Sensory Integration What is it? Who needs help with this? When do I intervene? How do I use it?

Sensory Integration Sensory Integration is the neurological process that organizes sensation from one’s own body and the environment. Then our body can react effectively in the environment

Sensory Integration Dysfunction (SID) Dysfunction occurs when a person with an intact nervous system, is unable to interpret sensory information appropriately. Thereby this dysfunction or misinterpretation of sensory information interferes with daily activities or development.

Normal SI SI Dysfunction You walk into a home, smell something like cookies cooking and you walk to the kitchen. (Your senses integrated information and allowed your body to move in the environment) You walk into a home, smell something like cookies cooking and you grab the scented candle. (Your senses are met and remain focused on 1 thing. Never occurs to you to go in the kitchen and look for real cookies.)

Sensory Dysfunctions Modulation Dysfunction Inability to process sensory input so that you can organize yourself for a motor or cognitive activity. Hypersensitivity Distractible, focus on small movement or sounds Hyperactive, poor coping skill Hypo sensitivity Oblivious to certain sounds, task Poor personal space Lethargic, sleepy or hypoactive Registration Dysfunction –Hypersensitivity Very definite food, clothing and play preference Overreacts to sounds or certain touch Hypo sensitivity Clumsy, careless, rough Daredevils, Loud voice, Puts things in mouth, ears, touching constantly Oblivious to hygiene Difficulty grasping rules, schedules

Sensory Integration Who needs help with this? Types of Sensory Defensiveness

Auditory Defensiveness – Sound Tactile Defensiveness - Touch Oral Defensiveness – Taste/Smell/Tactile Vestibular Insecurity – Balance & Movement

Auditory Defensiveness Student may show extreme sensitivity to common sounds (vacuum, bell, door slam) Frequently cover their ears to block out ‘loud’ noises Anxious or uncomfortable in noisy environment – may refuse or delay going into an assembly Avoids activities that most children enjoy (recess, birthday parties) May focus on wrong sounds and not complete task

Auditory Defensiveness How do I help Staff Intervention – assist in success –Recognize the need to intervene –Prepare the student for bell, fire drills ( desensitize) –Provide ear plugs or headset for assemblies (to decrease noise)- ‘white noise’ –“Buddy system” or Hand over hand assist –Headset to focus on task –Music therapy (consult speech therapy) –Provide alternate environment if possible

Tactile Defensiveness - Touch Student may overreact to ordinary touch experiences (touching playdoh, being touched by others, shirt/sock tag aversion) They dislike the ‘feel’ and are hesitant Avoids daily hygiene; inappropriate clothes Avoids light touch but seeks out deep touch (hugs) Fidgets inappropriately (rocking, clapping, shaking hands, rubbing same spot)

Tactile Defensiveness - Touch Staff Intervention – assist in success –Recognize the need to intervene –Provide desensitization – rice/beans box –Hand over hand to guide and touch new thing –Fun activities – pretend play for hygiene, demonstration, sequence, repetition, pictures –Crafts with various textures –Brushing, Weighted objects –Provide fidget toys and limits

Oral Defensiveness – Taste/Smell/Tactile Student may be a ‘picky’ eater May gag from certain textures, taste or smells Avoids messy meals (does not like food items to touch – eats items separate, unable to make a taco) Dislikes brushing teeth or washing face Aversion to food or cleaning smells, may show agitation Inappropriate tasting/mouthing non food items

Oral Defensiveness – Taste/Smell/Tactile Staff Intervention – assist in success –Recognize the need to intervene –Work with family to identify & obtain favorite foods, hygiene items (toothpaste, soap) –May place food items in recognizable container –Introduce one food item at a time – Avoid or modify environment – smell –Provide chew items for self stimulation

Vestibular Insecurity – Balance & Movement Student may have excessive fear of falling during ordinary movement Dislikes swinging, riding a bike, climbing, sliding Poor endurance/tires easy/poor muscle tone Overall weak muscles, especially pencil grip Walk on toes or ‘stiff’ with joints “locked” Can not sit ‘still’ in a desk; sits on feet, head down Poor socialization, avoids groups, poor boundaries

Vestibular Insecurity – Balance & Movement Staff Intervention – assist in success –Recognize the need to intervene –Encourage hand over hand assist during play time to climb, slide & ride, elicit peer assist –Adjust writing angle, size of pencil/color –Provide stretching, movement, ‘Yoga’ type activity –Utilize flexible seating &/or weighted vest; heavy work –“Buddy system” to play or socialize, role play

