Laurie Johnson, MHS, OTRL

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Sensory Integration in the Home An overview
Presented by Laurie Johnson, MHS, OTR/L
Adrienne Rousseau, parent of Autistic Child
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Sensory Integration is...
The neurological process that organizes sensation
from ones own body and from the environment and
makes it possible to use the body effectively
within the environment. (Ayres, 1979)
Praxis
SI
Modulation
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SI theory simplified
Figure 11-8 Sensory Integration Theory and
Practice, 2nd ed. Anita Bundy, Shelley Lane,
Elizabeth Murray
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Sensory Modulation
The capacity to regulate and organize the
degree, intensity, and nature of responses to
sensory input in a graded and adaptive manner.
This allows the individual to achieve and
maintain an optimal range of performance and to
adapt to challenges in daily life. (Miller
Lane, 2000)
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A Proposed Model
Dunn, W (2002). Implementing a Sensory
Processing Approach In School Practice. SCOTA
Conference, Charleston, SC.
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The Sensory Diet
the multisensory experiences that one normally
seeks on a daily basis to satisfy ones sensory
appetite a planned and scheduled activity
program that an occupational therapist develops
to help a person become more self-regulated.
(Kranowitz, 1998)
The amount and type of sensory input needed to be
most alert, adaptable, and skillful in ones
environment. With the right input, our bodies
feel calm, alert and ready to tackle daily
challenges. Negative sensory input can have a
disorganizing affect on the body.
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Tactile

• Sensation derived from stimulation to the skin
  (Bundy, et al. 2002)

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Tactile

• underresponsiveness/ poor registration
• Defensive/ Avoiding

principles

• 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
• .

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Proprioception

• Sensations derived from movement (ie. Speed,
  rate, sequencing, timing, and force) and joint
  position. Derived from stimulation to muscle and,
  to a lesser extent, joint receptors, esp. from
  resistance to movement. (Bundy, et al. 2002)

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Proprioception

• Underresponsive/ seeking as a modulator
• Defensive?? (little evidence for)

• .

principles

• Calming/ Organizing
• Heavy work, jump, crash, resistance, push/pull
• i.e. squeeze ball, carry groceries, jump on
  trampoline, tug of war, weighted bookbag, pillow
  crashing, hanging by arms or climbing

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Vestibular

• Sensation derived from stimulation to the
  vestibular mechanism in the inner ear that occurs
  through movement and position of the head
  contributes to posture and the maintenance of a
  stable visual field (Bundy et al., 2002)

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Vestibular

• Underresponsiveness/ poor registration/ seeking
• Defensive/ Avoiding
• Gravitational Insecurity

• 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 adults 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.

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By Wiley Miller Non Sequitar
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Visual

• Underresponsive/ Seeking
• Defensive/ Avoiding

• Alerting
• High intensity, contrast, or change of stimuli
• i.e. bright lights, contrasting colors
• Cover blocks in foil, roll a clear ball with
  moving objects inside, highlight words, label
  drawers with bright colors
• Use visual input to engage the seeking child

• Calming
• Low contrast, dim
• i.e. low lights, uncluttered environments,
  decreased competing stimuli with attending to a
  task, set up visual blinds with sheets over
  cluttered areas, allow visual breaks in a dark
  room

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Auditory

• Underresponsive/ Seeking
• Defensive/ Avoiding

• Alerting
• Strong intensity or changing sounds
• Music with unpredictable rhythm
• I.e.. Ring bell at stimuli you want child to
  attend to

• Calming
• Repetitive, constant, quiet
• Rhythmic music,
• Quiet spaces for child to retreat to when over
  stimulated
• Carry headphones with calm, rhythmic music
• Warn of loud noises, use earplugs
• In Class, seat away from loud speakers and traffic

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Taste/ Smell

• Underresponsive/ Seeking
• Defensive/ Avoiding

• Alerting
• Strong intensity
• i.e. Spicy, sour, such as warheads, sour patch
  kids, BBQ sauce, sour straws)

• Calming
• Mild intensity, nondistinct or familiar
  qualities, gradually progress tastes to expand
  diet
• i.e. Use unscented cleaning products/ soaps,
  start with bland foods (cream of wheat, mashed
  potatoes)

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There is no recipe that always works! Many
children do confusing things!! Examples A
professional trained in SI should help interpret
the childs behavior and develop an appropriate
program
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Xander
Age 5
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Tactile Sense
Defensive

• What it looks like in Xander
• Defensive with light touch, will not tolerate
  hair-brushing, haircuts, hair washing, etc.
• Particular about type of clothing, how it fits,
  tags must be cut out.
• Difficulty walking barefoot on grass, and must
  assimilate to sand slowly. Change in walking
  surface is tough when barefoot.
• Defensive with gentle touch or affection,
  prefers firm pressure when touched.

• How we treat Xander
• Equipment we have resistance tunnel, brush,
  koosh balls, cotton balls, sand, rice, beans
  playdoh, vibrating tools, and any food he will
  tolerate.
• Wilbarger brushing/joint compression protocol.
• Throughout the day we encourage Xander to try
  new input, with each success he is rewarded.
• Educate those Xander interacts with.

