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SenSoryIntegratIon:

A Practical Look at the Theoryand Model orIntervention

Megan Carrick, MOTR/L

, is workingas clinical director o her privatepractice in the north suburbs o Chicago, Illinois. She provides servicesor children ranging in age rominancy up to 15 years old. Meganprovides services through the IllinoisEarly Intervention Program, therapygroups, and school consultations.She holds a master’s degree inoccupational therapy rom MidwesternUniversity, is Sensory Integration andPraxis test (SIPT) certifed, and recentlyreceived her DIR® certifcation throughthe Interdisciplinary Council onDevelopmental and Learning Disorders(ICDL). Megan is pursuing a doctoratein inant and early childhood mentalhealth and development disorders. Seealso

www.azmckids.com.

InTROduCTIOn

How are we able to react so quickly,unconsciously or that matter, when we startto experience a all? Why is it that we can ridea bike without much thought o what our eet,hands, eyes, and ears are doing or how theywork together? How is it that we can learnnew dance steps just by watching others andollowing their lead? When our nervous systemand brain work together, we can engage ina dialogue with our environment. It is theunction o the brain and nervous systemworking together that allows us to experienceand communicate with our world, or example,engaging in things as simple as a smile oras complex as a double backip o a divingboard. This concept o a body-environmentdialogue is best known as the theory o sensoryintegration. It is the unconscious process bywhich we “organize sensation or use” (Ayres,2005). Eective sensory integration givesmeaning to our experiences by tuning intothe important inormation and dismissing orfltering out the unimportant. It allows us torespond to the world around us both purposelyand successully with what is reerred to as anadaptive response (Ayres, 2005).Ecient sensory integration allows us toreach and sustain a state o physiologicaland emotional homeostasis that we callregulation. While the environment can oteninundate us with sensory stimuli, we learnwhat sensory inputs help us eel good, whatsensory inormation to tune into, and whatsensory inormation to flter out. This processis necessary to reach and sustain the stateo arousal that is organizing, calming and,thereore, regulating, (Greenspan & Wieder,1998). No two people experience sensoryinormation the same way; rather, each personhas a unique sensory profle. Thereore, byproviding our nervous system with the righttypes o sensory stimuli, we can become calmand stay that way, or the most part. When weare calm and regulated, we can attend to theworld around us and take interest in people,objects, and experiences. Sensory and motorexperience, or lack thereo, can cause us tobecome dysregulated. I we experience toomuch sensory stimuli or too little, we maybecome overly excited or shut down. Thesearousal states, overly excited and shutdown,are orms o dysregulation. When we are inthese states, we need to nourish our arousalvia sensory inormation and sensory motorexperiences. Children and adults who suerrom sensory integration challenges lack theecient processing o sensory inormation,

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struggle in their ability to adaptively respondto their environment, and experience dicultyshiting their arousal back to a state o regulation.Because we all have a unique sensory profle,our perceptions truly are our own. Whilewe may experience many similarities in ourperceptions, when comparing them to others,we will never experience a situation in theexact same manner as any other person. Thisis important to remember as we think aboutpeople with challenges in processing andintegrating sensory inormation. What eelsgood to us does not eel good to everyone;what bothers us will not necessarily botherothers; and what helps us become regulatedwill not work or all. Essentially, it is impossibleto experience the world like any other person. Thereore, as proessionals and amily membersworking with children, it is imperative thatwe gain a true sense o these dierences topromote the most eective supports and thehighest quality o care or each child.

HIsTORy

In the 1950s, Dr. A. Jean Ayers began her work defning the model o sensory integrationtheory, evaluation, and intervention. Shepublished

Sensory Integration and the Child

in thelate 1970s and published a great deal o researchthroughout her career (Ayres, 2005). The theoryo sensory integration has been a staple inpediatric occupational therapy evaluation andintervention or many years and continues to bea much researched and implemented model.

sensORy InTegRaTIOn aT wORk

Sara is a 3-year-old girl attending her frst balletclass. She is eager to dance and has beenpracticing ballet or several months as hermother has been teaching her some o thebasic concepts per Sara’s request. She entersthe class, a drop o class with a window or hermother to watch rom, and is greeted by herteacher. The teacher, Miss Mary, reaches out totouch Sara on the shoulder as she introduceshersel. She asks Sara why she is taking ballet,while still placing a gentle hand on hershoulder. Sara looks to her mother and sees inher mother’s ace and eyes that it is sae andquite expected to respond to Miss Mary. Sara (inher very big girl voice) replies, “I want to dancelike the ballerinas in my book!”Miss Mary smiles and responds quite pleased,“That is good news because here we learn howto dance like real ballerinas.” Miss Mary thengently leads Sara into the classroom with thehand placed on her shoulder, and Sara turns to

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education & therapies

Chilr lt ho r romor itrtiochll lc thfcit proci o or iormtio,trl i thir bilitto ptivl rpoto thir viromt, xpricifclt hiti thirrol bc to  tto rltio.

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neck movement in any direction) systems inconcert with her visual, tactile, and auditorysystems to allow her to move across the roomgiven a subtle tactile cue rom her teacher.Sara’s nervous system sends rapid electricalimpulses to the brain where many centersare involved in quickly distributing, sharing,and essentially integrating the multitude o inormation. Because Sara can gain an accurateread on her environment quickly, she is able torespond adaptively by engaging in a way thatdemonstrates her intention while meeting thedemands o the immediate situation.I in act Sara were a child with a sensoryprocessing disorder, she would likely have avery dierent experience. The ability to meetenvironmental expectations and demands maybe compromised by poor processing and poorintegration; this leads to maladaptive responsesto many daily situations – even those that arequite routine.

Th bilit tomt viromtlxpcttio m m bcompromi bpoor proci poor itrtio; thil to mlptivrpo to mil ittio – vtho tht r qitroti.

Sensory Processing Disorder (SPD)Sensory ModulationDisorder (SMD)Sensory-Based MotorDisorder (SBMD)Sensory DiscriminationDisorder (SD)SORSURSSDyspraxiaPostural DisordersVisualAuditory TactileVestibularProprioception Taste/SmellSOR = sensory overresponsivity.SUR = sensory underresponsivity.SS = sensory seeking/craving.

dIagnOsIs

The theory o sensory integration has led tothe use o assessment tools and interventionto promote qualitative changes in a child’sregulatory capacities and observable behaviorsin their daily lie. Recent literature suggestsa new system or classifcation o

sensory processing disorders

(SPD) to help provide greaterdiagnostic specifcity (Miller, Anzalene, Lane,Cermak, & Osten, 2007).Miller and colleagues have proposed a newnosology or diagnosing sensory processingdisorders as illustrated in fgure 1 above.

nOsOLOgy deInITIOns

The proposed nosology suggests three patternsincluding sensory modulation disorders,sensory-based motor disorders and sensorydiscrimination disorders. Each pattern thenhas greater defnition in varying subtypes. Itis oten the case that many o these subtypes

wave at her mother through the observationwindow.In this example, Sara relies on her visual,tactile, auditory, vestibular, and proprioceptivesystems to support her adaptive responses. Shefrst relies on the visual and auditory systemsto take in the setting, the words o her teacher,and the expression on her teacher’s ace. Shelistens or tone o voice and volume, and shelooks or aective cues in the teacher andher mother’s acial expressions as she worksto gain a sense o the new adult’s intentionsbased on how she is communicating to Sara.Sara relies on her tactile system to perceive,discriminate, and accurately interpret thehand on her shoulder. She then relies on herproprioceptive (sensations o the muscles and joints) and vestibular (sensation o head and