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Impact of Sensory Integrative Dysfunction

Sensory integration is the organization of sensation for use.  Countless bits of sensory information enter our brain at every moment, not only from our eyes and ears, but also from every place in our body.  Sensations are food for the brain that provide energy and knowledge needed to direct our body and mind.  The greatest development of sensory integration occurs during an adapted response; a purposeful, goal directed response to a sensory experience.  In an adaptive response, we master a challenge and learn something new.  At the same time, the information of an adapted response helps the brain to develop and organize itself.  The first seven years of life our brain is a sensory processing machine nourished by having fun through play and movement.  The child who learns to organize his play is more likely to organize his activities that are required for daily living.

If the brain does a poor job of integrating sensations, this will interfere with many things in life.  The brain is not processing or organizing the flow of sensory impulses in a manner that gives the individual good, precise information about himself or his world.  Learning is difficult and the individual often feels uncomfortable about himself and cannot easily cope with demands and stress.  If the individual is blind or visually impaired his difficulty is compounded when attempting to make sense of his world.  

Complex medical problems associated with many syndromes at birth may result in delayed sensory integration development.  This delay may be due to either neurological disorders or the inability to partake in sensory experiences that nourish the brain because of medical issues.  Symptoms of irregular sensory processing in the brain are different for each child.  There are three basic sensory systems that impact how a child learns and behaves in his environment. They are the tactile, vestibular, and proprioceptive systems.  The following outline is a brief description of symptoms observed in each of the three systems when dysfunction of sensory processing is present:

The Tactile System:

Discriminative touch v/s protective touch

Dysfunction in the discriminative system may result in:

• Difficulty with fine motor skills for feeding, dressing, and writing
• Problems articulating sounds due to inadequate information from touch receptors in and around the face and mouth
• Difficulty with accurate visual perception and basic concepts
• Impaired awareness of body scheme
• Inefficiency in how one tactually explores an object or the environment in order to gain additional cues which may give meaning about the object or environment 
• Appears to contribute to somato dyspraxia – a specific disorder in motor planning

Dysfunction in the protective system may result in: 

• Interpreting ordinary contact as threatening
• May be frequently in a state of  Red Alert  
• May react with flight/fright/or fight – These behaviors may be physical or verbal
• Termed tactually defensive
• Some feel too much; some feel too little.   Some may have a high tolerance for pain because they do not accurately know what is happening to them
• They may not react to being too cold or too hot because they are unaware of temperature

Proprioceptive System:

The proprioceptive system is our unconscious awareness to our muscles and joints that constantly send information to our brain to tell us our body position and posture. 

Dysfunction in proprioception results in: 

• Slower body movements
• More clumsy movements
• Movements involve more effort
• Difficulty grading muscle force – muscle exertion is either too much or not enough when manipulating objects
• Difficulty feeling the weight of objects
• Difficulty planning body movements while performing gross or fine motor activities (getting on or off a riding toy, buttoning clothes, turning on a faucet, etc.)

Vestibular System:

The vestublar system responds to the position of the head in relation to gravity and accelerating or decelerating movement, linear or rotary movement. Vestibular receptors are the most sensitive of all sense organs and are major organizers of sensations in all other sensory channels.   

The location of the vestibular system is in the inner ear called the “labyrinth”.  Since abnormalities of the ears and hearing loss are common features in many syndromes, the influence of this system plays a major role in the developmental milestones of sensory processing and gross motor skills for these children.

Influence of vestibular system on eye and neck muscles:

• Ability to follow objects
• Ability to move eyes from one spot to another
• Ability to interpret - is it an object, our head, or our whole body that is moving?
• Ability to interpret – is our head moving or tilted?
• Ability to maintain a stable visual field

Influence of vestibular system on muscles of the body:

• Helps to generate muscle tone
• Helps us to move smoothly, accurately, and with proper timing

Influence of vestibular system on postural and equilibrium responses: 

• Helps with balance
• Facilitates spontaneous body adjustments
• Facilitates co-contraction of muscles
• Helps to elicit protective extension 

Other areas influenced by the vestibular system:

• Reticular Interactions – responsible for arousal of nervous system (calming effects v.s. arousal effects); vestibular system keeps level of arousal balanced.
• Relation to Space – perception of space; position and orientation within that space.
• Auditory Processes – helps brain process what is being heard; vestibular disorders slow down speech development.
• Emotional Development/Behavior – for emotions to be balanced the limbic system (generates emotionally based behavior) must receive well modulated input from the vestibular system.

Two types of vestibular disorders:

1. Under-reactive vestibular system
   • Child may tolerate an enormous amount of movement (merry-go-round, swinging, spinning) without getting dizzy or nauseous.
   • Has poor integration of the two sides of the body
   • Is easily confused by directions or instructions
   • Hands do not work well together, nor do his feet
2. Over-reactive vestibular system
   • Child is hypersensitive to vestibular input resulting in:
   • Gravitational insecurity – a feeling of anxiety or stress when assuming a new position, or when someone else tries to control his movement or position; swings, merry-go-rounds, and other playthings that move the body in non-ordinary ways may feel terrifying.
   • Intolerance to movement – discomfort during rapid movement; the child is not necessarily threatened by movement, it just makes him uncomfortable, or possibly even become nauseous.   

Evaluation/Intervention

Evaluation: 

If there is suspicion that a child has dysfunction with sensory motor processing an evaluation can be conducted by either an occupational therapist or physical therapist.  Evaluation consists of both standardized testing and structured observations of responses to sensory stimulation, posture, balance, coordination, and eye movements.  The therapist who conducts the testing may also informally observe spontaneous play, and may ask the parents to provide information about their child’s development and typical behavior patterns.  A report will follow the evaluation that provides test results and interpretation of what the results indicate.  The therapist will then make recommendations regarding the appropriateness of therapy using a sensory integrative approach.

Intervention: 

Providing intervention based on the principles of sensory integration theory requires that the therapist be able to combine a working knowledge of sensory integration theory with an intuitive ability to gain a child’s trust and create the “just right” challenge.  Therapy will involve activities that provide vestibular, proprioceptive, and tactile stimulation, and are designed to meet a child’s specific needs for development.  The activities will also be designed to gradually increase the demands upon a child to make an organized, more mature response.  Emphasis is placed on automatic sensory processes in the course of a goal-directed activity, rather than instruction or drilling the child on how to respond.  Parent or teacher involvement is crucial to the success of the child’s development and improved sensory processing.  The therapist may make suggestions to the parent or teacher about how to help the child in the home or school environment.

Lisa Ricketts, OTR
Texas School for the Blind and Visually Impaired
lisaricketts@tsbvi.edu
512-206-9190

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