Sensory integration therapy
Sensory integration therapy is based on A. Jean Ayres' theory of Sensory Integration. Ayres' Sensory Integration (ASI)  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 (, 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). 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).
The neurological process of sensory integration is a “particular way of viewing the neural organization of sensory information for functional behavior” (p. 325). 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),).
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). “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).
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). 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, Attention Deficit Hyperactivity Disorder (ADHD), and sensory modulation dysfunction
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. 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. At least three randomized clinical control trials for children with autism have been published in recent years; 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
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, 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, 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.
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 wearing weighted belts, weighted blankets, weighted vests, or bouncing on a trampoline or a large ball, skipping or pushing heavy objects.
The Vestibular system is located in the inner ear. It responds to movement and gravity and is therefore involved with our sense of balance, coordination and eye movements. 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
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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
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- Multisensory integration
- Occupational science
- Occupational therapy
- Sensory processing
- Sensory overload
- Sensory Processing Disorder Foundation
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- 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.
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- 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.
- 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.
- 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.
- 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.
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- Sensory Integration Global Network
- Sensory Integration Special Interest Section
- International Training in Sensory Integration
- List of Therapists Certified in Sensory Integration including the Sensory Integration and Praxis Tests