Sensory Integration Therapy: What is it and who benefits from it?

Sensory integration therapy. Sensory integration refers to the brain’s ability to organize sensory information that comes from our surroundings. Sensations come in as perception and it is the brain’s job to locate, sort, and order all of the incoming sensations we receive. Sensory integration theory originated from the work of Dr. A. Jean Ayres, who was an occupational therapist and educational psychologist. She believed that our senses give us information about the physical changes in our body and environment.

If the brain does not organize all of our sensations in a productive manner, then we will experience sensory integration dysfunction. The condition has now been termed Sensory Processing Disorder (SPD): a neurological disorder in which the sensory information that the individual perceives results in abnormal responses (STAR Institute). Individuals with this disorder will experience problems with their sense of touch, smell, sight, hearing, and coordination. It is a common disorder for individuals with Autism Spectrum Disorder and Attention Deficit Hyperactivity Disorder (ADHD). Many occupational therapists use Sensory Integration Therapy to help over-sensitive and under-sensitive adults and children regulate sensory difficulties.

Sensory Integration Theory: What is it?

The theory of sensory integration was developed by Dr. A. Jean Ayres, an occupational therapist with an educational psychology and neuroscience background. She began investigating the way the brain processes sensory information during her studies in the 1960’s. Ayres was influenced by how children with developmental disabilities could learn motor planning and execution from the four major sensory modalities: touch, proprioception, vestibular functions, and vision.

She believed that motor performance is closely related to perception and that the two are interchangeable. Ayres’ 1966 article on the Interrelation of Perception, Function, and Treatment stresses the importance of interpretation in sensory processing.

“The sensory receptors must be stimulated, followed by receipt of the resultant nerve impulses by the central nervous system. The next step is to attribute meaning to the sensory information on either a conscious or below-conscious level. Organizing and interpreting sensory information is the essence of perception” (Ayres, 1966).

Her earliest training procedures were consistent with neurophysiological approaches to the treatment of neuromuscular dysfunction. Ayres has shown that the effectiveness of a motor response is dependent on the accuracy of perception that was received. Developmental apraxia and dyspraxia have also been used in her work as she observed children having difficulty buttoning small buttons, handling tools, writing, and getting dressed. Motor planning is a virtue in her studies as they became therapies used to help children accomplish them automatically, such as walking and writing.

Without praxis, or the ability to plan and then direct the plan of movement, all the coordination and strength which can be garnered will be of little use. About two decades later, Ayres recognized that her theory could expand into other clinical populations other than children with learning disabilities. Ayres and Tickle applied the theory to children with autism and noted that it helped decrease tactile and other sensitivities to stimuli that interfere with their ability to play, learn, and interact. Since that time, sensory integrative principles have also been applied to various populations, including infants born at risk and/or with regulatory disorders, children with autistic spectrum disorders, fragile X syndrome, attention deficit disorder (ADHD).

Her approach became known as Ayres Sensory Integration®, (ASI) which is a Registered Trademark and is used by therapists all over the world as sensory integration therapy. ASI® includes the theory of sensory integration, assessment methods to measure sensory integration, and a core set of essential intervention constructs that can be utilized to intervene with clients who have difficulty processing sensory information. Sensory integration therapy is used in occupational therapy, pediatrics, and early childhood education.

Sensory Integration Therapy: What is sensory integration per se?

Sensory Integration is a theory of brain-behavior relationships that comes from all responses we receive from sensory domains. When the brain receives information from the environment around us, it goes through a stage called sensory processing. The combination of inputs and outputs in the nervous system create the responses we need to develop, learn, and experience. The sensations involved in sensory integration are what Jean Ayers called “food for the brain.” Sensations provide the energy and knowledge needed to direct the body and mind, but the brain must provide well-organized sensory processing in order for sensations to be digested and able to nourish the brain. Rather than using sensory integration in a neuroscientific way, Ayres applied it to a behavioral setting; a place where she can observe functional behavior in a natural setting of play. However, it is still important to understand the processes of sensation and perception on a scientific level.

