Sensory Integration

Erna Ariyanti K, MSc

 Assessment
• SIPT

• Sensory profile
 SPD Subtypes
• Sensory Discrimination Disorder

– Visual (eye)
– Auditory (ear)
– Tactile (touch)
– Vestibular (movement)
– Proprioception (muscle)
– Taste/smell (mouth/nose)
 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
 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
 Examples of Dyspraxia
• Poor gross motor skills • Proprioception
– Running – Poor motor control
– jumping and body awareness
• Poor fine motor skills during dressing
– Zipping • Vision
– Buttoning
• Navigating through
• Problems in figuring out crowded hallways
how to do movements
– Dressing
– Complex dance steps
 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
 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
 Review of challenges/characteristics…..

• Slow Processing - Difficulty shifting

attention

• Inattentive, Difficult to arouse

• Does not like change

or transitions -
Rigid – Demands routine
• 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
• Aggression to self or others
• Compulsive Behaviors

• Difficulty with clothing,

type of clothing, and
change of clothing
• 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
 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.
 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
 Creating The Sensory D.I.E.T.

D …..Do an Informal Assessment

I …..Individualize
E …..Environmental Supports
T …..The Power Senses
 Do an Informal Assessment
Assess the Environment and the Individual’s
response to a variety of sensory experiences

• Seeker?
• Active Avoider?
• Under-Responder?
• Overwhelmed
 Individualize the Sensory Diet

What has worked for one person may

not work at all
for someone else!
UNDER-RESPONDER SEEKER
Increase the use of
visual supports and routines.
Provide sensory
experiences frequently &
Structure the environment.
proactively
Time to respond
May need to limit
Careful encouragement to
excitatory experiences
try new experiences

Considerations for the Sensory

Diet

OVERWHELMED
ACTIVE AVOIDER
Control the environment
Modify the environment
Limit stimulation
to reduce the need
Limit change but to escape
prepare for changes Gentle introduction to
when they need to occur. new experiences
 Environmental Supports
• Organization
• Predictable, Structured,
Consistent Environment
• Task or Curriculum
• Visual Supports
• Escape Environments
 Proactively Schedule Sensory Activities

• Use the Power Senses throughout 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
 The Power Senses

Tactile System

Proprioceptive System

Vestibular System
 The Power Senses
• Vestibular
– Movement

• Proprioception
– Input through
joints and muscles

• Tactile
– Deep Pressure Touch
 The Power Senses

Tactile System
Two Tactile Systems
 Tactile System

• Pertains to the sense of touch

• Alerts to danger
• Gives body boundaries
• Helps provide a basis for body image
 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
 Discriminative : Pressure
Touch
• Deep touch/pressure, and vibration
• Activates Parasympathetic System
• Calms and organizes
• Allows for more cognitive
response
• Helps us learn and think
Dysfunction of the Tactile System
• Distractibility
• Hyperactivity
• Over/Under Sensitivity
• Hyper-vigilant
• Inappropriate pain sensation
• Avoids getting hands dirty
• Difficulties with clothing/textures
• Avoids whole hand
• Disorganized when touched
• Intolerant of wearing glasses/hearing aide
• Difficulty with Social Space
 Tactile Defensiveness is when…
- Sensitive to light touch
- Touch causes difficulty organizing behavior and
concentration
- Touch causes negative emotional responses
- Can become aggressive, if feeling threatened or
stressed
 Interventions for Tactile Defensiveness
• Brushing Protocols
– Wilbarger Protocol
– PRR
Brushing over arms, legs, back with a soft brush ,
followed by joint compressions
• Caution
– A brushing protocol should
only be implemented after
an assessment and training by a
qualified professional
To“fill the Proprioceptive
Input Tactile Input
sensory Vestibular
bucket” Input
quickly use Taste,
Smell,
the Power Vision,
Senses Auditory

Three Power Senses

will provide:
• more input
•more quickly
•to make changes
that are more rapid Based on Work of Bonnie Hanshu
www.sensoryprocessing.com
• AccessEnvironmental Supports
to an escape/private area

• Caution with placement.

Student may want to sit where no one
is behind him

• Some feel secure with boundaries that

keep others at a distance…..

• Others need space in

order to make a “quick escape”
Quiet Sensory Area
 Tactile
supports
Choose carefully…..
 Other Tactile Supports

• Consider the type of clothing and the way it

fits
– Tight?
– Loose?
– Fabric?
– Swimming/Water Play
– Body Sock Remove
tags from
clothing
 People Supports: What Others Can Do
• Avoid unnecessary touch
and Ask Permission

• Avoid touching face to gain attention

• Move slowly and provide “Waiting Time”-

up to 10 seconds

• When touch is necessary, use Deep Pressure Touch

 The Power Senses

Proprioceptive System
 Proprioceptive System
Muscles, joints, and tendons provide a person with a
subconscious awareness of body position via the feedback
from receptors in the muscles, tendons and
joints.
 Proprioceptive System
Motor Planning

Awareness of body in
time and space without
constant visually monitoring
Dysfunction of Proprioceptive System

