July 2019

ISSN: 2048-1357

Sensory Integration Education News

The Growing Body of

Sensory Integration Research
Sensory Adapted Dental
Environments
Sharon Cermak on sensory adapted
dental environments for children
with ASD

Dosage and ASI®

Stacey Reynolds and Hope Caracci

Sensory Environment
Questionnaire
Aimee Piller on the Participation and
Sensory Environment Questionnaire

SPM-2
Diana Henry shares more about the
revised assessment

AOTA Conference &

ESIC 2019
Synopsis from the American OT
Association Conference and the
European SI Congress 2019
Contents

Inside this issue

P3 P20 P33
Letter from Assessment ESIC 2019 Bursary
the Editor feature
Awards
Gina Daly tells us The Sensory
about what this Processing Measure We hear from the three SIE members
edition has to offer 2 (SPM-2) with Diana Henry who presented their research at this
year’s ESIC

P4 P24
Assessment Feature AOTA Conference P40
Assessing the Sensory Enviroment Round-up Research Updates
with Aimee Piller
Lelanie Brewer and Amy Stephens References and abstracts for recent

P8
document their key learning points articles related to sensory
from the world renowned AOTA integration and neuroscience
Environmental conference 2019

Feature Interested in writing a feature

for our international publication
Sensory Adapted Dental SensorNet?
Environments to Enhance
Involved in an innovative SI
Oral Care for Children with Autism
research or practice based
Spectrum by Sharon Cermak
project?

P10 Presented your SI research

Practice Based P28 or SI clinical work at a recent

conference?
Feature ESIC 2019 Round-Up Attended SIE modular training
Stacey Reynolds and Hope Caracci on Photo Montage capturing the recent and want to share your learning?
using an intensive design model of SI ESIC 2019 in Greece Contact : Gina Daly, Editor at
intervention in outpatient paediatric gina.daly@sensoryintegration.
settings: How and why to change
practice based on evidence
P30 org.uk for more details and the
authorship guidelines
ESIC 2019
P14 Annie Sampsonidis tells us about her
We would love to hear from you!

Educational Feature role in hosting ESIC.

Editor
Ellen McLaughlin on theoretical
and neuroscience foundations for Gina Daly
paediatric interventions
Membership Enquiries

P17 Suzanne Leyland

Cathy Maguire
Supporting Research
Design
Julia-Marie White received her MSc
through Ulster University and SIE and www.abgdesign.uk.com
shares her research project ISSN: 2048-1357

2 | SensorNet 54 : July 2019 sensoryintegrationeducation.com

EDITOR’S LETTER

Letter from
the Editor Gina Daly

O
ur July edition is here and occupational therapy’s relevance as a environment and the interaction with
we can’t wait to share it with health and human service profession. natural elements, with an emphasis
you! It has been a whirlwind From a sensory integration (SI) on care farming. The study aimed
here at Sensory Integration Education perspective it was magnificent to see to investigate whether contact with
(SIE) since our February edition and that SI was truly embedded in the nature contributes to improving
there is lots of varied content for you AOTA conference programme. There children’s sensory processing and
to enjoy in this current edition. We are is an AOTA SI special interest group therefore to their quality of life. The
honored to have input from a wealth which we joined and connected with beautiful video footage captured the
of experts in the field – Diana Henry, while in attendance. It was clear to see creative sessions which showcased
Sharon Cermak, Aimee Piller, Hope that SI is recognised in the US as being the child interacting on home-made
Caracci and Ellen McLaughlin to name a valuable approach that occupational swings, in water pools, squeezing
but a few. SensorNet is striving to be therapists use within their practice. and tasting natural fruit, discovering
a publication showcasing the latest The 6th European Sensory the various tactile experiences of
evidence, best practice guidelines Integration Congress (ESIC) was grass, hay, and mud all through the
and research pertaining to Sensory brought to us in June and was hosted natural context evoking a real sense of
Integration (SI). by the Hellanic Scientific Society for playfulness and true exploration.
In April, SIE was represented at Sensory Integration. Thessaloniki, in This was in stark contrast to the
the American Occupational Therapy Greece was the chosen location for previous presentation given that
Association (AOTA) conference the congress which brought delegates day, by Annamarie Andersen from
and expo by Lelanie Brewer, Head together from across the globe, with Sweden, which discussed the impact
of Education Programmes, Amy a primarily European audience. Three a sedentary lifestyle is having on
Stephens and myself as the editor occupational therapists were provided our young people today. Maria’s
of SensorNet. The AOTA annual with an SIE travel bursary grant presentation on the Greencare farm
conference and expo is the largest to present their SI research at this also rang very true to the type of
gathering of occupational therapists congress. You can read more about childhood I had growing up in the west
in the world with access to leaders their research within this edition. of Ireland in a small country location
in the field, the latest evidence based We value our SIE members and are where being outdoors in nature was
learning and plenty of networking always encouraging and supporting central to my upbringing and sensory
and social events. The diverse and new research - from early stage career development. This also had remnants
vast programme set out for this researchers to more advanced career of “bringing it back to basics” which
congress was astounding with every researchers. The ESIC programme was Wendy Hildenbrand called for at the
possible area of practice represented. dynamic, engaging and innovative with AOTA conference.
It was an inclusive and stimulating a key focus on bringing SI into everyday This edition has captured key
learning environment with a mix of participation. The theme of the learning and research from both the
short courses, oral presentations, congress was how sensory processing AOTA and ESIC conferences and
research posters, and “conversations translates into everyday participation demonstrates the growing body of
that matter” sessions which were and impacts on the quality of life. knowledge and evidence for sensory
intimate discussion forums with expert This congress pushed the boundaries integration. It also highlights how the
researchers, educators and clinicians. as it explored the possibilities of field of sensory integration is moving
The inaugural presidential address by expanding SI outside the clinical forward and is continuing to progress
Wendy Hildenbrand focused on the setting. With that in mind, there was and evolve.
new 3 R’s - relationships, resilience, a standout presentation given by
and relevance. Delegates were Warmest Regards,
Maria Protopapadaki on “Sensory
encouraged to “get back to basics” integration intervention on a Green
of restoring and creating meaningful Care Farm”, where sensory integration
relationships, embracing our collective intervention was implemented in
strength and capacity for personal and an outdoor farm setting. In this case Gina Daly
professional resilience, and committing study, the intervention was based Find us on Twitter
to innovative “doing” to assure both on the experiences of the natural Find us on Facebook

