The article presents what are the foundations of sensory integration and where are the causes of decreased occupational participation of people with sensory integration dysfunction. The interaction between the individual and the environment depends on effectiveness and appropriateness of sensory integration process and the ability of using sensory systems. Also some ways how to help person to better process sensory information are presented.
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In the 1950´s, dr. A. Jean Ayres began to develop sensory integration (SI) theory including evaluation procedures and intervention strategies for children with learning disabilities. Currently used with many other people with neurological conditions, including autism spectrum disorders, dyslexia, dyspraxia, pervasive developmental disorder, multiple sclerosis and speech delaysâ€¦
What is sensory integration?
Sensory integration is the process of organizing sensory inputs so that the brain produces a useful body response and also useful perceptions, emotions, and thoughts. Sensory integration begins in the womb as the fetal brain senses the movements of the mother´s body. (Ayres, 1972/2005)
Each person is different in the way of using sensory information and to make meaning of the environment. What is over stimulating for one person may be exciting and lively for another.
There are seven areas of sensory input:
Sight/Vision – What we see with our eyes makes up the visual sensory input. The images that get relayed to our brain.
Taste/Gustatory – All of the information we take in by using our mouth to taste something goes into the Gustatory System.
Smell/Olfactory – The way in which our nose assists us with taking in sensory input to process.
Sound/Auditory – Imagine all the many things there are to hear. All of this input is from the auditory system.
Touch/Tactile – The Tactile system is imbedded in our skin and makes up the largest sensory organ. Touch can feel good or bad depending on our mood, the force with which it’s given or our own history.
Movement/Balance (Vestibular System) – The Vestibular system is made up of three small bones in the inner ear. The vestibular system helps with balance, muscle tone and coordination, controlling eye movements, arousal states, attention levels, and emotional states.
Joint/Muscle (Proprioception) – The receptors in the muscles, joints, and tendons that provide information about the body’s position in space. The internal awareness of the posture of the body.
Central nervous system takes in, sort and organize sensory information from senses listed above. This is called sensory integrative process and occurs in five steps:
Sensory Registration – Becoming aware of stimulation.
“I feel someone touching me.”
Orientation and Attention – Selective attention is given to a stimulus.
“Something is touching me on the arm lightly.”
Interpretation – Giving meaning to the stimulus.
“It is a fly that has landed on my arm.”
Organization of a response – Determining some form of response.
“I think I’ll slap the fly so it will go away.”
Execution of the response – the only step that can be observed by others is this final step, the action that occurs.
“Slapping the fly away.”
(Warner and Lynch 2004)
There are three other factors which should be considered when looking at the sensory input and that are the intensity, duration and location of the input.
Sensory processing – Is there difference between children and adults?
We can say that children have an inner wish to seek out sensations that contribute to brain organization. This wish is based on the tendency of the brain, which requires the processing of sensory information. Adults, on the other way, with acquired deficits tend to avoid sensory stimulation which they cannot process.
CHALLENGING BEHAVIOUR AND REASON FOR IT…
Nowadays can often be traced to unacceptable behaviors such as:
The person covers his/hers ears, spits food out, brushing away light touch, jumping excessively at unexpected touch , sneezing…
FIND THE ANSWER…. Why is the person behaving in particular way?
Observed behaviour may be due to sensory or emotional difficulties.
Different types of insecure attachment have different sensory profiles e.g.
Avoidant child is likely to be tactile defensive, may use freeze/compulsive behaviour.
Anxious child is likely to be aggressive during fast movement on unstable surfaces.
Sensory difficulties may result in attachment difficulties in learning disabilities e.g. tactile defensiveness.
WHAT IS SENSORY INTEGRATION DYSFUNCTION (SID)?
Sensory Integration Dysfunction is inability to process sensory information appropriately in order to function in the surrounding environment. It occurs when the central nervous system processes sensations inefficiently or inaccurately. (Biel L. 2005)
One in twenty children are known to suffer from Sensory Processing Disorders (SPD)
Children with SPD experience everyday sensory information such as touch, sound, sight, taste, smell, movement, and body awareness differently than other children their age. (Miller L.J., 2006)
Sensory Integration Dysfunction can manifest as:
Inefficient motor, language, or emotional output
Sensory Modulation Disorder – Take in too much or too little information.
