Download Sensory Motor Approaches with People with Mental Illness Week 5

Sensory Motor Approaches with
People with Mental Illness
OT 460A
Surprise!!
• Sensory motor approaches are not just used
with children!!
• There can be sensory motor issues throughout
life
• There can be sensory motor issues related to
multiple illnesses and injuries
Sensory Systems According to Ayres
• Primary Level: Three basic sensory systems
– Vestibular (Ayres viewed this as the unifying
system)and Proprioceptive:
• facilitates gravitational security
• Involved with balance, eye movements, posture, muscle
tone
– Tactile:
• facilitates emotional bonding and attachment to mother
• Can facilitate calming and comfort
Sensory Systems According to Ayres
• Vestibular, Proprioceptive, and Tactile
Systems:
– Responsible for grounding the person and for
giving him or her the necessary information
needed to orient the self to the environment and
prepare for an adaptive response
Sensory Systems According to Ayres
• Second Level:
– Three basic senses (vestibular, proprioception, and
tactile) are integrated into:
• Body precept (maps of the body stored in the brain)
• Coordination of two sides of the body: allow bilateral
work to accomplish tasks
• Plan motor actions
• Attention and focus: issues are reflected by hyper or
hypoactivity
Sensory Systems According to Ayres
• Third Level:
– Impact of auditory and visual sensations make the
following possible:
• Speech and Language: begins with primary level
sensory systems and builds on these
• Eye-hand Coordination: begins with primary level
sensory systems and builds on these with the visual
system directing the hand
• Visual Perception: intimately related to tactile and
vestibular systems and is believed to be the end
product of earlier sensory integration
• Purposeful Activity
Sensory Systems According to Ayres
• Fourth Level is resultant end products of
sensory integration:
– Ability to organize and concentrate
– Self-esteem
– Control and confidence
– Academic learning ability
– Capacity for abstract thought and reasoning
– Development of dominance and hemispheric
specialization
Sensory Systems According to Ayres
• Beliefs
– Adaptive Response or Self-Adjusting Process
• Sensory Modulation: the brain organizes incoming
sensory information
– Brain inhibits or facilitates the flow of messages across nerve
junctions and synapses
– The repeated use of nerve pathways in a
sensorimotor function creates a neural memory or
map of that function
• The brain can recreate the movement at other times
Sensory Systems According to Ayres
• Beliefs:
– Hierarchical View: Must work developmentally
and sequentially
– For example, don’t teach hand movement to
improve eye-hand coordination unless you’ve
started with integration of vestibular,
proprioceptive, and tactile, the early systems
Sensory Integration Interventions
• Goal of S.I. Intervention:
– Improvement in CNS processing, specifically in
production of adaptive response instead of
isolated skill development
• Treatment:
– Sensory input within an environment that it can
be modulated
– Specific techniques to supply sensory input, e.g,
joint compression, rotary vestibular stimulation
New Theoretical Approaches Since
1970s in Contrast to Ayres
• Systems view of the brain in which the brain is an
integrated, holistic system.
• Sensory integrative dysfunction is due to multiple
interrelated systems that are not functioning
optimally
• Trend is to combine S.I. With other approaches, like
humanistic psychology
• Ross: Incorporate neurodevelopmental approaches,
e.g., NDT, with sensory stimulation
Sensory Systems According to King
• Lorna Jean King’s (One of Dr. Brayman’s and Robin’s
favorites!) focus on Schizophrenics
– Observed patients to determine sensory seeking
– Linked vestibular system abnormalities with physical
characteristics similar to Ayres’ children:
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Poor muscle tone
Dislike of movement (fear of falling)
Lack of response to vestibular input
Limited mobility of the head
“S” curvature of the spine (lordosis)
Shuffling gait
Holding arms and legs in a flexed, adducted, and internally rotated
position
• Poor balance
• Weak grip strength and atrophy of thenar eminence
Sensory Systems According to King
• King’s hypotheses:Schizophrenic clients have:
– Defective proprioceptive feedback mechanisms and
under-reactive vestibular systems
• Patient use sensory input effectively to determine position in
space
• Patients are unable to move fluidly
• Patient limits movement and this causes more problems
• This leads to decreased engagement in physical activity and
discomfort in social situations
– Movement and sensation play central roles in altering
biochemical states and biochemistry in turn affects
movement
Interventions According to King
• Pleasurable, noncortical activities: Start
subcortically by doing activities that increase
proprioceptive and vestibular input, e.g.,
dance
– Goal is to normalize movement patterns,
strengthen upper trunk stability, and increase
flexibility
• Changes in these areas will lead to improvements in
body image, self-confidence, attention, social skills
• Changes are the foundation for building cognitive and
daily life skills
Problems with King’s Theories
• No standardized assessment tools to evaluate
S.I. in adults
• Lack of evidence-based practice: studies were
inconclusive
Sensory Motor Strategies
• Consider alerting versus calming sensations
• Control the amount of sensory input within
the environment
• Therapist’s role is to be directive, yet, have fun
and be spontaneous
Goals of Sensory Motor Treatment
• Provide sensory stimulation and opportunities for
adaptive responses
• Focus on muscle tone, posture, and motor planning
• Provide motivation to participate through sensory
input
• Start with lower cognitive skills to build higher ones
• Provide multiple opportunities for practice of
functional tasks
• Reinforce achievements