Sensory Integration Therapy Sensory Integration Therapy – Some Aspects– Some Aspects

Sadhana P. JoshiSadhana P. Joshi

Head O.T. Department C.O.H.Head O.T. Department C.O.H.

IntroductionIntroduction

Definition• Sensory Integration is defined as a neurological process that organizes

sensation of one’s own body and the environment in the brain to make adaptive response and makes it possible to use the body efficiently within the environment.

• Sensory Integration function will include the awareness, discrimination and recognition of sensory stimuli from the environment and from the C.N.S and use of this sensory information to direct motor behaviour.

Background• S.I. Therapy was conceived and developed by Dr. Jean Ayers an

Occupational Therapist and psychologist. It explains the relationship between behaviour and neural function, especially sensory processes and integration.

• It describes and predicts relationship among neural functioning, sensory motor behaviour and academic learning.

Sensory Integration (Figure 1)Sensory Integration (Figure 1)

Input

Feedback/ Previous

Experience

Sensory

Stimuli

Adaptive

ResponseOutput

CNS Integration

Figure 2Figure 2

Assumption of Sensory IntegrationAssumption of Sensory Integration

a. Neural PlasticityPlasticity refers to the ability of brain to modify and change from 2 to 7

years of age.b. Occurs in developmental sequencesc. Brain functions as an integrated whole though it consists of parts that are

hierarchically arrangedd. Adaptive response

Requires the child to organize the sensation, accurately judge the requirement of the situation and execute response completely. [Controlled sensory input can be used to elicit adaptive response.]

Adaptive response contribute to development of S.I

Motor ability is a powerful organizer of sensory inputs.

e. Inner driveChild has inner drive to develop S.I. through participation in sensory

motor activity.

Sensory Integration and Praxi’s test (SIPT)Sensory Integration and Praxi’s test (SIPT)

Sensory Integration and Praxi’s test (SIPT) includes:a. Tactile and vestibular proprioceptive sensory processing test

i. Kinesthesiaii. Finger identificationiii. Graphesthesiaiv. Localization of tactile stimuliv. Post rotatory Nystagmusvi. Standing and walking balance

b. Form and space perception and visio-motor coordination testc. Praxi’s Test

i. Design copyingii. Constructional praxisiii. Postural praxisiv. Praxis on verbal commandsv. Sequential praxisvi. Oral praxis

Sensory Integration and Praxi’s test (SIPT)Sensory Integration and Praxi’s test (SIPT)

d. Bilateral integration and sequencing testi. Oral praxisii. Sequencing praxisiii. Graphesthesiaiv. Bilateral motor coordinationv. Space visualizationvi. Contralateral and preferred hand use

e. Bilateral motor coordinationRequires the child to imitate smoothly executed movements of hand and feet after they are demonstrated by examiner. Reciprocal interaction of right and left are used.

Signs and symptoms reflecting sensory integrative Signs and symptoms reflecting sensory integrative root problemsroot problems

Signs and symptoms reflecting sensory integrative root problems:Tactile sensitivity (Hyper)a. Express distress during groomingb. Prefers long sleeved clothing when it is warm and short sleeved when it is

cold.c. Avoid going barefoot especially sand or grass.d. React emotionally or aggressively to touch.e. They desist from splashing water.f. Has difficulty standing in line or close to other people.g. Rub or scratch out a spot that has been touched.Movement sensitivity (Vestibular)a. Become anxious or distressed if feet leave the ground.b. Fear of falling or height.c. Dislike activities if head is upside down (e.g. somersaults)Taste/ Smell sensitivitya. Avoid certain tastes or food smellb. Limit self to particular food, texture or temperature.

Signs and symptoms reflecting sensory integrative Signs and symptoms reflecting sensory integrative root problemsroot problems

Auditory filteringa. Is distracted or has trouble functioning if there is lots of noise aroundb. Appear to not hear what you sayc. Can’t work with background noised. Has trouble completing task when the radio is one. Has difficulty paying attentionLow energy / Weak motor signsa. Seems to have weak muscleb. Tires easilyc. Has a weak graspd. Can’t lift heavy objectse. Poor endurancef. Poor handwritingg. Problem in tying shoe lacesh. Poor sense of rhythmi. Poor A.D.Lj. Articulation problem in speech

Signs and symptoms reflecting sensory integrative Signs and symptoms reflecting sensory integrative root problemsroot problems

Visual / Auditory sensitivitya. Prefers to be in the darkb. Responds negatively to unexpected sound or bright lightc. Holds hands over ears to protect ears from soundd. Watches everyone when they move around the roome. Becomes frustrated when trying to find object in competing background

(e.g. cluttered drawer / shoes from rack)f. Difficulty in puzzlesEmotional and Behaviourala. Low self esteem, lack of self confidence, insecure, frustrated, irritable,

moody, aloofb. Self injury, temper tantrum, No peer relationship, impulsive, aggressivec. Resistant to change and stubbornCognitive / Academica. Attention problems, distractible, cannot refocus, lazy, slow, forgets

assignments/ directionb. Poor organization, sequencing and memory

Development Dyspraxia is a brain dysfunction that hinders the organization of tactile and sometimes vestibular and proprioceptive sensation and interferes with ability to motor plan.

