OTS 161: Unlocking the Power of the Vestibular System for Classroom Success
- Jayson Davies
- Oct 28, 2024
- 46 min read
Updated: Dec 18, 2024
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Welcome to the show notes for Episode 161 of the OT Schoolhouse Podcast.
Have you ever wondered how vestibular challenges might be impacting your students’ ability to succeed in the classroom?
In this episode, Dr. Annie Baltazar Mori and Dr. Jennifer Petersen join us to unpack the powerful connection between the vestibular and proprioceptive systems, sharing insights that can transform your approach to these often-overlooked issues. Vestibular disorders are frequently at the root of classroom challenges, affecting everything from focus to motor coordination. Our guests will guide us on how to help students improve not only their physical skills but also their confidence and self-esteem.
Tune in as Dr. Baltazar Mori and Dr. Petersen walk us through the latest research, share their clinical expertise, and offer practical strategies to help our students reach their full potential!
Listen now to learn the following objectives:
Learners will understand how the vestibular and proprioceptive systems interact.
Learners will identify at least 2 standardized assessment tools they can use to evaluate vestibular function in their students.
Learners will identify effective intervention strategies for vestibular disorders.
Learners will identify key strategies for educating teachers and others on recognizing vestibular challenges and embedding sensory-based interventions.
Guests Bios Annie Baltazar Mori OTD, OTR/L & Jennifer Petersen OTD, OTR/L, C/NDT
Dr. Annie Baltazar Mori is the owner and founder of playSense, a pediatric occupational therapy clinic in Redondo Beach, CA and ASImentoring.com an online Sensory Integration mentoring program. She earned her Doctoral and Master’s degrees in Occupational Therapy at the University of Southern California. She lectures, nationally and internationally, on topics related to theory and application of sensory integration and social participation.
She is an instructor for the Collaborative for Leadership in Ayres Sensory Integration (CLASI) and has taught as an adjunct instructor at Thomas Jefferson University teaching advanced practice certificate courses in autism. She regularly participates in research and is a contributing author on several scientific research and professional articles with a focus in the field of occupational therapy and sensory integration (Baltazar Mori et al. 2017; Auld-Wright et al., 2023; 2014; Koester et al., 2014; Mailloux et al., 2014). She served as the chairperson of the Sensory Integration Special Interest Section for the AOTA.
Dr. Jennifer Petersen is on faculty in the Department of Occupational Therapy at St. Ambrose University in Iowa. Her expertise and personal interest have led to leading several projects and studies with her students related to the Evaluation in Ayres Sensory Integration (EASI). Beyond research participation, Dr. Petersen has also published scientific research articles (Mailloux et. Al., in press; Petersen et al., 2020; Petersen, 2017; Frolek Clark et al., 2011).
Prior to teaching, she completed her Master’s in Occupational Therapy through St. Ambrose University and her Doctorate from Thomas Jefferson University. Additionally, she pursued advanced practice certificates in ASI through USC/WPS, Autism from TJU, and Neuro-Developmental Treatment from the Neuro-Developmental Treatment Association.
Dr. Petersen has a natural inquiry of understanding how to provide best practice evaluation and intervention to achieve family and child centered goals. Throughout her advanced education, she has practiced at various pediatric clinics and has thoroughly enjoyed being a part of each child and family’s journey.
Quotes
“Our senses are the only way that we gather information from the world. Sensory integration is needed to learn in the classroom and to participate with our friends and to participate in life. “
-Dr. Baltazar Mori
“Sensory integration is a neurological process that we all have, and for us to ignore the integration of the senses outside of a clinic would be a huge disservice to a child.”
-Dr. Baltazar Mori
“Vestibular system projects to that cerebellum. We know cerebellum helps us with balancing and motor coordination, and also projects to the oculomotor nuclei”
-Dr. Peterson
“We live in a multi sensory world, and our senses work together. We take in multi sensory information, and it doesn't just fall into pockets. The senses work together to understand what's happening and it's really hard to have vestibular input without proprioception.”
-Dr. Baltazar Mori
“An average nervous system registers movement for about six to 12 seconds. So you'd expect that nystagmus to go for that long.”
-Dr. Baltazar Mori
Resources
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Episode Transcript
Expand to view the full episode transcript.
Jayson Davies
Hey there ot friend. Welcome to Episode 161 of the OT school house podcast. Thank you so much for being here today. I want to start off this episode by asking you to raise your hand if you've felt at a loss when it comes to supporting a student that you know has difficulties processing vestibular stimuli. Trust me, I'm raising my hand right alongside you. Perhaps you've tried wiggle cushions, maybe some go noodle videos, and maybe even some sort of swing apparatus that you have access to, but still, you have yet to see a meaningful difference in how the student responds to vestibular input. Now, as you probably know, but are also frustrated by Vestibular Disorders are often the root cause behind so many challenges that we support within the classroom, from handwriting breakdowns as well as behavioral outburst, vestibular always seems to be at the root. Unfortunately, vestibular disorders can also be very difficult to diagnose or to identify and also treat without the proper tools and interventions on today's episode, that's exactly what we're going to uncover the tools and interventions to support students with vestibular disorders. I'm thrilled to be joined by two amazing ot practitioners who are here today to share their approach to evaluating and treating vestibular disorders in the school setting, Dr Jennifer Petersen, a professor at St Ambrose University, and Annie balance our Mori owner of a pediatric ot practice here in Southern California. Annie and Dr Peterson have decades of experience using a sensory integration framework to tackle vestibular challenges, and together, they're going to walk us through the latest research, share their clinical expertise and give us practical strategies that we can use to support our students. So get ready to rethink everything that you thought you knew about Vestibular Disorders. This is going to be an eye opening conversation, and you won't want to miss it. Stay tuned.
Amazing Narrator
Hello and welcome to the OT school house podcast, your source for school based occupational therapy tips, interviews and professional development. Now to get the conversation started, here is your host, Jayson Davies class is officially in session.
Jayson Davies
Dr Petersen and Annie, welcome to the OT school house podcast. It is such a pleasure having you here today. Really appreciate it. And since the two of you, I'm going to go ahead and kick it over to Annie really quickly and say, Hi Annie. How you doing?
Annie Mori
Hi Jayson. Nice to see you.
Jayson Davies
Nice to see you as well. Thank you so much for being here. Really appreciate it. And since we're with you, Annie, we'll, we'll kind of start with you, and then we'll dive over to Dr Peterson in just a moment. But Annie, I'd love for you to just to just to take a moment and share a little bit about where you are in the world of occupational therapy today and and maybe just a brief, brief how you got here.
