SENSORY INTEGRATION TECHNIQUES FOR SPEECH LANGUAGE

PATHOLOGISTS: AN INTRODUCTION
By
Scott Fox, M.A., CCC/SLP AND Erin Hofmann, M.A., CCC/SLP

I. INTRODUCTION
II. CLINICAL REASONING

1. What filter might you look through first (most obvious to your background and
orientation) to describe a child performance.
- First impressions - Applied Behavioral Analysis
- Play - Child directed vs. Adult directed
- Respiration - Craniosacral/myofacial
- Attention - Sensory Defensiveness
- Communication - Arousal/Modulation
- Syntax - Suck/Swallow/Breathe
- Pragmatics - Biomechanical
- Semantics - Postural Integrity
- Normative Data - Ocular motor
- Phonological Development - Self Regulation
- Augmentative Communication - CNS/Biochemistry/Neurochemistry
- Sign Language - Sensory Systems
- Auditory Processing - Sensory Processing
- Symbolic Representation - Sensory Integration
- Experienced Based Therapy - Sensory Motor Integration
- Age/Maturity - Motor Skills
- Behavior/Temperament - Visual Motor/Fine Motor
- Developmental Levels - Visual Perception
- Oral Motor Skills - ADL’s
- Feeding - Ethnicity/socioeconomic
- Cognition - Environment/Context
- Learning Styles - Occupational Performance
- Functional Skills - Expectations
- Family Dynamic/Culture - Past experiences/Opportunities
- Medical Diagnosis - Allergies
- Medications - Social Emotional

2. What does the child already know how to do to support what performance.
3. Under what circumstances (what environment, performance requirements, stressors,
etc.) Does the child do ? (Fill in the blank with one of her/his strategies.)
4. For what (your perceived) purpose does the child do ?
5. What will it take to support the child to do what he wants to do the way he wants to
do it. (Consider environments, criteria for success according to the child, stressors,
current level of alertness.)

Adapted from Oetter, 1995; Oetter, Fox and Rouse, 1999/ Oetter & Fox 11/00
I. INTRODUCTION TO SENSORY INTEGRATION

A. Sensory Integration: the ability of the nervous system to organize

sensory input for meaningful adaptive responses (Ayres).

• Sensory Integration is a process (from SI theory) and the ability

to:

- receive sensory stimuli

- attribute meaning to that stimuli or information

- integrate that information with other information

- integrate this data with prior sensory motor experience

- produce an efficient adaptive response

- register the adaptive or motor response for future use

* "treatment facilitates sensory integration by supporting different parts of the

nervous system to work together for more effective interaction with the
environment and self satisfaction." (as defined by Dr. A. Jean Ayres)

B. Arousal, Attention and Self Regulation

1. Arousal-is the state of the nervous system, describing how alert one
feels. (as defined by Williams and Shellenberger, 96)

2. Self Regulation-is the ability to attain, maintain, and change arousal

appropriately for a task or situation. (as defined by Williams and
Shellenberger, 96)
 C. Sensory Systems:
• Tactile/Somatosensory: Body sense. Largest sense organ.

• Vestibular: responds to body movement through space and

change in head position. It coordinates movement of eyes,
head, and body in relation to space.

- all other types of sensation are processed in reference to this vestibular

information so when the vestibular system is not functioning in an
accurate way the interpretation of other senses will be inaccurate.

• Proprioception- sense of body position: gives awareness of

body position. Perception of sensation from muscles and
joints.

- Heavy work- type of proprioception that includes

anything that works the muscles against gravity.

• Auditory:
• Vision:
• Smell:
• Gustatory:

D. Sensory Defensiveness: a constellation of symptoms that are the result of

defensive reactions to non-noxious stimuli across one or more
modalities (Wilbarger & Wilbarger, 1991).

E. Social Emotional Disorders Related to Sensory Defensiveness:

a pattern of learned behaviors that create habits and interaction styles that
is protective and defensive in nature. These stress and anxiety reactions
can continue after the primary symptoms of sensory defensiveness are no
longer present. (Wilbarger & Wilbarger, 1992)

F. Sensory Diet:
A term coined by occupational therapist Patricia Wilbarger to describe the
brains need for sensorimotor input, and if we provide the brain with
needed input we will feel more alert and attentive.

