Sensory Integration

Occupational therapists and occupational therapy assistants rely on knowledge and skills to guide their intervention planning as they help clients who are experiencing difficulties with engaging in occupation. Sensory integration theory, with its rich history grounded in the science of human growth and development, offers occupational therapy practitioners specific intervention strategies to remediate the underlying sensory issues that affect functional performance. This article articulates the core principles of sensory integration as originally developed by Dr. A. Jean Ayres, explains the rationale for developing a trademark specifically linked to these core principles, and identifies the impact that this trademark can have on practice. leaRninG oBJectiVeS After reading this article, you should be able to: 1. Recognize why the term Ayres Sensory Integration was trademarked. 2. Identify the core concepts of Ayres Sensory Integration in relation to typical development, patterns of sensory integration dysfunction, and principles of intervention. 3. Differentiate Ayres Sensory Integration from other approaches that use similar terms and strategies but do not include the same theoretical principles of this approach. intRoduction Biologist Edward Wilson (1998) stated that “scientific theories are the product of imagination—informed imagination. They reach beyond their grasp to predict the existence of previously unsuspected phenomena” (p. 57). Sensory integration theory, originated by A. Jean Ayres, fits this description because many aspects of her work represent concepts that require a great deal of imagination about previously unsuspected phenomena. Generated by an occupational therapist and developed primarily within the profession of occupational therapy, sensory integration theory and its application provide an important set of knowledge and skills for practitioners world-wide. Sensory integration is also one of the first theories generated within occupational therapy to undergo the rigor of providing evidence that validates its constructs while providing direction for the strategies clinicians use to remediate the underlying sensory issues that affect performance. Since Ayres’s early writings, beginning in the 1950s, many publications have contributed to the evolution of this theory, which is one of the most cited and applied of all theories within occupational therapy (Mulligan, 2002). As greater interest has developed in the role of brain function in behavior and learning, increased attention has been directed toward Ayres’s work. The result has been increased appreciation of the eloquence and substance of her research, as well as controversy related to documentation of the efficacy of some aspects of this approach. Part of the controversy stems from the many publications and intervention programs that do not truly reflect the principles of Ayres’s work but that have nonetheless been mistakenly associated with sensory integration (Parham, Cohn, et al., 2007). In an effort to clarify the concepts that do reflect Ayres’s sensory integration framework and to preserve the integrity of this work within occupational therapy, the Baker/Ayres Trust trademarked the term Ayres Sensory Integration. This article presents the rationale for establishing a trademark for this term, identifies the core concepts of Ayres Sensory Integration, and discusses the implications of this trademark for occupational therapy practitioners. This article does not evaluate the validity or usefulness of other sensory-based theories, diagnostic terms, or intervenUnderstanding Ayres Sensory Integration® AOTA Continuing Education Article NOW AVAILABLE! CE Article, exam, and certificate are now available ONLINE. Register at www.aota. org/cea or call toll-free 877-404-AOTA (2682). CE-2 SEPTEMBER 2007 n OT PRACTICE, 2( 7) ARTICLE CODE CEA0907 tions within or outside of occupational therapy. The terminology used in this article is consistent with that used by Ayres. Many terms have multiple meanings, such as sensory integration as a theory and frame of reference, and as a process related to multimodal processing that supports the formation and retrieval of multisensory perceptions in the central nervous system. Sensory processing is a generic term used to describe the way in which sensation is detected, transduced, and transmitted through the nervous system. Sensory processing deficits, therefore, can be used to describe any of the ways in which the above is flawed. Sensory integrative deficits, as used within occupational therapy, have been defined through many years of factor and cluster analyses, including confirmatory analyses, and may be identified through the use of standardized assessments, skilled observations, and parent and teacher report. Sensory-based strategies may or may not include those that are considered part of Ayres Sensory Integration. The varying ways in which these terms overlap and are used in practice may be