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MAKING SENSE OUT OF
SENSORY FOR SLP’S
Kelli Olmsted, MS OTR/L
Master Clinician Dementia and Sensory
Integration
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OBJECTIVES
1. Articulate terminology relative to sensory integration treatment techniques.
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SENSORY INTEGRATION THEORY
Sensory integration Theory
A. Jean Ayres
“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. The spatial and temporal aspects of inputs from different sensory modalities are interpreted, associated and unified.”
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SENSORY INTEGRATION THEORY
Sensory integration is information processing
Based on the brain-behavior relationship.
Developed to elaborate on relationships with
Sensory information deficits and learning deficits
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ASSUMPTIONS OF SI THEORY
Neural Plasticity
There is plasticity within the CNS.
The ability of our brains to structure, change or be modified, allowing to speculate that enhancement of function of the nervous system is possible through controlled tactile, vestibular, and proprioceptive input.
There are experimental brain research that indicate that plasticity persists into adulthood and possibly throughout life.
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ASSUMPTIONS OF SI THEORY
Developmental Sequence
During normal development, we develop
complex behaviors as result of circular process
and behaviors present at each stage in a
sequence, and in turn, basis for development of
complex behaviors.
Nervous System Hierarchy
The brain functions as an integrated whole but
is comprised of several small systems that are
hierarchy organized.
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NERVOUS SYSTEM HIERARCHY
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ASSUMPTIONS OF SI THEORY
Adaptive Behaviors
Evoking an adaptive behavior or promoting Sensory Integration and in turn the ability to produce an adaptive behavior reflects sensory integration.
Inner Drive
Individuals have an inner drive to develop sensory integration through participation in sensory motor activities.
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SENSORY PROCESSING
Bonnie Hanschu
The brain’s ability to organize and make sense of different kinds of sensations.
Underlying development of all motor and social skills.
Ability to learn and perform complex adaptive behaviors.
Brainstem contains the filtering system which prioritizes incoming information.
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THE READY APPROACH
Created by Bonnie Hanschu
Frame of reference
Normal Functioning
Disruption / Deficit:
Environment stimuli encounters body and brain on sensory level.
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THE READY APPROACH
Ready Approach focus on using strong sensations
influences engine (brain/body) that drives us, in turn
allowing us to influence our engine by influencing our
brains reaction.
Every brain has the potential to rewire itself in the
right environment.
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THE READY APPROACH
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THE READY APPROACH
Not Ready
Brain preoccupied
Cannot process meaning
React rather then adapt
At mercy of stimuli
Info for learning & exploring is disregarded. Biased to protection and comfort.
Ready Engage and respond
Catch on “Get IT”
Stay with the flow of events
Adapt to situational changes
Experience challenges
Interact freely
Be spontaneous
Feel safe, comfortable
Feel in control
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SENSORY PROCESSING /
SENSORY INTEGRATION
Bonnie Hanschu used this analogy to
distinguish between sensory integration, and
sensory processing:
“If sensory processing is the dance, sensory
integration makes it possible for that
dance to become a ballet.”
To create an intervention for a client, we may
need to intervene during the processing to
create the integration.
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SENSORY MODULATION
About arousal (alertness, awake, asleep and in
between)
Ability to make continuing sense of our changing
experience and keep and flow of situational
demands we experience.
Dysfunction is described as the inability to
regulate sensory information, how we organize
information, and how we form adaptive response.
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SENSORY MODULATION
Arousal
Displayed as excessive distractibility, inability to modulate arousal, clumsiness, and excessive or minimal sensitivity to touch, movement, sounds or sights.
Sensory modulation problems may be seen with or without defensiveness.
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SENSORY MODULATION
Habituation
Sensitization
Dampening / Enhancing
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SENSORY MODULATION
Optimal level of arousal
Individualized
The optimal level of stimulation theory
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SENSORY DEFENSIVENESS
Hypersensitivity to sensation resulting in a disorganized output
Patricia Wilbarger
Anterolateral systems response for pain and crude touch
Gate Control Theory
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SENSORY DEFENSIVENESS
Nervous system no longer believed to be hierarchical
Interpret stimuli from the environment with protective mechanisms.
