SENSORY INTEGRATION MADE SIMPLE

Jennifer Fortuna, MS, OTR/L & Liz Mills, M.O.T, OTR/L

STRATEGIES TO ADDRESS SENSORY PROCESSING DIFFERENCES AT HOME AND SCHOOL

OVERVIEW

• Introductions• Sensory Systems• Theoretical Principles • Sensory Integration• Sensory Stimuli• Regulation Challenges • Regulation Strategies• Additional Strategies• Questions

SENSORY SYSTEMS

Sensory Systems1. Sight2. Smell3. Taste4. Sound5. Touch6. Vestibular

7. Proprioceptive

A child’s ability to take in and use information through the senses and respond appropriately is

known as sensory integration (Thompson & Raisor, 2013; Lynch & Simpson, 2004).

THEORETICAL PRINCIPLES

Ayres Sensory Integration (1974): Five Basic Assumptions

1. The central nervous system is plastic.• The brain reorganizes itself after intervention.

2. Sensory integration develops in four phases.• Begins the first year of life and well developed by age

5.

3. The brain works as an integrated whole.• Lower and higher order brain functions influence each

other.

4. Adaptive interactions are critical to sensory integration.• Sensory feedback assists with refinement of adaptive

response.

5. People have an inner drive to develop sensory integration through participation in sensorimotor activities. • Confidence and skill mastery is linked to self-

actualization.

THEORETICAL PRINCIPLES

Dunn’s Model of Sensory Processing (1997)

Neurological Threshold:

Amount of stimuli required to produce a behavioral response. A high threshold requires a lot of stimuli; a low threshold requires very little stimuli.

Behavioral Response:

Anchored by acting passively (left) and actively (right) in relation to one’s threshold. A passive response works with threshold; active response works against threshold.

THEORETICAL PRINCIPLES

Williams & Shellenberger (1996): Pyramid of Learning

“Touch aids vision, vision aids balance, balance aids body awareness, body awareness aids movement and movement aids learning” (Kranowitz, 1998, p. 45).

SENSORY INTEGRATION

Role of the Central Nervous System

• Take in/process sensory stimuli• Filter out irrelevant information • Prioritize• Adapt to change• Regulate arousal levels• Produce a behavioral response

The CNS can work with you, or against you.

Behavior is dependent upon ability to process incoming sensory stimuli from the environment.

MOVEMENT BREAK

SENSORY STIMULI

• Children have an inner drive to seek out sensory stimuli from the environment.

• All children interpret sensory input differently; what is stimulating to one child might be overwhelming to another (Cole & Tufano, 2008).

• Provide a variety of lighting options (natural and controlled)

• Fiber optics, twinkle lights, disco ball, black lights, and table lamps

• Filter fluorescent lighting with fabric affixed with magnets

VISUAL STIMULI

AUDITORY STIMULI

• Headphones• Fish tank• Books on tape

• Musical instruments• Water elements• Sound machine

• Calming: chewy textures/sucking through a straw/gum/bubbles

• Alerting: cold/spicy/crunchy/sour• Chew toys/”chewelry”

ORAL-MOTOR STIMULI

• Have a “sniff” test• Scratch & Sniff stickers• Sort items by smell

OLFACTORY STIMULI

• Hand lotions• Flowers, herbs, grass clippings• Olfactory diary

• Therapeutic Brushing • Messy Play • Cooking/Baking

TACTILE STIMULI

• Gardening • Arts & Crafts • Fidget/squeeze toys•

• Swing/hammock• Hippity-hop• Move N’ Sit cushions

VESTIBULAR INPUT

• Scooter boards• Balance/rocker/wobble

boards • Sit N’ Spin

PROPRIOCEPTIVE INPUT

• ‘Squish’ Box• Weighted Blankets• Yoga

• Blanket “burrito” • Body sock • Climb/Jump

MOVEMENT BREAK

REGULATION CHALLENGES

LOW AROUSAL

HIGH AROUSAL

SENSORY SEEKING

SENSORY AVOIDING

A lot feels like a little

A little feels like a lot

A lot is never enough

A little is always too much

LOW AROUSAL

• Passive/low energy/moves slowly/tires easily

• Shows little interest in surroundings• Props self up during play• Unaware of wet/dirty diapers• Difficulty completing non-preferred tasks• May not respond when name is called• Misses cues frequently/difficult to engage• Does not notice when clothing is twisted on

