback
Might see clinical observations such as poor supine flexion, sequential finger touching, the ability to perform rapid alternating movements (diadokokinesis) and in-hand manipulation skills
Do not use or distribute without written permission.

5. Somatosensory Deficits Types of Dysfunction. Associated Behaviors
Modulation: Over or under responses to touch;  flexibility in behavior
Tactile Modulation: Irritability with handling
Hypo responsive to touch:  awareness of touch, clumsy
Tactile Discriminitive Disorder: Clumsy,  tactile localization, poor FM
Do not use or distribute without written permission.

6. Prop as Modulator: “Aggressive”, clumsy, “tuned out”.
Proprioceptive System Dysfunctions Types of Dysfunction Associated Behaviors
Prop as Modulator: “Aggressive”, clumsy, “tuned out”.
Hypo responsive to prop input: Clumsy,  postural tone
Proprio Defensive: (Does it exist?)
Do not use or distribute without written permission.

7. Types of Proprioceptive Dysfunction
Proprioceptive hypo responsivity
Low tone, fixing for stability, decreased tactile registration
Seeks proprioception to modulate arousal level
SMD, may bite, chew, crash, bang, self-stimulatory
GI (a vestibular-prop disorder)
Anxious when relationship to gravity is challenged, moves slow & carefully
Proprioceptive sensitivity
Dislikes weight bearing, unable or chooses not to move, often occurs with physically impairment
Do not use or distribute without written permission.

8. Primary Level of Integration
Supports suck, swallow and breathe pattern of new born infant
Brain must interpret sensations of touch from mother to establish his first emotional attachment (bonding)
Bonding gives baby his first feelings of his physical sense of self
Skin is the boundary of the self and tactile processing is a primary source of security for the infant
May lead to trouble being affectionate in later relationships, though they need affection more than another child
Primal source of comfort and security – emotional growth is threatened
Do not use or distribute without written permission.

9. A Dynamic Organ
Protective barrier to the human’s internal organs and tissues
Connecting to the outside world
20% of total body mass
Also assists with breathing, warmth regulation, metabolism, toxin cleaning, and elimination of redundant quantities of water
Do not use or distribute without written permission.

10. Epidermis External layer of skin Changes shape with body movements
Presence of keratin, a strong protein for protection
Melanin for protection from sun radiation
Lipid layers to protect from penetration of micro organisms
Do not use or distribute without written permission.

11. Do not use or distribute without written permission.

12. Dermis
Three types of tissue: Collagen, Elastic Tissue, and Reticular Fibers
Nutrition for epidermis
Nerve endings receptors for external impulses
Reticular layer includes blood vessels, nerves, oil glands, sweat glands, and hair follicles – regulation of body temperature as well as pain and itching
Do not use or distribute without written permission.

13. Receptors and Transduction
Mechanoreceptors – mechanical force (light touch, deep pressure, stretch or vibration) applied to the receptors – neural transmission occurs
Proprioceptive input from joints and muscles joins both the somatosensory pathways as well as the vestibular pathways
Tactile system includes thermo-receptors – temperature input
Do not use or distribute without written permission.

14. Slow acting receptors
Free nerve endings in skin, joint capsules, tendons and ligaments – pain and temperature
Merkel’s Disc in epidermis of hairless skin, hair follicles – deformation of skin
Ruffini ending in joint capsules and connective tissue – touch, skin stretch, and joint movement
Do not use or distribute without written permission.

15. Fast acting receptors
Hair follicle plexus in deep dermis – hair displacement, pain
Meissner’s corpuscles in skin and mucous membranes of tongue tip – touch
Pacinian corpuscles in subcutaneous tissue – pressure and vibration
Krause’s end bulb in hairless skin, near hair follicle plexus – cold, but below 20 degrees C no adaptation
Do not use or distribute without written permission.

16. Density Matters
Fine tactile discrimination (finger tips, palms, around the mouth) – density is high and receptor field is small – more skilled function
Abdomen and back – density is lower and receptor fields are larger
Passive vs active touch – regulation vs finer and more active discrimination
Do not use or distribute without written permission.

17. Dorsal Column Medial Lemniscal Pathway (DCML)
Tactile, vibration and proprioception
Detection of size, form and contour, texture and movement across the skin
Also proprioception – information relative to the position of the body and limbs in space
First synapse is in medulla of brainstem and from there form medial lemniscal fibers, travels through Reticular Activating System (regulation / modulation), then ascends to Thalamus
Problem above Medulla – functional loss opposite side of body. Below Medulla same side
Do not use or distribute without written permission.

18. Reaching the Cortex
Primary and secondary somatic sensory cortex (S-1 and S-11)
Areas 5 and 7 of posterior parietal lobe
S-1 precisely represents a somewhat distorted body image – sensory homunculus – body parts used mostly will have greater representation - flexibility
Do not use or distribute without written permission.

19. Interoceptors
Proprioceptors register movement of the limbs, position of the body and its parts in space.
Makes equilibrium possible (static feeling) and feel the weight or degree of wrist bending
Visceroreceptors (Interoreceptors) – informing on the condition of internal organs. (intestines, stomach, lungs etc.)
Do not use or distribute without written permission.

20. Proprioception
Sensing the direction and velocity of movement as well as determining the effort needed to grasp and lift objects
Spatial orientation of the body or body parts, rate and timing of movements, amount of force muscles are exerting
Also how much and how fast a muscle is being stretched
(influenced also by vestibular system, but more later)
Do not use or distribute without written permission.

