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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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Research Update: Sensory Over-Responsivity as an Added Dimension in ADHD

Anecdotally many Occupational Therapists who use Ayres’ Sensory Integration to inform assessment and practice report the close links between ADHD and sensory integration challenges. This article by expert Sensory Integration researchers Shelley Lane and Stacey Reynolds offers research evidence and neuroscience in strong support of the links between differences in processing and integrating sensory input for those who meet criteria for a diagnosis of ADHD.

Abstract “Years of research have added to our understanding of Attention Deficit Hyperactivity Disorder (ADHD). None-the-less there is still much that is poorly understood. There is a need for, and ongoing interest in, developing a deeper understanding of this disorder to optimally identify risk and better inform treatment. Here, we present a compilation of findings examining ADHD both behaviorally and using neurophysiologic markers. Drawing on early work of McIntosh and co-investigators, we examined response to sensory challenge in children with ADHD, measuring HPA activity and electrodermal response (EDR) secondary to sensory stressors. In addition, we have examined the relationship between these physiologic measures, and reports of behavioral sensory over-responsivity and anxiety. Findings suggest that sensory responsivity differentiates among children with ADHD and warrants consideration. We link these findings with research conducted both prior to and after our own work and emphasize that there a growing knowledge supporting a relationship between ADHD and sensory over-responsivity, but more research is needed. Given the call from the National Institute of Health to move toward a more dimensional diagnostic process for mental health concerns, and away from the more routine categorical diagnostic process, we suggest sensory over-responsivity as a dimension in the diagnostic process for children with ADHD”.

Read the full article here: Sensory Over-Responsivity as an Added Dimension in ADHD

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Neural Foundations of Ayres’ Sensory Integration.

Dr Susanne Smith Roley shared the draft of this with us when she teaching CLASI CASI M6 with ASI WISE in June. Lovely to see it in press and able to be shared! Thank you to all the authors! Just what’s needed to support practice.

Read it here: https://www.mdpi.com/2076-3425/9/7/153/htm

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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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Why learn the SIPT when the EASI is in development and about to be published, I don’t want to waste my money?

We regularly get asked this and similar questions. Here is our reply
ASI WISE is absolutely committed to the EASI. Our Directors have been and are all involved in the development of the EASI and the global normative data collection of the EASI.
Please know that once you learn Ayres’ Clinical Observation and the SIPT on our current M3, you will be able to easily transfer learning to the EASI, including in future interpretation based on normative data currently being collected. You will also be introduced to the EASI where it is “in development” on our modules.
Our combination of online and face to face training is a modular programme run in conjunction with CLASI. It is very robust and will equip you with the research to practice not only in the UK and Ireland, but also abroad.
While your learning is considered post-graduate learning, including critique and analysis of research – this learning also includes hands on practical development of the knowledge and skills to be able to assess and treat a range of clients across the lifespan.
Learning ASI is a bit like learning to drive a car – some theory can be done online and from books, or in online chat sessions – but you do have to eventually get in a car and learn to drive with helpful supportive instruction, feedback and application in real life. 
What do people say about our modules?
“That it is a great course where you’ll gain practical knowledge on sensory integration. It is fantastic to have three amazing OTs to provide you with examples and assist understanding your case studies.” Samantha Senior Paediatric Occupational Therapist
“Do it! Have an open mind be curious brave don’t be afraid to discuss challenge and critique; it will change your practice! ” Lindsey Lead OT in Intellectual Disabilities
“A very good course, hands on, very well documented and the best professionals in Ayres Sensory Integration teaching.” Alexandra PT
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Autism and Homelessness: Why does it matter to OT’s? And it should!

city urban bw brazilAlthough today I was sent a copy of a link to an article entitled “First significant study on autism and homelessness”, this is not the first I have known about the increased risk of homelessness in those with Autism or ways that as a profession Occupational Therapy can offer something to help reduce this risk.

