SENSORY INTEGRATION - Teresa Anderson,
OTR/L
SENSORY INTEGRATION:
INTEGRATION:
Strategies
to apply
within the
treatment
setting
Teresa Anderson, OTR/L
March 27, 2010
1
Agenda
Highlight strategies for successful learning
Introduce sensory integration theory
 Review sensory systems
 Identify signs of sensory dysfunction
 Discuss purpose of providing sensory input
 List sensory strategies for therapy sessions


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How children learn…
learn….
Exploring
Playing
 Imitating
 Practicing
 Using their senses


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MSHA Annual Convention - March 26-27, 2010
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SENSORY INTEGRATION - Teresa Anderson,
OTR/L
How to motivate children to
learn…
learn…

Follow a child centered approach
– provide opportunity vs. requirements
– no “wrong” way to play

Incorporate motivating activities
– child’s interests, preferred activities
Be aware of the child’s learning style
Provide the “just right challenge”
 Establish a rapport/trusting relationship


4
Learning should be…
be…..
FUN,
PLAYFUL,
&
MULTISENSORY!
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Sensory Integration

Based on the work of A.Jean Ayers, PhD, OTR

The organization of sensations for functional use
Input
Throughput
Output
(register)
(process)
(respond)
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MSHA Annual Convention - March 26-27, 2010
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SENSORY INTEGRATION - Teresa Anderson,
OTR/L
What Are The Sensory Systems?
Tactile System
 Vestibular System
 Proprioceptive System
 Auditory System
 Visual System
 Olfactory System
 Oral/Gustatory System

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Tactile System


The sense of touch
Detects harm, localizes pressure, determines
the quality of a stimulus (hot/cold,
rough/smooth, sharp/dull) and discriminates
between different types of touch (light/deep,
tickle/scratch)
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Vestibular System




The sense of movement, balance, & gravity
Detects if we are moving, how fast we are moving,
& in what direction we are moving
Coordinates movements of the eyes, head, & body
Maintains muscle tone, posture, & coordinates the
two sides of the body
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MSHA Annual Convention - March 26-27, 2010
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SENSORY INTEGRATION - Teresa Anderson,
OTR/L
Proprioceptive System

The sense of position & movement of the body

Uses information from the contraction or
elongation of muscles & joints to give awareness
of body position
– a..k.a. body awareness
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Auditory System


The sense of hearing
Registers sound, pitch, volume, and tone
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Visual System


The sense of sight
Detects color, size, brightness, shape,
texture, depth, & space
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MSHA Annual Convention - March 26-27, 2010
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SENSORY INTEGRATION - Teresa Anderson,
OTR/L
Olfactory System


The sense of smell
Detects fragrant, burnt, acidic, spicy, foul,
pungent, etc.
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Oral/Gustatory System
The sense of taste
Detects bitter, sour, salty, and sweet
 Reacts to temperature, texture, shape


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What Is Poor Sensory Integration?

The inability to organize sensations effectively

Inadequately registering, processing, &
responding to sensory input

Can impact attention, learning, skill
development, play, &/or behavior
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MSHA Annual Convention - March 26-27, 2010
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SENSORY INTEGRATION - Teresa Anderson,
OTR/L
Possible Signs Of Sensory Dysfunction…
Dysfunction…
Overresponsive or underresponsive to sensory
input
 Unusually high (impulsive, on the go) or low
(sedentary) activity level
 Attention &/or behavior issues
 Poor motor skills, limited play skills
 Coordination problems- clumsy, poor motor
planning, poor sequencing actions
 Poor organization

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Purpose Of Providing Sensory
Input…
Input…
To facilitate...
– An optimal arousal level
– An organized attention span
– Functional, purposeful activity participation
– Decreased sensory seeking behaviors &/or
sensory avoiding behaviors
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Arousal Level Continuum
Low arousal level
Underresponsive
Hyporesponsive
Disorganized
(seeking, poor registration)
Optimal Arousal level
Organized
High Arousal Level
Overresponsive
Hyperresponsive
Disorganized
(aversive, defensive)
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MSHA Annual Convention - March 26-27, 2010
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SENSORY INTEGRATION - Teresa Anderson,
OTR/L
Characteristics of an
OVERRESPONSIVE
Sensory System

