Transcript Sensory Integration : Theory , Disorders, Interventions

Sensory
Integration:
Theory,
Disorders,
Interventions
Presented by:
Alma Martinez, MOT, OTR
Valerie Villarreal, OTS
Maggie Flores, COTA
Sensory Integration (SI)
 Dr.
 Is
Jean Ayres -1963
the ability of a person to take in a
variety of sensory input, process and
understand it, and use it.
What Are The Senses?
 Vestibular-
movement
 Tactile- touch
 Proprioception- where are your body
parts?
 Visual- seeing
 Auditory- hearing
 Taste
 Smell
How Is Information Processed?
 Main
1)
2)
3)
sensory systems
Tactile
Proprioception
Vestibular
 Transmitters
of information from
environment to the brain
Why Sensory Integration?
 Increases
interaction with others
 Develops necessary skills
 Organization
Sensory Integration Theory
 Automatic
process
 Natural outcomes occur
 Learning problems
 Developmental lags
 Behavior issues
How is SI Used?
 Understanding
the WHOLE environment
 Learning
 Understanding
 Regulation
what is going on around us
Neurobiologically Based
Concepts
 Neural
Plasticity
 Central Nervous System Organization
 Adaptive Response
 Sensory Nourishment
Development Process of SI
 Detection
or registration of sensation
 Modulation of sensation
 Sensory discrimination
 Higher sensory integrative skills
 Targeted occupations
INPUT
Senses
SENSORY INTEGRATION
CNS
OUTPUT
Result
Sensory Processing Disorder (SPD)

“Problems in directing, regulating, interpreting, and
responding to sensory input.” (Miller, Anzalone, Lane,
Cermak, Osten, 2007)

Can influence child’s 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.
Impacts On Every day Life
 Activities
of Daily Living (ADLs)
 Social Participation
 Education/Work
 Play/Leisure
 Rest and Sleep
Ten Fundamental Facts About SPD
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
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
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
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
Sensory Over-Responsivity
 Proprioception


Difficulty being hugged
Difficulty with people moving your body
 Auditory
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

Fearful of sounds
Distracted by certain noises
Frequently cover ears
 Oral


“Picky” eater
Difficulty brushing teeth
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
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
Sensory Seeking/Craving
 Seeks
arousal of nervous system
(inappropriately)
 Tactile
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

Enjoy “bear” hugs
Crave touch of textures
Vestibular
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
Jumping
Enjoy spinning in circles, being upside down
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)
SPD Subtypes
 Sensory
 Visual
Discrimination Disorder
(eye)
 Auditory (ear)
 Tactile (touch)
 Vestibular (movement)
 Proprioception (muscle)
 Taste/smell (mouth/nose)
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
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
Examples of Dyspraxia
 Poor



fine motor skills
Zipping
Buttoning
 Problems
in figuring out
how to do movements


 Proprioception
Running
jumping
 Poor

gross motor skills
Dressing
Complex dance steps

•
Poor motor control and
body awareness during
dressing
Vision
•
Navigating through
crowded hallways
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
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

