Sensory Integration
What is it?Who needs help with this?
When do I intervene?How do I use it?
Sensory Integration
• Sensory Integration is the neurological process that organizes sensation from one’s own body and the environment. Then our body can react effectively in the environment
Sensory Integration Dysfunction (SID)
• Dysfunction occurs when a person with an intact nervous system, is unable to interpret sensory information appropriately. Thereby this dysfunction or misinterpretation of sensory information interferes with daily activities or development.
Normal SI SI Dysfunction
• You walk into a home, smell something like cookies cooking and you walk to the kitchen. (Your senses integrated information and allowed your body to move in the environment)
• You walk into a home, smell something like cookies cooking and you grab the scented candle. (Your senses are met and remain focused on 1 thing. Never occurs to you to go in the kitchen and look for real cookies.)
Sensory Dysfunctions
• Modulation Dysfunction• Inability to process sensory input
so that you can organize yourself for a motor or cognitive activity.
HypersensitivityDistractible, focus on small
movement or soundsHyperactive, poor coping skill
Hypo sensitivityOblivious to certain sounds, taskPoor personal space Lethargic, sleepy or hypoactive
• Registration Dysfunction
– HypersensitivityVery definite food, clothing and
play preferenceOverreacts to sounds or certain
touch
Hypo sensitivityClumsy, careless, roughDaredevils, Loud voice, Puts things in mouth, ears,
touching constantlyOblivious to hygieneDifficulty grasping rules,
schedules
Sensory IntegrationWho needs help with this?
• Types of Sensory Defensiveness
Types of Sensory Defensiveness
Auditory Defensiveness – Sound
Tactile Defensiveness - Touch
Oral Defensiveness – Taste/Smell/Tactile
Vestibular Insecurity – Balance & Movement
Auditory Defensiveness
Student may show extreme sensitivity to common sounds (vacuum, bell, door slam)
Frequently cover their ears to block out ‘loud’ noises
Anxious or uncomfortable in noisy environment –may refuse or delay going into an assembly
Avoids activities that most children enjoy (recess, birthday parties)
May focus on wrong sounds and not complete task
Auditory DefensivenessHow do I help
• Staff Intervention – assist in success– Recognize the need to intervene– Prepare the student for bell, fire drills (desensitize)
– Provide ear plugs or headset for assemblies (to decrease noise)- ‘white noise’
– “Buddy system” or Hand over hand assist – Headset to focus on task – Music therapy (consult speech therapy)– Provide alternate environment if possible
Tactile Defensiveness - Touch
• Student may overreact to ordinary touch experiences (touching playdoh, being touched by others, shirt/sock tag aversion)
• They dislike the ‘feel’ and are hesitant• Avoids daily hygiene; inappropriate clothes• Avoids light touch but seeks out deep
touch (hugs)• Fidgets inappropriately (rocking, clapping,
shaking hands, rubbing same spot)
Tactile Defensiveness - Touch
• Staff Intervention – assist in success– Recognize the need to intervene– Provide desensitization – rice/beans box– Hand over hand to guide and touch new thing– Fun activities – pretend play for hygiene,
demonstration, sequence, repetition, pictures– Crafts with various textures– Brushing, Weighted objects– Provide fidget toys and limits
Oral Defensiveness – Taste/Smell/Tactile
• Student may be a ‘picky’ eater• May gag from certain textures, taste or smells • Avoids messy meals (does not like food items to
touch – eats items separate, unable to make a taco)
• Dislikes brushing teeth or washing face• Aversion to food or cleaning smells, may show
agitation• Inappropriate tasting/mouthing non food items
Oral Defensiveness – Taste/Smell/Tactile
• Staff Intervention – assist in success– Recognize the need to intervene– Work with family to identify & obtain favorite
foods, hygiene items (toothpaste, soap)– May place food items in recognizable
container– Introduce one food item at a time– Avoid or modify environment – smell– Provide chew items for self stimulation
Vestibular Insecurity – Balance & Movement
Student may have excessive fear of falling during ordinary movement
Dislikes swinging, riding a bike, climbing, sliding
Poor endurance/tires easy/poor muscle tone
Overall weak muscles, especially pencil grip
Walk on toes or ‘stiff’ with joints “locked”
Can not sit ‘still’ in a desk; sits on feet, head down
Poor socialization, avoids groups, poor boundaries
Vestibular Insecurity – Balance & Movement
• Staff Intervention – assist in success– Recognize the need to intervene– Encourage hand over hand assist during play
time to climb, slide & ride, elicit peer assist– Adjust writing angle, size of pencil/color– Provide stretching, movement, ‘Yoga’ type
activity – Utilize flexible seating &/or weighted vest;
heavy work– “Buddy system” to play or socialize, role play
Sensory Diet – Individualized
• Individualized per student – some students are oversensitive to touch, but under responsive to movement
• Remains flexible and changeable with environment• Identify ‘triggers’ to inappropriate behavior/or reaction to
sensory stimuli• Transitions – what makes it smoother • Identify food/clothing likes/dislikes• How is peer interaction?• Note any gross or fine motor problems (does student fall
or bump into things, balance problems, writing, coordination problems
Environmental Set up
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» Today’s assignment -Can you focus on this?
