Sensory Integration

Children born with Cerebral Palsy may display an abnormal degree of sensory processing, whether decreased or increased. Sensory integrative dysfunction makes a child appear clumsy when he or she walks. Often fine motor skills are affected. Sensory dysfunction can also cause over-sensitivities or under-sensitivities that lead to mental and physical distraction or fatigue. Problems with sight, hearing, and balance are also addressed.

What is sensory integration therapy?

As humans, we rely on our senses to act and react.

Sensory processing is the information we receive and use that come through our senses. Our senses include not only sight, sound, touch, taste and smell, but also temperature, movement, gravity and body positioning. They inform our thoughts, feelings and physical reactions through complex receptors in the skin, muscles, joints and inner ear. These receptors process information collectively and unconsciously, which is then interpreted by the brain. The brain then uses the information for motor and social skills.

But imagine if one day, your ability to correctly perceive was compromised? If gentle touches seemed painful? If normal light seemed intolerably bright? If loud thunder was ignored? If the sound of heels against the floor was intolerable? And, if a normal sense of physical equilibrium was not achievable?

Sensory therapy uses specific strategies to help children sort through and process miscues that occur in the brain so that they can use their senses to develop knowledge, understand what is occurring around them, and function independently and appropriately.

Sensory integration therapy teaches children to use their senses in appropriate ways and with self regulation. Individuals with developmental disabilities and autism as well as premature infants are prone to sensory integration misfires.

What is sensory integration therapy?

Developed in the 1960s by occupational therapist and researcher Jean Ayers, Ph.D., sensory integration therapy is a process by which children build and strengthen the connections within the brain that most young people develop through childhood experiences. Therapy is designed to help children interpret sensory input, understand its relevance, and respond – especially to external stimuli that are often beyond their control.

For example, a child may be asked in therapy to pick up an object such as a ball. Though the child sees the ball, and understands what it’s used for, he or she may not be able to recognize or describe the ball because of visual miscues. The child may also inaccurately perceive the weight or texture of the ball due to over-sensitivity, or lack of sensitivity to touch.

The senses that sometimes are disordered in children with Cerebral Palsy are:

• Vision
• Auditory (Hearing)
• Olfactory (Smell)
• Tactile or Somosensory (Touch)
• Oral (Taste)
• Vestibular Processing (unconscious information obtained through the inner ear for equilibrium, position in space and gravity)
• Prioprioception Processing (unconscious information obtained by the muscles and joints regarding your position in space, the weight of objects, the pressures felt, the stretch, body movement, and position changes)

A child’s sensory processing is problematic if they are:

• Over-responsive – avoidance, caution and fearful
• Under-responsive – withdrawn, passive or difficult to engage
• Sensory seeking – impulsive and takes risks

The goals of sensory integration therapy are:

• Determine how a child’s specific sensory perceptions affect their overall physical, social and human development
• Identify and eliminate barriers caused by disordered perception
• Implement new sensory processing approaches that organize multiple sensations, filter out background stimuli, and compensate for deficits in perception
• Restore a child’s sense of body position and function (also known as vestibular and proprioception)
• Restore motor planning (praxis) capabilities, so a child can focus on his or her senses to plan movement, respond to other’s movements, and understand the body’s relationship to space
• Encourage activities that allow children to explore their environment, learn and develop their senses
• Assist children with perception issues in sorting out mixed messages
• Create a physical environment that fosters participation in activities that depend on the senses

Some signs that a child might be struggling with his or her sensory perception include:

• Strong reactions to textures, food and sound
• Discomfort sitting or standing
• Feeling too hot or too cold
• Over-sensitivity, or under-sensitivity, to touch
• Little reaction to external events
• High, or low, physical activity levels
• Lack of physical coordination
• Inappropriate physical responses
• Inability to link a task with the necessary physical function
• Restlessness and behavior issues
• Reclusiveness
• Speech delays
• Low self-esteem

Who benefits from sensory integration therapy?

Children are the largest benefactors of sensory integration therapy, but parents and caregivers also benefit.

