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Sensory Integration Therapy in Paediatric Rehabilitation

Original Editor - Syeda Bushra Zehra Zaidi

Top Contributors - Rajshri Suryavanshi, Syeda Bushra Zehra Zaidi, Abdullah Mahmoud Fahmy Hassany, Ahmed M Diab, Kim Jackson, Aminat Abolade and Matt Huey


Introduction

sensory integration

Sensory integration therapy (SIT) is grounded on Ayres's theory (ASI[1]) of sensory processing. This theory was guided by the principle that "intersensory integration is foundational to function".This intervention method is commonly provided by physiotherapists and occupational therapists, leading professionals in this field. [2]


Sensory integration(SI) is defined as the process by which individuals receive and organise sensations from the environment. It gives these sensations meaning and supports the development of abilities needed for participation in activities of daily living[3]. SI describes how the nervous system integrates sensory inputs into action. Two structures may be affected by registration and modulation disturbances: The Limbic System and The Vestibular and Proprioceptive Systems. Dyspraxia and sensory modulation dysfunction are the two primary kinds of dysfunction that are compared and contrasted in sensory integration therapy and sensory integrative dysfunction.

Regarding postulated sensory bases and overt signs, we distinguish between two types of dyspraxia (somatic dyspraxia, or deficiencies in bilateral integration and sequencing) and two types of sensory modulation dysfunction (over-responsivity and under-responsivity). We determined the limits and assumptions of SI intervention and theory. Our distinct emphasis on "doing" vocation sets occupational therapy practice apart from all other health professions. The Greek word praxis also means "doing," which serves as a reminder that when applying SI theory, our main focus should be on enabling the adults and children we deal with to accomplish the tasks they need and wish to do.[4]

Techniques in Sensory Integration Therapy

signs of autism kids

Techniques in Sensory Integration Therapy[5]:

  1. Play-Based Activities: Play is the primary medium used in SIT. Occupational therapists design playful activities that involve various sensory experiences to challenge the child's sensory processing abilities. These activities may include playing with swings, trampolines, large balls, and other equipment that provide sensory input.[6]
  2. Swinging and Spinning: Swinging and spinning activities are commonly used to provide vestibular (balance and movement) input. These activities can help children regulate their arousal levels and improve their balance and coordination. Swinging on a hammock or swing can offer different motions. Gradually increasing the intensity and duration can enhance tolerance and coordination. Spinning in a swivel chair provides vestibular input, it is essential to monitor and adjust the intensity to avoid overstimulation.[7]
  3. Deep Pressure Activities: Deep pressure activities, such as squeezing or wrapping a child in a blanket, provide proprioceptive input, which helps the child develop body awareness and calming responses.[8]
  4. Brushing Protocol: The Wilbarger Brushing Protocol[9] involves using a soft surgical brush to apply deep pressure to the child's skin. This technique is believed to reduce tactile defensiveness and improve sensory processing.
  5. Weighted Vests and Blankets: Weighted vests and blankets are used to provide deep pressure and proprioceptive input. They can help children feel more grounded and focused.[10]
  6. Therapeutic Listening: Therapeutic listening involves using specially designed music to stimulate a child's auditory system. It is believed to enhance sensory processing and self-regulation. Activities involving different sounds can help with auditory discrimination and processing[11]
  7. Visual Stimulation: Activities involving visual stimulation, such as tracking moving objects, playing with colorful lights, or engaging in visual discrimination exercises like sorting objects by colour or shape, can help improve visual processing, attention focus, and coordination.[12]
  8. Oral Motor Activities: Oral motor activities, such as chewing or blowing bubbles, can help improve oral sensory processing and support speech and feeding skills[13][14].
  9. Environmental Modifications: Occupational therapists may recommend modifying a child's environment to reduce sensory distractions or create opportunities for sensory exploration.[15]
  10. Sensory Diet: A sensory diet is a personalised plan that incorporates sensory activities throughout a child's daily routines to meet their sensory needs and enhance participation in daily activities.[16][17]
  11. Tactile Activities: Tactile activities, such as sensory bins(containers filled with materials like beans, sand, or water beads), and playdough with textured materials allow children to explore different textures through digging, pouring, and shifting. This improves sensory discrimination and tolerance to various textures.[18]
  12. Motor Planning Activities: These activities, such as navigating through obstacle courses engaging in gross motor activities like climbing and jumping, and practising fine motor skills like cutting with scissors, can enhance the ability to plan and execute motor actions based on sensory inputs. These may begin with prompting, then progress to single commands, followed by multiple commands at a time.[19]
  13. Calming and Relaxation Techniques: Activities such as breathing exercises, quiet time, squeezing a stress ball, or gentle massage can help with self-regulation and help reduce sensory overload.[20]

