SENSORY INTEGRATION PROGRAM AND A CHILD WITH DS

SENSORY INTEGRATION AND A CHILD WITH DS

Definition: Sensory integration is an innate neurobiological process and refers to the integration and interpretation of sensory stimulation from the environment by the brain.

In short Sensory integration is "the organization of sensory input for use".

In more simple words,

THE ABILITY TO TAKE THE INFORMATION THROUGH OUR SENSES AND EFFECTIVELY UTILIZE THE INFORMATION TO RESPOND TO THE DEMANDS OF OUR ENVIRONMENT.

Now as we all know our children are visual & audio learners. They are copy-cats & the receptive vocabulary is excellent. They love being with people. Their social quotient is very high. They can feel your non-verbal expressions. They love to cuddle & to be cuddled. Now if you go back and see the definition/meaning of Sensory integration, it is about using the sensory inputs meaningfully. Our children are good at using the sensory inputs..!!! Then why to design a SENSORY INTEGRATION PROGRAM FOR A CHILD WITH DS...???

CONFUSING???

Yes, because at times we mix the issues purely related to a child with Autism to a child having pure 21 trisomy.

When my child with DS is not able to chew solid food, I relate it to something wrong with the sensations...if she is not able to swallow again I connect it with her sensory system...!!!

If this is not purely a sensory issue then what??

Why nuk-brush & Z-vibes advised???

CONFUSING???

Let's understand the basics.

 Our Central Nervous System, with the help of our senses, takes the messages from our body and surroundings interpret them and organize a purposeful response. The brain, spinal cord, peripheral nerves & our senses all work together constantly & in synchrony. Thus the Sensory processing involves

SENSORY INTAKE-INTERPRETATION-RESPONSE

This is a continuous process & the entire team works constantly in coordination for the minutest daily endeavour. We receive all input through our senses, via seeing (visual), hearing (auditory), smelling (olfactory), tasting (taste), touching (tactile), movement and gravity (vestibular), and body position (proprioceptive). Each sense acts individually and in union with the others.

 For example let's have a look at one milestone. A child is trying to learn how to walk? To attract/encourage the child, you are standing at a reachable distance holding child's favourite toy & calling the child. Now see how the whole episode will proceed. From sitting position child stood up (body position/ proprioceptive), his soles touched the ground & took a grip (tactile), tried to balance his body (vestibular), listened to your call (auditory), attracted to the toy in your hand (visual), started stepping towards you which involved many muscles to work. Each sense has to play individually & in coordination with each other. Each muscle has to play individually & in coordination with each other. The entire process needs an efficacious nervous system, a network of peripheral nerves-spinal cord-brain.

In our children we need to incorporate SENSORY INTEGRATION PROGRAM NOT because of some Sensory processing dysfunctions (which are there in Autism) but;

·       They have hypotonic muscles

·       Loose ligaments

·       Hyper mobile joints

·       Weak deep tendon reflexes

·       Slower messaging system

·       Delayed reaction timings

·       Delayed equilibrium reaction

·       Deficient in developing Laterality(Dominance of one side of the brain)

·       High pain threshold

·       Deficient Hand-Eye coordination

We will try to understand one by one.

Chewing & swallowing: Chewing & swallowing involve jaw movement, buccal muscles, salivary gland secretions, tongue muscles, teeth, lip muscles, muscles of the palate, muscles of pharynx & muscles of esophagus. As muscles are weak the whole process becomes difficult for the child. The slower messaging system adds to the difficulty & delayed reaction time disrupts the coordination.

As we talked earlier repetition & training is the best option available. Practice helps to master. We need to train our children to improve upon chewing & swallowing. Nuk brush, Z-vibes, tethers, chewers, oral motor exercises are targeted for that.

Motor milestones: Delayed motor milestones and difficulty in body balance are because of low muscle tone, loose ligaments, weak deep tendon reflexes, hyper mobile joints, slow messaging system & in few children AtlantoAxial instability. For a single simple motor movement a series of reflexes are involved.

1.    Because of the weak muscles, the movement is slow.

2.    Because of the loose ligaments joint stability is low.

3.    Because of the difficulty in tactile localization & tactile discrimination judgement of movement is difficult

4.    Because of the slower messaging system the time taken to reach the message to brain is more.

5.    Because of the delayed response transmission the reaction time is longer.

6.    Because of the delayed proprioceptive response, judgement of body position is difficult.

7.    Feedback from the muscles and limbs, from vision and from balance systems is an integral part of all movement control.

Here everything happens at its own pace so it's difficult to coordinate effectively.

Practice helps to master. We incorporate sensory integration program targeted at tactile, vestibular & proprioceptive senses along with physiotherapy to achieve gross motor functions.

Because of the deficient laterality, the reaction time further increases. Brain gets confused while sending commands as to which hemisphere to send!

If we go back & have a look again on Sensory processing:

SENSORY INTAKE-INTERPRETATION-RESPONSE

Now it must be clear that because of the factors & reasons mentioned above the speed of sensory intake is low. The slower neurotransmission delays the signals to reach spinal cord &/or brain. Our children have weak logical & hierarchical thinking that delays the interpretation. Deficient laterality & slower neurotransmission delays the command signals. Low muscle tone & loose ligaments further delay the response.

For these reasons the SENSORY INTEGRATION PROGRAM for our children should include tactile, vestibular & proprioceptive senses.

What about sense of vision & hearing???

Our children are VISUAL LEARNERS so sensory integration program incorporating the sense of vision help our children to learn better, faster & conceptually. 
Practice for faster visual sensory input is also necessary.

The ability of RECEPTIVE VOCABULARY compels us to incorporate sensory integration program for auditory sense.
Practice for faster auditory sensory input is also necessary.

With this basic understanding I would like to show some ideas for,

SENSORY INTEGRATION PROGRAM:

All the senses are interlinked so there are no tight compartments. I have mentioned few activities under individual heading just to make it easier.

 

 

6. PROPRIOCEPTIVE

A Sense that is connected with the position and movement of the body.

To develop this sense swings, rolling, slides, carrying weight, pillow fights, rocking toys, riding on kangaroo ball, jumping on trampoline, using inflatables & bean bags, hanging from a bar etc.

 

7. VESTIBULAR

The sense of balance.

Walking on a plank, balancing on a ball, jumping on trampoline/bed/ball,bouncing on trampoline/bed/ball,playing in inflatables, swings(different types), climbing up & down stairs,running, skipping,turning, rotating, spinning, swivel chair, tumbling, slides, teeter totters, hopscotch, rocking chair/toys etc.

  

 

Sense of Touch: Tactile localization & discrimination

Texture books, sensory trays(lots of ideas available on internet), pillow fight, hammock swing, ball box, caressing with finger tips/feathers, rolling in mat, giving pressure on body, cuddle, sitting/sleeping on bean bag,

  

Sense of vision: Exposure to colourful things

Cheap & easily available 

(multipurpose use)

Toy telescope

Pop-up books

Find the difference

What is missing?

 Pick-a-boo

Charts

Flashcards

Sense of hearing(Auditory):

Sound Toys & listening to music/rhymes

Sound books

Sense of taste: Exposure to different taste.

Sense of Smell: Exposure to different smell. House hold things like soap, food items, perfume, incense stick, room freshener, floor cleaner etc.

 

All senses work together yet independent. The activities described work for more than one sense. 
We observe that some children dislike loud sound/music, some avoid certain food & few more are fussy about cloth texture. This is normal and child needs gradual desensitization.

It is easy to incorporate 

SENSORY INTEGRATION PROGRAM 

in daily routine of the child with this understanding.