VOLUME 26 NO 1 2016

Update on latest research in

Sensory Integration

CONTENTSSAISI NEWSLETTER VOLUME 26 NO 1 2016

3. Editor’s Letter

4. How do I answer questions from clients using information from research

14. Sensory processing in healthy adult population: a summary of two recent research projects

22. Activity Ideas

30. Book Review

32. CPD Programme Questionnaire

SAISI WEBSITE: www.instsi.co.za Views contained in articles appearing in this newsletter do not necessarily reflect the opinion of the South African Institute for Sensory Integration.

2 Volume 26 | No 1 | 2016

Editor’s Letter

HOW ExHILARATINg IT WAS TO REAd THE cONTRIBUTIONS TO THIS NEWSLETTER! RESEARcH VISITEd!

As the internet has become the new “informed opinion” in many households, it increasingly has become challenging to discern between what is scientifically proven and what the author’s own opinion is. Janine van der Linde gives a lovely overview of questions frequently asked by clients and linked the answers to published articles in reputable sources. giving us more to read!

Sensory integration intervention is popularly associated with occupational therapy in paediatrics. gina Rencken gives an update on some of the latest research of sensory integration in the adult population. A whole new world?

Then we are excited to have an international lecturer at our c4 course this year. Susan Smith Roley will be joining the team in training. She will also be presenting a two day workshop on Sensory Integration and Babies. do not delay another day – sign up for more of the latest information on Sensory Integration Therapy.

Amy Rode

“Live as if you were to

die tomorrow. Learn as if

you were to live forever”

Mahatma Gandhi

Volume 26 | No 1 | 2016 3

BY

Janine van der Linde

HOW dO I ANSWER QUESTIONS FROM cLIENTS USINg INFORMATION FROM RESEARcH

SEnSoRY IntEgRAtIon tHEoRY IS onE of

tHE moSt RESEARCHED fIELDS wItHIn

oCCuPAtIonAL tHERAPY, YEt It IS StILL

CRItICIzED foR HAVIng no EVIDEnCE.

ALtHougH VARIouS StuDIES wERE DonE

tHRougHout tHE YEARS tHERE wERE mAjoR

mEtHoDoLogICAL fLAwS SuCH AS VARIED

mEASuRES uSED to IDEntIfY PRoBLEmS,

uSE of SmALL SAmPLE SIzES, PooR DEfInIng

of IntERVEntIon PRInCIPLES AnD tHEn tHE

ABILItY to REPLICAtE tHESE StuDIES. DuE to

tHESE mEtHoDoLogICAL fLAwS tHERE IS StILL

ConfuSIon In tERmS of tHE VALuE of SEnSoRY

IntEgRAtIon IntERVEntIon.

In order to answer questions about the reliability and

validity of Ayres Sensory Integration® posed by medical

Aids, other healthcare workers as well as clients, we need

to be aware of the latest research and provide evidence

based treatment.

this article looks at some of the questions that people

may ask in terms of ASI® and some of the latest research

we can use to answer those questions.

this is by no means a complete or formal literature review.

A very large amount of research is available on the topic

but most of the articles described in this article were

published in the last 10 years.

1. on tHE IntERnEt tHEY tALk ABout SEnSoRY IntEgRAtIon AnD SEnSoRY PRoCESSIng. wHAt IS tHE DIffEREnCE?the term sensory integration was developed by jean A.

Ayres and used to describe the theory and principles used

within this frame of reference (Ayres 1972).

miller however proposed a change of the term to “sensory

processing” in order to discriminate between the term

Instructional Designer / Lecturer School of therapeutic Sciences, faculty

of Health Sciences, university of the witwatersrand, johannesburg.

B. occupational therapy (ufS)

m.Sc. ot (wits)

PhD candidate (wits)

4 Volume 26 | No 1 | 2016

for theory and the term for dysfunction (miller et al. 2007,

Schaaf and Davies 2010).

this change of terminology is not to recommend a change

in the actual theory, but rather the characterization of the

diagnoses.

there is however no consensus regarding this and in order

to ensure that the theory and principles as applied within

sensory integration as described by Ayres, it was decided

to trademark the term “Ayres Sensory Integration®” in

order to avoid confusion (Schaaf et al. 2015, Smith Roley

et al. 2007).

the classification of dysfunction as described

by miller (miller et al. 2007) also differs from the

dysfunctions originally identified by cluster and factor

analysis (mailloux et al. 2011).

It is important to know about the research available

on sensory integration and the different terms which

are being used. this knowledge will help to describe to

parents and other therapists what SI is and to clarify the

confusion regarding the information on the internet.

Article

Schaaf, R. C., and

P. L. Davies.

2010.

Smith Roley, Susanne,

zoe mailloux, Heather

miller-kuhaneck,

and tara glennon.

2007.

“Evolution of the

sensory integration

frame of reference.”

Am J Occup Ther 64

(3):363-7.

“understanding

Ayres’ Sensory

Integration.”

Link for download of article

occupational therapists and occupational therapy assistants rely on knowledge and skills to guide their intervention planning as they help clients who are experiencing difficulties with engaging in occupation. Sensory integration theory, with its rich history grounded in the science of human growth and development, offers occupational therapy practitioners specific intervention strategies to remediate the underlying sensory issues that affect functional performance. this article articulates the core principles of sensory integration as originally developed by Dr. A. jean Ayres, explains the rationale for developing a trademark specifically linked to these core principles, and identifies the impact that this trademark can have on practice.

Link for download of article

AUTHORS JOURNAL INFORMATION ABSTRAcT

“...we need to be aware of the

latest research and provide

evidence based treatment.”

Volume 26 | No 1 | 2016 5

Chang, Yi Shin, mathilde

gratiot, julia P owen,

Anne Brandes-Aitken,

Shivani S Desai,

Susanna S Hill, Anne B

Arnett, julia Harris,

Elysa j marco, and

Pratik mukherjee. 2015.

white matter

microstructure is

associated with auditory

and tactile processing in

children with and without

sensory processing

disorder. frontiers in

Neuroanatomy, 9.

Link to article for download

AUTHORS JOURNAL INFORMATION ABSTRAcT

2. IS tHERE A nEuRoLogICAL tESt tHAt CAn SHow tHAt mY CHILD mAY HAVE SEnSoRY IntEgRAtIon DIffICuLtIES?Sensory integration difficulties are not due to hard

neurological damage although there is research that

indicates that there are some neurobiological involvement

(Chang et al. 2015, owen et al. 2013).

Various studies were done to determine a specific

biological marker which can be used to diagnose sensory

integration difficulties. mcIntosh et al. (1999) investigated

sympathetic nervous system function by looking at

electrodermal reactivity during the administration of

sensory stimuli. this study found that children with sensory

integration difficulties show abnormal electrodermal

responses and habituate slower to sensory input. In two

studies by Schaaf et al. (2003) and Schaaf et al. (2010)

the researchers investigated the use of Electrocardiogram

data to detect parasympathetic difficulties in children with

sensory modulation disorder (SmD).

the studies indicated that children with SmD had a

different cardiac vagal tone from typical children. this is

an indication that children with SmD have an increased

parasympathetic reaction to sensory input compared with

typical children.

Davies and gavin (2007) then investigated whether EEg

technology will be able to identify Sensory processing

disorder (SPD). this study found that the EEg indicates

unique neural processing mechanisms in terms of children

with SPD. the latest research by Chang et al. (2015)

and owen et al. (2013) used diffusion tensor imaging and

found that children with sensory processing difficulties

display different white matter microstructure than typical

developing children.

Although all these studies indicate that there may be

biological markers that can be useful in determining

sensory integration difficulties, there is no conclusive

evidence yet. A lot more research, with larger samples

needs to be done to confirm these findings.

“...studies indicated that children

with SMD had a different cardiac

vagal tone from typical children.”

6 Volume 26 | No 1 | 2016

Using Research

owen, julia P.,

Elysa j. marco,

Shivani Desai,

Emily fourie,

julia Harris,

Susanna S. Hill,

Anne B. Arnett, and

Pratik mukherjee.

2013.

Abnormal white matter

microstructure in

children with sensory

processing disorders.

NeuroImage: Clinical, 2, 844-853.

