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CPD Update: Neurodevelopmental Soft Signs: Implications for Sensory Processing and Praxis Assessment—Part One

An interesting read, this AOTA CE Article links sensory integration and processing difficulties and higher functions linked to occupation and participation. 
A table in the article links types of neurodevelopmental soft signs (NSS) in Occupational Therapy evaluation and underlying brain areas implicated in the literature, commenting that
“Integrating clinical observations of NSS with advanced brain-based research expands our understanding of the sensorimotor scaffolding that leads to higher functions of behavior organization, communication, and cognition.”
To access/buy a copy you can find out more here:
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What is Ayres’ Sensory Integration Therapy?

At ASI Wise, to avoid confusion, we use the term sensory integration and processing difficulties. Different terms are used in different places to describe sensory integration difficulties. Some therapists may use sensory processing difficulties instead. Some may even use sensory processing disorder.

We currently have a robust test,  the SIPT, that allows us to describe sensory integration difficulties and reference research evidence to interpret the unique scores and pattern of scores that the child gets across 17 test items. We can use this data to inform our clinical reasoning, create a hypothesis about what sensory difficulties are contributing to participation challenges in everyday life. We set goals, plan and deliver the intervention, Ayres’ Sensory Integration Therapy measuring therapy outcomes. This is best practice.

“Active, individually tailored, sensory motor activities contextualised in play at the just right challenge, that targets adaptive responses for participation in activities and tasks.”

ESIC Schaaf 2019

Ayres’ Sensory Integration assessment and therapy is typically post-graduate education for Occupational Therapists, Physiotherapists and Speech and Language Therapists. Please check that your therapist has ASI Education that meets level 2 education standards as recommended by ICEASI.

For more information about programmes offering Certification in Ayres’ Sensory Integration across the globe, please visit www.cl-asi.org.

 

Thank you Saša Radić – Kabinet aRTisINCLudum aRTis INCLudum for sharing these.

Read “Occupational Therapy Interventions for Children and Youth With Challenges in Sensory Integration and Sensory Processing: A School-Based Practice Case Example”  – one young person’s story from AJOT May 2019 here. [Frolek Clark et al 2019].

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Workshop: Ayres’ Sensory Integration for Health and Wellbeing

Our two day workshop is a “great opportunity to reflect on clinical practice and learn new skills”. Find out more about the application of Ayres’ Sensory Integration beyond childhood to support health and wellbeing.

We can also offer 2 or 3 day onsite bespoke training and consultation for your organisation to support the development of sensory integration informed care pathways.

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Choosing Wisely ® and ASI – a fantastic initiative from AOTA – it got me thinking about why people think sensory is easy and just anyone can do it.

Just like a parent can decide a child has a cold and needs Calpol, a sensory rich home environment can help support development. However just like a child may need a Dr, Dentist or other specialist if they have a more serious illness, what some people need is specialist intervention.

Sensory Integration therapy requires years of training, first just to become a therapist and then the advanced training needed to accurately assess, develop a personalised intervention plan and then carry out the intervention. We might all know when tonsils need removing, but few of us would do it at home. Telling someone about how tonsils get removed or how sensory integration happens is very different to actually doing it, and doing it safely and so that the outcome is as expected. Sensory integration therapy is not just about swinging on a swing or bouncing on a ball – it is about so much more. And is definitely not about just about wearing headphones and having a bouncy cushion.

The superb article from AOTA’s CHOOSING WISELY programme – see link below – got me thinking. I get weekly emails from people offering to treat other people’s children without training, offering Sensory Profile assessments by mail from a questionnaire when they are not even a therapist.

Share this blog and have interesting discussions with clients, colleagues and line managers. As relevant here in UK and Ireland as in US. This really confirms what we teach in our modules and promote as an organisation; including the best standardised norm referenced tool currently at our disposal – the SIPT. No or limited assessment waters down efficacy. Standardised assessment (when possible) structured clinical observations and thorough clinical reasoning using a clear process are imperative. Data driven decision making.

https://www.aota.org/AboutAOTA/Membership/Tools/Periodicals/choosing-wisely-sensory.aspx

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EASI Update

Therapists across the globe are collaborating, giving of their time and energy to develop a new assessment tool to comprehensively assess sensory integration difficulties.

This is the final call for therapists wishing to join the team for the UK and Ireland EASI ( Evaluation of Ayres’ Sensory Integration) normative data collection project. You can read more about this global initiative, Goal 2 of the ASI 2020 Vision here.

