Workshop on sensory integration

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Workshop on sensory integration

• 
  M. ARUN KUMAR
• occupational
  therapist
• 
  

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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, 1979)
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SENSES

• Tactile Sense
• Input from the skin receptors about touch,
  pressure, temperature pain and movement of the
  hairs on the skin

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• Visual Sense
• Input form the retina of the eye.

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• Auditory
• Input form the inner ear.

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• Gustatory
• Input from the chemical receptors in the
• tongue.

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• Olfactory
• Input from the chemical receptors in
• the nasal structure.

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• Vestibular Sense
• Input from the inner ear, about equilibrium
  gravitational changes, movement experiences,
  and position in space
• .

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• Proprioceptive Sense
• Input from the muscles and joints about
• body position, weight, pressure, stretch,
  movement and
• changes in position in space.

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A Proposed Model
SI
Modulation
Praxis
Verbal
Discrimination
Poor Registration
Postural
Defensive
Scquencing
Oral
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SIGNS OF TACTILE DYSFUNCTION

• Hypersensitivity to Touch (Tactile Defensiveness)
• Avoids group situations for fear of
• the unexpected touch.
• May overreact to minor cuts, scrapes
• and or bug bites.
• Avoids using hands for play, sand.

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• Distressed about having hair, toenails, or
  fingernails cut.
• Resists brushing teeth and is extremely of the
• dentist
• May refuse to walk barefoot on grass or sand.
• May walk on toes only.

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• Hyposensitivity to Touch (Under-Responsive)
• May crave touch, needs to touch
• everything and everyone.
• Is not bothered by injuries, like cuts
• and bruises.
• May be self-abusive pinching,
• biting, or banging his own head.

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• Mouths objects excessively.
• Craves vibrating or strong sensory input.
• Has a preference and craving for
• excessively spicy, sweet, sour, or salty
  foods.

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• Poor Tactile Perception and
• Discrimination
• Has difficulty with fine motor tasks such
• as buttoning, zipping, and fastening clothes.
• Has difficulty using scissors, crayons,
• or silverware.
• Continues to mouth objects to explore
• them even after age two

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SIGNS OF VESTIBULAR DYSFUNCTION

• Hypersensitivity to Movement (Over-Responsive)
• Avoids/dislikes playground equipment
• i.e., swings, ladders, slides, or merry-go-
• rounds.
• Afraid of heights, even the height of a
• curb of step.
• Fearful of going up or down stairs or
• walking on uneven surfaces

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• May be fearful of, and have difficulty riding a
• bike, jumping, hopping, or balancing, or
  balancing
• on one food (especially if eyes are closed)
• Loses balances easily and may appears clumsy.
• Fearful of activities which require good balance.
• Avoids repaid or rotating movement

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• Hyposensitivity to movement (Under-Responsive)
• In constant motion, cant seem to sit still.
• Craves fast, spinning, and/or intense
• movement experiences.
• Always running, jumping, hopping etc
• Rocks body, shakes leg, or head while sitting.

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Poor Muscle Tone And/or Coordination

• Difficulty simultaneously lifting head, arms, and
  leg off the floor while lying on stomach
  (superman position).
• Fatigues easily!
• Poor fine motor skills difficulty using tools,
  
• such as pencils, silverware, combs, scissors
  etc.

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PROPRIOCEPTIVE DYSFUNCTION

• Sensory Seeking Behaviors
• Seeks out jumping, bumping, and crashing
  activities.
• Kicks his/her feet on floor or chair while
  sitting at desk/table.
• Bits or sucks on fingers and /or frequently
  cracks his/her knuckles.
• Love pushing/pulling/dragging objects.

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Difficulty with Grading of Movement

• Misjudges how much to flex and extend muscles
  during tasks/activities (i.e., putting arms into
  sleeves or climbing)

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AUDITORY DYSFUNCTION (NO DIAGNOSED HEARING
PROBLEM )

• Hypersensitivity to Sounds (Auditory
  Defensiveness
• Distracted by sounds not normally noticed by
  other i.e., humming of lights or refrigerators,
  fans, heaters, or clocks ticking.
• Runs away, cries, and/or covers with
• loud or unexpected sounds

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• Hyposensitivity to Sounds (Under-Registers)
• Often does not respond to verbal cues or to
  name being called.
• Talks self through a task, often out loud.

