As you look around the room in which your child will have his occupational therapy, you should see numerous pieces of large play equipment, mats on the floor, some ride-on toys, a ball pit and maybe a trampoline, a table for doing fine-motor work, and at least one swinging object suspended from above. The therapist will use these items to improve your child's sensory processing and integration in many different ways.

Therapy may concentrate on the vestibular, proprioceptive, and tactile senses — balance, body position, and touch — but includes other senses as well, both for therapeutic purposes and as distraction from potentially stressful activities.

While much of the equipment used may be specialized for therapists, some items may resemble what you'd see at a children's gymnastics class. Other items may be toy store purchases put to therapeutic use. OTs are a creative lot, and they often adapt things to their purposes in an effort to keep kids entertained and intrigued.

Swinging Things

A rope suspended from a hook in the ceiling can hold a wealth of activities for your child. The hook on the other end of the rope attaches to interchangeable swinging items to give your child a variety of different experiences.

Among the things you may see dangling from that rope in a therapist's office, or in some cases suspended from a metal frame, are these:

• Flat platform
• Inner tube
• Fabric sling
• Net
• Bolster
• Ladder
• Chin-up bar
• Fabric sack
• Disk just big enough to sit on

Your child may swing on these items while sitting, standing, or lying on her tummy. She may swing while playing a game, catching a ball, or answering questions. The swinging may be vigorous or gentle. The therapist will adjust this activity to your child's comfort level and need for sensory stimulation. At different points during the session, the OT may unhook one item from the rope and hook on another.

Balance Boosters

Swinging isn't the only tool in the therapist's playroom for improving balance. Other items that concentrate on giving good input to the vestibular sense include the following:

• Balance beam: It may be narrow or wide, high or low to the ground, made of wood or foam.

• Seesaw: Your child may sit on this alone with the therapist pushing one end, share it with another child, or walk on it to practice holding balance on a shifting surface.

• Balance board: This is a platform atop a curved base that rocks back and forth. Depending on the child's level of coordination and fear, that platform may be small — just the right size to stand on — or large enough to be set down, sat, crawled or walked on.

• T-stool: As the name suggests, this kind of stool has one seat and one leg. Your child will have to constantly adjust his body position to stay balanced.

• Rotation board: Your child can rotate this round disk while sitting or standing by turning his body. There may be handles on the sitting models, or a game on the standing version that involves moving a ball around.

• Fitness ball: There may be various sizes and colors of these giant inflatable balls that your child can sit on or lie on. A ball may be used as a seat for table work, or your child may lay on it face down and the therapist may roll it forward and backward.

The OT may also engage your child in balance activities like hopping, skipping, jumping, or standing on one foot. Sometimes these can be facilitated with special stepping stones or pathways on the floor, or sometimes they will be done as part of a game like Simon Says. There are many ways to lure your child into doing an activity she would otherwise feel uncomfortable doing or distract her from her discomfort while she's doing it. In this way, the sense of balance can be improved without causing stress for your child.

Jumps and Jolts

Activities that involve changes in position and hard jolts to the joints are helpful for both the sense of balance and the sense of body position. They can increase your child's level of calmness or alertness in addition to being delightful to him. You'll likely notice lots of equipment in the therapist's playroom to provide that much-needed input, including these:

• Bouncing balls: These inflatable balls have a handle to allow your child to sit on them and bounce around the room. There may be different sizes available for children of different sizes or who are more or less brave about bouncing high off the floor.

• Trampoline: This may be a one-person size on a metal frame or a larger inflatable version. Two boards with a spring between can also provide a satisfactory jumping experience without overwhelming a child who might be frightened by the movement.

• Crash pit: A soft surface — often a number of big foam blocks inside a stretchy fabric sack — is a great place for your child to throw himself to get lots of pressure on his joints without getting hurt.

• Ball pit: Children who dive into a ball pit and thrash around get great input to their sense of balance and body position, and those who prefer a more gentle experience still get good information for their sense of touch. Ball pits may be very large or just big enough for a child or two.

Finding multiple uses for things is common in sensory integration therapy. The colorful balls in the ball pit are good for more than stimulating the sense of touch and body position. They are also appealing to your child's visual sense. The therapist may use them to improve color recognition by having your child select balls of a certain color to throw out of the pit or back into it during cleanup. Throwing the small hand-sized balls through a hoop or into a bin also strengthens eye-hand coordination.

These tools may be combined with swings for some very intense input, with your child jumping off a swing and into a ball pit. Your child may also be encouraged to jump off a low platform or set of steps; slide down a slide feet or head first; or throw and catch a ball while jumping on a trampoline or playing in a ball pit.

Path of Most Resistance

Crawling through and pressing against things that provide resistance are also good for improving your child's sense of body position and improving muscle tone. Some of the things you may see in the therapist's playroom for accomplishing this are the following:

• Body sack: Your child can step into this bag of stretchy fabric, have the opening fastened shut, and then walk, jump, push out or up, roll around, or do therapist-led activities.

• Resistance tunnel: This is a tight stretchy tube that your child crawls through, often pushing a ball before him.

• Stretchy bands: Like rubber bands on steroids, these half-foot-wide strips or circles of colorful thin rubber can be stretched or pulled by your child to provide lots of good muscle work and input into the sense of body position.

Other activities that provide your child with deep pressure, weight bearing, and resistance might include carrying a large ball, block, or bolster across the room; being rolled up in a blanket or mat and pushing out of it; having a ball, block, or bolster placed on top of your child, to enjoy the deep pressure or to push it off; or pushing hands or feet against a therapist's hands.

Keeping in Touch

Activities that target the tactile sense, or sense of touch, are also a major component of an occupational therapy session with a sensory integration approach. Many of the activities listed above, like a ball pit or resistance tunnel, also have a strong tactile element. Some other activities that focus more directly on the tactile sense include these:

• Tub of rice: Just thrusting her hands into a tub of rice may be a comforting sensory experience for your child. The therapist can also put items in the rice for your child to find.

• Sand box: Like rice, sand can be a rich sensory experience for your child as she plunges her hands or her feet into it.

• Water play: Water is a sensory experience all its own, and therapy may include manipulating different objects in a tub or table filled with liquid.

• Textured stepping stones: Your child may remove her socks and shoes and take a walk along plastic stones or a special pathway that offers a variety of sensory experiences — bumpy, rough, prickly, smooth — as she steps and jumps along.

• Finger paint: If your child is overly sensitive to touch, she may not much like the feeling of finger-paint, but the therapist will work with her to increase her tolerance and ability to have fun with the slimy, slippery substance.

• Bubble wrap: Popping those plastic bubbles gives your child good tactile input and some stimulating input for the auditory sense, too.

• Links and chains: Toys that snap together into long strands require some force, some coordination, and a good feel for where the openings and connections are.

• Clay or putty: Getting your child comfortable with the feel of these malleable substances is another task the occupational therapist may tackle.

Puzzles, games, and toys of all types can also be useful in working on your child's sense of touch. Children who are particularly sensitive to touch may approach these activities with great reserve, while others will throw themselves into it with excess gusto. Modulating those reactions and finding novel ways to engage a child with an inaccurate sense of touch is one of the major tasks of occupational therapy using a sensory integration approach.