Sensory Integration: Difference between revisions
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== Introduction == | == Introduction == | ||
Sensory integration is also known as sensory processing. It refers to the ability of our brain to recognise and respond to signals sent by our sensory system. Our senses include hearing, vision, smell, taste, touch, proprioception, vestibular, and interoception. Sensory integration is important for a child's development | Sensory integration is also known as sensory processing. It refers to the ability of our brain to recognise and respond to signals sent by our sensory system. Our senses include: hearing, vision, smell, taste, touch, proprioception, vestibular, and interoception. Sensory integration is important for a child's development of social-emotional, motor, cognitive, adaptive, and other skills.<ref name=":1">Chumburidze N. Sensory Integration. Plus Course 2024</ref> When a child has difficulty processing various sensory stimuli, they may be diagnosed with sensory integration dysfunction (SID) / sensory processing disorder (SPD).<ref>Miller LJ, Nielsen DM, Schoen SA, Brett-Green BA. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2759332/pdf/fnint-03-022.pdf Perspectives on sensory processing disorder: a call for translational research.] Front Integr Neurosci. 2009 Sep 30;3:22. </ref> <ref name=":0" /> SPD is a "failure to modulate the effects of incoming sensory inputs."<ref>Barakat MKA, Elmeniawy GH, Abdelazeim FH. [https://bfpt.springeropen.com/articles/10.1186/s43161-021-00044-w Sensory systems processing in children with spastic cerebral palsy: a pilot study.] Bull Fac Phys Ther. 2021; 26 (27).</ref> Children can be hypo- or hyper-sensitive to sensory inputs. When children have difficulty processing and responding to sensory information, their ability to participate in daily activities, school activies, etc can be affected. This article discusses sensory integration and SID / SPD and offers recommendations for sensory integration therapy for children with cerebral palsy. | ||
== Senses == | == Senses == | ||
| Line 13: | Line 13: | ||
* Information is received from receptor cells in the skin | * Information is received from receptor cells in the skin | ||
* Skin (cutaneous) receptors provide information about light touch, pressure, vibration, temperature, and pain | * Skin (cutaneous) receptors provide information about light touch, pressure, vibration, temperature, and pain | ||
* '''Mechanoreceptors''' detect touch | * '''Mechanoreceptors''' detect touch:<ref>Marzvanyan A, Alhawaj AF. Physiology, Sensory Receptors. [Updated 2023 Aug 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539861/</ref><ref>Purves D, Augustine GJ, Fitzpatrick D, et al., editors. Neuroscience. 2nd edition. Sunderland (MA): Sinauer Associates; 2001. Mechanoreceptors Specialized to Receive Tactile Information. Available from: https://www.ncbi.nlm.nih.gov/books/NBK10895/</ref><ref>Iheanacho F, Vellipuram AR. Physiology, Mechanoreceptors. [Updated 2023 Sep 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK541068/</ref> | ||
** Hair follicles: affect touch perception | |||
** Pacinian corpuscles: sense vibrations and enable discrimination between smooth and rough surfaces / textures | |||
** Meissner corpuscles: sensitive to light touch, including a light tickle - they detect vibration and fine, discriminative touch<ref>Piccinin MA, Miao JH, Schwartz J. Histology, Meissner Corpuscle. [Updated 2023 Mar 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK518980/</ref> | |||
** Merkel complexes: detect skin indentation provide information on texture, curvature, and shape<ref>Bataille-Savattier A, Le Gall-Ianotto C, Lebonvallet N, Misery L, Talagas M. [https://onlinelibrary.wiley.com/doi/full/10.1111/exd.14685 Do Merkel complexes initiate mechanical itch?] Exp Dermatol. 2023 Feb;32(2):226-234. </ref> - they are activated by the applied pressure and location of objects we interact with | |||
** Ruffini corpuscles: detect stretch, as well as movement and finger position | |||
** C-fibre low threshold mechanoreceptors (LTM) respond to “pleasant” and “effective” mechanical stimuli like gentle stroking and brushing and small changes in skin temperature<ref>Huzard D, Martin M, Maingret F, Chemin J, Jeanneteau F, Mery PF, Fossat P, Bourinet E, François A. [https://www.science.org/doi/epdf/10.1126/sciadv.abo7566 The impact of C-tactile low-threshold mechanoreceptors on affective touch and social interactions in mice.] Sci Adv. 2022 Jul;8(26):eabo7566.</ref> | |||
Other receptors not part of the tactile system, but that help detect temperature, taste, smell etc, include: | Other receptors not part of the tactile system, but that help detect temperature, taste, smell etc, include: | ||
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=== Proprioception === | === Proprioception === | ||
