The Proprioception-Emotion Connection

Dr. Inmaculada Riquelme and team (University of Balearic Islands, Spain) examined 126 children aged 4-18 years, including 42 with autism spectrum disorder, 34 with cerebral palsy, and 50 typically developing peers.

Study Methodology

Researchers used comprehensive assessments:

• Proprioceptive acuity: Nottingham Sensory Assessment and Joint Position Error tasks (wrist movements, blindfolded)
• Proprioceptive reactive behavior: Short Sensory Profile Movement Subscale (parent-reported)
• Emotion knowledge: Emotion Matching Task
• Emotion regulation: Emotion Regulation Checklist
• Social responsiveness: Social Responsiveness Scale

Critical Findings

The research revealed significant correlations between proprioceptive deficits and emotional difficulties:

• Lower emotion knowledge (difficulty identifying and understanding emotions)
• Higher emotion lability/negativity (rapid mood shifts, negative emotionality)
• Challenges in emotion regulation across disorders

The Mechanism

The researchers propose that proprioception is essential for constructing emotions from somatic (body) states. When experiencing an emotion, the body changes (heart rate, muscle tension, breathing, posture). Proprioceptive receptors detect these changes and send information to the brain about internal state. The brain uses this proprioceptive information, along with context and past experiences, to construct the emotional experience.

Disorder-Specific Patterns

The study revealed distinct proprioceptive impairment patterns:

• Cerebral Palsy: Poorer proprioceptive acuity AND more proprioceptive reactive behaviors, with significant emotion knowledge deficits
• Autism Spectrum Disorder: Proprioceptive acuity similar to typically developing peers, but greater impairments in social responsiveness (communication, social interaction, mannerisms)
• Age and Pain Factors: Younger age linked to less movement-reactive behaviors; chronic pain associated with poorer proprioception

Practical Applications

This research validates sensory-based interventions for emotional regulation:

• Weighted blankets and compression clothing provide organizing proprioceptive input
• Heavy work activities (pushing, pulling, carrying) offer regulating sensory feedback
• Body awareness exercises strengthen the proprioception-emotion connection
• Proprioceptive rehabilitation may serve as a therapeutic target for balancing emotion regulation in neurodevelopmental conditions

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Body Awareness & Executive Function: The Strongest Correlation

Dr. Ted Brown and colleagues (Monash University, Australia) examined 40 typically developing children (mean age 7.42 years, 50% female) using comprehensive parent-report measures.

Study Design

The research used:

• Sensory Processing Measure (SPM) Home Form: 75-item caregiver questionnaire assessing sensory processing, social participation, and praxis
• Behavior Rating Inventory of Executive Function, 2nd Edition (BRIEF2) Parent Form: 63-item scale measuring executive function domains
• Statistical Analysis: Spearman correlations with bootstrapping and multilinear regression models

Significant Correlations Found

Multiple SPM subscales correlated with BRIEF2 composite scales:

• Behavior Regulation Index: r_s = .31 – .38, p < .05
• Emotion Regulation Index: r_s = .34 – .59, p < .05
• Cognitive Regulation Index: r_s = .32 – .45, p < .05
• Global Executive Composite: r_s = .32 – .45, p < .05

Regression Analysis Results

Why Body Awareness Matters for Executive Function

The research reveals three pathways:

Pathway 1: Body Awareness → Emotional Regulation → Cognitive Control
Children need to regulate emotions before engaging executive functions effectively. Proprioception enables: (1) awareness of arousal state, (2) recognition of body signals, (3) implementation of regulation strategies, and (4) achievement of optimal state for cognitive work.

Pathway 2: Proprioception → Motor Planning → Executive Function
Proprioceptive input is essential for motor planning, praxis, and visual-motor integration. These motor planning skills use the same brain networks as cognitive executive functions: sequencing steps, planning actions, monitoring execution, and adjusting based on feedback.

Pathway 3: Kinesthetic Learning → Cognitive Development
Proprioceptive experiences build spatial awareness, directional concepts, quantitative understanding, and temporal sequencing. These concepts, learned through physical movement, transfer to abstract cognitive work.

Practical Implications

Children with strong proprioception and executive function:

• Adjust body position when attention wanes (stands, stretches, shifts)
• Recognize “I’m getting frustrated” body cues and take breaks
• Use movement strategies for regulation (“I need to go jump”)
• Plan complex physical AND academic tasks effectively
• Modulate effort appropriately across situations

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Sensory Integration Training: Brain Imaging Evidence

Researchers Deng, Lei, and Du (Chinese research institution) used cutting-edge brain imaging technology to directly measure brain activity changes from sensory integration training in 18 children with ASD aged 6-11 years.

