Sensory Integration

Experiencing sensation is a hidden process of complex nonlinear relationships that support effort & action. The person both generates & experiences sensation from a variety of modalities that are modulated, matched with existing memories, synthesized into perceptions, & utilized for all aspects of interaction & occupation. The very act of experiencing sensation alters the nature of the individual & the way in which the individual experiences sensation.

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Sensory Integration a perspective for interpreting behavior

Nandgaonkar Hemant http://hotc4u.tripod.com/

Objectives What is sensory integration?

What are the assumptions of Sensory integration theory?

What are the boundaries of Sensory Integration Theory & Practice ?

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What is Sensory Integration?

A. Based on the work of A. Jean Ayres, PhD, OTR (Ayres, 1972, 1979, 1985) B. A process in the brain Ayres: the organization of sensation by the brain for use in everyday life

Sensory integration Dynamic process Self organizing activity of the individual interaction within an environmental context Individual gains & organizes sensory information through interaction with the environment Nandgaonkar Hemant P.

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Sensory integration sorts, orders & eventually puts all of the individual sensory inputs together into whole brain function

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What emerges from this process?

Increasingly complex behavior The adaptive response & occupational engagement

When the functions of the brain are whole & balanced, body movements are highly adaptive, learning is easy & good behavior is a natural outcome Interaction between sensory systems enable development Nandgaonkar Hemant P.

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What is Sensory Integration?

C. A theoretical framework for understanding human behavior Theory that applies neuroscience to give insight into observed behavioral patterns Provides a perspective for interpreting behavior in a special light D. A clinical framework for intervention Theoretical perspective is used to design assessment and intervention methods

The purpose of the theory in science is to provide a typology, a logical explanation, predication & potential for control, and a sense of understanding

theory of brain behavior relationship Theories are not facts, rather, theories represent provisional statements based on assumptions.

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Assumptions of Sensory Integration Theory 1. The Central Nervous System is plastic 2. Sensory Integration Develops 3. The brain functions as an integrated whole 4. Adaptive interactions are critical to sensory integration 5. People have an inner drive to develop sensory integration through participation in sensory motor activities Nandgaonkar Hemant P.

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Sensory nourishment 1. Sensory input in necessary for brain functioning

2. Results of sensory deprivation experiments 3 Certain types of sensory input are especially influential on Regulation of arousal and attention Formation of attachment and social relationships Organization of actions in the physical world

institutional environment Can contribute to sleep disturbances lack of appetite delayed language development poor concentration bumping the head against a surface Rocking, biting & pinching themeselves Nandgaonkar Hemant P.

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infant under 6 month who had been in an institution Listlessness Emaciation & pallor Relative immobility Quietness Unresponsiveness to stimuli like a smile or coo Indifferent appetite Failure to gain weight properly despite the ingestion of adequate diets Frequent stools Poor sleep An appearance of unhappiness Proneness to febrile episodes Absence of sucking habits Nandgaonkar Hemant P.

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Contributions of Sensory Systems

Contributions of Sensory Systems 1. Access to the world is mediated by sensory receptors •

Sensory receptors detect stimuli

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Sensory information is then moved into the central nervous system

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Sensory information is collated and organized into complex perceptual functions by the central nervous system (CNS)

Seven sensory systems 1.

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Hearing (auditory) Vision (visual) Smell (olfactory) Taste (gustatory) Touch (tactile) Pull of gravity and motion of head in space (Vestibular) Position and movement of muscles and joints (proprioceptive)

Contributions of Sensory Systems 3. Emphasis on tactile, Vestibular, and proprioceptive systems Primitive systems Early to mature Relay information about the body and its boundaries Influence interpretations of visual and auditory information

tactile system a. Primitive reflexes: rooting, sucking, grasping b. Emotional development: bonding & attachment c. Body scheme and skill in moving whole body d. OralOral-motor and hand skills e. Protection from potentially hazardous stimuli

Vestibular system a. Emotional security via relationship to gravity b. Reflexes and responses enabling the mastery of gravity * Head in upright position (head righting) * Extension against gravity * Equilibrium reactions * Control in maintaining posture against gravity

