32. Unpacking Clinical Language: Eye Control and the Vestibular System

In this episode, we’re wrestling with something that comes up all the time in clinic: how do we explain the tricky clinical terms (like ocular control) to parents without losing them? We are continuing on the journey of trying to unpack language, talking about how we translate what we’re seeing in terms of ocular motor functions, vestibular contributions, and somatosensory discrimination into language that actually lands and makes sense for families.

We start with unpacking how the vestibular system and sensory discrimination play into eye movements, then end with how modulation bumps into these issues, and how neurodevelopmental factors shape what we’re observing. We also take a little time to poke fun at chatGPT and AI in general. Happy Listening!

Resources & Mentions:

• Polyvagal Theory — Stephen Porg

• es

• Neuroception (component of Polyvagal Theory)

• Dan Siegel’s Model of Modulation (Window of Tolerance / “revving up and down”)

• Deb Dana’s Polyvagal Ladder

• Spirit Model (Sensory–Affective–Motor), Tracy Stackhouse

• Low Route of S / Low Route of A (within the Spirit Model)

• A-Functions / Affective Functions (affect, attention, autonomic, arousal, action)

• STEPSI Framework 

• DFX Learning Journeys / Learning Communities

• Mind 2 Mind Study Group

TRANSCRIPT

[00:00:00] 

Tracy: So in the mentoring space and in the clinical space this idea of how do we help parents and educators understand some of these complex ideas, but make them really accessible and use language that. translates, uh, you know, and I think that's what we're doing all the time, is trying to translate science into practice.

So finding the right language sometimes is a part of that discussion. And we've been having some fun conversations about that so I think that's where we're at. We're gonna keep that conversation going.

Michelle: Awesome. I, um, was writing a report this week and this idea, kept popping into my brain because in my mind I kept, um, thinking 'motor' and I was typing motor, for example, and ocular motor. Even, you know, Praxis and, I'm writing this report for people who are new, to [00:01:00] diagnosis, uh, journey with their child.

So it was like, what a Stoooppp writing motor. Like what even is motor in the context of a little child, who's playing and moving and new to their family. So yeah, it was just this juxtaposition of being very clinically focused and trying to be precise. And, you know, in my mind as I'm formulating, the assessment results and formulating, a description really for them about how all these. Apparent, random, presentations and impacts on function as showing up for this little one. And I'm already thinking about intervention and so the word motor kept coming up for movement really. But it was like, that's not what I wanna be saying. And that's not the introduction to movement and eye function and hand eye coordination and and, you [00:02:00] know, early movement patterns, that's not how I wanna be describing it or introducing it to the family. So, um, yeah, that was very front of mind for me today, uh, this week is just how do we. Sit in two spaces in a very precise clinical space in our mind, and in a very, accessible way for people who are, you know, maybe new or even early on in the journey.

Tracy: Well, and it's, it's, I love calling it the two spaces and then I think. Even in that, sometimes those spaces get subdivided, right? Because the clinical space, at least, you know, and it's, it's a little different I think in Australia with. NDIS funding and the way that things are funded here in the States.

But we often have to tie things back to this medical coding language in order to find that our services will get reimbursed. And that's an

advocacy piece that [00:03:00] we have to live in this clinical space that is also interfacing to this medical billing space and to the language of medicine, if you will, because unfortunately, or fortunately, you know, there's all directions and degrees of that.

But, sometimes we have to tie this to that more formal label or diagnostic information and then we move into the two spaces you're talking about, Michelle, where clinically we're refining our clinical reasoning and figuring out what are the layers and what are we gonna be approaching, and then all of that has to really be translated.

In a way that allows parents to understand the all of those lanes and layers and begin to approach it without feeling overwhelmed or feeling like we're talking just about difficulties or coming at this from that lens, that can feel so very deficit based instead [00:04:00] of really just understanding the unique needs and profiles that any of us might have.

So I think we have a lot of translating because we're translating for parents into the spaces that we hold as clinicians and then as clinicians we're translating into and out of that more kind of medical ease and then out of it so that we can really operate more holistically. I think it's hard, so I, that's why we're having these conversations 'cause it's a lot of places of translation.