Study Design

• Population: 18 children with ASD (Experimental n=9, Control n=9)
• Screening: Child Sensory Integration Scale to identify sensory processing disorders
• Intervention: 8 weeks of sensory integration training targeting seven sensory systems
• Assessments:
  • Sharpened Romberg Test for balance (Footscan technology for biomechanical evidence)
  • Go/No-Go task for executive function
  • fNIRS monitoring of prefrontal cortex neural activation during tasks

Balance Function Improvements

Sensory integration training significantly improved balance, especially under Visual Deprivation conditions, indicating a compensatory effect – when visual input is removed, properly trained proprioceptive and vestibular systems maintain balance.

Biomechanical evidence showed:

• Reduced center of pressure movement (COPx, COPy)
• Decreased total travel width (TTW)
• Reduced ellipse area (EA)

Translation: More stable, controlled, efficient balance – the nervous system integrated sensory information more effectively.

Brain Activation Changes

fNIRS imaging revealed enhanced neural activation in:

• Right Inferior Frontal Gyrus (R-IFG): Critical for stopping impulsive responses and inhibitory control
• Right Middle Frontal Gyrus (R-MFG): Essential for shifting between tasks/mental sets and cognitive flexibility

Behavioral Improvements

Go/No-Go task performance improved significantly:

• Reduced reaction time (faster cognitive processing)
• Increased accuracy ratio (better impulse control)
• Better discrimination between “go” and “no-go” trials

The Neural Integration Mechanism

Sensory Systems Targeted

The 8-week program included exercises targeting:

• Proprioception: Resistance balls, dumbbells, weighted activities, deep pressure
• Vestibular: Swinging, spinning, balance challenges, position changes
• Tactile: Texture exploration, pressure activities
• Visual: Visual tracking, eye-hand coordination
• Auditory: Sound discrimination, following verbal directions

Clinical Significance

The study suggests R-IFG/MFG activation could serve as biomarkers for assessing executive function improvements in children with ASD. This is revolutionary – we can now measure brain-level changes from sensory-based interventions, providing objective evidence of neurological impact.

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Reducing Hyperactivity Through Vestibular and Proprioceptive Exercises

Study Design

• Type: Single-blind randomized controlled trial
• Population: 22 children with mild-to-moderate ASD
• Duration: 8 weeks (November 2022 – November 2023)
• Groups:
  • ASD-E (Experimental): Conventional physiotherapy PLUS vestibular and proprioceptive exercises
  • ASD-C (Control): Conventional physiotherapy only
• Assessments:
  • Vanderbilt ADHD Diagnostic Parent Rating Scale (VADPRS)
  • Dunn’s Sensory Profile
  • Post-Rotatory Nystagmus (PRN) test for vestibular function

Dramatic Results

The Mechanism: Why This Works

The study supports Sensory Integration Theory’s explanation that hyperactivity in ASD is sensory-driven:

1. Arousal Regulation
Proprioceptive input (deep pressure, resistance, weighted activities) provides organizing, calming input to the nervous system. This modulates arousal levels, reducing sensory-seeking behaviors. Children no longer need to run, climb, or move excessively to get needed sensory input.

2. Body Awareness → Self-Regulation
Better proprioception = better awareness of body state and position. Children recognize their arousal level more accurately, can implement regulation strategies before becoming dysregulated, and reduce impulsive movement driven by poor body awareness.

3. Vestibular Input → Spatial Awareness and Postural Control
Swinging, spinning, and balance activities enhance spatial awareness. Improved postural control means less fidgeting and position-seeking. Enhanced sensory integration reduces “movement noise” from poor sensory processing.

4. Sensory Modulation
Training helps the nervous system modulate (regulate) sensory input appropriately, reduces hyper-reactivity to sensory experiences, decreases sensory-seeking behaviors, and supports emotional regulation by reducing sensory overload.

Effective Exercise Types

Proprioceptive Activities:

• Weighted tasks (carrying heavy objects, wearing weighted vests)
• Deep pressure (compressions, massage, squeezes)
• Resistance work (pushing, pulling against resistance)
• Heavy work (animal walks, wall pushes)

Vestibular Activities:

• Swinging (linear and rotational)
• Spinning (controlled, with breaks)
• Balance challenges (balance beam, unstable surfaces)
• Position changes (inversions, rolling)

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Sensory Integration-Based Sports Training: Motor and Social Skill Development

Study Design

• Type: Quasi-experimental design
• Population: 40 children aged 6-12 years with ASD
• Groups: Experimental (n=20) receiving sensory integration-based sports training vs. Control (n=20) engaging in standard physical exercises
• Duration: 12 weeks, three 60-minute sessions per week
• Assessments:
  • Bruininks-Oseretsky Test of Motor Proficiency, 2nd Edition (BOT-2)
  • Sensory Processing Measure (SPM)
  • Social Responsiveness Scale, 2nd Edition (SRS-2)
  • Qualitative observations and parent/therapist interviews

