Sensory Integration Seeing Behaviour Through Sensory Eyes OARCS Conference Heather MacEwen, O.T. Reg

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Sensory Integration  Seeing Behaviour Through
Sensory EyesOARCS Conference Heather MacEwen,
O.T. Reg. (Ont.)

• October 23, 2007
• Confidential
• This document is the confidential property
  of blueballoon Health Services. This document
  should not be shared by any means outside the
  designated personnel without the express written
  permission of authorized blueballoon management.

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Outline of Presentation

• Introduction
• Sensory Integration Background
• Dr. A. Jean Ayres Founder of Sensory
  Integration Theory
• Sensory Systems
• What? Where? Why?
• Manifestations of Sensory Integration Dysfunction
  (SPD)
• SIPT (Sensory Integration Praxis Tests)
• Key Principles to SI Intervention
• Discussion

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Heather MacEwen

• Occupational Therapist (MCl.Sc. OTC)
• Canadian and USA (educational, hospital and
  clinical settings)
• Experience with children with a range of
  abilities and disabilities
• Experience collaborating with other healthcare
  professionals and educational specialists
• Sensory Integration Training and Certification
  (SIPT) and Therapeutic Listening
• Co-founder of blueballoon
• Director, blueballoon Occupational Therapy

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Sensory Integration Background

• Sensory Integration is a theory of
  brain-behaviour relationships originally proposed
  by A. Jean Ayres in the 1970's (Bundy, Lane, and
  Murray, 2002).
• A. Jean Ayres (PHD, OTR) occupational therapist
  with advanced training in neuroscience and
  educational psychology
• Definition sensory integration is the
  neurological process that organizes sensation
  from ones own body and from the environment and
  makes it possible to use the body effectively
  within the environment (Ayres, 1972a)

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HUH? Say again?

• It is a process that occurs in the brain that
  allows us to make sense of our world by
  receiving, registering, modulating, organizing
  and interpreting information that comes to our
  brains from our senses.
• Sensory experiences include touch, movement, body
  awareness, sight, sound and the pull of gravity.
  The process of the brain organizing and
  interpreting this information is called sensory
  integration.
• Sensory integration provides a crucial foundation
  for later, more complex learning and behaviour.

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Sensory Integration Theory

• Sensory Integrationa theory, treatment approach
  and frame of reference! It is rarely used in
  isolation!
• Because we can't see the brain as it processes
  information, we rely on observations of a child's
  behaviour, then create hypothesis of what's
  happening in the brain.
• The brain processes all the information received
  by our senses, usually at an unconscious level,
  organizes it, and allows us to respond
  appropriately.

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Sensory Integration

• Sensory integration draws from literature from
  the fields of neuropsychology, neurology,
  physiology, child development and psychology
• Variety of disciplines and research areas have
  contributed to SI theory development and
  intervention strategies.
• Learning is believed to be "dependent on the
  ability to take in and process sensation from
  movement and environment and use it to plan and
  organize behavior" (Bundy, Lane, and Murray,
  2002).

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Sensory Integration at its BEST
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Sensory Systems

• Tactile System sensation derived from
  stimulation to the skin
• Proprioceptive System sensations derived from
  movement (i.e., speed, rate, sequencing, timing,
  and force) and joint position derived from
  stimulation to muscle and, to lesser extent,
  joint receptors, especially from resistance to
  movement
• Vestibular System sensation derived from
  stimulation to the vestibular mechanism in the
  inner ear that occurs through movement and
  position of the head contributes to posture and
  the maintenance of a stable visual field
• Visual System
• Auditory System
• Gustatory
• Olfactory

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And yet again

• Sensory integration provides a crucial foundation
  for later, more complex learning and behaviour.

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Possible Signs of Sensory Integration Dysfuction

• Children with SI dysfunction may present
  with some of the following behaviours
• over or under sensitivity to touch and/or
  movement experiences
• easily distracted
• clumsiness
• poor self concept
• trouble organizing themselves and their work
• emotional reactivity, trouble learning new skills
• easily frustrated
• trouble making transitions between activities or
  situations
• Many of these behaviours may be seen in
  developing children

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Manifestations of Sensory Integration
Dysfunction(Bundy, Lane, Murray, 2002)

• SI DYSFUNCTION

Poor Discrimination
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Sensory Modulation

• Modulation allows us to filter irrelevant sensory
  information while attending to meaningful
  sensations
• Sensory modulation disorder
• A problem in the ability to organize the degree
  and intensity and nature of response to sensory
  input in a graded and adaptive manner
• Under or over responsiveness to sensory input
  from the body or the environment

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Sensory ModulationDisorder

• Over Responsiveness (sensory sensitivity)
• The child reacts strongly and/or negatively to
  sensory input that most of us do not perceive as
  a threat
• The child is highly responsive to and distressed
  by changes in the environment
• It take very little input to elicit a response
• The child is easily distracted (appears to be
  different from that of ADHD)
• The child averts self-care tasks
• May lead to avoidance or withdrawal behaviours or
  emotional outbursts

