Presentation 5: What are sensory integration (SI) and Disfunction of SI? M. Windsor, ScD, OTR/L

The influence of SI on motor development and skill

Dyspraxia and Postural Disorders are associated with poor organization and motor performance. Tactile and proprioceptive processing deficits usually underlie sensory integration-based dyspraxia (deficits in praxis).

Praxis is the term that refers to the ability to plan and execute motor functions that are nonhabitual and require skill. In SI theory, it is hypothesized that there are several components of praxis that must be examined for assessing the performance problems and developing interventions. These are:

• Ideation (a cognitive understanding such as knowing that a chair is used for sitting, a ball is used for throwing; it involves conceptualizing the use or possibilities of an object or situation; it is predicated on the assimilation of information from appropriate experiences);
  
  
• Planning (the ability to develop a method to successfully accomplish the task, action; this often involves the ability to initiate, to sequence, and to terminate individual movements or patterns);
  
  
• Execution (the physical ability of the muscles/body to move; most SI therapy concentrates on ideation and planning; severe problems in execution usually involve diagnoses such as cerebral palsy which require use of additional theories and techniques. Although SI can and should be used in comprehensive intervention for such children, it is generally not used in isolation of other theories such as motor-learning).

Vestibular Processing Disorders may interfere with communication between the two sides of the brain, ability to cross the body midline during motor performance and sequencing skilled movement. These are all important components for high level fine motor skills.

A brief explanation of the underlying theory is that information from the sensory systems, (particularly, tactile, vestibular, proprioceptive) contribute to the child's development of a body scheme (an internal geographical representation of body parts, location, attributes, etc. that are refined with experience, age, and development). This body scheme provides the child with a point of reference for interaction. Initially it is global (e.g. the child differentiates him or herself from the blanket on which he or she lay); it becomes more refined (e.g., the child is aware that he or she can successfully use a hand to swipe a toy) and more differentiated (the child automatically stabilized the shoulder and arm to allow the fingers to manipulate puzzle pieces for placement in a form).

Bilateral integration (communication between the two sides of the brain) is thought to be associated with sensory processing, particularly within the vestibular system and is important for specialized developmental events. A concept of body midline (a tacit awareness of a center of the body comprised of two sides; a continuing refinement of body scheme;) emerges form further sensory processing of experiences (within and without the body) and provides a reference point for motor, cognitive, and social functions. This is the basis for bilateral motor coordination (skilled use of two sides of the body together); crossing the midline (using the right hand in the left field of vision and vice versa); sequencing (performing two or more movements, tasks, etc. in order), and complementary hand use (one hand holds the paper stable, while the other manipulates the scissor for cutting). Hand or extremity preference for specific motor skills (such as holding a pencil) is a natural progression in the developmental trend of bilateral motor coordination. Please note that preference is developed after use of two sides of the body well, not from having a "good" side and a "bad" side.

Bilateral integration and coordination are also the core foundations for laterality (awareness of one side of the body; one being the right side, the other being the left side) and directionality (expanding the concepts of left and right to objects other than the self). It is quite evident why early and varied experiences with proper sensory processing are important contributors to successful, functional adaptations in life, the goal of Sensory Integration Treatment.

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