Thursday, April 06, 2006

Research into Sensory Processing / Sensory Integration Disorders

At the end of this month, we're headed to AOTA, or the American Occupational Therapy Association in North Carolina to give a workshop, so here are some recent articles of interest.

For those unfamiliar with sensory processing disorders, these are not uncommon clusters of symptoms and behaviors resulting from usually brain-based sensory-sensory or sensory-motor mismatches. There are many different causes (for instance, mild injury, autism spectrum disorders, premature birth, untreated sensory problems in one modality, like vision or hearing, or even something that seems to run in the family), but improvement is almost always the rule with targeted therapy or training. The field is still bedeviled by problems of definition and standards for best practices, but it has come a long way in the last few years.

One of the reasons sensory processing disorders are so common is that in the brain, sensory pathways have to travel a long way to their targets. And in many conditions, chances are some injury or mismatch might happen somewhere. Throughout history, objective examination of the sensory system has bedeviled neurologists because symptoms were difficult to describe by patients (and not always fully conscious), and it was difficult objectifying pathology. In fact, it was only when some prominent neurologists decided to cut their own peripheral nerves and characterize the changes, that the bedside sensory exam really advanced (but that is another story!).

Here are the take-home points from articles:

- Proprioception (sensation of body position in space) has growing recognition as a dominant factor in motor imagery, motor coordination, and athletic expertise.

- Proprioception is not a fixed capacity at birth. It develops throughout childhood, and significant improvement can be seen from ages 8-10 to ages 16-18.

- Artificially-induced sensory-motor mismatches result in anomalous sensory symptoms in 66% of healthy volunteers. Excerpt: "Symptoms of pain were described as numbness, pins and needles, moderate aching and/or a definite pain. Other sensations included perceived changes in temperature, limb weight, altered body image and disorientation." This is interesting and may account for some SPD kids tactile sensitivity or sensory complaints.

- More on sensory-motor coordination via the cerebellum in kids diagnosed with Asperger Syndrome (bottom link). Although many different children and teens seem funneled into the AS label, we also see cerebellar signs are prominent in a majority of them. Cerebellar problems give rise to problems like "clumsiness" and low tone, dysgraphia, and motor planning difficulties. The biggest problem by the way, is that the way Aspergers is diagnosed these days, many may never get evaluated by a neurologist. At least among our clinic referrals, we see many children who would have been diagnosed with DCD or developmental coordination disorder some 5-10 years ago, now labeled Aspergers instead.

Pain with Sensory-motor Incongruence - Abstr
Proprioception Develops
Eide Neurolearning Blog: The Biology of Sound Sensitivity
Intro Ppt- Tactile Perception and Haptic Interaction
Proprioceptive in Motor Imagery- Abstr
Proprioception in Tennis - Abstr
Cerebellar Signs in Asperger Syndrome

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