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Excelling in Out Patient Therapy Services

Dont’ Look Down!

Symptoms

Zisi is a 2nd grader who hated recess. She refused to go on the swings or down slides, complained to her teacher that all the playground equipment was ‘too scary,’ and even went so far as to stay at her desk to avoid going out to play. At home, Zisi insisted her mother hold her hand when going down stairs. If she ever found herself in a high location, Zisi became extremely anxious and frightened. While all her peers rode bicycles, Zisi had yet to even try getting on a bike with training wheels. Even the hairdresser’s raised chair or dentist’s examination chair were cause for panic. Zisi’s common refrain was “Where am I going? I’m falling! I’m scared!

 Assessment

 Our therapist realized that Zisi had issues with gravitational insecurity. This is a sensory issue which is a combination of a vestibular issue and core issue. When our bodies experience a change in height or direction, the vestibular system located in the ear is stimulated into processing these changes and maintaining the body’s balance. Zisi, however, could not handle these stimuli like other children, and changes in position or height really confused her senses—which, in turn, caused her anxiety and attempts to stay still and close to the ground. Premature birth or a traumatic life event (such as a car accident or emotional trauma) can sometimes cause gravitational insecurity. Other children may just have a naturally weak ability to process vestibular stimulation. For Zisi, this was compounded by a weakness of her core, which added to her feeling of instability and deepened her fear of getting off the ground. The truth is, gravitational anxiety is just that—anxiety. Zisi actually possessed the requisite physical ability to ride a bike, go down steps or slide and jump. However, since Zisi could not do these activities as well as her friends, she felt like a failure in comparison and was led to believe that she did not have the ability to do these activities at all.

Solution

We encouraged Zisi with different core-strengthening and balancing activities, then slowly introduced movement. Since Zisi felt unsafe at heights of any size, we needed to stimulate her vestibular system without going past the threshold of her anxiety. We did this by beginning exercises at lowest possible position—crawling, or other activities that had very little change of height—and gradually increasing the height and complexity of her motions. The next step was having Zisi sit on an unmoving swing with a very large, flat seat; from there we slowly eased Zisi into slight swinging at incrementally higher heights. This gradual ascension allowed her to develop her neural networks to strengthen her vestibular system, allowing her to process changes in height. As her ability to process balance and height changes grew, so did Zisi’s confidence—and the anxiety she previously associated with being off the ground slowly disappeared. Zisi no longer has the crippling anxiety that once prevented her from doing normal, everyday activities, and now enjoys recess, outings with her family to the park, and riding her bike.


You can submit questions via email at therapythoughtsnj@gmail.com. To schedule an appointment call 732-813-HAND today or visit our website www.thetherapyplacenj.org for more info.
Names and details have been changed. This case study may be amalgamation of different patients or symptoms. The purpose of this article is to educate about conditions that may be treated with occupational therapy.