THE SENSORY INTEGRATION MODEL{ A. Jean Ayres }

                       

                   THE SENSORY INTEGRATION MODEL{ A. Jean Ayres }

1.      THEORY

          Organization 

·         Sensory integration is the neurological process that organizes sensation from one’s own body and the environment and allows for effective use of the body within the environment 

·         Sensory integration is a process in which sensory intake, sensory integration and organization, and adaptive occupational behavior result in a spiral of development

·          Sensory integration is concerned with multimodal sensory processing (i.e., integrating at least two sources of sensory information) in which sensory data are organized and processed in the brain, converted to meaningful information, and used to plan and execute motor behavior

·         Vestibular and proprioceptive sensation consists of inputs derived from active body movements

·         Children have an inner drive to seek out organizing sensations 

·         Mind and brain are interrelated; subjective experience is a necessary part of the adaptive spiral of sensory integration

2.      BASIC MODEL FOR UNDERSTANDING SI AND FUNCTION.

·         Level 1: Registration and modulation of sensory information are functional outcomes observed at this level.

·         Level 2a: Basic discrimination and perceptual functions are functional outcomes observed at this level.

·         Level 2b: More advanced discriminatory and perceptual abilities and functional use are outcomes observed at this level, with signs of skilled motor actions starting to develop. Discrimination of spatial and temporal qualities becomes more accurate and advanced.

·         Level 3: Motor actions become more and more skilled as well as praxis abilities for executing novel motor actions.

3.      ASSUMPTIONS

           Sensory integration theory is based on five assumptions

1.      The brain has neural plasticity, which is the ability to change or be modified as a result of ongoing experiences of sensory processing

2.      There is a developmental sequence of sensory integrative capacities

3.      The brain functions as an integrated hierarchical whole

4.       Brain organization and adaptive behavior are adaptive

5.       Persons have an inner drive to participate in sensory motor activities

4.      SEVEN BASIC THEORETICAL POSTULATES THAT FORM THE FOUNDATION FOR THE SENSORY INTEGRATION FRAME OF REFERENCE:

     

1.      Sensory information provides an important foundation for learning and behavior

2.      Sensory integration is a developmental process.

3.      Successful integration and organization of sensory information results in and is further developed by adaptive responses.

4.      The ‘‘just right challenge’’ provides the milieu for sensory integration to occur.

5.      Childrenhaveaninnatedrivetoseekmeaningfulexperiencesfromtheirenvironment.

6.      As a result of neuroplasticity, enriched experiences effect change in the nervous system. 

7.      Sensory integration is a foundation for physical and social engagement and participation in daily life activities and routines.

5.      POSTULATES OF SENSORY INTERGRATION THEORETICAL BASE

          The evolving theoretical base of sensory integration includes 10 basic postulates. Each postulate supports the theoretical base which states that it is critical that the therapist promotes growth and development toward the outcomes of the sensory integration process.

1.      An optimal state of arousal is a prerequisite for adaptive responses to occur.

2.      Sensory integration occurs during adaptive responses.

3.      Multiple sensory systems may be needed to facilitate an optimal state of arousal.

4.      Adaptive responses must be directed toward the child’s current developmental level.

5.      Activities that reflect the ‘‘just right challenge’’ produce growth and development.

6.      Problems with sensory modulation, or in the foundational abilities, contribute to deficits in the end product abilities.

7.      The child needs to be self-directed, with therapist guidance, for sensory integration to occur.

8.      Adaptive responses are elicited through activities that facilitate sensory modulation, discrimination, and integration, resulting in improved postural control, praxis/bilateral integration, and participation.

9.      Intervention is directed to underlying deficits in sensory modulation, discrimination and integration, and/or foundational abilities, and not toward training in specific skills or behaviors.

10.  As the child achieves increasingly complex adaptive responses in therapy, changes will be evident in the outcome abilities such as self-regulation, self-esteem, social participation, academic performance, and participation in daily life routines and activities.

