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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 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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Research into Practice: A study of safety and tolerability of rotatory vestibular input for preschool children

The answer to a question on SI4OT, a FB group for OT’s curated by our social media team, includes this interesting article.

This study was focussing on the vestibular system, and the researchers tried to work out the exact amount of vestibular input needed in therapy. The results strongly suggest that it is very individualised and requires direct therapist observation to know. This is exactly in line with Ayres’ teachings. There is no exact amount that can be prescribed

A study of safety and tolerability of rotatory vestibular input for preschool children

The use of sensory input to support function, health and wellbeing is an art and a science.

The science is knowing for instance that habituation of tactile input to Ruffini nerve ending is usually fairly rapid – eg light touch as we put arms in shirt sleeves while habituation to pain receptors will vary a lot and maybe ongoing after tissue damage we can’t always see.

The art is that our response to sensory input to sensory systems will vary greatly and is very individualised. This response is not just linked to immediate registration and perception of the input – meaning and memory need to be considered too.  Think about happy smells and songs that stay in your head all day. Think too about the response to trauma when a person smells their abuser’s perfume.

There is no recipe for how much to give and when. This is the art and science of ASI. So many factors impact on what a person needs and when to have an adaptive response.

This is why sensory input is not just something you can prescribe someone by saying;

“Give Jane 20 mins on a swing 3x a day” 

gray swing

Essential to practice is the person’s response to sensory input – Do they have an adaptive response?

“Ayres (1972b) described the adaptive response as central to praxis intervention. Adaptive responses are purposeful actions directed toward a goal that is successfully achieved, and the production of adaptive responses is thought to be inherently organizing for the brain. Ayres (1972b, 1985) further emphasized that SI intervention was a transaction among client, task, and environment.”

Bundy, A. and Lane, S. [2019], Sensory Integration Theory and Practice, 3rd Edition, [Philadelphia]. Available from: FADavis.

Watching and seeing this response to input, alongside feedback from the parents/family/person is what we do to understand each person’s unique responses and pattern. However, knowing and remembering that many things can impact on this, day to day and even minute by minute is essential. 

 

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Why do ASI Wise not use the term Practitioner or Advanced Practitioner ?

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 inline with advice and guidance from professional bodies and in consideration of professional registration. Please contact RCOT for further guidance about 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 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) as a nationally preferred and internationally recognised term by many programmes across the globe. This mindful and deliberate adoption of these terms was 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.