Category: practice

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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 behaviours that challenge 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 Therapy, 68 (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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PANDAS and PANS Update

Thank you to everyone who has messaged me about my earlier. article about PANDAS and PANS for more evidence to support the earlier post.

Research Evidence:

Screen Shot 2019-12-08 at 19.50.03

  • JCAP – Clinical Management of PANS:

    • Part 1 – Psychiatric and Behavioural Interventions – click to view

    • Part 2 – Use of Immunomodulatory Therapies – click to view

    • Part 3 – Treatment and Prevention of Infections – click to view

  • JCAP – Overview of Treatment of Pediatric Acute-Onset Neuropsychiatric Syndrome – click to view
  • IJPO – Improvement of Psychiatric Symptoms in youth following resolution of Sinusitis – click to view

from https://www.panspandasuk.org/resources

PANS PHYSICIAN’S NETWORK TREATMENT GUIDELINES

​These guidelines were first published in May 2018 following several meetings between the PANS Physicians’ Network UK (PPNUK) and the Charity PANS PANDAS UK.  Based on the US treatment guidelines originally written by the US PANDAS Physicians’ Network, these guidelines have been modified to adapt to UK medical practice,  GP’s are strongly encouraged to start treatment and investigations early as early treatment is likely to improve the long term outcome of these patients.

 

“There is gradually accumulating evidence that there are some children who experience sudden onset of a neuropsychiatric disorder (usually obsessive-compulsive disorder (OCD) or tics) following a Group A beta-haemolytic streptococcal infection (GABHS). The acronym PANDAS was first cited in 1998 to describe this group of patients.[1]However, neurological sequelae of streptococcal infection have been well recognised (eg, Sydenham’s chorea described by William Osler in 1894).[2]

Doubt remains about the aetiology of the condition and whether it can be considered an independent disease entity.[3]

More recently the term PANS (paediatric acute-onset neuropsychiatric syndrome) has been suggested, as it captures both the sudden onset and uncertainty about the aetiology.[4]”

from PANDAS Paediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infection

 

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Shared with permission: https://www.nimh.nih.gov/health/publications/pandas/index.shtml

Download your copy from NIMH here.

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Swedo et al 2012 “From Research Subgroup to Clinical Syndrome: Modifying the PANDAS Criteria to Describe PANS (Pediatric Acute-onset Neuropsychiatric Syndrome)”

Read the full article; “From Research Subgroup to Clinical Syndrome: Modifying the PANDAS Criteria to Describe PANS (Pediatric Acute-onset Neuropsychiatric Syndrome)Swedo et al 2012” here.

PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) is when an infectious trigger, environmental factors, and other possible triggers create a misdirected immune response results in inflammation on a child’s brain. In turn, the child quickly begins to exhibit life changing symptoms such as OCD, severe restrictive eating,  anxiety, tics, personality changes, decline in math and handwriting abilities, sensory sensitivities, and more.

PANS was introduced in 2012 by Dr. Susan Swedo in the paper From Research Subgroup to Clinical Syndrome: Modifying the PANDAS Criteria to Describe PANS (Pediatric Acute-onset Neuropsychiatric Syndrome).

The PANS Criteria
PANS is a clinical diagnosis. The following is the “working criteria” as listed Dr. Swedo’s paper on PANS:

Abrupt, dramatic onset of obsessive-compulsive disorder or severely restricted food intake.
Concurrent presence of additional neuropsychiatric symptoms, with similarly severe and acute onset, from at least two of the following seven categories: Anxiety Emotional lability and/or depression, Irritability, aggression and/or severely oppositional behaviors, Behavioral (developmental) regression, Deterioration in school performance, Sensory or motor abnormalities, Somatic signs and symptoms, including sleep disturbances, enuresis or urinary frequency
Symptoms are not better explained by a known neurologic or medical disorder, such as Sydenham’s chorea, systemic lupus erythematosus, Tourette disorder or others.

PANDAS CRITERIA

The hallmark trait for PANDAS is sudden acute and debilitating onset of intense anxiety and mood lability accompanied by Obsessive Compulsive-like issues and/or Tics in association with a streptococcal-A (GABHS) infection that has occurred immediately prior to the symptoms. In some instances, the onset will be 4 to 6 months after a strep infection because the antibiotics did not fully eradicate the bacteria. Many pediatricians do not know the latent variability of strep – Rheumatologists and Streptococcal Experts do.

When strep cannot be linked to the onset of symptoms, the NIMH states one should look into the possibility of PANS (Pediatric Acute-onset Neuropsychiatric Syndromes).

