What’s Sensory Got To Do With It?

1. What’s Sensory Got To Do With It? Sue Wimmer, MS,OTR/L Occupational Therapist EASA Marion, Polk & Linn counties

2. All behavior has meaning • One way to interpret behavior is through a sensory lens.

3. Sensory systems • Our sensory systems: • Help us to learn about the world around us. • Keep us safe and calm • Regulates our alert/calm level for best functioning • Helps us to attach and have social connections • Communicate to others how our sensory system is working

4. Sensory Systems • There are 5 familiar sensory systems and 3 that are not well known, but are very important. • Vision Proprioception (muscles and joints) • Smell • Taste Vestibular (balance and movement) • Hearing • Touch Interoception (what goes on inside us)

5. Seeing- Visual System • Vision integrates all the senses- especially the vestibular and proprioceptive • Orients and interacts with environment • Protective and key to survival • Very individualized- our choice colors, pictures, scenes • Big factor in being able to read and decipher letters

6. Smell –Olfactory System • Linked directly to Limbic system for emotional component and survival

7. Taste –Gustatory System • Not about nutrition • What tastes good to us • How we react to tastes • Used for self regulation

8. Hearing-Auditory System • Helps to locate where sound is coming from, screen out noises and pay attention • Communication • Safety – alert to loud and unusual noises • Integrates body with the vestibular system • Music/rhythm regulates heart rate, respiration, calming, alerting, change your mood • Discrimination between sounds and background noise

9. Touch-Tactile System • Largest sensory system- receptors all over the body- receiving tons of input all the time • One of first to develop in utero • Need to be able to reach out and touch world around us • You have a set amount of touch you need each day and get it one way or another • Have to be able to tolerate touch to learn and feel and also interact with others • Deep touch vs light touch

10. Proprioceptive System- Body Sense • Receptors in muscles and joints • Let us know where body is and what it is doing • Brain is “hungry” for input about what the body is doing and movement • Need a good system to be able to move about and explore your world • Good for regulation and calming

11. Vestibular System – Movement • Receptors in inner ears • Interrelates the ears and eyes for input • When you move, it kicks in • Major organizer for all systems and input lasts long time (hours) • It lets you know where you are in space and how your head is moving in relation to gravity • Posture, balance, equilibrium

12. Interoceptive System- Internal Organs • Internal sensory in our organs-stomach, bladder, intestines, heart, lungs • Tells us when we are hungry, thirsty, bladder and bowel needs, tummy ache, tired • Helps to regulate the functions of the body • Is the physical reaction; to pain, bad news, car sickness

13. 1). Help us learn about world around us • Again everything we learn about the world around us comes through our sensory receptors • If we see a beautiful sunrise • If we run from a bear • If we hear our child cry • Every one’s nervous system is unique and handles sensory input differently. What works well for you may not work for others! • Should occur in an automatic and effortless way

14. 1). Help us learn about world around us • When all our sensory systems are working together we are able to take in sights, sounds, smells, movement and function well in our lives by learning, loving, interacting and appreciating the world around us.

15. 2). Keeps us safe and calm • Our bodies are wired for protection and survival • Sensory Input comes in- brain evaluates it to see if we need to pay attention to it or not • If not, then our bodies go back to homeostasis • If so, then increases heart rate, opens eyes wider, shuts down digestion= gets us ready for fight or flight • If too much stimuli for nervous system to handle, then shut down= goes into fright

16. Stress cycle

17. 2).Keeps us safe and calm • If we are in fight or flight, we burn off the extra energy to get to pre-stress state • If not, then need to bring back to pre-stress state= relaxation techniques • Deep breathing, muscle relaxation, stretching, etc. • Also the longer a system is in a stress state, the stress set point is raised over time • Today’s stress= traffic jams, paperwork, deadlines, mental threat, not a physical threat

18. Stress

19. 2). Keeps us safe and calm • Top down vs bottom up strategies • If you tell yourself to calm down, how does that work? • If you do deep breathing, music, running how does that work?

