Sensory Integration OCT 1172Y April 12, 2005 Cooper, Fernandes, McTaggart, & Vogiatzis OCT 1172Y...

Sensory IntegrationSensory Integration

OCT 1172Y April 12, 2005Cooper, Fernandes, McTaggart,

& Vogiatzis

OCT 1172Y April 12, 2005Cooper, Fernandes, McTaggart,

& Vogiatzis

OutlineOutline

Theory and OriginsAssessmentTreatmentResearch EvidenceSummary

Theory and OriginsAssessmentTreatmentResearch EvidenceSummary

What is Sensory Integration?

What is Sensory Integration?

“organization of sensations for use” (in Parham & Maillot, 2001)

Can be used to describe:- a theory- a diagnosis- a functional pattern- a remediation approach

“organization of sensations for use” (in Parham & Maillot, 2001)

Can be used to describe:- a theory- a diagnosis- a functional pattern- a remediation approach

SI DefinitionsSI DefinitionsSENSORY INTERGRATION: Neuronal process occurring at

cellular level, which organizes sensory input for use. The "use" may be a perception of the body or the world, or an adaptive response, or a learning process, or the development of some neural function. Through sensory integration, the many parts of the nervous system work together so that a person can interact with the environment effectively and experience appropriate satisfaction.

SENSORY INTEGRATIVE DYSFUNCTION: An irregularity or disorder in brain function that makes it difficult to integrate sensory input effectively. Sensory integrative dysfunction may be present in motor, learning, social/emotional, speech/language or attention disorders.

- Alabama Occupational Therapy Association, 2000

SENSORY INTERGRATION: Neuronal process occurring at cellular level, which organizes sensory input for use. The "use" may be a perception of the body or the world, or an adaptive response, or a learning process, or the development of some neural function. Through sensory integration, the many parts of the nervous system work together so that a person can interact with the environment effectively and experience appropriate satisfaction.

SENSORY INTEGRATIVE DYSFUNCTION: An irregularity or disorder in brain function that makes it difficult to integrate sensory input effectively. Sensory integrative dysfunction may be present in motor, learning, social/emotional, speech/language or attention disorders.

- Alabama Occupational Therapy Association, 2000

Anna Jean Ayres 1920-1988

The Mother of Sensory Integration

Anna Jean Ayres 1920-1988

The Mother of Sensory Integration first identified sensory integrative dysfunction

struggled with learning problems similar to those she would later study

made discovery that such children had neural disorder resulting in inefficient organization of sensory input received by nervous system

developed diagnostic tools for identifying the disorder and proposed therapeutic approach

Research has had profound influence in field of occupational therapy

first identified sensory integrative dysfunction

struggled with learning problems similar to those she would later study

made discovery that such children had neural disorder resulting in inefficient organization of sensory input received by nervous system

developed diagnostic tools for identifying the disorder and proposed therapeutic approach

Research has had profound influence in field of occupational therapy

More DefinitionsMore DefinitionsProximal Senses: PROPRIOCEPTION: Perception of sensation from the

muscles and joints. Proprioceptive input tells the brain when and how muscles are contracting or stretching, and when and how the joints are bending, extending or being pulled or compressed. This information enables the brain to know where each part of the body is and how it is moving.

TACTILE: Pertaining to sense of touch on the skin. VESTIBULAR SYSTEM: The sensory system that responds

to the position of the head in relation to gravity and accelerated or decelerated movement; it integrates neck, eye, and body adjustments to movement.

Distal Senses: Hearing and Vision- Alabama Occupational Therapy Association, 2000

Proximal Senses: PROPRIOCEPTION: Perception of sensation from the

muscles and joints. Proprioceptive input tells the brain when and how muscles are contracting or stretching, and when and how the joints are bending, extending or being pulled or compressed. This information enables the brain to know where each part of the body is and how it is moving.

TACTILE: Pertaining to sense of touch on the skin. VESTIBULAR SYSTEM: The sensory system that responds

to the position of the head in relation to gravity and accelerated or decelerated movement; it integrates neck, eye, and body adjustments to movement.

Distal Senses: Hearing and Vision- Alabama Occupational Therapy Association, 2000

SensoryAvoiding

SensorySeeking

Sensory Registration andModulating Dysfunction

Sensory DiscriminationDysfunction

Functional Effects ofSensory Dysfuntion

Sensory IntegrativeDysfunctions

SensoryAvoiding

SensorySeeking

Sensory Registration andModulating Dysfunction

Sensory DiscriminationDysfunction

Functional Effects ofSensory Dysfuntion

Sensory IntegrativeDysfunctions

DSI TaxonomyDSI Taxonomy

Sensory Integrative Dysfunction SubtypesSensory Integrative

Dysfunction Subtypes Severity of symptoms highly individual and variable Sensory Registration and Modulating Dysfunction

information not registered correctly Sensory-Avoiding Sensory-Seeking

Sensory Discrimination Dysfunction decreased ability to distinguish different types of

touch, movement and/or body position Functional Effects of Sensory Dysfunction

delays in speech, language, or motor skills

Severity of symptoms highly individual and variable Sensory Registration and Modulating Dysfunction

information not registered correctly Sensory-Avoiding Sensory-Seeking

Sensory Discrimination Dysfunction decreased ability to distinguish different types of

touch, movement and/or body position Functional Effects of Sensory Dysfunction

delays in speech, language, or motor skills

Ayres’ Neurobiological Concepts

Ayres’ Neurobiological Concepts

SI necessary for optimal brain function “nourishment for the brain”

Sensory Diet – actively organize and use sensory input to act on environment

If adequate stimulation not available at critical periods,

brain abnormalities and behaviour disorders result (hallucinations, distortions)

Adaptive Response - efficiently organized incoming stimuli leading to goal-directed action on environment

Cyclical pattern: SI AR = SI being more effective

SI necessary for optimal brain function “nourishment for the brain”

Sensory Diet – actively organize and use sensory input to act on environment

If adequate stimulation not available at critical periods,

brain abnormalities and behaviour disorders result (hallucinations, distortions)

Adaptive Response - efficiently organized incoming stimuli leading to goal-directed action on environment

Cyclical pattern: SI AR = SI being more effective

… More Neurobiological Concepts


CNS and Hierarchy Model: Ascending control and specialization: spinal cord –

brain stem – cerebral hemispheres Descending Inhibition: Cortex commands lower

centers to ignore certain stimuli deemed unimportant

Refinement of primitive function provide sensorimotor foundation for higher order function

Cognitive and social skills scaffolded Brain does not operate exclusively as hierarchy but

as holistic characteristics

CNS and Hierarchy Model: Ascending control and specialization: spinal cord –

brain stem – cerebral hemispheres Descending Inhibition: Cortex commands lower

centers to ignore certain stimuli deemed unimportant

Refinement of primitive function provide sensorimotor foundation for higher order function

Cognitive and social skills scaffolded Brain does not operate exclusively as hierarchy but

as holistic characteristics



Neural Plasticity Exploration leads to significant increases in

dentritic branching, synaptic connection, synaptic efficiency

Change occurs at neuronal synaptic level when AR made

Bottom-Up Approach: AR activate neuroplastc capabilities and increase efficiency of SI at neuronal level

Neural Plasticity Exploration leads to significant increases in

dentritic branching, synaptic connection, synaptic efficiency

Change occurs at neuronal synaptic level when AR made

Bottom-Up Approach: AR activate neuroplastc capabilities and increase efficiency of SI at neuronal level

AssessmentAssessment

SI: AssessmentSI: Assessment

Measures performance components. Individual Tests (1962-68). Southern California Sensory Integration Tests

(SCSIT; 1972, 80). The Southern California Postrotary Nystagmus

Test (SCPNT; 1975).Tests had reliability & validity problems.