Vestibular system…………….. c. Management of body in space * Spatial orientation * Maintenance of stable visual field * Bilateral motor coordination Anticipation of how to move through space in changing situation

d. Works closely with proprioceptive system

proprioceptive system a. Reflexes mediating alignment of trunk, head, and other body parts b. Modulation of movement * Control of movement in midrange * Fluidity and precision in movement of body parts

olfactory & gustatory systems a. Caregiver Caregiver--infant bonding b. Protection from noxious substances c. Attraction to potentially nurturing substances

visual system a. late to develop

b. Minor contributor to caregivercaregiver-infant bonding * Visual acuity distance in newborns is about 10 inches •Eye contact emerges c. Informs person about distant stimuli d. Important in spatial orientation e. Critical in complex social and communication functions

Contributions of Sensory Systems auditory system a. Late to develop b. Informs person about distant stimuli c. Contributes to spatial orientation d. Critical in language development

Process of organizing sensory information for purposeful interaction

Basic Concepts Basic concepts

Behavioral manifestations

Sensory processing

Sensory integration Nandgaonkar Hemant P.

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The cycle

TREATMENT (Intake)

Sensory intake

Sensory integration

THEORY (Central Nervous system processing)

Planning & Organizing behavior

feedback

Adaptive interaction & learning

EVALUATION Nandgaonkar Hemant P.

(Output)

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Environmental Input & Motivation

Peripheral Sensory Processes

Regulation Of Behavior

Central Sensory Processes

Evaluation Of The Performance

Other Central Processes

Change In The Environment

Execution

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The Peripheral Sensory Processes

resting membrane potential

receptor potential

action potential

The receptor respond best to one Nandgaonkar Hemant P. form of energy

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Sensory registration

Sensory discrimination

Neuromodulation

CENTRAL SENSORY PROCESS

Intrasensory integration

Modulating Sensation

Intersensory integration Nandgaonkar Hemant P.

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Other central processes

Internal sensory maps

Planning & programming

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activation

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Sensory processing

Reception

modulation

integration

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organization

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Key Neurobehavioral & Organizational Processes

Sensory processing 1. Broad term that refers to the management of incoming sensory information by both the peripheral and central nervous system 2. Sensory integration is a component of sensory processing Nandgaonkar Hemant P.

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Sensory detection or registration 1. CNS records incoming sensory information at multiple levels 2. Enables the person to notice or attend to stimuli 3. Sensory stimuli may be detected by receptors yet not noticed 4. Probably involves complex interplay of processes involving the limbic system, reticular formation, & cerebral cortex Nandgaonkar Hemant P.

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Sensory modulation 1. Neuromodulation: process by which the CNS adapts its output to a continuously changing internal and external environment 2. Enables the CNS to regulate behavioral responses to sensory stimuli 3. Sensory modulation is a type of neuro modulatory process involving the adjustment of neural messages that convey information about the intensity, frequency, duration, complexity, and novelty of sensory stimuli Nandgaonkar Hemant P.

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Sensory modulation 4. If modulation is not working well, the person is unresponsive to sensory stimuli, craves excessive amounts of stimulation, or is overwhelmed and distressed by sensory stimuli 5. Linked to arousal level, which may be too low or too high if sensory modulation is not working well Nandgaonkar Hemant P.

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Sensory modulation 6. If working well, allows person to notice relevant stimuli and filter out unimportant stimuli 7. Contributes to selfself-regulation (ability of child to selfself-manage emotions & behavior) 8. Probably related to sensitization, habituation, and other facilitatory and inhibitory processes in the CNS Nandgaonkar Hemant P.

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Sensory discrimination 1. At a behavioral level, level, refers to the person’s ability to distinguish between different stimuli and to perceptually organize the temporal and spatial qualities of stimuli 2. Related to CNS processes of distinguishing between and organizing temporal and spatial characteristics of sensory stimuli Nandgaonkar Hemant P.

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Sensory integration 1. The ability to organize sensory information for use : umbrella term encompassing many CNS processes 2. Involves CNS processes of modulation and perceptual organization Nandgaonkar Hemant P.

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Sensory integration 3. Provides critical information for planning of action 4. Sometimes the term “Intersensory integration� is used by neuroscientists to refer to the CNS process in which a neuron, or cluster of neurons, receives input from more than one sensory system, so that it activity reflects multiple sensory inputs Nandgaonkar Hemant P.

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Body Scheme or Body Concept 1. SensorySensory-cognitive map of the physical self 2. requires sensory integration of tactile and proprioceptive information 3. Thought to be an important contributor to praxis 4. Key brain structures are thought to be the thalamus and parietal lobe Nandgaonkar Hemant P.

