Sensory Processing

1. Sensory Processing Or Sensory Integration Provides foundation that enables meaningful and purposeful participation in full range of daily activities

2. Sensory Processing is Important for: • Attention • Balance • Emotional Security • Flexibility • Healthy relationships with others • Self comforting • Self esteem • Self protection • Self regulation • Social Skills • Speech and language skills • Plus many other social, emotional, cognitive and gross/fine motor benefits as well as academics.

3. Dysfunction in Sensory Processing Can Affect: • Academic skills -ocular motor control • Adequate work habits -postural stability • Attention - self -comforting • Auditory discrimination -self-esteem • Balance -self protection • Behaviors -self regulation • Bilateral coordination -Social skills • Body awareness -speech and language skills • Concentration Gravitational security • Tactile discrimination • Hand writing • Healthy relationships with others • Daily Living skills • Emotional Security • Eye-foot coordination • Eye-hand coordination • Fine motor skills • Flexibility

4. Normal Sensory Processing • An Unconscious process of the brain (occurs without us thinking about it-like breathing) • Organizes information detected by our senses (taste, sight, hearing, smell, movement, gravity and position) • Gives meaning to what is experienced by sifting through all the information and selecting what to focus on (such as sitting in class and attending to teacher versus clock ticking, noise in hallway etc) • Allows us to respond or act to the situation we are experiencing in a purposeful manner (known as an adaptive response) • Forms underlying foundation for academic learning and social behavior

5. Examples of Adaptive Responses • Physical Responses: increase posture control, move eyes to look at person talking to you • Organized autonomic nervous system: improved digestion, respiration, sleep/wake cycles. • Emotional Stability under stressed conditions • Organized responses to routines

6. “Normal” Sensory Processing • Receiving input from the sensory receptors • Relaying information to the brain. • Identifying what information is important. • Blocking information that is not important. • Comparing information with past experience or other types of sensory experience to form a plan of action if needed. • Developing a plan. • Sending the message to the parts of the body needed to execute the plan. • Carrying out movements as planned. (adaptive response). • Dysfunction can occur at any stage of the process!!

7. Central Nervous System

8. Central Nervous System • The Central Nervous System acts like a “computer.” • The CNS receives input through the senses, the brain sorts and organizes the information to generate an output or response. • The CNS is composed of the brain, spinal cord, along with the nerves and end organs (the end of the nerves) that control our voluntary (reach for coffee cup) and involuntary acts (breathing). • The spinal cord, brain stem, cerebellum and cerebral hemispheres use the sensory input from the receptors to produce awareness, perception and knowledge, produce body posture, movements and the planning and coordination of movements, emotions, thoughts, memories and learning.

9. Our Senses • External Senses • Touch, hearing, sight, taste, smell, body awareness and movement/balance. • Internal Senses (these senses run on auto pilot) • Body centered senses • Coming from internal organs • Regulate functions such as hunger, thirst, digestion, body temperature, sleep, mood, heart rate and state of arousal • Some children lack internal senses processing and will not sense if they are hungry or need to go to the bathroom.

10. Automatic Responses • See a bear=run/yell. If dysfunction will not identify threat of the bear to run. • Touch the stove top with your finger=remove finger quickly from the heat. If dysfunction will not identify the heat and withdraw finger. • Smell a skunk= brain identifies the smell as a skunk. If dysfunction, may not “smell” the skunk • Eat a large meal=content, sleepy, feeling full. If dysfunction, may not feel full and keep on eating. • Taste spoiled milk= spit it out. If dysfunction, many not identify the milk as spoiled. • Combing hair a “normal” act but if dysfunction, may feel like hair is being pulled out.

11. Self Regulation • Modulation- brain turns switches on/off to regulate activity. Ex. increases activity level with volleyball and decrease activity with reading a book. • Inhibition-brain reduces connections between sensory intake and behavioral output when certain sensory information is not needed for a task. Ex. block noises in classroom. If not able to inhibit the sensory system my be overstimulate.

