About Sensory Integration Disorder and Sensory Integration Therapy

Lynette Yisrael
June 2004

What is Sensory Integration?

We are all familiar with the senses of touch, smell, hearing, taste and sight. Other important sensations are the pull of gravity, our own movement, and the awareness of our bodies in space. Our nervous systems receive, filter, organize and make use of motor and sensory information. This neurobiological process is called Sensory Integration. Sensory Integration is necessary for us to interact with our environments.

Sensory Integration begins in the womb as the three main sensory systems mature. The Vestibular System responds to gravity and movement. The Proprioceptive System receives input from muscles and joints. When these systems interact with tactile sensation (the sense of touch), the process of sensory integration takes place. Later, Sensory Integration is developed as children explore sensations and body movement by touching, rolling, hugging, crawling, jumping, and climbing.

Sensory Integration is necessary for motor coordination and motor planning. Balance and body scheme are affected by Sensory Integration. Even attention, emotional stability and self-esteem are related to Sensory Integration. Sensory Integration can be viewed on a continuum, with some people having a greater degree of Sensory Integration, and others having less. A lack of Sensory Integration can interfere with overall development, and there is a need for intervention. Careful study is necessary in order to determine which parts of the Sensory Integration process need to be addressed.

Dysfunction in Sensory Processing

Sensory Integration serves two main functions. It protects us from over-stimulation by sifting through sensations, disregarding some and reacting to others. It also helps us to interact with and learn from our environment.

The following are signs that a child may have a dysfunction in sensory-motor processing.

• Avoiding touch.
• Over-reacting to touch.
• Inability to identify objects by touch.
• Spinning, hand-flapping, head banging.
• Biting.
• Poor eye contact.
• Short attention span, distractibility, and hyperactivity.
• Lack of physical coordination.
• Clumsiness and lack of balance.
• Fear of movement, avoids motor play.
• Dislikes change.
• Outbursts.
• Difficulty using both sides of the body.
• Repetitive Speech
• Slow speech.
• Slow moving.
• Difficulty with copying.
• Emotionally immature, lacks coping skills.
• Behavior problems.
• Lacks body image and awareness.
• Difficulty relating to peers.
• Learning or academic problems.
• Raised shoulders.
• Poor fine motor control.
• Poor gross motor skills.
• Poor handwriting.
• Fear and anxiety in new situations.
• Objecting to change.
  Ritualistic behavior.

Formal tests can be done to determine deficits, but observations of a child’s normal daily life are needed to provide a complete picture.

Sensory Integration Therapy

Sensory Integration Therapy is usually done by Occupational Therapists. They assess developmental levels and determine whether sensory-motor processing is impaired. As well as providing Sensory Integration Therapy to children, Occupational Therapists sometimes work with families, training them to replicate therapy in a natural environment.

Sensory Integration therapy looks like play, because play is the child’s way of learning and developing. Activities are carefully chosen to stimulate development in deficient areas. Although parents can do many of these activities at home with their children, Occupational Therapists are trained to identify and address areas of special need.

Precautions should be taken not to provide children with more sensory stimulation than they are able to process. Their nervous systems may be profoundly affected by sensory stimulation. If any of the following signs occur, stimulation should be decreased in amount, or intensity. .(These signs of distress may be evident during therapy, or they may not occur for several hours.)

• Sweating
• Thirst
• Sleepiness
• Pale face
• Flushed face
• Rapid respiration and heart rate
• Slow respiration and heart rate
• Loss of bowel or bladder control
• Over activity
• Under activity

The following are examples of things that might be done in Sensory Integration Therapy.

Tactile deficits involve increased or decreased reaction to touch, or difficulty receiving information by touch. Children who have trouble identifying things by touch (tactile discrimination) have under-responsive tactile processing. They sometimes seem insensitive. They may not react to pain. They may seem sluggish, and may not explore their environments. They may have an impaired awareness of themselves.

Children with under-responsive tactile processing, therapy should be provided a wide variety of tactile experiences such as vibrations, stroking with a small soft-bristle (baby) brush, and rubbing. Children may play with shaving cream, play dough, silly putty, cornstarch mixed with water, rice, beans, and finger paints. They should be encouraged to use scissors, construction toys, markers and chalk.

Children who have over-responsive tactile processing may avoid touch and prefer solitary play. They may struggle when picked up or cuddled. They may show aversion to play dough, finger paints and glue.

