Introduction To

Sensory Integration Disorders

Bassem A. Abdel-Ghaffar
Speech & Language Pathologist Expert On Congenitally Deafblindness
Institute Of Special Pedagogy Oslo University - Norway

Think About The Following

• An acute awareness of background noises • Fascination with lights, fans, water • Hand flapping/repetitive movements • Spinning items, taking things apart • Walking on tip-toe • Little awareness of pain or temperature • Coordination problems

• Difficulty with transitions (doesn't "go • • • • with the flow") Self-Injury or aggression Extremes of activity level (either hyperactive or under active). Fearful in space (on the swings, seesaw or heights). Striking out at someone who accidentally brushes by them.

• Avoidance of physical contact with people and with certain "textures," such as sand, paste and finger paints. • The child may react strongly to stimuli on face, hands and feet. • A child may have a very short attention span and become easily distracted. • A strong dislike of certain grooming activities, such as brushing the teeth, washing the face, having the hair brushed or cut.

• An unusual sensitivity to sounds and smells. • A child may refuse to wear certain clothes or insist on wearing long sleeves/pants so that the skin is not exposed. • Frequently adjusts clothing, pushing up sleeves and/or pant legs.

Do You Know from which disorder this signs arising????

Sensory Integration Disorder


Sensory motor experiences in the early years of life are considered critical in developing the foundation for cognitive learning. Children learn about their world through all of their senses Sensory integration is the ability to combine information received through several senses and to organize it into meaningful messages.

• A. Jean Ayres, originator of the theory of Sensory Integration, considers the following sensory systems to be of primary importance in the organizational development of the central nervous system: • sense of touch (tactile perception) • sense of gravity (vestibular perception) • sense provided from muscles and joints (proprioception)

Sensory Integration Dysfunction Symptoms

SIGNS OF TACTILE DYSFUNCTION: Hypersensitive: Refuses or resists messy play, resists cuddling and light touch, dislikes kisses, rough clothes or seams in socks, resists baths, showers, or going to the beach.

SIGNS OF TACTILE DYSFUNCTION: Hyposensitive: Doesn't realize hands or face are dirty, touches everything and anything constantly, may be selfabusive, plays rough with peers, doesn't seem to feel pain (may even enjoy it!)

SIGNS OF VESTIBULAR DYSFUNCTION: Hypersensitive: Avoids playground and moving equipment, fearful of heights, dislikes being tipped upside down, often afraid of falling, walking on uneven surfaces, and avoids rapid, sudden or rotating movements.

SIGNS OF VESTIBULAR DYSFUNCTION: Hyposensitive: Craves any possible movement experience, especially fast or spinning, never seems to sit still, is a thrill seeker, shakes leg while sitting, loves being tossed in the air, never seems to get dizzy, full of excessive energy.

SIGNS OF PROPRIOCEPTIVE DYSFUNCTION: Under-responsive: Constantly jumping, crashing, and stomping, loves to be squished and bear hugs, prefers tight clothing, loves rough-housing, and may be aggressive with other children.

SIGNS OF PROPRIOCEPTIVE DYSFUNCTION: Over-responsive: Difficulty understanding where body is in relation to other objects, appears clumsy, bumps into things often, moves in a stiff and/or uncoordinated way.

SIGNS OF PROPRIOCEPTIVE DYSFUNCTION: Difficulty Regulating Input: Doesn't know how hard to push on an object, misjudges the weight of an object, breaks objects often and rips paper when erasing pencil marks.

SIGNS OF AUDITORY DYSFUNCTION: Hypersensitive: Covers ears and startled by loud sounds, distracted by sounds not noticed by others, fearful of toilets flushing, hairdryers and/or vacuums, resists going to loud public places (even cafeteria at school).

SIGNS OF AUDITORY DYSFUNCTION: Hyposensitive: May not respond to verbal cues, loves loud music and making noise, may appear confused about where a sound is coming from, may say "what?" frequently.

SIGNS OF ORAL DYSFUNCTION: Hypersensitive: Picky eater with extreme food preferences and limited repertoire, may gag on textured food, difficulty with sucking, chewing, and swallowing, extremely fearful of the dentist, dislikes toothpaste and brushing teeth.

SIGNS OF ORAL DYSFUNCTION: Hyposensitive: May lick, taste or chew on inedible objects, loves intensely flavored foods, may drool excessively, frequently chews on pens, pencils, or shirt.

