Integrated Listening Systems
Improves cognitive skills, communication, processing, concentration, memory and organization. If you would like more information please talk to your child’s therapist or visit our page on Integrated Listening Systems.
safe sound protocol
The Brain’s Way of Healing
“One of the most important books written on the nervous system in the last fifty years, Porges’ ambitious, meticulous, synthetic PolyVagal Theory provides a missing link between mind and the nervous system. It also helps explain, in fine detail, how our individual nervous systems influence, and are influenced by, our interactions with others. It describes how a facial expression, a
gesture, a certain tone of voice, can trigger a radical mental reorganization, and lead to engagement, and how our mental and nervous system states shift. Porges’ studies and his theory of the social vagus represents a major advance in human knowledge, and is already improving the practice of psychotherapy and mind-body medicine.”
– Dr. Norman Doidge, MD, Best selling author, The Brain’s Way of Healing (2016)
The use of sound as a tool to deliver therapy to the brain is the subject of an episode aired on October 27, 2016 on CBC’s The Nature of Things : “The Brain’s Way of Healing” is about neuroplasticity’s next step — healing the brain using totally non-invasive methods, including patterns of energy to resynchronize the brain’s neurons when illness or injury causes them to fire improperly.” View it here.
Safe sound protocol
I use a lot of play both during and after the SSP due to its many different therapeutic natures and benefits. Dr. Porges wrote how play is a neural exercise. ““Play” is a combination of sympathetic arousal and down regulation to a calmer state via face to face social engagement cues.” I have found this beneficial for a number of individuals during the SSP, such that those that engage in social interactive play at some time during the SSP have not tended to demonstrate negative experiences post SSP.
Following the SSP, play and games can be wonderful ways to develop social connectedness and relatedness. I’ve attached a list of the games in my office and some of the possible targets beyond safety are included. I also have a blog post about the benefits of play in my practice that goes over this more (which may not be the best written blog post on this subject, but it does have some valuable information).
There are any number of skills that I focus on during play, but one I wanted to quickly mention that doesn’t get enough focus is Interpersonal Synchrony. I often find that my clients who complete the SSP (regardless of diagnosis) are in need of support in this area, and play is such a wonderful way to work on this.
I was reminded of this by an occupational therapist friend, and to some degree it is available in my room all of the time to my clients without my even being aware of it, but proprioceptive stimulation can be calming for clients both during and after the SSP. “Proprioception is the sense of position of parts of the body and strength of effort needed in movement.” (from the Sensory Connection Program, Andrea Auch and Melanie Anonuevo). Some calming forms of proprioceptive input that I use include:
Slow, rhythmic movements
Heavy, sustained resistance
Chair push ups
Bean Bag Chair with Pillows
Squishing between two soft pillows
There are so many other great proprioceptive ideas out there if you search deep pressure, and I’m sure the occupational therapists in our group have wonderful ideas that go far beyond what I have here.
When it comes to the somatic side of things, I employ a number of different approaches based on the needs of my clients.
For direct ventral vagal interventions, I draw on a number of different sources, including:
· This has been discussed before in this group, but I recommend and utilize Stanley Rosenberg’s Self-Help Exercises from Accessing the Healing Power of the Vagus Nerve: Self-Help Exercises for Anxiety, Depression, Trauma and Autism frequently with my clients and parents. I find that the exercises are generally fairly easy to teach and learn. I probably use the first two, The Basic Exercise and Neuro-Fascial Release Technique for Social Engagement the most.
· Deb Dana’s Book The Polyvagal Theory in Therapy: Engaging the Rhythm of Regulation is packed with techniques that can be incorporated into any practice (I know I do so with mine). I’m always grateful to have it as a resource, as it reminds me that there are so many ways to help to tone the autonomic nervous system. She has suggestions in the areas of breathing, sound, touch, movement, experimenting with elements of the social engagement system
· Deb Dana did a webinar that I completed that was also awesome and she taught these two simple techniques that I teach to my clients and families that they find to be so beneficial (Dana, Bringing a Polyvagal Perspective into Therapy: How to Safely Navigate Emotional Storms, 2018):
Sighing resets physiology and psychology
Rule of Three—Repeat 3 times
First time the brain views this as chance
The second time it is viewed as coincidence
The third time, the brain starts to see a pattern
If the system is heading toward dorsal vagal:
Breath—extend exhale to bring more ventral vagal online
· Breathing Techniques (Phillips, 2018)
There are any number of breathing techniques out there. Three that I have found beneficial are:
““Just One Breath”: Ask the client to take one breath without changing anything. What is different?”
