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SENSORY ISSUES IN NEUROLOGICL CONDITIONS IN CHILDREN
- 1. SENSORY ISSUES IN NEUROLOGICL CONDITIONS IN CHILDREN Dr. Simran A. Mishra (MPT – IInd year) Under Guidance of : Dr. Suvarna Ganvir Department of Neuro-Physiotherapy DVVPF’s College of Physiotherapy, Ahmednagar 1
- 2. Introduction 3-4 Classification 5-6 Incidence & prevalence 7-8 Sensory Modulation Disorder 9-15 Sensory Based Moto Disorder 16-22 Sensory Discrimination Disorder 23-25 Sensory Integration 26-39 Recent Advances 40-42 2
- 3. INTRODUCTION • Sensory processing deals with how the brain processes sensory input from multiple sensory modalities. These include the five classic senses of vision, audition, tactile stimulation , olfaction and gustation. • Other sensory modalities exist, for example the vestibular sense and proprioception. Sensory Organs Motor and behavior al response s Sensory Specific Cortices Different Inputs Lonkar, Heather, "An Overview of Sensory Processing Disorder" (2014). Honors Theses. 3
- 4. 4 Sensory Integration and the Child: Understanding Hidden Sensory Challenges, 2005 by Western Psychological Services.
- 5. SENSORY MODULATION DISORDER SENSORY BASED MOTOR DISORDER • Dyspraxia • Vestibular Proprioceptive Disorders • Bilateral integration & sequencing • Visual • Auditory • Tactile • Taste • Smell • Vestibular • Proprioception SENSORY DISCRIMINATION DISORDER • Sensory Over responsivity • Sensory Under responsivity • Sensory Seeking / Craving Sometimes there can be a problem with the encoding of the sensory information. This disorder is known as Sensory Processing Disorder (SPD). This disorder can be further classified into three main types. Paula Kramer et al. Frames of reference for paediatric occupational therapy 3rd edition 5
- 6. CAUSES OF SENSORY PROCESSING DISORDER: • Estimated - 5 to 15 % children - some form of SPD • Causes of SPD: • Heredity, • Prenatal conditions/birth trauma, and • Environmental Factors • Miller et al (2006)- SPD- low birth weight or exposed to alcohol or drugs prior to birth Lonkar, Heather, "An Overview of Sensory Processing Disorder" (2014). Honors Theses. 6
- 7. 7 The prevalence of altered sensory modulation in selected neuro developmental/neurologic conditions (in %). Engel-Yeger B, Muzio C, Rinosi G, et al. Extreme sensory processing patterns and their relation with clinical conditions
- 8. S E N S O RY O V E R R E S P O N S I V I T Y TOUCH AUDITORY VISUAL OLFACTION 8 Sensory Modulation Disorder Comfort Exploration Participation TASTE Enjoys Engage Participate in social activity Comfort lights Enjoys Colours and patterns Eat and enjoys variety of food Stressed Food smell Hygiene products Avoids gathering Distressed by regular sounds Bothered Bright lights Colours Visually clustered Not bothered, responds to all smells Avoids lumpy or slimy Avoids salty or spicy Bothered by Clothing, Avoidant of tactile experience F U N C T I O N D Y S F U N C T
- 9. PROPRIOCEPTION VESTIBULAR 9 Sensory Modulation Disorder Avoids climbing activities Dislikes hanging activities Comfortable activities – coordination, engages in activities Enjoys movements in all planes and directions Avoids playground swings, rock n roll, slides, cautious D Y S F U N C T I O N F U N C T I O N Bialer, D. S., and L. J. Miller. 2011. No Longer A SECRET: Unique Common Sense Strategies for Children with Sensory or Motor Challenges. S E N S O RY O V E R R E S P O N S I V I T Y
- 10. S E N S O RY U N D E R R E S P O N S I V I T Y TOUCH AUDITORY VISUAL OLFACTION 1 0 Sensory Modulation Disorder Acknowledges touch Responds adequately TASTE Responds Recognizes Follows commands Enjoys colours and patterns Visual cues Eats if hungry Appreciates different tastes No recognition for pungent noxious smell Quite, passive No response withdrawal No notice to visual reminders Misses cues Notices smells Responds accordingly No response to hunger Tolerate extremes No response to touch, pain Drooling, dirt, wet, cuts F U N C T I O N D Y S F U N C T
- 11. PROPRIOCEPTION VESTIBULAR 11 Sensory Modulation Disorder Slow and plodding movements Weak grasps Grades force appropriately Uses tools Engages activities, movements in all planes and directions No indication of like and dislike D Y S F U N C T I O N F U N C T I O N Bialer, D. S., and L. J. Miller. 2011. No Longer A SECRET: Unique Common Sense Strategies for Children with Sensory or Motor Challenges. S E N S O RY U N D E R R E S P O N S I V I T Y
