By Rachel Mitchell (MT-BC)
Edited by Theresa Kwong, Communications Consultant

In my practice, I use a bottom-up sensory processing model, recognizing how impactful our sensory experiences can be in shaping our capacity to engage with the world around us. Additionally, I integrate a DIR Floortime model, emphasizing the significance of the therapeutic relationship and play to cultivate development. Through these, I aim to support my clients’ non-musical development by facilitating interventions that feel engaging and genuine.

What is Bottom-Up Sensory Processing?
Bottom-up sensory processing is a model that focuses on how our eight senses intake and process environmental stimuli before progressing upward through higher levels of cognitive functioning. Our eight senses are visual, auditory, olfactory, gustatory, tactile, vestibular, proprioceptive, and interoceptive.

When considering this model during a session, I observe if any component of the sensory system requires extra support before addressing other domains. For example, if a client is jumping and crashing into the bean bag, they may be seeking proprioceptive input. To support them, I can provide rhythmic body squeezes to music or organize their crashing through a structured song. If a client is spinning or rocking back and forth, they may be seeking vestibular input. For this, the client can sit on a swing or wobble board while engaging in activities. If a client frequently covers their ears, they may be demonstrating auditory sensitivities. For this, I can provide sensory headphones and begin with auditory stimuli at a volume they feel most comfortable with.

Music Choices with Bottom-Up Sensory Processing
The instrumentation and musical choices behind how I support the client depend on the non-musical goal. For example, I can support a client by inviting them to play the drum with me. Playing the drum can aid in grounding their senses by providing a stable tempo, tactile stimulation, and proprioceptive feedback.

If a client demonstrates sensitivities to loud, high-pitched sounds such as school bells or fire alarms, I can support the client by providing a safe space for them to engage in playing similar sounds themselves, such as tone bars, chimes, and singing bowls. Through this, they can become familiar with hearing these sounds in an environment they can expect and anticipate.

Taylor and Trott’s Pyramid of Learning (1991), Williams & Shellenberger Pyramid of Learning (1996)

What is DIR Floortime?
DIR® is the Developmental, Individual-differences, and Relationship-based model that focuses on the therapeutic relationship with emphasis on the child’s individuality within the context of play and reciprocal engagement. This is demonstrated through the clinician meeting the child where they are socially and emotionally, through their natural interests, and engaging with them through their worldview.

When considering this model during a session, I think about how I can build the therapeutic relationship and why the child is playing the way they are. For example, if a child begins to play the piano with their palm and all of their fingers spread out, playing intermittently, instead of telling the child not to play that way, I could imitate the child and make it rhythmic, joining in on their play. Another example: if a child loves to run, jump, and spin, instead of telling the child to sit, I can turn this into a selective attention game where, when they hear a certain instrument, they engage in the matching action. This combines their interest and feeling of movement with structure.

What Does a Session Look Like For Me?
As an example, I have a 5-year-old client with Autism Spectrum Disorder who is working on reducing proprioceptive input-seeking behavior and expanding their sentences to improve speech skills.

We begin with a hello song to initiate the session and provide structure, with the intention of the client reciprocating by waving or saying hello in response, providing their name when given the opportunity, and remaining within the space.

Next, we may create a schedule to provide structure, set expectations, and allow the client to anticipate what activities will follow each other. The schedule may provide a set amount of time for each activity and include break opportunities or child-led activities.

Then, the child might begin jumping and crashing into me, the clinician, and start playing the drums with a lot of force. As the clinician, I set up a safe environment with a weighted ball, stool, and crash pad. I remove other competing stimuli such as instruments or objects from the area. Then I sing, “Hickory dickory dock, the mouse rolls the ball and steps up, the clock strikes one, the mouse jumps down, hickory, dickory, dock, tick tock tick tock,” with the intention of providing an organized opportunity for proprioceptive input.

Next, I want to create an activity where the child works on saying, “I want to eat an ____” instead of solely labeling the food to request it. I bring out fake food toys and my guitar to create a call-and-response song. Then, the child picks up a stuffed animal from the shelf and begins to play with it. I choose to bring my guitar and toys over to join in, grabbing a stuffed bear for myself. I start singing, “What do you want to eat, Mr. Bear?” and have my stuffed animal answer, “I want to eat an apple,” then give my stuffed animal a toy apple. I then have my stuffed bear ask the child’s stuffed animal, “What do you want to eat?” and support the child in responding, “I want to eat an ____,” with toy food options provided in front of them.

We finish the session with a goodbye song to close our time together and provide structure, with the intention of the client reciprocating by waving or saying goodbye when given the opportunity and remaining in the space.

We may include additional interventions during the session depending on the complexity and progress toward goals, the number of goals, the client’s state of regulation and break time throughout the session, and overall time allotted.

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