All About Balance – Episode 39 with Michelle Riddle
Welcome to the All About Audiology podcast. I’m your host, Dr. Lilach Saperstein and on today’s episode, we’re going to be talking a lot about balance, not only about actual physical balance, like how we make our body and space, but also a lot of different ways that we can balance how we show up in the world for our kids, for our patients, for our students. And I have with me a very special guest, Michelle Riddle from British Columbia, that’s in Canada, hahaha, for those of you who are from New York, like me, just joking, and don’t necessarily know your geography. Anyway, Michelle Riddle is an occupational therapist, and also a registered holistic nutritionist. And she is going to share with us about a very interesting triad, like a three part paradigm. So, let’s welcome Michelle to the show.
LS: “Welcome, Michelle, thanks so much for coming on the show. Tell us a little bit about yourself and what you do.”
MR: “Yeah, hi, my name is Michelle Riddle. I’m an occupational therapist and registered holistic nutritionist. I am an instructor at Vancouver Island University and my passion is brain development. I have a company called Resilient Health and the goal is to be able to help people, especially our kids, develop in the way that is the best for themselves, to achieve their potential and bring that forward throughout their life.
Thank you so much for having me here today. This is really exciting. Yeah, the Visual-Vestibular-Auditory Triad, so there’s a three part series there that is necessary for us to be able to process information and to learn. And it’s a really interesting group of sensory organs. Because we have our eyes that are taking in the information from what we’re seeing in our environment, but they also have muscles and how the eyes move in space determines how we perceive what we’re looking at, how we can track visually, and how we can judge distances. Then we have our ears for hearing and also for registering vibration. And in the inside of our ears, we have the vestibular system. And this system is a wonderful system that ties that whole triad together.
So, with that triad, we need it to be able to control movement. We need it to be able to figure out where we are in space, to give us a three dimensional view of the world. Also to feel secure and stable. When our body is dealing with gravity all the time, if we’re not in control of our postural muscles, our brain senses that there’s something kind of off, what are we doing? How do we manage this? So, there can be an emotional component as well within this whole system. The three units, the visual system, the vestibular system and the auditory system all share the eighth cranial nerve. And there needs to be noise from the vestibular system along this nerve for the brain to really process the information from all of these systems.
LS: “Wow. That’s a lot, so, we’re gonna break that down. Let’s start from the beginning. First of all, what is an occupational therapist for those who don’t know exactly, specifically. I think a lot of people think oh, OT (occupational therapist) will help you hold a pencil. An OT will help children who have low muscle tone, maybe those are things that are commonly known about OT, but actually, we are big fans of interdisciplinary care. And there’s a lot of overlap between audiologists and speech pathologists for sure, those are super close. We’re always talking about communication. But we also have a big relationship together with OTs and PTs (physical therapist) for the vestibular system, the balance of how our bodies can stay stable. So, let’s start there, a little bit about OT and then how that ties in with vestibular care.”
MR: “Yeah, well occupational therapy is really a profession where we deal with people being occupied doing things. From the moment we come into the world, we are constantly doing stuff. And so, that’s what our whole profession is based on, it’s the idea that people want to be productive, whether you’re young, or whether you’re older, you want to be doing things that have an impact. And so, part of that is processing the information that comes into the body. That’s sensory processing, and that’s a specialty area of occupational therapy and with that, we really look a lot at this triad, because we deal with information that we see, information that we hear, and then how we manage our body in space or how we balance information with the vestibular system.”
LS: “Got it. And then that would be differentiated from physical therapy, which is more functional, how we use our muscles and bones, let’s say.”
MR: “Yeah, so a really good example would be: Say you have an adult who’s had a stroke and they have challenges with one of their arms. So, physiotherapists will work on range of motion with that arm or getting the elbow to bend. Occupational therapists would look on the task of how to brush teeth. So, can I grasp the toothbrush? Do I need a wrap around my hand? Do I have the spatial awareness to get this toothbrush into my mouth? Alright, so we look at the function of how that task can be brought forward.”
LS: “That’s very helpful. You’re the first OT we’ve had on the show, which is actually something that I really like. I’ve had a lot of audiologists on my show, clearly, but also I like bringing on people who come from a different perspective and a different point of view. And yet we’re all kind of working towards getting to the same goal. So, tell me about the kind of work that you do and the kind of patients you work with.”