- 12. S E N S O RY S E E K E R TOUCH AUDITORY VISUAL OLFACTION 1 2 Sensory Modulation Disorder Acknowledges touch enjoys and participates TASTE Responds Engages Alerts Participates Comfortable in lighted areas, enjoys colours Eats and Appreciates different foods Enjoys strong odour, smells people, toys during play Loud speaking Noise making Enjoys loud volume difficulty wait Fast changing images on TV spinning object, Enjoys blinking light Notices smells Responds accordingly Lick, Suck, Chews non- food, prefers crunchy food Overly affectionate Irritates biting, pinching F U N C T I O N D Y S F U N C T
- 13. PROPRIOCEPTION VESTIBULAR 1 3 Sensory Modulation Disorder Bumps, falls & crashes on purpose Fidgets, wiggles during play Moves smoothly, coordinated actions Engages activities, movements in all planes and directions Engages in excessive movements, never still, twirls/ Spins, no regards for safety D Y S F U N C T I O N F U N C T I O N Bialer, D. S., and L. J. Miller. 2011. No Longer A SECRET: Unique Common Sense Strategies for Children with Sensory or Motor Challenges. S E N S O RY S E E K E R
- 14. 1 4 Sensory Modulation Disorder • Sensory Profile ........Downloadschild sensory profile.pdf • Sensory Processing Measure (SPM)- • Sensory Processing 3 dimensional scale (SP3D): • ........DownloadsSP3d.png A S S E S S M E N T TO O L S
- 15. 1 5 Sensory Based Motor Disorder Dysfunction occurs when “hidden” proprioceptive & vestibular senses - allow our bodies to move & sense our body position, are impaired,” Praxis ability to conceive, plan, and organize a sequence of goal-directed motor actions Postural disorder- Individual lacks ability to stabilize body during movements or rest that unable to meet demands of environment or given motor task Lonkar, Heather, "An Overview of Sensory Processing Disorder" (2014). Honors Theses. Praxis incorporates cognitive, perceptual and motor component of control.
- 16. 1 6 Sensory Based Motor Disorder Lonkar, Heather, "An Overview of Sensory Processing Disorder" (2014). Honors Theses. DYSPRAXIA Ideation, planning & Programming action, & executing action • Slow to initiate and position their bodies effectively for motor tasks and often present with poorly coordinated fine and gross motor performance. • Difficulty in judging distance • Poor motor Imitation SCALES SIPT ........Downloads-SIPT.docx PRAXIS TEST COMPONENTS Sequencing Praxis (SPr) Postural Praxis (PPr) Oral Praxis (OPr) Praxis on Verbal Command(PrVC)
- 17. 1 7 Sensory Based Motor Disorder “Sensory Integration Theory & Practise“, Anne Fisher, Anita Bundy, (Second ed., pp. 435-451). Philadelphia. VESTIBULAR PROCESSING DISORDER : Postural Ocular Movement Disorder Gravitational Insecurity Intolerance/Aversive Response to movement Ayres etal., 1970, hypothesized Disorders of sensory integration related to the defects in vestibular- proprioceptive processing
- 18. 1 8 Sensory Based Motor Disorder Evanna , Susan Elizabeth, "Autism: Symptoms, Causes, and Treatments" (2007). University of Tennessee Honors Thesis Projects VESTIBULAR PROCESSING DISORDER : Emphasis is on Postural Control Evana etal., concluded that characteristics of POMD, is evidence of several tests and features described below :- • Inability to assume prone posture • Hypotonic extensor muscles • Poor proximal joint stability • Deficient postural adjustments • Poor equilibrium & supporting reaction • Poor kinaesthetic awareness Postural Ocular Movement Disorder
- 19. 1 9 Sensory Based Motor Disorder VESTIBULAR PROCESSING DISORDER : Gravitational Insecurity It may be view as SMD, An emotional or fearful reaction that is out of proportion to the actual threat or danger of the vestibular proprioceptive stimuli or the position of body in space. Great Fear Of fall, even in absence of danger Height Frightened May avoid walking or jumping. It is closely associated with GI and often overlap. Intolerance/Aversive Response to movement
- 20. • TO ASSESS POSTURAL CONTROL- EQUILIBRIUM & SUPPORTED REACTION • SIPT- Standing & Walking balance test, Kinesthesia test • Fisher et al- Developed 3 Objective test • 1. Tilt Board Tip • 2. Flat board Reach • 3. Tilt Board Reach Anita Bundy. Sensory Integration- Theory and practice. 20 VESTIBULAR PROCESSING DISORDER :