(Kranowitz C.S., 2006)
The Oversensitive Person
Avoid (seeks less) stimulation
Often reacts to too much information
Is overloaded by sensory stimuli
NORMAL SENSORY INTEGRATION
The Undersensitive Person
Seeks more stimulation
Takes in too little information
Seeks more information
Most persons fall into one category or another, but some may have characteristics of both types of reactions and responses. A person who is over stimulated by noise can also be under stimulated by touch or movement.
THEN WHAT DO WE DO ABOUT IT?
First we have to observe person’s behaviour and then we can try to determine the cause in sensory processing due to understand and to regulate challenging behavior.
Understanding Sensory Behaviour;
Often we get caught into managing challenging behaviour without understanding it. When observing a person´s behaviour we should pay particular attention to the 4 A’s:
Arousal – The ability to maintain alertness and transition between states.
Attention – The ability to focus selectively on a specific stimulus or desired task.
Affect – The emotional component of behavior.
Action – The ability to engage in adaptive, goal-directed behavior.
(Williamson G.G. and Anzalone M.E., 2001)
Table of Tools to use with the Undersensitive and Oversensitive person:
Use colored play dough for playtime.
Having a bean bag throw that they can toss.
Scheduled boards, visual schedules.
Peanut hunt to help hone visual skills.
Colored handouts or brightly colored art supplies.
Well defined play areas with taped off sections can help.
Try not to use florescent lights.
Allow them space to have images on the walls or pictures to look.
Use feelings cards, visual cues to teach facial expression.
Light covers or cloth drapes over bright lights.
Turn lights down or use fewer lights.
Shaded areas where children can get away from light.
Try not to use florescent lights.
Well defined play areas so person knows where they are allowed/expected to play.
Soft colors for the walls, bedrooms, classrooms, family rooms.
Let children wear sun visor or glasses for oversensitive vision.
Decrease number of choices for person to decrease overstimulation in visual choices.
Decrease wall clutter in classroom setting.
Textures foods, noisy foods, square foods, circle foods to give them a variety of texture and taste. Bitter, salty, sour, sweet.
Eat with a person so the undersensitive he/she can understands portions and how to chew rather than swallow whole food.
Give in small bites and small portions if choking is a problem.
Pudding play and cool whip play to encourage tasting.
Oversensitive person can become upset when other chew loudly, keep them close to you so you can monitor them.
Texture foods, noisy foods, square foods, circle foods to encourage exploration.
Eat with them to show them examples. Encourage them to try small bites of each food.
Scented play dough.
Smelly bath salts/soaps.
Variety of scents, flowers, herbs, foods, etc.
NOTE: Some oversensitive persons are allergic to some solutions or essential oils, be mindful.
Essential oils in light scents such as lavender to decrease sensitivity.
Avoid wearing strong perfumes as this may trigger person who are oversensitive.
Singing activities with finger plays, rhythm instruments and clapping with sounds or words.
Allow opportunities to make music and noise on their own.
Monitor music and TV volume especially if being offered headphones.
Relax box where person can get away from the noise.
Soft music at naptime.
White noise of classical music playing the background.
Earmuffs for calming and self-regulation.
Hang pictures (or solid blocks of color) on the wall to absorb sound for person.
Sensory tables (sand/water/rice/beans).
Squeeze pillows and bean bag chairs.
Therapy putty or hiding objects in putty to find them.
Variety of materials to touch/explore in the classroom.
Allow the use of gloves for person who do not want to get messy.
Ziploc bags with stuff inside so they can feel the item/object without getting messy.
Baggies with water, toothpaste, gel, play dough, paint, etc.
Use visual guides to assist the oversensitive person in having a boundary from others when they need space.
Piggy back rides, horsy rides.
Human burrito game.
Tag less clothing.
Spinning, jumping, swinging, etc.
Lots of space for physical movement in a safe environment.
movement and balance
Piggy back rides.
Allow for them to remove clothing when appropriate.
Use tag less clothing.
Soft fabrics and loose waistbands.
All types of physical activities.
Heavy work such as pushing pulling heavy objects.
Hold up the wall.
Carry weights while walking.
Sitting on the washing machine.
Climbing and swinging in safe environments.
Sucking through a straw.
muscle and joint
Hold up the wall.
Any kind of physical activity such as swimming, running, climbing, resistance activities.
Use them in small doses to they do not get overwhelmed.
Fabric bag, swing in a hammock.
