Sensory Integration: Theory, Disorders, InterventionsPresented by: Alma Martinez, MOT, OTRValerie Villarreal, OTSMaggie Flores, COTA

Sensory Integration (SI)

Dr. Jean Ayres -1963

Is the ability of a person to take in a variety of sensory input, process and understand it, and use it.

What Are The Senses?

Vestibular- movement Tactile- touch Proprioception- where are your body

parts? Visual- seeing Auditory- hearing Taste Smell

How Is Information Processed?

Main sensory systems 1) Tactile2) Proprioception3) Vestibular

Transmitters of information from environment to the brain

Why Sensory Integration?

Increases interaction with others Develops necessary skills Organization

Sensory Integration Theory Automatic process Natural outcomes occur Learning problems Developmental lags Behavior issues

How is SI Used?

Understanding the WHOLE environment Learning Understanding what is going on around

us Regulation

Neurobiologically Based Concepts

Neural Plasticity Central Nervous System Organization Adaptive Response Sensory Nourishment

Development Process of SI Detection or registration of sensation Modulation of sensation Sensory discrimination Higher sensory integrative skills Targeted occupations

INPUT SENSORY INTEGRATION OUTPUT

Senses CNS Result

Sensory Processing Disorder (SPD)

“Problems in directing, regulating, interpreting, and responding to sensory input.” (Miller, Anzalone, Lane, Cermak, Osten, 2007)

Can influence child’s response to: Environment People Tasks/activities

*Note: Some of us may have sensory processing challenges, but it is considered a Sensory Processing Disorder when the problem is severe enough to interfere with daily routines or roles.

Impacts On Every day Life

Activities of Daily Living (ADLs) Social Participation Education/Work Play/Leisure Rest and Sleep

Ten Fundamental Facts About SPD1. Sensory Processing Disorder is a complex disorder of the brain that affects

developing children and adults.2. Parent surveys, clinical assessments, and laboratory protocols exist to identify

children with SPD.3. At least one in twenty people in the general population may be affected by

SPD.4. In children who are gifted and those with ADHD, Autism, and fragile X

syndrome, the prevalence of SPD is much higher than in the general population.

5. Studies have found a significant difference between the physiology of children with SPD and children who are typically developing.

6. Studies have found a significant difference between the physiology of children with SPD and children with ADHD.

7. Sensory Processing Disorder has unique sensory symptoms that are not explained by other known disorders.

8. Heredity may be one cause of the disorder.9. Laboratory studies suggest that the sympathetic and parasympathetic

nervous systems are not functioning typically in children with SPD.10. Preliminary research data support decades of anecdotal evidence

that occupational therapy is an effective intervention for treating the symptoms of SPD.

from Sensational Kids: Hope and Help for Children With Sensory Processing Disorder (SPD)

p. 249-250 by Lucy Jane Miller, PhD, OTR

SPD SubtypesSensory Modulation Disorder

Sensory over-responsivity Too much information coming in

Sensory under-responsivity Information comes in but not responsive to it

Sensory seeking or craving ‘Needing’ more information

Sensory Over-Responsivity Brain has too LOW of a threshold Tactile

Difficulty with getting hair cuts Avoidance of touching certain textures

Vestibular Disoriented after bending down Anxious when feet leave the ground Avoids rapid or rotating movements

Visual Difficulty tolerating bright lights

Sensory Over-Responsivity Proprioception

Difficulty being hugged Difficulty with people moving your body

Auditory Fearful of sounds Distracted by certain noises Frequently cover ears

Oral “Picky” eater Difficulty brushing teeth

Sensory Under-responsivity

Brain has too HIGH of a threshold Tactile

Difficulty noticing touch Dress inappropriately for weather

Vestibular Does not get dizzy Enjoys being upside down or sideways “Thrill seeker”

Visual Often miss what is right in front of them

Sensory Under-responsivity

Proprioception Poor body awareness Floppy or poor posture

Auditory Listens to loud music or TV Talks to self during a task (out loud)

Oral May be able to eat anything

Sensory Seeking/Craving Seeks arousal of nervous system

(inappropriately) Tactile

Enjoy “bear” hugs Crave touch of textures

Vestibular Jumping Enjoy spinning in circles, being upside

down

Sensory Seeking/Craving

Proprioception Loves crashing or bumping into objects Craves highly physical activities

Auditory Speaks louder than necessary Needs to listen to music to concentrate

Oral Puts anything in mouth (searching for oral

input)

SPD SubtypesSensory Discrimination

Disorder

Visual (eye) Auditory (ear) Tactile (touch) Vestibular (movement) Proprioception (muscle) Taste/smell (mouth/nose)