Sensory processing (or sensory integration) is the way in which the central nervous system of the body receives messages from the senses of the body and uses that information to produce a reaction with an appropriate behavioral response. 

The brain has two types of nervous systems: the central nervous system and the peripheral nervous system. The Central Nervous System or (CNS) is a part of the nervous system that contains the brain and spinal cord. The brain allows for thoughts, the perception of the external environment, and control over bodily functions and movement. The spinal cord acts as the main source of communication between the body and brain. A disrupted spinal cord could lead to a miscommunication between parts of the physical body and brain. Neurons or nerve cells are responsible for receiving these signals to pass them down the cell body. The Peripheral Nervous System or (PNS) connects the CNS to the other parts of the body such as organs, limbs, and skin. The PNS allows for the ‘reaction’ to happen with the help of sensory and motor neurons. The system is divided into two parts: the Somatic Nervous System and the Autonomic Nervous System.

The somatic system carries sensory and motor information to and from the CNS and is responsible for voluntary movement. Sensory and motor neurons are important transmitters of sensory information because they allow us to make physical movements and respond to external stimuli. The autonomic system is the branch that controls involuntary functions such as heartbeat, respiration, and digestion. The Enteric Nervous System (ENS) is a division of the ANS that is responsible for regulating digestion and the function of the digestive organs.

It can also be broken down further into the Sympathetic Nervous System and Parasympathetic Nervous System. If you have heard of the fight-or-flight response, then you might be familiar with what it stands for. It is a crucial part of the sympathetic nervous system since it controls the body’s response to danger. The parasympathetic nervous system helps us recover by inducing homeostasis and calms the body down after it has been a stressful incident/environment.

It is important to know how the nervous systems work together by taking in information through the senses in order to create reactions and/or behaviors. There are three basic classes of neurons that transmit sensory information to different parts of our body: afferent neurons, efferent neurons, and interneurons. Afferent neurons transmit sensory signals to the CNS, efferent neurons transmit signals from the CNS to muscles and glands, and interneurons integrate information we receive from afferent neurons and direct the function of the body through efferent neurons.

Individuals who suffer from sensory issues will have disruptions with these connections. For example, a person having difficulty making a complete movement is caused by afferent neurons not communicating with that part of the body. All of our sensory receptors are found throughout most of the body. The receptors monitor the body’s internal and external conditions. They are connected to neurons that carry information to the CNS and are integrated there. When an adult or child exhibits a sensory issue, it is because the brain is not processing and integrating signals correctly. It is our brain’s job to evaluate, compare, and organize information and process them.

Brain processing is not only when integrating signals correctly, it also involves cognitive processes. CogniFit offers a scientifically validated software to precisely measure and trains each individual’s cognitive skills. Try it now.

Sensory Integration Therapy: How our senses are affected

The brain interprets information from our eyes, ears, nose, tongue, and skin. Together, they form our five senses which are: sight, hearing, smell, taste, and touch. There are also three additional senses: the proprioceptive, vestibular, and interoceptive senses. Proprioceptive sensors are in the joints and tendons and allow us to know where our body parts are. Functions of this sense include motor planning, body awareness, the force of movement, and posture. The vestibular sensors are in the inner ear which create an awareness of the body’s position to its surroundings. We receive input through our vestibular sense which is the active movement and balance sense. It also helps us coordinate movement and gravity, such as knowing if we are upside down. The input from muscles and joints allow the brain to know where each body part is and how it is moving. The interoceptive system is the sense of our internal organs. Sometimes the brain does not communicate with our senses effectively. Individuals can have sensory processing issues that may overwhelm and confuse them.

