S, A and M

Quick take

Sensory, affect, motor. Three letters that sit underneath almost everything we say on this show. In our very first Spirited Chat, Tracy explains where SAM came from and why every one of those letters has a high route and a low route of processing in the brain.

About this chat

This is the first of our Spirited Chats. We are hoping to give you one idea, and keep it short enough to fit between clients or on the drive home. We started at the very core of the SPIRIT Model, because if you’ve ever heard us say “the low route of M” and felt like we were speaking our own language, this one is for you.

Tracy traces SAM back to Dr Stanley Greenspan and shows the unique and amazing quality of her thinking mind as she builds on it. Michelle and Cory bring it back to the clinic, and how having three clear places to look really supports reasoning, particularly when a child’s presentation gets complicated.

Key topics and highlights

• Where SAM comes from. Dr Stanley Greenspan saw sensory, affective and motor processing as common roadblocks to social and emotional development. Knowing the origin helps you see why the model links these domains rather than treating them separately.
• Every system has two routes. Using Dan Siegel’s hand model of the brain, Tracy shows that sensory, affective and motor processing each have a relatively lower “downstairs” route and a higher “upstairs” route. For sensory, that’s the difference between modulation and discrimination, and it’s a distinction every paediatric OT needs.
• From model to clinic. Michelle describes SAM as a head torch: it tells her what to assess, and it shapes intervention through STEPPSI. When things get complicated, it’s the way back to basics.
• Differentiate to integrate. Good clinical reasoning starts with clarity. We separate what’s happening in each system so we can bring it back together in therapy.

Reflective practice prompts

1. When you read “sensory” in a report or referral, which do you default to: modulation or discrimination? What would change if you asked which one is meant?
2. Think of a child you’re currently working with in one domain. What might you notice if you looked at S, A and M side by side?
3. Where could sensation be your way into social and emotional engagement with a child this week?

Resources mentioned

• SPIRIT Model (Sensory, Affective, Motor), Tracy Stackhouse
• Dr Stanley Greenspan
• Dan Siegel’s hand model of the brain
• Ayres Sensory Integration
• STEPPSI
• DFX Learning Journeys

Timestamps

• 01:00Welcome to Spirited Chats
• 01:47Today’s topic: S, A and M in the SPIRIT Model
• 03:03Why “high route” and “low route” can sound like another language
• 03:21Where SAM comes from: Dr Stanley Greenspan
• 04:53“Which sensory?” Splitting it into low and high routes
• 05:44Dan Siegel’s hand model of the brain
• 06:50Modulation (low route) and discrimination (high route)
• 07:48Affect and motor have high and low routes too
• 08:21How the SPIRIT Model was built on SAM
• 09:09What SAM means in the clinic: assessment and intervention
• 10:06The head torch: going back to basics
• 10:55Sensation as a way into social and emotional work
• 11:11Differentiate to integrate

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