Sensory Integration (SI) & SIPT: Understanding the "Traffic Jam" in the Brain

We all know the 5 senses (Sight, Smell, Taste, Touch, Hearing), but in pediatric rehab, the "Hidden Senses"—Vestibular and Proprioception—are the kings of development. Sensory Integration (SI) theory, pioneered by Dr. A. Jean Ayres, explains how the brain organizes this sensory input for use. When this process fails, we see behavioral, motor, and learning issues. This guide covers SI basics, the SIPT test, and the concept of the "Sensory Diet."

1. The 3 "Hidden" Senses

Beyond the basic five, these three are critical for motor control and emotional regulation.

System	Location	Function
Vestibular (The GPS)	Inner Ear (Semicircular canals & Otoliths)	Detects movement, gravity, and head position. Tells us if we are moving or if the world is moving. Controls balance and arousal.
Proprioception (The Body Map)	Joints, Muscles, Ligaments	Tells us where our body parts are in space without looking. Essential for grading force (e.g., holding an egg without crushing it).
Interoception (The Internal State)	Internal Organs (Viscera)	Sensations of hunger, thirst, bathroom needs, and heart rate. Linked to emotional regulation.

[Image of vestibular system diagram showing semicircular canals]

2. The "Traffic Jam": Sensory Processing Disorder

Dr. Ayres described SPD as a "traffic jam" in the brain where signals are not processed correctly. It typically manifests in two ways regarding Modulation (Regulation):

A. Over-Responsive (Hypersensitive / Avoider)

• Behavior: Covers ears at loud noises, hates clothing tags, picky eater (texture), dislikes swings/movement.
• Reaction: Fight, Flight, or Freeze.

B. Under-Responsive (Hyposensitive / Seeker)

• Behavior: Crashes into walls, loves spinning, chews on shirts, touches everything, seems "deaf" when called.
• Reaction: Needs MORE intensity to register the sensation.

3. What is the SIPT?

The Sensory Integration and Praxis Tests (SIPT) is the "Gold Standard" assessment tool developed by Dr. Ayres for children ages 4 to 8 years, 11 months.

• It consists of 17 subtests measuring:
  • Visual perception (e.g., Figure-Ground).
  • Somatosensory processing (e.g., Finger Identification, Localization of Touch).
  • Praxis (Motor planning).
  • Vestibular-Proprioceptive processing (e.g., Standing Balance, Post-Rotary Nystagmus).
• Certification: Only SIPT-certified therapists can administer and score it. It is complex and time-consuming but provides detailed diagnostic data.

4. Dyspraxia: The Link to Sensory Issues

Praxis is the ability to conceptualize, plan, and execute a non-habitual motor act. It has three steps:

1. Ideation: Having an idea ("I want to climb that fort").
2. Motor Planning: Figuring out how to move the body to do it.
3. Execution: Doing the movement.

Dyspraxia (DCD): Children with poor tactile and proprioceptive processing often struggle with Praxis. They appear clumsy, break toys, and struggle to learn new skills (like riding a bike) but may be fine with familiar ones.

5. Treatment: The "Sensory Diet"

Just as we need food nutrients, our brains need sensory nutrients to function. A sensory diet is a personalized activity plan.

System Targeted	Activity Examples	Effect
Proprioceptive ("Heavy Work")	Pushing a heavy cart, carrying books, "wheelbarrow" walking, jumping on trampoline.	Calming & Organizing. The "safest" input; good for both seekers and avoiders.
Vestibular (Movement)	Swinging (linear vs rotary), spinning, hanging upside down, scooters.	Linear (back/forth) = Calming. Rotary (Spinning) = Alerting. (Use with caution!)
Tactile (Touch)	Brushing protocols (Wilbarger), deep pressure massage, sensory bins (rice/beans).	Deep pressure is calming; Light touch is alerting/agitating.

6. The Core Principle: The "Just Right" Challenge

In Ayres Sensory Integration (ASI) therapy, the child must be an active participant. Passive treatment (just spinning a child) is NOT integration.

• The activity must challenge the child slightly beyond their current ability but be achievable.
• Success elicits an Adaptive Response—the brain learns and organizes.
• Example: A child afraid of swings (gravitational insecurity) learns to tolerate a low, slow swing while holding a toy (distraction + proprioception).

7. Revision Notes for Students

Dr. A. Jean Ayres: Founder of SI theory.
The Big 3 Senses: Tactile, Vestibular, Proprioceptive.
Heavy Work (Proprioception): Generally calming/organizing. The "universal antidote" for sensory dysregulation.
SIPT: 17 subtests, Gold Standard for 4-8 years.
Dyspraxia: Motor planning deficit (Ideation -> Plan -> Execute).
Gravitational Insecurity: Excessive fear of movement/feet leaving the ground (Vestibular issue).

8. FAQs

Q1. Can you "cure" Sensory Processing Disorder (SPD)?

SPD is lifelong, but therapy rewires the brain to process input better. Children learn coping strategies and self-regulation tools ("sensory diet") to function successfully.

Q2. Why is "spinning" dangerous in therapy?

Rotary vestibular input is highly alerting and can cause adverse reactions (nausea, pale skin, meltdown) hours later. It must always be countered with heavy work (proprioception) to ground the system.

Q3. Is Sensory Integration the same as Sensory Stimulation?

No. Stimulation is passive (e.g., flashing lights). Integration requires the child to use the sensation to perform a purposeful task (Adaptive Response).

9. 10 Practice MCQs

Q1. Which sensory system provides the "safest" input that is generally calming and organizing?

Answer: B) Heavy work calms both over-responsive and under-responsive systems.

Q2. The SIPT is designed for children aged:

Answer: C) Specifically 4 years to 8 years 11 months.

Q3. A child who is "Tactile Defensive" will likely:

Answer: B) Their brain interprets light touch as a threat (pain).

Q4. Gravitational Insecurity relates to a dysfunction in which system?

Answer: A) It is an extreme fear of movement or having feet off the ground.

Q5. The goal of SI therapy is to elicit an:

Answer: B) A purposeful, goal-directed response to a sensory challenge.

Q6. Which activity provides linear vestibular input?

Answer: B) Linear movement is generally calming; rotary (spinning) is alerting.

Q7. Dyspraxia is fundamentally a problem with:

Answer: C) The ability to conceive, plan, and execute a new motor act.

Q8. A "Sensory Seeker" is considered:

Answer: B) They need MORE input to register the sensation, so they seek it out.

Q9. Interoception refers to sensing:

Answer: B) Often linked to toileting issues and emotional awareness.

Q10. Who pioneered Sensory Integration theory?

Answer: C) An occupational therapist and educational psychologist.

References

• Ayres, A. J. (2005). Sensory Integration and the Child (25th Anniv. Ed.). WPS.
• Roley, S. S., et al. (2007). Understanding Ayres Sensory Integration. OT Practice.
• Case-Smith, J., & O'Brien, J. C. (2014). Occupational Therapy for Children and Adolescents. Elsevier.