The child’s CNS is hyper alert to sensory input
(ie. aversive, defensive, low threshold)

‘Fight-or-flight’ or ‘fight-or-freeze’ response can
be triggered by sensory overload, fear, or stress

Tend to avoid sensory experiences

Need calming & organizing sensory input
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OVERRESPONSIVE
Tactile System (touch)
Aversive to touch
Exhibit “fight or flight”or “flight or freeze”
response to touch sensations
 Dislike messy activities
 Distress during grooming tasks
 Irritated by certain textures & temperatures
 Have a low pain tolerance


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Tools to address
overresponsiveness to touch

Allow child to self-initiate touch
Provide firm, predictable touch

Provide deep pressure activities

– High 5’s versus tickling, drum on the table versus hug
– Stomping, marching, hopping
– Clapping, drumming, banging
– Obstacle course, crawling games, animal walks

Provide toys that have a predictible texture

Incorporate games that do not require imposed touch
– Smooth plastic, smooth wood
– Head ,Shoulders, Knees, & Toes, Follow the Leader, Wheels on the
Bus, Going on a Bear Hunt
MSHA Annual Convention - March 26-27, 2010
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SENSORY INTEGRATION - Teresa Anderson,
OTR/L
OVERRESPONSIVE
Vestibular System (movement)
• Avoid movement
• Dislike age appropriate physical activities
• Cautious, slow moving, sedentary, hesitate
to take risks
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Tools to address
overresponsiveness to movement

Slow, gradual, predictable movements

Activities should be close to the ground on a firm, stable
surface
– Stealth mode, tip toe, slow-motion games, detective games
– Lay on stomach propped on elbows, side-lie, prone on wedge
– Sit on floor, in cube chair, in chair with back & arms

If movement is incorporated use linear movement
(front-back, side-side)
– Rocking chair, swaying activity, Row, Row, Row Your Boat
activity
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OVERRESPONSIVE
Auditory System
Aversive to sounds
 Cover ears to protect from noxious sounds
 Avoid loud environments
 Avoid play that involves sound/music

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MSHA Annual Convention - March 26-27, 2010
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SENSORY INTEGRATION - Teresa Anderson,
OTR/L
Tools to address
overresponsiveness to sound

Provide predictable sounds
– Consistent voice (ie. volume, pitch, pace, tone)
– Songs with repetitive/predictable phrases
– Toys that make only 1 sound

Provide a quiet environment

Use of headphones, earplugs, or earmuffs
– Small setting, calming music, white noise
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OVERRESPONSIVE
Visual System
May squint to protect eyes from light
Prefer to be in the dark
 Difficulty paying attention in bright
environments
 Avoid eye contact


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Tools to address
overresponsiveness to visual input

Decrease visual distractions
– Blank surrounding, position facing a corner, sit at
carrel desk

Dim lights or lights off

Allow to wear sunglasses or hat
Provide a tunnel, tent, fort, or small space
Avoid toys with spinning or blinking lights
– Use natural light versus florescent lights


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MSHA Annual Convention - March 26-27, 2010
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SENSORY INTEGRATION - Teresa Anderson,
OTR/L
OVERRESPONSIVE
Olfactory System (smell)


Gag with certain smells
Avoid certain smells
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Tools to address
overresponsiveness to smell
Decrease aromas in the environment
Allow to wear surgical mask or scarf
 May not be able to participate in food
activities


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OVERRESPONSIVE
Oral System
Food aversions, food selective, picky eater
 Gag with certain foods
 Refuse certain food textures &/or
temperatures
 May avoid tooth brushing &/or dental work
 Rarely mouth objects

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MSHA Annual Convention - March 26-27, 2010
10
SENSORY INTEGRATION - Teresa Anderson,
OTR/L
Tools to address
overresponsiveness to oral input

