Sensory

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The senses play a big role in how people perceive the world. The sights, smells and tactile experiences inform a child’s impressions early on, and often. They inform the body of so many things people find appealing in life, such as the fragrance of a rose, the vibrant colors of a beautiful painting, or the softness of a blanket.

When a child has a brain injury, sometimes these perceptions are off kilter with a decreased or increased ability to process. Sensory integration helps build the mental and physical framework within an individual’s nervous system to properly perceive sensory input, regulate his or her responses, and understand the significance behind a particular, texture, movement, or sound. The benefits of sensory integration therapy are often physical, but also psychological.

Sensory integration

Individuals with Cerebral Palsy or children born prematurely can display symptoms of sensory integrative dysfunction, an abnormal degree of sensory processing, whether decreased or increased. Sensory integrative dysfunction can make a child appear clumsy when he or she walks, or create difficulty with fine motor skills such as pencil control, which, in turn, can lead to delay in writing ability.

Sensory dysfunction can also cause over-sensitivities or under-sensitivities that lead to mental and physical distraction or fatigue. Problems with sight, hearing and balance can be addressed through sensory integration therapy.

What is sensory integration therapy?

Developed in the 1960s by occupational therapist and researcher Jean Ayers, Ph.D., sensory integration therapy is a process by which children build and strengthen the connections within the brain that most young people develop through childhood experiences. Therapy is designed to help children interpret sensory input, understand its relevance, and respond – especially to external stimuli that are often beyond their control.

For example, a child may be asked therapy to pick up an object such as a ball. Though the child sees the ball, and understand what it’s used for, he or she may not be able to recognize or describe the ball because of visual miscues. The child may also inaccurately perceive the weight or texture of the ball due to over-sensitivity, or lack of sensitivity, to touch.

The senses that sometimes are disordered in children with Cerebral Palsy are:

  • Auditory – hearing
  • Olfactory – smell
  • Oral – taste
  • Prioprioception processing – unconscious information obtained by the muscles and joints regarding your position in space, the weight of objects, the pressures felt, the stretch, body movement, and position changes.
  • Tactile or somosensory – Touch
  • Vestibular processing – unconscious information obtained through the inner ear for equilibrium, position in space and gravity.
  • Vision

A child’s sensory processing is problematic if they are:

  • Over-responsive – avoidance, caution and fearful
  • Sensory seeking – impulsive and takes risks
  • Under-responsive – withdrawn, passive or difficult to engage

The goals of sensory integration therapy are:

  • Assist children with perception issues in sorting out mixed messages
  • Create a physical environment that fosters participation in activities that depend on the senses
  • Determine how a child’s specific sensory perceptions affect their overall physical, social and human development
  • Encourage activities that allow children to explore their environment, learn and develop their senses
  • Identify and eliminate barriers caused by disordered perception
  • Implement new sensory processing approaches that organize multiple sensations, filter out background stimuli, and compensate for deficits in perception
  • Restore a child’s sense of body position and function (also known as vestibular and proprioception)
  • Restore motor planning (praxis) capabilities, so a child can focus on his or her senses to plan movement, respond to other’s movements, and understand the body’s relationship to space

Some signs that a child might be struggling with his or her sensory perception include:

  • Discomfort sitting or standing
  • Feeling too hot or too cold
  • High, or low, physical activity levels
  • Inability to link a task with the necessary physical function
  • Inappropriate physical responses
  • Lack or physical coordination
  • Little reaction to external events
  • Low self-esteem
  • Over-sensitivity, or under-sensitivity, to touch
  • Restlessness and behavior issues
  • Reclusiveness
  • Speech delays
  • Strong reactions to textures, food and sound

Who benefits from sensory integration therapy?

Children are the largest benefactors of sensory integration therapy, but parents and caregivers also benefit.

By providing coping strategies and treating the condition, therapists help children overcome these issues that, at least initially, may seem insurmountable. Success is achieved by implementing treatment that will help children build the mental and physical framework within their nervous system to properly perceive sensory input, regulate his or her responses, and understand the significance behind a particular, texture, movement, or sound.

All of these skills must be mastered for a child to maximally benefit from other therapies.