body, or if face is messy after eating• Need a lot of stimulation, but do not seek it

out

HIGH AROUSAL

• Over-responsive to sensory stimuli • Easily upset/may be difficult to console• Avoids movement (swinging, sliding,

climbing)• Anxious/nervous/hyperactive• Avoids messy play/picky eater• Temper tantrums• Difficulty with change/transition• Avoids/escapes activities/eye-contact • Difficulty eating in noisy environments • Strong clothing preferences

SENSORY SEEKING

• Observed to climb, run, crash, bang, spin• Always “on the go”• Difficulty understanding personal space• Impulsive/risk taker/safety risk• Chews on toys/clothing/household objects• Smells/explores/touches everything• May not notice when hands/face are

messy• Uncoordinated/clumsy• Enjoys looking at reflection in the mirror• Constantly bumps into people/objects

SENSORY AVOIDING

• Anxious/fussy • Rigid/stubborn/controlling • Observed to cover eyes/ears• Difficulty concentrating in class• Has difficulty with

change/transition/disruption• Focused on everything around them• Avoids to prevent overstimulation• Prefers to work alone, or in a small group• Temper tantrums and aggression• Require a great deal of structure

MOVEMENT BREAK

REGULATION STRATEGIES

The Goal of Sensory Integration is SELF REGULATION

• Calm and alert• Ready to learn

How? • Individualized sensory diet• Modified sensory experiences• Environmental adaptations• Movement breaks• Classroom modifications• Reduce stress/anxiety

Why?Change is due to neuroplasticity, the brain’s ability to change over time as a result of ongoing sensory experiences (Fisher & Murray, 1991).

REGULATION STRATEGIES

Sensory Diet: The daily total of sensory experiences needed to adaptively interact with the environment.

Sensory stimuli is embedded into daily routines and play.• A “taste-test” at snack time • Help mom/dad with heavy work during grocery

shopping • Read a book in a rocking chair before bed time

A sensory diet provides gradual exposure to sensory stimuli. Types of stimuli provided are determined by the child’s strengths/needs.

REGULATION STRATEGIES

Modify Sensory Experiences:

Gradually increase the intensity of sensory stimuli to desensitize the child and reduce anxiety.

Tactile Defensiveness and Messy Play• Introduce dry messy play before wet messy play• Use tools for wet messy play• Wear a glove for wet messy play • Dip fingertip into wet messy play

MOVEMENT BREAK

Oral-Motor Warm-Up:

Open your mouth, say ahhhhhhh…

Close your lips, say mmmmm…..

Pucker up, say ooooooo…

Make a big smile, say eeeeeeee…

Pop your lips, say ba-ba-ba…

Tongue out, say la-la-la…

Oops, I sneezed ahh-choo!

Clap your hands, hoo-ray!

REGULATION STRATEGIES

LOW AROUSAL

HIGH AROUSAL

SENSORY SEEKING

SENSORY AVOIDING

DecreaseIntensity

Increase Intensity

Maximize Input

LimitInput

LOW AROUSAL

Goal: Intensify sensory input to increase the likelihood child will notice/respond to cues in the environment.

Treatment: Enhance task features and contextual

cues with intensity/contrast/complexity and unexpectedness.

Decrease predictability of daily routines Utilize highly preferred items and

activities Vestibular

stimuli/swinging/spinning/bouncing Alerting oral-motor/cold or spicy foods Frequent music and movement activities

HIGH AROUSAL

Goal: Embed sensory experiences into ongoing tasks that support the child and minimize over stimulation.