Dr. Ayres states: “Sensory integration is the organization of sensation for use.  Our senses give us information about the physical conditions of our body and the environment around us.  Sensations flow into the brain like streams flowing into a lake.  Countless bits of sensory information enter our brain at every moment, not only from our eyes and ears, but also from every place in our bodies.  We have a special sense that detects the pull of gravity and the movements of our body in relation to the earth.  The brain must organize all of these sensations if a person is to move and learn and behave normally.  The brain locates, sorts, and orders sensations-somewhat as a traffic policeman directs moving cars.  When sensations flow in a well-organized or integrated manner, the brain can use those sensations to form perceptions, behaviors, and learning.  When the flow of sensations is disorganized, life can be like a rush-hour traffic jam.” (Ayres, 1979, p.5)

Individuals who have difficulty with touch sensations may not know the difference between squeezing something too hard or too soft. Proprioception works with this sense and affects how much force we use in certain activities. Visual problems come from the miscommunication between the brain and visual system. Individuals who have visual processing issues might have a hard time reading body language or notice an important small detail. Individuals can also have conditions of their other six senses too.

Many sensory issues are involved in:

• Sensory Processing Disorder
• ADD/ADHD
• Autism
• Speech/Language Disabilities
• Dyslexia
• Visual Processing Disorder
• Motor Apraxia
• Down’s Syndrome
• Fragile X Syndrome, such as OCD
• Emotional/ Behavioral Disorders
• Cerebral Palsy

Sensory Integration Therapy and relationship with Sensory Processing Disorder (SPD)

Sensory Processing Disorder (SPD), once known as sensory integration dysfunction, is a condition that occurs when the brain does not organize and respond to the sensory signals received from our body. SPD is not a recognized disorder in the Diagnostic and Statistical Manual, although it is a symptom of Autism. Both children and adults with SPD find it difficult to process specific sensory signals that do not create the correct response. They often have a difficult time doing daily activities every day because their senses are not organized to respond to stimulations from the environment. If these senses are disordered, it can actually make a child clumsy, awkward, tired easily, and hyperactive. Individuals can become sensitive or isolated when their sensory processing systems are overloaded thus disrupting sensory integration. In addition, children may have difficulty developing speech and language as well. SPD is a common condition that occurs with other disorders.

Some of the more common co-occurring disorders include Autism, Attention-Deficit Hyperactivity Disorder (ADHD), Post-Traumatic Stress Disorder (PTSD), Fragile X Syndrome, and learning and language disabilities. SPD consists of subtypes that affect the type of therapy used in the treatment plan. There are three main subtypes: Sensory Modulation Disorder (SMD), Sensory Discrimination Disorder (SDD), and Sensory-Based Motor Disorder (SBMD). Depending on the occupational therapist, sensory integration therapy is sometimes used for SPD. The therapy sessions are called play-time sessions because it really is all about the child having fun and learning at the same time. Some of the materials in therapy include: swings, rock walls for climbing, big pillows to jump on, tactile objects used for pushing, pulling, and touching, and obstacle courses for climbing and crawling.

Some common signs of sensory issues are difficulty responding to touch, sights, or sounds, displays coordination problems and poor body awareness, feels uncomfortable socializing, is easily distracted or impulsive, and/or cannot tolerate loud noises, eating food, or walking barefoot.

Sensory Integration Therapy: Sensory Modulation Disorder (SMD): Individuals with this condition have problems modulating sensory information. Regulating stimuli from the environment is difficult since the brain does not produce the correct behavior associated with the sensation. Issues can range throughout all of the seven senses: visual, auditory, gustatory, olfactory, tactile, vestibular, and proprioception. SMD has three extremes: sensory-over responsivity, sensory-under responsivity, and sensory craving. A large number of children experience difficulty processing and integrating sensory information.  Ahn, Miller, Milberger, and McIntosh (2004) found that 5%–15% of children in the general population of kindergarten-age children demonstrate difficulties with sensory modulation. Some common symptoms include: avoiding messy substances, disliking certain clothing because of their textures, over-sensitivity or under-sensitivity to smell, sound, or other stimuli, and refusing to eat certain foods because of how it feels or smells.

