Sensory Integration Sensory Integration ReviewReview

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Sensory Sensory processing/integrationprocessing/integration

is the organizing, processing and interpreting is the organizing, processing and interpreting of information from movement, touch, sounds, of information from movement, touch, sounds, visual input, taste and gravity that allows us to visual input, taste and gravity that allows us to interact with our world.interact with our world.

Sensory Integration Theory and Practice, 2nd ed.Anita Bundy, Shelley Lane, Elizabeth Murray

What is Sensory Modulation?What is Sensory Modulation?

Sensory modulation is when the senses work together. Sensory modulation is when the senses work together.

Each sense works with the others to form a composite picture of Each sense works with the others to form a composite picture of -who we are physically -who we are physically -where we are -where we are -what is going on around us-what is going on around us

Sensory modulation is a neurological function that is responsible Sensory modulation is a neurological function that is responsible for producing this composite picture. for producing this composite picture.

It is the organization of sensory information for on-going use. It is the organization of sensory information for on-going use.

Each sensory system has two Each sensory system has two componentscomponents

One that arouses or alerts our attentionOne that arouses or alerts our attention One that allows us to explore our environment One that allows us to explore our environment

and examine detailsand examine details

We need a balance between these two componentsWe need a balance between these two components

Passive Passive ActiveActive

HighHigh

ThresholdThresholdPoor Poor

RegistratioRegistrationn

Sensory Sensory

SeekingSeeking

Low Low

ThresholdThresholdDefensiveDefensive AvoidingAvoiding

Dunn, W (2002). Implementing a Sensory Processing Approach In School Practice. SCOTA Conference, Charleston, SC.

The Sensory DietThe Sensory Diet

A “sensory diet” (coined by OT Patricia A “sensory diet” (coined by OT Patricia Wilbarger) is an activity plan that provides the Wilbarger) is an activity plan that provides the sensory input a person needs to stay focused sensory input a person needs to stay focused and organized throughout the day. and organized throughout the day.

Sensory input needed to be:Sensory input needed to be:most alert, adaptable, and skillfulmost alert, adaptable, and skillful

Just as you may jiggle your knee or chew gum Just as you may jiggle your knee or chew gum to stay awake or soak in a hot tub to unwind, to stay awake or soak in a hot tub to unwind, children need to engage in stabilizing, children need to engage in stabilizing, focusing activities too. focusing activities too.

With the right input, our bodies feel calm, alert With the right input, our bodies feel calm, alert and ready to tackle daily challenges. Negative and ready to tackle daily challenges. Negative sensory input can have a disorganizing affect sensory input can have a disorganizing affect on the body.on the body.

TactileTactile

Sensation derived from stimulation to the skinSensation derived from stimulation to the skin

TactileTactile

AlertingAlertingLight touchLight touch

TicklingTickling

Hot or cold food (strong Hot or cold food (strong temperature)temperature)

Playing in textures (rice, sand, Playing in textures (rice, sand, beans, finger painting, playdoh)beans, finger painting, playdoh)

Go barefoot, use textured towels/ Go barefoot, use textured towels/ blankets/ objectsblankets/ objects

Chose crafts with touch feedback Chose crafts with touch feedback (gluing, clay molding, etc)(gluing, clay molding, etc)

CalmingCalmingFirm pressure on skin, longer durationFirm pressure on skin, longer duration

Hold hand firmlyHold hand firmly

Avoid unnecessary touch and Avoid unnecessary touch and forewarn of necessary touchforewarn of necessary touch

Weighted vests, blankets, etc.Weighted vests, blankets, etc.

Wilbarger Brushing Program (under Wilbarger Brushing Program (under OT direction)OT direction)

Oral tactile defensiveness strategiesOral tactile defensiveness strategies

..

• under responsiveness/ poor registration•Defensive/ Avoiding

principles:

Tactile SenseWhat it looks like in the child

• Defensive with light touch, will not tolerate hair-brushing, haircuts, hair washing, etc.

• Particular about type of clothing, how it fits, tags must be cut out.

• Difficulty walking barefoot on grass, and must assimilate to sand slowly. Change in walking surface is tough when barefoot.

• Defensive with gentle touch or affection, prefers firm pressure when touched.

