Sensory Integration Dysfunction/ Sensory Processing Disorder


Sensory Integration and Sensory Processing, or sensory motor processing, is our autonomic ability to receive sensory information interpret, organize, and respond to it. Both external and internal stimuli enter the body and neurological system.

These senses are foundational because the information gained from our senses creates the foundation for future learning and decision making (Schneider, 2001). Information from each of the senses, movement of the body, and gravity must be integrated and interpreted before children can successfully function in the world around them (Cheatum, 2000). Our senses are responsible for things such as coordination, attention, arousal levels, emotions, memory, autonomic functioning, and higher level of cognitive functions.

An interruption in the ability to absorb these senses into the learning environment is a sensory dysfunction or processing disorder. ( I will refer to this as sensory difficulties (SD) throughout this paper). The interpretations and reactions to sensory input are affected causing feedback on that information with motor, emotional, attention, and other responses in a flight or fight manner. Often they will have problems with interpersonal relations, academic achievements, behavior problems, vision problems, speech/articulation difficulties, eating problems, digestion and eliminating problems, sleep regulation problems, and very often coexists with allergies. One or more senses are over-or-under reactive to the stimuli.

We often find SD secondary or coexisting in people with Autism, ADHD, pervasive developmental disorder, cerebral palsy, fragile X syndrome, severe mental retardation, learning difficulties, language problems, and other neurological and developmental disabilities. Many people are unaware that other than those with a documented disability, “normal” children often have some form of SD. Dr. A Jean Ayres, Ph.D., an occupational therapist, came up with this theory in the 1950’s and 60’s.

In the diagram of the Central Nervous System below, we see that starting on the bottom of the pyramid of our central nervous system we have our sensory system. There are three autonomic neurological sensory systems: Tactile, Vestibular, and Proprioception. Tactile system includes three types of receptors: light touch- pressure, or like a bug crawling on the arm; discrimination-textures; third, temperature and pain. The role of this sense is to perceive the environment and provide reactions that protect for survival. Tactile system dysfunctions result in refusal in eating certain textured foods, refusal to wear certain clothes, avoiding getting hands dirty, avoid being touched. Dysfunctions in this system often lead to irritability, distractibility, hyperactivity, aggression, and negative emotional response to touch sensations. (Hatch, 1995).

Vestibular system is the inner ear, which detects movement and position of the head relating to gravity. A dysfunction in this system is two different ways. Children that are hypersensitive to Vestibular stimulation are fearful of movement activities such as swings or slides. They have a hard time learning to climb stairs or walk on uneven surfaces. These children appear to be very clumsy. Another way this system affects children is on the other extreme. This child may seek sensory experiences such as spinning. This child has a hypo-vestibular system and is constantly trying to stimulate their Vestibular system.(Hatch,1995).

Proprioception system is awareness of body position referring to the muscles, joints, and tendons. A dysfunction in the Proprioception system affects the child’s awareness of their body position in space. They have the tendency to fall, clumsiness, odd body posturing, resistant to motor movement, and difficulty manipulating small objects.(Hatch, 1995).

If one stage of this pyramid is disrupted, the whole pyramid is thrown off. The effects are seen throughout the pyramid. Many times these problems get overlooked until it has become so severe that there are extreme behavior problems, health issues, family issues, social, emotional, and educational issues. Often we look at the symptoms/characteristics of the child instead of trying to find the actual cause. The more severe cases need to be assessed and treated by an Occupational Therapist. These children need to be evaluated by a professional and will be tested using the Sensory Integration and Praxis Test (SIPT). (Stephens, 1997). For those other children that might seem to have some sensory issues, you need to understand their needs and make accommodations to help them become a successful learner. You might have 2-5 children in your classroom that have undocumented SD.

First you must determine which sensory systems are involved in the area of need. You must also know where the child is developmentally. You need to make notes of what the child is doing (don’t focus only on what the child is not doing) and any patterns in the behavior. Some children differ from one day to the next, having off days and successful days. Be sure to make note of this. The child with SD may have a difficult time reading cues in the environment (both verbal and non-verbal). If the child is receiving the sensory information, they might not have the ability to organize this information and produce an efficient response. For these children everyday ordinary tasks are extremely challenging to perform and respond to.

One or more common symptoms along with frequency, intensity, and duration may indicate SD. Frequency is how often throughout the day the behaviors are noticed. Intensity is the amount of avoidance or amount of seeking (depending on over or under stimulated) sensory information. Duration is how long each episode or unusual behavior lasts. When I refer to behavior, I mean all types not just bad behavior. You need to look at changes in the behavior or unusual behavior. There are several types of SD. I will describe some of the common behavioral patterns.