Sensory processing disorders (SPD) affect 5–16% of school-aged children and can cause long-term deficits in intellectual and social development. Current theories of SPD implicate primary sensory cortical areas and higher-order multisensory integration (mSI) cortical regions.

we investigate the role of white matter microstructural abnormalities in SPD using diffusion tensor imaging (DtI). DtI was acquired in 16 boys, 8–11 years old, with SPD and 24 age-, gender-, handedness- and IQ-matched neuro-typical controls. Behaviour was characterized using a parent report sensory behaviour measure, the Sensory Profile. fractional anisotropy (fA), mean diffusivity (mD) and radial diffusivity (RD) were calculated. tract-based spatial statistics were used to detect significant group differences in white matter integrity and to determine if microstructural parameters were significantly correlated with behavioural measures. Significant decreases in fA and increases in mD and RD were found in the SPD cohort compared to controls, primarily involving posterior white matter including the posterior corpus callosum, posterior corona radiata and posterior thalamic radiations.

Strong positive correlations were observed between fA of these posterior tracts and auditory, multisensory, and inattention scores (r = 0.51–0.78; p b 0.001) with strong negative correlations between RD and multisensory and inattention scores (r = − 0.61–0.71; p b 0.001). to our knowledge, this is the first study to demonstrate reduced white matter microstructural integrity in children with SPD.

we find that the disrupted white matter microstructure predominantly involves posterior cerebral tracts and correlates strongly with atypical unimodal and multisensory integration behaviour. these findings suggest abnormal white matter as a biological basis for SPD and may also distinguish SPD from overlapping clinical conditions such as autism and attention deficit hyperactivity disorder.

AUTHORS JOURNAL INFORMATION ABSTRAcT

Volume 26 | No 1 | 2016 7

3. How DoES tHE oCCuPAtIonAL tHERAPISt DEtERmInE tHAt mY CHILD HAS SEnSoRY IntEgRAtIon DIffICuLtIES?the sensory integration frame of reference guides the

assessment of a child to determine if they have sensory

integration difficulties (mailloux and miller-kuhaneck 2014).

faller et al. (2016) recommend the use of standardized

and structured clinical observations as assessment tools to

identify the sensory and motor factors that may play a role

in the child’s ability to participate in daily activities.

In terms of standardized assessments the Sensory

Integration and Praxis test (SIPt), the Sensory Profile and

the Sensory Processing measure were found to provide

valid and reliable information (Ayres 2004, Dunn 1999,

Schaaf 2015, mailloux and miller-kuhaneck 2014).

Ayres (1989) developed the Sensory Integration and Praxis

test (SIPt) to assess the child for sensory integration

difficulties.

this assessment tool is seen as the golden standard

in sensory integration measurement as it proved to be

extremely valid and reliable (Asher, Parham, and knox

2008, Ayres 1989).

Van jaarsveld, mailloux and Herzberg (2012) did a study

in South Africa and found the SIPt to be valid and reliable

for children from South Africa as well, although the children

tested better on some of the subtests.

Various cluster and factor analytical studies were done

on the SIPt to determine the specific sensory integration

dysfunctions that children may have difficulty with (Ayres

1989, mulligan 1998).

further analysis by mailloux et al. (2011) confirmed the

same dysfunctions as originally identified by Ayres.

mailloux, zoe,

Heather miller-kuhaneck.

2014.

“Evolution of a theory:

How measurement Has

Shaped Ayres Sensory

Integration®.”

The American Journal of Occupational Therapy 68 (5):495-9.

Link to article for download

AUTHORS JOURNAL INFORMATION ABSTRAcT

“...the SIPT, Sensory Profile and the Sensory

Processing Measure were found to provide

valid and reliable information.”

8 Volume 26 | No 1 | 2016

4. tHERAPIStS uSIng SEnSoRY IntEgRAtIon tHERAPY ARE onLY PLAYIng wItH mY CHILD. How Do I know tHAt You ARE ACtuALLY DoIng tHERAPY? ASI® intervention is based on the sensory integration

principles as described by Ayres. these principles focus

on the use of child directed play to provide the “just

right challenge” through providing a variety of sensory

opportunities (Schaaf 2015).

In order to ensure that therapy is effective and can be

discriminated from other sensory based treatments

the Ayres Sensory Integration® fidelity measure was

developed.

the fidelity measure measures the structural elements

(therapist qualification, components of the occupational

therapy report, physical environment and communication

with parents) as well as process elements (“presents

sensory opportunities, elicit adaptive responses, support

self-organization behaviour, collaborate in activity choices,

us a play context, help the child to maintain optimal

arousal, ensure success and the child’s safety”)

(Parham et al. 2011, Parham et al. 2007).

the data driven decision making process (DDDm) was

developed by Schaaf and colleagues (faller et al. 2016)

to guide assessment, intervention and measurement

of outcomes. During recent randomized trial studies in

children with Autism a manual for ot/SI intervention was

implemented in intervention and is based on the sensory

principles as set out in the ASI® fidelity measure (Schaaf

et al. 2014).

Schaaf, Roseann C,

teal Benevides,

zoe mailloux,

Patricia faller,

joanne Hunt,

Elke van Hooydonk,

Regina freeman,

Benjamin Leiby,

jocelyn Sendecki,

and Donna kelly.

2014.

“An intervention for

sensory difficulties in

children with autism:

A randomized trial.”

Journal of Autism and Developmental Disorders 44

(7):1493-1506.

this study evaluated a manualized intervention for

sensory difficulties for children with autism, ages

4–8 years, using a randomized trial design. Diagnosis

of autism was confirmed using gold standard measures.

Results show that the children in the treatment group

(n = 17) who received 30 sessions of the occupational

therapy intervention scored significantly higher

(p = 0.003, d = 1.2) on goal Attainment Scales (primary

outcome), and also scored significantly better on

measures of caregiver assistance in self-care (p = 0.008

d = 0.9) and socialization (p = 0.04, d = 0.7) than the

Usual Care control group (n = 15). the study shows

high rigor in its measurement of treatment fidelity and use

of a manualized protocol, and provides support for the

use of this intervention for children with autism. findings

are discussed in terms of their implications for practice

and future research.

AUTHORS JOURNAL INFORMATION ABSTRAcT

Using Research

“These principles focus on the use of child directed play

to provide the ‘just right challenge.’”

Volume 26 | No 1 | 2016 9

5. How Do You mEASuRE tHE outComE of tHERAPY?Recently a lot of emphasis has been placed on using

the Data-Driven Decision making process to determine

a child’s occupational performance difficulties, and the

client and performance factors that may influence their

performance (Schaaf 2015). this is a systematic process

that uses the data from assessment to not only guide

intervention but to determine measurable outcomes for

therapy (Schaaf 2015, faller et al. 2016).

goals for participation challenges can then be set up using

the goal attainment scale (gAS). the gAS can then also

be used as an outcome measure as goals are set up on

a specific scale to measure improvement. the authors

describe two types of outcomes: Proximal outcomes

and distal outcomes (faller et al. 2016). Proximal

outcomes take into account the factors that may influence

participation and set out to determine goals for improving

occupational performance. Distal outcomes are more

focused on the client factors and participation skills that

could affect the occupational performance.

In terms of outcome measures proximal outcomes can be

measured by the goal attainment scale, a client centered

tool that measures occupational performance on a

measurable scale (mailloux et al. 2007). this measure is

very sensitive to change, measurable and a good tool to

use in collaboration with parents to determine intervention

goals and then to measure the outcome of those goals.

Distal outcomes can be measured by looking at the change

in scores of the standardized tests from assessment prior

to intervention and again after intervention, e.g. the SIPt

scores (Schaaf 2015).

using outcome measures will not only guide more

purposeful intervention, but will also aid in providing

more evidence based practice. It will also aid in proving

to medical aids paying for occupational therapy, that the

interventions we use are science based, measurable and

that it does actually improve a child’s activity participation.

faller, Patricia,

joanne Hunt,

Elke van Hooydonk,

zoe mailloux, and

Roseann Schaaf.

2016.

“Application of

Data-Driven Decision

making using Ayres

Sensory Integration®

with a Child with Autism.”

The American Journal of Occupational Therapy

70 (1):1-9.

Health care and educational legislation and policy require

that clinicians demonstrate, using measurement and

report of outcomes, accountability for services rendered.

Clinical algorithms have been developed and are used

by various health care professionals to assist with

hypothesis generation and systematic clinical reasoning;

however, they do not explicitly guide measurement of

outcomes as part of the reasoning process.

Schaaf and colleagues developed the Data-Driven

Decision making (DDDm) process to address the

greater need for outcome measurement, systematically

support decision making, target intervention more

precisely, and measure and document outcomes. this

article describes the application of the DDDm process

with a child with ASD who received occupational therapy

using Ayres Sensory Integration®.