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Proprioceptive Sense
Seeker

• What is looks like in Xander
• Seeks high impact in play- running, jumping,
  bumping into people and objects often.
• Runs, jumps, bounces, wiggles nearly
  continuously! (Looks a lot like hyperactivity.)
• Even at rest he often rolls, kicks, flicks his
  arms/legs, drags his head, etc.
• Seeks deep impact during typical daily routine
  activities- rubbing against walls as he walks,
  bouncing off of or pushing on objects.

• How we treat Xander
• Equipment we have mini-trampoline, weighted
  vest, bear hug vest, weighted shoes, pillow and
  blanket, ball pit, therapy ball, vibrating tools,
  joint compressions (with brushing protocol).
• Allow plenty of time for gross motor play,
  including lots of rough play (wrestling, steam
  roller, pillow fights).
• Regular proprioceptive activity (every 15-30
  minutes).

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Vestibular Sense
Fluctuates

• How we treat Xander
• Equipment we have swings (indoor and outdoor),
  scooter board, mini-trampoline, therapy ball,
  during summer we go to the pool often.
• During periods of seeking, we give Xander
  sensory choices to feed his need - then
  transition to new activities.

• What is looks like in Xander
• At times he strongly seeks vestibular input by
  spinning, hanging upside down from furniture,
  standing on his head, swinging, riding his bike.
• Other times he avoids taking his feet off the
  ground, resists movement in the car, avoids
  swings, dislikes riding in the stroller/wagon..

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Visual Sense
Fluctuates

• How we treat Xander
• During defensive times we give him time in a
  dark room, sometimes with his eyes/head covered.
  
• In the community we take a blanket which he will
  pull over his head when over stimulated.
• Hand held video games give him something to
  focus on when the surroundings are too much to
  handle.
• We often use visual supports/ but keep them
  simple and avoid extraneous pictures/ colors

• What it looks like in Xander
• Easily overwhelmed in cluttered environment with
  numerous stimuli to accept
• Easily distracted by visual stimulus in every
  day environment and sometimes hides eyes
• Easily distracted by school work/ therapy/ ABA
  work that is visually over stimulating making it
  difficult to complete an assignment or task.
• Sometimes repeatedly tracks for no apparent reason

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Auditory Sense
Defensive

• What it looks like in Xander
• Defensive with loud sounds or too many sounds at
  once. If more than one person speaks at once, he
  is easily upset.
• Often screams or begins self stimulatory
  behavior in situations he cannot control when the
  auditory stimuli is overwhelming.
• Puts his hands over his ears and seeks a
  secluded space, usually with his own verbal
  protestattempting to drown out the offensive
  noise.

• How we treat Xander
• At home we limit unnecessary noise, enforce
  strict rules regarding appropriate speaking, give
  warnings for loud noises.
• In times of unexpected loud noise, we give bear
  hugs while removing him calmly and quietly from
  the noise/situation immediately.
• Outside our home we prepare by describing noises
  he will hear, or give him headphones to drown out
  the noise.

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The Sensory Diet
It is very important that regular sensory
activities are used to keep Xander centered for
optimal function throughout the day.
Morning Routine Brushing/Joint Compressions At
school Bear Hug Vest, Weight Vest, Crash mat,
Brushing/Joint Compression After school Quiet
Activity (rest time) Sensory Choice(s) Afternoon
Activities including calming input brushing
Evening Routine Brushing/Joint Compressions Outsid
e Play Sensory Choice(s) Dinner Bath/Brush
Teeth/Pajamas Brushing/Joint Compressions Quiet
Time (reading, tv, massage)
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Other ways to handle Sensory Integration
difficulty
Social Stories
Visual Schedule
How does your engine run? (ALERT Program)
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Special Circumstances
GROCERY STORE
DOCTOR
LIBRARY
DENTIST
WALMART
HAIR CUT
VACATION
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Some of Xanders successes
(all previously impossible with STRONG resistance)

• Xander tolerates his hair grown out and cut
  rather than buzzed!
• Xander goes to the dentist and has his teeth
  cleaned!
• Xander jumps in the pool, dives for toys, and
  completes a somersault!
• Xander eats a regular meal at school!
• Xander calmly says no thanks to sensory input
  he doesnt want, rather than screaming NOOO!

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References Ayres, A. J. (1979). Sensory
Integration and the Child. Los Angeles Western
Psychological Services. Bundy, A., Lane, S.,
Murray, E. (2002). Sensory Integration Theory and
Practice, 2nd Ed. Philadelphia. F.A.
Davis. Case-Smith,J. (2000, Sept.). Intervention
Strategies for Children With Autism. Seminar
handouts from lecture at SCOTA Conference,
Charleston, SC. Dunn, W. (2002, Feb.).
Implementing a Sensory Processing Approach in
School Practice. Seminar Handouts from lecture at
SCOTA Conference, Charleston, SC. Kranowitz,
Carol Stock. The Out of Sync Child Recognizing
and Coping with Sensory Integration Dysfunction.
New York, NY The Berkley Publishing Group,
1998. McIntosh, D.N., Miller, L. J., Shyu, V.
Hager, R. J. (1999). Sensory-modulation
disruption, electrodermal responses, and
functional behaviors. Developmental Medicine
Child Neurology, 41, 608615. Miller, L. J.,
Lane, S. J. (March 2000). Towards a consensus in
terminology in sensory integration theory and
practice Part 1 Taxonomy of neurophysiological
processes. Sensory Integration Special Interest
Quarterly, 23, 1-4.