The Sensory Integration and Praxis Tests (SIPT; 1985).

Measures performance components. Individual Tests (1962-68). Southern California Sensory Integration Tests

(SCSIT; 1972, 80). The Southern California Postrotary Nystagmus

Test (SCPNT; 1975).Tests had reliability & validity problems.

The Sensory Integration and Praxis Tests (SIPT; 1985).

SIPT DescriptionSIPT Description

17 subtests + observation in 4 areas:Sensory processing

tactile & vestibular-proprioceptive

Visual-spatial perceptionVisuomotor coordinationPraxis (motor planning)

Standardization: manual, training.

17 subtests + observation in 4 areas:Sensory processing

tactile & vestibular-proprioceptive

Visual-spatial perceptionVisuomotor coordinationPraxis (motor planning)

Standardization: manual, training.

Tactile Processing TestsTactile Processing Tests

GraphesthesiaFinger identificationLocalization of

tactile stimulation

GraphesthesiaFinger identificationLocalization of

tactile stimulation

Vestibular-Proprioceptive Processing Tests

Vestibular-Proprioceptive Processing Tests

Standing & walking balance

KinesthesiaPostrotary

nystagmus

Standing & walking balance

KinesthesiaPostrotary

nystagmus

Form & Space Perception Tests

Form & Space Perception TestsPosition in spaceSpace visualizationManual form

perceptionFigure-ground

perception

Position in spaceSpace visualizationManual form

perceptionFigure-ground

perception

Visuomotor Coordination Tests

Visuomotor Coordination Tests

Motor accuracy test

Motor accuracy test

Praxis TestsPraxis Tests

Design copyingPostural praxisSequencing praxis

Design copyingPostural praxisSequencing praxis

Normative Data

Normative Data

2000 children4-8 years oldM, F separatelyUS & Canada

pop.

2000 children4-8 years oldM, F separatelyUS & Canada

pop.

SIPT PsychometricsSIPT PsychometricsArea Reliability Validity

Sensory processing

inter-rater >.95test-retest .42–.70

Content: expert opinionConstruct: Rasch analysis for Praxis subscale.Discriminant: factor analysis distinguishes children w dysfunction

Praxis inter-rater >.94test-retest .70–.93

SIPT: SummarySIPT: Summary

Clinical utility: 2-3 hrs $300-$1000 Mail-in scoring

Reliability Poor/Moderate for sensory processing subscales. Good for praxis subscale.

Validity — good.

Clinical utility: 2-3 hrs $300-$1000 Mail-in scoring

Reliability Poor/Moderate for sensory processing subscales. Good for praxis subscale.

Validity — good.

TreatmentTreatment

Treatment GoalsTreatment Goals

Primary Goal: Improve the way the brain processes, organizes sensation to be used for perception, adaptation, and learning (NOT teaching specific skills such as handwriting)

Secondary Goals and Expected Outcomes of SI Intervention: Regulation of arousal states and attention Development of body scheme; Postural-motor and bilateral integration of function; Praxis for organizing behavior; Fine and Gross motor skills (handwriting); Visual-auditory aspects of learning ; Receptive and expressive language; Psychosocial functions (ex: self-concept, self-efficacy); Independence in ADLs

Primary Goal: Improve the way the brain processes, organizes sensation to be used for perception, adaptation, and learning (NOT teaching specific skills such as handwriting)

Secondary Goals and Expected Outcomes of SI Intervention: Regulation of arousal states and attention Development of body scheme; Postural-motor and bilateral integration of function; Praxis for organizing behavior; Fine and Gross motor skills (handwriting); Visual-auditory aspects of learning ; Receptive and expressive language; Psychosocial functions (ex: self-concept, self-efficacy); Independence in ADLs

Treatment PrinciplesTreatment Principles

SI intervention is highly individualized, therefore no set protocol or techniques are available.

In children the target populations are those with developmental disorders including learning disabilities, autism, pervasive developmental disorder, developmental co-ordination disorder.

Intervention centers around controlled and purposeful exposure to sensory input, and development of adaptive responses to sensory self and environment.

SI treatment incorporates basic neuro-developmental theory (bottom up approach).

SI intervention is highly individualized, therefore no set protocol or techniques are available.

In children the target populations are those with developmental disorders including learning disabilities, autism, pervasive developmental disorder, developmental co-ordination disorder.

Intervention centers around controlled and purposeful exposure to sensory input, and development of adaptive responses to sensory self and environment.

SI treatment incorporates basic neuro-developmental theory (bottom up approach).

Treatment ApproachTreatment Approach

Not a ‘cookbook’: Treatment is based on results of intensive assessment of individual sensory developmental level and needs.

Basic Principles used to guide intervention strategy using a variety of sensorimotor activities.

Not a ‘cookbook’: Treatment is based on results of intensive assessment of individual sensory developmental level and needs.

Basic Principles used to guide intervention strategy using a variety of sensorimotor activities.

Guide to TreatmentGuide to Treatment Creation of an appropriate individualized therapeutic environment. The

‘just right challenge’ of balancing abilities and challenges.

Enable the child to “learn how to learn” by incorporating a variety of activities that target specific sensory deficits.

Activities should incorporate integration of vestibular, proprioceptive and tactile stimulation designed to meet specific needs.

Outcome measures emphasize adaptive responses to sensory stimulation and associated environmental challenges in a bottom-up approach.

Do not use passive stimulation of the child, be child centered and fun! Tap into the ‘inner drive’ of the client.

Creation of an appropriate individualized therapeutic environment. The ‘just right challenge’ of balancing abilities and challenges.

Enable the child to “learn how to learn” by incorporating a variety of activities that target specific sensory deficits.

Activities should incorporate integration of vestibular, proprioceptive and tactile stimulation designed to meet specific needs.

Outcome measures emphasize adaptive responses to sensory stimulation and associated environmental challenges in a bottom-up approach.