AUTHORS JOURNAL INFORMATION ABSTRAcT

10 Volume 26 | No 1 | 2016

Using Research

ConCLuSIonResearch guides every theory and intervention that is being

used. It is therefore not only important to stay informed

but to also consider the implementation of evidence based

practice in the areas where we work.

Data-Driven Decision making could be a powerful tool

to provide evidence that our intervention and outcomes

are measureable and that we are making a difference in

children’s lives.

I would like to encourage therapists to stay informed

regarding the latest research. By having the knowledge

regarding what the evidence is, it will be easier to explain

to client’s what we do and that it is done in a scientific way.

Schaaf, Roseann C.

2015.

mailloux, zoe,

teresa A may-Benson,

Clare A Summers,

Lucy jane miller,

Barbara Brett-green,

janice P Burke,

Ellen S Cohn,

jane A koomar,

L Diane Parham,

and Susanne

Smith Roley.

2007.

“Creating Evidence

for Practice using

Data-Driven Decision

making.” The American Journal of Occupational Therapy 69 (2):1-6.

“goal attainment

scaling as a measure of

meaningful outcomes

for children with

sensory integration

disorders.”

American Journal of Occupational Therapy

61 (2):254-259.

to realize the American occupational therapy

Association’s Centennial Vision, occupational therapy

practitioners must embrace practices that are not

only evidence based but also systematic, theoretically

grounded, and driven by data related to outcomes.

this article presents a framework, the Data-Driven

Decision making (DDDm) process, to guide clinicians’

occupational therapy practice using systematic clinical

reasoning with a focus on data. Examples are provided

of DDDm in pediatrics and adult rehabilitation to guide

practitioners in using data-driven practices to create

evidence for occupational therapy.

goal attainment scaling (gAS) is a methodology

that shows promise for application to intervention

effectiveness research and program evaluation in

occupational therapy (Dreiling & Bundy, 2003; king et

al., 1999; Lannin, 2003; mitchell & Cusick, 1998).

this article identifies the recent and current applications

of gAS to occupational therapy for children with

sensory integration dysfunction, as well as the process,

usefulness, and problems of application of the gAS

methodology to this population. the advantages and

disadvantages of using gAS in single-site and multisite

research with this population is explored, as well as

the potential solutions and future programs that will

strengthen the use of gAS as a measure of treatment

effectiveness, both in current clinical practice and in

much-needed larger, multisite research studies.

Link for download of article

AUTHORS JOURNAL INFORMATION ABSTRAcT

Volume 26 | No 1 | 2016 11

REfEREnCESAasher, A. V., L. D. Parham, and S. knox. 2008.

“Interrater reliability of Sensory Integration and

Praxis tests (SIPt) score interpretation.”

Am J Occup Ther 62 (3):308-19.

Ayres, A jean. 1972. Sensory integration and learning

disorders: western Psychological Services.

Ayres, A jean. 1989. “Sensory integration and praxis test

(SIPt).” Los Angeles: Western Psychological Services.

Ayres, A.j. . 2004. Sensory Integration and Praxis test

manual. updated Edition - Eight Print ed. Los Angeles:

western Psychological services. original edition, 1989.

Reprint, 2004.

Chang, Yi Shin, mathilde gratiot, julia P owen, Anne

Brandes-Aitken, Shivani S Desai, Susanna S Hill, Anne B

Arnett, julia Harris, Elysa j marco, and Pratik mukherjee.

2015. “white matter microstructure is associated with

auditory and tactile processing in children with and without

sensory processing disorder.” Frontiers in Neuroanatomy

9:169.

Davies, Patricia L, and william j gavin. 2007. “Validating

the diagnosis of sensory processing disorders using

EEg technology.” The American Journal of Occupational

Therapy 61 (2):176.

Dunn, w. 1999. The Sensory Profile User’s manual. San

Antonio: the Psychological corporation.

faller, Patricia, joanne Hunt, Elke van Hooydonk, zoe

mailloux, and Roseann Schaaf. 2016. “Application of

Data-Driven Decision making using Ayres Sensory

Integration® with a Child with Autism.”

The American Journal of Occupational Therapy

70 (1):1-9. doi:

mailloux, z., S. mulligan, S. S. Roley, E. Blanche, S.

Cermak, g. g. Coleman, S. Bodison, and C. j. Lane.

2011. “Verification and clarification of patterns of sensory

integrative dysfunction.” Am J Occup Ther 65 (2):143-51.

mailloux, zoe, teresa A may-Benson, Clare A Summers,

Lucy jane miller, Barbara Brett-green, janice P Burke,

Ellen S Cohn, jane A koomar, L Diane Parham, and

Susanne Smith Roley. 2007. “goal attainment scaling as a

measure of meaningful outcomes for children with sensory

integration disorders.” American Journal of Occupational

Therapy 61 (2):254-259.

mailloux, zoe, and Heather miller-kuhaneck. 2014.

“Evolution of a theory: How measurement Has Shaped

Ayres Sensory Integration®.” The American Journal of

Occupational Therapy 68 (5):495-9.

mcIntosh, D. n., L. j. miller, V. Shyu, and R. Hagerman.

1999. “Sensory modulation disruption, electrodermal

responses, and functional behaviors.” Dev Med Child

Neurol 41. doi: 10.1017/s0012162299001267.

miller, L. j., m.E. Anzalone, S. j. Lane, S. Cermak, and E.t.

osten. 2007. “Concept Evolution in Sensory Integration: A

Proposed nosology for Diagnosis.” The American Journal

of Occupational Therapy 61 (2):6.

mulligan, S. 1998. “Patterns of Sensory Integration

Dysfunction: A Confirmatory factor analysis.” The

American Journal of Occupational Therapy 52 (10):819-

825.

owen, julia P., Elysa j. marco, Shivani Desai, Emily fourie,

julia Harris, Susanna S. Hill, Anne B. Arnett, and Pratik

mukherjee. 2013. “Abnormal white matter microstructure in

children with sensory processing disorders.” NeuroImage:

Clinical 2 (0):844-853. doi:

Parham, L Diane, Ellen S Cohn, Susan Spitzer, and jane A

koomar. 2007. “fidelity in sensory integration intervention

research.” The American Journal of Occupational Therapy

61 (2):216.

Parham, L Diane, Susanne Smith Roley, teresa A may-

Benson, jane koomar, Barbara Brett-green, janice P

Burke, Ellen S Cohn, zoe mailloux, Lucy j miller, and

Roseann C Schaaf. 2011. “Development of a fidelity

12 Volume 26 | No 1 | 2016

Using Research

measure for research on the effectiveness of the Ayres

Sensory Integration® intervention.” American Journal of

Occupational Therapy 65 (2):133-142.

Schaaf, R. C., and P. L. Davies. 2010. “Evolution of the

sensory integration frame of reference.” Am J Occup Ther

64 (3):363-7.

Schaaf, Roseann C, teal Benevides, zoe mailloux, Patricia

faller, joanne Hunt, Elke van Hooydonk, Regina freeman,

Benjamin Leiby, jocelyn Sendecki, and Donna kelly.

2014. “An intervention for sensory difficulties in children

with autism: A randomized trial.” Journal of Autism and

Developmental Disorders 44 (7):1493-1506.

Schaaf, Roseann C, teal w Benevides, Erna Blanche,

Barbara A Brett-green, janice Burke, Ellen Cohn, jane

koomar, Shelly j Lane, Lucy j miller, teresa A may-Benson,

Diane Parham, Stacey Reynolds, and Sarah A Schoen.

2010. “Parasympathetic functions in children with sensory

processing disorder.” frontiers in Integrative Neuroscience

4. doi: 10.3389/fnint.2010.00004.

Schaaf, Roseann C, Lucy jane miller, Duncan Seawell, and

Shannon o’keefe. 2003. “Children with disturbances in

sensory processing: A pilot study examining the role of the

parasympathetic nervous system.” American Journal of

Occupational Therapy 57 (4):442-449.

Schaaf, Roseann C. 2015. “Creating Evidence for Practice

using Data-Driven Decision making.” The American

Journal of Occupational Therapy 69 (2):1-6.

Schaaf, Roseann C., Sarah A. Schoen, teresa A. may-

Benson, L. Diane Parham, Shelly j. Lane, Susanne Smith

Roley, and zoe mailloux. 2015. “State of the Science:

A Roadmap for Research in Sensory Integration.” The

American Journal of Occupational Therapy 69 (6):1-7.

