Sensory Integration Art Science

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					     Movement &
Integrating the Senses:
   What’s it all about?

     Anita C. Bundy
   University of Sydney
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      Dyspraxia Support Group of NZ
            Four Questions
•   What is sensory integration?
•   What does it do?
•   Does it work?
•   Is it good for your child?




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What Is Sensory Integration?




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      Neurological Process

– organizes sensation from the
  body and the environment
– enables efficient and effective
  actions




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      Circular Process
     Sensory                      Sensory
      Intake                     Integration



                                           Planning &
Feedback                                   Organizing
                                            Behavior

                Adaptive
                Interaction/
                “Learning”
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          More Circular Process

                 Sensory
                 Sensory                           Sensory
  Vestibular       Intake
                  Intake                          Integration
Proprioceptive                                                     CNS
   Tactile                                                         Processing

                                                           Planning &
           Feedback                                        Organizing
                                                            Behavior

                                 Adaptive
                                 Interaction/
                                 “Learning”

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               One More Circle
Intervention   Sensory                      Sensory
                Intake                     Integration         Hypothesized
                                                               Site of Problem

                                                        Planning &
        Feedback                                        Organizing
                                                         Behavior

                          Adaptive
                          Interaction/
                          “Learning”
                          Evaluation
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Two Overlapping Types of
     Dysfunction


   Dyspraxia              Poor
                        Modulation




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       Each Associated With Poor
          Sensory Processing
  Vestibular                                            Vestibular


                             Poor
   Tactile       Dyspraxia Modulation                     Tactile



Proprioceptive                                         Proprioceptive




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            Each With “Subtypes”

                                                        Defensiveness
   BIS
                                                          Insecurity
                Dyspraxia            Poor
                                                      Aversive Response
                                   Modulation
Somato-
                                                      Under-responsive
dyspraxia




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  “Subtypes” Associated With
Different Sensory Processing . . .




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                              We won’t go
                                there !




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But . . . let’s look at
  DYSPRAXIA
& MODULATION
  in more detail



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              Dyspraxia
•   Dys=Latin for difficulty
•   Praxis=Greek for doing
•   Dyspraxia=difficulty with doing
•   Developmental condition
•   Difficulty with learning new tasks



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 Based in Poor Body Scheme

Resulting from poor sensory processing
  – Tactile (Touch)
  – Vestibular (Balance)
  – Proprioceptive (Muscles)




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            Continuum of Praxis

              SI-based dyspraxia                      “Normal”


Severely                                                         Hyper-
Deficient                                                        normal




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  Bilateral Integration &
    Sequencing (BIS)
• “Mild” problem
• Using 2 sides of body together
• Doing anticipatory (difficult) tasks
  – Catching &Kicking




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 Easy Vs. Hard Motor Tasks

        Child’s Movement



Easy     Control of Mvt                      Hard


       Object’s Movement


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    Somatodyspraxia
• More pronounced difficulty




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 Easy Vs. Hard Motor Tasks

        Child’s Movement



Easy     Control of Mvt                      Hard


       Object’s Movement


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Modulation




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Sensory Modulation Disorders
     •   Defensive
     •   Gravitational insecurity (fear)
     •   Aversive response (sick)
     •   Under-responsiveness




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           Defensive
• Things that others don’t mind
  – Tactile
  – Auditory
  – Visual




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   What you see . . .
• “Fight or flight” reaction
  – Hitting
  – Increased activity
  – Distractibility




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Gravitational Insecurity
• Fear of movement or being out
  of the upright
• Out of proportion to “threat”




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What You See . . .
 • Rigid posturing
 • Crying
 • Refusal




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Aversive Responses to
     Movement
  • Nausea or vomiting
  • Dizziness
  • Sweating and Pallor




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 What You See . . .
• Obvious signs
• Subtle signs
  – Refusal
  – Withdrawal




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       Under-responsive
• Seems not to notice sensory events
• Response is too little for event
• May be “sensory seekers”




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What Does Sensory
 Integration Do?




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     Aims of SI Intervention
• Better neural processing
• More effective and efficient
  actions
• Reactions in proportion to
  experience



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          Modulation
• React appropriately to sensation
• Focus on relevant information
• Move without fear, aversive reactions




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             Praxis
• Improve body scheme
• Plan and perform actions more
  spontaneously




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             Consultation
• Understand SI
  dysfunction better
   – Child, Parent,
     Teacher
• Develop strategies for
  doing own “job” better
  despite child’s SI
  problems

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How Well Does Sensory
  Integration Work?




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Conclusion only
 as good as the
    evidence



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        What is the Evidence?

