What Is Sensory Integration Therapy?

Introduction

Sensory integration therapy (SIT) is a therapeutic one-on-one intervention designed for children who struggle to process, interpret, and respond to sensory cues in their environment. SIT is mainly performed by trained occupational therapists and consists of systematic exposure to sensory input through a range of physical activities tailored to the client.

Sensory integration (SI) was first conceptualised by occupational therapist Dr. A. Jean Ayres in the 1970s, and refers to the recognition, integration and arrangement of sensory information received by our bodies from their surroundings.¹ Sensory integration is a neurological process that occurs throughout our lifetime and involves the internalisation of information from activities and actions that were taught during childhood, such as moving around, eating, learning and socialising. In other words, it describes the way our brain organises and responds to sensory information (sights, sounds, taste, touch, etc.).

The senses and their role in sensory integration therapy

The integration of sensory information occurs when incoming stimuli pass through our sensory modalities and reaches the brain. There are eight types of sensory processing systems in human beings:²

• Visual: sense of sight
• Auditory: sense of hearing
• Gustatory: a sense of taste
• Olfactory: sense of smell
• Tactile: sense of touch
• Vestibular: sense of the orientation of one’s body and its movements
• Proprioceptive: sensations from the muscles or joints
• Interoceptive: sensation from internal organs

The three sensory processing pathways often associated with sensory integration dysfunction are the tactile, vestibular and proprioceptive systems.²

Here is a brief overview of some of our senses and their contribution to sensory integration dysfunction:

Visual sense

The visual system enables the perception of visual stimuli. This pathway is responsible for receiving, processing, and interpreting vast amounts of visual information from our environment.³

Visual processing challenges may arise when the brain is unable to interpret and assign meaning to incoming sensory information. Some common examples of visual processing issues include an inability to learn the letters of the alphabet, reversing letters or words in writing, and difficulties in completing puzzles or games that require deep periods of concentration.³

Auditory sense

The auditory system is responsible for our sense of hearing. Every sound creates a vibration called a sound wave, which is picked up by short hairs in the ears and transformed into an electrical signal that can be detected and processed by the brain.⁴ Fun fact: the auditory system tends to respond faster to sensory stimuli than the visual system.⁵

Issues with the auditory system may not always be due to an abnormality in sensory integration. It is important to cross out other auditory complications first, such as hearing loss.

Individuals with auditory processing issues may have trouble understanding what is being said around them (especially in loud environments), struggle to follow verbal directions, and jumble up similar-sounding words, like ‘sister’ and ‘sitter’.⁶

Tactile sense

The tactile system is responsible for our sense of touch which allows human beings to feel touch sensations, including temperature and pain.⁷ Receptors on the surface of our skin send signals to our brain when we come into physical contact with something.

Modulation issues with the tactile system may manifest as a dysfunction in the ability to grasp an object with the correct amount of firmness, clumsiness tendencies (for example, defects in eye-hand coordination), and weak fine motor skills.⁷

Proprioceptive sense

The proprioceptive system sends information to the brain about the body’s positioning and spatial orientation at any given time. Receptors in muscles and joints sense the position of body parts and transmit signals to the brain to enable coordination and balance.⁸

Children and individuals with sensory processing issues may behave in a manner that is sometimes mistaken for disobedience or considered attention-seeking.⁸ However, these acts of ‘misconduct’ may be the individual’s way of coping with their sensory processing challenges. 

Some common examples of proprioceptive processing issues include someone struggling to kick or catch a ball, having to stare at their feet while walking to avoid falling and being unable to colour inside the lines at an age where that skill would be expected.⁸

Sensory integration dysfunction

When our brain fails to organise and interpret the information that has been brought in by any one of our eight senses, a condition known as sensory integration dysfunction occurs. People with this developmental issue struggle to socialise, and carry out everyday tasks perceived as normal by most, and often face learning and developmental challenges.⁹ Symptoms of sensory integration dysfunction vary depending on which senses are impaired.

