Stephanie M. L. Potts, MOTR/L

1. Sensory Integration Theory Part 1 Stephanie M. L. Potts, MOTR/L

2. Sensory Integration • Sensory Integration (SI) is defined as, “the neurological process that organizes sensation from one’s own body and from the environment and makes it possible to use the body effectively within the environment” (Ayres, 1979). • Sensory Integration focuses on 3 sensory systems: Tactile, Vestibular, and Proprioceptive • The interrelationship among these sensory systems is critical to one’s basic survival. When they do not interact properly is when you see sensory processing difficulties.

3. Tactile system • The tactile system relates to an individual’s sense of touch. • This is the sensory system that helps us learn about our bodies and our environment. “The tactile system includes nerves under the skin's surface that send information to the brain. This information includes light touch, pain, temperature, and pressure. These play an important role in perceiving the environment as well as protective reactions for survival” (Autism Research Institute, 2012).

4. Proprioceptive system • The joints of the musculoskeletal system and muscle receptors throughout the body are essential in allowing the body to maintain equilibrium (National Institute of Health, 2012). Proprioception is the ability to sense the position, orientation, and movement of the body and its parts in space. • “The proprioceptive system refers to components of muscles, joints, and tendons that provide a person with a subconscious awareness of body position. When proprioception is functioning efficiently, an individual's body position is automatically adjusted in different situations; for example, the proprioceptive system is responsible for providing the body with the necessary signals to allow us to sit properly in a chair and to step off a curb smoothly. It also allows us to manipulate objects using fine motor movements, such as writing with a pencil, using a spoon to drink soup, and buttoning one's shirt” (Autism Research Institute, 2012).

5. Vestibular system • The vestibular system collaborates with the visual system in order to allow the eyes to focus on an object while the head is in continuous motion (National Institute of Health, 2012). • The brain receives the information from these systems; processing and interpreting this information to maintain balance. Gravitational, linear, and angular acceleration through the vestibular system allow an individual to maintain postural control, along with information from one’s visual system, and orienting the head and eyes (Futrell, 2006). • The vestibular system allows a student to look up at the blackboard and back down at their paper without losing their place.

6. Signs of possible poor sensory processing and self-regulation • Bothered by clothing fabrics, labels, tags, etc. • Distressed by light touch or unexpected touch • Dislikes getting messy • Resists grooming activities • Very sensitive to sounds (volume or frequency) • Squints, blinks, or rubs eyes frequently • Bothered by lights or patterns • High activity level or very sedentary • Unusually high or low pain threshold • Fine motor delays (e.g., crayons, buttons/snaps, beading, scissors) • Gross motor delays (e.g., walking, running, climbing stairs, catching a ball ) • Illegible handwriting • Moves awkwardly or seems clumsy • Low or high muscle tone

7. Sensory Integration Theory • SI therapy provides opportunities for engagement in sensory motor activities that are rich in tactile, vestibular, and proprioceptive sensations. • The child is guided through challenging and fun activities designed to stimulate and integrate sensory systems, challenge his or her motor systems, and facilitate integration of sensory, motor, cognitive, and perceptual skills. • SI interventions can help decrease tactile and other sensitivities to stimuli that interfere with these individuals’ ability to play, learn, and interact

8. Principles of SI • Just Right Challenge • Therapist creates playful activities with achievable challenges • The Adaptive Response • In response to challenge, the child adapts his or her behavior with new and useful strategies, furthering development • Active Engagement • The methods of play incorporate new and advanced abilities that increase the child’s repertoire of skills and processing • Child Directed • Therapist constantly observes the child’s behavior and reads behavioral cues, follows the child’s lead or suggestions, and uses these cues to create enticing, sensory rich activities.

9. Benefits of SI • According to Jean Ayres (1979), outcomes from SI therapy include: • Ability to concentrate • Ability to organize • Increase in self-esteem • Increase in self-control • Increase in self-confidence • Improvement in academic learning ability • Capacity for abstract thought and reasoning • Specialization of each side of the body and the brain

10. SI Interventions used in school system • Weighted vests • Weighted blanket • Multisensory environment (Crash Room) • Ball chair • Wilbarger brushing protocol • Sensory diet

11. School suggestions • Keep routines and possessions organized. • Be consistent with rules and consequences. • Keep a picture activity schedule or calendar posted. • Create specific routines for troublesome times of day (music, cafeteria) • Discuss upcoming anticipated changes in routine at a point in time that is beneficial for your child. You will have to experiment with how early the child "needs to know." • Try to indirectly use your child’s sensory preferences for fun rewards to help you handle behavior. • Try NOT to restrict movement activities when student is being disciplined. For example: taking away recess time. Students need this movement time and his or her behavior may actually become more difficult later if this time is taken away. Instead choose to “walk and talk” with students; have student walk around playground talking to you about why they are unable to participate with their friends.

12. References • Ayres, J. (1979). Sensory integration and the child. Los Angeles: Western Psychological services. • Autism Research Institute. (2012, March). Sensory Integration. Retrieved from: http://www.autism.com/fam_page.asp?PID=372 • Bonggat, P., & Hall, L. (2010). Evaluation of the effects of sensory integration-based intervention by a preschool special education teacher. Education and Training in Autism and Developmental Disabilities, 45(2), 294-302. • Futrell, M. (2006, October). Neuromuscular Control, Proprioception and Balance. Retrieved from http://www.cofc.edu/~futrellm/nmcontrol.html • Mullen, B., Champagne, T., Krishnamurty, S., Dickson, D., & Goa, R. (2008). Exploring the safety and therapeutic effects of deep pressure stimulation using a weighted blanket. Occupational Therapy in Mental Health, 24(1), 65-89. • National Institute of Health. (2012, February). Balance Disorders. Retrieved from http://www.meei.harvard.edu/patient/balancedisorders.php • Olson, L. & Moulton, H. (2004a). Use of weighted vests in pediatric occupational therapy practice. Physical & Occupational Therapy in Pediatrics, 24(3), 45-60. • Schilling, D., Washington, F., & Deitz, J. (2003). Classroom seating for children with attention deficit hyperactivity disorder: Therapy balls versus chairs. American Journal of Occupational Therapy, 57, 534-541. • Stephenson, J., & Carter, M. (2011). Use of multisensory environments in schools for students with severe disabilities: Perceptions from schools. Education and Training in Autism and Developmental Disabilities, 46 (2), 276-290. • VandenBerg, N.L. (2001). The use of a weighted vest to increase on-task behavior in children with attention difficulties. American Journal of Occupational Therapy, 55, 621-628.