Cory: Yeah, totally. Excuse my sick voice this episode, but I'm here. Um, but the other thing that you brought to mind from both of what you've said is that we are always trying to translate it with precision. And that is actually so hard, like. You're saying ocular motor, which for me, 'cause I'm a clinician and I know what that means, I have all this associated imagery [00:05:00] and ideas that help me understand that.

Whereas if I have to explain that without that term, I have to use all of those other words to help them give the same imagery and do that without being too complicated and. Help them actually gain the idea that the eyes are moved by muscles and those muscles have to coordinate so that the eyes move together and not separately.

And the vestibular system or the gravity receptor. Like again, I very quickly get into all this other language that I then have to explain, explain, explain. it's very, it's hard to get a fine line between. The detail and the precision, but not too confusing, but still accurately reflect what's actually going on in ocular motor movement I think that's kind of what we're gonna try and do today, right? Is the [00:06:00] routes of sensation

Tracy: Uh huh.

Cory: affect, so I guess where do we wanna start? I mean is high route of sensation is sensory discrimination.

So maybe we should talk about, we've done that I think before,

Tracy: I think But you know what would be kind of fun is if we connected it to Ocular Motor as a starting point because Right, because what, that's kind of what you started to do, both of you as you were talking, and this is that translational space that we're gonna have to live in, and I think build out in our minds that we're holding all of that.

So if we're thinking about ocular motor, so ocular is our to do with our eyes. And and like you said, Cory, our eyes move. Um, but our eyes are in our head and our head is attached to our body. And so, as occupational therapists, when we look at eye movement, we're looking at it in the

concert of that complex that it lives in [00:07:00] eyes in head, head on body, body as a whole mover, and that has a set of sensory systems that support it. So we have to be able to connect those dots. And in the high route of s in the sensory discrimination function, when there are basic sensory. Integrative challenges in vestibular processing or in the visual system itself, in the proprioceptive system, sometimes in other systems that give rise to understanding.

Stability, mobility, near, far, me, out there, systems. All of that contributes to the way our eyes work and, and fuel us and give us information and how we access the world around us. So right away we have to go into that sensory circuitry that, across the domains. It's [00:08:00] not just vision and it, that's the, genius of sensory integration is that we understand that it isn't one thing, but it's the integration.

But then we have to. Be able to look at the bits and the parts and where might the issues be. So our treatment actually is effective and isn't just general. But then as OTs, we're always pulling back out to the lens of, well, how does this impact everyday life? And why is this important and why do we think this is important?

And I think with parents, you know, the starting conversation is usually around that, what's important in daily life, and then connecting them into the bits and the parts of what might be going on. But, you know, I think we just have to listen so carefully to their description and their concerns and, and then sometimes we land on, oh, so you're telling me that your child often can't find you when you call their name, and it doesn't seem like they[00:09:00]

know how to look up to regard that you've entered the room and you're really worried about how they interact with you and how they look and find you. And if that's what they're describing, then that cues us in to saying, we need to be looking at maybe some of these parts. And ocular motor is such a

way in, to seeing what's happening in the integration of the vestibular function in particular, and that's so foundational in our work. Anyway, those are all the ideas, and I'm just connecting across those spaces, Michelle, that you named, but I think that's what we have to do in our clinical thinking is we're, we're kind of moving between them and then trying to translate

what the family sees as the daily impact and then finding what is going on there. So yeah, I think it, it opens like all of these places of question and curiosity, whenever there's a [00:10:00] concern, and then each of these. Sub things that live on the spirit form, like ocular control. They all have a story behind them.

They all have all of this depth and richness to them. And, it can be mind boggling at first, but it's also like, a problem solving journey all the time. Yeah.

Michelle: I love it because it

Cory: Yeah, totally.

