SENSORY
INTEGRATION
IN PHYSICAL THERAPY
Aila Nica J. Bandong, PTRP
Unit Presenter
Instructor, Department of Physical Therapy
Clinical Supervisor, CTS- Pediatric Section
UP- College of Allied Medical Professions
LEARNING OBJECTIVES
At the end of the lecture, the students should be able to:
• discuss sensory integration theory
• define sensory processing disorder and its relation to
other conditions
• differentiate the types and subtypes of sensory
processing disorders
• describe the behaviors manifested by individuals
having sensory processing disorders
• discuss common assessment procedures for sensory
integration functions.
• describe intervention approaches to patients with
sensory processing disorders.
SENSORY INTEGRATION
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.
(DiMatties, 2004; Case-Smith, 2005)
tactile
vestibular
proprioception
olfactory
auditory
7
major
senses
visual
gustatory
EFFICIENT SENSORY INTEGRATION
Allows an individual to:
• Discriminate sensory information to obtain
precise information from the body and the
environment in order to physically interact
with people and objects
• Modulate sensory information to adjust to
the circumstances and maintain an
optimum level of arousal to attend to a
task
EFFICIENT SENSORY INTEGRATION
posture
modulation
discrimination
SENSORY MODULATION
The capacity to regulate and organize the
degree, intensity, and nature of
responses to sensory input in a graded
and adaptive manner.
(DiMatties, 2004)
THE PROCESS OF SENSORY INTEGRATION
Sensory
registration
Orientation
Interpretation
Organization
Execution
SENSORY PROCESSING DISORDER
• Inability to modulate, discriminate,
coordinate or organize sensation
adaptively (DiMatties, 2004).
• A global umbrella term that includes all
forms of this disorder, including three
primary diagnostic groups and the
subtypes within each (Miller et al., 2004).
SPD AND ASSOCIATED PROBLEMS
SPD
LD
ADHD
Sensory Processing Disorder
Sensory
Modulation
Disorder
Sensory
OverResponsivity
Sensory
UnderResponsivity
Sensory
Discrimination
Disorder
Sensory
Seeking/
Craving
Sensory-Based
Motor
Disorder
Dyspraxia
Postural
Disorders
SENSORY
MODULATION
DISORDER
• Sensory Over-responsivity
• Sensory Under-responsivity
• Sensory Seeking
SENSORY OVER-RESPONSIVITY
Oh no!!!
• aka hypersensitivity, sensory
defensiveness
• Heightened sensitivity to sensory stimuli
• Avoids situations that other individuals
typically enjoy
• Deemed as aggressive, very irritable,
cautious, or rejecting
• May resemble sensory underresponsivity if overwhelmed with sensory
input
Tactile Defensiveness
• Most commonly observed disorder of
sensory modulation
• Tendency to overreact to ordinary touch
sensations specifically light touch
• Avoids touching or being touched by
object and other people
Gravitational Insecurity
• A form of over-responsiveness to
vestibular input
• Overwhelmed by changes in head
position and movement (linear)
• Avoids moving or being unexpectedly
moved
• Gravitational insecurity vs postural
insecurity
Proprioceptive Over-responsivity
• May be rigid or uncoordinated
• Avoids activities that require strong
sensory input to joints and muscles (PE
classes, playground activities)
Visual over-responsivity
• Covers eyes, has poor eye contact,
inattentive to desk work
• Overreacts to bright lights
• Very alert and watchful
• Over excited with too much to look at
(crowded places, toy stores, etc)
Auditory Over-responsivity
• Covers ears to close out sounds or
voices
• Complains about noises that don’t
normally bother other people (parties,
carnivals, parades, playgrounds, happy
sounds
Olfactory Over-responsivity
• Objects to odors that usually don’t bother
other people
Gustatory Over-responsivity
• Strongly dislikes certain temperatures
and taste of foods
• May frequently gag or throw up while
eating
SENSORY UNDER-RESPONSIVITY
Oh
Hum..
