MAKING SENSE OUT OF

SENSORY FOR SLP’S

Kelli Olmsted, MS OTR/L

Master Clinician Dementia and Sensory

Integration

OBJECTIVES

1. Articulate terminology relative to sensory integration treatment techniques.

SENSORY INTEGRATION THEORY

Sensory integration Theory

A. Jean Ayres

“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. The spatial and temporal aspects of inputs from different sensory modalities are interpreted, associated and unified.”

SENSORY INTEGRATION THEORY

Sensory integration is information processing

Based on the brain-behavior relationship.

Developed to elaborate on relationships with

Sensory information deficits and learning deficits

ASSUMPTIONS OF SI THEORY

Neural Plasticity

There is plasticity within the CNS.

The ability of our brains to structure, change or be modified, allowing to speculate that enhancement of function of the nervous system is possible through controlled tactile, vestibular, and proprioceptive input.

There are experimental brain research that indicate that plasticity persists into adulthood and possibly throughout life.

ASSUMPTIONS OF SI THEORY

Developmental Sequence

During normal development, we develop

complex behaviors as result of circular process

and behaviors present at each stage in a

sequence, and in turn, basis for development of

complex behaviors.

Nervous System Hierarchy

The brain functions as an integrated whole but

is comprised of several small systems that are

hierarchy organized.

NERVOUS SYSTEM HIERARCHY

ASSUMPTIONS OF SI THEORY

Adaptive Behaviors

Evoking an adaptive behavior or promoting Sensory Integration and in turn the ability to produce an adaptive behavior reflects sensory integration.

Inner Drive

Individuals have an inner drive to develop sensory integration through participation in sensory motor activities.

SENSORY PROCESSING

Bonnie Hanschu

The brain’s ability to organize and make sense of different kinds of sensations.

Underlying development of all motor and social skills.

Ability to learn and perform complex adaptive behaviors.

Brainstem contains the filtering system which prioritizes incoming information.

THE READY APPROACH

Created by Bonnie Hanschu

Frame of reference

Normal Functioning

Disruption / Deficit:

Environment stimuli encounters body and brain on sensory level.

THE READY APPROACH

Ready Approach focus on using strong sensations

influences engine (brain/body) that drives us, in turn

allowing us to influence our engine by influencing our

brains reaction.

Every brain has the potential to rewire itself in the

right environment.

THE READY APPROACH

THE READY APPROACH

Not Ready

Brain preoccupied

Cannot process meaning

React rather then adapt

At mercy of stimuli

Info for learning & exploring is disregarded. Biased to protection and comfort.

Ready Engage and respond

Catch on “Get IT”

Stay with the flow of events

Adapt to situational changes

Experience challenges

Interact freely

Be spontaneous

Feel safe, comfortable

Feel in control

SENSORY PROCESSING /

SENSORY INTEGRATION

Bonnie Hanschu used this analogy to

distinguish between sensory integration, and

sensory processing:

“If sensory processing is the dance, sensory

integration makes it possible for that

dance to become a ballet.”

To create an intervention for a client, we may

need to intervene during the processing to

create the integration.

SENSORY MODULATION

About arousal (alertness, awake, asleep and in

between)

Ability to make continuing sense of our changing

experience and keep and flow of situational

demands we experience.

Dysfunction is described as the inability to

regulate sensory information, how we organize

information, and how we form adaptive response.

SENSORY MODULATION

Arousal

Displayed as excessive distractibility, inability to modulate arousal, clumsiness, and excessive or minimal sensitivity to touch, movement, sounds or sights.

Sensory modulation problems may be seen with or without defensiveness.

SENSORY MODULATION

Habituation

Sensitization

Dampening / Enhancing

SENSORY MODULATION

Optimal level of arousal

Individualized

The optimal level of stimulation theory

SENSORY DEFENSIVENESS

Hypersensitivity to sensation resulting in a disorganized output

Patricia Wilbarger

Anterolateral systems response for pain and crude touch

Gate Control Theory

SENSORY DEFENSIVENESS

Nervous system no longer believed to be hierarchical

Interpret stimuli from the environment with protective mechanisms.

Unique and identifiable behavioral phenomenon.

Affects arousal and can result in changeable behavior.

Presents in a wide range of symptoms and severity.

Understanding is ongoing process.

SENSORY DEFENSIVENESS

There are many types of sensory

defensiveness

Severity of sensory defensiveness varies from

mild to severe.