Sensory-Avoiding Children These children have an over-responsive nervous system to sensation. This is also called sensory defensiveness (SPD Network). These children may be diagnosed with sensory over-responsivity. Some signs are:

? Be very picky eaters or sensitive to food smells
? Respond to being touched with aggression or withdrawal
? Fear movements and heights, or get sick from exposure to movement or heights
? Feel uncomfortable in loud or busy environments
? Be very cautious and unwilling to take risks or try new things

Sensory-Seeking Children In some children their nervous system does not respond to sensory information. These children are considered under-responsive to sensation. Some behaviors seem in these children are:

? Hyperactivity
? Unaware of pain or touching others to hard
? Enjoy loud sounds often to loud
? Engaging in unsafe activities

Motor Skills Problems Some children have Motor Skills problems where they cannot carry out actions. They appear clumsy and accident prone. Some things you might notice in these children are:

? Trouble with balance, sequences of movement, and bilateral coordination
? Very poor fine motor skills
? Very poor gross motor skills
? Difficulty initiating movements
? A preference for sedentary activities like reading a book or watching TV
? A preference for playing with familiar toys

These children often appear to be manipulative, unhappy, controlling, and frustrated. They are often labeled as the “class clown”. They try to mask their problems often avoiding group activities. (SPD Network).

Some other SD are Auditory defensiveness related to sound. You might see the child always covering up their ears. They might be afraid of things such as the lawn mower, hair dryer, and vacuum. Another SD is Visual defensiveness with hypersensitivity to light. Then there is oral-motor defensiveness also known as tactile defensiveness in the mouth. Brush teeth can be very distressful for this child. Olfactory defensiveness is intolerance to smells. (Stephens, 1997). Being aware of these possible SD is one of the first steps. Now it is time to learn some techniques that might help the SD child.

One technique that I am really aware of is an individualized sensory diet. A sensory diet has nothing to do with food, instead it is “the 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). This plan works best if it is followed at school and at home. Working together with the child’s family and what goes on at home is very important.

The activities must be supervised and they must be appropriate for that specific child. Here are some examples of activities to do from the book Sensory Secrets:

Activities involving movement and joint action
? Exercising to music- including walking, skipping, jumping, running, galloping and hopping
? Engage in activates that require pushing, pulling, squeezing, lifting, carrying, twisting, and lugging.

? Jumping activities like jump rope or jumping on the trampoline.
? Playing catch with a variety of objects
? Activities that involve swinging, rocking, climbing, hanging from bars, teeter-totter, and merry-go-rounds.
? Riding a bike or scooter
? Walking on a balance beam

Activities involving Touch and Joint Interaction

? Rub lotion on hands and arms
? Splashing in water
? Play musical instruments
? Play with squishy toys
? Play with clay, play-doh, or finger-paints

There are many other techniques that can be useful. I know and have used a few. These are my suggestions:

? Weighted vest
? Beanbag chair
? Bag of birdseed to sit on
? Bounce on ball
? Roll ball over child on ground
? Wrap in tight blanket
? Shaving cream
? Sand or rice in small tub
? Vibrating toy
? Squishy ball (or balloon with flour inside)
? Crawling through tunnel
? Obstacle course
? Parachute play
? Trampoline
? scooterboard
? Deep pressure and brushing (if properly trained, please see attachment)
? Suck pudding through straw
? Suck on lollipops while doing work
? Chewing gum

There are many different activities that you can do. It all depends on where the need is for that child. Every child in the classroom can benefit from some of these activities. Other activities should be for that student exclusively.
The Wilbarger Deep Pressure and Proprioceptive Technique (DPPT)

The Creator:
The Wilbarger Deep Pressure and Proprioceptive Technique & Oral Tactile Technique (OTT) (formerly referred to as the Wilbarger Brushing Protocol or WBP) are techniques developed by Patricia Wilbarger, MEd, OTR, FAOTA. Dr. Wilbarger, is an occupational therapist and clinical psychologist who has been working with sensory processing theories for over 30 years. She is a cofounder of Sensory Integration International and AVANTI camp and well known for her clinical work in the NICU, schools, etc. She lectures internationally on sensory processing disorders and sensory integration. She has produced videotape, audiotape, and an intervention guide on the subject of sensory defensiveness.

More information on these publications or training courses are available from Professional Development Programs (Phone: (651) 439-8865, or at www.pdppro.com)

Based on the theory of Sensory Integration, the brushing technique uses a specific method of stimulation to help the brain organize sensory information. Ms Wilbarger and her daughter Julia Wilbarger, MS, OTR offer training courses on a regular basis for professionals who wish to use it in their practice. Additionally, through their continuing research, the technique is occasionally revised in method, and it is important for therapists to be aware of the most current method.
To use this technique with out instruction from a trained therapist could be harmful at the extreme, and at the minimum, useless.

