What is Sensory Integration?

Sensory Integration is the organization of sensory input for appropriate use.  This theory was developed by Dr. Jean Ayres, an occupational therapist, as well as for the intervention strategy that was based on this original theory.

The term Sensory Integration is used to describe certain processes that go on in our brain, allowing us to make sense of the information we get from our environment and act on it.  It is the process by which the brain interprets and organizes various sensory experiences including sight, sound, smell, touch, movement, body awareness, and the pull of gravity.

Sensory integration is a normal function of central nervous system and provides a foundation for more complex learning and behavior.  For some individuals sensory integration does not develop as efficiently as it should. Sensory integration dysfunction can result in motor development difficulties, learning difficulties, or behavioral concerns.

We take in information through our senses including sight, sound, taste, touch, smell, movement and pressure. Once this information reaches the brain it must then be organized for use.

How do I know if my child has a sensory integration disorder?

As efficient organization of sensory information provides the foundation for the development of functional skills, there can be many potential outcomes that might cause a parent concern.

A disruption in sensory processing can result in sensory defensiveness (sensory seeking or sensory avoiding behaviors), problems in self-regulation (activity levels too high or too low, not matched for the task at hand), and difficulties with praxis (the ability to conceive, organize and execute skills of all kinds). Disruptions in processing sensory information can interfere with self-care skills, language skills, motor skills, academic skills, and social/emotional skills.

Some specific concerns might be:

• Takes a long time to learn a new task/skill.
• Seems clumsy, has too many accidents.
• Not keeping up with peers.
• Presents as a behavior problem at school.
• Has trouble with handwriting.
• Demonstrates unpredictable behavior in social situations, especially new or highly stimulating ones.
• Acts restless/fussy when held.
• Displays short attention span.
• Seems overly dependent on routine or schedules and/or easily upset with minor changes.
• Acts impulsively or explosively.
• Angers easily or frequently accused of of fighting, acting out or "bullying" others.
• Appears overly colicky or fussy.
• Exhibits "picky" eating behavior.

What should I do if I suspect that my child has this difficulty?

If a child is suspected of having a sensory integrative disorder, an evaluation is needed. An evaluation usually consists of standardized testing (when possible), a structured observation of play and responses to sensory input, and an interview with the parent/guardian. If intervention is recommended it can be intensive (more than once a week), weekly, or consultative.

Can't they just practice?

We are sure that the family and teaching staff have tried to "teach" the child skills that appear difficult. Unfortunately, unless the child has the underlying ability to "be taught" the skill, it will not be mastered.  It is important to remember that not all types of learning, particularly motor learning, can be mastered by practicing. No matter how many times children practice a wrong pattern, it won't make it right.  Until they have the internal ability to do it correctly, they will be unable to correct the problem.

What would happen during therapy?

An important component of sensory integrative therapy is the inner drive and motivation of the child. This plays a crucial role in the selection of the therapeutic activities.  The therapist, based on the evaluation results, will utilize their specialized knowledge to analyze the tasks your child needs to master for successful involvement in life's roles.  The therapist will customize the activities during the session based on your child's needs.

Simply put, the therapist will set up the treatment room with the types of activities that the child needs in order to have more efficient and effective processing of sensory input.  This allows the child to guide the session, within the activities that the therapist has set-up, and therefore, capitalize on the inner drive.  This active involvement and exploration enables the individual's nervous system to become a more efficient organizer of sensory information.  The intention of intervention is to provide the child with a physically and emotionally stimulating environment, so that this comfortable experience allows for the development for more functional and efficient skills.

What is sensory processing, and how is it different from SI?

Sensory processing is the first step of sensory integration.  Sensory input must be taken in, filtered, and organize before integration can occur.  Integration is the final step of an organized response to inputs received. It includes a motor response typically called an adaptive response by followers of Ayres.

What is body awareness?

There is an internal body "map" each of us has that allows us to know where we are, what position we are in, and how we are moving at any given moment. The body map allows us to move without relying on our visual system to guide each movement. The body map is created over time as we develop from infancy throughout childhood, via repeated accurate sensory inputs produced from our motion through space. Inaccurate sensory perceptions do not allow for the creation of accurate body maps. Children with inaccurate body maps typically rely heavily on their visual systems and have significant difficulty with many aspects of motor skill.