“Porges: Out breath twice as long as the inhalation, dropping the diaphragm: Count in: 1-2; out: 3-4-5-6-[7-8]. Start with what is easy and then expand. If it helps, place hands on your diaphragm and press down gently”
“Calming breath: Breathe in: “Safe and secure;” breathe out: “relaxed and ready””
I also find this beneficial for a number of my clients: Finding the Breath (Pollak, 2014)
“Start by sitting comfortably, assuming a posture of dignity with your back straight, your spine relaxed but not rigid, eyes either softly open or closed.”
“Find your breath. We are often so busy that we often don’t realize that we are breathing. Simply notice your breath.”
“See where you feel your breath most strongly. It may be at the nostrils, at the chest, or in the belly. Allow yourself to feel the sensations of each inhalation and exhalation.”
“If your mind wanders, no problem. Give yourself permission to begin again.“
“Gently, kindly bring yourself back. Let the breath become your anchor, your friend. Rest in your breath.”
“Don’t be too ambitious; take it slow. We all have the ability to feel one breath completely.”
“When you are ready, stretch, wiggle fingers and toes, and open the eyes if they have been closed. Try to extend focused attention into your next activity.”
· Laughter: “Laughter is the best medicine. This can actually be true in the case of increased vagus nerve activity as laughter has been shown to increase heart rate variability in a study comparing (the) laughter (of) yoga participants. Laughter has also been found to be beneﬁcial for cognitive function and protects against heart disease. It increases beta endorphins, nitric oxide levels and beneﬁts the vascular system. It has also been shown that people put in humorous situations show a lower cortisol stress level overall.” (Habib, 2018)
· Exercise: “Mild exercise has been shown to stimulate gut ﬂow and gastric motility (peristalsis) which is mediated by the vagus nerve. This in turn means that mild low-level exercise can stimulate the vagus nerve” (Habib, 2018)
I find that some individuals have a difficult time integrating these new sensations that they are having during and after the SSP. There are some simple and easy integrating practices that I do with some clients:
· 3-4 Steps Forwards and Backwards—repeat as necessary; this repetitive motion backwards and forwards requires that the individual focuses on the here and now to complete
Walking forwards and backwards has influences on aspects of our memory (specifically walking backwards can influence memory for information) (Aksentijevic, Brandt, Tsakanikos, & Thorpe, 2019). Interestingly, in the some of the studies reviewed in this article participants didn’t even need to physically move backwards to get the benefits. They received the benefits from mentally imagining the backward motion.
Walking backwards can improve our attention, particularly for those who demonstrate difficulties with attention like individuals with ADHD. (Viggiano, Travaglio, Cacciola, & Di Costanzo, 2015)
Walking backwards appears to improve cognitive control (“[B]ackward locomotion appears to be a powerful trigger to mobilize cognitive resources. Thus, whenever you encounter a difficult situation, stepping backward may boost your capability to deal with it effectively”) (Mercola, 2018)
· PACE (from Brain Gym) (Dennison, Dennison, & Teplitz, 2000) (Dennison & Dennison, 1989)
o Drink Water
Drinking water is essential for nerve function. It increases the electrical across cell membranes, thereby making them ready to work.
All of the electrical and chemical actions of the brain and central nervous are dependent on water for conductivity.
o Brain Buttons
Rest one hand over your navel.
With the thumb and fingers of the other hand, feel for the two hollow areas under the collarbone about one inch out from the center of the chest, where the collarbone meets the sternum.
Rub these areas vigorously for 30 seconds to one minute, as you look left to right and right to left.
o Cross Crawls
Move one arm and its opposite leg to meet at the midline, then the other to its opposite leg, similar to marching in place with the elbows or hands to opposite knees as they rise.
Cross Crawl around 30-60 seconds.
Cross Crawl activates both brain hemispheres simultaneously. It engages the brain for coordinating visual, auditory, and kinesthetic abilities, thus improving such skills as listening, reading, writing, and memory.
Stand with your feet flat on the floor.
Cross your left ankle over your right ankle.
Next, extend your arms with the backs of your hands facing each other and cross the left wrist over the right so that your palms touch.
Interlace your fingers and swing your hands down and then up onto your chest.