• Clumsiness, a • Disorganized…..
tendency to fall Materials &
Thoughts
• Lacks awareness
of body • Poor or resistance to
position/odd handwriting
posture
• Eats in a sloppy
• Difficulty with manner
small objects
(buttons/ snap) • Resists new motor
movement activities
• Joint compression or extension
• “Heavy work” activities
• The larger the joint, the more
proprioceptive input
 Examples of “Heavy Work”
• Passive Joint Compressions
• Jumping/Trampoline
(floor may be better..)
• Stacking Chairs
• Weight Lifting
• “Bungee Cord” on Chairs
• Chewing Gum
• “Pretzel Hugs”
 Fine Motor Supports
• “Hand-prep”
exercise
• Limit Handwriting
Requirements
• Alternatives to • Alternatives &
handwriting Accommodations
– Keyboarding – Options in Word and
PowerPoint
– Software
– Set of notes
– Grips • Sensory Breaks
– Velcro on Shoes between tough
fine motor
activities
•
•
•
•
•
•
–Stay on schedule
–Pace language
–Use Concrete Language
–Use Wait Time
 The Power Senses

Vestibular System
 Vestibular System

The vestibular system refers to the structures

within the inner ear (the semi-circular
canals)

These structures detect movement and

changes in the position of the head.
• The brain needs vestibular input in
order to function

• Vestibular input provides the

Strongest Sensation
• Movement can change an individual’s attention,
arousal and alertness in the shortest period of
time

• The effects from vestibular input can last longer

than any other input.
 Hypersensitive: Active avoider and
overwhelmed
• Fearful reactions to ordinary movement activities
• Apprehensive walking or crawling on uneven or
unstable surfaces
• Seem fearful in open space
• Appear clumsy
• Want their feet on the ground!

• These folks need gentle experiences and support as

they become more comfortable
 Hypo-sensitive
Under-Responders and Seekers
• Seeker: Actively seek and demonstrate a need for
intense movement experiences (whirling, jumping,
spinning, spinning objects, pacing)
• May includes visual stim
• Be aware: Seeker can become over-excited
– Needs monitoring
– “Cap-off” vigorous vestibular activity with proprioception
(“heavy work” or joint compression)

• Under-Responder may need gentle encouragement to

engage in movement activities
 Activities that provide vestibular input
• Seeker/Avoider/Overwhelmed
– Linear, Calm, Slow, Controlled movement
to gain attention

• Under-Responder
– Unpredictable, multi-directional, spinning
(if individual requests), to alert and orient
someone who is under-responsive
– Be very cautious imposing vestibular
movement – can be very frightening
 Selected Strategies
• Swinging
• Rocking Chair
• Sit & Spin/Dizzy Disc

• Therapy Balls as Chairs

• Moveable Cushions or
• Deflated Beach Balls as Chair Cushions
 Selected Strategies

• Delivering Messages or Packages (or any job that

requires walking, moving, bending, etc.)

• Running Track or possible a Treadmill

• Movement breaks placed proactively in the day

 Remember……

•
 Creating The Sensory D.I.E.T.

D …..Do an Informal Assessment

I …..Individualize
E …..Environmental Supports
T …..The Power Senses
How can a therapist help my child?
• School-based therapist
• Part of a full evaluation or pre-referral tool
• Assist with program planning
• Educate staff and personnel
• Collaboration between school and clinic
• Clinic-based therapist
• Obtain observations of participation in school and home
• Educate the parent/caregiver
• Collaborate with the school therapist and school team
• Research
HOW CAN WE HELP OPTIMIZE
THE LEARNING EXPERIENCE??

By knowing what type of

strategies/activities to do with your
child that will help the body organize
and interpret sensory information to
the brain.
 Activities for tactile sense:

• Shaving cream
(unscented, if possible) • Ball pit
• Playdough
• Theraputty
• Blanket wrapping
• Textured food • Pressure vest
• Finger painting
• Hair gel • Gentle but firm
• Tactile road
• Playing dress-up
massage
• Vibrating toys
 Activities for Vestibular sense:
• Swings
• Scooter boards
• Wagon rides
• Self propelling toy cars
• Slides
• Obstacle courses
• Monkey bars
• Trampoline
• Rolling on mat

NOTE: This must be slow and brief at first, in very secure positions.
Activities for proprioceptive sense

• Crash pad • Weighted garments

• Crawling (can crawl • Pressure garments
through tunnel, over • Heavy work
beanbags or pillows) • Scooter board
• Running • Therapy ball
• Climbing • Jumping on a
trampoline
• Marching
• Wheelbarrow walks
• Wall push-ups
 Activities for auditory sense

• Soft music • Up beat music

• Soft voice • Loud voice
• White noise • Instruments/nois
• Quiet room e makers
• White noise
• Classical music
 Activities for visual sense:

• Soft colors • Bright colors

• Solid backgrounds • Bright lights
• Dim lights
• Desk lamp
• Uncluttered area
• Flash light tag
• Visual schedules
 What can we do about it?

AUDITORY: Information through the ears (sound)

• covers his/her ears during assemblies, gym and music classes, fire drills
Strategies
Ear phones or ear plugs
Prior notice of fire drills
Sitting away from speakers
Bal-a-vis-x

GUSTATORY: Information through the mouth (taste)

• extremely picky eater
• puts everything into the mouth
Strategies
Eight introductions
Never force
Teach safety and cleanliness; look first, ask second, and then insert
Terima kasih