SENSORY ISSUES IN
NEUROLOGICL CONDITIONS IN
CHILDREN
Dr. Simran A. Mishra
(MPT – II nd year)
Under Guidance of : Dr. Suvarna Ganvir
Department of Neuro-Physiotherapy
DVVPF’s College of Physiotherapy,
1
Ahmednagar
Introduction
3-4
Classification
5-6
Incidence & prevalence
7-8
Sensory Modulation Disorder
9-15
Sensory Based Moto Disorder
16-22
Sensory Discrimination Disorder
23-25
Sensory Integration
26-39
Recent Advances
40-42
2
INTRODUCTION
Sensory
Organs
• Sensory processing deals with how the brain
processes sensory input from multiple
Different
Inputs
sensory modalities. These include the five
classic senses of vision, audition, tactile
Sensory
Specific
Cortices
stimulation , olfaction and gustation.
• Other sensory modalities exist, for example
the vestibular sense and proprioception.
Motor and
behavioral
responses
3
Lonkar, Heather, "An Overview of Sensory Processing Disorder" (2014). Honors Theses.
4
Sensory Integration and the Child: Understanding Hidden Sensory Challenges, 2005 by Western Psychological Services.
Sometimes there can be a problem with the encoding of the sensory information. This disorder is known
as Sensory Processing Disorder (SPD). This disorder can be further classified into three main types.
SEN SO RY
M O D U LAT ION
D ISO R D ER
SEN SO RY
D ISC R IM IN ATION
D ISO R D ER
SEN SO RY BASED
M O TO R D ISO R D ER
• Sensory Over
• Dyspraxia
• Visual
responsivity
• Vestibular
• Auditory
• Sensory Under
responsivity
• Sensory Seeking /
Craving
Proprioceptive
• Tactile
Disorders
• Taste
• Bilateral integration
& sequencing
• Smell
• Vestibular
• Proprioception
5
Paula Kramer et al. Frames of reference for paediatric occupational therapy 3rd edition
C A U S E S O F S E N S O RY P R O C E S S I N G
DISORDER:
•
•
•
•
•
Estimated - 5 to 15 % children - some form of SPD
Causes of SPD:
Heredity,
Prenatal conditions/birth trauma, and
Environmental Factors
• Miller et al (2006)- SPD- low birth weight or exposed to alcohol or drugs prior to
birth
6
Lonkar, Heather, "An Overview of Sensory Processing Disorder" (2014). Honors Theses.
The prevalence of altered sensory modulation in selected neuro developmental/neurologic
conditions (in %).
7
Engel-Yeger B, Muzio C, Rinosi G, et al. Extreme sensory processing patterns and their relation with clinical conditions
Sensory Modulation Disorder
SENSORY OVER RESPONSIVITY
F
U
N
C
T
I
O
N
D
Y
S
F
U
N
C
T
TOUCH
Comfort
Exploration
Participation
Bothered by
Clothing,
Avoidant of
tactile
experience
AUDITORY
VISUAL
Enjoys
Comfort lights
Engage
Enjoys
Participate in
Colours and
social activity
patterns
Avoids
gathering
Distressed by
regular sounds
Bothered
Bright lights
Colours
Visually
8
clustered
OLFACTION
TASTE
Eat and
Not bothered,
responds to
all smells
enjoys variety
Stressed
Avoids lumpy
Food smell
or slimy
Hygiene
Avoids salty
products
or spicy
of food
Sensory Modulation Disorder
SENSORY OVER RESPONSIVITY
F
U
N
C
T
I
O
N
D
Y
S
F
U
N
C
T
I
O
N
PROPRIOCEPTION
Comfortable
activities –
coordination,
engages in activities
Avoids climbing
activities
Dislikes hanging
activities
V E S T I B U L AR
Enjoys movements in
all planes and
directions
Avoids playground
swings, rock n roll,
slides, cautious
9
Bialer, D. S., and L.
J. Miller. 2011. No
Longer A SECRET:
Unique Common
Sense Strategies for
Children with
Sensory or Motor
Challenges.
Sensory Modulation Disorder
SENSORY UNDER RESPONSIVITY
F
U
N
C
T
I
O
N
D
Y
S
F
U
N
C
T
TOUCH
AUDITORY
VISUAL
Acknowledges
Responds
Enjoys
touch
Recognizes
colours and
Responds
Follows
patterns
adequately
commands
Visual cues
No response
to touch, pain
Drooling, dirt,
wet, cuts
Quite, passive
No response
withdrawal
OLFACTION
Notices smells
Responds
accordingly
TASTE
Eats if hungry
Appreciates
different
tastes
No notice to
No
No response
visual
recognition
to hunger
reminders
for pungent
Tolerate
10
Misses
cues
noxious smell
extremes
Sensory Modulation Disorder
SENSORY UNDER RESPONSIVITY
F
U
N
C
T
I
O
N
D
Y
S
F
U
N
C
T
I
O
N
PROPRIOCEPTION
V E S T I B U L AR
Grades force
Engages activities,
appropriately
movements in all
Uses tools
planes and directions
Slow and plodding
movements
No indication of like
Weak grasps
and dislike
11
Bialer, D. S., and L.