Join EASI.png

See more about the EASI  – click on the image below or this link: powerpoint slides from Dr Suzanne Smith Roley.

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Introduction to the Evaluation in Ayres Sensory Integration® (EASI).

Mailloux Z1Parham LD2Roley SS3Ruzzano L4Schaaf RC5.

Abstract

Comprehensive, reliable, and valid assessment is essential for individually tailored, appropriate, and effective intervention planning and implementation. Research, education, and practice using an Ayres Sensory Integration® (ASI) approach have a long history of prioritizing comprehensive assessment. To meet the need for a set of tests that will fully evaluate the constructs of ASI with psychometrically strong, internationally appropriate, and easily accessible measurement tools, the development of the Evaluation in Ayres Sensory Integration®(EASI) has been initiated. This article introduces the EASI, describes the overarching plan for its development, and reports the results of promising preliminary analyses of discriminative validity data.

https://www.ncbi.nlm.nih.gov/pubmed/29280717

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Sensory Integration is in the spotlight in neuroscience news…

..but publications and research by OT’s are needed to show ASI is effective!

Screen Shot 2018-06-30 at 09.26.07What more do we need to show how mainstream sensory integration theory is becoming than this recent publication in Neuroscience News. It is just a pity it says we need new therapies when we have a good one that has gold standard randomised control trials showings its effectiveness in the ASD population.
Perhaps instead what we need funding and investment for is the research to test it with other clinical populations, and across the lifepsan…this is the challenge to us all. Ad we need to tell more people about Ayres’ Sensory Integration and the growing evidence base.
Listen to Roseann Schaaf discuss her journey to becoming a research leader in this field.
Ref:
UCSF”Living with Sensory Processing Disorder.” NeuroscienceNews, 28 June 2018.
<http://neurosciencenews.com/sensory-processing-disorder-9476/>.
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Research Update: Additional occupational therapy considerations for functional neurological disorders: a potential role for sensory processing.

Delighted to see this research article cited below as at the Merlin MS Centre in Cornwall Ayres’ Sensory Integration is a regularly used approach with adolescent and adult clients with functional neurological disorders.
At the Merlin MS Centre, as well as assessment using Sensory Integration and Praxis Test (SIPT), Ayres’ Clinical Observations and the Adult/Adolescent Sensory History, we use the Model of Human Occupation Screening Tool and the Berg Balance Scale which, while part of comprehensive assessment, as provide us with valuable pre and post outcome measures.
For more information about this research see: Click here
Citation:
Ranford, J., Perez, D., & MacLean, J. (2018). Additional occupational therapy considerations for functional neurological disorders: A potential role for sensory processing. CNS Spectrums, 1-2. doi:10.1017/S1092852918000950
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Supporting Practice – Your Questions Answered: Why did Ayres’ not consider the visual system?

So I was just asked “Why didn’t Ayres consider and put more importance of the visual system? I was a bit perplexed and so explored this further with the therapist asking the question. The OT explained that she has been taught that Ayres did not consider the visual and auditory systems and that this means that for School OT’s where many difficulties link to visual processing deficits, learning the SIPT is not a useful and that therapists should instead use other tools linking vision to motor skills like the Bruinicks or Movement ABC alongside TVPS or VMI to ensure they understand and consider visual deficits.

This OT is not the first person to ask this question, so here is a bit more information about the visual system in Ayres’ Sensory Integration, and her understanding about the impact of sensory integration difficulties on academic learning.

” Those of us who study the overt behavior of children with academic deficiencies, and, at the same time, try to keep informed on related neurological research, are making an effort to interweave both approaches to knowledge into a theoretical structure which may be used as a provisional basis for treatment of children with learning problems.”

Ayres 1964 re-printed in Ayres 1974

The Sensory Integration and Praxis Test(SIPT) has 2 tests that are motor free and directly assess visual skills; Space Visualisation (SV) and Figure-Ground (FG), and 4 more that further explore visual skills in conjunction with other sensory systems and contribution to function; Manual Form Perception (MFP), Design Copy (DC), Constructional Praxis (CPr) and Motor Accuracy (MAc).