For a number of years, OT’s have been talking about the risks of loss of occupation, social connection and homelessness for their clients with Autism. We know once the structure, safety and services of childhood and school and sometimes higher education are gone, things can become tricky. And we know about Ayres’ Sensory Integration, can help minimise the impact of sensory differences on development and skills necessary for everyday life.

In 2015 a briefing for frontline staff on Autism and Homelessness suggested that 12% of people diagnosed with autism in Wales had experienced homelessness. while among rough-sleepers in Devon, 9/14 might be classified as being on the autistic spectrum.

To read the 2015 briefing click here
The new study found almost identical data to the small study from Wales. The new study agrees that 12.3% of homeless people have traits of autism highly suggestive of an Autism diagnosis, in contrast to 1% in the general population.
This latest study in the peer peer-reviewed journal, Autism supports this earlier small-scale study evidence that adults with autism are over-represented among the homeless.
Now, the researchers and many organisations including the National Autistic Society are calling for more research to understand the links between autism and homelessness, so that prevention strategies can improve and support those who are at risk of becoming or are already homeless.
action alone beach boy
As an Occupational Therapist, I am perplexed and confused. Occupational Therapists working with young people with autism have for a long time repeatedly highlighted the risks of not addressing the difficulties of their paediatric clients. Ayres’ Sensory Integration therapy is about developing and learning transferrable play, school and life skills.
When this does not happen, as part of typical development, and remain unaddressed, then our young clients grow into adults with the same difficulties and challenges  – this is just common sense.
“The profession of occupational therapy should now wholeheartedly embrace the opportunity to grow our profession’s reputation – addressing sensory difficulties that challenge our clients with autism and prevent them from full participation in the occupational activities they choose to engage in.”        Smith @ ISIC 2018
These skills are usually learned through play, as part of typical development when a child is able to take in, make sense of and respond to the sensory events around them and within their own bodies. It is through this repeated interaction and learning via our senses that we use feedback to make memories and develop patterns of behavours.
adult alone bracelet casualWe use then use feedback and memory to think about and anticipate (feed-forward) what to do in new and novel situations – and to make the best choice of plan and carry it out. It is this that allows us to keep doing and learning, developing patterns of behaviour and increasingly more skillful behaviors and abilities. It is our ability to accurately process and integrate sensation that allows children to eventually become independent, capable adults, participating and functioning fully in all the occupational activities that are part of our adult life.
“Sensory Integration sorts, orders and eventually puts all the sensory inputs together into whole brain function. What emerges from this process is increasingly complex behavior, the adaptive response and occupational engagement.”
Ayres 1979
We have been left a rich history and legacy by Jean A Ayres and colleagues who first developed and then tested sensory integration theory in practice. Progress in the field of neuroscience has led to further development of the theory and tools for practice;  more recent developments in the field include the Fidelity Tool, Data Driven Decision Making Tool and, in development right now, the EASI (Evaluation of Ayres’ Sensory Integration), with increasingly more robust research studies with improved methodology.
More than any other profession, Occupational Therapists trained in Ayres’ Sensory Integration* have within their toolboxes the therapeutic skills to make meaningful measurable changes to their young and older client’s abilities to process and integrate sensation; learning that is truly life-changing.
Occupational Therapists trained in Ayres’ Sensory Integration* are able to address the underlying sensory challenges that research suggests underpins the difficulties commonly associated with Autism, that can impact on the development; movement, play, self-care and social interaction skills necessary to participate in occupation as we grow older.

A recent research study from a randomised control trial (one of the best types of research there is) in the USA by Schaaf and colleagues; An Intervention for Sensory Difficulties in Children with Autism: A Randomized Trial has shown Ayres’ Sensory Integration* makes a big difference to some of the skills children need to develop to become increasingly independent from caregivers as they get older.

Young people in the study group scored significantly better after therapy with Ayres’ Sensory Integration than young people in the care as usual group. Goal Attainment Scales scores and scores about self-care and socialisation skills all showed that after Ayres’ Sensory Integration Therapy* there was a significant improvement not seen in those just getting care as usual.

