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Sensory Integration 101
What is Sensory Integration? Sensory Processing? Sensory Modulation? A Sensory Diet?
What is the difference between Sensory Integration Disorder and Sensory Processing Disorder?
Sensory Modulation Dysfunction? Dysfunction of Sensory Integration? Somatosensory Dysfunction?
Threshold to Response? Tactile Defensiveness? Gravitational Insecurity? Dyspraxia? Somatodyspraxia?
AAAAAAUUGH!
First, let me say that I don't think
it's appropriate or necessary to throw most of these terms around when
working in schools as an OT. If you have a strong background in this
area, that's great and you probably understand all of these terms
better than I do. But school-based scope of practice very rarely
requires this level of conversation. See more of my rambling about this
here. This whole page is just here
as an attempt to clarify some of the concepts we may be using in
applying SI theory to our school practice.
These terms and others are used to mean different things by people in various locations or professions, and the meanings have changed over time so that they will also varied depending on when and with whom a professional was trained. Some aspects of sensory integration are based on medical and research-based facts, while others are theories which have yet to be proved or disproved. All of this can make it very confusing when someone is telling you that your child has a disorder you've never heard of and that swinging is going to help her! Is it a load of hooey? Is it medically sound?
To gain some perspective, let's start with a history of sensory integration. Within the occupational therapy world, sensory integration was born in the research and practice of A. Jean Ayres, an OT with advanced training in neuroscience and educational psychology. She was interested in the relationship between deficits in interpreting sensation from the body and environment with learning and motor difficulties. She popularized the term sensory integration, meaning,
Jean Ayres continued to develop and change her ideas and practice relating to sensory integration up until her death in 1988. She developed the Sensory Integration and Praxis Tests as a means to assess the components of sensory integration and guide treatment. She developed theories about typical patterns of disability based on factor analyses from her testing and from observations of children. From these theories she developed methods of treatment for specific patterns of disability using "enhanced sensory experiences." Over time, the therapy itself became known as sensory integration. Therefore, the term sensory integration now refers to three things:
Got all that? That's only the beginning of the confusion, because after Jean Ayres, people who had worked with her, people who had worked with those people, and others continued to add their own theories and ideas to the mix. Advances in neurological science and educational research have also helped sensory integration theory develop. But as often happens, different groups of people working on research and ideas in any given area came up with a bunch of different terms. The American Occupational Therapy Association (AOTA) and Sensory Integration International - aka The Ayres Clinic ---(this organization shut down after lots of splits in the profession over what is and isn't SI, side-taking, financial problems etc. Here's a link to a news article on the final messy demise if you're interested)--- both made attempts at standardizing the terminology used when discussing SI theory. They cleared up some terms and made suggestions on others. Still, it is confusing and other organizations continue to coin and use their own terms. In part, that is because these disorders are not diagnoses, such as would be made by a medical doctor or psychologist. They aren't diagnoses in the DSM-V or ICD-10 (though sensory problems are listed as part of the criteria for an Autism diagnosis). They are currently terms primarily used by occupational therapists, parents, and some educational specialists and psychologists. I haven't sat in on any professional boards on this, but as best I can tell, here is a glossary of general SI terms you may hear bandied about:
Aversion or Aversive Response
These terms and others are used to mean different things by people in various locations or professions, and the meanings have changed over time so that they will also varied depending on when and with whom a professional was trained. Some aspects of sensory integration are based on medical and research-based facts, while others are theories which have yet to be proved or disproved. All of this can make it very confusing when someone is telling you that your child has a disorder you've never heard of and that swinging is going to help her! Is it a load of hooey? Is it medically sound?
