1. Sensory Integration in the Educational Environment

2. The Senses  “We learn about our environment through our senses: motion, touch, taste, smell, vision, and hearing.  A newborn’s first experiences are through motion and touch (vestibular and tactile senses) as he is bathed, dressed, cuddled, rocked, and fed.

3. The Senses  The infant increases his learning capacity through the development of taste and smell (gustatory and olfactory senses) as he investigates objects by putting them in his mouth.

4. The Senses  “As the child matures, he develops increasing awareness of his body’s position in space (kinesthesia) enabling him to move under, over, and around objects without bumping into them.  He is also learning to balance while sitting, crawling, standing, and walking.

5. The Senses  “Simultaneously, sight and hearing (visual and auditory senses) are becoming more highly developed and are increasingly important for learning.”  OT Resources/siact.htm

6. Sensory Systems  VISION – information gained through sight, such as shape, form, color, lines, contrast  AUDITORY – information gained through hearing, volume, rhythm, tone, and pitch.  GUSTATORY – Information from taste buds, bitter, spicy, salty, sour.  OLFACTORY – Information from smells, a strong and primitive sense.  TACTILE – Information from head-to-toe sensors in the skin, temperature, pressure, pain, vibration  VESTIBULAR – Information from the inner ear about position in space, balance, movement  PROPRIOCEPTION – information received from the muscles, joints and tendons, push, pull, stretch, flex, planning of movement

7. AAAA theory proposed by occupational therapist Jean Ayres IIIIs the process of receiving information from the senses and interprets and integrates for use. HHHHelps us respond appropriately to situations we confront Sensory Integration

8. Can guide therapeutic interventions by:  Regulating arousal levels  Eliminating distractions  Easing anxiety  Encouraging communication  Regulating the comfort level of the student.

9. Sensory Integration “Sensory integration does not provide all the answers and does not offer a cure. It can help to explain some behaviors and offers strategies for interventions. “Sensory integration does not provide all the answers and does not offer a cure. It can help to explain some behaviors and offers strategies for interventions.

10. Sensory Integration  Please recognize that this framework provides only one piece of the [PDD] puzzle. Behaviors that initially appear sensory-related may be due to several other issues. Repetitive movements may represent a sensory-seeking behavior designed to reduce anxiety, or they may be involuntary tics or a reflection of obsessive-compulsive tendencies.” Building Bridges, p. 38 Building Bridges, p. 38

11. Process of Sensory Integration 1. Registration – becoming aware 2. Orientation – turning attention toward input 3. Interpretation – comparing to past experiences

12. Process of Sensory Integration 4. Organization – deciding how to respond to 5. Execution – retrieving information, deciding how to respond 6. Modifying the intensity of the response

13. Example:  A student on the playground is playing kickball: –He sees the ball (registration)-vision –He runs toward the ball (orientation)-visual, auditory, motor planning, tactile –Approaching the ball, he adjusts his speed and timing (interpretation)-visual, auditory, motor planning, proprioception

14. Example –He adapts his body position and prepares to kick at the ball (organization), auditory, vestibular, proprioception, tactile –He kicks the ball (execution/modulation)- visual, auditory, vestibular, tactile, proprioceptive visual –He then returns to normal stance-vestibular, tactile, proprioceptive

15. Example: Consider the act of learning to ride a bike: 1.The student needs to figure out how to approach getting on the bike. 2.He will visually take note of where the handle bars and seat area are located on the bike. 3.He then need to plan out how his body is going to move in order to get his body onto the seat. 4.He needs to know how much pressure to use on his grasp in order to work the handle bars and propel the foot pedals.

16. Example 5 Once the bike is in motion, he to be able to balance his body in order to maintain the bike in an upright position and be able to adjust his body movements according to the changes in direction 6 The environment also plays a large role in being successful with this skill. The student needs to be able to adjust to the wind, temperature, and noises that may be presenting during his riding experience. 7 The student will also need to know how much pressure he needs to apply to the break system and how to remove his body off the bike.

17.  It is important to think about all the sensory components we need to have working properly in order to perform the simplest activities in our daily lives. sensory components we need to have working properly in order to perform the simplest activities in our daily lives.

18. Over- and Under-Reactive Sensory Impaired Student  Many students have difficulty learning and taking in new information because their systems may operate at high levels of arousal and anxiety, and therefore overreact to sensory stimuli or they do not respond because they are under responsive to stimuli.

19. Over- and Under-Reactive Sensory Impaired Student  For Example: –The school fire alarm goes off; an over reactive student may exhibit extreme behaviors such as; screaming, covering his ears, jumping, and running around the room. –The under reactive student may not exhibit any response at all to the alarm.

20. The Sensory Schedule  The use of a Sensory schedule within the student’s academic setting can be an effective way in helping to regulate arousal levels.  The sensory schedule is a planned and schedule activity program that is incorporated in the student’s daily schedule and designed to meet the student’s specific sensory needs.