Unique and identifiable behavioral phenomenon.
Affects arousal and can result in changeable behavior.
Presents in a wide range of symptoms and severity.
Understanding is ongoing process.
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SENSORY DEFENSIVENESS
There are many types of sensory
defensiveness
Severity of sensory defensiveness varies from
mild to severe.
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RESEARCH
Limited research in this model of practice. There is
research based on effectiveness of SI with some
evidenced of intervention effectiveness. Children are
the basis in studies. Rare adult research with use of
this model / theory.
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RESEARCH
Interventions for Common Behavioral Problems
in Children with Disabilities. Renee Watling
(2005)
(OT Practice,Vol 10, Issue 15, pp12-15)
Behaviors emerge from sensory needs
Overwhelmed
Patterns of repetition
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RESEARCH
Snoezelen and Sensory-Based Treatment for Adults with Psychiatric Disorders. Donna Costa, Jessica Morra, Kimberly Call, Danielle Solomon, and Maribeth Sabino (2006)
(OT Practice, Vol 11, Issue 4,pp.19-23)
Snoezelen – Dutch words
Failure free environment
Using “time out”
Empowering client
Increasing quality of life
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RESEARCH
Using Snoezelen with Adults with Severe or Profound Mental Retardation. Skip O’Neal and Beth P. Velde (2006)
(OT Practice,Vol 11, Issue 20, pp.19-23)
Jan Hulsegge and Al Verheul
Multi-sensory environment
Leisure / restful activity
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RESEARCH
Using a Multisensory Environment: to decrease negative behaviors in Clients with Dementia. Lape, Jennifer E. (2009)(OT Practice, Vol 14, Issue 9, pp9-13)
Benefits of a multisensory room for tx of behaviors with clients diagnosed with dementia.
24 hour availability
Not a cure for undesirable behaviors, but effective solution to decreasing intensity of behaviors and allow person to engage in meaningful activities.
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RESEARCH
Occupational Therapy for Adults with Sensory Processing Disorder. May-Benson, Teresa A. (2009)(OT Practice, Vol 14, Issue 10, pp. 15-19)
Challenge of assessing adults
Sensory diet activities for home programs
Sessions should include: Preparatory activities, sensory activities, integrating activities, and organizing/wrap-up activities.
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OVERVIEW OF THE SENSES
Sense of Smell:
Unconscious and protective response, acrid and noxious odors are associated with danger.
Unique in one important aspect – it is the only sense that bypasses the circuitous pathway of normal sensory processing.
Communicated directly into the limbic system, the seat of our emotions.
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OVERVIEW OF THE SENSES
Sense of Taste / Oral:
Highly individualized by culture, and past food experiences.
Oral motor experiences begin with the sucking instinct of infant and is important throughout the lifespan.
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OVERVIEW OF THE SENSES
Sense of Vision:
Unifying system that assists to integrate and make sense of the other sensorimotor systems.
Directly links to vestibular system
Most critical for orienting ourselves and interacting in the environment (A. Jean Ayres)
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OVERVIEW OF THE SENSES
Sense of Hearing:
Sound impacts muscle tone, equilibrium and even the body's flexibility.
Don G. Campbell states that “music is a natural pacemaker”. The Mozart Effect (2001) Harper Collins Publishers
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OVERVIEW OF THE SENSES
Sense of Touch:
Skin is the biggest organ, and our biggest sense
organ.
Light touch has a rapid diffuse and spreading effect
that alerts the nervous system of danger.
Pressure touch is a localized, precise sensation
which is responsible for stereognosis.
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OVERVIEW OF THE SENSES
Deep tactile touch is very calming.
Receptors are located under the skin’s surface.
It provides a localized, precise sensation which
enables us to tell shapes, textures, and sizes of
hand held objects without looking at them.
