Reflection

I can see sensory integration as an important field of occupational therapy practice that can benefit many children and paediatric settings. Although within this blog I have only explored into two areas of sensory integration I am aware of how broad the interventions can be under this concept.

I think sensory integration provides positive results not just for children but for parents and family members as well. Much of the frustration around the child’s problems I found had a major if not more of an impact on the parent’s lives. This is important to consider when working with children and I found this happened frequently on my placement. I think sensory integration provides the child with the ability to further explore the world and can help to enhance their engagement in daily and play activities. I cannot conclusively say that sensory integration techniques are the best to use or can be implemented with every child; however I do think that the strategies of sensory integration do tend to have more positive effects on children.

Occupational therapy is a profession which fits into all different settings with a range of different age groups and clients. Children I think are able to gain a lot from occupational therapy as this profession is helping to enable children to engage in play activities and everyday tasks that the child attends to. I think occupational therapy is important to help the child develop and learn.

Through my blog I have discussed many of the benefits of sensory integration and how visual and tactile strategies may be used. Although I have mainly focussed on tactile I am able to see how all the senses are so important to help us as humans engage and take part in meaningful occupations. Even just imagining losing your eye sight for a day would seem impossible to cope with wouldn't it? After becoming aware of sensory integration I can understand just how useful our senses can be for us.

I hope you have enjoyed my blog; I thank you for taking the time to read it. I have thoroughly enjoyed discussing about this concept and strategies. Please feel free to comment on my blog and let me know what your thoughts are.

Sensory Profile

The sensory profile was developed by Dunn (1998) “…to assess the sensory responses of both children with disabilities and children without disabilities to a variety of commonly occurring sensory experiences” (Ermer & Dunn, 1998, p.284).  The sensory profile is an assessment occupational therapists can use in therapy sessions to record the frequency the child responds to the 125 common experiences in eight different categories being; auditory, visual, taste/smell, movement, body position, touch, activity level, emotional/social.

At first I did not know much about the sensory profile until my supervisor on placement let me observe the child during therapy sessions and fill out as much of the form as I could. I found this a useful tool to use with children who experience sensory processing difficulties as it made it easier to see what areas are needed to be focused on in future therapy sessions. The sensory profile is also a good way to see how the child progresses over time.

Here is a link to a website discussing a bit more information about the sensory profile, including the benefits and scoring of the assessment:

 http://www.pearsonassessments.com/NR/rdonlyres/6AB47882-1271-4D6A-BB3D-1AF8692D67B9/0/SP_TR_Web.pdf

The Just Right Challenge

The “Just Right Challenge” is when the Occupational Therapist makes sure that the activities chosen are challenging but also achievable so the child can then meet the challenges that are presented through play activities (Capital kids, n.d.). The just right challenge refers to the level of adaptive response (either emotional or physical) that the child is expected to make. If the child isn’t challenged enough then it is difficult to integrate an adaptive response however, the challenge should not be at a level which is unachievable for the child.  This is important for the occupational therapist to remember when using the sensory integration approach.

Intervention

I thought I would add in some information about the intervention in sensory integration in a bullet point list. Below I have added them to try make it easier to read. Let me know if you have any others to add if you know of any, and feel free to ask any questions.

• Sensory integration is child directed

• Activities should be thought out in advance by the therapist

• It is important for the therapist to plan for the response of the child to the sensory stimuli rather than the activity itself

• Sensory Integration interventions need to be meaningful to the child and the therapist needs to take this into account before planning each therapy session

• The therapist acts as a participant rather than an observer

• Organisation of the environment – such as having equipment available, and mats on floor to prevent any injuries

• Therapy is play focused and involves a range of different activities

• It is important to be aware of what else is happening in the child’s life at the time

• Small, constant and gradual change. Having controlled change in activities is more likely to develop an adaptive response

• Laughter is an emotional adaptive response – important to ask the child why they are laughing as could be due to either fear or happiness

• Therapy should be fun!

• Most importantly is to end on a success with sensory integration!

 Image retrieved August 23, 2011 from http://www.google.co.nz/imgres?q=messy+play&hl=en&gbv=2&tbm=isch&tbnid=6CejLY476FAsYM:&imgrefurl=http://www.childhaven.co.uk/schinfo.html&docid=qswfjnT8GiPanM&w=350&h=262&ei=PWNPToe2OuLymAWbzOT7Bg&zoom=1&iact=rc&page=7&tbnh=159&tbnw=216&start=70&ndsp=12&ved=1t:429,r:9,s:70&tx=122&ty=108&biw=1024&bih=656

Sensory Diet

"A sensory diet is a planned activity programme designed to meet a child's individual sensory needs throughout the day, enabling them to regulate their attention and therefore consistently engage in daily activities" (Nackley, 2001 as cited in Dunstan & Griffiths, 2008, p.6). The sensory diet is used commonly with children who are experiencing difficulties with things such as the ability to organise and regulate incoming sensory information (Dunn, 2000 as cited in Dunstan & Griffiths, 2008). The sensory modulation difficulties presented are that the child either lacks responsiveness (hyporesponsive) or is either sensitive to sensory stimulation (hyperresponsive) (Dunstan & Griffiths 2008). Sensory diets are useful to use on children who have sensory defensiveness.