Session Structure

1. Warm-up (10 minutes)
2. Sensory Integration Exercises (20 minutes):
   • Balance beams (proprioception + vestibular)
   • Trampoline jumps (vestibular + proprioception)
   • Resistance games (proprioception)
   • Tactile activities
3. Sports Drills (20 minutes):
   • Modified soccer
   • Obstacle courses
   • Team games
4. Cool-down (10 minutes)

Remarkable Results

Why This Matters – Functional Outcomes

This wasn’t just about motor skills – it was about real-world functional outcomes:

• Social engagement increased
• Withdrawal behaviors reduced
• Participation in group activities enhanced
• Emotional regulation improved (fewer meltdowns during activities)
• Executive function strengthened (following rules, taking turns, planning actions)

The Neural Integration Story

Researchers propose that structured sensory environments:

1. Promote synaptic plasticity – The brain creates new connections and strengthens existing ones
2. Enhance motor cortex excitability – Motor regions become more responsive and efficient
3. Integrate sensory-motor-cognitive networks – Different brain systems work together better
4. Support behavioral adaptation – Children can flexibly adjust to changing demands

Evidence of Emotional Regulation

During cool-downs, experimenters observed:

• Decreased hyperactive behaviors (sensory regulation)
• Increased calm engagement (arousal modulation)
• Better attention to instructions (executive function)
• More appropriate social interaction (emotional regulation)

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Sensory Processing & School Participation

Dr. Dulce Romero-Ayuso and team (University of Castilla-La Mancha, Spain) developed comprehensive assessment examining how sensory processing and executive functions affect school participation in 536 children aged 3-11 years (366 typical, 170 with neurodevelopmental disorders).

Study Design

• Respondents: 103 teachers (completed after 3+ months with children)
• Development Process: Literature review, consultations with occupational therapists and teachers, initial 74 items expanded to 85, finalized at 80 items
• Final Questionnaire: 54 items grouped into five factors
• Analysis: Exploratory factor analysis, reliability testing, validity assessment

Five Main Factors Identified

Factor 1: Initiation, Organization, Execution, and Supervision of Action

• Planning tasks
• Organizing materials
• Following through on actions
• Monitoring progress and self-correction

Factor 2: Inhibitory Control

• Stopping impulsive responses
• Waiting turns
• Controlling body movements and verbal output

Factor 3: Sensory Processing

• Tactile sensitivity
• Proprioceptive awareness
• Vestibular processing
• Visual and auditory processing

Factor 4: Emotional Self-Regulation and Play

• Managing frustration
• Regulating excitement
• Social interaction during play
• Emotional flexibility in group activities

Factor 5: Self-Competence

• Self-confidence in abilities
• Willingness to try new tasks
• Persistence with challenges

Validation Results

Critical Findings for Proprioception & Body Awareness

Sensory Processing Influences School Success:

The study identified sensory processing, including proprioception and vestibular systems, as crucial for:

• Social relations (interpreting body language, respecting personal space)
• Classroom activities (sitting appropriately, handling materials)
• Academic engagement (sustaining attention, following multi-step directions)
• Peer interactions (playground games, group work)

Tactile Sensitivity Predicts Self-Regulation:

Tactile sensitivity emerged as significant predictor of behavioral self-regulation. Children with tactile hypersensitivity or hyposensitivity struggle with:

• Tolerating clothing, tags, textures
• Participating in messy activities (art, science)
• Physical proximity to peers
• Emotional regulation during sensory experiences

Coordination and Learning Challenges:

The study noted associations between coordination difficulties (clumsiness, motor planning deficits) and:

• Reading challenges
• Dyscalculia (math learning disability)
• Writing difficulties
• Emotional and behavioral regulation problems in school

Disorder-Specific Patterns

Children with ASD:

• Sensory modulation problems (hyporesponsiveness, hyperreactivity)
• Difficulty with proprioceptive feedback
• Challenges interpreting vestibular input
• Impact on social-emotional regulation

Children with ADHD:

• Sensory processing affecting inhibitory control
• Movement-seeking behaviors (proprioceptive/vestibular needs)
• Difficulty modulating sensory input
• Executive attention challenges linked to sensory experiences

Teacher Observations

Teachers reported that children with sensory-motor challenges often:

• Seek movement breaks constantly (proprioceptive/vestibular needs)
• Struggle with handwriting (fine motor + visual-motor integration)
• Have difficulty with classroom transitions (motor planning + executive function)
• Show emotional dysregulation during unstructured time (sensory overload)
• Avoid certain activities (sensory defensiveness)
• Appear inattentive (actually overwhelmed by sensory input)