3 | SensorNet 54 : July 2019 sensoryintegrationeducation.com

ASSESSMENT FEATURE

Assessing the
Sensory Environment
Aimee Piller

Aimee Piller, PhD, OTR/L is a paediatric occupational therapist with more than
13 years experience. She owns and operates Piller Child Development, LLC, a
multidisciplinary paediatric therapy practice located in Phoenix, Arizona, USA.
She completed her masters in occupational therapy at Temple University in
Philadelphia, Pennsylvania, USA and her PhD in occupational therapy from
Texas Woman’s University in Denton, Texas, USA. Dr. Piller is the author of
the Participation and Sensory Environment Questionnaire–Teacher Version.
She has published and presented at a national level on a sensory environment,
interdisciplinary practice with a speech-language pathologist using sensory
strategies to support language development, and the importance and application
of practice-based research. She is passionate about the field of occupational
therapy and continues to practice paediatric occupational therapy with expertise
in sensory integration, feeding therapy, and motor development.

Sensory integration is an the sensory systems processes caregiver burden (Watling &
evidence-based intervention that input. Interventions provide Hauer, 2015). Sensory integration
is designed to influence children enhanced sensory experiences to is implemented by skilled
and adults with sensory processing illicit an adaptive response with occupational therapists to
differences to remediate sensory the result of improved adaptation, improve sensory processing of the
processing difficulties with the sensory processing, and in turn, person and increase participation
goal of increasing participation. participation (Bundy, Lane, within various environments
Sensory processing differences Murray, 2002). ​ and activities. Working from an
may occur in any of the sensory Sensory integration is an SI perspective involves eliciting
systems, in all of the systems, effective treatment for children an adaptive response and
or in how the sensory systems with various sensory processing building upon these adaptive
integrate and process together. needs. Although evidence is responses which will ultimately
Sensory processing consists of still emerging, current research change routines and habits thus
registration, modulation, and demonstrates the effectiveness increasing participation. The
the habituation of sensory input. of the intervention in improving sensory environment is an often-
Traditional sensory integration motor skills, participation in overlooked aspect of the physical
treatment was designed to structured tasks, sleep, social environment, but can greatly
address the difficulties in how participation, and reducing impact participation,

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ASSESSMENT FEATURE

especially for individuals with Direct sensory integration The result of the interaction of
sensory processing differences. intervention is an effective the person and the environment
Occupational therapists function treatment that utilizes the is participation (Law et al.,
under the assumption that environment to facilitate 1996). When the fit between
participation is a result of the the internal adaptive the environment and the
interaction of the person and process of the child. person is poor, participation is
the environment (Law, Cooper, Consideration of the sensory negatively impacted. The better
Strong, Steward, Riby, & Letts, environment in treatment the fit between the person and
1996). Participation increases can influence participation the environment, the more
when there is a greater fit and allow therapists to the person has successful
between these two elements. design interventions that can participation in occupations.
For a child with sensory increase participation within If the person is experiencing
processing differences, the fit chosen occupations. sensory processing difficulties,
between the person and the Participation is a key goal in and the components of the
environment is frequently occupational therapy principles sensory environment are a poor
poor, resulting in decreased and sensory integration fit for that individual’s sensory
participation. Occupational treatment is a tool used by processing, then the person may
therapists may utilize sensory occupational therapists to have decreased participation.
integration treatment to increase participation of For example, a child with hyper
remediate sensory processing the child or adult in chosen reactivity to auditory input
differences and increase the occupations. Participation and may have poor participation
fit between the person and the environment are linked in a room that is next to a
environment with a result together with one consistently construction zone that has excess
of increased participation. influencing the other. background noises.

Post-Intervention: Maximized fit between Person, Environment & Occupation

• Hyper reactivity
• Place sound absorbent
to sounds
material on walls
• Hypo reactivity to
• Sit child next to student
movement Person Environment
with quieter instrument for
• Decreased motor child to play
planning
• Child sits in rocking chair
for movement
• Provide visual schedule of
music time
Occupational Occupation
Performance:
Fit is maximized such that
child is participating with
group during music time.
Music Time-Supports & Modifications
• Teacher simplifies movement of songs
• Teacher builds in gross motor movement times for songs
From Piller (2017) adapted • Instrumental playing is modified to meet child’s motor skills
from Law et al., 1996 • Physical & verbal support is provided as needed