Treatment: Calming Activities Slow linear swinging/rolling/rocking Deep pressure/tight spaces/squish box Calming oral-motor Avoid strong scents, perfumes and room

sprays

SENSORY SEEKING

Goal: Add additional sensory input into the day so the child remains alert and does not have to interrupt the regular routine to load up on sensory input.

Treatment:• Require movement with purpose

throughout the day• Limit free time to wander around the room• Seating allows for movement in the

classroom • Regular vestibular/proprioceptive/tactile

input• Calming oral-motor• Fidget toys• Visual Supports

SENSORY AVOIDING

Goal: Honor the child’s need to limit sensory input and gradually broaden sensory experiences within accepted roles and routines.

Treatment:• Activities to calm/regulate• Calming oral-motor • Deep pressure• Opportunities to make choices• Visual supports

MOVEMENT BREAK

ADDITIONAL STRATEGIES

• Environmental Adaptations

• Visual Supports• Heavy Work• Quiet Corner• Therapy Garden • Natural Elements • Animal Assisted Therapy

ENVIRONMENTAL ADAPTATIONS

• Playful/purposeful/organized• Smart use of vertical/horizontal spaces • Include outdoor space for movement activities• Adjust sensory input to optimize occupational

performance

VISUAL SUPPORTS

• Picture schedules• Visual timer • Increase contrast

• “First-Then” chart• Color-coding

• Climb stairs with backpack

• Push/pull cart or basket• Lift/carry/stack

HEAVY WORK

• Animal walks• Digging in sand/dirt • Ride a bike

• Provide a quiet and safe spaces to decompress • Books, headphones, weighted blanket, and bean bags • Creates a sense of security and privacy to reduce anxiety• A-Frames and tents are simple and cost effective

QUIET CORNER

• Addresses a variety of maladaptive behaviors• Containers, walls, and raised bed gardens save space• Indoor gardening projects extend the growing season

THERAPY GARDEN

• Interact with nature • Document findings with

field notes• Address various areas of

need

NATURAL ELEMENTS

• Outdoor exploration• Sensory garden• Walking path

• Nature provides materials for inexpensive interventions

• Address visual closure, matching, scanning, etc.

NATURAL ELEMENTS

• Therapeutic riding • Pet therapy • Provides various types of stimuli at once

ANIMAL ASSISTED THERAPY

KEY POINTS

• All children interpret sensory input differently• Behavior depends on the one’s ability to process

incoming sensory stimuli from the environment.• A child’s need to seek or avoid sensory stimuli leads to

behavior.• The goal of sensory integration is SELF REGULATION.• Treatment is:

• Individualized• Incorporated into daily routine • Embedded into play

• The intensity of sensory experiences need to be individualized to reduce anxiety and optimize functional performance.

QUESTIONS?

REFERENCES

Ayres, J. (1974). The development of sensory integrative theory and practice. Dubuque, IA: Kendall Hunt.

Cole, M. B. &. Tufano, R. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: Slack Incorporated.

Dunn, W. (1997). The impact of sensory processing abilities on the daily lives of young children and their families: a conceptual model. Infants and Young Children, 9(4), 23-35.

Fisher, A., & Murray, E. (1991). Introduction to sensory integration theory. In A. G. Fisher, E. A. Murray, & A. C. Bundy (Eds.), Sensory integration: Theory and practice (pp. 3-26). Philadelphia: F.A. Davis.

Kranowitz, C.S. (1998). The out-of-sync child: recognizing and coping with sensory integration disorder. New York, NY: The Berkley Publishing Group.

REFERENCES

Lynch, S. & Simpson, C. (2004). Sensory processing: meeting individual needs using the seven senses. Young Exceptional Children, 7(4), 2-9.

Thompson, S.D. & Raisor, J.M. (2013). Preschool and primary grades: meeting the sensory needs of young children. Retrieved from

www.naeyc.org/yc

Williams, M.S. & Shellenberger, S. (1996). How does your engine run? A leader’s guide to the alert program for self-regulation. Albuquerque: Therapy Works Inc.