Benefits to sensory integration therapy include:

  • Anticipate action and outcome
  • Correctly interpret sensory input
  • Create physical equilibrium and sense of space
  • Develop positive behavior patterns
  • Eliminate fear
  • Encourage play and socialization
  • Lessen sensory defensiveness
  • Minimize input intolerance
  • Reduce negative physical reactions

Parents and caregivers also benefit from sensory integration therapy because they learn how to productively interact with their child, greatly enhancing the relationship.

What are the benefits of sensory integration therapy?

The benefits of sensory therapy are numerous, and far-reaching.

Because most people develop sensory perception unconsciously, it’s difficult to understand how sensory deficits affect an individual. Therapy allows children with sensory deficits to interpret stimuli, plan actions, and response.

Therapy also improves a child’s modulation, or ability to regulate neural messages in such a way they can respond to stimuli appropriately. The benefits of therapy are often physical, but also psychological.

The physical benefits of therapy include:

  • Balance responsivity – over responsivity and under responsivity
  • Gravitational security
  • Hand-eye coordination
  • Improved motor-planning
  • Improved sleep cycles
  • Language development
  • Posture

The psychological benefits of therapy include improvements in:

  • Attention
  • Confidence
  • Emotional outbursts and frustration
  • Moodiness
  • Procrastination
  • Restlessness
  • Socialization

When is sensory integration therapy advised?

Sensory integration therapy is advised by a professional after a qualified occupational therapist completes his or her assessment of a child. Therapy is usually advised early in a child’s development – sensory deficits should be dealt with in infancy of possible to give children the advantage of learning to adjust and compensate for his or her condition as he or she develops.

Addressing sensory deficits early improves:

  • Capacity to learn
  • Cognitive function
  • Emotional well-being
  • Physical function
  • Propensity to make friends and to socialize

What happens during sensory integration therapy?

Sensory integration therapy begins with a thorough evaluation and assessment of a child’s sensitivity to environment. This assessment is comprised of interviews with a child’s parents or caregivers, a health history, standard tests and observation in a clinical setting. The goal is to determine where deficits in a child’s sensory perception are and what interventions will help a child adapt and react to their environment.

A therapist will administer the Sensory Integration and Praxis Tests (SIPT). During the assessment, the therapist will evaluate:

  • Body positioning in relation to space and objects
  • Existing sensory-seeking behaviors
  • Eye-hand coordination
  • Modulation
  • Motor planning (praxis)
  • Movement perception
  • Planning and sequencing actions
  • Reaction to touch, sounds and textures
  • Spontaneous activity and play
  • Visual perception and eye movement

The therapist will determine activities that encourage organized responses to sensory input. Activities are practiced in a repetitive and continuous fashion so children can learn and retain the process. They learn how to self-regulate their responses, achieve a comfort level with sensations, and understand how the senses work collectively.

Sensory integration therapy is often disguised as “fun” for the child. The goal of therapy is to allow children to explore in an unencumbered environment that allows them to fine-tune their interpretations and responses. For example, a child that is uncomfortable with rough surfaces may play with grains of rice, so he or she can get used to its texture – which in turn neutralizes his or her discomfort with the sensations.

Therapy is ultimately successful when the child realizes the value of the outcome enough to continually use the learned process.

Other activities may involve:

Auditory – hearing

  • Instruments – drums, piano, guitar, keyboards and tambourines
  • Machines – lawn mower, washing machine, dishwasher and microwave
  • Music – radio, instruments, and chimes
  • Repetition – clocks, rap and drums
  • Water – fountains, faucets, waves, and waterfalls

Olfactory – smell

  • Air fresheners – lavender, pot pouri and sachets
  • Aromatherapy – candle and incense
  • Baking and cooking – breads, cookies, stews, bacon, onions and cabbage
  • Beauty aids – lotions, powders and perfumes
  • Environments – bathrooms, kitchens, garages and locker rooms
  • Vegetation – flowers and plants

Oral – taste

  • Candies – hard candy, soft candy, sour candy and licorice
  • Cheese – Feta, cheddar, cottage and blue cheese
  • Condiments – jelly, honey, spice and peanut butter
  • Fruits – strawberry, blackberry, grapes and bananas
  • Hot and cold items – Soups and popsicles
  • Milk-based items – Yogurts, milk shakes and ice cream