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ASSESSMENT FEATURE

The child may be so overcome and participation within one

with sensory input within the assessment. By examining
environment, that the child is these two concepts in a single
unable to participate to his or her assessment, therapists can
fullest ability simply because of design specific environmental
the poor fit between the person interventions that target
and the environment. Instead of increased participation in
participating in play and school specific tasks.
tasks, the child may run from ​ e PSEQ–TV is a teacher
Th
the room, stay away from the report assessment that consists
group, cover his or her ears, thus of three subtests designed
impacting the ability to engage to examine the impact of
in play and social activities, etc. the sensory environment on
Conversely, the same child with participation. The first subtest
auditory sensitivities in a quiet explores specific activities and
room, absent of background tasks that occur within the
noise may experience no preschool setting. Activities and modifications are currently
difficulties in participation, and include things such as circle needed to support participation.
perform all activities and tasks as time, snack or lunch time, Initial testing reveals that
the other children. This example classroom routines, instructional the PSEQ–TV is a reliable and
indicates the impact of the time, movement time, etc. valid assessment. Reliability
sensory environment. Each activity is broken down was established via internal
​Under sensory integration into specific tasks a child may consistency of 0.98 and test-retest
theory, therapists typically perform during the school day. reliability of 0.70. Construct
evaluate the sensory processing The respondent is asked to and content validity have
patterns of the person. They indicate how much the sensory also been established (Piller,
do not necessarily formally aspects of the environment Fletcher, Pfeiffer, Dunlap, &
examine the sensory aspects of impact participation for the child Pickens, 2017). Currently the
the environment. By including on a Likert scale from “none” assessment is available for free
an assessment of the sensory to “too much to participate.” use from https://participation
environment, the therapist is The second subtest explores andsensoryenvironment.weebly.
able to intervene at the level of the amount of support a child com/pseq---teacher-version.html.
the environment to increase is provided to participate in an The PSEQ–TV is a companion
participation more immediately. activity. Support may be physical, assessment to the Participation
The Participation and Sensory verbal, or visual. The third and Sensory Environment
Environment Questionnaire– subtest examines modifications Questionnaire (PSEQ) (Pfeiffer,
Teacher Version (PSEQ–TV) to the environment that support 2017), a parent report tool
(Piller, 2017) is an assessment participation. Modifications that examines the impact of
designed to examine the sensory include physical changes to the sensory environment on
environment, specifically the the environment, changes activities and tasks within the
school environment and how it to the task, or changing the home and community. The PSEQ
impacts participation for young timing of the activity. The and PSEQ–TV follow the same
children. Because of the unique assessment provides a baseline format for subtests and scoring,
aspects of each environment, for identifying where the child but are designed to examine
it is important to examine may be having barriers in three different environments,
specific environments, in this participation due to the sensory which are the school, home, and
case the preschool environment, aspects of the environment the community environment for
as well as how much support young children.

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ASSESSMENT FEATURE

The PSEQ also exhibits and modulation with the PSEQ which is designed to remediate
initially strong psychometric or PSEQ–TV, the therapist sensory processing differences.
properties with reliability at needs to use skills to analyse The PSEQ and PSEQ–TV is
0.96-0.98 and test-retest at 0.62- the activities and tasks that not only designed to identify
0.76. Evidence of construct, are impacted by the sensory barriers within the environment,
content, and concurrent validity environment, the information but also facilitators within the
have been established (Pfeiffer, gathered from using the PSEQ environment. Often teachers and
Piller, Slug, & Shiu 2018; and PSEQ–TV. In addition, the parents almost innately modify
Pfieffer, Piller, Bevans, & therapist must also consider the tasks and the environment or
Shiu, 2019). This assessment results of the sensory registration provide support to facilitate
is available for free at https:// and modulation profile of the participation (Piller & Pfeiffer,
participationandsensoryenviron child. The therapist should 2016). By honing in on specific
ment.weebly.com/view-pseq-tv. examine what aspects of the facilitators, the therapist can
html sensory environment influence guide teachers and parents
​The results of the PSEQ and participation based upon the to provide the best support
PSEQ–TV provide therapists child’s sensory processing. For and modifications to increase
with unique information about example, if the child’s sensory participation of their children.
how the sensory environment registration and modulation I​ n summary, the sensory
impacts participation within profile indicates hyper reactivity environment is often considered
specific activities and tasks. to tactile and the child is when addressing children with
When the results of this experiencing great difficulties sensory processing difficulties,
assessment are combined with in circle time participation, the but not in a formal manner.
other assessments that identify therapist may conclude that the Examination of the sensory
the sensory processing needs of tactile sensitivities of the child environment through a formal
the child, the therapist is able in combination with the tactile assessment, such as the PSEQ
to tailor interventions within aspects of the environment (i.e. and PSEQ–TV, provides a
the environment to change the other children sitting near and method to identify barriers and
sensory features to better fit the unexpectedly touching the child) facilitators to participation within
sensory needs of the child. This in may be impeding participation. the sensory environment. In
turn will increase participation. The therapist would then design combination with identification
Assessments that identify an intervention to modify where of the sensory processing needs of
sensory processing, specifically the child is sitting to decrease the person, the PSEQ and PSEQ–
modulation and registration, that unexpected tactile input of TV provides guidance for the
can be used in combination with other children. The modification therapist to design interventions
the PSEQ–TV and PSEQ include may be providing a separate that modify the environment,
assessments such as the Sensory area for the child to sit away thus increasing participation in a
Processing Measure (Parham, from other children, sitting in more immediate manner.
Ecker, Miller Kahaneck, Henry, a chair or modified chair to
You can reach Aimee
& Glennon, 2007) and Sensory provide a physical boundary
at: aimee.piller@pillerchild
Profile 2 (Dunn, 2014). These from unexpected touch of other
development.com
assessments assess the sensory children, or wrapping the child
in a weighted blanket while he or References:
processing patterns of the person
she sitting in circle time. https://www.sensoryintegration.
while the PSEQ and PSEQ–TV
org.uk/page-18983
examine the sensory features of Modifications to the sensory
the environment and how those environment can increase and
influence participation. facilitate participation, but are
To combine the results of the not designed to take the place
assessment of sensory registration of sensory integration therapy,