Annie Mori
Okay, well, first of all, thank you for having me. I'm really excited to be here and to speak to your communities. So I've been an occupational therapist for about 24 years now, and you know, from day one I knew I wanted to specialize in sensory integration, and so I've spent my entire career studying sensory integration, writing about it, learning about it, being mentored by experts in it, and Then advocating for it. So currently, I own a pediatric occupational therapy practice in Redondo Beach, California. We serve about 150 clients a week, providing primarily, well providing occupational therapy primarily using a sensory integration approach, because that is our specialty, and that's we're kind of a pretty niche practice in our area, and really diving into that.
Jayson Davies
fantastic, yeah. And I was just looking at your own personal website. Annie blitzesare morey.com THANK YOU. And, yeah, I was looking at some of your publications and your projects and whatnot. And you have been very involved with SI, as you mentioned, and especially with the evaluation of air sensory integration, the easy as as we've come to know it as, and we're going to dive more into that, I'm sure, the easy a little bit, but yeah, I just wanted to kind of mention that a little bit, because that is something that I know has been a long time in the works. And kudos to you and the entire team for kind of getting it to where it is today and where it's going to be in the future. That's awesome.
Annie Mori
Thank you. That's kind of a career highlight for me. I think,
Jayson Davies
yeah.
Annie Mori
It's really wonderful to be able to work on that team.
Jayson Davies
Absolutely, and we will definitely bring that up more as we get into our evaluation piece later today. Moving over to Dr Petersen, welcome First and foremost, but also, please share a little bit about where you are in the in your ot world today.
Jennifer Petersen
Yeah, thank you for having me as well. So I'm a similar story to Annie, and that upon graduating from my master's program, I initially went into learning more about sensory integration right from the beginning. Knowing that it had sparked an interest during my field work, and wanted to continue to learn about it, study it and and practice it. And so I have worked at a variety of different clinics over the years, and am now teaching at a well for me, it's a local university and Iowa, so a small university teaching entry level doctorate students. And beyond that, I still get to practice. So I practice in the summers, and then get to be a part of research opportunities and continue to grow and develop in that way as well.
Jayson Davies
Gotcha, and what does your practice look like when you're practicing in the summers?
Jennifer Petersen
Yeah, in the summers, I get to practice at an outpatient pediatric clinic. In Iowa, it's fairly common to have hospital based clinics, so it is a hospital based outpatient clinic.
Jayson Davies
Gotcha, all right. I want to kind of address this, because this is a podcast primarily for school based occupational therapy practitioners, and both of you have mentioned that you're working clinic based, which, in my opinion, is perfectly fine, because I want to give you the opportunity to share this, not me, because people have heard some of my thoughts on this. But why is, I guess, when it comes to sensory integration a little bit, and what you're doing from a quote, unquote clinical perspective with SI, why is that not just unique to a clinical setting and absolutely applicable to a school based setting?
Annie Mori
Well, I'll start off. I've been a school based therapist also, like for a big, big part of my career, over 12 years, and then I also do individual educational evaluations for the school districts currently, so I'm still very well embedded into the school based model. But you know, sensory integration is a neurological process that we all have, and for us to ignore the integration of the senses outside of a clinic would be a huge disservice to a child. We need our senses to learn. Our senses are the only way that we gather information from the world. So it makes sense that sensory integration is needed to learn in the classroom and to participate with our friends and to participate in life. So, you know, there's always, you know, clinic based model, or medical model, versus school based model. And just kind of my own soapbox on that is, at the end of the day, the outcomes might be a little different because school based is focused on certain outcomes, clinic based might be focused on different outcomes, such as ADLs, but the foundations are the same. That does not change. And so that's where I think that the an air sensory integration approach is really important, universally.
Jayson Davies
Absolutely. Dr Peterson, would you like to add anything? I think Andy did a pretty good job. But if there's anything you'd like to add, go for it.
Jennifer Petersen
I agree she, she stated that very well. You know, in even thinking back to kind of the roots of sensory integration, it started with Dr Jean Ayres, working with children with learning difficulties. And so when we think of that, that certainly is relatable to in the school, the setting in the school, because again, we're working to help children be able to learn, participate in their environments, and be able to have social interaction with other children within school. So going back to our history, I think it also supports it too.
Jayson Davies
Yeah, yeah, absolutely. All right, we're going to start to, you know, we talked a little bit about si just now, but transition to the vestibular disorders. And I guess I kind of want to start it off this way, because I've been practicing since 2012 and and correct me if I'm wrong. You both have been kind of practicing, especially within the SI world, longer and just more ingrained into si than I have. But when I was graduating and going through the SIFT program, there's a lot of talk about the vestibular system within Si, but within the last, I don't know, maybe five years, or maybe even less, I really started hearing more about Vestibular Disorders, not always directly tied to sensory integration. Typically, there is a like a sensory component to it, or there's always a sensory component to it, but I'm just hearing about it, I guess, separated out from SI, I hate to say separated out, because, again, like I said, it's a sensory disorder per se. But how is it that we're starting to view Vestibular Disorders Not just as overall sensory integration? If that question makes sense.
Jennifer Petersen
Well, you know, I like to think of this as sensory integration, and air sensory integration as that umbrella term, that ability to take in information, organize, sort through that information, be able to use it purposefully and meaningfully. But from there, what we have found, and this really started with airs earlier work, is that children that were having difficulty participating within their daily activities that there was four different categories, if you will, or constructs that kept showing up. And so what was found from factor analysis of these different tests that she had used is that there was reactivity, difficulties with perception, and then there was this category of vestibular bilateral integration as well as praxis, and so maybe you're referring to this in that category of vestibular bilateral integration, where you're thinking of it kind of it is still related to sensory integration, but it was its own construct. And now we're starting to hear the term postural ocular bilateral integration. So you might hear it called either vestibular bilateral integration or postural ocular bilateral integration.
Jayson Davies
Okay, so really quickly. Then, when we're talking today about a vestibular disorder, are we kind of calling it that vbis Or postural? Sorry, I already lost it, but is that kind of what we're using these terms almost interchangeably, a vestibular disorder would kind of be equal to vbis, vestibular bilateral integration.
Jennifer Petersen
That is one of the areas that they can have difficulty with. And but there's also, right, there's still vestibular reactivity difficulty, which you may have heard of as like gravitational insecurity in the past. And so that's having that hyper reactive response to vestibular input. So vestibular can be manifested, I guess it within the reactivity as well as perception. But then there is that category really pulling in vestibular, and it's these related motor functions, if you will.
Jayson Davies
Gotcha, okay And I kind of in my question, I kind of said that the last question how vestibular disorder is almost separate from sensory integration. But I kind of want to let you address that, is there a vestibular disorder that is outside of sensory integration, or is everything we're talking about today with vestibular disorder within the realm of kind of gene airs original ASI work?
