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Practical guide for early signs of sensory processing disorder in children. more...








The Theory of Sensory Integration

The Sensory Systems

Sensory Integration and Praxis

Sensory Integration and Modulation

Sensory Processing Disorder

Sensory Integration Treatment


Theory of Sensory Integration

Dr. A. Jean Ayres, an occupational therapist with advanced training in neurosciences and educational psychology, developed the theory of sensory integration to explain the relationship between deficits in interpreting sensory information from the body and the environment and difficulties with academic and motor learning (Bundy & Murray, 2002).

Ayres' primary objective when developing the theory of sensory integration was to explain the underlying cause of sensorimotor and learning problems in children in order to determine the optimal mode of intervention (Ayres, 1972; 1979). In the first publication of the theory in 1972 Dr. Ayres postulated that learning is a function of the brain and that disordered sensory integration accounts for some aspects of learning disorders and that enhancing sensory integration will make academic learning easier (Sensory Integration and Learning Disorders, 1972).

In 1989 sensory integration was defined as "the neurobiological process that organises 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 is information processing" (Ayers, 1989; p.9).

Since then a great body of research has been published on sensory integration and its potential application to diverse populations. In fact the theory of sensory integration has sparked more research and controversy than any other theory developed by an occupational therapist.

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The Sensory Systems

The Sense of Touch (the tactile system)

The tactile system is the largest sensory system and plays a major part in determining human physical, mental, and emotional behaviour. Touch sensations flow into the brain to tell us that something is touching us and play an important role in body awareness and movement.

The tactile system is important for:

Recognising shape and texture of objects
Identifying whether a stimulus is painful or dangerous
Planning movements
Development of fine more skills & manipulation of objects
Emotional security
Social skills


The Sense of Body Position and Movement (the proprioceptive system)

The word proprioception refers to the sensory information that we receive from our joints and muscles. This information is telling us about the position, movement, force, and direction needed for activities such as buttoning clothes, writing, screwing a lid on a jar or playing with a toy without breaking it.

The proprioceptive system is important for:

Development of an internal map of our body (body scheme)
Body awareness
Motor control and motor planning
Emotional security


Gravity, Balance, and Movement (the vestibular system)

The vestibular system is locate in our inner ear and is giving us information about where we stand in the world. It tells us where we are in relation to gravity; whether we are moving or standing still, and how fast or slow we are going.

The vestibular system is important for:

Physical activities such as running, climbing, dancing
Coordination of the two sides of the body
Knowing where we are going
Seeing clearly while moving


The Sense of Sight (the visual system)

The visual system helps us to navigate in the world and judge the speed and distance of objects and people.

The visual system is important for:

Following a moving object with our eyes
Writing letters and numbers
Fitting pieces into jigsaw puzzles and cutting along lines
Copying from the blackboard or from books


The Sense of Sound (the auditory system)

The auditory system is located in our ear and relates to the ability to receive sounds.

The auditory system is important for:

Locating sounds in the environment
Discriminating between sounds and words such as "ba" and "ma"
Attending to, understanding, or remembering what is read or heard
Making up rhymes and singing
Speaking and articulation


The Sense of Smell (the olfactory system)

Smell plays an important role in establishing and receiving memories and associations that influence some of our choices and preferences, such as a specific type of perfume or a certain type of soap. A baby can recognise his mother just through smell and our food choices are greatly dependent upon the sense of smell.


The sense of taste (the gustatory system)

Taste helps us to survive and provides us with essential information about bitter, salty, sweet, and sour flavours. These tastes are important in our selection of food or to inform us whether certain tastes might be harmful for our body.

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Sensory integration and Praxis

A. Jean Ayres (1972) defined praxis as the learned ability to plan and direct a temporal series of coordinated movements toward achieving a result - usually a skilled and non-habitual act.

Under the light of sensory integration theory, praxis is viewed as a uniquely human skill that enables the brain to conceptualise, organise, and direct purposeful interactions with the world (Ayres, 1985). Praxis includes knowing what to do as well as how to do it and is fundamental for skills such as getting dressed, learning to write, or playing.

Occupational therapists who view praxis from a sensory integrative perspective are concerned with the individual’s sensory processing and conceptual abilities (Ayres, 1985; Ayres et al., 1987).

Praxis includes 3 components (Ayres, 1989)

Ideation - knowing what to do
Motor planning - directing and organising the movement
Execution - carrying out the motor plan


Disorders of Praxis

Praxis and dyspraxia are complex concepts, and the terminology associated with them can be confusing. In a simple manner:

Dyspraxia is a generic term that refers to developmentally based disorders of praxis with a variety of etiologies
Sensory integrative- based dyspraxia refers to the praxis problems that have their bases in poor sensory processing

(Reevs & Cermark, 2002)

If praxis does not emerge, the result is Sensory-based Motor Disorder - dyspraxia, a developmental motor planning disorder. Sensory-based Dyspraxia is one of the most common manifestations of Sensory Processing Disorder in children with learning disorders or other developmental delays.

Sensory-based Motor Disorder - dyspraxia is a brain dysfunction that hinders the organisation of sensory information and interferes with the ability to motor plan. The nature of the disorder indicates that the problem begins early in the child's life and affects his development as he grows (Ayres, 2005).