Do not use passive stimulation of the child, be child centered and fun! Tap into the ‘inner drive’ of the client.

Guide Cont.Guide Cont. Promote caregiver awareness and understanding of

child’s underlying sensory integrative issues and their effects on development.

Integrate a planned activity schedule into the child’s natural environments.

Use direct, ‘hands on’ therapy individually or in small groups.

Include caregivers and other relevant professionals in treatment planning and initiation in a variety of environments.

Promote caregiver awareness and understanding of child’s underlying sensory integrative issues and their effects on development.

Integrate a planned activity schedule into the child’s natural environments.

Use direct, ‘hands on’ therapy individually or in small groups.

Include caregivers and other relevant professionals in treatment planning and initiation in a variety of environments.

Vestibular-Proprioceptive Activities

Vestibular-Proprioceptive Activities

Goal: provide stimulation of receptors that provide information about the position of the head in space, and the body through movement.

Consider various receptor types to determine method of input.

Three aspects of vestibular-proprioceptive (VP) sensory input: type of movement (linear or angular) speed (fast or slow) presence of resistance to active movement and pressure

Goal: provide stimulation of receptors that provide information about the position of the head in space, and the body through movement.

Consider various receptor types to determine method of input.

Three aspects of vestibular-proprioceptive (VP) sensory input: type of movement (linear or angular) speed (fast or slow) presence of resistance to active movement and pressure

VP ActivitiesVP Activities

Swing slowly in a hammock in prone position stimulates otolith organs and facilitate tonic postural responses

Swing in fast circles in a hammock stimulates semicircular canals and faciliates phasic postural

responses

Incorporate an elastic pull on a swing to allow the child stimulation of all receptor types allows movement in all directions, at various speeds

Swing slowly in a hammock in prone position stimulates otolith organs and facilitate tonic postural responses

Swing in fast circles in a hammock stimulates semicircular canals and faciliates phasic postural

responses

Incorporate an elastic pull on a swing to allow the child stimulation of all receptor types allows movement in all directions, at various speeds

Tactile ActivitiesTactile Activities

Must consider types of input: light touch, deep touch, pressure, discriminative touch as they stimulate various receptors

Use Ax results to direct intervention to inappropriate sensory responses (hypo or hyper)

Tactile defensiveness activities: Cover equipment with materials of different textures (ex: sheepskin) Brushing skin with paint brushes, textured mittens, powder, cream to

rub onto skin, boxes of dried beans, rice to hide objects in, vibrating equipment.

Must consider types of input: light touch, deep touch, pressure, discriminative touch as they stimulate various receptors

Use Ax results to direct intervention to inappropriate sensory responses (hypo or hyper)

Tactile defensiveness activities: Cover equipment with materials of different textures (ex: sheepskin) Brushing skin with paint brushes, textured mittens, powder, cream to

rub onto skin, boxes of dried beans, rice to hide objects in, vibrating equipment.

Other ActivitiesOther Activities

An adequate ceiling suspension system is required for many activities involving vestibulo-proprioceptive stimuli

Bolster swings, platform girder swings involve 2 points of suspension and help to develop equilibrium reactions, comfort with gravity, etc.

Flexion swings provide opportunity to develop antigravity flexion postures thought to be important in developing motor planning skills.

An adequate ceiling suspension system is required for many activities involving vestibulo-proprioceptive stimuli

Bolster swings, platform girder swings involve 2 points of suspension and help to develop equilibrium reactions, comfort with gravity, etc.

Flexion swings provide opportunity to develop antigravity flexion postures thought to be important in developing motor planning skills.

Research EvidenceResearch Evidence

Levels Of EvidenceHierarchy of Levels of Evidence for Evidence-Based

Practice:

Levels Of EvidenceHierarchy of Levels of Evidence for Evidence-Based

Practice: 1 Strong evidence from at least one systematic review

of multiple well-designed randomized controlled trials.

2 Strong evidence from at least one properly designed randomized controlled trial of appropriate size.

3 Evidence from well-designed trials without randomization, single group pre-post, cohort, time series, or matched case-controlled studies.

4 Evidence from well-designed non-experimental studies from more than one centre or research group.

5 Opinions of respected authorities, based on clinical evidence, descriptive studies, or reports of expert committees

FROM 2000 Eleanor Clarke Slagle Lecture – Our Mandate for the Millennium: Evidence-Based Practice, AJOT, 2000, 54, number 6, Margo B. Holm

Research EvidenceResearch Evidence

Randomized Controlled Trials were the main type of studies from early 80s to mid 90s

Most had inconclusive resultsMost studies were of children with

autism, learning disabilities, and developmental coordination disorder

Randomized Controlled Trials were the main type of studies from early 80s to mid 90s

Most had inconclusive resultsMost studies were of children with

autism, learning disabilities, and developmental coordination disorder

Author Ottenbacher, K

Title Sensory Integration Therapy: Affect or Effect?

Journal and Year American Journal of Occupational Therapy, 1982

Purpose/Research Question

1. Synthesize existing evidence on the efficacy of sensory integration therapy as applied to various clinical populations using quantitative reviewing techniques.

2. Expose consumers of research in OT to the methods and procedures of quantitative reviewing.

Type of Study Meta - analysis of treatment efficacy studies published between 1972 and 1981. Eight studies met this study's inclusion criteria.

Subjects across reviewed studies

317 subjects, ranging in ages from 4 to 62 years, with diagnoses of learning disabilities (N=191), mental retardation (N=89), aphasia (N=18), and "at-risk for learning disabilities" (N=19) participated in these 8 studies. Studies used random assignment, a combination of random assignment and matching on selected variables, and one study used pre-existing groups without experimental assignment. 47 statistical hypothesis tests of two-group comparisons were included in these 8 studies.

Results 1. When motor or reflex performance was considered, 12 of 19 hypothesis tests found an effect in favor of the treatment group. 7 found no difference.

2. When academic performance was considered, 9 of 17 hypothesis tests found an effect in favor of the treatment group. 8 found no difference.

3. When language function was considered, 6 of 11 hypothesis tests found an effect in favor of the treatment group. Four found no difference and 1 found an effect in favor of the no-treatment group.

Thus, greatest effect in favor of sensory integration treatment was found when the dependent variable was a motor or reflex measure, and the least effect was found when the dependent variable was a language measure. When effect was considered according to diagnostic category, sensory integration therapy had its greatest effect on subjects diagnosed as aphasic or at risk, and the least effect on subjects diagnosed as mentally retarded. Sensory integration therapy applied to the populations within these studies appears to have some empirical support, however widespread application of sensory integration therapy may be "more affect than demonstrated effect."

Notes No studies that met inclusion criteria and examined the effect of SI with persons with psychiatric or emotional disorders, physical disabilities, or with the geriatric population, were found.