7 | SensorNet 54 : July 2019 sensoryintegrationeducation.com

ENVIRONMENTAL FEATURE

Sensory Adapted
Dental Environments
for Children with ASD
Sharon Cermak

Sharon A. Cermak, Ed.D., OTR/L, FAOTA and Marinthea Richter, MA, OT

share their work on this exciting project which is continuing to expand across
client populations. The SIE team had the pleasure of meeting Sharon at both
the AOTA conference and at the ESIC where we connected, shared ideas and
discussed her research which she has detailed below.

Going to the dentist does not it difficult for families to find a disabilities (Shapiro, Melmed,
often make it to the top of any dentist. Ensuring good oral hygiene Sgan-Cohen, & Parush, 2009).
“fun things to do” list. The sound for children is crucial to overall Dr. Sharon Cermak (EdD), a
of the dental equipment, the health and well-being, however it professor at the Chan Division
sensation of the materials in and may be difficult to ensure adequate of Occupational Therapy and
around the mouth and the bright care for children with ASD given Occupational Science at the
lights and occasional strange their behavioral challenges. As University of Southern California
chemical smells is enough to a result, some children need (USC) was inspired by the work
make anyone apprehensive. Now pharmacological measures done by Dr. Shapiro and secured a
imagine how this experience is such as general anaesthesia for grant from the National Institute
perceived by children who are oral care. However, the risk of Dental and Craniofacial
hypersensitive to sensory input. and cost of performing routine Research (NIDCR) to conduct a
Children with Autism Spectrum preventative dental care under pilot and feasibility pilot study
Disorder (ASD) have a high general anaesthesia may preclude using SADE with children with
rate of co-occurring challenges this option for many children ASD to examine whether SADE
in sensory processing which with ASD. As such, innovative reduces physiological anxiety,
negatively affects their oral care approaches to oral care are needed. behavioral distress and subjective
(Stein, Polido, & Cermak, 2013). Initial research into Sensory pain during dental cleaning. The
They may become overwhelmed Adapted Dental Environments research was done in collaboration
by everyday sensory experiences (SADE) for children with with an interdisciplinary team
that may not bother typically developmental disabilities was including Dr. Jose Polido, DDS,
developing children, resulting in conducted by Dr. Michele Shapiro Director of the Dental Clinic at
increased self-stimulation and from Beit Issie Shapiro Centre in Children’s Hospital Los Angeles
negative behaviors that may make Israel. This study found that SADE (CHLA) and Associate Professor
oral care extremely challenging for could potentially be an important at the Ostrow School of Dentistry
the dental team and traumatic for consideration for dental cleaning USC, Marian Williams, Ph.D., a
the children and their family. As as it helped to enhance cooperative clinical psychologist at the USC
such, many dentists are not willing behavior and relaxation of 16 University Center for Excellence in
to treat children with ASD making children with developmental Developmental Disabilities at

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ENVIRONMENTAL FEATURE

CHLA and Michael Dawson, environment more comfortable processing and understand
PhD, a psychologist with expertise (Cermak et al., 2015). These results how sensory input from the
in Electrodermal Activity measures were encouraging as it showed that environment can influence
at USC. SADE might be beneficial for both the participation of people
The pilot and feasibility neurotypical children and children with sensory sensitivities. This
study included 44 participants with ASD, although the ASD group multidisciplinary research has
(22 children with ASD and 22 demonstrate greater benefits than given the professionals involved
typically developing children) the typically developing children. the opportunity to critically
between the ages of six and twelve The children with ASD also examine the often overlooked role
years. The children each had required fewer people to restrain of environmental design within
two dental visits (four months them during the cleaning in the health care and discuss how we can
apart), one in a regular dental SADE compared to the regular adapt settings to allow enhanced
office without any adaptations dental environment. This implies participation of children and
and one in the same dental office lower costs for care if fewer people adults with disabilities. We have
but with sensory environmental are needed to provide the care. extended our work to include
modifications. The modifications With these exciting results, suggested modifications to waiting
included playing soothing music Dr. Cermak applied for a large rooms, at oncology units, and in
(a mixture of classical music and grant from the NIDCR to launch emergency rooms. Environmental
nature sounds) in the background, a full-scale randomized control modifications have great potential
dimming the overhead fluorescent trial. A larger sample would to allow better access for children
lights, projecting soft moving provide better information about with ASD to dental care. As the
images (“blue or purple lava lamp the effectiveness of SADE and dental environment is more
bubbles” or swimming fish) onto enable the researchers to look at welcoming, we expect that children
the ceiling, and having the dentist moderating variables such as the will be less anxious and show more
use a dentist headlamp rather than child’s age, autism severity, and cooperative behaviour. In turn,
the large dental light. In addition, IQ, and also look at mediating parents will be less apprehensive
the dental chair had a cover on it variables to better understand about scheduling return visits to
with a butterfly with wings that causal mechanisms. This study the dentist, and dentists might be
attached to the side of the chair. was funded by NIH and is currently more willing to serve children with
An X-ray bib was placed over the underway with more than 200 ASD and other disabilities. These
child and the wings of the butterfly participants with ASD enrolled in factors will improve oral health for
wrapped around the child’s body the study. The team also added an children with ASD.
providing a deep pressure hug. economist to the team, Dr. Joel Research in this area is
These modifications were designed Hay, Professor of Pharmaceutical ongoing and expanding. In a
to decrease the child’s anxiety. and Health Economics at USC, to supplemental study, Dr. Cermak
Two electrodes were placed on examine cost effectiveness of the and her team received funding
the child’s fingers and we recorded intervention. The research team at to conduct a feasibility study of
electrodermal activity (EDA) CHLA and USC is currently hard SADE with children with Down
before, during, and after the at work collecting the data and are Syndrome. Dr. Cermak believes
dental cleaning to determine the eagerly awaiting the results. that this research has the potential
children’s physiological anxiety The SADE research has to revolutionize the manner in
levels. We also video-recorded opened the door for wonderful which children with disabilities
the child during the cleaning and collaboration between occupational receive oral health care services
coded it for child distress. Children therapists and dental professionals. not only in the United States of
completed subjective evaluations of Looking at the environmental America but around the globe.
pain and sensory discomfort after enhancement from a sensory References:
the dental cleaning and the dentist perspective is an emerging area https://www.sensoryintegration.
rated levels of cooperation. Both of occupational therapy practice. org.uk/page-18983#Ref2
groups of children had reduced Occupational therapists have a
subjective pain levels, reduced wealth of knowledge about sensory
anxiety, and found the SADE

