Sensory Integration and in the School Setting By Trisha Dolan, M.S.,O.T.R./L. 7/13.

Sensory Integration and in the School Setting

By Trisha Dolan, M.S.,O.T.R./L.7/13

The Attachment, Self-Regulation, and Competency (A.R.C.) Model for Trauma Intervention

• A.R.C. Model: Attachment, Regulation, and Competency – is a components based model

• Attachment: The interactions between children and their caregivers that have a longstanding impact on the development of identity, personal agency, working models of “the self”, and the capacity to regulate emotions.

• 4 types of Attachment: Secure, Insecure/Avoidant, Insecure/Ambivalent, Disorganized

• Two guiding goals for Attachment:• 1. to develop healthy attachments between the child • who has experienced trauma and their caregivers• 2. to create the safe environment f or healthy recovery

What is Sensory Integration?

• A. The ability to synthesize, organize and process incoming information received from the body an environment to allow for adaptive and purposeful goal-directed responses.

• B. A frame of reference to describe development of the typical child.

• C. Occupational behavior: Children have many roles and related responsibilities including the player, the creator, the explorer, the daughter/son, brother/sister, friend, leader/follower, student, etc. Children all have varying strengths and weaknesses that allow then to functionally adapt and successfully perform in their various roles during each day. It is when these deficits in sensory processing lead to misperceptions and maladaptive responses and delayed development that interfere with Function in these Roles that dysfunction now occurs.

Sensory System Functions• Each sensory system has 2 major functions/jobs:• 1. Sensory Arousal and Modulation Sensory registration, arousal

and modulation: refers to the nervous system’s ability to take in sensory information and then modulate (balance) this information collectively with all systems to maintain a calm and evenly aroused state to then adaptively perform and participate in more refined cognitive/motor/social/emotional activity

• 2. Sensory Discrimination : refers to the system’s ability to organize and interpret incoming sensory information to then make efficient judgments and plan refined skills and coursed of action. Development and utilization of discriminative skills is frequently based on efficient sensory registration, arousal, and modulation skills.

The 7 Sensory systems

• 1. Movement• 2. Proprioception-Muscle/Joint Perception• 3. Tactile Perception• 4. Vision• 5. Auditory• 6. Olfactory (smell)• 7. Gustatory

Tactile System

• This system impacts a child’s arousal and emotional tone, attachment, comfort with and bonding with caretakers, feeding, dressing, body scheme, and motor planning. This is the most mature system at birth.

• Stimulated by receptors in the skin for central nervous system processing of deep and light discriminative touch and pressure.

• Touch is carried by two different systems:• 1. deep touch and pressure system– old, primitive system, more calming• 2. light discriminative touch sytsem– newer system• more alerting

• Dysfunction occurs when they don’t function efficiently together to perceive touch as safe, whether by experience and/or innate neurologic status

Vestibular (movement): • This system impacts balance, muscle tone, reflexes, postural

control, body in space, arousal/calmness/safety, visual tracking and eye teaming, and a child’s ability to initiate motor movement.

• Consists of 5 distinct end organs: 3 semicircular canals that are sensitive to angular accelerations (head rotations) and 2 otolith organs that are sensitive to linear (or straight-line) accelerations.[1].

• Fluid in the semi circular canals moves hair cells that send information about direct and intensity of movement to create postural changes, body position in relation to gravity and arousal information to various limbic system and higher cortical areas.

The Vestibular and Auditory System diagram

Auditory System• Sound = is vibration measured in frequencies (hertz/per second)

• Structure: • Outer ear – shaped to dampen low frequencies and sharpen high

frequencies• Middle Ear – Protects ear from loud sounds• Inner Ear: Totally surrounded by bone to effectively change sound vibration

to electronic vibration to make understanding of sound through movement of the hair cells in the Organ of Corti in the Cochlea

• :• The auditory and and movement systems are really one system that are

connected through neural structures in the cochlea

• The Auditory System goes to every lobe of the brain

C. Kinesthetic/Proprioceptive (muscle/joint feedback):

• Stimulated by joint receptors regarding position sense, force, muscle tension, and sensation from one’s own body movement to:

• ~ have a notable modulating and organizing influence on other sensory systems and arousal

• ~ develop body and world scheme,• ~ know how/when/how much to move and to

vary direction • ~ have a large impact on one’s ability to sequence

motor actions (motor planning).

D. Visual System and Visual Perception

• Structure: 6 eye muscles around each eye which move both reflexively and voluntarily

• Two functions: 1. To scan environment to discriminate data in the world around us to ensure safety 2. To move our body safely through space

• Depends on and is inter related to the vestibular system• Is interconnected with other systems to form one synchronized

system to impact overall daily adaption, executive function and emotional, behavioral, and social interactions

Olfactory and Taste Systems

• E. Olfactory System : the sense of smell

• F. Gustatory (Taste):

Products of Sensory Processing

1. Emotional, Behavioral and Social Development 2. Sensory Motor Development 3. Perceptual Motor Development 4. Cognition/Intellect 5. Motor Planning (Praxis)

Motor Planning (Praxis): • Motor Planning: one’s ability to sequence motor actions into a complete

planned sequence to perform a variety of more complex motor actions that are important in a child’s occupational roles (i.e: child = explorer, communicator, T.L.C. receiver and giver, student, sibling, friend, etc.).