MR: “Yeah, my work right now is specializing mainly with kids and I’m looking at the issue of how they’re coping in the world that is really full of toxins right now and a few other things that can impact development. So, that’s my primary focus, the environmental component of health, especially in relation to developing brains for kids right now.”
LS: “Developing brains is one of my favorite things to talk about, hahaha, because it blows my mind, speaking of brains (pun intended). It’s like you take this tiny, tiny human that just was alive for four seconds and they’re already developing and growing neurons at an alarming rate. And then it just keeps going from there, like watching children learn in real time is the joy for me.”
MR: “The thing that I find such a professional motivator is that our bodies are so adaptable. They’re programmed to come forward in these wonderful, amazing ways. And when we put in the right ingredients, they managed to do just that. So, that’s the thing that’s super exciting. And that’s something that is really very interesting in this day and age because when we can really focus on those good ingredients and keeping out the things that causes damage to cells or cause inflammation, the kids function so much better when their bodies are left to do what they need to do.”
LS: “Wow. Recently, we had an episode that we’re focusing on trauma and how experiences can affect the brain development in the emotional reactions, the limbic system getting hijacked by this over-stimulation. And so, some of what you do, what you’re talking about is actually what the physical input is like food, and I don’t know, whatever other toxins you want to mention. There’s a long list of all the things we are exposed to, and how that can physically affect the neuro development.”
MR: “Yeah. And it all counts, you know, and that’s the thing that can feel overwhelming, is that there’s so much out there. So, it could be the chemicals, it could be trauma, it could be certain experiences. That’s called epigenetics, that’s all of the things that interact with our body. But the nice thing with that is that it all counts. So, making small changes can make a really big difference. So, when you take a look at chemicals, so let’s say, you live in an apartment, and within that apartment there’s carpet and there are plastics and a lot of things that give off gas. So, there are chemicals in the air. Well, there’s a couple of ways to deal with that, to reduce the load on these growing bodies. If you live near where there’s good air flows, or by the water or by trees, you can open a window. If you live by a highway and that’s not as easy to do, you can put in an air filtration system, or you can get some really great air filtering plants for the apartment. So, there are a lot of very simple strategies to really lower that chemical exposure that these kids have. It can be as simple as opening a window.”
LS: “Wow, it’s really good to reject an all or nothing, kind of like, well, if I can’t be vegan and live off the grid, then whatever, I can’t do anything. Like alright, we’re just gonna take it in. Like there’s definitely gradients and places where we can cut things out or change the environment in simple ways to make those changes. That’s so interesting.”
MR: “Yeah, for sure. So, regarding balance in the vestibular system, the vestibular system is really, really interesting. Because when we talk about being able to target one area, so, if you have a hearing impairment, and you possibly have a visual impairment as well, you can still function really well when the vestibular system is engaged. So, it’s lovely within that triad because when you have that foundational process in place, there’s a lot that can happen. And kids do this naturally. So, when their vestibular system is not functioning well, they move a lot. They’re trying to get it going. They’re shifting, they’re moving, they’re trying to get that system stimulated. Or they’re floppy, they’re lying down, they’re on the ground a lot, their body flops over.
So, they get stimulation through that system, they can process information a bit better. And that’s something for parents that can be really helpful, knowing that that’s what they’re doing, when they’ve got a lot of movement going on, or when they’re really floppy, because it’s tempting to say, ‘Sit up straight, stand up!’ So, letting the kids be able to move to stimulate the vestibular system means that they’ll be thinking clearer. They’ll be making sense of the information a bit better. And I’ll give you an example. My daughter was born with a hearing impairment and a visual impairment. And she also had sensory challenges as well. And for her, she moved all the time, she had to move in order to think. And when you’d ask her to be still, it was actually anxiety provoking for her because she couldn’t process the information. So, we were fortunate enough to start doing some work with rhythm and movement. And for her, that’s been the ticket through her life, being able to bring that forward. And she uses techniques by just adding some vibration in her body which stimulates the vestibular system. She’ll add a bit of rocking motion for herself when she’s talking to bring that information forward. So, it’s really exciting to be able to do that.”
LS: “That’s fascinating. I have to shout out to my mom who is a teacher with so many years of experience. And one of the things that she implements and talks about a lot, is that she sometimes does a spelling test for her third graders, and she’ll let them just lie down on the carpet in the classroom. She says, if you want to be on your belly and write your words, great. Be anywhere you want, let’s just do the spelling test, but you don’t have to sit in your chair for the whole time. And then that takes also some of the pressure off but I think it also engages this whole system where the child can think and can access information because they aren’t overwhelmed by this stiffness.”
