Theory & Model of

Sensory Integration
Mohammad S. Nazzal, PhD, OTR

Sensory integration is the

neurological process that
organizes sensations from ones
own body and from the
environment, and makes it
possible to use the body effectively
within the environment. Sensory
integration is information
processing. A. Jean Ayres, 1989

Definitions
Sensation
Integration
Sensory Integration
Neurologic Process
Theory

Adaptive Response

Sensation
Sensation is the fuel that feeds all human
experiences.
Information about our psychological, physical, and
cognitive experiences comes from our senses.

Sensation and sensory processing provide the

infrastructure for our experiences.
The sensory systems are the input mechanisms for
the nervous system.

Sensory Processing
The sensory neurons transmit information into the
nervous system, reaching higher brain centers.
Sensory processing is different from sensory input
itself.
Sensation is transmitting physical properties of a
stimulus to the brain.
Once in the brain, stimuli are changed, organized, and
compared to past experiences to determine the meaning
of the sensory input.

Sensory Integration
Sensory Integration refers to the
neurological process of receiving,
organizing, and responding to input from
the sensory systems:
Auditory, Visual, Gustatory (Taste), Tactile
(Touch), Vestibular (Balance & Movement),
Proprioceptive (Muscle & Joint sense)

 Each of our sensory systems has receptors,

which communicate information to the
brain.
give us sensory information about how our
bodies are moving, tell us all about our
bodies and about what is happening outside
of our bodies.

Sensory Systems
Near Senses

Far Senses

Vestibular
Tactile
Proprioceptive

Visual
Auditory
Olfactory
Gustatory

Vestibular System

Location

Function

Regulation of other sensory systems

Reticular Activating System
Muscle Tone
Balance and Movement
Bilateral Integration
Auditory-language Processing
Oculomotor Control
Emotions/Memory

Dysfunction
Vestibular Hyposensitivity
Vestibular Hypersensitivity
Postural insecurity
Gravitational insecurity

Poor Discrimination

Proprioceptive System

Location

Function

Kinesthesia
Body Awareness
Modulation/Grading of movement
Motor Planning
Postural Stability

Dysfunction

Tactile System

Location

Function

Protective
Discriminatory
Body Awareness
Motor Planning
Fine Motor Coordination

Dysfunction
Hyposensitive Tactile System
Hypersensitive Tactile System
Poor Discrimination

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Olfactory System

Gustatory System

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Visual System

Auditory System

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Summary of Sensory Input Mechanisms

Each sensory system processes a certain
type of input to inform the brain about our
bodies and the world around us.
Occupational therapists need to understand
these input mechanisms.
Through intervention, they provide the brain
with material to design adaptive responses that
enable us to participate successfully in our
lives.

Sensory Processing
Sensory processing is the mechanism of
organizing, making meaning, and
responding to sensory experiences.
The brain has ways of responding that are
separate from the sensory systems.
These ways of responding (the output) reflect
how the brain detects input and how the brain
regulates the input for responding (the input,
and the processing of the input in the brain).

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Underlying Concepts for Sensory-Processing

Patterns
Nervous system thresholds vary from person to
person.
People with low thresholds require less input to
activate neurons.
People with high thresholds require more input to
activate neurons.

Self-regulation strategies reflect how we act to

control sensory input.
Some people actively control the amount of sensory
input they receive.
Some people are passive, letting things happen.

Patterns of Sensory Processing (Winnie Dunn)

Neurological thresholds and self-regulation
continuums intersect, creating four patterns of
sensory processing:
Sensation seeking represents high thresholds and an
active self-regulation strategy.
Sensation avoiding represents low thresholds and an
active self-regulation strategy.
Sensory sensitivity represents low thresholds and a
passive self-regulation strategy.
Low registration represents high thresholds and a
passive self-regulation strategy.

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The theory & model of

Sensory Integration

Sensory integration is the

neurological process that
organizes sensations from ones
own body and from the
environment, and makes it
possible to use the body effectively
within the environment. Sensory
integration is information
processing. A. Jean Ayres, 1989

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Introduction
Sensory integration (SI) theory is a dynamic
and ecological theory (interaction with the
environment).
It describes the critical influence of sensory
processing on human development and
function.