[[Proprioception]] (kinaesthesia) helps us to move. Proprioception refers to information arising from skin, muscles, joints, ligaments, and bones.<ref name=":1" /> It allows us to perceive the location, movement, and action of | [[Proprioception]] (kinaesthesia) helps us to move. Proprioception refers to information arising from skin, muscles, joints, ligaments, and bones.<ref name=":1" /> It allows us to perceive the location, movement, and action of our body.<ref name=":2">Proske U, Gandevia SC. [https://journals.physiology.org/doi/epdf/10.1152/physrev.00048.2011 The proprioceptive senses: their roles in signalling body shape, body position and movement, and muscle force.] Physiol Rev. 2012 Oct;92(4):1651-97.</ref> | ||
* When we change position or move our limbs, the tissues (e.g. skin, muscle, tendons etc) surrounding the moving joint are deformed<ref name=":2" /> | * When we change position or move our limbs, the tissues (e.g. skin, muscle, tendons, etc) surrounding the moving joint are deformed<ref name=":2" /> | ||
* It has been su<nowiki/>ggested that [[Muscle Spindles|muscle spindles]] "play the major role in kinaesthesia"<ref name=":2" /> | * It has been su<nowiki/>ggested that [[Muscle Spindles|muscle spindles]] "play the major role in kinaesthesia"<ref name=":2" /> | ||
* The [[Skin Anatomy, Physiology, and Healing Process|skin receptors]] provide additional information<ref name=":2" /> | * The [[Skin Anatomy, Physiology, and Healing Process|skin receptors]] provide additional information<ref name=":2" /> | ||
| Line 37: | Line 36: | ||
The vestibular system provides information about movement, gravity, and head position:<ref name=":1" /> | The vestibular system provides information about movement, gravity, and head position:<ref name=":1" /> | ||
* It tells us | * It tells us if we are moving or stationary | ||
* It provides information about the direction and speed of our movements | * It provides information about the direction and speed of our movements | ||
* It helps to stabilise our eyes when we are moving | * It helps to stabilise our eyes when we are moving | ||
| Line 45: | Line 44: | ||
=== Hearing / Auditory System === | === Hearing / Auditory System === | ||
* The auditory system processes | * The auditory system processes sounds in the environment<ref name=":1" /> | ||
* Auditory receptors in the inner ear identify various sound stimuli, | * Auditory receptors in the inner ear identify various sound stimuli (e.g. loud / soft, far / near)<ref name=":1" /> | ||
* | * These sound stimuli are then processed by the central nervous system, to determine an appropriate response | ||
** | ** for example, in situations where safety is a concern (e.g. a fire alarm goes off), we recognise the sound and act accordingly)<ref name=":1" /> | ||
* Posture control can be influenced by sound frequency<ref>Siedlecka B, Sobera M, Sikora A, Drzewowska I. [https://www.actabio.pwr.wroc.pl/Vol17No3/11.pdf The influence of sounds on posture control]. Acta of Bioengineering and Biomechanics 2015;17(3):95-102.</ref> | * Posture control can be influenced by sound frequency<ref>Siedlecka B, Sobera M, Sikora A, Drzewowska I. [https://www.actabio.pwr.wroc.pl/Vol17No3/11.pdf The influence of sounds on posture control]. Acta of Bioengineering and Biomechanics 2015;17(3):95-102.</ref> | ||
=== Visual System === | === Visual System === | ||
| Line 57: | Line 56: | ||
=== Smell / Olfactory System === | === Smell / Olfactory System === | ||
* Our olfactory system allows us to distinguish various odours in the environment<ref name=":1" /> | * Our olfactory system allows us to distinguish various odours in the environment<ref name=":1" /> | ||
* It helps us to identify safe or potentially dangerous situations (e.g. the smell of smoke)<ref name=":1" /> | * It helps us to evaluate safety and identify safe or potentially dangerous situations (e.g. the smell of smoke)<ref name=":1" /> | ||
[[File:Sense of Smell - Shutterstock - ID 2209889937.jpg|thumb|200x200px|Sense of Smell|none]] | [[File:Sense of Smell - Shutterstock - ID 2209889937.jpg|thumb|200x200px|Sense of Smell|none]] | ||
=== Taste / Gustatory System === | === Taste / Gustatory System === | ||
* Our gustatory system distinguishes four tastes: sweet, sour, salty, and bitter | * Our gustatory system distinguishes four tastes: sweet, sour, salty, and bitter<ref name=":1" /> | ||
* 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<ref name=":1" /> | * 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<ref name=":1" /> | ||
[[File:Taste - Shutterstock - ID 411995191.jpg|thumb|148x148px|Taste|none]] | [[File:Taste - Shutterstock - ID 411995191.jpg|thumb|148x148px|Taste|none]] | ||
=== Interoception === | === Interoception === | ||
Interoception is | Interoception is "the sense involved in the detection of internal regulation, such as heart rate, respiration, hunger, and digestion".<ref name=":0" /> Through interoception, we can distinguish our body's internal sensations.<ref>Sensory. Available from https://pathways.org/topics-of-development/sensory/ [last access 13.02.2024]</ref> | ||
== Sensory Integration == | == Sensory Integration == | ||