The Theory:
Our skin is our largest sensory organ, followed closely by our muscles and skeleton, connected by our nervous system and governed by our brain. The sensory systems feed information from our environment, through sense receptors, and neural impulses via our nervous system, directly to the brain. The brain then organizes it, sends it back through the nervous system for use as understanding, adaptation, learning, and skill development.
When this system functions well, it allows a person to interact with their environment efficiently, developing necessary motor and language skills, and appropriate social/emotional behavior. When this system is unable to organize the information appropriately, a variety of symptoms can present; motor delays, tactile defensiveness, learning disorders, social or emotional difficulties, speech, and language deficits or attention disorders.

The Purpose and Benefit:
The DPPT has been found very beneficial to children with sensory integrative dysfunction, as outlined in the previous paragraph. This technique helps the brain and body work together more effectively.

Benefits noted are:

? Can improve ability to transition between activities (calming after emotional outburst, improving tolerance levels.)
? Can help children who have a fear of discomfort in being touched (tactile defensiveness)
? Can increase self regulation, self calming.
? Can increase the ability of the nervous system to use information from the senses more effectively, i.e. speech/motor skills.
? Can improve attention and focus.
? The students generally like the procedure!
Benefits received are directly related to correct administration and consistency.

The Technique:

To use this technique with out instruction from a trained therapist could be harmful at the extreme, and at the minimum, useless.

Therapists interested in offering this technique should contact the above mentioned group to be trained at an official seminar. Families should ensure the therapist offering this technique has the most recent training available.

Pediatric Building Blocks recommends that anyone who has been shown this technique be "updated" annually and their technique checked out by a trained therapist.

The DPPT uses a specific pattern of stimulation delivered through a specific type of brush and gentle joint compression or “pushing” to send information to the brain in an organized fashion. Simply put, it primes the brain to receive and organize information in an effective and useful way. It is done approximately every two hours for a specified number of days and then according to the needs of the child. Consistency is a critical factor! However, the protocol can be administered in between scheduled sessions, to assisting with transitions between activities, reducing overwhelm reactions, and re- organizing the nervous system after emotional upset.

The brush used for this technique, is a soft plastic surgical brush. OTHER TYPES OF BRUSHES ARE NOT APPROPRIATE FOR THIS TECHNIQUE! This brush has been found to be the most effective in stimulating nerve endings in the skin. The actual brushing is done using a very firm pressure, starting at the arms and working down to the feet, avoiding the chest and stomach. Brushing these sensitive areas may cause urination, defecation or vomiting. The brushing is slow and purposeful providing “proprioception” (input through muscles and joints.) It is not ‘scrubbing’, and should never be painful, or cause damage to the skin. Children may initially react with crying or other avoidance measures because it is new, and the re-organizing can be disquieting. Generally within a few sessions, it becomes pleasurable and children will often ask for it or do it themselves.

The joint compression is also done in a specific pattern; ten count repetition, using light pressure. Students can be taught to do this themselves, by using an alternative method of ‘wall’ push-ups, and jumping.

The final component is the oral swipe, used for Oral defensiveness, although this is sometimes omitted in schools due to hygiene and/or safety concerns, as it requires fingers in the mouth. Again, students can be taught to do this themselves.
No part of this technique should ever be painful or cause physical damage.

From Pediatric Building Blocks

I have been trained and certified in this brushing technique.

References

Ayers, A. Jean.Ph.D. (1972). Sensory Integration and Learning Disorders. Los Angeles: Western Psychological Services.

Cheatum, B., and Hammond, A., Physical activities for improving children’s learning and behavior. (2000), Illinois:Human Kinetics

Kranowitz, Carol Stock, M.A. (1998). The out-of-sync child, Recognizing and coping with Sensory Integration Dysfunction. NY: Skylight Press.

Schneider, Catherine Chemin, O.T.R., Sensory Secrets, How to jump start learning in children. (2001). Arkansas: Concerned Communications.

Websites

Hatch-Rasmussen, Cindy M.A., OTR/L (1995). Sensory Integration. Center for Autism. www.autism.org/si.html

Pediatric Building Blocks. The Wilbarger Deep Pressure and Proprioceptive Technique (DPPT). www.pbbkids.com/the_wilbarger_brushing_protocol.htm

SPD Network (2004) What is Sensory Processing Disorder? www.spdnetwork.org/aboutspd/whatisspd.html

Stephens, Linda C.MS, OTR/L. FAOTA (1997) Sensory Integrative Dysfunction in Young Children SEE/HEAR www.tsbvi.edu/Outreach/seehear/fall97/sensory.htm

Interview

Rebecca Roe OTR/L
Occupational Therapist
Pediatric Building Blocks

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