Smith Roley, Susanne, zoe mailloux, Heather miller-

kuhaneck, and tara glennon. 2007. “understanding Ayres’

Sensory Integration.”

van jaarsveld, Annamarie, zoe mailloux, and David S.

Herzberg. 2012. “the use of the Sensory Integration and

Praxis tests with South African children.” South African

Journal of Occupational Therapy 42 (3):12-18.

Volume 26 | No 1 | 2016 13

BY

Gina Rencken

SENSORY PROcESSINg IN HEALTHY AdULT POPULATION: A SUMMARY OF TWO REcENT RESEARcH PROJEcTS

A gRowIng BoDY of RESEARCH HAS

BEEn unDERtAkEn In tHE PASt fEw YEARS,

ExPLoRIng RELAtIonSHIPS BEtwEEn

SEnSoRY PRoCESSIng StYLES AnD

CognItIVE AnD EmotIonAL PRoCESSIng In

CLInICAL PoPuLAtIonS AS wELL AS noRmAL,

HEALtHY InDIVIDuALS. wItH tHE ImPoRtAnCE

of SItuAtIng SEnSoRY IntEgRAtIon tHEoRY

Into tHE LARgER ContExt of HumAn

PERfoRmAnCE, AnD BEttER unDERStAnDIng

tHE ImPACt of SEnSoRY PRoCESSIng AS

ExPERIEnCED In tHE DAILY LIfE of tYPICALLY

funCtIonIng ADuLtS, two of tHE moRE

RECEnt InVEStIgAtIonS Into SEnSoRY

PRoCESSIng ARE SHARED HERE,

wItH A HIgHLIgHtED nEED foR

InfoRmAtIon In tHE AREAS wE ARE

AS YEt unSuRE of.

SEnSoRY PRoCESSIng AnD ImPuLSIVItY In HEALtHY ADuLtSThe Association between Impulsivity and Sensory Processing Patterns in Healthy Adults karen Hebert

British journal of occupational therapy

2015, Vol. 78(4) 232–240

with growing interest in how sensory processing patterns

interact with an individual’s personality and temperament

styles, a research project was undertaken in a healthy

adult population to examine correlations between sensory

processing styles and impulsivity in typical adults.

the study held the following hypotheses:

• Impulsivitywouldbepositivelycorrelatedwith

high threshold sensory processing patterns.

B.ot(uP)2001, m.ot (ufS) 2011.

14 Volume 26 | No 1 | 2016

• Cognitivemeasuresofimpulsivitywouldbeassociated

with sensory processing styles characterized by sensory

hypersensitivity.

A newspaper advertisement recruiting generally healthy

adults between 18 and 60 years, with no history of

neurological disorder and who were not taking medications

affecting the nervous system resulted in 222 individuals

(79 men and 143 women) participating . Each participant

completed the Adult/Adolescent sensory profile (AASP),

a 60-item self-report scale measuring sensory processing

in four quadrants (low registration, sensation seeking,

sensory sensitivity and sensation avoiding); the Barratt

impulsiveness scale (BIS-II), a 30-item self-report scale

measuring personality and behavioural characteristics of

impulsivity in three domains (attentional impulsivity, motor

impulsivity and non-planning impulsivity ); and a response

inhibition go/no-go task where individuals are instructed to

press a key when a letter appears on a computer screen

except under certain circumstances. An omission error

occurred where a letter was not responded to, and a

commission error occurred when an incorrect response

was made. the assessment period lasted 90 minutes per

individual.

Data analysis was done by using Pearson’s correlation

tests to assess the relationship between AASP, BIS-

11 scores, and behavioural measures of impulsivity

(commission and omission error rate). Separate AnoVAs

with Scheffe post-hoc tests were used to determine if

significant differences in impulsivity existed across the

range of sensory processing patterns as there were no

significant correlations between self-report (BIS-11)

and cognitive measures (go/no-go) of impulsivity. the

calculations of the five possible response ratings for

each sensory processing pattern, as identified by the

Adolescent/ Adult Sensory Profile: user’s manual were

collapsed into three to allow for sufficient numbers at each

level in AnoVAS, with “less than most people” (less than 1

SD below the mean) incorporating the previous categories

of “much less than most people” and “less than most

people”; and “more than most people” (greater than 1 SD

above the mean) incorporating the categories “much more

than most people” and “more than most people”.

Chi-Square tests were used to examine the frequency

of individuals meeting the criteria for clinically significant

impulsivity (BIS-11>72) across the three collapsed levels

of each sensory processing style. findings at p<0.05 were

considered significant.

A low registration sensory processing style was positively

related to impulsivity across all three subscales (attentional,

motor and non-planning). Individuals with sensory

sensitivity displayed a small significant correlation with

impulsivity in the attentional subscale.

Correlations between AASP scores and cognitive

measures of impulsivity revealed a small but significant

positive correlation between sensory sensitivity and a

number of commission errors on the go/no-go task.

High neurological threshold scores (low registration

and sensory seeking) scores were examined in relation

to personality and behavioural measures of impulsivity,

revealing significant differences in attentional and motor

impulsivity in individuals with low registration scores.

there were no significant differences found for individuals

who were sensory seeking across any of the impulsivity

Article

“...individuals are instructed to press a key when a letter

appears on a computer screen except under

certain circumstances.”

Volume 26 | No 1 | 2016 15

subscales. Low neurological threshold scores (sensory

sensitivity and sensory avoiding) were examined in relation

to personality and cognitive measures of impulsivity,

showing a significant difference in attentional impulsivity

among individuals in the sensory sensitivity group, as well

as a significant difference in the rate of commission errors.

the hypothesis that impulsivity is positively correlated with

high threshold sensory processing patterns is partially

supported by the research evidence. Individuals with a low

registration, characterised by a high neurological threshold

and passive self-regulation, had higher self-reported rates

of impulsivity. the researchers described individuals with

low registration patterns as being less aware of sensory

inputs driving daily behaviour. Impulsivity is thought to

occur in the time between registration of a sensory input,

and the corresponding behavioural output, resulting in low

registration individuals at times experiencing behaviour as

an unexpected or unplanned event. It is thought that highly

impulsive individuals may in actual fact need more time to

accurately register sensory information, and thus spend

less time planning for a goal directed task.

An interesting finding that requires further exploration

is the relationship between low engagement with the

environment and self-reported impulsivity. Individuals with

clinical disorders such as bipolar, borderline personality,

tBI and ADHD frequently display impulsive behaviour and

could benefit from interventions designed to address this.

In all individuals, successful emotional regulation requires

awareness of internal body sensations and cognitive

processing during an emotional event. treatment designed

to improve awareness of sensory inputs associated with

emotions may have an important place in addressing

impulsive behaviours which hinder successful participation

in daily activities with sustained attention.

the hypothesis that cognitive measures of impulsivity are

associated with sensory processing styles characterised

by sensory hypersensitivity was partially supported by

results indicating that sensory sensitive individuals made

more errors in the go/no-go task assessing executive

response inhibition. Individuals with sensory sensitivity

displayed higher rates of trait impulsivity on attentional

subscales, suggesting that they may be impaired in the

ability to inhibit external input while sustaining attention on

a goal directed activity.

Indications from the study are that the executive function

skill of response inhibition is influenced by sensory

processing abilities, and this relationship requires further

exploration in clinical populations such as individuals with

ADHD.

Individuals with sensory processing styles involving

active self-regulation, as seen in the sensory seeking and

sensory avoiding groups, do not seem to have significant

impulsivity, possibly due to the active planning these

16 Volume 26 | No 1 | 2016

individuals employ to meet their neurological thresholds.

this careful planning reduces the potential for unwelcome

sensory input and impulsive action.

future research is recommended into determining

if teaching planning and self-regulation strategies

to individuals with passive regulation systems (low

registration and sensory sensitivity) can be useful in

addressing impulsive behaviour.

occupational therapists treat individuals with high rates

of impulsive behaviour, largely due to its association with

risk taking and engagement in dangerous behaviours, but

also because impulsivity often has a negative influence

on the individual’s ability to engage in school, work, and

community occupations. Information about a client’s

sensory profile provides a useful adjunct to interventions

targeting self-regulation.

further research is needed into determining the

neurological mechanisms linking sensory processing

difficulties and impulsivity, however they are correlated, and

addressing these may improve an individual’s performance

in daily activities.