20. 2). Keep us safe and calm • Some people go into fight-flight-fright at bright lights, smell peanut butter, touch of tag in shirt, brush on arm, or even the fan running in background • These people have Sensory Processing Disorder

21. 3). Self Regulation • We regulate ourselves through our sensory systems all day, every day • Individual for each person what works • Have a set routine we use to get through the day • Starts with getting up in the morning to calming self down at night • It’s the way our bodies are set up to operate

22. 3). Self Regulation • Chart • Ways you can regulate yourself • What do you use? • Visual • Auditory • Touch • Movement • Smell • Taste

23. 3). Self Regulation • How did we learn to use these? • Started before birth • Oral motor • Movement • Touch After birth- it is a way we learn to attach and survival Need to learn to self regulate to self calm, learn about self and later emotional regulation We will do whatever we need to for self regulation and may not always be socially acceptable

24. 4). Attachment and Social Connections • Remember how the brain receives a stimulus and then evaluates whether it is a threat or not? • If threat then fight-flight-fright • If not then can focus on making social connections • Calm state • Eyes open • Heart rate even • Breathing relaxed • Focused on outside world-inner world calm & full • Muscles relaxed to make expressions- smile • What do we use? Facial expressions, vocalizations and eye contact

25. 4). Attachment and Social Connections • Stephen Porges and Polyvagal theory • How this theory fits with attachment theory-fit between mother/caregiver and child • How this theory fits with sensory processing disorder?

26. 5). Communicates to others how our sensory system is working • Are we self regulated? • Do we use sensory input to alert when needed and calm when needed? • We need to have internal self regulation before we can have emotional or behavioral regulation. • Are we able to learn from the world around us? • Are we able to make social connections?

27. 5). Communicates to others how our sensory system is working • Behavior- “behavior is a reflection of organization of your nervous system at that moment and under those circumstances.” Patti Oetter • Thinking skills- cannot be in a higher level of thinking, when in fight or flight, cannot learn to problem solve, reason, explore if not regulated • Emotional impact –internal self out of control = poor self esteem , shame, embarrassment, guilt, self blame, what is wrong with me? • Social impact – has an impact on relations with others

28. Causes • Is due to some type of change in the brain/nervous system • Prenatal - drugs, illness, maternal stress • Birth complications- prematurity, birth trauma, asphyxia • After birth- traumatic brain injury, abuse, chemical abuse, PTSD • Other causes- viruses, auto immune disorders, drug reactions, nutritional/allergies • Genetics – not studied, but known fact

29. Normal development • Need to have self regulation to be able to develop physical, cognitive and social skills • If can’t self regulate will be stuck at an early developmental level, have poor self and emotional regulation • Sensory regulation is the foundation of all other developmental skills and social development

30. Normal Development

31. Teen Development • Challenges of teen development • Physical changes – • Growth spurt • Changes in body shape • Sexual –hormones, drives, • Brain changes • Pruning to make room for higher level thinking processes • Intellect –prefrontal cortex not developed until 25-27 yo. • Increase in dopamine= pleasure seeking • Social changes • Peer influence • Self conscious –self identity

32. Sensory Break

33. What can go wrong? • Actual brain change- new research • Cannot process sensory input= dysregulation • Top down- If tell to stop, ignore, etc. does not help • Just relax, no big deal, ignore it, “it’s all in your head” • May be misdiagnosed or not diagnosed at all!

34. What can go wrong ? • Stress • Over response • Under response • Poor or wrong response

35. Sensory Processing Disorder • Sensory processing disorder is difficulty in taking in and interpreting sensory information so that an appropriate response can be made for functioning. • Take in input • Interpret input • Respond/react = behavior is response to interpretation • Is an neurological deficiency what should be automatic task & takes conscious effort

36. Sensory Processing Disorder • As neuroscience has expanded and technology developed, we are able to study the brain as it is working and have expanded more on the theory. • Today is recognized as sensory processing disorder • New study is out with clinical proof that this is a brain based problem • Tried to get into DSM 5- Promising Practice • Becoming more aware of it and what impacts it can have on people

