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Sensory Diet Information and forms!!!!

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1 Sensory Diet Information and forms!!!! on Thu Feb 26, 2009 6:41 am


Specific For: _____________________
Requested By:
Occupational Therapist

Note: Please make daily observations of your child’s behaviors and write notes in the spaces provided.

AM Wake-Up:







During the night:


Public Places:

Additional Notes:

2 SENSORY DIET EXAMPLES on Thu Feb 26, 2009 6:41 am



Stop or Decrease Excitatory Vestibular Activities(ie, fast movements, quick changes or direction, rotary, or orbital movements) 2-3 hours before bedtime including Running, Spinning, Jumping, Swinging, Rocking,etc.
Decrease Caffeine Intake
Þ Make environment warm
Þ Use lavender scented bath products
Þ Use long, deep pressure strokes with wash cloth up/down arms, legs, back.
Þ Use straws to blow bubbles in the tube or blow around toy boats in water(Blowing provides calming effect)
Þ Dry off with heavy towel using long, deep pressure strokes.
Þ Massage using lotion (preferably unscented)
Þ Have child push parent from bathroom to bedroom (provides proprioceptive feedback)
Þ Provide brushing and joint compression protocol.
Þ Use weighted blanket, weighted animal, etc.
Þ Provide bear hugs
Þ Use calming CD such as classical music or ocean sounds
Þ See Calming Vestibular List


30-45 minutes prior to going out- Provide Brushing and Joint Compression Protocol.
Use of compression (body suit & tights) or weighted vest 15 minutes at a time.
Use of weighted animal (stuffed animal filled with beans for heaviness) placed across the lap or around the shoulders.
Chair push ups, hold the wall up, and other pushing or pulling games.
Child’s Backpack with books, picture cards, crayons, coloring book, 1lb wrist weights, etc. (For child to carry)
Provide child with visual of what you are shopping for ie. Magazine picture, etc. (Making the child part of the activity decreases boredom and re-directs some sensory seeking behaviors).
Provide child with opportunities to get out of stroller and push stroller to get proprioceptive (body awareness) feedback to promote calming.
Provide headphones over the ears to allow the child to control auditory input that is over stimulating.
Provide sunglasses for child to control visual stimulation.

Deep massage using lotion, Bears Hugs, Joint Compressions, Compression (Body suit & Tights) or weighted Vest or Blanket, Weighted Animals, Chewing on Chew Tube or Tubing Necklace, Blowing Bubbles, Horns, etc.**See Handouts.

One hour to 45 minutes prior to going to restaurant- Provide Brushing and Joint Compression Protocol.
Use of compression (body suit & tights) or weighted vest 15 minutes at a time throughout meal.
Use of weighted animal placed across the lap or around the shoulders.
Chair push ups, hold the wall up, and other pushing or pulling games.
Child’s Backpack with books, picture cards, crayons, coloring book, 1lb wrist weights, etc. (For child to carry)

One hour to 45 minutes prior to going out- Provide Brushing and Joint Compression Protocol.
Use of compression (body suit & tights) or weighted vest 15 minutes at a time during shopping trip.
Use of weighted animal placed across the lap or around the shoulders.
Provide child with visual of what you are shopping for ie. Magazine picture, etc. (Making the child part of the activity decreases boredom and re-directs undesirable behaviors).
Provide child with opportunities to get out of stroller and push stroller to get proprioceptive (body awareness) feedback to promote calming.
Provide child with large headphones that cover the ears so they can control auditory(hearing) input and limit overload.

