ABC’s of OT: how to use SENSORY INTEGRATION TECHNIQUES with older adults

What is Sensory Processing?

The ability to interpret the world around us through the use of the 7 Senses:

1. Sight

2. Sound

3. Taste

4. Touch

5. Smell

6. Proprioception (where is my body in relation to other people/objects?)

7. Vestibular Input (where is my head in relation to my center of gravity?

These 7 senses all work together and have an impact on one another

What is Sensory Modulation?

  • The ability to regulate how much input we receive through each of the 7 Senses in order to appropriately regulate our emotions and actively participate in our environment
  • SENSORY MODULATION IS UNIQUE TO THE INDIVIDUAL
  • Sensory stimuli can either facilitate or inhibit modulation and emotional regulation; this is unique to the individual
  • Adequate modulation of sensory stimuli MUST occur for an adaptive response (difficulty performing a specific, goal-directed action that matches or fits to the environment) to occur
  • We as humans naturally seek out sensory and motor experiences in order to organize our senses and emotions

Sensory modulation can be thought of as a pie chart. Each of us has our own unique pie chart, and the pieces of our pie are bigger or smaller depending on who we are and what sensory stimuli our specific body requires. This is known as a neurological threshold.

  • Some people have a high neurological threshold and will usually respond to sensory stimuli in one of two ways:
    1. The individual will fail to appropriately respond to typical sensory input that we all encounter on a daily basis OR
    2. The individual will need to experience any incoming sensory input for a longer amount of time in order to get its full effect (ex: use a weighted blanket for 20 minutes instead of 10)
  • Some people have a low neurological threshold and will often over-react to the tiniest slice of sensory input. (ex: a sound that might not seem loud to us may sound deafening to them and cause the individual to scream aloud in distress)

No matter who we are, sensory input will always lead us to have a behavioral response. The response could be small or great, but there is always some sort of action associated with too much or too little sensory input. These behavioral responses are broken into two categories:

  1. Passive: meaning that the individual makes no attempt to change the intensity or duration of the sensory input, and
  2. Active: meaning the individual seeks to avoid the sensory stimuli or will seek the sensory stimuli to obtain more input

Neurological Thresholds and Behavioral Responses combine together and form Four Categories that an individual could fall into, depending on his/her unique sensory modulation:

  1. Poor Registration: high neurological thresholds and passive behavioral responses
  2. Sensory Seeking: high neurological thresholds and active behavioral responses
  3. Sensory Sensitivity: low neurological thresholds and passive behavioral responses
  4. Sensory Avoiding: low neurological thresholds and active behavioral responses

In other words:

  1. Poor Registration = failed reaction to sensory input + no attempt to change the sensory input
  2. Sensory Seeking = failed reaction to sensory input + active avoidance or draw to sensory input
  3. Sensory Sensitivity = over-reaction to sensory input + no attempt to change the sensory input
  4. Sensory Avoiding = over-reaction to sensory input + active avoidance or draw to sensory input

How does Sensory Modulation change as we Age?

  • the nerve receptors that are responsible for receiving sight, sound, taste, touch, and smell, movement (vestibular input), and deep pressure (proprioception) atrophy as we age
  • disease such as Parkinson’s, Cerebral Palsy, Dementia, and Alzheimer’s, and events such as a stroke or a traumatic brain injury can further exacerbate this aging process

What is Sensory Integration?

The process of regulating external stimuli to facilitate appropriate sensory modulation

Why does Sensory Integration Matter?

Difficulty with Sensory Modulation can Result in:

  • decreased social engagement
  • decreased verbal communication
  • decreased environmental participation
  • decreased PO intake
  • increased agitation and wandering/exit-seeking
  • decreased direction-following
  • inability to follow functional routine
  • increased fall risk
  • poor sleep hygiene
  • decreased safety
  • poor quality of life

Sensory Integration is designed to resolve these issues.

