Sensory integration therapy

Sensory integration therapy (SIT) was originally developed by occupational therapist A. Jean Ayres in the 1970s to help children with sensory-processing difficulties. It was specifically designed to treat Sensory Processing Disorder (sometimes called Sensory Integrative Dysfunction). Sensory Integration Therapy is based on A. Jean Ayres's Sensory Integration Theory, which proposes that sensory-processing is linked to emotional regulation, learning, behavior, and participation in daily life. Sensory integration is the process of organizing sensations from the body and from environmental stimuli.
Theoretical concept
A. Jean Ayres' sensory integration theory describes the following:
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.
Empirically derived disorders of sensory integration.
Intervention approaches and strategies for sensory input.
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. Dr. Ayres defines sensory integration as the organization of an individual's senses for use. The brain must organize all of sensations if a person is to move, learn, and behave in a productive manner.
Individuals with sensory-processing difficulties often experience delayed or impeded typical behaviors and functioning as a result of interferences in neurological processing and integration of sensory inputs. Sensory dysfunction affects the neurological processing of sensory information and sensory systems which causes negative impacts on learning and development. ASI highlights the critical influence that sensory-processing has on a child's growth and development. It contributes to the understanding of how sensation affects learning, social-emotional development, and neurophysiological processes, such as motor performance, attention, and arousal.
ASI has been studied by different professions on diverse levels, such as by occupational therapists and researchers as a foundation for occupational performance and participation, and by psychologists on a cellular level as multi-sensory integration.
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".
Practice
Individuals with sensory processing disorder or sensory integrative dysfunction experience problems with their sensory systems, also known as basic senses of touch, smell, hearing, taste, sight, body coordination, and movement against gravity. They might also experience difficulties in movement, coordination, and sensing where one's body is in a given space. ASI focuses on three main sensory systems - vestibular, proprioceptive, and tactile. Each individual sensory system has specific receptors or cells within the body that deliver messages to the brain. These receptors are located in specific parts of the body - gustatory/taste (mouth), olfactory/smell (nose), visual (eye), auditory (ear), and vestibular (inner ear). Other receptors are spread throughout the body - tactile (skin) and proprioception (muscles and joints).
Sensory Integration Therapy, also known as sensory-based treatments or interventions, are designed to provide sensory activities or experiences to help individuals respond better to environmental stimuli (i.e., sensory input). The main goal and priority for the use of sensory integration therapies is to improve internal sensory processing, improve self-regulation, develop adaptive functioning skills, and to help the child successfully become participate in daily life experiences and activities. Sensory-based interventions or activities are structured and individualized per each child's specific individual needs. They range from passive activities (i.e., wearing a weighted vest, weighted blanket, receiving hugs, playing with shaving cream) to active activities (i.e., spinning around, jumping on a trampoline, running, climbing, walking on patterned blocks).
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, and sensory modulation dysfunction.
Occupational therapist are uniquely equipped to practice Ayres Sensory Integration (ASI) or Occupational Therapy Sensory Integration (OT-SI). During sessions, activities are presented to both challenge capabilities and assist and regulating a child (Parham & Mailloux, 2015). Activities are often specially tailored to meet individual needs. The goal of these session is to assist a child gain competence in participating in everyday activities in settings such as school, home and extra curriculars. Active participation is emphasized in order to maxims gains and learning. Children who require more structure are given modified activities that continue to offer freedom of choice in order to foster self-direction (Parham & Mailloux,2015).
Sensory overload examples
Visual
Covers eyes when lights are too bright
Stares at bright, fluorescent, or flickering lights
Stares at spinning objects
Holds items extremely close to eyes or face
Turns opposite direction or away from where teacher is lecturing
Easily distracted by extremely organized or unorganized rooms
Lack of eye contact or looks beyond person's face
Overwhelmed by too many colors, materials, or pictures in room
Turns or tilts head when reading across a page
Auditory
Covers ears when loud noises occur (i.e., fire drill, yelling, alarms)
Runs away from loud areas
Hums or sings to themself
Complains of noises inside room or outside of window
Covers ears in the cafeteria or in bathroom
Runs when toilet flushes
Prefers very loud music or no music at all
Tactile
Avoids touching certain surfaces or textures
Prefers to touch specific fabrics or textures
Touches everything in sight
Doesn't react to pain
Might bite or suck on their own skin
Doesn't react to or overreacts to extreme temperatures (i.e., wears shorts when extremely cold)
Dislikes getting hands and feet dirty, wet, in sand, or in paint.
Avoids getting hair, face, or head touched.
