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Sensory Integration and Auditory Integration Training

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by Rosalie Seymour, SLP/A, AIT Practitioner

Sensory Integration (SI) and Auditory Integration Training

It is a commonly held concept that we have five senses: Touch - Taste - Smell - Hearing - Vision. The truth is, we have many more senses than that. Some hold that we can divide the senses into internal and external senses: that the “sense of well-being” is a sense too, but an internal one. So, too, “homeostasis” or the sense of having returned to even keel, essential for the regulation of temperature, heart-rate, and breathing.

To return to the external senses - there are others we must consider besides the usual five:

  • Balance - a vestibular sense (inner ear), that responds to movement and to gravity. A change in position of the head stimulates this sense, and it works very closely with the control of eye movement.
  • Proprioception - the sensations caused by stretching or contracting of muscles and by compressing or stretching the ligaments and joints. Proprioceptors keep us informed of the where our limbs in space. (Without this sense we could not start a movement. Read “A Leg To Stand On “ - Oliver Sacks)

Types of Sensory Integration (SI) Problems: Also known as Sensory Processing Disorder (SPD)

Problems of sensory integration were first thought to fall into three categories (read Knickerbocker, and Carl Delacato). The person either was thought to be:

  • under-processing
  • over-processing
  • processing with interference or “white noise"

This being the case, an accurate investigation had to be made to find out which applied to the client, because treatment strategies would differ.

Sensory Modulation

More recent information supports the thinking that the issue at stake is one of a disorder of sensory modulation , which means that the person cannot properly regulate his sensory input, and that the ability to maintain a situation-appropriate state is faulty.

Just as the eye should respond differently to bright light and to darkness by adjusting the aperture of the pupil, so should the acuity of sensory processing fit the sensation. But these children and adults have senses that respond with random and variable effectiveness.- i.e. are ineffective for learning.

In this condition, one has an exaggerated response to light touch at one moment, followed by a seeming total unresponsiveness to pain the next. A child may act as if deaf at one time, and react with extreme overload at some insignificant sound. This behavior has been confusing to parents and professionals, but how confusing and frightening to be a child in this unstable - ever-changing world! It is believed by many that the autistic withdrawal is the result of this sensory instability, (and Dr. Guy Berard says specifically it is the result of hyper-sensitive hearing). The things they see, hear, and feel, can’t make sense to them, because they don’t appear reliably the same from moment to moment. Therefore, the children cannot build accurate perceptions, nor concepts; and their anxiety levels are extremely high.

Many professionals who practice Sensory Integration (SI) believe that the un-responsive or the under-responsive child, is in fact a child in sensory over-load, and is blocking the input to protect themselves from the seeming barrage of overwhelming sensations. The sensory processing brain centers are actually under-functioning, and cannot modulate the input.

Efficiency of Modulation

What needs to be done, is to bring the sensory modulator up to a level of efficiency, and then there is less sensory overload evident. This may be one of the reasons that Auditory Integration Training is helpful for hyper-acute hearing, since it works to stimulate auditory sensory processing.

We can better understand the role of Auditory Integration Training in the treatment of learning and developmental problems, if we understand the concept of SENSORY INTEGRATION.
 

The term has developed in Occupational therapy circles, chiefly through the work of Dr. A. Jean Ayres, from the University of Southern California.

Sensory Integration (SI)

Sensory Integration (SI) refers to the ability to take in, sort out and connect information delivered by the senses. The organism (man) interacts with his environment, (whether his social or physical environment). He gets to learn, to know about things by taking in information from his environment. Defined like this, sensory integration (SI) can be understood to be a fundamental activity that leads to communication between the person (organism) and his world.

Communication is an all-encompassing activity, but the aspect that overlaps with the concept of Sensory Integration (SI) refers to the processing of the stimuli delivered to the nervous system by the sensory end-organs.

Sensory Integration (SI) is the Organization of Sensations for Use

Sensations flow constantly into our brain at a rapid rate. These sensations need to be acted upon, organized and coordinated if a person is to learn efficiently. If these sensations can be well-managed, the brain can form perceptions, then concepts and derive meanings, and so can learn.

The flow of sensations into the brain activate brain potentials, and one can think of sensations as “food for the brain providing energy “ as well as “knowlege needed to direct the body and mind”.

Sensory deprivation is a state where the senses are deprived of stimulation totally or severely, e.g. where the subject is placed in a sound-proof room, with no light at all, and no touch sensations. In these experiments, the subjects have been found to very quickly become disorientated, and show signs of severe mental disturbances.

Clincial studies like these lend weight to the theory that sensory input is essential for adequate brain function - that the stimulation produces “brain tone”. They are responsible for the “alpha” or baseline brain waves of the conscious state. Dr. Alfred Tomatis and others believe that auditory input is the most vital sensory input for this function.