J. Miller. 2011. No
Longer A SECRET:
Unique Common
Sense Strategies for
Children with
Sensory or Motor
Challenges.
Sensory Modulation Disorder
SENSORY SEEKER
F
U
N
C
T
I
O
N
D
Y
S
F
U
N
C
T
TOUCH
AUDITORY
VISUAL
Acknowledges
Responds
Comfortable
touch
Engages
in lighted
enjoys and
Alerts
areas, enjoys
participates
Participates
colours
Overly
Loud speaking
Fast changing
affectionate
Noise making
images on TV
Irritates
Enjoys loud
spinning
biting,
volume
object, Enjoys
pinching
difficulty wait
12
blinking light
OLFACTION
TASTE
Notices smells
Eats and
Responds
Appreciates
accordingly
different foods
Enjoys strong
Lick, Suck,
odour, smells
Chews non-
people, toys
food, prefers
during play
crunchy food
Sensory Modulation Disorder
SENSORY SEEKER
F
U
N
C
T
I
O
N
D
Y
S
F
U
N
C
T
I
O
N
PROPRIOCEPTION
Moves smoothly,
coordinated actions
V E S T I B U L AR
Engages activities,
movements in all
planes and directions
Bumps, falls &
Engages in excessive
crashes on purpose
movements, never
Fidgets, wiggles
still, twirls/ Spins,
during play
no regards for safety
13
Bialer, D. S., and L.
J. Miller. 2011. No
Longer A SECRET:
Unique Common
Sense Strategies for
Children with
Sensory or Motor
Challenges.
Sensory Modulation Disorder
ASSESSMENT TOOLS
• Sensory Profile
..\..\..\..\Downloads\child sensory profile.pdf
• Sensory Processing Measure (SPM)-
• Sensory Processing 3 dimensional scale (SP3D):
• ..\..\..\..\Downloads\SP3d.png
14
Sensory Based Motor Disorder
Dysfunction occurs when “hidden” proprioceptive & vestibular senses - allow
our bodies to move & sense our body position, are impaired,”
Praxis
ability to conceive,
plan, and organize a sequence
of goal-directed motor actions
Praxis incorporates cognitive,
perceptual and motor component of
control.
Postural disorderIndividual lacks ability to stabilize
body during movements or rest that unable to meet
demands of environment or given motor task
15
Lonkar, Heather, "An Overview of Sensory Processing Disorder" (2014). Honors Theses.
Sensory Based Motor Disorder
DYSPRAXIA
Ideation, planning & Programming action, & executing action
• Slow to initiate and position their bodies effectively for motor tasks and often
present with poorly coordinated fine and gross motor performance.
• Difficulty in judging distance
• Poor motor Imitation
PRAXIS TEST COMPONENTS
Sequencing Praxis (SPr)
Postural Praxis (PPr)
SCALES
Oral Praxis (OPr)
Praxis on Verbal
SIPT
..\..\..\..\Downloads\-SIPT.docx
Command(PrVC)
16
Lonkar, Heather, "An Overview of Sensory Processing Disorder" (2014). Honors Theses.
Sensory Based Motor Disorder
VESTIBULAR PROCESSING DISORDER :
Postural Ocular Movement Disorder
Ayres etal., 1970, hypothesized
Disorders of sensory integration
related to the defects in vestibular-
Gravitational Insecurity
proprioceptive processing
Intolerance/Aversive Response to
movement
17
“Sensory Integration Theory & Practise“, Anne Fisher, Anita Bundy, (Second ed., pp. 435-451). Philadelphia.
Sensory Based Motor Disorder
VESTIBULAR PROCESSING DISORDER :
Postural Ocular Movement Disorder
Emphasis is on Postural Control
• Inability to assume prone posture
Evana etal., concluded that characteristics of
• Hypotonic extensor muscles
POMD, is evidence of several tests and
• Poor proximal joint stability
features described below :-
• Deficient postural adjustments
• Poor equilibrium & supporting reaction
• Poor kinaesthetic awareness
18
Evanna , Susan Elizabeth, "Autism: Symptoms, Causes, and Treatments" (2007). University of Tennessee Honors Thesis Projects
Sensory Based Motor Disorder
VESTIBULAR PROCESSING DISORDER :
Gravitational Insecurity
It may be view as SMD,
Great Fear Of fall, even in
absence of danger
An emotional or fearful reaction that is out of proportion
to the actual threat or danger of the vestibular
Height Frightened
May avoid walking or jumping.
proprioceptive stimuli or the position of body in space.