SIGNS OF OLFACTORY DYSFUNCTION: Hypersensitive: Bothered or nauseated by cooking, bathroom and/or perfume smells, may refuse to go places because of the way it smells, chooses foods based on smell, notices smells not normally noticed by others.

SIGNS OF OLFACTORY DYSFUNCTION: Hyposensitive: May not notice unpleasant or noxious odors, smells everything when first introduced to it, may not be able to identify smells from scratch 'n sniff stickers

SIGNS OF VISUAL DYSFUNCTION: Hypersensitive: Irritated by sunlight or bright lights, easily distracted by visual stimuli, avoids eye contact, may become overaroused in brightly colored rooms.

SIGNS OF VISUAL DYSFUNCTION: Hyposensitive: Difficulty controlling eye movements and tracking objects, mixes up similar letters, focuses on little details in a picture and misses the whole, looses his place frequently when reading or copying from the blackboard.

Thank You

Sensory Diet Activities

Sensory Diet Activities The sensory diet, a term coined by OT Patricia Wilbarger, is a carefully designed, personalized activity schedule that provides the sensory input a person's nervous system needs to stay focused and organized throughout the day.

A person whose nervous system is on "high trigger" will need more calming input, while someone who is more "sluggish" will need more arousing input to "jazz" up her nervous system. Infants, young children, teens, and adults can all benefit from a welldesigned sensory diet.

• To construct an effective sensory diet, you need the sensory smarts to truly understand your child's sensory difficulties and how they interfere with his life. • here are some activities to get you started. You can modify them depending on the age, arousal level (does she need stimulation or relaxation?), whether she is in school, at home, or away, and whether or not you have special equipment available

Proprioception Proprioceptive input (sensations from joints, muscles and connective tissues that lead to body awareness) can be obtained by lifting, pushing, and pulling heavy objects as well as by engaging in activities that compress (push together) or distract (pull apart) the joints.

Toddlers and Preschoolers • Make a "sandwich" by firmly pressing on your child's arms legs and back with pillows or rolling her up in a blanket. She can push her own stroller, and a stronger child can push a stroller or cart filled with weighted objects such as groceries. Your child can wear a backpack or fanny pack filled with toys (not too heavy!).

Schoolage kids • Jump on a mini-trampoline, play hopscotch, carry books from one room to another, help wash windows or a tabletop.

Teenagers and Adults • Shovel sand, rake leaves, push heavy objects like wood in a wheelbarrow, do push-ups against the wall, wear a heavy backpack or pull it on a luggage cart, wear a weighted vest (available from a sporting goods store that sells equipment for martial arts or weightlifting training.)

Vestibular • Vestibular input (the sense of movement, centered in the inner ear) can be obtained by spinning and swinging, and to a lesser extent, any type of movement.

Toddlers and Preschoolers • Swing on playground swings, trying various types of swings and movements, such as front and back and side to side. Spin on a Sit by office chair. Run in circles, ride a carousel, hold your child's arm and legs and spin him around like an airplane

Schoolage kids • Hang upside down from the monkey bars, roll down a grassy or hill (good proprioceptive input as well), use swings. • Teenagers and Adults • Swing on a hammock, use playground swings or merry-goround (you're never too old.

Tactile • Tactile input is the sense of touch and includes texture, temperature, pressure, and more. Don't forget that the tactile system includes not only the skin covering your body but also inner skin linings such as inside the mouth.

Toddlers and Preschoolers • Let her drink plain seltzer or carbonated mineral water to experience bubbles in her mouth (you can flavor with lemon, orange, etc.). Play with foamy soap or shaving cream, add sand for extra texture, use fingerpaint, play with glitter glue, mix cookie dough and cake batter, and so on. Let your child use the playground sandbox or create your own at home, filling a bin with dry beans and rice or other materials. Use clay. Don't force a child who is unwilling to touch all these "yucky"

substances. Let her use a paintbrush, stick, or even a toy for cautious exploration.

Schoolage kids • Eat frozen foods (popsicles, frozen fruit or vegetables), dress up in fun costumes to get used to the feel of unfamiliar clothing, play with make-up and face painting.

Teenagers and Adults • Sculpt, sew, weave, crochet or knit, create a scrapbook (lots of pasting and working with different textures), use sandpaper to smooth a woodworking project, take a very cold or hot shower or bath.

Auditory • Auditory input is what we hear and is neuroanatomically connected with the vestibular sense. In addition to listening to various types of music, both recorded and live, here are some ways to get calming and organizing auditory input.