What is the vestibular system?

This sense allows us to maintain our balance and upright posture. It is also closely involved with the visual system, allowing us to judge our motion in relation to the objects around us. This can sometimes play tricks on us (sitting in one of those movies where you feel like you are moving when you aren't). This sense allows us to feel secure with gravity and is a way of knowing where we are in relation to gravity (i.e.. if we are upside-down or sideways).

What is proprioception?

This is the sense that allows us to know what position our body parts are in. For example, without looking at them, you can tell if your elbows or knees are bent or straight. This sense also tells us about the force of our movements. So if we see a cup and want to reach for it, we can judge how much force and speed we are reaching with so we can accurately get our hand to the cup without knocking it over or missing it. We can also tell how hard we need to hold on to lift the cup without squashing it or dropping it. It is primarily proprioception you are using when you walk a familiar flight of stairs in the dark and know exactly where to place your feet and how high the steps are by the feel of the movement of your legs. This sense is extremely important for body awareness and coordinated movements.

What is sensory defensiveness?

Sensory defensiveness is a term coined by some OT's to describe a group of over sensitivities to touch, vision, auditory, movement and smell sensations. Sensory defensiveness is just oversensitivity to certain input. With the term defensiveness, a range of behaviors is implied. These behaviors are the things we can observe that indicate that a sensory input is aversive.

Who will pay for therapy?

Most insurance companies will pay for "medically necessary" therapy. Otherwise the family will assume financial responsibility. My experience with this process is that the insurance company will cover the cost of the evaluation, and then determine funding the services from the results of the evaluation.

When you contact the office for an evaluation, how to proceed with your insurance coverage will be explained.

What is the Sensory Integration and Praxis Test (SIPT)?

The SIPT (Sensory Integration and Praxis Tests) is a standardized test designed to help identify difficulties in the various areas of sensory functioning.  It is the only current standardized measure aimed specifically at the different areas often related to sensory integrative dysfunction.  The SIPT is designed to test children between the ages of 4.0 years/months-8.11 years/months.  Utilizing this tool outside these designated age ranges is strongly discouraged due to the reliability and validity of the test.  The test contains 17 different standardized subtests.  It is typically administered in 2-3 sessions often totaling 4-5 hours of rigorous testing procedures.  Due to necessary certification and cost, this test is not provided at my clinic.

Can Sensory Strategies be Applied by People Other Than a Therapist?

Sensory strategies are usually designed and outlined by a therapist, usually an Occupational Therapist or Physical Therapist who has had specialized training and extended coursework in the area of  Sensory Integration.  Under the supervision or guidance of this therapist, most of these strategies can then be applied or implemented by other individuals including but not limited to parents, teachers, speech therapists, classroom assistants, daycare providers, doctors etc..  This type of sensory program is often called a "sensory diet" or a "sensory motor home program".

What is a "brushing program" or Deep Pressure Proprioceptive Technique?

The Deep Pressure Proprioceptive Technique (DPPT) or brushing program, more accurately referred to as the Wilbarger Deep Pressure Protocol, is primarily used to treat children and adults with Sensory Defensiveness.   When appropriate, this protocol should only be prescribed by a Wibarger trained individual (who is typically an occupational or physical therapist).  It should be used in conjunction with other prescribed sensory activities and only after a thorough sensory interview and profile has been completed, deeming the child or adult an appropriate candidate.  This protocol is applied every two hours during wake time.   When used as indicated, it can dramatically improve the symptoms associated with mild to severe sensory defensiveness.   Please contact the clinic at 630.424.9100 if you would like more information about the use of this protocol.

For additional sensory information, contact Amy Antes.

What Do I Do If Coverage is Denied?

If therapy coverage is denied, you have the following options:

• Make an appeal to your insurance carrier for reconsideration. You must contact your insurance "Member Services" department to obtain steps necessary for the appeal process.
• Talk with the evaluating therapist to explore if there are any less expensive options. (i.e., therapy on a less frequent basis with a home exercise/activity program, community-based services, etc.)