KEY FINdINgS:

Individuals with a low registration sensory processing style

report higher rates of impulsive behaviours.

A sensory sensitive processing style is associated with

deficits in response inhibition.

FURTHER RESEARcH NEEdEd INTO:

• Relationshipbetweenlowengagementwiththe

environment and self-reported impulsivity.

• Determiningifteachingplanningandself-regulation

strategies to individuals with passive regulation

systems (low registration and sensory sensitivity)

can be useful in addressing impulsive behaviour.

• Examinesensoryprocessingstylesinadultclinical

populations known to display impulsive behaviours

(such as bipolar disorder, personality disorders,

ADHD).

• Exploretherelationshipbetweensensorystyles

and specific categories of impulsive behaviour.

“... impulsivity often has a negative

influence on the individual’s ability

to engage in school, work, and community

occupations.”

“...successful emotional regulation requires awareness

of internal body sensations and

cognitive processing during an

emotional event.”

Sensory Processing

Volume 26 | No 1 | 2016 17

SEnSoRY PRoCESSIng AnD AffECt In HEALtHY ADuLtSExploring the relationship between affect and sensory processing patterns in adults Engel-Yeger B, Dunn w (2011)

British journal of occupational therapy,

74(10), 456-464.

Affect has been receiving growing attention in wellbeing

therapy over the past years due to its close relation to

quality of life, well-being and health status. this study

moved away from the previous focus on personality traits,

emotional disturbances and health conditions, to suggest a

new perspective discussing the way individuals perceive

the world through their senses (sensory processing)

and positive or negative affect. Previous studies have

linked sensory hyposensitivity or a high neurological

threshold with depression and low arousal; while sensory

hypersensitivity has been associated with anxiety, high

levels of attention and arousal, and high levels of stress.

this was largely attributed to enhanced activity of the

limbic system, reticular system, hypothalamus and cortex.

Individuals experiencing this cascade of neurological

arousal (mostly children) were found to exhibit behaviour

such as hyper emotionality, difficult temperament, poor

self-regulation and negative affect. All these factors have

an influence on the individual’s ability to participate in

schooling, work, leisure and social participation.

the study aimed to elaborate the knowledge about the

relationship between sensory processing patterns and

positive/negative affect in typical adults.

It held the following hypotheses:

1. negative affect will be positively correlated with sensory

processing patterns associated with a low neurological

threshold (Sensation Avoiding and Sensory Sensitivity)

and with the Low Registration pattern.

2. Positive affect will be positively correlated with the

Sensation Seeking pattern.

3. Significant differences in positive/negative affect will

exist between the four sensory processing patterns.

Adverts were posted around neighbourhoods and 213

healthy individuals between the ages of 18 and 50

years, without the presence of systemic severe chronic

diseases, nervous system impairments or the need for daily

medication participated in the study.

they were visited in their homes, where they completed

a demographic questionnaire, winne Dunn’s Adolescent/

Adult Sensory Profile as well as the Positive and negative

Affect Schedule (PAnAS), a 20-item scale where

participants are asked to rate their feelings concerning the

positive or negative affect descriptors.

the five categories of sensory processing patterns defined

in the AASP manual was collapsed into three categories to

yield a higher number of participants in each group. “ much

less than most people ” and “less than most people” were

merged into “less than most people” ; “ similar to most

people” was left unchanged; and “more than most people”

and “much more than most people” were merged to “more

“This study moved away from the previous

focus on personality traits, emotional

disturbances and health conditions...”

18 Volume 26 | No 1 | 2016

Sensory Processing

than most people”. Pearson correlation scores examined

the relationship between the AASP and PAnAS scores.

AnoVA was computed with the Scheffe Post Hoc test to

control for number of comparisons to examine if significant

differences in PAnAS scores exist between the different

categories of each sensory processing pattern, with

probabilities at or below 0.05 being considered significant.

the first hypothesis, that there will be a relationship

between low neurological threshold sensory processing

patterns, low registration and PAnAS scores is supported.

the sensory sensitivity and sensory avoiding scores were

both positively correlated with higher negative affect. there

was also a positive correlation between the low registration

pattern of sensory processing, associated with a high

neurological threshold, and negative affect.

the second hypothesis, that there will be a relationship

between positive affect and the Sensation Seeking pattern

is supported.

the third hypothesis, that there will be differences in

positive/negative affect when compared with the different

categories of the four sensory processing patterns is

mostly supported.

In individuals with a low neurological threshold, significant

differences were found between patterns of sensory

sensitivity and positive as well as negative affect.

People who were less sensitive (scoring in the less

than most category) showed higher positive affect, while

individuals who were more sensitive (scoring in the

more than most category) had significantly higher negative

affect.

Significant differences were also found between

the Sensation Avoiding pattern, positive and negative

affect on the PAnAS, with less avoidant people scoring

higher positive affect, and more avoidant people scoring

higher negative affect.

In individuals with high neurological thresholds, significant

differences were found in individuals with low registration

“People who were less sensitive

(scoring in the less than most category)

showed higher positive affect...”

Volume 26 | No 1 | 2016 19

and positive as well as negative affect. Individuals with

in the category “less than most people” had significantly

higher positive affect, while those in the category “similar

to than most people” had significantly lower negative affect

than those in the “more than most people” category.

there were no significant differences found in the

sensation seeking pattern.

Clinical and research evidence has pointed to individuals

with sensory hypersensitivity being hypervigilant,

aggressive and controlling.

negative affect is shown in this study, to be related to

patterns of sensory sensitivity and sensation avoiding,

along with specific negative affect characteristics such

as distress, upset, guilt, shame, fear, jitteriness, hostility,

irritability and nervousness.

the strongest correlations were seen in the sensory

sensitivity and avoidant patterns and “upset” and

“jitteriness”, emphasizing the impact of annoying

sensations, inability to remain calm, and the effect

on participation and enjoyment in life situations.

the researchers postulated that these negative affect

characteristics may result from coping mechanisms

(mental preparation and cognitive strategies including

avoidance, activity choice and environmental manipulation)

used by individuals with sensory sensitive or avoidant

patterns of processing in an attempt to cope with

the cognitive and emotional burden of dealing with

unpleasant situations.

their low thresholds may cause them to detect

and respond to more stimuli than typically

functioning individuals, and require more effort in

participation.

Interestingly, when looking at individuals with high

neurological thresholds, individuals with sensory

processing patterns of Low Registration showed the same

negative affect characteristics as those individuals with

sensory hypersensitivity.

this may be explained by a possible relationship between

low registration and persistence and effortful attention, but

requires further study to be fully understood.

Low registration individuals characteristically fail to

accurately detect incoming sensory stimuli, and are often

misunderstood and labelled by society as being lazy,

withdrawn, inattentive, unmotivated or self-absorbed.

these perceptions could contribute to their negative affect.

this relationship also requires further investigation, along

with its potential impact on performance in daily living.

“There were no significant

differences found in the sensation

seeking pattern.”

“...possible relationship between low registration and

persistence and effortful attention...”

20 Volume 26 | No 1 | 2016

Sensory Processing

Sensation seeking on the other hand was positively

correlated with positive affect, possibly due to the active

self-regulation employed by individuals with this sensory

processing pattern. Active self-regulation provides control

over circumstances, and results in enjoyment of activity

choices and positive affect. the role of self-regulation

strategies could also be evaluated in a further research

project.

KEY FINdINgS:

Sensory processing patterns might be related to the

person’s positive/negative affect.

this relationship also exists among healthy adults and has

an impact on their adaptive behaviour.

FUTURE RESEARcH NEEdEd INTO:

Relationship between low registration, persistence and

effortful attention and affect.

Relationship between low registration and negative affect.

Role of self-regulation strategies in affect.

Examine clinical populations, such as people with

psychological, emotional or behavioural difficulties

(phobias, post-traumatic stress disorder and autism).

Volume 26 | No 1 | 2016 21

BY

Kirsten Redhead B. SC. ot & Shan van der Byl B. SC. ot

THE VALUE OF USINg AcTIVITIES BASEd IN SENSORY INTEgRATION FOR cHILdREN WITH PHYSIcAL dISABILITIES IN A ScHOOL SETTINg

In A SCHooL SEttIng It IS VERY

CHALLEngIng to Do PuRE AYRES

SEnSoRY IntEgRAtIon tHERAPY ®.

