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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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