Intro”George is a third grade student who is waiting for the school bus. He is challenged by sensory experiences during everyday activities that most of us don’t even think about. While he’s still reeling from the battle with mom over brushing his teeth (that peppermint toothpaste tastes like fire in his mouth) the school bus pulls up. George runs past the bus monitor’s haze of perfume and sits at the back of the bus. In his heightened state, he becomes even more aware of his new school shirt with its stiff label and that awful feeling like a wire brush being poked into the back of his neck. The sensory experiences of the movement of the bus, the sound of his excited classmates laughing and yelling above the roar of the bus engine all contribute to his increased agitation. By the time George arrives at school he is wound up and ready to unravel. There is no time to wait for the bus monitor’s direction…getting off the bus quickly becomes a matter of survival and he resorts to pushing, shoving and finally kicking his way out. Unfortunately, there is a price to pay for this seemingly outward aggression…he can expect another trip to the principal’s office.”(College of Allied Educators)Very first time, I had read the above paragraph and was in astonishment as never been imagine such state of existence in 9 years old boy. It was (6) months ago, Sensory Integration module started then, my interest has grown deeper. So , what actually is “Sensory Integration”What is Sensory Integration”Sensory Integration” means the process of the brain (CNS). When the brain receives sensations internally and/or externally through our sensory receiptors, the brain organizes, interprets and turns them into appropirate motor/ behavior to interact in daily activities. As per Jean Ayres, Sensory Integration is “The neurological process that organises sensation from one’s own body and from the environment and makes it possible to use the body effectively with the environment” https://www.sensoryintegration.org.uk/What-is-SI(www.sensoryintegration.org.uk)(Col)When we say about sensations , senses, receptor and, perception that respond in adaptive manners in daily living, there are much more interesting things to find out along the way, such as , is sensory integration in typical processing comes by itself to all of us ? What causes the sensory integration dysfunction ? Is there any cure that really helps ? What are those senses and how do they work ? Primarily, most of us know (5) senses, which are hearing, vision, smell , taste and touch. However, according to the research of A.Jean Ayres, Phd, OTR, the fundamental sensory systems have (8) senses that work together to hermonize with and organize all of our sensations for a person to move around, learn , grow up and behave in a productive manner.The 8 senses of Sensations1. Vision / Sight2. Auditory / Hearing3. Tactile / Touch4. Olfactory / Smell5. Gustatory / Taste6. Vestibular / Movement7. Proprioception / Body Position – awareness8. Interoception / Inside feeling – bodilyThe Tactile / Touch sense : Which concerns with the conscious perception of touch , pressure, pain, temperature, skin and fascia, from head to toe, shape and size of objects in the environment. It helps us differentiate between threatening and nonthreatening touch sensations.The Vestibular / Movement sense : Which provides information through the fluid filled canals in inner ear. Receptors in these canals pick up the direction of movement and send this information on to our brain. So we know if we are moving forwards, backwards, side to side, tilting our head, turning round or moving up and down. Our brain uses this information to plan for movements and help us maintain our balance.The Proprioceptive Body Position – awareness sense : Our muscles and joints have tiny sensory receptors that tell our brain where our body parts are. When you put a spoon to your mouth, you don’t need to look at the spoon to see where it is or feel for your mouth to know where to place the spoon, you know where your hand is in relation to your mouth. It is largely your proprioceptive receptors giving you this information.Your brain then uses this information to plan movements so that you can coordinate your body.Interoception / Inside feeling – bodily senses : This is a fairly new area for discussion in sensory integration; interoception is how our body tells our brain what is going on inside our body, when we are hungry or feel full, when our heart is beating fast or when we have that sensation of butterflies in the stomach. These sensory systems develop very early in the womb. Vision, hearing, smelling and tasting which develop slightly later, interact with other senses for us to respond in typical way as to communicate in daily living.As sensory processing is important for academic skills, body awareness, emotional security, fine motor skills, gross motor skills and gravitional security, a person who is having sensory processing dysfunction may find challenge some difficulties in these skills / areas. (Carol Stock Kranowitz)https://www.sensoryintegration.org.uk/What-is-SISensory Processing Disorder (SPD)When most of us respond with approprite manners to sensations receive and think that it is come by naturalistically but some of them are not. The brain has trouble receiving sensations (or) received sensations but unable to process (or) processes differently thus, responds with unusual or atypical behaviours, that is where Sensory Processing Disorder comes in.Sensory processing disorder, since 1994 is accepted in the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC:0-3R) and is not recognized as a mental disorder in medical manuals such as the ICD-10 or the DSM-5.According to Singapore Brain Development Centre, “Sensory Integration Dysfunction” is the “inability to modulate, discriminate, coordinate or organize sensation adaptively” and then respond with unusual / atypical manner/ behavior. (Singapore Brain Development Centre)https://www.understood.org/en/learning-attention-issues/child-learning-disabilities/sensory-processing-issues/understanding-sensory-processing-issues#item0(www.understood.org)(Carol