Sensory Integration

Question 1

Premise of Sensory Integration Theory (and it’s founder!)

Answer 1

• adequate sensory processing in the nervous system plus the integration of sensory information in the brain will lead to adaptive behavior and functional abilities
• based on neuroscience, developmental psychology, occupational therapy, and education
• Jean Ayres

Question 2

Definition of Sensory Integration

Answer 2

• the neurobiological process that organizes sensation from one’s own body and from the environment and makes it possible to use one’s body effectively with the environment.
• the spatial and temporal aspects of input from different sensory modalities are interpreted, associated, and unified.

Question 3

Sensory integration is ____________ ____________ and praxis and ____________ are both end products of sensory integration

Answer 3

information processing, perception

Question 4

Main points of sensory integration theory

Answer 4

• an individual’s interaction with the environment influences the development of the brain
• the nervous system is plastic (able to change)
• Sensorimotor experiences affect the brain’s plasticity
• Sensorimotor development is a part of learning.

Question 5

Different types of sensory input

Answer 5

• Visual
• Auditory
• Tactile
• Olfactory
• Gustatory
• Vestibular (balance)
• Proprioception (position in space)

Question 6

Visual input

Answer 6

enter the brain through the visual structures in the eyes; input is affected by levels of light and whether objects are standing still or moving

Question 7

Auditory input

Answer 7

input that enters the brain through the auditory structures of the ear; affected by volume and sound quality

Question 8

Tactile input

Answer 8

input enters the brain through the small nerve endings under the skin; get different feelings from texture, consistency and temperature

Question 9

Olfactory input

Answer 9

input that enters the brain through the olfactory neurons in the nasal cavity

Question 10

Gustatory

Answer 10

input that enters the brain through the taste buds on the tongue

Question 11

Vestibular input

Answer 11

input that enters the brain through the structures of the inner ear

Question 12

Proprioceptive input

Answer 12

input that enters the brain through the stretch receptors in the muscles, ligaments, and joint tissues.

Question 13

Which sensory system is the foundation of all others and why?

Answer 13

VESTIBULAR
- it is an important element of the CNS and crucial for the development of balance, coordination, motor control of the eye, bilateral coordination, and developing confidence and trust in movement. It allows us to develop a tolerance to motion, and fundamental functions such as posture and spatial orientation are affected by the vestibular processing system.

Question 14

Sensation seeking

Answer 14

enjoy sensory input and are constantly seeking for more within their environment

Question 15

Low registration

Answer 15

interpret sensory input around them less (at lower intensity levels) than others, and notice less in their environment

Question 16

Sensation avoiding

Answer 16

may appear bothered or overwhelmed by sensory input and tend to avoid these experiences as much as possible

Question 17

Sensory sensitivity

Answer 17

detect the sensory input around them more than others, and even notice sensory input that others may miss- they have a greater awareness of input.

Question 18

Signs of difficulty with the sensory system

Answer 18

• avoids or actively seeks out swinging, jumping, or climbing
• lack of coordination, frequent falling
• slow, cautious movement
• Easily becomes dizzy or never seems to become dizzy
• Watches moving/rotating objects (i.e. fans or clocks)
• prefers to sit during activities or has difficulty sitting still/paying attention
  -Slouches, holds head up with hands, prefers lying down

Question 19

Sensory processing disorder

Answer 19

Now an IND diagnosis- the inability to adequately process sensory information from multiple sources, resulting in maladaptive responses to the environment.

Question 20

Three categories of sensory processing disorders

Answer 20

1. Sensory modulation disorder
   - over-responsive (sensitive)
   - Under- responsive (slow)
   - Craving (seeking)
2. Sensory discrimination disorder
   - trouble discriminating between different senses
3. Sensory-based movement disorder
   - dyspraxia
   - postural disorders

Question 21

Sensory modulation disorder

Answer 21

• difficulty adjusting the nervous system to changes in sensory input (frequency, intensity, duration, complexity, novelty)

3 subcategories:
- Sensory over-responsivity: Responds to sensation faster, more intensely, longer duration; sensory overload causes a sympathetic reaction; difficulty in new environments; may present as sensory defensiveness;
child’s behavior is often rigid and controlling and will depend on which sensory systems are affected
- Sensory under-responsivity: decreased awareness, orientation, and response to sensory input, requires intense sensory input to notice and therefore takes longer to respond; appear sedentary, lethargic, apathetic; mislabeled “lazy” or unmotivated; child is often quiet and passive, appears withdrawn, difficult to engage with and/or self-absorbed because they do not detect sensory input in their environment; may lead to poor body awareness, clumsiness or movements that are not graded appropriately.
- Sensory-seeking: preference for intense and extreme sensory input; impulsive, intense, highly energetic, constantly moving, careless, restless, unsafe; high pain tolerance; the child will make vocal sounds to stimulate their auditory system, play roughly with toys, prefer spicy food, spin or rock self, fidget with objects, etc.