• “ It is a uniquely human skill that enables us to interact effectively with the physical world-requiring cognitive functions of Ideation, Integration of Sensory Input, and Planning that enables motor expression” (Ayres, 1985).

• Components of praxis include: imitation, ideation, initiation, construction, feedback, feed forward, grading, timing, sequencing, and motor planning

• Motor planning: impacting play, skill development, social understanding, relationships, attachment and behavioral and emotional regulation, and development of mastery

Heirarchy of Outcomes of Sensory Processing

The Limbic System• Is responsible for controlling various functions in the body important to

survival (heart rate, sweating, blood pressure, arousal, fight, flight, freeze)

• Is important in storing and interpreting emotional responses, storing memories, and regulating hormones – integrating emotional states with stored memories of physical function

• Is the sensory input processing center as sensory input travels upward towards the cortex

• Is the emotional launching point of emotions and emotional connector to the cognitive prefrontal cortex

* Is right beside and interconnected to the motor systems

The Limbic System

Limbic System (cont.)

Structures• Amygdala - almond shaped; is involved in emotional

responses of fear, anger, hunger, sexual reproduction, and memory

• Hippocampus - a tiny nub that records, files and then sends memories out to the appropriate part of the cerebral cortex for long-term storage and to retrieve them when necessary.

• Hypothalamus - about the size of a pearl, this structure wakes you up in the morning, gets the adrenaline flowing and is an important emotional center, controlling the molecules that make you feel exhilarated, angry, or unhappy.

Limbic system structures (cont)

• *Thalamus - a large, dual lobed mass of grey matter cells that relay sensory signals to and from the spinal cord, amygdala and the cerebrum. Involved in sensory perception and motor function.

• *Olfactory Cortex - receives sensory information from the olfactory bulb and is involved in the identification of odors.

• *Cingulate Gyrus - a fold in the brain involved with sensory input concerning emotions and the regulation of aggressive behavior.

• * The Limbic system connects to the Cingulate Cyrus which is the Gateway to the Frontal Cortex

• * The Frontal Cortex function is decision making, problem solving and planning

The following steps occur in an Ecological/Environmental Assessment:

• Identify and survey the natural environments of the student while observing the student in them. Focus on area of difficulty that the student seems to be having, with these general categories in mind:

• Posture Gross Motor Component Endurance Sensory Aspects Academic Components

• Fine and Visual Motor Aspects • Language Components - Listening, Speaking, Writing • Available Support

Additional Environmental Considerations~Ecological Assessment & Modes of Learning

• With your O.T., complete an Ecological /Environmental Assessment to assist in identifying:

• Identify potential barriers for your student to access and participate in the regular education environment.

• Decide how the typical school environment can be used to help students with and without disabilities achieve priority goals and objectives.

• To identify the accommodations which may be needed for the student to participate in a meaningful way.

• Identify viable sources of support for your student and the her/his teachers.

The Sensory Diet: developed together with you and your O.T

• Your O.T. can: • help guide you in the sensory motor choices you

provide to your student, as well as the intensity and duration with which they are provided or interacted with by the student.

• develop a sensory diet that includes many activities from those activities noted above as developing those that are especially unique to your particular student.

• help you complete an Ecological Assessment of the environments your student will be spending time in.

Sensory Organizers to Decrease Arousal To increase calming:• Use of High/Just Right/Low Body Engine terminology (from the A.L.E.R.T • Program for Sensory Organization)• Provide enclosed spaces such as tents and tunnels• Provide spaces that “surround” such as quiet work space,, bean bag chair, sleeping

bags, ball pit• Create Quiet /Cozy Spots to work in to minimize distractions and encourage self-

regulation when student is distracted or upset.• Touch:• Change a child’s seat/place in line, desk in a row, location in a group – to • minimize incidental touch• Be respectful of their personal space, and observe how they respond to • incidental daily touch from other children.• When using hand-over-hand guidance let them know first and then use firm • and constant pressure. • For tactually fidgety students -Place Velcro under the edge of the desk top to • allow non-disruptive fidgeting during listening tasks. • Have student assist teacher in meeting time, etc, by holding an appropriate • Item - to give hands an organizing task

Sometimes your student may require direct O.T. treatment due to the underlying and/or co-existing sensory and /or motor difficulties that are impacting successful and meaningful progress in their everyday home and school functioning. Please be sure to check-in and follow-up with your Occupational Therapist with any questions

Direct O.T. Treatment

Resources

• Resources:• Attachment, Self-Regulation and Competency by

Kinniburgh, Blaustein, and Spinazzola; Psychiatric Annals 35-5, May 2005-

• The S.M.A.R.T. Model: Sensory Motor Arousal Regulation Treatment by Warner, Cook, Westcott, and Koomar, The Trauma Center at JRI; 2011

• A User’s Guide to the Brain, by John Ratey,M.D., Vintage Books, 2002