Sensory and Self-Regulation Flashcards
Interoception
This refers to the person’s ability to discern their own feelings; relates to what the person is feeling inside. Examples are stress, exhaustion, or even physical symptoms like stomach upset.
Exteroception
Processing things from outside the body: tactile, vision, auditory, gustatory/olfactory stimuli.
Kinesthesia
Feelings of movement/balance, including proprioception and vestibular stimuli.
What % of nervous system is dedicated to processing/organizing sensory input?
Over 80%!
Tactile System
Largest sensory system, constantly activated.
• Main channel of sensory input prenatal/infancy
• Provides info about texture, size, shape, function of objects.
• Light touch, deep pressure, vibration, temperature, pain, skin stretch, and movement
Proprioceptive System
Provides info about: • Where body parts are in space • How body parts relate to one another • How fast body is moving • Timing • How much force muscles should exert
Input is almost always calming. “Heavy work always works.”
Vestibular System
Primary organizer of all other sensory inputs. Integrates movement, gravity and vibrations
• Receptors in inner ear (semicircular canals)
• Makes it possible to move against gravity gracefully
• Influences muscle tone and posture
• Tells us our direction and speed
• Essential to developing left-right or top-down eye movement for reading
• Stimuli can be alerting/aversive (ie: dizziness). Use proprioceptive input to counter.
Auditory System
Intimately connected to vestibular system; uses middle ear. First system that becomes functional in utero. • Involves 4 aspects of sound: 1. Intensity (loudness, decibels) 2. Frequency (pitch, wavelengths) 3. Duration 4. Localization
Visual System
Not the same as sight, which is mechanical and not learnable.
• Communication relies on vision.
• 75-90% of classroom learning depends on vision!
• Vestibular and proprioceptive systems profoundly influence vision
• Closely allied with motor skill until mastery of that skill
• Ocular motor and eye learning skills are crucial.
Statistics about the Visual System
- 90% of visual problems never diagnosed
- 25% of school aged children have undiagnosed visual problems
- 70% of juvenile delinquents have undiagnosed visual problems
- Often impaired in people with autism
Gustatory/Olfactory Systems
- Intimately connected to each other (most taste is actually smell)
- Texture and temperature (touch) and olfactory are aspects of food enjoyment/repulsion
- Most food aversions are touch issue
- Smell travels to limbic system (emotions, memory, pleasure, learning)
Interoception System
Sensing internal status.
• Rest of the alimentary canal beyond the mouth: hunger, digestive tract issues, bowel/bladder, etc.
• Awareness of overall body states such as tension and tiredness
• Awareness of emotional states such as anger, frustration, etc.
• Connected with “Mindfulness”
Sensory Processing “Rule”
We need to be able to DETECT and RECEIVE sensory info from environment, DISCRIMINATE what is important, INHIBIT and HABITUATE what is not, and then ORGANIZE, INTEGRATE, and MODULATE it in order to UTILIZE the information to complete a functional task.
• What is a threat? How to respond?
SID and SPD
SID = Sensory Integration Disorder SPD = Sensory Processing Disorder
• These are used interchangeably
• Disruption or dysfunction of one or more senses
• Considered to affect 10% of American children
• 3 primary groups of this disorder:
1) Sensory modulation
2) Sensory discrimination
3) Sensory based motor problems
Sensory Discrimination Disorder
Difficulty distinguishing one sense from another. Difficulty interpreting a particular sensation. Misgauging importance of objects and experiences.
• Common to see over aware of tactile, under aware of interoception
Sensory Modulation Disorder
Problem with inhibition (excitation balance). Can by hypo (less) or hyper (more) reactive. • Sensitivity • Responsiveness • Reactivity • Arousal • Alertness • Registration
Tolerance level or capacity of senses.
Continuum of sensory avoidance to sensory seeking.
• Identified through Sensory History Questionnaire.
Signs of Sensory Based Motor Problems
Postural disorder (Dyspraxia) • Low muscle tone • Bilateral coord. impairment • Equilibrium problems • “W” sitting • Shifting weight • Clumsiness • Inefficient motor movements for functional tasks • Overshooting when reaching for things • Difficulty with intricate manual tasks
Neurological process of learning:
Steps:
- Sensory Processing (presentation of novel info from environment)
- Social Emotional Regulation (interpretation and exploration of new approaches)
- Learning (This leads to development of behavior.)
ABCs of Behavior
A=Antecedent (what is causing the behavior?)
B=Behavior (what is it/what is it telling us?)
C=Consequence (what do they get out of the behavior?)
Causes of behavior
- Need for attention
- Sensory
- Desire for tangible
Tips for Regulating Behavior
Movement, Muscles and Messes!
Movement: body has to move to maintain attention.
Muscles: Heavy work always works!
Messes: Textures, fidgets, pressure, etc.
What is Sensory Processing?