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Sensory ModulationDisorder

• Under responsiveness (low registration)
• the child fails to react to the intensity of
  frequency of sensory input in the expected way
• there is limited responses to changes in the
  environment and/or facial expressions or gestures
• the child exhibits clumsiness
• the response is dulled or over modulated
• the child appears lethargic, passive,
  self-absorbed, low activity level
• a response requires high levels of input

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Sensory Discrimination

• Discrimination allows us to take in information
  from our sensory systems and use it
  successfully and appropriately in order to
  respond and make adaptive responses
• Children with sensory discrimination difficulties
  experience problems with identifying or
  interpreting sensory input
• Ex finding your keys in your pocket or purse
  without looking
• Ex locating and identifying your cell phone
  ring

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Praxis (more than just motor planning)

• Ideation
• The ability to recognize the potential of play in
  items and toys
• Knowing the goal
• Motor Planning
• The ability to plan and sequence ones motor
  actions to complete the desired task and outcome
• Motor planning requires that the child needs to
  cognitively plan the positions of the body and
  sequence movements accordingly
• Execution
• The ability to carry out the motor actions to
  perform the desired task
• Accomplishment

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Dyspraxia

• Dyspraxis means disordered motor planning.
• Apraxia means that motor planning is almost
  absent - characterized by loss of the ability to
  execute or carry out learned purposeful movements
  
• Breaking down praxis
• Praxis on verbal command
• This is the ability to integrate a verbal command
  and motor response
• Postural Praxis
• The ability to imitate body position is called
  postural praxis.
• Sequencing Praxis
• Sequencing tasks is the ability to know how to
  get things done in order.
• Oral Praxis
• This is the ability to organize sequenced
  movements in the area of the mouth.

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Implications?

• Sensory Integration Dysfunction can lead to
  various implications such as
• Social
• limited repertoire of social activities
• social isolation/withdrawal
• peer interactions and relationship
• aggressive behaviours
• Delinquency and substance abuse
• Stress Related Disorders
• Anxiety, stress
• Academic
• Learning disabilities
• Individuals that may be affected?
• Developmental Delayed, Pre-mature, Brain Injury,
  Typically Developing
• misinterpretation of behaviour

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SIPT(Sensory Integration and Praxis Tests)

• Sensory Integration and Praxis Test (SIPT)
  evaluates sensory processing deficits related to
  learning and behavior problems. The SIPT measures
  visual, tactile, and kinesthetic perception as
  well as motor performance.
• It is composed of 17 brief tests
• Author A.J. Ayres
• Published 1989
• Standardization 2,000 children (USA)
• Age range 4yrs -8yrs 11 months (may be used with
  the older child to describe difficulties)

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SIPT(Cont.)

• As a clinical tool the SIPT may serve as a
  diagnostic tool to discover patterns of sensory
  integration dysfunction. This test is an
  excellent measure of underlying sensory
  processing and praxis (motor planning) deficits
  that may be contributing to difficulties with the
  following areas
• Reading
• Writing
• Math
• Eye-hand coordination
• Gross motor skills
• Fine motor skills
• Oral motor skills
• Sequencing
• Visual-Perceptual/Visual motor
• Tactile Discrimination
• Tactile Perception

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SIPT17 tests in detail

• Fall into roughly four overlapping types
• Motor-free visual perception
• evaluate the ability to visually perceive and
  discriminate form and space without involving
  motor coordination (Space Visualization, Figure
  Ground)
• Somatosensory
• assess tactile, muscle and joint perception
  (Manuel Form Perception, Kinesthesia, Finger
  Identification, Graphesthesia, Localization of
  Tactile Stimuli)
• Praxis
• Practic skill is evaluated six different ways
  (Praxis on Verbal Command, Design Copying,
  Constructional Praxis, Postural Praxis, Oral
  Praxis, Sequencing Praxis)
• Sensorimotor
• Four sensorimotor test as their tasks require
  sensory integration (Bilateral Motor
  Coordination, Standing Walking Balance, Motor
  Accuracy, Postrotary Nystagmus)

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Key Principles of SI Intervention

• The focus of intervention is the sensory
  experience and the adaptive response in the
  context of play and purposeful activities
  (occupations).
• evaluating and modifying the sensory environment
  (focus is on integrating tactile, proprioceptive
  and vestibular sensations)
• the context of play
• active participation by the child
• child-directed interactions
• artful vigilance on the part of the therapist
• Just Right Challenge
• eliciting the adaptive response
• tapping the inner drive of the child the
  childs engagement is its own reward
• Example Mom says All Sally wants to do is
  swing on a swing!! Are you saying that youll
  let her swing and spin for an hour for
  treatment?
• ( source from Western Psychological Services,
  Sensory Integration Praxis Tests)

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Questions, Comments
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