- 21. 2 1 Sensory Based Motor Disorder “Sensory Integration Theory & Practise“, Anne Fisher, Anita Bundy, (Second ed., pp. 435-451). Philadelphia. BILATERAL INTEGRATION & SEQUENCING DEFICITS : • Inability to use two sides of body together in co-ordinated manner. • Traditionally vestibular- proprioceptive inputs, Recently Sequencing. • CLINICAL OBSERVATION- Poor B/L co-ordination, Rt- Lt Confusion, Avoidance of moving one arm across midline SIPT SP3D SPM SIPT- B/L Motor Co-ordination Sequencing Praxis Graphesthesia Oral Praxis SCALES:
- 22. 2 2 Sensory Discrimination Disorder “Sensory Integration Theory & Practise“, Anne Fisher, Anita Bundy, (Second ed., pp. 435-451). Philadelphia. • Ability to perceive & interpret sensory information accurately in daily life through recognition of qualitative & quantitative aspects of sensory features • Informs individual about size, weight, texture, location, & color • - need extra time to process sensory information because they have trouble figuring out what they are perceiving as quickly and naturally as other children do,”
- 23. 2 3 Visual Discrimination Tactile Discrimination Proprioceptive Discrimination Vestibular Discrimination Paula Kramer et al. Frames of reference for Paediatric occupational therapy 3rd edition Sensory Discrimination Disorder
- 24. 2 4 Paula Kramer et al. Frames of reference for Paediatric occupational therapy 3rd edition 2 4 Trouble performing fine motor task without looking Doesn’t know where touch without looking Difficulty balancing without using vision Poor extension against gravity Cannot judge time and distance during play Difficulty in maintaining good posture Poor Oculomotor control Difficulty in Tracking objects Difficulty in following moving target Difficulty in Copying from board VISUAL TACTILE PROPRIOCEPTION VESTIBULAR Sensory Discrimination Disorder
- 25. • Case 4 year old child requires person to carry him on escalators, gets scared when moving in-out of car, doesn’t step down from curb, he is independent, playing while sitting in house. Rationale ? Gravitational Insecurity • Case 6 year boy has poor sitting tolerance, weak grasp, unable to clear obstacles, repeated falls, prone to injury : rationale? SMD, Proprioception, Underresponsivity • Case 9 year old girl always visualizes objects with near proximity, faces difficulty in copying from board, unable to read news headline : rationale SDD, Visual 2 5
- 26. • Case 6 year old girl screams loud when someone pulls her cheeks, prefer hug from mother over kiss, prefers minimal clothing even in winter, Rationale ? SMD, Tactile Overresponsivity • Case 6 year boy has faces problem when someone asks to identify similar type of key, difficulty in naming the side key to be turned in lock: rationale? SDD, Dyspraxis, Cognitive Task • Case 9 year old girl was training for basketball, difficulty in throwing ball to target, difficulty in catching ball, difficulty in jumping on place for period of time: rationale SBMD, BISD, Planning & execution 2 6
- 27. 2 7
- 28. Taylor & Trott 1991 2 8
- 29. 2 9 Treatment of Neuromuscular disorders through understanding the principals of sensory organization in relation to motor impairment is of recent origin. • Kabat & Knott (1948), were the first to employ proprioceptive input to facilitate, motor output, especially in groups of muscle. • Temple Fay (1954), recognized that motor patterns of man’s evolutionary past still resides in cortex & these can be employed therapeutically, by eliciting them through sensory stim. • Ayres (1963), was first to recognize the potential therapeutic role of tactile stimulation in the development of maintenance of integrated motor action. Sensory Integration
- 30. S e n s o r yI n t e g r a t i o n S e n s o r yD i s c r i m i n a t i o n S e n s o r yM o d u l a t i o n S e n s o r yD e t e c t i o n A Model to Explain Sensory Integration Sensory Processing Bialer, D. S., and L. J. Miller. 2011. No Longer A SECRET: Unique Common Sense Strategies for Children with Sensory or Motor
- 31. 3 1 Supporting Children to Participate Successfully in Everyday Life by Using Sensory Processing Knowledge, Winnie Dunn,