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pRACTICE BASED FEATURE

Dosage in Ayres
Sensory Integration Stacey Reynolds

Stacey Reynolds and Hope Caracci on using an intensive design model of

SI intervention in outpatient paediatric settings: How and why to change
practice based on evidence.

H
ope and Stacey met some history of conducting funded Sensory Integration and Praxis
of the Sensory Integration research with over 30 peer Test (SIPT).
Education team at this review publications in the area of
Ayres Sensory Integration®
year’s American Occupational sensory processing and pediatric
Therapy Association Annual neurodevelopmental disorders. According to Ayres’ theory of
conference where they spoke Her research, conducted in the sensory integration, sensation
about the topic of ASI® and VCU Sensory Processing and (in various forms) provides the
dosage. Their highlights from this Space Evaluation (SPASE) lab, basis for learning and behavior.
congress included Ellen Cohn’s has focused on how children with Further, successful integration
Eleanor Clark Slagle lecture. neurodevelopmental disorders of sensory information is
Another highlight was seeing respond to sensory stimuli in necessary for appropriate
more and more practitioners their environment and how these adaptive responses and therefore
speaking at AOTA 2019 about responses impact functional supports participation in
shared decision making tools that performance and behavior. occupation. Foundational to
may assist therapists be more sensory integration theory is the
Hope Caracci is the Quality
client-centered and better able idea that both sensation and our
and Staff Development Manager
to make individualized decisions responses to sensation shape
in a large pediatric therapy at
regarding frequency, duration our interactions with the world,
The Children’s Hospital of The
and intensity of care. and have the capacity to alter
King’s Daughters in Norfolk,
brain pathways through neural
Stacey Reynolds is an Virginia. Hope has 20 years of
plasticity (Schaaf et al., 2010).
associate professor at Virginia experience as an occupational
Commonwealth University therapist with 15 of those ​ e term Ayres Sensory
Th
(VCU) and has a 10+ year years devoted to children. She Integration® (ASI®) refers to
specializes in treating children an individualized therapeutic
diagnosed with ASD and SPD as approach that is based on Ayres
well as determining appropriate theory and practice, which was
Hope Caracci
frequency, intensity and duration designed to remediate sensory
for children with chronic integrative problems in children.
conditions. Hope has published ASI® is also sometimes called
and presented on topics such as OT-SI to emphasize the focus on
evidence based practice, episodic occupation and participation as
care, mentorship, and leadership outcomes of improved sensory
at the local and national level integration. In this intervention,
and is certified to administer the an occupational therapy