Encourage “fun food”play

Encourage oral exploration & mouth games
– Paint in pudding, squeeze fruit to make juice, string cereal
– Straw games, mouth imitation games, blow whistle,
–
–
–
–
Play musical instruments, sing/hum,
Race cars over face, silly face games, face smoosh games
Mirror play
Simon Says
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Characteristics of an
UNDERRESPONSIVE
Sensory System

The child’s CNS is hypo-aroused to
sensory input (ie. seeking, high threshold)

Seek alerting sensory experiences due to
poor registration of sensory input
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UNDERRESPONSIVE
Tactile System (touch)
• Constantly touch people & objects
• Unaware of touch unless it is intense/firm
• Have a high pain tolerance
• Unaware they have dropped something
• Poor detection of twisted clothing or different fabrics
• Messy eater & unaware of food on their face or hands
• May play aggressively or intentionally bump, crash,
or fall
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MSHA Annual Convention - March 26-27, 2010
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SENSORY INTEGRATION - Teresa Anderson,
OTR/L
Tools to address
underresponsivness to touch

Incorporate multiple textures & touch experiences
– Putty, sand, noodles, shaving cream, foam soap, finger
painting, vibration, fur, textured balls, textured blocks,
puppets, gloves, dress-up, clapping/stomping games

Provide various types of touch
– Firm, tickle, compression
– Pillow sandwich, blanket wrap, ball roll, crawl through tight
spaces, jumping, crashing, rolling
– Obstacle course: crawl, roll, hop, somersault, bang, pull/push
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UNDERRESPONSIVE
Vestibular System (movement)
• Constantly moving, fidgeting, on the go
• Crave intense movement experiences
• Thrill seeker, risk taker, climber
• Often impulsive
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Tools to address
underresponsivness to movement


Pair short seated intervals with planned motor breaks
Use deep pressure & heavy work activities…
Out of seat activities
– Marching, dancing, hopping, jumping jacks, obstacle course,
crawling around room, animal walking, bunny hop, hippity hop ball
– Follow the Leader, Simon Says, Hokey Pokey, Red Light, Green
Light
In seat activities
– Stomping games, pounding/clapping games, chair push-ups, body
wiggles, Head, Shoulders, Knees, & Toes, Simon Says, Going on a
Bear Hunt
– Sit on a rocking chair, swivel chair, egg chair, large ball
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MSHA Annual Convention - March 26-27, 2010
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SENSORY INTEGRATION - Teresa Anderson,
OTR/L
UNDERRESPONSIVE
Auditory System (sound)
‘Tune out’ noises
May not respond when called
 May not turn head in direction of sound
 May play loud games (ie. bang objects,
sing loudly, toys with music)


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Tools to address
underresponsivness to sound

Provide a variety of sounds in the
environment
– Sing, play music, play with muscial toys
– Have rain storms, thunder storms, blast-offs,
train rides, police rescue
– Vary tone, pitch, and rate of speech (ie. sing
songs soft, loud, fast, slow)
– Make silly sounds
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UNDERRESPONSIVE
Visual System
Prefer bright lights & bright colors
 Visually inspect objects

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MSHA Annual Convention - March 26-27, 2010
13
SENSORY INTEGRATION - Teresa Anderson,
OTR/L
Tools to address
underresponsivness to visual input

Include activities/toys that have lights or visual
effects
– Light Bright, Simon, pinwheels, spinning tops
– Peek-A-Boo, infant toys
– Flashlight game, lights-on-lights-off game

Play games that elicit visual scanning/tracking
– Balloon toss, popping bubbles, scarf toss, marble maze,
flashlight games, lights-on-lights-off game, I spy, Where
is Waldo?
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UNDERRESPONSIVE
Olfactory System (smell)


Frequently smell objects
May not notice strong odors
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Tools to address
underresponsivness to smell

