Sensory integration therapy

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Sensory integration therapy is based on A. Jean Ayres' theory of Sensory Integration. Ayres' Sensory Integration (ASI) [1] is a theory that describes (1) how the neurological process of processing and integrating sensory information from the body and the environment contribute to emotional regulation, learning, behavior, and participation in daily life, (2) empirically derived disorders of sensory integration (,[2][3][4] and (3) an intervention approach. “Sensory integration theory is used to explain why individuals behave in particular ways, plan intervention to ameliorate particular difficulties, and predict how behavior will change as a result of intervention” (p. 5).[5] Sensory integration theory originated from the work of A. Jean Ayres, PhD, OTR, an occupational therapist and psychologist, whose clinical insights and original research revolutionized occupational therapy practice with children. Dr. Ayres wrote "Sensory Integration is the organization of sensations for use. Our senses give us information about the physical conditions of our body and the environment around us...The brain must organize all of our sensations if a person is to move and learn and behave in a productive manner" (p. 5).[6]

The neurological process of sensory integration is a “particular way of viewing the neural organization of sensory information for functional behavior” (p. 325).[7] It is studied by different professions on diverse levels (e.g., by occupational therapists as a foundation for occupational performance and participation, by psychologists on a cellular level as Multi-Sensory Integration (MSI),[8]).

As a theory, Sensory Integration is “a dynamic and ecological theory that specifies the critical influence of sensory processing on human development and function” (p. 793).[9] “It contributes to the understanding of how sensation affects learning, social-emotional development, and neurophysiological processes, such as motor performance, attention, and arousal” (p. 792).[9]

As an intervention approach, it is used as “a clinical frame of reference for the assessment and treatment of people who have functional disorders in sensory processing” (p. 325).[7] The theory includes a framework for assessment and intervention and is most commonly utilized by occupational therapy practitioners in their treatment of children with sensory integrative or sensory processing dysfunction.

People with Sensory Integrative dysfunction experience problems with their sense of touch, smell, hearing, taste, sight, body coordination, and movement against gravity. 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 integrative dysfunction is a common disorder for individuals with neurological learning disabilities such as an autism spectrum disorder,[10][11] Attention Deficit Hyperactivity Disorder (ADHD),[12] and sensory modulation dysfunction[13]

Dr. A. Jean Ayres pioneering research and inventive practice in sensory integration proliferated among therapy and educational professionals over the past several decades. Sensory integration theory and practice has been met with some resistance within the occupational therapy profession as well as in other disciplines.[7] Despite controversy, the research-base of sensory integration theory and practice is growing and expanding. Ayres Sensory Integration® was trademarked to delineate the core tenets of her theory and intervention techniques that continue to be used and taught today. Currently the intervention methods and tools Dr. Ayres pioneered continue to be questioned and investigated. Dr. Ayres anticipated and understood the necessity for the refinement and evolution of her work with the advancements in neurological science and our increased understanding of the brain and our central nervous system. A growing number of practitioners around the world are educated in sensory integration theory, assessment, and intervention techniques as well as taking up the call for further research to strengthen and enhance Dr. Ayres' original body of work.

The growing body of effectiveness research on Ayres Sensory Integration® intervention shows promising results. Recent studies have used a manualized approached to intervention and included the use of a valid and reliable fidelity measure of Ayres Sensory Integration® intervention.[14] At least three randomized clinical control trials for children with autism have been published in recent years;[15][16][17] The results of these studies have shown that in children with autism who have identified sensory integrative deficits measured using standardized tools such as the Sensory Integration and Praxis Tests and the Sensory Processing Measure, and have received occupational therapy with fidelity to Ayres Sensory Integration® intervention methods, have shown significant gains in social engagement and performance. Therefore, the effectiveness of Ayres Sensory Integration® intervention appears promising.

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,[18] 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 provided by weighted belts,[19] weighted blankets, or 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[20] 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 wearing weighted belts,[21] weighted blankets, weighted vests, or 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.[22] It responds to movement and gravity and is therefore involved with our sense of balance, coordination and eye movements.[23] 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. Learning skills are mainly depending on sensorimotor transformation. Studies in sensory and muscles synergies trying to highlight these transformations [24] Sensory synergy are believed to play an important role in integrating the mixture of environmental inputs to provide low-dimensional information to the CNS thus guiding the recruitment of motor synergies.

