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Sensory Integration Dysfunction: Whats a Family to Do

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Title: Sensory Integration Dysfunction: Whats a Family to Do


1
Sensory Integration Dysfunction Whats a Family
to Do?
  • Home ideas for students with difficulties with
    sensory processing
  • Elisa Wern OTR/L
  • Tools for Success February 1, 2003

2
Back to Basics What is Sensory Integration or
SI????
  • the term SI refers to Sensory Integration, which
    is a normal brain process
  • Basically SI is the ability for our body to take
    in information from the world and turn it into
    usable information, helping to orient us, keep us
    attentive, and able to move and be in the world.
  • dysfunction in sensory integration is used to
    refer to a child with a problem in the normal
    process of sensory integration, we call that
    Dysfunction in Sensory Integration, or DSI. (Dr.
    Lucy Miller)

3
What are some signs of Sensory Integrative
Dysfunction? 
  • overly sensitive to touch, movement, sights, or
    sounds
  • under-reactive to touch, movement, sights, or
    sounds
  • easily distracted
  • social and/or emotional problems
  • activity level that is unusually high or
    unusually low
  • physical clumsiness or apparent carelessness
  • impulsive, lacking in self control
  • difficulty making transitions from one situation
    to another
  • inability to unwind or calm self
  • poor self concept
  • delays in speech, language, or motor skills
  • delays in academic achievement

4
SENSORY INPUT
5
The Continuum of Processing/Responses to Sensory
Info
Typical
HYPO
Hyper
  • In each sensory system, a child may be
    under-responsive hyposensitive or
    over-responsive hypersensitive to input.
  • When a person is hyposensitive to input, they
    often need extra input within that sensory system
    to maintain a regulated, calm attention level.
  • They may not attend to sensory information
    presented to them, or they may seek out
    additional information.
  • When a person is hypersensitive to certain
    sensory information, that input can be perceived
    as painful or uncomfortable.
  • They may respond by avoiding or withdrawing or
    become anxious, distressed, or even aggressive.
  • Persons who may have unregulated sensory systems
    may also experience difficulties with motor
    planning, postural control, social/ emotional
    functioning, body awareness and scheme, and
    academic skills.

6
When are sensory integration problems actually
considered a dysfunction? Doesnt everyone
experience problems at one time or another?
  • Yes we all experience problems in processing
    sensory stimuli on occasion.
  • Examples
  • going to a rock concert with crowds of people can
    be so overwhelming that you have to leave before
    it is over.
  • Riding a roller coaster and feeling sick or
    wobbly when you get off means you were probably
    overloaded with vestibular stimuli.
  • Being overly sensitive to smells when you are ill
    is another example.
  • An occasional experience of disorganized
    sensations is very normal.
  • It becomes a dysfunction when the sensations are
    disorganized so much and so often that it
    interferes with activities of daily living.

7
Bubble Gum/Tootsie Roll Break
8
So what do I do?
  • If you think your child may have difficulty
    processing sensory information
  • Talk to your childs teacher to see what they are
    seeing
  • Try to incorporate activities at home and school
    with assistance of teacher to help your child
    better use and benefit from the information
    he/she takes in by senses

9
What Activities do I do?
  • Well, that depends on your child
  • Remember - There are two very broad categories of
    how children process informationthe hypo- and
    hyper-responses...
  • However, each child could be at different ends of
    the continuum for each type of sensory
    information

10
So you have to be a detective?!?!
  • Investigate your child - when do you see some of
    these behaviors?
  • When you do see them - what are they doing?
  • Do they avoid an activity most children enjoy?
  • Are they overly excited or do you notice they are
    always on the go or involved in particular
    activities?

11
Typical
HYPO
Hyper
Look at responses for each area
12
Why encourage sensory-based activities at home?
  • Children with sensory processing problems can
    benefit from appropriate sensory experiences
    within play or daily activities.
  • Most of the following suggestions provide either
    movement, muscle resistance/ "heavy work" or deep
    pressure to the skin and can help reduce touch
    and movement sensitivity, and improve body
    awareness and coordination.
  • "Sensory seekers" are very active children who
    are always on the go with a short attention span.
    They typically respond positively to increased
    sensory input in repetitive activities, which
    work muscles- this helps children focus their
    attention and coordinate their actions
  • Children who overreact to input may be very
    sensitive or distressed by certain sensory inputs
    (every day sounds like vacuums or blenders, being
    touched lightly, tickling) but find others
    enjoyable and calming (bear hugs, sleeping under
    heavy quilts, massage).