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OVERVIEW OF THE SENSES
The tactile system has a
profound influence on
our ability to learn. We
have 600 pain
receptors, 13 yards of
nerves, and 9000 nerve
endings on a ¾ inch
square on the back of
our hands.
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OVERVIEW OF THE SENSES
Sense of Proprioception:
Comes from the Latin word “for one’s own”.
It provides body awareness and boundaries.
Receptors in the muscles, tendons, and joints.
Theories of motor control.
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OVERVIEW OF THE SENSES
Vestibular Sense:
Receptors are hair cells located in the
semicircular canals, utricle, and saccule of
vestibular labyrinth
The vestibular apparatus acts as an internal
compass that signals changes in head position
or motion.
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VESTIBULAR SENSE CON’T
According to Ayres, “The vestibular system is a
major organizer of sensation in all other sensory
channels”.
Input we get tells us exactly where we are in relation
to gravity, whether we are still or moving, how fast,
and what direction.
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OVERVIEW OF THE SENSES
Power Houses of sensory input are:
Proprioceptive
Deep Tactile
Vestibular
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SENSORY STIMULATION PROGRAM
Sensory stimulation techniques are passively
provided to client.
Sensory integration techniques need to be presented
within the context of a meaningful activity and
require adaptive response.
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TOUCH EVALUATION
OBSERVATIONS
Under-Responsiveness:
Unaware pain
Temperature or how object feels
Rub against furniture / walls
Bump into others
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INTERVENTIONS FOR
UNDER-RESPONSIVE TOUCH
Speech Therapy:
Chewy Tube®
Tactile spoons
Vibration to stimulate oral awareness
Massage to face and neck muscle
Hugs and Tugs
Proprioception
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HUGS AND TUGS
Developed by: Kelli Olmsted, MS, OTR/L
Brenda Meiron, COTA/L
Developed to provide quick proprioceptive
input and deep pressure touch for sensory
needs.
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HUGS AND TUGS
Precaution: Be aware and careful with painful and / or arthritic joints.
This protocol is good for residents with poor attention to task, pacing, and / or high level of anxiety.
This is a great tool to place in a sensory diet and have staff complete.
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1. Approach resident in a quiet calm manner.
2. Ask “Can I give you a hug?”
3. Lean in and give resident an embrace with 10-12 quick pressure hugs and state “Can you hug me?” Approach resident in a quiet calm manner.
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4. Step back and state “you are going to feel a little
pressure on your shoulders”.
5. Open hands and place them on top of their
shoulders and press down 10-12 times, providing
deep tactile pressure bilaterally.
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6. Inform resident, “I’m going to squeeze your arms or give your arms hugs.”
7. Stand in front of resident and squeeze down length of both arms by cupping hands, working proximal to distal down the length of the arm. Complete arms bilaterally or one at a time.
