Note: This is an AI generated conversation taken from transcripts of real conversations with Karen Kangas (Occupational Therapist) as a novel way to make learning fast, fun and easy to listen to. AI has made some errors eg. The basal ganglia are not in the brainstem and the barrier vest is not rigid plastic (sigh) but spotting the errors makes it more fun 😉 and the take-home message is something you need to hear.
Click this link for instructions on making the barrier vest and more about how it works and how to use it > Empowering Movement: Karen Kangas on Transformative Therapies for Children with Complex Disabilities
Rapid Access Summary
Here’s the short summary of the useful stuff covered in this awesome AI conversation…🎙️
If you’ve spent any time in a special education classroom or a pediatric rehab clinic, you’ve likely seen the “90-90-90” rule in action: hips, knees, and ankles all at right angles, strapped in for “symmetry.” But according to veteran occupational therapist Karen Kangas, who has over 50 years of experience, this industry standard might be doing more harm than good.
Kangas, a self-described “badass” in the world of assistive technology (AT), argues that we’ve been treating the bodies of sensate children—those who can feel and respond to their environment—as if they were paralyzed adults. In her recent workshops and interviews, she challenges us to look beyond “postural management” and start looking at postural control.
The Gravity of the Situation
The foundation of Kangas’s philosophy is rooted in sensory integration, specifically the work of Jean Ayres. She emphasizes that human development isn’t “taught” - the body reveals its ability to sit and move when given the right opportunities.
Crucially, the body has two primary processing systems: tactile (resting) and vestibular-proprioceptive (active engagement with gravity). When a child is strapped into a highly contoured, symmetrical chair, their body is forced into tactile processing. They aren’t holding themselves up; the chair is holding them. To find the power to move, use their hands, or focus their eyes, a child must engage with gravity.
“Head control is actually controlled by the pelvis and by gravity,” Kangas explains. When we “jail” a child in a chair with headrests and trunk laterals, we often prevent them from finding the very pelvic stability they need to hold their own head up.
Presuming Intention
One of the most moving parts of Kangas’s work is her insistence on presuming intention. We often interpret a non-verbal child’s “extensor thrust” as a pathological symptom of Cerebral Palsy. Kangas sees it differently: these are often protective reactions.
When a child’s pelvis feels unstable, their body kicks into a “startle” or “opisthotonic reaction”—a surge of extensor tone meant to help them find gravity and protect their organs. If they hit an obstacle, like a rigid headrest or a tray, that tone increases. Kangas’s radical solution? Take the obstacles away. By removing headrests, leg rests, and trays during activity, she has shown that even children labeled as having “no head control” can sit at a regular desk and flip the pages of a book when they are interested in the task.
The Tools of the Trade: Beyond the Big Red Switch
Kangas also critiques how we approach access to Augmentative and Alternative Communication (AAC). While the industry has moved toward high-tech eye-gaze systems, she reminds us that access must be paired with activity.
She advocates for:
Electronic Sensors over Mechanical Switches: Mechanical switches require five distinct actions (locate, touch, press, hold, release) which can be impossible for a child with high tone. Electronic “proximity” or fiber-optic switches require zero pressure, making the technology “transparent” so the child can focus on the communication, not the “hit”.
The Barrier Vest: For children with dystonia who “bridge” or surge when touched on the back, Kangas uses a protective barrier vest. This “barrier” prevents the caregiver’s hands from accidentally triggering a protective reaction at the scapula or sacrum, allowing the child to relax and engage.
Feet on the Floor: Weight-bearing is the “calming” signal for the nervous system. Kangas frequently removes footplates to let children feel the actual ground, which she argues is the only way the body truly understands how to orientate support to gravity.
A Shift in Practice
For therapists and parents, the takeaway is a shift from “fixing” to “facilitating.” Kangas suggests the 1-2-3 approach for handling: instead of a sudden “1, 2, 3, lift,” use the count to signal your approach. “I’m coming close, 1, 2, 3, my hand is going to touch your shoulder, 1, 2, 3, ”. This predictability reduces hypervigilance and calms the body’s protective surges.
Ultimately, Kangas reminds us that “relaxation is not life”. A child might be symmetrical and “safe” on the bus, but for them to be a functional human being, they need the freedom to move, to be asymmetrical, and to struggle a little bit with gravity.
As she puts it: “The body knows how to do more by revealing itself... as we give it opportunities”.
