|Physical||Communication||Cognitive||Behavioural / Emotional|
Vision is our dominant sense and most of our perception, learning, cognition and activities are mediated through vision.
Vision is a complicated process and does not just involve what is ‘seen’ by the eye.
The process of vision can be broken down into;
Visual acuity refers to clarity of sight. Visual acuity can become blurred due to a variety of conditions. Visual field refers to the central and peripheral vision which together make up the ‘panorama’ of vision. Various neurological conditions can cause loss of visual field which may involve one or both sides of vision. A person may be blind to half their field of vision. Scanning techniques can be taught, or special prisms used to increase field of vision.
Visual motor abilities involve movement of the eyes. The eyes may no longer be aligned, or be unable to steadily gaze at an object, or to ‘track’ a moving object. It can also affect the ability to ‘scan’ documents or to focus. There may also be a loss of binocular vision and depth perception. Double vision or diplopia is a common result of head injury. Diplopia may be corrected using vision therapy or special lenses.
Visual perception may involve such things as loss of hand-eye co-ordination, the ability to associate what is seen with what is heard, the ability to remember information that is seen, the ability to recognise objects, and the ability to recognise where a person is in relation to objects around them. Lenses, prisms and visual rehabilitation activities are used in the remediation of these disorders.
Hearing loss can occur as a result of acquired or traumatic brain injury. There may be damage to the structure of the ear, to the nerves connecting the ear to the brain, or to the way hearing is processed within the brain. The hearing loss may be accompanied by Tinnitus which can be described as a ringing, hissing or roaring sound. Hearing problems can be distressing and result in isolation.
Treatment may include medical management, hearing aids, or auditory processing therapy. It’s important to determine how much of the hearing loss is caused by other symptoms such as memory or attention difficulties, which may also accompany a TBI.
Loss of taste and/or smell has been reported to be as high as 25 percent after traumatic brain injury. The loss of taste is generally due to loss of smell. Loss of smell has many possible causes including injury to the nose, nasal passages, sinuses, olfactory nerve, and injury within the brain. Unfortunately, there is no good treatment cure for post-traumatic anosmia (loss of smell). Typically, if a person doesn’t regain their ability to smell six months after the injury, the loss will likely be permanent.
Precautions may need to be taken as the person suffering loss of smell may not smell smoke in a fire, or gas escaping if an oven is left switched on etc. Vibrating fire alarms can be used under mattresses in beds, and it may be worth considering switching from gas cooking to other methods of cooking.
What is Sensory Integration?
Sensory integration is a sub-conscious and automatic neurological process that occurs in every person at every stage of life. It is important in all the things we need to do every day. i.e. getting washed, dressed, eating, socialising, learning and working. Sensory Integration looks at the interaction between and the development of the vestibular, proprioception, touch, vision, and hearing senses. These are important in supporting our ability to concentrate, develop self-esteem and confidence as well as having self-control and academic skills. Sensory experiences include touch, movement, body position, vision, smell, taste, sounds and the pull of gravity. For most people this develops naturally in childhood whilst doing normal childhood activities, such as crawling, walking and playing.
However, on a case by case basis we are becoming increasingly aware of brain injured children and young people and their parents reporting sensory integration problems following an acquired brain injury, particularly when the brain injury was sustained at a very early age. This appears to affect at least 50% of our child brain injury cases; yet to date very little research recognises these additional sensory issues as being related to an acquired brain injury.
In total we have 8 Senses. In addition those outlined above, we also have Tactile, Proprioception, Vestibular and Interoception senses, which are explained below.
The tactile system is our sense of touch which we receive through different sensory receptors in our skin. It is through the tactile system that we first receive information about the world when we
come out from the womb environment. The ability to process tactile information effectively allows us to feel safe and form bonding with those who love us. It contributes to our social and emotional development. One important role of our tactile system is its protective function that alerts us when something is unpleasant or dangerous. For some children, this function of the tactile system is not working normally. In our experience the tactile system can also change following a head injury or acquired brain injury. Children and young people sometimes may perceive most touch sensations to be uncomfortable or scary and react with a flight-or-flight response. This condition tactile defensiveness and was first identified by Dr A.J. Ayres, an American Occupation Therapist around the 1960s.
Our muscles and joints have tiny sensory receptors that tell our brain where our body parts are or what is touching them. So, when you put a spoon in your mouth, you don’t need to look at the spoon to see where it is, because you can feel it. You also don’t need to feel where you mouth is because you know and can coordinate food into your mouth. It is largely your proprioceptive receptors that give you this information and your brain is able to plan those movements to enable you to perform the task. A significant problem post head injury is not being aware of your extremities, such as your feet. Knowing where you feet are in space and time is important for preventing accidents, trips and falls. For example a person with Proprioception problems will sit on a chair but trip over the leg when they stand up because they will have no sensory feedback to prevent that happening. Alternatively they will walk past a chair and trip over the leg because they have no awareness of where there feet are in relation to the chair leg. Sensory Integration Therapy can help to relieve these symptoms.
In our inner ear we have small fluid filled canals. The fluid in the canals moves every time we move our head. Receptors in these canals pick up the direction of movement and send this information to our brain, so we know if we are moving forwards, backwards, side to side, tilting our head, turning around or moving up and down. Our brain uses this information to plan for movements and help us maintain our balance. Following a brain injury, in particular a traumatic brain injury or skull fracture, the fluid filled cavities can be damaged which causes then causes dizziness, unsteadiness and nausea as a few examples. Sensory Integration Therapy can help to relieve these symptoms.
Interoception is how our body tells our brain what is going on inside our body, such as when we are hungry or feel full, when our heart is beating fast or when we have ‘butterflies’ in our stomach. This sense can be significantly affected post brain injury, with children and young people reporting they never actually feel hungry. Sensory Integration Therapy can help to relieve these symptoms.
In 2015, Parnham and Mailloux identified four categories of Sensory Integration problems:
1. Sensory modulation problems
2. Sensory discrimination and perceptual problems
3. Vestibular bilateral functional problems
4. Praxis problems
Post brain injury children can present with arrange of sensory processing difficulties. All create problems for a child’s functioning in their own right; which can have a huge impact on their behaviour and reactions to certain situations.
If you think you child may be experiencing Sensory Integration Problems post brain injury, please contact us for further information.
"Intensive and individualized approaches work. A one-size-fits-all approach doesn't. You have to make it relevant to the child."
"We would like to see earlier identification and support for children with brain injuries to help them succeed in school."
"Case management for children and young people post acquired brain injury is 'pivotal' to successful outcomes and must be local"
"Families need to be properly supported as 'resilience' is key to delivering successful outcomes for children and young people."
"We are medical practitioners. The real experts are the parents. Over the last 35 years they have taught me everything I know"
"Positive and coordinated neuro-rehab interventions for children and young people is proven to bring health improvements; improve independence; reduces the need for sheltered living; decreases vulnerability; decreases drop-out rates in schools; decreases youth offending"
"Too often children and young people with ABI are discharged from hospital without specialist brain support that they and their families need to overcome lifelong challenges"
"Children and young people have poor social competence post brain injury due to reduced cognition, executive functions, and emotional control. As a result they are twice as likely to have mental health issues in the future"
"Participation in teen sports and normal activities leads to improved quality of life for children and young people post brain injury and helps to maximise outcomes"
"Healthy teens are better at identifying strategies to deal with barriers. KIDS WITH ABI'S CAN'T!"