SENSORY INTEGRATION

SENSORY INTEGRATION

Sensory integration / sensory processing  

        Sensory integration is the neurological process that organizes sensation from one’s own body and from the environment  and make it possible to use the body effectively within the environment.  It was found by  A. Jean Ayres an occupational therapist and educational psychologist in late 1960s and 1970s. she defined  sensory integration is the  “organization of sensation for use”.

         Sensory integration is the basis for learning. It is what allows us to get an idea of what is going on in the world around us. We learn when we take in new information, cross reference the new information to previous similar experiences, and make an assessment as to how we should proceed given the current set of information. For example, when you hear a dog barking, your ears take in the information and your brain attaches meaning to it, such as identifying it as an animal, not a cat but a dog, determining how close it is, and deciding whether it sounds like a big dog or a small dog. Then the brain matches that information with past experiences that have been stored as memory. If you have ever been bitten by a dog, you may run to get away when you hear the barking.

On the other hand, if you grew up with dogs, the sound may make you homesick for your childhood home. The development of sensory systems begins in the womb and continues throughout our lives. In the early childhood years, the nervous system is in hyper-development and sensory integration is being refined through typical childhood activities. This is why the first few years of childhood are considered the sensory-motor years, and are crucial for laying the foundation for our nervous system.

What is Sensory Processing Disorder?

          Sensory Processing Disorder (SPD) describes the difficulty that some people’s nervous systems have in making use of and integrating sensory information. The brain is not receiving messages, or the messages that are received are inconsistent, or the sensory information is consistent but does not integrate properly with other sensory information from the other related sensory systems.

Sensory Systems of our body

·        Vestibular (balance)

·        Proprioceptive (position sense & movement)

·        Tactile

·        Visual

·        Auditory

·        Smell & taste

The following are the problems the child may face due to the disturbances in the sensory processing.

Vestibular (balance):

Responsible for balance and equilibrium -  tells a child where he is in space

Ø  Low muscle tone

Ø  Poor balance and frequent falling

Ø  Frequent rocking when reading, writing, and listening

Ø  Has Clumsy

Ø  Unable to sit or stand still for academic activities (keep changing his/her posture)

Ø  Never gets dizzy/hyperactive

Ø  Prefers sitting activities and avoids playground activities

Proprioceptive:(position sense & movement)

•       Trouble judging the force needed to throw balls/catch

•       Difficultly in scissor cutting, application of pressure and direction while writing

•       Lite writer, frequently drops books, pencil, etc.

•       Problem in jumping, climbing, no left and right awareness

•       Lack of co-ordination between the two sides of the body

•       Falls often and accident prone, enjoys rough play

•        Poor awareness of space, etc.

•       Problem in imitating motor skills

•       Eye hand coordination problem etc.

•       Weight bear on one leg

Tactile:

•       Dislike contact games

•       Avoid sitting on carpet

•       Does not like others to hold hands when walking

•       Pulls back when parents tries to hold child

•       Does not prefers variety of foods, mouth objects

•       Overreacts to food on face, hands or body, thumb sucking

•       Avoids holding crayons or pencil

•       Prefers to play on smooth surfaces

•       Avoids having clothes touch palms

•       Frequently chews on the necklines of their shirts

•       Dislike having their teeth brushed, combing hair etc.

•       Avoids somersaults and standing in line

•       Socks feel uncomfortable and frequent removal of chapel

Visual:

•       Avoid Eye to eye contact

•       Likes to watch moving objects

•       Finger gazing and moving in front of eyes

•       Cannot track balls from one person to another

•       Lack of Visual attention and concentration

•       Moving head but not the eyes, reaching slowly

•       Reversing letters or words, losing the place in reading

•       Prefers same color dresses, etc.

    Auditory:

•           Repeatedly ask what, Difficultly hearing speech in noise

•           Constantly hums or sings to down out environmental noise, Covers ears frequently, etc..

      Taste:

•           Does not know the taste of foods, pica eater (pencil chalk piece crayons rubber paper), Prefers same taste, etc.

        Smell:

•           Smells his/her arm pit, smells before eats,

•           Dislike strong smell etc.

 What are some of the general signs of Sensory Processing Disorder?

           Here is a list of signs that may point to Sensory Processing Disorder:

• Overly sensitive to touch, movement, sights, or sounds

 • Underreactive 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 physical self-concept

 • Delays in speech, language, or motor skills

 • Delays in academic achievement

 Don’t we all have some sensory “issues”? 

        Yes, Many of us experience sensory processing difficulties. How much we are affected is often dependent on what is going on in our lives. For example, when you are under extreme stress and you are not sleeping well, you may use artificial ways to keep yourself alert, such as caffeine, and you may feel yourself becoming overly sensitive to noise or touch. Sensations that seemed pleasurable last week (your son singing the ABCs) are now annoying to your ears, so much so that you want to yell, “PLEEEEASE, no more ABCs!” Since you understand the sensation is temporary and you don’t want to hinder your son’s expression, you simply clench your jaw.

