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Coffee and Chat: Ayres’ SI and Learning Disabilities

Tonight’s Coffee and Chat is all about Ayres’ SI and Learning Disabilities with special guest working in the field of learning disabilities across the lifespan.

Come and Listen to our practising therapists and experts explore assessment tools, the role of consultation and how to deliver services that draw on the theory and practice of Ayres’ Sensory Integration.

Join us tonight 3 March 2021 at 7.30pm.

Book your FREE place now on Eventbrite.

Read about the application of Ayres’ SI in Learning Disabilities on this reference and reading list below.

Papers here include from therapists, Ros Urwin, whose Master’s in 2005  was the first UK study to investigate ASI with adults with learning disabilities in the UK, our colleague Rachel Daniels, whose work in this field was the focus of a research project and Ciara McGill, who we had the pleasure to teach on the journey that led to her Master’s Study publication with Ulster University.

  1. Cahill, S.M. and J. Pagano. 2015. Reducing restraint and seclusion: the benefit and role of occupational therapy. American Occupational Therapy Association.

  2. Champagne, T. and N. Stromberg. 2004. Sensory approaches in an-patient psychiatric settings: Innovative alternatives to seclusion and restraint. Journal of Psychosocial Nursing 42(9): 35–44.

  3. Daniels, R. 2015. Community occupational therapy for learning disabilities: The process of providing Ayres sensory integration therapy and approaches to this population. Birmingham: European Sensory Integration Conference. www.iceasi-org

  4. Department of Health. 2012a. Department of Health review: Winterbourne View hospital interim report. London: Department of Health.

  5. Department of Health. 2012b. Transforming care: A national response to Winterbourne View Hospital: Department of Health review final report. London: Department of Health.

  6. Department of Health. 2014. Positive and proactive care: reducing the need for restrictive interventions. London: Department of Health.

  7. Gay, J. 2012. Positive solutions in practice: using sensory focused activities to help reduce restraint and seclusion. Victoria: Office of the Senior Practitioner.

  8. Green, D., Beaton, L., Moore, D., Warren, L., Wick, V., Sanford, J. E., & Santosh, P. (2003). Clinical Incidence of Sensory Integration Difficulties in Adults with Learning Disabilities and Illustration of Management. British Journal of Occupational Therapy, 66(10), 454–463

  9. Lillywhite, A. and D. Haines. 2010. Occupational therapy and people with learning disabilities: Findings from a research study. London: College of Occupational Therapists.

  10. Leong, H. M., Carter, M., & Stephenson, J. (2015). A systematic review of sensory integration therapy for individuals with disabilities: Single case design studies. Research in developmental disabilities, 47, 334–351.

  11. McGill, C & Breen, C. 2020. Can sensory integration have a role in the multi‐element behavioural intervention? An evaluation of factors associated with the management of challenging behaviour in community adult learning disability services. British Journal of Learning Disabilities.

  12. Royal College of Psychiatrists. 2013. People with a learning disability and mental health, behavioural or forensic problems: The role of inpatient services. London: Royal College of Psychiatrists.

  13. Transforming Care and Commissioning Steering Group. 2014. Winterbourne View – Time for change: Transforming the commissioning of services for people with learning disabilities [Bubb Report]. London: NHS England.

  14. Urwin, R., & Ballinger, C. (2005). The Effectiveness of Sensory Integration Therapy to Improve Functional Behaviour in Adults with Learning Disabilities: Five Single-Case Experimental Designs. British Journal of Occupational Therapy, 68(2), 56–66. 

sensory integration leanring disabilities Ciara McGIll
Ciara McGill, Occupational Therapist

Click to access Reducing-Restraint-and-Seclusion-20150218.pdf

The effectiveness of sensory integration therapy to improve functional behaviour in adults with learning disabilities: five single-case experimental designs

Urwin, Rosalind and Ballinger, Claire (2005) The effectiveness of sensory integration therapy to improve functional behaviour in adults with learning disabilities: five single-case experimental designs. British Journal of Occupational Therapy68 (2)56-66.
 

Abstract

This paper describes a research project using a single-case experimental design (A-B-A), which aimed to explore the impact of sensory integration therapy (SIT) on level of engagement and maladaptive behaviour (measured through timed scores) and function (using Goal Attainment Scaling, GAS) for five learning disabled adults with tactile sensory modulation disorder.