Michelle: to be, really strength-based and neurodiversity affirming and positive, really so the question that came to me is why, a little child so distracted and why are they so clumsy? so that's what took me to, look at tracking sacades, uh, vestibular system. and the others. But that was the start of the conversation and the end of the conversation, they saw me do the assessment and have a look at [00:11:00] tracking sacades, convergence, divergence. And they noticed it was like, oh, look at her eyes, do that. so when I was able to then go, yeah, she can't separate her eyes from her head, and she's moving her head. Do you know what that. what happens then? So when that noise is made, her whole body is turning towards the noise to find what it is, and then, oh, that bag looks really exciting. Michelle's ball's over there. That looks really exciting. You know, that's possibly the, the base of this, in attention and, distractibility and they joined the dots. Like, you can kind of see it happen. You, it happened several times when I was with them, so it went from, oh, please pay attention. Michelle's here. You know, she's got things to do to, I just saw it show up again. Did you see that just happen? It's like, yeah. Like, yeah, she's not trying to not be with us [00:12:00] here.

And you know, she was really eager and sweet to be with us, but, um, yeah, that saccade, wasn't happening without, her head moving as well. So she bumped into the ball and, uh, and the

Cory: Mm

Michelle: the,

Cory: mm.

Tracy: Absolutely. So you're connecting how the. Ocular system, which on the spirit form anyway, we think about that as a kind of a foundational motor capacity. So we look at that in the low route of the motor system, but then we right away connect it to the high route of s, the sensory discrimination function because the vestibular system really does underlie that beginning midline orientation and then the ability to

smoothly and accurately, organize the tracking patterns and the movement patterns of the eyes. And so it's a set of [00:13:00] cranial nerves that are using the vestibular system as the foundation to sort that. But then what's so cool, so we're in the high route of S, but right away we're connecting into the high route of A, because these saccadic eye movements and being able to look toward and come back,

that's how working memory begins. That's where distractibility is anchored out of, is that I know what I'm looking toward and I look at it and then that informs what I was thinking before. But if you have to turn your whole body like this little one does, it takes you out of the here and now into the next thing and the next thing and the next thing.

And so lots of times, distractibility, we see it in the ocular motor system and we see it. Founded in that very first executive function, which is really psychotic eye movements. Um, so the high route of a on the spirit form is this executive functioning [00:14:00] kind of system, but it's based in sensory discrimination and basic motor function.

And we connect those dots and then we know what the treatment plan is. If you just see the distractibility. Then you follow that as a behavior, but you don't understand the foundation of it. So the high route of S and the high route of A are supported by the low route of M. Wow. That's mind blowing and so important.

Michelle: But it's kind of liberating. cause

then we don't go down the behavioral

route, which we, mm.

Cory: Yeah. Behavioral approach. Yeah, a hundred percent. I was gonna say the executive functioning box, I love on the, on the model, 'cause I, I'm looking down at my model right in front of me and,

Michelle: [00:15:00] Mm-hmm.

Cory: you might, you might see something in multiple boxes, and that's because Tracy's trying to give you clues as to like, this function relates many places in the brain. Like, so I, I, you know, it's got in that literal column, it's got. Sensory modulation and regulation because of course regulation impacts your ability to access all of your executive functions.

And then got orient, reorient to goal like eyes, ears, and midlines. And that of course brings you to the postural box because that's all about eyes is and midlines, and you've got the prospective motor control. So that's another thing, but it's about trying to integrate the sensory motor of functions to be able to do the executive functions that I think we, in the adaptive capacities of like what we are looking for of in function of life, [00:16:00] executive functions are often being described, uh, in the stories. so we could work on like lots of cognitive strategies and different things, and they're useful a hundred percent, but also want to pair that with understanding why that executive function capacity that may be attention for this kid or just, I guess this capacity is not just attention because it's so broad, but reorient, reorient a goal at midline, which was relating to a, an inability in this moment to even just have the capacity to separate my eyes from my head. So now I'm, if I have to reorient, I have to physically come back too, which is way harder than just like, move my eyes back. And so. That is tripping up all of her attention. But we could also talk about clumsiness as well relating to all of this as well. So, I don't know where to go, I love that the model can help cue [00:17:00] you. And you don't have to know every term on that, on the model, like you can do it blank. Yesterday I was saying to somebody I mentor, I, for a long time, I just used the s and the A and the M in my head. am I guessing that this is like sort of more motor based or affective or sensory based? And that kind of helped me. Of course it's blending, but at first that's all I could kind of come at and then add layers and layers and layers and layers and it's so fun to be able to add layers. Anyway,

Tracy: We could talk about the. We started with the ocular motor, but the other description of this little one was around not having the smoothest coordination. Generally, not just of the eyes and kind of attention, but also generally. And it's not uncommon for us to see, coordination issues coincide with.