On inhalation, place your tongue flat against the roof of your mouth, approximately one quarter inch behind your front teeth; lower it on exhalation.
Repeat the tongue placements, relaxing in this position during the course of four to eight complete breaths.
Uncross your legs, placing your feet flat on the floor.
Lightly join the fingertips of both hands together, as though enclosing a ball.
Close your eyes as you continue to lift your tongue on inhalation and lower it on exhalation, relaxing in this position during the course of four to eight complete breaths.
· Emotional Stress Release Points (Mahoney, 1989)
Lightly touch the emotional stress release point with your fingertips (or whole hand). Wait until you feel or sense a light vibration or pulse.
Focus on the event or problem.
See the details. (Be aware of the colours, sounds, shapes, smells and feelings involved.)
Make it real. (You may notice shallow breathing, flickering of your eyes or tearfulness.)
Continue to lightly hold the ESR point, breathe and relax. These signs of stress will pass.
Now play the day (or event) as you would like it to happen. Fantasy is OK here.
When your mind starts to wander you know the event is cleared of immediate stress.
Reassess how you feel (or your emotional energy towards your ’day’) on a scale of 0 – 10.
Repeat the process as different aspects of the stress comes to mind. It is okay to do it often.
“Frontal Eminences: Approximately three finger widths above each eyebrow directly above the eyes.”
“Hands: Thenar eminence, on the meaty part of the palm near the thumb, adjacent to the crease of the wrist. Mythical Lung 9 1/3.”
“Tibia: Approximately two finger widths below top of tibia on the flat inside surface.”
“Foot: Sole of the foot approximately one finger width lateral of Kidney 1, at the junction of the contact surfaces of the ball and side of the foot.”
· Interpersonal Neurobiology Integration Exercises and Principles
There are tons of things herefrom Daniel Siegel that I use when helping a client and or family.
A number of my clients benefit from his many acronyms in the process; I find it helps them to better place meaning to some of the information. One some like is FACES:
His Wheel of Awareness is also an exceptional tool
I also have training in aspects of manual therapy and integrate that training into my work. Deb Dana talks about the importance of touch in her book The Polyvagal Theory in Therapy: Engaging the Rhythm of Regulation, and undeniably to me the manual work that I do provides this touch in a graded, safe fashion that allows the clients that I work with who need this work an avenue for the facilitation of awareness, integration, and toning of the autonomic nervous system when dysfunction in a particular system may be impacting on it. There are so many different areas and techniques that can be chosen:
· One that I really like comes from an author whose classes I took over two decades ago by the name of Sharon Weiselfish-Giammatteo. Sharon’s book is: Integrative Manual Therapy for the Autonomic Nervous System and Related Disorders. The whole book is worth it though. This book covers techniques that impact on autonomically innervated muscular tissue, including arteries, veins, organs, lymph, and discs. Some of the techniques that I use frequently include:
Advanced Strain Counterstrain for Auditory Function—Tympanic 1: I find this benefits a number of the clients who indicate that they are having ear discomfort/pain during, or after, the SSP. They often report that the discomfort/pain subsides, and they are better able to tolerate longer sessions.
Advanced Strain Counterstrain for Vision—The Ocular Muscles: Atlee (2016) discusses how “Parasympathetic function can also be influenced through the parasympathetic component of the oculomotor nerve (Cr III) by applying a very soft gentle contact to the eyeballs.” (Attlee, 2016). This systematic approach often, I find, will decrease headaches during and following the SSP.
Advanced Strain Counterstrain for the Diaphragms—Sharon highlights 4 diaphragms, pelvic diaphragm, respiratory diaphragm, thoracic inlet diaphragm, and cranial diaphragm. I am often amazed at the change in autonomic state just by focusing on these four diaphragms.
There are also a series of gastrointestinal, cardiac, and cranial releases that can be beneficial depending upon the client.
· I also have training in cranial, gastrointestinal (visceral mobilization), respiratory, and lymphatic techniques. There are so many beneficial ones, and I think many manual therapists probably could recommend even more than I could. But one that I find beneficial is:
Hyoid release—the hyoid release is so beneficial for so many individuals during the SSP and following the SSP. I’ve found some people are fairly rigid in this area, and this can contribute to some of the somatic complaints that they have. This is a fairly simple technique.