Author Ottenbacher, K

Title Sensory Integration Therapy: Affect or Effect?



1. Synthesize existing evidence on the efficacy of sensory integration therapy as applied to various clinical populations using quantitative reviewing techniques.

2. Expose consumers of research in OT to the methods and procedures of quantitative reviewing.

Type of Study Meta - analysis of treatment efficacy studies published between 1972 and 1981. Eight studies met this study's inclusion criteria.


317 subjects, ranging in ages from 4 to 62 years, with diagnoses of learning disabilities (N=191), mental retardation (N=89), aphasia (N=18), and "at-risk for learning disabilities" (N=19) participated in these 8 studies. Studies used random assignment, a combination of random assignment and matching on selected variables, and one study used pre-existing groups without experimental assignment. 47 statistical hypothesis tests of two-group comparisons were included in these 8 studies.

Results 1. When motor or reflex performance was considered, 12 of 19 hypothesis tests found an effect in favor of the treatment group. 7 found no difference.

2. When academic performance was considered, 9 of 17 hypothesis tests found an effect in favor of the treatment group. 8 found no difference.

3. When language function was considered, 6 of 11 hypothesis tests found an effect in favor of the treatment group. Four found no difference and 1 found an effect in favor of the no-treatment group.

Thus, greatest effect in favor of sensory integration treatment was found when the dependent variable was a motor or reflex measure, and the least effect was found when the dependent variable was a language measure. When effect was considered according to diagnostic category, sensory integration therapy had its greatest effect on subjects diagnosed as aphasic or at risk, and the least effect on subjects diagnosed as mentally retarded. Sensory integration therapy applied to the populations within these studies appears to have some empirical support, however widespread application of sensory integration therapy may be "more affect than demonstrated effect."

Notes No studies that met inclusion criteria and examined the effect of SI with persons with psychiatric or emotional disorders, physical disabilities, or with the geriatric population, were found.

Group Research - Randomized Control Trial

Author Carte, E., Morrison, D., Sublett, J ., Uemura, A. & Setrakian, W.

Title Sensory Integration Therapy: A Trial of a Specific Neurodevelopmental Therapy for the Remediation of Learning Disabilities

Journal and Year Journal of Developmental and Behavioral Pediatrics, 1984


Examine effects of sensory integration treatment on hyporesponsive nystagmus, perceptual processing dysfunction and academic performance in spelling, arithmetic, reading, decoding and reading comprehension

Type of Study Case control study with random assignment (Replication of studies reported by Ayres '72 & '78)

Subjects Study participants were selected from an initial group of 270 children with learning disabilities who were receiving special education in public schools. Selection phases are detailed in article. Study participants included 87 children, 6-11 years old, with learning disabilities and reading retardation, SI dysfunction, perceptual deficits and reading delays (66 males, 21 females). Children were matched in pairs using Gates-MacGinitie NCE score, sex and age. Members of each pair were then randomly assigned to two groups: SI treatment (N=46), Control group (N= 41).

Dependent Variable Pretesting was done during the last third of the school year prior to therapy intervention. "Appropriately qualified testers were used for each phase of the assessment." WRAT, WISC-R, Gates-MacGinitie Test of Reading Comprehension. Pre- and post-intervention testing using SCSIT, SCPNT and clinical assessment was completed by occupational therapists who were certified in use of these procedures. 23 in SI group and 22 in control group had post-rotary nystagmus equal to less than 13 seconds at pretest. Posttesting utilized same sequence as assessment, and was completed within a four-week period immediately after the therapy program with the exception of SCPNT, which was administered three months after other posttesting.

Independent Variable 45 minute sessions during school hours in an "appropriately equipped room", 2-3x/week. 66 sessions over 9 months while children attended their public school programs (review of programs and parent interviews verified that SI techniques were not used privately or in schools, outside of parameters of this study). Therapy was provided by an occupational therapist and planned and supervised by one of the study authors to "ensure consistent use of SI techniques

Results "Individualized sensory integration therapy had no statistically significant effect on hyponystagmus duration, perceptual processing, or academic achievement." The lack of effect of therapy on any of the dependent variables for the general sample of LD children in the study is a replication of previous research." Authors contend that results of this study do not help to clarify the relationship between SI dysfunction and learning disabilities. They suggest that the "effects of therapy on components of the disorder require identification before trials of SI therapy on higher cerebral function can be effectively designed."

Notes Selection of children who were judged to be appropriate candidates for sensory integration therapy did not affect group's response to therapy.


Author Carte, E., Morrison, D., Sublett, J ., Uemura, A. & Setrakian, W.

Title Sensory Integration Therapy: A Trial of a Specific Neurodevelopmental Therapy for the Remediation of Learning Disabilities

Journal and Year Journal of Developmental and Behavioral Pediatrics, 1984


Examine effects of sensory integration treatment on hyporesponsive nystagmus, perceptual processing dysfunction and academic performance in spelling, arithmetic, reading, decoding and reading comprehension

Type of Study Case control study with random assignment (Replication of studies reported by Ayres '72 & '78)

Subjects Study participants were selected from an initial group of 270 children with learning disabilities who were receiving special education in public schools. Selection phases are detailed in article. Study participants included 87 children, 6-11 years old, with learning disabilities and reading retardation, SI dysfunction, perceptual deficits and reading delays (66 males, 21 females). Children were matched in pairs using Gates-MacGinitie NCE score, sex and age. Members of each pair were then randomly assigned to two groups: SI treatment (N=46), Control group (N= 41).

Dependent Variable Pretesting was done during the last third of the school year prior to therapy intervention. "Appropriately qualified testers were used for each phase of the assessment." WRAT, WISC-R, Gates-MacGinitie Test of Reading Comprehension. Pre- and post-intervention testing using SCSIT, SCPNT and clinical assessment was completed by occupational therapists who were certified in use of these procedures. 23 in SI group and 22 in control group had post-rotary nystagmus equal to less than 13 seconds at pretest. Posttesting utilized same sequence as assessment, and was completed within a four-week period immediately after the therapy program with the exception of SCPNT, which was administered three months after other posttesting.

Independent Variable 45 minute sessions during school hours in an "appropriately equipped room", 2-3x/week. 66 sessions over 9 months while children attended their public school programs (review of programs and parent interviews verified that SI techniques were not used privately or in schools, outside of parameters of this study). Therapy was provided by an occupational therapist and planned and supervised by one of the study authors to "ensure consistent use of SI techniques

Results "Individualized sensory integration therapy had no statistically significant effect on hyponystagmus duration, perceptual processing, or academic achievement." The lack of effect of therapy on any of the dependent variables for the general sample of LD children in the study is a replication of previous research." Authors contend that results of this study do not help to clarify the relationship between SI dysfunction and learning disabilities. They suggest that the "effects of therapy on components of the disorder require identification before trials of SI therapy on higher cerebral function can be effectively designed."