- 32. 3 2 INTERVENTION: CONSIDERATION Playful environment Adequate space Quiet space Safety Equipment Intervention time- 45- 60 min Parents Involvement Therapist to client ratio- 1:1 Paula Kramer et al. Frames of reference for paediatric occupational therapy, 2014 Treatment seeks response that reflect better SI and more normal pattern of sensory inputs. The motor response carries meaning in that it provokes sensory input, helps organize it, & provides an overt manifestation of neural integration.
- 33. 3 3 Sensory Modulation Disorder Treatment Sensory Integration & learning disorders., Jean Ayres
- 34. 3 4 Sensory Modulation Disorder Treatment Vestibular Sensory Integration & learning disorders., Jean Ayres
- 35. 3 5 Sensory Modulation Disorder Treatment Sensory Integration & learning disorders., Jean Ayres
- 36. 3 6 Sensory Modulation Disorder Treatment Visual Treatment Sensory Integration & learning disorders., Jean Ayres
- 37. 3 7 Sensory Modulation Disorder Treatment Sensory Integration & learning disorders., Jean Ayres
- 38. Vestibular- proprioceptive Variety of body position ex (prone, quadruped,), suspension swing, trampoline Postural-ocular movement disorder- Focusing & tracking objects Balance & Equilibrium disorder- Small & slow mvmt on swing small- avoid fall, slow- child can responds Ocular movements Swing Photos Sensory Integration & learning disorders., Jean Ayres 3 8 Treatment Sensory discrimination Disorder
- 39. Shelly J. Lane. Sensory Integration Theory and Practice. 3RD EDITION 3 7
- 40. COMBINED SENSORY MOTOR APPROACH TO ENHANCE PARTICIPATION OF A CHILD WITH WEST SYNDROME: A FOLLOW-UP CASE STUDY C H E TA N A A S H O K K U N D E , 1 S U VA R N A S H YA M G A N V I R S 2 ( 2 0 1 7 ) case report of male child- West Syndrome, 1 year C/C- unable to transit to sitting, standing, walking. poor ability to focus & orient environment, poor somatosensory, kinesthetic, proprioceptive awareness sensory integration & NDTTreatment Approach. GMFM was 3.98%, GMFCS level was V 5 yrs there was increase score of GMFM with 84.07%GMFCS changed to level II Combine Therapy- child to perceive better motor learning by modulating sensory perceptual issues. 40
- 41. 4 1 Modulation dysfunction Structure involved Under responsiveness Poor Limbic/ reticular activating system Hyper responsiveness Excess limbic/reticular activating system Gravitation insecurity Poor otolithic vestibular processing Aversive response Poor semicircular canal mediated info resulting in sympathetic hypofunction and parasympathetic activation Narayan A, Rowe MA, Palacios EM, et al. Altered Cerebellar White Matter in Sensory Processing Dysfunction Is Associated With Impaired Multisensory Integration and Attention. Front Psychol. 2021 Feb
- 42. 4 2 REFERENCES • Lonkar, Heather, "An Overview of Sensory Processing Disorder" (2014). Honors Theses. • Sensory Integration and the Child: Understanding Hidden Sensory Challenges, 2005 by Western Psychological Services. • Paula Kramer et al. Frames of reference for paediatric occupational therapy 3rd edition • Engel-Yeger B, Muzio C, Rinosi G, et al. Extreme sensory processing patterns and their relation with clinical conditions among individuals with major affective disord, 2016;236:112– 118. • Bialer, D. S., and L. J. Miller. 2011. No Longer A SECRET: Unique Common Sense Strategies for Children with Sensory or Motor Challenges • “Sensory Integration Theory & Practise“, Anne Fisher, Anita Bundy, (Second ed., pp. 435- 451). Philadelphia
- 43. 4 3 • Evanna , Susan Elizabeth, "Autism: Symptoms, Causes, and Treatments" (2007). University of Tennessee Honors Thesis Projects • Supporting Children to Participate Successfully in Everyday Life by Using Sensory Processing Knowledge, Winnie Dunn, PhD • Sensory Integration & learning disorders., Jean Ayres • Shelly J. Lane. Sensory Integration Theory and Practice. 3RD EDITION • Combined sensory motor approach to enhance participation of a child with west syndrome: a follow-up case study, Chetana Ashok Kunde,1 Suvarna Shyam Ganvirs2 (2017)
Editor's Notes
- It is important that the information of these different sensory modalities must be relatable. The sensory inputs themselves are in different electrical signals, and in different contexts.[6] Through sensory processing, the brain can relate all sensory inputs into a coherent percept, upon which our interaction with the environment is ultimately based. (sight), (hearing), (touch), (smell), (taste). (balance and the sense of movement) the sense of knowing one's position in space)