Each phase lasted 4 weeks and consisted of 24 measurements in total. Individually tailored SIT was given twice weekly for 4 weeks during the intervention phase (B), immediately prior to each individual’s participation in his or her prescribed horticulture task. The changes between phases in engagement, maladaptive behaviours and function scores, measured as the difference between baselines and intervention, were analysed visually and statistically for each participant.

The intervention produced significant improvements in engagement for participant four, with a highly significant deterioration in scores for all five participants on withdrawal of SIT. All the participants’ maladaptive behaviour decreased significantly on the introduction of SIT. Although there was no significant change to GAS scores for four participants, participant four’s score improved significantly with SIT. The withdrawal of SIT resulted in a highly significant deterioration in GAS scores for participants one, two, four and five. This study may be the first to suggest that SIT is effective in improving functional performance in adults with a learning disability with a tactile sensory modulation disorder.

Click to access Resource-OT-and-Learning-Disabilities_0.pdf

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Workshop: Ayres’ Sensory Integration, Trauma 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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Supporting Practice – Your Questions Answered: So did Ayres’ 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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A Weekend of Learning at Abbot’s Lea School, Liverpool – Using Sensory Strategies for Mental Health and wellbeing Weekend Workshop

The ASI Wise lecture team have been at Abbot’s Lea School in Liverpool this weekend with a fantastic group of committed and enthusiastic occupational therapists, speech and language therapists and teachers exploring the use of sensory strategies and Ayres’ Sensory Integration therapy to support children, young people and adults mental and wellbeing health.

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Experiential learning opportunities, embedded into the course, help participants to understand their own sensory systems and to experience the challenges that the people they are working with face on a daily basis.

 

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With a mixture of classroom-based and hands-on practical learning, participants explored how to use the spaces and environment available in both school and clinic to support regulation and praxis. The workshop provided an opportunity to hear about the theory and practice of Ayres’ Sensory Integration, it’s application supporting those with autism, ADHD and dyspraxia,  with up to date research and evidence supporting practice.

To find out more about our courses and learning here

 

 

We are so grateful to Abbot’s Lea School who have allowed us to use such a beautiful spacious venue. The three lovely well-lit rooms allowed us to create a pop-up sensory clinic, where participants had space to move about; extra room to break into groups supporting learning and the sharing of ideas. The school staff and local therapist volunteer support team have been incredibly welcoming and supportive, helping the workshop to run smoothly. As a bonus, the sun has shone all weekend which has allowed us to use the outdoor spaces, we have spotted a few daffodils and blossom trees around the city – it feels like spring is on its way.

Thank you to our volunteer therapists who helped to make the weekend such a success.

 

 

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Sensory Ladders

The first Sensory Ladders were made in 2001 for adults with sensory integration difficulties receiving help with mental health difficulties in Cornwall. Influenced by the paediatric Alert Program, they offered therapists a way to combine Dialectical Behaviour Therapy and Ayres’ Sensory Integration, addressing the development of the person’s self-awareness in collaboration with ward staff on an acute psychiatric inpatient unit.

The need to start with the person where they are at, before introducing learning about new ways of being, including the development of new skills, made it necessary for the Sensory Ladder to remain a very individualised and personalised journey within a close safe therapeutic relationship.

Both Ayres’ Sensory Integration(ASI) and Dialectical Behaviour Therapy(DBT) share a common understanding that development and change can only occur within a safe environment. The DBT idea of balancing safety and challenge reverberates strongly with Ayres’ concept of the ‘just right challenge’.

Creating a Sensory Ladder is about creating opportunities for an adult or child to learn to become aware of themselves in a new way – to explore and discover new things about mind, body and brain. It allows the therapist and person to do “curious wondering” together, and for the person to try new things – creating and promoting active but informed risk-taking; testing how we might feel and experience something when we do it differently; new ways of being – new ways of responding.

Making and using a Sensory Ladder is about the journey together within a safe therapeutic relationship. It’s about getting to see and know someone in a very different way, getting underneath the skin of behaviours that are perhaps being described by others as tricky or challenging.

The Sensory Ladder facilitates the reframing of behaviour that are a result of sensory integration challenges, providing the first step of acceptance of the behaviour necessary before strategies and therapy support development and change to happen.

To see more Sensory Ladders, visit our Sensory Ladder FB Page

 

https://.www.sensoryladders.org.

Pokemon Sensory Ladder copy