Conditions Treated with Sensory Integration Therapy

Sensory Integration Therapy (SIT) is used to treat conditions such as Autism Spectrum Disorder (ASD), Attention Deficit Hyperactivity Disorder (ADHD), Sensory Processing Disorder (SPD), Developmental Coordination Disorder (DCD), learning disabilities, intellectual disabilities, behavioral disorders, motor skill delays, anxiety disorders, and developmental delays. It aims to address difficulties in sensory processing, improve adaptive responses, and enhance overall functioning. SIT is often used in combination with other therapies and interventions tailored to each individual's needs.

The Role of Paediatric Occupational Therapists

Pediatric occupational therapists play a vital role in promoting children's functional abilities and participation in daily activities. They conduct assessments to identify a child's strengths and challenges related to motor skills, sensory processing, and self-regulation. Based on these assessments, they develop individualised intervention plans to address the child's unique needs. Occupational therapists may use sensory integration therapy to improve sensory processing and work on developing fine and gross motor skills to enhance a child's independence. They may recommend adaptive equipment or assistive technology to support children with physical or cognitive challenges. Collaboration with parents, caregivers, and other professionals is essential to ensure a holistic approach to the child's care. Pediatric occupational therapists may work in schools or provide early intervention services for infants and young children. Their goal is to promote optimal development, independence, and quality of life for children and their families.[21]

The Role of Pediatric Physiotherapists

The role of pediatric physiotherapists in utilising sensory integration techniques[22] is multifaceted, particularly in treating children with sensory processing disorders, developmental delays, and other neurological conditions

  • Physiotherapists conduct comprehensive assessments to identify sensory processing issues. They use standardised assessments[23] and observational methods to understand how a patient responds to sensory input, which guides individualised treatment plans.
  • Based on assessment findings, physiotherapists develop personalised treatment plans that incorporate sensory integration techniques tailored to the individual's needs. This may include activities that provide various sensory experiences to enhance functional skills.
  • Physiotherapists implement a variety of sensory-rich activities to promote engagement and improve motor skills. These activities may include balance tasks, tactile exploration, and proprioceptive exercises, which help regulate sensory input and enhance overall function.
  • Physiotherapists often collaborate with occupational therapists, speech therapists, and educators to provide a holistic approach to sensory integration. This teamwork enhances the effectiveness of interventions by combining different therapeutic perspectives.
  • Ongoing evaluation of the patient's progress is essential. Physiotherapists regularly assess the effectiveness of sensory integration techniques and adjust interventions as needed to ensure optimal outcomes.

Recommendations

  1. Pediatricians should not use sensory processing disorder as a diagnosis. When these sensory symptoms are present, other developmental disorders—specifically, autism spectrum disorders, attention-deficit/hyperactivity disorder, developmental coordination disorder, and anxiety disorder—must be considered and thoroughly evaluated, usually by appropriate referral(s) to a developmental and behavioral pediatrician, child psychiatrist, or child psychologist
  2. Pediatricians should recognize and communicate with families about the limited data on the use of sensory-based therapies for childhood developmental and behavioral problems.
  3. If the pediatrician is managing a child whose therapist is using sensory-based therapies, the pediatrician can play an important role in teaching families how to determine whether a therapy is effective.
  4. Pediatricians should inform families that occupational therapy is a limited resource, particularly the number of sessions available through schools and insurance coverage. The family, pediatrician, and other clinicians should work together to prioritise treatment based on the effects the sensory problems have on a child’s ability to perform the daily functions of childhood[24]

Conclusion

In conclusion, Sensory Integration Therapy (SIT) is a beneficial intervention based on Ayres's theory of sensory processing, [25]provided by pediatric occupational therapists to address sensory difficulties in children with various developmental disorders. SIT techniques, such as play-based activities, swinging, deep pressure, brushing, and others, offer a comprehensive approach. SIT can help children with conditions like Autism Spectrum Disorder, ADHD, and sensory processing difficulties, promoting better functioning and quality of life.Children with spastic diplegic cerebral palsy showed significantly more improvement in their functional mobility when they received SIT in addition to conventional physiotherapy. [26]

Collaboration among therapists, parents, and healthcare professionals is vital for personalised care and effective outcomes.