Occupational therapists commonly use SI

theory in practice as a frame of reference
with people who have sensory integrative or
sensory processing dysfunction that
adversely affects function

Dr. A. Jean Ayres

Recognized and described hidden disabilities,
referring to them as sensory integrative
dysfunction.
Her theory development was made through:
Keen observation of behavior.
Review of the neurophysiological underpinnings of
behavior
Synthesis of literature from neurology, psychology,
neurophysiology and education.
Ongoing research on assessment.
Statistical analysis of patterns of dysfunction.

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Key assumptions of Sensory

Integration Theory
(Five basic assumptions formed the
theoretical basis for Dr. Ayres
thinking)

(1)
Central nervous system plasticity
occurs throughout the life span.
Neuroplasticity: the remarkable
potential for change of the developing
brain.
.

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(2)
Hierarchial organization of the brain (Interactions between the higherorder (cortical) areas of the brain and those in the lower subcortical
areas as fundamental to adequate sensory integration).
Each sensory system has influence
on the other sensory systems.

Source: Sensory Integration and the Child; Ayres,

Jean

Organization of the Brain

Our nervous systems are constantly bombarded by
sensation, but not all sensory input reaches the cortex.
Incoming sensory messages are influenced by other
neurons as they ascend through the central nervous system.
Some neurons dampen their activity (inhibition).
Some neurons enhance their activity (facilitation).
The interplay of activity between the higher-level cortex
and subcortical structures also contributes to the selforganizing processes of the brain.

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(3)
Neurophysiological development of sensory integrative functions
occurs in a natural order and follow a basic sequence.

Development is viewed as an orderly, predictable

process that occurs in the brain undergoes.
This interrelated sequence results in the capacity for
learning.
Given an enriched, supportive environment, children
develop sensory and motor memories that help them
adapt to their own growth and interests in an everchanging environment.

These basic senses blend in such a way to enable

us to function in daily life. It is this complex
blending that is called sensory integration.

For example, vision integrates with proprioception and
touch  making it possible to have eye/hand
coordination to catch a ball.

Proper organization of the senses is necessary for the
brain to interpret a situation correctly and make an
appropriate response (an adaptive response).

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Sensory integration is developed

through active participation in
meaningful activities.

Sensory Integration and

Occupation
Sensory integration is fundamental to
interpreting information from the
environment and for learning.
Sensation is used to guide an individuals
engagement with people and objects in the
environment.
Crucial for engagement in needed and desired
occupations.

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(4)
Adaptive Response
The ability to make adaptive responses to everchanging environmental demands and challenges.
Allows us to learn something new and, in turn,
change the environment.

Ayres stressed the importance of organizing

adaptive responses to increasing complexity as a
key component of intervention.

(5)
Inner Drive
A child cannot be forced to generate an adaptive
response.
The drive for mastery or the motivation to explore
elicits individuals willingness to participate.

Two important treatment principles that support

the concept of an inner drive include providing
that child with:
The just right challenge.
The ability to choose activities, as long as they are
appropriately challenging.

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Sensory input is registered, processed,

integrated and organized to produce a
response or behavior.

Sensory
input

Neural
processing

Adaptive
Response

Sensory Integrative Dysfunction

(SID)
Sensory Integrative Dysfunction (SID) is when the
nervous system is unable to properly regulate
sensory information; as a result children often
experience problems with motor development,
coordination, behavior and socialization.
Simply put, sensory integrative dysfunction is
difficulty taking in, sorting out and/or connecting
information from the surrounding world.

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Assessment
The process of sensory integration cannot be observed directly.
Dr. Ayres used the term hidden disabilities when referring to
SI dysfunction.
To understand the way in which an individual processes
information, the therapist must rely on information from:
Interviews.
Direct observations.
Structured and unstructured assessments of skills and abilities
related to occupational performance.