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THINKING IN PICTURES-TEMPLE GRANDIN
Video
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TOUCH EVALUATION
OBSERVATIONS
Over-Responsiveness:
Avoids touching or being touched by objects
/ people
Upset when get dirty
Irritated by certain types of clothing and food
Dislikes unexpected light touch
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INTERVENTIONS FOR
OVER-RESPONSIVE TOUCH
Speech Therapy:
Avoid light touch
Decreased points of contact
Deep tactile input
Education on approach
Establish eye contact with activities
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MOVEMENT EVALUATION
OBSERVATIONS
Under-responsiveness:
Crave fast and spinning without getting
dizzy
Move or fidget constantly
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INTERVENTIONS FOR
UNDER-RESPONSIVE MOVEMENT
Speech Therapy:
Rocking
Swinging
Dancing
Clapping
Fidgets
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MOVEMENT EVALUATION
OBSERVATIONS
Over-responsiveness:
Avoids moving or being unexpectedly
moved
Insecure with gravity or anxious if tipped off
balance
Car sickness
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INTERVENTIONS FOR
OVER-RESPONSIVE MOVEMENT
Speech Therapy:
Rocking
Proprioceptive / tactile cues
Approach
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BODY POSITION EVALUATION
OBSERVATIONS
Under-responsiveness:
May slump/slouch
Actions appear clumsy or inaccurate
Bump into objects
Twiddle fingers
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INTERVENTIONS FOR UNDER-
RESPONSIVE BODY POSITION
Speech Therapy:
Hugs and Tugs
Collaboration with PT / OT on positioning
Head / neck position during mealtime
Adapting place setting
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BODY POSITION EVALUATION
OBSERVATIONS
Over-responsiveness:
May be rigid / tense / stiff / uncoordinated
Avoids of activities requiring body
awareness
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INTERVENTIONS FOR OVER-
RESPONSIVE BODY POSITION
Speech Therapy:
Relaxation techniques
Environmental changes
Hugs and Tugs
Proprioceptive input
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VISION EVALUATION
OBSERVATIONS
Under-responsiveness:
Even with good acuity may touch everything
to learn about it
Miss important visual cues
Miss written directions
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INTERVENTIONS FOR UNDER-
RESPONSIVE VISION
Speech Therapy:
Establish eye contact
Brightly colored adaptations
Multi modality (use of other senses)
Adapted place setting
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VISION EVALUATION
OBSERVATIONS
Over-responsiveness:
Becomes over-excited when too much to
look at
May cover eyes
May have poor eye contact
Overreact to bright lights
Hyper vigilant
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INTERVENTIONS FOR OVER-
RESPONSIVE VISION
Speech Therapy:
Dim lights
Decrease visual stimuli
Establish eye contact
Decrease serving size
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AUDITORY EVALUATION
OBSERVATIONS
Under-responsiveness:
Ignore voices
Difficulty following verbal directions
Speak in booming voice
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INTERVENTIONS FOR UNDER-
RESPONSIVE AUDITORY
Speech Therapy:
Music
Singing fast tunes
Whistling / humming
Visual cues
Head phones
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AUDITORY EVALUATION
OBSERVATIONS
Over-responsiveness:
May cover ears
May complain about noise
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INTERVENTIONS FOR OVER-
RESPONSIVE AUDITORY
Speech Therapy:
Ear Plugs
Headphones
Low soft music
White noise
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OLFACTORY EVALUATION
OBSERVATIONS
Under-responsiveness:
Ignore unpleasant odors
May sniff food, people, or objects
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INTERVENTIONS FOR UNDER-
RESPONSIVE OLFACTORY
Speech Therapy:
Alerting
Strong smells
Peppermint/citrus
Offer several different experiences
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OLFACTORY EVALUATION
OBSERVATIONS
Over-responsiveness:
May object to odors that others don’t notice
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INTERVENTIONS FOR OVER-
RESPONSIVE OLFACTORY
Speech Therapy:
Light scents
Be aware of your own smells (perfume /
cologne)
Avoid strong smelling foods
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AROMATHERAPY
The use of essential oils in therapy intervention.
Most commonly used: in lotion for massage, diffusers within room, added to bath, and/or inhalation.
Essential aromatherapy: A pocket guide to essential oils & aromatherapy.(4th
edition)(2003).New World Library, Novato, CA. Susan Worwood and Valerie Ann Worwood
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AROMATHERAPY – LAVENDER
Most Valuable Uses: Cuts, burns, Rheumatism, sunburn, insect bites, headaches, insomnia, infections, arthritis, anxiety, tension, panic, hysteria, fatigue, rashes, spasms
Used in Lotion for massage, diffusers, bath and inhalation.
Precautions: Some people with low blood pressure may feel a bit
dull and drowsy after using this oil.
Avoid in the early month of pregnancy.
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AROMATHERAPY – PEPPERMINT
Most Valuable Uses: headaches, nausea, fatigue, digestive problems, bowel disorders, muscular pain, shock, faintness, travel sickness, mouth or gum infections, mental tiredness, poor circulation.
Best used in a diffuser, inhalation, or low concentration of lotion.
