INTERVENTION BASED ON SENSORY INTEGRATION THEORY

Intervention starts with teaching teachers and parents about Sensory Integrative Dysfunction and help them develop strategies that help adapt or compensate for dysfunction.

This could mean changes in the environment, daily routines, people’s attitudes to the child and the goals set for achievement.

Environmental Modification

The environment is the source of most sensory stimuli. When someone is deprived of these inputs it is termed sensory deprivation. Sensory deprivation is a condition where the senses are deprived of stimulation totally or severely.

There have been war prisoners who have had to endure solitary confinement and have been found to suffer major psychological changes. This is because the subjects have been confined to a room without light, touch or sounds, which happens very often in severely handicapped people. Over a period of time they become disoriented and display severe mental disturbances.

The flow of external stimuli into the brain activates its potentials, bereft of which the brain goes numb. It is almost as if these sensations provide nutrition for it, since they are responsible for the “alpha” or baseline brain waves in the conscious state. Hearing imparts probably the most important input for sensory function. The sensory system stimulates the Reticular Activation System of the brainstem which is responsible for arousal, alertness, coordination of actions, and reacting to challenges ahead. RAS is essential to learning and to behavior management. This is because sensations need to flow constantly into our brain at a rapid rate, and one needs to act upon, react to and organize ones self to these inputs if learning has to take place.

Sensory Diet

Vestibular and auditory inputs are very important to learning disorders, and aid in building concentration and emotional well being. Individuals who cannot listen and concentrate are very likely to have developmental problems like autism, dyslexia, or speech and language disabilities, or find it difficult to interact with others.

An input in one modality often influences others; for example, it is found that children who are swung or bounced on a Swiss ball improve in their

speech. This is seen across the spectrum, with some children improving in learning and concentration after a lot of visual stimulation is given.

The brain acts like a central processing unit, with an impact on one sensory modulating modality spilling over into other modalities too. The part of the brain that does this sensory processing is the brainstem, including the midbrain, the pons, the medulla, the cerebellum and the limbic system.

The sensory integration therapist and parents should create a “sensory diet,” (a term coined by occupational therapist Anna Jean Ayres) which is a schedule of daily activities that gives the child requisite sensory inputs like a diet designed to meet an individual’s nutritional needs. The amount of sensory stimulation is just enough so that they can cope with. The sensory diet is based on the premise that externally controlled sensory input can affect one’s functional abilities. Children with hyposensitivity are given strong sensations, while children with hypersensitivity are given quieter activities.

For example we can play music in the class room, hang bright pictures in it or give a lot of interactive play. Otherwise, one can refrain from too much hugging, reduce distracting visual materials in the classroom, or avoid wearing strong perfumes.

There is a technique called the Wilbarger Protocol, which uses deep pressure to certain parts of the body followed by proprioception in the form of varied joint compressions. Children are given simple changes to their daily routine, like skipping, jumping, or just closing their eyes and listening to music that will help them over come their sensory problems.

Traditional Sensory Integrative Therapy

There is no known cure for this problem; that is why there are so many approaches and protocols. Therapists all over the world have used prism lenses, sensory stimulation like deep pressure, physical exercise and music, but there is no standard evidence-based treatment, because of the wide spectrum of disorders.

Traditional sensory integrative therapy is done by a therapist directly on her patient, in a one on one approach without influences from others. This is done in a room with suspended equipment that provides a variety of movement and sensory experiences, called a sensory integration room. It is important not to impose oneself on the child, but rather artfully select and modify activities according to its responses.

All inputs can be given – visual, tactile, auditory and proprioceptive input in a way that provides just enough challenge for the child to respond adequately to environmental challenges. It has been observed that the child is happier to initiate hugging rather than receiving it. The child is more comfortable with a firm unmoving touch that is anticipated. Later on, the child tolerates even light touch. Stimulation which may be initially perceived as unpleasant is tolerated later.

Overwhelming environmental stimuli such as bright colored lights or tight clothing should be removed for hypersensitive kids to increase the child’s comfort and ability to engage his attention. This is called the “just right”

challenge, which is redundant if the activity and the child’s perception of activity does not match.

Principles

• Just right challenge (the child must be able to meet the challenges /activities)

• Child-directed (the child’s preferred activities are used in the session).

• Active engagement (the child actively meets the challenge of activity, because it is fun)

• Adaptive response (the child modifies its approach to the challenge over a period of time)

• Rewards may be used to encourage children to tolerate activities they would normally avoid.

Some tips:

1. When the child likes a sticky texture, give art and craft activity with a lot of glue. If the child likes to play on sand, we can give materials like clean river sand, rice or ragi.

2. Some children, especially autistics, like pressure all over the body. They can be given regular hugs, involved in a game of hide and seek under blankets.

3. Those who detest odors can be given fragrances mixed in materials used in day to day activity. If they react too violently the fragrance can be given very mildly.

4. Music is a universal favorite, but again it depends on the genre that the child likes. Toys or musical instruments can be given as an experiment.

5. Group programs like Bhajans, clapping together, imitating the sounds of animals or birds singing rhymes in different pitches, are given and a child’s reaction gauged.

6. To improve proprioception (which is often poor in autism) we may include playing with heavy toys, bouncing on a trampoline or a large ball, skipping, pulling or pushing heavy objects. Playing a game of cricket or basketball can also help. Some times we can take the children on excursions or a visit to a park or playground, but it is important to ensure the child’s safety before planning such activities.

Balance

Our sense of balance and coordination are dependent on the stimuli given to the semicircular canals that stimulate responses to movement and gravity.

Therapy can include creative dancing rocking on a rocking horse, hanging

upside down, swinging on a rope, spinning, and rolling on the ground.

Obviously the child should be able to tolerate this and we should not stimulate in excess. Rocking back and forth motion will usually calm a child (watch a mother rock her crying baby) while vigorous motions like dance will stimulate them.

Skill Training

Sequential activity such as wearing a shirt or cleaning the teeth can be trained by giving preliminary activity like swimming, tackling obstacle courses. Hand function is promoted by giving toys and building blocks and asking the child to make a particular object.

Using both sides of the body or both hands together or in sequence can be trained by giving activities like crawling, skipping, playing a keyboard, juggling, cricket and such games. Eye and hand coordination can be improved with activities such as playing catch the ball, hitting a ball with a bat, tailing the donkey, tapping balloons across the room, and bouncing over beanbags and therapy balls.

CONCLUSION

Every person with disability has difficulty coping with his own handicap, and we need to look at him holistically and not just at the specific problem.

We need to realize that within him is a heart that yearns to be normal and we need to give him a lot of emotional and mental support. The special educator, clinical psychologist and psychiatrist are thus important members of the rehabilitation team. No program is complete unless it includes the treatment of the human mind and the various aspects of learning and behavioral disorders.

INTRODUCTION

Modern orthotic devices play a vital role in the field of orthopaedic and neurological rehabilitation. They are given to improve function, restrict or enforce motion, or increase support to a part of the body, like the spine or lower limbs. In India, where several adults suffer from the long term effects of childhood poliomyelitis, orthotics are an integral part of the life of persons with disability.

DEFINITION

An orthosis is a mechanical device fitted to the body to maintain it in an anatomical or functional position.