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Presentation 5: What are sensory integration (SI) and Disfunction of SI? M. Windsor, ScD, OTR/L

Intervention techniques

Sensory Integration Intervention that uses the "classical" delivery model (how Dr. Ayres practiced in her clinic) looks like spontaneous play between the child and the therapist (the art of therapy) but follows a defined belief system and theory-based principles (the science of therapy). A synopsis of these is:

  • There is an inner-drive within the child that, when tapped, facilitates growth, happiness, and success.

  • Intervention should always be respectful and, for children, playful (children learn through play).

  • There is always a capacity for change (plasticity) at all levels (cellular to behavioral). Context is very important in facilitating positive change.

  • The service delivery is direct (therapists works with usually one child) within a clinic setting that has specially designed equipment to elicit specific sensory experiences. Children are usually seen for hourly sessions for a minimum of one time per week.

  • Inherent with-in the therapy session are the concepts of self-directed activity and the adaptive response/behavior. Self-directed may be seen as the child "choosing" a task or a piece of equipment for play. Remember, the "choices" are predetermined by the therapist according to the assessment of sensory processing functions; also, the collaboration between the therapist and the child allows the therapist to suggest, guide, and scaffold (provide assistance physically, verbally, or psychologically in order for the child to accomplish the task) clinical experiences. (This should not be confused with therapist-directed activities, in which the therapist chooses tasks and directs the child's performance and participation.)

  • There are different types and levels of an adaptive response or behavior. For example the type may be a motor task, social interaction, improved organization of behavior, or personal behaviors (flexibility, self-regulation, attention, etc.). The levels range from responding to passive stimulation to increasing action-based competency (e.g., holding onto the ropes while swinging to performance of complex, unfamiliar activities).

  • Sometimes we explain intervention as providing opportunity for sensory processing that allows the child to grow and change. The child is presented with a "just right challenge" (a successful adaptive response; something, new, requiring greater skill but within the realm of child's ability). The child is motivated by the context (trust and collaboration with the therapist and increased ability to process sensory information for use through use of special materials and equipment) to perform the task. Success utilizes and re-organizes the sensory system, organizes behavior, promotes more adaptive actions within the environment.

  • Equipment, materials and activities are chosen to provide controlled sensory experiences that are never imposed upon the child. Sensory input is graded by type, intensity, duration, and frequency. There are general guidelines for using sensory input: Deep pressure, firm touch, resistance, brushing (sometimes), neutral warmth (body temperature, not hot or cold), rhythmic vestibular (movement, rocking) and slow vestibular (movement, rocking) are used to inhibit (calm or soothe) hyperactive or agitated (over aroused) children. Light touch, light placement of hands, soft textures, rotary, vertical linear, dysrhythmic, and fast vestibular are sensory inputs used to excite the nervous system (helping children to actively attend, concentrate, participate; this is helpful to children who seem lethargic or disinterested). Proprioceptive movements that involve "hard work" with resistance (activities that stimulate the joint receptors such as pushing, pulling, isometrics, bearing the body weight as in jumping, swinging from a trapeze, walking on the hands like a wheelbarrow, antigravity positions, climbing) are thought to organize the child. It is not uncommon for a therapist to prescribe oral-motor activities such as chewing, blowing, and sucking to help a child's attention and task completion during school. When sensory input is used, the child's responses are always observed carefully (principles for application are not written in stone) in order for the therapist to make changes in order to elicit an adaptive response.

  • When a child refuses to participate, the request to stop is honored. Refusal is understood as communication: the task was too difficult, the child does not believe he or she can perform it, the task was not meaningful or motivating. It is the responsibility of the therapist to collaborate with the child to development purposeful experiences and activities.

Some occupational therapists have developed their own theories and interpretation for using sensory integration in treatment. For example, Patricia Wilbarger has developed an expanded theory of Sensory Defensiveness (problems in modulation) that involves training in use of a highly specialized intervention called the Wilbarger Protocol. Although it is quite demanding, the regular intervals of sequenced deep pressure input followed by joint compression and traction have been helpful to some children with severe sensory defensiveness. Use of a Sensory Diet (adapting the environment to make the child more comfortable) and incorporating SI theory in the classroom and other contexts are natural extensions of the sensory integration knowledge base (e.g., the book The Out of Sync Child is a good example of how a teacher uses this theory to understand and teach such children). There are also more cognitive programs for helping children to develop organization, attention, and behaviors skills necessary for learning and socially interacting successfully in daily life. Be sure to talk with an OT about the many possibilities for using Sensory Integration to promote function.

            
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Last update on January 5, 2018