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Sensory Integration: Theory, Disorders, Interventions

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Title: Sensory Integration: Theory, Disorders, Interventions


1
Sensory Integration Theory, Disorders,
Interventions
  • Presented by
  • Alma Martinez, MOT, OTR
  • Valerie Villarreal, OTS
  • Maggie Flores, COTA

2
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.

3
What Are The Senses?
  • Vestibular- movement
  • Tactile- touch
  • Proprioception- where are your body parts?
  • Visual- seeing
  • Auditory- hearing
  • Taste
  • Smell

4
How Is Information Processed?
  • Main sensory systems
  • Tactile
  • Proprioception
  • Vestibular
  • Transmitters of information from environment to
    the brain

5
Why Sensory Integration?
  • Increases interaction with others
  • Develops necessary skills
  • Organization

6
Sensory Integration Theory
  • Automatic process
  • Natural outcomes occur
  • Learning problems
  • Developmental lags
  • Behavior issues

7
How is SI Used?
  • Understanding the WHOLE environment
  • Learning
  • Understanding what is going on around us
  • Regulation

8
Neurobiologically Based Concepts
  • Neural Plasticity
  • Central Nervous System Organization
  • Adaptive Response
  • Sensory Nourishment

9
Development Process of SI
  • Detection or registration of sensation
  • Modulation of sensation
  • Sensory discrimination
  • Higher sensory integrative skills
  • Targeted occupations

10
INPUT SENSORY INTEGRATION
OUTPUT
Senses
CNS
Result
11
Sensory Processing Disorder (SPD)
  • Problems in directing, regulating, interpreting,
    and responding to sensory input. (Miller,
    Anzalone, Lane, Cermak, Osten, 2007)
  • Can influence childs 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.

12
Impacts On Every day Life
  • Activities of Daily Living (ADLs)
  • Social Participation
  • Education/Work
  • Play/Leisure
  • Rest and Sleep

13
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14
Ten Fundamental Facts About SPD
  • Sensory Processing Disorder is a complex disorder
    of the brain that affects developing children and
    adults.
  • Parent surveys, clinical assessments, and
    laboratory protocols exist to identify children
    with SPD.
  • At least one in twenty people in the general
    population may be affected by SPD.
  • 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.
  • Studies have found a significant difference
    between the physiology of children with SPD and
    children who are typically developing.
  • Studies have found a significant difference
    between the physiology of children with SPD and
    children with ADHD.
  • Sensory Processing Disorder has unique sensory
    symptoms that are not explained by other known
    disorders.
  • Heredity may be one cause of the disorder.
  • Laboratory studies suggest that the sympathetic
    and parasympathetic nervous systems are not
    functioning typically in children with SPD.
  • 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

15
SPD Subtypes
  • Sensory 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

16
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

17
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

18
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

19
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

20
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

21
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)

22
SPD Subtypes
  • Sensory Discrimination Disorder
  • Visual (eye)
  • Auditory (ear)
  • Tactile (touch)
  • Vestibular (movement)
  • Proprioception (muscle)
  • Taste/smell (mouth/nose)

23
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

24
SPD Subtypes
  • Sensory Based Motor Disorder
  • Dyspraxia
  • Difficulty motor planning
  • Postural disorder
  • Poor cocontraction
  • Muscle tone (Low)
  • Equilibrium and posture
  • Immature reflexive abilities
  • Bilateral Integration

25
Examples of Dyspraxia
  • Proprioception
  • Poor motor control and body awareness during
    dressing
  • Vision
  • Navigating through crowded hallways
  • Poor gross motor skills
  • Running
  • jumping
  • Poor fine motor skills
  • Zipping
  • Buttoning
  • Problems in figuring out how to do movements
  • Dressing
  • Complex dance steps

26
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

27
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28
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

29
Support Groups
  • Moms Connect About Autism-MoCAA
  • http//www.momsconnectaboutautism.com
  • Sensory Planet Social Network
  • http//www.sensoryplanet.com/home.php
  • SPD Parent SHARE
  • http//www.spdparentshare.com