Sensory Discrimination Disorder Examples

Proprioception Constant slamming of doors Pushing too hard (to increase awareness)

Tactile Need to use eyes when searching for object in

backpack or purse Taste/smell

Difficulty distinguishing between flavors or scents Vestibular

Frequently falls out of chairs

SPD Subtypes

Sensory Based Motor Disorder

DyspraxiaDifficulty motor planning

Postural disorderPoor cocontractionMuscle tone (Low)Equilibrium and posture Immature reflexive abilities Bilateral Integration

Examples of Dyspraxia Poor gross motor skills

Running jumping

Poor fine motor skills Zipping Buttoning

Problems in figuring out how to do movements Dressing Complex dance steps

Proprioception Poor motor control

and body awareness during dressing

• Vision• Navigating through

crowded hallways

Examples of Postural Disorders Low muscle tone

‘slumped’ in chair Leans on things

Poor balance Often trips or bumps into objects Difficulty with riding a bike or jumping

Poor stability Sits in awkward positions

Head and eye stability Difficulty when reaching for objects

Use of two sides of body not stabilizing paper to write

How Do You Feel About…

Cold shower Wool clothing Panty hose Sweatpants The feel of Jell-O in your mouth The sound of birds Bright colored walls in the bedroom The smell of perfume Elevators Roller Coasters

Support Groups

Moms Connect About Autism-MoCAA http://www.momsconnectaboutautism.co

m Sensory Planet Social Network

http://www.sensoryplanet.com/home.php SPD Parent SHARE

http://www.spdparentshare.com

References American Occupational Therapy Association. (2008). Occupational

therapy practice framework: Doman and process (2nd ed.). American Journal of Occupational Therapy, 62, 625-645.

Baranek, G., Foster, L. & Berkson, G. (1997) Tactile defensiveness & stereotyped behaviors. Am J. of Occupational Therapy, 51, 91-95

Bundy, A., Lane, S., Murray, E. (2002). Sensory integration theory & practice. Philadelphia: F.A. Davis Company.

Dunn, W., Myles, B. & Orr, S. (2002). Sensory processing associated with Asperger syndrome: A preliminary investigation. AJOT, 56, 97-102.

Kimball, J. (1999). Sensory integrative frame of reference. In Kramer, P. & Hinojosa, J. Frames of Reference for Pediatric Occupational Therapy. Baltimore: Williams & Wilkins.

Kranowitz, C. (2004). The out-of-sync child: Recognizing and coping with sensory processing disorder 2nd ed. New York: Berkley.

Miller, L. Anzalone, M., Lane, S., Cermak, S. & Osten, E. (2007). Concept evolution in sensory integration: A proposed nosology for diagnosis. Am J of OT, 61, (2), 135-140.

Henry, D. A, Kane-Wineland, M., & Swindeman, S. (2007). Tools for Tots: Sensory Strategies for Toddlers and Preschoolers 2007.

http://spdlife.org http://www.spdfoundation.net/facts.html http://autism.org.uk http://sensoryprocessingdisorder.com

Review of challenges/characteristics…..Slow Processing - Difficulty shifting

attention

Inattentive, Difficult to arouse

Does not like change or transitions - Rigid – Demands routine

Difficulty with, or seeks out, certain types of foods/textures

Smells all food before eating - smells objects

Unable to sit with anyone behind them in class

Difficulty attending from the back of the room

Explosive emotions or lack of emotions or incongruent emotional

responses

Aggression to self or othersCompulsive Behaviors

Difficulty with clothing, type of clothing, and

change of clothing

Perseveration on topic or activity - Fixation on sensory stimuli

Clumsy, awkward, difficulty in sports

Over or Under-reaction to painUnsure of group situations,

cautious, or a loner2

The “Sensory Diet” includes….

PROVIDING SENSORY EXPERIENCES A combination of sensory experiencescombination of sensory experiences

needed by a person to adaptivelyadaptively interactinteract with the environment (“make it through the day”).

MAKING ENVIRONMENTAL MODIFICATIONS Modification and organization of the

environment in order to decrease stressdecrease stress on a fragile sensory system.

Those with sensory processing challenges

May not be able to filter and focus

May attempt to adjust in a maladaptive way

(Ex: Escalation of Mood, Shutting Down)

Will require a “sensory diet” enriched with unique sensations and experiences

Creating The Sensory D.I.E.T.

