Sensory integration

How do our senses work together and what happens when they don't?

Gail Deuce provides some practical advice for professionals who support children with sensory integration difficulties.

What are our senses?

If you were to ask people to name the human senses it is likely that they would identify the senses of vision, hearing, touch, taste and smell.

But we have two more senses: our sense of balance (vestibular sense); and the sensation from our tendons, joints and muscles that lets us know where each part of our body is and how it is moving (proprioceptive sense).

Balance

Our vestibular (balance) sense has a role in:

• detecting motion
• detecting and responding to gravity
• providing stability during body movement
• locating body parts and organising our body movements
• influencing muscle tone and posture
• facilitating crossing the midline (bilateral coordination)
• motor control, coordination and sequencing
• assisting with auditory and visual perception
• modulating arousal and alertness for attention and calming
  (Dr G Williams, CHARGE Foundation Manual 2002).
  
  Balance difficulties will affect all these areas and will clearly have an effect on the development of gross motor skills and walking. They will also influence how we are able to use our vision and hearing.

Balance and vision

Balance problems can make it difficult to:

• maintain a stable visual field
• track moving objects smoothly
• define whether it is oneself or the object that is moving.

A child with balance difficulties may only be able to use their vision effectively when in a secure position. Some children also learn to use their vision to help them stay upright. They will need clear vertical markers to help them achieve this. (Ref: Brown, 2003).

Balance and hearing

Some children may need to move more to enable them to listen. But other children may not be able to listen when concentrating on moving and maintaining their balance. There is also research that suggests there is a link between balance and walking, and the development of language and the ability to process sound - for example, Travis and Thelin (2007).

Proprioception - where am I?

Our proprioceptive sense uses the sensations we receive from our muscles, joints and tendons to provide us with information about our body position, weight or pressure, our physical movements and changes of position in space, how we stretch and so on. It is this sense that allows us to constantly adjust our body position (for example, to stop us falling out of a chair) and use movements to operate on the world around us.

A poorly developed proprioceptive sense can lead to:

• poor core stability
• poor gross motor skills
• poor fine motor skills
• difficulty imitating movements
• bilateral coordination difficulties
• difficulty organising body movements
• difficulty using your body to act on your environment
• a need to stimulate the proprioceptive (and vestibular) sense by increased movement.

Sensory integration

It is important that we monitor and encourage the development of all of these senses in each individual child.

During each moment of our everyday life we all take in a continual stream of information simultaneously through our different senses. We then process that information and make an appropriate response.

Sensory integration is the process that "puts it all together" and allows us to sort out and use all this information so that we can engage in everyday life with relative ease and perform many actions and skills automatically.

Sensory Integration Dysfunction (Also known as Sensory Processing Disorder)

For most of us, sensory integration is an automatic process. However, there are a significant number of children who are not able to cope with and understand all the different sensory input they receive, or respond appropriately to these incoming sensations. This directly affects their ability to interact with the world around them. This difficulty is known as Sensory Integration Dysfunction (Anderson and Emmons, 2004).

Anecdotal evidence suggests that as many as 1 in 5 children in school experience difficulties with sensory integration. It is also recognised that these numbers increase in children with damaged neurological systems.

Research

There is no single accepted or commonly used definition of Sensory Integration Dysfunction to be found in literature.

From the 1960s to the 1980s, there was a significant amount of research that focussed on sensory dysfunction and sensory modulation problems (see Bogdashina, 2003). However, it is most prevalent today in the Occupational Therapy (OT) profession and literature, where the foundation was laid down by Jean Ayres. Original definitions considered the proprioceptive, vestibular and tactual senses, but more recent definitions now consider all the senses.

What impacts does sensory integration dysfunction have?

During the process of sensory integration we all need to constantly decide which information to respond to and which to ignore. This can be extremely difficult for children with sensory integration dysfunction. It will affect their ability to successfully use all the information being received simultaneously through their different sensory modalities, or make any appropriate responses.

Children with sensory integration dysfunction may:

• show postural insecurity when sitting or standing
• enjoy strong rhythmic movements
• resist changes to body position
• show delay in fine/gross motor skills and poor head control
• experience difficulty with balance and poor saving reflexes
• have problems regulating arousal levels and fluctuate between being hypo-responsive and hyper-responsive
• attempt to gain information and make sense of the world through repetitive behaviours and actions
• seek behaviours to provide very strong sensory inputs
• develop adaptive behaviours
• have problems organising their movements and actions
• have difficulty engaging in constructive exploration
• only be capable of using certain sensory channels at any one time.
  (Bogdashina, 2003; Brown, 2000; Deuce, 2002).

