Sensory Integration

1. What is sensory integration? How does it relate to a child's development?

The term Sensory Integration is used to reflect the theory developed by A. Jean Ayres, an Occupational Therapist as well as for the intervention strategy that was based on the original theory.

Sensory Integration is the brain's ability to take in, process,and organize sensory input from the 7 senses (sight, sound, smell, touch, movement,body awareness and the pull of gravity), but also to integrate them together.  This is how we perceive our environment and the people and physical objects in it, how we relate our body to them, as well as how they relate to each other. 

Sensory Integration is a normal phenomenon of the central nervous system functioning and provides a foundation for more complex learning and behavior. We are all sensory processors,every waking minute. Here are some examples: 

  • learning and remembering which direction to run on a ball playing field
  • finding something in your book bag, pocket, or purse, without using your eyes
  • Perceiving a piece of fruit such as an orange, by color, shape, texture, weight,smell and taste
  • holding a pen correctly, writing on paper, pressing down with just the right amount of pressure, with looking.

Sensory Processing and the ability to organize sensations also affect our emotions and feelings as well. Here are a few examples:

  • a comforting touch vs. a painful shot
  • a roller coaster ride vs. slow rocking on the front porch
  • the smell of our favorite dish cooking vs. odor of gas in home

2. What are sensory integrative (also called sensory processing) disorders?

  • Sensory integrative/processing disorders area a set of conditions caused by an insufficient ability of the central nervous system to take in, register,  modulate, perceive, and/or combine sensory experiences (input) from the environment around us. It starts with the most basic senses n the "sensory food chain", and moves upward. the senses affected include any or all of the following:

Vestibular: our sense of movement, the pull of earth's gravity, and position in space;the first sensory organ to be completed during prenatal development. This sense allows us to maintain our balance and upright posture. It is also closely involved with the visual system, allowing us to judge our motion in relation to the objects around us. This can sometimes play tricks on us ( sitting in one toe movies where you feel like you are moving when you are not) This sense allows us to feel secure with gravity and as a way of knowing where we are in relation to gravity (i.e. if we are upside down or sideways).

Tactile: our sense of touch, not just from the hands but from all over the body, including the inside of the mouth.

Proprioception: our internal sense from joints and muscles: the bases of muscle memory. This is a sense that allows us to know what position our body parts are in. For example, without looking a the, you can tell if your elbow or knees are straight or bent. This sense also tells us of about the force of our movements. So if we see a cup and want to reach for it, we can judge how much force and speed we are reaching with so we can accurately get out hand to the up without knocking it over or missing it. We can also tell how hard we need to hold on to lift the cup without squashing it or dropping it. It is primarily proprioception you are using when you walk a familiar flight of stairs in the dark and and know exactly where to  place your feet and how high the steps are by the feel the movement of your legs This sense is extremely important for body awareness and coordinated movements.

Auditory: not just hearing, but perception of different sound wave frequencies, perceiving the correct bits and pieces of sound that make up words,and organizing them in the correct sequence. For example, perceiving the word caterpillar instead of callerpitter.

Visual:not simply seeing, but perceiving brightness of light, spatial orientation, form, vertical vs. horizontal,color,shape,direction, etc.

Olfactory and Gustatory: our sense if smells, odors, taste, but also our perception of the intensity of them.  Under-reactive individuals seek excessive salt, sweetness, or hot and spicy while, overly-reactive people may tolerate only very bland, or just a handful of different flavors in their repertoire of foods.

In SI/P disorders the person affected is not blind to sensory input. Rather, the neural messages  become disorganized as they travel up towards the higher brain centers. The messages may also become overly-amplified or diminished and are hence un-usable. Sensory inputs are the building blocks of learning and relating to our environment and the people in it.