Stock Kranowitz, Out-of-Sync Child Has Fun, 2003)https://childmind.org/article/the-debate-over-sensory-processing/Pic : GoogleSensory Integration IssuesRecently Parham and Mailloux (2015) identified four categories of sensory integration problems.? Problems with sensory modulation? Problems with sensory modulation occur when our brain either over responds to, or under responds to sensations. For example, if someone over responds to touch they may be very aware of the tag in the back of their top. If someone is under responsive to touch they may not even notice someone tapping them on their back.? Sensory discrimination and perceptual problems? This problems is when the brain has difficulty to interpret the sensory information it receives and the person then, struggles with subtle differences in the sense and unable to distinguish between whether hard or soft , near or far, cool or hot, etc. ? Vestibular bilateral functional problems? This problems can result in poor balance and difficulties with coordinating two sides of the body, balancing and coordination problems.? Praxis problems? Praxis problems is motor planning problems that how our brain plans for and carries out movements we have not been skilled before. https://www.sensoryintegration.org.uk/What-is-SI(http://www.sensoryintegratiion.org.uk)As sensory processing is the neurological process and sensory processing dysfunction (SPD) too is uncontrollably brain-based process that affects one’s development, academic learning, behavior, daily communication, friendships and other areas, along with these might possibly be difficulties, finding ways how to deal with them is the most important. There are many therapies however, the popular among them and shows promising results is Sensory integration therapy and practice. Sensory integration therapySensory integration therapy is based on the original research of Jean Ayres. Dr. A. Jean Ayres pioneering research and inventive practice in sensory integration proliferated among therapy and educational professionals over the past several decades. Sensory integration theory and practice has been met with some resistance within the occupational therapy profession as well as in other disciplines.She identified patterns of sensory motor dysfunction in children with a variety of special needs and hypothesized five syndromes of sensory dysfunction (1965, 1966a, 1966b, 1969). Ayres hypothesized that sensory integration dysfunction contributed to communication and learning disorders observed in children and that facilitating higher levels of sensory integration through sensory integration therapy might ameliorate such deficits.Sensory integration (SI) therapy has been practiced mainly by occupational therapists for almost 50 years now. As collaboration between speech-language pathologists and occupational therapists has increased, especially in early intervention and preschool populations, speech-language pathologists have become increasingly interested in sensory integration therapy. Frequently, a practicum placement or a first job is the speech-language pathologist’s first introduction to this therapy approach. Many speech-language pathologists find sensory integration therapy approach very appealing. The concepts seem logical, the activities are often fun, and collaboration is rather effortless. Speech language pathology, however, is a science-based discipline, so speech-language pathologists must examine the scientific evidence supporting therapeutic approaches before adopting them.http://sig2perspectives.pubs.asha.org/article.aspx?articleid=1768116https://www.siglobalnetwork.org/ayres-sensory-integrationCase StudyTo learn how sensory integration therapy works, refer below example/ sensory diet plans / practice that work out for sensory processing dysfunction. sensory integration therapy and diet plan is carefully drawn and planned by Occupational Therapist.? Daniel, 9yrs? He is a very active boy. Daniel, one of the autistic kids who is coexisting with SID and struggling in his daily living.Concern AreaDaniel cannot focus on his study and just want to move around jumping in the classroom. He has difficulty in writing, very clumsy and words are everywhere ups and downs on page. He complains that he is unable to write between the lines, if he puts in effort to write, pencil point breaks, lines are smudged, and when mistakes are erased, they don’t really erase all the way but the paper tears. In the classroom, he is humming and flapping his hand frequently. He said his socks and shoes are too tight that causing him so uncomfortable, then he removes them.When break time comes, peers are playing the ball game, he sits in the corner and saying that doesn’t know how to catch the ball when flying over to him. He often bump into objects and people too. I. Accessment and possible cause finding ? Daniel’s behaviour of moving around and jumping – seeking tactile input? Remove socks and shoes – Tactile over-sensitivity? Humming and flapping his hand – Seeking tactile input / cutting unwanted noise from others/ entertain himself with certain and predicable movement? Writing difficulty – impairement of proprioception, eye tracking, poor hand-eye coordination, Visual-motor difficulty, lacking fine motor skill? Unable to perform in the ball game – Bilateral coordination, Vestibular & Proprioceptive dysfunction? Bump into objects and people – Poor Spatial control, body awareness, disorganized, clumsyII. Proposed Sensory Diet Plan? Cycling in the air? Give your best shot? Sandsational Land III. Details method of Proposed Sensory Diet Plan? Cycling in the airThis is alerting game for Daniel. What he needs is only a skipping rope. Lie down on the mattress or yoga mat, put the handle of skipping rope between his big and finger toe. Both hands are holding the rope to pull and release alternatively. It is exactly like cycling in lying position. This supports his right hand – right leg and left hand – left leg coordination to be better. Frequency : twice a day Duration : 30 sec – 1 min each time x 2 setIntensity : Full