* Sensory defensiveness can affect any or all of the sensory systems

* Often leads to an avoidance of interaction with environment.

 Effects on Directed Activities
communication/attention/learning
Sensory Defensiveness Sensory Defensiveness

• Decreased exploration/interaction • Therapressure Protocol

• Distracted/bothered by various types of • Sensory Diet
Sensory input (over or under-reactive) • Pressure and proprioception
• Oral hyper/hypo sensitivity • Oral input
• Poor respiratory rate/rhythm/depth • Climbing/jumping/crashing
• Continuous state of hyper vigilance • Bite and tug
• Difficulty changing level of attention • Resistive suck
• Poor peer interaction • Pulling
• Withdrawn • Heavy work
• Resistance to participating in activities • Hide outs
• Attending • Music

* Refer to Sensory Defensiveness in Children

Aged 2-12 (Wilbarger & Wilbarger)

Arousal/Attention Arousal/Attention
• Ability to sustain and shift attention • Pressure and proprioception
• Modulation of arousal for various • Bite/blow/suck/chew
activities
• Resistive suck (water bottle)
• Attention to communication partner • Sitting/bouncing on therapy ball
• Ability to interpret non-verbal cues.
• Movement
• Attention to task
• Heavy work
• Maintain posture appropriate to activity
• Music/rhythm
• Interaction with environment
• Alert Program (How Does Your Engine
• Topic maintenance Run)
• Rate/Rhythm/volume/frequency of • Hand fidgets
speech
• Seating alternatives
• Turn taking
• Breathe work
• Music
* Refer to How Does Your Engine Run? (Williams
& Shellenberger)
• Refer to Take Five! (Williams &
Shellenberger)
Respiration/Posture Respiration/Posture

• Respiratory support for speech • Blow toys

• Decreased MLU • Kazoo conversation
• Final consonant deletion/stopping • Belly ball
• Increased rate • Hand placement
• Pitch/rhythm • Growling and crawling like animals
• Difficulty with continuants • Bubble jar
• Attention • Blow darts
• Written language • Vestibular
• Need for continuous movement • Seating adjustments
• Increased or decreased arousal • Music

* Refer to M.O.R.E. (Frick, Oetter, & Richter)

Movement/Vestibular Movement/Vestibular

• Exploration • Front to back

• Turn taking • Side to side
• Processing • Rotation
• Attention/modulation • Upside down
• Increased or decreased arousal • Swings
• Sequence in time and space • Slides
• Non-verbal • Scooter boards
• Posture • Rolling on floor or over therapy ball
• Muscle tone • Obstacle course
• Orientation • Play Ground equipment
• Concepts • Trampoline
• Stable visual field • Change of head position
• Stable auditory field

* Refer to Sensory Integration and the Child (Ayres)

***The information in this handout represents only a small sample of interventions. All
activities should be directed and monitored by qualified therapists. Activities should be
modified on an ongoing basis to best facilitate each child’s progress.
***The information printed in this handout was modified from the following list of
references:

REFERENCES

Ayres, A.J., Sensory Integration and the Child. 1985. Western Psychological
Services, Los Angeles, CA.

Frick, S., Oetter, P., Richter, E. M.O.R.E. Integrating the Mouth with Sensory
and Postural Functions. 1995. PDP Press, Inc, Hugo, MI.

SII. A Parent’s Guide to Understanding Sensory Integration. 1986. Sensory

Integration International, Torrance, CA.

Wilbarger, P. & Wilbarger, J.L. Sensory Defensiveness in Children Aged 2-12.

1991. Avanti Educational Programs, Denver.

Williams, M.S., Shellenberger, S. How Does Your Engine Run? The Alert
Program for Self-Regulation. 1994. Therapy Works Inc.,
Albuquerque, NM.

Windeck, S.L., & Laurel, M. (1989). A theoretical framework combining speech-

Language therapy with sensory integration treatment. Sensory Integration
Special Interest Section Newsletter, 12(1).