Annie Mori
Well, you know, I think we need to understand where the where the vestibular challenges come from. Is it developmental, or is it an injury? And if it's an injury, then perhaps we think of it separate outside of air sensory integration, so there would be some kind of head injury or insult, or something that might have come that has occurred that then you would treat it a little differently, yeah. But if it's a developmental issue, if it had to do with something that happened in utero, or whatever it was that the vestibular impact on the vestibular system has affected development, then I think we need to look at it under that umbrella of air sensory integration, because the vestibular system is so entwined in our developmental trajectory that you have to look at the integration of the senses and how they're working together when you're working with a child with vestibular difficulties.
Jayson Davies
Perfect. Yeah. Thank you for bringing that up, because there is that idea of, you know, more of an injury related vestibular disorder. And I, yeah, I hadn't thought about that. So thanks for bringing that up. But so, so let's dive into it then, because we know what it is. Now we're talking about here a little bit. What are some of those developmental concerns that might start to appear with a child, and we can start as early as zero, of course. But what are some of those developmental concerns that we might begin or might see with a child as they're being referred to. OT why might they be referred if it's related to a vestibular concern?
Annie Mori
Well, I mean, gosh, it could be so many different things. I mean, in early, early infancy, there could be it challenges with breastfeeding, latching on to, you know, a nipple, and with feeding, early feeding issues, there might be some regulation issues that might be happening difficulty. You know, I've had a lot of families talk about how difficult it is to do a diaper change because they can't lay their child back in space without the child having a, you know, having a complete meltdown and being very upset. Oh, wow. So, and nobody's thinking, Oh, that must be their vestibular system. They're just thinking of the performance challenges that they're experiencing. And then it's our job as OTs to decide or to investigate what, what could that possibly be?
Jayson Davies
Yeah, yeah.
Annie Mori
And so in those instances, I do kind of a task analysis, and I would say to myself, well, it seems like there's some vestibular opportunities within this task, and so maybe we need to look at that.
Jayson Davies
Gotcha.
Annie Mori
So those are like early crawling is another one where it kind of comes up sitting up might be a little delayed, more delayed than usual. Jenny, what would you add?
Jennifer Petersen
In like, yeah, those postural controls, so being able to sit upright or catch themselves when they're starting to fall, so right when they're learning how to sit or to stand, if they that they can orient to where upright is. And if they're not upright, that they are able to catch themselves. Let's start to tell us a little bit more about that vestibular system in those earlier years.
Jayson Davies
All right, and then, like, let's fast forward a little bit, you know, to kindergarten, first grade. TK, what are some of the things that you might start to hear from teachers that might cue you in a little bit? Hey, maybe I need to look at some vestibular stuff.
Annie Mori
Well, you know, I always talk about like, Are they ready for school? Is their body ready for school? And so even just our preschoolers, right? Or the T cares, right? And and what does that mean? Well, vestibular base. Do they have the balance to sit still? Can they do static postures for an appropriate amount of time for a child that age? What do they look like at circle time? Can they stand in line. Can they stay in a chair, you know, for a relative amount of time to to focus and and take in a lesson, you know? And how are they playing on the playground? What is their visual spatial skills like? And then thinking about coordination related to that, the bilateral integration. Are they using scissors by the time they get to kindergarten? That should happen. Can they dress themselves? What happens when they go to the bathroom at school? Are they able to undo if they have a button on their pants? Can they undo that? Can they get their jacket on and they zip up the zipper? Those kinds of things when they get into school?
Jayson Davies
Yeah. And I kind of want to take a step back, because we mentioned vestibular bilateral integration and and you mentioned a little bit of, kind of, some of the ADL skills that that might be impacted as well. For those listening who you know, haven't gone through sift or easy or any of the other trainings, can we get a brief description of vbis and, kind of, what, what sense, obviously, vestibular, is in play, but what other senses might be at play a little bit. What's the interaction going on there?
Jennifer Petersen
Yeah, I'll go ahead and jump in at this. So what we have found through the research is that the vestibular system is demonstrating an inefficiency within processing the information, and then we're seeing it really through the guy I've been kind of calling them related motor functions, but that can be identified as use bilateral integration, using the two sides of the body together. It can also be seen within postural control, just as I talked about with being able to sit up right. And then also the ocular motor skills as well, so the ability to look at an object and be able to complete a tracking of it from right to left, or even complete some jumping with your eyes from right to left or up to down, so looking at your desk and then looking back up at the teacher. And so those are some of the categories within that, but vestibular, bilateral integration that you would see,
Jayson Davies
Yeah, yeah. And as you were talking there, the other term that popped into my head was praxis, you know, being able to plan and whatnot. Does Praxis add another component to what you were just kind of talking about? Or is that three step activity, kind of that praxis? Or how would you kind of bring that into the... Yeah.
Annie Mori
And I think I would also add the s, which we haven't talked about, of vbis, which is sequencing. Yes, again, I think good job. And I think that as clinicians, we we get sequencing can be a confusing thing to look at. And really we're looking at motor sequencing, the fluidity of movement from one action to the next. And we often measure it as, you know, like, we'll follow a three step craft activity, or, you know, we'll do a three step something or other, multi step, whatever. But we really need to think of it as, like, motor transitions. So even a sequence of going, when the teacher says they're in circle time, and the teacher says, Okay, now everyone, go grab the spelling paper and go sit at your desk and that sequence of stand up, turn around, walk, stand in line, turn around, go back to your desk, all of the balance, the coordination, The ocular motor stability to navigate a busy environment that you need to do that sequence of motor skills is really important, and those aren't really there's not really much cognitive layered into that, like heavy cognitive requirements layered into that versus a three step craft activity, there's some more cognitive demands embedded in that. So it gets a little murkier in terms of what are we really measuring, but when we really are thinking about like fluid motor sequences, how is this child moving around a space? How are they moving from one, one action to the next, and is it stop and go, which creates inefficiencies and delays? So those are the kids that you often hear, well, they're usually the last ones there. They finish, they finish their work, last those kinds of things. So sequencing is another big piece of that pattern that I think is easy to get missed, because those kids can really mask they're just slow, and maybe they're not a behavior problem, or there's no like, really big Academic issues other than that, they take a long time. Well, sequencing is a Praxis aspect of praxis, and when we do our assessments, you know, we have an assessment for sequencing, Praxis sequences, and we're looking at that motor fluidity. And you know what Jenny talked about earlier, about this factor analysis of testing scores, and how we got these kind of groups of or these patterns of challenges in sensory integration. Typically, we see that test of sequencing Praxis grouped together with other vestibular based tests like balance, postural control, ocular motor skills, vestibular nystagmus. So that's that's kind of how that got folded into that, for lack of a better word diagnostic category, but that's how I got it got embedded in there.
