BSPT3 REHAB106 LEC AY 2022-2023

SENSORY INTEGRATION et
SENSORY DYSFUNCTION
Danica Kaye Barredo, PTRP
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3. Patients may also have difficulty using sensory
information to plan and organize what they need to do.
TABLE OF CONTENTS
4. Thus, they may not learn easily.
I. SENSORY INTEGRATION
II. TACTILE SENSATION Brain-Behavior Connection
III. VESTIBULAR SENSE ● A strong link between the brain as the physical or
IV. PROPRIOCEPTIVE SENSE biological component and behavior as mental as
V. SENSORY PROCESSING DISORDER TREATMENT psychological aspect.
● A person with Sensory Integration Dysfunction has a
disorganized brain, many aspects of their behavior are
SENSORY INTEGRATION disorganized and overall development is disorderly.

● It is the neurological process of organizing information

we get from our bodies and the world around us for Behavior Problems Self-regulation problems
use in daily life. - Almost always occur:
● It takes place in the CNS. present with a - The person is
○ Its main task of the CNS is to integrate the person with Sensory unable to “rev up”
senses. Integration or calm down once
○ Sensory processing machine Dysfunction aroused.
○ Over 80% of the nervous system is involved in - They may also
processing or organizing sensory input. perform unevenly.

Self-Regulation
● The ability to control one's activity level and state of TACTILE SENSATION
alertness, as well as one’s emotional, mental or ● Plays a major part in determining physical, mental and
physical responses to sensations. emotional human behavior
● It is self-organization. ● Each individual needs constant tactile stimulation to be
organized and functioning.
Fundamental Sensations:
1. Vestibular Two Components make up the Tactile Sense:
2. Tactile 1. Protective/Defensive System
3. Proprioceptive a. Its purpose is to alert an individual to
potentially harmful stimuli.
SENSORY INTEGRATION DYSFUNCTION 2. Discriminative System
● aka “Sensory Integration Disorder”, “Sensory a. It tell us:
Integrative Disorder” or “SI” i. That we are touching something or
● The inability to process information received through that something is touching us
the senses. ii. Where on our body the touch occurs.
● The result of inefficient neurological processing. iii. Whether the touch is light or deep
iv. How to perceive the attributes of the
Pathophysiology object, such as its shape, size,
1. Dysfunction happens in the CNS when a glitch occurs, temperature, density and texture
the brain cannot analyze, organize and connect - or
integrate- sensory messages. TACTILE DYSFUNCTION
2. The result is the person cannot respond to sensory ● The inefficient processing in the CNS of sensations
information to behave in a meaningful, consistent way. perceived through the skin.