Signs and Symptoms of Poor Sensory Modulation

General:

  • Fluctuating or extreme responsiveness while engaging in everyday activities
  • Difficulty interacting with the environment
  • Difficulty initiating, planning, sequencing, or executing new actions (dyspraxia)
  • Tendency to avoid or reject simple challenges
  • Poor initiation of activities (ideation)
  • Difficulty with goal-directed action on the environment (poor adaptive response)

Tactile Defensiveness:

  • Over-response to ordinary touch sensations
  • May demonstrate irritation and discomfort from a variety of textures
  • May dislike brushing hair or teeth
  • May demonstrate hostility, distractibility, anger, temper tantrums, fear, and/or distress

Poor Proprioceptive Modulation:

  • Discrimination deficits demonstrated by poor awareness of position of body, body parts, and body schema
  • Clumsiness, awkward movements
  • Distractibility
  • Decreased motor planning
  • Movement difficulties
  • Reliance on visual cues or other cognitive strategies to motor plan, guide movements, and perform tasks
  • Use of too much or too little force
  • Poor awareness of personal space
  • Seeks heavy resistance and pressure

Poor Vestibular Modulation:

  • Increased sensitivity to movement, seen in aversion to movement impacting on the sympathetic nervous system
  • Decreased sensitivity to movement, characterized by seeking intense vestibular stimulation without complaints of feeling dizzy, and by tendency to be a thrill seeker, unaware of potential danger
  • Gravitational insecurity, characterized by excessive fear during typical activities, especially when the individual’s feet are off the ground, when moving backwards or upwards in space, or when walking on uneven terrain
  • Decreased balance
  • Decreased bilateral coordination
  • Low endurance
  • Poor motor planning/sequencing

How can Sensory Integration Techniques Benefit our Residents?

  • improved social engagement
  • improved verbal communication
  • increased environmental participation
  • increased PO intake
  • decreased agitation and wandering/exit-seeking
  • improved direction-following
  • improved ability to follow functional routine
  • decreased fall risk
  • improved sleep hygiene
  • increased safety
  • improved quality of life

How can we Improve Sensory Modulation?

ALWAYS REMEMBER: sensory modulation is unique to each individual and sensory integration techniques should always be patient-centered

  • Create an environment that facilitates active participation in the task at hand
  • Gradually and slowly introduce sensory stimuli
  • Promote organized adaptive responses (aka goal-directed behavior)
  • Closely observe the patient’s response
  • Make sure that the patient can see the source of the sensory stimuli
  • Provide controlled sensory activities that simultaneously provide proprioceptive and vestibular input
  • Begin with slow, linear movements and deep touch pressure
  • Provide activities in various body positions combining vestibular and proprioceptive information
  • Follow tactile stimuli with joint compression

For most people:

  • Firm pressure and resistance is less threatening than light touch
  • Linear movement is less threatening than slow movement
  • Slow movement is less threatening than rapid movement
  • Self-applied stimuli are more tolerable than passive application of tactile stimuli

Proprioceptive Interventions Include:

  • Firm touch, pressure/massage, joint compression, or traction
  • Resistance to active movement
  • Provide slow linear movement, resistance, and deep pressure
  • Use adaptive techniques (weighted doll, weighted blanket, hot pack)
  • Heavy work tasks (ex: table washing with thick towels)

Vestibular Interventions Include:

  • Moving the head away from the center of gravity
  • Slowly introducing linear movement with touch pressure
  • Using linear vestibular stimuli to increase awareness of spatial orientation
  • Walking
  • Rocking in a rocking chair or unlocked wheelchair (with supervision)
  • Performing any sort of gross motor activity (balloon volley, ball toss, ring toss, UB exercise, Tai Chi, stretching program, bowling activity)

How can We Determine what Types of Sensory Techniques to Use and with Who?

  • If a patient is a reliable historian about his/her personal health and current functional status, he/she will likely be able to answer questions about his/her sensory preferences. Standardized assessments can be used to guide these interviews:
    • Allen’s Cognitive Levels Screen
    • Adult Sensory Profile
  • Patients who have been diagnosed with dementia, Alzheimer’s, altered mental status, or other similar progressive disease are often unable to directly answer questions about his/her sensory preferences; therefore information can be obtained through:
    • Family interviews
    • Therapist/nurse/LNA/recreation staff trial and error

What does a Typical Sensory Program Look Like?

  1. Vestibular Activity:
    • Ball toss, balloon volley, ring toss, walk, stretching program, exercise program
  2. Simple, Singular Activity that stimulates ONE of the following senses:
    • Sight
    • Sound
    • Taste
    • Touch
    • Smell
  • All other sensory stimuli should be eliminated as much as possible
  1. Proprioceptive Input:
    • Hand massage
    • Joint compressions
    • Weighted blankets
    • Weighted doll
    • Muscle belly massage across both shoulders/upper arms

 

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