- Means by which brain receives, detects, integrates sensory input
- Produces adaptive response; effective response to interpretation of input
- Allows individual to attend/focus, develop motor skills, and participate in social interactions
Sensory Integrative Dysfunction (SID)
Cluster of symptoms that reflect CNS dysfunction.
• Not a primary sensory deficit (ie: hearing)
• Not secondary results of CNS injury or chromosomal abnormality (Down Syndrome)
• Leads to disorganized/maladaptive interactions with people/objects
• Produces distorted internal sensory feedback that reinforces problem.
• Jean Ayres developed early intervention treatment/assessment strategies in early 70s
Sensory Processing Disorders (SPD)
Often a secondary diagnosis (to ASD, learning disability, ADD, anxiety, etc.), and has a range of severity including poor social adaptation. Categories: • Sensory Modulation Disorders (SMD) • Sensory Discrimination Disorders • Sensory-based Motor Disorders
Early Signs of Sensory Processing Dysfunction
- Lack of cuddling
- Failure to make eye contact
- Oversensitivity to sounds/touch
- Oral motor difficulties
- Poor self-regulation
- Irritability/Colic
- Lack of curiosity
- Disorganized/destructive exploration of environment
Signs of Sensory Processing Dysfunction in Toddlers
- Unable to organize body postures/gestures for nonverbal communication
- Avoids dressing/hygiene
- Handles toys and objects ineptly
Signs of Sensory Processing Dysfunction in School-Aged Children
- Difficulty sitting and listening
- Difficulty attending
- Difficulty using writing/art tools
- Avoidance of motor activities
Screening and Assessment of Sensory Processing
Top-down approach (focus on occupation and role performance). Clinical observations and standardized screening test. 5 major areas: • Sensory Modulation • Sensory Discrimination • Postural-Ocular Function • Bilateral Motor Coordination • Praxis
OTR and COTA in Screening for SPD
- COTA may be trained to administer structured assessment and may participate in interviews with caregiver or questionnaires of teacher
- Interpretation of findings is responsibility of OTR
- SPD may be problem causing occupational performance such as poor handwriting and trouble with self-care
Observation Checklists used in Assessment of SPD
- Sensorimotor History Questionnaire
- Teacher Questionnaire of Sensory Behavior
*Observation in natural environment, and interview of teachers/primary caregivers
Sensory Integration and Praxis Test (SIPT)
Formal assessment tool to measure vestibular, proprioceptive, and somatosensory processing; visual perceptual and visuomotor integration; integration of both sides of body and praxis. Praxis test measures: • Postural imitation • Motor planning on verbal request • Motor sequencing abilities • Imitation of oral movements • Graphic reproduction • 3-dimensional block construction
Gravitational Insecurity
Fear when being moved through space.
Tactile Defensiveness
Overly sensitive to touch sensations.
Sensory-seeking
Constantly in search of sensations.
Sensory Hypersensitivity
Extreme responses to sensations
Sensory-Based Movement Disorders
- Postural system disorganization
- Impairments in internal visualization and motor planning
- Deficits in postural-ocular control
- Bilateral motor coordination dysfunction
- Mild hypotonia possible
- Impaired postural mechanism (developmental dyspraxia)
Postural-Ocular and Bilateral Integration Dysfunction
- Milder in severity
- Irregularities in sensory modulation
- Atypical ocular pursuits
- Low duration of postrotary nystagmus
- Impairments of midline crossing
- Delayed establishment of lateral dominance
- Impaired postural mechanism
- Immature gait pattern
Postrotary Nystagmus
Test used to determine if child has vestibular disability. Child sits on rotation disk and eyes are checked for nystagmus (uncontrolled movements) as it turns.
Assessments of Posture, Ocular Function, and Bilateral Integration
INFANT:
• Test of Sensory Function in Infants
• The Infant/Toddler Sensory Profile
TODDLER/SCHOOL-AGED: • Sensory Profile • First STEP Screening Test • DeGangi-Berk Test of Sensory Integration • Miller Assessment for Preschoolers
ADOLESCENT:
• The Adolescent/Adult Sensory Profile
• Bruininks-Oseretsky Test of Motor Proficiency
Praxis
Ability to register and organize tactile, proprioceptive, vestibular and visual information.