10 | SensorNet 54 : July 2019 sensoryintegrationeducation.com

pRACTICE BASED FEATURE

practitioner presents activity Table 1. OT-SI High level of evidence dosage table
challenges individually tailored to
Citation Total number How many Average number of Length of
improve the sensory integration of sessions weeks? sessions per week each session
capacity of a child by helping the Miller, Coll & 20 10 2 45 - 60 mins
brain be better able to organize Schoen (2007)
sensory information. Within Pfeiffer et al. 18 6 3 45 mins
this approach the occupational (2011)
therapist creates an environment Schaaf et al. 30 10 3 60 mins
that evokes increasingly complex (2014)
adaptive responses from the child
using the child’s own drive and
​Miller, Coll, and Schoen (2007) for 45 minutes for six weeks.
interest to facilitate engagement.
randomly assigned 24 children Group 1 received an OT-SI
This approach is much different
with sensory modulation intervention based on Ayres
from a sensory – based approach
dysfunction (SMD) into an OT-SI theory and adhering to fidelity
in which a more passive
group, no treatment group, or criteria, and group 2 received
application of sensory strategies
an activity group. Children were fine motor (FM) interventions;
is applied to a child (Reynolds et
evaluated for sensory modulation assignment to either Group
al., 2017).
disorder (SMD) using rigorous 1 or Group 2 was random.
Best Evidence criteria; comorbidities included Both groups demonstrated
The strength of intervention attention deficit hyperactivity significant improvements
research in the fields of medicine disorder (ADHD) or learning towards individualized functional
and health care are frequently disability. The children were goals, but the OT-SI group
rated according to hierarchies provided therapeutic intervention demonstrated statistically greater
of evidence. These hierarchies 2x per week for 45-60 minutes improvement than the FM group.
enable different research methods for 10 weeks. Results found The OT-SI group also showed
to be ranked according to that the group receiving OT-SI fewer mannerisms associated
their rigor and validity of their made functional gains that were with autism than the FM group
findings. Three articles have been significantly greater than the as measured by the Social
published studying the effects children in the other two groups. Responsiveness Scale, indicating
of OT-SI, which are ranked at Children in the OT-SI group OT-SI interventions may have an
the highest level of evidence for also increased significantly more impact on core features of Autism
their research design and also than the other groups on the Spectrum Disorder (ASD).
include other elements of rigor Attention subtest and Cognitive/ Schaaf et al. (2014) randomized
including the use of intervention Social composites of the Leiter children into OT-SI group and
fidelity manuals and measurable International Performance Scale- usual care (UC) intervention
functional goals (Miller, Coll, Revised. Outcomes on the Short group, and they received
& Schoen, 2007; Pfeiffer et al., Sensory Profile, Child Behavior intervention 3x per week for 60
2011; Schaaf et al., 2014). These Checklist and physiology were minutes for 10 weeks. Inclusion
three articles are discussed in the expected direction, with criteria included diagnoses of
briefly below. Importantly, all the OT-SI group having greater autism and sensory processing
three apply OT-SI using a high- gains, but statistically significant disorder (SPD). Results showed a
frequency dosing model of 2-3 differences were not found with significant difference between the
times per week for 6-10 weeks. the small sample. OT-SI group and the UC group
​ feiffer et al. (2011) studied
P on individualized functional goals
two groups of children who with the OT-SI group achieving
received OT services 3x per week significantly higher scores.

11 | SensorNet 54 : July 2019 sensoryintegrationeducation.com

pRACTICE BASED FEATURE

Results also revealed outpatient pediatric practice Scientific reasoning guides

significantly greater settings continue to see clients a therapist to apply research
improvement for the OT-SI once a week indefinitely. And evidence to clinical practice, and
group compared to the UC little research exists to explain in the case of OT-SI, informs
group in the areas of Self- the process practitioners might practitioners to consider
Care Functional Skills and use to select the dosage for a applying an intensive dosage
Social Functions subtests of client’s plan of care or what of therapy. However, other
the Pediatric Evaluation of factors influence their decision forms of reasoning also inform
Disability Inventory (PEDI). No making. Some factors might the decision making process.
significant changes were shown include the culture of the facility Pragmatic reasoning addresses
on the Pervasive Developmental (e.g., the expectations that clients “…both the practice context in
Disorders Behavior Inventory. will be seen a certain number of which therapy is occurring as
​Based on these three high times per week) and scheduling well as personal factors within
level studies, there is reason logistics (Caracci, Reynolds & each individual practitioner”
to support the use of an OT- Ivey, 2018). However, it’s unlikely (Schell & Schell, 2008). When
SI approach for children with that these factors alone will applied to OT-SI, pragmatic
deficits in sensory processing result in the optimal therapeutic reasoning leads practitioners
which impact function. However, dose for each client. There is also to consider if they have the
it is important to not only pressure that some clinicians proper training, environment,
consider the type of intervention, feel obliged to continue services and equipment to implement
but the dosage used during as long as a family desires, the intervention. It also leads
service delivery. And if we are which may lead to children the therapist to collaborate with
using these studies to support remaining on a therapists families to ensure that they are
our clinical practice, there is a caseload for prolonged periods able to participate in an intensive
need to contemplate how dosage of time. Fortunately, scientific, frequency of therapy. That is,
is being determined in clinical pragmatic, narrative, interactive, is the family able to commit to
practice as well. conditional and ethical reasoning being at therapy 2-3x per week?
may help therapists make Do they have the transportation
educated decisions about dosage and resources to attend
Clinical Reasoning
in occupational therapy using consistently? Do they understand
Despite the evidence described OT-SI approach and effectively the financial implications of
above, most practitioners in communicate decisions to intensive therapy? Are they able
families and administrators. to afford multiple co-payments
each week? The answers to these
questions may support or deter
a therapist from recommending
a high frequency OT-SI approach.
As a therapist considers
whether an intensive OT-SI
approach is warranted they may
use interactive and narrative
reasoning to see the big picture.
Practitioners may maximize the
therapeutic relationship and build
rapport through active listening,
sharing personal stories,

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pRACTICE BASED FEATURE

subsequent therapy sessions.

Practitioners must monitor and
report progress to caregivers
regularly, and changes to
frequency should be made if a
lack of progress is noted. This
is especially important because
families are investing a high
level of time and resources to
the care plan, and should not
continue to do so if the plan is
not working. Goal Attainment
Scaling (GAS) may be one way
to create goals that provide
joint problem solving, objective information that may
Physical Therapy Association,
and using positive verbal and inform a therapist and caregiver
and American Speech-Language-
nonverbal communication. of progress or lack thereof (for
Hearing Association released
This type of reasoning is closely more information on GAS see
a joint consensus statement
aligned with Ayres’ approach to Mailloux et al., 2007).
indicating it is not acceptable
using an individualized, client for administrative guidelines to Conclusion
centred approach to intervention. influence a clinician’s clinical Sensory integration interventions
With a “no therapist left behind” judgment related to dosage. That continue to be heavily
mentality clinicians, caregivers is, a therapist must ethically make scrutinized, yet they are one of
and children become partners decisions related to how much the professions most evidence
during intervention. and how often a client is seen in based approaches for children
During this process the therapy based on their clinical with neurodevelopmental
therapist will ensure caregivers and professional reasoning disorders. It is important that
are directly involved in all secondary to the client’s need for clinicians and administrators
sessions, and consider a family’s skilled services. understand how to make the
past experiences and expectations Conditional reasoning guides best decisions related to the
to make sense of their therapists to monitor therapy frequency and duration of OT-
circumstances and recommend progress and be flexible and SI and how to support their
dosage based on what is best for respond to changing conditions. decisions using evidence based
the individual client. Therefore, when recommending a practice, clinical reasoning and
Ethical and conditional high frequency of intervention it caregiver collaboration.
reasoning should also guide a becomes increasingly important
therapist’s decision for dosage, for practitioners to create References:
and national therapy associations goals with caregivers that are https://www.sensoryintegration.
have started providing guidance realistic and easily monitored, org.uk/page-18983#Ref3
for practitioners related to this with a specific start and end
decision making process (Caracci, date. Discharge should be the
Reynolds, & Ivey, 2018). In 2014 goal, and therefore discussions
the American Occupational regarding discharge should occur
Therapy Association, American upon initial evaluation and at

