Sensory Integration

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Introduction

Sensory integration is also known as sensory processing and it is brain's ability to recognise and to respond to signals sent by our senses. These senses include hearing, vision, smell, taste, touch, proprioception, and vestibular. Sensory integration plays a significant role in the development and maintenance of social-emotional, motor, cognitive, adaptive, and other skills. It impacts the child's participation in daily activities, school activities, and more. When the brain has difficulties processing these various sensory stimuli, the child may be diagnosed with a condition called sensory integration dysfunction (SID) or more recently, sensory processing disorder (SPD). It is a "failure to modulate the effects of incoming sensory inputs." Children can demonstrates either hypo- or hyper-sensitivities to sensory inputs and their obstructed processing and response to sensory information can lead to daily activities limitations. This article discusses sensory integration and sensory integration dysfunction. Additionally, it offers sensory integration therapy recommendations for children with cerebral palsy.

Senses

Touch or Tactile Sensation

• Information is received from receptor cells in the skin
• Skin (cutaneous) receptors provide information about light touch, pressure, vibration, temperature, and pain. The touch receptors are mechanoreceptors, chemoreceptors and thermoreceptors.
• Mechanoreceptors include the following:
  • Hair follicles which affect touch perception
  • Pacinian corpuscles allow to discriminate between smooth and rough surfaces
  • Meissner corpuscles are sensitive to light touches and allow to feel a light tickle
  • Merkel complexes are activated by the applied pressure and location of objects we interact with
  • Ruffini corpuscles are activated by stretching the skin
  • C-fiber low threshold mechanoreceptors (LTM) respond to “pleasant” and “affective”mechanical stimulus like gentle stroking and brushing and small changes in skin temperature
• Chemoreceptors respond to chemicals in taste, smell and in internal changes. They regulate cardiovascular and respiratory functions.
• Thermoreceptors detect changes in the skin temperature.

Proprioception

Proprioception (kinaesthesia) helps us to move because of the information arising from skin, muscles, joints, ligaments, and bones. It allows us to perceive the location, movement, and action of the body.

• With change in position, the tissue surrounding moving joint becomes deformed
• Muscle spindles are considered to have the major role in kinaesthesia
• The skin receptors provide additional information
• The Golgi tendon organs contribute to proprioception

Vestibular Sense

Vestibular system provides information about movement, gravity, and changing head position:

• It informs us that we are moving or stationary.
• It provides information about direction and speed of our movements.
• It helps to stabilise our eyes when we are moving.
• It informs us if objects around us are moving or stationary.

Hearing

• Auditory system processes the sounds of the environment.
• Auditory receptors in the inner ear identify various sound stimuli: its intensity, frequency and spectrum.
• Posture control can be influenced by sound frequency.
• It allows us to respond to sound stimuli accordingly, like when there is a safety concern acknowledged by the alarm sound.

Visual

• Helps us see and perceive the environment around us
• Visual system identifies sights and understands what the eyes see
• Visual inspection is an important component in maintaining body balance as it helps in body position in space

Smell

• It allows us to distinguish various odours in the environment.
• It helps us to identify safe or potentially dangerous situations.

Taste

• It allows us to distinguish four different tastes: sweet, sour, salty, and bitter.
• It allows us to identify desirable foods that are pleasant to us as well as those that are potentially undesirable, such as a bitter dish.

Sensory Integration

Sensory integration "is the potential to develop adequate motor and behavioural reactions to stimulus"--Ayres

The input from the senses is received, organised and interpreted to create a reaction appropriate to the type of stimulation received. This is called sensory processing.

Sensory Integration Dysfunction

Sensory Integration Disorder is "difficulty detecting, modulating, interpreting, and/or responding to sensory inputs, which is severe enough to disrupt participation in everyday living activities and routines, as well as learning."

Sensory integration dysfunction is a problem in the ability to ‘‘organise sensory information for use.’’--Ayres

Sensory integration dysfunction may lead to the following deficits:

• initiating or sustaining peer interactions
• developing engaged relationships
• participating in activities of daily living
• regulating arousal behaviours
• language development

In general, the manifestations of sensory integration processing deficits may include the following:

• responses to stimulation more quickly
• responses to stimulation more intensely
• responses to stimulation a longer duration than do typically developing individuals

Examples:

1. Extreme responses to stimuli including as noise in a classroom, odors in a restaurant, the touch of clothing, or the movement of playground equipment.
2. "Fight, flight or freeze" behavioural responses in a form of aggression, withdrawal, or preoccupation with the expectation of sensory input.
3. Severe difficulty forming and maintaining peer relationships
4. Extreme efforts to control events in the environment by over-reliance on routines
5. Behaviour regulation problems like temper tantrums, outbursts, hitting, kicking, biting, or spitting
6. Profound withdrawal from group
7. Slow to respond to sensation requiring "more intense stimuli to respond to the demands of the situation"

Sensory Integration Dysfunction and Cerebral Palsy

Children with cerebral palsy often have deficits in one or more sensory systems, including proprioception, tactile sensation, and visual perception. Their reaction to sensory stimuli may be as follow:

• Hyper-responsiveness to tactile input:
  • Do not like to be touched
  • Avoidance of activities that involve getting messy,
  • Resistance to light touches
  • Avoidance of certain types of clothing
• Hypo-responsiveness to tactile input:
  • Lacking ability to localise touch or response when touched
  • Placing items in the mouth
  • Preference for activities or situations involving brushing hair, touching or hugging
  • Failure to recognise when hands or face are messy
  • Enjoyment of activities involving vibration

• Hypo-responsiveness to proprioceptive input:
  • Biting or chewing on non-food objects
  • Engaging in pinching or hitting others or oneself
  • Difficulty to changing body posture to match activity demands
  • Expressing low, high, or variable muscle tone impacting the processing of proprioceptive information

• Hyper-responsiveness to proprioceptive input:
  • Crying in weight-bearing positions or when joints are moved
  • Choosing not to move or engage in activities
• Hyper-responsiveness to vestibular input:
  • Overreacting when moved in space
  • Becoming fearful of bouncing or swinging
  • Disliking sudden or quick movements
• Hypo-responsiveness to vestibular input:
  • Enjoying being moved and rocked passively
  • Seeking opportunities to fall without regards to safety
  • Liking excessive spinning, swinging, and active movements

Sensory Integration Therapy

• Targets seven sensations:auditory, visual, gustatory (taste), olfactory (smell), somatosensory (proprioception and touch), vestibular, and interoceptive (the sense involved in the detection of internal regulation, such as heart rate, respiration, hunger, and digestion)
• It is postulated that sensory integration therapy (SIT) directly improve attentional, emotional, motoric, communication, and/or social difficulties

Goal:

1. To facilitate the child's daily functioning
2. To elicit the child's adaptive response in a form of appropriate reaction to environmental or situational requirements

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