Sensory Diet – Individualized Individualized per student – some students are oversensitive to touch, but under responsive to movement Remains flexible and changeable with environment Identify ‘triggers’ to inappropriate behavior/or reaction to sensory stimuli Transitions – what makes it smoother Identify food/clothing likes/dislikes How is peer interaction? Note any gross or fine motor problems (does student fall or bump into things, balance problems, writing, coordination problems

Environmental Set up KJHK:LKDJFLKJL:JVLKJLKNVLKDJVNL KNVKNVDLKNVDLKNVLKNDVLKNDVLK NVNVNDLKJDLKJLKDVJLKVNLVN:VNL DVNDVNDVLNVLKNVLKNVLKNVL:?V?? »Today’s assignment -Can you focus on this? KJHKL:KJHJL:KJBCNML SLJKLJDUFOIUOSIU OIUOASIFUOAIUOIAUOIUOICJHLKAJSLKAJCLKJ AVIOVOIVOIHVKLJASLKJSALKJLKAVJOIIJCVOIV CJVJLKAVJLKAVJKLVJVPAPPAPOIHAVKLAVLKJ AVLKJAVLKJALKVJKLJ

Environment Limit extraneous visual material; provide written instruction/assignments/notes Organize class materials with labels (colors, words & pictures) Use note cards or tape number/letter line on desk Use tactile manipulative Limit auditory distractions – prepare SID student for scheduled drills Define student space with visual & tactile aide

Schedules Flexible but structured and organized Pictures or color coded (ST & OT assist) Encourage families to share home schedules & changes anticipated. Notify them of school changes Encourage staff to recognize student need for flexibility in schedules --- allow space for “melt downs”

Auditory, Sight, Smell Quiet Space Headphones Calm music Alerting music Highlighter strip Calming scents Alerting scents Calming, safe space >concentration <overload Low volume, 60 bps, limit/no change tempo Medium volume,80 bps, frequent changes Decreases visual stimuli, organizes Lavender & vanilla – calm Peppermint & lime - alerting

Sensory Diet Environmental Schedule Auditory, Sight, Smell Tactile – touch Oral – Motor Vestibular – movement & balance Proprioception – movement & resistance

Tactile - Touch Deep touch – ‘hug yourself’ shoulder press by teacher/peer Textures – glue on sticks on place in box Dough – hide items, make shapes, letters Ball bath or box of beans/rice- hide items Calming, deep pressure > focus & attention > discriminative touch Calm, propioceptive input, strengthen hands & fingers for handwriting Alerting, whole body discriminative light touch

Oral Motor Gum – mix flavors Chew device Water bottle –add lemon Wide straw less effort Calming Deep pressure to jaw Calming Propioceptive input Facilitates convergence of eyes Prepares eyes for reading/computer work

Vestibular- Movement & Balance Rocking chair, glider, ball chair, upside down ball Scooter board, Barrel crawl, swinging, trampoline, rolling, net swing spin Calming, > attention, body awareness,> motor planning Alerting, facilitates back & upper body strength & stability > Head & eye control, Integrates visual & vestibular systems

Proprioception – movement & resistance Preparatory activities Weighted vest, blanket, lap pad, pencil weight Burrito, pillow crash Wall & chair push ups Funny face– lace your fingers together, place hands on top head & press down, suck in your cheeks to make fish face Calming, > focus >attention, > body awareness Use the least amount of time for desired result Calming, deep pressure, body awareness Calming, strengthens upper extremities, prepares hands for handwriting Calming, provides organizing input, especially after sensory overload

Classroom Tips Preferential seating Visual cues to secure student attention Have student repeat instruction prior to beginning task Keep tone even and moderate pace Provide outline & vocabulary list Provide notes and let student highlight Sequential steps for directions. Define specific boundaries & rules

Handwriting Tips Encourage strengthening by modifying surface (vertical & horizontal) Small pencil for tripod grasp Typing/keyboarding skills may be an alternate form of writing. Start early showing the student how to type his name Graph paper used to align numbers, letters Alternate forms of paper – large lines, colored lines, raised lines Directional maze tracing & cutting Stencils for letter formation Tactile letter formation (playdoh, sponge, trace shaded or dots) Cutting cardboard, playdoh, darkened outlined objects

References American Occupational Therapy Association “Answers to Questions Teachers Ask About Sensory Integration”