Sensory Integration Lecture Notes 2023 PDF

8/23/2023 Sensory Integration “Life is a sensory experience. During every moment of our life we experience the world through our varied sensory systems. Sensory experiences drive our behavior and contri...

8/23/2023 Sensory Integration “Life is a sensory experience. During every moment of our life we experience the world through our varied sensory systems. Sensory experiences drive our behavior and contribute to the organization of our thoughts and emotions.” (Coren, Porec, & Ward, 1984) Sensory Integration Theory History Dr. A Jean Ayres Observed perceptual, motor coordination, and sensory processing problems in a clinical population of children with learning disabilities Sensory Integration One of the most commonly used frames of reference in pediatric OT practice Is the most researched area in OT today “Research suggests that 10%–55% of children without a diagnosed disability have difficulties in sensory processing and 40%–88% for children with various diagnoses.” (Pfeiffer, May-Benson, & Bodison, 2017) *Pfeiffer, B., May-Benson, T. A., & Bodison, S. C. (2017). State of the Science of Sensory Integration Research With Children and Youth. American Journal of Occupational Therapy, 72(1). doi:10.5014/ajot.2018.721003 1  8/23/2023 https://youtu.be/1_Iuj8dr9oY What is Sensory Integration? Sensory integration is the process of receiving and organizing sensory information within the central nervous system in order to make an adaptive response. An adaptive response occurs when a person successfully meets an environmental challenge. Sensory Integration Analogy Feedback Observable movement & behaviors Input Processor Output 2  8/23/2023 Sensory Integration Approach Typical Sensory Integration (Refer to Table 12-2 in book) Typical sensory motor development allows the child to engage in and participate in a wide range of meaningful and purposeful occupations Atypical Sensory Integration Dysfunction in sensory motor development may interfere with a child’s performance in occupational performance areas (Refer to Table 12-1 in book) Typical Atypical Foundations of Sensory Integration Therapy Three concepts according to A Jean Ayres: Learning and function are dependent on efficient sensory integration Problems in sensory processing interfere with learning, functional skills, and behavior Providing enhanced sensations in the context of meaningful activity require increasingly adaptive responses that facilitate learning, skills, and behavior 3  8/23/2023 So…what senses are we talking about? Tactile (touch) 5 basic (foreground) Visual (sight) 3 hidden (background) senses: senses: Vestibular (movement) Auditory (hearing) Tactile (touch) Proprioception (body position) Olfactory (smell) Visual (sight) Interoception (internal sense) Gustatory (taste) *this one is fairly new and is not included in Auditory (hearing) your book Olfactory (smell) Vestibular (movement) Gustatory (taste) Proprioception (body position) Interoception (internal sense) Touch/Tactile One of the three foundational systems addressed in sensory integration treatment (other two are vestibular and proprioception) Processes sensory information through the receptors in the skin Pressure, vibration, temperature, and pain Two divisions: “Warning" system- alerts us to danger (flight or fight system) Focused system- make fine touch distinctions or discriminations needed for skilled movement and manipulation of objects Visual Consists of the eye and 6 sets of eye muscles Sensory information is processed through the eye Influences posture, balance, development of visual perception and spatial awareness Works with vestibular and proprioceptive systems for spatial orientation and skill performance 4  8/23/2023 Auditory Consists of 3 major components: outer ear, middle ear, and inner ear Influences orientation to the environment, regulation of arousal state, emotion, and perception of one’s position in environment Vestibular First system to develop in utero Gets input from the inner ear, the eyes, and proprioceptive system Provides information to the brain about the head's position in space, balance, velocity and acceleration Close relationship to gravity, safety, and attention One of the three foundational systems addressed in sensory integration treatment (other two are tactile and proprioception) Vestibular System (cont.) 5  8/23/2023 Proprioception One of the three foundational systems addressed in sensory integration treatment (other two are tactile and vestibular) Primary receptors are in the tendons/muscles of the body and some sensory receptors in the skin Processes pressure that is applied to the body and provides the brain with input that tells it where your joints and muscles are in space Works closely with vestibular system as well Proprioception (cont.) Interoception Not in your book, one of the newer senses to become popular Helps you feel what’s going on inside the body: hunger, thirst, fatigue, bowel & bladder feelings, sexual arousal, hot & cold internally Self-regulation: ability to manage reactions to feelings