13 | SensorNet 54 : July 2019 sensoryintegrationeducation.com

EDUCATIONAL FEATURE

Theoretical and
Neuroscience foundations
for paediatric interventions
Dr. Ellen McLaughlin, Ed.D., OTR/L, FAOTA, is an
associate professor and Program Director, for the
Occupational Therapy programme in Misericordia
University. She presented a short course on
"Theoretical and Neuroscience Foundations for
Paediatric Interventions" at the AOTA conference in
April. This presentation was evidence based and the
Ellen McLaughlin
information was synthesised succinctly which made
it meaningful for clinicians. Dr. McLaughlin, kindly
shared a snapshot of this short course for the benefit
of our readers allowing us to disseminate information
from this international conference.

As therapists we always strive to We can adapt this challenge appropriate challenge and dosage,
provide the best experiences for about research to our activities changes to the brain will occur
our clients so they can achieve as clinicians by: (Lane & Schaaf, 2010).
their potential. Clearly specifying There is a strong foundation
the theoretical and neurological • Ensuring that valid of basic research that supports
principles that underlie some of assessments have been conducted these claims (Lane & Schaaf,
our most common interventions to confirm that the performance 2010), yet therapists must consider
helps us to move in that direction deficits seen are due to sensory and specifically apply each of the
efficiently and effectively. In a processing difficulties. elements in this principle.
recent editorial, The State of the • Articulating the specific
Active involvement in an
Science in Sensory Integration principle that guides the
(Pfeiffer, May-Benson & enriching Sensory Environment
intervention being used, with
Bodison, 2018, p. 2) it was stated, some understanding of the When providing multisensory or
“researchers should articulate the neurological processes of why the cross modal sensory interventions
underlying mechanism for why intervention is proposed to work. it is essential that these sensory
the intervention…..is expected elements be required components
to enhance child participation… of the task. Strong task analysis
this would allow researchers to Sensory Integration from a skills with critical judgment
test the underlying theory of Broad Perspective​ must be applied here, as simple
why the intervention is thought inclusion of a specific sensation
to be helpful, as well as the Principle: If we provide an may not be enough to elicit the
intervention’s effectiveness in enriching sensory environment, change in the nervous system.
supporting child participation. “ with active engagement & Recent computational models of
multisensory processing in the

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EDUCATIONAL FEATURE

brainstem suggest that for sensory In this case, activation of Colum Pathway - Thalamus
integration to advance during mechanoreceptors (by shaking – Posterior Insular Cortex –
development, direct experience in your hand, rubbing or placing Orbitofrontal Cortex
coordinated sensory processing pressure on the skin) starts
Principle: If we utilize
is necessary to surpass the brain’s a process called presynaptic
soothing social touch we can
tendency to have individual inhibition, whereby the pressure
impact emotional regulation, and
sensory inputs compete, rather impulses conveyed along the
promote social responsiveness
than collaborate (Cuppini, Stein & dorsal column medial leminiscus
and connection.
Roland, 2018). pathway “fire back” at the dorsal
Soothing social or pleasant
horn area of the spinal cord to
Appropriate challenge & dosage touch is differentiated from
inhibit the nociceptive (pain,
To achieve this, it must be based discriminative touch or pressure
tickle, itch) sensations that are sent
on a valid, clear assessment, touch. While it starts out on the
along the anterolateral nociceptive
with interventions focused to same dorsal column pathway, the
pathway, to lessen them. When
include the specific sensory receptors are different, and the
deep pressure is instead used for
functions implicated, at the final processing areas in the brain
a more generalized effect, other
just right level, as one size does are different.
pathways are implicated and the
not fit all in respect to sensory It has been shown through
focused neurological effect occurs
integration interventions. physiological measures, behavioral
higher up, in brain stem areas.
These brain stem areas impact responses and functional brain
the reticular activating system imaging that these C tactile
Deep Pressure
which has a direct influence on primary afferents contribute to
increasing parasympathetic activity pleasant touch and provide an
Key Neurological Areas:
through increased vagal tone, and important sensory underpinning
Low threshold Aβ
decreasing sympathetic response. of social behavior (Liljencrantz
Mechanoreceptors - Dorsal
The effect of deep pressure using & Olausson, 2014). For this type
Horn - Dorsal Column
a pressure vest after a stressor was of touch, the emotional, sense of
Pathway - Reticular Formation
applied, resulted in outcomes such self/ body scheme, interoceptive
-Vagal and Parasympathetic
as lessening of arousal as measured and embodied cognition
System - Sympathetic System -
by physiological parameters processes of the brain are most
Cortical Awareness.
such as heart rate, respiration, impacted. Clinicians working
Principle: If you apply sustained, electrodermal activity (Reynolds, with mental health and trauma
deep tactile input to the skin, it Lane & Mullen, 2015). Champagne, may be particularly interested in
can produce an inhibited, relaxed Mullen, Dickson, & Krishnamurty investigating evolving research
state in the client, affecting such (2015) confirm the physiological in this area, as it indicates that
areas as mood, muscle tone, and effects of deep pressure sensation activation of these fibers triggers
autonomic function. in adults. More recently, Bestbier oxytocin release, reducing
A common intervention & Williams (2017) provided an physiological arousal, impacting
for occupational therapists account of significant results in positive affect and potentially
to employ is the use of deep a well-designed study conducted inhibiting pain (Walker, Trotter,
pressure, often as a method to in a residential facility with 8 Swaney, Marshall, & Mcglone).
calm the nervous system through children with autism or severe
brushing, wrapping in blankets, intellectual disabilities over a
Movement Input
and using compression devices period of three months.
or garments. When we use deep
Key Neurological Areas:
pressure to reduce a negative
Soothing Tactile Input Oxygen consumption –
sensory tactile experience,
improved inhibition evident via
such as tactile defensiveness,
Key Neurological Areas: EEG – increased activation of
we are incorporating a process
Unmyelinated C Tactile anterior cingulate cortex and
involving presynaptic inhibition.
Afferents on Hairy Side of Skin superior frontal gyrus – better
-Mechanoreceptors-Dorsal executive functioning.

