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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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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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CPD on the Sofa: An Activities Guide for Enhancing & Practicing Executive Function Skills

Supporting development is everyone’s business. If you are a therapist practicing Ayres’ Sensory Integration, parent education and support between sessions with sensory rich activities to support development through ploy is likely to be a part of what you do. The resource includes downloadable printable activities guides for different ages, that will make great handouts for parents and teachers. Another great resource from Harvard..

Parents bringing their children to therapy are dedicated – no matter who is funding the therapy. A weekly commitment to therapy sessions while juggling family life will test even the most organised Mum or Dad’s diary and working day. Fun easy to do activities that can support therapy and provide ideas for what to do when the ideas run out are a bonus.

These activities in this resource from Harvard are just so much more. Research has shown that this collection includes age-appropriate activities and games that adults can use to support and strengthen executive function and self-regulation skills in children.

Follow this link for more information and access to these great downloads: developing-child.harvard.edu/resources/activities-guide-enhancing-and-practicing-executive-function-skills-with-children-from-infancy-to-adolescence/

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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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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.

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