MR: “Yeah. And what happens is that the vestibular system is always sending information to the brain of where you are in space. And if it doesn’t have a good grasp of postural control, if your brain’s not hearing the signals from that system clearly, then your body is going to either, get you down on the ground, where you’re safe and secure, or going to move you more so that the brain hears the noise through the system. You need to have that noise coming for your eyes and ears to process information. I do energy management in schools, and there was this one boy who really wasn’t able to focus. And so I suggested that the kids could take any position they wanted to see if they could find one that helped them pay attention. So, he put himself on his chair backwards. He flopped himself down, head down towards the ground, his legs up over the back of the chair and found doing that he was able to focus for like 20 minutes and he naturally knew to do that position. It’s extreme but for him, his brain just really wasn’t hearing that vestibular system at all. And so, turning up the volume was enough to allow him to focus and process the information.”
LS: “I think we also see this in neuro-typical kids who just like spinning. That’s just an enjoyable experience and they want to induce that spinning and induce the dizziness. And then they fall and it’s funny and they laugh and they do it again and again and again. And we are like, why is this a fun game? Why are you going in circles? But, even that can be an engaging way to just be in your body as a kid, which is like that freedom to just do whatever works.”
MR: “I love that term “be in your body”. That’s huge with turning the system on because it allows you to experience your body as it relates to space. And when you know where your body is, you don’t get up and accidentally knock over somebody’s papers or their drink or you don’t bump into somebody as you’re trying to stand in line.”
LS: “Ah, that clumsiness.”
LS: “I love this kind of conversation because one person’s, ‘Oh, that kid is so clumsy’, is another person’s, ‘Let’s evaluate their vestibular system.’ You know what I mean? Hahaha.”
MR: “Yeah, exactly. Let’s see what’s going on here and can we stimulate it enough so that that clumsiness starts to go away.”
LS: “Exactly. And just seeing things for what’s the root cause? What’s underlying? What other factors are affecting it? And the education that makes you know that. You know what, I’m just feeling inspired right now.”
MR: “Hey, that’s great.”
LS: “Yeah, sometimes I get the chills about how exciting it is that we learn stuff that’s like super sciencey and technical, like the vestibular ocular arc is how we see and our eyes move based on how we move our head… It’s very tedious at times when you’re gonna go into it. But then you come and get this bird’s eye view of how this matters for your kids’ functioning in life and how they’re functioning with other kids and being able to learn. So, yeah, I love it.”
MR: “Well, and that’s such a great example. Because when you’re trying to copy something off the board, you need that postural stability, like a tripod for a camera, in order to be able to go up and down smoothly and get your eyes to adjust in both places. You also need it to be able to track and if you’re not stable in your trunk or in your body, what happens is that you’re not being able to track while you’re missing letters, you’re missing words, you’re missing details. And that gets really frustrating for these kids.”
LS: “The visual processing, that’s what you’re talking about.”
MR: “Yeah, the visual processing. It’s much harder. And, again, with these kids, there are often implications around, you know, acting out or withdrawing for something. No, I don’t want to do it or being a goof because this was really hard, but I don’t want anyone to know that, so I’m going to be be goofy and funny and distract from the thing that’s hard for me.”
LS: “Totally. That’s such an interesting and important conversation around behavior and what’s underneath the behavior. And like this whole paradigm that when you see a child that’s “misbehaving”, what is it that you’re expecting and then to look at it, not that they’re doing it because something happened before, but they’re actually maybe doing it in anticipation of what will happen, like this will be challenging or I’m going to mess up or I’m not going to succeed at this. Yeah, that’s just my tangent.
I want to ask you about the kind of treatment or treatment plans that you put into place, like what can what can people do? What are the things that you do to help support this important triad?”