<blockquote>Sensory integration "is the potential to develop adequate motor and behavioural reactions to stimulus" -- Ayres</blockquote>The input from the senses is received, organised and interpreted to create a reaction appropriate to the | <blockquote>Sensory integration "is the potential to develop adequate motor and behavioural reactions to stimulus" -- Ayres</blockquote>The input from the senses is received, organised and interpreted to create a reaction appropriate to the stimuli received. This is called sensory processing. | ||
== Sensory Integration Dysfunction == | == Sensory Integration Dysfunction == | ||
<blockquote>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."<ref name=":0">Camarata S, Miller LJ, Wallace MT. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7726187/pdf/fnint-14-556660.pdf Evaluating Sensory Integration/Sensory Processing Treatment: Issues and Analysis.] Front Integr Neurosci. 2020 Nov 26;14:556660.</ref></blockquote><blockquote>Sensory integration dysfunction is a problem in the ability to ‘‘organise sensory information for use.’’<ref>Ayres AJ. The development of perceptual-motor abilities: a theoretic basis for treatment of dysfunction. Am J Occup Ther. 1963 Nov-Dec;17:221-5.</ref> -- Ayres</blockquote>Sensory function is | <blockquote>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."<ref name=":0">Camarata S, Miller LJ, Wallace MT. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7726187/pdf/fnint-14-556660.pdf Evaluating Sensory Integration/Sensory Processing Treatment: Issues and Analysis.] Front Integr Neurosci. 2020 Nov 26;14:556660.</ref></blockquote><blockquote>Sensory integration dysfunction is a problem in the ability to ‘‘organise sensory information for use.’’<ref>Ayres AJ. The development of perceptual-motor abilities: a theoretic basis for treatment of dysfunction. Am J Occup Ther. 1963 Nov-Dec;17:221-5.</ref> -- Ayres</blockquote>Sensory function is essential for motor ability, social skills, and various behaviours. Disruption in modulation, discrimination or integration of sensory input can create a cascading effect that impacts all levels of sensory processing (motor, social, behavioural). This disruption can translate to problems with participation at home, school, and in the community.<ref name=":0" /> | ||
Sensory integration dysfunction may | Sensory integration dysfunction may cause an individual to have difficulty with the following:<ref name=":0" /> | ||
* initiating or sustaining peer interactions | * initiating or sustaining peer interactions | ||
* developing | * developing relationships | ||
* participating in activities of daily living | * participating in activities of daily living | ||
* regulating arousal behaviours | * regulating arousal behaviours | ||
* language development | * language development | ||
Sensory integration processing deficits may cause an individual to:<ref name=":0" /> | |||
* | * respond to stimulation more quickly | ||
* | * respond to stimulation more intensely | ||
* | * respond to stimulation for longer than individuals who do not have difficulty with sensory integration processing | ||
Examples:<ref name=":0" /> | Examples:<ref name=":0" /> | ||
* extreme responses to stimuli, including noise in a classroom, odours in a restaurant, the touch of clothing, or the movement of playground equipment | |||
* "fight, flight or freeze" behavioural responses, such as aggression, withdrawal, or preoccupation with the expectation of sensory input | |||
* severe difficulty forming and maintaining peer relationships | |||
* extreme efforts to control events in the environment by over-reliance on routines | |||
*behaviour regulation problems like temper tantrums, outbursts, hitting, kicking, biting, or spitting | |||
*profound withdrawal from the group | |||
*slow to respond to sensation, requiring "more intense stimuli to respond to the demands of the situation"<ref name=":0" /> | |||
=== Sensory Deficits and Cerebral Palsy === | === Sensory Deficits and Cerebral Palsy === | ||
Children with cerebral palsy often have deficits in one or more sensory systems, including proprioception, tactile sensation, and visual perception.<ref name=":1" /> | Children with cerebral palsy often have deficits in one or more sensory systems, including proprioception, tactile sensation, and visual perception.<ref name=":1" /> This can affect their functional activities, especially bilateral arm activities, such as eating, playing, dressing, and showering.<ref>Erkek S, Çekmece Ç. [https://www.mdpi.com/2227-9067/10/11/1723 Investigation of the Relationship between Sensory-Processing Skills and Motor Functions in Children with Cerebral Palsy.] Children. 2023; 10(11):1723.</ref> Children with cerebral palsy and sensory processing difficulties may react to sensory stimuli in the following ways. | ||
* '''Hyper-responsiveness to tactile input''':<ref name=":1" /> | * '''Hyper-responsiveness to tactile input''':<ref name=":1" /> | ||
