Triveni Goswami Vernal
Registered Special Educator (CRR A64010)

I recently attended a two-day workshop on
‘Sensory Integration Practice based on Clinical Reasoning’ organized by Samathva Rehabs Private Limited. The workshop was conducted by Dr. Manish Samnani, Senior Occupational Therapist, Researcher and Clinical Director, SOCH, Gurgaon. In this blog, I will be sharing some significant insights from the workshop.

WHAT IS SENSORY INTEGRATION ?

Sensory Integration comprises of Sensory Modulation (ability to tolerate sensations) and Sensory Perception (ability to register the sensations). Sensory Perception is the base of a sensory experience …if we cannot register a sensation, we will not be able to modulate it.

When an individual experiences challenges with sensory modulation, it often manifests itself as behavioural challenges. Sensory Modulation can include Hypo-Responsiveness/Under-Responsiveness to a sensory stimulus, thus engaging in seeking behaviour or Sensory Defensiveness thus avoiding the sensory stimulus.

The process of Sensory Integration is not mediated by Cognition (hence there is no presence of volition). It is dealt with by the brain stem, not by the cortex. Sensory Integration is independent of cognition and communication difficulties. It is foundational to Cognition. It is at the sub-cortical brain stem level.

Sensory Integration can take care of functions associated with Writing, Equilibrium and Protection.

IMPORTANCE OF ASSESSMENT

When an individual comes to a professional for help with certain challenges related to the sensory system, the professional must first Assess rather than merely Guess what the reason/s for the challenges are, based on what they see. Sensory Assessment can be multi-layered . One test can lead to various interpretations. As a clinician, one must look at–
a) The reason for Referral
b) Generate a Hypothesis
c) Collect Data
d) Test the Hypothesis

The professional must be a keen observer, when the individual performs the task given, diligently take notes and then arrive at an interpretation.

AYRE’S SENSORY INTEGRATION MODEL: Dr. A . Jean Ayre developed a hierarchical framework for sensory integration in which it is posited that foundational sensory processing skills are important for developing higher level cognitive and academic skills.

In this model, at the base of the pyramid, information from various sensory systems (gustatory, olfactory, visual, proprioceptive, vestibular,
visual, auditory, tactile etc) is integrated to form an understanding of the world.

Then comes Sensory Motor Development (ability to screen input, motor planning, awareness of both sides of the body, postural security etc).

Then comes, Perceptual Motor Development (eye-hand coordination, auditory language skills, visual spatial perception, occular motor control etc).

And at the very top of the pyramid is Cognitive Intellect (Behaviour, Academic Learning and Daily Living Skills).

HOW SHOULD A PROFESSIONAL PLAN THE GOALS?

After a thorough assessment has been made, the professional can work on 2 main goals:

a) Self-Regulation: Help the individual achieve a “Just Right State”. This can be done by creating “Just Right” challenges/activities to elicit an Adaptive Response from the individual.

b) Adaptive Response — Reaction to environmental information that is appropriate and successful, i.e., the response is appropriate to the stimulus.

In Sensory Integration, a professional should be careful not to provide explicit instructions but try to elicit a response from the individual when he /she performs the activity. Let the individual struggle and figure out how to do it. The focus should be on eliciting an adaptive response while performing the activity.  Saying things like “look at me”, or “hold the ball properly” during the task, can often lead to missing out on opportunities to elicit the response.

INTERACTION BETWEEN ACTIVITY LEVELS AND LEVELS OF AROUSAL

It is important to note that an individual will behave differently on the basis of their activity levels as well as their levels of arousal (state of their attentiveness).

If an individual has a High activity level and also High Arousal level, the individual can have Tactile Defensiveness (avoidance of tactile stimuli).

If an individual has High Activity levels and Low Arousal levels, then the individual may be a Sensory Seeker.

If the individual has  Low activity levels, and High Arousal, the individual may have Gravitational Insecurity (a vestibular issue, where they experience anxiety when the feet have to leave the ground).

If the individual has Low Activity levels and Low levels of Arousal, the individual may be Hypo-Responsive (the individual may not want to engage in any activity).

Thus we see that Sensory Integration plays a significant role in the development of varying skills in an individual and subsequently, impacts the quality of life of that individual. Hence, proper assessment of sensory dysfunction can play a vital role in shaping an individual’s sensory integration.

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Author Dr.Triveni Goswami Vernal

Dr.Triveni Goswami Vernal is a Registered Special Educator (CRR: A64010), a Psychologist and an Expressive Arts Therapy Practitioner (UNESCO-CID). She is an Avaz Certified Educator and Certified in Dyslexia Teacher Training. She is also an art educator for children with additional needs.

“Splash of Colours”
Acrylic Painting on Ivory Paper (300 GSM)
Kabir Vernal