Sensory Integration Therapy New

Sensory Integration Therapy – Some Aspects Sadhana P. Joshi Head O.T. Department C.O.H.

Introduction Definition •

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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 •

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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 Stimuli

Feedback/ Previous Experience

Adaptive Response

Input

CNS Integration

Output

Figure 2

Assumption of Sensory Integration a. Neural Plasticity Plasticity refers to the ability of brain to modify and change from 2 to 7 years of age. b. Occurs in developmental sequences c. Brain functions as an integrated whole though it consists of parts that are hierarchically arranged d. 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.

a. Inner drive Child 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) includes: a. Tactile and vestibular proprioceptive sensory processing test i. ii. iii. iv. v. vi.

Kinesthesia Finger identification Graphesthesia Localization of tactile stimuli Post rotatory Nystagmus Standing and walking balance

b. Form and space perception and visio-motor coordination test c. Praxi’s Test i. ii. iii. iv. v. vi.

Design copying Constructional praxis Postural praxis Praxis on verbal commands Sequential praxis Oral praxis

Sensory Integration and Praxi’s test (SIPT) d. Bilateral integration and sequencing test i. ii. iii. iv. v. vi.

Oral praxis Sequencing praxis Graphesthesia Bilateral motor coordination Space visualization Contralateral and preferred hand use

e. Bilateral motor coordination Requires 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 root problems Signs and symptoms reflecting sensory integrative root problems: Tactile sensitivity (Hyper) a. Express distress during grooming b. 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 sensitivity a. Avoid certain tastes or food smell b. Limit self to particular food, texture or temperature.

Signs and symptoms reflecting sensory integrative root problems Auditory filtering a. Is distracted or has trouble functioning if there is lots of noise around b. Appear to not hear what you say c. Can’t work with background noise d. Has trouble completing task when the radio is on e. Has difficulty paying attention Low energy / Weak motor signs a. Seems to have weak muscle b. Tires easily c. Has a weak grasp d. Can’t lift heavy objects e. Poor endurance f. Poor handwriting g. Problem in tying shoe laces h. Poor sense of rhythm i. Poor A.D.L j. Articulation problem in speech

Signs and symptoms reflecting sensory integrative root problems Visual / Auditory sensitivity a. Prefers to be in the dark b. Responds negatively to unexpected sound or bright light c. Holds hands over ears to protect ears from sound d. Watches everyone when they move around the room e. Becomes frustrated when trying to find object in competing background (e.g. cluttered drawer / shoes from rack) f. Difficulty in puzzles Emotional and Behavioural a. Low self esteem, lack of self confidence, insecure, frustrated, irritable, moody, aloof b. Self injury, temper tantrum, No peer relationship, impulsive, aggressive c. Resistant to change and stubborn Cognitive / Academic a. Attention problems, distractible, cannot refocus, lazy, slow, forgets assignments/ direction n. 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 Therapy •

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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 Therapy Direct Treatment Activities Direct treatment activities to assist adaptation to sensory sensitivity (Tactile processing) includea. Application of heavy pressure / Joint compression b. Brushing c. Localization of touch d. Work with tactual modalities – Lotion paint, beans, rice, clay, foam e. Water play f. Rolling on textured surface g. Swimming Perception of proprioception plus modulation of high activity level and hypersensitivity through use of heavy work – a. Increase weight of object b. Use of heavy weight pattern (pushing, pulling and stabilizing) c. Jumping with impact d. Carrying heavy object e. Use of resistive activity f. Riding equipments which require muscle activation g. Climbing activities – ropes, ladder, ramps.

Central Principles of Therapy Treatment of vestibular processinga. Graded experience in movement through mobile surface e.g. Swing or scooter board b. Graded experience in use of vision to perceive moving target and flow c. Stabilizing postural control activities which facilitates head, neck and extensor control d. 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 arousala. Quality of sensory information can shift level of arousal. b. Taste and smell i. ii. iii. iv.

Salt, Sour, bitter, hot taste – Alerting Sweet and warm – Relaxing Citrus, smoke – Alerting Vanilla – Relaxing

i. ii. iii. iv.

Sucking – Calming Blowing, chewing, licking – Arousing Crunchy food – Alerting Smooth food – Calming

c. Oral motor

Central Principles of Therapy d.

e.

f.

g.

Touch – may be calm or alert

i. ii. iii. iv. v.

Light touch – Alerting Deep pressure – Organizing and centering Temperature can increase or decrease the awareness Cool temperature – Alerting Warm temperature – Calming

i. ii. iii. iv. v.

Fast movement – Alerting Slow movement – Relaxing When body moves in space with orient head in difference plane – Alerting Horizontal position – conductive to sleep Vertical – Alert

i. ii. iii. iv.

Subdued and dark environment – Relaxing Bright light – Alerting Open space, subdued colors – Calming Changing and moving visual information can increase alerting response

i.

Speech pattern, rhythm, sing-song pattern help children organize themselves. Sound can be hypnotic, amusing, relaxing as well as alerting and excessively stimulated. All sensory motor information can alert nervous system depending on mode of delivery, quality of information, context and state in which it is delivered.

Movements

Visual

ii.

Sound

Central Principles of Therapy Sensory Integrated Equipments a. Tactile Equipments – Different pillows, rugs, textures, sand pit, water pool b. Non suspending moving equipments – Balls, barrels, tilt-boards, jumping board. c. Hanging equipments – Hammocks, platform swings, suspended ladders. e. Motor planning equipment – Variety of obstacles, Jungle gym etc. Conclusion Sensory Integration approach is having – a. Non cognitive emphasis b. Flexible sequences c. Exploration and creativity d. Child’s control e. Therapist guided f. One to one inter-reaction g. Improve brain processing h. Suspended equipment mandatory.

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