Sensory Integration Flashcards
Premise of Sensory Integration Theory (and it’s founder!)
- 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
Definition of Sensory Integration
- 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.
Sensory integration is ____________ ____________ and praxis and ____________ are both end products of sensory integration
information processing, perception
Main points of sensory integration theory
- 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.
Different types of sensory input
- Visual
- Auditory
- Tactile
- Olfactory
- Gustatory
- Vestibular (balance)
- Proprioception (position in space)
Visual input
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
Auditory input
input that enters the brain through the auditory structures of the ear; affected by volume and sound quality
Tactile input
input enters the brain through the small nerve endings under the skin; get different feelings from texture, consistency and temperature
Olfactory input
input that enters the brain through the olfactory neurons in the nasal cavity
Gustatory
input that enters the brain through the taste buds on the tongue
Vestibular input
input that enters the brain through the structures of the inner ear
Proprioceptive input
input that enters the brain through the stretch receptors in the muscles, ligaments, and joint tissues.
Which sensory system is the foundation of all others and why?
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.
Sensation seeking
enjoy sensory input and are constantly seeking for more within their environment
Low registration
interpret sensory input around them less (at lower intensity levels) than others, and notice less in their environment
Sensation avoiding
may appear bothered or overwhelmed by sensory input and tend to avoid these experiences as much as possible
Sensory sensitivity
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.
Signs of difficulty with the sensory system
- 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
Sensory processing disorder
Now an IND diagnosis- the inability to adequately process sensory information from multiple sources, resulting in maladaptive responses to the environment.
Three categories of sensory processing disorders
- Sensory modulation disorder
- over-responsive (sensitive)
- Under- responsive (slow)
- Craving (seeking) - Sensory discrimination disorder
- trouble discriminating between different senses - Sensory-based movement disorder
- dyspraxia
- postural disorders
Sensory modulation disorder
- 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.
Sensory-based Motor disorder
incorrect processing of sensory information leads to motor problems that affect POSTURAL control and/or MOTOR PLANNING (praxis)
Sensory discrimination disorder
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
Which disorders are often primary to sensory processing disorders (i.e. sensory processing disorder would be secondary to these)
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
Sensory Integration and Praxis Tests (SIPT)
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
Sensory Profile 2
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
Adolescent/Adult Sensory Profile
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
Test of Sensory Function in Infants (TSFI)
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
Berk Test of Sensory Integration
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
What is the goal of sensory integration intervention?
to improve the processing and integration of sensory information to allow participation in childhood occupations, including ADLs, school work, extracurriculars, and play.
General principles of OT treatment for SPDs
- the focus of treatment is primarily on tactile, vestibular, and proprioceptive processing (as these three systems form the base of sensory processing)
- Treatment should provide a just-right challenge
- the treatment environment should be enticing, encouraging the child to actively engage in play.
- 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.
Treatment of Tactile Defensiveness
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
Treatment of difficulty regulating arousal levels
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
Treatment for children who crave movement
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
Treatment for difficulty with tactile discrimination
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
Adaptations for auditory defensiveness
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.
Adaptations for Sensitivity to light frequencies
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
Adaptations for tactile defensiveness
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
Adaptations for difficulty with modulation
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
Adaptations for difficulty regulating levels of arousal
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
Sensory Diets
- 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
Wilbarger Brushing protocol
- 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.
Equipment commonly used in SI therapy
- 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)
Praxis
the neurological process by which cognition directs motor action; it is an intricate process intertwining motor, sensory, and cognitive skills.
Praxis - broken into 4 steps
- ideation- the ability to form an idea
- motor planning- organization and plan for the idea happens, includes understanding when and how to move the body and/or objects.
- execution- this is the actual performance of the idea
- feedback and adaptation- this is being able to identify how the task went, identify any areas of improvement, and make those changes.