• Less response or sensitivity to
sensory stimuli
• Passive, quiet, withdrawn, easily
exhausted, uninterested
• Lacks “inner drive” to do things
Tactile Under-responsivity
• Unaware of messy face, hands, or
clothes
• Does not know whether he/she has
been touched or notice how things feel
• Often drops items
• Does not know he/she has already wet
his/her pants
Vestibular Under-responsivity
• Does not object to being moved
• Unaware of falling
• Poor self-protection skills
Propioceptive Under-Responsivity
• Does not move for play
• Tendency to become more alert after
actively pushing, pulling, lifting, and
carrying heavy loads
Visual Under-responsivity
•
•
•
•
Ignores visual stimuli
Slow response to approaching objects
Does not turn away from bright light
Stares and looks straight through faces
and objects
Auditory Under-responsivity
• Ignores ordinary sounds and voices
• Does not respond to name calling
• May require extremely loud, close, or
sudden sounds to get attention
Olfactory Under-responsivity
• Unaware of unpleasant odors
• Inability to smell food/meal
Gustatory Under-responsivity
• High tolerance to spicy food
SENSORY SEEKING
• Characterized by insatiable craving for
sensory input or stimulation in the
affected sensory modalities
• Usually labeled as having
More!!!
“social/behavioral problems”
Sensory-seeking behaviors:
Tactile
• Wallows in mud
• Dumps out bins of toys and rummages
through them purposely
• Rubs against wall or other objects, loves
to touch things
Sensory-seeking behaviors:
Proprioception
•
•
•
•
•
•
•
Loves being squeezed, hugs, very clingy
Talking continuously
Thrill-seeking
Stomping instead of walking
Intentional falling or bumping into objects
Pushing against large objects
Throwing objects forcefully
Sensory-seeking behaviors:
Vestibular
•
•
•
•
Restless: constantly moving
Thrill-seeking
Gets into upside-down positions
Craves fast, spinning movements
Sensory-seeking behaviors:
Visual
• Seeks visually stimulating scenes
• Attracted to shiny objects, bright flickering
light
Sensory-seeking behaviors:
Auditory
• Welcomes loud noises and TV volumes
• Loves crowded places with noisy action
• Speaks loudly
Sensory-seeking behaviors:
Olfactory
• Seeks strong odors
• Loves to sniff food, other objects, even
people
Sensory-seeking behaviors:
Gustatory
• Licks or tastes even inedible objects
• Prefers very spicy or hot foods
SENSORY
DISCRIMINATION
DISORDER
Tactile
• Cannot distinguish objects by touch
alone, without visual cues
• Problems with processing sensations of
pain and temperature
• Difficulty identifying where he/she has
been touched
Vestibular
• Difficulty feeling falling, most evident
when eyes are closed
• Gets easily confused when turning,
changing direction, or getting in and out
of a position
• Unable to tell if he/she has had enough
movement
Proprioception
• Unfamiliar with own body
• Difficulty positioning limbs for purposeful
movement
• Difficulty grading movement
• May bump or crash into others
unintentionally
Visual
• Confuses figures, objects, faces
• May miss expressions and gestures
during interaction
• Difficulty exhibited during visual tasks
Auditory
• Confuses sounds (letters, consonants at
ends of words)
• Cannot repeat or make up rhymes
• Sings out of tune
• Difficulty paying attention to one sound
without being distracted by other sounds
Gustatory
• Difficulty distinguishing distinct smells
• Can not gauge how strong the taste of a
certain food is (too spicy, sweet, salty,
sour, or not?)
• May choose or reject food just by looking
at it
SENSORY-BASED
MOTOR
DISORDER
• Dyspraxia
• Postural Disorders
PRAXIS
Ability to conceptualize, plan, and
execute a non-habitual
motor act.
(Case-Smith, 2005)
DYSPRAXIA
A term used in regard to children referring
to a condition characterized by difficult
with praxis that cannot be explained by
a medical diagnosis or developmental
disability and that occurs despite
ordinary environmental opportunities for
motor experiences.
