Spirited Conversations - Engaging and Elevating Pediatric OT

Sensory, affect, motor (S.A.M). Three letters that sit underneath almost everything we say on this show. In our very first Spirited Chat, Tracy explains where SAM came from and why every one of those letters has a high route and a low route of processing in the brain.

Spirited Chats are our new short episodes: one idea, short enough to fit between clients or on the drive home. We started at the very core of the SPIRIT Model, because if you've ever heard us say "the low route of M" and felt like we were speaking our own language, this one is for you.

Tracy traces SAM back to Dr Stanley Greenspan and shows the unique and amazing quality of her thinking mind as she builds on it. Using Dan Siegel's hand model of the brain, she explains why sensory processing splits into modulation and discrimination, and why affect and motor have their own high and low routes too. Michelle and Cory then bring it back to the clinic: how SAM guides assessment and intervention, and why having three clear places to look matters most when a child's presentation gets complicated.

Clinical reasoning starts with clarity. We differentiate so we can integrate.

Find the show notes and more Spirited Chats at https://www.spiritedconversationspodcast.com/

Build your clinical reasoning with DFX's Learning Journeys: https://dfxlearningjourneys.thinkific.com/

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If a child is relying heavily on their visual system to drive movement, the missing piece might not be where you think.

This one started the way our best conversations usually do, with Michelle bringing a genuine clinical wondering. A five and a half year old, a diadochokinesis task, and a quality of movement that looked robotic no matter how much practise was offered. We took that single clinical moment and mapped it through the SPIRIT model, and landed somewhere we did not expect: the vestibular system as the foundational source of bilateral coordination, rhythm and midline reference.

Tracy did what Tracy does and made the neuroscience not just accessible but genuinely exciting, and by the end of it we were all doing bicep curls at home. This is one of those episodes where we kept saying we would keep it simple, and then absolutely did not, in the best possible way.

WHAT WE COVER

• Bilaterality as a distinct sensory integrative function. Dr Ayres identified bilaterality as its own cluster within sensory discrimination, not just a motor output. That changes how we reason about coordination tasks that look straightforward on the surface.

• The vestibular system as the foundation for bilateral movement. Before a child can coordinate two limbs in an antiphase pattern they need a stable midline reference, and that reference is vestibularly mediated. If the foundation is shaky, children may compensate by watching you the entire time rather than generating movement from within.

• In phase versus antiphase movement patterns. The difference between homologous bilateral movement and the more demanding antiphase patterns, and why grading back to the simpler pattern tells you so much about where the breakdown actually sits.

• Rhythm, the saccule, and why gravity is always working. How the saccule functions as a background rhythm detector, and what the vestibular system's constant relationship with gravity means for rhythm generation and for multisensory supports in treatment.

• Top down versus bottom up coordination. When a child is manufacturing movement through visual monitoring and cognitive effort rather than generating it from an embodied sense, that is clinically significant and observable.

FREE CPD WORKSHEET

Five reflective practice prompts, free to download and ready for your CPD record. Grab it with the full show notes and transcript at spiritedconversationspodcast.com

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This is a short bonus from us, and it comes with an invitation. From the 9th to the 14th of November 2026, Tracy is leading a Spirited Retreat in Ubud, Bali, through CPD Retreats, and we wanted our listeners to know.

If you have ever wanted to learn the SPIRIT model deeply, this is the way to do it. You complete the SPIRIT course online beforehand at your own pace, then land in Bali with around 25 others, mostly paediatric OTs, though other professions and educators are welcome too. Mornings are theory and lectures with Tracy. Afternoons are practical: you spend time with children in the local community, then come back together and use the SPIRIT model to clinically reason what you saw and plan for the next day. Each evening there is something restorative built in.

Michelle went last year and says it shifted the way she thinks about herself as a clinician, not just the strategies she uses. There are only a few spots left. If you can make it to Bali in November, Tracy would love to see you there.

Sign up here: https://cpdretreats.com.au/retreats/ols/products/a-spirited-retreat-with-tracy-stackhouse-bali-september-2025-a-spr-rtr-wth1

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What does it really mean for sensory integration to be a developmental theorym and how does that change the way we see the children in front of us?

In this episode, we pick up right where Episode 33 left off. Tracy opens with a powerful quote from the Sensory Integration Theory and Praxis textbook that bridges sensory discrimination and executive functioning, and the conversation takes off from there.

We explore how Praxis doesn't arrive all at once but interacts with a child's changing developmental competence, from the six-month-old reaching for a toy, all the way to the basketball player executing a perfect shot. Tracy shares a rich clinical story of a little boy with Fragile X syndrome whose play shifted dramatically, not because he was taught new skills, but because his motivational system was met exactly where it was. And we get into genuinely fascinating territory around sensory surplus, neurodivergence, and what it means when a child needs to spend far longer making sense of perceptual qualities before they can move into representational play.

Timestamps:

00:00 Introduction & recap of Episode 33

01:43 Tracy's quote from Sensory Integration Theory and Praxis (2nd ed., 2002)

03:00 Sensory integration as a developmental theory — the spiralling continuum

07:17 What does "developmental theory" really mean here?