Prioprioception processing

  • Balancing on floor or beam
  • Crawling through tunnels
  • Dancing
  • Hitting balls
  • Jumping, bouncing
  • Playing in boxes filled with balls, beans
  • Rolling or crawling on a rug
  • Spinning on chairs
  • Swinging

Tactile or somosensory – touch

  • Hard – rock, counters and floors
  • Interaction – stationary, pliable, moldable, bendable and breakable
  • Items – beans, rice, beads and bolts
  • Pressure – push, tickle, rub, claw, pressing, pulling, holding and squeezing
  • Soft – cotton ball, fur and feathers
  • Surfaces – picky, sticky, rough, pointy and smooth
  • Textures – sand, water, and paints
  • Vibration – dryer, hair blower and blender

Vestibular processing

  • Bouncing on bed, ball or parent’s knees
  • Shaking the head
  • Sliding
  • Sommersaults and hand stands
  • Standing on one foot and standing on one foot with eyes closed
  • Swinging in blanket, in swings, or on a rope
  • Throwing a ball
  • Turning head left and right at rapid pace
  • Walk heel to toe without support

Vision

  • Colored, strung, flahsing, holiday and strobe lights
  • Neon, patterned and florescent papers
  • Wind socks, wind-up toys, activity boxes and age-appropriate mobiles

The therapist will monitor a child’s progress to make sure he or she is reaching pre-determined goals. At the conclusion of therapy, a child should exhibit more comfort with stimuli that was previously bothersome.

Where does sensory integration therapy take place?

Sensory integration therapy can take place at locations that practice occupational therapy; though specialized centers do exist. Where therapy takes place will be dictated by a child’s condition, the availability of therapy, and insurance coverage.

Therapy will often take place at:

  • A child’s home
  • Hospitals
  • Inpatient rehabilitation centers
  • Outpatient clinics
  • Schools
  • Skilled nursing centers

The setting for sensory integration therapy is extremely important because at the crux of sensory dysfunction is a child’s perception of his or her environment. For this reason, centers that offer sensory integration will have high- and low-tech equipment, from hug machines, to indoor swing sets.

Sensory integration may also include at-home work; the therapist will instruct the parent on how to complete exercises at home.

Who provides sensory integration therapy?

Sensory integration therapy services are typically provided by a licensed occupational therapist that has completed additional training in the sub-specialty of sensory integration therapy.

The practice is a relatively new specialty; certification is recommended, but not required. However, occupational therapy is regulated by all states.

Currently, only Western Psychological Services (WPS) in California is the only certifying-body for therapists who practice sensory integration. However, the organization offers courses throughout the United States. Occupation therapists, physical therapists, and speech therapists have completed certification, according to WPS.

WPS’ certification program is made up of four courses, including:

  • Interpretation and assessment
  • Invention
  • Sensory perspective
  • Specialized techniques

In the occupational therapy industry, the certification is seen as a practical and desirable step for therapists that would like to offer sensory therapy.

WPS has a list of sensory integration-certified therapists that have completed training in each state.

What are the risks or special considerations associated with sensory integration therapy?

When a child begins sensory integrations therapy, he or she can receive too much sensory stimulation, which can result in reactions which could be disruptive, like willfulness or frustration. For this reason, a therapist – as well as parents or caregivers – must monitor a child’s reactions to counteract those reactions.

Additionally, some sensory integrations techniques might make a child uncomfortable.

All of these situations can be mitigated when a trained occupational therapist implements a highly-structured plan of intervention that is both well-organized and fun for the child.

Associative Conditions

father laughing with son in wheelchair

Associative conditions

Cerebral Palsy affects muscle tone, gross and fine motor functions, balance, coordination, and posture. These conditions are mainly orthopedic in nature and are considered primary conditions of Cerebral Palsy. There are associative conditions, like seizures and intellectual impairment that are common in individuals with Cerebral Palsy. And, there are co-mitigating factors that co-exist with Cerebral Palsy, but are unrelated to it. Understanding conditions commonly associated with Cerebral Palsy will enhance your ability to manage your child’s unique health concerns.
Associative Conditions