Sensory Integration: Theory, Disorders, Interventions

1. Sensory Integration: Theory, Disorders, Interventions Presented by: Alma Martinez, MOT, OTR Valerie Villarreal, OTS Maggie Flores, COTA

2. Sensory Integration (SI) • Dr. Jean Ayres -1963 • Is the ability of a person to take in a variety of sensory input, process and understand it, and use it.

3. What Are The Senses? • Vestibular- movement • Tactile- touch • Proprioception- where are your body parts? • Visual- seeing • Auditory- hearing • Taste • Smell

4. How Is Information Processed? • Main sensory systems • Tactile • Proprioception • Vestibular • Transmitters of information from environment to the brain

5. Why Sensory Integration? • Increases interaction with others • Develops necessary skills • Organization

6. Sensory Integration Theory • Automatic process • Natural outcomes occur • Learning problems • Developmental lags • Behavior issues

7. How is SI Used? • Understanding the WHOLE environment • Learning • Understanding what is going on around us • Regulation

8. Neurobiologically Based Concepts • Neural Plasticity • Central Nervous System Organization • Adaptive Response • Sensory Nourishment

9. Development Process of SI • Detection or registration of sensation • Modulation of sensation • Sensory discrimination • Higher sensory integrative skills • Targeted occupations

10. INPUT SENSORY INTEGRATION OUTPUT CNS Senses Result

11. 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.

12. Impacts On Every day Life • Activities of Daily Living (ADLs) • Social Participation • Education/Work • Play/Leisure • Rest and Sleep

14. Ten Fundamental Facts About SPD • 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

15. 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

16. 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

17. Sensory Over-Responsivity • Proprioception • Difficulty being hugged • Difficulty with people moving your body • Auditory • Fearful of sounds • Distracted by certain noises • Frequently cover ears • Oral • “Picky” eater • Difficulty brushing teeth

18. 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

19. 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

20. Sensory Seeking/Craving • Seeks arousal of nervous system (inappropriately) • Tactile • Enjoy “bear” hugs • Crave touch of textures • Vestibular • Jumping • Enjoy spinning in circles, being upside down

21. 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)

22. SPD Subtypes • Sensory Discrimination Disorder • Visual (eye) • Auditory (ear) • Tactile (touch) • Vestibular (movement) • Proprioception (muscle) • Taste/smell (mouth/nose)

23. 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

24. 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

25. Examples of Dyspraxia • Poor gross motor skills • Running • jumping • Poor fine motor skills • Zipping • Buttoning • Problems in figuring out how to do movements • Dressing • Complex dance steps • Proprioception • Poor motor control and body awareness during dressing • Vision • Navigating through crowded hallways

26. 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

28. 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

29. Support Groups • Moms Connect About Autism-MoCAA • http://www.momsconnectaboutautism.com • Sensory Planet Social Network • http://www.sensoryplanet.com/home.php • SPD Parent SHARE • http://www.spdparentshare.com

30. References • 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

31. Review of challenges/characteristics….. • Slow Processing - Difficulty shifting attention • Inattentive, Difficult to arouse • Does not like change or transitions - Rigid – Demands routine

32. 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

33. Aggression to self or others • Compulsive Behaviors • Difficulty with clothing, type of clothing, and change of clothing

34. 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

35. So What Can We Do? The "Sensory Diet"

36. The “Sensory Diet” includes…. • PROVIDING SENSORY EXPERIENCES • A 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.

37. Those with sensory processing challenges • May not be able to filter and focus • May attempt to adjust in a maladaptive way (Ex: Escalation of Mood, Shutting Down) • Will require a “sensory diet” enriched with unique sensations and experiences

38. Creating The Sensory D.I.E.T. D …..Do an Informal Assessment I …..Individualize E …..Environmental Supports T …..The Power Senses

39. Do an Informal Assessment Assess the Environment and the Individual’s response to a variety of sensory experiences • Seeker? • Active Avoider? • Under-Responder? • Overwhelmed

40. Individualize the Sensory Diet What has worked for one person may not work at all for someone else!

41. 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 • ACTIVE AVOIDER • Modify the environment • to reduce the need • to escape • Gentle introduction to • new experiences OVERWHELMED Control the environment Limit stimulation Limit change but prepare for changes when they need to occur.

42. EnvironmentalSupports • Organization • Predictable, Structured, Consistent Environment • Task or Curriculum • Visual Supports • Escape Environments

43. Proactively Schedule Sensory Activities • Use the Power Sensesthroughout the day in order to help a person alert, attend, act, and react • At times, additional activities or input may be needed based on the behaviors observed

44. Proprioceptive System Vestibular System The Power Senses Tactile System

45. The Power Senses • Vestibular • Movement • Proprioception • Input through joints and muscles • Tactile • Deep Pressure Touch

46. The Power Senses Tactile System

47. Protective Two Tactile Systems Discriminative

48. Tactile System • Pertains to the sense of touch • Alerts to danger • Gives body boundaries • Helps provide a basis for body image

49. 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

50. Discriminative : Pressure Touch • Deep touch/pressure, and vibration • Activates Parasympathetic System • Calms and organizes • Allows for more cognitive response • Helps us learn and think