Notes Selection of children who were judged to be appropriate candidates for sensory integration therapy did not affect group's response to therapy.


Author Kaplan, B., Polatajko, H., Wilson, B. & Faris, P.

Title Reexamination of Sensory Integration Treatment: A Combination of Two Efficacy Studies

Journal and Year Journal of Learning Disabilities, 1993


Is SI therapy a useful treatment for children with learning problems?

Type of Study Experimental Control [combined results of study by Wilson, et al (1992) - "Alberta study" and study by Polatajko et al, (1991) - "Ontario study"]

Subjects Total of 95 children, between ages of 5 years, 2months and 8 years, 11months from two separate studies yielded three groups: children receiving Sensory Integration treatment (N=49), children receiving tutoring (N=15), children receiving perceptual-motor training (N=31).

Dependent Variable Evaluators were blind to treatment assignment. Alberta Study: (N=29) Pre-test assessment, midtreatment at 6 months and post-treatment at 12 months were completed by 2 occupational therapists, a physical therapist and psychologist who were blind to group assignment. Testing was completed over two half-day periods with rest breaks, and extended if child's attention or motivation required shorter sessions. Ontario study: (N=66) Each group was followed when intervention ended and again after 3 months of no therapy. Evaluators were blind to children's group assignment.

Independent Variable

Alberta study: Two 50-minute sessions per week for 75 1:1 sessions over 12 months - One group, SI therapy provided by 2 occupational therapy clinical supervisors who were certified in the administration and interpretation of the SCSIT. Other group, tutoring ("a skill development approach in which children were taught academic material not intended to generalize beyond the specific skill acquired.").

Ontario study: Intended to replicate practice of SI therapy in a typical clinic. Well-defined therapy manuals to guide intervention (details available from author). One group had OT/Sensory Integrative therapy, once a week, one hour duration, 6 months using "sensory modalities to elicit an adaptive motor response." Other group had OT/Perceptual Motor therapy, once a week, one hour, duration, 6 months to "increase PM function."

Results Change over time was documented, but no differences between intervention groups for children with learning or pre-learning deficits. "Failed to find any statistical evidence that SI treatment improves the academic performance of learning disabled children more than a placebo." "The clinical effect of these therapies may be minimal" and authors are "unable to find any support favoring SIT over other interventions for children with learning or prelearning deficits."


Author Kaplan, B., Polatajko, H., Wilson, B. & Faris, P.

Title Reexamination of Sensory Integration Treatment: A Combination of Two Efficacy Studies



Is SI therapy a useful treatment for children with learning problems?

Type of Study Experimental Control [combined results of study by Wilson, et al (1992) - "Alberta study" and study by Polatajko et al, (1991) - "Ontario study"]

Subjects Total of 95 children, between ages of 5 years, 2months and 8 years, 11months from two separate studies yielded three groups: children receiving Sensory Integration treatment (N=49), children receiving tutoring (N=15), children receiving perceptual-motor training (N=31).

Dependent Variable Evaluators were blind to treatment assignment. Alberta Study: (N=29) Pre-test assessment, midtreatment at 6 months and post-treatment at 12 months were completed by 2 occupational therapists, a physical therapist and psychologist who were blind to group assignment. Testing was completed over two half-day periods with rest breaks, and extended if child's attention or motivation required shorter sessions. Ontario study: (N=66) Each group was followed when intervention ended and again after 3 months of no therapy. Evaluators were blind to children's group assignment.


Alberta study: Two 50-minute sessions per week for 75 1:1 sessions over 12 months - One group, SI therapy provided by 2 occupational therapy clinical supervisors who were certified in the administration and interpretation of the SCSIT. Other group, tutoring ("a skill development approach in which children were taught academic material not intended to generalize beyond the specific skill acquired.").

Ontario study: Intended to replicate practice of SI therapy in a typical clinic. Well-defined therapy manuals to guide intervention (details available from author). One group had OT/Sensory Integrative therapy, once a week, one hour duration, 6 months using "sensory modalities to elicit an adaptive motor response." Other group had OT/Perceptual Motor therapy, once a week, one hour, duration, 6 months to "increase PM function."

Results Change over time was documented, but no differences between intervention groups for children with learning or pre-learning deficits. "Failed to find any statistical evidence that SI treatment improves the academic performance of learning disabled children more than a placebo." "The clinical effect of these therapies may be minimal" and authors are "unable to find any support favoring SIT over other interventions for children with learning or prelearning deficits."

Research Evidence (2)Research Evidence (2)

Early 90s and throughout the 90s, start to see a lot of literature reviews (and some systematic reviews as well)

These look to synthesize many studies together of specific populations to try to find more substantial evidence

Mostly conclude that there is no clear evidence in support of sensory integration

Early 90s and throughout the 90s, start to see a lot of literature reviews (and some systematic reviews as well)

These look to synthesize many studies together of specific populations to try to find more substantial evidence

Mostly conclude that there is no clear evidence in support of sensory integration

Author Polatajko, H. Kaplan, B. & Wilson, B.

Title Sensory Integration Treatment for Children with Learning Disabilities: Its Status Twenty Years Later

Journal and Year Occupational Therapy Journal of Research, 1992


To provide an update concerning recent replications of AJ Ayres' work (1972-78) in order to evaluate the generalizability of those earlier findings. Twenty years after Ayres' original article on the use of sensory integration treatment with children with learning disabilities, what do we know about the efficacy of SI treatment in improving the academic and motor skills of children with learning disabilities?

Type of Study Literature review of studies of SI treatment for children with learning disabilities


Seven studies (all randomized clinical trials) included a total of 311 children, ranging from 4.8 to 13 years old. Gender not described in review.

Results Improvement over time was noted in all studies with the exception of no improvement in reading or math noted in one study. Group differences were examined with

1. "mixed results" for SI treatment compared to no treatment, 2. "mixed results" for SI treatment compared to placebo, 3. SI treatment did not do better on any of the gross motor, fine motor, or nystagmus comparisons when

compared to another non-SI treatment. 4. SI treatment was as effective as perceptual motor training.

Authors "failed to find any statistical evidence that SI treatment improves the academic performance of learning disabled children more than a placebo." "Statistically, overall SI treatment may be similar to perceptual-motor training." "The clinical effect of these therapies may be minimal."

Notes All studies included pre- and post- treatment testing. One study included mid-treatment testing. Academic performance (reading and math) was measured in all 7 studies. In addition, six studies also included measures of motor, visual-motor, sensory-motor and nystagmus, language performance. SI treatment was provided, but amount of treatment varied considerably across studies, ranging from 1-3 sessions per week, 1-3 hours per week, with a total range of 19.5 to 76 hours. All children received at least one hour of treatment per week.

