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Integration (SI) and Auditory Integration Training
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.
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
Problems of sensory integration
were first thought to fall into three categories (read Knickerbocker,
and Carl Delacato). The person either was thought to be:
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.
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
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
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.
(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
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
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”).
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.
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
dyslexia, or speech and language disabilities, and perhaps emotional
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
Guy Berard has gone on to develop - through his effective
- 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.
who work with Sensory Integration (SI) techniques, have reported changes
across modalities- e.g. speech may improve when the child is swung and
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
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
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)