** | ** does not like to be touched | ||
** | ** avoids activities that involve getting messy | ||
** | ** resists light touch | ||
** | ** avoids certain types of clothing | ||
* '''Hypo-responsiveness to tactile input''':<ref name=":1" /> | * '''Hypo-responsiveness to tactile input''':<ref name=":1" /> | ||
** | ** lacks the ability to localise touch or response when touched | ||
** | ** places items in their mouth | ||
** | ** may have a preference for activities or situations involving brushing their hair, touching or hugging | ||
** | ** may fail to recognise when their hands or face are messy | ||
** | ** enjoys activities involving vibration | ||
*'''Hyper-responsiveness to proprioceptive input:'''<ref name=":1" /> | |||
** cries when they are weight-bearing positions or when their joints are moved | |||
** chooses not to move or engage in activities | |||
* '''Hypo-responsiveness to proprioceptive input''':<ref name=":1" /> | * '''Hypo-responsiveness to proprioceptive input''':<ref name=":1" /> | ||
** | ** bites or chews on non-food objects | ||
** | ** engages in pinching or hitting others or themself | ||
** | ** has difficulty changing body posture to match activity demands | ||
** | ** may have low, high, or variable muscle tone, which impacts the processing of proprioceptive information | ||
* '''Hyper-responsiveness to vestibular input:'''<ref name=":1" /> | * '''Hyper-responsiveness to vestibular input:'''<ref name=":1" /> | ||
** | ** overreacts when moved in space | ||
** | ** becomes fearful of bouncing or swinging | ||
** | ** dislikes sudden or quick movements | ||
* '''Hypo-responsiveness to vestibular input:'''<ref name=":1" /> | * '''Hypo-responsiveness to vestibular input:'''<ref name=":1" /> | ||
** | ** enjoys being moved and rocked passively | ||
** | ** seeks opportunities to fall without regard to safety | ||
** | ** likes excessive spinning, swinging, and active movements | ||
== Sensory Integration Therapy == | == Sensory Integration Therapy == | ||
Before incorporating SIT, it is important to understand that there is limited evidence | Before incorporating Sensory Integration Therapy (SIT) into a rehabilitation plan, it is important to understand that there is limited evidence for SIT, "with few positive outcomes and some null or negative outcomes".<ref name=":0" /> | ||
SIT targets seven sensations: auditory, visual, gustatory (taste), olfactory (smell), somatosensory (proprioception and touch), vestibular, and interoception. <ref name=":0" /> It is suggested that SIT directly improves attentional, emotional, motoric, communication, and/or social difficulties. <ref>Miller LJ, Fuller DA, Roetenberg J. Sensational Kids: Hope and Help for Children With Sensory Processing Disorder (SPD). New York, NY: Penguin, 2014.</ref> | |||
'''Goals:'''<ref name=":1" /> | '''Goals:'''<ref name=":1" /> | ||
* To facilitate a child's daily functioning | |||
* To elicit a child's adaptive response in the form of an appropriate reaction to environmental or situational requirements | |||
'''General Recommendations:'''<ref name=":1" /> | '''General Recommendations:'''<ref name=":1" /> | ||
* Establish clear goals | |||
* Ensure the child's physical safety | |||
* Prepare the child before starting an activity (safety, posture, muscle tone) | |||
* Promote sensory-enriched activities | |||
* Collaborate with the child on activity choice and maximise the child's success | |||
* Guide self-organisation and support optimal arousal | |||
* Build a therapeutic alliance through positive and supportive relationships | |||
* Provide a "just-right" challenge | |||
* Determine the activity's intensity and duration | |||
* Promote positive experiences and respect a child's preferences | |||
* Integrate into daily routine | |||
* Incorporate every movement into play | |||
=== Environment and Equipment === | === Environment and Equipment === | ||
Every '''environment''' | Every '''environment''' a child resides in is appropriate for SIT, including schools, homes, yards, and playgrounds. However, sensory rooms tend to be utilised most frequently for treatment. Ensuring a child's physical safety is essential. Clinicians must carefully observe a child's reactions and pay attention to signs the child is becoming overwhelmed. If the child does become overwhelmed, the clinician should take prompt action and proactively change the situation.<ref name=":1" /> | ||
'''Equipment''' for the multi-sensory room should include materials | '''Equipment''' for the multi-sensory room should include materials that address the seven senses: | ||
* | * tactile: sand, foam, and various textures<ref name=":1" /> | ||
* | *proprioception: ball pool / pit, therapy ball, heavy blanket<ref name=":1" /> | ||
* | *vestibular: platform swing, bolster swing, net swing, tilt board, trampoline, ramp<ref>Rassafiani M, Akbarfaimi N, Hosseini SA, Shahshahani S, Karimlou M, Tabatabai Ghomsheh F. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7660028/pdf/ijcn-14-029.pdf The Effect of the combination of active vestibular interventions and occupational therapy on Balance in Children with Bilateral Spastic Cerebral Palsy: A pilot randomized controlled trial]. Iran J Child Neurol. 2020 Fall;14(4):29-42.</ref> | ||
