Sensory Integration

What is sensory integration?

“Sensory Integration is the neurological process that organises sensation from one’s own body and from the environment and makes it possible to use the body effectively within the environment.  The spatial and temporal aspects of inputs from different sensory modalities are interpreted, associated and unified.  Sensory integration is information processing… The brain must select, enhance, inhibit, compare and associate the sensory information in a flexible, constantly changing pattern, in other words the brain must integrate it.”  (Ayres,1989).

The integration of sensory information from all of the senses is necessary to support optimal function. The senses include vision, hearing, taste, smell and touch, as well as the sense of movement (vestibular) and body position (proprioception). Ayres specifically emphasised the importance of the touch, movement and body position senses in the sensory integrative process (Ayres, 1972).

In other words:

Sensory integration is the process by which we receive information from the external environment through our senses (eyes, nose, ears, mouth, muscles, skin), organize this information in our brain, and use it to participate in everyday activities. We need to have a response that is appropriate for the situation we are participating in.  All humans go through this process every day. It happens continuously through the day and it starts from the day we are born. 

What are the 4 levels of sensory integration?

level 1: Simulation of all senses

Level 2: body awareness when vestibular, proprioception and tactile systems integrate

Level 3: refinement happens when hearing, understanding of language and communication starts

Level 4: Skill progression- motor and cognitive skills can coordinate together for academic learning

Is sensory integration the same as sensory processing?

The terms “sensory integration” and “sensory processing” both refer to the processes in the brain that allow us to take the signals from our senses, make sense of those signals and respond appropriately. The concept of sensory integration was first developed and described by Dr A Jean Ayres in the 1970s.

When do Sensory Integration Difficulties Occur?

Problems in sensory integration/processing occur when a person’s nervous system is unable to process sensory information from the environment and the body effectively. So, a person may struggle to understand, process and adapt to sensory input. This means that they can often give an incorrect response to a situation. 

How are behaviour and Sensory processing linked?

What are the signs of sensory integration/sensory processing difficulties?

A person with a well-modulated nervous system adapts effectively to changes in the environment and is able to maintain a level of arousal and attention appropriate to the task at hand. The person is able to block out irrelevant information from the environment, attend to relevant information and respond appropriately and adaptively. This enables them to engage in a meaningful manner in activities of daily life.

Difficulty responding to the sensory information can be seen in either under or either over reactive to information. This affects their ability to effectively carry out activities of daily living tasks.  

Main challenges that may be seen in children with sensory challenges can be grouped into the following areas and the behaviours or symptoms can be seen under each:

• Person being overwhelmed easily (sensory sensitive) 

o    may cry a lot

o    need to be at the back of the class

o   doesn’t answer questions

o   shy

o   Avoid activities

• Person doesn’t register a lot of information (low arousal) 

o   need a lot of repetition

o   needs lots of hugs

o   look like they daydreaming

o   slow work pace

• Person seeks input 

o   very busy

o   out the chair often

o   tapping desk

o   rocking on the chair

o   jumping on furniture

• planning/perception difficulties

o   organisation difficulties

o   co ordinating their bodies in new motor tasks difficult

o   appear clumsy

o   hesitant in new environments

o   struggle in PE

o   battle to organise their desks - pencils all over the place/ lost

o   difficulties with how hard or soft to press in tasks

o   difficulties with finding objects without looking

o   struggle with orientating objects

• Postural control and bilateral integration difficulties

o   Slouched posture

o   Struggled to maintain an adequate posture white seated at a table

o   Struggle to make postural adaptions while moving

o   Poor visual contact with a moving object

o   Difficulty using two sides of the body together

o   Difficulty with bilateral tasks (cutting, dressing, using cutlery, motor sequences like skipping and galloping)

How is it diagnosed?

The evaluation of sensory processing challenges is an on-going process. Continued discussion with caregivers, teachers or people in the person’s life is important. Using qualified Sensory Integration Practitioners is essential.

A combination of the following is used to gather data: (this is specified to children)

·        Interviews with parents, caregivers, teachers etc.

·        Sensory history questionnaires, standardized questionnaires, i.e. The Sensory Profile by W. Dunn, The Touch Inventory for Pre-schoolers (TIP), Sensory Processing Measure Home (by Parham and Ecker), Sensory Processing Measure School (by Kuhaneck, Henry and Glennon) as well as non-standardized questionnaires, i.e. checklist for tactile defensive behaviour, sensory motor history.