· Neurofascial Processing: “NFP signifies: N for neural, F for fascial and P for process. The neural or nervous system transmits signals through the body. The fascial system is a thin layer of connective tissue that covers every organ, vessel and nerve in the body, like a body suit. NFP integrates the nervous system and the fascial system with sensory information and emotional health.” (Burnham, 2018) The book Body Wisdom has a more detailed look at these.
“NFP involves placing your hands (no need to press) over specific parts of your body, called Process Centers (PC) for extended periods of time, and simply “being with” what comes to consciousness while doing so.” (Burnham, 2018)
Key process centers for Executive Functioning and Cognition: (Burnham, 2018)
Frontals (forehead): Thought, Judgement, Behavior, Attention Deficit Disorder
Limbic System (at the bridge of nose or frontonasal and eyes): the center for survival and has to do with rage responses
Parietals (top of the Head): home of the sensory and motor cortex and associated with feelings and sensations (sight, sound, taste, smell, touch) as well as action and movement
Mental Body (2 to 3 inches above Left eye at the hairline, ½ an inch off the body): Thoughts, Perseveration
Thanks for sticking with this long rambly set of ideas. Hopefully there was something beneficial in here for someone.
Aksentijevic, A., Brandt, K. R., Tsakanikos, E., & Thorpe, M. J. (2019). It takes me back: The mnemonic time-travel effect. Cognition, 242-250.
Attlee, T. (2016). Face to Face with the Face: Working with the Face and the Cranial Nerves through Cranio-Sacral Integration. Philadelphia: Singing Dragon.
Burnham, K. (2018, December). NeuroFascial Process (NFP): A CenterIMT Program. Retrieved from oppt.com
Dana, D. (2018). Bringing a Polyvagal Perspective into Therapy: How to Safely Navigate Emotional Storms. Eau Claire: PESI.
Dana, D. (2018). The Polyvagal Theory in Therapy: Engaging the Rhythm of Regulation. New York: W W Norton & Company.
Dennison, G. E., Dennison, P. E., & Teplitz, J. V. (2000). Brain Gym for Business: Instant Brain Boosters for On-the-Job Success. Ventura: Edu-Kinesthetics, Inc.
Dennison, P. E., & Dennison, G. E. (1989). Brain Gym: Teacher’s Edition Revised. Edu Kinesthetics.
Habib, N. (2018, December). 19 Ways to Stimulate Your Vagus Nerve. Retrieved from Living Proof Institute: thelivingproofinstitute.com/19-ways-to-stimulate-your-vagus-nerve
Lindaman, S. (2019, February 6). How Polyvagal Theory Helps Us Understand the Effectiveness of Theraplay. Retrieved from Theraplay.org: www.theraplay.org/articles-about-theraplay/111-theraplay-best-practice-updates/274-article-polyvagal-theraplay
Mahoney, F. (1989). More ESR Points: Life Beyond the Frontal Eminences. Touch for Health International Journal, 58-59.
Mercola, J. (2018, December 8). Walking Backward Boosts Your Memory. Retrieved from mercola.com: https://articles.mercola.com/sites/articles/archive/2018/12/08/benefits-of-walking-backward.aspx
Phillips, M. (2018, December). Polyvagal Solutions to Trauma and Pain: Ericksonian Pathways. Retrieved from Slideplayer.com: https://slideplayer.com/slide/12084911/
Pollak, S. M. (2014). Sitting Together: Essential Skills for Mindfulness-Based Psychotherapy. New York: The Guilford Press.
Porges, S. (2019, February 6). Polyvagal Theory. Retrieved from Presence Academy: http://www.presence.academy/porges-poly-vagal/
Tucci, J., Weller, A., & Mitchell, J. (2018). Realizing “Deep” Safety for Children Who Have Experienced Abuse: Application of Polyvagal Theory in Therapeutic Work With Traumatized Children and Young People. In S. Porges, & D. Dana (Eds.), Clinical Applications of the Polyvagal Theory: The Emergence of Polyvagal-Informed Therapies (pp. 89-105). New York: W W Norton & Company.
Viggiano, D., Travaglio, M., Cacciola, G., & Di Costanzo, A. (2015). EFFECT OF BACKWARD WALKING ON ATTENTION: POSSIBLE APPLICATION ON ADHD. Translational Medicine, 48-54.
