Tricia Simon
Principal Speech and Language Therapist
ABMU Health Board
November 2009
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What is sensory integration
Which client groups often have difficulty with
this skill
Which professionals may be involved
What might intervention look like – case
examples
Sensory integration is the neurological process
that organises sensation from one’s own
body and from the environment and makes it
possible to use the body effectively within the
environment. Sensory integration is
information processing. The brain must
select, enhance, inhibit, compare and
associate the sensory information in a
flexible, constantly changing pattern, in other
words the brain must integrate it.
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Physical clumsiness
Difficulty learning new movements
Activity level unusually high or low
Poor body awareness
Inappropriate response to touch, movements,
sights or sounds
Poor self esteem
Social and/or emotional difficulties
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Pervasive Developmental Disorder (including
Autism and Aspergers Syndrome)
Attention Deficit Hyperactivity Disorder
(A.D.H.D./A.D.D,)
Learning Disorders ( i.e. specific learning
difficulties e.g. dyslexia)
Developmental Disabilities
Fragile X Syndrome
Developmental Coordination Disorder [DCD]
(including Dyspraxia)
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Often Occupational Therapists
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Speech and Language Therapist
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Physiotherapist
The focus or goal of intervention may change
depending on the professional background.
Profiles and direct assessment of
 visual
 auditory
 tactile
 olfactory
 gustatory
 vestibular - movement
 proprioception – body position
Levels of self regulation
1. Autonomic regulation
Biological regulation e.g. sleep, digestion, temperature.
2. Modulation
Regulation of arousal levels in response to stimuli
3. Sensory discrimination
Interpret and organise information
4. Executive function
Modulate, interpret and organise response
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Seek out excessive amounts of one type of
stimulation
Avoid specific sensations
May be agitated, constantly on the go
Or quiet, withdrawn, self abusive, sleep a lot
May fail to register or recognise stimulus and
ignore what is happening
May respond with alarm as they don’t fully
understand what is happening
Sensory difficulties may result in
client operating only in survival mode
Mental state
cognition
Area of brain
calm
abstract
Neocortex
aroused
Concrete, rigid
Subcortex
alarmed
Emotional
Limbic
fear
reactive
Midbrain
terror
Reflex only
brainstem
Survival response may be:
 Freeze, defiance, aggression
 Or avoidance, compliance, dissociation
Hyper excited or defensive
Shut out stimuli through to shut down
Response to stress: freeze, fight, flight, fright, vigilance?
How do they self calm? E.g. head bang, deep pressure
Calm, alert and attentive
Hypo: Under responsive or high threshold
How do they alert themselves e.g. spinning, chew
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Assessment leads to a profile of the amount,
type and duration of sensory stimulus the
person can cope with
Aim to facilitate a controlled regulated
response to all sensory stimuli through the
just right combination of alerting and calming
stimuli
ALD – work at first two levels of regulation
and modulation to achieve a calm alert state
to allow learning and relating to others.
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Control volume of stimuli in the environment
Education for carers e.g. tactile defensive, not
rejecting touch/affection.
Aim to sensitise parents and carers to the
individual’s behaviours and help them
become aware of and modify their
interactional styles according to the
individual’s cues.
Therapist support carers to carry out
intervention (rather than carry out the
intervention themselves)
Taste/smell
Calming/nurturing
Alerting/Challenging
Sweet, vanilla, salt
Sour, citrus, spice, bitter
Oral texture Suck, blow, bite, crunch
Chew, lick
temp
Cool to moderate
extreme
tactile
deep pressure
Light/unexpected touch
movement
Stretch and resistance
(hang, pull, push, crawl,
carry heavy load), bounce
Linear move e.g. swing
Rotary move e.g. spin
auditory
Vibration, rhythm music
Speech sounds
Observe what the individual seeks.
Aim for the individual to remain regulated during all stimuli.
Initially therapist/carer acts as regulator by structuring environment.
Eadaoin Bhreathnach: OT and counsellor
Uses theories of
 Sensory integration
 Attachment classification
Use of therapeutic space from both sensory
processing and attachment perspectives.
Observed behaviour may be due to sensory or
emotional difficulties.
Different types of insecure attachment have
different sensory profiles e.g.
 Avoidant child likely to be tactile defensive,
may use freeze/compulsive compliance
 anxious child likely to be aggressive during
fast movement and unstable surfaces.
Sensory difficulties may result in attachment
difficulties in LD e.g. tactile defensiveness.
