Sensory Integration Flashcards
SI in OT refers to 3 things:
- the theory
- evaluation methods
- a specific approach to intervention
why do OTs get a bad wrap when it comes to SI?
the term is used so loosely within and outside of the profession
When working with sensory interventions, DON’T say ….. DO say …..
“I’m DOING sensory integration” / “I’m treating sensory processing disorder”
when working with SI, we work from a ……. perspective, NOT …….
occupation-based perspective / single theory or model
Steps in SI theory (kind of long but there’s an example):
sensory intake (ex: from clothes) > sensory integration (I’m uncomfortable) > planning and organizing behavior (I’m going to sit differently) > adaptive responses and learning > feedback (I’m more comfortable) > sensory intake…..
why does SI theory feed into emotional regulation?
you have to address the sensory aversion to avoid a negative emotional association
the ………. takes the information from the emotions in our …….. system and associates it to anything
amygdala / limbic
I don’t like Natalie > I can’t stand anyone who looks like Natalie
3 characteristics of SI theory
- explains why individuals behave in particular ways (unable to regulate sensory info)
- helps plan intervention to improve particular dysfunctions (monitor what you’re asking of the kid)
- predicts how behavior will change as a result of therapy (knowledge of the patterns and brain processes helps ability to predict)
5 assumptions from Ayres SI theory
- CNS is plastic
- SI develops over time
- brain functions as an integrated whole
- adaptive interactions are critical to SI
- there is an inner drive to develop SI through participation in sensorimotor activities
Ayres goal was to develop a theory to describe and predict relationships among:
neural functioning, sensorimotor development, and academic learning
Ayres definition of SI
the neurological process that organizes sensation from one’s own body and from the environment and makes it possible to use the body effectively within the environment
when Ayres defined SI, she was moving beyond the concept that….
body, mind, and learning are separate
2 outcomes of CNS dysfunction (chart)
- sensory modulation dysfunction
- dyspraxia (somatodyspraxia and BIS)
expressions of modulation dysfunction (4) - top to bottom
- aversive response
- gravitational insecurity
- defensiveness (tactile, auditory, visual…)
- under responsiveness
expressions of modulation dysfunction lead to (4) - top to bottom
- avoidance
- distractibility (inc activity)
- withdrawn
- sensory seeking
CNS site for modulation dysfunction
limbic/reticular
postural control is impacted by which senses
- visual
- vestibular
- proprioceptive
- tactile
discrimination is impacted by which sense
all (vis, vest, prop, tactile, aud)
2 expressions of dyspraxia
- BIS (feedforward-dependent)
- somatodyspraxia (feedforward & feedback-dependent)
expressions of dyspraxia lead to (4) - top to bottom
- clumsiness
- clowning
- avoidance of motor behavior
- exaggerated or diminished force
modulation dysfunction manifests from difficulties in the ……………. areas, while dyspraxia manifests from ……………. areas
- limbic/reticular
- posture/discrimination
T/F: there can be a mixture of avoidance & sensory seeking
true
gravitational insecurity looks like …………….. and interventions look like ……………
- avoiding anything off the ground (chairs, swings)
- start at the ground and make tiny increases until body can regulate it
- sloooooooow process b/c gravity is always “on”
adaptive responses
using sensation and experience to organize a successful goal directed action in the environment
adaptive responses are based upon which type of sensory information
ANY
benefit of adaptive responses
allows a child to successfully meet a challenge in the environment
child’s role in adaptive responses
ACTIVE DOER - you can’t put a kid’s hand in goo and call it SI b/c you’re taking their worst fear and putting it in a box with them
6 levels of adaptive responses
- tolerating passive stimuli during activity
- holding on and staying put
- alternate contraction and relaxation of muscle groups
- move independently in a familiar way
- move independently in an unfamiliar way
- complete a complicated activity requiring unfamiliar way, difficult timing, or multiple adaptations
importance of “staying put” adaptive response
let them know they’re safe and wait out fight or flight response
importance of alternating contraction/relaxation of muscle groups in adaptive response
increase self-efficacy & muscle memory
why should kids move in familiar then unfamiliar ways within adaptive responses?
