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Research Update: Sensory Modulation Disorder (SMD) and Pain: A New Perspective

Pain and sensory integration difficulties including sensory sensitivity are thought to be features in many disorders including CFS/ME and hyper mobility. Recent research and evidence is exploring the links.

Abstract “Sensory modulation disorder (SMD) affects sensory processing across single or multiple sensory systems. The sensory over-responsivity (SOR) subtype of SMD is manifested clinically as a condition in which non-painful stimuli are perceived as abnormally irritating, unpleasant, or even painful. Moreover, SOR interferes with participation in daily routines and activities (Dunn, 2007; Bar-Shalita et al., 2008; Chien et al., 2016), co-occurs with daily pain hyper-sensitivity, and reduces quality of life due to bodily pain. Laboratory behavioral studies have confirmed abnormal pain perception, as demonstrated by hyperalgesia and an enhanced lingering painful sensation, in children and adults with SMD. Advanced quantitative sensory testing (QST) has revealed the mechanisms of altered pain processing in SOR whereby despite the existence of normal peripheral sensory processing, there is enhanced facilitation of pain-transmitting pathways along with preserved but delayed inhibitory pain modulation. These findings point to central nervous system (CNS) involvement as the underlying mechanism of pain hypersensitivity in SOR. Based on the mutual central processing of both non-painful and painful sensory stimuli, we suggest shared mechanisms such as cortical hyper-excitation, an excitatory-inhibitory neuronal imbalance, and sensory modulation alterations. This is supported by novel findings indicating that SOR is a risk factor and comorbidity of chronic non-neuropathic pain disorders. This is the first review to summarize current empirical knowledge investigating SMD and pain, a sensory modality not yet part of the official SMD realm. We propose a neurophysiological mechanism-based model for the interrelation between pain and SMD. Embracing the pain domain could significantly contribute to the understanding of this condition’s pathogenesis and how it manifests in daily life, as well as suggesting the basis for future potential mechanism-based therapies.”

Read more here: Sensory Modulation Disorder (SMD) and Pain: A New Perspective

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AOTA Article: Trauma and OT

Many Occupational Therapists using a sensory integration approach in their clinical practice have worked productively and mindfully with children, adults and older adults with trauma. Our unique education and training facilitates our practice in a range of settings- schools, mental health settings and hospitals, where as a profession we are tasked to address barriers to participation in everyday life.

Occupational Therapists are uniquely placed to be able to offer not only cognitive behavioural and occupation based activities.

Neuroscience now provides us with the evidence to support our practice of Ayres’ Sensory Integration with our clients with trauma – confirming our understanding about how trauma impacts early and ongoing sensory and motor development, underlying physiology and levels of arousal and attention.

Now and into the future, we will need to further consider the evidence for how inter-generational trauma manifests in underlying neurobiological processes that underpin function – the sensory, motor and cognitive building blocks of participation in everyday life.

To read the full article please follow this link. https://www.aota.org/~/media/Corporate/Files/Publications/CE-Articles/CE-article-May-2019-Trauma.pdf

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Clinical Dilemma: The theory of Sensory Integration and how it is currently informing practice in young people with trauma. But what about Fidelity?

An interesting video about how this therapist is applying learning about sensory integration to inform her practice in young people with trauma. It is really important to the growing application of Ayres’ Sensory Integration in the field of trauma that we clearly define what we are doing and how we practice, how we work in away that meets Fidelity or not. We need to describe what we do – and if it is according to Fidelity so that what we describe is clear – when is it the use of the theory of sensory integration to inform clinical reasoning and develop and implement sensory informed cognitive behavioural approaches and when is it Ayres’ Sensory Integration. This is an important and critical distinction. This does not mean either approach is not valid or useful – but just that we are clear about what we are delivering so our intervention and outcomes can be measured and reported clearly.

Can we use the assessments from ASI and then deliver sensory approaches, sensory strategies and not one to one therapy according to Fidelity to Ayres’ Sensory Integration? Yes, sometimes this is all we might be funded or able to do a bit is is the best we are able to offer given local commissioning and geographical challenges.

I work with young people with trauma and I use Ayres’ Sensory Integration that meets Fidelity, but I can also sometimes only deliver consultation – but my strategies and clinical reasoning are deeply embedded in the theory of Ayres. When I do this the results can make a significant impact on the person’s ability to be safe, takes less medication or self-harm less, as my theoretical knowledge is sound and robust, grounded in current neuroscience and Ayres’ theory.

How do you practice if you work with trauma using Ayres’ theory, and how do you record what you do?

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Clinical Dilemma: The theory of Sensory Integration and how it is currently informing practice in young people with trauma. But what about Fidelity?

An interesting video about how this therapist is applying learning about sensory integration to inform her practice in young people with trauma. It is really important to the growing application of Ayres’ Sensory Integration in the field of trauma that we clearly define what we are doing and how we practice, how we work in a way that meets Fidelity or not. We need to describe what we do – and if it is according to Fidelity so that what we describe is clear – when is it the use of the theory of sensory integration to inform clinical reasoning and develop and implement sensory informed cognitive behavioural approaches and when is it Ayres’ Sensory Integration. This is an important and critical distinction. This does not mean either approach is not valid or useful – but just that we are clear about what we are delivering so our intervention and outcomes can be measured and reported clearly.

Can we use the assessments from ASI and then deliver sensory approaches, sensory strategies and not one to one therapy according to Fidelity to Ayres’ Sensory Integration? Yes, sometimes this is all we might be funded or able to do. It is the best we are able to offer given local resources, commissioning and geographical challenges.

I work with young people with trauma and I use Ayres’ Sensory Integration that meets Fidelity, but I can also sometimes only deliver consultation post assessment – but my strategies and clinical reasoning are deeply embedded in the theory of Ayres. When I do this the results can make a significant impact on the person’s ability to be safe, takes less medication or self-harm less, as my theoretical knowledge is sound and robust, grounded in current neuroscience and Ayres’ theory. Now we need the research to eveidence this way of working when funds and time is limited.

How do you practice if you work with trauma using Ayres’ theory, and how do you record what you do?

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When trauma occurs, the brain changes

Bessel A. van der Kolk M.D. is a clinical researcher who integrates developmental, neurobiological, psychodynamic and interpersonal aspects of the impact of trauma and it’s treatment. Learn a bit more from him about how perceptual changes happen because of trauma, and how this impacts on engaging with ordinary situations, focus as well as attention. Hear how this can impact on someone’s sense of self.