• Ideation or ability to conceptualize internal images of purposeful actions
• Planning the sequence of movements within demands of task and environmental contexts, including anticipatory actions
Developmental Dyspraxia (Types)
Somatodyspraxia: deficits due to inefficient processing of tactile-kinesthetic, proprio, and vestibular input within body
Visuodyspraxia: poor processing of visuospatial information and performing visual construction tasks
Visuo-somatodyspraxia: combination of previous two clusters
Dyspraxia on Verbal Command: difficulty translating a verbal command into a motor plan (language related)
Assessments for Praxis
• Observe child playing (may have trouble figuring out how to climb/ride something) • Bayley Scales of Infant Development-II • Miller Assessment for Preschoolers Tests check if they: - imitate hand movement - imitate posture - complete a maze - copy tower/block designs - complete a puzzle
How to Facilitate Sensory Modulation
- Determine level of arousal
- Provide sensory preparation
- Monitor cognitive, affective and physiologic responses
- Monitor patterns of responsivity
- Offer rewards as necessary
- Prescribe sensory diet
Promoting Sensory Discrimination
- Child must be able to modulate before discriminating
- Allow child to seek input
- Identify target sensory system
- Infuse activities with controlled novelty while watching for affective changes
- Grade complexity of input
- Intervene/assist as needed
- Provide challenging and age-approp activities that are fun
- Provide opportunities to apply discrimination abilities
Intervention for Sensory-Based Movement Disorders
- Provide foundational intervention, sensorimotor treatment and environmental adaptations
- Promote improved somatosensory body scheme organization
- Use bilateral manipulative activities to promote symmetry/asymmetry
- Provide challenges or just-right challenge
- Use 2- and 3-dimensional construction activities
- Prepare activities with projected action sequences and that require formation of actions from ideas or images
- Ask questions to encourage cognitive processing
- Include activities that challenge suck-swallow-breathe synchrony.
Self-Regulation in Pediatrics
Ability to adjust your level of alertness and how you display emotions through behavior to attain goals in socially adaptive ways.
• Closely tied to sensory processing
• Known by many names: self-control, self-management, anger control/management. **OTP’s use self-regulation for these.
• Self-regulation changes by the environment/context (ie: acceptable basketball game vs. symphony behavior)
Neurological Component to Self-Regulation
Ability or inability to process sensory information will create adaptive responses which can affect emotions/behavior.
• Making sense of info perceived by sensory system.
• As children develop, they become more self aware and can avoid or cope with sensory input to regulate behavior.
Executive Functioning
Cognitive processes involved in conscious control of thoughts and actions.
• Can be compared to a command/control center in our brains that oversees our actions and mental operations (problem solving)
• Develops through childhood and fully developed in mid-twenties
• Includes: Working Memory, Impulse Control, Thinking Skills
Controlling Emotions
Processes that are responsible for controlling your emotional reactions in order to meet your goal.
• Develops in late 20s
• First step is to identify/understand emotions (ie: frustration or anger?)
• Emotions automatically triggered in response to events
• Cognitive abilities key in controlling emotions to problem solve, process emotions and what reactions they warrant
• Environment affects development and impulse control, and is the BIGGEST CHANGE OT CAN MAKE in controlling emotions.
How OT fits into self-regulation:
- Developmental perspective
- Family centered care (family participates)
- Knowledge of sensory processing/integration
- Task analysis, grading, functional skills
- Rapport building
- Whole child perspective
ALERT Program
Mary Sue Williams, OTR/L and Sherry Shellenberger, OTR/L created this program to incorporate sensory integration and cognitive approaches to self-regulation.
• Teaches self awareness to understand own arousal
• Uses terminology related to a car’s engine
• “engine running low, high or just right”
• Experiments with sensorimotor methods to change “engine levels”
• “Engine Tune-ups”
• Also a similar method called “Take Five!”
Zones of Regulation
Leah Kuypers, MA Ed. OTR/L created this method to incorporate social thinking principles and strategies.
• Uses color labeling for various ages (older typically developing students may not respond)
• Emotions are a color (ie: angry = red; I hit a punching bag when I’m red)
• Uses cognitive behavioral learning
• Sequential learning
Basics for Teaching Self-Regulation
- Teach child/group that all emotions are valid and it’s ok to feel them
- Teach most common emotions
- Categorize emotions: 1-5; Red, Yellow, Blue; Engine running high/low; etc.
- Teach reactions to emotions and appropriate people, places, times to express them
- Teach about sensory processing; seeking/avoiding behaviors and what helps to regulate
- Teach appropriate coping/calming strategies
- Child centered approach is key!!!
What are Executive Functions?
- Brain-based pathways that are required for humans to execute/perform tasks.
- Skills necessary for learning.
- “Conductor,” “Coach,” or “CEO” of you
- Types: Behavioral, Cognitive, and Emotional
Executive Functioning Skills
- Planning
- Time management
- Sustained attention
- Organization
- Working memory
- Inhibition
- Shifting
- Task initiation
- Emotional control
- Cognitive flexibility
- Metacognition (awareness of own thoughts)
- Goal-directed persistence
Independent Learner Characteristics
- Curious
- Self-motivated
- Self-examines/monitors
- Accountable/responsible
- Critical thinking/problem solver
- Comprehension/Understanding without instruction
- Persistent
- Manages time
Inhibition
Behavioral control of stopping impulsive act and being able to consider consequences first.