* | *hearing: water (fountains, faucets, waves, and waterfalls), music (radio, instruments, chimes), instruments (drums, piano, guitar, keyboards and tambourines)<ref name=":3">Sensory Integration. Available from https://www.cerebralpalsy.org/about-cerebral-palsy/treatment/therapy/sensory-integration-therapy [last access 13.02.2024]</ref> | ||
* | *visual: neon, patterned and florescent papers, coloured, strung, flashing, holiday and strobe lights, wind socks, wind-up toys, activity boxes and age-appropriate mobiles<ref name=":3" /> | ||
* | *smell: air fresheners (lavender, pot pouri and sachets), candles, lotions, powders, perfumes, flowers, plants, breads, cookies, stews, bacon, onions<ref name=":3" /> | ||
* | *taste: fruits, milk-based items, hot and cold items, candies, cheese<ref name=":3" /> | ||
=== Activities === | === Activities === | ||
The following activities | The following activities are examples of how elements of sensory integration can be used to help treat sensory deficits. | ||
==== Tactile Activities ==== | ==== Tactile Activities ==== | ||
* Playing with different brushes, drawing with soap crayons or chalk on the body, and erasing with various textures | * Playing with different brushes, drawing with soap crayons or chalk on the body, and erasing with various textures<ref name=":1" /> | ||
* | * Engaging in different play activities with Play-Doh, like hiding small objects in it or creating a tactile bin for finger exploration<ref name=":1" /> | ||
* Exploring kitchen time activities, such as mixing, tasting, smelling, and washing vegetables | * Exploring kitchen time activities, such as mixing, tasting, smelling, and washing vegetables<ref name=":1" /> | ||
* Preparing a tactile bag using a zipper bag filled with conditioner cream and food colours | * Preparing a tactile bag using a zipper bag filled with conditioner cream and food colours with small beans or toys hidden inside<ref name=":1" /> | ||
* Creating sensory balloons | * Creating sensory balloons (e.g. balloons filled up with materials like cereals, flowers, sand, etc)<ref name=":1" /> | ||
* Making a tactile board using a piece of wood, tissue, and different materials | * Making a tactile board using a piece of wood, tissue, and different materials<ref name=":1" /> | ||
==== Proprioceptive Activities ==== | ==== Proprioceptive Activities ==== | ||
* Engaging in playground activities | * Engaging in playground activities<ref name=":1" /> | ||
* Participating in gross motor activities | * Participating in gross motor activities<ref name=":1" /> | ||
* Encouraging imitations of various movements | * Encouraging imitations of various movements<ref name=":1" /> | ||
* Weight-bearing activities, such as crawling and push-ups | * Weight-bearing activities, such as crawling and push-ups<ref name=":1" /> | ||
* Resistance activities like pushing and pulling | * Resistance activities like pushing and pulling<ref name=":1" /> | ||
==== Vestibular Stimulation Activities ==== | ==== Vestibular Stimulation Activities ==== | ||
* Spinning, rocking, climbing, sliding, riding toys, walking, running | * Spinning, rocking, climbing, sliding, riding toys, walking, running<ref name=":1" /> | ||
* Standing on one foot | * Standing on one foot, progressing to standing on one foot with eyes closed<ref name=":3" /> | ||
* Throwing a ball | * Throwing a ball<ref name=":3" /> | ||
* Shaking | * Shaking head or turning head from left to right at a rapid pace<ref name=":3" /> | ||
* Bouncing on bed, ball or parent’s knees | * Bouncing on bed, ball or parent’s knees<ref name=":3" /> | ||
* Swinging in a blanket, | * Swinging in a blanket, swing, or on a rope<ref name=":3" /> | ||
== Resources == | == Resources == | ||
Revision as of 02:47, 21 February 2024
Original Editor - Nino Chumburidze
Top Contributors - Ewa Jaraczewska, Jess Bell, Lauren Heydenrych and Tarina van der Stockt
Introduction[edit | edit source]
Sensory integration is also known as sensory processing. It refers to the ability of our brain to recognise and respond to signals sent by our sensory system. Our senses include: hearing, vision, smell, taste, touch, proprioception, vestibular, and interoception. Sensory integration is important for a child's development of social-emotional, motor, cognitive, adaptive, and other skills.[1] When a child has difficulty processing various sensory stimuli, they may be diagnosed with sensory integration dysfunction (SID) / sensory processing disorder (SPD).[2] [3] SPD is a "failure to modulate the effects of incoming sensory inputs."[4] Children can be hypo- or hyper-sensitive to sensory inputs. When children have difficulty processing and responding to sensory information, their ability to participate in daily activities, school activies, etc can be affected. This article discusses sensory integration and SID / SPD and offers recommendations for sensory integration therapy for children with cerebral palsy.
