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

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Presentation on theme: "Sensory Integration: Theory, Disorders, Interventions Presented by: Alma Martinez, MOT, OTR Valerie Villarreal, OTS Maggie Flores, COTA."— Presentation transcript:

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  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 1) Tactile 2) Proprioception 3) 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 Senses CNS 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

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14 Ten Fundamental Facts About SPD 1. Sensory Processing Disorder is a complex disorder of the brain that affects developing children and adults. 2. Parent surveys, clinical assessments, and laboratory protocols exist to identify children with SPD. 3. At least one in twenty people in the general population may be affected by SPD. 4. 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. 5. Studies have found a significant difference between the physiology of children with SPD and children who are typically developing. 6. Studies have found a significant difference between the physiology of children with SPD and children with ADHD. 7. Sensory Processing Disorder has unique sensory symptoms that are not explained by other known disorders. 8. Heredity may be one cause of the disorder. 9. Laboratory studies suggest that the sympathetic and parasympathetic nervous systems are not functioning typically in children with SPD. 10. 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 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

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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  m m  Sensory Planet Social Network   SPD Parent SHARE 

30 References  American Occupational Therapy Association. (2008). Occupational therapy practice framework: Doman and process (2 nd ed.). American Journal of Occupational Therapy, 62,  Baranek, G., Foster, L. & Berkson, G. (1997) Tactile defensiveness & stereotyped behaviors. Am J. of Occupational Therapy, 51,  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,  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 2 nd 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),  Henry, D. A, Kane-Wineland, M., & Swindeman, S. (2007). Tools for Tots: Sensory Strategies for Toddlers and Preschoolers    

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 Work Sheet Which is your student/child? Identify the sensory type (or types) that you observe to be true of your student or child

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37 The “Sensory Diet” includes….  PROVIDING SENSORY EXPERIENCES combination of sensory experiences adaptively interact  A combination of sensory experiences needed by a person to adaptively interact with the environment (“make it through the day”).  MAKING ENVIRONMENTAL MODIFICATIONS decrease stress  Modification and organization of the environment in order to decrease stress on a fragile sensory system.

38 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

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

40 D o an Informal Assessment Assess the Environment and the Individual’s response to a variety of sensory experiences  Seeker?  Active Avoider?  Under-Responder?  Overwhelmed

41 I ndividualize the Sensory Diet What has worked for one person may not work at all for someone else!

42 SEEKER Provide sensory experiences frequently & proactively May need to limit excitatory experiences ACTIVE AVOIDER Modify the environment to reduce the need to escape Gentle introduction to new experiences UNDER-RESPONDER Increase the use of visual supports and routines. Structure the environment. Time to respond Careful encouragement to try new experiences OVERWHELMED Control the environment Limit stimulation Limit change but prepare for changes when they need to occur. Considerations for the Sensory Diet

43 E nvironmental Supports  Organization  Predictable, Structured, Consistent Environment  Task or Curriculum  Visual Supports  Escape Environments

44 Proactively Schedule Sensory Activities throughout the day  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

45 The Power Senses Tactile System Proprioceptive System Vestibular System

46 T he Power Senses  Vestibular  Movement  Proprioception  Input through joints and muscles  Tactile  Deep Pressure Touch

47 The Power Senses Tactile System

48 Two Tactile Systems

49 Tactile System  Pertains to the sense of touch  Alerts to danger  Gives body boundaries  Helps provide a basis for body image

50 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

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

52 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

53 Tactile Defensiveness is when… - S ensitive to light touch - Touch causes difficulty organizing behavior and concentration - Touch causes negative emotional responses - Can become aggressive, if feeling threatened or stressed

54 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

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56 To“fill the sensory bucket” quickly use the Power Senses Three Power Senses will provide: more input more quickly to make changes that are more rapid Based on Work of Bonnie Hanshu

57 Environmental Supports  Access 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”

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62 Quiet Sensory Area

63 Tactile supports

64 Choose carefully…..

65 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

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67 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

68 The Power Senses Proprioceptive System

69 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.

70 Proprioceptive System Motor Planning Awareness of body in time and space without constant visually monitoring

71 Dysfunction of Proprioceptive System  Clumsiness, a tendency to fall  Lacks awareness of body position/odd posture  Difficulty with small objects (buttons/ snap)  Disorganized….. Materials & Thoughts  Poor or resistance to handwriting  Eats in a sloppy manner  Resists new motor movement activities

72 Activities that provide proprioceptive input  Joint compression or extension  “Heavy work” activities  The larger the joint, the more proprioceptive input

73 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 ”

74 Fine Motor Supports  “Hand-prep” exercise  Limit Handwriting Requirements  Alternatives to handwriting  Keyboarding  Software  Set of notes  Grips  Velcro on Shoes  Alternatives & Accommodations  Options in Word and PowerPoint  Sensory Breaks between tough fine motor activities

75  Organizational Supports  Visual Supports  Color coding  Timers/Watches  Written directions  Written rule reminders

76 What Can Others Do  Stay on schedule  Pace language  Use Concrete Language  Use Wait Time

77 The Power Senses Vestibular System

78 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.

79  The brain needs vestibular input in order to function  Vestibular input provides the Strongest Sensation

80  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.

81 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

82 Hypo-sensitive 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

83 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

84 Selected Strategies  Swinging  Rocking Chair  Sit & Spin/Dizzy Disc  Therapy Balls as Chairs  Moveable Cushions or Deflated Beach Balls as Chair Cushions

85 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

86 Remember……  Do NOT withhold recess/gym based on the child’s behavior or inability to complete work  Movement and activity may be the input the child needs in order to maintain behavior, concentrate and learn!

87 Environmental Supports  Firm Supportive seating  Feet on floor  Desk and chair that fit  Railings on step  Cushion for movement  Space to move and pace

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

89 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

90 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.

91 Activities for tactile sense:  Shaving cream (unscented, if possible)  Playdough  Theraputty  Textured food  Finger painting  Hair gel  Tactile road  Playing dress-up  Ball pit  Blanket wrapping  Pressure vest  Gentle but firm massage  Vibrating toys

92 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.

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

94 Activities for auditory sense  Soft music  Soft voice  White noise  Quiet room  Up beat music  Loud voice  Instruments/noise makers  White noise  Classical music

95 Activities for visual sense:  Soft colors  Solid backgrounds  Dim lights  Desk lamp  Uncluttered area  Flash light tag  Visual schedules  Bright colors  Bright lights

96 If you have any questions or concerns regarding your child development and sensory processing 1- Contact your pediatrician/primary care physician 2- Get a referral for skilled therapy services 3- Contact your therapy provider of choice

97 Any questions?

98 Alma Martinez MOT, OTR Valerie Villarreal OTS Maggie Flores, COTA You may reach us at : 6550 Springfield Ave Ste. 101 (956)


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