One of the main strategies which can be used to help reduce high arousal levels in children is the use of ‘calming strategies’. An example of this is using deep pressure touch by using a brush. According to Brody (n.d.) the majority of children tend to respond better to firm touch, rather than light touch. This is because it gives their bodies information on where they are being touched as well as what is expected of them in terms of movement. Generally with children who have high arousal levels, calming techniques such as ‘brushing’ are useful to use if the child becomes distressed from a certain task. Usually I found within play sessions if the child was not focused or was not enjoying the session then the calming techniques could be used to help reduce the child’s stress. This is a useful tool for parents to use as well, as they are able to continue with the sensory diet at home and different strategies can be taught to the parents depending on their child and what their needs are. Strategies can also be used for children who are under aroused. Some examples around this can be changing the lighting and playing joyful music. I did not get to use this as much on my placement but did manage to see a few over reactive children and learnt some of these strategies with them.

"Therapy input for children with tactile sensitivities usually focuses on providing calming, deep pressure input and recommending environmental modifications to allow the child to feel safe at home and school/playcentre" (Dunn, 2000 as cited in Dunstan & Griffiths, 2008, p.6)

Here is a website I stumbled across which outlines more about the sensory diet and ways in which parents are able to create a sensory diet for their children. It also shows a sample sensory diet which is easy to follow:

http://sensorysmarts.com/sensory_diet_activities.html

I also found this youtube clip which summarizes the calming 'brushing' technique used on highly aroused children. It shows the occupational therapist using this technique on different parts of the child's body and it is easy to see the child is relaxed and wants more!

Play and Therapy Ideas for Treatment

Play is the primary occupation for most children. Play offers children “…the opportunity to develop gross motor, fine motor, visual motor, cognitive, language, imagination, attention, and social skills” (Aquilla, Sutton, & Yack, 2003, p.103).

On my paediatric placement messy play activities were used constantly throughout therapy in order to actively engage the child for me and my supervisor to observe their sensory input. Using play in therapy helped me to see why the child was having difficulties in everyday tasks. It is noted that “in sensory integration, play is used as a treatment medium and motivator to promote organization of sensory information.” (Couch, Deitz, & Kanny as cited in Benson & Nicka 2006, p.2). Sensory integration also improves a child’s eagerness to try new activities in play, as well as helps them express emotions, desires and increase socialization with other children (Benson & Nicka, 2006).

In relation to tactile play activities there are a range which can be used depending on the needs of each child. On my fieldwork placement many of the tactile activities were based around ‘messy play’ tasks to help encourage the child to use their hands and familiarize themselves with the use of soft and smooth textures. Some of the activities used water, bubbles, paint, shaving cream and sand to help engage the child. “Children enhance their development through active exploration of the environment, manipulation of materials, toys, and other physical stimuli” (Benson & Nicka, 2006, p.2).

While I was on my placement I was only briefly introduced to visual strategies and did not explore this as much as tactile strategies but after further research I found that sight is an important everyday sense we all use. I never realized the impact that vision problems can have on children and with their development and learning. According to Ayres & Robbins (2005), the visual sense is central to being a competent social being. Having poor visual perception can impact on the child’s learning tremendously. Children have to concentrate extremely well in order to just focus on something like the blackboard during class. It has been mentioned that these children “…may tire of the task much more quickly than other children or lose important details necessary to fully understand the concept that is being taught.” (Ayres & Robbins, 2005, p.118). I have found vision to be of value for any task a child does and before learning about sensory integration theory I had never realized how important this sense was for development. I am eager to learn more about this concept and to one day even use this theory in practice.

Image received August 20, 2011 from http://www.google.co.nz/imgres?q=finger+painting&hl=en&gbv=2&tbm=isch&tbnid=C3PZfxfFOLv8cM:&imgrefurl=http://tipnut.com/homemade-fingerpaint-recipe/&docid=cLhK_Amg7mPchM&w=425&h=230&ei=PGJPTtTPDYOCmQXHj4D6Bg&zoom=1&iact=hc&vpx=676&vpy=372&dur=2458&hovh=165&hovw=305&tx=203&ty=89&page=2&tbnh=80&tbnw=147&start=12&ndsp=12&ved=1t:429,r:3,s:12&biw=1024&bih=656

Tactile and Visual Senses

As mentioned previously the two senses I will be exploring in this blog will be the tactile and visual senses. In this post I will be outlining a bit more about these two senses and what sort of signs children with these deficits may have.

Tactile system: the primary function of the tactile system is to provide a protective mechanism. This system gives the child information about things in the environment such as texture, temperature, shape and size. The sense of touch also allows the child to determine whether something is painful to touch, the amount of pressure, as well as the location of the object (Sensory Integration, n.d.).

What are some of the signs of tactile dysfunction? Here are a few mentioned below, retrieved from the source Sensory Integration, (n.d.).