Senses[edit | edit source]
Touch / Tactile System[edit | edit source]
- Information is received from receptor cells in the skin
- Skin (cutaneous) receptors provide information about light touch, pressure, vibration, temperature, and pain
- Mechanoreceptors detect touch:[5][6][7]
- Hair follicles: affect touch perception
- Pacinian corpuscles: sense vibrations and enable discrimination between smooth and rough surfaces / textures
- Meissner corpuscles: sensitive to light touch, including a light tickle - they detect vibration and fine, discriminative touch[8]
- Merkel complexes: detect skin indentation provide information on texture, curvature, and shape[9] - they are activated by the applied pressure and location of objects we interact with
- Ruffini corpuscles: detect stretch, as well as movement and finger position
- C-fibre low threshold mechanoreceptors (LTM) respond to “pleasant” and “effective” mechanical stimuli like gentle stroking and brushing and small changes in skin temperature[10]
Other receptors not part of the tactile system, but that help detect temperature, taste, smell etc, include:
- Chemoreceptors respond to changes in the concentration of chemicals in the body - they can detect tastes, smells and other internal changes. They help regulate many systems, including cardiovascular and respiratory functions
- Thermoreceptors detect changes in temperature
Proprioception[edit | edit source]
Proprioception (kinaesthesia) helps us to move. Proprioception refers to information arising from skin, muscles, joints, ligaments, and bones.[1] It allows us to perceive the location, movement, and action of our body.[11]
- When we change position or move our limbs, the tissues (e.g. skin, muscle, tendons, etc) surrounding the moving joint are deformed[11]
- It has been suggested that muscle spindles "play the major role in kinaesthesia"[11]
- The skin receptors provide additional information[11]
- It is also suggested that Golgi tendon organs contribute to proprioception[11]
Vestibular System[edit | edit source]
The vestibular system provides information about movement, gravity, and head position:[1]
- It tells us if we are moving or stationary
- It provides information about the 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
To learn more about the peripheral vestibular system, please click here.
Hearing / Auditory System[edit | edit source]
- The auditory system processes sounds in the environment[1]
- Auditory receptors in the inner ear identify various sound stimuli (e.g. loud / soft, far / near)[1]
- These sound stimuli are then processed by the central nervous system, to determine an appropriate response
- for example, in situations where safety is a concern (e.g. a fire alarm goes off), we recognise the sound and act accordingly)[1]
- Posture control can be influenced by sound frequency[12]
Visual System[edit | edit source]
- Our visual system helps us see and perceive the environment around us[1]
- It identifies sights and understands what the eyes see[1]
- Visual inspection is also important in maintaining body balance as it helps position the body in space[13]
Smell / Olfactory System[edit | edit source]
- Our olfactory system allows us to distinguish various odours in the environment[1]
- It helps us to evaluate safety and identify safe or potentially dangerous situations (e.g. the smell of smoke)[1]
Taste / Gustatory System[edit | edit source]
- Our gustatory system distinguishes four tastes: sweet, sour, salty, and bitter[1]
- 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[1]
Interoception[edit | edit source]
Interoception is "the sense involved in the detection of internal regulation, such as heart rate, respiration, hunger, and digestion".[3] Through interoception, we can distinguish our body's internal sensations.[14]
Sensory Integration[edit | edit source]
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 stimuli received. This is called sensory processing.
Sensory Integration Dysfunction[edit | edit source]
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."[3]
Sensory integration dysfunction is a problem in the ability to ‘‘organise sensory information for use.’’[15] -- Ayres
Sensory function is essential for motor ability, social skills, and various behaviours. Disruption in modulation, discrimination or integration of sensory input can create a cascading effect that impacts all levels of sensory processing (motor, social, behavioural). This disruption can translate to problems with participation at home, school, and in the community.[3]
Sensory integration dysfunction may cause an individual to have difficulty with the following:[3]
- initiating or sustaining peer interactions
- developing relationships
- participating in activities of daily living
- regulating arousal behaviours
- language development
Sensory integration processing deficits may cause an individual to:[3]
- respond to stimulation more quickly
- respond to stimulation more intensely
- respond to stimulation for longer than individuals who do not have difficulty with sensory integration processing
Examples:[3]
- extreme responses to stimuli, including noise in a classroom, odours in a restaurant, the touch of clothing, or the movement of playground equipment
- "fight, flight or freeze" behavioural responses, such as aggression, withdrawal, or preoccupation with the expectation of sensory input
- severe difficulty forming and maintaining peer relationships
- extreme efforts to control events in the environment by over-reliance on routines
- behaviour regulation problems like temper tantrums, outbursts, hitting, kicking, biting, or spitting
- profound withdrawal from the group
- slow to respond to sensation, requiring "more intense stimuli to respond to the demands of the situation"[3]
Sensory Deficits and Cerebral Palsy[edit | edit source]
Children with cerebral palsy often have deficits in one or more sensory systems, including proprioception, tactile sensation, and visual perception.[1] This can affect their functional activities, especially bilateral arm activities, such as eating, playing, dressing, and showering.[16] Children with cerebral palsy and sensory processing difficulties may react to sensory stimuli in the following ways.