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Hypersensitive ➔ Tactile defensiveness, the
to Touch tendency to react negatively and
emotionally to unexpected, light
touch sensations
➔ Will not react only to actual touch
but also to the anticipation of
being touched
➔ Patient overreacts with a
fight-or-flight response
◆ A person may typically
avoid unexpected, light
touch but accept, even
crave, deep touch, like a
bear hug.
◆ Deep touch feels good
and actually helps
sensitivity to light
◆ This person needs touch
information more than a
person with a
well-regulated tactile
sense.
◆ To get the stimulation
the brain needs, patients
may repeatedly touch
those surfaces and
textures that provide
soothing and comforting
tactile experiences.
◆ Patients may touch and
feel everything in sight,
bumping and touching
others, running his
hands over furniture and
walls, and handling
items that others
understand they
shouldn't.
Hyposensitive ➔ Tends to under-react to tactile
to Touch experiences.
➔ Needing extra stimulation, they
may constantly touch objects and
people.
➔ They may be under-responsive to
touch, whether the touch is
soothing or painful.
➔ May not react to touch effectively
enough to do a good enough job
of self-protection.
➔ May be unaware of touch
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altogether, unless the touch is
very intense
VESTIBULAR SENSE
● Signals the position of the head and body are in
relation to the surface of the earth.
● Takes in sensory messages about balance and
movement from the neck, eyes, and body and sends
these messages to the central nervous system for
processing
● Helps generate muscle tone that allows us to move
smoothly and efficiently.
● Tells us whether we are moving or standing still, and
whether objects are moving or motionless in relation to
our body.
● Informs us what direction we are going in, and how fast
we are moving.
“The vestibular system is the unifying system. It forms the
basic relationship of a person to gravity and to the physical
world. All other types of sensation are processed in reference
to this basic vestibular information.
The activity in the vestibular system provides a "framework"
for the other aspects of our experience.
Vestibular input seems to "prime" the entire nervous system
to function effectively.
When the vestibular system does not function in a consistent
and accurate way, the interpretation of other sensations will
be inconsistent and inaccurate, and the nervous system will
have trouble getting "started."
VESTIBULAR DYSFUNCTION
● The inefficient processing in the brain of sensation
perceived through the inner ear.
The person with an efficient vestibular system may have one or
more problems with the integration of movement sensations.
They may:
a. Be hypersensitive movement, and have:
i. Intolerance to movement
ii. Gravitational insecurity
1. A fearful or anxious reaction to
non-threatening movements such as
changes in head position, not having
both feet on the floor, or movements
requiring balance.
b. Be hyposensitive to movement, with increased
tolerance and desire for movement
c. Both
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a. Simultaneous sensations of head and body
Manifestations position when the person actively moves
➔ May not develop the postural responses necessary to b. Example: Needed for throwing a ball or
keep upright. climbing stairs
➔ May sprawl on the floor, slump when the patient sits,
and lean their head on their hands when they are at the PROPRIOCEPTIVE DYSFUNCTION
table. ● Inefficient processing of sensations perceived through
➔ May be awkward, uncoordinated and clumsy the muscled, joints, ligaments, tendons and connective
➔ May fall often, tripping on air when she moves, tissues.
bumping into furniture when they move slightly off the ● Usually accompanied by problems with the tactile
center of gravity. and/or vestibular systems
➔ May have visual problems (eye movements are ● A person can’t control or monitor their gross motor and
influenced by the vestibular system) fine motor muscles, motor planning is very challenges
➔ May have inadequate gaze stability
➔ May be unable to focus on moving objects or on Manifestations:
objects that stay still while she moves. ➔ May be clumsy and easily frustrated
➔ May have become confused when looking up at the ➔ May tackle everybody amd everything
chalkboard and back down to her desk. ➔ May show confusion when walking down the street,
➔ Reading problems may have arisen if she didn't getting in and out of the bathtub
develop brain functions imperative for coordinating ➔ Manipulating objects may be difficult
left-to-right eye movements. ➔ May exert too much or too little pressure on objects,
➔ Difficulties processing language. struggling to turn door knobs and regularly breaking
➔ Difficulty moving in an organized way interferes with her items and pencil points
behavior, attention, and emotions. ➔ May have a poor grip on heavy objects or on
lightweight objects
➔ Difficulty with lifting and holding on to objects of
PROPRIOCEPTIVE SENSE
different weights.
● “Position Sense” ➔ Needs to use his eyes to see what his body is doing
● Refers to sensory information about one’s movement ➔ May be fearful when moving in space because he lacks
or body position; unconscious sense of body postural stability.
movement ➔ Maybe emotionally insecure because each new
● Provides intake that helps integrate touch and movement and each new position throw him off guard.
movement sensations
● Sends messages about whether the muscles are BEHAVIOR PROBLEM ASSOCIATED WITH SENSORY
stretching or contracting, and how the joints are INTEGRATION DYSFUNCTION
bending and straightening. Sensory Integration Dysfunction may contribute to or exacerbate
● Function to increase body awareness and to contribute other problems.
to motor control and motor planning (praxis). - The following symptoms may have an SI component
-or they may be caused by some other developmental
Receptors: Muscles, joints, ligaments, tendons and connective problem.
tissue
Stimuli: Movement and gravity
Unusually high ● May always be on the go
activity level ● Move with short and nervous
Proprioception is closely connected to both tactile and the gestures
vestibular systems: ● Play or work aimlessly
1. Tactile-Proprioceptive (or Somatosensory) Perception ● Be quick-tempered
a. Refers to simultaneous of touch and body ● Easily excited
position ● Low sitting tolerance
b. Example: judging the weight of a glass of milk
Unusually low ● May move slowly and in a
of holding a pencil efficiently in order to write
activity level daze
2. Vestibular-Proprioceptive Perception ● Fatigue easily
● Lack initiative and
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“stick-to-it-ivness”
● Show little interest in the
world