Sensory modulation refers to the ability of the brain to regulate and appropriately respond to sensory inputs.¹⁰ Defects in sensory modulation, known as sensory modulation disorders (SMDs), are the result of imbalances in our body’s reactions to sensory inputs.

There are two main subtypes of SMDs: over-responsivity and under-responsivity.

Over-responsivity 

Sensory over-responsivity (SOR) occurs when an individual is hypersensitive to sensory stimuli and may have an exaggerated reaction to sensory input that others perceive as harmless.¹ 

Symptoms of sensory over-responsivity include:¹

• Sensitivity to the sensation of touch
• Strong (and often negative) reaction to loud sounds
• Uncomfortableness with the texture, shape, or temperature of certain foods

Under-responsivity

Sensory under-responsivity (SUR) occurs when an individual may not respond adequately to sensory stimuli and might even express a reduced reaction to sensory input that would normally elicit a heightened response in others.¹ 

Symptoms of sensory under-responsivity include:¹

• Failure to recognise when in pain
• Restlessness
• Delayed responsiveness to surroundings

Sensory integration therapy

Role of occupational therapists

Sensory integration therapy (SIT) is mainly conducted by occupational therapists who are trained to help children and individuals with sensory processing difficulties improve their ability to carry out everyday tasks. Occupational therapists develop a ‘sensory diet’ of activities that are tailored to the client to help counteract the sensory integration issues interfering with their everyday lives.

Sensory integration (SI) programs often involve exposing an individual with a sensory processing disorder to a range of activities that stimulate their senses and brain. As such, SI sessions may involve trampolines, climbing walls, and swings, as well as various exposure activities like touching different types of objects and substances to activate movement sensations in the body.⁹ 

Collaboration with other healthcare professionals

Sensory integration practitioners are mainly occupational therapists; however, other healthcare professionals like physiotherapists may be able to help treat physical symptoms of patients’ neurological conditions through movement- and balance-based activities.¹

Research and evidence supporting sensory integration therapy

Studies on the effectiveness of SIT

The value of sensory integration therapy for individuals with sensory processing challenges is not yet entirely clear. Whilst the limited amount of published research on SIT leaves us unable to draw definitive conclusions on its efficacy, its benefits have been highlighted. One major downside of many SIT studies involving children with sensory processing issues is that they do not follow up with their participants to understand and evaluate the long-term effects (both positive and negative) of the treatment regimen.

One recent study looked to evaluate the long-term effectiveness of occupational therapy sensory integration (OT-SI) for children with sensory processing challenges.¹¹ The results of this study showed that there was a statistically significant improvement in children’s ability to perform everyday activities after OT-SI.¹¹ These benefits were also evident 6-12 months post-OT-SI treatment. This breakthrough highlights the unique value of skilled occupational therapy services in improving an individual’s ability to perform everyday activities with ease and comfort.

Criticisms and debates within the scientific community

Despite the success of these research studies, one of the main controversies surrounding SIT is the limited amount of evidence supporting its long-term effectiveness. Additionally, many SIT studies have only tested small groups of children and testing parameters often vary between studies - making it hard to determine if SIT is truly responsible for these positive results.¹² More experimental research on the overall benefit of SI therapy needs to be carried out before definitive conclusions can be made.

Summary

Sensory integration therapy (SIT) is a therapeutic approach designed to improve the quality of life of children and individuals with sensory processing challenges. SIT involves working with a trained healthcare professional (normally an occupational therapist) to improve an individual’s response to sensory inputs via a program of various physical activities tailored to the client. 

Sensory integration forms an integral part of our daily functioning in everyday tasks, such as moving around or eating. An impairment in our brain’s ability to organise and react to the information that is being sent to it through our senses necessitates taking appropriate measures to remedy the fault. Any one (or combination) of our eight senses may be affected; however, dysfunctions in the vestibular, tactile, and proprioceptive systems are most commonly seen in patients with sensory processing disorders. Limited evidence on the effectiveness of SI therapy has sparked debate within the scientific and medical communities. However, recent studies have shown that SIT programs can have a significant long-term effect on the ability of the afflicted individual to carry out everyday tasks.