Prepared and summarized by The Out of Sync Child: Recognizing and Coping with Sensory Processing Disorder -Kranowitz C.S., M.A.; 1998.
Case example: Mitja
Ten years old boy with autistic spectrum disorder.
Hyperexcited signs – smile, bounce up and down, hands in mouth can then escalate to agitation (pacing, rocking), aggression, and not registering pain.
Problems on different levels:
Autonomic regulation – lots of physiological issues:
epilepsy, allergies, tunnel vision, middle ear problems.
low tone – difficulty regulating muscle control,
seeking proprioception (jumping),
tactile defensive – either emotional or postural challenge not sensory.
Sensory discrimination – interpret:
auditory processing problems, body scheme problems,
Regulate during activities by:
provide calming stimuli -lots of proprioception (pull, push, lift, hold);
chewing dried fruit/ carrot/ apple, suck on water bottle, trampoline, squeeze ball,
primary need is to address health and physiological difficulties e.g. tunnel vision.
THE SENSORY DIET
A sensory diet is a term (named by Patricia Wilbarger, Occupational Therapist) used to describe sensory activities that are used to treat kids with Sensory Integration Disorder. Those are routine activities and are designed to aid the regulation of the nervous system to lower or raise levels of arousal and serve as calming or arousing activities. (Kranowitz C.S., Miller L.J. (2006)
Everyone needs different amounts and different types of sensory input throughout the day to maintain a calm and alert state. Some people are able to achieve their optimal level of sensory input in a healthy and functional way, while others need external support.
Basic steps in sensory diet are:
D â€¦..Do an Informal Assessment (Assess the Environment and the Individual’s response to a variety of sensory experiences).
I â€¦.. Individualize (What has worked for one person may not work at all for someone else).
E â€¦.Environmental Supports (Other People, Organization, Predictable, Structured, Consistent Environment, Task or Curriculum, Visual Supports, Escape Environments).
T â€¦..The Power Senses (Vestibular Movement, Proprioception Input through joints and muscles, Tactile Deep Pressure Touch). (Kranowitz C.S., Miller L.J., 2006)
Case study Martin
He is eight years old boy who:
often seeks tactile information and provide visual stimulation by shaking the shiny objects in front of the eyes.
He regulates his nervous system through touch by:
Holding objects (e.g., trucks, mirrors); touching and hugging peers.
His sensory diet activities include:
Playing with finger paint, or clay at times throughout the day.
Doing dishes in a kitchen sink filled with water.
Having breaks to play with tactile bins, mirror and other shiny toys.
Case study Danijela
She is six years old girl who:
often seeks tactile information, avoid oral sensory stimulus, and vestibular stimulus.
She has hard time to cope in a special school environment:
she often pinch person who touches her,
she avoids to eat food of a crispy texture,
touches and throws everything around her and produce noise,
she has difficulty sitting for more than 5 minutes at a time.
Her sensory diet activities include:
Every 30 minutes during her school program, she has a 10 minute “sensory break”.
She does proprioceptive and vestibular activities using schedule with “picture exchange communication symbols”(PECS).
Activities: walking in a circle, crawling on the ground, and playing with a weighted ball. She helps to move heavy bins and laundry baskets.
There are seven different types of sensory stimulus, which can cause different sensory integration issues. So we have to adapt Sensory Integrative Therapy with different types of activities, based on the individuals needs. It usually includes Vestibular Movement, Proprioception Input through joints and muscles and Tactile Deep Pressure Touch. These activities are part of a routine activities (sensory diet) and help build foundation for the other skills.
REFERENCES AND TEXTS USED:
Ayres, A. J. (1972/2005). Sensory Integration and the Child. Los Angeles: Western Psychological Services.
Biel L. (2005) Raising a Sensory Smart Child: The Definitive Handbook for Helping Your Child with Sensory Processing Issues.
Kranowitz C., Miller L.J. (1998/2006). The Out-of-Sync Child: Recognizing and Coping with Sensory Processing Disorder, Revised Edition.
Miller L.J. (2006). Sensational Kids. Penguin Group, Inc.: New York.
Warner and Lynch. (2004). Preschool Classroom Management: 150 Teacher Tested Techniques.
Williamson G.G., Anzalone M.E. (2001). Sensory Integration and Self-Regulation in Infants and Toddlers: Helping Very Young Children Interact with their Environment.
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