12. Self regulation • Habituation- we become accustomed to a familiar sensory message, our brain automatically tunes them out. Ex. tags in clothes, seat belt. But if the brain does not habituate the sensation can lead to overstimulation. • Facilitation- Brain promotes connections between sensory intake and behavioral output by sending messages of displeasure (ex. motion sickness) or pleasure (ex. the calming feeling of rocking in rocking chair). • Facilitation lets us know when we need to stop activities or will give us the “go ahead” signal for pleasurable activities.

13. What happens with Sensory Processing Dysfunction • There is a dysfunction of the brain that affects developing children and adults. These individuals misinterpret everyday sensory information, such as touch, sound and movement. Some feel bombarded by sensory information; others seek out intense sensory experiences or have other problems. • Children with sensory integration dysfunction affects the way their brains interpret the information they take in and also how they act on the information with emotional, attention, motor and other responses.

14. What happens to the sensory information • 1. The brain does not receive the message due to disconnection in the neuron cells. Problems getting the sensory impulse to the brain. “Bad” wiring so not connecting the information to produce an appropriate response/action. • Or • Sensory Messages are received inconsistently. Problem within the brain stem filtering the sensory messages. Only portions of the sensory information/message is received or the brain can’t sort how to use the sensory information for an appropriate response (action). • Or • Sensory messages are received consistently, but do not properly connect with other sensory messages. Limited “meaning” of the sensory messages are identified in the brain so unable to produce a useful/purposeful response.

15. When brain poorly processes sensory messages, inefficient motor, language, or emotional output is the result. Child has difficulties figuring out what’s going on inside and outside of his/her body. The child is unsure of the information he/she is receiving from the sensory input is accurate perception of the information.

16. All this information coming into my brain—doesn’t know what to do!!!! • The brain has difficulty organizing and sorting the sensory information it is bombarded with the information and makes it difficult for a child to focus on what is important at the time.

17. Tactile System • Tactile receptors are located in the skin • Most primitive type registers light touch (i.e. feel spider crawling on skin) but POWERFUL alarm system. • Second type of receptor is for pressure touch. We recognize the “feel” of things. Ex. in your pocket identify keys or coins with your fingers. • SUSTAINED OR PRESSURE TOUCH ALSO HAS ROLE IN COUNTERING OR SUBDUING ALARM AND ANXIETY. EX. baby crying, wrap the baby in blanket and apply pressure, most babies calm and go to sleep. • Third type of receptor register heat, cold and pain. This is important for survival. Ex. finger too close to heat to stove, you will automatically pull finger away.

18. Tactile Dysfunction • May result in self imposed isolation, general irritability, distractibility and hyper activity. • Treatment: first important to protect the individual as much as possible from sudden and unwanted touch. • Second-implement various kinds of activities utilizing sustained pressure can use to decrease over-reactivity.

19. Tactile Defensiveness • Individual is extremely sensitive to light touch • Tactile system is immature and working improperly • Abnormal neural signals are sent to the cortex in the brain which can interfere with other brain processes. • Brain is overly stimulated and may lead to excessive brain activity, which neither be turned off nor organized. • Over-Stimulation in the brain can make it difficult for an individual to organize one’s behavior and concentrate and may lead to a negative emotional response to touch sensations.

20. Tactile Dysfunction • Hyperactive • Dislike certain food due to texture • Dislike teeth brushing, using toothpaste, combing hair, washing hair, showering • Prefers clothing that totally covers body , regardless of temperature • Does not like clothing, tags etc • Dislike physical touch • Poor relationship with peers • May become physically or verbally aggressive when touch is perceived as a threat • Dislikes groups/crowds • Dislikes hands being dirty • Hypoactive • Does not react to painful experiences • Has difficulty manipulating tools, writing, toys • Craves touch, may touch constantly or indiscriminately • Mouth objects

21. Auditory System (hearing) • Auditory processing is term used to describe what happen when your brain recognizes and interprets the sounds around you. • We hear when energy that we recognize as sound travels through the ear and is changed into electrical information that can be interpreted by the brain. • The disorder part of auditory processing disorder means that something is adversely affecting the processing or interpretation of the information