and environment Sensed through receptors in the internal organs 6  8/23/2023 Interoception (cont.) The Umbrella Term https://youtu.be/D1G5ssZlVUw 7  8/23/2023 Sensory Processing Disorder (SPD) (Sensory Integration Dysfunction) Children who have SI dysfunction have a cluster of symptoms that are believed to reflect dysfunction in the CNS processing sensory input Dysfunction leads to disorganized interactions with the environment, which in turn causes distorted internal sensory feedback, which reinforces the problem. Ranges exist from mild to severe Remember, this is the umbrella term… Sensory Modulation Disorder Child experiences difficulty processing sensory information into appropriate behavior/responses which match the intensity of the sensory information Over Responsive Under Responsive Sensory Seeking Sensory Discrimination Child experiences difficulty distinguishing between similar sensations Need additional time to process sensory information Their capacity to perceive the information as quickly and naturally as other children do is reduced 8  8/23/2023 Sensory Based Motor Disorder Child has trouble controlling, planning and supporting their movements into a smooth, coordinated and sequenced way. Sensory Based Motor Disorder: Postural Disorder This is the mildest in severity as compared to praxis Result from inadequate sensory discrimination of vestibular and proprioceptive inputs Sensory Based Motor Disorder: Dyspraxia Praxis: A higher level cognitive process that allows a child to effectively interact with objects and the environment It involves planning what to do and how to do it! Is not a sensory system, BUT it is dependent on the integration of multiple sensory systems functioning efficiently 3 parts: Ideation- the idea of what to do Motor Planning- how are we going to do it Motor Execution- performing the movement correctly 9  8/23/2023 Misdiagnosed ~20% of children identified as having ADHD likely have been misdiagnosed According to one study, 40% of children who showed symptoms of either ADHD or SPD had symptoms of both How do we assess a child with SPD? Sensory History (Table 12-7) Family/Teacher Interview Formal testing (Table 12-9) Sensory Integrative and Praxis Test (SIPT)- table 12-8 Miller Assessment of Preschoolers Degangi-Berk Test of Sensory Integration Sensory Processing Measure Sensory Profile Clinical Observations Table 12-10 Clinical Observations What are all of these senses going to look like in the child YOU see in therapy? 10  8/23/2023 *From Sensational Brain Tactile Under Responsive Over Responsive (flight or fight system is May not feel pain - may bite self or other out of control) self abuse such as head banging Severe form is called tactile defensiveness May not be aware of injuries such as cuts, May perceive light touch as painful bruises, burns May shrink from touch May not be able to distinguish different types of touch May not tolerate touch from clothing, people, objects, textures Lack normal awareness of being touched May avoid playing with finger paint, sand, Sensory Seeking: glue (messy things) may enjoy sensations that should be painful Vision Under Responsive Over Responsive Walk into objects as if they were not Bothered by bright lights there Become distressed in unusual visual Under-responsive to items in the visual environments field or to colors/movement Dislikes certain lights (flickering, strobe, Sensory Seeking: etc) enjoys watching objects spin more than most kids their age Flipping light switches on/off repeatedly 11  8/23/2023 Auditory Under Responsive Over Responsive May not orient to sounds Overly distracted by noises Will not startle to loud sounds Startle easily to sounds Sensory Seeking: Become upset or annoyed by normal sounds (blow dryer, vacuum) Likes certain sounds to happen over and over again Taste and Smell Under Responsive Over Responsive Appears not to notice odors that Overreaction to odors other children notice Nausea or emotional upset in Sensory Seeking: response to odors Likes to taste non-food items Likes to smell non-food items Vestibular Under Responsive Over Responsive Crave movement experiences gravitational insecurity - low tolerance for Do not get dizzy or nauseous with excessive movement; fearful of leaving Earth’s surface spinning/swinging Extreme fear of movement, especially climbing May have explosive movements and poor or other activities where the child's feet leave judgment in starting and stopping activities the ground Sensory Seeking: Become overwhelmed by spinning/changes in body positions Spin or whirl more than other children May have nausea/dizziness after normal vestibular movement Shows distress when head is tilted away from upright position 12  8/23/2023 Proprioception Under Responsive Sensory Seeking: Very slow moving Loves jumping and crashing activities Poor body awareness Walks on toes Prefer crunchy or chewy foods Don't appear to notice moving or stretching limbs or other body parts May hold crayons/pencils too tightly Often have floppy or poor posture Low levels of energy and arousal, will usually prefer