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Sensory under-responders are just the opposite of their hyper counter-parts. They require intense, prolonged and changing/novel sensory input in order to respond effectively. These individuals often appear as though "the elevator isn't going all the way to the top." With these particular individuals, we should be paying close attention to possible subluxations within the sympathetic nervous system so as to up-regulate input to the CNS.

As with any condition, it isn't all that cut and dry. Those with SPD can either by hyper-sensitive, hypo-sensitive or both. To make it even more complicated, they can change from situation to situation. Therefore, knowing some of the signs will help you better work with them in your offices.

Practice Pearls

Below are some tips to help identify if a patient may have sensory issues and some practice pearls to help facilitate achieving a better adjustment (these children may be difficult to adjust due to their hyper-sensitivities). Chiropractic care MUST be a cornerstone of treatment with these patients as it has the most profound influence on regulation of the autonomic nervous system!

Hyper-auditory patients may not like the sound of cavitation from an osseous adjustment or the "click" from an activator. The sound from drop tables may also be alarming. When trying to adjust them, they may tighten up in defense and anticipation; especially with cervical adjusting. These children often times have a history of chronic ear infections.

Pearl: Keep room noise to a minimum; avoid clocks, music, etc. Have only that patient in the adjusting room so as to minimize noise from others. If you practice open adjusting, have a separate quiet area to work with these individuals. Allowing them to wear ear buds with an iPod playing their favorite music may be helpful.

Hyper-visual patients may appear hyperactive and easily distracted; they may have difficulty relaxing when getting adjusted. These children are often misdiagnosed as having ADHD.

Pearl: Minimize visual chaos with dimming lights (avoid fluorescents if possible) and too much wall art. If you practice open adjusting, screen off one area to minimize movement from others about the area. Allow the use of sunglasses if necessary to relax.

Hyper-tactile patients will not like touch and may attempt to pull your hands off of them and/or tighten up in defense. Again, this is common when attempting to adjust the cervical spine. Often times, children will cry in anticipation of touch. These children often appear anxious and controlling. (Note: Hypo-tactile patients may appear to have a high pain tolerance and areas of concern may be overlooked as pain may not register with palpation or movement.)

Pearl: Deep pressure tends to me more soothing than light touch to these patients, perform some deep joint compression or massage prior to adjusting.

Hyper-vestibular patients may not like head movement; therefore, they do not like their cervical spine adjusted. These children often appear fearful of gravitational challenges and head movement. (Note: Hypo-vestibular children often need movement in order to pay attention; therefore, appear hyperactive.)

Pearl: Have the patient perform some self-regulated vestibular exercise prior to getting adjusted. Such as balancing on a wobble board or balance cushion and/or performing head flexion/extension and rotation maneuvers.

Hyper-proprioceptive patients often have poor posture as they fatigue easily. These children often have aggressive outbursts and are easily frustrated.

Pearl: In addition to adjusting, give exercises that require resistance against gravity; especially in a prone extension position.

Other office pearls:

  • Have paperwork filled out in advance to avoid wait time.
  • Have sensory inviting chairs such as bean bags and rocking chairs.
  • Avoid using chemicals to clean in your office.
  • Avoid scented perfumes, lotions and candles by you or your staff.
  • Set-up a calming environment.

Dr. Monika Buerger has been in practice for 22 years and currently practices in Ammon, Idaho. She is a contributing author to the text book "Pediatric Chiropractic" Volumes I and II by Anrig/Plaugher with chapters on History & Physical Examination, Neurodevelopmental Disorders and Sensory Processing Disorders. She is a speaker for the International Chiropractic Pediatric Association (ICPA) as well as other organizations. She is also the founder of the Intersect4kids program; a certification program for doctors of chiropractic in "The Care and Management of Children with Neurodevelopmental Disorders." For more information, visit

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