By providing coping strategies and treating the condition, therapists help children overcome these issues that, at least initially, may seem insurmountable. Success is achieved by implementing treatment that will help children build the mental and physical framework within their nervous system to properly perceive sensory input, regulate their responses, and understand the significance behind a particular, texture, movement, or sound.

All of these skills must be mastered for a child to maximally benefit from other therapies.

Benefits to sensory integration therapy include:

• Lessen sensory defensiveness
• Develop positive behavior patterns
• Correctly interpret sensory input
• Minimize input intolerance
• Eliminate fear
• Reduce negative physical reactions
• Create physical equilibrium and sense of space
• Encourage play and socialization
• Anticipate action and outcome

Parents and caregivers also benefit from sensory integration therapy because they learn how to productively interact with their child, greatly enhancing the relationship.

What are the benefits of sensory integration therapy?

The benefits of sensory therapy are numerous, and far-reaching.

Because most people develop sensory perception unconsciously, it’s difficult to understand how sensory deficits affect an individual. Therapy allows children with sensory deficits to interpret stimuli, plan actions, and respond.

Therapy also improves a child’s modulation, or ability to regulate neural messages in such a way they can respond to stimuli appropriately. The benefits of therapy are often physical, but also psychological.

The physical benefits of therapy include:

• Hand-eye coordination
• Improved motor-planning
• Gravitational security
• Posture
• Balance responsivity (over responsivity and under responsivity)
• Improved sleep cycles
• Language development

The psychological benefits of therapy include improvements in:

• Socialization
• Procrastination
• Moodiness
• Restlessness
• Emotional outbursts and frustration
• Confidence
• Attention

When is sensory integration therapy advised?

Sensory integration therapy is advised by a professional after a qualified occupational therapist completes his or her assessment of a child. Therapy is usually advised early in a child’s development – sensory deficits should be dealt within infancy if possible to give a child the advantage of learning to adjust and compensate for his or her condition as he or she develops.

Addressing sensory deficits early improves:

• Physical function
• Cognitive function
• Capacity to learn
• Emotional well-being
• Propensity to make friends and to socialize

What happens during sensory integration therapy?

Sensory integration therapy begins with a thorough evaluation and assessment of a child’s sensitivity to environment. This assessment is comprised of interviews with a child’s parents or caregivers, a health history, standard tests and observation in a clinical setting. The goal is to determine where deficits in a child’s sensory perception are and what interventions will help a child adapt and react to their environment.

A therapist will administer the Sensory Integration and Praxis Tests (SIPT). During the assessment, the therapist will evaluate:

• Reaction to touch, sounds and textures
• Body positioning in relation to space and objects
• Movement perception
• Motor planning (praxis)
• Planning and sequencing actions
• Modulation
• Existing sensory-seeking behaviors
• Visual perception and eye movement
• Eye-hand coordination
• Spontaneous activity and play

The therapist will determine activities that encourage organized responses to sensory input. Activities are practiced in a repetitive and continuous fashion so children can learn and retain the process. They learn how to self-regulate their responses, achieve a comfort level with sensations, and understand how the senses work collectively.

Sensory integration therapy is often disguised as “fun” for the child. The goal of therapy is to allow children to explore in an unencumbered environment to fine-tune their interpretations and responses. For example, a child that is uncomfortable with rough surfaces may play with grains of rice, so he or she can get used to its texture – which in turn neutralizes his or her discomfort with the sensations.

Therapy is ultimately successful when the child realizes the value of the outcome enough to continually use the learned process.