21. Sources of proprioceptive input
Joint receptors fires primarily at the extremes of range (flexion and extension) – preventing hyperflexion or extension
Most effective stimulus for muscle spindle is stretch – dynamic and static
Primary fibers – velocity of change in muscle length and amount of change
Secondary fibers – static positions, sustained stretch and contraction
Both fibers critical for location of body and limbs in space
Creating adaptive behavior against resistance may be the most effective way for generating proprioceptive feedback.
Joint compression and traction less effective sources of proprioception than active muscle contraction against resistance
Do not use or distribute without written permission.

22. Proprioception vs Tactile Input
Proprioception – sensations of movement or position that arise as result of the individual’s own movement
Tactile sensation – awareness or perception of the location, or change in position of an external stimulus applied to the skin
Deep touch pressure is not a source for proprioception
Do not use or distribute without written permission.

23. Somatosensory Interpretation
Activity in the primary sensory cortex as well as reticular formation influences the interpretation of tactile input even before it reaches the cortex
Secondary cortex (S-11, Brodmann’s area)only fires if primary cortex has fired
Projections from the secondary cortex to the insular lobe – tactile memory
Do not use or distribute without written permission.

24. Parietal Lobe Areas 5 and 7 5 for touch and proprioception
7 for somatosensory and visual inputs
Lesions attributed: deficits in spatial perception, visual-motor integration and directed attention
Also concerns manipulation of objects (haptic perception)
Lesions in right hemisphere – agnosia in contralateral side of the body and body space – tactile intact, but fail to recognize and attend to this side of the body and environment around it
Do not use or distribute without written permission.

25. More on DCML Impacts on both object manipulation and motor planning
Modulating arousal
Deep touch pressure and proprioceptive information have a calming input
In-hand manipulation
Do not use or distribute without written permission.

26. Anterolateral System (AL)
Primarily mediates pain, crude touch (detection of objects position), and temperature
Also neutral warmth and “tickle” sensation
Also called spinothalamic pathway
Rough stimuli (rubbing, squeezing, pinching)
DCML input inhibits transmission in the AL pathways – thalamus is the relay station
Also overlay between deep touch pressure and proprioception
Observed to diminish sensation of pain and tactile defensiveness
Do not use or distribute without written permission.

27. More on AL
Tactile defensiveness associated with AL pathways and with central interpretation of input
Projects through regions of the brain: arousal (reticular system), emotional tone (limbic structures) and autonomic regulation (hypothalamus)
Do not use or distribute without written permission.

28. Trigeminothalamic Pathway
Somatosensory input from the face
Trigeminal ganglion
Input to the spinal track of the trigeminal nerve carries primarily pain, temperature and non discriminative touch from face and mouth to CNS
Primary sensory cortex has wide representation of regions around the mouth
Do not use or distribute without written permission.

29. Body Awareness (Percept)
A person’s perception of his/her own body, consisting of sensory pictures, or “maps” of the body stored in the brain
May also be called body scheme, body image, or neuronal model of the body
Body Schema is an unconscious mechanism underlying spatial motor coordination that provides the CNS with information about the relationship of the body and it’s parts to environmental space
Body Scheme: Internal representation and awareness of the body in action and the relationship of body parts to each other.
Proprioception from active movement assists in development of body scheme
Do not use or distribute without written permission.

30. Functional Considerations
Important in determining behavior
Touch is our first language, first to function in utero
Mediates our first experiences of the world
Nourished, calmed, attached to others (bonding)
Primary system for making contact with the external world
Do not use or distribute without written permission.

31. Blackwell (2000)
There remains little doubt that tactile stimulation is an important factor in the social, emotional, physiological, and neurological development of infants and young children. Consequently, it is one of the most essential elements in the nurturing and healing environment of the infant and child.
Do not use or distribute without written permission.

32. Attachment and Bonding
Avoidant Profile
Ambivalent Profile
Disorganized Profile
Securely attached profile
Do not use or distribute without written permission.

33. Maude Le Roux, OTR/L, SIPT, IMC
9 Lacrue Avenue, Suite 103 Glen Mills, PA 19342
Maude Le Roux, OTR/L, SIPT, IMC
Website
Facebook
LinkedIn
Blog
Do not use or distribute without written permission.

34. Book Resources
Ayres, A. Jean, and Jeff Robbins. Sensory Integration and the Child: Understanding Hidden Sensory Challenges. Los Angeles, CA: WPS, Print.
Brody, Viola A. The Dialogue of Touch: Developmental Play Therapy. Northvale, NJ: J. Aronson, Print.
Bundy, Anita C., Shelly Lane, and Elizabeth A. Murray. Sensory Integration: Theory and Practice. Second ed. Philadelphia: F.A. Davis, Print.
Lane, Shelly, and Anita C. Bundy. Kids Can Be Kids: A Childhood Occupations Approach. Philadelphia: F.A. Davis, Print.
Masgutova, Svetlana, and Denis Masgutov. Tactile Integration: Masgutova Method of Neurosensorimotor Facilitation. Print.
Montagu, Ashley. Touching: The Human Significance of the Skin. New York: Columbia UP, Print.
Schaaf, Roseann C., and Zoe Mailloux. Clinician's Guide for Implementing Ayres Sensory Integration: Promoting Participation for Children with Autism. Bethesda, MD: American Occupational Therapy Association, Print.
Do not use or distribute without written permission.