MR: “So, one of the really cool things that I use and it’s super simple is brain processing and looking at the crossing midline. Okay, so using your eyes to look at one hand, and then look at the other hand, so you’re just simply crossing midline, you’ve got to stabilize your hand to follow that. Then you can advance that by taking a ball going across the middle of the ball from one hand to the other, and then back and then the other and back. Now you had rhythm, across and back and across. And you can do this with young kids. You could take a ball, pass it around a circle for me and to you and me and to you. When I do this training with groups of caregivers or service providers, I get the whole group up and I give them instructions to just follow the rhythm. So, I just start clapping, and walking. And what happens is that within about three seconds, everybody starts walking in a line. So, rhythm regulates, it gives us that idea that we have to be the same, we have to be a part of this, everybody’s all over the room. And then they follow immediately into a line and start moving with the same steps, the same cadence. So, using rhythm is a really big part of that. Bouncing balls, you have to have balance, you have to have depth perception, you have to have muscle control. So, those are really simple tasks that can be done.”
LS: “Do you know about Dr. Bruce Perry and his work on regulation and trauma? I saw a video he was talking about how hip hop and other very rhythm heavy kind of music is extraordinarily successful at regulating and keeping people in resilience and keeping them in, not in dissociation, but again with being in the body and how if you do a dance class or if you do a drumming circle, anything that’s exactly this dis-regulation.”
MR: “Yeah, it could be any form of music or any form of of rhythm. And this can be useful for kids no matter what their level of hearing impairment is and offering different ways if they do have significant tones of feeling that vibration in that rhythm as well.”
LS: “Because then they can get it from a sensory. I always laugh about the five senses that we learned about in school, your eyes, your ears, your nose, your taste, your hands, and that’s it. And it’s like, wait a minute, what about proprioception, like how you are in space with your hands and your feet versus the floor, or your hands to each other. And then there’s more. We have more senses than that.”
MR: “We do. Yeah.”
LS: “Want to tell us?”
MR: “So, there’s a proprioception. There’s kinesthetic awareness. The proprioception is where we move in relation to ourselves. The kinesthetic awareness is where we are in space. So, it’s how we align ourselves with the world around us. And then we have interoception, which is the ability to perceive where we are in space without some of our senses giving us feedback. So, being able to close your eyes and walk forward without falling down, that is an interoception. So, yeah, there’s lots of processing capacities that we have. And again, the vestibular system is a sensory system. And so we don’t talk about it in the same sense as we do eyes and ears, but we really should because it is the foundation for all of those. So, the system itself is actually just a set of three bones. And they’re all going in different angles. There’s heavy fluid in those bones and there are little hairs. And so, as we move, the fluid moves, it bends the hairs and that tells us where our body is in space. So, it’s a lovely, lovely system.”
LS: “I remember when we first learned about the semicircular canals that are going on on different planes, there was a picture in the textbook of a ballerina. And first it showed her doing a demi plié. She was going up and down, bending up and down. And then it showed her doing a spin. So, that was turning. And then it showed her going, just taking steps forward, taking steps back. And I was like, I will never forget that picture, the diagram of this ballerina because you just imagine how much input you need in order to do a couple steps in a dance, in a ballet routine, and how you’re using all these different planes like x, y, and z. Like all the different directions: up/down, forward/back and then twirling.”
MR: “It’s so integrated, so that ballerina is such a lovely example of that. And with that integration, it makes it complex. But it also, again back to that that wonderful system, where different inputs can have different experiences or often offer different values. So, you don’t have to tackle the whole system. You can start work simply on the idea of going up and down, you know, so adding that movement. If somebody is very sensitive, if their vestibular system is hyperactive and signals too quickly, then you can start conditioning that system by adding slow patterned movements.
So, the two things that when I do training is rhythm regulate, so getting that rhythm there, but also structure stabilizes. So, knowing what is coming, knowing the system, offering stability before that mobility can really help to build that system in a balanced way.”
LS: “I love your alliterations. So, rhythm regulates and structure stabilizes, because then you have anticipation and you have learning going on in that system.”
LS: “And it’s like super high order processing coming. It’s kind of like a top down, bottom up, what you’re describing.”
MR: “Yeah, yeah, exactly!”
LS: “Like that rhythm regulation is working upwards, right. And then the structure stabilizes would be top down.”
LS: “So fun. I just really love learning.”
MR: “Yeah, yeah. And with the spinning, the twirling, the different angles, it’s interesting doing an assessment, because you’ll often see these kids who never get dizzy, you know. I’ll put them in the swing and I’ll spin them and spin them and spin them and spin them and I’ll stop and I’ll say, ‘Okay, you got to get up and walk.’ And they do. Hahaha. They’re not dizzy, their eyes are not moving. There’s nothing going on there. And it’s like, no wonder you move all the time, right? Their vestibular system is really not signaling in the way that it should to perceive where the body is. And so, adding those movements can really help to build that system to be more sensitive, as well.”