37. Sensory Processing Disorder • SPD is 3 distinct disorders with subcategories • Sensory modulation • Sensory based motor disorder • Sensory discrimination disorder • 5-20% of children have SPD • 80-90% of children on the Autism Spectrum have SPD • ? % of adults have it

38. Sensory Processing Disorder

39. Sensory Processing Disorder • Have on a continuum- • Mild –interferes slightly with functioning (self care, work/school, leisure/recreation, rest, social interactions) • Moderate- interferes with 2-3 areas of functioning • Severe- interferes with all areas of life • Can be in more than one sensory system • Can be over-responsive in one system and under-responsive in another • Can vacillate between over and under-responsive • Rachel Schneider calls self “Delayed Diagnosis Sensory Adult”

40. Sensory Processing Disorder • Sensory modulation- • Unable to regulate the nervous system to meet the demands of the environment • Most commonly seen of the disorders • Bombarded by sensory input all the time • Need to know what to do about it and how to respond to it • Cannot match the response (behavior) to the input • Off center, out of focus, out of sync, missing a beat

41. Sensory Modulation Disorder • Over responsiveness • Most common seen & often thought all SPD is • Very reactive to small amount of stimuli • Systems thrown into fight or flight • Easily aroused by one or multi systems • Input is scary, painful, dangerous to them • Automatically go into self protection • Need consistency and predictability • Is a real thing for them –even if stimulus is not for us

42. Over –responsiveness • What it looks like: • Keep people at arms length/avoid crowds • Cannot brush hair, teeth, shower • Use extreme measures to control world/rigid routine • Hypervigilant • Wear headphones- all time with no music on • Wear hat or hood – all time • Irritable • Anxious • Avoid stairs, elevators, escalators

43. Sensory Modulation Disorder • Under Responsiveness • Process sensory input very slowly or requires a lot of input to respond • Needs frequent and intense input • The system does not take in enough to respond or react • Is just as difficult to live with, but not as bothersome to others around them • May not be identified as easily

44. Under responsiveness • What it looks like: • Seek attention as class clown, so not see physical delays • Talk loudly • Bump into people, things • Self medicate to rev self up • Miss social/sensory cues • Withdraw into own highly imaginative world to find stimulation • Lazy, lethargic • Always tired –exhaust easily

45. Sensory Modulation Disorder • Sensory Craving • Different than over responsiveness • Intense addiction to sensory stimuli – but causes disorganization and frenetic behavior • You think needs more input, then will calm down, but not so, just disorganizes them more • Input needs to be given in a specific way- structure, boundaries and small doses • Thrill seekers, confrontational, creative and imaginative If have seen one, you know it!

46. Sensory Craver • What it looks like: • Seek sensation to elicit dopamine= movement • Arrogant/extrovert • Intense • Creative • Thrill seeking • Hyperactive – seeking input – but takes little input and can crash easily • Seek intense activity- mountain biking, sky diving, etc. • Self medicate • Always something in mouth

47. Sensory Based Motor Disorder Postural disorder: Difficulty processing input from proprioceptive and vestibular system Feel uncomfortable with movement and change in body position Weak muscle tone– marshmallow kids/adults Difficulty sustaining upright posture Usually seen with under-responsive Clumsy due to poor body awareness Usually poor fine motor skills

48. Postural Disorder • What it looks like: • Often found with under-responsive modulation • Couch potato-lazy • Cannot sit up-slumps at desk • Clumsy • Disorganized –appearance, room, movement • Tires easily and quickly • Poor fine motor skills • Low muscle tone- marshmallow • Feel unstable and insecure

49. Sensory Based Motor Disorder • Dyspraxia: • Difficulty planning, sequencing and following through with motor actions • Putting things together, running & kicking ball, doing crafts, • Sits on sidelines and watches • Challenged with new movements • Klutz in gym or aerobics class

50. Dyspraxia • What it looks like: • Cannot catch ball, dance or ride a bike • Poor planning – scheduling, organization, • Uncoordinated • Poor handwriting, doing fine motor skills • Doing crafts, construction (legos, models, etc) • Avoids most sports, physical activity