The acute onset means a Y-BOCS (Yale Brown Obsessive-Compulsive Scale) score of >20 and or a Chronic Tic Disorder YGTSS (Yale Global Tic Severity Scale) often with multiple tics. Below is the symptom criteria for PANDAS. Additional symptoms may be present.

A clinical diagnosis of PANDAS is defined by the following criteria:

  • Presence of significant obsessions, compulsions, and/or tics
  • Abrupt onset of symptoms or a relapsing-remitting course of symptom severity
  • Pre-pubertal onset
  • Association with streptococcal infection
  • Association with other neuropsychiatric symptoms

from http://pandasnetwork.org/medical-information/

Sensory Issues and PANDA’s: Read more here

https://latitudes.org/forums/topic/14571-sensory-issues/

Interestingly no one asked for evidence of Sydenham’s Chorea, which has been well documented for much longer. Perhaps because it has a very physical presence that is clinically easier to diagnose, especially as the condition progresses to full-blown ataxic movement patterns, as well as the neuropsychiatric symptoms.

from: https://patient.info/doctor/sydenhams-chorea

In the 1930s, if a doctor saw a patient with chorea, especially if the patient were a child or young woman, it was a reasonable assumption that the diagnosis was Sydenham’s chorea. In western societies today, such a presentation is unlikely to be Sydenham’s chorea and considerable thought must be given to the differential diagnosis. The time course of the chorea is useful diagnostically: most previously healthy children with an acute or subacute chorea have an autoimmune aetiology[17]. Additional causes of childhood choreas include:

  1. Other autoimmune causes, such as seen in systemic lupus erythematosus.
  2. Genetic causes*
  3. Athetoid cerebral palsy.
  4. Drug-induced causes – metoclopramide, phenothiazines and haloperidol are the most important.
  5. Primary and metastatic brain tumours affecting the basal ganglia.
  6. Metabolic – bilirubin encephalopathy and toxins, especially carbon monoxide, manganese and organophosphate poisoning.

*Genetic Causes can include:

  • Benign hereditary chorea starts in childhood and is a non-progressive chorea. Inheritance is usually autosomal dominant, although rare cases of autosomal-recessive and X-linked inheritance have been reported[18].
  • Wilson’s disease is an autosomal-recessive disorder of copper metabolism.
  • Ataxia telangiectasia and other related conditions.
  • Huntington’s disease presents most often between the ages of 35 years and 45 years but it can be younger, especially if inherited from the paternal line. There is usually but not invariably, a family history. A juvenile form exists that should be seen as a variation of the normal form and not a distinct entity[19].

see more here: Rapid onset sensory reactivity, movement difficulties, tics, mood changes and reduced attention may be PANDAS or PANS

 

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CPD: Understanding and Applying Trauma-Informed Approaches Across Occupational Therapy Settings

AOTA has really helpful and supportive articles right now – promoting the best clinical practice, with an emphasis on participation in occupation.

This article is particularly pertinent to OT’s using ASI theory and practice to create therapeutic environments supporting and scaffolding participation in daily life for those with trauma.

Read the full article here.

 

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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:
To purchase the article and CEU credits
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Why do ASI Wise not use the term Practitioner or Advanced Practitioner ?

ASI Wise UUSI3 CLASI M6M6

Please make sure your EHCP does not specify Sensory Integration Practitioner or Advanced Practitioner, as this may rule out many expert therapists who have received training by world experts. The preferred description should be Occupational Therapist with post-graduate certification in Ayres’ Sensory Integration.

“I am an OT and I’m interested in becoming an ASI Practitioner with your programme? What does ICEASI Education Standards mean and is it the same as other Practitioner and Advanced Practitioner courses? What do I call myself on completion of the ASI Wise CLASI CASI Programme, Practitioner or Advanced Practitioner as some of my colleagues have done Advanced Practitioner training and can’t see the difference? Thank you. Jo.”

Hi Jo

Thank you for your question. I would suggest that you describe or sign yourself on reports as

Jo Blogs
Occupational Therapist
CLASI Certification in Ayres’ Sensory Integration. (www.iceasi.org)

 

This would clearly describe your profession, while also describing your training in Ayres’ Sensory Integration meeting internationally accepted ICEASI standards. The choice of this term by both ASI Wise and CLASI is in line with advice and guidance from professional bodies and in consideration of professional registration. Please contact RCOT for further guidance about the use of preferred terms and practice guidance for Occupational Therapists who have additional learning or post-graduate continuing professional development within the area of Ayres’ SI

The continuation of our long history and partnership with Ulster University means our ASI Wise CLASI programme is now accredited on the Ulster University post-graduate education Master’s pathway. This partnership is in line with developments within the professions OT, PT and SLT, and the terms and awards we have mindfully chosen are important and critical to our professional development in this area. .

