Sensory Integration Therapy
Patty Donnellan, OTR/L
Sensory Integration (S.I.) is the ability of the brain to detect, modulate, discriminate, and integrate the three special sensory systems – tactile (touch), vestibular (movement), and proprioceptive (body awareness). Although these sensory systems are less familiar than the visual (seeing), auditory (hearing), gustatory (taste) and olfactory (smell), they are critical in order for humans to experience, interpret and respond to the various stimuli in our environment.
Tube-fed children are prone to develop S.I. dysfunction or difficulties. This may be a result of the fragile medical conditions which warranted the tube placement, their premature nervous systems or their lack of early sensory input. Sensory integration dysfunction in children causes them to process sensory stimuli from the environment (i.e. sights, sounds, touch, tastes, smells, and movement) in an inaccurate way, resulting in “sensory seeking” or “sensory avoiding” behaviors, or “dyspraxia.”
Children who have “sensory seeking” behavior are commonly children with nervous systems that are under-responsive to sensation (hypo-sensitive). They do not always process sensory information that is coming into the brain. They may seek intense sensory experiences for an extended duration. They may demonstrate any or all of the following behaviors:
Hyper-activity, impulsivity, decreased response to pain
Poor body awareness - clumsiness, touching objects or others too hard or too often
Love for foods that are spicy, hard/crunchy, extremely cold/hot in temperature, carbonated drinks, and over-stuffing their mouth of food
Children who have sensory avoidant behavior or “sensory defensiveness” are commonly children with nervous systems that are overly responsive to sensation (hyper-sensitive). They may have “fight or flight” responses to sensory stimuli. They may demonstrate any or all of the following behaviors:
Responding to being touched with withdrawal or aggression (Tactile Defensiveness)
Unwilling to take risks, extremely cautious in their environment (e.g. playgrounds)
Motion sickness, afraid of heights (e.g. carsickness, refuses to get on a slide)
Anxious/uncomfortable in over-stimulating environments (e.g.malls, playgrounds, public transportation)
Very picky eater – refuses to eat certain textured foods, sensitive to some food smells or temperatures (Oral defensiveness)
Avoiding touch with substances (e.g. messy foods, mud, sand) or will only use utensils or fingertips rather than whole hand to manipulate objects
Struggles with self-care activities; will only wear certain types of material for clothing and or wear clothing in a particular way (e.g. socks, no hats); complains with face washing, hair brushing, tooth brushing, and hair cutting.
Children who have “dyspraxia” have poor motor coordination as a result of decreased proprioceptive (body awareness) and/or vestibular (movement) processing of the central nervous system. A child with dyspraxia may be a very clumsy child or a child who has much difficulty coordinating the tongue for movement when formulating words or managing foods.
It is important to note that a number of medical conditions can also interfere with efficient and effective sensory processing. Examples include gastro-esophageal reflux, low muscle tone, side effects to certain medications and visual impairment. For example, a child with low muscle tone in the body or mouth requires an intense amount of sensory input in order to facilitate a muscular response. Some medications can affect the sense of taste or cause nausea, which may cause a child to react to a mealtime experience in an overly sensitive manner. Or, a child with a visual or auditory impairment may have a startle response to food entering if they are not warned that food is about to enter the mouth or is not permitted to explore the food beforehand. A choking or gag response may occur in these situations and can be confused with thinking that the child has an oral defensiveness due to sensory integration dysfunction. A child with reflux may experience excessive vomiting resulting in an inflamed throat and mouth, most likely leaving him/her uninterested in eating.
If you suspect that your child may have sensory integration difficulties, it is first suggested that you keep a journal of when these behaviors occurred, where they happened, who was involved, and how your child responded. You then may see a pattern of why these behaviors occurred. The journal will be helpful information when seeking the help of an occupational therapist (O.T.). When seeking the help of a therapist, review with him/her their background and whether they are experienced with sensory integration therapy. Not all O.T.s are formally trained or certified in Sensory Integration Theory.
The goal of S.I. therapy in occupational therapy is to help the child’s sensory system adapt to the normal “occupations” of childhood – playing, eating, dressing, washing and sleeping. Treatment helps to improve a child’s self-regulation, sensory-motor abilities, social participation and self-esteem. This is accomplished by motivating and guiding the child through challenging activities, helping the child’s nervous system make a successful and organized response. Most importantly, occupational therapists strive to provide parents with a clear understanding of S.I. and supply a “sensory diet” - a custom home program designed specifically for their child. The sensory diet provides a number of activities and ideas to help the child on a daily basis at home and in the community. The key to a successful sensory diet is that it is effective in providing the input your child’s nervous system needs, it easily fits into a normal routine, and it is fun for both the parent and child. The time frame of treatment is variable according to insurance benefits and your child’s needs. As a parent, you should see changes in your child’s behavior fairly quickly, if therapy is consistent and the home sensory diet is carried over on a daily basis by caregivers.
Here are some mealtime ideas that may be helpful when working with tube-fed children (eaters and non-eaters) that have sensory issues:
Let them play with the food as much as possible. Make food fun. If they throw the food, instead have them kiss it or bite it goodbye into an “all done bowl.” Always offer the food you are eating for them to explore. Talk about it with them, e.g. “It’s soft, hot, green, etc.”
For non-eaters, encourage the child to explore their favorite toys orally. Dip them into flavored water, pureed foods, etc. Help the child be more comfortable with hands/ toys/ foods being in or near their mouth.
Be observant of the eating environment – Does your child need a distraction such as music? Does your child need a puppet/favorite character to help them model eating? Would it help to place a mirror in front of them to see where their mouth is? Is the seating comfortable and positioning appropriate so that they do not slip out or slump?
Make eating time a regular routine and make it fun!
Before eating: Do the Wilbarger brush therapy/joint compressions as well as an oral stimulation warm-up (e.g. NUK brush, toothbrush, massager, fingers, washcloth).
During eating: Do not present all foods at once. Instead, present them one at a time. When your child gestures or says that they are all done with that food, clear all of it away from the table, hands and mouth with a wash cloth before going onto the next food.
It is helpful to make a picture book that tells a story using their personal photos doing oral exercises of “How to warm up your mouth before eating.” Make it a routine to use this book before mealtimes.
After eating, praise the child for whatever success they had. If there was none, always be positive and say, “Nice trying!”
On a regular basis, perform massage (for example the Rice Infant Sensory Stimulation (RISS)).
To learn more about Sensory Integration, see the Reference Section of this newsletter.