Spirited Conversations - Engaging and Elevating Pediatric OT

If a child is relying heavily on their visual system to drive movement, the missing piece might not be where you think.

This one started the way our best conversations usually do, with Michelle bringing a genuine clinical wondering. A five and a half year old, a diadochokinesis task, and a quality of movement that looked robotic no matter how much practise was offered. We took that single clinical moment and mapped it through the SPIRIT model, and landed somewhere we did not expect: the vestibular system as the foundational source of bilateral coordination, rhythm and midline reference.

Tracy did what Tracy does and made the neuroscience not just accessible but genuinely exciting, and by the end of it we were all doing bicep curls at home. This is one of those episodes where we kept saying we would keep it simple, and then absolutely did not, in the best possible way.

WHAT WE COVER
Bilaterality as a distinct sensory integrative function. Dr Ayres identified bilaterality as its own cluster within sensory discrimination, not just a motor output. That changes how we reason about coordination tasks that look straightforward on the surface.

The vestibular system as the foundation for bilateral movement. Before a child can coordinate two limbs in an antiphase pattern they need a stable midline reference, and that reference is vestibularly mediated. If the foundation is shaky, children may compensate by watching you the entire time rather than generating movement from within.

In phase versus antiphase movement patterns. The difference between homologous bilateral movement and the more demanding antiphase patterns, and why grading back to the simpler pattern tells you so much about where the breakdown actually sits.

Rhythm, the saccule, and why gravity is always working. How the saccule functions as a background rhythm detector, and what the vestibular system's constant relationship with gravity means for rhythm generation and for multisensory supports in treatment.

Top down versus bottom up coordination. When a child is manufacturing movement through visual monitoring and cognitive effort rather than generating it from an embodied sense, that is clinically significant and observable.

FREE CPD WORKSHEET
Five reflective practice prompts, free to download and ready for your CPD record. Grab it with the full show notes and transcript at spiritedconversationspodcast.com

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This is a short bonus from us, and it comes with an invitation. From the 9th to the 14th of November 2026, Tracy is leading a Spirited Retreat in Ubud, Bali, through CPD Retreats, and we wanted our listeners to know.
If you have ever wanted to learn the SPIRIT model deeply, this is the way to do it. You complete the SPIRIT course online beforehand at your own pace, then land in Bali with around 25 others, mostly paediatric OTs, though other professions and educators are welcome too. Mornings are theory and lectures with Tracy. Afternoons are practical: you spend time with children in the local community, then come back together and use the SPIRIT model to clinically reason what you saw and plan for the next day. Each evening there is something restorative built in.
Michelle went last year and says it shifted the way she thinks about herself as a clinician, not just the strategies she uses. There are only a few spots left. If you can make it to Bali in November, Tracy would love to see you there.
Sign up here: https://cpdretreats.com.au/retreats/ols/products/a-spirited-retreat-with-tracy-stackhouse-bali-september-2025-a-spr-rtr-wth1
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What does it really mean for sensory integration to be a developmental theorym and how does that change the way we see the children in front of us?

In this episode, we pick up right where Episode 33 left off. Tracy opens with a powerful quote from the Sensory Integration Theory and Praxis textbook that bridges sensory discrimination and executive functioning, and the conversation takes off from there.

We explore how Praxis doesn't arrive all at once but interacts with a child's changing developmental competence, from the six-month-old reaching for a toy, all the way to the basketball player executing a perfect shot. Tracy shares a rich clinical story of a little boy with Fragile X syndrome whose play shifted dramatically, not because he was taught new skills, but because his motivational system was met exactly where it was. And we get into genuinely fascinating territory around sensory surplus, neurodivergence, and what it means when a child needs to spend far longer making sense of perceptual qualities before they can move into representational play.