Jayson Davies
Okay, perfect. And again, for those of us who haven't taken an anatomy course recently, or an easy course recently, remind us again, kind of just in the brain, where a lot of this integration is happening a little bit, so that way we just can kind of visualize it a little bit as we go on to discuss more today.
Jennifer Petersen
Yeah, I'll jump in the vestibular system projects to. At this point, we know it projects to so many different areas within the brain, but I think there's some that are kind of Hallmark ones that we certainly should know that it's projecting to. So that vestibular system projects to that cerebellum. We know cerebellum helps us with balancing and motor coordination. It also projects to the oculomotor nuclei, which, again, as I talked about before, impacting our ability to track with our eyes or complete saccades with our eyes, as well as the lateral vestibular spinal track, which is helps us with our extensor muscles of our posture, so sitting upright. So those are just a few of the different areas that that vestibular system is reaching out to when you think of the nervous system.
Jayson Davies
Yeah, the brain is so complex, right? Like everything is going on. And Dr Peterson, Jenny, I have to give you a round of applause, because I did not prompt you with that question beforehand, and you just pulled those out of thin air, which means you obviously know your stuff, because that is one that I have heard 100 times, but could not explain it to you as well as you just did. So thank you appreciate it. All right, Annie, I spoke to your website earlier, and many of the publications that you have, and Dr Peterson, I know you have been a part of some of those same ones, as well as your own. I kind of want to just give you both the opportunity to just share a little bit about the research behind Vestibular Disorders. Maybe some sensory in there. I know we've talked a little bit about this already, but is there anything else that we haven't addressed before we start diving into evaluations and intervention that you'd like to share related to the research behind Vestibular Disorders.
Annie Mori
Well, really quick before we do dive into the research, I do want to mention, and we haven't talked about, this, is the role of the proprioceptive system with the vestibular system, because I don't want that to get forgotten, or for us to think of treating sensation in silos, because it is sensory integration. They we work we live in a multi sensory world, and our senses work together. We take in multi sensory information, and it doesn't just fall into pockets. It the senses work together to understand what's happening and and it's really hard to have vestibular input without proprioception. So we talk about those ocular motor skills, those vestibular messages are going to the muscles of the eye, which are our proprioceptors right and our postural muscles right. That that sensation of falling or balance, that information is getting sent to our postural muscles to right ourselves. So our proprioceptors rely on vestibular information to do the job that they need to do, to hold us upright, to coordinate ourselves, to balance ourselves, all of those things. So I just needed to make sure we included the proprioceptive system in that, in this discussion.
Jayson Davies
Yeah, yeah, the two systems, I mean, and a lot of people are obviously adding the third of interoception, but yeah, I mean OTs, ot practitioners, right? We vestibular and pro go hand in hand. But thank you. Yeah, we can't forget about the all important proprioception, of course, when talking about bbis and vestibular disorders and all of that. So thank you. And yeah, Dr Peterson, I don't know if you want to add anything to that or talk a little bit about just any sort of research that you've done kind of related to Vestibular Disorders and the impact that they have.
Jennifer Petersen
Yeah, well, one of my recent works that I had done was, during my post professional doctorate, I had the opportunity to be mentored by Dr Zoe may you, as well as Dr Roseanne shaft, and in doing so, it afforded the opportunity because of the timing I was able to utilize the developing easy at the time so the evaluation in air sensory integration and examine the vestibular and proprioceptive test on the easy and so some of those tests, just as we had talked about previously, of looking at ocular motor skills, postural control, such as, you know, maybe a prone extension position, and as well as the vestibular nystagmus test. So I was looking at those tests that you may have heard of, and seeing if they differentiated, if we were able to see a difference between children that were typically developing or children with possible sensory integration concerns. And so some of the research that I had done examine, do these tests, can they show a difference between typical and not typical? And in fact, they do. And so they are tests now that are part of the easy so that was one of my more recent research articles. But I believe Annie has some articles that might help us to kind of lead into sensory integration and vestibular impacting students and and learning, If Annie wants to talk on some of those articles that she has found,
Annie Mori
well, you know, I think vestibular disorders have been studied for a long time In sensory integration, and like Jenny mentioned, Dr Ayers studied this with children with learning disabilities, you know, in the in the 70s and, you know, just looking into the research around Vestibular Disorders, you know, in the in the 90s and early 2000s there was some work being done, not just in occupational therapy, But in other fields around learning disorders and the vestibular which is really interesting to see that there's especially around language development, so kids with dyslexia or any kind of reading challenges. So there was, there was, there was some pieces in there, and of understanding that theoretically, this makes sense, that the vestibular system is having a role in in learning. And Dr Ayers had some early research around that as well, showing that kids with vestibular or kids with sensory integration issues, and having identified with learning disorders, actually made, made some nice gains early on with it with an SI approach. So it's in the literature. It's there. For some reason, it just stopped being looked at. You know, I think perhaps autism came on the scene and that became a really big focus. But that, that vestibular system, it's there in the research. And, you know, I had the opportunity to work on a project where we did research around children with cochlear implants and the vestibular and well, we looked at sensory integration challenges with kids with cochlear implants. And what we found, we tested a group of children, and we found, by and large, as a group, they had challenges with Vbi. They fell into that vbis pattern. And so those kids, which makes sense, because the Cochlear, the Cochlear system is, or the Cochlear structure is, is part of the vestibular system. And so, of course, that system would be impacted, and we had hypotheses around it, because we wondered, and we had observed these kids and and so we did the study on them, with them, and it was pretty eye opening to see that that was as a group that was a challenge for them, that they were they had more challenges in that area.
Jayson Davies
Gotcha and again, kind of just because not all of us have the education that that you and and myself, Dr Peterson have with a cochlear implant. What is that process, atomically, and why would they have vestibular difficulties? What I mean, I guess, just really, really briefly, like, why would that that vestibular processing be impacted with a cochlear implant?
Annie Mori
Well, structurally, you know that receptor is right there in the inner ear, your cochlea, your lateral your semicircular canals, your otolus, which are two structures of the vestibular system. They're right there. They're together and so and then the other thing to remember is our cochlea process is sound, but sound is vibration, and vibration is movement, good point. So there's movement going through that space and that structure. So your vestibular system is being impacted and being vibrated when you hear things. So there is an impact on the vestibular system. It's not to say the vestibular system, you know, is a huge player in auditory and I think, you know, I would have to let ot audiologists weigh in on that, because I am not an audiologist, but the structures are close to each other, and they and the vestibular system certainly is getting stimulation from sound. And so when a child has difficulty with that structure and and that vibration might not be accurate or unreliable. That means the vestibular system is not getting reliable information, so it can't provide the rest of the nervous system reliable information to respond.
