Sensory Integration in the Home: An overview
Presented by: Laurie Johnson, MHS, OTR/L Adrienne Rousseau, parent of Autistic Child
The neurological process that organizes sensation from one s own body and from the environment and makes it possible to use the body effectively within the environment. (Ayres, 1979)
Figure 11-8 Sensory Integration Theory and Practice, 2nd ed. Anita Bundy, Shelley Lane, Elizabeth Murray
³The capacity to regulate and organize the degree, intensity, and nature of responses to sensory input in a graded and adaptive manner. This allows the individual to achieve and maintain an optimal range of performance and to adapt to challenges in daily life.´ (Miller & Lane, 2000)
Poor Registration Defensive
Sensory Seeking Avoiding
Dunn, W (2002). Implementing a Sensory Processing Approach In School Practice. SCOTA Conference, Charleston, SC.
³the multisensory experiences that one normally seeks on a daily basis to satisfy one¶s
sensory appetite; a planned and scheduled activity program that an occupational therapist develops to help a person become more self-regulated.´ (Kranowitz, 1998)
The amount and type of sensory input needed to be most alert, adaptable, and skillful in one¶s environment. With the right input, our bodies feel calm, alert and ready to tackle daily challenges. Negative sensory input can have a disorganizing affect on the body.
Sensation derived from stimulation to the skin (Bundy, et al. 2002)
underresponsiveness/ poor registration Defensive/ Avoiding
Light touch Tickling Hot or cold food (strong temperature) Playing in textures (rice, sand, beans, finger painting, playdoh) Go barefoot, use textured towels/ blankets/ objects Chose crafts with touch feedback (gluing, clay molding, etc)
Firm pressure on skin, longer duration Hold hand firmly Avoid unnecessary touch and forewarn of necessary touch Weighted vests, blankets, etc. Wilbarger Brushing Program (under OT direction) Oral tactile defensiveness strategies .
Sensations derived from movement (ie. Speed, rate, sequencing, timing, and force) and joint position. Derived from stimulation to muscle and, to a lesser extent, joint receptors, esp. from resistance to movement. (Bundy, et al. 2002)
Underresponsive/ seeking as a modulator Defensive?? (little evidence for)
Heavy work , jump, crash, resistance, push/pull i.e. squeeze ball, carry groceries, jump on trampoline, tug of war, weighted bookbag, pillow crashing, hanging by arms or climbing
³Sensation derived from stimulation to the vestibular mechanism in the inner ear that occurs through movement and position of the head; contributes to posture and the maintenance of a stable visual field´ (Bundy et
Underresponsiveness/ poor registration/ seeking Defensive/ Avoiding
Changes in speed and direction Change of head position Swinging (tire swing with lots of directional changes) Sliding Somersaults Dragging on a blanket Bouncing on adult s knee/ therapy ball Movement activity prior or during a thinking task Movement breaks in class (accompany on errands to office, library, etc.)
Linear, predictable, repetitive Head moving in straight line I.e.. Rocking chair, bouncing up and down, gentle linear swinging Allow child to direct Couple with organizing inputs (proprioceptive input, deep pressure, etc.) I.e. Swing and crash! Child swings with feet held firmly with pulling/ pushing, etc.
By: Wiley Miller Non Sequitar
Underresponsive/ Seeking Defensive/ Avoiding
High intensity, contrast, or change of stimuli i.e. bright lights, contrasting colors Cover blocks in foil, roll a clear ball with moving objects inside, highlight words, label drawers with bright colors Use visual input to engage the seeking child
Low contrast, dim i.e. low lights, uncluttered environments, decreased competing stimuli with attending to a task, set up visual blinds with sheets over cluttered areas, allow visual breaks in a dark room
Underresponsive/ Seeking Defensive/ Avoiding
Strong intensity or changing sounds Music with unpredictable rhythm I.e.. Ring bell at stimuli you want child to attend to
Repetitive, constant, quiet Rhythmic music, Quiet spaces for child to retreat to when over stimulated Carry headphones with calm, rhythmic music Warn of loud noises, use earplugs In Class, seat away from loud speakers and traffic
Underresponsive/ Seeking Defensive/ Avoiding
Strong intensity i.e. Spicy, sour, such as warheads, sour patch kids, BBQ sauce, sour straws)
Mild intensity, nondistinct or familiar qualities, gradually progress tastes to expand diet i.e. Use unscented cleaning products/ soaps, start with bland foods (cream of wheat, mashed potatoes)
There is no recipe that always works! Many children do confusing things!!
Examples A professional trained in SI should help interpret the child·s behavior and develop an appropriate program
How we treat Xander Equipment we have: resistance tunnel, brush, koosh balls, cotton balls, sand, rice, beans playdoh, vibrating tools, and any food he will tolerate. Wilbarger brushing/joint compression protocol. Throughout the day we encourage Xander to try new input, with each success he is rewarded. Educate those Xander interacts with.
