Sensory Motor Approaches with People with Mental Illness OT 460A

Surprise!! Sensory motor approaches are not just used with children!! There can be sensory motor issues throughout life There can be sensory motor issues related to multiple illnesses and injuries

Sensory Systems According to Ayres Primary Level: Three basic sensory systems – Vestibular (Ayres viewed this as the unifying system)and Proprioceptive: facilitates gravitational security Involved with balance, eye movements, posture, muscle tone – Tactile: facilitates emotional bonding and attachment to mother Can facilitate calming and comfort

Sensory Systems According to Ayres Vestibular, Proprioceptive, and Tactile Systems: – Responsible for grounding the person and for giving him or her the necessary information needed to orient the self to the environment and prepare for an adaptive response

Sensory Systems According to Ayres Second Level: – Three basic senses (vestibular, proprioception, and tactile) are integrated into: Body precept (maps of the body stored in the brain) Coordination of two sides of the body: allow bilateral work to accomplish tasks Plan motor actions Attention and focus: issues are reflected by hyper or hypoactivity

Sensory Systems According to Ayres Third Level: – Impact of auditory and visual sensations make the following possible: Speech and Language: begins with primary level sensory systems and builds on these Eye-hand Coordination: begins with primary level sensory systems and builds on these with the visual system directing the hand Visual Perception: intimately related to tactile and vestibular systems and is believed to be the end product of earlier sensory integration Purposeful Activity

Sensory Systems According to Ayres Fourth Level is resultant end products of sensory integration: – Ability to organize and concentrate – Self-esteem – Control and confidence – Academic learning ability – Capacity for abstract thought and reasoning – Development of dominance and hemispheric specialization

Sensory Systems According to Ayres Beliefs – Adaptive Response or Self-Adjusting Process Sensory Modulation: the brain organizes incoming sensory information – Brain inhibits or facilitates the flow of messages across nerve junctions and synapses – The repeated use of nerve pathways in a sensorimotor function creates a neural memory or map of that function The brain can recreate the movement at other times

Sensory Systems According to Ayres Beliefs: – Hierarchical View: Must work developmentally and sequentially – For example, don’t teach hand movement to improve eye-hand coordination unless you’ve started with integration of vestibular, proprioceptive, and tactile, the early systems

Sensory Integration Interventions Goal of S.I. Intervention: – Improvement in CNS processing, specifically in production of adaptive response instead of isolated skill development Treatment: – Sensory input within an environment that it can be modulated – Specific techniques to supply sensory input, e.g, joint compression, rotary vestibular stimulation

New Theoretical Approaches Since 1970s in Contrast to Ayres Systems view of the brain in which the brain is an integrated, holistic system. Sensory integrative dysfunction is due to multiple interrelated systems that are not functioning optimally Trend is to combine S.I. With other approaches, like humanistic psychology Ross: Incorporate neurodevelopmental approaches, e.g., NDT, with sensory stimulation

Sensory Systems According to King Lorna Jean King’s (One of Dr. Brayman’s and Robin’s favorites!) focus on Schizophrenics – Observed patients to determine sensory seeking – Linked vestibular system abnormalities with physical characteristics similar to Ayres’ children: Poor muscle tone Dislike of movement (fear of falling) Lack of response to vestibular input Limited mobility of the head “S” curvature of the spine (lordosis) Shuffling gait Holding arms and legs in a flexed, adducted, and internally rotated position Poor balance Weak grip strength and atrophy of thenar eminence

Sensory Systems According to King King’s hypotheses:Schizophrenic clients have: – Defective proprioceptive feedback mechanisms and under-reactive vestibular systems Patient use sensory input effectively to determine position in space Patients are unable to move fluidly Patient limits movement and this causes more problems This leads to decreased engagement in physical activity and discomfort in social situations – Movement and sensation play central roles in altering biochemical states and biochemistry in turn affects movement

Interventions According to King Pleasurable, noncortical activities: Start subcortically by doing activities that increase proprioceptive and vestibular input, e.g., dance – Goal is to normalize movement patterns, strengthen upper trunk stability, and increase flexibility Changes in these areas will lead to improvements in body image, self-confidence, attention, social skills Changes are the foundation for building cognitive and daily life skills

Problems with King’s Theories No standardized assessment tools to evaluate S.I. in adults Lack of evidence-based practice: studies were inconclusive

Sensory Motor Strategies Consider alerting versus calming sensations Control the amount of sensory input within the environment Therapist’s role is to be directive, yet, have fun and be spontaneous

Goals of Sensory Motor Treatment Provide sensory stimulation and opportunities for adaptive responses Focus on muscle tone, posture, and motor planning Provide motivation to participate through sensory input Start with lower cognitive skills to build higher ones Provide multiple opportunities for practice of functional tasks Reinforce achievements