How we treat the child

• Equipment we have: resistance tunnel, brush, koosh balls, cotton balls, sand, rice, beans playdoh, vibrating tools, and any food he will tolerate.

• Wilbarger brushing/joint compression protocol.

• Throughout the day we encourage the child to try new input, with each success he is rewarded.

• Educate those Xander interacts with.

Defensive

ProprioceptionProprioception It is the sense that indicates whether the body It is the sense that indicates whether the body

is moving with required effort, as well as is moving with required effort, as well as where the various parts of the body are located where the various parts of the body are located in relation to each other. in relation to each other.

ProprioceptionProprioception..

Calming/ Calming/ OrganizingOrganizing

““Heavy work”, jump, crash, resistance, Heavy work”, jump, crash, resistance, push/pullpush/pull

i.e. squeeze ball, carry groceries, jump i.e. squeeze ball, carry groceries, jump on trampoline, tug of war, on trampoline, tug of war, weighted bookbag, pillow crashing, weighted bookbag, pillow crashing, hanging by arms or climbinghanging by arms or climbing

•Underresponsive/ seeking as a modulator•Defensive?? (little evidence for)

principles

Proprioceptive Sense

What is looks like in a child

• Seeks high impact in play- running, jumping, bumping into people and objects often.

• Runs, jumps, bounces, wiggles nearly continuously! (Looks a lot like hyperactivity.)

• Even “at rest” he often rolls, kicks, flicks his arms/legs, drags his head, etc.

• Seeks deep impact during typical daily routine activities- rubbing against walls as he walks, bouncing off of or pushing on objects.

Seeker

How we treat the child

• Equipment we have: mini-trampoline, weighted vest, bear hug vest, weighted shoes, pillow and blanket, ball pit, therapy ball, vibrating tools, joint compressions (with brushing protocol).

• Allow plenty of time for gross motor play, including lots of rough play (wrestling, “steam roller”, pillow fights).

VestibularVestibular Sensation that contributes to our balance and Sensation that contributes to our balance and

our sense of spatial orientation, is the sensory our sense of spatial orientation, is the sensory system that provides the dominant input about system that provides the dominant input about movement and balance.movement and balance.

VestibularVestibular

AlertingAlertingChanges in speed and directionChanges in speed and directionChange of head positionChange of head positionSwinging (tire swing with lots of Swinging (tire swing with lots of

directional changes)directional changes)SlidingSlidingSomersaultsSomersaultsDragging on a blanketDragging on a blanketBouncing on adult’s knee/ therapy ballBouncing on adult’s knee/ therapy ballMovement activity prior or during a Movement activity prior or during a

thinking taskthinking taskMovement breaks in class (accompany Movement breaks in class (accompany

on errands to office, library, etc.)on errands to office, library, etc.)

CalmingCalmingLinear, predictable, repetitiveLinear, predictable, repetitive

Head moving in straight lineHead moving in straight line

I.e.. Rocking chair, bouncing up and I.e.. Rocking chair, bouncing up and down, gentle linear swingingdown, gentle linear swinging

Allow child to direct Allow child to direct

Couple with “organizing inputs” Couple with “organizing inputs” (proprioceptive input, deep (proprioceptive input, deep pressure, etc.) pressure, etc.)

I.e. Swing and crash! Child I.e. Swing and crash! Child swings with feet held firmly with swings with feet held firmly with pulling/ pushing, etc.pulling/ pushing, etc.

•Under responsiveness/ poor registration/ seeking•Defensive/ Avoiding

•Gravitational Insecurity

Vestibular Sense

What is looks like in a child

• At times he strongly seeks vestibular input by spinning, hanging upside down from furniture, standing on his head, swinging, riding his bike.

• Other times he avoids taking his feet off the ground, resists movement in the car, avoids swings, dislikes riding in the stroller/wagon..

Fluctuates

How we treat the child

• Equipment we have: swings (indoor and outdoor), scooter board, mini-trampoline, therapy ball, during summer we go to the pool often.

• During periods of seeking, we give the child sensory choices to feed his need - then transition to new activities.

