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Autism/OT Month: Understanding the Distinction between Sensory Integration and Sensory-Based Strategies

There are many interventions and treatment techniques for assisting children diagnosed with autism.

Research indicates that about 90% of children diagnosed with autism also have sensory processing challenges. Therefore sensory processing must be evaluated.

Two of my favorite standardized rating scales are the Sensory Processing Measure – Preschool (SPM-P) for 2 to 5 year olds and the Sensory Processing Measure (SPM) for 5 to 12 year olds.  These can be completed by the parents, day care provider, classroom teacher, art, music, and PE, recess, and cafeteria and bus school staff.

The gold standard performance standardized evaluation is the Sensory Integration Praxis Tests (SIPT).

Once identified, two of the most used intervention processes are:
1. Using an ASI® or OT/SI sensory integration approach
2. Using sensory-based strategies.

Though a distinction between the two must be understood, they can also be used together.

The distinction is described in the book titled Occupational Therapy Practice Guidelines for Children and Adolescents with Challenges in Sensory Processing and Sensory Integration (AOTA, 2011).

ASI® or OT/SI involves individualized intervention using sensation in an intentional manner to support a child’s ability to succeed in daily life activities.

A Nov 2013 study in the Journal of Autism & Developmental Disorders revealed efficacy of OT/SI in children with Autism.

Below see child on a bolster swing working on postural adjustments in an OT/SI clinic.

Special training is required to provide OT/SI. Core principles of sensory integration intervention as described in the Fidelity Measure (Parham et.al, 2007) include the following:

  1. Qualified professional, occupational therapist, physical therapist or speech and language pathologist.
  2. Intervention plan is family-centered, based on a complete assessment and interpretation based on the patterns of sensory integrative dysfunction, collaboration with significant people in the individual’s life, adherence to ethical and professional standards of practice.
  3. Safe environment that includes equipment that will provide vestibular, proprioceptive and tactile sensations and opportunities for praxis.
  4. Activities rich in sensation especially those that provide vestibular, tactile and proprioceptive sensations and opportunities for integrating that information with other sensations such as visual and auditory.
  5. Activities that promote regulation of affect and alertness and provide the basis for attending to salient learning opportunities.
  6. Activities that promote optimal postural control in the body, oral-motor, ocular motor areas and bilateral motor control sustaining control while holding against gravity and maintaining control while moving through space.
  7. Activities that promote praxis including organization of activities and self in time and space.
  8. Intervention strategies that provide the “just-right challenge.”
  9. Opportunities for the client to make adaptive responses to changing and increasingly complex environmental demands. Highlighted in Ayres Sensory Integration ® intervention principles is the “Somato-motor adaptive response” which means that the individual is adaptive with the whole body, moving and interacting with people and things in the 3-dimensional space.
  10. Intrinsic motivation and drive to interact through pleasurable activities, in other words, play.
  11. Therapist engenders an atmosphere of trust and respect through contingent interactions with the client. That is the activities are negotiated, not pre-planned, and the therapist is responsive to altering the task, interaction and environment based on the client’s responses.
  12. The activities are their own reward and the therapist ensures the child’s success in whatever activities are attempted by altering them to meet the child’s abilities.

Therapists, teachers and parents can go to www.siglobalnetwork.com for more information.

You can find many of the specialized equipment at School Specialty-Abilitations.

Sensory-Based Strategies are also known as “occupational therapy using sensory-based interventions.” Sensory-based strategies are often an integral part of early intervention, school-based practice, and community based programs that emphasize collaborative team empowerment. They may be used in conjunction with OT/SI.

Sensory-based strategies can take a multisensory approach or provide specific sensations (proprioceptive, tactile, vestibular, etc.) to help with challenges in sensory integration and processing. These strategies can be used with the individual child, a small group, or an entire classroom.

They may include adapting activities as well as making changes to the environment, all the while monitoring the child’s adaptive response to the intervention’s effectiveness. They may include items for a sensory diet, a term coined by occupational therapist Patricia Wilbarger that means a carefully designed, personalized activity plan that provides the sensory input a person needs to stay focused and organized throughout the day.

A more inclusive term is “sensory buffet”, which refers to the many possible sensorimotor activities that can be offered to the child (similar to the many food choices available at a buffet). A sensory buffet includes many different types of sensory input that can be used in various intensities and combinations (Henry, Kane-Wineland, & Swindeman, 2007).
I have listed a few of my favorite sensory “tools” for use in providing sensory-based strategies on the School Specialty –Abilitations Henry OT page.

Below, see the child at home using the ball with storage legs (chair ball) while doing his homework.

 

Children with sensory processing challenges often demonstrate variable performance. Therefore, interventions may need to be modified on an ongoing basis. Collaboration among the caregivers, the OT/SI clinic based therapist, the school based therapist and all school staff working with the child is key

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