(Case-Smith, 2005)
DYSPRAXIA
A child with dyspraxia may manifest with
difficulties in the following areas:
• Components of praxis
• Gross motor skills
• Fine motor skills
I can’t
do that…
Components of Praxis
• Awkward
• Clumsy
• Apparently careless (though being
careful)
• Accident prone
Gross Motor Planning
• May have poor motor coordination
• Late development or acquisition of motor
skills such as jumping, running, skipping
• Has problems negotiating stairs, walking,
moving around furniture and crowded
areas
Fine Motor Planning
• Difficulty with manual tasks
• Difficulty tracking moving objects,
focusing, and shifting gaze
• Poor eye-hand coordination
• Problems articulating clearly
• Difficulty keeping mouth closed: drool
excessively
POSTURAL DISORDERS
• Problems with movement
patterns
• Problems with balance
• Problems with coordination
(unilateral, bilateral
integration and sequencing,
crossing the midline)
Don’t want
to…
Components of Movement
• May have decreased tone
• Difficulty with transitions and
maintenance of positions
• Usually slouches or sprawls
• Difficulty rotating body
Balance
• Difficulty shifting weight
• Loses balance easily when walking or
turning or changing positions
Unilateral Coordination
• No definite hand preference: uses either
hands for activities
Crossing the Midline
• Difficulty using a hand, foot, or eye on the
opposite side of the body
Bilateral coordination
• Difficulty using both sides of the body for
symmetrical activities
• Difficulty using one hand to assist the
other during functional activities
• If with poor sequencing of actions,
referred to as bilateral integration and
sequencing (BIS)
ASSESSMENT
of Sensory Integrative
Functions
ASSESSMENT PROCEDURES
•
•
•
•
Interviews and questionnaires
Informal and formal observations
Standardized tests
Consideration of services and resources
available to and appropriate for the
family
Interviews and Questionnaires
• History taking
• Identifying presenting problems of the
child and how long these were so
• Identify goals and priorities of the family
• Used to decide whether further objective
assessment is required
Informal and Formal Observations
• Informal observations
– Natural settings (schools, in the home, etc.)
• Clinical observations
– Involve a set of specific tasks, reflexes, and
sighs of nervous system integrity
associated with sensory integrative
functioning
Commonly Used Clinical Observations
•
•
•
•
•
Crossing body midline
Equilibrium reactions
Muscle tone
Prone extension
Supine flexion
Standardized Tests
• Sensory Integration and Praxis Tests
– In depth evaluation of sensory integrative
functions
• School Functional Assessment
– Evaluation of occupation
• Miller Assessment for Preschoolers
– Not solely for sensory integrative functions
but has items on sensory integration
Consideration of Available Resources
• Identify the type of services the child is
receiving as well as response to these
services
• What other services or programs that the
child needs
CLASSIFICATION OF SPD
Based on the number of areas of
development that are affected
• MILD: individual can adapt to the stimuli
• MODERATE: a few (about 2) areas are
affected
SEVERE: almost, if not all, areas of
development are affected
INTERVENTION
for Sensory Processing
Disorders
STRATEGIES
•
•
•
•
Classical SI Therapy
Compensatory skill development
Group therapy programs
Alternative and complementary programs
for intervention
PRINCIPLES OF CLASSICAL SI THERAPY
•
•
•
•
Just right challenge
Adaptive response
Active engagement
Child directed
Techniques that address
sensory modulation disorders
Sensory Over-responsivity
Tactile Defensiveness
• Activities that provide increased tactile
and proprioceptive sensation
– Deep touch
– Combined tactile and proprioception
– Primarily proprioception
GRAVITATIONAL INSECURITY
Guidelines
• Activities that are performed initially with
the patient’s feet near or on the ground
• Activities that promote gradual
