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 |
