THE SPINNING PROTOCOL
The spinning protocol was developed by Mary Kawar MS, OTR after years of researching and studying the vestibular system. She determined that in order to optimally stimulate and organize the vestibular system, it was necessary to stimulate all three pairs of semicircular canals.
After a child is determined to be an appropriate candidate for the spinning program by a qualified professionally trained OT in this area of Sensory Integration therapy, the child's parents, teachers, and other team members may be trained to implement the spinning protocol.
- Have the child sit upright on the rotation device (i.e. spinning board, sit-n-spin with board on top, platform swing, etc), with the head positioned at a 30-degree angle to the floor (the opening of the ears should be in line with the corner of the eyes, with this imaginary line parallel to the floor).
- The child is then turned counter-clockwise for up to 10 rotations (see therapist for specific number of rotations) at a speed of 1 revolution per 2 seconds. Observe the action of the eyes in response to this stimulation (you should see a horizontal movement of the eyes, known as post-rotary nystagmus).
- Allow the child to sit still and "recover" for 10-20 seconds, or until he/she feels ready to spin again. Then repeat the spinning in the clockwise direction (same duration and velocity) and again observe the eyes, and allow 10-20 seconds for "recovery".
- Next, have the child lay on his/her side on the board, with the head and spine aligned horizontally and nose positioned at a 45-degree angle to the floor/board. Provide spinning in counter-clockwise direction (up to 10 rotations at same rate of speed as in sitting), and observe eyes for vertical movement (nystagmus) this time.
- Allow "recovery time", and proceed in spinning the child in the clockwise direction (up to 10 rotations at same speed). Observe eyes and allow time for recovery.
- Have the child roll onto his/her other side and repeat steps 4 and 5. **It is essential to have the child lie on each side, as one semicircular canal of the left ear is in line with a different canal of the right ear (and vice versa); and the only way to optimally stimulate all areas is by rotating the child each direction, on each side.**
- Spinning should be followed up with visual tracking exercises to bring the reflexive eye movements to a more volitional/functional level. Using a motivating one-inch object/light held 16 inches from the child's nose, instruct the child to follow the object with his/her eyes (preferably without moving head) in vertical, horizontal, diagonal, and figure eight motions.
It is essential to avoid overloading the child's system, as some children may be extremely sensitive to rotary input. Please watch for the following signs of sensory overload:
- Change in respiration rate (breathing faster or slower than usual)
- Any "flight" (running away, avoidance, etc) response
If any of these signs are observed, have the child get up immediately (within 5-10 seconds) and run, jump, push, pull, etc to provide the system with counteractive "heavy work"/proprioceptive input.