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An intelligence of doing

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Praxis 1. An intelligence of doing (Ayres, 1985) 2. Involves cognitive processes of ideation and motor planning

3. Ideation: the ability to conceptualize a novel action, generate an idea of what to do 4. Motor planning: the ability to organize a novel action, know how to do it – organization of action in space and time Nandgaonkar Hemant P.

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Praxis 5. Enables person to produce adaptive behavior 6. Involves use of feedback to adjust performance 7. All parts of the brain contribute to this complex ability Special role of frontal lobe, parietal lobe, thalamus, & cerebellum Dependent on sensory integration and cognition Nandgaonkar Hemant P.

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Organization of Behavior 1. Ability to organize action in the present time and space, as well as in future time and space

Examples: Planning what to do in today– today–and doing it Planning what to do over the weekend Planning what to do next summer Nandgaonkar Hemant P.

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Organization of Behavior 2. Dependent upon complex processes, including sensory integration and praxis

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BaSiCs Emphasis on the bodybody-centered senses: tactile, proprioceptive, and Vestibular Sensory systems have pervasive influences on the organization of behavior, learning, and emotions

Sensory input is important, but adaptive use of sensory information is critical Child is an active participant in development and adaptation

Adaptive responses 1. Adaptive response = successful response to environmental challenge 2. Must come within child: involves child’s desire for mastery 3. Child must be acting on the world 4. Each adaptive response lays the groundwork for more complex responses

Adaptive responses

5. Adaptive responses result in more complex sensory integration processes

6. Adaptive responses drive development forward

7. May be evidenced in motor, cognitive, language, or socialsocial-emotional areas

Requirements for an adaptive response

Environment that presents sensory information Challenges to the child that are neither too great nor too small

Requirements for an adaptive response Sensory integration within the child (organization and filtering of information) Motivation to meet challenge that comes from within the child Organization of a response that meets the challenge

Neuroplasticity & adaptive responses 1. Neuroplasticity = potential for a neurological structure or function to change as a result of experience Biological base for development, learning, and recovery from brain injury Active, exploratory organism is necessary for brain changes Most dramatic potential for change is in young organisms

Potential for changes is present throughout the lifespan

2. Adaptive responses lead to better sensory integration via Neuroplasticity

Developmental versus reactive plasticity

Developmental Neuroplasticity Occurs during maturation Provides a theoretical underpinnings for Sensory Integration

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Reactive Neuroplasticity Potential for the CNS to regain lost function after insult It’s a rule rather than exception

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Proposed mechanisms Dentritic arborization Synaptogenesis Sprouting Enhanced myelination Change in structure Unmasking Substitution & reorganization Nandgaonkar Hemant P.

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Dentritic arborization Increase in number of Dentritic branches of a given neuron Therefore greater capacity for synaptic exchange Enhanced neural communication & processing Enriched environment Nandgaonkar Hemant P.

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Synaptogenesis Increase in number of synapse Increase in receptor sites Increase in the number of synaptic knobs as well as and improved efficiency in the release & use of neurotransmitter substances

Appear to be related to environmental demands or requirements for use Nandgaonkar Hemant P.

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Sprouting Process of neuronal recovery whereby a neighboring, uninjured neuron gives off sprouts/ offshoots which attempt to bypass injured neuron to regain function lost by injury

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Enhanced myelination Proposed increase in myelin Enhances neuronal transmission & conduction velocity, create potential for more advanced skills & behavioral interactions Enriched environments Specific goal directed, task oriented training Nandgaonkar Hemant P.

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Change in structure Brain structure may be modified as a result of environmental demands & sensory input

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unmasking The uncovering of an area or pathway in the nervous system which has always existed but is not currently being utilized In tactile defensiveness – unmasking of DCML, RA, ANS Nandgaonkar Hemant P.

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Substitution & reorganization Currently functioning area expands its function & also becomes responsible for the lost area or function

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Both internal & external circumstances

Hebb Synapse A pre synaptic cell’s persistent success in activating a postsynaptic cell strengthens & retains the synapse contact between the pre & post synaptic neurons Neurons that fire together, wire together

Experience dependent adaptability

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Long term Potentiation Controlled bursts of stimulation across synapse produced long lasting increase in synaptic efficiency

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Relevance of Sensory Integration to the Daily Lives of Children

A. What kids do – their occupations?

Explore & play Chores Self care School work Nandgaonkar Hemant P.