D …..Do an Informal Assessment

I …..Individualize

E …..Environmental Supports

T …..The Power Senses

Do an Informal Assessment

Assess the Environment and the Individual’s response to a variety of sensory experiences

Seeker? Active Avoider?

Under-Responder? Overwhelmed

Individualize the Sensory Diet

What has worked for one person may not work at all for

someone else!

SEEKERProvide sensory experiences frequently & proactivelyMay need to limit excitatory experiences

ACTIVE AVOIDERModify the environment to reduce the need to escape Gentle introduction to new experiences

UNDER-RESPONDERIncrease the use of visual supports and routines. Structure the environment. Time to respondCareful encouragement to try new experiences

OVERWHELMED

Control the environmentLimit stimulation Limit change but prepare for changes when they need to occur.

Considerations for the Sensory

Diet

Environmental Supports

OrganizationPredictable, Structured,

Consistent EnvironmentTask or Curriculum

Visual SupportsEscape Environments

Proactively Schedule Sensory Activities

Use the Power Senses throughout the throughout the dayday in order to help a person alert, attend, act, and react

At times, additional activities or input may be needed based on the behaviors

observed

The Power SensesTactile System

Proprioceptive System

Vestibular System

The Power Senses

Vestibular Movement

Proprioception Input through

joints and muscles

Tactile Deep Pressure Touch

The Power Senses

Tactile System

Two Tactile Systems

Tactile System

Pertains to the sense of touch

Alerts to dangerGives body boundaries

Helps provide a basis for body image

Protective System

Activates “Fight, Fright, or Flight”Born with this system- “Primal”Stimulated by light touch, pain, temperatureProcessed through the emotional, excitatory

portion of the limbic system  NOT a cognitive response

Discriminative : Pressure Touch

Deep touch/pressure, and vibrationActivates Parasympathetic SystemCalms and organizesAllows for more cognitive response

Helps us learn and think

Dysfunction of the Tactile System

Distractibility Hyperactivity Over/Under Sensitivity

Hyper-vigilant Inappropriate pain sensation Avoids getting hands dirty Difficulties with clothing/textures Avoids whole hand Disorganized when touched Intolerant of wearing glasses/hearing aide

Difficulty with Social Space

Tactile Defensiveness is when…

- Sensitive to light touch- Touch causes difficulty organizing behavior

and concentration - Touch causes negative emotional responses

- Can become aggressive, if feeling threatened or stressed

Interventions for Tactile Defensiveness

Brushing Protocols Wilbarger Protocol

PRRBrushing over arms, legs, back with a soft brush , followed by joint compressions

Caution A brushing protocol should

only be implemented after an assessment and training by a qualified professional

Vestibular Input

Proprioceptive Input Tactile Input

Taste, Smell, Vision, Auditory

To“fill the sensory bucket”

quickly use the Power

Senses

Three Power Senses will provide:• more input•more quickly •to make changes

that are more rapid Based on Work of Bonnie HanshuBased on Work of Bonnie Hanshuwww.sensoryprocessing.comwww.sensoryprocessing.com

Environmental Supports Access to an escape/private area

Caution with placement. Student may want to sit where no one is behind him

Some feel secure with boundaries that keep others at a distance…..

Others need space in order to make a “quick escape”

Quiet Sensory AreaQuiet Sensory Area

Tactile supports

Choose carefully…..Choose carefully…..

Other Tactile Supports Consider the type of clothing and the way it

fits Tight? Loose? Fabric? Swimming/Water Play Body Sock

Remove tags from

clothing

People Supports: What Others Can Do

Avoid unnecessary touch and Ask Permission

Avoid touching face to gain attention

Move slowly and provide “Waiting Time”- up to 10 seconds

When touch is necessary, use Deep Pressure Touch

The Power Senses

Proprioceptive System

Proprioceptive System

Muscles, joints, and tendons provide a person with a subconscious awareness of body position via the feedback from receptors in the muscles, tendons and joints.

Proprioceptive System

Motor Planning

Awareness of body in

time and space without constant visually monitoring

Dysfunction of Proprioceptive System

Clumsiness, a tendency to fall

Lacks awareness of body position/odd posture

Difficulty with small objects (buttons/ snap)

Disorganized….. Materials & Thoughts

Poor or resistance to handwriting

Eats in a sloppy manner

Resists new motor movement activities

 Activities that provide proprioceptive input

Joint compression or extension

“Heavy work” activities

The larger the joint, the more proprioceptive input

Examples of “Heavy Work”Passive Joint CompressionsJumping/Trampoline

(floor may be better..)Stacking ChairsWeight Lifting

“Bungee Cord” on Chairs Chewing Gum

“Pretzel Hugs”

Fine Motor Supports “Hand-prep” exercise Limit Handwriting

Requirements Alternatives to

handwriting Keyboarding Software Set of notes Grips Velcro on Shoes

Alternatives & Accommodations Options in Word and

PowerPoint

Sensory Breaks between tough fine motor activities

Organizational SupportsVisual SupportsColor codingTimers/WatchesWritten directionsWritten rule reminders

What Can Others Do

Stay on schedulePace languageUse Concrete Language

Use Wait Time

The Power Senses

Vestibular System

Vestibular System

The vestibular system refers to the structures within the inner ear (the semi-circular canals)

These structures detect movement and changes

in the position of the head.