-have familiar experiences to build on
then
-increase level of tolerance and give them control of the environment
when do you know adaptive responses are truly integrated and generalized?
the final stage is taking place: completing difficult activity in unfamiliar way, difficult timing, or with adaptataions
neural plasticity
structure and function of nervous system changes in response to ongoing stimulation
examples of neural plasticity
- meaningful and active engagement of child on environment may produce permanent changes
- adults with stroke
- adults who have part of their brain removed can have full cognitive recovery
ways to promote neural plasticity
- promote meaningful and purposeful activities
- make them want to engage so they’re in charge of the environment
feedback
- response from env that changes interaction (pushing a pull door)
- outcome feedback following action
- production feedback (through muscles & body in space)
- how we learn new behaviors
feedforward
- anticipatory control
- sending signals ahead of mvmt as we prepare for the mvmt
incorporating feedback & feedforward into intervention
work through and process feedback then talk about how to change it in the future (feedforward)
where do adaptive responses occur & why? how do you take advantage of this?
limbic system b/c emotions are tied into the response - tie in emotion to enhance the level of trust
what promotes adaptive responses?
interactions with the environment
inner drive
children have the innate desire to interact with their environment
when does the first recognizable response to sensory stim occur?
5 1/2 weeks gestation
the most important sense for the newborn
-touch
-smell
-movement
(this is why kangaroo care is so important)
importance of tactile input for newborns
establishes trust relationship w/ caregiver
newborn feeding is a reflection of…..
essential sensory integration skills
vestibular input and newborns
very calming
relationship of sensory input to the birthing process
it’s usually how decisions are made (water birth, kangaroo care right after)
with sensory system maturation in childhood….
the child becomes more independent with exploring the environment > more precise movements > increased sophistication with manipulating objects
why are most sensory dysfunctions missed until childhood?
typical childhood activities place more demand on the child as they get older (academic env, unsupervised play, more in control of sensory experiences), so there are wider gaps in which to notice dysfunction
Ayres found that SI measures in children are equal to adults at age ….. indicating …..
7 - fully mature SI system and minimal growth opportunities past this age
3 primary processing sites in SI expressions of dyspraxia (Ayres)
- vestibular system
- proprioceptive system
- tactile system
functional implications of SI dysfunction
- poor posture and body movements
- poor discrimination of sensory input
- altered relationships w/ sensory env and childhood occupations
- impacted roles, relationships, interactions, and engagement
- parent’s feelings about selves and role as parent
vestibular system is related to ……
- vision
- balance, leading into proprioception
somatosensory system is broken into …..
- tactile (more external)
- proprioception (through muscles and joints)
why is deep pressure considered proprioceptive?
you’re changing the input the joint receives (ex: spine is where compressions should be felt)
2 types of receptors
exteroceptors and proprioceptors
exteroreceptors are found in …… and include 4 types
- in the skin
- Meissner’s corpuscles (fast)
- Pacinian corpuscles (fast)
- Merkel’s disks (slow)
- free nerve endings (slow)
proprioceptors are found in …… and include 2 types
- in soft tissue (deep)
- golgi tendon organs
- muscle spindle (tonic and phasic)
fast adapting receptors
- heat and pain
- respond to initiation of input
slow adapting receptors
- light/deep touch
- respond to ongoing information
which parts of the body have more receptors?
face, feet, hands
-common aversive reactions to socks, shoes, gloves, food…
2 organs responsible for vestibular sense
- otoliths
- semicircular canals
otoliths: movement
slow and linear mvmt in any position
otoliths: facilitated responses
tonic postural movements
otoliths: examples
prone in net swing moving slowly back and forth, jumping on a trampoline, 2 point suspended equipment
semicircular canals: movement
fast (anything > 6 cycles per minute), transient, angular movements
semicircular canals: facilitated responses
phasic postural responses, such as equilibrium
semicircular canals: examples
- spinning in a net swing
- 1 pt suspension equipment
what is commonly associated with vestibular difficulites?
nystagmus
vestibular and tactile input come together, because ….. (example)
proprioception and tactile input are similar and when combined, they tell us where we are in space (rocking and flapping at the same time)
4 motor tracts
- pyramidal (corticobulbar and corticospinal)
- reticulospinal
- vestibulospinal
- rubrospinal (red nucleus)
pyramidal tract
- proprioceptive input
- cortex to SC or face
- force of mucle contraction
- volitional mvmts
- fine precision grip
- motor learning
- prep for internally generated movements
reticulospinal tract
- proprioceptive input
- pontine reticulospinal connections
- medullary reticulospinal tract
pontine reticulospinal connections
facilitates axial and proximal limb muscles
medullary reticulospinal tract
exerts more generalized inhibition of muscles
vestibulospinal tract
- vestibular input
- projections to neck extensors and vertebral column extensors
- extensors are facilitated and flexors are inhibited
- strong influence on muscle tone, postural adjustments, postural control, stability
rubrospinal tract (red nucleus)
- proprioception & vestibular input
- primarily facilitate flexors of distal muscles closely w/ corticospinal tract
- spinal reflexes
motor tracts for proprioceptive input
- pyramidal
- reticulospinal
- rubrospinal
motor tracts for vestibular input
- vestibulospinal
- rubrospinal
options to provide proprioceptive input
- crawling through tunnel
- climbing
- trampoline
- sliding
- scooterboard: proprioceptive and vestibular
responses facilitated by proprioception
- postural repsonses
- body scheme
- regulated force of action
can you separate movement from body positioning?
