Sensory Integration Frame of Reference

Background of Frame of Reference

History

Occupational Therapy and Sensory Integration

• Developed by Jean Ayers in the 1970s.
• Developed as a way to understand certain behaviors seen in children with different disabilities

Autism

Cerebral Palsy

OT provides opportunities to expand and integrate a child's sensory systems through a variety of experiences in play that utilize each of these systems. With exposure, the child can learn to integrate and refine the motor output or responses to life experiences and occupations.

Background

Infants with Regulation Issues

ADHD

Sensory Processing Disorder

Learning Disabilities

Down Syndrome

Trauma

(Schaaf et al., 2010)

Ayers defined SI as a "neurological process that organizes sensations from one's own body and the environment and makes it possible to use the body effectively in the environment"

Inefficient processing leads to "dysfunction" which causes problems in learning, development, and behavior.

SI looks to restore effective processing by integrating and enhancing each of the sensory systems

(Case-Smith & O'Brien, 2015)

The Sensory Systems

Occupational Therapy for Sensory Processing Disorder

Tactile- Sensory input from the skin receptors about touch, pressure, temperature, pain, and movement of the hairs on the skin.

Visual- Sense which provides information about color, shape, and distance of objects from one another, as well as movement of objects and people.

Auditory- Sense which allows us to locate, capture, and discriminate sounds in our environment.

Olfactory- Sense which registers and categorizes information about the odors encountered by sensing the chemicals in the air.

Gustatory- Taste sensation

Proprioceptive- Body awareness or the sensation that communicates where all of our body parts are in relation to one another and how they are moving in relation to one another

Vestibular- Sense of balance that tells your body where you are in space and in relation to the ground; your perception of body position and movement

Interoception- Sensation that lets an individual understand whats going on inside the body: feelings of hot, cold, full, thirsty, when you need to use the restroom

Overview

(Delaney, 2009; Case-Smith & O'Brien, 2015)

The interactions between all of the sensory systems contribute to complex behaviors or end products.

For example, lets look at a child learning to ride a bike. "The child must integrate sensations from the proprioceptive and vestibular system in order to learn how to balance on the bicycle. The vestibular, proprioceptive, and visual systems must accurately and quickly detect when the child begins to fall, and then must be rapidly integrated with each other to produce motor reactions that counteract the fall. After trials of falling, the child integrates sensory information efficiently enough to make appropriate weight shifts to maintain balance. This adaptive response enable the child to balance effectively on bicycle. The nervous system has been changed through this experience to better integrate multi-sensory information to produce dynamic balancing so the child is more adept to ride a bicycle.

WE DO THIS FOR ALL OF OUR EVERYDAY INTERACTIONS AND OCCUPATIONS!!

(Pathways, 2013)

Theoretical Basis of Frame of Reference

Evaluation Process

(Case-Smith & O'Brien, 2015)

Standardized Assessments

Occupational Profile and Chart Review

PDMS 2

Sensory Processing Measure

• An individually administered motor performance assessment that is good at indicating developmental delay and whether the child is on track to meet developmental milestones.
• Offers age-based standard scores, age equivalents, and percentile ranks.
• Subtests include: Reflexes, Stationary Locomotion. Object Manipulation, Grasping, and Visual-Motor Integration

M-FUN

• Parent and/or teacher questionnaire which assesses aspects of sensory processing, praxis, and social participation.
• Likert Rating Scale: (“Always”, “Frequently”, “Occasionally”, and “Never”)
• Identifies the child’s sensory tendencies as “Definite Dysfunction”, “Some Problems”, and “Typical” in comparison to typical children their age in the categories listed to the right.

Occupational

Profile

• Child's Routines and Daily occupations
• Roles of the child
• Occupational performance contexts (envrionmental, cultural, etc.)
• Performance deficits
• Impact of Dx on daily life
• Values and Interests of the child
• Parental concerns

