Workshop on sensory integration

1. Workshop on sensory integration M. ARUN KUMAR occupational therapist

2. Sensory Integration is... The neurological process that organizes sensation from one’s own body and from the environment and makes it possible to use the body effectively within the environment. (Ayres, 1979)

3. SENSES • Tactile Sense Input from the skin receptors about touch, pressure, temperature pain and movement of the hairs on the skin

4. Visual Sense Input form the retina of the eye.

5. Auditory Input form the inner ear.

6. Gustatory Input from the chemical receptors in the tongue.

7. Olfactory Input from the chemical receptors in the nasal structure.

8. Vestibular Sense Input from the inner ear, about equilibrium gravitational changes, movement experiences, and position in space .

9. Proprioceptive Sense Input from the muscles and joints about body position, weight, pressure, stretch, movement and changes in position in space.

10. A Proposed Model SI Modulation Praxis Verbal Discrimination Poor Registration Postural Defensive Scquencing Oral

11. SIGNS OF TACTILE DYSFUNCTION • Hypersensitivity to Touch (Tactile Defensiveness) Avoids group situations for fear of the unexpected touch. May overreact to minor cuts, scrapes and or bug bites. Avoids using hands for play, sand.

12. Distressed about having hair, toenails, or fingernails cut. • Resists brushing teeth and is extremely of the dentist • May refuse to walk barefoot on grass or sand. • May walk on toes only.

13. Hyposensitivity to Touch (Under-Responsive) • May crave touch, needs to touch everything and everyone. • Is not bothered by injuries, like cuts and bruises. • May be self-abusive; pinching, biting, or banging his own head.

14. Mouths objects excessively. • Craves vibrating or strong sensory input. • Has a preference and craving for excessively spicy, sweet, sour, or salty foods.

15. Poor Tactile Perception and Discrimination • Has difficulty with fine motor tasks such as buttoning, zipping, and fastening clothes. • Has difficulty using scissors, crayons, or silverware. • Continues to mouth objects to explore them even after age two

16. SIGNS OF VESTIBULAR DYSFUNCTION • Hypersensitivity to Movement (Over-Responsive) • Avoids/dislikes playground equipment; i.e., swings, ladders, slides, or merry-go- rounds. • Afraid of heights, even the height of a curb of step. • Fearful of going up or down stairs or walking on uneven surfaces

17. May be fearful of, and have difficulty riding a bike, jumping, hopping, or balancing, or balancing on one food (especially if eyes are closed) • Loses balances easily and may appears clumsy. • Fearful of activities which require good balance. • Avoids repaid or rotating movement

18. Hyposensitivity to movement (Under-Responsive) • In constant motion, can’t seem to sit still. • Craves fast, spinning, and/or intense movement experiences. • Always running, jumping, hopping etc • Rocks body, shakes leg, or head while sitting.

19. Poor Muscle Tone And/or Coordination • Difficulty simultaneously lifting head, arms, and leg off the floor while lying on stomach (“superman” position). • Fatigues easily! • Poor fine motor skills; difficulty using “tools”, such as pencils, silverware, combs, scissors etc.

20. PROPRIOCEPTIVE DYSFUNCTION Sensory Seeking Behaviors • Seeks out jumping, bumping, and crashing activities. • Kicks his/her feet on floor or chair while sitting at desk/table. • Bits or sucks on fingers and /or frequently cracks his/her knuckles. • Love pushing/pulling/dragging objects.

21. Difficulty with “Grading of Movement” • Misjudges how much to flex and extend muscles during tasks/activities (i.e., putting arms into sleeves or climbing)

22. AUDITORY DYSFUNCTION (NO DIAGNOSED HEARING PROBLEM ) Hypersensitivity to Sounds (Auditory Defensiveness • Distracted by sounds not normally noticed by other; i.e., humming of lights or refrigerators, fans, heaters, or clocks ticking. • Runs away, cries, and/or covers with loud or unexpected sounds

23. Hyposensitivity to Sounds (Under-Registers) • Often does not respond to verbal cues or to name being called. • Talks self through a task, often out loud.

24. ORAL INPUT DYSFUNCTION Hyposensitivity to Oral Input (Under-Registers) • May lick, taste, or chew on inedible objects. • Frequently chews on hair, shirt, or fingers. • Constantly putting objects in mouth

25. Hypersensitivity to Oral Input (Oral Defensiveness) • Picky eater, often with extreme food preferences; i.e., limited repertoire of food, picky about brands, resistive to trying new foods or restaurants, and may not eat at other people’s houses. May gas with textured foods. • Has difficulty with sucking, chewing, and swallowing, may choke or have a fear ofchoking.

26. Resists/refuses/extremely fearful of going to the dentist or having dental work done. • May only eat hot or cold foods Refuses to lick envelopes, stamps, or stickers, because of their taste. • Dislikes or complains about toothpaste and mouthwash. • Avoids seasoned, spicy, sweet, sour orsalty foods; prefers bland foods.

