I talk a lot about sensory integration (SI) in dementia care. It’s one of my favorite strategies to utilize and integrate into care plans, and for good reason. There is so much science behind why these techniques work and how we can integrate them into care.
First off, let’s define it.
Sensory Integration is the process in which our bodies receive, process, and make meaning of the sensory input that they receive. Beyond the Five Sense we all know and love (sight, sound, taste, touch, smell), our bodies also utilize proprioception, vestibular input, and interoception to understand how our bodies are moving, where we are in space, and what’s occurring within our bodies.
If any of these systems are off, or if the body does not integrate these systems typically, we can become dysregulated; this can manifest as increased frustration/irritability, increased distress, fatigue, dizziness, clumsiness, or an overall lack in our sense of self.
We could literally talk for days about the various aspects of the sensory system and how it works. But for the sake of today, I want to focus specifically on Proprioceptive Input.
Proprioception lets our brains understand how our bodies are moving. It is an essential part of balance and mobility.
It utilizes sensory receptors in the body (found in the skin, muscles, and joints) to send signals via the nervous system to the brain, telling the brain how the body is currently positioned and moving. Certain areas of the brain, like the sensorimotor cortex, then execute movements additional movement throughout the entire body.
A poor proprioceptive system can result in poor motor planning and motor control, poor body awareness (increased ‘clumsiness’), decreased posture, and increased instance of loss of balance with or without falls.
It can also result in what’s called “sensory seeking”. Meaning the body doesn’t feel grounded because the brain is not receiving enough input from the proprioceptors. This can result in an almost visceral emotional response if left unmet. We see this a lot in kids; they might start playing too hard with their toys, crashing into the couch or jumping up and down, biting, chewing, or even stomping their feet. It’s all a natural reflex that the body performs in order to increase the amount of proprioceptive input it receives.
In individuals living with dementia, this can become more complicated.
We know that dementia causes atrophy with eventual loss of brain tissue, greater than the atrophy that already occurs in the aging process without any additional pathology. We also know that without proper use, the peripheral tissues can atrophy as well; tissues like the skin, bones, joints, and muscles that all contain the sensory receptors that are part of the proprioceptive system.
And if all of these tissues show atrophy (both from the pathology and from any disuse/ impacts of aging that can occur in all adults), that proprioceptive system is not integrated effectively.
So we start to see increased falls, decreased mobility, poor posture, and increased sensory seeking in some of our older adult Residents.
In my experience, unlike children, older adults living with dementia will either not show those natural reflexes to increase proprioceptive input independently OR they will attempt to get increased proprioceptive input in unsafe or inappropriate ways.
Typically they become more frustrated, will walk around for hours at a time without resting, and will be resistant to verbal redirection alone. And unfortunately, within the skilled nursing setting, will often be labeled as showing “increased behaviors”. They may also show an increase in frequency of falls, sometimes resulting in injury.
So in the clinical setting, when I’m asked to assess a Resident on The Memory Unit due to “increased behaviors” or increased instance of falls, I’m always going to assess how much proprioceptive input they’re receiving throughout the day. I’ll then trial increased amounts of external proprioceptive input as a means of improving emotional regulation and safety.
These external proprioceptive inputs can be anything that’s going to safely increase deep pressure to the joints, muscles, and skin. Chewing crunchy foods, performing resistive exercises, wearing a weighted blanket, taking a long walk. All are simple, easy ways to increase proprioceptive input and thereby hopefully improve emotional regulation and calm affect in your Residents.
Sources:
The Memory Unit OT 
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