• This assessment looks at a child’s visual motor, fine motor, and gross motor skills in order to identify delays, determine eligibility for services, and helps identify a need for intervention and classroom adaptations.
• This assessment uses playful and engaging activities to promote compliance with testing procedures. Children participate in functional tasks expected for their age.
• Able to monitor change over time with subsequent testing with this assessment.
• Two Different Testing Components:
• 1. Performance
• Workbook and play activities/games to assess gross motor, fine motor, and adaptive skills
• Gross Motor Tasks:
• 1. Statue
• 2. Ball Balance
• 3. Bouncing Ball
• 4. Soccer
• 5. Jumping
• Fine Motor Tasks:
• 1. Go Fishing
• 2. Clay Play
• 3. Penny Bank
• 4. Origami
• 5. Snack Time
• Visual Motor Tasks:
• 1. Mazes
• 2. Race Car
• 3. Hidden Forks
• 4. Find Puppies
• 5. Draw a Kid
• 6. Writing
• 7. Go Fishing
• 2. Participation
• Home Observation Check List
• Classroom Observation Check List

Chart Review

BOT 2

Sensory Profile 2

• Parent and/or teacher rating form which evaluates a child's sensory processing patterns in the context of home, school, and community-based activities.
• Identifies how sensory processing is contributing to or interfering with participation in daily occupations.
• Likert Rating Scale

• The Sensory Integration Frame of Reference “combines concepts from human development, neuroscience, psychology, and occupational therapy into a holistic framework for viewing behavior and learning” (Schaaf et al., 2010, p.100)
• There are seven theoretical postulates of the Sensory Integration Frame of Reference:

• Individually administered assessment that uses engaging, goal-directed activities to measure a variety of behaviors and foundations for motor performance (gross and fine motor skills).
• One of the most widely used comprehensive measure of gross motor and fine motor performance for children. It is used by a variety of professionals including OT, PT, Neurologists, Physical Rehabilitation Specialists, etc.
• Offers age-based standard scores, percentile ranks, age equivalency, and descriptive categories for all subtests: Fine Motor Precision, Manual Dexterity, Fine Motor Integration, Upper-Limb Coordination, Bilateral Coordination, Balance, Running Speed and Agility, and Strength
• Descriptive categories include: “Average”, “Below Average”, or “Well Below Average”.

• Medical Diagnosis
• Co-morbid diagnoses and impact on daily life
• Significant medical history
• Past therapies
• Previous hospital stays
• Birth history
• Follow-up appointments with specialists
• Orders for OT evaluation and treatment
• Developmental concerns with meeting milestones
• Educational and medical reports (IEP, formal diagnostic testing, genetic testing etc..)

SIPT

• The Sensory Integration Praxis Test= Gold Standard SI Assessment
• 17 standardized tests
• Computer-scored
• Age: 4 years- 8 years 11 months
• Measures visual and tactile perception and discrimination, visual-motor skills, bilateral integration and sequencing, and praxis and vestibular-proprioceptive function.
• Activities: Construction, imitation, facial gestures, sequencing, visual-spatial planning, follow verbal
• directions, standing balance, and walking balance.

(Schaaf et al., 2010)

POSTULATE TWO

Sensory Integration is a developmental process.

POSTULATE ONE

Sensory information provides an important foundation for learning and behavior.

POSTULATE THREE

Successful integration and organization of sensory information results in and is further developed by adaptive responses.

Information taken from Standardized Assessment Chart Completed for Objective #1: Learning Activity #3 for Experiential Internship. Information came from Individual Assessment Manuals/Clinical Instructor Experience with

• Development occurs in a sequence and is based on experiences that a child has throughout their development and interaction with the world.
• Our early experiences as a child act as the foundation for our sensory systems and help with maturation of these systems. They are important for establishing effective neuronal pathways and lay the foundation for higher level sensory motor activity.
• PLAY AND EXPLORATION ARE VITAL TO MATURATION OF A CHILD"S SENSORY SYSTEM

• Body related senses (proprioceptive, tactile, and vestibular sensory input) provide a reference point relative to the environment, which is critical for all learning and behavior.
• Current sensory information is checked against a person's existing "body sensory map". This map has been developed from previously learned motor and sensory experiences and helps to update the brain's knowledge about the body. This is then used to plan and execute motor actions in response to each environmental situation.
• Knowledge and feedback enhances the child's ability to act and interact effectively with the environment.

• An adaptive response is an appropriate action in which the individual responds successfully to an environmental demand.
• When encountering a new situation, the child draws upon one's previous understanding of their abilities and competencies and modifies them accordingly to organize new behavior and meet the current demands of the task or environment.
• Successfully meeting challenge demands results in new learned adaptive responses and provides increased motivation to engage in more complex and challenging activities.