To gain some perspective, let's start with a history of sensory integration. Within the occupational therapy world, sensory integration was born in the research and practice of A. Jean Ayres, an OT with advanced training in neuroscience and educational psychology. She was interested in the relationship between deficits in interpreting sensation from the body and environment with learning and motor difficulties. She popularized the term sensory integration, meaning,
| "The 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." (Sensory
Integration and Learning Disorders, 1972) |
Jean Ayres continued to develop and change her ideas and practice relating to sensory integration up until her death in 1988. She developed the Sensory Integration and Praxis Tests as a means to assess the components of sensory integration and guide treatment. She developed theories about typical patterns of disability based on factor analyses from her testing and from observations of children. From these theories she developed methods of treatment for specific patterns of disability using "enhanced sensory experiences." Over time, the therapy itself became known as sensory integration. Therefore, the term sensory integration now refers to three things:
| 1. The neurological process as
described in the quote above, |
| 2. The theory regarding the
integration of sensation and how it relates to motor and learning
difficulties, and |
| 3. The assessment and therapy
guided by sensory integration theory used to address suspected deficits
in the sensory integration process. |
Got all that? That's only the beginning of the confusion, because after Jean Ayres, people who had worked with her, people who had worked with those people, and others continued to add their own theories and ideas to the mix. Advances in neurological science and educational research have also helped sensory integration theory develop. But as often happens, different groups of people working on research and ideas in any given area came up with a bunch of different terms. The American Occupational Therapy Association (AOTA) and Sensory Integration International - aka The Ayres Clinic ---(this organization shut down after lots of splits in the profession over what is and isn't SI, side-taking, financial problems etc. Here's a link to a news article on the final messy demise if you're interested)--- both made attempts at standardizing the terminology used when discussing SI theory. They cleared up some terms and made suggestions on others. Still, it is confusing and other organizations continue to coin and use their own terms. In part, that is because these disorders are not diagnoses, such as would be made by a medical doctor or psychologist. They aren't diagnoses in the DSM-V or ICD-10 (though sensory problems are listed as part of the criteria for an Autism diagnosis). They are currently terms primarily used by occupational therapists, parents, and some educational specialists and psychologists. I haven't sat in on any professional boards on this, but as best I can tell, here is a glossary of general SI terms you may hear bandied about:
Aversion or Aversive Response
a negative reaction to a sensory input,
such as withdrawing from
the input or protesting it. A more intense aversive response would be
going into "fight, fright, flight" mode.
Aversion/Intolerance to Movementsimilar to gravitational insecurity,
but more specifically
characterized by autonomic nervous system response (nausea, heart rate,
sweating, that sort of thing) to movement that most people would
consider non-noxious; thought to be the result of poor processing of
vestibular input.
Dyspraxiaa condition in which the ability to
plan unfamiliar motor tasks
is impaired (see Motor Planning). Considered a developmental condition,
since motor planning is a developmental skill. Speech therapists often
refer to the same concept, as regards to articulation and oral motor,
as Apraxia.
Gravitational Insecuritythought to result from poor sensory
modulation of vestibular
(gravitational and movement) and proprioceptive input; manifested as
fear of being out of upright position, having feet off of the ground,
and/or fast movements through space. Responses to this input are out of
proportion to any actual danger and also to any postural deficits the
individual may have.
Heavy Workthis is activity that provides proprioceptive input through stretch
receptors in active muscles and joints that are bearing a load. It is
often a term used in sensory diets. It is,
ideally, movements with large muscle groups (hamstrings, shoulder
girdle, pecs,
abdominals, etc) against resistance and is symmetrical and sustained.
Think pushing a heavy box across the floor. Pedalling a bike up a steep
hill. Playing tug-o-war. Holding yourself up on a chin-up bar. Even (in
a less intense way) chewing on gum or squeezing a stress ball. For a
link to many many such activities, click here.
Motor PlanningThe process of taking in sensory
information about one's
environment as well as one's own place in space, movement, force, and
so on in order to successfully imagine and complete a motoric task. For
more, click here
PraxisSee motor planning. The terms dyspraxia
and apraxia come from this word, and both mean difficulty with praxis.
In my experience, speech therapists tend to use apraxia and OTs and PTs
use dyspraxia.
Proprioceptionfrom the Greek, meaning sense of self.
The sensations derived
from movement from sensors in muscles that are triggered by stretch and
by contraction of the muscles, the deeper part of our skin, and a
little bit from joint position that
tell us where we are in
space and how we are moving. See Heavy Work.
Also, the term Kinesthesia is sometimes used interchangeably with
Proprioception, but not usually by OTs. It tends to be used more in
psychology, dance, and other fields. It puts more of an emphasis on
movement and less on position-in-space.
Sensory Defensivenessthought to result from poor sensory
modulation of sensory input
in any or all of the categories; strong aversive response to sensory
input that most people would consider non-noxious. (Includes Tactile
Defensiveness, below, and Gravitational Insecurity, above)
Sensory Dietthis refers to a set of sensory
strategies for a particular child
that are put together into a daily program or schedule. The term "diet"
is used to
stress that our bodies require minimal amounts of sensory input to
thrive, just as they require food and drink. Usually, an
occupational therapist will work with the child's care-giving and/or
educational and/or therapeutic team to find useful strategies and
determine how often, for how many minutes, and how intensely the
strategies are usually needed. These are then formalized into a daily
sensory diet.
