Sensory Integration Therapy

– Some Aspects

Sadhana P. Joshi
Head O.T. Department C.O.H.
 Introduction

Definition
• Sensory Integration is defined as a neurological process that organizes
sensation of one’s own body and the environment in the brain to make
adaptive response and makes it possible to use the body efficiently within
the environment.
• Sensory Integration function will include the awareness, discrimination and
recognition of sensory stimuli from the environment and from the C.N.S
and use of this sensory information to direct motor behaviour.

Background
• S.I. Therapy was conceived and developed by Dr. Jean Ayers an
Occupational Therapist and psychologist. It explains the relationship
between behaviour and neural function, especially sensory processes and
integration.
• It describes and predicts relationship among neural functioning, sensory
motor behaviour and academic learning.
 Sensory Integration (Figure 1)

Sensory
Input
Stimuli

Feedback/ Previous
CNS Integration
Experience

Adaptive
Output
Response
Figure 2
 Assumption of Sensory Integration
a. Neural Plasticity
Plasticity refers to the ability of brain to modify and change from 2 to 7
years of age.
b. Occurs in developmental sequences
c. Brain functions as an integrated whole though it consists of parts that are
hierarchically arranged
d. Adaptive response
Requires the child to organize the sensation, accurately judge the
requirement of the situation and execute response completely.
[Controlled sensory input can be used to elicit adaptive response.]

Adaptive response contribute to Motor ability is a powerful

development of S.I organizer of sensory inputs.

a. Inner drive
Child has inner drive to develop S.I. through participation in sensory
motor activity.
 Sensory Integration and Praxi’s test (SIPT)
Sensory Integration and Praxi’s test (SIPT) includes:
a. Tactile and vestibular proprioceptive sensory processing test
i. Kinesthesia
ii. Finger identification
iii. Graphesthesia
iv. Localization of tactile stimuli
v. Post rotatory Nystagmus
vi. Standing and walking balance
b. Form and space perception and visio-motor coordination test
c. Praxi’s Test
i. Design copying
ii. Constructional praxis
iii. Postural praxis
iv. Praxis on verbal commands
v. Sequential praxis
vi. Oral praxis
 Sensory Integration and Praxi’s test (SIPT)
d. Bilateral integration and sequencing test
i. Oral praxis
ii. Sequencing praxis
iii. Graphesthesia
iv. Bilateral motor coordination
v. Space visualization
vi. Contralateral and preferred hand use
e. Bilateral motor coordination
Requires the child to imitate smoothly executed movements of hand and
feet after they are demonstrated by examiner. Reciprocal interaction of
right and left are used.
 Signs and symptoms reflecting sensory integrative
root problems
Signs and symptoms reflecting sensory integrative root problems:
Tactile sensitivity (Hyper)
a. Express distress during grooming
b. Prefers long sleeved clothing when it is warm and short sleeved when it is
cold.
c. Avoid going barefoot especially sand or grass.
d. React emotionally or aggressively to touch.
e. They desist from splashing water.
f. Has difficulty standing in line or close to other people.
g. Rub or scratch out a spot that has been touched.
Movement sensitivity (Vestibular)
a. Become anxious or distressed if feet leave the ground.
b. Fear of falling or height.
c. Dislike activities if head is upside down (e.g. somersaults)
Taste/ Smell sensitivity
a. Avoid certain tastes or food smell
b. Limit self to particular food, texture or temperature.
 Signs and symptoms reflecting sensory integrative
root problems
Auditory filtering
a. Is distracted or has trouble functioning if there is lots of noise around
b. Appear to not hear what you say
c. Can’t work with background noise
d. Has trouble completing task when the radio is on
e. Has difficulty paying attention
Low energy / Weak motor signs
a. Seems to have weak muscle
b. Tires easily
c. Has a weak grasp
d. Can’t lift heavy objects
e. Poor endurance
f. Poor handwriting
g. Problem in tying shoe laces
h. Poor sense of rhythm
i. Poor A.D.L
j. Articulation problem in speech
 Signs and symptoms reflecting sensory integrative
root problems
Visual / Auditory sensitivity
a. Prefers to be in the dark
b. Responds negatively to unexpected sound or bright light
c. Holds hands over ears to protect ears from sound
d. Watches everyone when they move around the room
e. Becomes frustrated when trying to find object in competing background
(e.g. cluttered drawer / shoes from rack)
f. Difficulty in puzzles
Emotional and Behavioural
a. Low self esteem, lack of self confidence, insecure, frustrated, irritable,
moody, aloof
b. Self injury, temper tantrum, No peer relationship, impulsive, aggressive
c. Resistant to change and stubborn
Cognitive / Academic
a. Attention problems, distractible, cannot refocus, lazy, slow, forgets
assignments/ direction
n. Poor organization, sequencing and memory

