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Have you ever heard of the "Bottom Up Approach",  and wondered what it meant  in relation to our work as therapists and educators?


The best way to explain it, is to simplify the mechanisms of the brain as much as we can. The brain consists of many different parts. All of which have different functions. These parts can be grouped into 3 major areas:


  • The Cortex.

  • The Limbic Brain

  • The Brainstem.


The Brainstem is the part of the brain that develops first, and it is the part of the brain that is responsible for primal reflexes. It controls our heartbeat, our breathing, tension in our muscles etc. It is the part of the brain that asks "Am I safe?"


The next part of our brain to develop is the Limbic Brain, or midbrain. This is responsible for emotional development and regulation. It is the part of the brain that asks,"Am I Liked?"


The cortex develops 3rd and is the most advanced part of the brain. It is responsible for thinking, learning, and inhibiting reflexes. It is the part of the brain that asks "Can I learn". 


As speech therapists and educators, the work we want to get done each day, is often heavily reliant on the cortex working well. However, it will come as no surprise to anybody that all of the parts of the brain are intrinsically linked. If one part of the brain is not functioning optimally, it will have a direct impact on every other part of the brain.

For example, if a child feels safe in their environment (brainstem), and cared for (limbic brain), they will be more relaxed, regulated and primed to learn (cortex). If they feel unsafe or unliked they will be less likely to concentrate or learn. The same can be said for adults – we know that if something terrible happens to us we will not be able to concentrate immediately after the event.


So, what does this mean for our therapy? In short it means You might have a list of therapy goals you want to tick off your list that require a child’s cortex to be firing on all cylinders. But if the child in front of you is dysregulated or upset, you need to change those goals immediately. Instead, sit down with the child. Be still. Listen to them. Do whatever it is they need you to do in that moment to help them feel safe and loved.


Sometimes as therapists we can be afraid to do this. We only see each child for a limited amount of time each week and spending an entire session on anything other than our session plan can feel like a waste of time. But in fact it is the opposite. Ensuring that the child feels safe and loved will set them up for success.  Sometimes the best therapy is knowing when to stop therapy.

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