- Hyper-responsiveness to tactile input:[1]
- does not like to be touched
- avoids activities that involve getting messy
- resists light touch
- avoids certain types of clothing
- Hypo-responsiveness to tactile input:[1]
- lacks the ability to localise touch or response when touched
- places items in their mouth
- may have a preference for activities or situations involving brushing their hair, touching or hugging
- may fail to recognise when their hands or face are messy
- enjoys activities involving vibration
- Hyper-responsiveness to proprioceptive input:[1]
- cries when they are weight-bearing positions or when their joints are moved
- chooses not to move or engage in activities
- Hypo-responsiveness to proprioceptive input:[1]
- bites or chews on non-food objects
- engages in pinching or hitting others or themself
- has difficulty changing body posture to match activity demands
- may have low, high, or variable muscle tone, which impacts the processing of proprioceptive information
- Hyper-responsiveness to vestibular input:[1]
- overreacts when moved in space
- becomes fearful of bouncing or swinging
- dislikes sudden or quick movements
- Hypo-responsiveness to vestibular input:[1]
- enjoys being moved and rocked passively
- seeks opportunities to fall without regard to safety
- likes excessive spinning, swinging, and active movements
Sensory Integration Therapy[edit | edit source]
Before incorporating Sensory Integration Therapy (SIT) into a rehabilitation plan, it is important to understand that there is limited evidence for SIT, "with few positive outcomes and some null or negative outcomes".[3]
SIT targets seven sensations: auditory, visual, gustatory (taste), olfactory (smell), somatosensory (proprioception and touch), vestibular, and interoception. [3] It is suggested that SIT directly improves attentional, emotional, motoric, communication, and/or social difficulties. [17]
Goals:[1]
- To facilitate a child's daily functioning
- To elicit a child's adaptive response in the form of an appropriate reaction to environmental or situational requirements
General Recommendations:[1]
- Establish clear goals
- Ensure the child's physical safety
- Prepare the child before starting an activity (safety, posture, muscle tone)
- Promote sensory-enriched activities
- Collaborate with the child on activity choice and maximise the child's success
- Guide self-organisation and support optimal arousal
- Build a therapeutic alliance through positive and supportive relationships
- Provide a "just-right" challenge
- Determine the activity's intensity and duration
- Promote positive experiences and respect a child's preferences
- Integrate into daily routine
- Incorporate every movement into play
Environment and Equipment[edit | edit source]
Every environment a child resides in is appropriate for SIT, including schools, homes, yards, and playgrounds. However, sensory rooms tend to be utilised most frequently for treatment. Ensuring a child's physical safety is essential. Clinicians must carefully observe a child's reactions and pay attention to signs the child is becoming overwhelmed. If the child does become overwhelmed, the clinician should take prompt action and proactively change the situation.[1]
Equipment for the multi-sensory room should include materials that address the seven senses:
- tactile: sand, foam, and various textures[1]
- proprioception: ball pool / pit, therapy ball, heavy blanket[1]
- vestibular: platform swing, bolster swing, net swing, tilt board, trampoline, ramp[18]
- hearing: water (fountains, faucets, waves, and waterfalls), music (radio, instruments, chimes), instruments (drums, piano, guitar, keyboards and tambourines)[19]
- visual: neon, patterned and florescent papers, coloured, strung, flashing, holiday and strobe lights, wind socks, wind-up toys, activity boxes and age-appropriate mobiles[19]
- smell: air fresheners (lavender, pot pouri and sachets), candles, lotions, powders, perfumes, flowers, plants, breads, cookies, stews, bacon, onions[19]
- taste: fruits, milk-based items, hot and cold items, candies, cheese[19]
Activities[edit | edit source]
The following activities are examples of how elements of sensory integration can be used to help treat sensory deficits.
Tactile Activities[edit | edit source]
- Playing with different brushes, drawing with soap crayons or chalk on the body, and erasing with various textures[1]
- Engaging in different play activities with Play-Doh, like hiding small objects in it or creating a tactile bin for finger exploration[1]
- Exploring kitchen time activities, such as mixing, tasting, smelling, and washing vegetables[1]
- Preparing a tactile bag using a zipper bag filled with conditioner cream and food colours with small beans or toys hidden inside[1]
- Creating sensory balloons (e.g. balloons filled up with materials like cereals, flowers, sand, etc)[1]
- Making a tactile board using a piece of wood, tissue, and different materials[1]
Proprioceptive Activities[edit | edit source]
- Engaging in playground activities[1]
- Participating in gross motor activities[1]
- Encouraging imitations of various movements[1]
- Weight-bearing activities, such as crawling and push-ups[1]
- Resistance activities like pushing and pulling[1]
Vestibular Stimulation Activities[edit | edit source]
- Spinning, rocking, climbing, sliding, riding toys, walking, running[1]
- Standing on one foot, progressing to standing on one foot with eyes closed[19]
- Throwing a ball[19]
- Shaking head or turning head from left to right at a rapid pace[19]
- Bouncing on bed, ball or parent’s knees[19]
- Swinging in a blanket, swing, or on a rope[19]
Resources[edit | edit source]
- What is Sensory Integration?