·        Observations in natural settings, i.e. home / school / playground.
Clinical observations and formal observations during standardized testing.

·        Formal assessment / Standardized testing, i.e. The Sensory Integration and Praxis Tests (SIPT), Evaluation in Ayres Sensory Integration (EASI), Millers Assessment for Pre-schoolers (MAP), the Test of Sensory Function in Infants (TSFI) and DeGangi-Berk Test of Sensory Integration.

·        Continued observation during therapy and continued interaction with parents is of the utmost importance.

What are the interventions for sensory processing disorder?

Occupational therapists trained in Ayres Sensory Integration® use purposeful activities, specialized equipment and sound clinical reasoning to create opportunities for enhanced sensory integration in therapy.

Therapeutic activities are designed to provide the child with opportunities to master challenges during participation in activities and meet demands presented by the environment. In doing so, the therapist aims to effect change in the naturally malleable nervous system of the young child towards more effective sensory processing.

Once the child is processing and organising sensory information more effectively, he/she will find it easier to interact positively with his/her peers, play creatively and achieve success in all of his/her occupational performance areas at home and at school.

The Royal College of Occupational Therapy released its informed view of ‘Sensory Integration and sensory-based interventions’ in February 2021. This should be read and considered when working in this field.

Relating Sensory Processing to Brain Injuries

https://biblioteca-ito.s3.us-west-1.amazonaws.com/sensory-processing-abilities-children-traumatic-brain-injuries.pdf

This article is one that helps to understand the possible sensory processing patterns that may be presents in children that have suffered a brain injury.

‘After a traumatic brain injury (TBI), it is common for children to have difficulty developing cognitive abilities at a rate similar to that of their peers (Anderson et al, 2005; Anderson et al, 1995; Dennis, 2000; Sellars et al, 2004).

Challenges with executive skills of planning, organization, and working memory are well documented in the paediatric TBI population; however, little information is available that describes the way in which children receive, integrate, and respond to the sensory information that forms the basis of these executive skills.’

The article described that 90% of the children in the study demonstrated ‘poor registration’ abilities and 80% demonstrated ‘sensory-seeking’ behaviours. This suggests that the children in the study are not noticing the key elements of tasks and are less able to actively use cues in the environment to aid their performance. Missing key information in a task has the potential to affect executive skills because it is necessary for children understand what is required of them to plan, organize, and carry out a task.

The article suggests that children with TBI respond differently to sensory information in comparison to their typically developing peers.

How do sensory processing issues relate to mental health diagnoses?

Sensory processing difficulties in psychiatric disorders: A meta-analysis

This article is a meta-analysis of 33 studies, which compared patients with various types of psychiatric disorders and relating to a general pattern of sensory processing difficulties.

It found that many individuals with psychiatric disorders report difficulties in sensory processing in clinical practice, including increased awareness or sensitivity to external stimuli like sounds, lights, or smells. Overall, the results showed that patients showed elevated levels of low registration, sensory sensitivity and sensory avoiding behaviours. There were lowered sensory seeking behaviours.

The results of this study confirm earlier findings by Pfeiffer et al. (2014), indicating differences between the sensory processing patterns of individuals with serious mental illnesses and typically developing peers.

What experience do you have with sensory integration?

I have worked with both adults and children with sensory challenges for 14+ years. Many of these cases had associated comorbid diagnosis complicating the situation. These include mental health challenges and substance abuse problems in adults. I have also worked with premature children, vulnerable infants, children with neurologically impairments, ADHD and many more conditions. As each and every person uses sensory processing in their daily lives, this has helped me understand some of the secondary effects that make it difficult to interact effectively.

I began my formal training to become an Ayres Sensory Integration® Trained Therapist in 2016. I met the Standards for Qualification by the International Council of Education in Ayres Sensory Integration® (ICEASI) and successfully completed the Fidelity Measure in 2020.

In 2020 I participated and was recognised as a South African International Normative Data Collector (INDC) for the Evaluation and Assessment in Sensory Integration (EASI). The South African data contributed to the worldwide standardization of this new sensory integration test. This testing process was from 2020-2022. The testing was completed through SAISI and led by CLASI (The Collaborative for Leadership in Ayres Sensory Integration) in America.

In 2022 I was asked to join the South African Institute for Sensory Integration (SAISI) as a post-graduate ‘Protocol Marker’. I now actively assist in the qualification process of ASI® therapists. I mark and moderate during the qualification process, as well as mentor therapists.

Catherine Hauvette, Occupational Therapist, Expert Witness and Case Manager.