Monday, November 26, 2012

Let's talk about sensory processing

Lets Talk Sensory Processing- By: Kelly Martin, OTR

The term sensory processing refers to the way that our nervous system receives sensory messages and turns them into physical responses.  For example, have you ever been preparing a meal and walked away from it and all of the sudden you smell something is burning? Your sensory system processes this information and elicits a physiological response, your heart rate increases and you rush to the kitchen to quickly turn off the stove.  This is your sensory system in action.

Children with sensory processing disorder have trouble integrating the sensory information they receive with an appropriate response.  The way I have always explained SPD to parents is simple, every person processes sensory information in their own way.  For example, some people might enjoy the smell of something that others find noxious.  Personally, I do not wear wool clothing because my tactile system finds it irritating- however this is not the case with most people.

For children with SPD, their defenses can be so significant that it impacts their day-to-day interactions.  With a similar example, a tag on their shirt may irritate some children, so much so, that they are not able to focus on important tasks in school because they are hyper-focused on the tag that is bothering them.



Children can be impacted by SPD in countless ways.  This is referred to as their “profile” they may be over responsive to auditory input but under responsive to movement or vestibular input. These factors are indicative of a possible sensory modulation disorder.  A child may be clumsy, uncoordinated or “just not athletic”  These are all possible identifiers of a sensory based motor disorder.  Another child may have difficulty identifying the direction with which noises are made, they may have difficulty  eating certain foods secondary to their texture, these are factors that may be indicative of a sensory discrimination disorder. In short, Sensory Processing Disorder is an umbrella term that encompasses three identified subgroups (Sensory Modulation Disorder, Sensory Based Motor Disorder and Sensory Discrimination Disorder) and further into the subtypes of each subgroup. To make things more difficult and confusing, most children to not fit neatly into one subgroup or category.  (See figure below)

Here is a quick description of the subtypes of sensory processing disorder and the terms commonly used to describe the subtypes:
Subtypes of Sensory Modulation Disorder:
Sensory over-responsivity (SOR): SOR is a term that describes a persons response to sensory stimuli as more intensely, quickly and for a longer period of time.  This child is over registering sensory input.   The child's response to such input is described as “fight or flight”, they may avoid certain types of sensory input or they struggle to control their environment as a means of protecting themselves or limiting the potential for such input to occur.

Sensory under-responsivity (SUR): Children with this subtype under register sensory input. These are children that exhibit less of a response to sensory information than the situation demands, i.e. taking longer to react. These children may show a low affect, they may be lethargic, socially withdrawn, they may have poor posture or may be under responsive to pain and temperature.

Sensory seeking (SS): Children that are sensory seeking (SS) CRAVE sensory experiences and will actively seek out ways to get what they are looking for, sometimes in socially unacceptable ways (pinching, pushing, spinning, crashing to the floor) which may appear, to some, as a child that is simply “misbehaved”.  In school this may be the child that moves around non stop, bumps into people when standing in line or likes to sit in the teachers lap or very close to others when at circle time.

Subtpyes of Sensory Based Motor Disorder (SBMD)-

Dyspraxia- The term Praxis refers to plan and execute a motor task. Dyspraxia refers to a persons inability to plan, coordinate and execute both familiar and non familiar movements.  A child with dyspraxia may be described as clumsy, uncoordinated, or avoidance of movement.

Postural Disorder- Children with postural disorder may have low muscle tone, weak musculature specifically in the trunk or stabilizing muscle groups such as the shoulders, hips and abdominal or back.  These children will have poor seated posture, they may fall out of their chairs often, slump over their desks or rest their heads on the desk while working. They may have difficulty sitting on the floor at circle time or participating in playground play or during PE class.

Sensory Discrimination Disorder- (Tactile, Auditory, Visual, Gustatory, Olfactory, Proprioception, Vestibular and Interoception) 
We all know our five senses, we learn them as early a Pre-School.  They are your auditory, gustatory, olfactory, tactile and visual sense (hearing, tasting, smelling, feeling and seeing)  Three other senses that are crucial to a persons ability to effectively discriminate the world around them.  These are the vestibular and proprioceptive systems as well as interoception ( movement sense, position sense)  Children with sensory discrimination disorder have difficulty identifying differences or similarities of input.  An example would be the ability to decipher the difference between a penny and a quarter in the hand without looking at the coins or reaching into a desk and being able to pull out  a pencil amid folders, notebook and markers.
           
As an occupational therapist, it is my goal to improve my clients’ occupations, for children, this means schoolwork, play and self care. SPD can often impact these occupations greatly.  I found this chart that I this is not only cute but also helpful in explaining the 
breakdown of our sensory systems and some tips for activities or modification:











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