Sensory Integration Therapy: Sensory-Over Responsivity: Children and adults will experience sensations on a more intense level and the sensations will be faster and have a longer duration than normal sensory responsivity. The over-stimulation can happen from ay sensory stimuli, such as sound, movement, and touch. Behavioral responses will include aggression, fear, avoidance, and withdrawal. People with this condition are always in a state of high arousal and the sensations they receive are often painful/unpleasant. The over-stimulation can cause the child to have trouble with common everyday activities, such as hugging and eating foods of different textures. Avoidance of these activities can lead to tantrums and non-stop crying in infants and children.

Sensory Integration Therapy: Sensory-Under Responsivity: Some individuals under-respond to sensory information and have less of a response to the stimuli. They take longer to react and they find the situation to be demanding and uncomfortable. An example of this would be a child not noticing that he/she bumped into something. A high tolerance for pain is present and some do not notice they bumped into something until they see the bruise. Both children and adults are seen as passive, quiet, apathetic, withdrawn from others, or lethargic to people around them. They are also unaware of their own body sensations, such as hunger and the urges to use the bathroom.

Sensory Integration Therapy: Sensory-Craving: These individuals are sensation-seeking and have a craving for sensory experiences at all times. They seek sensation in ways that are extreme compared to others. Children may not understand personal space and may crave physical contact with others. Examples of this condition include: crashing, jumping, swinging, swinging, touching, and talking. Children with sensory craving disorder are often diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) or Attention Deficit Disorder (ADD).

Sensory Integration Therapy: Sensory Discrimination Disorder (SDD): People suffering from this disorder have a hard time perceiving information because the brain confuses the stimuli. Discrimination disorder is present in each of the eight senses. Individuals will struggle with interpreting meaning to objects, detecting the differences in things, processing things they touch, following directions, using too much or too little force, poor balance, and not being aware of hunger/thirst.

The senses associated with SDD listed are:

• Tactile: Individuals will not be able to process things they touch. They must be able to see it in physical form in order to know that it is there. They may also not be aware that someone or something has touched them.
• Gustatory/Oral: This disorder will include not being able to distinguish taste, temperature, and texture while eating.
• Olfactory: Individuals cannot identify odors and smells, such as something burning.
• Auditory: People who suffer from this disorder have a hard time distinguishing sounds apart from others. They are sometimes misdiagnosed with ADHD or get in trouble for never listening. Common signs include not knowing who is speaking, difficulty understanding instructions verbally, and language issues.
• Visual: This condition includes having difficulty distinguishing between colors and shapes, poor depth perception, lining things up, and knowing right from left.
• Vestibular: People will be unaware of where their body is in the space around him. Common symptoms include difficulty determining body position, elevation, and poor posture.
• Proprioceptive: Individuals cannot figure out how much force to use with an object or another person. They may drop objects easily, break utensils, slam doors, and not be able to determine how far something can go, such as throwing a ball.
• Interoceptive: Individuals cannot judge what is going on with their organs such as not being able to notice if they are hungry, full, thirsty, out of breath, or need to use the bathroom.

Sensory Integration Therapy: Sensory-Based Motor Disorder (SBMD): Children and adults with this disorder have difficulty with balance, motor coordination, and performance. The brain does not produce a motor output from the sensory message input. They may not understand the space around them and not know how to move the body in the right direction. There are two different types of SBMD: Postural Disorder which is an impaired perception of body position which creates poorly developed movement. The person will have a hard time moving their muscles, such as not chewing correctly and having difficulty focusing eyes. Dyspraxia. which is difficulty executing skilled movement (fine-gross motor skills) and new movement patterns that respond to the environment. People with this condition cannot do most physical activities because their brain does not allow them to follow through with the complete movement.

Sensory Integration Therapy: A form of occupational therapy

Occupational therapy has been an effective method of treatment for decades. We have come to understand that the brain is more complex than we once thought and new findings on neuroscience balance old methods with new ones, such as neuroplasticity. Research has shown that sensory integrative frameworks used in occupational therapy can help the brain repair itself through the course of learning.