Sensory Integrative Dysfunction (sometimes
called Sensory
Integrative Disorder or Disorder of Sensory Integration - DSI)difficulty with central nervous system
(brain, mostly) processing
sensation, especially vestibular, tactile, or proprioceptive, which
result in poor praxis, poor modulation, or both. See Sensory Processing
Disorder, below.
Sensory Integrative-based Therapya program of intervention involving
meaningful therapeutic
activities that include enhanced sensation--especially tactile,
vestibular, and proprioceptive--active participation, and adaptive
interaction. Translation: the child is engaged in an activity that is
meaningful to her that works on developing needed skills while the
therapist sets up or guides the activity so that the child will be
getting stronger or different sensory input that usual. That extra
sensory input
triggers reflexes and other neuromuscular connections that are meant to
facilitate successful completion of the difficult motor skill. Example:
a girl with poor balance and motor planning, suspected to be due to
reduced awareness of body-in-space. In one therapy activity, she wears
a weighted vest (enhancing proprioceptive
input) while straddling a bolster swing (working on balance) and
pulling a rope to make herself swing (working on motor planning while also
providing herself extra vestibular input).
The muscle work of pulling the rope also provides proprioceptive input.
Sensory Modulationthe ability to regulate and organize
reactions to sensory input
in
a graded manner (jumping when you hear a loud bang, but not when the
air conditioner cycles on). The balancing of excitatory and inhibitory
inputs, and adapting to environmental changes (not jumping at every
bang when your office is next to a large construction job).
Sensory Modulation
Dysfunctiona pattern of dysfunction where a person
under- or over-responds
to sensory input from the body or environment. There are four types:
gravitational insecurity, sensory defensiveness, aversive response to
movement, and under-responsiveness.
Sensory Processingthis includes the responses of sensory
receptor cells (such as
touch receptors in the skin or light receptors in the back of the
eyes), but more importantly it includes the process that takes place
within the brain. It is making sense of the sensory input our brain
receives from the rest of our body. There is a "clearinghouse" stage,
where our brain decides what is worth paying any attention to at all
and passes it on to the specific areas for processing sound, sight,
touch, temperature, gravitational awareness, etc. Sensory processing
includes reception, modulation,
integration, and organization of sensory stimuli. Some people also use
this term to mean the behavioral responses to sensory input (aversion
or attraction, for example).
Sensory Processing DisorderO.K. this is a bit confusing. The terms
sensory integration disorder or
dysfunction of sensory integration
are often heard (and abbreviated DSI to distinguish it from sudden
infant death syndrome - SIDS). Various specialists in the
field of
SI decided that it was time for a term that differentiated the
theorized disorders involving sensory processing from the neurological
use, the theory of, and the term for treatment, "sensory integration."
So they came up with this term. It is an umbrella term covering all
types of dysfunctions in processing sensory input. Here is a chart
which may or may not clarify it for you.
One goal of the profession is to get some official diagnosis included in the DSM and the ICD at some point.
Sensory RegistrationOne goal of the profession is to get some official diagnosis included in the DSM and the ICD at some point.
Noticing sensory stimuli in the
environment; "tuning in" to a
particular stimuli.
Somatodyspraxiaa relatively severe form of
sensory-integrative-based dyspraxia
(poor motor planning) characterized by difficulty with both easy and
more difficult motor tasks; thought to be based in poor processing of
tactile and likely vestibular and proprioceptive sensations. No
musculoskeletal or neurological disabilities are present (spinal cord
injury or muscular sclerosis with muscle wasting, for example).
Somatosensory DysfunctionI believe this refers to the suspected
poor processing leading to
somatodyspraxia, above.
Tactile DefensivenessThe state of exhibiting an aversive
response to tactile input, or
types of tactile input (most often light touch), that most people would
find non-noxious
Threshold to Responsethis term is sometimes used to mean the
same thing as sensory
registration. However, it has been discouraged since threshold is
typically a neurologically-used term when referring to the actual
response of a single nerve to an input, or the amount of signaling
that a muscle cell requires before firing.
Vestibular sensation derived from stimulation to
the
vestibular mechanism in the inner ear (liquid-filled tubes, hair cells)
from movement and positioning of the head; contributes to posture and
the maintenance of a stable visual field.