Other kinds of, [00:18:00] uses. So sensation for a use that sensory integration Ayres right, and the purpose of sensory discrimination. High route of s really always lands in some kind of skillfulness and the highest kind of skill that our movement systems, our motor systems coordinate our coordinated high level.

Highly practicable refinable kinds of skills. And so we have automatic skills, like looking is pretty automatic, but we can get better at it. But we can get really better at using our fingers. We can get a whole lot better at using our feet as kickers or our legs as climbers or our arms as bat swingers.

We can get quite skillful at any of these skill. But they're all sitting back in that sensory discrimination foundation, and it's so powerful to know that it's liberating as a [00:19:00] clinician to know that.

Michelle: Hmm.

Cory: mm I'm thinking about my current four month, four and a half month old, because vision doesn't it like, so eye control and vision isn't there even for the first, there, but it's not really there. Like you look at a new baby, their eyes are kind of everywhere. Like they don't hold their eyes or can't very easily do that.

They can, but not very easily. And then three months later when the head is stabilizing on the neck. when there's enough support, stability from a surface, either a person or the floor, then the head and the neck can pull and hold together enough, which is like related to the maturation where I was reading of the proprioceptive signals in the neck.

So that, where is the position of your head from the joints and the [00:20:00] receptors there, and then. The vestibular system, which is telling you head's tipping or not. So those two things come together enough then to get the eyes to come and find things, see things, and then suddenly it's like, oh my God, I'm reaching and the integration of those things in certain positions is so amazing brings to mind the fact that we don't ever, we try to get these things to integrate in multiple positions because I look at my three month old and I have her in prone and she can do that on a supporting surface, then it's integrating for her there. But if I put her in upright, like a sitting, she's like, again, because it's not integrated there, there's not enough stability yet to do that in that position.

So we often get kids much

later in life, and they're up and they're moving, but things haven't come together sometimes. We are looking at it, coming together not just in one situation or in one [00:21:00] postural position, but many planes. And can they still, like, if you can, can you even get it for your kiddo, Michelle?

It's like, can't quite get it yet in upright sitting still. can she, in any position, like,

Michelle: what? I've never thought about that. Cory, you are right. Developmentally,

Cory: It is so fascinating. Yeah.

Michelle: the positions at the same time. Never doing it. I always do it in the upright. More supported or less supported, but yeah.

Cory: I had this.

Michelle: get into lead out? Down? Yeah.

Cory: Yeah, I had the thought when I was watching. I was like, maybe I should test everybody in

Tracy: For sure.

Cory: for Cades. 'cause like that's where we first kind of get

Tracy: It is where we first get it and it's, you know, it's so funny because I think we think about things but we don't know to apply them across because I know that, for instance, Michelle, you have had some opportunities to learn about vestibular ocular function, and even maybe [00:22:00] even taking some training from Mary Kawar or, and she talks about vestibular activation and getting kids out of upright and working in this, in supine and prone for these very reasons.

But then sometimes I think we learn about doing something like a clinical observations test, and we learn about it here, but we aren't applying other knowledge that we know.

Cory: 100. I said prone, but I'm

Tracy: That's okay.

Cory: I just realized earlier. But yeah, sup

Tracy: Yeah.

Cory: instead of using terminology, lying on their back.

Michelle: that's right.

Cory: Um, and sorry, just to make you feel better, Michelle. I didn't either until I had such a tangible experience of seeing it emerged developmentally. I never tested kids for eye control lying on their back, but I had this moment of seeing it come together in typical development,

Michelle: why why don't we?

Cory: And I'm like, maybe I should test them on their back and then test them in upright and see how that's different. Like that would give me such a big clue. as to the integration of the [00:23:00] head, neck, proprioceptive, vestibular communication function that helps you get your eyes working.