confusing. Therefore, when using these terms and evaluating a client’s abilities or a practitioner’s focus during intervention, it is important as therapists and consumers to understand the research underlying the identification of a certain type of sensory problem and the sensory-based methods used during intervention. Rationale FoR eStaBliShinG a tRademaRK FoR the teRm AYRES SENSORY INTEGRATION® A review of the use of the term sensory integration yields a concerning number of references to sensory integration that involve methods void of key occupational therapy principles, such as promoting an adaptive response and engagement in occupation (Glennon & Smith Roley, 2006, 2007; Smith Roley & Glennon, 2006). In recent years, a proliferation of sensory stimulation treatment centers have typically involved passive visual, auditory, and movement sensations (e.g., www.sensorylearning.com, www.sensorycenter.com, www.neurosensorycenter.com, www.sirri.com), which often are provided by individuals who are not occupational therapists and whose professional credentials are sometimes difficult to discern. Several therapists from outside the United States also have reported concerns about other professions, such as physical education and psychology, whose members claim sensory integration as a psychoeducational tool while also demonstrating some efforts to limit occupational therapy’s involvement in the assessment and intervention of children with sensory integration deficits. Lastly, it has become common for sensory activities to be proposed as rewards for appropriate behavior or performance during discrete trial training for children with autism and sensory integration, which is often misunderstood or misrepresented within these communities (e.g., www.autism-society.org/site/PageServer? pagename=ab out_treatment_learning#SensoryIntegration). The Baker/Ayres Trust shared the professional concerns regarding confusion around sensory integration theory and established a trademark for the term Ayres Sensory Integration. coRe concePtS in ayReS SenSoRy inteGRation Bundy, Lane, and Murray (2002) noted that sensory integration theory is used to explain behavior, plan intervention, and predict how behavior will change through intervention. They identified the three main components of sensory integration theory as describing typical sensory integration development, defining sensory integrative dysfunction, and guiding intervention programs. A clear and comprehensive understanding of these three aspects of Ayres Sensory Integration will assist occupational therapy professionals in appropriate and effective application of this approach. tyPical SenSoRy inteGRation FunctioninG Ayres built sensory integration theory on her understanding of neurobiology. Before the publication of her classic book, Sensory Integration and Learning Disorders (Ayres, 1972b), she published numerous essays on her theories, setting forth the key components of the relationship between sensory integration and performance through her analysis of existing research. These principles informed her work in test development and later research that defined various types of sensory integration deficits and the related deficits in motor learning, academic abilities, attention, and behavior. In 1960, Ayres challenged the principles of “purposeful activity” that focused on exercising a component of a motor pattern, proposing that “1) learning takes place as a function of reward or reinforcement, 2) one learns what he does, and 3) learning takes place because there is a purpose for its taking place” (Ayres, 1960, p. 38). She believed that a person must perceive the goal and process of the intervention in order to benefit from it, highlighting the perceptual awareness of occupational engagement. Drawing on motor control theories, Ayres (1960) proposed that motor learning follows inherent maturational sequences and is influenced by, if not dependent on, incoming sensation. In 1961, Ayres proposed that the development of the body scheme in children created a postural model to understand visual-motor development, and she proposed that the ability to sit up and sit still required perceptual support from the vestibular and proprioceptive systems in addition to the neuromotor systems, thus highlighting postural control as an essential foundation for more skilled academic and motor performance. She further posited that the tactile, vestibular, proprioceptive, and visual systems provided key data in the development of reading and writing and may be impaired in children with learning disabilities. Ayres’s early references to what is now commonly called sensory modulation began in 1964. Ayres (1964) informed readers of the Earn . 1 AOTA CEU (one NBCOT PDU/one contact hour, see page CE-7 for details. CESEPTEMBER 2007 n OT PRACTICE, 2( 7) ARTICLE CODE CEA0907 importance of tactile functions, and she proposed that the ability to focus and maintain attention and to keep a steady level of activity