Author Polatajko, H. Kaplan, B. & Wilson, B.

Title Sensory Integration Treatment for Children with Learning Disabilities: Its Status Twenty Years Later

Journal and Year Occupational Therapy Journal of Research, 1992


To provide an update concerning recent replications of AJ Ayres' work (1972-78) in order to evaluate the generalizability of those earlier findings. Twenty years after Ayres' original article on the use of sensory integration treatment with children with learning disabilities, what do we know about the efficacy of SI treatment in improving the academic and motor skills of children with learning disabilities?

Type of Study Literature review of studies of SI treatment for children with learning disabilities


Seven studies (all randomized clinical trials) included a total of 311 children, ranging from 4.8 to 13 years old. Gender not described in review.

Results Improvement over time was noted in all studies with the exception of no improvement in reading or math noted in one study. Group differences were examined with

1. "mixed results" for SI treatment compared to no treatment, 2. "mixed results" for SI treatment compared to placebo, 3. SI treatment did not do better on any of the gross motor, fine motor, or nystagmus comparisons when

compared to another non-SI treatment. 4. SI treatment was as effective as perceptual motor training.

Authors "failed to find any statistical evidence that SI treatment improves the academic performance of learning disabled children more than a placebo." "Statistically, overall SI treatment may be similar to perceptual-motor training." "The clinical effect of these therapies may be minimal."

Notes All studies included pre- and post- treatment testing. One study included mid-treatment testing. Academic performance (reading and math) was measured in all 7 studies. In addition, six studies also included measures of motor, visual-motor, sensory-motor and nystagmus, language performance. SI treatment was provided, but amount of treatment varied considerably across studies, ranging from 1-3 sessions per week, 1-3 hours per week, with a total range of 19.5 to 76 hours. All children received at least one hour of treatment per week.

Review Article

Author Hoehn, T. & Baumeister, A.

Title A Critique of the Application of Sensory Integration Therapy to Children with Learning Disabilities



Review theoretical orientations and empirical findings pertaining to problems in sensory integration exhibited by children with learning disabilities and review recent studies in SI therapy. Do children with Learning Disabilities legitimately and differentially exhibit problems in Sensory Integration and is SI therapy helpful to them in any way?

Type of Study Overview of sensory integration theoretical contentions and detailed review of 7 studies published from 1982-1994 (2 separate articles covered the same experiment). All but one of the studies included comparisons between at least two groups.


Children 5-11 years old, "described as having both Learning Disabilities and sensory integration dysfunction." Some children received special education services during study period.

Procedures Literature search for experimental reports since 1982 that assess effectiveness of SI therapy. Inclusion criteria:

1. studies utilized SI therapy according to an operational definition adapted from Ayres, 2. subjects were children with learning disabilities, 3. involved comparison between two conditions, 4. dependent measures included motor or reflex functions, academic abilities and/or language,

reported results in quantitative form

Results Author raises concerns with theoretical and diagnostic issues involved in adequately understanding possible relationships among sensory integration dysfunction. Results "raise serious doubts as to the validity or utility of SI therapy as an appropriate, indicated treatment for the clinical population in question - and, by extension, for any other groups diagnosed as having sensory integrative dysfunction."

Notes Independent variables: In every study, SI treatment is reported as specific SI therapy principles and techniques, designed to provide "vestibular, proprioceptive, and tactile stimulation within a meaningful, self-directed activity in order to elicit an adaptive motor response." Trained, experienced professionals provided SI therapy and comparison treatment "over a relatively long period of time and considerable number of sessions."

Review Article

Author Hoehn, T. & Baumeister, A.

Title A Critique of the Application of Sensory Integration Therapy to Children with Learning Disabilities



Review theoretical orientations and empirical findings pertaining to problems in sensory integration exhibited by children with learning disabilities and review recent studies in SI therapy. Do children with Learning Disabilities legitimately and differentially exhibit problems in Sensory Integration and is SI therapy helpful to them in any way?

Type of Study Overview of sensory integration theoretical contentions and detailed review of 7 studies published from 1982-1994 (2 separate articles covered the same experiment). All but one of the studies included comparisons between at least two groups.


Children 5-11 years old, "described as having both Learning Disabilities and sensory integration dysfunction." Some children received special education services during study period.

Procedures Literature search for experimental reports since 1982 that assess effectiveness of SI therapy. Inclusion criteria:

1. studies utilized SI therapy according to an operational definition adapted from Ayres, 2. subjects were children with learning disabilities, 3. involved comparison between two conditions, 4. dependent measures included motor or reflex functions, academic abilities and/or language,

reported results in quantitative form

Results Author raises concerns with theoretical and diagnostic issues involved in adequately understanding possible relationships among sensory integration dysfunction. Results "raise serious doubts as to the validity or utility of SI therapy as an appropriate, indicated treatment for the clinical population in question - and, by extension, for any other groups diagnosed as having sensory integrative dysfunction."

Notes Independent variables: In every study, SI treatment is reported as specific SI therapy principles and techniques, designed to provide "vestibular, proprioceptive, and tactile stimulation within a meaningful, self-directed activity in order to elicit an adaptive motor response." Trained, experienced professionals provided SI therapy and comparison treatment "over a relatively long period of time and considerable number of sessions."

Research Evidence (3)Research Evidence (3) Starting late 90s and into 2000s, almost all

research conducted for sensory integration was single subject design (and also some qualitative studies as well)

This likely reflects that although previous RCTs, etc had failed to demonstrate the effectiveness of S.I., clinicians felt that in practice (without the strict exclusion/inclusion criteria…or strict controls that are required by RCTs), S.I. had in fact benefited some of their clients and wanted to try to document this

Starting late 90s and into 2000s, almost all research conducted for sensory integration was single subject design (and also some qualitative studies as well)

This likely reflects that although previous RCTs, etc had failed to demonstrate the effectiveness of S.I., clinicians felt that in practice (without the strict exclusion/inclusion criteria…or strict controls that are required by RCTs), S.I. had in fact benefited some of their clients and wanted to try to document this

Single Subject Research

Author Davidson, T. and Williams, B.

Title Occupational therapy for children with developmental coordination disorder: A study of the effectiveness of a combined sensory integration and perceptual-motor intervention

Journal and Year British Journal of Occupational Therapy, 2000


To examine whether a 10-week occupational therapy intervention of combined sensory integration and perceptual-motor training was effective at 12-month follow-up among children with Developmental Coordination Disorder.

Type of Study Single subject - group design with pre-test and post-test assessment.

Subjects From consecutive referrals to pediatric occupational therapy clinic between January 1996 and January 1997 Inclusion criteria: Children with a diagnosis of DCD according to DSM IV and ICD 10 criteria

Exclusion criteria: Children with known psychiatric or neurological condition

These criteria yielded sample of 37 children whose gender and ages were not specified in the article.

