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OVERVIEW
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Michael is a third grade
student who is waiting for the school bus. He is
challenged by sensory experiences during everyday
activities that most of us don't even think about.
While he's still reeling from the battle with mom
over brushing his teeth (that peppermint toothpaste
tastes like fire in his mouth) the school bus pulls
up. Michael runs past the bus monitor's haze of
perfume and sits at the back of the bus. In his
heightened state, he becomes even more aware of his
new school shirt with its stiff label and that
awful feeling like a wire brush being poked into
the back of his neck. The sensory experiences of
the movement of the bus, the sound of his excited
classmates laughing and yelling above the roar of
the bus engine all contribute to his increased
agitation. By the time Michael arrives at school he
is wound up and ready to unravel. There is no time
to wait for the bus monitor's direction...getting
off the bus quickly becomes a matter of survival
and he resorts to pushing, shoving and finally
kicking his way out. Unfortunately, there is a
price to pay for this seemingly outward
aggression...he can expect another trip to the
principal's office.
This digest defines sensory
integration and sensory integration dysfunction
(DSI). It outlines evaluation of DSI, treatment
approaches and implications for parents and
teachers, including compensatory strategies for
minimizing the impact of DSI on a child's life.
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WHAT IS SENSORY INTEGRATION?
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Sensory Integration is a
theory developed over more than 20 years by A. Jean
Ayres, an occupational therapist with advanced
training in neuroscience and educational psychology
(Bundy & Murray, 2002). Ayres (1972) defines
sensory integration as "the neurological process
that organizes sensation from one's own body and
from the environment and makes it possible to use
the body effectively within the environment" (p.
11). The theory is used to explain the relationship
between the brain and behavior and explains why
individuals respond in a certain way to sensory
input and how it affects behavior. The five main
senses are:
- Touch - tactile
- Sound -
auditory
- Sight -
visual
- Taste -
gustatory
- Smell -
olfactory
In addition, there are two
other powerful senses:
- vestibular (movement and
balance sense)-provides information about where
the head and body are in space and in relation
to the earth's surface
- proprioception
(joint/muscle sense)-provides information about
where body parts are and what they are
doing
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WHAT IS SENSORY INTEGRATION DYSFUNCTION?
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Dysfunction in sensory
integration is the "inability to modulate,
discriminate, coordinate or organize sensation
adaptively" (Lane et al., 2000, p. 2).
How efficiently we process
sensory information affects our ability
to:
- discriminate
sensory information to obtain
precise information from the body and the
environment in order to physically interact with
people and objects. An accurate body scheme is
necessary for motor planning, i.e., being able
to plan unfamiliar movements. It involves having
the idea of what to do, sequencing the required
movements, and executing the movements in a
well-timed, coordinated manner.
Michael frequently bumps
into others and drops items on the way to class
because of his poor body scheme. He often hands
in crumpled assignments that reflect the
challenges of holding a pencil in his hand and
making precise movements to achieve legible
handwriting. Concentrating on his school work
intensely may lead him to fall off his chair. To
most people, Michael appears to be a sloppy,
clumsy, and forgetful child.
In gym class, Michael
cannot master jumping jacks, somersaults make
him feel sick, and he has given up on ever being
able to connect with a baseball. His timing was
always off. He resorts to being the class clown
to cover up for his difficulties. Michael
certainly doesn't feel good about himself. He
can't do what other kids seem to do so
effortlessly-and then there is the teasing...
- modulate
sensory information to adjust to
the circumstances and maintain optimum arousal
for the task at hand. Sensory modulation is the
"capacity to regulate and organize the degree,
intensity and nature of responses to sensory
input in a graded and adaptive manner" (Miller
& Lane, 2000).
Sensory defensiveness, a type
of sensory modulation problem, is defined by
Wilbarger and Wilbarger (1991) as "a constellation
of symptoms related to aversive or defensive
reactions to non-noxious stimuli across one or more
sensory systems" (Wilbarger & Wilbarger, 2002a,
p. 335) It can affect changes in the state of
alertness, emotional tone, and stress (Wilbarger
& Wilbarger, 2002a).
Michael demonstrates many
symptoms of sensory defensiveness, which affect his
attention, learning, and behavior. His teacher's
instructions get lost in competition with a clock
ticking, the echo of peers walking and talking in
the hall. He is off task and he finds solace in
humming or chewing on the end of his pencil,
sensory seeking behaviors that help ease the
discomfort. Fortunately, he has gym class before
lunch. Running bases in gym class gives him a
legitimate opportunity for the "heavy work" that
his body needs. It sure makes him feel better and
prepares him for the biggest challenge of
all-eating lunch in the school
cafeteria.
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HOW IS DSI IDENTIFIED?
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DSI is identified through
evaluation by an occupational therapist who has
advanced training in sensory integration, using one
or more of the following practices:
- Gathering information
about the child's performance in daily life
tasks within the context of the classroom,
school, and/or home environment.
- Skilled observation of
the child: the therapist sets up a play
environment and observes the child's responses
to different types of sensory input and motor
planning ability.
- Parent/caregiver sensory
questionnaires /standardized checklists, e.g.,
Sensory Profile (Dunn, 1999), non-standardized
checklists.
- Parent/caregiver
interview: the therapist identifies specific
functional problems related to problems with
sensory processing.
- Standardized tests of
general development and motor functioning, e.g.,
Sensory Integration and Praxis Test Battery
(SIPT) (Ayres, 1989).
- Clinical observations of
posture, coordination, etc.
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Tourette
Syndrome "Plus" © Copyright 1998 - 2005 Leslie
E. Packer, PhD. except as noted.
All rights reserved
This page last updated January 7, 2005.
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