Michelle: to the

capacity And what

capacities do they have it,

Cory: yeah.

Michelle: at their best and maybe it is in

Cory: Yeah. Yeah.

Michelle: So interesting. And I think that's the point, Tracy, that sometimes we get a little, I get. Not prescriptive, maybe the words administrative, like I've learned, we did the SOSI-M, we've done COMPS, we've done the Clin obs.

 Originally I think that's from Ayres and it's been adapted the form that I use. But, um, you don't, administration of those is not in supine or prone even. So I just haven't

Tracy: Yeah.

Michelle: Developmental knowledge with adapting it to, a test.

Cory: Yeah. Well, and, and you're supposed to do it standardized, like, 'cause obviously with the SOSI, which is. structured observations of sensory integration [00:24:00] motor which we, we both love using, but, and so you have to do that in that way, and it makes sense to do it in upright because kids are spending their time and upright.

But if we tested it lying down and saw that it was better, it would be such a clue, for our clinical reasoning around, well, why is

that

happening

Michelle: we

Tracy: that's

right.

Tracy: That's where you start. And so in the spirit training, and again, you know, I think the content is there, but it's the application that I love being able to explore with both of you. So what I wanna point you to are a couple of things that, guide this, okay.

In the lower out of m we have this really beautiful graphic that goes through all of the different developmental positions.

Michelle: Mm

Tracy: And when you're thinking about a capacity, we, we learn this in the logic of social emotional development in the EDCs, and I map that onto this spiraling continuum and the idea of the landing pad.

So how this [00:25:00] applies in this situation is if you see a child struggling. In upright with ocular pursuits and getting, not being able to maintain that and that derailing something, then you do wanna think about, well, where's their landing pad? Where, what's the foundation below that? And it often is to go into those developmental motor patterns, go down to a lower level and see is it still. Struggle Struggly. If I get them out of gravity, is it still Struggly? If I support their, you know. Vestibular proprioceptive processing linkage, um, and give them a little bit more ability to show me if this is still there or not. And then I can find where I'm at at the lowest level, and then I work from that.

And that.

Cory: Mm-hmm.

Tracy: kind of logic. A [00:26:00] developmental approach to sensory integration is really what I'm trying to promote. And I think this is exactly why. So it's a beautiful conversation and you have the thinking tools, but we don't always remember to apply it to all aspects of what we're learning about an individual.

Cory: And it's a deep learning

Tracy: It is,

Cory: for like for yourself as well. 'Cause what Michelle and I just integrating those two separate pieces of information and then knowing how to.

Have that inform what you're

Tracy: Mm-hmm.

Cory: What you just said, Tracy, it's, well if they can't get it in upright developmentally, , what comes before? And so you're kind of then having to go, well, do I know that? Like,

Michelle: do I

Cory: and

if I don't know that, how do I

Tracy: Yeah.

Cory: Like where do I get that information? I just think it's super helpful, obviously for me watching it, and experiencing it as a parent,

it

Tracy: Yeah.

Cory: But when it's not just happening, then that's why we wanna look at all those

Michelle: [00:27:00] Hmm.

Cory: discriminative functions that you're talking about,

Tracy: Mm-hmm.

Cory: So like what is the vestibular system's job in its highest

Tracy: Yeah.

Cory: which is discrimination? Like it has to discern really precisely. The movements of the head.

In relation to gravity and in relation to the body

Tracy: Mm-hmm.

Cory: And then also it has to help the eyes adjust to all that movement. And then we all know that, and so that helps us clue into the fact that, Hmm. How is the vestibular system responding and picking up gravity by my tests. Like then I can do the ClinObs and I can look at you pick up against gravity that looks really hard. Now I can look at, you, try to track something and that's also really hard. Or I can try and tip you a little bit off center. Do you adjust or not?