Question 22

Sensory-based Motor disorder

Answer 22

incorrect processing of sensory information leads to motor problems that affect POSTURAL control and/or MOTOR PLANNING (praxis)

Question 23

Sensory discrimination disorder

Answer 23

incorrect processing of sensory input ( i.e., kiddo stares for a long time at a row of beads and then spins in a circle)- incorrect bodily response to visual input

Question 24

Which disorders are often primary to sensory processing disorders (i.e. sensory processing disorder would be secondary to these)

Answer 24

Autism, ADHD (sensitive to visual input - distractibility-; under-responsive to auditory input; often seek vestibular and prop. input), Cerebral palsy (especially sensitive to tactile, olfactory, and gustatory input; difficulty interpreting vestibular and prop. input; may have sensory symptoms that resemble Autism), TBI (sensory issues correspond to the damaged areas of the brain), DCC (difficulty with vestibular and auditory input, sensory modulation, and difficulty integrating sensory input to perform motor tasks), Fragile X syndrome (similar to Autism), Sensory deprivation (difficulty with sensory modulation and emotional regulation

https://sensoryhealth.org/basic/subtypes-of-spd

Question 25

Sensory Integration and Praxis Tests (SIPT)

Answer 25

Ages: 4-0 to 8-11 Admin: child asked to complete activities defined on 17 different subtests Areas evaluated: visual, tactile, and kinesthetic perception; motor performance

Question 26

Sensory Profile 2

Answer 26

Versions: infant (0-6 months), toddler (7-35 months), child (3-14 years), short form (3-14 years), school companion (3-14 years), and Spanish Caregiver forms (3-14 years) Admin: questionnaires completed by child's caregivers and teachers - Areas evaluated: Sensory Systems split into auditory, visual, tactile, movement, body position, and oral input; Behavior is split into attention, behavioral, and social-emotional factors; sensory processing patterns are split into registration, seeking, avoiding, sensitivity

Question 27

Adolescent/Adult Sensory Profile

Answer 27

Age: 11 years through adulthood Admin: questionnaires completes by child's caregiver, teacher or self Areas evaluated: Sensory systems split into social participation, vision, hearing, touch, body awareness, balance and motion, planning and ideas

Question 28

Test of Sensory Function in Infants (TSFI)

Answer 28

Age: 4-18 months Admin: 24 items through simple interaction with the infant Areas evaluated: overall sensory processing as well as subdomains: reactivity to deep pressure, visual-tactile integration, adaptive motor function, ocular motor control, reactivity to vestibular stimulation

Question 29

Berk Test of Sensory Integration

Answer 29

Age: 3-5 years Admin: child asked to perform 36 test items scored on a numerical scales Areas evaluated: overall sensory processing as well as these three subdomains: postural control, bilateral motor integration, reflex integration

Question 30

What is the goal of sensory integration intervention?

Answer 30

to improve the processing and integration of sensory information to allow participation in childhood occupations, including ADLs, school work, extracurriculars, and play.

Question 31

General principles of OT treatment for SPDs

Answer 31

1. the focus of treatment is primarily on tactile, vestibular, and proprioceptive processing (as these three systems form the base of sensory processing) 2. Treatment should provide a just-right challenge 3. the treatment environment should be enticing, encouraging the child to actively engage in play. 4. Treatment is child-directed. Child directs treatment by giving behavioral cues that the Th observes and reads. The TH adjust treatment based on these cues that indicates what the child wants and will find enticing.

Question 32

Treatment of Tactile Defensiveness

Answer 32

Symptoms: child does not like to be touched; complains about clothing feeling uncomfortable; may remove clothing in inappropriate places; will not wear a hat or gloves when it is cold outside; may hit or kick other who get to close Focus of treatment: desensitize the nerve ending near the surface of the skin to decrease the child's sensitivity to touch Examples: - Willbarger brushing protocol - Wrapping in a heavy blanket to play "hot dog" or folding a large bean bag over the child to play "taco" - Rolling a soft "rolling pin" on a child's back - Squishes using handing, hugs, a therapy ball on the back or other similar techniques - play with toys in textures graded from non-threatening to more aversive textures

Question 33

Treatment of difficulty regulating arousal levels

Answer 33

Symptoms: jumping around frequently; crashing into objects or people; climbing on or around the desk; constantly moving Focus of treatment: provide proprioceptive input in the form of "heavy work" so a child can feel their body's position in space and know how fast or slow they are moving at a given point in time. Examples: - catch with a weighted ball or large therapy ball - Roll in or find toys in a ball pit - Play "turtle" by walking on hand and feet with a large bean bag on the back - crawl in a stretchy lycra tunnel or play "blob" in a body sock - Jump or roll on a crash mat - wheelbarrow walks or donkey kicks