 


 

*Ayres’ Sensory Integration Therapy is usually a postgraduate qualification, and it is recommended that practitioners have qualifications equivalent to ICEASI Level 2. Please ask your therapist about their level of education in Ayres’ Sensory Integration.

 

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CPD on the Sofa: Early Experiences Shape Executive Function – (our own personal air traffic control system)

Executive function skills help us plan, focus attention, switch gears, and juggle multiple tasks—much like an air traffic control system at a busy airport.

This downloadable paper provides a great way of explaining executive function to teachers and parents, drawing on the latest neuroscience and research in early development. The air-traffic analogy makes is a great tool in the therapist tool box when education parents about the importance of early development, the environment in which we learn and develop and how to support and promote development, ultimately enhancing participation in all activities and occupations of daily life – you can download the free resource here: developingchild.harvard.edu/resources/building-the-brains-air-traffic-control-system-how-early-experiences-shape-the-development-of-executive-function/

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Resources Update: Sensory University

Sensory University offers discounted pricing on school supplies, special needs toys and equipment’s for autism. See and read more at sensoryuniversity.com/

We love the look of this great product for use at school…

Desk Buddy- a Multi Textured Tactile Chewable Ruler

This product may be a useful sensory strategy to help a child who constantly fidgets.

Their website describes how it was developed by a team of Occupational Therapist, School Teachers, and product engineers who combined efforts to create this product for use both at home and in the classroom.

“For children who are constantly looking for different textures to touch or “fidget” with, the Desk Buddy® is both practical and socially acceptable in a school setting. It is simply a ruler sitting on their desk. The desk buddy is constructed from an FDA approved material so its even safe to chew on if the need were to arise. Completely dishwasher safe, and naturally bacteria resistant. “Every Child Needs a Desk Buddy® Colors shipped at random. Special request will be honored if possible.

BP, latex and Phthalate free material, coloring, and flavor. FDA approved materials and dishwasher safe.”

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Resources for Practice in Mental Health and Trauma-Informed Care: improving self-regulation to eliminate control and restraint aka TMAV

On our courses, we teach staff from CAMHS and adult/older adult mental health services how to use Ayres’ Sensory Integration to inform care including for those who have had early trauma.

On our in-house courses, we regularly teach mixed staff teams including Mental Health Nurses and Healthcare Assistants, CPN’s, OT’s, PT’s, SLT’s and Therapy Support Staff, Complementary Therapists, Psychologists and Psychiatrists. Working with staff teams from forensic, secure, acute and longer stay units, our lecturers help teams to develop and implement sensory informed care pathways. This includes working with sensory providers to develop secure safe sensory rooms for safe self-regulation and sensory-rich movement activities suitable for secure and forensic environments, where ligature risks mean traditional swings and other equipment cannot be used.

The use of Ayres’ Sensory Integration to support health and well-being has grown across the UK and Ireland.

The research and evidence base is expanding across the globe, with more clinical audits and studies being published that report that Ayres’ Sensory Integration is

  • improving self-awareness
  • improving self-regulation
  • promoting participation in everyday life
  • increasing clients ability to engage with others, with therapy

this means that there are significant reductions in

  • days in secure or acute care
  • deliberate self-harm
  • the use of PRN medication
  • the need for the use of physical support aka TMAV

We’d like to thank Tina Champagne for pointing us in the direction of this resource which fits so neatly alongside the resources and tools we teach on our courses.

Tina ChampagneTina is a colleague and critical friend of ASI WISE – having started her journey into sensory integration in parallel to our journey here in the UK where we were focussing on improving participation in care and daily life, addressing development of skills and occupations including self care to reduce self harm and use of PRN medication. We finally met in 2004 at a first conference about ASI in MH in Cornwall, UK.

Her work in addressing the use of chemical (mace) and mechanical (cuffs) restraints in the US helped transform their mental health care and she wrote several chapters in this free online resource about developmental trauma and practical ways to institute trauma-informed care.

Resources for Eliminating Control and Restraint aka Therapeutic Manage of Aggression and Violence 

https://www.mass.gov/files/documents/2016/07/vq/restraint-resources.pdf

 

 

 

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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.

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