6.      PROBLEMS AND CHALLENGES

·         When individuals have deficits in processing and integrating sensory inputs, difficulties in planning and producing behavior occur that interfere with conceptual and motor learning 

·         Recently, a new categorization has been proposed that identifies three main sensory processing disorders:

Ø  Sensory modulation disorder

§  Sensory overresponsivity

§  Sensory underresponsivity

§  Sensory seeking/craving

Ø  Sensory-based motor disorder

§  Postural disorders

§   Dyspraxia

Ø  Sensory discrimination disorder

§  Visual

§  Auditory

§  Tactile

§  Taste/smell

§  Position/movement

7.      KEY OF SENSORY INTERGATIVE ABILITIES

·         The abilities supported by sensory integration are consistent with the pattern so function and dysfunction identified through research.

·         They include: sensory modulation, sensory discrimination (primarily tactile, vestibular, and proprioceptive as well as auditory, visual, taste, and smell), postural-ocular control, praxis, and bilateral integration and sequencing.

8.      GENERAL SENSORY INTEGRATION TREATMENT PRINCIPLES

·         Sensory processing needs to be experienced in a meaningful way for learning to take place.

·         When using activities that provide vestibular input, angular movement stimulates the semicircular canals and facilitates phasic, fleeting postural reactions. Linear movements (up and down and forward and backwards) stimulate the utricle hair cells and facilitate tonic  postural extension and increased muscle tone, which is needed in maintaining antigravity extensor postures. Whilst linear vestibular movements facilitate postural extension, only heavy work can promote postural flexion. First work for total flexion through phasic fleeting movements and then grade to activities that promote tonic sustained flexion.

·         Always work for an adaptive response; if only sensory stimulation is provided without active participation and adapted responses from the child, no integration and learning will take place.

·         Where applicable, use short concrete language as processing of verbal information places extra demands on the sensory systems. Both the mentally retarded child and the child with ASD experience language difficulties.

·         Routine and structure provide a lot of security to both the mentally retarded child and the child with ASD, who especially experience challenges with change/transitions.

·         Decrease anxiety as far as possible by allowing the treatment session to flow, keeping activities familiar (challenges within the activity could vary), and support children in anticipating change.

·         Notes must be kept on the child’s responses to treatment and progress. Feedback on the child’s progress should be given regularly to parents/ caregivers and other members of the team.

9.      THERAPEUTIC INTERVENTION 

·         Aimed at remediation (change) of the sensory integrative problem 

·         Goal is to improve ability to integrate sensory information by changing organization of the brain 

·         Enhanced sensory intake, which occurs when a child plans and organizes adaptive behavior in a meaningful activity, improves ability of the CNS to process and integrate sensory inputs

10.  PRACTICE RESOURCES ASSESSMENT 

·         Assessment procedures traditionally included a formalized battery of tests (Sensory Integration and Praxis Tests), informal observation of performance, and data gathered from caretakers and other sources 

·         Data are used to arrive at an assessment of whether a person has a sensory integrative impairment and, if possible, to specify the nature of that impairment 

·         The Sensory Integration and Praxis Tests (SIPT) are a battery of tests designed to helpthe therapist identify and understand sensory integrative impairments in children four through eight years of age

·          Because the SIPT cannot be used with many clients who receive sensory integrative services and because of the training and time involved in learning and administering the SIPT, other assessment strategies are increasingly used

·         The Sensory Profile (Dunn, 1999), which is a measure of responses to commonly occurring sensory experiences designed for children aged 3 to 10 years, and the Adolescent/Adult Sensory Profile, which is a self-report (Brown, Tolefson, Dunn, Cromwell, & Filion, 2001)

·         The Gravitational Insecurity Assessment (May-Benson & Koomar, 2007), which consists of 15 activities that create fear-inducing situations for children with gravitational insecurity and is used to identify children with this problem

·         The Test of Ideational Praxis (May-Benson, 2001; May-Benson & Cermak, 2007), in which children are asked to show the examiner all the things they can think of doing with six standard objects

·         The Sensory Processing Measure-School (Miller-Kuhaneck, Henry, Glennon, & Mu, 2007) is a rating scale that captures information on sensory processing, praxis, and participation in school