3 More info on Sensory Processing Disorder on Thu Feb 26, 2009 6:42 am


Sensory Processing Difficulties

1. Strips off clothing
2. Frequently adjusts clothing as if it binds or is uncomfortable.
3. Sensitive to seams in clothes, tags, or certain clothing textures
4. Indicates distress when barefoot
5. Fights being dressed or undressed
6. Enjoys mostly soft textured clothing
7. Resists grooming in any of the following
a. face washing
b. hair combing
c. hair cutting
d. tooth brushing
e. nail trimming
f. hair washing
8. Dislikes bathing
9. Avoids/dislikes messy things on face or hands ( ie sand, dirt, fingerpaints, glue, playdough, chalk, food, etc.)
10. Overly sensitive to unexpected touch
11. Withdraws or hits when peers reach toward or are nearby
12. Rubs spot after being touched
13. Avoids palm/hand contact with objects or people
14. Prefers to cuddle/hug on own terms
15. Seems to have increased response to pain, overly aware of cuts and bruises
16. Prefers to play alone, away from other children
17. Displays a strong need to touch objects or people
18. Dislikes crowds, busy places
19. Mouths objects or clothing
20. Prefers to be in corner, under table, behind furniture
21. Spits out/rejects certain food textures
22. Picky eater – dislikes many foods
23. Gags easily with food textures/utensils in mouth
24. Sensitive to temperatures in food
1. Shows decreased awareness of being touched
2. Decreased awareness if clothes are poorly adjusted
3. Delayed, little or decreased response to pain
4. Displays a strong need to touch objects or people
5. Seeks oral input through mouthing objects, chewing on objects or clothing
6. Unaware food is on mouth when eating – messy eater
7. Drops carried objects and doesn’t know it

Self-Regulatory Behaviors ( seeking tactile input ) :
• Engages in persistent hand to mouth activity
• Mouths objects or clothing
• Persistently has hand in pants or pants pockets
• Sits on hands/feet
• Pushes or rubs body against objects/walls/people
• Insists on holding an object in hand
• Rubs fingers against hand or other fingers
• Self-injurious behaviors present – pinches, bites self, hits, slaps, etc.

1. Becomes anxious or distressed when the body leaves the ground ( doesn’t like feet off the ground, upside down positions, climbing, etc.)
2. Dislikes or fears excessive movement activities such as swings, rides, roughhousing, etc.
3. Acts cautious about gross motor movement, playground equipment, trying new movement experiences
4. Becomes overly excited after movement
5. Experiences frequent car sickness
6. Dislikes when someone bumps them or moves them off balance
7. Has a fear of heights
8. May not like rocking/bouncing
9. Prefers to be upright
Self-Regulatory Behaviors (increasing vestibular input) :
• Rocks body
• Wags head
• Rotates or twirls body
• Waves or flicks fingers near eyes
• Paces
• Has spurts of running
1. Props head or leans when sitting or standing
2. Collapses onto furniture
3. Loses balance easily
4. Clumsy-falls or trips often
5. Seems lethargic or slow to respond to movement demands
6. Prefers sitting or sedentary activities
7. May crave fast and spinning movements
8. Moves constantly, rocks, or fidgets
9. Enjoys being upside down
10. Poor endurance, tires easily
11. Has slow or no protective responses


1. Locks joints to stabilize movement
2. Rigid in movement
1. Weak grasp
2. Poor endurance for activities
3. Hangs onto objects for support
4. Difficulty lifting heavy objects
5. Clumsy/awkward in movement
6. Is awkward getting on or off equipment or chairs
7. Difficulty grading movement or pressure ( knocks things over, under/over shoots target, grasp too tight on objects or too loose, difficulty being gentle, difficulty pouring accurately)
8. Acts hard on toys ( bangs a lot, throws, forceful with toys )
9. Uses high stepping when ascending/descending stairs
10. Difficulty with dressing
11. Moves heavily, clapping feet with each step
12. Feels limp, like a “sack of potatoes” when being moved by someone else
13. Has poor posture – may have tendency to slide off supporting surfaces

Self-Regulatory Behaviors ( increasing proprioceptive input ):
• Flaps hands, clasps, jumps, stamps to an unusual degree
• Toe walks
• Pulls against objects clenched in mouth
• Presses or bangs heels or wrist
• Climbs in inappropriate places
• Pushes or leans heavily against people/furniture
• Grinds/clenches teeth
• Bites objects/others
• Butts head or body against wall
• Self-injurious - bangs head, slaps/hits self, bites hand/wrist/arm