22. Auditory System dysfunction • Difficulties paying attention to and remembering information presented orally • Difficulties carrying out multi-step directions • Poor listening skills, unable to follow verbal directions • Increased time to process auditory information • Low academic performance • Behavior problems • Language difficulties (vocabulary and understanding language) • Difficulty with reading, comprehension etc • Easily upset by sounds (alarms, clock ticking, people talking etc) • Cover ears • Distracted by sounds • Oblivious to sound • Does not respond to name called

23. Visual System (sight) • The ability to analyze and interpret visual input is referred to as visual processing or visual perceptual skills. Affect academics. • Just because an individual can see clearly does not guarantee that the brain will be able to make sense of the incoming information. • Helps us also read body language and other non verbal cues during social relations. Over-responsive- dislikes bright lights or sunlight, cover eyes in bright light, avoids eye contact. Under-responsive- Stare at bright light, watch flickering or blinking lights, loose place when reading in book or copying information. Other dysfunction signs: bumps into things, lacks personal boundaries, disorganized possessions and space, poor attention to visual details, poor handwriting, gets lost easily, poor balance

24. Olfactory (smell) and Gustatory (taste) • These 2 systems are closely linked. • They allow us to enjoy tastes and smells of foods and cause us to react negatively to unpleasant or dangerous sensations. • Over responsive- won’t try new foods, picky eater, gag on food textures, bothered by smells. • Under responsive-smells everything, taste non-food items, does not notice odors that others notice.

25. Proprioceptive System (body awareness) • Components of muscles, joints and tendons that provide a person with subconscious awareness of body position. • Gives the nervous system input on the position of muscles, joints and tendons. This is important as it provides us with information on how far to reach, how much pressure to use, where we are in space and what our body scheme is. • Essential in helping our bodies assimilate and process both movement (vestibular) and touch (tactile) information

26. Proprioceptive Dysfunction • Clumsiness • Tendency to fall • Lack of awareness of body position in space • Resistance to new motor activities • Stiff uncoordinated movements • Craves sensation of deep pressure against the body • Over responsive- seeks jumping, bumping, crashing, stomping feet with walking • Under responsive- weak grasp , poor endurance, clumsy, awkward movements.

27. Vestibular System (movement and balance) • The vestibular system conveys sensory information about head orientation and motion from receptors in the inner ear. Its three main functions are • Coordination of head and eye movement • Helping to maintain upright posture and balance (equilibrium) • Conscious perception of spatial orientation and motion

28. Vestibular System does more than allow us to stand upright: • Coordinates information from vestibular organs in inner ear. • Eyes:20% of visual neurons respond to vestibular stimulation (spinning, head shaking or rocking). If visual information removed (eyes closed/dark), the individual will feel as if they are drifting or falling. • Auditory Information-anything affect auditory information can affect vestibular functions. • Pressers on the soles of the feet-provide information to vestibular areas of the brain regarding surface standing on. Allow us to calculate weight and posture adjustments that will allow upright balance and movement. • Facial and eye nerves and masseter muscle of jaw-respond to vestibular information.

29. Dysfunction in Vestibular System • Dysfunctions in the vestibular system can cause anxiety or panic attacks, a need for self-stimulation, abnormalities in muscle tone, difficulty defecating, teeth grinding and chin tapping, hand flapping, academic problems, drooling, etc. Exercises that activate a wide range of inputs to the vestibular system have been found to be effective in reducing or eliminating vestibular problems. • Over active vestibular system: anxious with feel leave ground, over excited with movement, get car sick, scare to jump etc, tries to control and manipulate to avoid distressing sensations, which may make them appear obstinate and uncooperative, wants constant physical support from adults. • Under-active vestibular system: moves constantly, poor endurance, clumsy, has trouble doing anything requiring both sides of the body, thrill seeker, confuses right/left, reverse letters and reads words backwards, can not follow a moving object, draw a line, does not become dizzy even after minutes of spinning, loves fast moving equipment, has trouble holding head up while sitting, does not attempt to catch self when falling.