We were looking for supplemental speech for articulation concerns during the summer. Not only did we get help in articulation, but help with his Sensory Processing Disorder. The Safe and Sound Protocol helped in ways I didn’t realize were available through speech therapy. My son’s speech is more intelligible and many of his sensory phobias have dissipated. Clear Speech is great at addressing the child’s needs in the usual ways as well as introducing the newest most innovative therapy treatments available.
My son has a limited amount of words, was hard to understand when he did speak, and was sensitive to loud sounds. After starting therapy I can understand him better, he rarely covers his ears for loud sounds, and has a larger vocabulary. The most important advice I can give is to follow your instincts. Our pediatrician did not think my son had a delay, therefore we did not pursue therapy in a timely fashion. I wish I would have followed my gut sooner.
My son, Zach, began speech therapy in 2015 with great success. His annunciation became clearer and more understandable in just a year. Once he graduated from speech therapy, he continued on with writing comprehension to further his language understanding. Now, a middle schooler, his writing has improved to grade level and in some cases above level. Thank you Clear Speech therapists! Because we needed help with annunciation and writing, I would recommend their SLPs to any parents whose child could benefit. With their 1:1 ratio, kids get faster results than the SLPs within the school districts as their ratios are higher and sessions are shorter.
Prior to speech therapy at Clear Speech, it was hard for my child to communicate. He also was combative and frustrated. He now is able to speak in sentences and describe what it is if I didn’t understand the first time. He also has more confidence. Lucas is no longer combative. With any child that has delayed speech, you should seek speech therapy and any help before school will be a huge benefit.
My son could not say his “g” and “k” sounds. Melisa Aar has been so fantastic with my son. He is able to say all his sounds now and is more confident when he talks to people. The therapists are so personable here and we would give Miss Melissa 5 stars for being so awesome!
Both of my kids had speech delays and would get frustrated due to their lack of language development. Now I can carry on full conversations. They both are a lot more focused! They love coming to their sessions and have had progress in their behavior and attitudes! I would highly recommend Clear Speech to any family needing speech services. The progress I’ve seen in both my children has been amazing since we started coming here! The therapists are so friendly and professional!
Before I came to Clear Speech therapy my child was not speaking. No sentences or anything. Life was challenging not just for me but for my child as well. I noticed my child is now saying more sentences, has improved eye connection, and is a better listener. I would recommend to another family that it is very important to get your child into speech therapy as soon as you can because it’s like a tool, not only for your child, but it also helps the parent work with your child on speech and learning to communicate.
My daughter’s pediatrician recommended speech therapy services for our two year old. Although was able to follow directions and understand others, she wasn’t speaking as much as she should have been. After started services, he speech has gotten clearer and she seems much more confident talking, communicating, and identifying. her breath control has gotten better as well as her tolerance to having her face touched. After the Safe and Sound Protocol, she has gotten much more patient, willing to share, and follow directions. Her melt downs from not getting her way are at a minimal as well as she takes more to time to understand why something is the way it is.
When we first joined Clear Speech we had been using the birth to 3 program. Maddie was making some progress but she was still so delayed. Because of her new therapist, Michelle, Maddie has discovered her voice. She is still delayed but able to communicate so much more. Our son, Camden, also has Apraxia and he is becoming better since working with Michelle. It has improved so much. Maddie and Cam are both able to communicate more with us which has greatly helped our day to day lives. We now have tools as parents to help with the two of them and the stress has gone down. Don’t hesitate to seek out speech services. It is never too early to at least have your child evaluated. Once a line of communication is opened between you and your child, it is like a whole new world.
Before going to Clear Speech, my son didn’t understand language receptively nor could he express his feelings in words. He was getting frustrated very easily. Now, our son can understand and has started talking to us about how he feels and what he wants. This makes our daily life a lot easier and less stressful.
Prior to getting therapy at Clear Speech, I noticed my kids had a hard time telling me and others what they needed. They would become very frustrated so most days they had tantrums, they would hit, and when unfamiliar were around they would be very quiet and interact. Our day-to day routines have improved significantly since starting speech therapy. When they couldn’t communicate, we spent hours each day managing their frustrations and trying to understand their needs. Now we can move through our day with little to no frustration. When frustrations do happen, they can use their words to solve the problem. Clear Speech has been a great experience for all three of my children. I recommend to families who need speech therapy to get started as early as possible. Commit to the therapy process and soon you will be able to better connect with your kiddo and hear what they need!
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Location: 3602 Everett Ave
Everett, WA 98201
Telephone: (425) 252-9908
Fax: (425) 259-6317