ICE-ASI Webinar
Sensory Integration Beyond the Clinic
Fidelity, praxis and meaningful practice across everyday settings
Sensory integration is too often imagined as something that can only happen in a traditional clinic. For many people, the image is immediate: suspended swings, specialist equipment, ceiling hooks, mats, rollers, and a carefully designed therapy space. Those environments matter, and they matter deeply. They support the delivery of Ayres Sensory Integration with strong structural fidelity and offer rich opportunities for therapeutic challenge. Yet if we stop there, we risk shrinking the reach of the theory and underestimating what thoughtful, well-trained therapists can do in the real environments where people actually live, learn, recover, and participate.
A key message in our very own ASI Wise Kath’ Smiths presentation is that sensory integration does not stop when access to a clinic stops. Instead, the question becomes how to work with as close to fidelity as possible in settings beyond the clinic, while holding onto the theory, the goals, the process, and the playful, relational spirit of the work.
This is not about diluting sensory integration. It is about protecting its essence while extending its reach.
Keeping the goals in mind
Kath grounds this discussion in a much-loved phrase from Dr Schaaf: “keep the goals in your head, the activities in your pocket, and the fun in your heart”.
That framing is important because it immediately distinguishes what must remain constant from what can change. The goals do not change because the person is no longer in a clinic. The sensory integration challenges linked to participation do not disappear because therapy is happening in a school hall, on a ward, in a garden, or in a community park. The need for the “just right challenge”, active engagement, and meaningful adaptive response does not change either. Nor does the importance of playfulness, motivation, safety, and therapeutic relationship.
What changes is the activity, and often the environment.
This is where advanced clinical reasoning matters. The therapist has to know what sensory and motor functions they are addressing, understand the person’s unique pattern of strengths and challenges, and then shape activity within the affordances of the available setting. In other words, the task changes, but the therapeutic logic remains the same.
Fidelity as a practical commitment
Kath names fidelity clearly and directly. She speaks about working with as close to fidelity as we can get and aiming to be right on that fidelity mark, even when traditional clinic equipment is not available. This is an important framing because it resists two common errors.
The first error is to assume that fidelity means nothing can count unless it happens in a fully equipped sensory integration clinic. The second is to assume that any sensory activity in any setting can simply be called sensory integration. Kath avoids both positions. Instead, she presents fidelity as something practical, principled, and worth striving for.
In her framing, fidelity begins with theory. The work must be bound within the theory we know and use, namely, sensory integration. From there, fidelity is carried through the goals, the therapist’s assessment and reasoning, the process elements of intervention, and the way the environment is used or adapted.
She points out that process elements are often more achievable across varied settings than the structural elements. A therapist can still protect active engagement, therapeutic use of self, playfulness, just-right challenge, meaningful sensory-motor experiences, and opportunities for adaptive responses in many settings. What becomes more difficult is replicating some structural features of the traditional clinic, especially suspended equipment and the full range of vestibular affordances it provides.
This matters because Kath does not frame work beyond the clinic as identical to clinic work. She is honest about the challenge. Yet she also insists that therapists can get very close when they understand fidelity well enough to adapt intelligently, rather than abandoning the model the moment the hooks are missing from the ceiling.
Praxis beyond the clinic
One of the strongest themes running through the presentation is praxis. Kath presents praxis as something we can actively support outside the clinic through playful, meaningful, sensory-rich activities that require ideation, planning, sequencing, and doing.
This matters because praxis is sometimes narrowly associated with formal testing or specific clinic-based tasks. In Kath’s framing, praxis is much more alive than that. It is body-based problem-solving in action. It is the process of generating an idea, organising the body, planning movement, sequencing action, adjusting to the environment, and carrying out a purposeful response. It is deeply tied to participation.
Praxis is woven throughout her examples. Sometimes she names it directly, referring to supporting the development of praxis. At other times, she describes its elements in functional clinical language: building obstacle courses, constructing dens, transporting materials, navigating routes, using both sides of the body together, adjusting posture, targeting objects, and organising movement through space. She also links praxis to bilateral integration, postural control, ocular motor demands, visual motor coordination, and the person’s motivation and interests.
What is powerful here is that praxis is not presented as something confined to a therapy room. It is shown as something that can be supported in schools, hospital wards, gardens, homes, farms, parks, and community spaces, wherever the therapist can create opportunities for meaningful sensory-motor challenge.
Schools as real places of sensory integration practice
There is a particularly strong emphasis on schools. Kath directly challenges the idea that sensory integration cannot really happen in school settings. Her answer to that view is clear: no, hang on a minute, it is not like that.
This matters in the current climate because many therapists work primarily or entirely in education settings. Some may feel that unless they have a clinic, their work must be limited to strategies, environmental advice, or indirect consultation. Kath’s presentation opens a wider door. She shows that schools can be valid, rich, and highly practical environments for sensory integration-informed work, including interventions that aim to maintain fidelity as closely as possible.
School halls and gyms often contain equipment that is more useful than people first realise. Mats, benches, vaulting boxes, trampettes, scooter boards, hoops, ropes, balls, beanbags, and PE cupboard resources can all be incorporated into carefully designed, sensory-rich activities. These are not random games. They are opportunities to support vestibular and proprioceptive processing, posture, bilateral integration, visual-motor coordination, ideation, planning, sequencing, and adaptive responses.