SV         5                    Motor-free visual perception; mental rotation

FG         2                    Motor-free figure-ground perception

MFP       14                  Recognition of forms held in hands; visualization

DC         4                    Visuopraxis; two-dimensional construction

CPr        3                    Three-dimensional visual space management

MAc       6                    Eye-hand coordination; somatopraxis

Jean A Ayres’ absolutely understood the importance of the visual system, her papers, books, and the SIPT manual make clear reference to this. Ayres did not consider vision just in terms of assessment, but also in how she recommended intervention approaches that would address deficits in the visual systems ability to support participation in daily life.

“Visual perception of the external world is at least partially dependant upon adequate perception of the construction of one’s own body or body scheme. The ability to perform complex motor tasks is dependant on mastery of the ability to do certain basic motor planning. Acquiring these two kinds of ablities occur sumultaneously and the acquisision is mutually dependant…

…any child who is severaly deficient in visual-motor function should begin…by learning to roll over, initiating motion by looking at a bright object placed at the side. This is an early step in ocular control…

…a recreational game through the ingenuity of the supervisor of the activity…

…The use of the eyes along with the body is essential, for it is the beginning of the dvelopment of one of the fundamental uses of the eyes – the guiding of total body action.”

Ayres 1961 in Ayres 1974

Research data from the SIPT and its predecessor, the SCSIT clearly showed the emergence of a pattern linking visual and movement difficulties called visuo and somatodyspraxia;

Read more here:

Verification and Clarification of Patterns of Sensory Integrative Dysfunction

Patterns of sensory integration dysfunction in children from South Africa

Correlational study between structured clinical observations and the Sensory Integration and Praxis Test

In her seminal work, Sensory Integration and Learning Disorders, Ayres 1972 discusses the importance of the development of Form and Space Perception, summarising the significant work of the time by Goins, Punwar, Frostig, and others. She describes the underlying neuroanatomy of visual perception, and it’s development in man. Ayres concluded the chapter exploring theories of dual modes of vision, advanced by Trevarthen, Gibson, and Held in the late 1960’s, before describing treatment approaches to develop form and space perception.

“…it is appropriate to close a therapeutic session which emphasized somatosensory and vestibular stimulation with task that focus on visual form and space perception. It is anticiapted that the earlier treatment enhances the capacity for visual perception and that sitting still while engaged in visual perception tasks helps quiet the child before he leaves the therapy area.”  Ayres 1972

from Chapter 15 – Sensory Integration and Visual Deficits, including Blindness in the book Sensory Integration with Diverse Populations written by Smith Roley, Blanche and Schaaf published in 2001.

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Occupational Therapy and Trauma 3: A Tool for considering the physical environment in children’s residential homes to address sensory processing issues in trauma-affected children

This article by Clinical Psychologists Christopher Robinson and Alicia Madeleine Brown in the Scottish Journal of Residential Child Care includes a lovely environmental checklist (adapted from Simpson 2009) used in considering the physical environment in three children’s residential homes.

Abstract: Sensory processing issues are generally considered to be clinically significant in children who have suffered abuse and trauma and much has been written about the possible neurological correlates of such sensitivities (De Bellis and Thomas, 2003; van der Kolk, 2014). Comparatively little focus has been given to the functional aspects of these sensitivities, and particularly how these might interact, in context, with a child’s underlying neurological vulnerabilities. In this respect, the environment surrounding the child is a neglected area of significant, perhaps critical, importance. In terms of potential hypersensitivity to environmental stimuli, children with Autistic Spectrum Conditions (ASC), although with different aetiological correlates to trauma affected children, are known to face profound environmental challenges. Children with ASCs have received a wealth of attention in the literature with regard to these sensory challenges, whereas, in contrast, trauma affected children have received very little direct attention at all. It is the aim of this paper to focus on the environmental aspects of sensory processing in trauma affected children, specifically in relation to the physical environment of children’s residential homes.

from the Scottish Journal of Residential Child Care 2016 – Vol.15, No.1 Scottish Journal of Residential Child Care ISSN 1478 – 1840 6

Read the full article free here.

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RESOURCES FOR PRACTICE: USING THE THEORY OF AYRES’ SENSORY INTEGRATION TO INFORM CLINICAL PRACTICE WITH OLDER ADULTS – 1.

We need to consider the importance of maintaining tactile discrimination skills – adequate tactile perception is necessary for using tools in a skillful way for participation in lifelong hobbies like sewing, model making, cake icing and painting.

Last night we were delighted to receive a great fb update from our friend and colleague Tina Champagne. She has just received her advance copy of her book, which will be a great resource to inform and support healthcare professionals working with older adults with dementia, using a sensory integration frame of reference.

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To pre-order your copy click here.