• Get out in nature and listen. Go to the beach or sit still and listen to a thunderstorm or windstorm. If you hear birds singing, try to identify what direction a given bird is calling from. • Listen to natural sounds recordings such as a rainstorm, waves crashing against the beach, or birds in the forest. Sometimes natural sound recordings also feature light instrumentation with flutes, keyboards, etc.

• Play a listening game: you and your child sit very quietly and try to identify the sounds you hear (traffic, the hum of the refrigerator, a door shutting, etc.). • Listen to Hemi Sync recordings of sounds and music specially engineered to promote calming, focus, energy, or creativity.

• Encourage your child to play a musical instrument. For a child with auditory sensitivity, controlling the sounds she hears can be especially helpful. If your child is fearful of loud noises, let him control the volume on the stereo, exploring soft vs. loud music. • Get a white noise machine, tabletop rocksand-water fountain, or aquarium.

• If your child is visually distractible, simplify the visual field in his home or school environment for a calming effect. Alternately, if your child seems visually "tuned out," i.e., does not seem to respond easily to visual stimulation, add brightly colored objects to attract visual attention. For example, a child who has trouble getting aroused for play may be attracted by a brightly painted toy chest filled with appealing colored toys.

• colored toys. • Hide clutter in bins or boxes or behind curtains or doors—a simple, solid-color curtain hung over a bookshelf instantly reduces visual clutter. • Use solid colored rugs instead of patterned ones and solid-colored walls (for example, avoid patterned wallpaper).

• Have your child sit at the front of a classroom where there is less visual distraction. He may also need to sit away from the window to avoid the distraction of the outdoors. Keep in mind, however, that some children do best sitting in the back of the room so they can monitor what other kids are doing without constantly turning around. Work with the teacher to see which seating arrangement works best for your child.

• Avoid toys, clothes, towels, etc., in colors that your child find stress-inducing such as bright orange, yellow, and red (your child may have a different "hated" color.)

Smell • If your child has sensory problems, certain odors can stimulate, calm, or send him into sensory overload.

• Explore scents with your child to find the ones that work best to meet your goal (either to soothe or to wake up). While everyone has different preferences, vanilla and rose are generally calming. Peppermint and citrus are usually alerting. Let's say your child needs help staying calm and loves vanilla

• You can use vanilla soaps and bath oils to ease bath time, vanilla candles or oils in an aromatherapy burner or machine at bedtime, and vanilla body lotion. Note: Avoid lavender and tea tree oil products for boys as several recent studies show a link with enlarged breast development in boys. It's probably safest to avoid using these products for girls as well.

• Play a smelling game with your SI child. Have her close her eyes or wear a blindfold and try to identify smells such as mango syrup, apple, peanut butter, and soap. • Life stinks sometimes. Accept your child's opinion about something she thinks smells "gross." Then help her find something that smells nice.

Taste • Taste input is strongly influenced by smell (as an experiment, chew some gum until the flavor is gone, then hold a lemon under your nose; the gum will taste like lemon). • Strong tastes can stimulate the mouth of a child with SI and make him more willing to try new foods. Before presenting new foods, let the child have one peppermint, sour gummy bear, or other strongflavored food.

• If your child does not have a strong negative reaction to refined sugar (becomes very "hyper" or gets very sleepy), get an assortment of flavored jellybeans. Eat one at a time, and have her guess which flavor it is.

• Children will be more likely to taste something if they help make it. Let him help you select foods. For example, let him choose between chicken or fish, string beans or sugar snaps, and potato or rice. Then let your child arrange the meat in the baking pan, break off vegetable tips and dump in water, and so on. Let him help you arrange food on each plate into a pleasing presentation.

• Don't forget to play with your food.

Sample Sensory Diet • Here is a sample sensory diet, created for a 7yrs old child whose sensory seeking behavior interfered with his attention and learning.

• Activities should be individualized for each child and modified frequently to meet changing needs. A separate program was worked out for this child with the school, including frequent movement breaks, an inflatable seat cushion for wiggling while remaining seated, and providing crunchy/chewy oral comfort snacks at handwriting time.