Common clues of SID

Some common clues that may determine if a child is
having sensory integration problems are:

Unusually high or low activity levels

Impulsive or a risk taker
Short attention span, easily distracted
Problems with muscle tone and coordination; child may be clumsy,
awkward, and accident prone
Resistance to new situations; child may become stubborn or
uncooperative with any minor change to their routine. For
example, such as a substitute teacher who does things differently.
Academic, social, and emotional problems.
inability to plan an approach to tasks

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Typical signs of sensory integrative dysfunction may include:

Trouble with writing, drawing, cutting or pasting

Difficulty with manipulation of small objects
Difficulty or avoidance of playground games or equipment
Bothered by sounds or smells
Needs help to organize or finish tasks
Deficient social skills
Dressing problems
Dislike of haircuts, shampooing, nail cutting
Over sensitive or under sensitive to pain
Sleep problems
Eating/feeding problems
Irritability
Seeks out intense sensory experiences

Psychological sequences of SID

When a child sees, feels or hears things differently, and is being

disciplined for this, it tends to be hard on his ego.
Behavior is often not under his own control. It is natural for others to
expect him to react in a typical fashion, but he cant.
A bright child may know something is not right and not understand
why. He may begin compensating for his differences by avoiding tasks
that are hard or embarrassing.
These children might appear to be bored, unmotivated, troublesome
or stubborn.
Many of these children seem unhappy.
The end result is often one of low self-esteem

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Some of the children may have medical or

educational labels

These include, but are not limited to:

Hyperactivity
Attention Deficit Disorder
Learning Disability
Speech and Language Disorder
In-coordination
Autism Spectrum Disorders
Dyslexia.
Fragile X Syndrome
Mental Retardation
Pre-maturity.

Evaluation
Clinical Observation
Parent/Teacher Report
Sensory Questionnaires
Winnie Dunns Sensory Profile
Touch Inventory for Elementary School-Aged
Children (TIE)
Developmental History by Ayres

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 Standardized Tests
Sensory Integration and Praxis Test (SIPT)
DeGangi-Berk Test of Sensory Integration
(TSI)
Test of Sensory Functions in Infants (TSFI)
Various Sensorimotor Tests

Intervention Planning
Occupational therapy practitioners using a
sensory integrative approach are guided by
evaluation data.
Therapeutic activities are designed to
address the identified deficits.
Specific attention is given to the impact of the
tactile, proprioceptive, and vestibular systems
in function.

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SI Therapy
Therapy is almost always fun.
Children learn best when playing.
This is when the childs brain is the most responsive
to changing and learning new things.
In therapy the child will be guided through play
activities that challenge the ability to respond
appropriately to sensory input by making a successful
organized response.
Intervention delivered in a playful style at the childs
level could elicit the childs inner drive to learn and
develop.
Facilitates enhanced neuronal growth and development.
Leads to increased skill and independence in daily life activities.

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SI Therapy
It provides the child with the proper amount and type
of sensory information that his/her nervous system
requires to properly function. By providing the
appropriate sensory information the child is able to
develop adaptive behavior that leads to sensory
integration.
The goal of these activities will be to direct the brain
to automatically respond correctly to sensory input
specific to the childs areas of need.
An occupational therapist will guide the child through
a variety of activities to help train the body to properly
process sensory information.

SI Therapy
Some examples are:
The use of specialized swings to experience specific
movement sensations
lying or sitting on therapy balls to improve balance.
moving through an obstacle course to improve motor
planning.
The children obtain a sense of competence in the treatment
setting and integrate the skills learned at therapy into daily
living, self-confidence and self-esteem.
SI therapy will lead to functional improvement in self-care,
motor coordination, emotional adjustment, social skills or
better school achievement.

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Hallmark Features of Intervention Using

Sensory Integration
A qualified therapist
The use of sensory opportunities
Opportunities to move through space
The therapists scaffolding of success
Providing environmental affordances
Assisting in organization of behavior

Guiding Principles of the Actual

Intervention
Intervention based on sensory integration
theory is child-directed.
The therapist observes the child to understand
the childs current capabilities.
Activities are structured around the childs
interests and abilities.
The child is engaged in treatment by eliciting
his or her intrinsic motivation to play.

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Basic Tenets of Sensory Integration

Integrated sensation is nourishment for the
brain.
Adaptive responses are required to successfully
meet challenges essential for growth and
development.
The inner drive of the human being invites the
experience of life.
Active participation promotes organization.
Artful vigilance is essential on the part of the
therapist to facilitate the just-right challenge.