Timestamps:
00:00 Introduction & recap of Episode 33
01:43 Tracy's quote from Sensory Integration Theory and Praxis (2nd ed., 2002)
03:00 Sensory integration as a developmental theory — the spiralling continuum
07:17 What does "developmental theory" really mean here?
08:14 The embodied experience of a six-month-old becoming a reacher
10:34 Praxis elaborating from affordances — the basketball example
12:33 The interrupted development of Episode 33's little cherub
14:22 "Praxis interacts with the changing developmental competence of the child"
18:00 Connecting to executive functioning — planning and inhibitory control
20:06 Sledging, dysregulation, and the autonomic nervous system
20:33 Affect is the glue — Stanley Greenspan
21:48 Clinical story: the boy with Fragile X and the red cars
26:33 Attunement, pacing, and knowing when to stretch
29:00 How you find the affect inside a child's category interest
30:03 Sensory discrimination as the foundation of executive function shifting
31:20 Executive functions are embodied before they are cognitive
33:27 Visual discrimination and cognitive flexibility
35:00 Stuck in developmental stages — integration dependency
37:26 From concrete/literal to representational thinking
38:42 The million repetitions problem — and why play partners get tired
41:00 Filling the perceptual cup
42:04 Wired to Feel — autism as a condition of sensory surplus
44:00 Motivational bias, executive function, and the "not done yet" feeling
45:26 Affect as the glue in pathway building
47:12 Meeting children exactly where they are
49:14 DIR, honeypots, and what it means to really be with a child in play
49:55 Did affect unlock self-other connection?
53:15 Pulling it together for parents — the relief of knowing this is the work
54:52 We don't teach shoe-tying to 2-year-olds — developmental readiness

Resources mentioned:
Sensory Integration Theory and Praxis, 2nd ed. (2002) — Anzaloni & Murray
Children Adapt — Gilfoyle, Grady & Moore
Wired to Feel: Autism as a Condition of Sensory Surplus — Sweezy & Bergenfeld (2025)
DIR/Floortime — Stanley Greenspan
Early Start Denver Model — Sally Rogers
SPIRIT Model — Tracy Stackhouse, Developmental FX
The Felt Sense Polyvagal Model — Jan Winhall

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Check out DFX's learning journeys to sign up for our learning journeys community and take any of the courses available to build your clinical reasoning skills -->
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In this episode, we dive deep into the clinical reasoning behind a case study of Cory's involving a 3.5-year-old boy. We do our best to link the experiences of this little boys daily challenges, such as dressing, social interactions, and emotional regulation, and unpack them through the lens of sensory integration and praxis.
We explore the vital difference between "high route" and "low route" brain processing of sensations and affect, and how we can use playful, relational interactions to bridge the gap. We also discuss the intersection of sensory integrative knowledge and Polyvagal Theory. With another aha moment in how the foundation of safety becomes a way we can facilitate sensory discrimination to emerge for motor planning and skill development.

Check out DFX's learning journeys to sign up for our learning journeys community and take any of the courses available to build your clinical reasoning skills --> https://dfxlearningjourneys.thinkific.com/

Full transcription of our episode is available on our website.

Timestamps
00:00 Introduction
01:30 Case Study: Functional challenges
02:52 Observations in Daycare
04:39 Therapeutic Approach and Techniques
07:04 Progress and Insights
09:15 Discussion on Sensory Integration and Praxis
19:17 Practical Applications and Tools
26:22 Playful Beginnings: Exploring Interaction
26:48 Progress and Social Development
29:23 Understanding Sensory Discrimination
32:28 Trusting Theories in Practice
33:19 Praxis in Action: Another Case Study
36:42 Reflecting on Clinical Observations
43:01 Developmental Pathways and Testing

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Website: https://www.spiritedconversationspodcast.com/

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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 unpack how the vestibular system and sensory discrimination play into eye movements, how modulation bumps into these issues, and how neurodevelopmental factors shape what we’re observing. Happy Listening!

Check out DFX's learning journeys to sign up for our learning journeys community and take any of the courses available to build your clinical reasoning skills --> https://dfxlearningjourneys.thinkific.com/

Full transcription of our episode is available on our website.

Timestamps:
00:00 Introduction to Translating Clinical Concepts
00:36 Challenges in Communicating Clinical Terms
02:26 Navigating Clinical and Medical Spaces
05:58 Understanding Ocular Motor Function
08:25 Connecting Sensory Systems to Daily Life
19:01 Developmental Perspectives on Sensory Integration
26:19 Integrating Information for Developmental Understanding
26:59 Vestibular System and Its Functions
28:39 Motor Control and Its Origins
30:25 Challenges with AI in Understanding Motor Skills
37:20 Clinical Reasoning and Interpretation
38:30 Attachment and Motor Development
42:03 Connecting Threads in Therapy
44:19 Concluding Thoughts and Future Discussions

Connect with us:
Instagram: https://www.instagram.com/spiritedconversations_ot/
Facebook: https://www.facebook.com/spiritedconversationsOT
YouTube: https://www.youtube.com/@spiritedconversations_OT
Website: https://www.spiritedconversationspodcast.com/

Loved this episode and want an easy cost free way to support us? Subscribe to our youtube channel!
Hosted on Acast. See acast.com/privacy for more information.