Frequently Asked Questions (FAQ)
- What is sensory integration?
- What is Therapeutic Listening?
- What is Apraxia?
- What is motor planning (praxis)?
- Is therapy covered by my insurance?
What is sensory integration?
Most of us know what helps us to relax after a stressful day, what helps us to concentrate, and things we can do to revive ourselves. We all have developed methods for providing ourselves with sensory inputs (sounds, foods, textures, activities) to enable us to respond to various situations.
Sensory integration is the ability to take in information through our senses (touch, taste, sound, vision, and movement), organize and process that information so we can respond appropriately to that situation (adaptive response).
From very early on children must be able to take in information from their environment in order to perform skills without thinking about them. They need to be able to determine which information is important and which information is not. Children who cannot do this may withdraw from situations and people, may develop atypical and/or stereotypical ways of playing, may become aggressive and have a tantrum for no apparent reason, and may have difficulty with the simplest tasks most of us take for granted.
Following are descriptions of the sensory systems and what it may look like if there is disruption within that sensory system:
Tactile System
The tactile system is our system of touch. Touch makes us feel safe and comfortable and allows us to bond with those around us so we can develop socially and emotionally. There are two parts to the tactile system - one is the protective system and the other is the discriminative system.
The protective system lets us know when there is danger and causes a “flight, fright, fight” response. The discriminative system lets us know where we are being touched and what it is that is touching us.
When the tactile (discrimination) system is not working properly the following can occur:
- Difficulty with fine motor and self care skills
- Difficulty articulating sounds
- Decreased visual perceptual skills
- Difficulty understanding basic concepts
- Exhibit the need to touch everything, have difficulty keeping hands to self
When the tactile (protective) system is not working properly the following can occur:
- Withdrawal from group situations
- Misperception of touch even when it is not threatening
- Overreaction to clothing or food textures or tastes
- Under-responsive to pain
- May not like to be held or cuddled
Vestibular System
The vestibular system encompasses our sense of movement and gravity. It lets us know which way is up, down, horizontal, and vertical. It also lets us know if we are moving, what direction we are moving, and how fast we are going. The vestibular system helps us to develop proper muscle tone, posture and bilateral coordination. This system is imperative to the functioning of the central nervous system and allows for other sensory inputs to be processed.
When the vestibular system is not working properly the following may occur:
- Difficulty making sense of visual information
- Difficulty with tasks that require two hands
- Difficulty with coordinated movements and development of gross motor skills
- Difficulty with sequencing and timing
- Extreme need for activity and movement/difficulty sitting still
- Lack the desire to engage in movement activities
- Fearful of movement experiences
- Inappropriate emotional responses
- Speech and language deficits
- Difficulty using words to reflect what they know
- Difficulty with nonverbal communication/body language
Proprioceptive System
The proprioceptive system consists of receptors located within our joints, tendons, ligaments, and connective tissue. Proprioception occurs when we stretch and tighten our muscles against the pull of gravity. Sensations that come through the proprioceptive system are closely linked to the tactile and vestibular systems. The proprioceptive system tells us where the body is in space, how our body parts relate to each other, how much and how quickly are muscles are stretching, and how much force our muscles are using.
Disruption in the prorioceptive system can result in:
- Decreased body awareness/bumping into objects
- Postural instability
- Difficulty with motor planning
- Difficulty grading movements — using too little or too much force
- Motor incoordination
Auditory System
The auditory system works together with the vestibular system as sound and movement are processed. The auditory system is the first sensory system to develop. The auditory system is not only responsible for hearing, but also for balance, coordination, flexibility, and equilibrium.
There are two components of the auditory system. The first is the defensive component which occurs when we are startled by a loud or unexpected sound. As we develop we learn to tune out sensations that are not threatening. The second component is the discriminative component. The discriminative component helps us determine the "what" and "where" of sounds.
Children who have difficulty with auditory processing may exhibit:
- Irrational fears of household appliances and noises
- Become distressed by sudden noises, thunder, sirens, or alarms
- Difficulty responding to when their name is called
- Difficulty following directions, frequently asking “What did you say?”
- Difficulty attending in a noisy environment
- Difficulty differentiating between speech sounds, words, or phrases
Visual System
The visual system is responsible for what we see in our environment. The visual system also has two components which consist of the protective and discriminative components. These two systems work together, allowing us to see clearly. These systems also enable us to understand the objects we see, where they are, and how they feel (without touching them).
Children who have difficulty processing visual information may exhibit:
- Covering of the eyes when in direct sunlight
- Preference for watching spinning and/or shiny objects
- Difficulty following a moving object (i.e. catching a ball)
- Difficulty making eye contact
- Difficulty with discrimination (puzzles, letters, colors)
- Difficulty developing spatial and temporal concepts
- Poor eye-hand coordination
- Difficulty with coordination and balance
What is Therapeutic Listening?