13
General guidelines for organizing home
activities for children with sensory processing
disorders
  • Keep routines/possessions in the home organized
    and structured as much as possible.
    Predictability and a daily routine can be very
    helpful.
  • Be consistent with daily rules and consequences.
    Perhaps all family members can discuss house
    rules, determining appropriate behavior and
    routines (and consequences when they are not met)
    in advance. These can be posted if necessary.

14
  • Keep a large calendar or schedule posted. The
    calendar can be made with "event" stickers or
    photos for a child not yet reading. The system
    used should highlight the daily and weekly
    routine and allow a visual representation of the
    childs day. In that way, the child can be
    alerted to changes in advance. Perhaps the child
    can go over the schedule for the following day
    each evening before bed.

15
  • Create specific routines for difficult times of
    the day or responsibilities (e.g., bedtime, bath
    time, morning self care before school). The
    routine can be broken into small steps and these
    can be posted in a checklist form or picture form
    for the child to look at each time the routine is
    performed. If the child is old enough, the
    checklist might help him/her be independent in
    the routine.

16
  • Make errands and transitions concrete and
    illustrate with pictures, when possible. For
    children who need extreme predictability and
    routine - make a photo book of places you go with
    your child, and keep it in the car, so that when
    a daily schedule is disrupted, you can show the
    child "This is where we have to stop today before
    we go to.." This may help with distress levels
    when the normal schedule is not being followed.

17
Choosing Activities
How does your Child Respond?
  • Children can have different responses to
    different sensory input - which can make choosing
    what activities to do with your child difficult!

Response
AVOIDER
SEEKER
PROVIDE INPUT IN APPROPRIATE WAYS
EXPOSE TO ACTIVITIES OVER TIME WITH SUPPORT
ENCOURAGEMENT
18
Children Who Need Sensory Input to Stay on
Task(HYPO) SEEKERS
  • Some children are "sensory seekers" and become
    more organized and attend better to a task if
    they receive periodic movement input, such as  
  • Sit on a camping/inflatable pillow filled with a
    small amount of air. This allows for movement
    while doing seat work without leaving the desk.
    There are companies that sell wiggle seats, but
    any partially deflated pillow will produce the
    same effect, for less money!
  • Suggest 5 minutes of swinging or climbing during
    outside play time before having to concentrate on
    a task such as homework.
  • Rhythmical, sustained movement e.g., marching,
    washing windows/tables or bouncing can be
    organizing to the central nervous system.
  • Never discipline a "sensory seeker" by taking
    away free play outside at home or P.E. at school
    - you will intensify the random movements,
    fidgeting and outbursts if they are not able to
    get the info they seek and need.

19
  • Some children also need extra sensory input to
    their mouths (ORAL) and hands (TACTILE) in order
    to organize their behavior, such as
  • Drinking from water bottles kept at desk (send
    them home weekly to be washed).
  • Chewing on rubber tubing placed on the end of a
    pencil, straw or coffee stir stick. 
  • A bucket or fanny pack of "squeezies" in can be
    used by children who like to fiddle with
    something in their hand. A "squeezie" is a small
    object which is soft and can fit in the hand
    e.g., balloons filled with flour, soft balls,
    "dog" toys or koosh balls. 
  • Like we have --- You can inexpensively make a
    fidget toy with sand or flour and balloons.

20
  • Hanging by the arms on the monkey bars for 20-30
    seconds at a time.
  • Pushing/carrying heavy objects i.e., books,
    moving desks or "pushing" against walls.
  • A reading corner in the childs room with a bean
    bag chair makes a wonderful place to escape from
    too much stimulation and help get ready for more
    focused homework. They might enjoy reading or
    sitting under the bean bag chair more than
    sitting on it.     REMEMBER Some children
    need to move in order to pay attention. Watching
    children can provide cues to choosing activities
    to provide appropriate sensory for organizing
    behavior and improve attention. 

21
Children Who are Oversensitive to Sensory Input -
(Hyper) AVOIDERS
  • Children who are sensitive to light, unexpected
    sensory input often prefer firm
    touch/pressure/input which helps organize their
    behavior. Keep the following tips in mind
  • Approach the child from the front to give a
    visual cue that light touch is coming. 
  • Firm pressure to the shoulder or back is
    preferable to a gentle hand placement or a brush
    to the sleeve, arm or face.

22
  • When working on home work area should be out of
    traffic towards the periphery/sides of the room
    so that the child has a good view of whos moving
    and where they are going. 
  • Crowded places and situations can cause
    discomfort because of the possibility for
    unexpected bumps and brushes. Seat a small child
    in the adults lap or next to a quiet child
    during a group gathering. Place older children to
    the side or in back of the group.

