Notes on Praxis, Sensory Processing, and OT Language Alignment

Praxis, Ideation, and the Organization of Movement

Jean Ayers perspectives on sensory-based neurodevelopment emphasize praxis: the organization of movement as the core process for adaptive function. Praxis is a Greek term for how movement is organized to meet a task.
Key definition: Praxis is the organization of movement through novel (child-led) but therapist-directed activities that promote the child's adaptive response.
Adaptive response: when a child leads an activity, the OT develops tasks aligned with the child’s interests and motivation to challenge their movement organization.
Just-right challenge: gradually increase difficulty to elicit higher adaptive responses and expand the child’s repertoire of motor and adaptive strategies.
Visual of praxis loop (ideation → motor plan → execution → feedback → feedforward): a continuous cycle that supports learning and adaptation.

The Praxis Process: Ideation to Feedforward

Ideation: forming the idea of what to do. In typically developing children, ideation often arises by observing others. Children may see peers doing something interesting and think, “I might like to try that.”
Ideation challenges in autism: children on the autism spectrum may have reduced peer-led ideation depending on their level of autism and social attention to peers.
Motor plan: translating the idea into a plan for the body—how to get from here to there. Often implicit and not consciously verbalized; the nervous system streamlines planning behind the scenes.
Execution: carrying out the motor plan.
Feedback: evaluating how the action went (e.g., ball landed correctly, foot placement, catching the swing, etc.).
Feedforward: planning adjustments for next attempts based on past feedback; part of implicit learning: realizing, “that didn’t work, I’ll try this differently next time.”
Sensory basis: all of this is guided by input from our senses (see next sections). The five senses plus vestibular, proprioceptive, and interoceptive information inform ideation, planning, and execution.

Sensory Bases of Praxis: Senses, Proprioception, Vestibular, and Interoception

The five classic senses: see, hear, taste, smell, touch.
Vestibular sense: information about head position and movement in space (balance and orientation).
Proprioceptive sense: information from joints and muscles about body position and movement in space.
Interoception: internal signals from inside the body (hunger, fullness, need to use the bathroom, etc.).
Interoception language gap: young children often lack words to label internal states; language development supports recognizing needs (e.g., potty training, hunger) and linking them to actions.
Interoceptive dysfunction: disordered interoception can influence functional outcomes, including eating behaviors and continence (examples: Prader-Willi syndrome with satiation issues, encopresis, enuresis).
All these systems feed into praxis: they influence how ideas become motor plans, how movement is executed, and how feedback/feedforward loops refine performance.

From Sensory Input to Praxis Loop: Feedback and Feedforward

Feedback: information about how execution went and what adjustments are needed (e.g., “Was the ball in the right place?”).
Feedforward: anticipatory adjustments for future attempts based on past feedback; part of implicit learning.
Both rely on multi-sensory input to guide motor adaptation and learning.
The “operating system” concept: much of this processing happens implicitly in the CNS, integrating sensory input to guide behavior without explicit instruction.

The Senses and Sensory Processing: A Core OT Concept

Sensory input as more than just raw data; the body’s response determines functional outcomes.
Multisensory integration (neuroscience lens): the combination of sensory inputs that produces greater responses than the sum of individual inputs alone. This concept captures how the brain binds multiple senses to guide action.
Sensory processing (OT/clinical lens): an overarching construct describing neuronal interactions in the brain with incoming sensory signals and the resultant responses, emphasizing functional outcomes.
Sensory discrimination (perception): the cognitive ability to differentiate between stimuli (e.g., rough vs smooth, hungry vs tired) and attach meaning to sensations.
OT vs neuroscience language gap: OTs interpret sensory information in terms of functional meaning and motor skills, while neuroscientists may describe cellular/molecular processes. Bridging language improves communication with families and other professionals.
The difference: OT focus is on how the nervous system’s inputs translate into movement and function; neuroscience often emphasizes underlying mechanisms at a granular level.

Sensory Modulation and Sensory Registration

Sensory modulation: the balance of excitatory and inhibitory processes in the CNS in response to sensory input. The nervous system aims to maintain homeostasis for functional engagement.
When modulation is off, a child may appear “out of step” with peers due to inappropriate arousal in context (too high or too low).
Sensory registration: the ability to notice and respond to salient environmental information while filtering out less important input. High vs low registration reflects sensitivity to stimuli.
Example of registration nuance: a splash of water on a sleeve may be irritating at a low level (high registration), but being drenched may become tolerable (low registration relative to the situation).
Individual variability: a person can exhibit high registration to some stimuli and low registration to others, depending on preparation and context.

Arousal and Self-Regulation

Arousal: related to alertness and readiness for input, not merely stimulation. It reflects how “awake” or engaged someone is.
Low arousal example: a child lying supine with a marker, showing reduced readiness for activity.
High arousal example: an active, highly engaged state that may disrupt group routines if not self-regulated.
Self-regulation: the ability to regulate the flow of input within the nervous system. OT approaches include teaching sensory strategies to modulate alertness, processing, and integration.
Knobs metaphor: the sensory experiences that we can adjust to move the nervous system up or down; teaching children and caregivers how to use these knobs supports self-advocacy and self-regulation.
Distinction in disciplines: OT sees self-regulation as a nervous-system, sensory-strategy process; behavioral science tends to describe self-regulation in terms of observable behaviors, emotions, cognition, and executive functions.

