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Sensory Processing / Sensory Integration

by Mary N. Neal, Retired Occupational Therapist

and Speech Language Pathologist

April 2025

A discussion of sensory processing needs to start with defining the senses we’re going to be including. We all know about the 5 senses: sight, hearing, smell, touch, and taste. Two more sensations we’ll be considering are vestibular and proprioception. The vestibular sensory input comes from the semicircular canals located in the inner ear. They deal with movement, and how you and the world around you are moving. Anyone who’s had an inner ear infection can tell you how it affects balance, a feeling of dizziness, even nausea. Proprioception originates in special receptors located in the skeletal muscles that react to pressure changes and movement in the muscles, tendons and joints. Processing the incoming proprioceptive input tells you where your body is in space. My proprioceptive information tells me I’m sitting here with my feet on the floor, legs not crossed, with my fingers on the keys of my computer keyboard. It lets me hit the right keys, at least some of the time, and tells me if the pressure I’m using to do so is adequate. I also know if I raise my arm above my head without having to look at it, I can walk without having to watch my feet, and I can close my eyes and touch my nose with my finger.

The initial study of sensory processing disorders is generally credited to A. Jean Ayers, an occupational therapist who came to prominence in the 1960’s. While the ideas are not new, they began to get a lot more attention as recognition of autism spectrum disorders increased. For a good description of the symptoms of autism, I recommend you look at the website for Autism Speaks. The predominant symptoms involve difficulties in language and communication skills, but a little further down the list you’ll see “under- or over-sensitivity to sensory stimulation.” In all my years working as an occupational and speech therapist, I never worked with someone on the autism spectrum who didn’t have sensory processing disorder, but conversely, I did work with many children who had sensory processing difficulties but were not on the spectrum .

So, what makes the processing “disordered?” Think of the incoming information from the senses as regulated in the brain by a dial or slide, in which there is a “normal” setting where the information is accurately interpreted and acted upon. When there’s a problem with the processing, the dial/slide could move in one direction so that input is “muted.” Your brain will feel like it needs more input/information to be able to act upon it. Or, the dial/slide could be mis-set in the other direction so that incoming information is way too much and the brain is so overwhelmed it can’t process it and function. A couple examples of extremes make the issues obvious. I worked with one little girl who was hyper-sensitive to auditory input. We were at a fund-raising event for the therapeutic riding center where I worked with her. All was going fairly well ‘til the live band started up. She began to scream bloody murder, had a complete meltdown, and had to be taken home. Another child I worked with had an extremely under-sensitive vestibular system. He was what would be called a “sensory seeker.” He simply couldn’t be still, as he was always trying to get more vestibular information for his brain to organize and regulate. In conversation with his dad, he used his dad as a human jungle gym. When it came to using the movement of a horse to help provide input and help calm him, something that generally meets with good success with kids like this, I had chosen a very calm horse to cope with all the movement from the child on his back. Not only was this not helping, but I was also really concerned about the safety of having this child on the horse. Deciding to give it one more try before telling the dad we just couldn’t continue the horse therapy, I got the horse in our program who had the absolute most movement, which most of us would probably describe as bone-jarring. Amazingly, adding more vestibular input with this movement helped. The child was able to sit without flailing his body, and he especially loved the trot (of course, that required a person on each side of him jogging alongside and gently holding him to keep him safe). He also loved to lie back so his head was rocked back and forth with the movement of the horse’s hindquarters. More amazing yet, all this input helped his system organize and regulate to the point where we had barrels set around the arena where we could stop to work on puzzles and other projects. His parents had no idea he could complete a simple puzzle, much less that he recognized the letters of the alphabet! When the sensory seeking for movement began again, he did another round or two of the arena and we were able to stop again for a few minutes of activity.