A study done on the evidence for sensory-driven neuroplasticity examined the effectiveness of learning in sensory environments. This idea is supported in the human data demonstrating that brain processing of sensory input is flexible and dynamic and that the greatest changes come when interaction with the environment is not forced but rather self-initiated. The studies indicated that neuroplastic changes were development, dynamic (reactive), and task specific.

Sensory integration therapy is performed by an occupational therapist in an environment that is therapeutic for both children and adults experiencing sensory processing disorders and other developmental and behavioral problems. The sensory integration approach can benefit individuals with ASD and others who have ADHD, OCD, and learning disabilities. Sensory Integration Therapy (SI) is based on Dr. Ayres theoretical approach. When a child is in occupational therapy, the therapist will rely on various strategies to assess the issues at hand. If there are issues with sensory processing, the therapist can use Sensory Integration Therapy evaluation methods including observation of the child in the natural setting, caregiver and teacher interviews, standardized testing, and structured clinical observations to determine the specific ways in which disordered use of sensation is interfering with the child’s functional performance.

Occupational therapists who offer this specialized therapy will first evaluate the individual’s response to various sensory inputs, motoric challenges, and social interactions. If deficits are suspected, the official Sensory Integration and Praxis Tests can be administered to determine the areas that are a problem. The Sensory Integration Therapy ARI approach uses proprioceptive, tactile, and vestibular tasks to help the child develop skills within their area of difficulty.

Sensory integration therapy helps adults and children by exposing them to sensory stimulation in a structured, repetitive way. The theory behind it is that over time, the brain will adapt and allow the brain to process and react to sensations more efficiently. The program will have challenges, unique sensory activities, and specialized equipment such as scooters, balls, and trampolines. In sensory integration therapy, special exercises are used to strengthen the patient’s sense of touch (tactile), sense of balance (vestibular), and sense of where the body and its parts are in space (proprioceptive). It appears to be effective for helping patients with movement disorders or severe under- or over-sensitivity to sensory input. Sensory gyms are a major component of occupational therapy with an (SI) approach. These gyms are rich with sensory equipment, such as weighted vests, “squeeze machines,” brushing techniques (Wilbarger Brushing protocol), swings, and trampolines. The therapist’s goal during sensory integration therapy is to create a sensory stimulating environment that helps define all senses, eliminates barriers that may be social or perceptive, and helps the individual understand their movements and how it affects the world around them.

Individuals can truly benefit from sensory integration therapy in a way that helps them learn about how to perceive the world around them. Coping strategies and therapy that resembles play-time will help children and adults regulate their senses. Both physical changes and psychological changes develop during the course of treatment. The therapist will encourage the child to learn self-regulation and understand how their senses work together as a whole.

Therapists can use instruments and music for the auditory sense, aromatherapy and flowers for olfactory, hot and cold food for taste, strobe lights and activity boxes for vision, and soft and hard materials for touch (tactile). For proprioception processing, tunnels, trampolines, and balls are perfect activities for the child to learn where an object is in space and how it relates to their body. For vestibular processing, many therapists use swings and physical activities such as standing on one foot without exposing eyes and walking heel to toe without support. The therapist’s goal is to inform parents that their child’s needs can also be met at home using sensory integration therapy. The child will also be put on a special “sensory-diet” that is unique to their symptoms and condition. They can also incorporate different methods and sensory activities into the child’s classroom routine by speaking with their teachers at school. Occupational therapy and sensory integration therapy are wonderful resources for children and adults with various disorders/conditions.

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References:

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Jenna Buono

Jenna is a recent graduate who earned her B.A. in Psychology with a minor in Cognitive Science. She is passionate about how the mind functions and will continue her education studying Behavioral Neuroscience. She hopes to work with children and do research in the field of Developmental Psychology.