Children with over-responsive tactile systems may need calming activities such as low lighting, soft music, slow rocking, deep pressure, being wrapped in a blanket, and sucking on something. Their environments can be modified to reduce stress by eliminating excessive stimuli. Some therapists encourage these children to participate in a variety of tactile experiences similar to those given under-responsive children. Strong rewards are often used (like gum, candy or coins hidden in a substance) in order to entice these children to participate in something they so find unpleasant.

Following are general principles about the sense of touch for parents whose children have over-responsive tactile systems. Most importantly, do not take withdrawal personally: it is the feeling of touch that is being rejected – you are not being rejected.

• It is easier for children with over-responsive systems to tolerate firm, unmoving touch than light or moving touch.
• Sometimes firm touch preceding light touch makes light touch more tolerable.
• Anticipated touch bothers less than unexpected touch.
• Self-applied touch is more easily tolerated than touch by others. (It is easier for the child to hug you than to be hugged.)
• Changes in tactile stimulation may be difficult at the time but tolerated later. (For example, putting on or taking off clothes may be protested, but once the change has taken place, the new state is accepted.)
• Protect children from sensory stimuli they find disturbing. If they are sound sensitive, then whisper. If they are light sensitive, use natural light. Read their non-verbal cues, and respect their areas of sensitivity.

The Proprioceptive System receives input from joints and muscles. This input helps us to locate our bodies in space. When children have poor proprioception, their movements are often slow and clumsy. They may have trouble learning new skills, especially if they don’t see the skills demonstrated first with their eyes. Therapy may include bouncing on a trampoline, bouncing on a large ball, crawling, hanging from a bar by the arms, tug-o-war, activities with weights, prolonged drawing on a vertical chalkboard, jumping rope, pillow fights, throwing a weighted ball (like a beach ball partially filled with water), and pushing heavy objects.

The Vestibular System involves inner ear responses to movement and gravity. This system influences balance, emotions, muscle tone, and eye movements. Vestibular processing may be under-responsive, or over-responsive. When the vestibular system is under-responsive, children may seem "floppy" and "slouch." They often love merry-grounds and swings. They may be slow developing hand dominance, and may bump into furniture. Children with over-responsive vestibular systems may scream when picked up, fear heights, experience motion sickness, and may be disoriented after bending over.

Depending on the type of vestibular problem, therapy might include rocking in a rocking chair, swinging, hanging upside down in a tire swing, spinning on playground equipment, laying in various positions on a swinging hammock, rolling, somersaulting, turning cartwheels, dancing, and therapy balls. Activities involve the head in a variety of positions (upright, tilted, upside down). When activities are done with closed eyes, the vestibular system receives more stimulation.

Motor Planning influences the ability to learn a new motor skill. It involves planning the steps involved in a new task, and executing them according to plan until the skill is mastered and it becomes natural and easy (like tying one’s shoes, or riding a bike). Children who have motor planning problems find it difficult to learn new skills. They struggle and think very hard when learning new tasks, and it takes a long time for skills to feel natural and easy. Therapy might include mazes, obstacle courses, constructional toys, building blocks, sequences of tasks, Simon Says, Red Light – Green Light, swimming, playing charades, and playing tag while running backwards or sideward.

Bilateral Coordination can be improved by crawling games, "animal" walks, jumping jacks, jumping rope, playing catch with a big ball, bouncing a ball with two hands, and hopscotch. Bilateral integration also benefits from playing the piano, swimming the breaststroke, tug-of-war, and pulling a wagon with a rope. Playing T-ball helps if the child swings totally through. Cleaning chalkboard erasers by clapping them together, cutting with scissors, and identifying right and left on someone else all aid bilateral integration.

Immature Motor Components can be helped by "commando crawling," wheelbarrow walking, doing pushups or holding a slide position, and giving piggy back rides to younger children.

Eye-Hand Coordination can be improved by hitting with a bat, popping bubbles, throwing and catching balls, beanbags and balloons.

Visual Perception can be stimulated by the following activities: puzzles, tracing, dot-to-dot, activities distinguishing letter’s and numbers that appear similar (like 2/5, b /d, p / q), hidden pictures, stringing beads, and sorting nuts and bolts. Visual memory games like "Concentration," and building blocks like Legos, also help visual perception.

