Sparkly Jacket: A story for physical therapists

She sparkled all the way over to school the other day, I dropped her off, and it was great.

Then… that day, I did too much. And it was too much for my sensory processing bandwidth. Too many things squeezed into my calendar, too many alarms going off reminding me of all these things, too many quick transitions between activities requiring max levels of focus (including sensorimotor focus when needing to camouflage my natural facial expressions and posture in order to appear professional), too many hours without food or drink because of limited bandwidth to notice my hunger and thirst cues. Too much sound to process and spoken language I needed to generate without time to rest.

I picked my daughter up from school.

AND THEN! The sun shone brilliantly down on this amazing jacket and reflected right into my eyes just as my poor kiddo asked me a question, and suddenly I had one too many things to process in that moment with my already depleted resources. The migraine that had been brewing reared its head with full force. I had to sit down on the ground and cover my eyes.

Was this awesome jacket at fault? No, not really. It was just the final straw.

Would wearing sunglasses have prevented the migraine? Honestly, probably not. In my overloaded state, it could have been any of the inputs I’m sensitive to that could have pushed things over the edge. The next unexpected sound, the exhaust fan in the kitchen, or an unanticipated touch could have had the same result. Each of these things, in isolation, I can process without any problem, but it’s the cumulative effect that can push my circuits beyond their limit.

All of us as human beings have a limited processing capacity, and if we push ourselves to run at our maximum capacity for long enough, we will experience negative health consequences of one kind or another. Those of us who are autistic run up against these limits more quickly than others unless we can pace our activities and structure our environments to meet our sensory processing needs.

Even though I am incredibly fortunate to be able to structure my time and environment in a way that allows me to meet my sensory needs most of the time, days like this still happen occasionally. This is a huge improvement compared to several years ago, before I understood my needs, when I was dealing with migraines, pain, and digestive issues more days than not, despite doing all the right things with exercise, nutrition, talk therapy to try and manage stress, etc.

So, why am I sharing this (other than to highlight the amazing jacket)?

Because as physical therapists, so many of our patients with chronic pain and similar conditions have underlying sensory needs that are driving their symptoms, and they’ve never heard from a healthcare professional that this could be a possibility.

We have to be aware of the fact that humans have a huge range of potential sensory needs, and that no two humans will have exactly the same set of sensory needs.  When we give advice, as healthcare professionals, we have to consider the possibility that patients have not yet had the opportunity to understand and explore these needs. Our society tends to value the ability to “go with the flow” by ignoring the signals our bodies give when overloaded, especially if the situations that overload us don’t match up with cultural expectations for what should. There are so many children who push through discomfort in order to make it through school, only to get used to that discomfort and come to the conclusion that a baseline sensation of unease is normal by the time they reach adulthood.

You might ask, aren’t occupational therapists the ones who teach about sensory health? Well, we definitely need more occupational therapists in the United States working with adults with chronic pain, so that we as physical therapists can refer to occupational therapy (and co-treat)! However, as a profession, we as PT’s absolutely can learn to better help our patients by learning about the wide range of sensory needs that folks might have. 

At the very least, we can learn to recognize signs that unmet sensory needs might be contributing to a patient’s condition, and direct our patients to the right resources or other professionals. And I would argue that as physical therapists, we use sensory strategies with our patients all the time – we just could learn to be more specific about which strategies we try with whom. We use manual therapy and electrical stimulation – somatosensory inputs! We use auditory, visual, and tactile cues with exercise! We consider sensory integration when assessing balance! It is absolutely within our scope of practice to become better at matching our sensory strategies to our patients’ individual needs in order to help them meet their goals for improved movement.