A scooter board treasure hunt, for example, becomes much more than a fun movement break. It offers tactile and proprioceptive input through the hands and body, vestibular input through movement and turning, and opportunities for motor planning as the child navigates space, follows routes, adjusts direction, and responds to changing demands. Add target throwing, reaching, sorting, or tool use, and the task becomes even richer. Kath also describes the use of games like scooter board avalanche, where playful retrieval, movement, fine-motor challenges, and problem-solving are woven together.
Even where suspended equipment is limited, there may still be opportunities. Portable equipment, such as a pop-up swing, can create additional vestibular possibilities. Traditional school resources can also be repurposed creatively. A gym mat trolley can become a giant scooter board. Benches can be inverted or turned into pathways. Mats can become tunnels or even be used to create barrel-like structures. A PE cupboard can become a therapeutic resource bank if the therapist views it through a sensory integration lens.
This is where Kath’s framing is especially valuable. She does not present schools as second-best settings. She presents them as real places of therapy, where participation matters and where sensory integration work can occur in meaningful ways related to the child’s daily life.
Hospital, mental health and learning disability settings
Kath also gives significant attention to working with bigger bodies and to practice in hospital and adult settings, including mental health services, learning disability services, inpatient units, and even seclusion environments.
This is important because sensory integration is still too often assumed to belong mainly to paediatric practice. Kath’s examples push back against that limitation. She describes how sensory integration-informed intervention can be shaped for adolescents, adults, and older adults, even in more restrictive settings.
In these contexts, therapists may use rocking chairs, weighted seating, therapy balls, bean bags, cross trainers, static bikes, rowing machines, treadmills, wall-based activities, and calming spaces in ways that preserve sensory-motor challenge and therapeutic intention. A static bike may offer rhythm, effort, and proprioceptive input. A cross-trainer may increase vestibular and postural demands. A therapy ball can support prone extension, balance, movement, and playful interaction. Tug of war, wall squats, pushing, pulling, reaching, and movement-based imaginative play can all be adapted to the person and the setting.
What stands out here is Kath’s insistence that, even when environments are restrictive, therapy need not become passive. Therapists can still support action, challenge, adaptation, and participation. They can still invite praxis. They can still create space for a person to engage with their body in meaningful, motivating ways.
This extends sensory integration beyond childhood and beyond idealised environments. It shows what is possible when the therapist keeps fidelity to the therapeutic relationship in mind, knows the person well, and uses imagination without losing clinical rigour.
Home and community as therapeutic environments
The presentation also expands into homes, gardens, parks, farms, woodlands, and community leisure spaces. Again, the emphasis is not on making do with less. It is on seeing possibilities through the lens of sensory integration.
Homes can offer tables for Lycra tunnels, mattresses for bouncing or crashing, stairs for sliding, duvets filled with balls for immersive tactile and proprioceptive play, and gardens for movement, construction, and obstacle-based activity. Community parks often provide opportunities for climbing, balancing, pushing, pulling, swinging, or resistance-based activities that can be used thoughtfully. Farms and woodland areas may offer logs, mud, uneven surfaces, natural climbing, lifting, carrying, building, and dynamic body-based problem-solving.
Kath’s farm case example brings this alive beautifully. In that example, the child’s interests, strengths, and goals are held clearly in mind. The environment offers logs, trees, mud, boats, sand, and structures to build with. The child is not just moving. He is imagining, constructing, planning, carrying, balancing, creating, and adapting. His sensory integration needs are being addressed through activities that are meaningful to him and grounded in who he is.
This is where praxis, motivation, sensory challenge, and fidelity come together. The therapist is not simply offering outdoor play. She is using the available environment to support sensory integration goals through purposeful, relational, and playful activities that remain true to the model.
Person, environment and task
Kath also draws helpfully on the language of person, environment and task, noting its resonance with Ayres’ own early thinking. This framing helps therapists explain their work, but it also helps them plan it.
The person brings sensory strengths, sensory challenges, interests, motivations, fears, preferences, and goals. The environment brings affordances and limits. The task or occupation is then shaped at the meeting point between the two. Good therapy happens when these are deliberately brought together.
This planning becomes especially important outside the clinic, where the therapist must think more consciously about how fidelity is protected. What sensory input is being offered here? What motor planning demand is present? How is the just-right challenge being created? What makes the activity meaningful for this particular person? How is the environment being used rather than simply accepted?
In this way, work beyond the clinic remains thoughtful. In many ways, it requires even more thoughtfulness.
Not a compromise, but a wider application
Perhaps the most important message in Kath’s presentation is that practice beyond the clinic is not automatically a compromise. It is not less work. Nor is it an excuse to become vague about sensory integration. Instead, it is an invitation to extend the theory’s reach with honesty, creativity, and fidelity.
Schools stand out especially strongly in this message. They are not just places for classroom strategies or consultation around equipment. They can be active spaces where therapists support sensory integration, praxis, participation, and adaptive response in ways that connect directly to learning and everyday life. But the same is true, in different ways, for wards, homes, gardens, parks, and community spaces.
What matters is not whether the room looks like a clinic. What matters is whether the therapist understands the person, upholds the principles, shapes the activity thoughtfully, and uses the environment in a way that supports meaningful sensory-motor challenge.
That is the heart of Kath’s framing.
Sensory integration beyond the clinic is still sensory integration when it remains grounded in theory, informed by assessment, guided by fidelity, and brought to life through playful, meaningful, sensory-rich activity. Praxis can be supported there. Participation can be supported there. And for many people, these settings may be exactly where the work matters most.