Like we're just looking at the discriminative adaptive functions of the vestibular system. And it's not just the [00:28:00] vestibular system. And that's why it gets hard to learn it because it's always integrating with the other systems. It's not just the higher out of s and a, but it's also influencing the motor system because it, has to help the body respond to gravity. So innately it's gonna pull in all of the motor system. Well, we don't just flop on the ground when we start falling over, we have a motor system to respond to it. Anyway, I don't know what other terminology that's bringing to mind for you guys, but we could keep trying to find new words to discuss.

Tracy: Yeah.

Michelle: very.

Basic and simple, but where even does motor come from? I guess it comes from the physio world. Like what, how did MO become a thing? Is it a Latin word that started years ago?

Cory: That's such a good question and

Tracy: I actually don't know the answer to that question either, which is fun. I think [00:29:00] about, the movement systems and all of the various parts of our bodies that move, and they all move over time with increasing skillfulness. Um, but there's the automatic parts of our movements and there's the more volitional parts of our movements, and we have to know the differences between those in order to really help improve those motor skills and the way our body.

Engages in movement is the way we become effective. The movement of my social interaction, the movement of my affect, my energy, but also the movement of my, limbs and fingers and eyes and shoulders, and even my head and my ears. All of it has movement. So muscle control. Motor control.

I think it'd be kind of fun. We could, um, we could look it up and here's here's, here's gonna be a hilarious trial log. Uh, thing. [00:30:00] I, I would begin by looking it up by going to my trusted sources and advisors, so I. I would go to my NDT books, I would go to Ayres, I would go to Lois Bly, I would go to my neuroscience books, which I have 50 of them right in within my reach almost.

And I would go to those sources first and Cory would go to AI and I would laugh.

Cory: I would go to ai, but then I would not trust it

Tracy: Thank you. Thank you.

Cory: it, it doesn't, this is why I'm trying to talk to talk about

Tracy: I, I know.

Cory: I'm like,

it can be helpful, but it

is deceptive

Tracy: is deceptive and that's why I brought it up. Not to make fun of you, but to sort of poke at.

Cory: love it.

Tracy: You can't just Google this stuff. Um, you can on some level, but you have to know what your question is and what the thread is and where your, why, your curiosity arose and you have to guide it or you will be deceived and [00:31:00] I'm gonna trust my. Knowledge partners, which are, you know, the, the research and evidence-based practice very quickly compared to just a open question on the internet. And I love that we're actually talking about this because I think it's really important that we're all

Cory: Yeah.

Tracy: discerning in an era where you can quickly get information and it may be totally inaccurate.

Cory: I

Tracy: Yeah.

Cory: about this the other day, like you could get so easily get about like an activity. So say you're

Tracy: Yeah.

Cory: kid, it's like, oh, my kid is, um, my kid seems really clumsy. And then, and they like, they wouldn't without you, Michelle have even really known that controlling their eyes was hard.

Right. But they can't pay attention. Like that might be what the parent. Types in like some activities to help my clumsy child who can't seem to pay attention. And AI might pump out a bunch of activities, but that they, it doesn't ever understand [00:32:00] background piece of where is that potentially not integrating, like why maybe that hard for that child.

'cause like I said at the start, you could do a bunch of cognitive strategies help with attention, and I'm not saying they're not useful, but you never then get adaptive capacity in the ability to discriminate head position in relation to

the neck,

Tracy: Yeah.

Cory: to stability and midline for eye control.

Tracy: Yeah.

Cory: so. It could pump out a whole home program based on like who knows what, like, and it can do it really well. But I'm like, well, that's not where they're at yet. It's not developmentally appropriate

Michelle: if you

provide that context, I'm likely

to do both. I'm likely to go say to AI. Okay. Using Lois Bly. Um, Kendall Ayres, so I'll feed it some context of The data I wanted to draw from it. Still doesn't quite know [00:33:00] it. I was searching up terms, or neurodiversity, the history of that actually. And I knew that, um, bloom. Was the first in text to write about it and it wasn't pumping it out. So I think on the third question I was like, find the quote and you know the source, of Bloom. Oh, thank you Michelle. Good idea. That's a very clever question you're asking, but it was like I had to. Tell you three times

to go to

Cory: Yeah.