HowEVER, wE ContInuALLY DRAw

on ASI® PRInCIPALS AnD uSE SEnSoRY

IntEgRAtIon EQuIPmEnt, wHICH wE

ComBInE wItH otHER fRAmES

of REfEREnCE DEPEnDIng on

tHE DIAgnoSIS of tHE CHILD.

“We have had fun experimenting with

different techniques and have observed changes

in the children”

22 Volume 26 | No 1 | 2016

we have found that when working with the

Cerebral Palsy (CP) population the efficiency

of our therapy has been greatly enhanced by

incorporating sensory integration techniques.

we have had fun experimenting with different

techniques and have observed changes

in the children that we wouldn’t have seen

without our ASI® background

in the following children:

Activity Ideas

Volume 26 | No 1 | 2016 23

CHILD A

CLInICAL PICtuRE

CP (moderate Spastic Quadriplegia),

low level of alertness at times.

funCtIonAL DIffICuLtIESDue to physical limitations his movements are restricted.

He is able to crawl (non-reciprocally) but is unable to

walk. He needs assistance to move around, but is

becoming more confident and independent in propelling

his wheelchair. He has poor spatial concepts and body

schema and struggles with certain fine motor tasks.

A tHERAPY goALfor spatial concepts to improve so that he is able to copy

simple forms and to complete a drawing of a person.

ACtIVItIES uSED In oCCuPAtIonAL tHERAPY SESSIonStactile massage and exposure to different tactile

fabrics on body parts to develop body awareness.

facilitated him through simple obstacle courses

involving crawling over, under, through etc.

to develop spatial concepts.

Platform swing:

this is one of the easiest swings to use with children

with physical disabilities as it is more stable than other

swings (particularly when hooked onto two suspension

points). Sitting astride over a block gives a similar

experience to a bolster swing, but because of the

stability that this swing offers, it is an ideal swing to

use to encourage using his hands as when throwing

an object at a target or “fishing”.

It was also a great swing for him to learn to use his own

body to propel the swing in different ways assisting with

the development of body schema.

Lying on his tummy on the swing and reaching for different

objects ‘in the water’ (on the floor) provided him with

a different movement experience and also encouraged

the development of eye-hand coordination.

(for a child who copes well with this activity,

the hammock is a great upgrade).

Bolster swing:

this swing provides a comfortable position for a

child with increased tone in their legs as the legs

are positioned on either side of the bolster.

when the child is encouraged to hold on, it encourages

supination in the fore-arms which is often restricted in

“...to learn to use his own body to propel

the swing in different ways...”

24 Volume 26 | No 1 | 2016

Activity Ideas

children with CP. In order to prevent him from poking his

chin forwards, visual stimuli were incorporated into the

games to encourage a better head and neck position.

He was also able to propel this swing independently and

enjoyed the freedom and movement on the swing.

Flexion swing:

while this swing may not encourage the best position

for a child with spastic quadriplegia, it does give a different

movement experience which is important for developing

body in space awareness as a foundation for the

development of spatial skills.

Spandex was wrapped around him on the swing to ensure

that he was secure, enabling him to enjoy the movement

in the swing. to combine input to the visual and vestibular

system, games were introduced where he needed to look

at different things in the room e.g. find an object with a

specific colour or shape. this swing is by far his favourite

and he still often asks for it.

when we needed to progress to work on visual perceptual

activities it worked well to use upbeat music. this

encouraged him to be more alert and focused and we

were able to progress through different table-top activities

more quickly.

Child A is now able to identify different body parts and

use spatial concepts. He can more appropriately add

parts to an incomplete picture of a person and was

better able to copy simple forms as his spatial skills

developed. Enjoying different sensory experiences in

therapy has given him a good foundation and we can

now work on developing his visual perception and

copying skills.

Volume 26 | No 1 | 2016 25

CHILD B

CLInICAL PICtuRECP (Hemiplegia), developmental delay,

challenging behaviour and tactile defensiveness.

funCtIonAL DIffICuLtIESRefused to stand and unable to walk despite good physical

potential. He was referred to occupational therapy by his

physiotherapist because she was unable to work with him

towards achieving ambulation.

He could not tolerate wearing a splint, would not take

weight through his hemiplegic leg and had difficult-to-

manage behaviour (such as biting, pulling hair, hitting and

screaming) when “hands on” facilitation or hand-over-hand

assistance was attempted.

A tHERAPY goAL to be able to tolerate hands-on facilitation and to be able

to weight-bear so that he can learn to walk.

ACtIVItIES uSED In tHERAPY SESSIonSInitially he was co-treated by physio- and occupational

therapy and in addition was seen 1:1 by each discipline

for a second weekly session.

He was exposed to various tactile stimuli such as shaving

foam on a tray/therapy block/mirror, water with squeeze

toys/sponges, rapper snappers (concertina type plastic

tubes which makes a noise and provide resistance when

pulled and squeezed), bean bags with different textures to

feel and weighted balls to move.

He was positioned in sitting over a block and trunk rotation

as well as reach of the hemi arm together with tactile

exploration was encouraged.

this initial exposure to various tactile stimuli proved difficult

as he still protected his hemi arm in a mass flexed posture

and strongly avoided any touch or movement of the arm.

He also tended to bite or throw any objects he was given.

He continued to avoid weight bearing on his hemi leg.

After a few sessions it was decided (in desperation!) to

try sit him on a rubber inflated animal instead of the static

block.

we found that he absolutely loved to bounce.

It resulted in him laughing and smiling and then becoming

“When his behaviour in the classroom became

unmanageable, the class assistant would

take him on the playground swing.”

26 Volume 26 | No 1 | 2016

calm and relaxed and increased his tolerance for tactile

input. over the next few sessions, it became obvious that

he was extremely vestibular seeking and this was the key

that opened the door to success in therapy.

He was supplied with regular vestibular input combined

with “whole body” tactile and/or proprioceptive input in the

hammock swing, the frog swing, the fixed flexion swing and

in spandex. when his behaviour in the classroom became

unmanageable, the class assistant would take him on the

playground swing.

Besides him thoroughly enjoying vestibular input and a

noticeable change in his behaviour afterwards, he was

happy to allow his arm to be almost straightened, placed

or used as long as he was provided with vestibular input at

the same time. His hemi arm was used to “hold” around

the pole of the flexion swing.

He also stretched out his arms towards the therapist while

in the hammock to allow the therapist to catch his hands

and swing him.

In the frog swing he was happy to leave his Afo (ankle-

foot orthosis) in place on his foot and started to put this

foot onto the ground and experience the sensation of

pressure through his leg. He began to tolerate standing

and weight bearing through his hemi leg when “jumping”/

bouncing on the big outside trampoline with the therapist

holding him in supported standing.

the wilbarger deep pressure brushing protocol was

introduced and used for a short period.

He was provided with a bead necklace that he could

chew on for oral input, as not everything else that went

into his mouth was safe or appropriate. It was then

possible to reintroduce the previously used sensory and

developmental play activities with greater success.

much of his challenging behaviour decreased or even

disappeared.

Child B has recently become more willing to use

both hands in messy play activities and as a result is

participating better during the class developmental

play groups. He began to work more cooperatively in

his physiotherapy sessions and has learned to walk

independently, which has been very exciting for him!!

Activity Ideas

Volume 26 | No 1 | 2016 27

CHILD C

CLInICAL PICtuRE

CP (Dystonia)

funCtIonAL DIffICuLtIESDependent in all areas, restricted to a buggy, speaks

in short sentences, highly frustrated resulting in difficult

behaviour at home and in the classroom.

He has recently started to attend regular individual

therapy sessions.

A tHERAPY goALto provide and engage him in fun sensory rich play

activities (it is so important for him to enjoy the learning

experiences that he has missed out on due to his severe

physical disability) to develop a solid “foundation” on

which to build his basic concepts, visual perceptual

skills and future academic abilities.

ACtIVItIES uSED In oCCuPAtIonAL tHERAPY SESSIonSExposure to various movement experiences through

putting him on a variety of swings in the therapy room

(see previous comments on swings). He particularly

loved being bounced and swung wildly from side to side

in spandex where he felt secure while getting intense

vestibular input.

He usually ended up shouting “faster” and “more”. He

also repeatedly requested the frog swing where he gets to

move himself in space and experiment with the cause and

effects resulting from his own body movements.

this is an experience that was new to him and has been

assisting with enhancing body awareness. He has also

been practicing to achieve a grasp with both hands on the

bar of the platform swing while sitting on a bolster as well

as maintaining his grasp and balance while the swing is

moving.

while having fun, language and basic concepts of colour,

number (counting), position (up/down/left/right and

across) and shape were stimulated.