3. Is there more than one type of S.I. disorder?

There are 4 major sub-types of sensory processing disorder:

  1. Sensory Modulation Dysfunction
  2. Developmental dyspraxia
  3. Postural-BilateralIntegration Dysfunction
  4. Generalized Dysfunction (impairments in all areas)

This set of problems first began to be identified by A, Jean Ayers in the 1960s. Ayers, an OT, initially noticed that people with primary motor disorders also had significant visual-spatial, tactile, and vestibular perceptual impairments. Later she identified the movement disorders of apraxia (or developmental apraxia) in children, as well as postural bilateral integration dysfunction. She also identified patterns of over-reactivity or under-reactivity to sensory experiences that we now cal sensory modulation dysfunction.

Sensory Modulation Dysfunction: Just as you can control the volume on your radio or TV from very faint

to quite loud, the brain has built in systems that automatically decide how much sensory information they will allow to enter. This ability allows us to  filter sensations, putting more emphasis on those that are important at the moment, while damping down those that are not, a process called inhibition. However, children with SMD are not effective sensory modulators. Their brains may interpret a tickling feather as painful, a conversational tone of voice as too loud or a little bit of movement as making them dizzy. The smell or taste of many foods may actually make them vomit.. 

At other times,the opposite can happen. The child may seem sluggish, or unaware of sensory stimuli. A bad fall that causes a bruise doesn't make them cry, or they can spin in circles repeatedly and not feel They may even seem to crave sensory experiences, like engaging in a  lot of falling and crashing play.

Developmental Dyspraxia:

is a type of coordination disorder where the child is unable to mentally visualize and figure out ,or plan new or skilled movements. People usually say the child is clumsy. The movements might involve large muscle actions like learning how to roller skate or do a cartwheel; or fine hand/finger skills for handwriting or using tools like scissors or eating utensils.

Children with milder impairments have a mental picture of what they wish to do, called ideation, but can not execute the body positions and movement sequence to accomplish it. More severely impaired children do not have a mental picture of the image at all.

Even more significantly, Ayers found these dyspraxic children showed underlying pattern of impairment in the detection, organization, and the discrimination of sensory information from the skin (tactile) . joints and muscles (proprioception)and/or vestibular system (inner ear equilibrium). Her hypothesis for successful intervention was to treat the underlying sensory processing issues, not an educational process to teach the child how to execute specific movements.

Postural-Bilateral Integration:

Children demonstrate problems with 

  • immature developmental reflexes and core muscle patterns
  • poor ability to use tow sides of the body together
  • do not cross midline
  • poor lateral dominance development
  • poor fluid eye movements
  • confusion about space, distance, and directionality
  • unusual fear/discomfort in certain positions such as on tummy, moving backwards, doing downstairs
  • they switch hands, write on the wrong side of paper, confuse letters, have difficulty with reciprical patterns.

4. How do I know if my child has a sensory integration disorder?

As efficient organization of sensory information provides the foundation for the development of functional skills, there can be many potential outcomes that might cause a parent concerns.

A disruption in sensory processing can result in sensory defensiveness, ( sensory seeking or sensory avoidance behaviors), problems in self regulation (activity levels to high or to low, not matched for the task at hand), and difficulties with praxis (the ability to conceive, organize, and execute skills of all kinds). Disruptions in processing sensory information can interfere with self care skills,language skills, motor skills, academic skills, and social/emotional skills. 

Some specific concerns might be: 

  • takes a long time to learn anew task or skll
  • seems clumsy

5. Can't they just practice?

We are sure that the family and teaching staff have tried to "teach" the child skills that appear difficult. Unfortunately, unless the child has the underlying ability to "be taught" the skill, it will not be mastered by practicing. It is important to remember that not all types of learning, can be mastered by practice.No matter how many times a  child practices  a wrong pattern, it wont make it right. Until they have the internal ability to do it correctly, they will be unable to correct the problem.

6. Why is sensory integration disorder not listed in the ICD-10 diagnostic manual? so who pays?

Most of the individual components of SPD can be identified within ICD-10, but there is not yet a set of listings that encompass the family of SPD. However there is a code for sensory integration in the CPT manual. Most insurance companies will pay for medically necessary therapy. Otherwise the family will assume financial responsibility. Our experience with this process is that the insurance company will cover the cost of the evaluation, and then determine funding the service from the results of the evaluation.