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Environment
• Limit extraneous visual material; provide written instruction/assignments/notes
• Organize class materials with labels (colors, words & pictures)
• Use note cards or tape number/letter line on desk
• Use tactile manipulative• Limit auditory distractions – prepare SID student
for scheduled drills• Define student space with visual & tactile aide
Schedules
• Flexible but structured and organized
• Pictures or color coded (ST & OT assist)
• Encourage families to share home schedules & changes anticipated. Notify them of school changes
• Encourage staff to recognize student need for flexibility in schedules --- allow space for “melt downs”
Auditory, Sight, Smell
• Quiet Space• Headphones
• Calm music
• Alerting music
• Highlighter strip• Calming scents• Alerting scents
Calming, safe space>concentration<overloadLow volume, 60 bps, limit/no
change tempoMedium volume,80 bps,
frequent changesDecreases visual stimuli,
organizesLavender & vanilla – calmPeppermint & lime - alerting
Sensory Diet
• Environmental
• Schedule
• Auditory, Sight, Smell
• Tactile – touch
• Oral – Motor
• Vestibular – movement & balance
• Proprioception – movement & resistance
Tactile - Touch
• Deep touch – ‘hug yourself’ shoulder press by teacher/peer
• Textures – glue on sticks on place in box
• Dough – hide items, make shapes, letters
• Ball bath or box of beans/rice- hide items
• Calming, deep pressure
• > focus & attention• > discriminative touch• Calm, propioceptive
input, strengthen hands & fingers for handwriting
• Alerting, whole body discriminative light touch
Oral Motor
• Gum – mix flavors• Chew device
• Water bottle –add lemon
• Wide straw less effort
• Calming• Deep pressure to jaw
• Calming Propioceptive input
• Facilitates convergence of eyes
• Prepares eyes for reading/computer work
Vestibular- Movement & Balance
• Rocking chair, glider, ball chair, upside down ball
• Scooter board, Barrel crawl, swinging, trampoline, rolling, net swing spin
• Calming, > attention, < fidgeting, > body awareness,> motor planning
• Alerting, facilitates back & upper body strength & stability
• > Head & eye control, Integrates visual & vestibular systems
Proprioception – movement & resistancePreparatory activities
• Weighted vest, blanket, lap pad, pencil weight
• Burrito, pillow crash
• Wall & chair push ups
• Funny face– lace your fingers together, place hands on top head & press down, suck in your cheeks to make fish face
• Calming, > focus >attention, > body awareness
• Use the least amount of time for desired result
• Calming, deep pressure, body awareness
• Calming, strengthens upper extremities, prepares hands for handwriting
• Calming, provides organizing input, especially after sensory overload
Classroom Tips
• Preferential seating• Visual cues to secure student attention• Have student repeat instruction prior to
beginning task• Keep tone even and moderate pace• Provide outline & vocabulary list• Provide notes and let student highlight• Sequential steps for directions. • Define specific boundaries & rules
Handwriting Tips• Encourage strengthening by modifying surface (vertical &
horizontal)• Small pencil for tripod grasp• Typing/keyboarding skills may be an alternate form of writing. Start
early showing the student how to type his name• Graph paper used to align numbers, letters• Alternate forms of paper – large lines, colored lines, raised lines• Directional maze tracing & cutting• Stencils for letter formation• Tactile letter formation (playdoh, sponge, trace shaded or dots)• Cutting cardboard, playdoh, darkened outlined objects
References• American Occupational Therapy Association “Answers to Questions Teachers Ask
About Sensory Integration”• www.superduperinc.com• www.henryot.com• www.lati3.com