30
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

31
Review of challenges/characteristics..
  • Slow Processing - Difficulty shifting attention
  • Inattentive, Difficult to arouse
  • Does not like change
    or transitions -
    Rigid Demands
    routine

32
  • 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

33
  • Aggression to self or others
  • Compulsive Behaviors
  • Difficulty with clothing,
    type of clothing, and
    change of clothing

34
  • Perseveration on topic or activity - Fixation on
    sensory stimuli
  • Clumsy, awkward, difficulty in sports
  • Over or Under-reaction to pain
  • Unsure of group situations, cautious, or a loner

2
35
Work Sheet
  • Which is your student/child?
  • Identify the sensory type (or types) that
    you observe to be true of your
    student or child

36
So What Can We Do?
The "Sensory Diet"
37
The Sensory Diet includes.
  • PROVIDING SENSORY EXPERIENCES
  • A combination of sensory experiences needed by a
    person to adaptively interact with the
    environment (make it through the day).
  • MAKING ENVIRONMENTAL MODIFICATIONS
  • Modification and organization of the environment
    in order to decrease stress on a fragile sensory
    system.

38
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

39
Creating The Sensory D.I.E.T.
  • D ..Do an Informal Assessment
  • I ..Individualize
  • E ..Environmental Supports
  • T ..The Power Senses

40
Do an Informal Assessment
  • Assess the Environment and the Individuals
    response to a variety of sensory experiences
  • Seeker?
  • Active Avoider?
  • Under-Responder?
  • Overwhelmed

41
Individualize the Sensory Diet
  • What has worked for one person may not work at
    all for someone else!

42
Considerations for the Sensory Diet
SEEKER Provide sensory experiences frequently
proactively May need to limit excitatory
experiences
UNDER-RESPONDER Increase the use of visual
supports and routines. Structure the
environment. Time to respond Careful
encouragement to try new experiences
ACTIVE AVOIDER Modify the environment to reduce
the need to escape Gentle introduction to new
experiences
OVERWHELMED Control the environment Limit
stimulation Limit change but prepare for
changes when they need to occur.
43
Environmental Supports
  • Organization
  • Predictable, Structured, Consistent
    Environment
  • Task or Curriculum
  • Visual Supports
  • Escape Environments

44
Proactively Schedule Sensory Activities
  • Use the Power Senses throughout the day 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

45
The Power Senses
Tactile System
46
The Power Senses
  • Vestibular
  • Movement
  • Proprioception
  • Input through
    joints and muscles
  • Tactile
  • Deep Pressure Touch

47
The Power Senses
Tactile System
48
Two Tactile Systems
Protective
Discriminative
49
Tactile System
  • Pertains to the sense of touch
  • Alerts to danger
  • Gives body boundaries
  • Helps provide a basis for body image

50
Protective System
  • Activates Fight, Fright, or Flight
  • Born with this system- Primal
  • Stimulated by light touch, pain, temperature
  • Processed through the emotional, excitatory
    portion of the limbic system
  •  NOT a cognitive response

51
Discriminative Pressure Touch
  • Deep touch/pressure, and vibration
  • Activates Parasympathetic System
  • Calms and organizes
  • Allows for more cognitive response
  • Helps us learn and think

52
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

53
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

54
Interventions for Tactile Defensiveness
  • Brushing Protocols
  • Wilbarger Protocol
  • PRR
  • Brushing 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

55
Why Focus on The Power Senses?
56
Tofill the sensory bucket quickly use the
Power Senses
  • Three Power Senses will provide
  • more input
  • more quickly
  • to make changes that are more rapid

Sensory Bucket
Based on Work of Bonnie Hanshu www.sensoryprocessi
ng.com
57
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