Miller et al. (2007)
• 80+ studies
• ~1/2 were “effective”




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 Most studies
are very small



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         Two Meta-Analyses
Ottenbacher, K. (1982).            Vargas, S., & Camilli, G.
  Sensory integration                (1999). A meta-
  therapy: Affect or                 analysis of research on
  effect? American                   sensory integration
  Journal of                         treatment. American
  Occupational                       Journal of
  Therapy, 36, 571-578.              Occupational
                                     Therapy, 53, 189-198.


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       Four Systematic Reviews
Arendt, R. E., MacLean,   Hoehn, T. P. &
  W. E., & Baumeister, A.  Baumeister, A. A.
  A. (1988). Critique of   (1994). A critique of the
  sensory integration      application of sensory
  therapy and its          integration therapy to
  application in mental    children with learning
  retardation. American    disabilities. Journal of
  Journal on Mental        Learning Disabilities,
  Retardation, 92, 401-    27, 338-350.
  411.

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       Four Systematic Reviews
Polatajko, H. J., Kaplan,     Schaffer, R. (1984).
  B. J., & Wilson, B. N.        Sensory integration
  (1992). Sensory               therapy with learning
  integration treatment for     disabled children: A
                                critical review.
  children with learning        Canadian Journal of
  disabilities: Its status 20   Occupational Therapy,
  years later.                  51, 73-77.
  Occupational Therapy
  Journal of Research, 12,
  323-341.
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“Curiouser and
  Curiouser”
    Meta Analyses:
Sensory integration was
  effective before 1980
  but not afterward



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“Curiouser and
  Curiouser”
      Reviews
• Studies are not
  rigorous enough to
  come to a valid
  conclusion
• SI may not be
  effective

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              What a Muddle!
                   “Would you tell me,
                     please, which way I
                     ought to walk from
                     here?”




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 “Gold Standard” Evidence:
Randomised Controlled Trials

How do we know
 it’s good
 research?
 – 3 things to
   evaluate
 (Miller et al., 2007)

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     1. Sample:
    Who they studied
• Similar
• Well-defined
• Randomly assigned



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      Sample: The Studies
• Varied in age from 3 to adult
• Varying diagnoses
  –   cognitive impairments
  –   psychiatric disorders
  –   LD*
  –   autism



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      2. Intervention
        (What they did)
• Clearly described
• Replicable
• Continuous monitoring (“fidelity”)




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     Intervention: The Studies
• Some may not be SI
• Rarely replicable
  – Polatajko, Law et al produced a
    manual but it was not widely
    available
• None had a method of coding
  fidelity

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       3. Outcomes:
(What they tried to change)
  •   Meaningful
  •   Appropriate
  •   Sensitive
  •   Assessed “blind”



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Outcomes: The Studies
 •   Educational (Math & Reading)
 •   Behaviour
 •   Language
 •   Motor Skills
 •   Sensory-perceptual



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     So, Does SI Work?
The evidence is pretty inconclusive




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           Two Current Studies
                 Miller et al., (2007)

1. Pilot study: Children with poor modulation
• Purpose:
  –   Identify who will respond
  –   Develop manual and procedures for fidelity
  –   Identify outcomes
  –   Clarify methodology
• One group pre-test/post-test (30 children total)
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         Two Current Studies
                Miller et al., (2007)

2. RCT adhering to all the criteria
  – 3 groups (24 children total)
  – 10 weeks, 2x/week
  – Results: SI group significantly better
     • Goal Attainment Scaling
     • Leiter: Cognitive & Social




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      Does SI Work?
• Yes, for some
• We know it works better
  than no intervention and
  it’s a lot more fun than
  many interventions
• There’s lots more
  research to do!

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Is Sensory Integration Good
      For Your Child?




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     Is SI good for your child?
1. Do your child’s PRIMARY difficulties
   match the description of SI theory?
  Poor coordination and/or poor modulation

                YES                                  Proceed


                 NO                                  Think Carefully



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     Is SI good for your child?
2. Are there any other reasons for the
   problems?


               YES                                  Think carefully

                NO                                  Proceed



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     Is SI good for your child?
3. Do you have access to a therapist skilled in
    SI theory and who has the necessary
    equipment and space?

                YES                                  Proceed


                 NO                                  Think Carefully



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     Is SI good for your child?
4. Is your child’s therapist skilled at and
    willing to consult to you and your child’s
    teachers?

                YES                                  Proceed


                 NO                                  Think Carefully



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     Is SI good for your child?
5. Does your child respond within a very short
    time to the intervention?


               YES                                  Proceed


                NO                                  Think Carefully



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Conclusions: Sensory Integration . . .
• Is NOT a miracle cure
• IS a powerful
  intervention for some
  children
• Is worth the research!




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