body, especially hand-leg bilateral movementFocus on : Alerting and Organizing Details of practiceTools Required Skipping ropePreparation May arrange in bed room or in living room on Yoga mat tooWhat he can do Lying on bed and act like cyclingTargets on Aiming to progress in bilateral coordination, Improve gross motor skill and developing movement of big joints. Gradation/ Strategies On bed, prefer lying at near the base of the bed, put each handle of skipping rope in between big toe and index toe. Hold the rope in both hand, then move legs in circular motion by pull and release the rope alternatively like cycling in the air. If he is unable to perform this, mom could help him holding his legs and move accordingly After he reahed this skill successfully , mom can train one more step that ask him to do in two different speeds, slow and fast alternatively. b. Give your best shotThis needs two different colors of glass marble balls. Mom or dad whoever available to play with Daniel. If both Mom and Dad are available then we can add one more different color of glass marble ball to play (3) party.Make/ draw one designated area of square or circle on your floor. (If weather permit, can go down to play ground to play). Standing from 1 or 2 meter far, throwing/ rolling marble ball towards the designated area. After 10 round of throwing, who hits the most marble balls into the designated area will be the winner. Tip – Upon Daniel’s mood, let him win some rounds to increase his interest in this game. Record the game result by adding the frequency of winning, you may reward him with his favorate food or stickers or activity like bring him to sibling house to meet up/ play, every end of the week or month. Frequency : twice a day Duration : 30 mins/ each timeIntensity : Full body, involve big joint in upper and lower bodyFocus on : Alerting and Organizing Details of practiceTools Required Two or three sets of different color glass marbel balls , each set is about 10 balls Ample space about 2 to 3 meters long way 2 to 3 Matching color bowls with glass marbel ballsPreparation Choose (or) draw circle / square shape designated area about 0.5 meter radiaus, mark the point for starter, one to two meter far from it. (depand on how far he can throw to reach)What he can do Aiming toward designated area and throw the glass marble ball, take turn and throw til 10 round. Who hits the most marble balls to the targeted area wins.Targets on Aiming to progress in bilateral coordination Improve gross motor skill and developing movement of big joints.Gradation/ Strategies All participants to hold each bowl that included (10) matching colour glass marble balls, stand at the starting point and throw the first ball to the designated area. Take turn and play for all (10) balls. After finished 10 rounds, ask him to count how many glass marbel balls that hit the designated area, seperate according to the colour and put them into same colour matching bowls. Set up another starting point one meter away from original starting point. Do a few frog jump to reach the original starting point then, start to throw the glass marble ball, that will be more challenging for him. c. Sandsational land Let’s Daniel to feel tactile discremination of different texture materials such as hard, soft, smooth, rough and at the same time, he will be thrilled by playing with his favorite animation characters toys in creative way.Frequency : Once a week Duration : 30-45 mins/ each timeIntensity : Full body, especially hand-leg bilateral movementFocus on : Alerting , Organizing and CalmingDetails of practiceTools Required Sand, rice, big fabric bag, Tray – L 18″ X W 12″ X H 2″ , favorite animation characters toys 3 to 5 pcs, dices, small gel toy, small stones, sea shells, 3 small colorful blocks, feather, glass balls, palm tree toy, sand play set sand scoop to get ready by sidePreparation put all different texture materials into big fabric bag that filled with rice Sand-filled trayWhat he can do Feel and pick different texture materials from fabric bag one by one, then decorate on sand tray as he likes.Targets on Different texture of materials like rice, dry sand, wet sand and others definitely will give him tactile input of discrimination. Learn, decorate creatively and also mom can find what he wants/ says / feels from the way he deorated.Gradation/ Strategies First, let him feel the rice on his palm and touch all materials before putting into fabric bag. Then, ask him to take out one by one. After all has been taken out, he can decorate them in the sand tray. Happy playing. When he is in touch with them often and get used to, then, just let him feel and take them out without prior touching. After awhile he finds that too easy, then mom can upgrade one thing in sand tray. In sand tray, wet with water on half of the tray and other half to leave dry. By doing this, he will feel different texture of wet and dry sand alternately. This time he may prefer to use sand scoop to setting up mould and decorate in more creative way. kidslearninghq.comfinger-painting-tipsbenefits-of-finger-paintingmiddletownautism.comcase-study-1Pathways.orgDevelopment/7-sensesSingapore Brain Development Centresensory-integrationSensory-processing-disorder.comtactile-defensivenessImplicationIn every sensory integration therapy practice, there are 3 main settings- at school, at home and clinical setting to perform to get the best of one’s result and, collaboration of all expertises , teachers and parents is really important and parents play the most dominant role as they are the best facilitator of their child.Sensory integration therapy must be safe, fun , appropriate, easy, friendly and sensory-motor based practice as well as customize for every particular case. It is also involved (3) stages which are alerting, organizing and calming to meet sensory needs of the child. The effects / results can be vary and, depend on mild to severity. As sensory integration therapy is research-base, growing, expanding and trusted therapy, there is hope to connect SID-children to typical sensory world and, having fun like any other kids too.