Week 2: SI Frame of reference: theory and Practice

Sensory Integration

organization of sensory info to make an adaptive response

originated in the work of A.Jean Ayres

Adaptive response (AR)

successfully meeting an environmental challenge

elected by activities that facilitate sensory modulation, discrimination and integration, resulting in improved posture control, praxis/bilateral integration and participation

Our senses 

visual, auditory, tactile, taste, olfactory, proprioception, vestibular, interoception 

Neuro maturation  

involves: 

hierarchical organization of cortical and subcortical areas (bottom up) 

developmental sequence of learning and skills acquisition 

neuroplasticity  

A Jean Ayres

explains behaviors through neural functioning.

concerns with childhood occupation s

interventions draw from neuromaturation and systems theory 

SI interventions 

“just right challenge” to create neuropathways

OTP and child collaborate

child directed

playful 

• controlling the rate, timing, frequency and duration of sensory input to facilitate sensory modulation and sensory discrimination

Systems theory 

organism environmental interactions

actions of the enviroment on the organism and the reaction of the organism on the enviroment is the essence of the SI response. 

Modulation Model 

Winnie Dunn

over and under sensory responsivity are discussed in terms of thresholds 

sensory sensitivity → avoiding → registration → seeking 

tool: the sensory profile 

Models of Modulation 

Lucy Jane Millers

consist of these 3 areas…over responsively, under responsively, seeking/craving 

Model for Ideation

Teresa May Benson

ideas for motor actions begin with perception of objects in the enviroment, or from previously performed and internalized motor schemas 

studies showed that individuals with the worst ideational abilities had above average IQ and language skills. 

Tina Champagne

studied the relationship between sensory processing and mental health diagnosis

developed sensory modulation program (FOR)

SI prenational period 

Protective response to tactile stim 

Neonatal period SI

tactile = attachment

proprioception = mold to mother  

vestibular = fully functional at birth 

visual (high contrast), auditory, self regulation =non developed

First 6 m SI

Rise up against gravity

head control, bilateral coordination, reach/bang/primitive grip 

voluntary vs reflexes 

intentional engagement 

SI 6-12m 

increase

mobility, auditory awareness and vocalization tactile perception ore refine which helps with self feeding

SI 2 yr old 

improved

Body positions, balance and posture, discrimination and localization of tactile sensations, Motor planning, ideational praxis  

sense of agent of power 

SI Development 3-7 yr old

Peer interactions, visual motor, motor planning on more advance equipement, organization of ADLs/general routines , greater self efficacy when mastering occupations. 

Outcomes of adequate SI

modulation/discrimination/integration → self regulation → postural/ocular/bilateral control → praxis → self efficacy → participation

Assessment of SI functions

Record review→ Interview (SP, Sensory processing measure → Direct observations (bilateral coordination, vestibular, praxis, tone) → standardized testing 

Subtests Provide Information About SI skills

Millar Function and Participation Scales (praxis, vestibular, visual motor integration, visual perception)

BOT: (bi lateral coordination

VMI: (visual motor, visual perception)

Occupation based assessments

provide information about the extent to which sensory processing difficulties may be affecting functional performance

Sensory Modulation

tendency to generate responses that are appropriately graded in relation to incoming sensory stim

Under responsiveness in sensory modulation 

when to pay attention to a stimulus and when to ignore it, safety concents 

Over responsiveness in sensory modulation 

Tactile, visual, auditory, olfactory and taste defensiveness, gravitational and postural insecurity, increase pain tolerance

Sensory Discrimination

ability to distinguish between different sensory stimuli (hot, cold, dull, sharp)

Sensory discrimination 

process of giving meaning to sensory information 

Vestibular bilateral function (postural and bilateral integrration disorder or bilateral integration and sequencing pattern)

constellation of clinical signs and test scores that involve motor outcomes of vestibular processing

use formal and informal observation and test  

Praxis/motor planning

conceptualize → plan → and execute non habitual motor act

Dyspraxia

problems with motor planning. part of Developmental Coordination Disorder 

ideation (not knowing problem)

Ideomotor (not knowing plan to solve). 

Execution (lack of coordination of plan) 

Ayres Dyspraxia

somatodyspraxia

• poor praxis, impaired tactile and proprioceptive progressing 

Visudyspraxia: 

• poor praxis and impaired visual perception 

Sensory seeking behavior

may serve an adaptive function for SI challenges

Intervention for Sensory Modulation Disorder

• AR → maladaptive response

• modify one sensory system → AR in another

• facilitate development of foundation abilities

• routines = optimal level of arousal

• encourage play

Intervention for dyspraxia 

just right challenge = AR

sensory rich experience = body awareness

adjust frequency, intensity, duration to match needs

Intervention for somatodyspraxia 

• develop body schema

• demand negotiation of space

• ask questions/guide problems

• new challenges with opportunities to practice and master skills

intervention for ideation 

top down approach

• bridge current experiences with past  

• familiar mental images to describe actions

• encourage to imitate and expand 

• increase awareness of object affordances 

Intervention for bilateral integration/sequencing deficits

• provide vestibular proprioceptive experiences

• visual motor challenges = improve timing and spatial skills

• child creates environments = sequencing and self organization 

• provide activities that contain multistep motor sequences 

Measuring outcomes of SI intervention

function based goals

changes on standardized assessments

goal attainment scores: systematic monitoring of meaningful goals. 

Intervention related to modulation….should provide 2/3

tactile (ie shaving cream, ball pit) 

vestibular (swing, scooter) 

proprioceptive  (heavy work, crawling through tunnel) 

Interventions related to sensory discrimination

between size and shape, with no visual cures

stepping over or on textured objects

finding treasure sin playdoh/putty

Interventions related to bilateral integration and sequencing

• infusion of vestibular input

• puzzle while seated on a therapy ball

• swinging on a platform swing on prone, while catching a ball

Interventions related to promoting praxis 

“just right challenge”, large building blocks to create pyramid, taking snack out of bag, opening the container, using appropriate utensils and eating. After eating, wiping self and table, and throwing out garbage