Michelle: of this

term. So, you know, you have to know what you're looking for. And I, even if I said, what does lo ly say about the root of ocular motor difficulties, know, they might land on it, they'll go and land in the wrong spot. And then I can think, oh yeah, Lois Bly said that off. I trot. It's not refined enough even when you feed

Cory: it. also makes up stuff. It's like, and you can even feed it. Like we try to feed it stuff and be like, don't make up anything. Don't do anything. But Sam Altman, who's like the literal creator, [00:34:00] like with the chat GPT, he's like, people trust AI way too much. Like they just take it for fact. He's like, it is. It makes, it is not fact yet, like you have to at it anyway.

I did look up on Google, although it's all AI integrated, so how do we escape that? I do not know, but the Latin root of the word motor is mot, MOT. I don't know how you pronounce it, but it's derived from the Latin verb, vere. I don't know how. that either, but which means to move

so it makes sense. Motor to move.

Who, which one is it? Sherrington that says motor is the final

pathway.

Tracy: Yeah, he does. And also recently I was rereading a lot of, content from Daniel Stern and, 'cause he's one of my favorites, and so he, he's kind of the, the real literal father of interpersonal neurobiology before Dan Siegel really. He also said that, the movement system is where we learn everything.

It's how we understand everything. [00:35:00] It's where we can obtain our understanding about what's happening and. Particular for him. He was interested in understanding it for the development of self and the development of self and other connectedness and relationship, and that you can see everything in the motor systems.

So in the spirit model, we connect that the motor capacities do come from foundational motor systems themselves. 'cause in the brain we have motor circuitry, but they're also linked to the sensory discrimination functions in particular. They're also though drawing from the activation circuitry of the regulatory system.

And so where you see a lot of kids struggling to get ocular pursuits. It can be based, not so much in sensory discrimination functions that we've been talking about, but it could be that they're really in a protective [00:36:00] state and they're unable to move out of their frozen, vigilant, midline, and just have the ease and fluidity of scanning and tracking patterns.

And you can see kids be, you know, in states of freeze or in states of activation, all just through their movement patterns and often through their ocular movement patterns. And so we always have to be open and curious and wondering about what's happening here. Because the treatment plan for someone who has distractible ocular pursuits, the, like the little one you were talking about, Michelle, is very different than the one for a child who's kind of frozen and unable to pursue anything other than, the most stable thing in the environment, which might not be a human.

Um, and so they're gonna look sort of similar if you just check, check the boxes on the SOSI, but they're not gonna be [00:37:00] there. Those, those findings are there for an entirely different reason, and we have to be careful about interpretation. That's where the whole art of therapy really comes from

interpreting what it is that we're noticing. Then deciding based on that interpretation, what we're gonna do about it. So that's clinical reasoning in a nutshell, right? And we have to have impressions that we then run through the filters of our knowledge to get to what is it that we might be able to do to support, you know, development and support function.

Michelle: Gosh.

Cory: I have like a tangible I wanna say body felt sense of kid that may be stuck frozen, and not able to Cade kind of in a protective state. Right.

Tracy: Mm-hmm.

Cory: like a, a tangible bodily experience of knowing that, but I'm not sure if I could, I guess I would talk [00:38:00] about it depends what protective state they're in.

So I don't know. Tracy, can you give more of a

Michelle: I jump in

Cory: like Yeah. You go and give a description or something? Yeah.

Michelle: resonated and it was harder for me to talk about but that is absolutely part of this little child's history, early childhood and so there's absolutely this sympathetic activation happening, and I don't know what, guess that's. I don't know whether you in intuited, that's what I was talking about, Trace a while or that's just part of this system, but there's also, I think due to some perhaps, insecure attachment, these, , I think they're not worried about having errors.

They're on the go and they're fun loving. I think they're not chasing refinement. So when they are on the go and not going for [00:39:00] precision and they fall off a ball, for example, their sense of self. Isn't solid enough yet, is my feeling., Because of their attachment issues, I'm making some leaps here.