Research on Sensory Integration Therapy[edit]

See also[edit]


  1. ^ Smith Roley, Susanne; Mailloux, Zoe; Miller Kuhaneck, Heather (September 2007). "Understanding Ayres' Sensory Integration.". OT Practice. 12 (17): CE1–8. 
  2. ^ Ayres, A. Jean (1998). Sensory Integration and Praxis Tests. Manual. Los Angeles: WPS. 
  3. ^ Mulligan, Shelly (1998). "Patterns of sensory integration dysfunction: A confirmatory factor analysis.". American Journal of Occupational Therapy. 52: 819–828. doi:10.5014/ajot.52.10.819. 
  4. ^ Mailloux, Zoe; Mulligan, Shelly; Roley, Susanne S.; Blanche, Erna I.; Cermak, Sharon (2011). "Verification and clarification of patterns of sensory integrative dysfunction.". American Journal of Occupational Therapy. 65: 143–151. doi:10.5014/ajot.2011.000752. 
  5. ^ Murray, Anita C.; Lane, Shelly J.; Murray, Elizabeth A. (2001). Sensory integration. (2. ed.). Philadelphia: F.A. Davis. ISBN 0-8036-0545-5. 
  6. ^ Ayres, A. Jean (2005). Sensory integration and the child : understanding hidden sensory challenges (25th anniversary ed., rev. and updated / by Pediatric Therapy Network ; photographs by Shay McAtee. ed.). Los Angeles, CA: WPS. ISBN 978-087424-437-3. 
  7. ^ a b c Parham, D. & Mailloux, Z. (2010). Sensory Integration. In Case-Smith, J. & O’Brien, J. (Eds.), Occupational Therapy For Children (6th ed.). (pp 325-372). Maryland Heights, Missouri: Mosby Elsevier.
  8. ^ Wallace, Mark T.; Stein, Berry E. (1997). "Development of multisensory neurons and multisensory integration in cat superior colliculus.". Journal of Neuroscience (17): 2429–2444. 
  9. ^ a b Smith Roley, S. & Jacobs, E. S. (2009). Sensory Integration. In Crepeau, E. B., Cohn, E. & Boyt Schell, B. (Eds.), Willard & Spackman’s Occupational Therapy (11th ed.). (pp. 792-817). Baltimore, MD: Lippincott Williams & Wilkins.
  10. ^ 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 3086654Freely accessible. PMID 21289533. 
  11. ^ 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. doi:10.1023/A:1005547422749. PMID 11098877. 
  12. ^ 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 3149116Freely accessible. PMID 21852983. 
  13. ^ Miller, L. J.; Reisman, J. E.; McIntosh, D. N; Simon, J. S. S. Roley, E. I. Blanche, & R. C. Schaaf, eds. An ecological model of sensory modulation: Performance of children with fragile X syndrome, autistic disorder, attention-deficit/hyperactivity disorder, and sensory modulation dysfunction (PDF). 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. 
  14. ^ Parham, D.; Smith Roley, S.; May-Benson, T. (2011). "Development of a fidelity measure for research on effectiveness of Ayres Sensory Integration® intervention.". American Journal of Occupational Therapy. 65: 133–142. doi:10.5014/ajot.2011.000745. 
  15. ^ Fazlioglu, Y; Baran, G. (2008). "A sensory integration therapy program on sensory problems for children with autism". Perceptual and Motor Skills. 106: 415–422. doi:10.2466/pms.106.2.415-422. 
  16. ^ Pfeiffer, B.A; Koenig, K.; Kinnealey, M.; Sheppard, M.; Henderson, L. (2011). "Effectiveness of Sensory Integration Interventions in Children With Autism Spectrum Disorders: A Pilot Study". American Journal of Occupational Therapy. 65: 76–85. doi:10.5014/ajot.2011.09205. 
  17. ^ Schaaf, R.C (2013). "An intervention for sensory difficulties in children with autism: A randomized trial". Journal of Autism and Developmental Disorders. doi:10.1007/s10803-013-1983-8. 
  18. ^ "The Wilbarger Protocol: Helping People Sensitive to Touch". National Autism Resources. Retrieved 12 August 2012. 
  19. ^ "MIRACLE BELTS PROVIDE RELIEF FOR MILITARY FAMILIES". Military Press. Retrieved March 19, 2013. 
  20. ^ "Proprioception". International Encyclopedia of Rehabilitation. Retrieved 30 April 2014. 
  21. ^ "A Sense of Awareness". The Frederick News Post. Retrieved August 14, 2007. 
  22. ^ 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. 
  23. ^ 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 3060360Freely accessible. PMID 20921198. 
  24. ^ Alnajjar, F.; Itkonen, M.; Berenz, V.; Tournier, M.; Nagai, C.; Shimoda, S. (2015). "Sensory synergy as environmental input integration.". Front Neuroscience. 7: 136. doi:10.3389/fnins.2014.00436. 

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