Sensory Processing, Sensory Integration, Seating and
Access
By Karen M. Kangas OTR/L
6925 Upper Road, Shamokin, PA 17872 570-644-1032; Email: kmkangas@ptd.net
Occupational Therapist, licensed and certified Seating, Positioning & Mobility Specialist,
Assistive Technology Specialist, Clinical Educator, Consultant
Sensory Integration: “self initiated, self modulated, and self controlled”
1. The Body’s processing systems
a. Tactile processing, body is “resting”
b. Vestibular processing, body is “active”
2. Kinesthetic and Proprioceptive Senses 3. Coordinated Visual Sense
4. Motor planning, what is this really?
Physiological Process of Movement (“Physiology not physics”)
• Based on body’s need for survival and protection
• Moving within its sensory systems, primarily mobility and motor control utilize the tactile and vestibular
systems
Seating for Postural management: what we do to “manage” a child’s body, Imposed seating
• Safe, passive transport
• Being fed by another person, swallowing
• Body stillness, relaxation is necessary
• Primarily demands use of tactile system, tactile processing
• Needed when body is to be receptive
Seating for Postural Control, what is needed for the child to control her body,
situationally specific
• Independent control of movement
• Pelvic stability (which is control of mobility) is critical
• Utilizing weight bearing, especially pelvic
• Primarily demands use of vestibular system, vestibular processing
• Needed when body is to be active
Physiological Process of Movement cont. . . .
• Initiation of motor acts, new patterns vs.
automatic ones
• Transitional patterns, a precursor to isolation of movement, (ROTATION)
• Equilibrium reactions and postural
security are developed through active and independent movement, and are
DULLED
by lack of movement
Physiological Process of Movement cont. . . .
• Impact of independent mobility on cognitive exploration and understanding
• Moving with INTENT (intention)
• Stability is an “active” holding on/still
• Consistent (process) movement based on sensory-motor information
• Importance of routines, for anticipation of motor acts/control required
• Importance of novelty, for consistency development
• Repetition of activity vs. repetition of act
• Isolated patterns develop with functional demand and use, not from motor or visual –motor practice
• The task defines the motor act, NOT the ACCESS method.
Motor/muscle Tone, varies with diagnostic category
1. Cerebral palsy, quadraglegia, hemiplegia, diplegia
a. Spasticity, Athetosis, mixed b. Dystonia, mixed, ataxia
c. Rigidity
2. Hypotonicity vs. hypertonicity, really is tactile vs. vestibular processing
3. Other CNS disorders
4. Progressive disabling diseases (MD, SMA, OI, arthrogryposis)
5. Traumatic Brain Injury
Learning Styles and Learning Theory
1. Mastery of adaptation, development of mastery 2. Assimilation, Accommodation, Construction &
Conservation
3. Auditory, Visual and Combo
4. Cognitive conscious, Limbic emotional 5. Interest driven, curious, talents
6. Assumption of Competence
7. Development is not “hierarchical” but multi-leveled 8. We are all “learning disabled” or have “sensory
processing problems”
9. Lack of experience, enhanced anxiety
10. Speed of learning based on task, and all above and is individual in nature
11. Different tasks have different demands
A Definition of Access
How an individual is able to manage an activity of interest with intention,
independently
How to manage a particular machine at a particular time for a specific activity
which will produce an output (vocal or printed)
Old paradigms we need to leave behind
• Figuring out ACCESS first, before involvement in activity
• Finding the OPTIMAL site
(this is following adult paradigm of
assessment developed for those with acquired injuries or degenerative
disease)
New paradigms we need to embrace
– Access is the last, not the first – Child must know activity
• The machine, how it works
• The software the machine controls, the real activity
• How a method of access works, by seeing it work first
• Beginning, middle, and end of activity
• Repeating the activity in frequency, rather than in length of time
New paradigms we need to embrace
• In children, switch sites develop and increase
• Scanning can lead to direct selection
– (2 switch step, 3 switch mouse, head mouse)
• Direct selection and scanning can be used simultaneously, and task
specifically
Old paradigms we need to leave behind
• Seating for function is to be
restrictive, controlling the body
• The seating the child comes to school in, is the “right” seating for activity
• If only the student could hold up her head then we could work
• The student wants to use her hands
New paradigms we need to embrace
-Seating must allow for task participation and performance
-Seating must provide pelvic weight bearing for visual convergence
-Seating must be situationally specific, task specific and change
-For hands to work, heads must work, for heads to work, the pelvis must be weight bearing
Old paradigms we need to leave behind
-Consistent switch site/s exist and are to be “found” in assessment before
AAC/AT device use can occur
-Single switch scanning is where to start, it’s the simplest
-Use only one or two choices to begin, it’s easier
-”Hand over hand” helps the child learn to use her hands
New paradigms we need to embrace
• Access sites (body sites) develop from interest, intention, and experience with activity, not in
isolation
• Consistency is not what is needed, interest, intention, and attention are needed
• The activity must be known, with the beginning, middle and end obvious
• Repetition of the activity will bring anticipation of motor use and support its accuracy
• Motor learning requires: no verbal prompts, a mental rehearsal, and specific feedback at activity’s end
New paradigms we need to embrace
• The switch is NOT the activity
• Electronic (zero pressure) switches vs. mechanical switches for AAC, computer, mobility (automaticity and transparency)
• Don’t use automatic scanning first, 2 switch needed
• Set up activity for student to join, supporting postural control to the activity itself, and its anticipation
• Activities need to build, and be interesting, and complex
• Mistakes will be made, expected, and encouraged
• Alternative access must be used by others to support the “mental rehearsal” or “visualization”
New paradigms we need to embrace
• Work for short periods, frequent breaks, support knowledge of beginning, middle and end of activity
• Increase numbers of activity, to support a larger repertoire of experience and
control
• Expect real “access” to be revealed rather than “taught”
• The activity must be known, and contain success and challenge, risk and reward
Understanding CP/Tone Problems
• 1. Tone Management/relaxation
• 2. Use & knowledge of body postures
• 3. Sensory Integration inexperience
• 4. “Primitive” reflexes
• 5. Opisthotonic reaction/Startle reflex
• 6. Obligatory Reflexes/Extensor Spasm
• 7. Spasticity, Athetosis, Ataxia, Dystonia, Mixed
Molly, Christopher, Gretchen,
Connor Videos
Videos on-line
http:pattanat.com
1. “The Challenge of Developing Consistency of Access”
2. “The Challenge of Integrating the Use of AT equipment for independent
control and access of multiple systems”