Include scented activities/toys
– Scented markers, scratch & sniff stickers,
scented playdoh, paint, glue, shaving cream,
cooking activities, nature walk, “secret”
containers, scent box
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MSHA Annual Convention - March 26-27, 2010
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SENSORY INTEGRATION - Teresa Anderson,
OTR/L
UNDERRESPONSIVE
Oral System
Minimal reaction to sour, tangy, or bitter
foods
 Frequently mouth objects

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Tools to address
underresponsivness to oral input

Provide a variety of temperatures & textures

Provide foods with a zing

Provide intra-oral input
– Crunchy, hard, chewy, lumpy, smooth, hot, cold
– Bitter, sour, spicy, tangy
– Nuk brush, vibratory input, electric toothbrush, chewy
tubes, whistles, gum, crunchy/chewy food, thickened
liquid

Play mouth games
– Lip smacking, bubble blowing, straw blowing, blow up
balloon, blow whistle
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Characteristics Of
PROPRIOCEPTIVE Dysfunction







Poor body awareness
Uncoordinated, clumsy, fall, trip
Space invaders - lean on, bump into, or sit/stand to
close people or objects
Intentionally seek joint compression or elongation (ie.
jump, fall, bump, or crash into objects, slap feet,
stretch limbs, stiffen body)
Throw too hard/too soft, squeeze too hard/to soft, use
heavy/light applied pressure
May leave clothing twisted on their bodies
Difficulty completing tasks without visual feedback
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MSHA Annual Convention - March 26-27, 2010
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SENSORY INTEGRATION - Teresa Anderson,
OTR/L
Tools to address
Proprioceptive Dysfunction

Activities that provide heavy work (stretching &
shortening muscles/joints)
– Open/close door, help rearrange furniture, push
stroller/wagon, tug-o-war, wall push-ups, chair push-ups,
erase chalkboard, carry heavy books or backpack, playground
activities (monkey bars, trampoline, jump off platform),
obstacle course, crawling, animal walks

Body awareness games/tools
–
–
–
–
Head, Shoulder, Knees, & Toes, Simon Says, Hokey Pokey
Obstacle course, stomping games, clapping games
Pillow sandwich, buurrito wrap, small spaces
Sit on a carpet square, in a cube chair, in a chair with back &
arm support, in a laundry basket
– Use of a mirror for visual feedback
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REMEMBER…
REMEMBER…
Learning should be fun & motivating
 Have creative activities up your sleeve
 Sensory activities should not be threatening but
rather tools to enhance an optimal arousal level,
increase self-confidence, & encourage skill
development

**PLEASE consult with a child’s occupational
therapist or refer to occupational therapy
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Summary
Highlighted strategies for learning
Defined sensory integration theory
 Reviewed the sensory systems
 Identified signs of sensory dysfunction
 Discussed purpose of providing sensory input
 Listed sensory strategies for therapy sessions


48
MSHA Annual Convention - March 26-27, 2010
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SENSORY INTEGRATION - Teresa Anderson,
OTR/L
Questions
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References
Anderson, E. & Emerson, P. (1996). Unlocking the Mysteries of Sensory
Dysfunction: A resource for anyone who works with or lives with, a child
with sensory issues. Arlington, TX: Future Horizons.
Ayers, A. J. (1979). Sensory Integration and the Child. Los Angeles, CA:
Western Psychological Services.
Kranowitz, Carol Stock, M.A. (1998). The Out-of-Sync Child: Recognizing
and coping with sensory integration dysfunction. New Your, NY: The
Berkley Publishing Group.
Kranowitz, Carol Stock, M.A. (2003). The Out-of-Sync Child Has Fun:
Activities for kids with sensory integration dysfunction. New York, NY:
The Berkley Publishing Group.
Miller, Karen (1999). Simple Steps: Developmental Activities for Infants,
Toddlers, and Two Year Olds. Beltsville, MD: Gryphon House, Inc.
Williamson, G. and Anzalone, M. (2001). Sensory integration and self
regulation in infants and toddlers: Helping very young children interact with
their environment. Washington, DC: Zero to Three.
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