progression to backward space during
swing
Techniques that address
sensory discrimination
disorders
TACTILE
• Brushing or rubbing the skin with various
textures
• Using a vibrator
• Hiding body parts under balls or heavy
cushions or a mixture of dried rice and
beans
VESTIBULAR
• Activities that provide linear or angular
movement
• Opportunities for vertical and upside
down movements
• Activities that include frequent starts and
stops, changes in direction, or speed
PROPRIOCEPTION
• Activities that provide resistance to
movement
– Weight of the body against gravity
Techniques that address
sensory-based motor disorders
Postural Disorders
TO DEVELOP TONIC POSTURAL EXTENSION
• Activities providing linear movement in
either the horizontal or vertical plane
• Bouncing in prone will promote lifting of
head against gravity  prone on elbows
while doing reaching/weight shifting 
prone on hands  activities  activities
that require prone extension while
supporting body weight with the arms
TO DEVELOP TONIC FLEXION
• Activities should provide resistance to
movement into flexion or those that
require sustained flexion
• Activities that require flexion of the head
and upper trunk only  full antigravity
flexion
TO DEVELOP RIGHTING AND
EQUILIBRIUM REACTIONS
• Create activities that challenge
equilibrium but that can be accomplished
with automatic fluid responses
– Assuming developmental positions
– Reaching activities
Techniques that address
sensory-based motor disorders
Dyspraxia
IDEATION
• Provide physical guidance  withdraw
physical cues and model activities 
provide full instructions  parial prompts
or cues
PLANNING AND SEQUENCING
• Obstacle course that requires smooth
transitions between several different
types of action sequences.
COMPENSATORY SKILL DEVELOPMENT
• Helps the child and family develop
coping strategies in the face of SPD
• Modify, adapt the environment, activity,
or how people interact with the child
• Focused on the task or functional activity
rather than the underlying problem or
disorder
SENSORY DIET
• Planned, scheduled activities performed
throughout the day to help children
maintain an optimal level of arousal
• Include alerting, calming, and organizing
activities that are based on the child’s
performance
GROUP THERAPY PROGRAMS
• Transition from individual therapy for the
child to apply the lessons learned or
newly developed skills in social, peer
context with less support from the
therapist
ALTERNATIVE PROGRAMS
• Wilbarger Approach
• “How Does Your Engine Run”: The alert program for
self-regulation
• Water-based intervention
• Hippotherapy
• Oculomotor control: An integral part of sensory
integration
• Therapeutic listening
• Craniosacral therapy and Myofascial release
• The Farm
Something to think about…
Can adults have
sensory processing
disorders?
Do you have questions???
THANK YOU
FOR
LISTENING!
References
Bundy, A. C., Lane, S., Murray, E. (2002). Sensory integration: Theory and practice.
Philadelphia; F. A. Davis Company.
Case-Smith, J. (2005). Occupational therapy for children (5th ed). Misssouri: Elsevier
Mosby.
DiMatties, M. (2004). Understanding sensory integration. Retrieved 12/28/2008 from
www.ericdigests.org/2004-1/sensory.htm.
Kranowitz, C. (2005). The out-of-sync child: Recognizing and coping with sensory
processing disorder. Retrieved 12/28/2008 from
http://books.google.com.ph/books?id=3gtL9XaZ8GwC.
Miller, L. J., Fuller, D. (2007). Sensational kids: Hope and help fro children with sensory
processing disorder. Retrieved 12/28/08 from
http://books.google.com.ph/books?id=KsX376z2Vp8C.
Miller, L. J., Lane, S., Cermak, S., Anzalone, M., Koomar, J. (2004). Position statement
on terminology related to sensory integration dysfunction. Retrieved 12/28/2008 from
http://www.spdbayarea.org/SPD_why_the_name_sensory_processing_disorder.htm.
Roley, S., Mailloux, Z. (2002). Ayres sensory integration. Retrieved 12/28/2008 from
http://www.siglobalnetwork.org/asi.htm.