 Is there a cure for SPD?

      We know from studies and documentation that children with SPD who receive intense therapy and learn self-coping mechanisms are more successful academically and socially. Also, science tells us that nervous system development continues into adulthood and our experiences certainly impact that development. It is reasonable to assume that providing a nervous system with experiences that aid in healthy integration is going to have long term benefits. It is important to note that when an occupational therapist works with a child with sensory processing disorder, the therapist is not simply treating the sensory issues but rather targeting that child’s “occupational deficits” that are impacting his or her life.

 I was told to take my son to an occupational therapist. What is that? 

        Occupational therapists can be thought of as the professionals trained to be the ambassadors between your nervous system’s processing of information and your actual functional abilities. Their goal is to help their patients lead independent, productive, and satisfying lives. They work with individuals who have conditions that are mentally, physically, developmentally, or emotionally disabling. They help these individuals develop, recover, or maintain daily living, play and work/academic skills. Occupational therapists help clients improve their basic motor functions and reasoning abilities and compensate for permanent loss of function.

 Why does my child avoid eye contact and seem socially awkward? 

           For many children and some adults with SPD (sensory processing disorder) , it is difficult to listen to someone and look at them at the same time. The vestibular(balance), visual, and auditory systems work closely together, so if someone is having difficulty processing sensory information, they may need to “cut off” one channel so that they can concentrate on the other one. A child with difficulties processing sensory information from social situations is perhaps the most taxing of all. These children require a unique blend of internal sensory processing and natural external steps. This can be very difficult, because social effectiveness is hard to practice, as there are seemingly dire consequences when you fail. Here are some things to consider when helping a child with SPD become more socially at ease:

 • Try not to be uncomfortable with your child’s efforts to be social, even when they are not effective. Reward the effort because it is very difficult to take that kind of risk.

• Help your child become aware of his own sensory issues in social situations. Use programs such as “How Does Your Engine Run” and apply that to social situations.

 • Consider putting your child on a sensory diet and have him do certain sensory activities that have a more calming effect right before a social event.

 • Use social stories to help your child know how he should act in a given social situation.

 • Try role play for upcoming social situations (older children really benefit from this). You can videotape your child role-playing and have her watch it so she can see herself socially engaging.

 Why does my child have a meltdown when his schedule is changed? 

         Try to imagine that you are driving a car in the dark and the lights just went out, but you know the road like the back of your hand and so you know you can make it home. Now imagine someone changed the road. You would either be stuck in a ditch or lost somewhere. How would you feel? Many children who have sensory processing difficulties rely on outside structure, whether it’s a schedule set in stone or environmental cues. This structure provides a framework that your child knows how to navigate without having to worry about changes in the outside world. When the set schedule changes, he may not be able to see himself doing whatever the new thing is, because he had prepared his body and brain to do what was originally planned. To one child it may be seen as an exciting new activity, but to a child with SPD, it is like being pushed out on stage in front of a live audience without a script.

 Is a speech delay a sign of SPD?

          Yes, a speech delay may be the result of underlying sensory processing difficulties. Many aspects of neurological functioning impact our ability to communicate effectively. For instance, if a child is having auditory processing difficulties, he may have difficulty locating where sounds are coming from or discriminating between similar yet different sounds. This will impact his understanding of language as well as his expressive speech. If a child has tactile/ proprioceptive processing difficulties, this could affect oralmotor skills. Using your lips, tongue, and other articulators correctly to form words is a very complicated oral-motor skill. In addition, many children with sensory processing difficulties have poor muscle tone, which may result in weak muscles around the jaw, cheeks, lips, and tongue. Tactile defensiveness can also interfere with a child’s ability to use his mouth correctly, affecting speech production.

 Is social communication related to sensory integration difficulties? 

           Sensory processing difficulties will directly affect social communication. This is because social communication requires attending to incoming sensory stimuli from others, such as body language, auditory and visual input, as well as the greater environment.

 Should I stop occupational therapy if my child’s behavior becomes worse? 

       It is very common for children who have SPD to “lose it” when they first begin a new therapy program. The therapist is asking your child to engage in activities that challenge her nervous system, which may be overwhelming. It is hard for any of us to get out of our comfort zone, much less a child who has been battling her own nervous system for years. Keep in mind that she is engaging in therapy in a safe environment, and this will eventually help your daughter/son to take in the information and make sense of it in her everyday life. Make the therapist aware of your daughter’s behavior and remember that sensory integration therapy is a slow but steady process.

 What is a sensory diet? 

            A sensory diet is an individualized program of sensory activities designed to help a specific child function better at home and school. This program should be set up and monitored by an occupational therapist who is familiar with your child’s sensory needs. It is important to remember the program that works today may not be the same one that will work three months from now. The program will be modified to meet your child’s changing needs. Usually, a sensory diet is designed by the occupational therapist in conjunction with the family and other team members.