Practical Implications: Observations, Proximal-to-Distal Reasoning, and Handwriting

Proximal-to-distal principle: start with core trunk control and proximal stability before refining distal hand movements (e.g., handwriting).
Implication: if trunk control or core strength is weak, handwriting and fine motor tasks will be compromised; addressing proximal stability first is often necessary.
Clinical reasoning example: observe posture, trunk control, and muscle tone to determine the primary factors limiting task performance (e.g., handwriting difficulty may be secondary to trunk control rather than an isolated fine motor weakness).
Interaction with classroom expectations: a teacher may refer a child for handwriting, but the root issue could be proximal strength, trunk control, or modulation; OT communicates findings and rationale to teachers and parents.

Real-World Illustration: Sensory Experiences Across the Lifespan

Catherine Duclose Rose (adult autistic artist) as a lived example: describes sensory avoidance and “sensory seeking” experiences with art materials; LEGO commissions showcase complex sensory responses in adulthood.
This illustrates that sensory experiences persist and can be integrated into creative, professional pursuits, highlighting the variability of sensory profiles across the lifespan.
Using first-person perspectives helps clinicians and families understand sensory experiences beyond abstract terminology.

Language, Communication, and Interdisciplinary Collaboration

Reading and terminology: clinicians often discuss terms like sensory integration, sensory processing, and multisensory integration; these terms may not be familiar to teachers, ABA therapists, neurologists, or physicians.
Translation is essential: to ensure understanding, clinicians should translate OT concepts into language used by other professionals and families (e.g., linking ADLs to daily living skills or adaptive skills).
Why this matters: effective communication supports reimbursement, access to services, and evidence-based collaboration across disciplines.
Sensory integration vs multisensory integration: OT uses sensory integration to describe the organization of sensory information for functional use; neuroscience emphasizes multisensory integration as the combination of inputs at the neural level.
Sensory processing vs sensory modulation vs sensory registration: distinct but interconnected constructs used to describe how sensory inputs are perceived and acted upon.

Fieldwork, Telehealth, and Assessment Context

Course and fieldwork integration: upcoming activities include observational assessments based on sensory integration to prepare for lab and fieldwork experiences.
Telehealth activity: planning and designing a telehealth session, submitting plans for review, and filming for course objectives.
Emphasis on practical observations: learning to identify sensory-driven behaviors and to communicate observations in a clinically meaningful way.

Key Terms and Concepts (Glossary)

Praxis: the organization of movement; the process by which movement is planned and executed in a purposeful way.
Ideation: forming the idea of what to do, often initiated by observing others.
Motor plan: the internal plan for how to execute a movement.
Execution: carrying out the motor plan.
Feedback: information about the outcome of an action.
Feedforward: anticipatory adjustments for future actions based on prior feedback.
Multisensory integration: combining multiple sensory inputs to generate a response greater than the sum of any single input.
Sensory processing: the overarching construct describing brain–body processing of sensory input and resultant responses.
Sensory modulation: balancing excitatory and inhibitory inputs to maintain homeostasis and functional engagement.
Sensory registration: noticing and responding to salient environmental information while filtering out less important input.
Arousal: level of alertness or readiness for processing information.
Self-regulation: managing the flow of sensory input and nervous system arousal to meet task demands.
Interoception: internal bodily signals (hunger, fullness, need to use the bathroom, etc.).
Proprioception: sense of body position and movement via joints and muscles.
Vestibular sense: information about head movement and position in space.
Adaptive skills / ADLs / Living skills: terminology differences across professions; OT contexts often use sensory-based language while other fields may refer to functional daily living skills.
Proximal to distal: a developmental sequencing principle prioritizing core stability before distal fine motor tasks.
Just-right challenge: gradually increasing task difficulty to optimize learning and adaptation.
Prader-Willi syndrome / encopresis / enuresis: examples of interoceptive-related challenges affecting satiety and continence.

Closing Thoughts for Practice and Communication

All humans have sensory systems that shape learning and behavior; differences exist in how these systems respond and regulate. Functional participation improves with empathy, appropriate supports, and clear communication.
Clinicians can enhance function by teaching both children and caregivers about the “knobs” of sensory regulation and how to adjust arousal, processing, and integration in everyday contexts.
The ultimate goal is to support self-advocacy and self-regulation through age-appropriate language, enabling better collaboration with teachers, families, and other professionals.

References to Course Logistics

Upcoming topics: further exploration of sensory-based assessments, fieldwork integration, and telehealth activities.
PDMS-3 resources: red shelf materials and the components of the PDMS-3 (examiners manual, motor activities, item guide to administration).
Reminder: ensure accessibility of PDMS-3 materials for successful administration.