Occupational Therapy
Occupational Therapy (OT) for children helps develop physical and adaptive skills that will help the child improve interactions and functional skills in the physical and social world. The functional skills that OT focuses on developing are related to sensory-motor integration, which allows the child to accurately interpret and organize information from the senses. Areas addressed include: the use of hands and fingers, co-ordination of movement, self-help skills, such as dressing, eating with a fork and spoon, tying shoe laces, fine and gross motor skills; positioning for school work, and handwriting.

• What is Sensory Integration?
• Sensory Integration Disorders
  Overly Sensitive (Sensory Defensiveness)
  Under Reactive to Sensory Stimulation
  Coordination (motor planning deficit)
  Summary
• How Do I Know if an Individual Has Sensory Integration Dysfunction?
• What is Fine Motor Development?
• What is Gross Motor Development?

What is Sensory Integration?
Every moment we get a great deal of information from our senses. We use this information to organize our behavior and successfully interact with the world. Our senses give us information about the physical status of our body and the environment around us. We are all aware of the common senses, such as sight, touch, taste, smell and hearing. However, there are other “hidden” sensations, which are just as essential to our survival. Our nervous system detects changes in movement and gravity, which impacts our balance and movement, and is called the vestibular system. This sensory system provides us with knowledge of the position of one’s head in relation to gravity and movement. We use this to go down a slide, or to ride a playground swing without falling off. The other “hidden” sense is our muscle and joint sense (proprioception), which is the internal awareness of the position of one’s joints and muscles in space. This allows us to lift a spoon to our mouths without spilling our soup, or to hold a pencil and write using appropriate pressure on the pencil so as not to fatigue while writing in school.

Sensory Integration Disorders
In our daily routine almost everything we do requires adequate sensory integration. But what happens if one or more of our senses are not being interpreted properly by the child’s nervous system? This child would not feel the usual security, safety and fun that other children feel when they learn something new, especially through play and interaction.

When the process of Sensory Integration is disordered, a number of problems in learning, motor development or behavior may be observed:

• Overly Sensitive (Sensory Defensiveness):
  Distractible and disorganized in a busy environment (loud sounds, lots of uncontrolled movements, during transitions and when is touched lightly or unexpectedly). Avoidance of certain textures, clothes, and food. Fearful reaction to ordinary movement. Acting aggressively with unexpected sensory input (Fight-Fright-Flight).
• Under Reactive to Sensory Stimulation:
  Seeks out intense sensory experiences such as body whirling, falling and crashing into objects. May appear oblivious to pain or to body position. May fluctuate between under and over responsiveness. It might appear with an unusual high/low activity level. Constantly on the move or may be slow to get going, also may fatigue easily.
• Coordination (motor planning deficit):
  May have poor balance. May have great difficulty learning a new task that requires motor coordination (cursive writing), or appears awkward, stiff and clumsy. Poor crossing body midline, affecting child’s handwriting, gym, socialization and the ability to learn new academic concepts.

Summary:
The senses work together. Each sense works with the others to form a composite picture of who we are physically, where we are, and what is going on around us. Sensory integration is a critical function of the brain that is responsible for producing this composite picture. It is the organization of sensory information for on-going use. For most of us, effective sensory integration occurs automatically, unconsciously, and without effort. For some of us, the process is inefficient, demanding effort and attention with no guarantee of accuracy. When this occurs, our goals are not easily attained.

Finally, the goal of sensory integrative therapy is to facilitate the development of a child’s ability to process sensory input in a more efficient way. Sensory integration is a term for a process in which the normal brain pulls together all of the various sensory messages in order to form coherent information on which we can act.

How Do I Know if an Individual Has Sensory Integration Dysfunction?
An individual may need to be referred for an occupational therapy evaluation if difficulties are seen in several of these areas or if one area causes major functional problems.

• Has difficulty regulating sleep/wake cycle--settling for sleep, staying asleep, and waking without irritability.
• Is over-sensitive to stimulation--over-reacts to touch, taste, sounds, or odors.
• Was unusually fussy, difficult to console, or easily startled as an infant.
• Strongly dislikes baths, haircuts, or nail cutting
• Uses an inappropriate amount of force when handling objects, coloring, writing, or interacting with siblings or pets
• Was slow to roll over, creep, sit, stand, or walk, or to achieve other motor milestones.
• Has poor muscle tone, fatigues easily, leans on people, or slumps in a chair
• Is clumsy, falls frequently, bumps into furniture or people, and has trouble judging position of body in relation to surrounding space
• Has difficulty learning new motor tasks; experiences frustration when attempting to follow instructions or sequence steps for an activity.
• Avoids playground activities, physical education class, and/or sports
• Does not enjoy age-appropriate motor activities such as jumping, swinging, climbing, drawing, cutting, assembling puzzles, or writing.
• Finds it difficult to make friends with peers; prefers to play with adults or younger children.

What is Fine Motor Development?
Fine motor is the developmental area that involves skills which require the coordination of the small muscles of the body, including those of the hands and face. Examples of fine motor skills include stacking small blocks, picking up small objects between thumb and finger, stringing beads, tracking an object with the eyes, smiling, using the toes to wriggle into sand or the lips and tongue to taste and feel objects.

What is Gross Motor Development?
Gross motor is the developmental area for the movement of the large muscles of the body, movement involving the arm, leg, or feet muscles or the entire body. These muscles are needed to carry out day-to-day activities in and around the play area and school, like running and jumping.

Gross motor and fine motor skills develop in tandem because many activities depend on the co-ordination of both sorts of skills.

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