23
The Alert Program
  • The Alert Program teaches strategies for self
    regulation/processing to improve functional
    skills for learning.
  • The Alert Program uses the analogy of engine
    speeds to make it easier for children to
    understand.

24
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How Do We Get to the Just RightEngine Speed?
  • Sensory-motor Strategies
  • Heavy Work
  • Proprioceptive input from the muscles and
    joints
  • Can have both a calming and alerting influence
  • Can be used when engines are in high or low
    speeds

28
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29
Put Something in the Mouth
  • Many common strategies used to regulate alert
    state involve the mouth.
  • Both children and adults use the mouth to change
    state.
  • Foods that are alerting tend to be cold,
    sour/tart, spicy, minty, or crunchy.
  • Foods that are calming tend to be warm, smooth or
    sweet.
  • There are also foods that provide heavy work to
    the jaw and cheek muscles.

30
MOVE
  • Gross motor movements are those that hold the
    body up against gravity and allow children to
    move.
  • These activities usually use large muscle groups.
  • Movement can be used to improve attending/alert
    state.
  • Try moving before you need to concentrate.

31
TOUCH
  • Tactile input can be alerting or calming.
  • Light touch can be alerting. Deep pressure touch
    can be calming.
  • Many of us may rely on having something in the
    hand for self-regulation.

32
LOOK
  • Visual input in the environment significantly
    affects our ability to attain, maintain and
    change our levels of alertness.
  • Dim lighting, muted colors, and plain walls can
    be calming.
  • Bright lighting, lots of color, and variety tends
    to be alerting.

33
LISTEN
  • Sounds that are most alerting are ones that are
    arrhythmical, of short duration, loud, or novel.
  • Sounds that are calming (easiest on the nervous
    system) tend to be rhythmical (in a predictable
    pattern), of long duration, quiet, and familiar.
  • White noise is a type of sound that provides a
    filter for the listener.

34
Incorporating sensory input in specific home
routines
  • Bath time scrub with washcloth or bath brush,
    use a variety of soaps and lotions for bathing
    play on the wall with shaving cream or silly
    soap rub body parts with lotion after bath (deep
    pressure like a massage) or sprinkle powder onto
    body parts and either rub or brush into the skin.

35
  • Meal preparation or baking let your child help
    with mixing ingredients, especially if they are
    thick since this will work arm and hand muscles.
    If baking, let child help mix and roll dough and
    push it flat, if needed. Allow child to help
    carry pots of cold water for the stovetop (with
    supervision of course). If needed, have child
    help tenderize meat by pounding with a meat
    mallet.

36
  • Grocery shopping have child push the shopping
    cart, carry groceries and help put them away. 
  • Mealtime encourage child to drink from a straw
    and provide lots of very chewy and resistive
    foods, if they are tolerated. If you have trouble
    keeping your child seated because she likes to
    jump up for stimulation, try an air-filled seat
    cushion, which will allow motion within the seat.
    Perhaps using a weighted lap blanket will help
    the child remain seated at the table longer.

37
  • Around the house let the child help vacuum, and
    also help move furniture before and after
    vacuuming. Read books together in a rocking
    chair. Provide a quiet place for the child who
    gets too wound up. This place should be used as a
    "decompression" spot (not as a punishment). When
    you see the child getting a little excited you
    can say"you know, it looks like you could use a
    quiet place now, you seem a little excited." The
    place should be quiet, comfortable, soft, and
    dim.

38
  • Bedtime if your child has trouble sleeping you
    can try adjusting the linens to add weight and
    texture. Sometimes adding lambs wool or something
    soft allows for deeper uninterrupted sleep. Also,
    heavier blankets and quilts (even if it seems too
    hot) may help. You can also try different fabrics
    for the sheets and pillowcases (cotton jersey for
    example)

39
Miscellaneous Home Ideas
  • Play the "sandwich" game using couch or bed
    pillows. Sandwich your child between two pillows
    and squish them. Apply pressure to their command
    (ask harder or softer). Some children like a lot
    more pressure then we think they would.
  • Make up obstacle courses around the house using
    furniture, toys and other objects to reinforce
    sequencing body movements. Have the child do as
    many steps as they are able to remember and
    complete. You can use crawling, hopping,
    skipping, climbing, rolling, and a variety of
    other movements depending on how much space you
    have available. 