58
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59
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62
Quiet Sensory Area
63
Tactile supports
Heavy Blankets, Pillows, Lap Pads
Pencil Grips
Fidget Items
64
Choose carefully..
Seeker may want this.....
....but need this to avoid getting too "high"...
Avoider Overwhelmed
Under-Responsive
Or
65
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
66
Body Sock
67
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

68
The Power Senses
69
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.

70
Proprioceptive System
  • Motor Planning
  • Awareness of body in
  • time and space without
  • constant visually monitoring

71
Dysfunction of Proprioceptive System
  • Disorganized.. Materials Thoughts
  • Poor or resistance to handwriting
  • Eats in a sloppy manner
  • Resists new motor movement activities
  • Clumsiness, a tendency to fall
  • Lacks awareness of body position/odd posture
  • Difficulty with small objects (buttons/ snap)

72
 Activities that
provide proprioceptive input
  • Joint compression or extension
  • Heavy work activities
  • The larger the joint, the more proprioceptive
    input

73
Examples of Heavy Work
  • Passive Joint Compressions
  • Jumping/Trampoline
    (floor may be better..)
  • Stacking Chairs
  • Weight Lifting
  • Bungee Cord on Chairs
  • Chewing Gum
  • Pretzel Hugs

74
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

75
ALL will need environmental supports
  • Organizational Supports
  • Visual Supports
  • Color coding
  • Timers/Watches
  • Written directions
  • Written rule reminders

Under-Responders will need clear and noticeable
supports
76
What Can Others Do
  • Stay on schedule
  • Pace language
  • Use Concrete Language
  • Use Wait Time

77
The Power Senses
78
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.

79
  • The brain needs
    vestibular input in
    order to function
  • Vestibular input
    provides the
    Strongest Sensation

80
  • Movement can change an individuals attention,
    arousal and alertness in the shortest period of
    time
  • The effects from vestibular input can last longer
    than any other input.

81
Hypersensitive Active avoider and
overwhelmed
  • Fearful reactions to ordinary movement activities
  • Apprehensive walking or crawling on uneven or
    unstable surfaces
  • Seem fearful in open space
  • Appear clumsy
  • Want their feet on the ground!
  • These folks need gentle experiences and support
    as they become more comfortable

82
Hypo-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 stim
  • Be 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

83
 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


84
Selected Strategies
  • Swinging
  • Rocking Chair
  • Sit Spin/Dizzy Disc
  • Therapy Balls as Chairs
  • Moveable Cushions
    or Deflated Beach Balls
    as Chair
    Cushions

85
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

86
Remember
  • Do NOT withhold recess/gym based on the childs
    behavior or inability to
    complete work
  • Movement and activity may
    be the input the
    child needs in order to
    maintain behavior, concentrate
  • and learn!

87
Environmental Supports
  • Firm Supportive seating
  • Feet on floor
  • Desk and chair that fit
  • Railings on step
  • Cushion for movement
  • Space to move and pace

88
Creating The Sensory D.I.E.T.
  • D ..Do an Informal Assessment
  • I ..Individualize
  • E ..Environmental Supports
  • T ..The Power Senses

89
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

90
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.

91
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

92
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.

93
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

94
Activities for auditory sense
  • Soft music
  • Soft voice
  • White noise
  • Quiet room
  • Up beat music
  • Loud voice
  • Instruments/noise makers
  • White noise
  • Classical music

95
Activities for visual sense
  • Soft colors
  • Solid backgrounds
  • Dim lights
  • Desk lamp
  • Uncluttered area
  • Flash light tag
  • Visual schedules
  • Bright colors
  • Bright lights

96
If you have any questions or concerns
regarding your child development and sensory
processing 1- Contact your pediatrician/primary
care physician2- Get a referral for skilled
therapy services3- Contact your therapy provider
of choice
97
Any questions?
98
Alma Martinez MOT, OTRValerie Villarreal
OTSMaggie Flores, COTAYou may reach us at
6550 Springfield Ave Ste. 101(956)
725-4555email fivestartherapy_at_yahoo.com
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