We are delighted to be able to offer our modules as part of the MSc in Advancing Practice, with the award offered in relation to your profession eg MSc Advancing Practice {Occupational Therapy). The careful decision by our team, in discussion with Professor Suzanne Martin last year, was made with careful consideration of national developments regarding career progression for AHP’s and earlier but also current RCOT advice.

As well as having being taught by internationally published and leading works experts, this means someone receiving assessment or intervention from you would know you are trained to a standard that includes being able to deliver specialist assessment (including taught administration of standardised norm-referenced ‘gold standard’ assessment the SIPT or now the EASI – in line with international standards). The ICEASI international standards are helping ensure that programmes include necessary learning and requirements for the safe practice of Ayres’ SI, regardless of any often ‘unrelated’ academic accreditation. University approval of academic standards does not consider international standards and consensus regarding the practice of Ayres’ SI. It is important that therapists understand this clear distinction.

ICEASI standards ensure that you know and understand the neuroscience and theory, be able to provide a comprehensive specialist assessment of sensory integration and processing challenges (and strengths), including with standardised norm-referenced tools ( SIPT and EASI).

Our programme meets ICEASI International minimum standards for learning about Ayres’ SI and ensures occupational therapists are able to use relevant tools with confidence, employing advanced clinical reasoning to develop a hypothesis to support intervention planning, delivery and measurement of progress/outcomes.

Compentancy in SI
©ICEASI 2017 in Mori et al 2017, AOTA OTP Volume 22 Issue 12 p 8 – 13.

Not all terms used abroad are the same as here in the UK or Ireland. Practitioner and Advanced Practitioner in the UK refer to terms historically used and linked to a specific programme.

AHP titles are protected and regulated, so a standardised term OT/PT/SLT with Certification in ASI (ICEASI) is a nationally preferred and internationally recognised term by many programmes across the globe. This mindful and deliberate adoption of these terms as part of the ICEASI Vision from 2015, and provides a means to ensure those investing in therapy are assured of the education level of knowledge and skills of the therapist they are commissioning.

The term also allows recognition in any country of any therapist who has had training in a similar programme anywhere in the world. There have been occasions in the UK of some therapists with very adequate training eg SAISI whose education on SI Modular programmes is the same as the UK Practitioners/Advanced Practitioner were being advised that unless they retrained to the term Practitioner/Advanced Practitioner in order to practice.

Those who had historically been practising via other equal older routes have had their qualifications called into question, including in tribunal proceedings. The need to have a way of equating programmes across the globe was essential and the process to establish this began as far back as 2010.

Since then, at ICESI and later ICEASI international meetings, representatives from many international organisations have explored a way to establish an international standard for education in ASI. Programmes that meet criteria that have been agreed by the consensus of member organisations will equate to a therapist having learnt and applied knowledge and skills to assess, interpret and clinically reason to practice – being able to provide and reflect on intervention using the principles of Ayres’ SI.

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Our Directors; Amanda Adamson, Kath Smith and Ros Urwin have been meeting up and collaborating with colleagues from across the globe at international conferences and forums representing SIN and Now ASI Wise. Since 2010, they have represented ASI education in the UK and Ireland, actively contributing to the development of the learning standards. Key to their decision to establish the ASI Wise programme was national debate and discussion about terminology and professional practice issues raised by RCOT in 2015. Read more here about ICEASI.

Completion of ASI WISE’s CLASI CASI which meets ICEASI standards will mean therapists are grounded in, know and understand seminal theory and history of ASI and are aware of and can apply current research and evidence in practice. See ICEASI Standards.

This will include the ability to understand in detail, use and apply a wide range of assessment tools and methods to clinically reason how to provide intervention to anyone of any age and in any clinical setting; including how to use and interpret the current “gold standard tool” the SIPT (Sensory Integration and Praxis Test), with learning about a new test in development the EASI (Evaluation of Ayres’ Sensory Integration).

Please see our shop for more information about our modules and other workshops supporting the learning of therapists wanting to practice Ayres’ Sensory Integration. Our programme, with accreditation by Ulster University far exceeds international minimum standards with live interactive tutoring and access to a vibrant community of practice.

You can read more feedback about our workshops and courses on our pages.