Gustatory (Taste)
Refuses to eat or gags on certain foods
Eats extreme tasting foods (i.e., lemons, hot sauce, lots of salt or pepper)
Sensitive to hot or cold foods
Licks, tastes, or tries to eat play dough, objects, or toys
Olfactory (Smell)
Might smell everything they touch
Sensitive to odors (i.e., perfume, air fresheners, essential oils)
Might not smell or recognize bad odors
Sniffs other people
Breathes through their mouths instead of nose
Vestibular
Might seem like a "thrill seeker" (i.e., jumping from high places, climbing furniture, running extremely fast)
Difficulties with sitting or remaining still
Prefers to lie down instead of sitting up
Enjoys being upside down
Easily loses balance when walking, going up and down the stairs, or standing
Rocks back and forth
Proprioceptive
Touches walls while walking
Stands too close when talking to others
Chews, pulls, or twists items (i.e., pencils, shirt, toys, hand or arm)
Accidentally leans, trips, crashes, or bumps into objects or people
Deliberately falls or crashes into things
Walks stiff and uncoordinated
Pulls fingers or cracks knuckles constantly
Frequently breaks toys or objects
Sensory activity examples
Visual
Spinning tops or toys
Light up toys
Use a flashlight or pen light to draw attention
Visual memory games
Colored chalk, markers, crayons, and pencils
Lava lamps
Bubbles
Look in mirror
Coloring mixing activities
Light table
Shadow exploration
Parachute play
Auditory
Incorporate music during activities
Noise cancelling headphones
Background noise, white noise, or sound machine
Books, puzzles, toys, or manipulatives with sound
Bubble wrap
Snap, clap, or stomp
Play with music instrument
Kazoo toy
Listen to nature sounds outside (i.e., birds, ducks, dogs)
Tactile
Play dough
Sensory bin with rice, beans, cereal, or waterbeads
Theraputty
Sand or water play
Lotion massage rub to hands and arms
Fidget toys
Scratchy gloves, sand paper, cotton balls, brushes
Finger writing or hand play with shaving cream or whipped cream
Finger paint
Bubble wrap
Felt strips
Textured foam paper
Carpet samples
Play dress up and practice zipping, buttoning, snapping, tying or looping laces
Gustatory (Taste)
Mouth and chewing toys
Vibrating toys
Vibrating toothbrush
Sour, salty, crunchy, snacks
Drink warm or cold liquids
Variety of straw types (i.e., hard, soft, rubber, textured)
Olfactory (Smell)
Lotion with calming or alerting aromas
Scented soaps to wash hands
Essential oils diffuser, necklaces, bracelets
Scented markers or stickers (non-toxic)
Scented play dough, finger paints, or sensory dough
Scented bubbles
Create scented bottles with aromas, spices, or oils
Vestibular
Rocking chair
Spinning
Twirling
Bend over and place head below heart
Fast, alternating movements
Ride tricycles, scooter boards, or scooters
Jumping jumps
Bounce and roll on therapy ball - slow or fast
Therapy ball chair
Sit N Spin
Take a longer route to and from class
Vibration toys
Proprioceptive
Playground - climb, hang, run through, and go under equipment
Sand play - dig or pour
Jump on trampoline
Jumping or running in place
Theraputty exercises
Stand up to do work
Chair or wall push ups
Obstacle course
Bear or crab walk
Yoga poses
Push or carry a heavy box around the room
Carry weighted backpack
Body sox play
Arm circles
Sit ups
Wheelbarrow walking
Evidence and Effectiveness
While sensory-based interventions are highly advocated for, there continues to be a lack of empirical support. There is disagreement over their therapeutic worth, largely due to problems with methodology and confusion of terms and conflation with similar and related approaches.
Ayres' theory of sensory integration is frequently critiqued. Emerging evidence with improved methodology, the development of a Fidelity Measure and increasing focus of resources on areas of practice that might not typically attract medical research funding, means that the much needed evidence for Ayres SI is now emerging.
Hume and colleagues support the use of Ayres’ Sensory Integration (ASI), making the case for why review of science and evidence should be ongoing.The current report updates and extends the work on evidence-based, focused intervention practices begun with an initial review of the literature from 1997 to 2007 (Odom et al. 2010a, b) and extended through a second report that covered the literature from 1990 to 2011 (Wong et al. 2015); extending this systematic review through 2017 added 567 articles to the review. As the intervention literature has provided more empirical information and as practices have evolved, some of the classifications required reconceptualization and revision of previous definitions. In an active research area, knowledge does not stand still, and in fact, identification of EBPs should be dynamic, reflecting the growth of knowledge across time (Biglan and Ogden 2019).In their article they clearly state the importance of clearly defining what sensory integration therapy is and what it is not; helping to clarify and delineate the clinical practice reported in their article, from other related approaches based on Ayres SI theory. It is important to note that Sensory Integration refers explicitly to the classical sensory integration model developed by Jean Ayres (2005) and not to a variety of interventions that address sensory issues but have been found to be unsupported (Case-Smith et al. 2015; Watling and Hauer 2015).
History
In the 1950s, Dr. A. Jean Ayres, an occupational therapist and psychologist, developed the theory and framework of sensory integration. Her book Sensory Integration and the Child, first published in the 1970s, was a means of helping families, therapists, and educators of children with sensory-processing difficulties and sensory processing disorders to better organize and improve self-regulation of body and environmental sensory inputs.
Ayres' approach has proliferated among therapy and educational professionals over the past several decades. It has been met with some resistance within the occupational therapy profession and in other disciplines.
See also
Multisensory integration
Music therapy
Occupational science
Occupational therapy
Sensory processing
Sensory overload
Sensory Processing Disorder Foundation
References
Therapy
Occupational therapy
Alternative therapies for developmental and learning disabilities