Jayson Davies
Gotcha. Thanks for sharing. Yeah, and just before you were talking about before we hit record, you were sharing a little bit about working with a student or a client who had dual bilateral cochlear implants, correct? Not cochlear implants. She actually had her cochlea removed. Oh, yeah, and she was a teenager, and so she so this was an injury, right? This was a vestibular injury, but that work that we did together was so illuminating in terms of the impact of the vestibular system. Now she had developmentally sound like nervous system, and so when she lost her vestibular system, her nervous system had to reorganize without this information on balance and coordination. And I mean, the the fallout of the vestibular, of not having a vestibular system was fascinating, and it just impacted everything interesting, everything for her. I would love to learn more about that, whether it be like a paper, I don't know if you put together anything, or if that would be an amazing like feature to just learn more about, whether it's a YouTube video or or an article, but yeah, I mean, that's just not something you obviously see every day, and it's just, yeah, you can't, you can't plan for that, which makes it very unique and very interesting to learn more about.
Annie Mori
Yeah, and because she had had typically developing experiences up until that point, because those experiences had shifted so dramatically, she was really able to articulate what was different and what she was experiencing and so and then, you know, I would step in with questions, because I had my thoughts on what could be happening, and then she and I would really work together to figure out, like how to make how she could participate more fully in life, because it was just so impactful.
Jayson Davies
That's a huge point that you bring up, because as we transition to talking more about evaluations here, we have to remember that our students, especially if it's, you know, whatever the concern is, developmental, they've never experienced anything else, like this teenager that you're talking about that had a functioning vestibular system. And so the students or the clients that we're seeing, whether they be five months old, five years old, 10 years old, unless it is that later on set for whatever reason, right? If it's developmental, they've never experienced anything else, and so they don't know that it shouldn't be scary to be five feet off the ground and whatnot. And so that's just really important for us to all keep in mind when we're evaluating students. That's a That's a tough one to remember. Sometimes agreed. All right, so let's dive into the evaluation process a little bit. Earlier, you spoke about some of the concerns, and I think a lot of what you mentioned earlier, whether it be ADL, difficulty crossing midline, some of those are just pretty common things that we see in the schools. So now as you're seeing those things as a teacher is referring a student for maybe it be some some behavioral concern. Maybe it'd be for handwriting or whatnot. And in your mind, what makes you start to wonder, could this be a vestibular thing? Could this be a vestibular related disorder?
Jennifer Petersen
Yeah, I think just like you started to say, you start to have this hunch of what you're seeing. So maybe the teacher is saying that the child's having difficulty with cutting, and then they're not using, you know, they're not holding their paper with their hand while they're coloring, and then maybe they're having difficulty with zipping their backpack. And so you start to hear from the teacher some of these concerns, and then maybe you get an opportunity to stop by the classroom, and you can actually see some of the challenges that we had described earlier. And that's, you know, that starting to build your that's just the start of building kind of this hunch of, oh, I need to put on my sensory integration lens and look into this further, and from then though, and I know your listeners have had information on evaluation, so because I have listened in the past, right, we have to document you. Has talked about, well, we have to get multiple forms of evidence. So that's great that we've heard from the teacher. We might hear from a parent sometimes, and then we can see the child having these difficulties. And then from there, we want to gather more information. So a performance based assessment is really helpful. And that's there's a couple that would look at these the vestibular system. And of course, I alluded to one with my own research of the evaluation in air sensory integration. There's also the so cm, I believe, has come out, and so it's looked at, also at vestibular so those are some performance based assessments. And then beyond that, we want to, you know, maybe we have a questionnaire, a standardized questionnaire, and so possibly, like the SPM two, would look further into it?
Jayson Davies
Yeah, definitely. And I actually want to dive into maybe not all of those, but definitely some of those a little bit further, especially the easy I know that's one that both of you are very familiar with. And so I do kind of want to deconstruct that a little bit and kind of talk about some of the specific pieces of the easy that might relate to the vestibular sense. And I actually want to start with one that I think everyone knows the initials of PRN. And this was something that recently, like, again, kind of just had a moment where someone asked, what is PRN? At a conference I was at recently, I was like, Oh my gosh, I forgot. Not everyone knows what PRN is. Not everyone knows the research behind PRN. Not everyone knows whether it is a research based, evidence based, way to look at vestibular and so I want to give you two again. You two are brilliant. You know more about sensory than I ever will, but what is the PRN and kind of what's the research a little bit behind it, into what it actually shows.
Annie Mori
So post triggering Nystagmus is a reflex, and it's a symptom of or indicator for the integrity of the vestibular system. Is it registering? Is it inhibiting sensation? And it really only measures when you when you administer this test, because it is, it is standardized. We do have norms around it. You can assess children from six months through 13 years now, 12 years, 11 months. We don't have norms for adults yet, but I'm sure that will happen one of these days. But we do know we have norms for that age group, and we are assessing you, how you position the child, the number of rotations, the velocity you use, that's all very standardized. And then you're looking at how long you have a nystagmus after you spin. And that's that flicker back and forth of your eyes. And the standard amount of time is between six and 12 seconds. An average nervous system registers movement for about six to nine seconds, so you'd or six to 12 seconds, so you'd expect that nystagmus to go for that long. Anything lower than that, we understand that as hypo or poor registration of movement that they're not readily registering it. It doesn't happen fast enough for them anything longer, any longer duration. We tend to interpret that as lack of inhibition, and that's a different part of the brain. It's more of those regulatory centers of the brain that's acting on the vestibular system, rather than the vestibular systems not receiving the information which is or not readily receiving the information it's receiving it. But so that comes from that's that's a different aspect. And so that test helps us to understand a piece of the vestibular system, because we're really only looking at one of the semicircular canals. We have three. And the way that this child's position and the way that we're administering the test, we just really get at the lateral canal, and that is why we don't just use that test to say that child has a vestibular challenge, because there are many variables when you administer that test that make those scores not strong, not very reliable, and so we want to be sure that we pair that test with other measures of the vestibular system, so balance, bilateral integration, ocular motor skills, sequencing, postural control. We want to make sure we're we are building as much evidence for that, for a challenge in that area.
Jayson Davies
Awesome, Annie, as I was listening to you, you kept answering the next question that I wanted to ask you, because you just knew what I was going to add. No, that's perfect. But one thing you didn't answer that I want to ask, because if I recall correctly, the PRN actually stabilizes pretty early on and correct me if I'm wrong. But you said, what was it six to 12 seconds for an average PRN of nystagmus after the rotations? Is there a point pretty early on or later that that becomes kind of like everyone beyond this is up to 13 of course, we haven't gone into adults, as you mentioned. But does that kind of that six to 12 seconds? Is that established pretty early on and pretty consistent beyond that, or does it change all the way up to that 13 years?