So they just keep going, keep going, keep going. And so they're not going for refinement or, or goals, they're just like on the go. Next thing, next thing, next thing. Um, so I think that's the other layer in this. That we are not necessarily going to precision because of, that the real low route of A issues and sense self and agency and the motivational pull. To get precision and refinement. It's easier on the sense self to be a go go goer and kind of fun and, and doing and feeling the the risk of the fall, I guess. And the, you know, the, the [00:40:00] up tip of falling over and kind of maybe hitting the wall, but not quite hitting the wall like that is the other pieces of, this little cherub's presentation. I dunno if that

Cory: I just had,

Michelle: that

up tip Cory.

Cory: had an aha, like as you were talking, 'cause you're talking about the attachment and how when that's a bit disrupted, , and we have kiddos that we have who have been removed and, know, have big disruptions. I was just thinking about safety

relational safety, helping reinforce stability in midline, which you are then. And then I'm like, well, if you

Tracy: That's right.

Cory: if you never have safety stability to come back to midline and sit in that, then you will just go, go, go, go,

go, go, go. Like, yeah,

like, yeah, like, you know, you just.

Michelle: Here on there.

Cory: It's [00:41:00] gotta be reinforced relationally because that's how it works. Um, but then, then we get, we are just going to the cascade of like, you dance with these kiddos where relational interactions can feel so full on, or like disarming to them sometimes because it's so not norm. It's like visiting, just gotta dance with them in and out of visiting that, because they don't, they don't always trust that yet, or, but I'm like, we are not saying every kid with,

Michelle: No.

Cory: with

travel tracking

Tracy: Yeah.

Cory: an object has trauma.

Please don't go away thinking that. But just know that there's more than one reason that you may have trouble

with eye control.

Tracy: That's right. Yeah. Absolutely. And you know, our job is to continue to [00:42:00] remain open to exploring all the options. And even when we notice something that's quite a clear and obvious connection, you know, this. Ocular pursuit issue is based in some motor issues that are grounded back in the high route of s vestibular proprioceptive processing, and then that's linking over to the high route of a, and this.

You know, kind of sticktuitiveness beginning and start stop signaling and how all, but then that does always connect to sense of self and sense of other, because the start stop mechanism also comes from the relational space. And so just knowing those thread connections on the spirit, it helps you to say, you know, the evidence starting place here is low route of m.

Let's look at the pursuits. But now let's look at the high route of s. Figure out what's happening on a sensory, [00:43:00] discrimination level for vestibular processing, proprioceptive processing. Looking at those partners makes all the sense in the world. There's logic, there's science behind that. We're gonna connect that to the high route of a, and then we will connect down to the low route A, because there's direct

thread connections. There's neural networks that do that, and those then start to lead us to ahas, lots of ahas, and then we can figure out where to go and then we can deconstruct that for the family and start to talk about, how do we coach them to support their affective system to find.

Each other and to find moments that are shared and to prolong those and to grow how we share those in the literal space from small to bigger. And how do we return and return and find and seek and, use our bodies and our systems to explore all of that [00:44:00] in meaningful ways that get us to where the next level is.

So it's beautiful. It's, it's very cool and we can keep it simple in our language with parents, but we can also really make sure we're connecting the threads.

And I'm drawing lines in the air 'cause I'm drawing the thread connections. yeah.

Cory: Yeah. I think, I think I would still like to go through some of the terminology of the higher out of a, so the motivational bias, like I would love to unpack some of those terminologies, we've mentioned it a lot today, but we haven't yet got to sort of unpack some of that together. And it's important because what we were talking about today. Has, like you said, such a strong, it's, it comes into that function of what's interesting to this little child how that's showing up in of the executive functioning, the higher out, the motivational biasing, the stick-to-it-ness, the all of that.

So maybe we could [00:45:00] unpack that I get like next time or depends on the mood. You know, we'll try. Um, but this is probably a good place to stop and integrate, so thank you both for such a

wonderful conversation.

Tracy: Yeah. Thank you so much and thanks for the fun little detour part of the conversation about using our resources wisely. And I think, you know, Cory, you're creating some really fun content around this. Separate from the podcast, in the space that you're sharing your OT mind. So keep doing that. And, this is just, it's so fun to have this trialog with you guys. Thank you.

Cory: Thanks for the prop! See you guys.

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