Intolerance/Aversive Response to movement
19
It is closely associated with GI and
often overlap.
VESTIBULAR PROCESSING DISORDER :
• TO ASSESS POSTURAL CONTROL- EQUILIBRIUM & SUPPORTED
REACTION
• SIPT- Standing & Walking balance test, Kinesthesia test
•
•
•
•
Fisher et al- Developed 3 Objective test
1. Tilt Board Tip
2. Flat board Reach
3. Tilt Board Reach
20
Anita Bundy. Sensory Integration- Theory and practice.
Sensory Based Motor Disorder
B I L AT E R A L I N T E G R AT I O N & S E Q U E N C I N G D E F I C I T S :
• Inability to use two sides of body together in co-ordinated manner.
• Traditionally vestibular- proprioceptive inputs, Recently Sequencing.
• CLINICAL OBSERVATION-
SCALES:
Poor B/L co-ordination,
Rt- Lt Confusion,
Avoidance of moving one arm
across midline
SIPT
SP3D
SPM
SIPT- B/L Motor
Co-ordination
Sequencing Praxis
Graphesthesia
Oral Praxis
21
“Sensory Integration Theory & Practise“, Anne Fisher, Anita Bundy, (Second ed., pp. 435-451). Philadelphia.
Sensory Discrimination Disorder
• Ability to perceive & interpret sensory information
accurately in daily life through recognition of qualitative
& quantitative aspects of sensory features
• Informs individual about size, weight, texture, location, &
color
• - need extra time to process sensory information because
they have trouble figuring out what they are perceiving as
quickly and naturally as other children do,”
22
“Sensory Integration Theory & Practise“, Anne Fisher, Anita Bundy, (Second ed., pp. 435-451). Philadelphia.
Sensory Discrimination Disorder
Visual
Discrimination
Tactile
Discrimination
Proprioceptive
Discrimination
23
Paula Kramer et al. Frames of reference for Paediatric occupational therapy 3rd edition
Vestibular
Discrimination
Sensory Discrimination Disorder
VISUAL
Difficulty in
Tracking objects
Difficulty in
following moving
target
Difficulty in
Copying from board
TACTILE
PROPRIOCEPTION
VESTIBULAR
Difficulty balancing
without using vision
Poor extension against
gravity
Cannot judge time and
distance during play
Difficulty in
maintaining good
posture
Poor Oculomotor
control
Trouble performing
fine motor task
without looking
Doesn’t know
where touch without
looking
24
Paula Kramer et al. Frames of reference for Paediatric occupational therapy 3rd edition
• Case
4 year old child requires person to carry him on escalators, gets scared when
moving in-out of car, doesn’t step down from curb, he is independent, playing
while sitting in house. Rationale ?
Gravitational Insecurity
• Case
6 year boy has poor sitting tolerance, weak grasp, unable to clear obstacles,
repeated falls, prone to injury : rationale?
SMD, Proprioception, Underresponsivity
• Case
9 year old girl always visualizes objects with near proximity, faces difficulty in
copying from board, unable to read news headline : rationale
SDD, Visual
25
• Case
6 year old girl screams loud when someone pulls her cheeks, prefer hug from
mother over kiss, prefers minimal clothing even in winter, Rationale ?
SMD, Tactile Overresponsivity
• Case
6 year boy has faces problem when someone asks to identify similar type of
key, difficulty in naming the side key to be turned in lock: rationale?
SDD, Dyspraxis, Cognitive Task
• Case
9 year old girl was training for basketball, difficulty in throwing ball to target,
difficulty in catching ball, difficulty in jumping on place for period of time:
rationale
SBMD, BISD, Planning & execution
26
27
Taylor & Trott 1991
28
Sensory Integration
Treatment of Neuromuscular disorders through understanding the principals of sensory
organization in relation to motor impairment is of recent origin.
• Kabat & Knott (1948), were the first to employ proprioceptive input to facilitate, motor
output, especially in groups of muscle.
• Temple Fay (1954), recognized that motor patterns of man’s evolutionary past still
resides in cortex & these can be employed therapeutically, by eliciting them through
sensory stim.
• Ayres (1963), was first to recognize the potential therapeutic role of tactile stimulation
in the development of maintenance of integrated motor action.
29
A Model to Explain Sensory Integration
Sensory Processing
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Bialer, D. S., and L. J. Miller. 2011. No Longer A SECRET: Unique Common Sense Strategies for Children with Sensory or Motor Challenges.
31
Supporting Children to Participate Successfully in Everyday Life by Using Sensory Processing Knowledge, Winnie Dunn,
INTERVENTION:
CONSIDERATION
Playful environment
Adequate space
Quiet space
Safety
Equipment
Intervention time- 45- 60 min
Parents Involvement
Therapist to client ratio- 1:1
Treatment seeks response that reflect better SI and more normal pattern of sensory inputs.