“... requested the frog swing where he gets to move himself in space and experiment with the cause and effects resulting from his own

body movements...”

28 Volume 26 | No 1 | 2016

Activity Ideas

musical instruments to develop “cause and effect” as well

as hand function and eye-hand co-ordination were used

with music. (A computer switch has also been introduced

to him for further development of cause and effect and a

tool to interact with computer activities.)

touch activities such as “feely” books and “tactile boxes”

were used to encourage upper limb awareness and

function, eye-hand co-ordination and interaction with

objects. Because it has been so difficult for him to bring

his hands to the midline and to grasp, hold and release

objects, he has been getting very little opportunity to

explore and physically interact with 3D objects/toys in

space. He usually has been left to look at things and

watch others play with them. In occupational therapy

sessions this interaction with toys has been facilitated and

supported.

when he does not want to leave therapy he stiffens his

body into extension so that he cannot be easily placed into

his buggy. this situation then gets used as an opportunity

to hang him and swing him upside-down by his feet (only if

he has not eaten recently). generally CP children do not

get to experience being upside-down like a non-disabled

child who usually manage to frequently put themselves into

this position. then the game is over and it is time to leave

with a reassurance of when the next session will be.

Child C has only started with therapy recently. He

is more verbal in occupational therapy than in the

classroom and will request certain activities. He

has been motivated to participate fully in the various

activities and loves coming to therapy sessions. He is

always reluctant to leave because he is having such

fun...

Volume 26 | No 1 | 2016 29

THE cLINIcIAN’S gUIdE FOR IMPLEMENTINg AYERS SENSORY INTEgRATION® - PROMOTINg PARTIcIPATION FOR cHILdREN WITH AUTISMBY

Anneke Krüger

Roseann C. Schaaf, PhD, OTR/L, FAOTA, and Zoe Mailloux, OTD, OTR/L, FAOTA

Launched at the 2015 ESIC by the authors, this guidebook

is the collaborative product, born from the implementation

of a trial research study based in the field of Autism and

Ayers Sensory Integration®.

However, it not only gives a precise and replicable

system for research purposes, it also provides a

practical, measurable and outcomes based framework for

implementing ASI® effectively in the everyday practice of

clinicians. this guidebook comprises of 2 main sections,

of which the first gives a concise overview of the theory

of Ayers Sensory Integration®, Autism and Sensory

Integration, the Adaptive Response and similarities and

differences in other approaches used in treatment of

children with Autism. Common patterns of SI dysfunctions

are also reviewed according to the identifying measures,

functional problems and behavioural manifestations.

this is followed by an introduction to and an overview of

DDDm – Data Driven Decision making – the systematic

approach using data as the basis for clinical reasoning,

used throughout the guidebook. An in-depth chapter

unpacks each step of DDDm with relevant forms,

interpretation tools, therapeutic planning guidelines etc.

this creates a comprehensive tool enabling the therapist

to use the data gained in assessment and treatment

effectively, but also to optimise the therapeutic process

as a whole. this process creates a replicable plan

(“manualisation”) within the realm of ASI®, strengthening

our evidence based practice within ASI®

and wider paediatric occupational therapy.

occupational therapist

B. occupational therapy (uP 2005)

30 Volume 26 | No 1 | 2016

Book Review

tHE StEPS AnD CHAPtERS InCLuDE:

1. Identifying the child’s strengths and participation

challenges, which includes gaining all the background

information and ascertaining challenges that will form

the focus of intervention.

2. Conducting the comprehensive assessment.

Various assessment tools and respective

interpretation is discussed.

3. generating a hypothesis. Here the presenting

picture and occupational performance difficulties

are linked in a process of clinical reasoning

to establish how intervention will have an effect

on outcomes.

4. Developing and scaling goals. Specific areas

of participation is targeted through goal setting

and appropriate scaling of goals.

5. Identifying outcome measures.

this involves establishing the desired effect

of intervention and the concepts of proximal

(sensory motor factors) and distal (participation

challenges aligning with set goals) outcomes.

6. Setting the stage for intervention.

this provides preparation guidelines on aspects such

as training and experience of the therapist, equipment

and space. It also discusses collaboration with the

main stakeholders through training and adaptations of

environment, routine etc. furthermore the dosage as

well as assessing adherence to intervention plan and

fidelity (ASI® fidelity) is discussed.

7. Conducting the Intervention. Clear guidelines on the

intervention process, context and addressing specific

sensory motor problems with examples are given

8. measuring the outcomes.

the guidebook further includes appendices on the use

of the Ayers Sensory Integration® fidelity measure and

case studies providing valuable application examples.

It is an easy read that can provide generalised and also

very specific guidance with a variety of applications,

whether conducting research, or an experienced clinician

or a therapist still assimilating your knowledge and skill

base. It supports the development of your assessment,

interpretation, clinical reasoning skills as well as guide

knowledge and effective intervention approaches. this is

a valuable resource all round as it comprises of concise

recapturing of the theoretical base and interpretation in

ASI®, logical and clear processes and has user-friendly

documentation included for reproduction. A powerful tool

in cementing ASI® in evidence-based practice.

“Specific areas of participation is

targeted through goal setting and appropriate

scaling of goals.”

Volume 26 | No 1 | 2016 31

MULTIPLE CHOICE

cPd PROgRAMME QUESTIONNAIRE

HOW dO I ANSWER QUESTIONS FROM cLIENTS USINg INFORMATION FROM RESEARcH janine van der Linde

1. One of the major methodological flaws of Sensory Integration Research is: a. Sample size to small b. Difficulty with replicating the study c. Limited resources d. All of the above e. A and B

2. One study by davies and gavin found that: a. the use of diffusion tensor imaging indicated unique neural processing mechanisms in terms of children with SPD. b. the use of EEg technology indicated unique neural processing mechanisms in terms of children with SPD. c. the use of functional magnetic resonance imaging, or fmRI indicated unique neural processing mechanisms in terms of children with SPD.

3. The Sensory Integration and Praxis Test (SIPT) is: a. both valid and reliable in South Africa and abroad b. both valid and reliable c. has not yet been found valid or reliable

4. The results of an experimental study by Schaaf et al. revealed: a. the children who received 30 sessions of the occupational therapy intervention scored significantly higher (p = 0.003, d = 1.2) on goal Attainment Scales (primary outcome), and also scored significantly better on measures of caregiver assistance in self-care (p = 0.008 d = 0.9) only compared to the usual Care control group b. the children who received 30 sessions of the occupational therapy intervention scored significantly higher (p = 0.003, d = 1.2) on goal Attainment Scales (primary outcome), and also scored significantly better on measures of caregiver assistance in self-care (p = 0.008 d = 0.9) and socialization (p = 0.04, d = 0.7) compared to the usual Care control group c. neither a or b

5. The Process elements of the Fidelity Measurement: a. measures therapist qualification, components of the occupational therapy report, physical environment and communication with parents b. Presents sensory opportunities, elicit adaptive responses, support self-organization behavior, collaborate in activity choices, us a play context, help the child to maintain optimal arousal, ensure success and the child’s safety c. measures only the physical environment and communication with parents d. Elicit adaptive responses, support self-organization behavior and ensure success and the child’s safety

If You HAVE not uSED CPD SoLutIonS BEfoRE, PLEASE uSE tHE LInk on tHE HomEPAgE of tHIS wEBSItE to ACCESS tHE CPD SoLutIonS wEBSItE. AnSwER muLtIPLE CHoICE QuEStIonS AnD EARn CPD PoIntS.

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6. distal outcomes can be defined as: a. outcomes that take into account the factors that may influence participation and set out to determine goals for improving occupational performance b. outcomes focused on the client factors and participation skills that could affect the occupational performance c. outcomes that take into account the factors that may influence participation

7. Necessary knowledge in order to answer questions about the reliability and validity of Ayres Sensory Integration Therapy include: a. Awareness of the latest research b. Provision of evidence based treatment c. A and B d. none of the above

8. The difference between sensory integration and sensory processing can be described as follows: a. Sensory integration refers to the practical implementation of intervention. b. Sensory processing refers to the theoretical concepts underlying sensory integration. c. Sensory integration is used to describe the theory and principles used within this frame of reference. d. All of the above.