Question: Why is the client doing a behaviour
Potential answers
 Can’t tolerate the sensation – hyperexited or
defensive reaction
 Not enough sensory information (high threshold or
under responsive) – sensory seeking
 Cognition/ stage of development; difficulties with
perception and misinterpretation.
 Past ‘trauma’ or negative experience
 Communication
 Emotional/attachment e.g attract attention
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Start where is comfortable in terms of
physical space and sensory stimulation –
don’t trigger a self stimulatory/ SIB reaction
or survival mode
Tune in
Work at their pace
Stop before triggering threshold for stimuli –
ensure a positive experience
Parallels with Intensive Interaction approach
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Withdraws (‘sleeps’) at day service – in foetal
position in wheelchair with t-shirt over his
head
 Moves away when touched
 Emerges to accept food and drink only
 Foster carers – chews bedding/mattress at
home
Levels of self regulation; John
1. Autonomic regulation - physiological
Rubella
stress pattern
Chest infection
?gastric issues
2. Modulation
Avoidant
Hypervigilant?
Disengages
tone
Self soothes – taps his head
Tactile defensitve
posture
3. Sensory discrimination - interpret
Postural control very good
Follows instructions around food, active withdrawal at other
times
4. Executive function
Organise around food and posture
Hyper excited or defensive
Shut out stimuli through to shut down
Response to stress: freeze, fight, flight, fright, vigilance?
How do they self calm? E.g. head bang, deep pressure
Calm, alert and attentive
Hypo: Under responsive or high threshold
How do they alert themselves e.g. spinning, chew
Cut out/shut down – foetal position, under
bedclothes/t-shirt, eyes closed
Stress reactions
 Freeze – foetal position
 Fight – SIB banging head, destroying mattress
 Flight – move away
 Fright – scream
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Tactile defensiveness – Is he defensive to the
sensation or emotional avoidance/control?
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Tapping head
Tshirt pressure
Foetal position – pressure on joints
Chew
Suck
Retreats into self
Aim to engage in positive experience – tune in
and mirror what he seeks
Aim for calm alert state so need to use calming
interventions
 Sucking
 Bite –melt foods
 Chewing
 Movement (car, rocker)
 Deep pressure – careful in case control issues
 Rhythm of SIB or tapping
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Autistic
Hyperexcited signs – smile, bounce up and
down, hands in mouth can then escalate to
agitation (pacing, rocking), aggression, and
not registering pain.
Triggered by pub, football match – important
for relationship with Dad.
Levels of self regulation; Paul
1. Autonomic regulation – lots of physiological issues
Low tone, epilepsy, cleft palate, hayfever, eczema, allergies,
tunnel vision, middle ear problems, high sugar intake, high
urine output
2. Modulation
Low tone – difficulty regulating muscle control
Seeking proprioception (jumping)
Tactile defensive – either emotional or postural challenge not
sensory
3. Sensory discrimination - interpret
Auditory processing problems, body scheme problems
Delayed processing with food, cognition
Gravitational insecure (won’t tilt head)
4. Executive function
Problems planning movement – uses reflex fight/flight
Regulate during family activities by
 Reducing noise (ear coverings?), therapeutic
listening to reduce defensiveness.
 Provide calming stimuli –lots of
proprioception (pull, push, lift, hold) e.g.
chewing dried fruit/ carrot/ apple, suck on
water bottle, trampoline, squeeze ball, walk
hills
Primary need is to address health and
physiological difficulties e.g. tunnel vision
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Lots of input for challenging/self injurious
behaviour but no solutions found to date
Often sleeps at day service (staff report this
as a good day)
Noisy at home
Difficult to engage and interact with
Signs of hyperexcitation
Fight – hits self
Flight – increased agitation
Fear – when carer moves away increased SIB
What calms – hitting self on head, hitting foot on
wheelchair
Calm alert state
1:1 on holiday
Nurturing type activities (massage, cuddles, food)
Being outside
Water
hoist
Sleep – is this shut down/escape from
sensory overload at day service?
 Tactile defensiveness – trigger for SIB
 Vestibular – postural insecurity and needs
lots of proprioception (deep pressure) but
without being worried about balance
 Auditory – can’t cope with sudden sounds
 Fear reaction when staff move away –
attachment
Give staff strategies to support calm state and
evidence the need for 1:1
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What is the person’s past experience and
learning?
What patterns is the person following –
emotion or sensory based, or is there another
reason for their actions e.g. communication,
cognition/ developmental level.
What will help e.g. environment,
activities/sensations
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Sensory integration network UK and Ireland
www.sensoryintegration.org.uk