Impulsivity ● Lack in self-control
● Unable to stop after starting
an activity
○ Example: Patient
may pour juice until
it spills, run into
trees and people,
and talk out of turn
Distractibility ● Have a short attention span,
even for activities they enjoy
● May pay attention to
everything except the task at
hand
● May be organized and
forgetful
Problems with ● Either tense or “loose and
muscle tone and floppy”
motor ● May be awkward, clumsy,
coordination apparently careless and
accident prone
Problems with ● Has trouble climbing stairs,
Motor Planning* negotiating obstacle courses
and equipment, riding bikes,
dressing, getting in and out of
the car, and using eating and
writing utensils
● Ability to learn new motor
skills such as clapping out
rhythms and skipping, may
develop noticeably later than
other children’s
Lack of definite ● May not use one hand
hand preference consistently when handling
by age of 4 or 5 tools such as pens and forks
● Use either hand to reach for
an object
● Switch from right to left when
handling it, eat with one hand
but draw with the other, or
use both hands to handle
scissors
Poor Hand-Eye ● Have trouble using pens,
Coordination creating art projects, doing
puzzles, eating neatly, or
tying shoes
● Handwriting may be sloppy
and uneven
Resistance to ● Objects to leaving the house,
novel situations meeting new people, trying
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new jobs or tasting different
foods
● May be panicky for no
obvious reason
Difficulty making ● May seem stubborn and
transitions from uncooperative when it is time
one situation to to come for dinner, get into
another (or out of) bathtubs, change
from one activity to another
● Minor changes in routine will
upset patients who “do not
go with the flow”.
High level of ● Struggling to accomplish
frustration tasks that peers do easily, the
person may give up quickly
● May be a perfectionist and
become upset when art or
work projects don’t meet his
expectations
● Insisting on being the winner,
the best, or the first, they may
be a poor game-player
Self Regulation ● Unable to “rev up” or calm
Problems down once aroused
● Perform unevenly: “with it”
one day, “out of it” the next
Academic ● Difficulty in learning new skills
Problems and concepts
● Perceived as an
underachiever
Social Problems ● Hard to get a ong with and
difficult making friends and
communicating
● Need to control his
surrounding territory and
have trouble sharing
Emotional ● Be overly sensitive to change,
Problems stress, and hurt feelings and
be disorganized, inflexible
and irrational
● May be demanding and
needy, seeking attention in
negative ways
● May be unhappy, believing
and saying that lie is crazy,
no good, dummy, loser, and a
failure
● Low self-esteem is one of the
most telling symptoms of
poor sensory control
*[Motor planning is the ability to conceive of, organize, sequence
and carry out complex movements in a meaningful way. ]
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Associated Problems ● OTs use this approach for children with sensory-based
1. Auditory-Language Problems motor difficulties who may or may not have a
2. Speech/Articulation Difficulties neurodevelopmental diagnosis.
3. Vision Problems ● The focus of intervention should always be on
4. Eating Problems promoting occupations (self-care, school and work)
5. Digestion and Elimination Problems rather than the remediation of underlying impairments.
6. Problems with Sleep Regulation
7. Allergies Why do PTs need to understand the concept of SI?
- ‘learning and movement difficulties may be exacerbated
Developmental Conditions who may have SI dysfunction: by difficulties with registering or processing sensory
information, which can affect function and
➔ Autism participation’.
➔ Pervasive Developmental Disorder - Stimulation of all the senses (tactile, proprioceptive,
➔ Serious Language Difficulty vestibular, visual, and auditory) is recognized and often
used by therapists as part of their interventions for
➔ Fetal Alcohol Syndrome
motor control, and motor learning with functional goals.
➔ Fragile X Syndrome
➔ Severe mental retardation BALANCED SENSORY DIET
➔ Learning disabilities and/or attention deficits ● Defined as a planned and scheduled-activity
programme that an occupational therapist develops
SENSORY PROCESSING DISORDER TREATMENT specifically to meet the needs of the individual’s own
nervous system
Starting therapy early is key for treating SI as this can help ● Individualized diet of tactile, vestibular and emotional
children learn how to manage their challenges. needs
● Purpose is to help the person become more focused,
There are different types of therapy: adaptable and skillful
1. Sensory Integration therapy (SI) ● A daily sensory diet fulfills physical and emotional
a. Uses fun activites in a controlled environment needs.
b. Child experiences stimuli without feeling
overwhelmed Sensory Diet Combination
c. Child can develop coping skills for dealing - Alerting or calming may come depending on the
with that stimuli and these coping skills can individual’s needs
become a regular, everyday response to
stimuli Alerting ➔ Activities benefit the
2. Sensory Diet under-sensitive individual, who
needs a boost to become
a. Will supplement other SI therapies
effectively aroused
b. Refers to a list of sensory activities for home ➔ Examples:
and school which are designed to help the ◆ Crunching dry cereal,
child stay focused and organized during the popcorn, chips, crackers,
day nuts, pretzels, carrots,
c. Customized based on the child’s needs celery, apples or ice
cubes
3. Occupational Therapy
◆ Taking a shower
a. Therapists can help with fine motor skills,
◆ Bouncing on a therapy
such as handwriting ball
i. They can teach everyday skills, such ◆ Jumping up and down
as getting dressed and how to use on a trampoline
utensils
Organizing ➔ Activities help regulate the
individual’s responses
SENSORY INTEGRATION THERAPY
➔ Examples:
● Approach was devised by Jean Ayres (1979) to “take ◆ Chewing granola bars,
in, interpret, and use spatial-temporal aspects of fruit bars, liquorice, dried
sensory-information from the body and the apricots, cheese,
environment to plan and produce organized motor gum,bagels, bread crusts
behavior’ ◆ Hanging by the hands

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from a chinning bar

◆ Pushing or pulling heavy
loads
◆ Getting into an
upside-down position

Calming ➔ Activities that help the

oversensitive individual decrease
hyper-responsiveness to sensory
stimulation
➔ Examples:
◆ Sucking hard candy,
frozen fruit or a spoonful
peanut butter
◆ Pushing against walls
with hands, shoulders,
backs, buttocks and
head
◆ Rocking, swaying or
swinging slowly back
and forth
◆ Deep pressure massage
◆ Taking a bath

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