Dependent Variable Retrospective review of routine clinical data to provide pre-test post-test assessments on group of children who were referred to a pediatric occupational therapy clinic. Measures included Movement Assessment Battery for Children and Beery-Buktenica Developmental Test of Visual-Motor Integration. Post-test was "about one year" after pre-test. Both assessments were carried out with two therapists present. Therapists were aware of children receiving intervention.

Independent Variable 10-week block of treatment using "combined sensory integration and perceptual-motor approach" followed with a school or home program. Authors identified sensory integration as involving "sensory stimulation and adaptive responses according to the child's neurological needs... involves full body movements that provide vestibular, proprioceptive and tactile stimulation. Goal of therapy is to improve the way that the brain processes and organizes sensation." Perceptual motor program defined as "more prescriptive...requires the child to perform fine and gross motor activities in order to improve the skills necessary for optimal functioning. Each child's program reported as "individualized," using clinical observations to categorize reasons for difficulties before treatment was determined.

Results Statistically significant improvements were found only for fine-motor skills and visual-motor integration and not on Movement ABC score. A 10-week block of occupational therapy using a combined sensory-integration and perceptual-motor treatment approach, may be relatively ineffective at 12-month follow-up.

Notes Other research suggests that children with DCD maintain or slightly improve skills with maturation, so small statistical improvements of this study are questioned. With no control group, what would have happened to these children over the 12-month period if no intervention was provided?


Author Davidson, T. and Williams, B.

Title Occupational therapy for children with developmental coordination disorder: A study of the effectiveness of a combined sensory integration and perceptual-motor intervention

Journal and Year British Journal of Occupational Therapy, 2000


To examine whether a 10-week occupational therapy intervention of combined sensory integration and perceptual-motor training was effective at 12-month follow-up among children with Developmental Coordination Disorder.

Type of Study Single subject - group design with pre-test and post-test assessment.

Subjects From consecutive referrals to pediatric occupational therapy clinic between January 1996 and January 1997 Inclusion criteria: Children with a diagnosis of DCD according to DSM IV and ICD 10 criteria

Exclusion criteria: Children with known psychiatric or neurological condition

These criteria yielded sample of 37 children whose gender and ages were not specified in the article.

Dependent Variable Retrospective review of routine clinical data to provide pre-test post-test assessments on group of children who were referred to a pediatric occupational therapy clinic. Measures included Movement Assessment Battery for Children and Beery-Buktenica Developmental Test of Visual-Motor Integration. Post-test was "about one year" after pre-test. Both assessments were carried out with two therapists present. Therapists were aware of children receiving intervention.

Independent Variable 10-week block of treatment using "combined sensory integration and perceptual-motor approach" followed with a school or home program. Authors identified sensory integration as involving "sensory stimulation and adaptive responses according to the child's neurological needs... involves full body movements that provide vestibular, proprioceptive and tactile stimulation. Goal of therapy is to improve the way that the brain processes and organizes sensation." Perceptual motor program defined as "more prescriptive...requires the child to perform fine and gross motor activities in order to improve the skills necessary for optimal functioning. Each child's program reported as "individualized," using clinical observations to categorize reasons for difficulties before treatment was determined.

Results Statistically significant improvements were found only for fine-motor skills and visual-motor integration and not on Movement ABC score. A 10-week block of occupational therapy using a combined sensory-integration and perceptual-motor treatment approach, may be relatively ineffective at 12-month follow-up.

Notes Other research suggests that children with DCD maintain or slightly improve skills with maturation, so small statistical improvements of this study are questioned. With no control group, what would have happened to these children over the 12-month period if no intervention was provided?


Author Linderman, T. & Stewart, K.

Title Sensory Integrative-Based Occupational Therapy and Functional Outcomes in Young Children With Pervasive Developmental Disorders: A Single-Subject Study



Determine effects of SI therapy on functional behaviors of children with pervasive developmental disorder

Type of Study Single subject - AB design

Subjects From pre-school children with PDD who were referred to occupational therapy department at a Children's Health Center in Tacoma, Washington, two 3 year-old boys with PDD were selected.

Dependent Variable Targeted behaviors: social interaction, functional communication during mealtime, approach to new activities, response to holding and movement using Cook's Functional Behavioral Assessment for Children with Sensory Integration Dysfunction. 8 baseline measurements were collected over 2 weeks for each child. During treatment phase, 16 measurements were collected for child 1 and 13 for child 2.


Child 1 - SI therapy, 1 hour/week for 11 weeks, Child 2 - SI therapy 1 hour/week for 7 weeks. Intervention was provided by an OT with 14 years of experience, with 7 years experience practicing sensory integrative-based OT. Therapy provided in all sessions was "consistent with the description of sensory integrative-based occupational therapy" by Ayres, Koomar and Bundy. Intervention was child-directed and available equipment included "several large pillows, a small trampoline, a trapeze bar, a suspended platform swing, a Lycra swing, "body socks," a bounce pad, a child-sized table and chair, and a selection of textured and manipulative toys and activities

Results As measured by parent report and observation, a carefully implemented program of SI-based occupational therapy led to improved functional behaviors, increased social interaction, approach to new activities, response to holding/hugging, response to movement, decreased disruptive behaviors, increased spontaneous speech, play, attention to activity and conversation. Improved functional behaviors were noted in the natural context of their homes, with the exception of functional communication during mealtime by Child 2. Authors conclude, "that a program of sensory integrative-based occupational therapy, when used with persons with PDD, may lead to improved functional behaviors in the natural context of the home."

Notes Future research is needed with a larger sample and longer intervention period. A return to baseline phase is needed "in order to provide documentation regarding the functional outcomes of this intervention."


Author Linderman, T. & Stewart, K.

Title Sensory Integrative-Based Occupational Therapy and Functional Outcomes in Young Children With Pervasive Developmental Disorders: A Single-Subject Study



Determine effects of SI therapy on functional behaviors of children with pervasive developmental disorder

Type of Study Single subject - AB design

Subjects From pre-school children with PDD who were referred to occupational therapy department at a Children's Health Center in Tacoma, Washington, two 3 year-old boys with PDD were selected.

Dependent Variable Targeted behaviors: social interaction, functional communication during mealtime, approach to new activities, response to holding and movement using Cook's Functional Behavioral Assessment for Children with Sensory Integration Dysfunction. 8 baseline measurements were collected over 2 weeks for each child. During treatment phase, 16 measurements were collected for child 1 and 13 for child 2.