Supporting learning

What to consider

When working with a child who experiences sensory integration dysfunction it is important to discover:

• what sensory components support or prevent the child's ability to do a task; and
• whether conflicting demands are being placed upon the child.

We also need to consider:

• whether we are working at the child's pace and giving the time needed to allow the child to take in the information, process it, formulate a response and then give the response
• in each learning situation whether a multi-sensory approach or uni-sensory approach is best
• whether there is appropriate therapy input, including a sensory integration programme
• developing strategies to help the child handle sensory overload
• developing strategies to manage fatigue
• what working positions are offered. Adapted furniture may need to be offered, including 'active seating' and
• facilities for safe rest periods.

Practical activities

Some practical activities that might be used to promote the proprioceptive and vestibular senses are:

• experiencing large movements and movement through space
• rolling/ bouncing on a physio ball
• swinging in a blanket/hammock/swing
• hydrotherapy
• rebound therapy
• 'rough and tumble' play
• increasing body awareness
• physiotherapy/ stretches
• massage
• 'tac pac' activities
• climbing/crawling over and under large pillows, bean bags, large apparatus, etc.
• firm handling/ hugs
• use of a weighted blanket/ waistcoat
• a secure, small learning environment.

Specialist input

We can all recognise and acknowledge the impact of sensory integration difficulties on a child's learning and compensate for this. However, only a specialist occupational therapist or physiotherapist with additional expertise in sensory integration dysfunction (sensory processing disorder) can develop a remediation programme.
For some children, home and school-based activities are better than using special rooms with equipment. It might be that, rather than receiving pure sensory integration therapy in a specially designed room with specific equipment, a child may benefit more from the use of a sensory integration approach where the specialist occupational therapist or physiotherapist provides advice about activities that can be undertaken in the home and school environments.
This may include the development of a "sensory diet" that considers how the child is seeking to be "fed" through their different senses and how this can be provided in an acceptable way and at a level that they require.

References

• Anderson E and Emmons P (2004). Unlocking the Mysteries of Sensory Integration Dysfunction. Arlington, Texas: Future Horizons INC.
• Ayres AJ (1979). Sensory integration and the Child. Los Angeles: Western Psychological Services.
• Bogdashina O (2003). Sensory Perceptual issues in Autism and Asperger Syndrome: Different Sensory Experiences Different Perceptual Worlds. London: Jessica Kingsley Publishers.
• Brown (2003)
• Educational and Behavioral Implications of Missing balance sense in CHARGE Syndrome.
• California Deaf-Blind Services resources Spring
• Brown D (2005). CHARGE Syndrome Behaviors: Challenges or adaptations? American Journal of Medical Genetics Part A 133(3). Published Online: 21 Jan 2005.
• Deuce G (2002). Sensory Integration Dysfunction in Deafblind Children. Dbi Review July- December
• Hefner M and Davenport L (2002). CHARGE Syndrome management Manual for Parents. CHARGE Foundation, USA.
• Koomar J, Kranowitz C and Szlut S (2002). Answers to Questions Teachers Ask About Sensory Integration. Available from SensoryResources.com.
• Travis L. and Thelin J (2007). Vestibular Function, Balance and Motor Development. 8th International CHARGE Syndrome Conference' Costa Mesa CA
• Williams MS and Shellenberger S (1994). "How does your engine run?" A Leader's Guide to the Alert programme for Self-regulation.
• Albuquerque: Therapy Works INC. How does your engine run?

About the author

Gail Deuce is a qualified teacher of the deaf and has a M.Ed. in Multi-sensory Impairment. She currently works as a consultant teacher for Sense, a charity that provides advice, information, support and services for deafblind people, their families, carers and the professionals who work with them.

Gail has over twenty years experience in the field of special education, working initially in schools for children with severe learning difficulties and then a school for the deaf before moving into peripatetic work focusing on learners who are deafblind. Gail has worked for the ILEA (Inner London Education Authority), and Surrey, Bedfordshire and Essex local authorities, before joining Sense in December 2001.

Gail has a particular interest in CHARGE and is on the committee for the CHARGE Family Support Group. She has recently embarked on a PhD, undertaking research considering the challenges to learning for children with CHARGE Syndrome.
For more information about CHARGE, see Understanding Coloboma in our Eye Conditions section.