The brain needs vestibular input in order to function

Vestibular input provides the

Strongest Sensation

Movement can change an individual’s attention, arousal and alertness in the shortest period of time

The effects from vestibular input can last longer than any other input.

Hypersensitive: Active avoider and Hypersensitive: Active avoider and overwhelmedoverwhelmedFearful reactions to ordinary

movement activities Apprehensive walking or crawling on

uneven or unstable surfacesSeem fearful in open spaceAppear clumsy Want their feet on the ground!

These folks need gentle experiences and support as they become more comfortable

Hypo-sensitiveHypo-sensitive Under-Responders and Seekers

Seeker: Actively seek and demonstrate a need for intense movement experiences (whirling, jumping, spinning, spinning objects, pacing)

May includes visual stimBe aware: Seeker can become over-excited

Needs monitoring “Cap-off” vigorous vestibular activity with

proprioception (“heavy work” or joint compression)

Under-Responder may need gentle encouragement to engage in movement activities

 Activities that provide vestibular input Seeker/Avoider/Overwhelmed

Linear, Calm, Slow, Controlled movement to gain attention

Under-Responder Unpredictable, multi-directional, spinning (if

individual requests), to alert and orient someone who is under-responsive

Be very cautious imposing vestibular movement – can be very frightening

Selected StrategiesSwingingRocking ChairSit & Spin/Dizzy Disc

Therapy Balls as ChairsMoveable Cushions

or Deflated Beach Balls

as Chair Cushions

Selected Strategies

Delivering Messages or Packages (or any job that

requires walking, moving, bending, etc.)

Running Track or possible a Treadmill

Movement breaks placed proactively in the day

Remember……Remember……Do NOT withhold recess/gym based on

the child’s behavior or inability to complete work

Movement and activity may be the input the child needs in order to maintain behavior, concentrate and learn!

Creating The Sensory D.I.E.T.

D …..Do an Informal Assessment

I …..Individualize

E …..Environmental Supports

T …..The Power Senses

How can a therapist help my child? School-based therapist

• Part of a full evaluation or pre-referral tool• Assist with program planning• Educate staff and personnel• Collaboration between school and clinic

Clinic-based therapist• Obtain observations of participation in school and

home• Educate the parent/caregiver• Collaborate with the school therapist and school team

Research

How can we help optimize the learning experience??

By knowing what type of strategies/activities to do with your child that will help the body

organize and interpret sensory information to the brain.

Activities for tactile sense: Shaving cream

(unscented, if possible)

Playdough Theraputty Textured food Finger painting Hair gel Tactile road Playing dress-up

Ball pit Blanket wrapping Pressure vest Gentle but firm

massage Vibrating toys

Activities for Vestibular sense:

Swings Scooter boards Wagon rides Self propelling toy cars Slides Obstacle courses Monkey bars Trampoline Rolling on mat

NOTE: This must be slow and brief at first, in very secure positions.

Activities for proprioceptive sense

Crash pad Crawling (can crawl

through tunnel, over beanbags or pillows)

Running Climbing Marching Wall push-ups

Weighted garments Pressure garments Heavy work Scooter board Therapy ball Jumping on a

trampoline Wheelbarrow walks

Activities for auditory sense Soft music Soft voice White noise Quiet room

Up beat music Loud voice Instruments/noise

makers White noise Classical music

Activities for visual sense: Soft colors Solid backgrounds Dim lights Desk lamp Uncluttered area Flash light tag Visual schedules

Bright colors Bright lights

If you have any questions or concerns

regarding your child development and

sensory processing

1- Contact your pediatrician/primary care

physician

2- Get a referral for skilled therapy services

3- Contact your therapy provider of choice

Any questions?

Alma Martinez MOT, OTRValerie Villarreal OTSMaggie Flores, COTAYou may reach us at :6550 Springfield Ave Ste. 101(956) 725-4555email: fivestartherapy@yahoo.com