Sensory integration therapy

Sensory integration therapy or sensory integrative therapy attempts to treat Sensory Integration Dysfunction. Some of these treatments (for example, sensorimotor handling) have a questionable rationale and no empirical evidence. Other treatments have been studied, with small positive outcomes, but few conclusions can be drawn due to methodological problems with the studies. These treatments include prism lenses, physical exercise, auditory integration training, and sensory stimulation or inhibition techniques such as "deep pressure"—firm touch pressure applied either manually or via an apparatus such as a hug machine or a pressure garment. Weighted vests, a popular deep-pressure therapy, have only a limited amount of scientific research available, which on balance indicates that the therapy is ineffective. Although replicable treatments have been described and valid outcome measures are known, gaps exist in knowledge related to sensory integration dysfunction and therapy. Because empirical support is limited, systematic evaluation is needed if these interventions are used.

Hypothesis
Children with sensory integration dysfunction frequently experience problems with their sense of touch, smell, hearing, taste and/or sight. Along with this will often be difficulties in movement, coordination and sensing where one's body is in a given space. This is a common disorder for individuals with neurological conditions such as an autism spectrum disorder.

Individuals may be overly sensitive to certain textures, sounds, smells and tastes, while wearing certain fabrics, tasting certain foods, or normal everyday sounds may cause discomfort. The opposite is also possible - for example a child with an autism spectrum disorder may feel very little pain or actually enjoy sensations that neurotypical children would dislike: strong smells, intense cold or unpleasant tastes.

The brain seems unable to balance the senses appropriately in cases of Sensory Integration Dysfunction. The brain may not be able to filter out background stimuli yet admit what is important, so the individual may have to deal with overwhelming amounts of sensory input day and night.

Sensory integration therapy with children
This involves occupational therapy with the child placed in a room specifically designed to stimulate and challenge all of the senses. During the session, the therapist works closely with the child to encourage movement within the room. The therapy is driven by four main principles:

• Just Right Challenge (the child must be able to meet the challenges through playful activities)

• Adaptive Response (the child adapts behavior to meet the challenges presented)

• Active Engagement (the child will want to participate because the activities are fun)

• Child-directed (the child's preferred activities are used in the session).

Sensory Integration therapy is careful to not provide children with more sensory stimulation than they can cope with. The occupational therapist looks for signs of distress. Children with lower sensitivity (hyposensitivity) may be exposed to strong sensations, while children with heightened sensitivity (hypersensitivity) may be exposed to quieter activities. Treats and rewards may be used to encourage children to tolerate activities they would normally avoid. For more information on Sensory Integration Dysfunction, see the Sensory Problems fact sheet.

Guidelines for children with heightened sensitivity
Parents can find it very distressing if their child rejects hugs, cuddles and other demonstrations of affection. This can be interpreted as a personal rejection when it is a discomfort with unpleasant touch. These guidelines may help in more appropriate touch with autistic children who have hypersensitivity:

• The child finds it easier to initiate hugging than receive it

• Touch is more tolerable when the child anticipates it

• Firm, unmoving touch is better than light or moving touch

• Light touch may be tolerable after firm unmoving touch

• Initial stimulation may be unpleasant but tolerated later.

Typical therapies for different senses
The sense of touch varies widely between children experiencing sensory integration dysfunction. When children enjoy the feel of sticky textures, the therapist may use materials such as glue, play dough, stickers, rubber toys and sticky tape. Other materials that can be useful for tactile sensation include water, rice, beans and sand.

Children on the autism spectrum often enjoy a sense of firm overall pressure. This can be given by wrapping them up in blankets, being squashed by pillows and firm hugs. These can form a basis for play, interaction and showing affection. Experiences that may be claustrophobic for neurotypical children may be enjoyed, such as being squashed between mattresses, and making tunnels or tents from blankets over furniture.

A therapist will be aware of a child's response to the smell of substances, and may experiment with putting different fragrances in play dough or rice. If a child actively likes strong odors, specific toys with this feature can be used in therapy. Sound can be focused on by experimenting with talking toys, games on computers, musical instruments, squeaky toys and all sorts of music. Clapping together, rhymes, repeating phrases and tongue twisters are useful activities. Some children on the autism spectrum respond to music but not voices, in which case a melodic or “sing-song” voice may be preferred. The therapist may try different tones of voice, pitches, and gauge a child's reaction.

Proprioceptive system
The Proprioceptive System helps children (and adults) to locate their bodies in space. Autistic children often have poor proprioception and will need help to develop their coordination. Therapy may include playing with weights, bouncing on a trampoline or a large ball, skipping or pushing heavy objects.

Vestibular system
The Vestibular system is located in the inner ear. It responds to movement and gravity and is therefore involved with our sense of balance, coordination and eye movements. Therapy can include hanging upside down, rocking chairs, swings, spinning, rolling, somersaulting, cartwheels and dancing. All these activities involve the head moving in different ways that stimulate the vestibular system. The therapist will observe the child carefully to be sure the movement is not over stimulating.

Back and forth movement is typically less stimulating than side-to-side movement. The most stimulating movement tends to be rotational (spinning) and should be used carefully by the therapist. Ideally therapy will provide a variety of these movements. A rocking motion will usually calm a child while vigorous motions like spinning will stimulate them. Merry-go-rounds, being tossed on to cushions or jumping trampolines can be favorite activities with some children.

Learning new skills involving movement
Skills such as tying shoe laces or riding a bike can be difficult as they involve sequences of movements. Therapy to help in this area may use swimming, mazes, obstacle courses, constructional toys and building blocks. Difficulty with using both sides of the body together can occur in some cases of sensory integration dysfunction. A therapist may encourage a child with crawling, hopscotch, skipping, playing musical instruments, playing catch and bouncing balls with both hands to help with bilateral integration.

Hand and eye coordination can be improved with activities such as hitting a ball with a bat, popping bubbles, and throwing and catching balls, beanbags and balloons.

Research on Sensory Integration Therapy

Although Sensory Integration Therapy is widely used and supported by anecdotal evidence, there is as yet little research that would establish it as an evidence-based treatment. One study found only poor quality evidence providing either no, or at best equivocal, support for Sensory Integration therapy (Dawson and Watling 2000). There have been many studies done but these have not been conducted rigorously enough for Sensory Integration Therapy to be considered an evidence-based treatment, despite it being widely used as an intervention for Autism and other developmental disorders.