Precautions: Irritation of the skin and mucous membranes
Avoid contact with the eyes
Avoid if pregnant or nursing (could discourage flow of milk)
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AROMATHERAPY – ROSEMARY
Most valuable uses: muscular pain, Rheumatism, arthritis, muscular weakness, constipation, coughs, colds, memory enhancement, overwork, general debility, hangovers, acne, exhaustion, poor circulation, skin care, migraine, headaches, sinus problems, appetite stimulant
Best used as a rub, massage, inhalation
Precautions: Avoid if pregnant
Avoid using with individuals with epilepsy
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AROMATHERAPY – BASIL
Most valuable uses: weak nervous condition, tension, stress, muscular spasm, concentration, and physical and mental sluggishness, increase appetite
Best used in a diffuser or inhalation
Precautions: Avoid if pregnant
Do not use in baths
Do not use with children under 16 year of age
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AROMATHERAPY –
CHAMOMILE ROMAN
Most Valuable Uses: pain relief, fevers, skin problems, muscular spasms, sedative, depression, nervousness
Best used: lotions, massage, diffuser, inhalation
Precautions: none known
Blends well with lavender
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TASTE EVALUATION
OBSERVATIONS
Under-responsiveness:
Licks or taste inedible objects
May like spicy or hot foods
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INTERVENTIONS FOR UNDER-
RESPONSIVE ORAL
Speech Therapy:
Lollipops
Chewy / crunchy foods
Chewy Tubes®
Massage
Gum
Temperature stimulation to lips and tongue
Vibration
Oral massage
Oral motor exercises
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TASTE EVALUATION
OBSERVATIONS
Over-responsiveness:
Strongly object to certain textures and
temperatures of food
Often gag when eating
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INTERVENTIONS FOR OVER-
RESPONSIVE ORAL
Speech Therapy:
Diet texture / Assessment
Nuk® Massage Brush – desensitize to
decrease gagging
Massage
Temperature stimulation to lips and tongue
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SENSORY FOOD FACTS
Alerting
Crunchy
Sour
Spicy
Chewy
Calming
Chewy
Warm
Hard candy / lollipop
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SENSORY MODULATION
Treating modulation disorders:
How is the client responding?
Optimal level of arousal
Individualized
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SENSORY DEFENSIVENESS
Wilbarger Thera-Pressure Protocol
Wilbarger Oral Thera-Pressure Protocol Patricia Wilbarger
These protocols are usually used for sensory
defensiveness only, however, there have been
improvements when used with behaviors.
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SENSORY DEFENSIVENESS
Demonstration of Wilbarger Thera-Pressure
Protocol
Demonstration of Wilbarger Oral Thera-Pressure
Protocol
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BREAK
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SENSORY DIETS
Scheduled activity program
Individualized specifically for resident’s sensory
needs
Purpose: assist the client / patient to become more
focused, adapted and independent with functional
activities
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EXAMPLE OF SENSORY DIET
Hugs and Tugs
Rub back before getting out of bed
Joint proprioception to trunk in sitting
Massage – lavender lotion
Suckers
Rocking chair
Heavy backpack 10-15 min
Moving furniture (supervised)
Wall push ups
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SENSORY TOOL KIT
Sissel® Seat
Five vibe
Lollipops
Lotion – unscented
Essential oils
Ace bandages
Rice bags
Baby doll / bunny
Snake (vibration)
Theraband
Ear plugs
Wilbarger Thera-Pressure
Brush
Tactile rollers
Stereognosis bag
Shaving cream / pudding
Fabric book
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QUESTIONS?
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THANK YOU FOR YOUR
ATTENTION AND
PARTICIPATION IN THE
COURSE TODAY!
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REFERENCES
Ayres, A.J. (1989) Sensory integration and the child. Los Angeles, Western Psychological Services.
Hanschu, B. (2002) The Ready Approach, modified by L. Barker.
Wilbarger, P, Wilbarger, J.(2001, revised 2006) Sensory defensiveness: A Comprehensive Treatment Approach
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