Annie Mori
Yeah, we have a article on that, and we tested children as young as six months. And so that was from that age, from six months old through 12 years, 11 months, we know that it's pretty stable between six and 12 seconds.
Jayson Davies
Okay.
Annie Mori
So a school age child, you could definitely expect that.
Jayson Davies
Yeah, yeah, definitely right. So I guess my follow up question then is, is the PRN one of the first, to a degree, it can almost be like a screening tool, maybe, and correct me if I'm wrong. But would that be one of the first, like little pieces that you might use with a student who you have considerations with vestibular disorder, and then from there, move on to some of those other tests that you were talking about?
Jennifer Petersen
I mean, as a screener, potentially, potentially. But I think I just with caution, because, you know, you can still have, like, an average registration in that one time that you administer it and and then show challenges in other areas. So it's, it's that test is not like the the key to a vestibular disorder, it's just a piece of data. So I think I would, I would do that with caution. If there was a lot of reports of related challenges that seemingly are could be vestibular based, then you definitely should look deeper, even with or without problems with PRN.
Jayson Davies
Gotcha. Okay, cool, so let's talk about some of those other assessment pieces, especially within the easy or if you want to venture out of the easy as well. What are some of those other components that you want to look at? You mentioned that the PR end looking at, I believe you said it's the lateral.
Jennifer Petersen
My circular canal.
Jayson Davies
Yes, canal, thank you. Yes. But you mentioned, right? We have to look at the other areas, and it's just one piece of it. So it. So can you go into a little bit more detail as to what those other pieces might be and what they look like?
Jennifer Petersen
Yeah. So, you know, in looking at balance, that's primarily looking at more of a static ability to sustain that upright position. It can become more dynamic depending on your if you're doing movement with it, or if you have the child close their eyes, but that's going to be looking at those OTs. So that's the structures within the vestibular system that is primarily where gravitational pull is being processed and registered, as well as any kind of the linear movement, or maybe even just like a slight head tilt, so balance postural control would be the same way of looking at the OT list is looking at their functioning and and then when we look at the ocular motor skills, that is definitely something that's more again, does go back. So back to kind of my research when I was doing the examining the Construct validity of the vestibular test. What I had also done was looked at these related tests of ocular motor balance, postural control, bilateral integration. And what I found when I looked at the vestibular Nystagmus is what we called it, but otherwise known as the post rotary nystagmus, is that it had the strongest relationship with ocular motor and that makes sense, because we also see that within the reflex, right? So I think that's that certainly is easier to grasp that type of concept. Is why, you know, vestibular we would also see that in ocular motor skills, because of knowing are the knowledge on the post ordering nystagmus.
Jayson Davies
So you called it vestibular nystagmus, aka PRN, within that. And remind me again, either of you how many total a tool, or, I guess, how many total pieces are within the easy?
Jennifer Petersen
there are 20 tests total.
Jayson Davies
20 total test. And then how many of those would you say are kind of help to build up your picture of the vestibular system all 20? Or is it kind of?
Jennifer Petersen
Well, there's six of these that are related to this vestibular proprioceptive test as to kind of what we're describing right now, but there are other there are more than six when you're starting to look at more sensory reactivity and.
Annie Mori
Visual spatial skills.
Jennifer Petersen
visual spatial Thank you.
Jayson Davies
Gotcha. Okay. So then I I'm trying to, like, in my mind, I'm trying to think, Okay, if we have a student, we're interested in learning more about the vestibular system, whether or not we start with PRN, but we have at least six of these different tools within the easy that we could potentially use. We have the SPM to which I think most of us are pretty familiar with. And then, of course, we just have our standard observations and our structured observations, seeing the student in the classroom as well as maybe one on one to look at some balance, even if we're not necessarily using the structured version of the easy, but I guess, how does this all come together? What are we it's hard because I don't want to dive, like, too far into the easy, because I know not everyone has the training of the easy, but I really want to give you both the opportunity to kind of share, like, what you are really looking for during that evaluation. What? What are really keen into and if you want to dive further into the easy, feel free to it. But what are you really starting to synthesize, I guess, when it comes to your evaluation and a child that has a vestibular disorder?
Annie Mori
Well, you know, when I'm looking at I first look at the performance challenges. I'm listening to what the teacher is saying, what the parents are saying. I'm going in and observing something similar and trying to just gather data about the child's performance. And then I'm going into my actual performance assessment, where I'm going to get, you know, standard scores that are going to confirm or deny my Soft Skills of observation, right? So then I go in and I'm I'm looking for and I'm going to choose an assessment that's going to help me understand these performance challenges I'm seeing. So if I see a child struggling with sitting upright in a chair difficulty at circle time, and I'm not going to choose a fine motor test, I'm going to choose a test that's going to look at balance and look at some functions that might like get to that issue. So I might use the brunix. I might go to that and look at the balance test of the brew Next, if that's what I have accessible to myself, but I want to make sure that I'm choosing tests that are going to actually tell me what I need to know. You know, if you have that training in using a performance based sensory assessment, then certainly you should be doing that, because that's going to give you those pieces. Now, on the easy You don't have to give all 20 of those tests. You can, if you have an understanding of what you're looking at and you really just want to hone in on the vestibular test, you can. But I think Jenny and I would both agree that the whole battery gives you a full picture, because, like I said, they don't work in silos. One impacts the other. There's kind of a cascade that happens. And so you do want to, you want to get that, that evaluation piece, in place, and and you know, you're looking at again, depending on the performance challenges, is it, does it seem like it's a bilateral task, right? Are they struggling with, like putting papers into a folder, zipping their backpack using scissors, okay, that could be bilaterally. Jenny said, like not holding their paper down, that could be bilateral. And we also know, like developmentally, we got to go back to those postural skills, because you can't use your two hands at midline if you don't have stable posture. So you got to look at that. Then you have to look at the integrity of the vestibular system, which would be your vestibular nystagmus test. So like looking at the bilateral, the postural, the balance and in a static environment, I think that's what's really important, is that a lot of these kids with vestibular issues, they are probably pretty good, good athletes. They do really, really well, as long as they're moving right or they want to move, they want to move a lot because they're trying to turn on their vestibular system. And once it's on, those functions help them. But in a classroom, they don't get to turn that on like, I mean, it should be on all the time in typical development. By the time you're school aged, your vestibular system should work with relatively little stimulation. But, you know, for some kids, that's not the case. And the older they get, the younger grades, teachers are much more forgiving for those kids that need to move, but by the time they get to, you know, second grade, that forgiveness kind of goes away, and they're expected to sit still, and they're not sitting still. And then, you know, guess what? We get more referrals in second and third grade, because that's when the training wheels start to fall off, and those kids are like, Oh, well, now I can't move, and I need to move to do so that's why those static environments are really important. And understanding how they do when they're still.