RESEARCH

Limited research in this model of practice. There is

research based on effectiveness of SI with some

evidenced of intervention effectiveness. Children are

the basis in studies. Rare adult research with use of

this model / theory.

RESEARCH

Interventions for Common Behavioral Problems

in Children with Disabilities. Renee Watling

(2005)

(OT Practice,Vol 10, Issue 15, pp12-15)

Behaviors emerge from sensory needs

Overwhelmed

Patterns of repetition

RESEARCH

Snoezelen and Sensory-Based Treatment for Adults with Psychiatric Disorders. Donna Costa, Jessica Morra, Kimberly Call, Danielle Solomon, and Maribeth Sabino (2006)

(OT Practice, Vol 11, Issue 4,pp.19-23)

Snoezelen – Dutch words

Failure free environment

Using “time out”

Empowering client

Increasing quality of life

RESEARCH

Using Snoezelen with Adults with Severe or Profound Mental Retardation. Skip O’Neal and Beth P. Velde (2006)

(OT Practice,Vol 11, Issue 20, pp.19-23)

Jan Hulsegge and Al Verheul

Multi-sensory environment

Leisure / restful activity

RESEARCH

Using a Multisensory Environment: to decrease negative behaviors in Clients with Dementia. Lape, Jennifer E. (2009)(OT Practice, Vol 14, Issue 9, pp9-13)

Benefits of a multisensory room for tx of behaviors with clients diagnosed with dementia.

24 hour availability

Not a cure for undesirable behaviors, but effective solution to decreasing intensity of behaviors and allow person to engage in meaningful activities.

RESEARCH

Occupational Therapy for Adults with Sensory Processing Disorder. May-Benson, Teresa A. (2009)(OT Practice, Vol 14, Issue 10, pp. 15-19)

Challenge of assessing adults

Sensory diet activities for home programs

Sessions should include: Preparatory activities, sensory activities, integrating activities, and organizing/wrap-up activities.

OVERVIEW OF THE SENSES

Sense of Smell:

Unconscious and protective response, acrid and noxious odors are associated with danger.

Unique in one important aspect – it is the only sense that bypasses the circuitous pathway of normal sensory processing.

Communicated directly into the limbic system, the seat of our emotions.

OVERVIEW OF THE SENSES

Sense of Taste / Oral:

Highly individualized by culture, and past food experiences.

Oral motor experiences begin with the sucking instinct of infant and is important throughout the lifespan.

OVERVIEW OF THE SENSES

Sense of Vision:

Unifying system that assists to integrate and make sense of the other sensorimotor systems.

Directly links to vestibular system

Most critical for orienting ourselves and interacting in the environment (A. Jean Ayres)

OVERVIEW OF THE SENSES

Sense of Hearing:

Sound impacts muscle tone, equilibrium and even the body's flexibility.

Don G. Campbell states that “music is a natural pacemaker”. The Mozart Effect (2001) Harper Collins Publishers

OVERVIEW OF THE SENSES

Sense of Touch:

Skin is the biggest organ, and our biggest sense

organ.

Light touch has a rapid diffuse and spreading effect

that alerts the nervous system of danger.

Pressure touch is a localized, precise sensation

which is responsible for stereognosis.

OVERVIEW OF THE SENSES

Deep tactile touch is very calming.

Receptors are located under the skin’s surface.

It provides a localized, precise sensation which

enables us to tell shapes, textures, and sizes of

hand held objects without looking at them.

OVERVIEW OF THE SENSES

The tactile system has a

profound influence on

our ability to learn. We

have 600 pain

receptors, 13 yards of

nerves, and 9000 nerve

endings on a ¾ inch

square on the back of

our hands.

OVERVIEW OF THE SENSES

Sense of Proprioception:

Comes from the Latin word “for one’s own”.

It provides body awareness and boundaries.

Receptors in the muscles, tendons, and joints.

Theories of motor control.

OVERVIEW OF THE SENSES

Vestibular Sense:

Receptors are hair cells located in the

semicircular canals, utricle, and saccule of

vestibular labyrinth

The vestibular apparatus acts as an internal

compass that signals changes in head position

or motion.

VESTIBULAR SENSE CON’T

According to Ayres, “The vestibular system is a

major organizer of sensation in all other sensory

channels”.

Input we get tells us exactly where we are in relation

to gravity, whether we are still or moving, how fast,

and what direction.