Additional Information

[27]
Description: Occupational Therapist Tina Malian discusses what is sensory processing disorder and the array of techniques and equipment used to treat children with sensory processing disorder at Joe DiMaggio Children's Hospital Rehabilitation Centers.
[28]

Description: Learn how occupation therapy can be used as a treatment for children who struggle with sensory integration issues. This video shows occupational therapists and health professionals experts, discussing how occupational therapy works, and the benefits that occupational therapy provides.

References

  1. ↑ Smith Roley, S., Mailloux, Z., Miller-Kuhaneck, H. & Glennon, T. (2007). Understanding Ayres' Sensory Integration. OT Practice 12(7).
  2. ↑ 1.Schoen SA, Lane SJ, Mailloux Z, May‐Benson T, Parham LD, Smith Roley S, et al. A Systematic Review of Ayres Sensory Integration Intervention for Children with Autism. Autism Research [Internet]. 2018 Dec 12;12(1).
  3. ↑ Randell E, McNamara R, Delport S, et al. Sensory integration therapy versus usual care for sensory processing difficulties in autism spectrum disorder in children: study protocol for a pragmatic randomised controlled trial. Trials. 2019;20(1):113
  4. ↑ 1.Benson JD, Beeman E, Smitsky D, Provident I. The Deep Pressure and Proprioceptive Technique (DPPT) Versus Nonspecific Child-Guided Brushing: A Case Study. Journal of Occupational Therapy, Schools, & Early Intervention. 2011 Jul;4(3-4):204–14. ‌
  5. ↑ Pollock N. Sensory integration: A review of the current state of the evidence. Occupational therapy now. 2009;11(5):6-10.
  6. ↑ Rabiei F, Ehteshamzadeh P, Homaei R, Jayervand H. Effectiveness of Play Therapy Based on Sensory Integration on Communication Skills, Social Interaction, Stereotyped Behaviors, and Motor Development in Boys with Autism Spectrum Disorder. Quarterly Journal of Child Mental Health. 2024 Jan 10;10(4):93-108.
  7. ↑ Mays NM, Beal-Alvarez J, Jolivette K. Using movement-based sensory interventions to address self-stimulatory behaviors in students with autism. Teaching Exceptional Children. 2011 Jul;43(6):46-52.
  8. ↑ Bestbier L, Williams TI. The immediate effects of deep pressure on young people with autism and severe intellectual difficulties: Demonstrating individual differences. Occupational therapy international. 2017;2017(1):7534972.
  9. ↑ Weeks, & Boshoff, Kobie & Stewart, Hugh. (2012). Systematic review of the effectiveness of the Wilbarger Protocol with children. Pediatric Health, Medicine and Therapeutics. 3. 79. 10.2147/PHMT.S37173.
  10. ↑ Stephenson J, Carter M. The use of weighted vests with children with autism spectrum disorders and other disabilities. Journal of autism and developmental disorders. 2009 Jan;39:105-14.
  11. ↑ Hall L, Case-Smith J. The effect of sound-based intervention on children with sensory processing disorders and visual–motor delays. The American Journal of Occupational Therapy. 2007 Mar 1;61(2):209-15.
  12. ↑ Belyaeva E, Kartashova O, Sokolaeva N, Snezhko Z, Spichak V. Effects of visual impairment on sensory integration and new opportunitiesfor inclusive education. Bangladesh Journal of Medical Science. 2021;20(4):801.
  13. ↑ Voniati L, Papaleontiou A, Georgiou R, Tafiadis D. The effectiveness of oral sensorimotor intervention in children with feeding disorders. Current Developmental Disorders Reports. 2021 Dec;8:201-11.