- Warutkar VB, Krishna Kovela R. Review of Sensory Integration Therapy for Children With Cerebral Palsy. Cureus. 2022 Oct 26;14(10):e30714.
References[edit | edit source]
- ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 1.14 1.15 1.16 1.17 1.18 1.19 1.20 1.21 1.22 1.23 1.24 1.25 1.26 1.27 1.28 1.29 1.30 1.31 1.32 1.33 1.34 1.35 Chumburidze N. Sensory Integration. Plus Course 2024
- ↑ Miller LJ, Nielsen DM, Schoen SA, Brett-Green BA. Perspectives on sensory processing disorder: a call for translational research. Front Integr Neurosci. 2009 Sep 30;3:22.
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 3.9 Camarata S, Miller LJ, Wallace MT. Evaluating Sensory Integration/Sensory Processing Treatment: Issues and Analysis. Front Integr Neurosci. 2020 Nov 26;14:556660.
- ↑ Barakat MKA, Elmeniawy GH, Abdelazeim FH. Sensory systems processing in children with spastic cerebral palsy: a pilot study. Bull Fac Phys Ther. 2021; 26 (27).
- ↑ Marzvanyan A, Alhawaj AF. Physiology, Sensory Receptors. [Updated 2023 Aug 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539861/
- ↑ Purves D, Augustine GJ, Fitzpatrick D, et al., editors. Neuroscience. 2nd edition. Sunderland (MA): Sinauer Associates; 2001. Mechanoreceptors Specialized to Receive Tactile Information. Available from: https://www.ncbi.nlm.nih.gov/books/NBK10895/
- ↑ Iheanacho F, Vellipuram AR. Physiology, Mechanoreceptors. [Updated 2023 Sep 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK541068/
- ↑ Piccinin MA, Miao JH, Schwartz J. Histology, Meissner Corpuscle. [Updated 2023 Mar 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK518980/
- ↑ Bataille-Savattier A, Le Gall-Ianotto C, Lebonvallet N, Misery L, Talagas M. Do Merkel complexes initiate mechanical itch? Exp Dermatol. 2023 Feb;32(2):226-234.
- ↑ Huzard D, Martin M, Maingret F, Chemin J, Jeanneteau F, Mery PF, Fossat P, Bourinet E, François A. The impact of C-tactile low-threshold mechanoreceptors on affective touch and social interactions in mice. Sci Adv. 2022 Jul;8(26):eabo7566.
- ↑ 11.0 11.1 11.2 11.3 11.4 Proske U, Gandevia SC. The proprioceptive senses: their roles in signalling body shape, body position and movement, and muscle force. Physiol Rev. 2012 Oct;92(4):1651-97.
- ↑ Siedlecka B, Sobera M, Sikora A, Drzewowska I. The influence of sounds on posture control. Acta of Bioengineering and Biomechanics 2015;17(3):95-102.
- ↑ Pankanin E. Visual control is important in maintaining the body's balance. Journal of Education, Health and Sport. 2018;8(8):381-387.
- ↑ Sensory. Available from https://pathways.org/topics-of-development/sensory/ [last access 13.02.2024]
- ↑ Ayres AJ. The development of perceptual-motor abilities: a theoretic basis for treatment of dysfunction. Am J Occup Ther. 1963 Nov-Dec;17:221-5.
- ↑ Erkek S, Çekmece Ç. Investigation of the Relationship between Sensory-Processing Skills and Motor Functions in Children with Cerebral Palsy. Children. 2023; 10(11):1723.
- ↑ Miller LJ, Fuller DA, Roetenberg J. Sensational Kids: Hope and Help for Children With Sensory Processing Disorder (SPD). New York, NY: Penguin, 2014.
- ↑ Rassafiani M, Akbarfaimi N, Hosseini SA, Shahshahani S, Karimlou M, Tabatabai Ghomsheh F. The Effect of the combination of active vestibular interventions and occupational therapy on Balance in Children with Bilateral Spastic Cerebral Palsy: A pilot randomized controlled trial. Iran J Child Neurol. 2020 Fall;14(4):29-42.
- ↑ 19.0 19.1 19.2 19.3 19.4 19.5 19.6 19.7 19.8 Sensory Integration. Available from https://www.cerebralpalsy.org/about-cerebral-palsy/treatment/therapy/sensory-integration-therapy [last access 13.02.2024]