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ORAL INPUT DYSFUNCTION

• Hyposensitivity to Oral Input (Under-Registers)
• May lick, taste, or chew on inedible objects.
• Frequently chews on hair, shirt, or fingers.
• Constantly putting objects in mouth

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• Hypersensitivity to Oral Input (Oral
  Defensiveness)
• Picky eater, often with extreme food preferences
  i.e., limited repertoire of food, picky about
  brands, resistive to trying new foods or
  restaurants, and may not eat at other peoples
  houses. May gas with textured foods.
• Has difficulty with sucking, chewing, and
  swallowing, may choke or have a fear ofchoking.

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• Resists/refuses/extremely fearful of going to the
  dentist or having dental work done.
• May only eat hot or cold foods Refuses to lick
  envelopes, stamps, or stickers, because of their
  taste.
• Dislikes or complains about toothpaste and
  mouthwash.
• Avoids seasoned, spicy, sweet, sour orsalty
  foods prefers bland foods.

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SIGNS OF OLFACTORY DYSFUNCTION (SMELLS)

• Hypersensitivity to Smells (Over-Responsive)
• Reacts negatively to, or dislikes smells which do
  not usually bother, or get noticed, by other
  people.
• Refuses to eat certain foods because of their
  small.
• Bothered/irritated by small of perfume or
  cologne.
• Bothered by household or cooking smells.
• May refuse to play at someones house because of
  the way it smalls

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• Hyposensitivity to Smells (Under-Responsive)
• Has difficulty discriminating unpleasant odors.
• May drink or eat things that are poisonous
  because they do not notice the noxious smell.
• Fails to notice or ignores unpleasant odors.
• Makes excessive use of smelling when introduced
  to objects, people, or places.

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VISUAL INPUT DYSFUNCTION (NO DIAGNOSED VISUAL
DEFICIT)

• Hypersensitivity to Visual Input
  (Over-Responsiveness)
• Sensitive to bright lights will squint, cover
  eyes, cry and/or get headaches from the light.
• Has difficulty keeping eyes focused on
  task/activity he/she is working on for an
  appropriate amount of time.
• Avoids eye contact.
• Easily distracted by other visual stimuli in the
  room i.e., movement, decorations, toys, windows,
  doorways etc.

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• Hyposensitivity to Visual Input (Under-Responsive
  or Difficulty with Tracking, Discrimination, or
  Perception)
• Has difficulty telling the difference between
  similar printed letters or figures i.e., pq,
  bd, and x, or square and
• rectangle.
• Has difficulty locating items among Has
  difficulty locating items among other items
  i.e., papers on a desk, clothes in a drawer,
  items on a grocery shelf, or toys in a bin/toy
  box.

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• Often loses place when copying from a Book or
  the chalkboard.
• Has difficulty telling the difference between
  different colors, shapes, and sizes.
• Makes reversals in words or letters when copying,
  or reads words backwards i.e., was for saw
  and no for on after first grade.
• Difficulty judging spatial relationship in the
  environment i.e., bumps into objects/people or
  missteps on curbs and stairs.

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BEHAVIOURAL ISSUES

• Aggressiveness- hitting, kicking, throwing
  tantrums
• Disruption- screaming, crying
• structure demonstrate inflexibility when
  transitioning between activities
• Self-stimulation (e.g. head banging, biting)

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Academic
Intellect
Learning
cognition
Daily
Living
Behavior
Activities
Auditory
Attention
Visual-
Perceptual
Language
Special
Development
Center
Skills
Perception
Functions
Motor
Ocular
Postural
Eye-hand
Motor
Adjustment
Coordination
Control
Development
Sensory
Reflex
Ability to
Body
Scheme
Screen Input
Maturity
Motor
Awareness of
Postural
Motor
Planning
Two Sides of Body
Security
Systems
Sensory
Olfactory
Auditory
Gustatory
Visual
Proprioception
Tactile
Vestibular
CENTRAL NERVOUS SYSTEM
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Sensory Integration Equipment