sedentary monotonous tasks May hold crayons/pencils too lightly What are we trying to accomplish with OT assessment? To identify the impact of sensory processing and praxis problems on a child’s function (how does it affect their occupations?) To identify specific sensory integrative problems To provide information to assist with treatment planning 10 Principles to Ayres Sensory Integration Intervention Ensure physical safety of the child Collaborate with child in activity choice Provide sensory opportunities Support sensory modulation for Tailor activity to just-right challenge attaining/maintaining regulated state Ensure activities are successful Challenge postural, ocular, oral, Support intrinsic motivation to play and/or bilateral motor control Establish therapeutic alliance with Challenge praxis and organization of child behavior 13  8/23/2023 Progression of development Treatment Planning Treatment planning in sensory integration involves developing goals and objectives that result from an increase in the frequency or duration of an adaptive response. These underlying goals would include reduction of under-reactivity or over- reactivity and improvement in integration of the senses(sensory modulation). However, because sensory modulation is thought to improve end products, goals for improving the end products are included. For example, reduction in gravitational insecurity may result in increased socialization on the playground when the child begins to interact with others while climbing on the equipment. Therefore, improved social interaction may be a goal in treatment planning using an SI approach. Treatment Planning Another example: Sensory integration also is geared at developing praxis in children with developmental dyspraxia. This would occur after sensory modulation occurs. Therefore, goals and objectives could be developed that would include improvement in activities requiring motor planning such as dressing, lacing, stringing beads, handwriting. Goals and objectives would also depend on the setting for treatment. In an outpatient setting the goals might include improvement in motor skills while in a school setting, the goals would have to be related to skills that are educationally related. 14  8/23/2023 What do we actually do in treatment for these children??? Play at Home vs. Play at Therapy Home- child will only choose activities that are most comfortable. Disorganization of sensory input interferes with all play opportunities and Therapy- OTP guides the play experience toward specific sensory experiences so that an adaptive response can occur When the child masters something new, they learn something new Sensory Diet Customized program designed to help regulate responses to variety of sensory input Regularly scheduled activities and routines Environmental accommodations and supports Sensory snacks Supportive leisure activities 15  8/23/2023 Interventions Work the body- find appropriate ways to give the body the input it needs to regulate, 10-20 minute breaks every 2 hours Work the brain- provide seat based activities to provide input during learning Work the room- make environmental modifications to meet sensory needs Proprioceptive Heavy work/deep pressure activities These are organizing the brain and body and almost always improve attention and focus Vestibular Movement activities Fast and arrhythmic movements are alerting Slow and rhythmic are calming Inversion Intolerance to movement/gravitational Insecurity- linear movements on swing, supine 1st then prone 16  8/23/2023 Tactile Light touch tends to be alerting Deep touch/pressure calming Wilbarger Protocol- therapeutic brushing Must be trained to administer Brushing is firm enough to not tickle, but not so much that it hurts Relieves stress, anxiety, relaxes muscles, promotes calmness, and helps with focus and attention Follow up with 10 quick, short compressions on every joint Auditory Slow rhythmic music is calming Fast music is alerting Visual Add light for under-responsive, visually eye catching toys Dim/low lighting for calming/over-responsiveness 17  8/23/2023 Smell Aroma therapy Scented markers Taste & Oral Input Provide input to the mouth Hard, crunchy, sour candy/food is alerting Gum or candy they can suck on is calming Chewing, sucking, or activities that involve blowing are calming Blowing bubbles Chewing gum or chewy toys Drinking through a straw or using a sports water bottle Recommended Resource *Theinspiredtreehouse.com *therapystreetforkids.com *Sensationalbrain.com/Brain Works *LemonLimeadventures.com 18  8/23/2023 My Top 10 Books on Sensory Processing Sensory Processing 101 Sensational Kids Raising a Sensory Smart Child Superkids Activity Guide The Out-of-Sync Child The Out-of-Sync Child 101 Games and Activities Sensory Integration and Building Bridges Through No Longer A Secret Sensory Integration Has Fun for Children…. the Child Review Katie, who is 5 years old, is having trouble focusing in True or False: Children with sensory discrimination school. She is disrupted from her work when she problems tend to seek