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Sensory integration
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The most important step in promoting sensory integration in children is to recognize that it exists and that it plays an important role in the development of a child. By learning more about sensory integration, parents, educators and caregivers can provide an enriched environment that will foster healthy growth and maturation. Remember that Sensory Integrative Dysfunction is a heavy burden. Your understanding and support can lighten the load.

Sensory integration
What is Sensory Integration Dysfunction?
Dysfunction in Sensory Integration (DSI) is a problem in processing sensations, which causes difficulties in daily life. DSI is a complex neurological disorder, manifested by difficulty detecting, modulating, and discriminating or integrating sensation adaptively. DSI causes children to process sensation from the environment or from their bodies in an inaccurate way, resulting in "sensory seeking" or "sensory avoiding" patterns or 'dyspraxia," a motor planning problem.
What does DSI look like?
DSI and Sensory Seeking
These children have nervous systems that do not always process that sensory input is "coming in" to the brain. They are under-responsive to sensation. As a result, they seek out more intense or longer duration sensory experiences. Some behaviors that can be observed are:
Hyper-activity as they seek more and more movement input
Unawareness of touch or pain, or touching others too often or too hard (may seem aggressive)
Engaging in unsafe behaviors, such as climbing too high
Enjoying sounds that are too loud, such as TV or radio volume
DSI and Sensory Avoiding
These children have nervous systems that feel sensation too easily or too much. They are overly responsive to sensation. As a result, they may have "fight or flight" responses to sensation, a condition called "sensory defensiveness." Some behaviors that can be observed are:
Responding to being touched with aggression or withdrawal
Afraid of, or becomes sick with movement and heights
Very cautious and unwilling to take risks or try new things
Uncomfortable in loud or busy environments such as sports events, malls
Very picky eater and/or overly sensitive to food smells
DSI and Dyspraxia
These children are clumsy and awkward. They have particular problems with new motor skills and activities. Some behaviors that can be observed are:
Very poor fine motor skills such as handwriting
Very poor gross motor skills such as kicking, catching, throwing balls
Difficulty imitating movements such as "Simon Says"
Trouble with balance, sequences of movements and bilateral coordination
What are some signs of Sensory Integrative Dysfunction?
Overly sensitive to touch, movement, sights, or sounds
Under reactive to touch, movement, sights, or sounds
Easily distracted
Social and/or emotional problems
Activity level that is unusually high or unusually low
Physical clumsiness or apparent carelessness
Impulsive, lacking in self control
Difficulty making transitions from one situation to another
Inability to unwind or calm self
Poor self concept
Delays in speech, language, or motor skills
Delays in academic achievement
What is sensory integration?
The senses work together. Each sense works with the others to form a composite picture of who we are physically, where we are, and what is going on around us. Sensory integration is the critical function of the brain that is responsible for producing this composite picture. It is the organization of sensory information for on-going use.
For most of us, effective sensory integration occurs automatically, unconsciously, without effort. For some of us, the process is inefficient, demanding effort and attention with no guarantee of accuracy. When this occurs, the goals we strive for are not easily attained.

Sensory experiences include touch, movement, body awareness, sight, sound, and the pull of gravity. The process of the brain organizing and interpreting this information is called sensory integration. Sensory integration provides a crucial foundation for later, more complex learning and behavior.

For most children, sensory integration develops in the course of ordinary childhood activities. Motor planning ability is a natural outcome of the process, as is the ability to adapt to incoming sensations. But for some children, sensory integration does not develop as efficiently as it should. When the process is disordered, a number of problems in learning, development, or behavior may become evident.
The concept of sensory integration comes from a body of work developed by A. Jean Ayres, PhD,OTR.As an occupational therapist, Dr. Ayres was interested in the way in which sensory processing and motor planning disorders interfere with daily life function and learning. This theory has been developed and refined by the research of Dr. Ayres, as well as other occupational and physical therapists. In addition, literature from the fields of neuropsychology, neurology, physiology, child development, and psychology has contributed to theory development and intervention strategies.

Who has problems with sensory integration?
You may know a child who, although bright, has difficulty using a pencil, playing with toys, or doing self-care tasks, like dressing. Perhaps you have seen a child so fearful of movement that ordinary swings, slides, or jungle gyms generate fear and insecurity. Or maybe you have observed a child whose problems lie at the opposite extreme uninhibited and overly active, often falling and running headlong into dangerous situations. In each of these cases, a sensory integrative problem may be an underlying factor. Its far-reaching effects can interfere with academic learning, social skills, even self-esteem.
Research clearly identifies sensory integrative problems in children with developmental or learning difficulties. Independent studies show that a sensory integrative dysfunction can be found in up to 70% of children who are considered learning disabled by schools.