OVERVIEW OF THE SENSES

Power Houses of sensory input are:

Proprioceptive

Deep Tactile

Vestibular

SENSORY STIMULATION PROGRAM

Sensory stimulation techniques are passively

provided to client.

Sensory integration techniques need to be presented

within the context of a meaningful activity and

require adaptive response.

TOUCH EVALUATION

OBSERVATIONS

Under-Responsiveness:

Unaware pain

Temperature or how object feels

Rub against furniture / walls

Bump into others

INTERVENTIONS FOR

UNDER-RESPONSIVE TOUCH

Speech Therapy:

Chewy Tube®

Tactile spoons

Vibration to stimulate oral awareness

Massage to face and neck muscle

Hugs and Tugs

Proprioception

HUGS AND TUGS

Developed by: Kelli Olmsted, MS, OTR/L

Brenda Meiron, COTA/L

Developed to provide quick proprioceptive

input and deep pressure touch for sensory

needs.

HUGS AND TUGS

Precaution: Be aware and careful with painful and / or arthritic joints.

This protocol is good for residents with poor attention to task, pacing, and / or high level of anxiety.

This is a great tool to place in a sensory diet and have staff complete.

1. Approach resident in a quiet calm manner.

2. Ask “Can I give you a hug?”

3. Lean in and give resident an embrace with 10-12 quick pressure hugs and state “Can you hug me?” Approach resident in a quiet calm manner.

4. Step back and state “you are going to feel a little

pressure on your shoulders”.

5. Open hands and place them on top of their

shoulders and press down 10-12 times, providing

deep tactile pressure bilaterally.

6. Inform resident, “I’m going to squeeze your arms or give your arms hugs.”

7. Stand in front of resident and squeeze down length of both arms by cupping hands, working proximal to distal down the length of the arm. Complete arms bilaterally or one at a time.

THINKING IN PICTURES-TEMPLE GRANDIN

Video

TOUCH EVALUATION

OBSERVATIONS

Over-Responsiveness:

Avoids touching or being touched by objects

/ people

Upset when get dirty

Irritated by certain types of clothing and food

Dislikes unexpected light touch

INTERVENTIONS FOR

OVER-RESPONSIVE TOUCH

Speech Therapy:

Avoid light touch

Decreased points of contact

Deep tactile input

Education on approach

Establish eye contact with activities

MOVEMENT EVALUATION

OBSERVATIONS

Under-responsiveness:

Crave fast and spinning without getting

dizzy

Move or fidget constantly

INTERVENTIONS FOR

UNDER-RESPONSIVE MOVEMENT

Speech Therapy:

Rocking

Swinging

Dancing

Clapping

Fidgets

MOVEMENT EVALUATION

OBSERVATIONS

Over-responsiveness:

Avoids moving or being unexpectedly

moved

Insecure with gravity or anxious if tipped off

balance

Car sickness

INTERVENTIONS FOR

OVER-RESPONSIVE MOVEMENT

Speech Therapy:

Rocking

Proprioceptive / tactile cues

Approach

BODY POSITION EVALUATION

OBSERVATIONS

Under-responsiveness:

May slump/slouch

Actions appear clumsy or inaccurate

Bump into objects

Twiddle fingers

INTERVENTIONS FOR UNDER-

RESPONSIVE BODY POSITION

Speech Therapy:

Hugs and Tugs

Collaboration with PT / OT on positioning

Head / neck position during mealtime

Adapting place setting

BODY POSITION EVALUATION

OBSERVATIONS

Over-responsiveness:

May be rigid / tense / stiff / uncoordinated

Avoids of activities requiring body

awareness

INTERVENTIONS FOR OVER-

RESPONSIVE BODY POSITION

Speech Therapy:

Relaxation techniques

Environmental changes

Hugs and Tugs

Proprioceptive input

VISION EVALUATION

OBSERVATIONS

Under-responsiveness:

Even with good acuity may touch everything

to learn about it

Miss important visual cues

Miss written directions

INTERVENTIONS FOR UNDER-

RESPONSIVE VISION

Speech Therapy:

Establish eye contact

Brightly colored adaptations

Multi modality (use of other senses)

Adapted place setting

VISION EVALUATION

OBSERVATIONS

Over-responsiveness:

Becomes over-excited when too much to

look at

May cover eyes

May have poor eye contact

Overreact to bright lights

Hyper vigilant

INTERVENTIONS FOR OVER-

RESPONSIVE VISION

Speech Therapy:

Dim lights

Decrease visual stimuli

Establish eye contact

Decrease serving size

AUDITORY EVALUATION

OBSERVATIONS

Under-responsiveness:

Ignore voices

Difficulty following verbal directions

Speak in booming voice

INTERVENTIONS FOR UNDER-

RESPONSIVE AUDITORY

Speech Therapy:

Music

Singing fast tunes

Whistling / humming

Visual cues

Head phones

AUDITORY EVALUATION

OBSERVATIONS

Over-responsiveness:

May cover ears

May complain about noise

INTERVENTIONS FOR OVER-

RESPONSIVE AUDITORY

Speech Therapy:

Ear Plugs

Headphones

Low soft music

White noise

OLFACTORY EVALUATION

OBSERVATIONS

Under-responsiveness:

Ignore unpleasant odors

May sniff food, people, or objects

INTERVENTIONS FOR UNDER-

RESPONSIVE OLFACTORY

Speech Therapy:

Alerting

Strong smells

Peppermint/citrus

Offer several different experiences

OLFACTORY EVALUATION

OBSERVATIONS

Over-responsiveness:

May object to odors that others don’t notice

INTERVENTIONS FOR OVER-

RESPONSIVE OLFACTORY

Speech Therapy:

Light scents

Be aware of your own smells (perfume /

cologne)

Avoid strong smelling foods

AROMATHERAPY

The use of essential oils in therapy intervention.

Most commonly used: in lotion for massage, diffusers within room, added to bath, and/or inhalation.

Essential aromatherapy: A pocket guide to essential oils & aromatherapy.(4th

edition)(2003).New World Library, Novato, CA. Susan Worwood and Valerie Ann Worwood

AROMATHERAPY – LAVENDER

Most Valuable Uses: Cuts, burns, Rheumatism, sunburn, insect bites, headaches, insomnia, infections, arthritis, anxiety, tension, panic, hysteria, fatigue, rashes, spasms

Used in Lotion for massage, diffusers, bath and inhalation.

Precautions: Some people with low blood pressure may feel a bit

dull and drowsy after using this oil.

Avoid in the early month of pregnancy.

AROMATHERAPY – PEPPERMINT

Most Valuable Uses: headaches, nausea, fatigue, digestive problems, bowel disorders, muscular pain, shock, faintness, travel sickness, mouth or gum infections, mental tiredness, poor circulation.

Best used in a diffuser, inhalation, or low concentration of lotion.

Precautions: Irritation of the skin and mucous membranes

Avoid contact with the eyes

Avoid if pregnant or nursing (could discourage flow of milk)

AROMATHERAPY – ROSEMARY

Most valuable uses: muscular pain, Rheumatism, arthritis, muscular weakness, constipation, coughs, colds, memory enhancement, overwork, general debility, hangovers, acne, exhaustion, poor circulation, skin care, migraine, headaches, sinus problems, appetite stimulant

Best used as a rub, massage, inhalation

Precautions: Avoid if pregnant

Avoid using with individuals with epilepsy

AROMATHERAPY – BASIL

Most valuable uses: weak nervous condition, tension, stress, muscular spasm, concentration, and physical and mental sluggishness, increase appetite

Best used in a diffuser or inhalation

Precautions: Avoid if pregnant

Do not use in baths

Do not use with children under 16 year of age

AROMATHERAPY –

CHAMOMILE ROMAN

Most Valuable Uses: pain relief, fevers, skin problems, muscular spasms, sedative, depression, nervousness

Best used: lotions, massage, diffuser, inhalation

Precautions: none known

Blends well with lavender

TASTE EVALUATION

OBSERVATIONS

Under-responsiveness:

Licks or taste inedible objects

May like spicy or hot foods

INTERVENTIONS FOR UNDER-

RESPONSIVE ORAL

Speech Therapy:

Lollipops

Chewy / crunchy foods

Chewy Tubes®

Massage

Gum

Temperature stimulation to lips and tongue

Vibration

Oral massage

Oral motor exercises

TASTE EVALUATION

OBSERVATIONS

Over-responsiveness:

Strongly object to certain textures and

temperatures of food

Often gag when eating

INTERVENTIONS FOR OVER-

RESPONSIVE ORAL

Speech Therapy:

Diet texture / Assessment

Nuk® Massage Brush – desensitize to

decrease gagging

Massage

Temperature stimulation to lips and tongue

SENSORY FOOD FACTS

Alerting

Crunchy

Sour

Spicy

Chewy

Calming

Chewy

Warm

Hard candy / lollipop

SENSORY MODULATION

Treating modulation disorders:

How is the client responding?