excessive input of the affected hears someone walk down the hall. Her parents sensory system due to underresponsiveness. inform the occupational therapy assistant that she is a picky eater with different-textured foods. She becomes emotionally distressed when she is hugged. Katie is displaying: a) Sensory-seeking behavior b) Sensory-defensive behavior c) Sensory-habituation behavior d) Typical, age-appropriate behavior Review Katie, who is 5 years old, is having True : Children with sensory trouble focusing in school. She is discrimination problems tend to seek disrupted from her work when she hears excessive input of the affected sensory someone walk down the hall. Her parents system due to underresponsiveness. inform the occupational therapy assistant that she is a picky eater with different- textured foods. She becomes emotionally distressed when she is hugged. Katie is displaying: b) Sensory-defensive behavior 19  8/23/2023 Review Lauren began first grade a month ago. She enjoys Jade is startled whenever someone outside her visual going outside for recess. However, Lauren seems to field taps her shoulder. She often cries when the lights dominate her friends and always suggests that they are turned on after naptime, which makes her engage in imaginative play rather than playing disorganized for the rest of the day. The occupational hopscotch, kickball, or swinging. Lauren completes therapy assistant informs the teacher that Jade is simple actions like jumping, but coordinating the sensory defensive and recommends to calm and upper and lower body is difficult for her. Lauren’s organize Jade. problems are related to: a) Vestibular input, such as spinning in a chair a) Cephalocaudal dyspraxia b) Deep pressure input, such as brushing the skin b) Somatodyspraxia c) Auditory input, such as a familiar song c) Bilateral integration and sequencing d) Visual input, such as toys with bright colors d) Sensory discrimination Review Lauren began first grade a month ago. She Jade is startled whenever someone outside enjoys going outside for recess. However, her visual field taps her shoulder. She often Lauren seems to dominate her friends and cries when the lights are turned on after always suggests that they engage in naptime, which makes her disorganized for imaginative play rather than playing the rest of the day. The occupational therapy hopscotch, kickball, or swinging. Lauren assistant informs the teacher that Jade is completes simple actions like jumping, but sensory defensive and recommends to calm coordinating the upper and lower body is and organize Jade. difficult for her. Lauren’s problems are related to: b) Deep pressure input, such as brushing the skin c) Bilateral integration and sequencing Review As the occupational therapy assistant at an outpatient True or False: Skilled postural responses depend on clinic, you begin working with Gavin. His parents and discrimination of proprioceptive and vestibular input. teachers are concerned about his social interaction and play skills. He refuses to climb the jungle gym with the rest of his friends. You want to assess Gavin for gravitational insecurity by: a) Sitting him on a yoga ball and rolling him backward with support b) Having him climb up to the clinic’s slide with cues c) Pushing him on a trapeze with his feet held up in the air d) Having him jump into a foam pit 20  8/23/2023 Review As the occupational therapy assistant at True: Skilled postural responses depend an outpatient clinic, you begin working on discrimination of proprioceptive and with Gavin. His parents and teachers are vestibular input. concerned about his social interaction and play skills. He refuses to climb the jungle gym with the rest of his friends. You want to assess Gavin for gravitational insecurity by: a) Sitting him on a yoga ball and rolling him backward with support Review Rhonda is 8 years old. She comes into A child who has poor body awareness your clinic and takes off her jacket. You and problems producing actions in ask her to hang her jacket in the closet, response to feedback most likely has: but she stares at the hanger you place in her hand. Rhonda most likely has: a) Bilateral coordination problems a) Ideation problems b) Projected action sequence problems b) Bilateral coordination problems c) Ideation problems c) Motor planning problems d) Motor planning problems d) Projected action sequence problems Review Rhonda is 8 years old. She comes into A child who has poor body awareness your clinic and takes off her jacket. and problems producing actions in You ask her to hang her jacket in the response to feedback most likely has: closet, but she stares at the hanger d) Motor planning problems you place in her hand. Rhonda most likely has: a) Ideation problems 21  8/23/2023 Review True or False: Small objects like pipe cleaners to bend, stress balls, and chewing gum are all included in a sensory snack portion of the sensory diet. Review True: Small objects like pipe cleaners to bend, stress balls, and chewing gum are all included in a sensory snack portion of the sensory diet. 22