In the previous article, we discussed the science behind sensory processing skills, the brain centers involved, and the signs and symptoms of the modulation disorders. We also mentioned that the most efficient ways to encourage development of these skills was through a sensory diet targeted toward executive function skills. In this article, we shall break down these skills and match them with the suggested sensory diets that will not only enhance but continue to decrease chances of modulation meltdowns and difficulties with comprehending the overall environment.

First however let us define what we mean by Sensory Diet in the first place.

The term “Sensory diet” was coined by Occupational therapist, Patricia Wilbarger (1984), and can be defined as a carefully designed, scheduled activity plan, that provides the sensory input a person’s nervous system needs to stay focused and organized throughout the day. Each sensory diet is specially designed to meet a child’s specific sensory needs. Wilbarger and Wilbarger (1991) developed the approach to provide the “just right” combination of sensory input to achieve and maintain optimal levels of arousal and performance in the nervous system. The ability to properly identify and respond appropriately to sensations can be enhanced by a proper sensory diet.

There are certain types of sensory activities that are similar to eating a “main course” and are very powerful and satisfying. The most powerful and longest lasting activities on the nervous system include deep pressure touch, joint compression or traction, movement, and heavy work (Wilbarger, 1995).

The Wilbarger Approaches target the seven senses based on a person’s defensiveness or modulation symptomatology. The difference in the Execu-Sensory Diet that we utilize is the focus on the preparation of the sensory system for cognitive input. What that means is the diet is meant to support the growth of Executive Function Skills, no matter what the age or the need for a surrogate Pre-Frontal assistance from an adult.

Here are the major sensory components and the executive function skills they target:

1. Therapeutic Massage – Response Inhibition, Sustained Attention

Therapeutic massage is utilized to improve the tactile and proprioceptive systems. We utilize this on four extremities in an orderly fashion, and is usually done in a proximal to distal motion to desensitize the sensory nerves and ultimately send messages to the brain that a particular arm and/or leg is being isolated and given feedback. Usually also during the therapeutic massage, relaxing oils or lotions such as lavender chamomile scents that are hypoallergenic and have thick consistencies help reduce the friction and improve the natural biological feedback.Therapeutic Massage stimulates Gamma-Amino Butyric acid (GABA) in the brain, which is responsible for the sense of well-being, calming the nervous system down.

Response Inhibition is the suppression of a person’s actions that are inappropriate in a given context and that interfere with goal-driven behavior. For example, it is one’s ability to control calling out, storming out of a classroom, or touching others or other people’s property. Sustained Attention, or vigilance, as it is more often called, refers to the state in which attention must be maintained over time. It would be listening and attending to a classroom lesson or mini lesson for at least 5 minutes even when there are distractions in the room.

Therapeutic massage supports the development of these two skills by giving the extremities the grounding force to be able to attend to the task and decrease impulsive responses because the brain is able to map out where the person is in space and can maneuver the environment appropriately depending on what the current demands are required of them.

2. Therapeutic Brushing – Emotional Control, Flexibility

Therapeutic Brushing is more famously associated with the Wilbarger Brushing Protocol that is commonly used for people with tactile defensiveness, and for Autism-like presentations of touch sensitivities. The Therapeutic Brushing we utilize however does use the Therapressure Brush that the WIlbarger Protocol uses, however it is similar to the Therapeutic Massage wherein it is done proximal to distal and only on four extremities in an orderly fashion; whatever arm or leg that was started on with the massage will also be the same arm/leg that will initiate the brushing as well. We strongly suggest that the brushing technique be performed ONLY AFTER the massage in order for the sensory nerves to “zero out”  and not be stimulated to a negative “high” to where the fight or flight status of the brain becomes activated. The purpose of the Therapeutic Brushing is to increase awareness centers and promotes Serotonin in the brain, which is the neurotransmitter that helps improve mood and social functioning.

Emotional Control is defined by Dr. Richard Guare and Dr. Peg Dawson as the ability to manage emotions to achieve goals, complete tasks, or control and direct behavior. People who struggle with emotional control tend to have angry outbursts or behavior outbursts such as destroying or throwing objects, aggression towards self or others, and threats to harm oneself. Flexibility on the other hand is the skill that is defined as the ability to adapt to new situations, improvise, and shift strategies to meet different types of challenges. For example, a child who may be expecting to see a movie at a particular time and would not be able to due to circumstances would be able to bounce back and restructure the day or be able to find a solution to the disappointing outcome in a more proactive manner.

Therapeutic brushing supports the development of Emotional Control and Flexibility mainly due to the release of Serotonin right after the GABA process from the Therapeutic Massage. The sense of well-being meeting the sense of mood stabilization, which includes digestion, appetite and overall memory in learning. Frustration tolerance improves with different situations and thinking processes are supported efficiently by the calming effects and mood stabilization brought about by Serotonin.

