Understanding Sensory Processing Patterns: A Physiotherapist's Perspective

Sensory Processing in Physiotherapy

Sensory processing refers to the way our nervous system receives, interprets, and responds to sensory information from the environment in the form of external stimulus and our own bodies in the form of internal stimulus. This information is gathered through our senses, which include sight, hearing, touch, taste, and smell, as well as proprioception (awareness of body position) and vestibular (balance and spatial orientation) input. In physiotherapy, a deep understanding of sensory processing is essential.

Patterns of Sensory Processing

Sensory processing patterns refer to how individuals perceive and respond to sensory stimuli in their environment. Understanding these patterns is essential for physiotherapists when assessing and treating patients with various musculoskeletal and neurological conditions. Here are the three primary patterns of sensory processing:

Sensory Modulation Patterns:

Sensory modulation refers to how an individual regulates or modulates their responses to sensory stimuli. There are three main subtypes within sensory modulation patterns:

•  Sensory Over-responsivity (Sensory Avoiding): 

Individuals with this pattern are hypersensitive to sensory input. They may avoid or become easily overwhelmed by sensations like touch, sound, or light. For a physiotherapist, understanding this pattern is crucial to adapt treatment techniques to minimize sensory discomfort. For example, using softer materials for therapeutic equipment or reducing background noise during sessions.

 

• Sensory Under-responsivity (Sensory Seeking): 

In contrast, individuals with sensory under-responsivity may seek more intense sensory input to feel sensations adequately. They may appear unaware of or unresponsive to certain stimuli. A physiotherapist should be aware of this pattern to engage the patient effectively in therapy, possibly using sensory-rich activities to maintain their attention and motivation.

 

• Sensory Craving: 

Some individuals have a sensory craving pattern, which means they actively seek out sensory experiences. They may enjoy activities that provide deep pressure, intense movement, or strong sensory input. A physiotherapist can incorporate sensory-rich exercises or equipment to engage and motivate patients with this pattern.

 

Sensory Discrimination Patterns:

Sensory discrimination patterns involve how well an individual perceives and interprets specific sensory qualities. These patterns are essential for fine-tuned motor control and coordination. For a physiotherapist, understanding a patient's sensory discrimination abilities can guide treatment planning:

 

• Sensory Discrimination Deficits: 

Some individuals may struggle to differentiate between sensory stimuli, leading to challenges in tasks requiring precision. Physiotherapist can tailor exercises to improve sensory discrimination, enhancing motor control and coordination.

 

• Sensory Discrimination Excess: 

In contrast, individuals with heightened sensory discrimination may notice subtle differences but may become overwhelmed by them. This pattern can affect their ability to filter out irrelevant sensory information during therapy. Physiotherapist should create an environment that minimizes distractions and helps the patient focus on relevant cues.

 

Sensory-Based Motor Patterns:

Sensory-based motor patterns relate to how sensory input influences an individual's motor responses and movement patterns. Understanding these patterns is critical for physiotherapists when designing rehabilitation programs:

• Postural Responses: 

Sensory input, particularly from proprioception and vestibular senses, plays a significant role in postural control. Physiotherapist need to consider these inputs when working with patients to improve balance and coordination.

 

• Motor Planning: 

Some individuals may have difficulties with motor planning due to sensory processing challenges. They may struggle with sequencing movements or adapting to changes in the environment. Physiotherapists can design exercises that focus on motor planning and adaptability.

• Sensory-Motor Integration: 

Successful motor function often depends on the integration of sensory input and motor output. Physiotherapists should assess how well a patient's sensory processing supports their motor skills and adjust interventions accordingly.

Examples of conditions where sensory processing is used:

• Autism Spectrum Disorder (ASD)
• Attention-Deficit/Hyperactivity Disorder (ADHD)
• Sensory Processing Disorder (SPD)
• Post-Traumatic Stress Disorder (PTSD)
• Fibromyalgia
• Stroke
• Multiple Sclerosis (MS)
• Parkinson's disease
• Alzheimer's Disease and Dementia
• Chronic Pain Conditions
• Cerebral Palsy

 

Role of Sensory Processing in Physiotherapy

Sensory processing plays a fundamental role in physiotherapy by influencing how patients perceive and respond to sensory stimuli related to movement, touch, balance, and pain. Physiotherapists use their understanding of sensory processing to design effective treatment plans and interventions for individuals with various musculoskeletal and neurological conditions. Here's how sensory processing helps in physiotherapy:

Assessment:

Physiotherapist begin by assessing a patient's sensory processing abilities, it includes:

• proprioception (awareness of body position)
• vestibular function (balance and spatial orientation)
• tactile sensitivity (sensitivity to touch)

Assessment tools and clinical observations help determine whether sensory processing issues may be contributing to the patient's condition. Below is an overview of what the assessment process should contain:

• Patient History
• Clinical Observations - Pay attention to their posture, facial expressions, and any signs of discomfort or sensory-seeking behaviors.
• Sensory History Questionnaires
• Sensory Profiling - Conduct sensory profiling to assess sensory preferences and sensitivities. This can involve activities such as having the patient rate their comfort level with various sensory stimuli (e.g., textures, sounds, tastes) or using sensory preference scales.
• Direct Sensory Assessment - include the Romberg test to assess balance and the assessment of joint position sense to evaluate proprioception.
• Observation of Motor Function - Assess whether sensory processing challenges impact their ability to perform activities of daily living or specific motor tasks.
• Behavioral Observations - Note any sensory-seeking or sensory-avoiding behaviors, as well as their ability to adapt to sensory challenges.
• Standardized Sensory Processing Assessments - use of standardized assessments such as the Sensory Integration and Praxis Test (SIPT) or the Sensory Processing Measure (SPM) to provide a structured evaluation of sensory processing abilities.
• Environmental Assessment - Evaluate the patient's living and working environments to identify sensory triggers or modifications that may be necessary to support their sensory needs.
• Feedback from the Patient

 

Treatment Planning:

Once sensory processing patterns are identified, physiotherapist can tailor treatment plans to address specific sensory needs. For example:

• Sensory Modulation:

If a patient has sensory over responsivity, the therapist may use gentle and gradual sensory stimuli to desensitize them to touch or movement, making therapy more comfortable.

 

• Sensory-Based Motor Training:

Understanding sensory-based motor patterns helps physiotherapist select appropriate exercises and activities that enhance balance, coordination, and motor planning. Patients with proprioceptive deficits, for instance, may benefit from specific proprioceptive exercises.

• tactile stimulus - different patterned fabrics and objects with different surfaces
• vestibular stimulus - swings and exercise balls
• proprioception - positioning tasks
• visual studies - activities such as eye tracking in different directions with toys of different colors and sizes.

 

• Pain Management:

Sensory processing influences pain perception. Physiotherapists can incorporate sensory modulation techniques such as TENS (transcutaneous electrical nerve stimulation) or manual therapy to help reduce pain sensitivity.

 

• Creating a Comfortable Environment:

It is important to modify treatment environment to accommodate sensory processing patterns. For individuals with sensory hyper-responsivity, reduce extraneous stimuli like bright lights or loud noises to create a more comfortable space for therapy.

 

• Sensory Integration:

In cases where sensory processing challenges are prominent, physiotherapists may collaborate with occupational therapists who have specialized in sensory integration therapy. This interdisciplinary approach helps individuals with sensory processing disorders improve their ability to process and respond to sensory information effectively.

 

• Balance and Coordination Training:

Understanding vestibular and proprioceptive input is crucial in balance and coordination training. Physiotherapist use exercises that challenge and improve these sensory systems to enhance a patient's balance and movement control.

• disordered orientation leads to poor postural control i.e. slouched or hyperextended
• Stability issue causes difficulty in maintaining an upright position,
• high degree of energy expenditure is consumed by the patient
• lack of flexibility in movement
• lack of conscious awareness causes poor perception of external or internal stimuli
• maintaining Coordinating movements may also to affect breathing

 

• Patient Education:

Physiotherapists educate patients about their sensory processing challenges and strategies to self-regulate sensory responses. This empowers patients to manage their symptoms and improve their participation in therapy.

 

• Adaptation and Progress Tracking:

Sensory processing considerations are ongoing throughout the rehabilitation process. Physiotherapists continually adapt interventions based on the patient's progress and sensory responses, ensuring that therapy remains effective and safe.

 

• Neurorehabilitation:

For patients with neurological conditions such as stroke or traumatic brain injury, sensory re-education is essential. Physiotherapists work on retraining the brain's ability to process sensory input, which is vital for regaining mobility and functional independence.

• repetitive practice
• Task-specific practice
• Variable practice
• Increasing difficulty