Therapeutic Listening (TL) is an auditory intervention approach that uses organized sound patterns inherent in music to impact all levels of the nervous system. Therapeutic Listening was developed by Sheila Frick, OTR/L and Colleeen Hacker, OTR/L. and was derived from the earlier works of Alfred Tomatis, Guy Berard, and Ingo Steinback.
Therapeutic Listening combines sound training with sensory integrative techniques. Listening is voluntary and involves the process of detecting sound and organizing it and interpreting it for use with information from our other senses.
Therapeutic Listening can be effective for children who:
- Have a history of chronic middle ear infections/chronic fluid in middle ear
- Disturbance in sleep/wake cycles
- Have sensory defensiveness
- Have self-regulation difficulties
- Have varying degrees of arousal
- Have difficulty following directions
- Have attentional difficulties
- Have speech and language delays
What is Apraxia?
Apraxia is a motor speech disorder also known as Childhood Apraxia of Speech and/or Developmental Verbal Dyspraxia. Children have problems saying sounds, syllables and words. The child typically knows what he/she wants to say however the brain has difficulty sending the appropriate signals to move the necessary parts (lips, jaw, tongue). There are two types of apraxia which include oral and verbal.
Oral apraxia is when a child has difficulty with simple motor commands such as show me your tongue, show me how to blow, or demonstrating different mouth, tongue, and lip movements. Verbal apraxia is when a child has difficulty producing sounds, syllables, words, and sequencing sounds.
Children with apraxia often show inconsistency from one day to the next. They often appear to grope for the right sound or word. Children who have apraxia may also have difficulty varying the rhythm, using appropriate inflection, and using appropriate stress on words which also affects their speech.
What is motor planning (praxis)?
Motor planning (praxis) is the ability to organize, plan, and execute motor skills in a refined and efficient manner. There are several components to praxis, all of which require the ability to process information from the tactile, vestibular, proprioceptive, auditory and visual systems. Components of praxis include imitation, ideation, initiation, construction, feedback, feed-forward, grading, timing, sequencing, and motor planning.
Imitation occurs very early on in life. Babies can imitate facial expressions, movements, and vocalizations. This early development leads to the ability to use gestures and facial expressions later in life.
Ideation is the ability to come up with an idea based on past imitative experiences. This is where children explore how things work andexplore their environment while using their body (crawling, climbing, walking).
Initiation occurs when a child has a clear idea how to begin a certain activity. Children who have difficulty with praxis may not know how to perform the simplest tasks that we as adults take for granted.
Construction enables children to put objects together in new and different ways. Construction is important for knowing how to organize belongings and spaces.
Feedback occurs so we can refine our motor skills. It is our memory of how we do things. This occurs as we repeat tasks and therefore they become more automatic. Feedback allows us to understand what happened.
Feed-forward allows us to anticipate the next step, strength, or speed required to perform certain motor tasks without thinking about them. Feedback and feed-forward work together, allowing us to feel an error before we see it.
Grading refers to the ability to vary the intensity of what we do. Everything we do requires some sort of grading. For example, we would use different intensity if we patted a bay versus congratulating a football player.
Timing and sequencing allows us to perform motor acts at the appropriate time and in the correct order. It requires the ability to understand visual space, speed, and distance.
Motor planning allows us to create, use, and combine various motor acts to perform new, more complex motor acts. The more we practice a motor task the more automatic it becomes, and the less we have to think about it.
Children who have difficulty with praxis may have difficulty creating, organizing, or learning new movement patterns and combining those movement patterns into new motor sequences. These children may have the following characteristics:
- Clumsy or accident prone
- Frequently drop things
- Difficulty with simple motor tasks
- Difficulty learning basic self care skills
- May prefer to play with self or adults versus other children
- Difficulty playing with toys appropriately/difficulty with pretend play
- Passive and reluctant to try new activities
- Have difficulty following directions
- May have speech-language deficits (concept development)
Is therapy covered by my insurance?
- Call your insurance company to see if occupational and/or speech therapy benefits are available.
- Ask your insurance company if pre-certification is required and what information is necessary to complete the pre-certification requirements. Pre-certification usually requires an evaluation, prescription for services, and a treatment plan to determine if the services are medically necessary.
- Ask your insurance company if there are limitations as to what will be covered. Most insurance companies will only pay for services that are medically necessary which means typical delays will not be covered.
- Know your annual deductible for your insurance plan.
- Ask if there is a co-payment and/or co-insurance per visit.
- Ask if there are limitations on the amount of services that can be delivered in a calendar year. Most plans will give a dollar amount or will give a set number of sessions that are allowed within a calendar year.
- A prescription will be required prior to the evaluation and for service delivery.
- A prescription for services must include a diagnosis, the frequency (i.e. 1 time per week), and the duration (i.e. 6 months).