Child 1 - SI therapy, 1 hour/week for 11 weeks, Child 2 - SI therapy 1 hour/week for 7 weeks. Intervention was provided by an OT with 14 years of experience, with 7 years experience practicing sensory integrative-based OT. Therapy provided in all sessions was "consistent with the description of sensory integrative-based occupational therapy" by Ayres, Koomar and Bundy. Intervention was child-directed and available equipment included "several large pillows, a small trampoline, a trapeze bar, a suspended platform swing, a Lycra swing, "body socks," a bounce pad, a child-sized table and chair, and a selection of textured and manipulative toys and activities

Results As measured by parent report and observation, a carefully implemented program of SI-based occupational therapy led to improved functional behaviors, increased social interaction, approach to new activities, response to holding/hugging, response to movement, decreased disruptive behaviors, increased spontaneous speech, play, attention to activity and conversation. Improved functional behaviors were noted in the natural context of their homes, with the exception of functional communication during mealtime by Child 2. Authors conclude, "that a program of sensory integrative-based occupational therapy, when used with persons with PDD, may lead to improved functional behaviors in the natural context of the home."

Notes Future research is needed with a larger sample and longer intervention period. A return to baseline phase is needed "in order to provide documentation regarding the functional outcomes of this intervention."

Meta-Analysis of StudiesMeta-Analysis of Studies

Vargas & Camilli, 1999. AJOT, 53, 189.Recent (1983-93) studies show no

effect for SI versus No Treatment. Older studies showed significant

effect, but had fewer outcome ms.All studies showed same effect for SI

versus Alternate Treatments.Results independent of treatment hrs.

Vargas & Camilli, 1999. AJOT, 53, 189.Recent (1983-93) studies show no

effect for SI versus No Treatment. Older studies showed significant

effect, but had fewer outcome ms.All studies showed same effect for SI

versus Alternate Treatments.Results independent of treatment hrs.

H. J. Polatajko, Ph.D., OT Reg. (Ont.), OT(C), FCAOT

H. J. Polatajko, Ph.D., OT Reg. (Ont.), OT(C), FCAOT

“effectiveness of treatment should NOT be based on consensus of practitioners”

“look to research data NOT opinion”

“my DATA are in the literature and they clearly do not support the efficacy of SI!”

“Again, let me re-iterate, look to data not opinion, it is the only way we will move forward…there is extensive criticism of SI in the literature based on data!”

“effectiveness of treatment should NOT be based on consensus of practitioners”

“look to research data NOT opinion”

“my DATA are in the literature and they clearly do not support the efficacy of SI!”

“Again, let me re-iterate, look to data not opinion, it is the only way we will move forward…there is extensive criticism of SI in the literature based on data!”

D.Cameron, Ph.D. , M.Ed., B.Sc. (O.T.)

D.Cameron, Ph.D. , M.Ed., B.Sc. (O.T.)

“I don’t use S.I. Treatment or the SCSIT but there are clinicians who do”

“They feel that they see improvements in the clients that they see which is why they continue to use the techniques”

“The research does not demonstrate this effect which might be due to it’s lack of effectiveness, lack of good studies, variability of children in the research projects, etc.”

“I don’t use S.I. Treatment or the SCSIT but there are clinicians who do”

“They feel that they see improvements in the clients that they see which is why they continue to use the techniques”

“The research does not demonstrate this effect which might be due to it’s lack of effectiveness, lack of good studies, variability of children in the research projects, etc.”

Darlene Hubley

OT, Bloorview MacMillan Children's Centre Darlene Hubley

OT, Bloorview MacMillan Children's Centre “I do not think that there is consensus amongst OTs…”

“I suspect many of my colleagues would agree there is a significant lack of evidence in the literature to support SI treatment”

She does not use formal S.I. Assessments/treatments, but has used sensory integration equipment on occasion in the past

“..many OTs grapple with how to understand and and help kids, families and teachers manage sensory dysfunction”

Ellen Yak who wrote the book, “Building Bridges through Sensory Integration” provided an education session for the OTs at Bloorview MacMillan just last week

“I do not think that there is consensus amongst OTs…”

“I suspect many of my colleagues would agree there is a significant lack of evidence in the literature to support SI treatment”

She does not use formal S.I. Assessments/treatments, but has used sensory integration equipment on occasion in the past

“..many OTs grapple with how to understand and and help kids, families and teachers manage sensory dysfunction”

Ellen Yak who wrote the book, “Building Bridges through Sensory Integration” provided an education session for the OTs at Bloorview MacMillan just last week

Recommendations for PracticeRecommendations for Practice

Controversial subject that has now been in existence for decades

Now recognize the importance of evidence-based practice

Re-examine the levels of evidence Level 1 systematic reviews are at top However, some clinicians are still using this theory…

we must ask ourselves why??

Controversial subject that has now been in existence for decades

Now recognize the importance of evidence-based practice

Re-examine the levels of evidence Level 1 systematic reviews are at top However, some clinicians are still using this theory…

we must ask ourselves why??

SI Summary SI Summary

Limitations Ayer’s theory that higher level cognitive and motor

functions, such as language and handwriting, develop post sensory integration improvements is not proven by the research.

The theory and interventions lack support by higher levels of evidence with comparisons of SI to control, non-treatment groups.

The SIPT has very poor clinical utility (time and $ make it impractical).

SI theoretical explanations of etiology of learning disabilities not supported by the research.

The individual nature of SI dysfunction and treatments make large scale, scientifically rigorous studies difficult.

Limitations Ayer’s theory that higher level cognitive and motor

functions, such as language and handwriting, develop post sensory integration improvements is not proven by the research.

The theory and interventions lack support by higher levels of evidence with comparisons of SI to control, non-treatment groups.

The SIPT has very poor clinical utility (time and $ make it impractical).

SI theoretical explanations of etiology of learning disabilities not supported by the research.

The individual nature of SI dysfunction and treatments make large scale, scientifically rigorous studies difficult.

Summary Cont.Summary Cont.

Strengths and Contributions Sensory Integration and Praxis Tests (SIPT) -Validity is good.

Reliability is good for praxis tests. Uses a “client centered” approach to treatment intervention. Concept of “inner drive” is aligned with OT (occupational

performance through a PEO fit). Has support of parents and practitioners from a variety of

disciplines through lower levels of evidence (client evidence, professional clinical experience, case-studies).

Has stimulated OT research development in the area of sensory processing (ex: Winnie Dunn).

Helped OT discussion and research around importance of EBP .

Strengths and Contributions Sensory Integration and Praxis Tests (SIPT) -Validity is good.

Reliability is good for praxis tests. Uses a “client centered” approach to treatment intervention. Concept of “inner drive” is aligned with OT (occupational

performance through a PEO fit). Has support of parents and practitioners from a variety of

disciplines through lower levels of evidence (client evidence, professional clinical experience, case-studies).

Has stimulated OT research development in the area of sensory processing (ex: Winnie Dunn).

Helped OT discussion and research around importance of EBP .

Sensory Integration OCT 1172Y April 12, 2005 Cooper, Fernandes, McTaggart, & Vogiatzis OCT 1172Y...

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