Sensory integration therapy

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Sensory integration therapy or sensory processing therapy attempts to treat Sensory processing disorder.[1][2] Some of these treatments (for example, sensorimotor handling) have a questionable rationale and no empirical evidence. Other treatments have been studied, with small positive outcomes, but few conclusions can be drawn due to methodological problems with the studies. These treatments include prism lenses, physical exercise, auditory integration training, and sensory stimulation or inhibition techniques such as "deep pressure"—firm touch pressure applied either manually or via an apparatus such as a hug machine or a pressure garment.[3] Although replicable treatments have been described and valid outcome measures are known, gaps exist in knowledge related to Sensory processing disorder and therapy.[4] Because empirical support is limited, systematic evaluation is needed if these interventions are used.[5]

Hypothesis[edit]

Children with Sensory processing disorder experience problems with their sense of touch, smell, hearing, taste and/or sight. Along with this might possibly be difficulties in movement, coordination and sensing where one's body is in a given space. According to proponents of sensory integration therapy, Sensory processing disorder is a common disorder for individuals with neurological learning disabilities such as an autism spectrum disorder,[6][7] Attention Deficit Hyperactivity Disorder (ADHD),[8] and sensory modulation dysfunction[9]

According to proponents of sensory integration therapy, individuals afflicted by Sensory processing disorder may be overly sensitive to certain textures, sounds, smells and tastes, while wearing certain fabrics, tasting certain foods, or normal everyday sounds supposedly cause discomfort. Proponents also claim that, for example, a child with an autism spectrum disorder may feel very little pain or actually enjoy sensations that neurotypical children would dislike: strong smells, intense cold or unpleasant tastes.

Typical therapies for different senses[edit]

The sense of touch varies widely between children experiencing Sensory processing disorder. When children enjoy the feel of sticky textures, the therapist may use materials such as glue, play dough, stickers, rubber toys and sticky tape. Other materials that can be useful for tactile sensation include water, rice, beans and sand. Conversely, children who are very sensitive to touch may go through a brushing program that attempts to desensitize children to touch by systematically brushing their body at regular intervals throughout the day. The brushing program is called the Wilbarger protocol,[10] named after Patricia Wilbarger, the occupational therapist that developed it.

Children on the autism spectrum often enjoy a sense of firm overall pressure. This can be given by wrapping them up in blankets, being squashed by pillows and firm hugs. These can form a basis for play, interaction and showing affection. Experiences that may be claustrophobic for neurotypical children may be enjoyed, such as being squashed between mattresses, and making tunnels or tents from blankets over furniture.

A therapist will be aware of a child's response to the smell of substances, and may experiment with putting different fragrances in play dough or rice. If a child actively likes strong odors, specific toys with this feature can be used in therapy.

Sound can be focused on by experimenting with talking toys, games on computers, musical instruments, squeaky toys and all sorts of music. Clapping together, rhymes, repeating phrases and tongue twisters are useful activities. Some children on the autism spectrum respond to music but not voices, in which case a melodic or “sing-song” voice may be preferred. The therapist may try different tones of voice, pitches, and gauge a child's reaction.

Proprioceptive system[edit]

The Proprioceptive System helps children (and adults) to locate their bodies in space. Autistic children often have poor proprioception and will need help to develop their coordination. Therapy may include playing with weights, bouncing on a trampoline or a large ball, skipping or pushing heavy objects.

Vestibular system[edit]

The Vestibular system is located in the inner ear.[11] It responds to movement and gravity and is therefore involved with our sense of balance, coordination and eye movements.[12] Therapy can include hanging upside down, rocking chairs, swings, spinning, rolling, somersaulting, cartwheels and dancing. All these activities involve the head moving in different ways that stimulate the vestibular system. The therapist will observe the child carefully to be sure the movement is not over stimulating.

Back and forth movement is typically less stimulating than side-to-side movement. The most stimulating movement tends to be rotational (spinning) and should be used carefully by the therapist. Ideally therapy will provide a variety of these movements. A rocking motion will usually calm a child while vigorous motions like spinning will stimulate them. Merry-go-rounds, being tossed on to cushions or jumping trampolines can be favorite activities with some children.