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B. Development of skills and capabilities 1. SelfSelf-regulation of emotions and arousal 2. Ability to figure out how to interact with the environment (physical & social) 3. Establishment of work, play, motor, and social skills

4. Engagement in meaningful and purposeful occupations Nandgaonkar Hemant P.

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C. Construction of identity Who am I becoming ?

What can I do ?

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Sensory Integration as a Clinical Frame of Reference

Historical perspective on Ayres’s work 1. Occupational therapy : purposeful behavior, everyday occupations 2. 1960s : PerceptualPerceptual-motor treatment approaches 3. Funding for field of learning disabilities 4. In private practice while doing research 5. Primary concern : to help children by synthesizing and applying knowledge of nervous system development Nandgaonkar Hemant P.

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Research tradition 1. Test development : SCSIT, SIPT 2. Psychometric approach to theory development (e.g., factor analytic studies) 3. Effectiveness studies Nandgaonkar Hemant P.

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Assessment methods used 1. Standardized instruments 2. Formal and informal observations 3. Parent questionnaires

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Typology of sensory processing disorders

Perceptual or discrimination disorders a.

Child has difficulty deciphering sensory information accurately

b. Tactile and visual perceptual problems measured by SIPT c. Often seen in children diagnosed with LD. ADD, Developmental Coordination Disorder, and developmental disabilities

Modulation disorders a. Disorders involving under – or over-responding to sensory input, usually with a typical affective response (may be flattened or heightened) b. Defensiveness – generalized, or specific to particular sensory systems * Tactile defensiveness * Gravitational insecurity * Other systems * Child often has problems identified as behaviorally difficult

Modulation disorders

c. Under responsiveness * Most severe cases involve poor sensory registration – child is passive and oblivious to stimuli * Other cases involve sensation-seeking behaviors – child gets into trouble by seeking intense input

Modulation disorders d. Special role of proprioceptive system in modulation e. Some children will vacillate between the extremes of over-and under-responding, especially children with autism f. Often seen in children diagnosed with LD, ADD, regulatory disorders, autism spectrum disorder, fragile x syndrome, and other development disorders

Vestibular and bilateral integration disorders a. Difficulty with postural and equilibrium functions of Vestibular system b. Vestibular problems often linked with poor bilateral coordination and sequencing of movements c. Often seen in children diagnosed with LD or ADD, sometimes Developmental Coordination Disorder

Dyspraxia

a. Involves difficulty conceptualizing and/or planning novel actions b. SIPT studies link this with both tactile and visual perceptual problems

Dyspraxia c. Association with tactile perception is very robust d. Thought to be dependent upon general sensory integrative capacities e. Often seen in children diagnosed with LD, Development Coordination Disorder and other development disabilities

SI DYSFUNCTION

DYSPRAXIA

POOR MODULATION Nandgaonkar Hemant P.

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Boundaries of sensory integration Theory & Practice

Boundaries & the population SI theory is intended to explain mild to moderate problems in learning & behavior Especially problems associated with motor in coordination & poor sensory modulation that cannot be attributed to frank CNS damage Nandgaonkar Hemant P.

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Sensory integrative functions

Sensory integration is the neurological process that organizes sensation from one’s own body & from the environment & makes it possible to use the body effectively within the environment. The spatial & temporal aspects of inputs from different sensory modalities are interpreted, associated & unified. Sensory integration is information processing…………

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The brain must select, enhance, inhibit, compare & associate the sensory information in a flexible, constantly changing pattern. In other words, the brain must integrate it.

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Ayres (1989) Sensation from the body, especially during purposeful activity provide the means by which a neuronal model or percept of the body is established………………

An accurate body scheme is necessary for practic tasks, for a sense of directionality & for relating body to space. At the same time conceiving, planning, & executing adaptive action is major means by which sensation is made meaningful & translated into body percept…………….

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Praxis is uniquely human aptitude that underlies conceptualization, planning & execution of skilled adaptive interaction with the physical world………..(and ) is fundamental to purposeful activity. Praxis & perception are both end products of Sensory integration……………

Somatosensory, vestibular & visual input to sensory integration & praxis are essential to organism environmental interactions……

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Question What is Sensory Integration?

What are the boundaries of sensory integration theory?

What are the end products of sensory integration?

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