Jayson Davies
I love that we just got, like, an entire insight into Annie's evaluation process, and, like, how she goes through that. And I love that, and it kind of leads right into the next, the next step, which is that intervention phase, and how you start to move from what you were just talking about. Especially important. Like, as you mentioned, a lot of our evaluations come in that second, third grade, when the training wheels are falling off, as you've mentioned. And and how do we then begin to take those assessment results and move into the intervention process? And I guess kind of a way to start off with is when we do our evaluation, we can provide direct, direct intervention. We can provide accommodations. We can provide, potentially, teacher training support to a paraprofessional and whatnot. And so what are some of the things that you might start to recommend, kind of thinking of that classroom setting, what are some things that might come out of your evaluation that you might want to start to recommend?
Jennifer Petersen
I think starting, just as you said, starting with kind of parent teacher education is an important piece, because if you can create awareness as to the area of difficulty, the area of challenge that then is impacting the student's ability to participate in in the action required of them, or to be able to sit at their desk, or to be able to complete those bilateral tests that that we keep talking about from there. Then we, you know, the teachers, has this buy in of, okay, so what can we do about it? Then, if I have an understanding of the problem, what can we do about it? And so at that point, we can certainly encourage, within that classroom, encourage participating in more vestibular activities, so that would be getting the head out of the upright position. And to make that, you know, those movement breaks are great, the ability to participate in, you know, encouraging recess for these children. So instead of taking away recess, if it's occurring, making sure that these children need recess, because they will participate better after recess. So I think that goes along with the education component. And I'll let Annie add on some more to this as well.
Annie Mori
Yeah, I think when I'm starting to develop kind of my intervention plan, after I've done my evaluation, I think of two approaches. First, I have the getting by approach, because what is this child? What can I put in place for this child now to help them get by? Do they need a rocking chair? Do they need? They're a band on their chair. What does my assessment tell me that will support them the best? And sometimes looking at the scores that they actually where they perform well, that tells you their strengths, and that might tell you, Okay, this is actually, if I put this into place, this might help them do better. So looking at their strengths as well can help you align those accommodations for them. So you've got your getting getting by strategies, and I think the education falls into that as well, right? So everybody can start problem solving, and then you've got your getting better approach. And this is like, how am I going to directly intervene for this child? What am I going to do to address the vestibular system? So that long term, this child is making gains and that they don't need ot at some point, right, because that their vestibular system is doing what it's supposed to do, and it's supporting them. And then eventually these getting by strategies start to fade away as well. So I kind of think of those two approaches, and I use my assessment results to tell me what to do with that if there's a vestibular based, you know, for example, if the child has, you know, unreliable vestibular input, and I see that their vestibular nystagmus score is low, they have a low score on, you know, postural control and a low ocular motor score, but balance and bilateral integration look good. Well, maybe I'm really going to work on a lot of vestibular, ocular motor activities and postural activities. So I'm going to do a lot of scooter board, a lot of scooter board, and a lot of targets, and in a really fun way, maybe prone over the ball, working on those postural and ocular skills, along with vestibular input to get that system working and making the connections it needs to make.
Jayson Davies
Again, just another little gem there. I love how you broke it down into two different ways to go about it, both the proximal kind of the accommodation get by right now, but then the more longer term of what can we do for the future? And I think that is really tough for school based occupational therapy practitioners, because we're constantly told, call it right, call it incorrect, whatever you want to say right, like we are kind of at the taxpayers discretion, per se. And so it's almost like you need to do the least to do the most. And so I think some people get stuck in that. Let me just provide the rocking chair. Let me just provide the sit and wiggle cushion. And then we don't move forward with the how to get better aspect, and that's important. I think a lot of us have administrators that might say, Hey, if you can do this with a consult, providing a rocking chair or whatnot, then why do you need to do the one time a week service? And so I kind of want to touch upon that really quickly, is what's your elevator pitch? I would love to hear both of yours. Kind of like, what is that elevator pitch for? Why this student doesn't just need a simple accommodation, and you kind of already not an elevator pitch, but a very detailed explanation, but Dr Peterson, if you might like, just a quickly explanation to an administrator, to a parent, to a teacher, as to why maybe just the accommodation isn't enough.
Jennifer Petersen
Yeah, you know one piece I guess, that we haven't talked on yet, that I usually pull in is when children are having these difficulties and students are having these difficulties, they become fairly self aware that it's taking them a little bit longer to do these tasks. It's more challenging for them to do these tasks, and it starts to weigh on them. And then that impacts their confidence and it impacts their self esteem. And as their confidence and their self esteem can diminish then at that point, you know, then, then we're dealing with more occurring, you know, mental health difficulties, and so we know that that can be one of the products if we don't work on improving and providing these compensatory strategies to help that child get through the day, but also to help change that system so that it is working better, so that things become a little bit easier for them. And so that's a piece that I also speak to when talking with parents and teachers.
Jayson Davies
Yeah, and then kind of on, not necessarily a flip side, but another side of the spectrum, is that we have many people, myself included, over the years, that it's just really hard to implement sensory integration in a school setting. We oftentimes don't have the necessary requirement for the sensory integration fidelity measure, right? We don't have that that equipment. A lot of the research is like three hours a week or plus, and we just don't have that time frame within school based occupational therapy, right? So what are some things that we can start to do to use some of maybe the theory, the strategies behind Si, even if we're not following the fidelity measure, how can we start to support students in that way?
Annie Mori
Yeah, I mean, I think you can always use an SI informed approach in schools, and even if you don't have an air sensory integration clinic space at the school, there's a lot you can do with a scooter board and a ball. And I had many years where I walked onto a playground, carrying my platform swing, hanging it over the monkey bars, and doing that. So there are ways that you can get the intensity or the activities that you you need to do to implement an air sensory integration approach, or at least an informed approach at school. And so you have a lot of equipment, actually, as a school based therapist, that you can do, and you don't necessarily need 45 minutes. You know, a good chunk of of a clinic based or an outpatient setting is we're working on self rate. We're working on the regulation. And if you can embed regulating activities ahead of your treatment session, perhaps you're picking up the child a little more regulated. So you can get to some of that work of the bilateral, the postural, if that's the case, so you don't have to kind of organize the child up front.