What it looks like in Xander Defensive with light touch, will not tolerate hair-brushing, haircuts, hair washing, etc. Particular about type of clothing, how it fits, tags must be cut out. Difficulty walking barefoot on grass, and must assimilate to sand slowly. Change in walking surface is tough when barefoot. Defensive with gentle touch or affection, prefers firm pressure when touched.
How we treat Xander Equipment we have: minitrampoline, weighted vest, bear hug vest, weighted shoes, pillow and blanket, ball pit, therapy ball, vibrating tools, joint compressions (with brushing protocol). Allow plenty of time for gross motor play, including lots of rough play (wrestling, ³steam roller´, pillow fights). Regular proprioceptive activity (every 15-30 minutes).
What is looks like in Xander Seeks high impact in playrunning, jumping, bumping into people and objects often. Runs, jumps, bounces, wiggles nearly continuously! (Looks a lot like hyperactivity.) Even ³at rest´ he often rolls, kicks, flicks his arms/legs, drags his head, etc. Seeks deep impact during typical daily routine activities- rubbing against walls as he walks, bouncing off of or pushing on objects.
How we treat Xander Equipment we have: swings (indoor and outdoor), scooter board, mini-trampoline, therapy ball, during summer we go to the pool often. During periods of seeking, we give Xander sensory choices to feed his need - then transition to new activities.
What is looks like in Xander At times he strongly seeks vestibular input by spinning, hanging upside down from furniture, standing on his head, swinging, riding his bike. Other times he avoids taking his feet off the ground, resists movement in the car, avoids swings, dislikes riding in the stroller/wagon..
How we treat Xander During defensive times we give him time in a dark room, sometimes with his eyes/head covered. In the community we take a blanket which he will pull over his head when over stimulated. Hand held video games give him something to focus on when the surroundings are too much to handle. We often use visual supports/ but keep them simple and avoid extraneous pictures/ colors
What it looks like in Xander Easily overwhelmed in cluttered environment with numerous stimuli to accept Easily distracted by visual stimulus in every day environment and sometimes hides eyes Easily distracted by school work/ therapy/ ABA work that is visually over stimulating; making it difficult to complete an assignment or task. Sometimes repeatedly tracks for no apparent reason
How we treat Xander At home we limit unnecessary noise, enforce strict rules regarding appropriate speaking, give warnings for loud noises. In times of unexpected loud noise, we give bear hugs while removing him calmly and quietly from the noise/situation immediately. Outside our home we prepare by describing noises he will hear, or give him headphones to drown out the noise.
What it looks like in Xander Defensive with loud sounds or too many sounds at once. If more than one person speaks at once, he is easily upset. Often screams or begins self stimulatory behavior in situations he cannot control when the auditory stimuli is overwhelming. Puts his hands over his ears and seeks a secluded space, usually with his own verbal protest«attempting to drown out the offensive noise.
The Sensory Diet
It is very important that regular sensory activities are used to keep Xander centered for optimal function throughout the day.
Morning Routine Brushing/Joint Compressions At school: Bear Hug Vest, Weight Vest, Crash mat, Brushing/Joint Compression After school: Quiet Activity (rest time) Sensory Choice(s) Afternoon Activities including calming input & brushing
Evening Routine Brushing/Joint Compressions Outside Play Sensory Choice(s) Dinner Bath/Brush Teeth/Pajamas Brushing/Joint Compressions Quiet Time (reading, tv, massage)
Other ways to handle Sensory Integration difficulty«
´How does your engine run?µ (ALERT Program)
DOCTOR GROCERY STORE
Some of Xander¶s successes«
(all previously impossible with STRONG resistance)
Xander tolerates his hair grown out and cut rather than buzzed! Xander goes to the dentist and has his teeth cleaned! Xander jumps in the pool, dives for toys, and completes a somersault! Xander eats a regular meal at school! Xander calmly says ³no thanks´ to sensory input he doesn¶t want, rather than screaming ³NOOO!´
Ayres, A. J. (1979). Sensory Integration and the Child. Los Angeles: Western Psychological Services. Bundy, A., Lane, S., Murray, E. (2002). Sensory Integration Theory and Practice, 2nd Ed. Philadelphia. F.A. Davis. Case-Smith,J. (2000, Sept.). Intervention Strategies for Children With Autism. Seminar handouts from lecture at SCOTA Conference, Charleston, SC. Dunn, W. (2002, Feb.). Implementing a Sensory Processing Approach in School Practice. Seminar Handouts from lecture at SCOTA Conference, Charleston, SC. Kranowitz, Carol Stock. The Out of Sync Child: Recognizing and Coping with Sensory Integration Dysfunction. New York, NY: The Berkley Publishing Group, 1998. McIntosh, D.N., Miller, L. J., Shyu, V. & Hager, R. J. (1999). Sensory-modulation disruption, electrodermal responses, and functional behaviors. Developmental Medicine & Child Neurology, 41, 608²615. Miller, L. J., & Lane, S. J. (March 2000). Towards a consensus in terminology in sensory integration theory and practice: Part 1: Taxonomy of neurophysiological processes. Sensory Integration Special Interest Quarterly, 23, 1-4.