  14. ↑ Sjögreen L, Gonzalez Lindh M, Brodén M, Krüssenberg C, Ristic I, Rubensson A, McAllister A. Oral sensory-motor intervention for children and adolescents (3-18 years) with dysphagia or impaired saliva control secondary to congenital or early-acquired disabilities: A review of the literature, 2000 to 2016. Annals of Otology, Rhinology & Laryngology. 2018 Dec;127(12):978-85.
  15. ↑ Bodison SC, Parham LD. Specific sensory techniques and sensory environmental modifications for children and youth with sensory integration difficulties: A systematic review. The American Journal of Occupational Therapy. 2018 Jan 1;72(1):7201190040p1-1.
  16. ↑ Randell E, Wright M, Milosevic S, Gillespie D, Brookes-Howell L, Busse-Morris M, Hastings R, Maboshe W, Williams-Thomas R, Mills L, Romeo R. Sensory integration therapy for children with autism and sensory processing difficulties: the SenITA RCT. Health Technology Assessment. 2022 Jun 15;26(29).
  17. ↑ Reynolds S, Lane SJ, Richards L. Using animal models of enriched environments to inform research on sensory integration intervention for the rehabilitation of neurodevelopmental disorders. J Neurodev Disord. 2010;2(3):
  18. ↑ Grace T. Baranek, Laura G. Foster, Gershon Berkson; Tactile Defensiveness and Stereotyped Behaviors. Am J Occup Ther February 1997, Vol. 51(2), 91–95.
  19. ↑ Abraham MC. Sensory integration: practical strategies and sensory motor activities for use in the classroom. Carson-Dellosa Publishing; 2002 Jan 2.
  20. ↑ Teresa Garland MO. Self-regulation interventions and strategies: Keeping the body, mind & emotions on task in children with autism, ADHD or sensory disorders. Pesi Publishing & Media; 2014 Feb 1.
  21. ↑ Angela D. Mandich, Helene J. Polatajko, Jennifer J. Macnab, Linda T. Miller. (2001) Treatment of Children with Developmental Coordination Disorder. Physical & Occupational Therapy In Pediatrics 20:2-3, pages 51-68.
  22. ↑ Karcı M, Gün N. The Effects of Physiotherapy Program with Ayres Sensory Integration for a 3-Years-Old Child with Low Muscle Tone and Speech Disorder: A Single Case Study. Fenerbahçe Üniversitesi Sağlık Bilimleri Dergisi. 2023 Apr 4;3(1):123-30.
  23. ↑ Burns, C.O., Dixon, D.R., Novack, M. et al. A Systematic Review of Assessments for Sensory Processing Abnormalities in Autism Spectrum Disorder. Rev J Autism Dev Disord 4, 209–224 (2017).
  24. ↑ Zimmer M, Desch L, Rosen LD, Bailey ML, Becker D, Culbert TP, McClafferty H, Sahler OJZ, Vohra S, Liptak GS, Adams RC, Burke RT, Friedman SL, Houtrow AJ, Kalichman MA, Kuo DZ, Levy SE, Norwood KW Jr, Turchi RM, Wiley SE. Sensory Integration Therapies for Children With Developmental and Behavioral Disorders. Pediatrics. 2012;129(6):1186-1189.
  25. ↑ Lane SJ, Mailloux Z, Schoen S, Bundy A, May-Benson TA, Parham LD, Smith Roley S, Schaaf RC. Neural Foundations of Ayres Sensory Integration®. Brain Sci. 2019 Jun 28;9(7):153. doi: 10.3390/brainsci9070153. PMID: 31261689; PMCID: PMC6680650.
  26. ↑ Warutkar VB, Kovela RK, Samal S. Effectiveness of Sensory Integration Therapy on functional mobility in children with spastic diplegic cerebral palsy. Cureus. 2023 Sep 21;15(9):e45683. [1]
  27. ↑ Joe DiMaggio Children's Hospital. Sensory Integration Therapy. Available from: https://www.youtube.com/watch?v=4mqHm27fopk [last accessed 2/8/20023]
  28. ↑ Pathways. How Occupational Therapy Helps with Sensory Integration Issues. Available from: https://www.youtube.com/watch?v=4-jqtlwfw5M&t=3s [last accessed 2/8/20023]
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