淺談感覺統合 - Sensory Integration

在學齡前，小朋友的大腦，可以說是一部處理感覺的機器。在這段時期，小朋友都是直接藉由各種感覺，來認識自己的身體和他周遭的環境。他會學習在空間中如何對抗地心引力、做出適當的肢體活動、並且要學習不同的感覺刺激，所代表不同的意義；更重要的是，在這些過程中，小朋友可以學習如何去主宰環境、能夠因應環境的要求，扮演適當的角色，例如做一個好的遊戲者、學習者，並適當的與他人相處。

小朋友的大腦，在正常狀態下，是一個組織良好的系統。我們雖然無法透視小朋友的大腦，但是，小朋友外顯的行為表現，就是大腦活動的反射。當小朋友表現出來的行為，與一般兒童不太一樣，或是沒有依循著發展程序發展時，我們便可以猜想，小朋友的大腦，是否有組織整合不佳的問題。感覺統合(Sensory Integration)是大腦組織整合感覺訊息，為應付環境需求，做出適應性反應的一個過程。所以，這樣一個理論架構的提出，可以提供我們在治療上某種程度的幫助。但由於大腦中感覺整合的過程，遠比我們想像中的複雜，而且臨床上，小朋友表現出來的情形，也會不太相同，因此，感覺統合理論也同其他治療性的理論一樣，都有被不斷修正研究的必要。
感覺統合的創始者珍‧艾爾絲博士，在一九五○年代初，開始致力於感覺統合理論的研究與發展，一開始，她利用此理論治療介入的對象，大部份為學習障礙的小朋友，她發現有許多智力正常的小朋友，但是一直學不會綁鞋帶、動作很笨拙，或是在課業上的學習上，會有學習不佳的情形。後來，這個理論被延伸到其他有神經行為發展問題的小朋友身上，包括智能障礙、自閉症、情緒困擾、不同形式的行為異常，及其他神經感覺基礎的問題。
感覺統合的三大主要系統：

(一)觸覺系統：是最基本、影響力最大的系統。觸覺是提供我們有關周圍環境的訊息最主要的來源，可以讓小朋友避開或抵抗危險，同時，它對小朋友心理社會化的發展，非常的重要。小朋友經由觸覺，在早期，可以和媽媽建立親密的關係，而在以後，可以幫助發展良好的人際關係基礎。另外，在手部動作方面，觸覺和區辨覺的建立，可以促進小朋友對物體形狀、大小、重量的認識，是往後認知發展重要的基礎。

(二)前庭系統：它能使小朋友去感受到地心引力的作用，及身體各種形式的移動及運動。而前庭系統在腦幹部的前庭神經核，能夠經由上行或下行神經通路及腦幹本身的功能，影響其他的感覺系統。它與眼外肌也有密切的關連，所以對於小朋友視覺-動作的協調，也有很大的幫助，而前庭系統最重要的功能之一，是對肌肉張力的影響，使小朋友能發展出正常的肌肉張力(尤其是對抗地心引力的肌肉群)、維持姿勢、產生動作及發展出正確的身體空間概念。此外，它會告訴我們個體在環境中的空間關係，使人在身體與情緒上有安全感，也有助於小朋友的心理發展。

(三)本體感覺：本體感覺主要是經由肌肉、關節或骨骼等受器而來的訊息，而其對感覺統合最大的功用，是維持肌肉正常的收縮，使關節能夠自由活動，因為動作是促進感覺統合發展最主要的途徑。它可以影響神經系統的興奮狀態，增加本體感覺的輸入，有助於情緒的正常化，另外，本體感覺會影響個體視覺知覺及身體空間概念的發展，進而影響個體計畫活動的能力。同時，因為本體覺本身有抑制性作用，我們可以利用一些有阻力本體覺活動，使活動量太高的小朋友安靜下來。

而感覺統合的治療原則，就是利用臨床觀察及各種評估工具，去分析小朋友在那些方面產生了問題，而針對上述所提三大系統，直接給予小朋友各種適合的感覺刺激，或者利用特別設計的活動，間接的給予刺激，感覺與動作之間有密切的關連，利用經過設計的活動，來控制各種感覺刺激的輸入，小朋友為了達成既定的目標，自然會整合各種輸入的刺激，做出適當的動作反應。感覺統合理論的提出，使人們不再只著重於運動功能的訓練，而進一步注意到感覺與動作之間的重要關連，而評估的進行、治療活動的設計，都必須經由合格的職能治療師來進行，才能達到最大的治療效果。

復健醫學系　汪宜霈 講師 (Chinese Vesion)

Sensory processing (sometimes called "sensory integration" or SI) is a term that refers to the way the nervous system receives messages from the senses and turns them into appropriate motor and behavioral responses. Whether you are biting into a hamburger, riding a bicycle, or reading a book, your successful completion of the activity requires processing sensation or "sensory integration."

Sensory Processing Disorder (SPD, formerly known as "sensory integration dysfunction") is a condition that exists when sensory signals don't get organized into appropriate responses. Pioneering occupational therapist and neuroscientist A. Jean Ayres, PhD, likened SPD to a neurological "traffic jam" that prevents certain parts of the brain from receiving the information needed to interpret sensory information correctly. A person with SPD finds it difficult to process and act upon information received through the senses, which creates challenges in performing countless everyday tasks. Motor clumsiness, behavioral problems, anxiety, depression, school failure, and other impacts may result if the disorder is not treated effectively.

Research by the SPD Foundation indicates that 1 in every 20 children experiences symptoms of Sensory Processing Disorder that are significant enough to affect their ability to participate fully in everyday life. Symptoms of SPD, like those of most disorders, occur within a broad spectrum of severity. While most of us have occasional difficulties processing sensory information, for children and adults with SPD, these difficulties are chronic, and they disrupt everyday life.

What SPD looks like
SPD can affect people in only one sense–for example, just touch or just sight or just movement–or in multiple senses. One person with SPD may over-respond to sensation and find clothing, physical contact, light, sound, food, or other sensory input to be unbearable. Another might under-respond and show little or no reaction to stimulation, even pain or extreme hot and cold. In children whose sensory processing of messages from the muscles and joints is impaired, posture and motor skills can be affected. These are the "floppy babies" who worry new parents and the kids who get called "klutz" and "spaz" on the playground. Still other children exhibit an appetite for sensation that is in perpetual overdrive. These kids often are misdiagnosed - and inappropriately medicated - for ADHD.

SPD is most commonly diagnosed in children, but people who reach adulthood without treatment also experience symptoms and continue to be affected by their inability to accurately and appropriately interpret sensory messages.

These "sensational adults" may have difficulty performing routines and activities involved in work, close relationships, and recreation. Because adults with SPD have struggled for most of their lives, they may also experience depression, underachievement, social isolation, and/or other secondary effects.

Sadly, misdiagnosis is common because many health care professionals are not trained to recognize sensory issues. The SPD Foundation is dedicated to researching these issues, educating the public and professionals about their symptoms and treatment, and advocating for those who live with Sensory Processing Disorder and sensory challenges associated with other conditions.

Source: SPD Foundation : http://www.spdfoundation.net/aboutspd.html