While these two examples are extreme, sensory processing challenges affect most of us in some way. What makes the difference between the disorders some people are faced with and most of us is that we have found ways to cope with the things that “bug” us so that they don’t interfere with our ability to continue with our daily activities. For example, if you are very tactilely sensitive, you may cut the tags off your clothes and avoid rough fabrics. Or if certain food textures are unpleasant (not the flavor, but the feel of it in your mouth), you just avoid that food. If loud noises really distress you, you might choose to enjoy music at home instead of attending a live concert. I’ve seen people hold their hands over their ears when a train goes by. One friend got headphones for her older son when the new brother’s crying was more than he could handle. Kids seem to have more need of vestibular stimulation than most adults do. As a kid, I remember swinging upside down on the monkey bars and spinning the merry go round just as fast as I could. It’s not unusual to see kids doing that sort of activity on the playground at school, then being much more ready to sit and focus back in the classroom. As an adult, I enjoy rocking in a rocking chair but avoid roller coasters. When you see the kids in the school hallways that always seem to drag their hands along the walls, is that a bad habit or an attempt to get more proprioceptive input? We can also use sensory stimulation to help us in certain situations. Are you one of those people who tap their foot quickly and incessantly during a lecture and drive your neighbors crazy? You’re using sensory stimulation to stay alert! Oral stimulation is used in many ways by people trying to function better. When on a long drive, I eat crunchy foods to stay alert. Some people chew their pencils ‘til almost nothing is left or twirl their hair if its long enough. Chewing fingernails may be a way of trying to calm an anxious nervous system. Also, in one person, they may seek one kind of input while avoiding others. For example, the little girl I mentioned who had a meltdown over noise, sought oral input even chewing on aluminum foil (just thinking about that makes me cringe!).

So, in summary (finally), how our brains process incoming sensory information is vital to navigating our world each day. Although none of us probably have the processing dial set to “normal” in all ways, most of us manage to function perfectly adequately. Recognizing challenges in others, especially the children in our lives, may help us help them also learn to navigate the world, or help you know when assistance from a professional might really help. Understanding what sensory processing is all about may also help you understand those who do have more severe sensory processing challenges.

Gastroesophageal Reflux Disease (GERD)

by Joseph Flynn, PharmD

March 2025

Gastroesophageal reflux disease (GERD) has become a very treatable disorder with highly effective medications now available over the counter (OTC) at any pharmacy of your choosing. Proton pump inhibitors (PPIs) work by blocking enzymes in the stomach lining which produce acid. Reducing this acid can help with GERD symptoms such as: heartburn, regurgitation, chest pain, difficulty swallowing, nausea, burping, and coughing.

The OTC options are Prilosec (omeprazole), Prevacid (lansoprazole) , and Nexium (esomeprazole). These should be taken 30 to 60 minutes prior to a meal for optimal acid-lowering. When taken via self-direction, use should not exceed 14 days and no more than three times per year. If directed by your doctor for more complicated indcations such as gastric ulcers, H. pylori, erosive esophagitis, Zollinger-Ellison syndrome, or Barrett’s esophagus use can be extended to more long-term.

For GERD is it strongly recommended to try non-pharmacologic treatments first in hopes that medication is not needed:

-Elevating the head of the bed six inches.
-Avoiding meals two to three hours before bedtime.
-Weight loss, if appropriate.
-Smoking and alcohol cessation.
-Avoiding foods that worsen symptoms (e.g., caffeine, chocolate, spicy foods, acidic foods, high-fat foods).
-Stress reduction.

As mentioned, PPIs are very effective in treating GERD, but these are a mainstay in the hospital to prevent stress ulcers. After getting discharged, these are continued and then lead to long-term use when not always warranted. The ease of getting them OTC also lead to this long-term use. As with any medication, the benefits need to outweigh the risks for long-term use to be appropriate. If you have a complicated condition, like the examples listed above in paragraph two, this may be appropriate. In many instances this is not appropriate. Unfortunately, the downsides to PPI use are lengthy:

-Reduced absorption of calcium, magnesium, iron, HIV meds, and vitamin b12
-increased risk for pneumonia
-Increased risk for C. difficile infections and diarrhea.
-Increased risk for hip, wrist, and spine fractures

Overall, PPIs have been a wonderful discovery leading to a highly successful option in treating gastrointestinal bleeds, ulcers, and common heartburn. With that so, caution should be taken to not use these agents long-term unless deemed necessary by a physician or specialist. In many cases, continuing an PPI long-term can be detrimental to your health. Alternative short-term options like calcium carbonate (TUMS), famotidine (Pepcid), or Mylanta are acceptable alternative to PPIs for heartburn and likely easier on the pocketbook.

Together we can be a healthier community.
Joseph Flynn, PharmD

Photo by National Cancer Institute on Unsplash