Goals of Occupational Therapy Using

Sensory Integration Stategies
Increase in the frequency or duration of
adaptive responses.
Cognitive, language, and academic skills.
Gross and fine motor skills.
Self confidence and self-esteem.
Enhanced occupational performance and
social participation.
Enhanced family life.

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Questions to think about???

1. How would you communicate your understanding of the
evidence to parents who are seeking occupational therapy
intervention that uses a sensory integration approach?
2. A characteristic behavior that is seen in children with autism is
self-stimulatory behavior, such as hand flapping or repetitive
rocking.
How might you make the case that this is the result of
inadequate neural inhibition?
Can you make the converse case: that it is the result of
inadequate neural facilitation?

Levels of Treatment
Praxis/Skill

Discrimination

Self-Regulation

Modulation

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Treatment
Modulation
Homeostasis

Self-Regulation
Sensory Diet

Discrimination
Perception

Praxis/Skill

Questions????

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Definitions and concepts

Praxis:
Praxis is the process of getting the idea, initiating, and
completing new motor tasks. It is an end product of input
from all the necessary systems and the brain. Integrated
information from the sense of touch, balance and
movement, vestibular, vision and hearing, may be
necessary for good motor planning.
Dyspraxis: disordered motor planning.
Apraxia means that motor planning is almost absent.
Individuals with motor planning problems have to think harder to
complete a new motor task
They might appear stubborn or lazy, because they can complete a
more difficult task, but cannot generalize the skill to an easier task.

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Postural Praxis:
Postural Praxis: The ability to imitate body
position is called postural praxis.
Individuals with this difficulty are often poor at
sports or games.
If the instructor says, Hold the bat like this, they may
have a greater difficulty than average in grasping how
to place the body or move.
An infant may become stuck under a table when
crawling, being unable to figure out how to move their
body to get out.
Individuals with postural praxis problems may appear
wooden in their movement.

Praxis on verbal command: This is the ability to

integrate a verbal command and motor response.
For example, if a child is given a direction to sit
down and pick up your pencil,
Sequencing Praxis: Sequencing tasks is the ability
to know how to get things done in order. Some
children have dressing problems because they
cant sequence whether to put the undershirt or the
shirt on first.

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 Oral Praxis: This is the ability to organize

sequenced movements in the area of the mouth.
Naturally, it is often a problem area for children with
speech problems. Drooling, feeding problems and
difficulty in blowing bubbles, whistles, reading etc..

Constructional Praxis: difficulty with construction

tasks.
frustration playing with blocks and toys.
Difficulty dressing dolls may be observed.

THE VESTIBULAR SYSTEM

The inner ear is the sensory organ for balance, the inner ear
is part of a larger system called the vestibular system.
The vestibular system has a great influence in balance, and
eye movements, as well as an influence over muscle tone.
Balance can affect behavior by causing an individual to be
withdrawn in a group situation. It may also cause a person
to be fearful due to insecurity brought on by postural
insecurity. It may also create the appearance of
restlessness.
Effect on learning: Indirectly vestibular problems are
thought to have an influence on learning. This is because
of the vestibular systems profound control over the neck
and eyes.

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Clumsiness:
A clumsy child often trips over his or her
own feet, and may experience frequent falls.
While sitting they may squirm in the seats,
or even fall off their chairs onto the floor,
evoking frequent comments to sit still.

Gravitational Insecurity:
An irrational fear of movement off the
ground. Children with gravitational
insecurity may exhibit limited participation
in gross motor play; avoidance or fear of
escalators, elevators, or cars; or resistance
to being off the ground.

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Postural Insecurity:
Posturally insecure individuals are
abnormally fearful of falling.
As infants they may be slow to roll over and
may startle frequently to movement.
Generally as young children they will be
fearful of being pushed over.

TACTILE DEFENSIVENESS:
Tactile defensiveness is an irritability to
touch, especially light touch. The faulty
nervous system interprets light touch as
being painful, irritating, or threatening.
This will generally result in undesirable
behavior.

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