Making Sense of Sensory Integration

CONNECTING THE SENSES TO FUNCTIONAL PERFORMANCE…

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COREY YATES OTD, OTR/L

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What is Occupational Therapy (OT)?

• Promoting independence and improving quality of life
• Helping people with a physical, cognitive, and/or psychosocial disabilities be as independent as possible in all areas of their lives and live the best quality of life
• Facilitating Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL)
• Also, rest/sleep, work, play, leisure, education & social participation.
• OT services may be consultative or involve direct individual or group intervention

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Why look at sensory?

• Because it is an essential part of our daily functioning!
• Connection to brain and body health
• We have the ability to gain awareness and make changes!

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What is Sensory Integration (SI)?

General Definition:

• Organizing sensory input to respond and interact with the environment
• Input used to create perceptions, thoughts, emotions and actions
• Influences and is influenced by learning and behavior

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Key Concepts

• SI comes from nervous system
• Modulation: refers to someone’s sensitivity level and ability to filter/prioritize environmental stimuli (responsiveness/how sensitive)
• Discrimination: ability to perceive and differentiate input (skill)
• Sensory processing is the sequence of registering, orienting, discriminating and responding to sensory stimuli
• Sensory input from all channels integrated together in brain to form responses and interact with environment
• Sensory integration is foundational for all functional skills

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Who is affected by Sensory Integration?

• EVERYONE!!!
• Approximately 5-16% of population experiences sensory processing deficits/disorders
• Approximately 35% of gifted population experiences sensory processing deficits/disorders
• People with ADHD/ADD are more likely to have sensory processing deficits/disorders and increased frequency of anxiety disorders
• More than 80% of children with ASD experience comorbid sensory processing deficits/disorders and are more likely to have anxiety
• Many people with learning disabilities may also experience sensory processing differences
• Many people with genetic diagnoses also experience sensory processing deficits/disorders
• Children with sensory processing disorders are at greater risk for anxiety and depression

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SI Lays the Foundation For…Everything!

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• Regulation of arousal state
• Grading physical movements
• Posture (control & endurance)
• Behavioral regulation
• Emotional regulation
• Social skills
• Motor-planning
• Mapping and planning time
• Link to Executive Functions

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Interoception

What happens when we do not �accurately process and integrate sensation?

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• When people are over-sensitive or under-sensitive to different sensory channels, it can cause dysfunction
• People may experience difficulty with just one sensory channel, or multiple
• People may be over-sensitive to some sensory channels and under-sensitive to others
• Sensory processing disorders can manifest indifferent ways: discrimination disorders, modulation disorders, motor planning (dyspraxia), postural disorder
• Potential for many functional deficits with severity of impact ebbing and flowing throughout life

Tactile System /Touch

�Signs of Possible Problems:

• Dislike standing in line or difficulty w/ personal space awareness
• Dislike touching/playing w/ messy things
• Frequent mouthing/chewing on objects
• Avoids or craves specific food textures
• Constant touching of things/others
• Difficulty w/ writing utensils or other materials (scissors, ruler, etc)
• No or decreased reactions to bumps/falls/scrapes
• Specific about clothing textures (bothered by tags)
• Decreased or extra-sensitive hot/cold awareness

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This Photo by Unknown Author is licensed under CC BY-SA

Vestibular System

Relationship to balance and gravity

• Difficulty staying still during seated tasks; frequent movement in general
• Rocking (while seated or standing)
• Craves spinning or swinging (‘never seems to get dizzy’)
• Likes being upside-down
• Fears or avoids movement
• Difficulty w/ looking between board and desk or between

book and paper/computer

• Dislikes head tilted back for hair washing
• Avoids movement activities (swings, roller-coasters)
• Car sickness, boat sickness; difficulty w/ elevators/escalators

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Signs of Possible Problems:

This Photo by Unknown Author is licensed under CC BY-SA

Proprioceptive System:

Muscles & Joints; Body Awareness

• Clumsy (frequent bumps into objects, drops/spills things)
• Stomps feet, bangs hands, slams doors/objects
• Writes extra hard (or too light), breaks writing utensils
• Fatigue or cramping during writing
• Difficulty typing on computer
• Difficulty sequencing movements (such as multiple-step physical directions)
• Playing and physical interactions are too rough/aggressive (ex. Hard high fives or hand-shakes)
• Deliberate falls, seeking out hugging or deep pressure
• Mouthing/chewing objects
• Fidgeting
• Poor motor planning (riding bike or using scissors)

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Signs of Possible Problems:

This Photo by Unknown Author is licensed under CC BY

Visual System

Signs of Possible Problems:

• Poor eye contact (either w/ or w/o emotional distress)
• Turns head to side, or gets close when looking at things
• Seeks intense input (such as close-up looking at lights)
• Difficulty tracking objects (such as ball to catch o watching teacher walk across the classroom)
• difficulty w/ moving spaces on game board; difficulty w/ puzzles or handwriting
• Difficulty finding things (such as a game in a closet)
• Easily distracted by things in environment
• Loses place when reaching and/or difficulty copying from board
• Difficulty separating eye from head movements
• Frequent rubbing eyes, or complaint of eyes being blurry, itchy or tired

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Auditory System

Signs of Possible Problems:

• Sensitive to noises (covers ears w/ loud or sudden noises, such as toilet flush; easily bothered by background noise)
• Doesn’t always respond to name
• Difficulty locating sound (where is the ringing phone?)
• Constantly distracted by background noise
• Requesting repeated directions (”huh? What”)
• Constant making of noises (humming, etc)
• Prefers loud music/electronics

Interoception/Visceral Sense

Sensation of the internal organs: such pain, hunger/fullness, bowel/bladder, sleep/awake

• Decreased awareness of need to use bathroom; frequent accidents (may be night or day); may ‘all of a sudden’ feel need to use the bathroom
• Altered sleep performance (difficulty falling alseep, frequent waking up)
• Over-eating (doesn’t seem to get full)
• Not feeling gradual hunger (all of a sudden ‘starving’)
• Decreased awareness of pain, or over-sensitive to pain
• Difficulty with temperature regulation

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Signs of Possible Problems:

This Photo by Unknown Author is licensed under CC BY-SA

Olfactory & Gustatory Systems

Smell & Taste

• Sensitive to smell, complains of things smelling bad; difficulty concentrating around strong smells
• Smelling people and/or objects
• Strong behavioral and/or emotional responses to smells/tastes
• Prefers foods with extra spice, or extra bland
• Limits food textures
• Eats inappropriate objects (such as paper)

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Signs of Possible Problems:

Function or Dysfunction?

• Range of normal
• Appropriate to have likes dislikes
• Do preferences limit your function?
• Is arousal state within functional limits to allow engagement?
• Is academic success being achieved?
• Are social skills impacted?
• Are emotional and behavioral responses impacted?

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What can we do?

• Activities that are beneficial for all humans!
• Be well rounded in using coping strategies (cognitive, sensory-based, social-emotional, physical)
• Use routines and preparatory strategies
• Modify environments and routines as needed
• Give choices, but also provide firm/clear boundaries
• Honor your own sensory needs and use your self-regulation to guide your childrens’ (or those you caring for/interacting with)
• Create an environment that allows for mistakes and growth
• Be communicative about needs; be proactive rather than reactive
• Differentiate between ‘moments to grow’ and ‘moments to survive’
• Focus on positive and reinforcing positive responses
• Know when to seek out help

Resources & References

• Sensory Integration and the Child by Jean Ayres
• Learn to Move, Move to Learn by Jenny Clark Brack
• Living Sensationally: Understanding your senses, by Winnie Dunn
• SPD foundation.net
• Children’s Stories (ex: search “sensory integration children’s stories” on www.amazon.com)
• AOTA Addressing Sensory Integration Across the Lifespan through occupational therapy www.aota.org
• Star Institute for Sensory Processing Disorder www.spdstar.org
• To read more about Interoception: www.mahlerautism.com
• Sensational Kids: Hope and Help for Children with Sensory Processing Disorder (SPD) by Lucy Jane Miller
• American Occupational Therapy Association. (2020). Occupational therapy practice framework: Domain and process. American Journal of Occupational Therapy, 74(Suppl. 2), 1–87.
• American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013.

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