Learning new skills involving movement[edit]

Skills such as tying shoe laces or riding a bike can be difficult as they involve sequences of movements. Therapy to help in this area may use swimming, mazes, obstacle courses, constructional toys and building blocks.

Difficulty with using both sides of the body together can occur in some cases of Sensory processing disorder. A therapist may encourage a child with crawling, hopscotch, skipping, playing musical instruments, playing catch and bouncing balls with both hands to help with bilateral integration.

Hand and eye coordination can be improved with activities such as hitting a ball with a bat, popping bubbles, and throwing and catching balls, beanbags and balloons.

Research on Sensory Integration Therapy[edit]

Although Sensory Integration Therapy is widely used and supported by anecdotal evidence, there is as yet little research that would establish it as an evidence-based treatment. One study found only poor quality evidence providing either no, or at best, equivocal support for Sensory Integration therapy (Dawson and Watling 2000).[7] There have been many studies done but these have not been conducted rigorously enough for Sensory Integration Therapy to be considered an evidence-based treatment, despite it being widely used as an intervention for Autism and other developmental disorders.[1]


See also[edit]

References[edit]

  1. ^ a b Zimmer M, Desch L (June 2012). "Sensory integration therapies for children with developmental and behavioral disorders". Pediatrics 129 (6): 1186–9. doi:10.1542/peds.2012-0876. PMID 22641765. 
  2. ^ "Sensory integrative therapy". Research Autism. Retrieved 2007-10-08. 
  3. ^ Baranek GT (2002). "Efficacy of sensory and motor interventions for children with autism". J Autism Dev Disord 32 (5): 397–422. doi:10.1023/A:1020541906063. PMID 12463517. 
  4. ^ Schaaf RC, Miller LJ (2005). "Occupational therapy using a sensory integrative approach for children with developmental disabilities". Ment Retard Dev Disabil Res Rev 11 (2): 143–8. doi:10.1002/mrdd.20067. PMID 15977314. 
  5. ^ Hodgetts S, Hodgetts W (2007). "Somatosensory stimulation interventions for children with autism: literature review and clinical considerations". Can J Occup Ther 74 (5): 393–400. doi:10.2182/cjot.07.013. PMID 18183774. 
  6. ^ Marco EJ, Hinkley LB, Hill SS, Nagarajan SS (May 2011). "Sensory processing in autism: a review of neurophysiologic findings". Pediatr. Res. 69 (5 Pt 2): 48R–54R. doi:10.1203/PDR.0b013e3182130c54. PMC 3086654. PMID 21289533. 
  7. ^ a b Dawson G, Watling R (October 2000). "Interventions to facilitate auditory, visual, and motor integration in autism: a review of the evidence". J Autism Dev Disord 30 (5): 415–21. PMID 11098877. 
  8. ^ Ghanizadeh A (June 2011). "Sensory processing problems in children with ADHD, a systematic review". Psychiatry Investig 8 (2): 89–94. doi:10.4306/pi.2011.8.2.89. PMC 3149116. PMID 21852983. 
  9. ^ Miller, L. J.; Reisman, J. E.; McIntosh, D. N; Simon, J. "An ecological model of sensory modulation: Performance of children with fragile X syndrome, autistic disorder, attention-deficit/hyperactivity disorder, and sensory modulation dysfunction". In S. S. Roley, E. I. Blanche, & R. C. Schaff. Understanding the nature of sensory integration with diverse populations (Tucson, AZ:: Therapy Skill Builders). pp. 75–88. ISBN 9780761615156. OCLC 46678625. Retrieved 2013-07-26. 
  10. ^ "The Wilbarger Protocol: Helping People Sensitive to Touch". National Autism Resources. Retrieved 12 August 2012. 
  11. ^ Angelaki DE, Cullen KE (2008). "Vestibular system: the many facets of a multimodal sense". Annu. Rev. Neurosci. 31: 125–50. doi:10.1146/annurev.neuro.31.060407.125555. PMID 18338968. 
  12. ^ St George RJ, Fitzpatrick RC (February 2011). "The sense of self-motion, orientation and balance explored by vestibular stimulation". J. Physiol. (Lond.) 589 (Pt 4): 807–13. doi:10.1113/jphysiol.2010.197665. PMC 3060360. PMID 20921198. 

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