By Jennie - Provisional Psychologist
Have you ever wondered why two individuals can be so different? Why can one individual focus on their homework while the other does not sit still for even two seconds? Why does one individual just not get how to work their way around a ball while the other is a sports superstar? Why can one person brush their hair by themselves while the other kicks and screams when anyone approaches with a comb? Why does one individual have an inconsolable meltdown every time they’re at the supermarket while the other can handle the trip just fine?
Well, questions like these can be traced back to our central nervous system and sensory systems!
In 1991, an occupational therapist named Kathleen Taylor and a special educator named Maryann Trott developed a model called the Pyramid of Learning to understand how our central nervous and sensory systems support all higher level functioning. Here, the pyramid of learning has five levels that build on top of each other:
The first level at the base is the central nervous system (CNS). The CNS is a complex network with three interconnected functions: sensory input, integration (the processing, organisation and flow of input), and motor output. Consisting of the brain and the spinal cord, the CNS takes in information about external stimuli (i.e., the world around us like how bright a light is) and internal stimuli (i.e., inside our body like how hungry we are), and interprets it to decide on an appropriate response. This tier of the pyramid is closely linked to the next, which is the sensory level.
The second level highlights our sensory systems: auditory (hearing), gustatory (taste), olfactory (smell), proprioception (spatial orientation and body position), tactile (touch), vestibular (balance and movement), and visual (sight). As you can probably gather, these sensory systems are what collect information to send to the CNS.
The third level on the learning pyramid is sensory motor skills, which function adequately while our sensory systems can effectively detect and integrate input. This tier includes the following:
Ability to screen input (being able to focus on more important stimuli while ignoring others)
Awareness of two sides of the body
Body scheme (awareness of the body through movement)
Motor planning (involves planning movement)
Postural security (being confident in maintaining certain postures to prevent falling)
Reflex maturity (adequately developed reflexes)
The fourth level is perceptual motor skills, which are extensions and advancements of blocks in the previous tier.
Attention
Auditory language skills (which includes hearing and speaking)
Hand-eye coordination (using what you see as a guide for hand movement)
Ocular motor control (being able to locate and focus on something in the environment)
Postural adjustment (adjusting posture to maintain balance)
Visual-spatial perception (identifying physical objects in space and recognising relationships between them)
The fifth level concerns cognition and includes academic learning, behaviour, and daily living activities.
Now that we know that higher order levels of functioning all go back to the sensory systems and the CNS, we can start to understand the validity of a bottom-up approach in comparison to a top-down approach to skill development. A top-down approach looks at where someone is currently at and aims to strengthen existing skills to improve the ability to participate and be independent in functional activities. On the other hand, a bottom-down approach looks at the causes of an issue or a deficit and aims to strengthen or obtain those skills to improve the level of impairment and ability to function in everyday life.
Let's look at an example of both approaches in terms of improving handwriting in a child. For a top-down approach, we may look to change things like pencil grip or the shape and thickness of the pencil to better accommodate the child. We may start with mediums that glide easily like pastels or markers before moving to ones that require more effort like pencils. We could also target wrist and hand strength by completing lots of writing exercises and practicing every day. Notice how we start at the top of the pyramid of learning and have tried to adapt to improve the targeted skill. For a bottom-down approach, we would look at the underlying sensory processing factors, such as tactile, proprioceptive, and vestibular systems. A child with proprioceptive dysfunction may have trouble controlling their grip and hold the pencil too tight, leading to wrist and hand fatigue. A child with vestibular dysfunction may need to constantly move around to receive sensory input. They may need to fidget or wriggle a lot, so it might be difficult for them to hold a pencil for long periods of time. A child with difficulties in sensory processing and motor planning may need to actively (rather than automatically) think about writing with one hand while holding the paper still with the other, which can lead to mental and physical fatigue. Here, we have looked at the base of the pyramid of learning and have sought to understand the sensory reasons for difficulties in handwriting. Next, we would move on to targeting these sensory issues by supporting the child's tactile, proprioceptive, vestibular, and other sensory needs.
Both of these approaches have their strengths and weaknesses, and both can be used in the therapy setting for building skills and promoting independence.
The pyramid of learning highlights how sensory input, integration and regulation is important for attention, behaviour, and learning. It stresses that the building blocks at the base of the pyramid need to be solid and adequately developed to build the following tiers on top and have them work efficiently.
What does all this mean? Well, it means not to underestimate the role of the CNS and sensory system in everyday life. Things ranging from fidgeting during quiet class time, to being inattentive even though someone is clearly talking, to hitting and kicking when others are being loud, can all have some CNS and/or sensory regulation component.
Now that we understand this, we can aim to look at “behaviour” and “dysfunction” from another perspective, try to uncover the underlying factors, and support adequate CNS function and sensory regulation to help current and future cognitive development. Which is exactly what we stand for at Wildflower Holistic Services - regulating the whole individual to succeed!