Sensory-Motor Integration Disorder

The OT assesses how well a child receives, interprets, and responds to sensory input from their environment. This includes evaluating responses to stimuli such as touch, movement, sight, sound, and body position (proprioception).

• Tactile processing: The OT observes the child’s response to different textures and touch. Is the child overly sensitive (avoiding touch or certain textures) or under-responsive (seeking out touch or appearing indifferent to it)?
• Vestibular processing: The OT looks at how the child responds to movement and balance activities, such as spinning, swinging, or walking on uneven surfaces. Children with vestibular processing issues may feel dizzy or unsteady or avoid movement altogether.
• Proprioceptive processing: The OT assesses the child’s ability to sense their body position and control their movements. The therapist may look at how the child navigates physical space, uses appropriate pressure when grasping objects, and coordinates movements.
• Auditory and visual processing: The OT may observe how the child responds to visual stimuli (like lights or tracking objects) and sounds (such as loud noises or music). Children may be hyper- or hypo-sensitive to these inputs.

The OT assesses how the child’s motor skills are impacted by sensory processing. This includes evaluating both fine and gross motor coordination.

• Fine motor skills: The OT evaluates the child’s ability to perform tasks that require small, precise movements, such as grasping, manipulating small objects (e.g., beads, buttons), cutting with scissors, or writing with a pencil.
• Gross motor skills: The OT assesses the child’s ability to perform larger movements, such as running, jumping, balancing, climbing, or navigating playground equipment. Coordination during activities like catching or throwing a ball is also observed.

Motor planning, also known as praxis, is the ability to conceive, plan, and execute motor actions. Children with sensory motor integration disorders often struggle with dyspraxia (difficulty with motor planning), which the OT evaluates through various activities.

• Imitation and copying: The OT may ask the child to imitate actions, such as clapping hands, or to follow simple movement sequences like hopping or skipping.
• Novel tasks: The OT may introduce unfamiliar tasks or activities to see how well the child plans and executes the movements required to complete them.
• Sequencing movements: The OT evaluates how well the child can organize and execute multiple steps in the correct order, such as stringing beads or following a multi-step instruction (e.g., get a ball, throw it, and return).

Postural control and balance are critical for stability during movement. The OT assesses the child’s core strength, stability, and balance while performing various activities, such as:

• Sitting upright in a chair without slouching or leaning.
• Standing on one foot or balancing on a stability ball or balance beam.
• Performing activities that challenge dynamic balance, such as walking on uneven surfaces or hopping.

The OT assesses muscle tone and strength, as these factors influence a child’s ability to control movement. Children with sensory motor integration disorders may exhibit low muscle tone (hypotonia) or high muscle tone (hypertonia), which can affect movement and posture.

• Hypotonia: The OT evaluates whether the child appears floppy, tires easily, or has difficulty maintaining upright posture.
• Hypertonia: The OT looks for signs of excessive muscle tightness, rigidity, or difficulty in fluid movement.

Bilateral coordination refers to the ability to use both sides of the body in a coordinated way. The OT assesses the child’s ability to perform tasks that require two-handed or two-sided coordination, such as:

• Catching or throwing a ball using both hands.
• Cutting with scissors (requiring one hand to hold the paper while the other cuts).
• Climbing or performing tasks that involve cross-lateral movements (e.g., crawling, where one hand moves with the opposite leg).

Visual-motor integration is the ability to coordinate visual input with motor output, a key component of many daily tasks. The OT assesses the child’s ability to perform tasks such as:

• Drawing, tracing, or copying shapes.
• Catching or hitting a moving object.
• Completing puzzles or mazes that require precise eye-hand coordination.

The OT assesses how sensory and motor challenges affect the child’s ability to perform daily living tasks, such as:

• Dressing (zipping, buttoning, tying shoelaces).
• Feeding (holding utensils, drinking from a cup without spilling).
• Grooming tasks like brushing teeth or hair.

Children with sensory motor integration issues often have distinct behavioral responses to sensory stimuli, which the OT will observe. This can include:

• Sensory seeking behaviors: Some children may seek out sensory input, such as crashing into objects, spinning, or seeking strong pressure through tight hugs or heavy lifting.
• Sensory avoidance: Other children may avoid sensory input, showing distress or withdrawing from certain textures, sounds, or movements.
• Emotional regulation: The OT evaluates how well the child can regulate emotions and behavior when faced with overwhelming sensory inputs. Children may become easily frustrated, anxious, or dysregulated in response to certain stimuli.

The OT looks at how the child adapts to new sensory or motor challenges. For example:

• Does the child respond to sensory input appropriately?
• Can the child adjust their body movements based on environmental feedback, such as stepping over obstacles or catching themselves when they begin to lose balance?

A tailored plan of sensory activities that the child engages in throughout the day to regulate their sensory system. These activities might include:

• Swinging or spinning (vestibular input).
• Jumping on a trampoline or heavy lifting (proprioceptive input).
• Play with different textures (tactile input).
• Visual stimulation games, like catching bubbles or following moving objects.

Using weighted vests, blankets, or compression garments to help the child feel more grounded and calm.

Encouraging movement through obstacle courses, balancing on a stability ball, or using balance beams to improve vestibular processing.

Incorporating sensory bins, play dough, finger painting, and other textured materials to help desensitize or engage the child’s tactile system.

Activities that involve using the hands and fingers in a coordinated way, such as:

• Cutting with scissors.
• Stringing beads or placing small objects in containers.
• Practicing handwriting or drawing to enhance visual-motor coordination.
• Building with blocks or Lego sets to improve dexterity.

Activities that require using both sides of the body together, such as:

• Jumping jacks.
• Throwing and catching with two hands.
• Playing on playground equipment (monkey bars, ladders).

Activities that engage the abdominal and back muscles to improve overall stability, such as:

• Plank exercises or yoga poses.
• Rolling on an exercise ball or holding balance positions.
• Wheelbarrow walking or crab walking to improve upper body strength.

Encouraging activities that improve sitting balance, such as sitting on a therapy ball during tasks, or practicing maintaining an upright position during fine motor work.

Designed to require the child to navigate various motor challenges, such as climbing, crawling, jumping, and balancing. The complexity can be adjusted to challenge motor planning abilities.

Activities that involve multiple steps in sequence, such as setting up a game, preparing a snack, or completing a puzzle.

Playing “Simon Says” or copying movements in a mirror to enhance the child’s ability to imitate and sequence actions.

Teaching the child coping strategies to calm down when overstimulated, such as:

• Deep breathing exercises.
• Using calming sensory tools like fidget toys, stress balls, or weighted blankets.
• Engaging in repetitive or rhythmic activities, like rocking or swinging, to self-regulate.

Creating consistent routines that help the child anticipate sensory inputs and transitions, reducing anxiety and meltdowns.

Encouraging activities that promote emotional awareness and control, such as labeling emotions, using social stories, or implementing visual schedules to manage transitions.

Providing sensory breaks, fidget tools, or a quiet corner for the child in school.

Creating sensory-friendly spaces at home with access to calming tools (like a quiet room, dim lighting, or sensory bins) to help the child regulate when overwhelmed.

Introducing tools like chewable jewelry for oral sensory needs, noise-canceling headphones, or wobble cushions for sitting to help with focus and sensory regulation.