(Schaaf et al., 2010, p. 106)

(Schaaf et al., 2010, pp. 101-102)

(Schaaf et al., 2010, p. 106)

Therapist Observation

POSTULATE FIVE

Children have an innate drive to seek meaningful experiences from their environment.

POSTULATE FOUR

The "Just Right Challenge" provides a milieu for sensory integration to occur.

POSTULATE SEVEN

Sensory Integration is a foundation for physical and social engagement and participation in daily life activities and routines.

POSTULATE SIX

As a result of neuroplasticity, enriched experiences effect change in the nervous system.

• Children are driven to explore, interact with, and master their environments.
• SI treatment provides a structured environment where the child's innate motivation is to participate and gain mastery over their environment.

• Learning occurs when a child meets and successfully accomplishes a task.
• The "Just Right Challenge" is created by the therapist and requires ongoing clinical reasoning skills.
• The "Just Right Challenge" engages the child and invites participation and success.
• Facilitating the "Just Right Challenge" requires assessment of the child's skills and abilities, considers the environmental context, anticipates the child's needs, grades the sensory and motor aspect of the task for motivation, spontaneous play, and successful performance/completion of task.

• Neuroplasticity is the nervous system's ability to change in response to environmental inputs and demands.
• Optimal sensory experiences that invite action and active participation influence growth and development of the sensory system, and subsequently, behavior.
• To interact in our world effectively, we must filter and organize millions of sensory experiences and information and respond to the changing environment.
• Treatment and facilitating sensory experiences will help the child make neuronal pathways and higher level adaptive responses.

• SI provides foundation for engagement in meaningful occupations and activities that support participation in everyday life.
• SI considers the dynamic relationship between the child's abilities/disabilities and the environment.
• SI supports occupational engagement in areas of work, play, leisure, rest within a variety of social, physical, and cultural contexts.
• SI deficits interrupt roles, routines, and daily activities of children and families.

(Schaaf et al., 2010, p. 107)

(Schaaf et al., 2010, pp. 109-110)

(Schaaf et al., 2010, p. 106)

(Schaaf et al., 2010, pp. 106-107)

(Schaaf et al., 2010)

• A therapist observes the child's reaction to a variety of sensory input and the child's ability to complete effective adequate adaptive responses in response to the environment.
• A therapist looks at:
• Ability to self-regulate
• Ability to modulate force/movement when completing occupations and moving through environment.
• Ability to discriminate a variety sensory input (tactile, auditory)
• Ability to integrate multiple sensory experiences for interaction in the environment
• Postural control
• Bilateral coordination
• Praxis
• Play skills
• Social interaction
• Abiltity to complete age-appropriate self-care skills
• Ability to participate in age appropriate academic tasks
• Response to a variety of sensory input (over-responsivity, under-responsivity, or sensory craving)

References

(Schaaf et al., 2010)

Sensory Integration Frame of Reference

• Delaney, T. (2010). 101 games and activities for children with autism, asperger's and sensory processing disorders. New York, New York: McGraw Hill.
• Kranowitz, C.S. (2003). The out of sync child: Recognizing and coping with sensory processing disorder. New York, New York: The Berkley Publishing Group.
• Parham, L. D., & Mailloux, Z. (2015). Sensory Integration In J. Case-Smith, & J. C. O’Brien (Eds.), Occupational therapy for children and adolescents (7thed., pp. 258-303). St. Louis, MO: ELSEVIER.
• Schaaf, R.C., Schoen, S.A., Roley, S.S., Lane, S.J., Koomar, J., & May-Benson, T.A.(2010). A frame of reference for sensory integration.In P. Kramer & J. Hinojosa (Eds.), Frames of reference for pediatric occupational therapy (pp. 99-182).Baltimore, MD: Lippincott, Williams, & Wilkins.

Postulates for Change

FIVE

ONE

Additional Postulates for Change

Activities that reflect the "just right challenge" produce growth and development.

An optimal state of arousal is a prerequisite for adaptive responses to occur.

Sensory Modulation Disorder

• Focus on facilitating appropriate adaptive response
• Raising child’s sensory modulation to optimal level
• Increase support of family and therapist to support engagement and structure routine

Sensory Discrimination

• Promote development of body awareness
• Therapist provides opportunities for increased feedback, development of tactile discrimination skills, visual pursuits, and visual discrimination

Basic Assumptions

(Schaaf et al., 2010, pp. 153)

(Schaaf et al., 2010)

SIX

TWO

Sensory integration occurs during adaptive responses.