Question 34

Treatment for children who crave movement

Answer 34

Symptoms: always running; loves to ride bikes or swing; difficulty staying in line; OR sensitive to movement; walks stiffly, afraid to swing or ride a bike; complains of dizziness frequently; gets motion sick in a car Focus of treatment: provide graded vestibular activities to help meet the child's movement needs. activities should be introduced in a gradual and nonthreatening way for children who are sensitive to movement; higher level challenges can be introduced for children who crave movement. Examples: - swinging in or on a variety of swings, grade activity from slow movement with feet on the floor for hypersensitive children to high swinging for under-responsive children. - rolling on a scooter board to pick up toys - swinging prone on a swing to put together a puzzle - standing on a balance board to toss bean bags - jumping on a small trampoline - sitting on a therapy ball to play catch - Rock in a glider rocker - pool therapy

Question 35

Treatment for difficulty with tactile discrimination

Answer 35

Symptoms: does not notice when face or hands are dirty; does not notice when clothing is out of alignment; difficulty holding pencils, crayons; drops items frequently; leans on other people, cannot stay in own personal space Focus of treatment: provide activities that will stimulate the nerve ending just under the skin, arousing the tactile sensors Examples: - play with tactile media: sand, dried beans, dried rice, shaving cream, play doh etc. - Jump or roll in a pile of pillows with different textures - play games that require feeling and identifying objects with vision occluded (Ned's Head) - Construct art projects using a variety of tactile media

Question 36

Adaptations for auditory defensiveness

Answer 36

Purpose of adaptation: decrease the amount of auditory input to reduce a child's distress when around loud noises or in crowded areas examples: - noise reducing headphones - ear plugs - instruction or testing in a quiet room with fewer students present - foreshadowing before loud noises are going to occur - allow child to work in a quieter place to focus on classroom tasks.

Question 37

Adaptations for Sensitivity to light frequencies

Answer 37

purpose of adaptation: block or filter light to offset frequencies, increase access to natural light Examples: - sunglasses - visors - Filter covers over fluorescent light fixtures - lamps for soft lighting - turn off light on sunny days and use natural light

Question 38

Adaptations for tactile defensiveness

Answer 38

Purpose of adaptations: provide deep pressure input to desensitize the nerve endings just under the skin Examples: - compression garments or tight-fitting undergarments - remove tags on clothing or tagless clothing - seamless socks, slip on shoes - extra space at tables where the child must sit with other children - defined space during carpet time or assemblies

Question 39

Adaptations for difficulty with modulation

Answer 39

purpose of adaptation: provide adaptations to foreshadow activity and environment changes during the day Examples: - visual schedules - visual or auditory timers - written instructions - checklist or mini schedules for specific tasks - foreshadow changes in the schedule, special events

Question 40

Adaptations for difficulty regulating levels of arousal

Answer 40

Purpose of adaptation: provide adaptations that will allow movement outlets and/or provide input to increase arousal Examples: - wiggle cushion - ball chair - standing desk - chewing gum or cnady - ice chips - aromatherapy - movement breaks

Question 41

Sensory Diets

Answer 41

- a schedule of sensory activities and adaptations specially designed to help meet a child's sensory processing needs - sensory diets are designed by OT and custom for each child - The activities in a sensory diet are usually performed according to a daily schedule so the child gets the right amount of sensory input at the right times. - caregivers and educators should be educated in how to provide the activities and adaptations included - sensory diets used at school should be documented in a child's IEP or 504

Question 42

Wilbarger Brushing protocol

Answer 42

- a specific protocol to reduce tactile defensiveness - administered using a surgical scrub brush - must be administered according the protocol - therapists should be trained in administration of the protocol before using it with children or training caregivers or teachers in its use.

Question 43

Equipment commonly used in SI therapy

Answer 43

- ball pit - chewable toys (direct sensory and oral stimulation and calming/self-regulatory input - Therapeutic swings (swinging and providing sensory input can have a powerful impact on the brain's ability to process and use sensory information)

Question 44

Praxis

Answer 44

the neurological process by which cognition directs motor action; it is an intricate process intertwining motor, sensory, and cognitive skills.

Question 45

Praxis - broken into 4 steps

Answer 45

1. ideation- the ability to form an idea 2. motor planning- organization and plan for the idea happens, includes understanding when and how to move the body and/or objects. 3. execution- this is the actual performance of the idea 4. feedback and adaptation- this is being able to identify how the task went, identify any areas of improvement, and make those changes.