LS: “I’m thinking about neuro-diversity, maybe we can go in that direction. So, I don’t know how to segue into that idea.”
MR: “Yeah, so well, neurodiversity, I mean, it’s really interesting because we see so many interesting processing challenges for many different conditions. But for kids who have perhaps the symptoms of being somewhere on the autism spectrum, they will be trying to stimulate their vestibular systems. That’s one of the diagnostic keys with having the altered movement. So, they may be spinning, they may be watching a spinning ball or looking at the repetitive movement.”
LS: “What are those, the flashing strobe lights?”
MR: “Yeah, yeah, exactly. And so, when we dig deeper, those are the symptoms that we see. When we dig deeper, what it means is that their vestibular system is not firing as it should. And they need that system to be firing in order to process information. So, when we start addressing the vestibular system and building its capacity, then information processing improves, it’s much easier for them to start engaging with the world in a way that makes, you know, is a bit more typical.”
LS: “What advice would you have for our listeners when they’re listening to all these big, high level ideas, but they want to know today about their kid, what can they do to super charge and really support their child’s development in the context of the vestibular auditory visual triad.”
MR: “Yeah. So, well, the first thing is, as much as possible, using the eyes, the ears and the vestibular system together. So, lots of playtime, you know, catching balls, rolling balls, singing, dancing, moving around in space, looking at each other, dancing with each other and looking into each other’s eyes as you do. So, there can be some really fun things that you can do. Even with a baby, holding them in your arms and dancing like, you know, getting the movements to settle baby, we naturally do that. We start rocking them and looking at them and say, ‘Oh it’s okay.’ We get the tone, right?”
LS: “So, what you’re saying is your professional opinion is that we should play, hahaha.”
MR: “Yeah, 100%. The professional opinion is that you should play face to face, move a lot, use song, use dance. Be right there with your kids. It’s the greatest way to do this. And if you have a child that moves a lot, or that is floppy, know that their system is telling you something. Their vestibular system needs more information or it needs less information. And being able to use structured steady movement to bring them along can be really helpful or allowing them to find their best position. So, if they’re reading or having to focus, let them figure it out because their bodies naturally tell them, and then you’ll get a child who is learning better and is cooperating a lot more.”
LS: “That’s wonderful. And I think we can all take that advice. And even you know, as adults, us as parents, like, when’s the last time that you just put on music and danced for two minutes? Like that could be a thing that calms them down.”
MR: “It could and it does, right?”
MR: “Especially in this time right now. You know, we’re dealing with the isolation, finding ways to use our energy and to connect all of the different parts of our body.”
LS: “Thank you so, so much for coming on to the All About Audiology podcast and sharing so much of your enthusiasm, expertise and encouragement for our listeners.”
MR: “Thank you so much for having me. It’s a pleasure.”
LS: “If people want to find you or follow you, where can they go?”
MR: “So, if you need to contact me or want to contact me, the best way is by email. So, it’s firstname.lastname@example.org. Or, I have a website that is just under construction right now. So, it’s www.resilienthealth.ca.”
LS: “Excellent. And we’ll have all those links in the show notes and full transcripts of all podcasts are also on the website at allaboutaudiology.com. Thank you so much, Michelle.”
MR: “Oh, thank you so much. Take care.”
Wow, these episodes just get me fired up. I’m so excited about sharing this one with you guys. So, tell me what you think about some of the topics we talked about and ways that you can encourage your children’s development and their regulation with rhythm and with structure. So, have you had interactions with occupational therapy, does your child get any kind of care or treatment therapy like that, and have you seen that have an effect?
So, you guys know that the All About Audiology podcast and my beliefs, my passion is that we got to see kids as a whole. And yes, I focus on hearing and yes, I’m an audiologist. But it’s super, super important to me that we look at how your child is functioning and how they’re interacting with others, how they’re able to learn, and also how it’s affecting the family’s dynamic, you know, with sibling interactions. What it’s like to go to the playground with your kid, right? What is the day to day life look like when you’re with your kiddo? And what are the specific challenges they’re dealing with? And also what are their super strengths that we really want to tap into?
So, definitely send me an email or contact me through Instagram or Facebook @allaboutaudiology podcasts and I can’t wait to hear what you thought of this episode. Thank you for listening. I’m Dr. Lilach Saperstein and you’re listening to the All About Audiology podcast.