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Sensory Integration and Self Regulation

November 2, 2007
by Marie Anzalone Sc. D, OTR, FAOTA

Marie Anzalone was funny and informative.

In her presentation Marie cover the topics of Sensory Integration as a theory describing and explaining a process of individual differences, a strategy for assessment and describing dysfunction, and also a method of intervention.

She stated individuals with sensory processing disorder have difficulty registering sensory input.

Sensory input can be cumulative and may have a long duration depending on the individual.

Marie pointed out that if a child doesn't register the input they cant react to it.

This is the first step to sensory processing is registering and identifying sensory input through the seven modalities, sight, sound, taste, smell, touch, proprioception and vestibular input.

Every individual is different and will respond differently.

Marie referred to the current "Taxonomy" of Sensory Modulation disorder (SMD)

SOR- sensory -over responsivity (avoidance/defensive)
SUR- sensory -under responsivity (ozone) (in a lot of cases late to be identified) SS-sensory seeking/craving (risk taker) disorganized?

Sensory-based Motor disorder (SBMD)
Dyspraxia
Postural Disorders Sensory Discrimination Disorder (SDD)
visual
auditory
tactile
taste/smell
proprioception
movement/vestibular

Marie made a point that part of proprioception is being able to judge how much force in needed to engage in an activity. the judgment is based on person's sensory history with his/her environment. Ie: if they have picked up a cup with water before they know how much it should weigh again and will use the correct force. The judgment is not conscious it becomes second nature. People who have difficulty with proprioception would have to concentrate on each movement and may have difficulty performing the task.

Sensory integration is developmental but will not increase skills, it will however help organize a person so they can learn to increase their skills.

Marie discussed the treatment of Preterm babies being born. A baby born to early will have their senses develop differently because of the change in the environment. She stated the too much stimulation may upset you or I, but it could kill an premature baby.

We are all designed to develop a certain way, some may develop faster than others. In the womb our environment is protective against senses we are yet ready to encounter. For a baby born to early their priority for what senses needs to develop first change. The auditory verses the visual development.

Marie stated it was important to understand the intensity of the modality and understand also that input maybe layered (a continuum), depending on the duration of the effects of the first sensory input. If certain input, like brushing is used, it could be very intense because of the structure of the modality.

Activity:
1- stretch your hand out in front of you, palm facing you. Then quickly bring your hand to your nose.
2- Put your hand in front and close to your chest, palm out, then bring hand out to your neighbors nose
3- Face your neighbor and quickly bring you head to your neighbors.

The intensity of each activity increases. Remember that imposing therapy on a child could affect them with similar intensity.

Activity:
Touch the back of your hand -first hard then lightly - which is more intense?

Touch the palm of your hand, then touch your lip - which is more intense?

The light touch should be more intense.

Sensory-based self regulation is expressed as arousal, attention, affect and action. Each one of these has an effect on the other. Ie: Your arousal level effects your attention and so on.

Arousal - your level of arousal affects your learning. Most learn in a quiet alert state.

Attention-best to work from the bottom-up manipulate the body to gain attention and adjust arousal.

Affect -Mental health - Most children with autism live with fear and stress. They lack interaction and that affects their social competency.

Action- goal directed behavior -- 3 steps of praxis - ideation, motor planning, execution.

When movements are automatic it improves learning. When the steps of the movements become an unconscious thought, the action is smooth.

Remember - at first quality of movement is not as important as the function.


Sensory Threshold - As more sensory input is taken in, it builds up until it reaches the sensory threshold where is starts to register.

Regulation
What modality would you use to get child off the baseline?
At what point did it register?
What would bring the child down to zone of optimal organization?

Children with sensory modulation issues may have too narrow a zone.


Another area of concern with sensory modulation disorder is the responses are not always consistent with what is expected.

Marie presented ideas about SI The factors: both intrinsic and extrinsic

The Intrinsic included: sensory reactivity, self regulation of the 4 A's and development

The Extrinsic included: interaction of child and environment, social environment (parent, siblings, peers), physical environment (home and other)


Listed are three functional problems:

A child with SOR

IADL/ADLs are difficult
Social interaction
Sleep disregulation
Feeding issues
Clothing preferences
Limited exploration

An under responsive child

Difficult developmental interactions
Limited attempts at exploring
Risk of developmental delays
Sleep disorders 


A child with Dyspraxia

Disruptive play skills
Inflexible
Difficulty with transitions
Play involves peers not of the same age group
May be controlling
Sloppy
Global disorganization
Self esteem issues
Not a multi tasker


To address some of the issues a sensory diet can be implemented, it is important to observe and determine what sensory input is being sought out and what input is being avoided. Most importantly is how does the child respond to the input -is it arousing or calming? Also to understand that each child is unique and respond in their own way.


Sometimes small environmental changes can affect the input greatly on a child. Changing the routine, perhaps the time of day or the order in which something is done. Or eliminate activities or introduce new ones, or even reduce stress.

SI intervention is
Child directed and individualized
Designed to include sensory
Active
Flexible
Fun and playful
With graded challenges

Marie also went over the STEP-SI in her power point presentation The presentation was done in one day and included a lot of information. I found her with good humor and very committed to helping young children. If you can see her -go.

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