Development Dyspraxia is a brain dysfunction that hinders the

organization of tactile and sometimes vestibular and proprioceptive
sensation and interferes with ability to motor plan.
 Central Principles of Therapy
• Central idea of this therapy is to provide and control sensory input
especially the input from the vestibular system, muscles and joints and
skin in such a way that a child spontaneously forms the adaptive
responses that integrate those sensations.
• Sensory integration occurs when a child spontaneously plans and executes
a successful adaptive response to sensory input (e.g. reaching for an
object)
• Child must actively participate with the environment to improve the
organization of his nervous system.
• Therapist designs an environment that enables the child to interact more
effectively than has ever done before. Therapist must encourage, cajole,
lure and manipulate the child into choosing the activities that will help his
brain develop. She cannot organize the child’s brain for him. He must do it
himself, but it is evident that he can’t do without her help.
 Central Principles of Therapy
Direct Treatment Activities
Direct treatment activities to assist adaptation to sensory sensitivity
(Tactile processing) include-
a. Application of heavy pressure / Joint compression
b. Brushing
c. Localization of touch
d. Work with tactual modalities – Lotion paint, beans, rice, clay, foam
e. Water play
f. Rolling on textured surface
g. Swimming
Perception of proprioception plus modulation of high activity level and
hypersensitivity through use of heavy work –
a. Increase weight of object
b. Use of heavy weight pattern (pushing, pulling and stabilizing)
c. Jumping with impact
d. Carrying heavy object
e. Use of resistive activity
f. Riding equipments which require muscle activation
g. Climbing activities – ropes, ladder, ramps.
 Central Principles of Therapy
Treatment of vestibular processing-
a. Graded experience in movement through mobile surface e.g. Swing or
scooter board
b. Graded experience in use of vision to perceive moving target and flow
c. Stabilizing postural control activities which facilitates head, neck and
extensor control
d. Incorporate visual motor activities which assist the child to stabilize their
gaze, localize object shift between visual frame of references, track and
scan their environment while moving.
Treatment of arousal-
a. Quality of sensory information can shift level of arousal.
b. Taste and smell
i. Salt, Sour, bitter, hot taste – Alerting
ii. Sweet and warm – Relaxing
iii. Citrus, smoke – Alerting
iv. Vanilla – Relaxing
c. Oral motor
i. Sucking – Calming
ii. Blowing, chewing, licking – Arousing
iii. Crunchy food – Alerting
iv. Smooth food – Calming
 Central Principles of Therapy
d. Touch – may be calm or alert
i. Light touch – Alerting
ii. Deep pressure – Organizing and centering
iii. Temperature can increase or decrease the awareness
iv. Cool temperature – Alerting
v. Warm temperature – Calming
e. Movements
i. Fast movement – Alerting
ii. Slow movement – Relaxing
iii. When body moves in space with orient head in difference plane – Alerting
iv. Horizontal position – conductive to sleep
v. Vertical – Alert
f. Visual
i. Subdued and dark environment – Relaxing
ii. Bright light – Alerting
iii. Open space, subdued colors – Calming
iv. Changing and moving visual information can increase alerting response
g. Sound
i. Speech pattern, rhythm, sing-song pattern help children organize
themselves. Sound can be hypnotic, amusing, relaxing as well as alerting and
excessively stimulated.
ii. All sensory motor information can alert nervous system depending on mode
of delivery, quality of information, context and state in which it is delivered.
 Central Principles of Therapy
Sensory Integrated Equipments
a. Tactile Equipments – Different pillows, rugs, textures, sand pit, water pool
b. Non suspending moving equipments – Balls, barrels, tilt-boards, jumping
board.
c. Hanging equipments – Hammocks, platform swings, suspended ladders.
e. Motor planning equipment – Variety of obstacles, Jungle gym etc.

Conclusion
Sensory Integration approach is having –
a. Non cognitive emphasis
b. Flexible sequences
c. Exploration and creativity
d. Child’s control
e. Therapist guided
f. One to one inter-reaction
g. Improve brain processing
h. Suspended equipment mandatory.
Thank You