08:14 The embodied experience of a six-month-old becoming a reacher

10:34 Praxis elaborating from affordances — the basketball example

12:33 The interrupted development of Episode 33's little cherub

14:22 "Praxis interacts with the changing developmental competence of the child"

18:00 Connecting to executive functioning — planning and inhibitory control

20:06 Sledging, dysregulation, and the autonomic nervous system

20:33 Affect is the glue — Stanley Greenspan

21:48 Clinical story: the boy with Fragile X and the red cars

26:33 Attunement, pacing, and knowing when to stretch

29:00 How you find the affect inside a child's category interest

30:03 Sensory discrimination as the foundation of executive function shifting

31:20 Executive functions are embodied before they are cognitive

33:27 Visual discrimination and cognitive flexibility

35:00 Stuck in developmental stages — integration dependency

37:26 From concrete/literal to representational thinking

38:42 The million repetitions problem — and why play partners get tired

41:00 Filling the perceptual cup

42:04 Wired to Feel — autism as a condition of sensory surplus

44:00 Motivational bias, executive function, and the "not done yet" feeling

45:26 Affect as the glue in pathway building

47:12 Meeting children exactly where they are

49:14 DIR, honeypots, and what it means to really be with a child in play

49:55 Did affect unlock self-other connection?

53:15 Pulling it together for parents — the relief of knowing this is the work

54:52 We don't teach shoe-tying to 2-year-olds — developmental readiness

Resources mentioned:

Sensory Integration Theory and Praxis, 2nd ed. (2002) — Anzaloni & Murray

Children Adapt — Gilfoyle, Grady & Moore

Wired to Feel: Autism as a Condition of Sensory Surplus — Sweezy & Bergenfeld (2025)

DIR/Floortime — Stanley Greenspan

Early Start Denver Model — Sally Rogers

SPIRIT Model — Tracy Stackhouse, Developmental FX

The Felt Sense Polyvagal Model — Jan Winhall

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Check out DFX's learning journeys to sign up for our learning journeys community and take any of the courses available to build your clinical reasoning skills --> 

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In this episode, we dive deep into the clinical reasoning behind a case study of Cory's involving a 3.5-year-old boy. We do our best to link the experiences of this little boys daily challenges, such as dressing, social interactions, and emotional regulation, and unpack them through the lens of sensory integration and praxis.

We explore the vital difference between "high route" and "low route" brain processing of sensations and affect, and how we can use playful, relational interactions to bridge the gap. We also discuss the intersection of sensory integrative knowledge and Polyvagal Theory. With another aha moment in how the foundation of safety becomes a way we can facilitate sensory discrimination to emerge for motor planning and skill development.

Check out DFX's learning journeys to sign up for our learning journeys community and take any of the courses available to build your clinical reasoning skills --> https://dfxlearningjourneys.thinkific.com/

Full transcription of our episode is available on our website. 

Timestamps

00:00 Introduction

01:30 Case Study: Functional challenges

02:52 Observations in Daycare

04:39 Therapeutic Approach and Techniques

07:04 Progress and Insights

09:15 Discussion on Sensory Integration and Praxis

19:17 Practical Applications and Tools

26:22 Playful Beginnings: Exploring Interaction

26:48 Progress and Social Development

29:23 Understanding Sensory Discrimination

32:28 Trusting Theories in Practice

33:19 Praxis in Action: Another Case Study

36:42 Reflecting on Clinical Observations

43:01 Developmental Pathways and Testing

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In this episode, we’re wrestling with something that comes up all the time in clinic: how do we explain the tricky clinical terms (like ocular control) to parents without losing them? We are continuing on the journey of trying to unpack language, talking about how we translate what we’re seeing in terms of ocular motor functions, vestibular contributions, and somatosensory discrimination into language that actually lands and makes sense for families.

We unpack how the vestibular system and sensory discrimination play into eye movements, how modulation bumps into these issues, and how neurodevelopmental factors shape what we’re observing. Happy Listening!

Check out DFX's learning journeys to sign up for our learning journeys community and take any of the courses available to build your clinical reasoning skills  --> https://dfxlearningjourneys.thinkific.com/

Full transcription of our episode is available on our website. 

Timestamps:

00:00 Introduction to Translating Clinical Concepts

00:36 Challenges in Communicating Clinical Terms

02:26 Navigating Clinical and Medical Spaces

05:58 Understanding Ocular Motor Function

08:25 Connecting Sensory Systems to Daily Life

19:01 Developmental Perspectives on Sensory Integration

26:19 Integrating Information for Developmental Understanding

26:59 Vestibular System and Its Functions

28:39 Motor Control and Its Origins

30:25 Challenges with AI in Understanding Motor Skills

37:20 Clinical Reasoning and Interpretation

38:30 Attachment and Motor Development

42:03 Connecting Threads in Therapy

44:19 Concluding Thoughts and Future Discussions

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Website: https://www.spiritedconversationspodcast.com/

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In this episode, we dive into the complexities of neurodiversity, sensory modulation, and the importance of safety and curiosity in therapy and life. Through some of our personal stories and clinical anecdotes, we explore how embracing individual differences and showing up authentically can foster resilience, learning, and connection.