- Sensory modulation refers to an individual’s ability to respond adaptively to sensation over a broad range of intensity and duration, Sensory modulation describes the way in which an individual responds to sensory stimuli in the environment. When functional, sensory modulation means that an individual is able to respond in a manner, which is appropriate to the degree, nature, and intensity of the sensory information experienced difficulty can be encountered when the individual does not respond appropriately to the incoming stimuli and is unable to adapt the response to every changing circumstance in daily life. Proposed are three subtypes of sensory modulation disorder: over-responsivity, under-responsivity, and sensory seeking Comforted by touch Explores all types of play materials with hands Wears all types of textured clothing Participates willingly in daily living activities with tactile components, Comforted by touch Explores all types of play materials with hands Wears all types of textured clothing Participates willingly in daily living activities with tactile components Distressed by environmental noises (vacuum cleaner, blender, siren, and toilet flush) Attends gatherings of all sizes Participates in community social activities Avoids gatherings such as birthday parties, malls, parades, restaurants, and church services Bothered by brightly colored or patterned materials Bothered by visually cluttered environments Bothered by food smells as well as smell of ronments household or hygiene products Avoids some environments because of smells
- Freely engages in sustained muscle activation or traction to joints
- Sensory under-responsivity describes children who exhibit less response to sensory information than the situation demands, taking longer time to react or requiring a higher intensity/longer duration of sensory messages Does not notice when touched Does not respond to pain, such as bumping, falling, cuts, or bruises Does not notice dirt, wet Does not notice something too hot or too cold Does not notice drooling or food on face Acknowledges unexpected sounds such as fire drills, hall bells, and so on , Attends gatherings and is a participating member in community social activities Does not respond when name is called Does not respond to verbal directions given only once Does not respond to unexpected loud sounds Tends to be quiet, passive, or withdraw in social situations Does not seek food when hungry
- Sensory seeking describes children who actively look for or crave sensory stimulation and seem to have an almost insatiable desire for sensory input (Table 6.4). Often, these children are in constant movement and may engage in unsafe behaviors to satisfy their need for sensory input. They can be seen as extreme risk takers, whose sensory needs interfere with attention. Touches people to the point of irritating them Difficulty taking turns when talking movies
- It is caregivers questionnaire, two different version, upto 3 years and other 4-11, which includes demographic details of child, it includes sensory and behavioural domains such as auditory, visual, touch, movement, body position, oral, conduct, social environment, attention, score key is 5 pt scale wt 1 being never and 5 being almost always. Scores are raw score, different items are combined and four quadrants are for seeking, avoiding, sensitive, bystander. Complete picture of children's sensory functioning at home, at school, and in the community. SPM consists of three forms: (2 to 5 years old) • Home Form • Main Classroom Form • School Environments Form Social Participation Vision Hearing Touch Body Awareness (proprioception) Balance and Motion (vestibular function) Planning and Ideas (praxis) Total Sensory Systems 4 POINT likert scale- Never, Ocassionaly, Frequently, Always Measure of Sensory Modulation Measure of Sensory Discrimination Measure of Posture and Praxis Assesses sensory processing across all sensory domains SCORING: 8 Domains : Visual, Tactile, Auditory, Vestibular, Proprioception, Postural, Praxis, and Complex Task Domains
- Three process are part of praxis ideation, planning and sequencing and execution.
