Sensory integration therapy

Sensory integration therapy (SIT) was originally developed by occupational therapist A. Jean Ayres in the 1970s to help children with sensory-processing difficulties. It was specifically designed to treat Sensory Processing Disorder (sometimes called Sensory Integrative Dysfunction). Sensory Integration Therapy is based on A. Jean Ayres's Sensory Integration Theory, which proposes that sensory-processing is linked to emotional regulation, learning, behavior, and participation in daily life. Sensory integration is the process of organizing sensations from the body and environmental stimuli.

Theoretical concept
A. Jean Ayres' sensory integration theory describes the following:


 * How the neurological process of processing and integrating sensory information from the body and the environment contribute to emotional regulation, learning, behavior, and participation in daily life.
 * Empirically derived disorders of sensory integration.
 * Intervention approaches and strategies for sensory input.

Sensory integration theory is used to explain why individuals behave in particular ways, plan intervention to ameliorate particular difficulties, and predict how behavior will change as a result of intervention. Dr. Ayres defines sensory integration as the organization of an individual's senses for use. The brain’s ability to organize sensations supports a person in moving, learning, and reacting to situations appropriately.

Individuals with sensory-processing difficulties often experience delayed or impeded typical behaviors and functioning as a result of interferences in neurological processing and integration of sensory inputs. Sensory dysfunction affects the neurological processing of sensory information and sensory systems which causes negative impacts on learning and development. ASI highlights the critical influence that sensory-processing has on a child's growth and development. It contributes to the understanding of how sensation affects learning, social-emotional development, and neurophysiological processes, such as motor performance, attention, and arousal.

ASI has been studied by different professions on diverse levels, such as by occupational therapists and researchers as a foundation for occupational performance and participation, and by psychologists on a cellular level as multi-sensory integration.

As an intervention approach, it is used as "a clinical frame of reference for the assessment and treatment of people who have functional disorders in sensory processing".

Practice
Individuals with sensory processing disorder or sensory integrative dysfunction experience problems with their sensory systems, also known as basic senses of touch, smell, hearing, taste, sight, body coordination, and movement against gravity. They might also experience difficulties in movement, coordination, and sensing where one's body is in a given space, also known as proprioception. Each individual sensory system has specific receptors or cells within the body that deliver messages to the brain. These receptors are located in specific parts of the body - gustatory/taste (mouth), olfactory/smell (nose), visual (eye), auditory (ear), and vestibular (inner ear). Other receptors are spread throughout the body - tactile (skin) and proprioception (muscles and joints).

Sensory Integration Therapy, also known as sensory-based treatments or interventions, are designed to provide sensory activities or experiences to help individuals respond better to environmental stimuli (i.e., sensory input). The main goal and priority for the use of sensory integration therapies is to improve internal sensory processing, improve self-regulation, develop adaptive functioning  skills, and to help the child successfully become participate in daily life experiences and activities. Sensory-based interventions or activities are structured and individualized per each child's specific individual needs. They range from passive activities (i.e., wearing a weighted vest, weighted blanket, receiving hugs, playing with shaving cream) to active activities (i.e., spinning around, jumping on a trampoline, running, climbing, walking on patterned blocks).

According to proponents of sensory integration therapy, sensory integrative dysfunction is a common disorder for individuals with neurological learning disabilities such as an autism spectrum disorder, attention deficit hyperactivity disorder, and sensory modulation dysfunction.

Occupational therapists are uniquely equipped to practice Ayres Sensory Integration (ASI) or Occupational Therapy Sensory Integration (OT-SI). During sessions, activities are presented to both challenge capabilities and assist and regulating a child (Parham & Mailloux, 2015). Activities are often specially tailored to meet individual needs. The goal of these sessions is to assist a child in gaining competence in participating in everyday activities in settings such as school, home and extra curriculars. Active participation is emphasized in order to maxims gains and learning. Children who require more structure are given modified activities that continue to offer freedom of choice in order to foster self-direction (Parham & Mailloux,2015).

Visual

 * Covers eyes when lights are too bright
 * Stares at bright, fluorescent, or flickering lights
 * Stares at spinning objects
 * Holds items extremely close to eyes or face
 * Turns opposite direction or away from where teacher is lecturing
 * Easily distracted by extremely organized or unorganized rooms
 * Lack of eye contact or looks beyond person's face
 * Overwhelmed by too many colors, materials, or pictures in room
 * Turns or tilts head when reading across a page

Auditory

 * Covers ears when loud noises occur (i.e., fire drill, yelling, alarms)
 * Runs away from loud areas
 * Hums or sings to themself
 * Complains of noises inside room or outside of window
 * Covers ears in the cafeteria or in bathroom
 * Runs when toilet flushes
 * Prefers very loud music or no music at all

Tactile

 * Avoids touching certain surfaces or textures
 * Prefers to touch specific fabrics or textures
 * Touches everything in sight
 * Doesn't react to pain
 * Might bite or suck on their own skin
 * Doesn't react to or overreacts to extreme temperatures (i.e., wears shorts when extremely cold)
 * Dislikes getting hands and feet dirty, wet, in sand, or in paint.
 * Avoids getting hair, face, or head touched.