Central Principles of TherapyCentral Principles of Therapy

• Central idea of this therapy is to provide and control sensory input especially the input from the vestibular system, muscles and joints and skin in such a way that a child spontaneously forms the adaptive responses that integrate those sensations.

• Sensory integration occurs when a child spontaneously plans and executes a successful adaptive response to sensory input (e.g. reaching for an object)

• Child must actively participate with the environment to improve the organization of his nervous system.

• Therapist designs an environment that enables the child to interact more effectively than has ever done before. Therapist must encourage, cajole, lure and manipulate the child into choosing the activities that will help his brain develop. She cannot organize the child’s brain for him. He must do it himself, but it is evident that he can’t do without her help.

Central Principles of TherapyCentral Principles of Therapy

Direct Treatment ActivitiesDirect treatment activities to assist adaptation to sensory sensitivity

(Tactile processing) include- a. Application of heavy pressure / Joint compressionb. Brushingc. Localization of touchd. Work with tactual modalities – Lotion paint, beans, rice, clay, foame. Water playf. Rolling on textured surfaceg. SwimmingPerception of proprioception plus modulation of high activity level

and hypersensitivity through use of heavy work – a. Increase weight of objectb. Use of heavy weight pattern (pushing, pulling and stabilizing)c. Jumping with impactd. Carrying heavy objecte. Use of resistive activityf. Riding equipments which require muscle activationg. Climbing activities – ropes, ladder, ramps.

Central Principles of TherapyCentral Principles of Therapy

Treatment of vestibular processing-a. Graded experience in movement through mobile surface e.g. Swing or

scooter boardb. Graded experience in use of vision to perceive moving target and flowc. Stabilizing postural control activities which facilitates head, neck and

extensor controld. Incorporate visual motor activities which assist the child to stabilize their

gaze, localize object shift between visual frame of references, track and scan their environment while moving.

Treatment of arousal-a. Quality of sensory information can shift level of arousal.b. Taste and smell

i. Salt, Sour, bitter, hot taste – Alertingii. Sweet and warm – Relaxingiii. Citrus, smoke – Alertingiv. Vanilla – Relaxing

c. Oral motori. Sucking – Calmingii. Blowing, chewing, licking – Arousingiii. Crunchy food – Alertingiv. Smooth food – Calming

Central Principles of TherapyCentral Principles of Therapy

d. Touch – may be calm or alerti. Light touch – Alertingii. Deep pressure – Organizing and centeringiii. Temperature can increase or decrease the awarenessiv. Cool temperature – Alertingv. Warm temperature – Calming

e. Movementsi. Fast movement – Alertingii. Slow movement – Relaxingiii. When body moves in space with orient head in difference plane – Alertingiv. Horizontal position – conductive to sleepv. Vertical – Alert

f. Visuali. Subdued and dark environment – Relaxingii. Bright light – Alertingiii. Open space, subdued colors – Calmingiv. Changing and moving visual information can increase alerting response

g. Soundi. Speech pattern, rhythm, sing-song pattern help children organize themselves.

Sound can be hypnotic, amusing, relaxing as well as alerting and excessively stimulated.

ii. All sensory motor information can alert nervous system depending on mode of delivery, quality of information, context and state in which it is delivered.

Central Principles of TherapyCentral Principles of Therapy

Sensory Integrated Equipmentsa. Tactile Equipments – Different pillows, rugs, textures, sand pit, water poolb. Non suspending moving equipments – Balls, barrels, tilt-boards, jumping

board.c. Hanging equipments – Hammocks, platform swings, suspended ladders.d. Motor planning equipment – Variety of obstacles, Jungle gym etc.

ConclusionSensory Integration approach is having –a. Non cognitive emphasisb. Flexible sequencesc. Exploration and creativityd. Child’s controle. Therapist guidedf. One to one inter-reactiong. Improve brain processingh. Suspended equipment mandatory.

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