1. Dislikes bright lights / sunlight
2. Covers eyes in brightly lit room or outside
3. Watches everyone when they move
4. Easily visually distracted
5. Avoids eye contact

1. Doesn’t notice when people come into room
2. Difficulty finding objects in room,
drawer, table
3. Picks up pictures or objects and looks
very closely and carefully at them

Self-Regulatory Behaviors:
• Avoids eye contact
• Likes to watch objects spin for long periods
• Likes to watch flickering or blinking lights for long periods

1. Overreacts to unexpected or loud noises
2. Dislikes, is afraid, or cries over certain sounds or noises in environment
(vacuum cleaners, hair dryers, kitchen appliances, mowers, sirens, etc.)
3. Seems distracted by almost unnoticeable
sounds i.e., refrigerator, fans, heaters, etc
4. Holds hands over ears when louder
noises are present
1. Seems oblivious within an active environment
2. Seems confused about what directions sounds come from
3. Appears not to hear at times
4. Fails to listen, or pay attention to what is said to them
5. Makes loud noises frequently
6. Talks incessantly

Taste and Smell

1. Rigid about what to eat, doesn’t like to try new foods
2. Finds many smells offensive
1. Says all food tastes the same
2. Explores environment by smelling everything
3. Taste non-food items before playing with them

