Introduction
Hi my name is Megan-Lee Carrington I am a third year Occupational Therapy student about to embark on my last placement before becoming a qualified OT. My previous placements have been in community physical and mental rehabilitation, older person’s mental health and special education. While on the special education placement I was introduced briefly to sensory integration and was immensely intrigued by how it was used with the children. Therefore I have chosen to investigate the sensory integration approach and present to you my findings within this blog.
What is Sensory Integration?
Sensory integration was first brought to light in the 1960’s and 1970’s by A. Jane Ayres. Ayres was a psychologist and an occupational therapist that specialised in child development. Ayres explained sensory integration as a way the brain organizes sensory information to produce functional behaviour (Parham & Mailloux, 2010). Ayres theorised that higher cortical organization such as reasoning and decision making is dependent on the development of sensory organisation processes. She wrote that the “vestibular system is the unifying system. It forms the basic relationship of a person to gravity and the physical world. All other sensations are processed in reference to this vestibular information”(Ayres, 1979 cited in Bruce & Borg, 2002, p. 303). Ayres then went on to develop the ‘Ayres sensory integrative approach’. Dunn (2011) describes three basic concepts that underpin this approach. The first is ones ability to receive and organise sensory input in relation to their environment. The second is that the foundation for cognitive development and emotional regulation is related to how well the child’s brain can organise such input. Lastly is the connection the child makes between a sensory experience and whether that experience is meaningful to them or not, further increasing cognitive and emotional development. But if a child is deprived of sensory experiences then the brain has little need to develop. Because the brain is not receiving new input from the body’s senses it does not create new synaptic connections, which reduces the speed and amount of information the brain can process. The result of this in children is developmental delay or disorders which can lead to behavioural and social difficulties.
Developmental delays/disorders:
Developmental disorders are not only acquired after birth, some are congenital. Such as Autism, Chromosome disorders, Fragile X syndrome or Down’s syndrome. Winnie Dunn cited in (Dunn & Daniels, 2002) developed a model called ‘Dunn’s model of sensory processing’. This model explained how children with developmental delay/disorders have differing thresholds for stimulation and how they typically respond. Four different characteristics were identified; low registration, sensation seeking, sensory sensitivity and sensory avoiding. Children who experience low registration are passive self regulators who have high neurological threshold for stimulation. The behaviours often exhibited by these children a repetitive, withdrawn or apathetic. The contrast to this is a child with a high neurological threshold but is an active self regulator, known as sensation seeking. These children crave sensory input and actively seek it, mostly in the form of deep pressure. Children who have low neurological thresholds and regulate the sensory input passively are sensory sensitive, they have difficulty maintaining attention, are highly distractible and hyperactive. Whereas sensory avoiders are active regulators with a low neurological threshold, they regulate the amount of input by exhibiting avoidant behaviours such as tantrums (Dunn & Daniels, 2002). This information is gathered through observation from parents and or caregivers and the therapist through an assessment know as the Sensory Profile.
Sensory Integration techniques:
Deep Pressure
Deep pressure works by facilitating an increase in the parasympathetic system reducing the fight or flight response initiated by the sympathetic system (Leew, Stein & Gibbard, 2010). The role of the parasympathetic system within the body is to promote relaxation and reduce energy consumption (Marieb & Hoehn, 2007). When deep pressure is used with children this can reduce anxiety and over arousal to stimuli, and increase attention to task (Leew, Stein, & Gibbard, 2010). Ayres and Robbins (2005) discuss the calming effects heavy touch pressure has on some children with Autism. Of course deep pressure is not suitable for all children as discussed earlier some are sensory seekers and some are avoiders. An Autistic child who is a ‘seeker’ will crave deep pressure for instance in their hands. Ayres and Robbins observed that some children act as if “their hands are uncomfortable much of the time, and that hard pressure makes them feel better” (p. 129). Common deep pressure techniques used to calm or increase attention and alertness in children are; stretching and compressing joints of the arms and legs, weighted vests and blankets (Champagne, 2011), Hug-Machine and pressure garments (Baranek, 2002).
Here are some clips of the techniques identified above in use:
Start this clip at 56 second and watch till 1:42 for the occupational therapists perspective.
Joint compression therapy:
Weighted vest's in the class room
Personal experience
While on my paediatric placement I was introduced to a 12 year old boy named Andrew. He had a diagnosis of Autism and could not speak but knew some sign language. Andrew already had in-place a coping strategy introduced by my supervisor that work extremely well. The students in this class had a sensory room with different sized therapy balls, different textured toys and lights. I was told that Andrew found bouncing and rolling on the therapy balls calming and enjoyable. One day I was visiting the class and observed Andrew become frustrated at a writing activity he was doing. I was expecting this to turn into a full blown meltdown as the teacher aid was not able to calm him down. Instead he got up and took himself to the sensory room and used the therapy balls. After a few minutes he came out, returned to his desk and continued with his writing task. I was amazed he had completely calmed down and was able to reengage without fuss. This experience proved to me how effective sensory integration can be for children with developmental delays/disorders.
Conclusion
In summary I have introduced sensory integration and the theory behind this approach. I have introduced and discussed one type of intervention technique commonly used within sensory integration interventions. During the research for this approach it became clear to me how unique this section of the occupational therapy profession is. It is understandable why therapists need post qualification training to be able to practice using this approach and within this area. I find pride in reading the success sensory integration has had on children’s lives, or watching clips when a child’s face lights up with delight after receiving an intervention such as deep pressure. It is exciting to think that this is part of the occupational therapy profession and that I could be making such changes in a child’s life in the near future.
References
Barnek, G. (2002, October). Efficacy of sensory and motor interventions for children with autism. Journal of autism and developmental disorders, 32(5), 397-422. Retrieved July 23, 2012, from ProQuest health and medicine.
Bruce, M., & Borg, B. (2002). Psychosocial frames of reference: Core for occupation based practice. Thorofare, NJ: SLACK Incorporated.
Champagne, T. (2011). Sensory modulation and environment: Essential elements of occupation (3rd ed.). Sydney, Australia: Pearson Australia Group.
Dunn, W., & Daniels, D. (2002). Initial development of the infant/toddler sensory profile. Journal of early intervention, 25(1), 27-41. Retrieved July 23, 2012, from ProQuest health and medicine.
Hodgetts, S., & Hodgetts, W. (2007). Somatosensory stimulation interventions for children with autism: Literature review and clinical considerations. The Canadian journal of occupational therapy, 75(5), 393-400. Retrieved July 25, 2012, from ProQuest health and medicine.
Khilnani, S., Field, T., Hernandez-Reif, M., & Schanberg, S. (2003, November). Massage therapy improves mood and behaviour of students with attention-deficit/hyperactivity disorder. Child and youth, 38(152), 623-638. Retrieved July 25, 2012, from ProQuest health and medicine.
Leew, S., Stein, N., & Gibbard, B. (2010, April). Weighted vests' effect on social attention for toddlers with autism spectrum disorder. Canadian journal of occupational therapy, 77(2), 113-124. Retrieved July 23, 2012, from ProQuest.
Marieb, E., & Hoehn, K. (2007). Human anatomy and physiology (7th ed.). San Francisco, CA: Pearson Benjamin Cummings.
Parham, D. & Mailloux, Z. (2010). Sensory integration. In J Case Smith, & J.C. O’Brien (Eds.), Occupational therapy for children (6th Ed) (pp. 325-372). St. Louis, Mo. London: Mosby.