Sensory integrative problems are not confined to children with learning disabilities, however. They transect all age groups as well as all intellectual levels and socio-economic groups. Consider the following human problems:

Premature birth - More and more premature infants survive today; they enter the world with fragile, easily over stimulated nervous systems and multiple medical complications. Parents need to learn how to give their premature infant the sensory nourishment their child requires for optimal development, and how to avoid detrimental over stimulation.
Autism and other developmental disorders - Although autism is rare, it occurs more often than blindness. Severe difficulty with sensory processing is a hallmark of the disorder. Autistic children seek out unusual quantities of certain types of sensations and are extremely hypersensitive to other types. Similar traits are often seen in other children with developmental disorders. Improving sensory processing leads these children to more productive contacts with people and environments.
Learning Disabilities - As many as 30% of school-aged children are estimated to have learning disabilities. Research indicates that a majority of these children, although normal in intelligence, are likely to have sensory integrative problems. These children are also more likely than their peers to have had a premature birth, early developmental problems, and poor motor coordination. Early intervention can improve sensory integration in these children, minimizing the possibility of school failure before it occurs.
Delinquency and substance abuse - Numerous studies indicate that learning-disabled children are at risk for later delinquency, criminality, alcoholism, and drug abuse. Repeated failure in school opens the door to self-destructive activities. By interrupting the vicious cycle of failure, intervention to help children with sensory integration and learning problems may also prevent serious social problems later in life.

Stress related disorders - Sensory integrative difficulties that appear in childhood often are not outgrown. When sensory inefficiencies in adults do not allow them to perform optimally in the workplace, stress can build up. Additionally, there is mounting evidence that stress in parents can lead to child abuse, violence in the home, and problems that pass from generation to generation. Recognition of the sensory processing component of these problems contributes an important element in aiding people to achieve greater satisfaction in their home life and competence in their work.
Brain injury - Trauma to the brain from accidents and strokes can have profound effects on sensory functioning. People who suffer from these effects deserve treatment that will lead to the best possible recovery. In order for this to occur, the health professionals who serve them must address their sensory deficits.

The Treatment
What is the Treatment for Sensory Integration Dysfunction?
Occupational Therapy (OT) is used to treat Sensory Integration Dysfunction. The goal of OT is to enable children to take part in the normal "occupations" of childhood - such as playing with friends, enjoying school, eating, dressing and sleeping - which are often problems for children with DSI. Each child is provided with an individualized treatment plan. Therapists sometimes also consult at home or school. Parents are directly involved in treatment sessions so that they can learn more about their child and, together with the therapist, can figure out how to incorporate their family's priorities into treatment.
What does Occupational Therapy look like?
Treatment is fun! It occurs in a sensory-enriched gym with lots of swinging, spinning, tactile, visual, auditory and taste opportunities. Using an approach we call "STEP-SI" (pronounced "step - S - I") with input from parents, we begin to understand how the child perceives sensation and how that affects his/her attention, emotions, motor skills or learning abilities. We evaluate for each child:
- The responses in each sensory system (e.g. movement, touch, taste, etc.)
- The need for more vs. less complexity and structure in completing activities
- The responses to "enriched' compared to "simple" surroundings
- The necessity for having expected vs. new experiences
- The child's ability to preview and adjust responses before acting
- The need for less or more intense interactions with others
The overall goals of Occupational Therapy are to improve Social Participation, Self-Esteem, Self-Regulation and Sensory-motor Abilities. In addition, we strive to give parents a toolbox of ideas to use in helping their child become regulated and coordinated. We support parents perception that their child's disability is real, even though it is a "hidden handicap." We also help parents to become strong advocates for their child at school and in other situations.
What steps can be taken?
If a child is suspected of having a sensory integrative disorder, a qualified occupational therapist can conduct an evaluation. Evaluation usually consists of both standardized testing and structured observations of responses to sensory stimulation, posture, balance, coordination and eye movements. After carefully analyzing test results and other assessment data along with information from other professionals and parents, the therapist will make recommendations regarding appropriate treatment.
If therapy is recommended, the child will be guided through activities that challenge his or her ability to respond appropriately to sensory input by making a successful, organized response.

Training of specific skills is not usually the focus of this kind of therapy. Adaptive physical education, movement education and gymnastics are examples of services that typically focus on specific motor skills training. Such services are important, but they are not the same as therapy using a sensory integrative approach.

One important aspect of therapy that uses a sensory integrative approach is that the motivation of the child plays a crucial role in the selection of the activities. Most children tend to seek out activities that provide sensory experiences most beneficial to them at that point in development. It is this active involvement and exploration that enables the child to become a more mature, efficient organizer of sensory information.

Hemant P.Nandgaonkar
Pediatric Rehabilitation Center
Specialty childcare clinic

101, Ambica Plaza, 90 Feet Road,
Mulund (East), Mumbai-400 081.
Consulting Hours:Monday to Saturday 8 P.M.
Phone: 561 4493,591 8913