VisualVisual

AlertingAlerting

High intensity, contrast, or change of High intensity, contrast, or change of stimulistimuli

i.e. bright lights, contrasting colorsi.e. bright lights, contrasting colorsCover blocks in foil, roll a clear Cover blocks in foil, roll a clear ball with moving objects inside, ball with moving objects inside, highlight words, label drawers highlight words, label drawers with bright colorswith bright colors

Use visual input to engage the Use visual input to engage the seeking childseeking child

CalmingCalming

Low contrast, dimLow contrast, dim

i.e. low lights, uncluttered i.e. low lights, uncluttered environments, decreased environments, decreased competing stimuli with attending competing stimuli with attending to a task, set up visual blinds with to a task, set up visual blinds with sheets over cluttered areas, allow sheets over cluttered areas, allow visual breaks in a dark roomvisual breaks in a dark room

•Underresponsive/ Seeking•Defensive/ Avoiding

Visual Sense

What it looks like in a child

• Easily overwhelmed in cluttered environment with numerous stimuli to accept

• Easily distracted by visual stimulus in every day environment and sometimes hides eyes

• Easily distracted by school work/ therapy/ ABA work that is visually over stimulating; making it difficult to complete an assignment or task.

•Sometimes repeatedly tracks for no apparent reason

FluctuatesHow we treat the child

• During defensive times we give him time in a dark room, sometimes with his eyes/head covered.

• In the community we take a blanket which he will pull over his head when over stimulated.

• Hand held video games give him something to focus on when the surroundings are too much to handle.

• We often use visual supports/ but keep them simple and avoid extraneous pictures/ colors

AuditoryAuditory

AlertingAlerting

Strong intensity or changing soundsStrong intensity or changing sounds

Music with unpredictable rhythmMusic with unpredictable rhythm

I.e.. Ring bell at stimuli you want I.e.. Ring bell at stimuli you want child to attend tochild to attend to

CalmingCalming

Repetitive, constant, quietRepetitive, constant, quiet

Rhythmic music, Rhythmic music,

Quiet spaces for child to retreat to when Quiet spaces for child to retreat to when over stimulatedover stimulated

Carry headphones with calm, rhythmic Carry headphones with calm, rhythmic musicmusic

Warn of loud noises, use earplugsWarn of loud noises, use earplugs

In Class, seat away from loud speakers In Class, seat away from loud speakers and trafficand traffic

•Under responsive/ Seeking•Defensive/ Avoiding

Auditory SenseDefensiveWhat it looks like in a child

• Defensive with loud sounds or too many sounds at once. If more than one person speaks at once, he is easily upset.

• Often screams or begins self stimulatory behavior in situations he cannot control when the auditory stimuli is overwhelming.

• Puts his hands over his ears and seeks a secluded space, usually with his own verbal protest…attempting to drown out the offensive noise.

How we treat the child

• At home we limit unnecessary noise, enforce strict rules regarding appropriate speaking, give warnings for loud noises.

• In times of unexpected loud noise, we give bear hugs while removing him calmly and quietly from the noise/situation immediately.

• Outside our home we prepare by describing noises he will hear, or give him headphones to drown out the noise.

Taste/ SmellTaste/ Smell

AlertingAlerting

Strong intensityStrong intensity

i.e. Spicy, sour, such as warheads, i.e. Spicy, sour, such as warheads, sour patch kids, BBQ sauce, sour sour patch kids, BBQ sauce, sour straws)straws)

CalmingCalming

Mild intensity, nondistinct or familiar Mild intensity, nondistinct or familiar qualities, gradually progress qualities, gradually progress tastes to expand diettastes to expand diet

i.e. Use unscented cleaning i.e. Use unscented cleaning products/ soaps, start with bland products/ soaps, start with bland foods (cream of wheat, mashed foods (cream of wheat, mashed potatoes)potatoes)

•Underresponsive/ Seeking•Defensive/ Avoiding

The Sensory DietMorning Routine

Brushing/Joint Compressions

At school: Bear Hug Vest, Weight Vest, Crash mat, Brushing/Joint Compression

After school: Quiet Activity (rest time)

Sensory Choice(s)

Afternoon Activities including calming input & brushing

Evening Routine

Brushing/Joint Compressions

Outside Play

Sensory Choice(s)

Dinner

Bath/Brush Teeth/Pajamas

Brushing/Joint Compressions

Quiet Time (reading, tv, massage)

Other ways to handle Sensory Integration difficulty…

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Visual Schedule

“How does your engine run?”

(ALERT Program)