Support Groups
 Moms

Connect About Autism-MoCAA
http://www.momsconnectaboutautism.co
m
 Sensory

http://www.sensoryplanet.com/home.php
 SPD

Planet Social Network
Parent SHARE
http://www.spdparentshare.com
References
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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
Review of challenges/characteristics…..
 Slow
Processing - Difficulty shifting
attention
 Inattentive,
 Does
Difficult to arouse
not like change
or transitions Rigid – Demands routine
 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
 Aggression
to self or others
 Compulsive Behaviors
 Difficulty
with clothing,
type of clothing, and
change of clothing
 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
The “Sensory Diet” includes….
 PROVIDING
A
SENSORY EXPERIENCES
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.
Those with sensory processing challenges
 May
 May
not be able to filter and focus
attempt to adjust in a maladaptive way
(Ex: Escalation of Mood,
Shutting Down)
require a “sensory diet” enriched with unique
sensations and experiences
 Will
Creating The Sensory D.I.E.T.
D …..Do an Informal Assessment
I …..Individualize
E …..Environmental Supports
T …..The Power Senses
Do an Informal Assessment
Assess the Environment and the Individual’s response to a
variety of sensory experiences
 Seeker?
 Active
Avoider?
 Under-Responder?
 Overwhelmed
Individualize the Sensory Diet
What has worked for one
person may not work at all
for someone else!
UNDER-RESPONDER
Increase the use of
visual supports and routines.
Structure the environment.
Time to respond
Careful encouragement to
try new experiences
SEEKER
Provide sensory
experiences frequently &
proactively
May need to limit
excitatory experiences
Considerations for
the Sensory Diet
OVERWHELMED
Control the environment
Limit stimulation
Limit change but
prepare for changes
when they need to occur.
ACTIVE AVOIDER
Modify the environment
to reduce the need
to escape
Gentle introduction to
new experiences
Environmental Supports
 Organization
 Predictable,
Structured,
Consistent Environment
 Task or Curriculum
 Visual
Supports
 Escape Environments
Proactively Schedule
Sensory Activities
 Use
 At
the Power Senses throughout the day in
order to help a person
alert, attend, act, and react
times, additional activities or input may be
needed based on the behaviors observed
The Power Senses
Tactile System
Proprioceptive System
Vestibular System
The Power Senses
 Vestibular
 Movement
 Proprioception
 Input
through
joints and muscles
 Tactile
 Deep
Pressure Touch
The Power Senses
Tactile System
Two Tactile Systems
Tactile System
Pertains
to the sense of touch
Alerts to danger
Gives body boundaries
Helps provide a basis for body
image
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
Discriminative : Pressure Touch
Deep
touch/pressure, and vibration
Activates Parasympathetic System
Calms and organizes
Allows for more cognitive
response
Helps us learn and think
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
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
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
To“fill the
sensory
bucket”
quickly use
the Power
Senses
Vestibular
Input
Three Power Senses
will provide:
• more input
•more quickly
•to make changes
that are more rapid
Proprioceptive
Input
Tactile Input
Taste,
Smell,
Vision,
Auditory
Based on Work of Bonnie Hanshu
www.sensoryprocessing.com
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”
Quiet Sensory Area
Tactile
supports
Choose carefully…..
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
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
The Power Senses
Proprioceptive System
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.
Proprioceptive System
Motor Planning
Awareness of body in
time and space without
constant visually monitoring
Dysfunction of Proprioceptive System
 Clumsiness,
 Disorganized…..
 Lacks
 Poor
a
tendency to fall
awareness of
body position/odd
posture
 Difficulty
with small
objects (buttons/
snap)
Materials & Thoughts
or resistance to
handwriting
 Eats
in a sloppy manner
 Resists
new motor
movement activities
Activities that provide
proprioceptive input
Joint
compression or extension
“Heavy
The
work” activities
larger the joint, the more
proprioceptive input
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”
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
 Organizational
Supports
Visual Supports
Color coding
Timers/Watches
Written directions
Written rule reminders
What Can Others Do
Stay on schedule
Pace language
Use Concrete Language
Use Wait
Time
The Power Senses
Vestibular System
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.
 The
brain needs
vestibular input in
order to function
 Vestibular
input
provides the
Strongest Sensation
 Movement
can change an individual’s
attention, arousal and alertness in the
shortest period of time
 The
effects from vestibular input can last
longer than any other input.
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
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
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 underresponsive
Be very cautious imposing vestibular movement – can
be very frightening
Selected Strategies
 Swinging
 Rocking
Chair
 Sit & Spin/Dizzy Disc
 Therapy
Balls as Chairs
 Moveable Cushions
or Deflated Beach Balls
as Chair Cushions
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
Remember……
 Do
NOT withhold recess/gym based on
the child’s behavior or
inability to complete work
 Movement
and activity
may be the input the
child needs in order to
maintain behavior, concentrate
and learn!
Creating The Sensory D.I.E.T.
D …..Do an Informal Assessment
I …..Individualize
E …..Environmental Supports
T …..The Power Senses
How can a therapist help my
child?

School-based therapist
•
•
•
•

Clinic-based therapist
•
•
•

Part of a full evaluation or pre-referral tool
Assist with program planning
Educate staff and personnel
Collaboration between school and clinic
Obtain observations of participation in school and home
Educate the parent/caregiver
Collaborate with the school therapist and school team
Research
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.
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
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.
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
Activities for auditory sense
 Soft
music
 Soft voice
 White noise
 Quiet room
 Up
beat music
 Loud voice
 Instruments/noise
makers
 White noise
 Classical music
Activities for visual sense:
 Soft
colors
 Solid backgrounds
 Dim lights
 Desk lamp
 Uncluttered area
 Flash light tag
 Visual schedules
 Bright
colors
 Bright lights
If you have any questions or concerns
regarding your child development and
sensory processing
1- Contact your pediatrician/primary care physician
2- Get a referral for skilled therapy services
3- Contact your therapy provider of choice
Any questions?
Alma Martinez MOT, OTR
Valerie Villarreal OTS
Maggie Flores, COTA
You may reach us at :
6550 Springfield Ave Ste. 101
(956) 725-4555
email: [email protected]