Resources & Mentions:

• Ruth Lanius and Dr. Stephen Porges (on neuroception and sensory matrix)
• Lois Hickman, OT, and nature-based therapy
• 
  

If you enjoyed this episode, check out our Instagram for more resources and Cory’s “Spirit” rap. Keep showing up, stay curious, and embrace your own unique innate qualities!

TIMESTAMPS

0:00 — Introduction, no context, just starting

0:08 — Hosts reflect on being non-professional communicators and podcasting

0:38 — The experience of listening to yourself on a podcast

0:55 — Balancing each other's communication styles

1:27 — Embarrassing travel stories and trusting the process

2:16 — Resilience and strengths-based language

4:33 — "Neuro spicy" and personal quirks

5:43 — Funny story about ADHD realization

9:13 — Learning from yourself and collective learning

10:19 — Embracing neurodiversity in the podcast

11:41 — Recap of last episode and moving into new terminology

12:47 — Discussion of neuroception and modulation

14:15 — Sensory matrix and evolving language

17:02 — Sensory affective dual process

18:22 — Mobilization and nervous system responses

21:02 — The importance of safety and curiosity in therapy

29:23 — The "milk and butter" story: using curiosity and safety in therapy

36:05 — Reflections on the story and its impact

39:23 — The importance of following the child's lead in therapy

43:58 — Wrapping up, next episode preview, and social media plug

43:26 — Final thoughts and goodbyes

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In this episode, we delve into the complexities of sensory modulation and regulatory systems, discussing how we understand these elements and how they influence therapeutic practice. We explore the polyvagal theory, sensory modulation matrix, and how we can create shared terminology in those spaces. Through real-life examples and theoretical discussions, we bring to light the importance of precise language and shared understanding in clinical settings. The episode highlights the dynamic interplay between sensory processing, state regulation, and adaptive functions, offering insights into how therapists can better support children with diverse needs.

TIMESTAMPS

00:00 Introduction and Welcome Back

00:17 Celebrating Learning Communities

01:07 Community Feedback and Growth

02:30 Discussing Terminology in Therapy

04:06 Exploring Sensory Issues

07:27 Precision in Clinical Language

11:36 Understanding State Dependency

18:17 Polyvagal Theory and Regulation Models

22:07 Understanding Sensory Modulation and Regulation

22:39 The Interplay of Sensory Modulation and Neuroception

23:27 Linking Sensory Modulation to Treatment Plans

26:06 The Role of Arousal and Autonomic States

29:30 Practical Examples of Sensory Modulation

35:33 Integrating Polyvagal Theory and Regulatory Capacities

41:36 The Sensory Modulation Matrix

43:55 Building a Shared Language in Communities

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Website: https://www.spiritedconversationspodcast.com/

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In this episode, we dive into a fascinating discussion about the intersection of scientific research and therapeutic practice. Tracy shares a heartfelt experience of hosting scientists at the Developmental FX clinic, where they observed therapy sessions for individuals with Fragile X syndrome, autism, and other developmental disorders. The conversation highlights the importance of integrated models of care, the subtle yet profound impact of high-quality therapy, and the critical role of co-regulation. We also reflect on the teachings of Dr. Ayers, the challenges and rewards of being a therapist, and the significance of collaborative partnerships in advancing child development.

TIMESTAMPS

00:00 Introduction and Greetings

02:15 A Day at Developmental FX

05:17 The Nuances of Therapy

10:51 Challenges and Reflections

17:24 The Importance of Co-Regulation

22:15 Translating Theory into Practice

34:07 Celebrating the Team's Work

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In this insightful episode, we explore the transformative role of play and playfulness in paediatric occupational therapy from multiple perspectives. From real-life case studies to theoretical discussions on the STEPPSI model and polyvagal theory, we uncover how play enhances child development and therapy. Learn about the challenges and triumphs therapists face in incorporating fun into clinical practice, and discover strategies for balancing playful engagement with therapeutic goals. Through stories, research, and practical tips, we highlight the profound impact of playful interactions and social dynamics in fostering growth and emotional regulation in children.

00:00 Exploring Play in Child Development

01:16 The Origins and Evolution of STEP SI

05:24 Personal Journeys into Pediatric Occupational Therapy

08:05 The Vulnerability and Joy of Play

10:03 Balancing Playfulness and Professionalism

20:55 Clinical Reasoning in Play-Based Therapy

25:18 Playfulness vs. Play: Definitions and Applications

28:45 Case Study: Attuned Play in Therapy

33:19 Struggles with Play and Skill Development

34:28 Letting Go of the Agenda

35:30 A Breakthrough in Play

38:22 The Importance of Play in Therapy

39:28 Navigating Play and Regulation

41:31 Personal Reflections on Play

45:20 Autonomic Nervous System in Play

47:15 Grandchildren and Play Dynamics

53:06 Therapeutic Strategies in Play

59:14 Concluding Thoughts on Play

Connect with us: 

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Facebook: https://www.facebook.com/spiritedconversationsOT

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Website: https://www.spiritedconversationspodcast.com/

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