3. Joint Vibration – Metacognition, Working Memory, Organization

Joint Vibration is unique to the Execu-Sensory Diet because we utilize a battery operated 4-point massager which is gives out a medium vibration cycle to the major joints of the extremities, such as the shoulder, elbow, wrist, fingers for the arm and the hip, knee, ankle and toes for the leg. As with the first two techniques, the extremity that was started on the first two will also be the extremity that will be utilized to initiate this technique. Of all of the techniques, this is the one that requires the most care; some people will react to the low-medium vibration as ticklish, while others will claim that it is painful and can incite fight, flight or freeze. Usually, however, the reason why this is the third step in the diet is because GABA and Serotonin have already been activated and the sensorimotor system is in ‘trust’ mode. This may not be true for students with extreme sensory processing deficits, thus training is essential for this particular modality.

The neurotransmitter that is released by Joint Vibration is Dopamine. This is the neurotransmitter that helps control the brain’s reward and pleasure centers. Dopamine also helps regulate movement and emotional responses, and it enables us to take action to move toward rewards that we see.

Metacognition is the awareness and understanding, analysis, and control of one’s cognitive processes, especially when engaged in learning. The overused thinking about thinking is what pop culture uses to define this skill. Working Memory on the other hand, is involved in the selection, initiation, and termination of information-processing functions such as encoding, storing, and retrieving data. It is usually referred to as the RAM system of our cortices, constantly remembering tasks or sequences of skills that need to be rearranged and retrieved at any given moment. An example or using working memory is taking a test that requires one to have access to formulas in short term recall that can be used.

Lastly, Organization is considered the skill of putting things into a logical order or the act of taking an efficient and orderly approach to tasks. The ability to prioritize what should come first, next etc. is how organization is developed and displayed on a daily basis.

Now, Joint Vibration supports Metacognition, Working Memory and Organization by the release of Dopamine. With the sensation of the brain being rewarded by the experience of joint vibration, the calm of GABA and the stabilization of emotions by Serotonin, the efficiency in short-term recall, hierarchical assignment of tasks needing to be accomplished and the awareness of the processes involved in being efficient and organized are enhanced by the neurotransmission of Dopamine. Learning is equated as something pleasurable and positive.

4. Modified Auditory Integration – Goal-directed Persistence, Time-Management

Modified Auditory Integration is a modality that we use with children who have difficulty maintaining where they are spatially in relation to the environment and to others in their immediate proximity. We also tend to use the Sound Health Series at 50% volume with closed, supra-aural, dynamic hi-fi stereo headphones. Auditory Integration is based on the Tomatis Method which is to improve the auditory system, people who can hear sounds may not be able to take in the full spectrum of these sounds, which means they might find it difficult to listen properly. According to Dr Tomatis, this happens when muscles are not working properly and through auditory stimulation it is possible to retrain the muscles of the inner ear so that it can function without distortion. Overall, Auditory Integration initiates Dopamine release in the brain similarly to Joint Vibration however from a direct sensory system rather than from a joint receptor system. This is the only modality that is used from start to finish of the ESD.

Goal-directed persistence is the capacity to have a goal, follow through to the completion of the goal, and not be distracted by competing interests. A good example would be when there is a game or a toy that the child may want, and a structured process of steps are put in place in order to ‘earn points’ to get closer to earning the reward, such as doing chores efficiently, or doing well in school allows the child to delay gratification and continue to persist toward the final achievement of the goal.

Time Management is ability to plan and control how you spend the hours in your day to effectively accomplish your goals, such as being able to gauge how long an assignment will take to finish or how much longer one needs to be able to get from one place to the next. The opposite of course to efficient time management is procrastination, and for some whose sensory processing systems limit their understanding of time, rigidity in multiple step task accomplishment.

Modified Auditory Integration supports development of Goal-Directed Persistence and Time Management by continuing the Dopamine release happening with the Joint Vibration protocol. It meets the joint receptors sense of reward by allowing the auditory system to ‘listen’ not only to the music but also to the body, and ultimately provide that platform to improve and build on sitting throughout the whole diet protocol; time management on the other hand is measured by the ability of the neurotransmission to relay the benefits from Serotonin, GABA and Dopamine thus signalling indirectly the beginning, middle and end of the protocol via the use of the Modified AIT.

5. Counting and Hierarchy – Planning/Prioritization, Task Initiation

Counting and Hierarchy involves a specific rote and tonal count in a calm voice from 1-15 for every single extremity and every single modality and technique used. The Hierarchy obviously provides predictability and structure to the diet, to a point that the child can self-direct the diet and ultimately tailor the diet according to his/her needs at given points in time, ultimately breaking them down into what has been coined as Sensory Snacks. 

Planning and Prioritization is when one organizes work, sets priorities, and determines resource requirements. In this case, the counting and the order of the diets assist with determining the generalized prioritization of the diet as well as anticipation of what is next, and last without increasing Acetylcholine release.

Task Initiation is knowing how to get started on a task and sustaining the attention and effort levels needed to complete the task, which in this case again is supported by the predictability of the materials, the diet protocol from one time to the next, the language, the tone of voice up to the signaling of when it is the end.

For more detailed information on training of the Execu-Sensory Diet, or for more related literature that supports this particular methodology, please email us or check out our published abstracts related to this topic. Hopefully this will provide you with some clarity on how the sensorimotor systems play an integral part in wholistic cortical development, especially in regards to supporting the development of Executive Functioning Skills.