Sensory diet modification and regulation

Sensory Systems: OT Ideas for Identification and Modulation

In the clinic and school-based setting, each patient and child we see is different.

Individuals come to occupational therapy with a different set of experiences, perspectives, and even sensory systems functioning when compared to others. This is why I like occupational therapy.

You may recall the discussion about sensory experiences and sensory systems from your education. Sensory experiences are an inherent part of daily occupations and activities. Sensory systems are responsible for processing the sensory information and experiences we find in daily life.

For each of us, our sensory systems are unique and we may have different responses to each of our sensory experiences. For this reason, your patients — whether adults or children — may react differently to the same stimulation. In some cases, sensory responses may be considered maladaptive and inhibit a person’s ability to fully engage in an occupation.

No two clients are the same!

Examples of sensory responses impacting occupational function may range from a child’s decreased participation in dressing tasks due to non-tolerance of scratchy or stiff clothing, to an older adult having difficulty remaining awake and engaged during feeding tasks. There are a wide variety of sensory system types and combinations.

For the purposes of simplification, this article will discuss three major groups of sensory categories, how to identify these groups and help your patients navigate their sensory experiences, and the variety of available online resources.

The three major sensory system groups reviewed in this article are:

  1. Over-Responsive to Sensory Input
  2. Under-Responsive to Sensory Input
  3. Sensory Seekers

If a patient is demonstrating maladaptive sensory behaviors that are impacting their participation in occupations, a therapist must first determine which sensory category their patient may fall into. This is completed via observation, skilled occupational interview, and communication with parents, teachers, and/or caregivers. There are also several assessments, with a common example being the Adult/Adolescent Sensory Profile.

Once the sensory category is identified, use your clinical judgment to determine what intervention technique might help your patient increase participation in occupations in the clinic, classroom, home, or work environments.

Over-Responsive to Sensory Input

When an individual is over-responsive to sensory input they may have a sensitive tactile system, they may show signs of distress in busy, loud, and bright environments, they may be easily distracted, and they may be fearful of playground equipment including swings or jungle gyms.

Observe the patient/child for the following or ask a parent or teacher if the child demonstrates any of the following behavior (SPD Support, 2011):

  • Distressed by clothes: materials, tags, seams, belts, tights, stiff jeans
  • Dislikes “light touch” or tickles (may “wipe off” area that was touched)
  • Avoidance of touching anything “messy” or excessive hand washing
  • Dislikes being barefoot or hates to wear shoes and/or socks
  • Demonstrates car/motion sickness
  • Fearful of heights, swinging, or bike riding
  • Prefers very bland and/or single texture foods, dislikes anything spicy
  • Sensitive to smells including cooking and cleaning products
  • Sensitive to noises that others are not bothered by such as clocks, appliances, vacuums, etc.
  • Easily distracted by auditory or visual stimuli 

Once you determine a patient/child may have an over-responsive sensory system, there are several ideas and modifications to help this individual modulate their sensory environment. Ideas to help over-responsive sensory systems include:

  • Use deep pressure touch
  • Provide joint compression/traction
  • Encourage exploratory and “messy” play with various textures in small doses
  • Seamless and tag-less clothes
  • Earplugs or noise canceling headphones
  • Let them wear a hat in bright or visual distracting environments
  • Use play-doh or theraputty prior to messy meals or tactile play to desensitize the hands
  • In school, allow the child to be at the front or back of the line to reduce chances of bumping into or touching others
  • Provide a safe, sensory retreat or body sock
Consider creating a “sensory corner” for a safe and learning-conducive place within your clinic or classroom.

Under-Responsive to Sensory Input

Individuals who are under-responsive to sensory input may seem lethargic, unmotivated, and/or it may be difficult to get and retain their attention.