The “Self-Regulation and Play” Connection

Factor 4 specifically underscored how sensory processing influences social interactions during play, which in turn affects:

• Emotional regulation development
• Executive function practice (turn-taking, rule-following)
• Peer relationship building
• Self-concept formation

Children with sensory processing challenges struggle with playground games because:

1. Motor demands exceed their coordination abilities
2. Unpredictable sensory input (being bumped, loud noises) triggers dysregulation
3. Complex motor planning interferes with game participation
4. Social rejection due to clumsiness impacts emotional well-being

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Motor Skills → Executive Function → Emotion Understanding: The Mediation Pathway

Researchers Li, Wang, Xin, and Gu (Chinese research team) examined 662 children aged 3-6 years from two preschools in Kaifeng, Henan province, China (303 females, 359 males).

Study Assessments

• Gross Motor Skills: Test of Gross Motor Development-Second Edition (TGMD2) – locomotor and object control subsets
• Executive Function:
  • Inhibition control (Children’s Stroop task)
  • Cognitive flexibility (Dimensional Change Card Sort task)
  • Working memory (Beads tasks)
• Emotion Understanding:
  • Emotion recognition (matching and identification tasks)
  • Emotion comprehension (Test of Emotion Comprehension: external cause, desire, belief, reminder)
• Analysis: Regression and mediation analysis using SPSS 21 with bootstrapping (5000 resamples)

Correlations Found

Regression Results

• Gross motor skills → Emotion comprehension: β = 0.32, p < 0.001
• Gross motor skills → Emotion recognition: β = 0.19, p < 0.001

Mediation Effect

The Mechanism – How It Works

Physical Activities Build Executive Functions:

Gross motor skills (running, jumping, balancing, climbing) requiring goal-directed behavior demand:

1. Planning and sequencing (executive function practice)
2. Inhibiting impulsive movements (inhibitory control)
3. Remembering rules and steps (working memory)
4. Adapting to changing situations (cognitive flexibility)

Executive Functions Enable Emotion Understanding:

These same executive function skills are then applied to:

• Understanding complex emotional situations
• Recognizing context-dependent emotional meanings
• Integrating situational knowledge with emotional knowledge
• Comprehending causes and consequences of emotions

Practical Implications

This research explains why physical activity matters for emotional development:

• Movement isn’t just “burning energy” – it’s building cognitive skills
• Gross motor play develops executive functions needed for emotion regulation
• Physical games with rules practice the same skills used in social-emotional situations
• Coordination activities strengthen the brain networks managing emotions

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Fundamental Motor Skills & Executive Function in Preschoolers

Researchers Han, Zhao, Kong, and Xie (China) examined 394 preschool children (age 4.07 ± 0.76 years) from four urban and two rural preschools in Shanxi, China.

Study Assessments

• Fundamental Motor Skills (TGMD-2):
  • Locomotor skills: run, hop, gallop, jump, leap, slide
  • Object control skills: catch, throw, kick, strike, bounce, roll
• Executive Function (NIH Toolbox Cognition Battery):
  • Inhibition control
  • Working memory
  • Cognitive flexibility
• Analysis: Partial correlation and multiple linear regression, controlling for age, gender, BMI, and setting

Overall Relationship

Differential Effects: Locomotor vs. Object Control

Locomotor Skills (Movement through space):

Object Control Skills (Manipulating objects):

Why the Difference?

Locomotor Skills Demand More Complex Cognitive Processing:

• Sequencing body movements in space
• Maintaining balance during dynamic movement
• Coordinating multiple body parts simultaneously
• Navigating spatial relationships
• Adjusting to changing surfaces and conditions

These demands directly exercise:

• Working memory: Remembering movement patterns and sequences
• Cognitive flexibility: Adapting movements to different contexts
• Inhibition: Controlling impulsive movements

Object Control Skills Focus on Specific Demands:

• Precise timing and force modulation
• Hand-eye coordination
• Impulse control (wait for right moment to catch, kick, throw)

These primarily exercise inhibitory control.

Practical Applications

For maximum executive function development, children need:

1. Diverse locomotor experiences: Running, hopping, skipping, galloping, leaping, sliding, climbing
2. Object control practice: Catching, throwing, kicking, striking, bouncing
3. Combined activities: Sports and games integrating both (soccer, basketball, obstacle courses)

Key Insight: Locomotor skills may be particularly important for developing the full range of executive functions, while object control skills contribute primarily to inhibitory control. Both are valuable, but for comprehensive executive function development, prioritize movement-based activities.

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