What is A Sensory Diet?



                                                                         


A sensory diet is a carefully designed, personalised activity plan that provides sensory input to a child or adult who needs to stay focused and organised throughout the day (Occupational Therapist Patricia Wilbarger). It is developed by an Occupational Therapist specifically according to person’s sensory needs and abilities. It is developed to achieve particular goals considering child’s preferences, limitations, and available resources.


For example, a child having touch sensitivities will be given a sensory diet of activities which will have a calming effect since they support oversensitive children to decrease hypersensitivity towards sensory stimulation.Fast light- touch sensations increase arousal levels whereas slow sensations have calming effects (Schaaf and Roley, 2001).
Activities such as deep pressure massage, pushing-pulling, sucking hard candy or fruit, hand push-ups, rocking, swinging, running, obstacle courses are some of the generalised examples.




Heavy work (movement against resistance or weight) activities provide proprioceptive input. It helps to regulate arousal levels both the ways meaning in calming the child over-aroused child and stimulating the under-aroused child. 


Sensory Diet is similar to the nutritional diet of the human body. As food and water are basic requirements for body’s survival as well as functioning, similarly sensory diet is essential for reaching, maintaining and improving child’s ideal (optimal) level of alertness. The aim of sensory diet is to support the child in becoming more focused, organised, adaptable and skilful. It helps the child to perform a meaningful task in a successful manner.


A child with low arousal (under-aroused) levels needs alerting activities, whereas a child with high arousal (over-aroused) levels requires calming activities. Due to sensory reactivity or modulation issues, a child may have poor self-regulation and emotional regulation skills (Schaaf & Roley, 2001). Personalised sensory diet helps to improve attention span and concentration levels hence improving the quality of life and academic achievement.


According to the founder of Sensory Integration Approach, Dr A Jean Ayres (1972), the child should be actively engaged in activity or therapy session, and sensory experiences should be matched with a “just right” challenge that requires the child to give an adaptive response. For example, a child with hyperactivity and impulsivity can be given calming activities such as pushing the wheelbarrow or counted chair push ups as a movement break depending on his level of hyperactivity, age, and physique

                                                                  
Children with Autism, Attention Deficit Hyperactivity Disorder (ADHD), Developmental Coordination Disorder (DCD), Developmental Delay have difficulties in sensory integration and praxis deficits causing problems in reading writing, copying from the blackboard, listening and understanding instructions in the classroom. Minimal to moderate noise, an odour of different environmental objects, visual sensitivities towards fluorescent light are some of the examples that do not bother a typically developing child while working or sleeping. This happens since child’s body “tunes itself automatically” and gets adapted to environmental demands. However, in an atypically developing child “tuning” component does not work well, causing the child to struggle at each step and every moment since his body has to “tune itself manually” to get adapted to environmental demands.


Due to slow information processing, any instruction or command given will take the time to process the information and then respond. The child will answer correctly to what has been asked, however, it may take a little time and hence person has to be patient.


The purpose of the sensory diet is to provide sensory “tune ups” throughout the day so that child keeps on getting input needed for information processing correctly. The activities recommended in a plan should have long lasting effect on behaviour as diet is the group of alerting, organising and calming tasks.


The child with sensory integration dysfunction needs an individualised diet of tactile, vestibular, auditory and proprioceptive nourishment that means all the activities should be based on these three sensory systems. Careful planning is the key to perfect sensory diet.



  What is Sensory Integration?       


As first described by Ayres (1972), sensory integration is defined as “the organisation of sensory information for use” (p.1). It is a neurological process that enables us to make sense of our world by receiving, registering, modulating, organising, and interpreting information that comes to our brains from our senses.

Researchers and clinicians have explored many aspects of sensory integration in a variety of populations including typically developing children, children with learning disabilities, Autism, Aspergers, and attention deficit hyperactivity disorder (ADHD). 

Recently Ayres Sensory Integration© trademark denotes the adherence to the core principles of Ayres original theoretical framework. This copyright distinguishes it from other often applied clinical practices.  Mailloux, Roley, and Glennon (2007) have been working on Ayres Sensory Integration Fidelity tool which is correlated to trademark.


Occupational Therapist's Role in Planning Sensory Diet:


Sensory Diets are planned by Occupational Therapy practitioners who use sensory integration therapy for intervention purpose. They are mostly trained in Sensory Integration which enables them to work precisely with children and adults having mental health issues. Due to the better understanding of child’s sensory processing difficulties and requirements they can formulate reliable and achievable goals along with intervention strategies. All the activities are aimed at enhancing the child’s ability to participate in the day to day chores within the school, home and community.

                                                                   

Referral: Occupational therapist receives a referral from  GP,  SENCO/ head teacher depending on Borough as each borough has different systems.On getting the referral, OT  communicates to family and makes observations from SI point of view.
OT efforts to discover child's strengths and areas of weaknesses as he assesses sensory challenges (e.g.- touch, smell, vision, movement, hearing) and motor difficulties such as  poor body awareness, handwriting difficulties, right and left discrimination and then  plans  activities according to child’s needs and abilities on discussion with child, parents or caregivers following the client-centred approach.

Comprehensive Assessment : The assessment and information gathering involves taking histories, structured interviews. The main sensory integration assessment involves touch, movement, sight, hearing, smell, pressure, and taste. Along with these areas, behaviour, body awareness, motor coordination, learning in a classroom, attention, emotional liability is also assessed within different settings. 
Sensory Checklists: Occupational Therapists carry out clinical observations in structured and unstructured environments, follow sensory checklists and  use the standardised assessment tool called as Sensory Integration Praxis Test (SIPT), SPM, and Sensory Profile. The OT should be trained and certified to administer SIPT assessment.

Education: Educates child and family about sensory Diet plan and how it works.

Setting Goals and Outcome Identification: Therapist sets achievable, flexible and systematic goals for the child. He selects and schedules activities according to child’s abilities and deficits. Therapist set’s appropriate goals which are compatible with family’s beliefs, ethics and religion. They should work well within a family routine.

Activities Selection & Sensory Diet Planning: Activities are planned in correlation with goals. Mainly activities involving three sensory systems - tactile, vestibular, and proprioceptive are chosen since they are baseline systems for all behaviours. For example, child doesn’t like to be touched or hair washed, happens due to deficits in touch system, likes too much of movement or rocking happens due to deficits in vestibular system (sensory seekers), lacks body awareness, happens due to proprioceptive difficulties or is a picky eater happens due to oral hypersensitivities.So the activities are planned depending on sensory system deficits and careful planning is the key to sensory diet.

Follow-up: After a period of time therapist re-analyses effectiveness of intervention Plan. Activities are changed as the child able to accomplish the "just right" challenge. Activity modification and task gradation while measuring the outcome of the intervention is an important part of therapy plan. 


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