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Sensory and Visual Strategies for Adults with Multiple Disabilities. Presenter: Dan Zerwas, OTR/L SIPT Occupational Therapist, Registered/Licensed Sensory Integration Certified. What is sensory integration?.

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Sensory and Visual Strategies for Adults with Multiple Disabilities

Presenter: Dan Zerwas, OTR/L SIPT

Occupational Therapist, Registered/Licensed

Sensory Integration Certified


Sensory integration is an innate neurobiological process and refers to the integration and interpretation of sensory stimulation from the environment by the brain. In contrast, sensory integration dysfunction is a disorder in which sensory input is not integrated or organized appropriately in the brain and may produce varying degrees of problems in development, information processing, and behavior.


When the sensory system is immature and working improperly, abnormal neural signals are sent to the brain, which can interfere with other brain processes. This, in turn, causes the brain to be overly stimulated and may lead to excessive brain activity, which can neither be turned off nor organized. This type of over-stimulation (hyper-responsive) in the brain can make it difficult for an individual to organize one’s behavior and concentrate, which may lead to a negative emotional response.


Opposite is (hypo-responsive) where the typical amount of input is not registered or registered at a very low level. Extra sensory input may need to be imposed for the person to register it in the brain.


The seven sensory systems:









The retina of the eye is a receptor that is sensitive to light waves in the environment. Light stimulates the retina to send visual sensory input to the visual processing centers in the brainstem. These centers process the impulses and relate them to other types of sensory information, especially input from the muscles and joints and vestibular system. This forms our basic awareness of the environment and the location of things in it.


42-90% of children with profound disabilities also have visual impairments.

  • Most complex and dominant sensory system
  • Most important sense for:
  • Survival
  • Time and space orientation
  • Anticipation / Adaptation
  • Learning, memory, recall


Staff should be in client’s visual field when approaching them.

Use as many tactile cues as possible.

Limit visual distractions and complex patterns.

Provide deep pressure and vibration as tolerated.

Use movement as much as possible (e.g. Rocking chair/swing).

Determine stimulating vs. calming activities.


Sound waves in the air stimulate the auditory receptors in the inner ear to send impulses to the brain stem auditory centers. These nuclei process the auditory impulses along with impulses from the vestibular and the muscles and skin. The auditory organizing centers are very close to the visual processing center in the brain stem, and the two exchange information.

Used for localization of sound.

Used to process auditory language.

Safety mechanism.



Keep noise levels low (e.g. Television).

Staff in client’s visual field when communicating with them.

Use appropriate language and sentence length.

Use tactile and visual cues.

Warn prior to intrusive sounds (e.g. Fire Alarm).

Determine stimulating vs. calming activities.


The skin has many different kinds of receptors for receiving sensations of touch, pressure, texture, heat or cold, pain, and movement of the hairs on the skin. Although we may not think much about the role of touch in our lives, the tactile system is the largest sensory system and it plays a vital role in human behavior, both physical and mental.

Builds memory of texture/experiences.

One of the first means of environmental interaction: emotional and motor.

Over sensitive/under sensitive.



Deep pressure to skin.

Provide heat/cold as they relate to it.

Warm hands prior to touch.

Joint compressions/brushing programs.

Determine stimulating vs. calming activities.


Both receptors send information about danger. Smells evoke strong emotions and memories, both good and bad. Perfumes/colognes can evoke very negative reactions from clients who have been abused if they make the association. Taste of foods can also evoke a very strong positive response or negative response.

  • Foods can be refused due to texture, taste, temperature, or smell.


Find out as much as you can about past likes and dislikes.

Provide aromatherapy.

Limit colognes and perfumes worn by staff.

If client refuses a food, try it as a different texture.

Try all food options: bitter, sweet, salty, spicy, etc. if no restrictions.

Determine stimulating vs. calming activities.


Sensory information caused by contraction and stretching of muscles and by bending, straightening, pulling, and compression of the joints between bones. This information is sent mostly during movement but also when we are still.

This system is almost as large as the tactile system due to the large amount of joints and muscles.

Helps us move: Hand skills for fine motor/self cares.

Movement increases body awareness/regulation.

May see this in a client that trips/falls, maximal/minimal activity level, or leans on staff/objects.



Movement and added weight increases balance, digestion, and bone density.

Maximize during chores.

Push, pull, and carry objects.

Stationary bikes, floor pedals, arm bikes, etc.

Determine stimulating vs. calming activities.

amtryke 2700


Inner ear with winding passages and two types of vestibular receptors. Receptors are tiny calcium carbonate crystals attached to hair-like neurons that sense gravity and change in movement of the head.

The second type of receptor lies in tiny fluid filled closed tubes called semicircular canals. Three pairs of canals-one lying up and down, one left to right, and the third front to back. Movement of the head in any direction causes pressure of the fluid to send input to the brain.


The combination of input from the gravity receptor and the semicircular canals is very precise and tells us exactly where we are in relation to gravity, whether we are moving or still, and how fast we are going and in what direction.

Works the same as a gyroscope in an airplane. Pilots will fly in circles or spiral with just vision. Visual information is useless unless one can relate what is seen to some physical reference, which the semicircular canals provide.



Ride bikes

Rocking Chairs

Ride in vehicles


Walks with pedometers/charts

Determine stimulating vs. calming activities


Biological Challenges

Sensory Reactivity-------------------Take In

Hypo Hyper


Sensory Processing------------------Make Sense of

Sensory Cognitive


Motor System----------------------------How you use it

Muscle Tone Motor planning



Emotional Responses

High ResponsivenessLow ResponsivenessFluctuating

Intense Emotions Flat affect Labile

Avoidance Little facial expression Difficult to console

Fight/Flight Lacks Initiation Unpredictable

(208) 639-9468

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Carol Gray


Dan Zerwas, OTR/L SIPT


Available for:


Staff Training / Consulting

Client Evaluations

Program Development