The motor response carries meaning in that it provokes sensory input, helps organize it, &
provides an overt manifestation of neural integration.
32
Paula Kramer et al. Frames of reference for paediatric occupational therapy, 2014
Treatment
Sensory Modulation Disorder
33
Sensory Integration & learning disorders., Jean Ayres
Treatment
Sensory Modulation Disorder
Vestibular
34
Sensory Integration & learning disorders., Jean Ayres
Treatment
Sensory Modulation Disorder
35
Sensory Integration & learning disorders., Jean Ayres
Treatment
Sensory Modulation Disorder
Visual
36
Sensory Integration & learning disorders., Jean Ayres
Treatment
Sensory Modulation Disorder
37
Sensory Integration & learning disorders., Jean Ayres
Treatment
Sensory discrimination Disorder
Vestibularproprioceptive
Variety of body position ex
(prone, quadruped,), suspension
swing, trampoline
Postural-ocular
movement
disorder-
Swing Photos
Balance &
Equilibrium disorder-
Small & slow mvmt on swing
small- avoid fall, slow- child can
responds
Ocular movements
Focusing & tracking objects
38
Sensory Integration & learning disorders., Jean Ayres
37
Shelly J. Lane. Sensory Integration Theory and Practice. 3RD EDITION
C O M B I N E D S E N S O RY M O T O R A P P R O A C H T O
E N H A N C E PA RT I C I PAT I O N O F A C H I L D W I T H
W E S T S Y N D R O M E : A F O L L O W- U P C A S E S T U D Y
C H E T A N A A S H O K K U N D E , 1 S U VA R N A S H Y A M G A N V I R S 2 ( 2 0 1 7 )
case report of male
child- West Syndrome,
1 year C/C- unable
to transit to sitting,
standing, walking.
sensory integration
& NDTTreatment
Approach.
GMFM was
3.98%,
GMFCS level
was V
poor ability to focus & orient
environment, poor
somatosensory, kinesthetic,
proprioceptive awareness
5 yrs there was increase
score of GMFM with
84.07%GMFCS
changed to level II
Combine Therapy- child to perceive better motor learning by modulating
40
sensory perceptual
issues.
Narayan A, Rowe MA, Palacios EM, et al. Altered Cerebellar White Matter in
Sensory Processing Dysfunction Is Associated With Impaired Multisensory
Integration and Attention. Front Psychol. 2021 Feb
Modulation dysfunction
Under responsiveness
Structure involved
Poor Limbic/ reticular activating
system
Hyper responsiveness
Excess limbic/reticular activating
system
Gravitation insecurity
Poor otolithic vestibular processing
Aversive response
Poor semicircular canal mediated
info resulting in sympathetic
hypofunction and parasympathetic
activation
41
Praxis
Structure involved
Ideation
Planning
Prefrontal cortex, basal ganglia
Lateral premotor, supplementary
motor areas (SMA)
Execution
Motor cortex, corticospinal and
corticobulbar tract
Bilateral integration and sequencing
(posture)
Vestibular and proprioceptive
processing
SMA- Proprioceptive dependant.
Somato dyspraxia (tactile
discrimination or perception)
Dorsal column medial lemniscal
pathway
( detection of size, form, contour,
texture, position of body, limb in space)
42
REFERENCES
• Lonkar, Heather, "An Overview of Sensory Processing Disorder" (2014). Honors Theses.
• Sensory Integration and the Child: Understanding Hidden Sensory Challenges, 2005 by
Western Psychological Services.
• Paula Kramer et al. Frames of reference for paediatric occupational therapy 3rd edition
• Engel-Yeger B, Muzio C, Rinosi G, et al. Extreme sensory processing patterns and their
relation with clinical conditions among individuals with major affective disord, 2016;236:112–
118.
• Bialer, D. S., and L. J. Miller. 2011. No Longer A SECRET: Unique Common Sense Strategies
for Children with Sensory or Motor Challenges
• “Sensory Integration Theory & Practise“, Anne Fisher, Anita Bundy, (Second ed., pp. 435-
451). Philadelphia
43
• Evanna , Susan Elizabeth, "Autism: Symptoms, Causes, and Treatments" (2007). University of
Tennessee Honors Thesis Projects
• Supporting Children to Participate Successfully in Everyday Life by Using Sensory Processing
Knowledge, Winnie Dunn, PhD
• Sensory Integration & learning disorders., Jean Ayres
• Shelly J. Lane. Sensory Integration Theory and Practice. 3RD EDITION
• Combined sensory motor approach to enhance participation of a child with west syndrome: a
follow-up case study, Chetana Ashok Kunde,1 Suvarna Shyam Ganvirs2 (2017)
44