In accordance with Sensory Integration theory, two levels of dysfunction in praxis have been identified:

Bilateral Integration and Sequencing Deficit: is a mild form of Sensory-based Motor Disorder that involves:

Difficulty using the two sides of the body in a co-ordinated manner & sequencing motor tasks
Poor vestibular & proprioceptive processing


Somatodyspraxia: is a more severe form of Sensory-based Motor Disorder that involves:

Difficulty in formulating action plans; a problem with the motor-planning of new, rather than habitual, movements
Poor tactile, vestibular & proprioceptive processing


A Checklist for Problems in Praxis

Some characteristics of poor motor planning are listed below. The following characteristics include some of the symptoms of a problem in praxis.

Difficulty planning and organising the sequences of movements in activities such as cutting with scissors or riding a bicycle
Difficulty with daily activities such as getting dressed, using knife and fork
Tendency to bump into and/ or trip over things
Taking longer to learn skills such as tying shoelaces, writing letters or numbers, catching a ball
Poor gross motor control when running, climbing, jumping, and going up and down stairs
Doing things in inefficient ways
Low self-esteem
Difficulty when transitioning from one activity to another

(Source: Ayres, 2005; Kranowitz, 2003)

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Sensory Integration and Modulation

Modulation of sensory input is critical to our ability to engage in daily life activities. Filtering of sensations and attending to those that are relevant and attending attention to task requires a good level of sensory modulation (Lane, 2002). When modulation is inadequate, the child's attention may be continually diverted to ongoing changes in the environment and this may interfere with learning and play. Current research is examining Sensory Modulation Disorder (SMD) as a valid clinical syndrome (Miller et al. 2007) 


A Checklist for Problems in Sensory Modulation

Some characteristics of poor sensory modulation are listed below. The following characteristics include some of the symptoms of a problem in sensory modulation.

Aversion or struggle when picked up, hugged, or cuddled
Aversion to certain daily life activities, including baths or showers, cutting of fingernails, haircuts, face washing and dental work
Responding with aggression to light or unexpected touch to arms, face, legs
Avoidance of certain styles or textures of clothing (e.g. scratchy)
Avoidance of play activities that involve body contact
Dislike getting hands in sand, finger-paint, paste
Exaggerated fear of falling or heights
Become anxious when feet leave the ground
Seem particularly slow at movements
Avoid jumping down from higher surfaces
Avoid climbing, escalators, or elevators
Seem to misunderstand what is said
Have difficulty looking and listening at the same time
Seem distracted if there is a lot of noise around
Hold hands over ears
Gag easily with food in mouth
Picky eater
Mouth objects
Express discomfort with light
Rock unconsciously
Become overly excitable during movement activities
Be "on the go"
Be slower than others to respond to sensation

(Ayres, 2005; Lane, 2002; Dunn, 1999)

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Sensory Processing Disorder

"A sensory integrative problem may interfere directly with the learning process in the brain, or it may cause poor behaviour that interferes with schoolwork"

(Ayres, 2005)

For most children, sensory integration develops in the course of ordinary childhood activities. But for some children, sensory integration does not develop as efficiently as it should. When the process of sensory integration is disordered, a number of problems in learning, development, and/ or behaviour may become evident (Sensory Integration International, 1991).

Sensory Processing Disorder (SPD) manifests itself in two major ways: poor praxis and poor modulation (Bundy & Murray, 2002).

Sensory Processing Disorder (SPD) may exist on its own, or it may coexist with:

Attention Deficit and Hyperactivity Disorder (ADHD)
Asperger's Syndrome
Fragile X Syndrome
Autistic Spectrum Disorder (ASD)
Pervasive Developmental Disorder (PDD)
Cerebral Palsy (CP)
Spina Bifida
Nonverbal Learning Disorder (NLD)


Some Common Signs and Symptoms of Sensory Processing Disorder

"A child with sensory processing disorder often develops in an uneven way"

Hyperactivity and distractibility
Delays in speech and language
Low muscle tone and coordination problems
Slow development of motor skills
Poor organisation of behaviour
Learning difficulties at school
Sensitivity to movement, touch, sights, sounds, and smells
Poor organisation skills in adolescence

(Ayres, 2005; Sensory Integration International, 1991)

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Sensory Integration Treatment

"The belief that a child will outgrow his problem...may prevent him from getting professional help at the age that it will do the most good"

How therapy works

"Therapy involving therapeutic sensory experiences...can be more effective than drugs, psychological analysis, or rewards and punishment in helping the brain and body to develop optimally"

During Sensory Integration Therapy, the child is guided through activities that challenge his or her ability to respond appropriately to sensory input by making a successful organised response (SII, 1991). Therapy takes place in a safe and interesting environment and through the use of specialised suspended equipment the child is afforded the opportunity to integrate sensations arising from the vestibular, proprioceptive, tactile, visual, and auditory systems. Treatment is developed in collaboration with the child and aims at meeting the child's specific needs for development. The activities are also designed to elicit autonomic responses and are graded to lead

to higher levels of organisation that will promote the child's interaction with the environment. Specific skills training is not part of sensory integration treatment, rather activities are used to help the child develop the underlying abilities that are necessary for learning and mastering of skills.

Sensory Integration Therapy & Equipment

Therapy using sensory integration as a frame of reference is dynamic and fun for the child. The clinical setting is safe and provides the child with the opportunity to explore appealing pieces of equipment: platforms to swing on, barrels to climb through, trapezes to swing from, and big blocks to climb over. The therapist and the child engage in a play situation where the child is motivated to seek new experiences and under the guidance of the trained professional to achieve success that probably would not occur in unguided play. The playful atmosphere incorporates opportunities for the child to take in enhanced sensation and promotes adaptive interactions with the environment.

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