A sensory diet will not be successful if it is carried out only during occupational therapy sessions. The sensory diet activities must be implemented by the family and everyone else on the team. Frankly, all children would probably benefit from a sensory diet. Many of today’s children get bombarded with too much of one kind of sensation and too little of other kinds. A sensory diet is simply a way for your child to get a well-balanced set of activities to reach an optimal level of engagement in her surroundings. A child who has sensory processing disorder requires a sensory diet. It helps a child with modulation difficulties to react appropriately by learning self-regulation strategies; it increases the focus of a child by helping her engage in activities that calm overarousal; and it increases the activity level of an underaroused child. My child’s therapy sessions look like play to me.

What am I paying for? 

           It may not seem like therapy or “work” to you, but it’s important to remember that for a child with sensory processing difficulties, playing may be the hardest thing he has to do. By making the therapy sessions fun, your child’s occupational therapist is keeping him motivated so that he will continue to participate in the activities he designs for him. By utilizing fun play as a motivator, the therapist can provide your child with just the right challenge, which should encourage your child to view new sensory experiences in a positive way. This will eventually lead to him to be comfortable with or even enjoy different sensations in his world and then eventually adapt or alter how his body responds to sensory input.

If your child doesn’t enjoy active play, the therapist still wants her to move. It is crucial that all children move, and children with SPD may need to be supported and encouraged to move more than the average child. You understand your body best when you have to learn to move in different and changing environments. By challenging your body to process and react to different visual, touch, proprioceptive, vestibular, and auditory information, you allow the nervous system to grow. Children with SPD require activities designed to help them move, because their nervous systems are not driven toward natural experimentation with their bodies and exploration of the world. Play is the occupation of a child it is the active participation of a child. Child learns and experience new things in playful situation.

SENSORY MOTOR DEVELOPMENT IN CHILDREN WITH AUTISM

Sensory motor foundation skills rely on the interaction of sensation and movement.  We receive sensory information from our bodies and the environment through our sensory systems. This sensory information then needs to be organized and processed to be able to produce an appropriate motor or movement response to be successful in daily tasks at home or at school.  

THE SENSORY SYSTEMS

1.     Vestibular system (movement sense) : 

·       Responsible for movement and position in space

·       Maintains head stability

·       Controls balance and eye movements

·       Provides physical/ emotional security

2.     Proprioceptive system (joint sense):

·       Awareness of body positions

·       Provides precise information about body/limbs position and movement without vision

·       Provides awareness of pressure

3.     Tactile system (touch sense):

·       Provides input from the skin

·       Information on texture, temperature, size, shape without vision

4.     Visual system:

·       Information through what is seen

·       Responsible for visual perception, memory, discrimination and in turn visual motor coordination

5.     Auditory system(Hearing sense):

·       Sound detection and localization

·       Verbal memory

·       Responsible for speech and language development

6.     Olfactory system (sense of smell):

·       Awareness of various smell

·       Discrimination of good and bad smell

·       Olfactory memory

7.     Gustatory system (sense of taste):

·       Awareness/ discrimination of taste

·       Accounts for oral sensitivity

·       Aids in feeding

MECHANISM OF SENSORY MOTOR DEVELOPMENT

·       Happens through four levels

·       Involves the coordination of the seven senses mentioned above

·       Expects proper functioning of all the seven senses

·       Results in producing appropriate responses to be successful in work, ADL and play in children

MANIFESTATION OF DEFICITS IN SENSORY MOTOR DEVELOPMENT

1.     Components

·       Motor development (gross and fine)

·       Cognitive development

·       Social ad communication skills

·       Emotional/ behavioral issues

2.     Areas

·       Play

·       ADL

·       Work and productivity

3.     Contexts

·       Home

·       School/classroom

·       Public places like park, shopping malls, etc

MANAGEMENT

  1. Providing Sensory diet and  environment for adaptive response to occur

             Sensory diet involves the therapeutic use of sensation through activities embedded within the daily routine. It simply means selecting various activities that would address the sensory needs of the child and make them available to the child throughout the day. It requires planning and setting up the environment that provides the child an access to voluntarily involve in activities and meet the sensory demands continuously. Preferably, the activities should de self-selected, self-initialized, and self-organized as the sensory experiences are most effective in producing an adaptive response when they are incorporated in self-selected meaningful activities.

       For example, If a child has tactile defensiveness, activities that help to reduce defensiveness or avoiding reactions should be repeated at regular intervals throughout the day to maintain an optimal level of arousal and adaptation. In this case, the child’s activities can be planned using play dough, soapy water, sand, glue, corn flour, wheat flour, rice, etc, to enrich the play environment with exposure to different textures.

        A sensory stimulation given at a particular session enables the child to function at an optimal level at that particular session. Whereas a sensory diet planned for the entire day at various settings like home, school, community, etc, will help the child attain a better adaptation throughout the day and in long term will in turn result in overall progress.

2. Prevention/ control of behavior issues

3. Develop/ teach Motor skills

4. Teach coping strategies

5. Provide social and emotional support