Sensory Integration Review Plus Regulation Tools How Does Your Engine Run 5 Point Scale Social Stories Visual Schedules and More

Sensory processing/integration is the organizing, processing and interpreting of information from movement, touch, sounds, visual input, taste and gravity that allows us to interact with our world. is the organizing, processing and interpreting of information from movement, touch, sounds, visual input, taste and gravity that allows us to interact with our world.

Sensory Integration Theory and Practice, 2 nd ed. Anita Bundy, Shelley Lane, Elizabeth Murray

What is Sensory Modulation? Sensory modulation is when the senses work together. Each sense works with the others to form a composite picture of -who we are physically -where we are -what is going on around us Sensory modulation is a neurological function that is responsible for producing this composite picture. It is the organization of sensory information for on-going use.

Each sensory system has two components One that arouses or alerts our attention One that arouses or alerts our attention One that allows us to explore our environment and examine details One that allows us to explore our environment and examine details We need a balance between these two components We need a balance between these two components

Passive Passive Active ActiveHighThresholdPoorRegistrationSensorySeeking LowThresholdDefensiveAvoiding Dunn, W (2002). Implementing a Sensory Processing Approach In School Practice. SCOTA Conference, Charleston, SC.

The Sensory Diet A “sensory diet” (coined by OT Patricia Wilbarger) is an activity plan that provides the sensory input a person needs to stay focused and organized throughout the day. A “sensory diet” (coined by OT Patricia Wilbarger) is an activity plan that provides the sensory input a person needs to stay focused and organized throughout the day.

Sensory input needed to be: most alert, adaptable, and skillful Just as you may jiggle your knee or chew gum to stay awake or soak in a hot tub to unwind, children need to engage in stabilizing, focusing activities too. Just as you may jiggle your knee or chew gum to stay awake or soak in a hot tub to unwind, children need to engage in stabilizing, focusing activities too. 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. 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.

Tactile Sensation derived from stimulation to the skin Sensation derived from stimulation to the skin

Tactile Alerting 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) Calming 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. under responsiveness/ poor registration Defensive/ Avoiding principles:

Tactile Sense What it looks like in the child 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 the child 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 the child to try new input, with each success he is rewarded. Educate those Xander interacts with. Defensive

Proprioception It is the sense that indicates whether the body is moving with required effort, as well as where the various parts of the body are located in relation to each other. It is the sense that indicates whether the body is moving with required effort, as well as where the various parts of the body are located in relation to each other.

Proprioception. Calming/ Organizing “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 Underresponsive/ seeking as a modulator Defensive?? (little evidence for) principles

Proprioceptive Sense What is looks like in a child Seeks high impact in play- running, jumping, bumping into people and objects often. Runs, jumps, bounces, wiggles nearly continuously! (Looks a lot like hyperactivity.) Even “at 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. Seeker How we treat the child Equipment we have: mini- trampoline, 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, “steam roller”, pillow fights).

Vestibular Sensation that contributes to our balance and our sense of spatial orientation, is the sensory system that provides the dominant input about movement and balance. Sensation that contributes to our balance and our sense of spatial orientation, is the sensory system that provides the dominant input about movement and balance.

Vestibular Alerting Changes in speed and direction Change of head position Swinging (tire swing with lots of directional changes) SlidingSomersaults 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.) Calming 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. Under responsiveness/ poor registration/ seeking Defensive/ Avoiding Gravitational Insecurity

Vestibular Sense What is looks like in a child 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.. Fluctuates How we treat the child 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 the child sensory choices to feed his need - then transition to new activities.

Visual Alerting 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 Calming 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

Visual Sense What it looks like in a child 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 Fluctuates How we treat the child 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

Auditory Alerting Strong intensity or changing sounds Music with unpredictable rhythm I.e.. Ring bell at stimuli you want child to attend to Calming 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 Under responsive/ Seeking Defensive/ Avoiding

Auditory Sense Defensive What it looks like in a child 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. How we treat the child 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.

Taste/ Smell Alerting Strong intensity i.e. Spicy, sour, such as warheads, sour patch kids, BBQ sauce, sour straws) Calming 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) Underresponsive/ Seeking Defensive/ Avoiding

The Sensory Diet 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… Social Stories Visual Schedule “How does your engine run?” (ALERT Program)