30. Types of Sensory Integration/Processing Dysfunction • Sensory Modulation Dysfunction • Difficulties in the capacity to regulate and organized the degree and intensity of the response to sensory input in a graded and adaptive manner. • This regulates mood, attention, level of arousal and activity level. • Psychological reactions are internal, unconscious and out of the individuals control. • Difficulty tolerating or adjusting to minor changes in routine, disregard or impaired ability to interact with others, disrupted sleep and wake cycles, attention problems, easily distracted , or fixated on one activity with difficulty shifting focus, feel uncomfortable in busy environments.

31. Three Subtypes of modulation dysfunction • 1. Sensory Avoiding-(over responsive): the CNS is over responsive to sensation. The nervous system feels sensation too easily or too intense and the individual feels like they are constantly bombarded with information. Consequently they have a “fight or flight” response to sensation and often referred to as “sensory defensive.” • 2. Sensory Under responsitivity: poor sensory registration or awareness. Sensory system does not register information effectively and may require excessive amounts of sensory input in order to process sensation to produce a response. Need a “boost” to go and do activities. • 3.Sensory Seeking/Craving: The system does not easily notice sensory input and thus seeks out sensory stimulation. The sensory seeking is performed to raise arousal levels. Sensory seeking can be observed in individual who are over responsive to sensory input.

32. Sensory Discrimination Disorder • Difficulties with correctly registering or recognizing sensory input on a neurological level in order to use the information functionally. Sensory Discrimination is often causes of dyspraxia or poor motor coordination. • Problems with discerning and assigning meaning to sensory stimuli.

33. Sensory Based Movement Disorders • Dyspraxia: Problem with planning, sequencing and executing unfamiliar actions resulting in awkward and poorly coordinated motor skills typically seen with sensory deficits. May experience awkward, poorly coordinated motor skills. Dyspraxia may also co-occur with perceptual, visual motor or language problems. Poor ability to generate a learned activity to other similar motor skills. Poor sequencing or rhythm of motor actions. Dyspraxia individuals usually have poor sensory modulation and poor sensory discrimination. • Poor Ocular Disorder: Difficulties with control of posture or quality of movements seen in low muscle tone or joint instability and/or poor functional use of vision. May have hypo or hypertonic muscle tension/tone or joint instability. Poor muscle co-contraction for movement against gravity and poor posture control. Difficulties with oculo-motor control and functional vision. This often co-occurs with vestibular, proprioceptive and/or visual-motor problems.

34. Sensory Integration Therapy • Sensory Integration is a therapy approach that involves controlling sensory stimulation in order to elicit an ‘adaptive response’ (and action or response to the situation in a purposeful manner) according to the child’s brain functions. Therapy usually involves activities that provide Tactile (touch), Proprioceptive (body position sense) and Vestibular (body movement sense) as stimulation. • Sensory Integration therapy strategies are designed to keep a flow of neuro-chemical steady in the brain throughout the day for improved learning. Very important to implement therapy strategies daily and consistently throughout the day as instructed by your therapist to obtain benefits.

35. Therapy is graded to “just right challenge” • Hyper responsiveness Normal Range Hypo-responsive • -----------------------------------------------------I------------------------------------------------------ • Over-registration Optimal Under-registration • “Engine High” “Just Right” “Engine Low” • Activities are implemented to assist with organizing the sensory information to allow the child to move toward participation in activities in the “just right” mode. These activities are planned, scheduled activities imbedded through the day to help the individuals achieve or obtain the “just right.”