Auditory Closure can be increased by rhymes, tongue twisters, and clapping patterns, and by having children repeat phone numbers and addresses given to them orally.

Research has demonstrated that results from Sensory Integration Therapy are enhanced when children chew or suck while engaged in activities. Care will have to be taken that children do not choke – they should not chew gum or candy while running, or doing other strenuous physical activities. But many of the activities (especially those done seated) can be performed while children are chewing on something or sucking thick liquids (like shakes) through a straw. If they suck through the straw too easily, a thinner straw should be used. Chewing and sucking also help to calm children when they are under stress.

Some children are under-aroused part of the day and over-aroused other parts of the day. Children usually seek out the types of stimulation they need. They should be introduced to various sensory experiences and their responses should be observed. If they enjoy a certain type of stimulation, a variety of activities providing that stimulation can be introduced.

Activities should be fun and playful. They should build on past activities, but have an element of novelty. As well as helping children develop an interest in themselves and their environments, activities help form social relationships.

"Therapy has made a world of difference for Eric," said his mother . . . "Before therapy, he didn’t like to be held. Now he comes and hugs me on his own. That alone has make it worth it" (Dialogue, Heartspring, June, 1995, p.4).

Sensory Integration Therapy not only helps children interact with their environments, but it also helps them interact with other people. By enhancing their sensory systems, Sensory Integration Therapy helps children learn more easily, and become "better-adjusted" individuals.

Resources

Missouri Occupational Therapy Association
(314) 225-2535

Sensory Integration International
1602 Cabrillo Avenue
Torrance, CA 90501
(310) 787-2110

American Occupational Therapy Association – Sensory Integration Special Interest Section
4720 Montgomery Lane
P. O. Box 31220
Bethesda, MD 20824-1220
(301) 652-2682

Sensory Integration Quarterly

http://www.familyvillage.wisc.edu/general/sensory.htm

http://www.autism.org/si.hml

Glossary

Body Scheme: The perception of one’s own body; body image; and internal awareness of body parts. This awareness comes from information provided by our senses.

Coordination of Two Body Sides: In order for there to be coordination between the two body sides there must for both fine motor skills (writing, dressing, eating) and gross motor skills (running and skipping, playing with a ball).

Kinesthesia: The conscious process of using information provided by vision, tendons, muscles, joints, and by the inner ear to form an awareness of one’s body in space.

Motor Planning: The process of thinking through the steps of a motor process. This is necessary when one is learning a new skill such as tying shoes, Once the skill is learned, motor planning no longer occurs.

Ocular Motor Control: This is the part of vision that involves motor control. Examples include being able to track a slowly moving object; being able to distinguish head movement from eye movement; and being able to quickly change focus from distant objects to close objects.

Postural Body Adjustments: positions that are assumed and then held. The ability to do this involves being able to inhibit excess movements, differentiate body parts, and trunk rotation.

Postural Reflexes: Automatic motor patterns such as the Asymmetrical Tonic Neck Reflex, and the Tonic Labyrinthine Reflex. These two reflexes are normal for a baby about 4-6 months old. These reflexes must become inhibited for more complex voluntary movements to take place.

Proprioceptive System: The system that transmits information about the relative positions of specific body parts from the tendons, muscles and joints to the brain. This system allows one to know where his or her body parts are without having to look at them. A well functioning system leads to coordination. Deficits in the system lead to clumsiness.

Sensorimotor Integration: The integration of information provided by the senses. The nervous system receives and organizes information in order to make an appropriate response.

Tactile Sensation: The sense of touch. The sense of touch provides two main types of information:

• Protective touch – pain and temperature alert us to potentially harmful stimuli.
• Discriminative touch – provides information about the quality of stimuli such as hard or soft, rough or smooth.

Dysfunction in the tactile system may result in a lack of information from touch, or it may result in over-sensitivity (hypersensitivity) to touch.

Vestibular System: Knowledge about the relationship of one’s head to gravity and movement that is provided by information from the inner ear. It lets you know if you are moving, or if the room is moving, if you are right side up ,or upside down. It lets you know how fast you are going, and in which direction. It influences equilibrium responses, and emotional responses to movement. Dysfunction in this system may result in a lack of awareness of heights, or in fear of movement.

Author
Lynette Yisrael
University of Missouri-Kansas City
Institute for Human Development, A University Affiliated Program