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The goal of occupational therapy at the Cerebral Palsy (Spastic) Children’s Association of Penang (CPCAP) is to increase children’s participation in the activities of daily life. It places importance on meaningful and purposeful functional tasks and activities performed throughout life. This is carried out by enabling people to do things that enhance their ability to participate or by modifying the environment to better support their participation.
At CPCAP Occupational Therapy enables children with cerebral palsy to participate in activities of daily living that are meaningful for them. Occupational Therapy can provide children with positive, fun activities to enhance their cognitive, physical, and fine motor skills and increase their self-esteem and sense of accomplishment. An Occupational Therapist too has to look into the needs of using orthosis, seating equipment, and wheelchairs according to individual requirements. Children with cerebral palsy also have Sensory Integration dysfunction. Sensory Integration is the ability to organize and process sensory information from our body as well as from the environment, to perform goal-oriented behavior. Children with cerebral palsy may experience decreased sensation or a limited understanding of how the brain interprets what it sees.
To improve the services provided, the Sensory Integration unit was set up to provide sensory-perceptual-motor (SPM) training for children with cerebral palsy who have sensory integration dysfunction. This sensory-perceptual-motor training teaches the children to process the sensory inputs and produce organized behavior which will improve their daily functional abilities.
WHAT IS SENSORY INTEGRATION?
Sensory integration is about how our brain receives and processes sensory information so that we can do the things we need to do in our everyday lives. Jean Ayres defined sensory integration as: “The neurological process that organizes sensation from one’s own body and from the environment and makes it possible to use the body effectively with the environment” (1972)
THE 8 SENSES
In sensory integration, we are interested in all 8 senses. You can probably immediately think of 5 only – seeing, hearing, tasting, smelling, and the sense of touch. The other three are proprioception, vestibular, and interoception, these are defined below.
PROPRIOCEPTION
Our muscles and joints have tiny sensory receptors that tell our brain where our body parts are. When you put a spoon to your mouth, you don’t need to look at the spoon to see where it is or feel for your mouth to know where to place the spoon; you know where your hand is in relation to your mouth. Your brain then uses this information to plan movements so that you can coordinate your body.
VESTIBULAR
In our inner ear, we have small, fluid-filled canals, the fluid in these canals moves every time we move our head. Receptors in these canals pick up the direction of movement and send this information to our brain. So we know if we are moving forward, backward, side to side, tilting our head, turning around, or moving up and down. Once again, our brain uses this information to plan for movements and help us maintain our balance.
INTEROCEPTION
Interoception is how our body tells our brain what is going on inside our body when we are hungry or feel full, when our heart is beating fast, or when we have that sensation of butterflies in the stomach. Jean Ayres was particularly interested in the interaction between and development of the vestibular, proprioception, touch, vision, and hearing. She saw these as important in supporting our ability to use our body, concentrate, develop self-esteem and confidence as well as having self-control and academic skills. We continue to see the link between poorly developed senses and these abilities both in research and in practice.
SENSORY INTEGRATION PROBLEMS
Recently Parham and Mailloux (2015) identified four categories of sensory integration problems
1. Problems With Sensory Modulation
Problems with sensory modulation occur when our brain either over-responds to or under-responds to sensory information. Problems with modulation can cause the person to become anxious, fearful, angry, and frustrated.
2. Sensory Discrimination and Perceptual Problems
This is when the brain has difficulties making sense of the sensory information it receives. The person then struggles to interpret subtle differences in the sense.
3. Vestibular-Bilateral Functional Problems
These problems are a result of problems with our vestibular sense and can result in poor balance and difficulties with coordinating two sides of the body.