• THERAPY BALL
• BALANCE BOARD

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SWINGS

• FLAT SWING
• T - SWING

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• BOLSTER SWING
• ROUND SWING

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• TYRE, TUBE SWING
• HAMMOCK

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• TRAMPOLINE
• SCOOTER BOARD

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• RAMP
• BALL BATH

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• TACTILE
• VISUAL ITMES

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• TUNNEL
• STEPS
• AUDIO TAPES

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(No Transcript)
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SI ROOM
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SI ROOM 2
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• Tactile Processing
• Rubbing with different textures
• Soft to Hard
• Hard to Soft
• Sand Play
• Clay activity

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TACTILE

• Underresponsiveness/ poor registration
• Defensive/ Avoiding

principles

• Alerting
• Light touch
• Tickling
• Hot or cold food (strong temperature)
• Playing in textures (rice, sand, beans, finger
  painting, playdoh)
• Go barefoot, use textured towels/ blankets/
  objects
• Chose crafts with touch feedback (gluing, clay
  molding, etc)

• Calming
• Firm pressure on skin, longer duration
• Hold hand firmly
• Avoid unnecessary touch and forewarn of necessary
  touch
• Weighted vests, blankets, etc.
• Wilbarger Brushing Program (under OT direction)
• Oral tactile defensiveness strategies
• .

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VESTIBULAR

• Underresponsiveness/ poor registration/ seeking
• Defensive/ Avoiding
• Gravitational Insecurity

• Alerting
• Changes in speed and direction
• Change of head position
• Swinging (tire swing with lots of directional
  changes)
• Sliding
• Somersaults
• Dragging on a blanket
• Bouncing on adults knee/ therapy ball
• Movement activity prior or during a thinking task
• Movement breaks in class (accompany on errands to
  office, library, etc.)

• Calming
• Linear, predictable, repetitive
• Head moving in straight line
• I.e.. Rocking chair, bouncing up and down, gentle
  linear swinging
• Allow child to direct
• Couple with organizing inputs (proprioceptive
  input, deep pressure, etc.)
• I.e. Swing and crash! Child swings with feet
  held firmly with pulling/ pushing, etc.

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• B) Vestibular Processing
• Therapy ball Workout
• Supine position
• Prone position

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• Sitting position
• Trampoline workout
• Jumping in different motion with changing
  activities.

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• Swing
• Sitting standing position
• with challenging activities.

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• Balance Board
• Sitting standing position
• with challenging activities.

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• For Gravitational Insecurity

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• Proprioception Processing
• Joint compression
• Weight bearing with therapy ball

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• Hand Walk
• Scooter Board
• Rope Ladder

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Proprioception

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

• Calming/ Organizing
• Heavy work, jump, crash, resistance, push/pull
• i.e. squeeze ball, carry groceries, jump on
  trampoline, tug of war, weighted bookbag, pillow
  crashing, hanging by arms or climbing

principles
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VISUAL

• Underresponsive/ Seeking
• Defensive/ Avoiding

• Alerting
• High intensity, contrast, or change of stimuli
• i.e. bright lights, contrasting colors
• Cover blocks in foil, roll a clear ball with
  moving objects inside, highlight words, label
  drawers with bright colors
• Use visual input to engage the seeking child

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

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AUDITORY

• Underresponsive/ Seeking
• Defensive/ Avoiding

• Alerting
• Strong intensity or changing sounds
• Music with unpredictable rhythm
• I.e.. Ring bell at stimuli you want child to
  attend to

• Calming
• Repetitive, constant, quiet
• Rhythmic music,
• Quiet spaces for child to retreat to when over
  stimulated
• Carry headphones with calm, rhythmic music
• Warn of loud noises, use earplugs
• In Class, seat away from loud speakers and
  traffic

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TASTE/ SMELL

• Underresponsive/ Seeking
• Defensive/ Avoiding

• Calming
• Mild intensity, nondistinct or familiar
  qualities, gradually progress tastes to expand
  diet
• i.e. Use unscented cleaning products/ soaps,
  start with bland foods (cream of wheat, mashed
  potatoes)

• Alerting
• Strong intensity
• i.e. Spicy, sour, such as warheads, sour patch
  kids, BBQ sauce, sour straws)

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THANK YOU
Comments and Questions?