40
TACTILE EXPERIENCES
  • Making mudpies and sandcakes
  • Drawing with wet or dry chalk
  • Painting sidewalks and fences with water
  • Handling and pedaling tricycles
  • Walking barefoot
  • Planting in the garden
  • Playing in the sink or bathtub
  • Building with blocks
  • Manipulating small objects such as Legos,
    dominoes and jigsaw puzzles
  • Using classroom tools, such as crayons, scissors,
    and brushes
  • Examining natural objects, such as pine-cones,
    feathers, sticks, and rocks
  • Lying on pillows or beanbag cushions
  • Curling up in "secret hideaways"
  • Petting and feeding animals
  • Finger-painting with paint, shaving cream, or
    chocolate pudding
  • Gluing art projects
  • Manipulating play dough
  • Washing hands with soap and drying hands with
    towels
  • Stirring cookie dough
  • Eating snacks with different textures, such as
    cheese, pretzels, and fruit
  • Handling rhythm instruments
  • Playing Dress up
  • Hugging and roughhousing gently with
    friends/family

41
More Tactile Experiences
  • games of "find the buried toy in the shoebox full
    of dry macaroni noodles (or Slime)",
  • "draw/write with your fingers in the whipped
    cream (or shaving cream) on the mirror",
    playdough, and similar activities.
  • You can let your child play with a vibrating
    massager, or you can give him a massage with it.
  • Create critters with gum drops (they're sticky)
    and toothpicks. You can eat them when you're
    done!

42
VESTIBULAR EXPERIENCES
  • Swinging in circles on a tire swing
  • Riding on a playground merry-go-round
  • Swinging back and forth
  • Riding up and down, walking, and balancing on a
    seesaw
  • Jumping on a trampoline or mattress
  • Jumping from a step or from the playground
    equipment
  • Climbing a jungle gym
  • Sliding down a slide
  • Ascending and descending stairs
  • Rolling and sledding down the hill
  • Somersaulting
  • Running
  • Walking on uneven surfaces, such as grass or sand
  • Walking on a balance beam, railroad tie, or low
    wall
  • Let your child rock in a chair or spin him around
    while holding him tightly
  • Get a hammock chair and hang it from the swing
    set for a deep pressure swing.

43
Oral Processing Experiences
  • Any candy that is resistive or tough to chew -
    for example tootsie rolls or gummy bears
  • some children respond well to an electric
    toothbrush when doing their morning/night routine
    - for children who are very defensive - this is
    something which must be done with great caution
  • You may want to get one of those lollipops that
    twirl around. They have a handle with a battery
    that makes it spin. It provides good oral input,
    and you can find them at the checkout area of
    department stores like Wal-Mart.

44
Other Good Oral Input Sources
45
PROPRIOCEPTIVE EXPERIENCES
  • Pushing and pulling wagons
  • Moving through an obstacle course
  • Playing "bumpety-bump" on the tire swing
  • Hanging from monkey bars
  • Stretching up to the sky, like growing plants
  • Playing horsey
  • Wheelbarrow walking
  • Pouring sand, beans, water, or juice from one
    container to another
  • Ripping paper
  • Hammering nails into Styrofoam
  • Pressing pegs into pegboards
  • Getting in and out of seat belts, jackets and
    boots, shoes and socks
  • Opening doors without help
  • Tumbling on the ground
  • Wrestle.
  • Make a kid sandwich out of your child. He can be
    the meat. Two cushions can be the bread.
  • Encourage the heavy pet dog to sleep and play
    with your child.
  • Monkey bars and swinging from a trapeze or rings
    provide pressure to the joints.

46
Resources for Parents
  • Heavy work list for parents (Deanna Sava and
    Elizabeth Haber both OTs) - FOR ALL THOSE
    SEEKERS OUT THERE!
  • Internet sites listing email sign up or I can
    mail it to you if you dont have access to email!
  • The Out of Sync Child by Carol Stock Kranowitz
  • ISBN 0399523863
  • There is also a new companion book out with many
    more activities - The Out of Sync Child Has Fun
    also by Carol Stock Kranowitz
  • ISBN 0399528431
  • Take Five! Staying Alert at Home and School, by
    Mary Sue Williams and Sherry Shellenberger ISBN
    0964304112

47
How to find OTs in the School System
  • Call your childs school and leave a message for
    the OT who covers that school.
  • If you have general questions or are searching
    for a resource in a particular area feel free to
    email me at Elisa_at_alumni.ufl.edu and I will try
    my best to help connect you to resources or other
    assistance...

48
ANY QUESTIONS?????????
Have a great time playing with your child - and
helping him or her to better use his sensory
system both at home and at school...
Hopefully you have gained some new understanding
of what sensory processing is, how to determine
your childs sensory needs - and strategies and
activities to use with your child - remember you
are a key to your childs success - be a
detective and then HAVE FUN!
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