Morning Routine • Massage feet and back to help wake up • Listen to therapeutic listening CD • Use vibrating toothbrush and vibrating hairbrush • Crunchy cereal with fruit and some protein • Jump on mini-trampoline

After school • Go to playground for at least 20 minutes • Push grocery cart or sister's stroller • Spinning • Mini Tramp — add some variety: have him play catch or toss toys into a basket while jumping

• Massage feet to "reorganize," body sox, make body sandwiches, wheelbarrow walk • Do ball exercises • Listen to therapeutic listening CD • Oral work — sucking thick liquids through a straw, crunchy and chewy snacks (to give input into jaws and teeth)

Dinner Time • Help with cooking, mixing, chopping, etc. • Help set table, using two hands to carry and balance a tray • Provide crunchy and chewy foods

Night time • Family time: clay projects, painting projects, etc. • Warm bath with bubbles and calming essential oil • Massage during reading time

Tips for Helping Your Child with Sensory Problems • To desensitize gums, provide tactile input. Wear a rubber finger cot, swipe with a washcloth, or use an Infadent finger cot or Toothettes • If your child can't tolerate foamy toothpaste, try Orajel toddler toothpaste, which does not foam.

• Develop a predictable routine for when and how to brush. Help your child choose the brushing pattern which will always be used. For example, she could decide to always start with the top teeth and to brush from left to right, front to back. A consistent brushing pattern will help your child motor plan this complex activity, learn to predict when and where she will feel various sensations (rather than be a "victim" of horrible sensations), and help your child feel proud about keeping her mouth and teeth nice and clean.

Bathing • If your child doesn't like "slimy" soap or shampoo, try foamy soap (also good for tactile play—unlike shaving cream, it doesn't have a strong smell).

• Try using a large container of water for rinsing since the extra weight of the water might feel soothing. Alternately, your child might be more comfortable if he simply feels in control of the water. In this case, provide a sprinkling can (beach or garden toy) or a hand-held shower attachment. Count down together to rinsing: "1, 2, 3, rinse."

• Use a foam visor or a washrag held over the face when rinsing. This is good for a child who hates water on his face or who hates tilting his head back for rinsing. You might also have him dry his face immediately after washing it even if he's still in the shower or bath. • If toweling dry is a problem, experiment with softer (or harder) towel textures. You can also try pre-warming the towel in the dryer for a few minutes.

Going to Bed • Make sure the room is dark enough (or light enough) for your child to sleep. A small amount of light might comfort one child, while light creeping in through the curtains or under the door might disturb another.

• Try a white noise machine, fan, aquarium, or even a radio set on static to create white noise to block out sleep-disturbing sounds. Some children fall asleep more easily listening to gentle music such as Mozart or CDs specifically designed to promote sleep.

• Give calming deep pressure input via a backrub or massage using long, firm strokes. Even just squeezing feet, legs, hands, and arms, can be very soothing at bedtime. You can also try using a weighted blanket

Getting a Haircut • Use the word "trim" instead of "cut." • Visit the hair salon to simply check it out and watch other children get their hair trimmed. Familiar places are less scary. • Massage your child's scalp before a haircut using your hands, handheld vibrator, or vibrating hairbrush

• Many children dislike the plastic cape with its scratchy closure. Instead use a soft towel and clip or an oversized shirt. • Go to a child-friendly haircutting salon or create your own at home with candy and an absorbing video to watch. • Have the barber or stylist give the child a big soft brush or a dry washrag with baby powder on it to brush off stray hair as it is cut. Use baby powder on irritated skin afterward.

Clothing • Some tactile-defensive kids insist on supersoft, allcotton clothing. • Some children are more comfortable wearing snug clothing or tight clothing worn beneath their other clothes. Try bicycle shorts, tights, "too small" t-shirts, etc. • When buying clothes for a tactile-sensitive child, avoid scratchy nylon threads and items made of polyester blends which can pill and cause discomfort. • Buy seamless socks from places like

Shopping • Avoid shopping during peak hours when stores are most crowded and noisy. • Let your child push the grocery cart for sensory input. Many grocery stores have junior carts for smaller children. Also, pushing a stroller can help a toddler or preschooler get calming input. Add packages for extra weight.

Potty Training • Some children are disturbed by the size and feel of a large toilet seat. Bring your child to the store and help her to pick out a potty chair or a small, cushioned vinyl ring that fits onto an adult toilet seat.

• Some children are frightening by the sound of flushing. A sense of control might help: together, count off to the flush, for example: "1, 2, 3, FLUSH!" Make lots of noise as the toilet is flushing, shouting "hooray!" • Sometimes, tight clothes provide sensory input that distracts a child from the sensation of needing to use the potty. Loose clothing such as boxer shorts may help him recognize when he has the urge to go.

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