Sensory Modulation Differences (Assessment and Intervention)

Question 1

Winnie Dunn quote

Answer 1

“Embrace the fog; the fog makes it possible to recognize clarity when it comes along.”

Question 2

Sensory reactive continuum

Answer 2

hyporeactivity to hyperreactivity

Question 3

Sensory modulation

Answer 3

• the ability to generate appropriate responses to sensory stimulation without over-responding or under-responding

Question 4

Neurological thresholds (sensory modulation)

Answer 4

• the amount of stimuli required for a neuron to respond
• nervous systems responds quickly = low threshold for sensory input
• nervous system responds slowly = high threshold for sensory input

Question 5

Sensory modulation depends upon

Answer 5

• habituation = recognizing familiar sensory information as unimportant
• sensitization = heightened awareness important sensory stimuli

Question 6

Sensory modulation occurs on a neurological threshold continuum

Answer 6

• under-responsive to input, high neurological threshold
• just right response to sensory stimuli
• over-responsive to sensory input, low neurological threshold

Question 7

Self-regulation

Answer 7

• the ability of people to maintain their own needs in response to sensory input
• the ability to maintain a calm, alert state
• the awareness of and engagement in activities that keep one in a “just right” state for the activity
• may manage self-regulation by adding sensory input (ex: while studying, may fidget, twirling hair, chewing fingernails, listening to music to better attend)
• may manage self-regulation by reducing sensory input (ex: while studying, may need a quiet, distraction-free environment)

Question 8

Sensory over-responsiveness (SOR)

Answer 8

• these children over-respond to typical sensory input within the environment, hyper-respond to sensory input
• overwhelmed by typical sensory input and react strongly, often with anxiety
• they have a low threshold for sensory input
• these children are the easiest to identify because the behaviors are easy to notice and report
• common for when people to think of sensory processing problems only think of sensory over-responsiveness

Question 9

Children can be overresponsive in all sensory systems

Answer 9

• tactile defensiveness (tactile over responsiveness) = hyperreactive to ordinary touch, light touch is aversive (tolerate deep touch better), self-applied input tolerated better than touched by others
• gravitational insecurity (vestibular over responsiveness) = hyperreactive to vestibular input from the pull of gravity; fear of movement, moves slowly, overwhelmed by changes in head position, fear of heights, and decreased exploration
• auditory over responsiveness (cannot tolerate loud noises)
• over-responsive to visual input
• over-responsive to smell
• over-sensitive to taste
• children who display over sensitivity in more than one sensory system are described as sensory defensive

Question 10

Children with sensory over-responsiveness

Answer 10

• have higher than typical levels of anxiety
• may be more emotional than typical peers with outbursts
• avoids certain environments
• high rates of sensory over-responsiveness reported in individuals with diagnoses of ADHD, anxiety, OCD, and Autism

Question 11

Sensory under-responsiveness (SUR)

Answer 11

• these children are under-responsive (hyporesponsive) to typical sensory input within the environment
• high threshold for sensory input
• children can be under-responsive in all sensory systems such as tactile, vestibular, proprioception, visual, auditory, taste, and smell

Question 12

Behaviors of children with sensory under-responsiveness

Answer 12

• appear not to notice or respond to certain stimuli
• may appear lethargic (tactile)
• may not respond to sensations such as pain (tactile)
• may not notice when clothing is on incorrect or shoes are on wrong feet (tactile)
• may have poor fine motor skills (tactile/proprioceptive)
• may use too much or too little force to complete an activity (proprioception)
• may not actively explore environment
• may appear sensory seeeking

Question 13

Assessing sensory modulation

Answer 13

• occupational profile
• standardized assessments
• observation in the natural environment
• structured clinical observations (seeing how they respond)
• the assessments look at both motor and modulation

Question 14

Standardized assessments

Answer 14

• Sensory Profile-2: Questionnaire
• Sensory Processing Measure (SPM)
• Structured Observations of Sensory Integration - Motor (SOSI-M)

Question 15

Sensory Profile-2 (standardized assessment)

Answer 15

• checklist completed by caregiver or client
• assess sensory processing patterns in the context of everyday life

Available for a variety of groups including:
- Infant Sensory Profile-2 (birth to 6 months)
- Toddler Sensory Profile-2 (7 to 35 months)
- Child Sensory Profile-2 (3:0 to 14:11)
- Adolescent/Adult Sensory Profile (14:11 to adult)
- School Companion Sensory Profile-2 (completed by teacher)