Optimal level of arousal

Individualized

SENSORY DEFENSIVENESS

Wilbarger Thera-Pressure Protocol

Wilbarger Oral Thera-Pressure Protocol Patricia Wilbarger

These protocols are usually used for sensory

defensiveness only, however, there have been

improvements when used with behaviors.

SENSORY DEFENSIVENESS

Demonstration of Wilbarger Thera-Pressure

Protocol

Demonstration of Wilbarger Oral Thera-Pressure

Protocol

BREAK

SENSORY DIETS

Scheduled activity program

Individualized specifically for resident’s sensory

needs

Purpose: assist the client / patient to become more

focused, adapted and independent with functional

activities

EXAMPLE OF SENSORY DIET

Hugs and Tugs

Rub back before getting out of bed

Joint proprioception to trunk in sitting

Massage – lavender lotion

Suckers

Rocking chair

Heavy backpack 10-15 min

Moving furniture (supervised)

Wall push ups

SENSORY TOOL KIT

Sissel® Seat

Five vibe

Lollipops

Lotion – unscented

Essential oils

Ace bandages

Rice bags

Baby doll / bunny

Snake (vibration)

Theraband

Ear plugs

Wilbarger Thera-Pressure

Brush

Tactile rollers

Stereognosis bag

Shaving cream / pudding

Fabric book

QUESTIONS?

THANK YOU FOR YOUR

ATTENTION AND

PARTICIPATION IN THE

COURSE TODAY!

REFERENCES

Ayres, A.J. (1989) Sensory integration and the child. Los Angeles, Western Psychological Services.

Hanschu, B. (2002) The Ready Approach, modified by L. Barker.

Wilbarger, P, Wilbarger, J.(2001, revised 2006) Sensory defensiveness: A Comprehensive Treatment Approach

Moore, K. (2005) The Sensory Connection Program Manual. Framingham, MA;Therapro

Campbell, D.G (2001) The Mozart Effect, Harper Collins Publishers.

REFERENCES

Worwood, S. Worwood, V.A. (2003)Essential Aromatherapy: A pocket guide to essential oils & aromatherapy,Novato, CA New World Library

Aegis Therapies Manual: Complex Disease Management

Aegis Therapies Manual: Dementia: Systematic Approach to Intervention

Aegis Therapies Manual: Dementia II:Beyond the Basics

REFERENCES

Bundy, A.C, Fisher, A.G., Murray, E.A. (1991)Sensory integration theory and practice, Philadelphia, F.A. Davis Company.

Hansen, M. (1998) Pathophysiology: Foundations of disease and clinical Interventions Philadelphia W. B. Saunders Company.

Kielhofner, G. (1997) Conceptual Foundations of Occupational Therapy (2nd edition) Philadelphia, F. A. Davis Company.

REFERENCES

Neistadt, M. E., Blesedell Crepeau, E. (1998) Willard and Spackman’s Occupational Therapy. (9th

Edition) Philadelphia, Lippincott Williams & Wilkins.

Keating, K. (1983) The Hug Therapy Book, Center City, MN, Hazelden.

Henry, D. (1998). Tool Chest for Teachers, Parents & Students. Arizona: Henry OT Services

Williams, M.S. & Shellenberger, S. (2001) How Does Your Engine Run: Leader’s Guide to The Alert Program for Self-Regulation. Albuquerque: Therapy Works, Inc.

REFERENCES

Kranowitz, C.S. (2003) The out-of-sync child has fun. New York: The Berkley Publishing Group

Brown, C. E. & Dunn, W. (1999) Adolescent/Adult Sensory Profile Manual. San Antonio, TX: Psychological Corporation.

Using a Multisensory Environment: to decrease negative behaviors in Clients with Dementia. Lape, Jennifer E. (2009)

(OT Practice, Vol 14, Issue 9, pp9-13)

Occupational Therapy for Adults with Sensory Processing Disorder. May-Benson, Teresa A. (2009)

(OT Practice, Vol 14, Issue 10, pp. 15-19)

REFERENCES

Nolte, John (2002) The Human Brain An

introduction to Its Functional Anatomy. (Fifth

Edition). St. Louis, Missouri: Mosby, Inc

Gutman, Sharon A. Quick Reference

Neuroscience for Rehabilitation Professionals.

Thorofare, NJ: SLACK Inc