Other activities may involve:

Vision

• Neon, patterned and florescent papers
• Colored, strung, flashing, holiday and strobe lights
• Wind socks, wind-up toys, activity boxes and age-appropriate mobiles

Auditory (Hearing)

• Water – fountains, faucets, waves, and waterfalls
• Machines – lawn mower, washing machine, dishwasher and microwave
• Music – radio, instruments, and chimes
• Repetition – clocks, rap and drums
• Instruments – drums, piano, guitar, keyboards and tambourines

Olfactory (Smell)

• Air fresheners – lavender, pot pouri and sachets
• Aromatherapy – candle and incense
• Beauty aids – lotions, powders and perfumes
• Vegetation – flowers and plants
• Baking and cooking – breads, cookies, stews, bacon, onions and cabbage
• Environments – bathrooms, kitchens, garages and locker rooms

Tactile or Somosensory (Touch)

• Hard – rock, counters and floors
• Soft – cotton ball, fur and feathers
• Surfaces – picky, sticky, rough, pointy and smooth
• Textures – sand, water, and paints
• Items – beans, rice, beads and bolts
• Interaction – stationary, pliable, moldable, bendable and breakable
• Vibration – dryer, hair blower and blender
• Pressure – push, tickle, rub, claw, pressing, pulling, holding and squeezing

Oral (Taste)

• Fruits – strawberry, blackberry, grapes and bananas
• Milk-based items – Yogurts, milk shakes and ice cream
• Hot and cold items – Soups and popsicles
• Candies – hard candy, soft candy, sour candy and licorice
• Condiments – jelly, honey, spice and peanut butter
• Cheese – Feta, cheddar, cottage and blue cheese

Vestibular Processing

• Standing on one foot and standing on one foot with eyes closed
• Throwing a ball
• Shaking the head
• Bouncing on bed, ball or parent’s knees
• Swinging in blanket, in swings, or on a rope
• Sommersaults and hand stands
• Turning head left and right at rapid pace
• Walk heel to toe without support
• Sliding

Prioprioception Processing

• Swinging
• Dancing
• Playing in boxes filled with balls, beans
• Crawling through tunnels
• Hitting balls
• Spinning on chairs
• Balancing on floor or beam
• Rolling or crawling on a rug
• Jumping, bouncing

The therapist will monitor a child’s progress to make sure he or she is reaching pre-determined goals. At the conclusion of therapy, a child should exhibit more comfort with stimuli that was previously bothersome.

Where does sensory integration therapy take place?

Sensory integration therapy can take place at locations that practice occupational therapy, although specialized centers do exist. Where therapy takes place will be dictated by a child’s condition, the availability of therapy, and insurance coverage.

Therapy will often take place at:

• Schools
• Outpatient clinics
• Inpatient rehabilitation centers
• Hospitals
• Skilled nursing centers
• A child’s home

The setting for sensory integration therapy is extremely important because at the crux of sensory dysfunction is a child’s perception of his or her environment. For this reason, centers that offer sensory integration will have high- and low-tech equipment, from hug machines, to indoor swing sets.

Sensory integration may also include at-home work; the therapist will instruct the parent on how to complete exercises at home.

Who provides sensory integration therapy?

Sensory integration therapy services are typically provided by a licensed occupational therapist that has completed additional training in the sub-specialty of sensory integration therapy.

The practice is a relatively new specialty; certification is recommended, but not required. However, occupational therapy is regulated by all states.

At the time this site was published, Western Psychological Services (WPS) in California is the only certifying-body for therapists who practice sensory integration. However, the organization offers courses throughout the United States. Occupation therapists, physical therapists, and speech therapists have completed certification, according to WPS.

WPS’ certification program is made up of four courses, including:

• Sensory perspective
• Specialized techniques
• Interpretation and assessment
• Invention

In the occupational therapy industry, the certification is seen as a practical and desirable step for therapists that would like to offer sensory therapy.

WPS has a list of sensory integration-certified therapists that have completed training in each state.

What are the risks or special considerations associated with sensory integration therapy?

When a child begins sensory integrations therapy, he or she can receive too much sensory stimulation, which can result in reactions that could be disruptive, like willfulness or frustration. For this reason, a therapist – as well as parents or caregivers – must monitor a child’s reactions to counteract those reactions.

Additionally, some sensory integrations techniques might make a child uncomfortable.

All of these situations can be mitigated when a trained occupational therapist implements a highly-structured plan of intervention that is both well-organized and fun for the child.