Jayson Davies
Okay, and I and kind of to go along that with that, because you mentioned maybe getting the student a little more regulated before your session. That just popped into my mind, like working with the teacher, working with the paraprofessional. To what extent might a pair professional be able to support you in this role of being able to provide si self regulating supports? What might you be able to support them in their I guess? How far can they go? How far can should we not be asking them to go? And I know that's all you know, very dependent on the people, dependent on the setting. But if you have any experience or any thoughts on that, I'd love to hear from either of you.
Jennifer Petersen
Yeah. So you know, certainly there is the role, right, and making sure we're sticking within within our role. But a lot of times in Iowa, the role is consultative, and so we are providing education to teachers as well as paraprofessionals. And so that education piece is going to be really important. And when we think of the education piece, yes, we can give the anatomical structures, or, you know, all those components that I talked about earlier, but we can also help them just pick up on cues from the child. So helping them pick up on the cues of the child starting to get frustrated, or the child that's starting to move around or get a little antsy in their seat by being able to pick up on some of those subtle cues that can then allow the paraprofessional to say, Oh, hey, why don't you go up and get a drink? Okay, so that we can at least then provide some activity within the day and provide some of those more regulation strategies, or maybe we're going to put heavy books in the backpack so that way, then the child can carry those books from one classroom to another. Or, you know, we need to find what works for the school, certainly. But I think the beginning piece is picking up on the subtle cues that we are skilled at doing as a clinician, and teaching those skilled observations to someone else, so that way they can then embed the strategies that we might have for them.
Jayson Davies
Perfect. Thank you. And then, of course, just before we wrap up today, the biggest reason for referrals in school based occupational therapy is handwriting. We can't deny that self regulation is up there. Sensory is up there. Other fine motor skills were up there. Executive functioning now is up there. But handwriting is definitely, by far and foremost, the largest reason for referrals. So when talking about Vestibular Disorders and handwriting, where does that come into play? I know you talked a little bit about gene airs, originally looking at learning disorders, so kind of go hand in hand here, but from your perspectives, how does Vestibular Disorders and handwriting go hand in hand? And what can we do?
Annie Mori
Well, the vestibular system really informs that timing and sequencing that we need for handwriting. So like, how do we coordinate the speed of our hand moving across the paper with the strokes that we're making for our letters? And just this letter formation is a sequence in and of itself. And then there's spatial aspects right to handwriting, and that spatial awareness comes from our vestibular system as well. So it's important to look at all of those links, and we often work on handwriting here at play sense and without ever picking up a pencil, we make improvements in handwriting by just being on the swing. And what we always tell parents is children practice handwriting every day, and if we're not addressing the underlying challenges with handwriting, such as the vestibular system, then they will continue to practice imperfectly all the time. So we want to get that, get that underlying challenges addressed, so that that practice becomes perfect.
Jayson Davies
Absolutely, that's awesome. Again, Annie, I just love your very simple, straight to the point, but like, very relatable answers that, like teachers, parents, can understand these, like, these are things that we can share with them, and we're not going deep into the weeds as to what vbis is, what you know, vestibular, what proprioceptive is we can kind of keep it more, you know, neutral level, I guess you call it ot jargon aside, and really explain to them. So that's fantastic, yeah. Well, Annie and Dr Petersen, I want to say thank you so much for being here today. We really appreciate it. And this is, again, I kind of alluded to it up front. I'm starting to hear vestibular disorder outside of just within sensory integration, or maybe it's just that we're highlighting vestibular disorders within sensory integration. Maybe that's a better way of putting it, but it's definitely something that I think people are starting to key into more we're kind of associating it, as you just said, Annie more with like handwriting and other skills, as opposed to just fine motor skills for handwriting, or just fine motor skills for cutting, there is that vestibular component. So thank you so much. Really appreciate you coming in and just sharing about how it all connects with that. I want to give you both the opportunity to just kind of share where anyone listening out there can learn more about you and or the work that you're working on right now. And Dr Petersen, if you'd like to kick us off with that.
Jennifer Petersen
Yeah. So you can certainly reach me through our university website, through so st Ambrose University in Iowa, dr, Jenny Peterson is where you'll be able to find me. You can always email me too with any questions. So Peterson, jennifer@sau.edu and then both of us. You can find us through CLASI as well, because we both are affiliated with the CLASI organization.
Jayson Davies
Awesome. And we'll share all the links to that as on the OT school house podcast website. So be sure to check that out. Also, I will add to that just Google Scholar her name, and you will find many articles come up. So between Annie and Dr Peterson, you'll find plenty of sensory related articles that I think would be a great if you want to learn more. That's a great way to do it. Articles are never a bad way to learn more. And Annie, I don't know if you want to share, maybe your clinic website.
Annie Mori
Yeah, you can reach me at my placeence clinic, my website's placensekids.com or you can email me directly at Annie at place kids.com
Jayson Davies
Great. Well, thank you so much, Annie. Thank you, Jenny. We really appreciate you being here, and definitely we'll be in touch.
Annie Mori
Thanks, Jayson.
Jennifer Petersen
thanks so much.
Jayson Davies
One more time. Thank you so much to Annie and Dr Peterson for joining us today to share their wealth and knowledge on Vestibular Disorders and how we can support our students with vestibular disorders, from understanding the connection between the vestibular and proprioceptive systems to also understanding assessment tools like the easy to get a comprehensive picture, they have given us so many clinical truths to take back to our practice, I personally really appreciate how they emphasize both the need for short term, quote unquote, getting by strategies, as well as the longer term, quote unquote, getting better interventions. I think that that is something we often forget as ot practitioners, that we can kind of do both. I think sometimes we get locked in to try and do in one versus the other, but it is something where we can do both. We can kind of maybe put some accommodations in to support the student right now, while also providing interventions to support the student longer term. So now that you've wrapped up this episode, be sure to revisit the resources that Annie and Dr Peterson mentioned, like the CLASI the easy as well as their own websites. And you can also dive in deeper to the research and keep expanding your toolbox when it comes to evaluating and treating vestibular disorders. We have provided the resources that they mentioned on this episode over at ot schoolhouse.com/episode161, so you can head over there to get all the resources that we discussed today. And as an extra bonus for all of you, ot school house collaborative members listening today, you can also receive a certificate of completion for listening inside the community right now. And if you're not a member yet, we would love to have you join us over at ot schoolhouse.com/collab members of the OT school house collaborative have the ability to earn professional development from listening to select episodes of the OT school house podcast. And you also have unlimited access to our CEU courses, resources, goal, bank, research, library and so much more. Again, you can learn all about that over at ot schoolhouse.com/collab I'd love to see you over there, and I'd love to help you out. All right. Well, that is going to wrap us up for today. Thank you so much for listening along, and I can't wait to see you in the next episode of the OT school house podcast. Until then, keep being the OT practitioner that your students and teachers want and need. I'll catch you next time. Take care.
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