Presented by: Amanda Cutting

Problems with sensory modulation, or in the foundational abilities, contribute to deficits in the end product abilities.

Additional Postulates for Change

EIGHT

(Schaaf et al., 2010)

THREE

Bilateral Integration and Sequencing Deficits

• Vestibular-proprioceptive experiences based on balance, core stability, endurance, and crossing midline.
• Child engaged in creating, setting up, participating in, and cleaning up activity.
• Visual perception and visual motor integration.
• Visual perceptual or visual motor tasks used to generalize skills in daily activities.

Therapeutic environment used to promote change

11 General Principles

• Enticing equipment is likely to increase engagement
• A physically safe environment
• Opportunities in at least 2 out of the 3 sensory systems (tactile, vestibular, proprioceptive)
• Maintain appropriate levels of awareness and affective state
• Achievable challenge to sensory modulation, discrimination, or integration
• Challenge child’s ability to plan motor tasks
• Choose the activity based on collaboration with the child
• Increase complexity of challenge
• Facilitates challenge where child is successful
• Environment that supports play
• Positive therapeutic rapport

Adaptive responses are elicited through activities that facilitate sensory modulation, discrimination, and integration, resulting in improved postural control, praxis/bilateral

integration, and participation.

Multiple sensory systems may be needed to facilitate an optimal state of arousal.

(Schaaf et al., 2010, pp. 154-155)

SEVEN

FOUR

(Schaaf et al., 2010)

The child needs to be self-directed, with therapist guidance, for sensory integration to occur.

Adaptive responses must be directed toward the child’s current developmental level.

(Schaaf et al., 2010)

Additional Postulates for Change

TEN

NINE

Somatodyspraxia

• Environment used to navigate through unusual size and shaped spaces
• Guides child to problem-solving
• Varies activity demands
• Ideational in somatodyspraxia
• Bridges current and past experiences
• Encourage child to imitate and expand on the therapist’s actions

Dyspraxia

• Providing “just right challenge”
• Provide sensory opportunities at appropriate intensity, frequency, and duration (enhance body awareness)

As the child achieves increasingly complex adaptive responses in therapy,

changes will be evident in the outcome abilities such as self-regulation, self esteem,

social participation, academic performance, and participation in daily life routines and activities.

Intervention is directed to underlying deficits in sensory modulation, discrimination and integration, and/or foundational abilities, and not toward training

in specific skills or behaviors.

(Schaaf et al., 2010, pp. 153-154)

(Schaaf et al., 2010, pp. 151-152)

(Schaaf et al., 2010)

Function/Dysfunction

Praxis

Sensory Modulation

Function: Appropriate responses to sensory stimulus in a variety of environments.

Dysfunction:

• Sensory Over-Responsivity- Exaggerated response to a stimulus that people with normal sensory systems would find innocuous; feel sensation too easily and too intensely ;"fight or flight" response to those stimuli
• Sensory Under-Responsivity- Decreased response to a sensory stimulus (longer reaction time, higher pain threshold, etc.); poor body awareness clumsiness and movements that are not graded appropriately
• Sensory Seeking- Craving sensory stimulation; insatiable desire for sensory input (constantly moving, crashing, bumping, jumping, touching things); difficulty understanding "their space vs. other's space"

Function: Effortless and automatic adaptation to changes in the environment

Dysfunction:

• Somatodyspraxia- Inability to learn, plan, or generalize motor skills, must include a
• sensory component to the issue to be considered somatodyspraxia
• Ideational difficulties- Inability to conceptualize a goal or the steps necessary to achieve a goal
• Difficulty with motor planning- Inability to automatically organize the movements necessary to perform a skill
• Execution difficulties- Inability to implement a planned action (need motor control)

(Schaaf et al., 2010, p. 112; STAR 2017)

(Schaaf et al., 2010, pp. 115-117)

Bilateral Integration and Sequencing

Sensory Discrimination

Function: Ability to perform smoothly and skillfully use both sides of the body in coordination

Dysfunction: Difficulty with lateralization, crossing midline, performing smooth movements, performing movements with many steps, and establishing hand dominance

Function: Ability to distinguish between a variety of sensory input

Dysfunction: Inability to distinguish between sensory input

(Schaaf et al., 2010, p. 117)

(Schaaf et al., 2010, pp. 113-114)