21. The Sensory Schedule  Not every student with a diagnosis of Autism/Asperger’s Syndrome requires a sensory schedule within their educational setting.  Attending various specials such as physical education, music, art, and transitioning between classes is in itself a break for the sensory system.

22. Sensory Schedule  Each student is assessed on an individual basis and interventions are set in place according to the needs of the student.  The development of the sensory schedule is an ongoing process that is modified as the student grows and changes and becomes more comfortable in their learning environment.  The Occupational Therapist along with other educational staff need to observe and assess the student’s sensory processing needs in order to determine what types of sensory activities would benefit the student.  Refer to Sensory schedule handout.

23. Sensory Schedule Continued  The main goal of the sensory schedule is to prevent sensory overload by offering activities that help satisfy the nervous system’s sensory needs.  The schedule may consist of providing several calming activities throughout the day in order to prevent a “meltdown”.  Some common indicators that a student may be approaching a “meltdown” are: –Silliness –Noise making –Aimless running or pacing –Off task behaviors –Emotional outbursts –Self stimulating behaviors –Avoiding tasks at hand

24. Sensory Schedule  The most powerful calming sensory activities are: deep touch/pressure, heavy work and movement.  These activities have the most significant and long lasting effects on the student.  There are other activities that are also beneficial, but their impact is not as intense or long lasting. These activities incorporate the use of the mouth, auditory, visual, or smell experiences.

25. Sensory Schedule  The most successful sensory schedule is when you have the student actively participate in order for the student’s sensory system to more successfully process the incoming information.

26. Organizing Techniques  These activities can help a student who may be over or under-reactive become more focused and attentive. –Sucking on hard candy –Vibration-use a vibrating pillow, battery operated wiggle pen or toy massager –Proprioceptive activities-especially hanging with arms, pushing, or lifting heavy objects –Chewing or blowing –Adding rhythm to the activity

27. Calming Techniques  Calming activities can help a child who may be anxious or who are sensory defensive.  These activities assist in relaxing the nervous system and may reduce hypersensitive responses to various inputs.

28. Examples of Calming Techniques –Deep-pressure –Joint Compression –Stretching –Snuggling in a weighted blanket, beanbag chair, or foam pillows –Slow rocking or swinging –Neoprene vest –Weighted vest or collar –Lap pad –Sucking –Fidget toys –Quiet music with a steady beat –Bear hugs –Finger hugs and tugs –Reduce noise and light levels when possible

29. Alerting Techniques  Alerting techniques can help a student who is under-reactive to sensory input, passive, or lethargic become more focused and attentive.  It is important to first determine if the student is in a “shutdown” mode in response to a negative reaction to certain input. In this particular case alerting activities should not be utilized as it may further aggravate the situation.  Alerting activities should be closely monitored in order to prevent over stimulation.

30. Examples of Alerting Techniques –Bright lighting and fresh cool air –Fast swinging –Quick unpredictable movement (bouncing on a ball, lap, or mini-trampoline –Drinking ice water or carbonated drink –Running-tag games, hide “n” seek, running errands –Sitting on a ball chair, water mat, or air pillow –Misting cool water from spray bottle on face –Loud, fast music and sudden noises –Cause and effect toys with sound and lights –Strong odors (peppermint, etc.) –Visually stimulating rooms

31. Tactile Dysfunction  Students with a dysfunctional tactile system may be hypersensitive or hyposensitive to touch or may have difficulty discriminating between different textures, temperatures, and other tactile input. Some students may have problems regulating touch input and may excessively register the input. They may also be unable to stop or screen out touch sensations. These are the students who are always aware of the feel of their clothes against their skin, their hair against their necks, and their glasses against their noses. Many touch sensations are interpreted as threatening and something to be avoided.

32. Tactile Dysfunction  Some students may have no difficulty touching objects or people but cannot tolerate receiving a touch that is not self directed.  These students may appear anxious, controlling, aggressive, unwilling to participate in school activities, and not flexible.  These behaviors enable the student to control the touch input he is receiving from the environment. Such simple activities such as brushing one’s teeth and hair are often perceived as a very uncomfortable experience for the student.

33. Tactile Dysfunction –Other students are under-responsive to touch. These students may have low arousal levels and may not register to touch input unless it is very intense. They do not get appropriate feedback about where they are being touched which can significantly affect how they perceive their body within their environment and how they move and interact. May walk on tiptoes, or creep using fingertips and knees only –May struggle in an attempt to avoid being handled during bathing, dressing, and other personal care routines

34. Tactile Dysfunction  Students with tactile dysfunction will often develop poor body awareness and motor planning abilities. Some students may experience poor touch discrimination. They can register touch but are unable to determine the features of what they are touching. These students have difficulty discriminating between textures, have problems identifying objects by using their sense of touch, and do not develop memories from touch experiences.