- Ideation is the conceptualization of a goal and some idea of the steps necessary to achieve that goal. Children who have difficulty with ideation do not recognize play opportunities with novel toys Motor planning is the ability to automatically organize a motor act so that it can be performed or implemented. execution involves the implementation or production of motor movements. Offers the most complete and flexible assessment of sensory integration available 4 years to 8 years, 11 months 17 tests provide a comprehensive assessment The SIPT measures visual, tactile, and kinesthetic perception as well as motor performance. It is composed of the following 17 brief tests:
- Great Fear Of fall, even in absence of danger Height Frightened May avoid walking or jumping.
- POMD is Defined by the presence of meaningful cluster of the following
- GI was traditionally hypothesiszed could be result from poor modulation from otolith, with further studies it was considered another possible basis pertains to be the contribution of vp inputs to the development of body scheme and resolution of sensory conflicts
- Involve poorly coordinated use of two sides of the body and deficits in performing sequences of movement Hypothesized to reflect poor processing of vestibular and proprioceptive sensations
- Sensory discrimination refers to the individual’s ability to interpret and differentiate between the spatial and temporal qualities of sensory information—or the ‘‘where is it,’’ ‘‘what is it,’’ and ‘‘when did it occur’’ response.
- Able to track objects Able to localize and follow a moving target, Able to maintain stable vision with eyes moving or head moving, Difficulty keeping track of place on a page Difficulty following a moving object with eyes Difficulty copying from the blackboard Able to identify object in hand without looking Able to localize touch on body, Able to identify shape drawn on the back of the hand Awareness of position and body parts Has trouble performing fine motor tasks without looking Has trouble identifying an object in hand without looking Cannot discriminate shape drawn on hand Does not know where touched without looking Has difficulty maneuvering through space without bumping into objects Able to use graded force, timing, and distance appropriately in play and daily activities Able to detect body position in relationship to gravity Awareness of body position and weight of body part Able to maintain posture at table for class and home activities Poor extension against gravity Decreased core stability Poor balance Lack of postural background movements Delayed standing and walking balance Fatigues easily. Ability to sit still comfortably Ability to move through space without tripping and falling Established coordinated use of the two sides of the body and both hands, Falls over easily Poor oculomotor control while moving Poor body spatial awareness Poorly coordinated use of the two sides of the body, as in jumping, skipping, hopping, catching, or throwing a ball Right-left confusion Delayed or lack of hand dominance Poor lateralization of hand function
- Is an unconscious process of the brain • Organizes information detected by the senses
- Forms the underlying foundation for academic learning and social behavior, he brain must locate, sort, and organize all incoming sensory input • When sensations flow in a well organized and integrated manner, the brain can use those sensations to form perceptions, behaviors, and learning • When disorganized, everyday life can feel like a traffic jam
- hypothesized that there is a relationship between a person’s nervous system operations and self-regulation strategies, and that the interaction of these functions creates 4 basic patterns of sensory processing A “threshold” is the point at which there is enough input to cause a nerve cell or a system to activate. When a stimulus is strong enough to trigger the threshold, it causes activation, when a person has low sensory thresholds, this means that the person will notice and respond to stimuli quite often because the system readily activates to those sensory events. When a person has high thresholds, this means that the person will miss stimuli that others notice easily because the system needs stronger stimuli to activate. A second construct that is important to understand is self-regulation, a behavioral construct that is also on a continuum. At one end of the continuum, persons have a passive strategy; they let things happen around them, i.e response in accordance with threshold and then react response to counteract threshhold When these 2 continua intersect, 4 basic patterns of sensory processing emerge
- Opposed to improved motor skill for just the sake of skill development