11.  TREATMENT APPROACH 

·         Sensory integrative experiences selected to benefit a child are derived from identification of the child’s problems and the theory concerning the underlying reasons for those problems (i.e., the particular difficulty processing sensory information)

·          Play is a vehicle for therapy; in play the child is given control and enticement to choose appropriate sensory motor behaviors 

·         Three factors are critical for maintaining a playful approach to intervention

Ø  Perception of inner control

Ø  Intrinsic motivation

Ø  Freedom from the constraints of reality

·         Overall, there is a shift in orientation from an exclusive focus on remediating the underlying problem in the client to focusing on how the problem interacts with the external conditions that interfere with everyday performance and deciding on the most efficacious strategy of intervention

12.  OUTCOMES OF ADEQUATE SENSORY INTERGRATION

·         To achieve this outcome, the sensory integration frame of reference focuses on sensory motor areas that provide the foundation for successful participation including:

            

Ø  The ability to modulate, discriminate, and integrate sensory information from the body and from the environment

Ø  Self-regulation to regulate and maintain an arousal level, and/or an activity level needed to appropriately attend and focus on the task or activity

Ø  Maintaining postural control including muscletone,strengthandbalance,ocularcontrol,andbilateralcoordinationandlaterality

Ø  Adequate praxis

Ø  Organizing behavior needed for developmentally appropriate tasks and activities

Ø  Development of self-esteem and self-efficacy

·         These outcomes build on each other and provide the foundation to support the child’s participation in self-care, play, social activities, and academic tasks that are developmentally appropriate

13.  FUNCTION AND DYSFUNCTION CONTINUA FOR SENSORY INTERGRATION FRAME OF REFERANCE

·         The function–dysfunction continua included the following:

Ø  Atypical responses (i.e., unusual over-, under-, or fluctuating responsivity) to the sensory aspect of materials, activities, or situations (sensory modulation disorder) 

Ø  Poor ability to conceptualize, plan, and execute motor actions associated with signs of poor perception of touch and body position (somatodyspraxia) 

Ø  Poor ability to coordinate both sides of the body, and atypical postural and ocular mechanisms associated with signs of inefficient processing and perception of movement and body position (bilateral integration and sequencing deficit) 

Ø  Poor visual perception and visual motor integration (constructional and visuodyspraxia)

14.  PRECAUTIONS FOR AYRES SENSORY INTEGRATION THERAPY

·         A child can never be left unattended to in an SI area. Apparatus used without supervision and guidance could cause serious injuries. 

·         Doctors, other staff members and parents/caregivers should always be informed that a child is exposed to SI treatment. Doctors should also be consulted about any condition that might be aggravated by especially vestibular stimulation (e.g. epilepsy and ventricular shunts). Feedback received from them plays a valuable part not only in the adaptation of the programme but also in the success of the programme. 

·         SI equipment must always be kept in a good condition, and mattresses should always be placed under suspension apparatus to reduce the chance of injury. Polystyrene chips should be changed regularly as they disintegrate easily, and the chances of ingesting pieces or getting them stuck in body cavities are a strong possibility.

·         SI activities are never forced onto a child. A golden rule of SI therapy is that if a child does not enjoy it, his nervous system is not integrating, and thus, no learning will take place.

·         As many children with more severe child psychiatric conditions are not able to communicate effectively, it is of the utmost importance to observe them very closely, this observation should be continued by caregivers for at least two hours after treatment. Any signs of  distress, which indicate autonomic nervous system reactions, should be reported and treated accordingly. Signs of stress include the following: paleness, sweating, tachycardia, nausea or vomiting, extreme fear and/or agitation, constant yawning, overexcitement, constant crying, falling asleep or losing consciousness. Depending on the symptoms, the necessary intervention should be made by either exposing the child to inhibitory or excitatory activities. If a child loses consciousness because of over­inhibition of the brainstem, give excitatory stimulation such as light touch applied to the soles of the feet and face or ice applied to the face. It must always be remembered that these children’s nervous systems can be much more sensitive to sensory stimulation and adverse reactions can easily occur.