This post is a continuation from our initial post about Sensory Integration. This post will focus on Sensory Integration Treatment Ideas. As we approach treatment, it is extremely important to treat each child as an individual and not specifically their diagnosis. Observe, assess and respond to each child’s unique presentation and specific sensory needs.
1) Vestibular Input
The vestibular system is housed in the inner ear. Our vestibular system responds to changes in gravity, and is therefore activated by movement, contributing to one’s balance and muscle tone. Movement generally has an impact on arousal level, and may be used to facilitate a calming or an alerting response. Vestibular input may be linear (equipment suspended from two suspension points), angular (one suspension point), or rotary (Around one axis), and may be delivered in horizontal, vertical or angular planes, with the receiver in an upright, inverted, prone, supine or sidelying position. Each type of movement, plane of movement, and position of the receiver will have individualized effects.
- The most powerful and longest lasting sensation (may last 4-8 hours after spending 15 minutes on a swing hung from two suspension points in a linear direction).
- Causes very strong brainstem sensation, which is best if done (followed by proprioception) before a cortical task, in order to help the brainstem focus on automatic functions so the cortex can adequately learn (45 minutes-2 hours before a task).
- Shown to cause release of the neurotransmitter histamine.
- Histamine is known to alert the central nervous system, which allows for more efficient sensory processing.
Levels of Vestibular Input in Order of Increasing Intensity:
- Up and down
- Front to back movement
- Side to side movement
- Diagonal movement
- Arc movements (resembling shape of rainbow)
- Inversion (upside down)
Often, children who are overresponsive to sensory input, or “high arousal” prefer and require predictable, rhythmic, slow movement/sounds/touch, and benefit from opportunities to exert his or her control. Children who are underresponsive, or “low arousal” to sensations may benefit from fast, unpredictable, arrhythmic, angular inputs.
- Bouncing on therapy ball
- Being pulled on a scooter board
- Rocking in a rocking chair
- Log rolling on the floor or down ramp
- Going down a slide
- Being pushed on a swing
- Independent swinging
- Playing on a sit and spin
- Spinning on a swing
- Being held upside down
- Spinning in an office chair
- Rolling over a therapy ball (on stomach and on back)
- Magic carpet (drag the child around the floor on a blanket-depending on child’s needs use different planes of movement, side to side, spin)
- Hammock (can use a large blanket held on each end by an adult. Swing the child in side to side or from front to back)
2) Proprioceptive Input
Proprioception refers to input from one’s muscles, tendons, joints and ligaments, also known as “the position sense”, and is responsible for internal perception of body position and force exerted. Propioceptors are facilitated via stretching/lengthening, compressing/shortening, and/or contracting ones muscles. They are functionally recruited during resistive, or “heavy work” activities. Proprioception “wakes up” the muscles, increasing motor responsivity, graded motor control, coordination, and strength.
- Best source of sensory input to help with sensory modulation & regulation disorders
- Facilitates the release of serotonin, which is the master regulator in the central nervous system, as well as dopamine.
- Serotonin is our “coping chemical”, as it breaks up dopamine to prevent hyperactivity and overprocessing of information, resulting in a neutral state.
- Serotonin also sets the firing level for all other neurotransmitters. If released suddenly, in large amounts, the brain responds with endorphins, which may create “emotional highs”.
- Self-injury may also cause the release of serotonin, and may contribute to biting, pinching, hitting, and head banging. In addition, aggressive behaviors are often met with proprioceptive and deep touch input (holding down, firm grip, etc.), which enhances serotonin levels back to a calming level, creating a vicious cycle.
- Joint compressions
- Carrying heavy objects
- Pushing heavy objects
- Pulling or pushing another individual on a scooter board
- Crab walking
- Bear walking
- Wheelbarrow walking
- Hanging from monkey bars
- Crawling on all fours
- Jumping on a trampoline
- “Crashing” into large cushion
- Body sock
- Therapy ball activities
- Theraband activities
3. Tactile Input
The tactile system is one of the largest sensory systems in our bodies, and plays an important role in our ability to interact with the environment around us. The tactile system is responsible for our ability to recognize the qualities of objects, such as hard, soft, sharp, dull, rough, smooth, etc. The tactile system also provides us with information about the quality of touch we are receiving. Variables such as temperature, pressure, and texture help us determine what we are touching and how we should respond to it. Some people are hypersensitive, and overreact to tactile input. Other people are hyposensitive, and underreact to tactile input. Both types of poor registration can lead to difficulty manipulating objects and interacting effectively within our environment.
- Deep touch is calming, while light touch is alerting and may result in a protective or avoidance response.
- Light touch can cause the release of arousing brain chemicals (cortisol/ adrenaline: sympathetic nervous system, flight or fright response), which may result in aggression and/or hyperactivity.
- Deep pressure touch input such as massage, squishing and squeezing, facilitate the release of dopamine (activating the parasympathetic nervous system for a relaxed, neutral, homeostatic state), which may wash away cortisol and adrenaline involved in the fight/ flight response (of the autonomic nervous system).
- Too much dopamine may increase hyperactivity, and may be regulated by increasing serotonin levels via proprioceptive input to muscles and joints.
- For a child who has tactile defensiveness, or demonstrates a heightened sensitivity to tactile input, it is imperative not to force his or her interaction with a noxious input, as the stress associated with his or her resistance will impede progress and novel learning from occurring.
Levels of Touch
1. Self touch
2. Object touch (i.e. Willbarger brushing protocol, vibration, pulling child on blanket, ball pit, rolling therapy ball over child)
3. Touch from another person (i.e. massage, joint compressions, hugging)
- Water play
- Sand play
- Shaving cream play
- Tactile discs
- Finger painting
- Sensory sorting activities
- Use of fidget toys
Most children will benefit from an individualized “sensory diet”, based on each child’s unique sensory needs. A sensory diet incorporates specific, appropriate sensory activities, rich in vestibular, proprioceptive, and/or deep pressure touch sensations, into existing daily routines. Sensory diet activities carried out across home and school environments seek to help the child regulate and process sensations appropriately, maintain a neutral learning state, and decrease stress chemicals. Environmental modifications and behavioral strategies may also be incorporated into one’s sensory diet (i.e. timer, picture schedule, weighted vest, inflatable seat cushion) to support function.
Ayres, A. Jean, and Jeff Robbins. Sensory integration and the child: Understanding hidden sensory challenges. Western Psychological Services, 2005.
Bogdashina, Olga. Sensory perceptual issues in autism and asperger syndrome: Different sensory experiences-different perceptual worlds. Jessica Kingsley Publishers, 2016.
Parham, L. Diane, et al. Fidelity in sensory integration intervention research. The American Journal of Occupational Therapy 61.2 (2007): 216.
Siegelbaum, Steven A., and A. J. Hudspeth. Principles of neural science. Eds. Eric R. Kandel, James H. Schwartz, and Thomas M. Jessell. Vol. 4. New York: McGraw-hill, 2000.
Vargas, Sadako, and Gregory Camilli. A meta-analysis of research on sensory integration treatment. American Journal of Occupational Therapy; 53.2 (1999): 189-198.
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