Sensory Integration (SI)

The theories behind sensory integration (SI) were first developed by an occupational therapist and researcher, Jean Ayres. In the U.S. and Canada, many OTs are at least familiar with the principles of SI, although technically to practice it one must have completed special training and attained a certificate from Sensory Integration International. SII will provide parents with a list of trained therapists and evaluators.

In the U.K., the treatment methods recommended by Madeleine Portwood for children with developmental dyspraxia are very similar to SI. Portwood is an educational psychologist with the Durham County Council, and the author of Developmental Dyspraxia: A Practical Manual for Parents and Professionals (Educational Psychology Service, 1996).

Note to teens and adults with PDDs: Like other forms of occupational therapy, sensory integration work can easily be adapted to meet the needs of adolescents and adults. Some adults may be more comfortable with doing a SI-style program of their own design in privacy, while others might want to see an SI specialist in a clinic or hospital.

Adults with sensory-system dysfunction have often devised all sorts of ways to reduce their exposure to difficult or painful sensations, although this avoidance leads to increased isolation. We know of adults with PDDs who  have installed expensive sound-proofing in their homes, who only buy soft cotton clothing, and whose "picky" eating habits have more to do with avoiding unpleasant textures than with taste.  These coping strategies are admirable, but anyone who truly wants to break out of old life patterns without experiencing the discomfort of the past can look to SI techniques for help.

Sensory integration work is based on the idea that people with motor or sensory problems have difficulty processing the information their body receives through the various senses. Just as Auditory Integration Training attempts to desensitize the sense of hearing, SI exercises are intended to reduce sensory disturbances related to touch, movement, and gravity. These disturbances can occur in any or all of the following areas:

Processing: how quickly (or if) the sensation reaches the central nervous system to be interpreted.

          Analysis: how the person interprets the sensation.

Organization: how the person responds to their analysis of the sensation.

 Memory: how (or if) the person remembers similar sensations and proper responses from the past.

Disturbances can occur in either the traditional five senses (sight, hearing, smell, taste, and touch) or in less well-known senses--senses that actually have a greater effect on gross-motor development. SI exercises generally work on the latter. These "whole body" senses are:

Tactile: based in the system created by the entire skin surface and the nerves that serve it, this sense processes information taken in via all types of touch.

Proprioceptive: based in the muscles, ligaments, joints, and the nerves that serve them, this sense information about where the body and its various parts are in space.

Vestibular: based mostly in the inner ear, which acts as a sort of internal carpenter's level, this sense processes information about how the body interacts with gravity as it moves and attempts to retain its balance.

Most of us never think about these senses, unless they are suddenly disordered in some way, such as from an inner-ear infection, a dizziness-producing carnival ride, or a leg that "asleep" and causes stumbling. For many people with PDDs, however, dysfunction in these sensory systems is the norm—in fact, for many it this very sensory dysfunction that is the most pervasive part of the disorder, and that may lead to its most disabling effects. Many behaviors commonly thought of as "autistic," including toe walking, hand-flapping, and rocking, can be attempts to deal with sensory integration dysfunction.

Infants and young children learn to interpret the world around them through their senses. If the information comes in all wrong or cannot be processed properly, the world is a confusing place.  Imagine trying to pay attention to your mother's lullaby if it sounded like an electric drill, or trying to play with a toy when your clothing was causing intense discomfort. The tactile, proprioceptive, and vestibular senses are our most elemental ways to relate to the environment--they're with us from the earliest nervous-system development in the womb. Problems in this area are fundamental, because they interfere with the ability to learn the basic skills that are the building blocks for all others.

Luckily, sensory integration work can help most people with PDDs get better control of the information they take in. Please consult an occupational therapist that is trained in SI techniques if possible, or at least explore further by reading some of the SI-related books. The Out-of-Sync Child, (Perigee, 1998) by Carol Stock Kranowitz, while not aimed at the more intense SI problems experienced by autistic-spectrum people, is another widely available source of information. It is an adequate guide starting a home-based sensory integration program when you can't find professional help.

SI activities are usually quite simple. Special equipment is not a must, although some parents have used swings, hammocks, and small items that can be obtained from catalogs. The following lists offer a few examples of typical SI activities that may be done at home. 

For tactile-sensitivity problems (under- or over-sensitivity):

The so-called Wilbarger brushing technique is based on the use of firm strokes with a soft surgical brush (available inexpensively from medical-supply stores) on the back, arms, and legs. Brushing is interspersed with joint compression, in which the elbows, arm sockets, knees, and hip joints are pushed together firmly several times in succession. It's hard to explain this practice in print--it's really something you should be taught in person.

Handling materials with a variety of textures, such as wet or dry sand, shaving cream, dry beans, and water.  Children can be encouraged to play with the materials even put them on their arms, legs, or face if appropriate. 

Deep-pressure massage or hugs

Making a "kid burrito" by rolling the child up tightly in a blanket, or a "kid sandwich" by (carefully) squishing the child between two gymnastic mats or sofa cushions.

Parents and other caregivers should also avoid introducing people with tactile over-sensitivity to unnecessary unpleasant sensations. Clothing problems are very common in this group, with tags and scratchy materials being frequent offenders. Incidentally, tactile under-sensitivity is a common cause of hyperactive behavior. 

For proprioceptive problems:

Swinging (clinics often use a big therapy swing that lets the person swing in a prone position).  Jumping on a small trampoline.  The joint-compression technique mentioned above.

For vestibular problems:

Walking on a balance beam.  Balancing on a large "therapy ball" as it moves.

OT work aimed at strengthening and developing gross-motor skills (people with vestibular problems tend to have low muscle tone).

Exercises that encourage "crossing the midline:" using the left hand and arm on the right side of the body, and vice versa. Examples include some kinds of dancing, and rocking from side to side.

Stair climbing:

Most of these exercises actually work on more than one sense at once. Activities can be combined and varied to keep SI work fun--and most children do think it's fun! Adults with long-term sensory issues may have a hard time getting started with an SI program, especially since some of the activities may seem childish or silly.

One special area of concern is oral tactile dysfunction. For years, parents have told their physicians that their children with PDDs had strange, limited food preferences. Many prefer bland, textureless foods, and self-select from only a few favorites: peanut butter, white bread, and applesauce only, for example. Although sometimes food preferences may have their roots in allergy issues (some allergists say that the foods we crave tend to be the very ones we are allergic to), if texture appears to be the primary issue, the problem is more likely to be oral defensiveness. OTs can work to desensitize the nerves in the mouth, helping these children to gradually tolerate more textures and broaden their diet.

Sensory integration differences extend to eating habits. Some people with PDDs will stuff their mouths to the bursting point, for instance, and may not notice when food gets on their faces or hands. The issue here is tactile under sensitivity, and that can also be addressed by an OT.

Most speech therapists are also knowledgeable about sensitivity problems in the mouth and throat, and may be able to help.

In addition to exercises that reduce sensory defensiveness, or that help the under sensitive patient integrate and process sensations, clinicians recommend making a sensory diet part of daily activities at home and at school. This means integrating soothing sensory experiences into daily activities at a regular interval. These activities could include:

Slow repetitive rhythmic movements, such as Tai Chi, water aerobics, or using a rocking chair.

Firm pressure on the skin, from hugs, compression devices, or another source.

"Heavy work," such as moving furniture, carrying heavy bags, or lifting weights.

Activities done upside down, such as headstands or tumbling.