no
can the vestibular system act without the proprioceptive system?
not really - they’re tied too closely together
3 somatosensory tracts
- dorsal column medial lemniscus
- anterolateral system
- trigeminal (facial)
dorsal column medial lemniscus
- vibration
- discriminatory touch
- touch-pressure
- proprioceptive info
2 parts of anterolateral system
- spinothalamic
- spinoreticular
spinothalamic
sharp pain and temperature
spinoreticular
- dull/burning pain
- temperature
- pressure and non discriminatory touch
trigeminal tract
pain, temp, light touch/pressure
limbic system is involved in
memory, emotions, learning, motivation
reticular activating system characteristics
diffuse system that runs through the brainstem, reticular formation nuclei in the core of the brainstem
reticular activating system is involved in …..
alertness, arousal, and attention
T/F: sensory processing is completed mostly in primary cortical regions of the brain
false
T/F: sensory processing receives greater specificity in interpretation as it progresses through CNS
true
T/F: a weak stimulus will activate the same number of receptors and action potentials that a strong stimulus will activate
false
with stimulus encoding (not sure what that is), sensory receptors respond optimally to …..
specific types of input depending on the receptor
fast adapting sensory receptors …..
respond only at the onset and offset of the stimulus input
semicircular canals detect …..
changes in direction and acceleration/deceleration
lateral inhibition
- focuses sensory input from receptors to sharpen its interpretation
- performed by specialized cells (interneurons)
- allows discrimination and localization of sensory input
T/F: lateral inhibition is used to help spread a small sensory stim to a large area so it will be noticed
false
T/F: the sensory homunculus where the DCML/ML pathway terminates, is flexible and can change based on use or disuse
true
T/F: the sensations carried in the AL system can be localized precisely
false
somatodyspraxia
unable to tell where your body is in space in order to do coordinated mvmts
how is somatodyspraxia different from poor coordination?
it’s tactile, vestibular, and proprioceptive
know how to tell the difference between the two
somatodyspraxia difficulties
- tactile discrimination w/ vestib and proprio
- anticipatory, feed forward mvmts and adaptive interactions
somatodyspraxia interventions
- body awareness
- response to sensory input
sensory discrimination disorder
difficulty interpreting qualities of sensory stimuli (what is in my hand, what is touching me and where, position in chair, am i in motion)
smooth, graded, coordinated movements come from …..
discrimination in tactile, proprioceptive, and vestibular systems
interventions for sensory discrimination disorder
grade the amount of stimulation
BIS
- difficulty using both sides of body
- deficits in sequences of mvmt
- difficulty with projected action sequences
BIS is a possible result of….
poor proprioceptive and vestibular processing
BIS interventions
- bilateral coordination activities
- base of support
- postural stability
- build strength and muscle tone
when is dyspraxia usually detected?
3 years old - may be interpreted as individual differences as first, because children reach their developmental milestones
struggle increases with fine motor skill development
dyspraxia is more recognizable when…..
occupation and participation become more advanced - play challenges my emerge
underresponsive modulation
- display inability to orient to relevant stimulation
- can appear under-active or engage in sensory seeking activities
poor registration looks like….
- doesn’t respond to name
- withdrawn
- likes to play alone
overresponsive modulation
- symptoms that are a result of aversive or defensive reactions
- overly sensitive or avoidant
- cover ears, shut down, etc..
sensory seeking characteristics
- on the move
- crashing, bumping…
- excessive spinning
- eating dirt or sand
- almost impossible to do activities that do not allow movement
aversive response to movement
- strong discomfort, nausea, etc following angular or rotary mvmt
- semicircular canals are reponsible
which organs are responsible for gravitational insecurity?
otolith organs
know difference between
Ayres, Dunn, and Miller!!!