27. SIGNS OF OLFACTORY DYSFUNCTION (SMELLS) Hypersensitivity to Smells (Over-Responsive) • Reacts negatively to, or dislikes smells which do not usually bother, or get noticed, by other people. • Refuses to eat certain foods because of their small. • Bothered/irritated by small of perfume or cologne. • Bothered by household or cooking smells. • May refuse to play at someone’s house because of the way it smalls

28. Hyposensitivity to Smells (Under-Responsive) • Has difficulty discriminating unpleasant odors. • May drink or eat things that are poisonous because they do not notice the noxious smell. • Fails to notice or ignores unpleasant odors. • Makes excessive use of smelling when introduced to objects, people, or places.

29. VISUAL INPUT DYSFUNCTION (NO DIAGNOSED VISUAL DEFICIT) Hypersensitivity to Visual Input (Over-Responsiveness) • Sensitive to bright lights; will squint, cover eyes, cry and/or get headaches from the light. • Has difficulty keeping eyes focused on task/activity he/she is working on for an appropriate amount of time. • Avoids eye contact. • Easily distracted by other visual stimuli in the room; i.e., movement, decorations, toys, windows, doorways etc.

30. Hyposensitivity to Visual Input (Under-Responsive or Difficulty with Tracking, Discrimination, or Perception) • Has difficulty telling the difference between similar printed letters or figures; i.e., p&q, b&d, + and x, or square and rectangle. • Has difficulty locating items among Has difficulty locating items among other items; i.e., papers on a desk, clothes in a drawer, items on a grocery shelf, or toys in a bin/toy box.

31. Often loses place when copying from a Book or the chalkboard. • Has difficulty telling the difference between different colors, shapes, and sizes. • Makes reversals in words or letters when copying, or reads words backwards; i.e., “was” for “saw” and “no” for “on” after first grade. • Difficulty judging spatial relationship in the environment; i.e., bumps into objects/people or missteps on curbs and stairs.

32. BEHAVIOURAL ISSUES • Aggressiveness- hitting, kicking, throwing tantrums • Disruption- screaming, crying • structure; demonstrate inflexibility when transitioning between activities • Self-stimulation (e.g. head banging, biting)

33. Academic Intellect Learning cognition Daily Living Behavior Activities Auditory Attention Visual- Perceptual Language Special Development Center Perception Skills Functions Motor Ocular Postural Eye-hand Motor Adjustment Coordination Control Development Sensory Reflex Ability to Body Scheme Screen Input Maturity Motor Awareness of Postural Motor Planning Two Sides of Body Security Systems Sensory Olfactory Auditory Gustatory Visual Proprioception Tactile Vestibular CENTRAL NERVOUS SYSTEM

34. Sensory Integration Equipment THERAPY BALL BALANCE BOARD

35. SWINGS FLAT SWING T - SWING

36. BOLSTER SWING ROUND SWING

37. TYRE, TUBE SWING HAMMOCK

38. TRAMPOLINE SCOOTER BOARD

39. RAMP BALL BATH

40. TACTILE VISUAL ITMES

41. TUNNEL STEPS AUDIO TAPES

43. SI ROOM

44. SI ROOM 2

45. Tactile Processing Rubbing with different textures Soft to Hard Hard to Soft Sand Play Clay activity

46. Alerting Light touch Tickling Hot or cold food (strong temperature) Playing in textures (rice, sand, beans, finger painting, playdoh) Go barefoot, use textured towels/ blankets/ objects Chose crafts with touch feedback (gluing, clay molding, etc) Calming Firm pressure on skin, longer duration Hold hand firmly Avoid unnecessary touch and forewarn of necessary touch Weighted vests, blankets, etc. Wilbarger Brushing Program (under OT direction) Oral tactile defensiveness strategies . TACTILE • Underresponsiveness/ poor registration • Defensive/ Avoiding principles:

47. Alerting Changes in speed and direction Change of head position Swinging (tire swing with lots of directional changes) Sliding Somersaults Dragging on a blanket Bouncing on adult’s knee/ therapy ball Movement activity prior or during a thinking task Movement breaks in class (accompany on errands to office, library, etc.) Calming Linear, predictable, repetitive Head moving in straight line I.e.. Rocking chair, bouncing up and down, gentle linear swinging Allow child to direct Couple with “organizing inputs” (proprioceptive input, deep pressure, etc.) I.e. Swing and crash! Child swings with feet held firmly with pulling/ pushing, etc. VESTIBULAR • Underresponsiveness/ poor registration/ seeking • Defensive/ Avoiding • Gravitational Insecurity

48. B) Vestibular Processing Therapy ball Workout Supine position Prone position

49. Sitting position Trampoline workout Jumping in different motion with changing activities.

50. Swing Sitting standing position with challenging activities.