Shift
Behavioral control of transitioning from one task to another; preferred to non-preferred activity; letting go of a specific interest; behavioral and cognitive shifting.
Cognitive Control
Ability to “take a breath” before acting/reacting.
• Initiate: begin task independently
• Working Memory: Sustaining attention to task/directions
• Plan/Organize: plan ahead, develop strategies (start and complete things)
• Organize Materials: backpacks, folders, etc. (no clutter)
• Monitor: pay attention to task; error monitoring (acknowledging mess-ups)
Emotional Control
We are born with “reactivity” to stimulation (ie: temperament).
• Development leads to regulation of reactions (turn on a fan when hot; do things to relieve stress)
• NO ONE is perfect at this! (see: road rage!)
Marshmallow Test
1960s-70s, Dr. Walter Mischel of Stanford came up with this test about executive function in regards to delaying gratification.
• 4 years old
• Wait 15 minutes to get 2nd marshmallow
• 2/3 could not wait
• At 18 yo, 100% of kids who “passed” the test were successful
• Success measured by SAT scores, educational attainment, BMI
Moral: Better organized kids become better organized adults! (CAN be taught!)
Method to control responses
Traffic light:
(Red) STOP > (Yellow) Think, Reflect, Plan > (Green) Continue to monitor
- Practice when child is CALM.
How are Executive Function Skills attained?
- Learned in day to day activities with real life problems.
- Developed by modeling and supported practice.
- Keep an executive functioning skills mindset when engaging in tasks and externalize the process.
- Use Behavior Modification (reinforce immediately/consistently; any reinforced behavior increases in frequency)
- Make taught behaviors into routines
Steps to Teach Executive Functioning Skills
1) Identify weakness
2) Set a goal
3) Teach child the skill
4) Look for opportunities to allow child to pursue independence
5) Discuss the skill (mediate and model it)
6) Practice the skill
7) Set up opportunities to reinforce their EFFORT (“catch them” doing it)
8) Provide just enough support for success
9) Review and revise
Strategy for Developing Inhibition
1) Earn the things they want (ie: save money for something)
2) Delaying gratification
3) Reinforce efforts (like STOPPING, waiting)
Strategy for Developing Sustained Attention
1) Assess how long it takes to complete a task, then use a timer (Can you beat your time?)
2) Catch them being good
3) Incentive plans (first___ then reward)
Strategy for Developing Shift
1) Practice shifting (role play, provide notice before task will change)
2) Give child a “script” for handling specific situations
3) Reinforce efforts (transitions, returning to tasks)
Strategy for Developing Planning/Organization
1) Recognize organization is a learned skill
2) Plan explicitly (say out loud, form routines, have child help develop plans; ie: bedtime routine)
3) Reinforce efforts
Strategy for Developing Initiation
1) Break up task into pieces (start small)
2) Offer a bad example (bring out critic)
3) Plan an approach
4) Reinforce effort (begin task = immediate reinforcement; begin independently = bonus points!)
Strategy for Developing Working Memory
1) Have child repeat what you said (use eye contact)
2) Develop cues (snap fingers; make backpack remind you of ___)
3) Talk/sing your way through it
4) Make learning ACTIVE
5) Reinforce efforts (ie: try to remember later)
Strategy for Developing Monitoring Skills
1) Model desired behavior
2) Use language- be the commentator (recognize their strategies out loud)
3) Explain what will be done (ask what will be done)
4) Explain while doing (ask what they are doing)
5) Explain what was done (ask for summary)
6) Reinforce efforts (eg. Verbalization)
Strategy for Developing Emotional Control
1) Therapy
2) Recognize cues to emotion (triggers)
3) Use active listening and negotiate
4) Label emotions
5) Role play and model
6) Practice control (breathing, mindfulness)
7) Reinforce efforts
8) Cope Ahead
For a child with aversion to movement/touch, poor penmanship and athleticism, low tone, and poor endurance, what FOR would a tx session of swinging, throwing, painting be considered?
Sensory Integration (working on his aversion to movement/gravitational insecurity)
For a child with aversion to movement/touch, poor penmanship and athleticism, low tone, and poor endurance, and who wishes to play soccer, what would be an example of a carefully planned session?
If you observe, then decide to instruct the child on the techniques of playing soccer, with verbal and demonstrative instruction and by playing soccer with him.
For a child with aversion to movement/touch, low tone, and poor shoulder co-contraction and endurance, what would be a good activity to work on poor shoulder co-contraction and endurance?
Wheelbarrow walking
Postural-Ocular Disorder
- Poor balance and low muscle tone
- Difficulty crossing midline
- Slouched sit
- Difficulty reading across a page/copying words from the board
Developmental Dyspraxia
Difficulty understanding positioning, even after directions; ie: cannot get on a bicycle without being backward/sideward.