35. The Wilbarger Protocol for Sensory Defensiveness  This program was developed by an Occupational Therapist by the name of Patricia Wilbarger. She is an internationally recognized expert who specializes in the assessment and treatment of sensory defensiveness. Slides 35-41 are for your information only and only to be used under the direction of an OT!

36. Wilbarger Protocol  An Occupational Therapist who has been trained to use the technique, and who knows sensory integration theory, needs to teach and supervise the Wilbarger Protocol. It is important that this technique be carried out in a proper manner as it may be uncomfortable for the student and may cause an undesirable result.

37. The Wilbarger Protocol, continued  The first part of the Wilbarger Protocol involves providing deep pressure to the skin on the arms, back, and legs through the use of a special surgical brush. It is similar to receiving a deep massage using a surgical brush. The brush is used in a fast and firm manner and provides consistent deep pressure input to a wide skin surface on the body.  The face and the stomach areas are never brushed  Never brush on open or irritated skin areas

38. Wilbarger Theory  The brushing: –Shuts down the protective receptors in surface of the skin –Allows the discriminating receptors below the surface to keep working –The student then is able to receive sensory information without distress

39. Wilbarger Protocol  After the brush massage, the student receives gentle compressions to the shoulders, elbows, wrists/fingers, hips, knees, ankles, and back. The compressions provide proprioceptive input to all of our joint surfaces. The entire routine should only take about three minutes.

40. The Wilbarger Protocol continued  It is important to remember that there is currently lack of documented research to substantiate this technique.

41. Wilbarger Protocol  However, this technique has been utilized by many parents and professionals who have reported that their students/children have responded in a positive manner demonstrating a reduction in sensory defensiveness, as well as improved behavior and interaction.

42. Vestibular System  Vestibular system function:  Is to enable the student to orient himself in space and to make adaptive and exploratory eye, head and limb movements. It interacts with the visual and the propriceptive, to inform the student:

43. Vestibular It interacts with the visual and the proprioceptive system to inform the student: –Whether the student, the surface, or objects are moving –How well and where the student is moving –What are the positions of the joints in relationship to one another –Maintain balance and assist in making accommodations –Enhances muscle tone (balance between loose or tense muscle) – the tension of the muscles

44. Dyspraxia  Dyspraxia-The partial loss of the ability to coordinate and perform purposeful movements.  Motor Planning-The ability to organize sensory input and execute a series of movements.

45. Example:  Dyspraxia/Motor Planning –A student has difficulty organizing the steps in order to put on a shirt. –Difficulty riding a bike –Difficulty kicking a ball

46. Vestibular Dysfunctions –The student may be fearful of movement and hesitant to participate in movement activities - Righting and equilibrium reaction may be delayed - May avoid movement and prefer to remain curled up with the head resting on the surface –Unsure of location in space and have difficulty identifying or localizing body parts –Strives to maintain upright postures by relying heavily on visual and proprioceptive feedback and may fix gaze on the floor rather than on direction

47. Vestibular Dysfunction –May bump into objects because of a distorted senses of movement –May have difficulty walking in the dark or on uneven surfaces –May exhibit rigid posture and may move only in straight planes –May easily be overcome with motion sickness –May spend hours rocking, or shaking the head and/or hands –May engage in repetitive spinning motions

48. Proprioceptive System  Proprioceptive system function: Information coming from the joints, muscles, tendons send messages to help the student to accommodate the environment.

49. Proprioceptive System –Position of body parts –Responds when a muscle is pulled and stretched –Responds to maintain touch pressure –Assists in developing body scheme for motor planning

50. Proprioceptive System  Proprioceptive Dysfunction: –May have difficulty planning and directing movement –Pain threshold may be high and responses to pain lessened –May crave intense tactile input such as head banging, pinching, biting, and hitting –May walk on tiptoes, or creep using fingertips and knees only –May struggle in an attempt to avoid being handled during bathing, dressing, and other personal care routines –May be particularly sensitive to light intermittent touch –May want to remain in control of physical contact with others

51. Olfactory/Smell  Olfactory- Sense of smell, most primitive sense that contributes to alert or calming state

52. Gustatory/Taste  Gustatory/taste- Impacts alert state. –May crave very spicy foods and reject sweet ones –May be a picky eater –May reject certain texture (crunchy, slimy, lumpy) –May spit out or frequently gag

53. Interventions in the Classroom  Examine the room for distractions  Discuss placement of seating  Discuss changes in routine  Construct quiet space  Adapt students tools –Pencils, paper, scissors –Dynamic seating –Visual schedules

54. Interventions in the Classroom  Examine other venues of school day  Sensory schedule  Observing the student in his educational environment

55. Sensory?  Behaviors regardless of events or people  Receives or avoids sensory stimuli  Behavior to escape  Controlling or manipulating  Behavior Intervention Plan (BIP) does not work

56. Learned Behaviors  Specific circumstances/people  Primarily to avoid or escape  Has been used in the past  BIP successful

57. Teamwork Thank you for previewing!