36. Treatment Strategies Heavy Work Activities (proprioceptive Input) • If engaged in for 10-15 minutes tends to last around 2 hours • Heavy work activities are used with sensory processing difficulties to help increase attention, decrease defensiveness, as well as assisting with regulating and modulating the nervous system, assists with organizing, improve body awareness and improvements in muscle tone and assist with calming for sleep. • Proprioceptive input is the performance of tasks that involve heavy resistance and input to the muscles and joints, and is essential in help our bodies assimilate and process both movement (vestibular) and touch (tactile) information. This system and these activities provides our body with information on how far to reach, how much pressure, where we are in space, what our body scheme is, assist with regulating and calming our system. • Proprioceptive system gives the nervous system input on the position of muscles, joints and tendons. • These activities are imperative for children who have difficulties regulating their arousal levels. These individuals require regular heavy input into their neurological systems to assist with calming them down. The thought is these activities help their bodies receive regular input into their muscles and joints in the most appropriate way so they can get the input they crave and settle their bodies.

37. Proprioceptive Input Weighted vest Stationary Bike Weighted blanket Bag of Balls Pressure clothing (vests, tops) Bozu Wall Push Ups Cocoon Scooter Board Physioball between back and wall Bouncing/Jumping Activities (ball, trampoline) Body Sox Ball Chair Cloud Hang hugs/compressions Fidget/squishy balls Brushing protocol Oral motor activities (gum, candy) Finger Ball Roll Air Bed

38. Vestibular Activities • Lycra Swing • Gym Spin (red/blue in sensory room) • Desk chair • Red rotation board • Purple rocker • Rocking Chair

39. Aromatherapy • Essential oils and/or lotion may be used for sensory strategies to assist with calming; organizing also has been known to assist with behaviors, aggressions and obsessions. • Therapist will indicate on sensory data tracker the type of scent and how to use.

40. References • Sensory Integration and Practice 2nd Edition, 2002. Anita C Bundy, Shelly J. Lane and Elizabeth A. Murray. • Exploring the Spectrum of Autism and Pervasive Developmental Disorders, 2000, Carolyn Murray – Slutsky, MS, OTR, Betty A. Paris, PT. • Sensory Profile Users Manual, Winnie Dunn, PHD, OTR, FAOTA 1999. • Ready Bodies and Learning Minds, 2nd Edition, Athena Oden, PT. • The Out of Sync Child by Carol Kranwitz, MA 2005. • www.spiralfoundation.net • www.OTOUTCOMES.com • www.sensory-processing-disorder.com • www.kidscando.org • A. Jean Ayers, Sensory Integration Theory and Practice • Raising a Sensory Smart Child: The Definitive Handbook for Helping your Child with Sensory Integration Issues (Lindsey Biel, Nancy Peske) • Too Loud, Too Bright, Too Fast, Too Tight: What to do If You are Sensory Defensive in an Over stimulating World (Sharon Heller) • SPD network • Sensory Integration Dysfunction. “The Misunderstood, Misdiagnosed and Unseen Disability” (Sandra Nelson). • Sensory Integration and Learning Disorder by A. Jean Ayes, PHD. • Sensory Integration and the Child by A. Jean Ayres, PHD. • Sensational Kids : Hope and Help for Children with Sensory Processing Disorder by Lucy Jane Miller, PHD, OTR

41. Additional Information Raising a Sensory Smart Child: The definitive Handbook for Helping Your Child with Sensory Processing Issues by Lindsey Biel. • The Out-of-Sync Child: Recognizing and Coping with Sensory Processing Disorder, Revised Edition by Carol Kranowitz and Lucy Jane Miller. • The Out-of-Sync Child Has Fun, Revised Edition: Activities for Kids with Sensory Processing Disorder by Carol Stock Kranowitz. • The Ultimate Guide to Sensory Processing in Children: Easy Everyday Solutions to Sensory Challenges by Roya Ostovar. • Sensational Kids: Hope and Help for Children with Sensory Processing Disorder by Ph.d, OTR, Lucy Jane Milder and Doris A. Fuller. • Too Loud, Too Bright, Too Fast, Too Tight: What to do If you are Sensory Defensive in an over stimulating world by Sharon Heller. • Making Sense of your Senses: A workbook for Children with Sensory Processing Disorder by Christopher Auer and Michelle A. Auer.