It is easy to conceptualize that the sensory system provides the input that stimulates the Reticular Activation System of the brainstem to arousal. The RAS is responsible for the regulation of alertness, and co-ordination and regulation of focus (attention) and the efficient management of input and of output. The proper functioning of this system is essential to learning and to behavior management.

Sensory integration is the putting together of sensations. If one were eating a biscuit, you would be feeling it with your fingers, smelling it , tasting it, and seeing it. Also the sensors of the muscles and joints would be activated, the hands, arms and shoulder, lips, tongue and throat. What tells us we are holding a vanilla biscuit and not a chocolate one? Are we holding one or two biscuits? What makes the fingers work together, the teeth chew without biting the tongue?

All the sensations come together in one area in the brain that sorts, co-ordinates connects and selects from all the various sensations pouring in. This coordinated input is delivered to the higher cortical levels, that experience the biscuit as a whole. Then we may come to an awareness, something like “ I like these vanilla biscuits.”, and we appropriacy of social behaviors, e.g. “ Would it be OK to ask for more?"

The Ear and Sensory Integration (SI)

The discipline of occupational therapy emphasizes the importance of the vestibular system of the inner ear, that affects balance and gravity response, and muscle tone. The importance of this aspect of sensory process to learning disorders, concentration and emotional well-being has been demonstrated repeatedly in research and practice, and mention should be made of the contribution of Harold Levinson (“Smart But Feeling Dumb”).

However, the other equally crucial part of the ear, the cochlea, with its auditory function, is not of lesser importance in sensory integration. Focus on its role in learning and development has not been on auditory sensory integration. Audiologists, who deal with hearing issues, have dealt almost totally exclusively with hearing loss, and disorders of the cochlea that lead to degrees of deafness.

Auditory sensory integration has scarcely received mention. The information about the role of audition in neurological development and in emotional well-being has come from other sources, such as music therapy, and also from two French Ear-Nose and Throat specialists, whose work - independently of each other - has contributed a greater understanding of this matter.

  • Dr. Tomatis' theory of auditory development suggested that the individual whose ability to “stretch out his ear” to listen is impaired for some reason, will suffer developmental problems, whether autism, dyslexia, or speech and language disabilities, and perhaps emotional problems. Dr. Tomatis' approach was a breakthrough in many ways, and here it is relevant to mention that he saw the role of the ear as a whole - both the vestibular as well as the cochlea - in the development of higher cognitive functions.

  • Dr. Guy Berard has gone on to develop - through his effective intervention strategy - the evidence to underline this belief. Changes in the auditory integration affects the functioning of the vestibular system. The resulting effect on learning, development and emotional well-being can be significant. We have seen that the effect on the processing of other modalities can change significantly , e.g. taste, vision, - as a result of AIT.

Occupational therapists who work with Sensory Integration (SI) techniques, have reported changes across modalities- e.g. speech may improve when the child is swung and bounced!

Developmental optometrists, doing eye-integration and co-ordination exercises, have seen profound changes in speech and responsiveness.

It is clear that whatever is happening when we impact on one sensory modulating modality, spills over to affect other modalities too. This invites us to look into the function of that part of the brain that does sensory processing: the brainstem or mammalian brain, including the areas called the midbrain, the pons, the medulla, the cerebellum and the limbic system.

Interventions

It is possible to interpret the reports of change after intensive sensory stimulation according to the views mentioned above. In particular for this paper, attention is drawn to the anecdotal reports of change after Berard Auditory Integration Training. Various papers documenting these reported changes (Veale, Monville & Nelson), have noted improvements in language and learning, in attention focus, in sensory modulation and limbic (emotional) stability. Various research reports have confirmed these observations, and added evidence of changes indicating more efficient neurological organization.

Even though this form of intensive sensory stimulation is not confirmed as an intervention specifically designed to cure the medical aspects of sensory integration disorder, it would appear that this intervention has beneficial effects that extend to impacting in the area of how the sensory units are managed by the pre-cognitive neurological system, and that this brings (sometimes unexpected) improvements in a wide range of behaviors. Parents have reported improved appetite for picky eaters, improvements in muscle tone, the cessation of bed-wetting, changes in mood and attitude (more cheerful).

Dr. Guy Berard book is entitled Hearing Equals Behavior. Indeed, through the impact of the ear on all that allows us our humanity, perhaps through its key role in maintaining effective sensory integration, and thus neurological integration, we are likely to see scientific evidence grow in its support of this notion.

This will be of particular interest, because this notion points the way to the way to more effectively assist people who demonstrate various difficulties, ranging all the way from poor listening skills, to concentration problems and learning difficulties;- and as Dr. Guy Berard asserts, those with mood disorders linked to sound processing difficulties.

At the very least, a new door of enquiry has been opened, and those who have pursued this route of intervention have found benefits that range from mildly pleasing to life-changing.

Understanding Sensory Issues in Autism:
Hypersensitive Hearing Can Be Treated With Auditory Integration Training
(10:57 minutes)

 


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