1.       Hypersensitivity to touch (Tactile defensiveness): these can be things such as

-          the child becomes fearful, aggressive or anxious with even the lightest touch

-          the child does not like to be held or cuddled

-          avoids standing or having close proximity to other people

-          avoids affectionate touch from other people besides parents or close relatives

-          avoids touching certain textures

-          avoids to wear new clothing or clothes with a rough texture

-          avoids the use of hands for play activities

-          avoids messy play activities such as with paints, mud, water, glue, glitter, shaving foam, play-doh, sand etc

-          is a picky eater and will only eat certain foods.

2.       Hyposensitivity to touch (Under-Responsive): these can be things such as

-          excessively mouths objects

-          the child may crave touch and needs to touch everything

-          hurts other children or people while playing

-          may be self-abusive; e.g. pinching, biting, etc

-          seeks out sensory surfaces that provide strong tactile feedback

-          touches soft/smooth textures frequently

-          seeks out messy play activities

-          has a preference for excessivley sweet, salty, sour or spicy foods

3.       Poor Tactile Perception and Discrimination: these can be things such as

-          child may be afraid of the dark

-          continues to mouth objects

-          has difficulty figuring out physical characteristics of objects; shape, size, weight, etc

-          may not be able to identify which part of their body was touched

Visual stimuli: these types of stimuli are a lot more variable and transient than some of the other sensory systems. Visual stimuli “…tend to last only as long as the stimulus is present” (Sensory Integration, n.d., p.3).

Now how about some of the signs of visual dysfunction? Below is a list of some of these:

1.       Hypersensitivity to visual input (Over Responsiveness)

-          avoids eye contact

-          sensitive to bright lights; often will squint or cover eyes

-          rubs his/her eyes

-          becomes easily distracted by other visual stimuli in the room

What is Sensory Integration?

Taste, Smell, Touch, See, Hear! Senses - we all have them and we all use them but can you imagine living life without being able to use one or even more of them? Sound challenging? This is what it is like for children who have sensory processing problems, whether they have sensory integrative disorder, developmental delay, autism or another sensory condition. Our senses are all the same and by becoming aware of how our sensory system works can really impact on how a child can engage in play activities and daily tasks.

On my placement I learnt about sensory integration through therapy sessions and discussion with my supervisor. Seeing how play sessions were set up and the activities that were chosen to engage the child, made me understand more about the concept. At first I wasn’t sure why or how the child developed problems with their senses. It wasn’t until I researched more about the term sensory integration that many of the sensory problems were due to the information not becoming integrated through the child's neurological pathways.

Sensory Integration was first developed by an Occupational Therapist Jean Ayres in the 1960s. According to Capital Kids website (n.d.). Sensory integration refers to the process by which we receive information from our internal and external environments through our senses. The seven senses being, vision, hearing, touch, taste, smell, vestibular, and proprioception. As humans we respond to these stimuli automatically. The central nervous system sends this information to the appropriate parts of the brain. This information then becomes processed so that we can respond to the stimuli in an adaptive manner. Occupational Therapists tend to focus closely on the proprioceptive, vestibular, and tactile senses the majority of the time. Sensory integration is the foundation for children's learning and behaviour which enables them to develop skills necessary in life .

Many of the clients I worked with had developmental delay and this is when I first used sensory integration techniques. Some of the children were either over aroused, anxious, or fearful of touching a certain texture. “Once arousal levels are regulated, interventions that focus on communication, socialization, and skill development have a better chance of success.” (Aquilla, Sutton, & Yack, 2003, p.36).

Each child is different and different strategies will work effectively on some children and may not be so effective on others. Being able to choose the appropriate activities, setting up the environment, and controlling the amount of sensory input can produce effective results over time. However, it is important to be patient and always remain a positive attitude as well as trying different strategies if some do not work. The tools and strategies used can be easily transferred to the child's home environment with the correct teaching methods being supplied from the therapist to the parent. 

Please feel free to read further blogs I have provided about sensory integration in my 'blog list' over on the right side of this page as there is a list of extra blogs there which explain more about sensory integration.

Welcome!

Hello and welcome to my blog! This blog will be discussing the use of Sensory Integration in play with children.  My name is Fiona Fraser and I am currently in my final year studying towards a Bachelor of Occupational Therapy.  During my three years studying at the School of Occupational Therapy at Otago Polytechnic, I have been exposed to many different settings and experiences on my fieldwork placements. One of these settings was Paediatrics. I have always been interested in this area and see myself working there sometime in the future.

During my paediatric fieldwork placement I was first introduced to the concept of sensory integration with children who had sensory processing problems. At first I had never heard of the term before and was interested to see how it was used within play therapy. After being involved in play therapy sessions I learnt more about sensory integration and how it can be used to increase a child’s participation in everyday activities. This made me quickly become interested to see how the different techniques were used and to see the benefits of them.

Within this blog, I plan to discuss my learning of sensory integration drawing from a variety of literature as well as some of my own reflections from placement. I plan to outline two sensory strategies that I used on my placement, these being tactile and visual strategies.