Question 16

Dunn’s Sensory Processing Framework

Answer 16

• identifies sensory preferences
• considers the interaction of two continuum
• neurological threshold continuum (low to high threshold)
• behavioral continuum (passive to active self-regulators)

Question 17

Dunn’s Sensory Processing Classification

Answer 17

• registration (bystanders) = (high threshold, low activity to regulate) easy going, not bothered by the environment
• seeking (seekers) = (high threshold, high activity to regulate) move, touch, chew, and spin
• sensitivity (sensors) = (low threshold, low activity to regulate) ask people to be quiet, cover ears
• avoiding (avoiders) = (low threshold, high activity) create routines, avoid activities, play alone

Question 18

Sensory-based intervention: things to consider before you begin!

Answer 18

• be careful when using vestibular-based intervention: it can be very powerful and children can become overwhelmed (sick), even the sensory seekers
• proprioceptive input has a calming effect on sensory over-responsive kids, an alerting effect on sensory under-responsive kids, and does not have adverse reactions (which is why this is generally a safe pace to begin with)
• when considering tactile information, consider more than just tactile input to the hands (the entire body has tactile receptors)
• rarely does an activity utilize only one sensory system

Question 19

Interventions for children with sensory over-responsiveness

Answer 19

• the goal of therapy is to increase a child’s threshold for sensory input so typical sensory input does not interfere with engagement in occupations

Question 20

Interventions for children with sensory over-responsiveness: tactile over-responsiveness (tactile defensiveness)

Answer 20

• proprioception input
• linear vestibular input
• deep pressure
• brushing program
• sensory diet
• modify environment
• educate family, teachers, and caregivers
• cognitive interventions such as social stories

Question 21

Interventions for children with sensory over-responsiveness: over-responsive to vestibular input

Answer 21

• create a just right environment for children to explore
• begin with linear activities (forward/backward, left/right, up/down) with child’s feet on the floor
• encourage child to gradually explore more movement
• proprioceptive input has calming impact on system

Question 22

Interventions for children with sensory under-responsiveness

Answer 22

• the goal of therapy is to meet a child’s need for sensory input so he or she can correctly process input in their environment and produce an appropriate response
• includes sensory-rich activities in tactile and proprioception including ball pits, jumping, and crashing activities
• if sensory seeking is present, activities which have a calming impact on the sensory system such as linear swinging, deep pressure, and proprioception will be appropriate

Question 23

Sensory-seeking behaviors inlude

Answer 23

• engagement in increased movement throughout the day, described as “active” kids, running, jumping, and spinning
• engage in proprioceptive input such as hitting, banging, bumping, falling on purpose, and giving hugs
• appear to have “no fear”, risk takers
• tendency to touch items and people to the point of annoyance
• smell foods or objects
• put non-food items in mouth

Question 24

Reasons for sensory seeking behaviors

Answer 24

• generate additional sensory input to compensate for inadequate perception in one or more sensory systems
• regulate general arousal level
• modulate hyper or hyporeactivity in other sensory systems

Question 25

Intervention for children who are sensory seeking

Answer 25

- goal of therapy is to identify strategies by which children can attain a high level of sensory stimulation without getting hurt or being socially disruptive - intervention includes exploring various sensory input to see what helps child meet their needs - look at vestibular = swinging high, spinning - proprioception = jumping or trampoline, crash pads, punching bag, and hippety hop - tactile = fidgets, playdough, shaving cream, and finger paint - oral = crunchy foods and gum

Question 26

Sensory diets

Answer 26

- sensory-rich activities embedded into a child's day to support appropriate sensory regulation - differs from a home exercise program in that the timing within the daily routine is critical - the goal is to provide a child with sensory experiences to keep the sensory system within a calm, alert state and not become overwhelmed

Question 27

Considerations of sensory diet

Answer 27

- create activities for all sensory systems (tactile, visual, auditory, smell, vestibular, oral/taste, and proprioception) - consider what is realistic in the environment of home or school - consider if the child has a low threshold and becomes easily overwhelmed or a high threshold that is not being met to maintain a calm, alert state - assess the most challenging times of a child's data and how to provide sensory supports prior

Question 28

Evidence-based practice

Answer 28

- brushing protocol - therapeutic listening