9. Why was it decided to trademark the term “Ayres Sensory Integration®”? a. for marketing purposes of sensory integration. b. It serves to acknowledge implementation of sensory integration based on the theory and principles as described by Ayres and as to avoid confusion amongst various terminologies. c. to ensure reliable and consistent service provision across service providers. d. All of the above.

10. Miller (Miller et al. 2007) has proposed differences in sensory integration with regards to: a. Sensory integration terminology b. Classification of sensory integration dysfunctions c. A and B

11. Sensory integration difficulties can be classified as: a. Hard neurological damage b. no neurobiological involvement c. Some neurobiological involvement d. none of the above

12. Schaaf et al.’s research results using Electrocardiogram data, indicated the following: a. Children with SmD had a different cardiac vagal tone from typical children and an increased parasympathetic reaction to sensory input compared with typical children. b. Children with SmD had a different cardiac vagal tone from typical children and a decreased parasympathetic reaction to sensory input compared with typical children. c. Children with SmD had a different cardiac vagal tone from typical children and a fluctuating parasympathetic reaction to sensory input compared with typical children. d. none of the above.

13. Research results found that EEg technology: a. Shows no difference between neural processing mechanisms in terms of children with SPD. b. were not successful in deriving any data on studies of children with SPD. c. Have shown to successfully identify unique neural processing mechanisms in terms of children with SPD. d. none of the above.

14. Research by chang et al. (2015) and Owen et al. (2013), who used diffusion tensor imaging, found that: a. Children with sensory processing difficulties display different white matter microstructure than typical developing children. b. Children with sensory integration difficulties show abnormal electrodermal responses and habituate slower to sensory input. c. white matter microstructure between typical developing children and children with SPD shows no differences. d. none of the above.

15. The following scientific findings may distinguish SPd from overlapping clinical conditions such as autism and attention deficit hyperactivity disorder: a. the suggestion of abnormal white matter as a biological basis for SPD b. Reduced white matter microstructural integrity in children with SPD c. Disrupted white matter microstructure that predominantly involves posterior cerebral tracts d. All of the above.

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16. The sensory integration frame of reference is used as : a. Diagnostic tool for sensory integration difficulties. b. guidelines for the assessment of a child to determine if they have sensory integration difficulties. c. Serves as a service-provider model for sensory integration intervention. d. All of the above.

17. The following assessments were found to be reliable and valid standardized assessments for sensory integration dysfunction: a. SIPt b. Sensory Profile c. Sensory Processing measure d. All of the above.

18. A study conducted by Van Jaarsveld, Mailloux and Herzberg (2012) on South African children found the SIPT to be valid and reliable for children from South Africa as well, although: a. the children tested worse on some of the subtests. b. the children tested better on all of the subtests. c. the children tested worse on some and better on some subtests. d. the children tested better on some of the subtests.

19. Schaaf and colleagues developed the data-driven decision Making (dddM) process to address the following: a. the greater need for outcome measurement. b. Systematically support decision making. c. target intervention more precisely. d. measure and document outcomes. e. All of the above.

20. The importance of using outcome measures include: a. It guides more purposeful intervention b. Aids in providing more evidence based practice c. none of the above. d. A and B

SENSORY PROcESSINg IN AdULT POPULATIONS: A SUMMARY OF TWO REcENT RESEARcH PROJEcTS. gina Rencken

1. The study: Sensory processing and impulsivity in heathy adults presented the following hypothesis: a. Impulsivity would be positively correlated with high threshold sensory processing patterns. b. Cognitive measures of impulsivity would be associated with sensory processing styles characterized by sensory hypersensitivity. c. neither d. Both

2. Both studies discussed included the following amount of participants: a. 100-200 b. 200-300 c. neither d. Both

3. The Adolescent/Adult sensory profile is: a. A questionnaire completed by spouse or significant other measuring sensory processing in four quadrants. b. A questionnaire completed by the person him/ herself, in conjunction with their spouse/or significant other measuring sensory processing in four quadrants. c. neither d. Both

4. The Barratt impulsiveness scale measures: a. Behavioural characteristics of impulsivity b. Personality characteristics of impulsivity c. neither d. Both

5. Low registration sensory processing style from the AASP positively correlated with the following BIS-II domains: a. Attentional impulsivity and motor impulsivity b. Attentional impulsivity, motor impulsivity and non-planning impulsivity c. neither d. Both

6. Sensory sensitivity sensory processing style from the AASP positively correlated with the following BIS-II domains: a. Attentional impulsivity and motor impulsivity b. Attentional impulsivity, motor impulsivity and non-planning impulsivity c. neither d. Both

7. Sensory seeking sensory processing style from the AASP positively correlated with the following BIS-II domains: a. Attentional impulsivity and motor impulsivity b. Attentional impulsivity, motor impulsivity and non-planning impulsivity c. neither d. Both

8. Which of the following statements are true? a. In individuals with a low registration sensory processing styles impulsive behaviours often occur prior to registration of sensory input and corresponding behavioural output. b. In individuals with a low registration sensory

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processing styles impulsive behaviours often occur in the time between registration of sensory input and corresponding behavioural output. c. neither d. Both

9. The following statement/s is true for individuals with a low registration sensory processing profile with impulsive behaviours: a. they need more time to accurately register sensory information. b. they spend more time on planning for goal directed tasks. c. neither d. Both

10. Emotional regulation requires the following: a. An awareness of internal body sensations. b. Cognitive processing c. neither d. Both

11. Individuals with sensory processing styles involving active regulation include: a. Sensory seeking and sensory avoiding groups b. Sensory seeking and sensory sensitive groups c. neither d. Both

12. Individuals with sensory processing styles involving active regulation displayed: a. A positive correlation with impulsivity as they are “on the go” all the time. b. no correlation with impulsivity. c. neither d. Both

13. In the article Exploring the relationship between affect and sensory processing patterns in adults the following were part of the hypothesis: a. negative affect will positively correlate with sensory processing patterns associated with low neurological thresholds. b. Positive affect will positively correlate with sensation seeking patterns. c. neither d. Both

14. Individuals with a low neurological threshold displayed the following patterns with regards to positive and negative affect on the PANAS: a. Individuals who were less sensory sensitive (scoring in the less than most category) had a more positive affect. b. Individuals who were less sensory avoiding (scoring

in the less than most category) had a more positive affect. c. neither d. Both

15. clinical and research evidence has pointed to individuals with sensory hypersensitivity being: a. Hypervigilant b. Aggressive and controlling c. neither d. Both

16. Negative affect is shown in this study related to patterns of sensory sensitivity and sensation avoiding and strongest correlations with specific negative affect characteristics such as: a. upset b. jitteriness c. neither d. Both

17. These negative affect characteristics described for individuals with sensory sensitive and sensory avoiding patterns could most likely be due to: a. Coping mechanisms used by these individuals in an attempt to cope with the cognitive and emotional burden of dealing with unpleasant situations. b. the avoidance of sensory stimuli requiring more effort in participation. c. neither d. Both

18. Individuals with a low registration sensory pattern also correlated with a negative affect. The researches postulated that this could be due to: a. Labelling of these individuals by society as being lazy. b. Labelling of these individuals by society as being self-absorbed. c. neither d. Both

19. Sensation seeking individuals positively correlated with a positive affect most likely due to: a. their short registration of sensory input. b. their impulsive nature. c. neither d. Both

20. Sensory processing patterns might be related to the person’s negative/positive affect. a. this relationship is true for individuals in the healthy adult population. b. this relationship is true for individuals in the clinical adult population. c. neither d. Both

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Mission• ToensurerelevanttraininginASIforoccupationaltherapists

• Toensurecontinuedprofessionaldevelopmentwithin the field of ASI

• Toalignourtraining,assessmentandtreatmentprotocols with international standards

• ToplayaleadingroleintheapplicationofASIinSouthAfrica

• ToensurebestevidencebasedpracticeinASI

• ToraiseawarenessofASIamongstrelevantstakeholders

• Tonetworkwithkeystakeholders

• Tosupportandeducateallroleplayersinvolved in the care and development of the client

• ToencourageresearchinthefieldofASIinSAandabroad

• ToensureequalaccessibilitytoASIassessmentandtreatment for all South Africans

• Toenhanceandenableallindividualschallengedwith sensory integration difficulties or dysfunctions to live occupationally fulfilled lives

VisionTo provide an internationally accepted standard of training

and education in Ayres Sensory Integration (ASI)

in order to deliver a service of excellence to the ultimate benefit of all clients

within the South African context.