Gustatory (Taste)

 * Refuses to eat or gags on certain foods
 * Eats extreme tasting foods (i.e., lemons, hot sauce, lots of salt or pepper)
 * Sensitive to hot or cold foods
 * Licks, tastes, or tries to eat play dough, objects, or toys

Olfactory (Smell)

 * Might smell everything they touch
 * Sensitive to odors (i.e., perfume, air fresheners, essential oils)
 * Might not smell or recognize bad odors
 * Sniffs other people
 * Breathes through their mouths instead of nose

Vestibular

 * Might seem like a "thrill seeker" (i.e., jumping from high places, climbing furniture, running extremely fast)
 * Difficulties with sitting or remaining still
 * Prefers to lie down instead of sitting up
 * Enjoys being upside down
 * Easily loses balance when walking, going up and down the stairs, or standing
 * Rocks back and forth

Proprioceptive

 * Touches walls while walking
 * Stands too close when talking to others
 * Chews, pulls, or twists items (i.e., pencils, shirt, toys, hand or arm)
 * Accidentally leans, trips, crashes, or bumps into objects or people
 * Deliberately falls or crashes into things
 * Walks stiff and uncoordinated
 * Pulls fingers or cracks knuckles constantly
 * Frequently breaks toys or objects

Visual

 * Spinning tops or toys
 * Light up toys
 * Use a flashlight or pen light to draw attention
 * Visual memory games
 * Colored chalk, markers, crayons, and pencils
 * Lava lamps
 * Bubbles
 * Look in mirror
 * Coloring mixing activities
 * Light table
 * Shadow exploration
 * Parachute play

Auditory

 * Incorporate music during activities
 * Noise cancelling headphones
 * Background noise, white noise, or sound machine
 * Books, puzzles, toys, or manipulatives with sound
 * Bubble wrap
 * Snap, clap, or stomp
 * Play with music instrument
 * Kazoo toy
 * Listen to nature sounds outside (i.e., birds, ducks, dogs)

Tactile

 * Play dough
 * Sensory bin with rice, beans, cereal, or waterbeads
 * Theraputty
 * Sand or water play
 * Lotion massage rub to hands and arms
 * Fidget toys
 * Scratchy gloves, sand paper, cotton balls, brushes
 * Finger writing or hand play with shaving cream or whipped cream
 * Finger paint
 * Bubble wrap
 * Felt strips
 * Textured foam paper
 * Carpet samples
 * Play dress up and practice zipping, buttoning, snapping, tying or looping laces

Gustatory (Taste)

 * Sour, salty, crunchy, snacks
 * Drink warm or cold liquids

Olfactory (Smell)

 * Lotion with calming or alerting aromas
 * Scented soaps to wash hands
 * Essential oils diffuser, necklaces, bracelets
 * Scented markers or stickers (non-toxic)
 * Scented play dough, finger paints, or sensory dough
 * Scented bubbles
 * Create scented bottles with aromas, spices, or oils

Vestibular

 * Rocking chair
 * Spinning
 * Twirling
 * Bend over and place head below heart
 * Fast, alternating movements
 * Ride tricycles, scooter boards, or scooters
 * Jumping jumps
 * Bounce and roll on therapy ball - slow or fast
 * Therapy ball chair
 * Sit N Spin

Proprioceptive

 * Playground - climb, hang, run through, and go under equipment
 * Sand play - dig or pour
 * Jump on trampoline
 * Jumping or running in place
 * Theraputty exercises
 * Stand up to do work
 * Chair or wall push ups
 * Obstacle course
 * Bear or crab walk
 * Yoga poses
 * Push or carry a heavy box around the room
 * Carry weighted backpack
 * Body sox play
 * Arm circles
 * Sit ups
 * Wheelbarrow walking

Evidence and Effectiveness
While sensory-based interventions are highly advocated for, there continues to be a lack of empirical support. There is disagreement over their therapeutic worth, largely due to problems with methodology and confusion of terms and conflation with similar and related approaches.

Ayres' theory of sensory integration is frequently critiqued. Emerging evidence with improved methodology, the development of a Fidelity Measure and increasing focus of resources on areas of practice that might not typically attract medical research funding, means that the much needed evidence for Ayres SI is now emerging. Since much of the effects of sensory based interventions are hard to quantify and measure, this is why it seems there is not much evidence for it.

Hume and colleagues support the use of Ayres’ Sensory Integration (ASI), making the case for why review of science and evidence should be ongoing. "The current report updates and extends the work on evidence-based, focused intervention practices begun with an initial review of the literature from 1997 to 2007 (Odom et al. 2010a, b) and extended through a second report that covered the literature from 1990 to 2011 (Wong et al. 2015); extending this systematic review through 2017 added 567 articles to the review. As the intervention literature has provided more empirical information and as practices have evolved, some of the classifications required reconceptualization and revision of previous definitions. In an active research area, knowledge does not stand still, and in fact, identification of EBPs should be dynamic, reflecting the growth of knowledge across time (Biglan and Ogden 2019)."In their article they clearly state the importance of clearly defining what sensory integration therapy is and what it is not; helping to clarify and delineate the clinical practice reported in their article, from other related approaches based on Ayres’ SI theory. "It is important to note that Sensory Integration refers explicitly to the classical sensory integration model developed by Jean Ayres (2005) and not to a variety of interventions that address sensory issues but have been found to be unsupported (Case-Smith et al. 2015; Watling and Hauer 2015)."

History
In the 1950s, Dr. A. Jean Ayres, an occupational therapist and psychologist, developed the theory and framework of sensory integration. Her book Sensory Integration and the Child, first published in the 1970s, was a means of helping families, therapists, and educators of children with sensory-processing difficulties and sensory processing disorders to better organize and improve self-regulation of body and environmental sensory inputs.

Ayres' approach has proliferated among therapy and educational professionals over the past several decades. It has been met with some resistance within the occupational therapy profession and in other disciplines.