Observe the patient/child for the following or ask a parent or teacher if the child demonstrates any of the following behavior (SPD Support, 2011):

  • Appears lethargic and/or may be described as “lazy” and unmotivated
  • Doesn’t notice if hands or face are dirty
  • Elevated pain threshold
  • Does not seem to get dizzy
  • Difficult to engage and/or does not interact with peers

Those who are under-responsive to sensory input require an alerting, engaging, and active environment to get their systems going. Ideas to help individuals who are under-responsive to sensory input include:

  • Facilitatory tactile input: tickles and light touch
  • Alerting environment: music, lights, encouraging voice
  • Vibrating toys or pillows
  • Inflatable wiggle cushions
  • Encourage movement or brain breaks prior to tabletop work
  • Allow extra time for processing of sensory input
Sensory bins are another easy way to help children engage in therapy and explore different sensory experiences and textures. As occupational therapist Zuzanna Congalton explains, sensory bins also help address fine motor skills, visual perception, tactile defensiveness, grip strength, grasp development, sequencing, and attention.

Sensory Seekers

Sensory seekers crave repetitive and/or intense sensory input. Author and researcher Miller (2006) describes sensory seekers as individuals who “have an intense craving for sensory experiences and will actively seek this out, often in ways that aren’t matched or appropriate to the environment e.g. running around during group time.”

Observe the patient/child for the following or ask a parent or teacher if the child demonstrates any of the following behavior (SPD Support, 2011):

  • Loves to touch and be touched
  • Fidget with items all the time: pencils, pens, zippers, hair
  • Thrill seeker; loves fast movement and spinning
  • Frequently tips/rocks chair and/or falls out of chair
  • Often appears restless when sitting
  • Seeks out crashing, “squishing,” and bumping activities; may jump on furniture or run into other people
  • Difficulty sleeping

Sensory seekers have high sensory thresholds and often require extra, purposeful sensory input to meet their high sensory thresholds and to help regulate their systems (Dunn, 1997). Ideas to help include:

  • Sitting on a therapy stool, ball chair, or sit disk
  • Designing a sensory diet for your child in conjunction with an OT
  • Implement “heavy work” experiences prior to seated tasks and frequently throughout day
  • In the classroom, implement brain break activities such as the S’cool moves or the Alert program
  • Vestibular and proprioceptive input throughout the day or during recess
  • Fidget toys
  • Weighted lap pad
  • Consider: Is it possible to stand to do work?

Resources

To help share knowledge and understanding of sensory systems with parents and teachers, I’ve compiled a list of online resources. These websites discuss sensory systems in patient friendly language and provide resources and forums for therapists, parents, and teachers.

Therapeutic Listening®
Therapeutic listening is a sound-based intervention tool that is used to assist patients with self-regulation and modulation of sensory experiences. This website offers information portals for therapists and parents, as well as continuing education courses for practitioners.

Sensory Processing Disorder Foundation
The STAR Institute for Sensory Processing Disorder offers a website full of information including continuing education, treatment ideas, and the latest research related to sensory issues.

Alert Program, “How Does Your Engine Run?”
The Alert Program includes resources for parents, teachers, and therapists. Resources are used for instructing patients in self-regulation and sensory diets to improve attention, coping strategies and executive functioning.

Have you had any unique experiences treating sensory systems? What tools do you use to help modulate sensory experiences in your practice? Let us know in the comments!

References

References

  1. Dunn, W. (1997). The impact of sensory processing abilities on the daily lives of young children and their families: A conceptual model. Infants and Young Children, 9(4), 23-35.
  2. Miller, L. J., & Fuller, D. A. (2006). Sensational kids: Hope and help for children with sensory processing disorder (SPD). New York: G.P. Putnam’s Sons.
  3. SPD Support – Sensory Support for Parents, Adults, and Professionals. (2011). Retrieved from http://spdsupport.org/
  4. Voss, A. (2013). Understanding your child’s sensory signals. (2nd ed.).

About Kyla Salisbury

Kyla Salisbury
Outpatient and Home Health OT working with a variety of diagnoses and patient populations ranging from pediatric to geriatric. UMary OT Grad, 2016; MSU Architecture Grad, 2011.

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