4 Re: Sensory Diet Information and forms!!!! on Thu Feb 26, 2009 6:43 am


In explaining sensory processing it is important to breakdown not only
the subsystems of the sensory system, but also the types of processing into
Sensory Modulation and Sensory Discrimination. It is thought that if an
individual’s over-reactive, under-reactive or fluctuating response to sensory
input is in a manner that is disproportional to that input then that individual
has a sensory modulation disorder (Koomar & Bundy, 1991). These systems
often fluctuate daily, if not on an hourly basis unlike those of sensory
discrimination disorders in which the individual has poor ability to
discriminate input from all the senses. Symptoms of discrimination problems
remain fairly consistent over time (without intervention). Both types of
processing disorders can occur in the vestibular, proprioceptive, and tactile
The process of sensory integration underlies the development of all
motor and social skills and the ability to perform daily living tasks. The
process involves the brain’s ability to organize and make sense of different
kinds of sensory information entering the brain at the same time. Sensory
Integration is manifested by the ability to produce an adaptive response.
The primary sensations involved in the process come from the vestibular,
tactile, and proprioceptive systems.
How to Use This Handout?
There are three sensory systems that primarily effect sensory
integration in children. They are the proprioceptive system, vestibular
system, and tactile system. These are in the pages that follow. The author
has separated the pages into yellow for the proprioceptive system, blue for
the vestibular system, and green for the tactile system.
Within each system there are typical behaviors that are most often
seen. These are listed under sample behaviors. It should be remembered
that not all behaviors are listed here, but those that are listed are the ones
that are most common.
With the sample behaviors is a list of activities that are common
treatments for these sensory behaviors. This list is called activities to try.
This list provides individual activities for those particular students in your
class that you have concerns about, or there are activities that you can have
the entire class doing in between activities or as time filler.
Although there are students who do have sensory integration
dysfunction, all students can benefit from added sensory experiences in
their school day. The purpose of these handouts is to provide suggestions
for sensory integration in the classroom and school environment. This
author provides these suggestions as a spring board to the creativity of
teachers like you. Teachers are the people who know how to change
classroom routines and how to deal with full classrooms all at once. These
activities are examples and you as the classroom teacher will have many
additional ideas or suggestions to modify your classrooms and classroom
Bottom-line is that ALL children need to move and experience all kinds
of sensations. Sensory Integration is something that occurs everyday with
all people; just some children require increased experiences. Have Fun! Be
Creative! Enjoy!
Proprioceptive System
The proprioceptive system has its receptors in muscles,
tendons, and joints. Sensory information from this system is
created by the contraction and stretching of muscles and by the
bending and straightening, pulling and compression of joints
between bones. This information is constantly being sent to the
brain to tell us about our body’s position and where our arms and
legs are. When we have adequate proprioceptive procession, our
brain knows where all our body parts are and what they are doing
without our having to look at them.
Sample Proprioceptive Behaviors:
• Difficulty with body awareness
• Difficulty with personal space
• Stomping his or her feet
• Grinding his or her teeth
• Chewing on clothing, pencils, etc.
• Difficulty maintaining attention
• Crashing into people or objects
• Physically rough with people or objects
• Difficulty with size of handwriting
• Increased pencil pressure
• Tight pencil grip
Activities to Try…..
• Moving desks for various activities
• Placing chairs up on desks or down off desks
• Erase or wash boards
• Carrying heavy objects (i.e. dictionary) to other rooms in school
• Theraband on chair legs
• Using bean bag chairs
• Wall or Chair push-ups
• Writing while laying on the floor
• “Worry Stone” or squeeze ball as a fidget toy
• Chewy Snacks
• Wheelbarrow walking, crab walking, jump between centers or
• Provide firm pressure to child’s shoulders
• Using theraputty or play dough before writing
• Give yourselves a hug
• Squeeze hands, etc.
• Stack chairs without making a sound
• Line up with bean bag on head without dropping
• Doing jumping jacks between activities
• Theratubing on ends of pencils to chew on (check for Latex allergy)
Vestibular System
The vestibular system has its receptors in the inner ear
and senses movement of the head in all directions. The sensory
input we get through the vestibular system tells us exactly where
we are in relation to gravity, whether we are moving or still, how
fast we are going, and in which direction. Through its influence
on muscle tone, vestibular system affects posture and movement.
Sample Vestibular Behaviors:
• Excessive Blinking
• Spurts of running
• Rolling or moving head while sitting still
• Appears to be in constant motion
• Difficulty sitting still
• Sitting on his or her feet
• Rocking in place
• Making repetitious vocal sounds
• Difficulty paying attention
Activities to try:
• Balancing a bean bag on head while walking to centers or lining up
• Music playing during work times
• “Shake the Wiggles Out”
• Rocking at morning meeting (knees to chest)
• Popcorn Popper—Sitting in a chair and slowly begin popping up, getting
faster, then back to slow
• Delivery system to parts of building
• Run and stop quickly in a repetitive pattern
• Bouncing on a therapy ball—class take turns
• Balloon volleyball
• Rocking Puppies—On all fours, rocking back and forth
• Ball pass—around a circle, overhead to under legs
• Move and sit cushions to sit on at desks or circle time
• Therapy ball as a chair
• Jumping jacks
• Paper Passer
• Provide increased opportunities to move
• Tiptoe Walking
• Using balance beams
• Rolling back and forth to put together a puzzle, etc.
Tactile System
The tactile, or touch receptors, are located under the skin
and differentiate light touch and pressure touch. Light touch
sensation alerts the nervous system to be wary of possible
danger. Pressure touch calms the nervous system, and because it
enables us to discriminate shapes, textures and sizes by touch, it
defines our body boundaries and is fundamental to how we learn
about objects and people.
Sample Tactile Behaviors:
• Rubbing hands on walls
• Touching everything or everyone
• Excessive fingers in nose or mouth
• Licking hands, arms, etc.
• Sensitive to getting dirty
• Unusual reaction to finger-paints, etc.
• Sensitive to textures on clothing, tags, etc.
• Clothing is not always adjusted appropriately
• Excessive hugging
• Sitting on laps
Activities to Try:
• Playing or practice writing in rice, shaving cream, etc.
• Using Chalkboards
• Rubbing hands together or on various body parts
• Use multisensory approaches to learning new tasks
• Use worry stones as fidgets
• Sucking candy, etc. for breaks or during work time (Beware of
• Rubbing hands vigorously with washcloths, etc to “get ready to work”
• Stereognosis Activities
• Using Lotions or waterless soaps to clean up

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