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EDUCATIONAL FEATURE

Principle: Movement increases randomly assigned to a 2-week hunger, thirst, urination, sleep, and
blood flow to the brain, promoting mint gum chewing experience, or those that reflect emotions such
attention, mental clarity and a control group the gum chewers as anxiety, excitement, and calm.
memory. Movement will assist were found to have significantly It includes any bodily information
children to focus. better scores on measures of that is sent by either small diameter
Movement breaks, sensory anxiety and mood (Yu, Chen, Liu, C or A fibers through lamina I and
pathways, advocating for recess & Zhou, 2013). Geriatric research the spinothalamic tract to the insula
time…all of these activities also shows us that there is a clear and cingulate cortex (Craig, 2002),
contribute to better attention, association between geriatric loss and to vagus and glossopharyngeal
executive functioning and of teeth and loss of the ability to cranial nerves and the solitary tract
learning for our children. Studies chew with cognitive decline and (Critchley and Harrison, 2013).
with elementary and adolescent dementia (Azuma, Zhou, Niwa, & Mahler (2017) provides a multitude
children have demonstrated this Kubo, 2017). of interventions addressing distress
on a neurological level through It all starts when the muscle tolerance and recommending
viewing activity of the brain, as spindle embedded in the muscle mindfulness skills to improve
well as in academic outcome and the golgi tendon organ interoceptive awareness and
measures (Hillman, et al, 2014). located on the tendon, which are provide increased self-control for
The more consistency, enjoyment sensory receptors, detect muscle better occupational performance,
and intensity we can integrate and tendon lengthening and particularly for children with
into these movement activities, shortening. These impulses are autism spectrum disorder. Payne,
the better. sent through conscious pathways Levine, and Crane-Godreau,
to our cortex for awareness, and address interoception difficulties
through unconscious pathways to and interventions associated
Proprioception with trauma.
our brainstem for cranial nerve
input from chewing. Chewing Interoceptive feelings are
Key Neurological Areas: suppresses the hyperactivity of the regulated by the brain’s insular
Muscle spindle and golgi tendon hypothalamus-pituitary-adrenal cortex. Today’s scientists are now
sensory receptors – dorsal column (HPA) axis which then can have identifying connections between an
pathways to conscious cortical a positive effect on, stress related under or over-functioning insular
and unconscious brainstem hippocampus cognitive deficits. cortex with ASD, OCD, PTSD,
areas – hypothalamus, pituitary, ADHD, anxiety, BPD, etc.
adrenal areas
It is often our intent to improve
Interoception
Principle: If we activate sensory processing and integration
proprioceptors in the context and to modulate arousal and
Key Neurological Areas:
of meaningful occupation, we emotional regulation levels, as
Visceral organs or muscles - these are neurological foundations
can increase awareness of body
small diameter C or A fibers – essential for the social interaction,
scheme, modulate arousal state
spinothalamic tract or vagus and attention and environmental
and ultimately improve focus in
glossopharyngeal cranial nerves interactions that are embedded in
purposeful activity.
and the solitary tract– insula – the performance demands of every
One way that therapists
cingulate cortex. child’s day. When we carefully
often use proprioception is to
help children modulate their Principle: If we optimize our ability consider the theoretical and
arousal levels through oral motor to detect and process interoceptive neurological principles that support
stimulation, specifically chewing. signals we can influence sensory our interventions we increase
Chewing is an effective stress- and emotional regulation our chances of providing the best
coping behavior. While evidence supporting daily behaviors. therapeutic outcomes possible.
was not available to document Interoception is the sensing and References:
the impact of this clinically awareness of our internal body
https://www.sensoryintegration.
with children, in a comparison signals, including those that help
org.uk/page-18983#Ref4
of nursing students who were us maintain homeostasis, i.e.

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SUPPORTING RESEARCH

Supporting Research
Julia-Marie White received her MSc through
Julia-Marie White
Ulster University and Sensory Integration
Education. Here, she shares her research project.
Julia-Marie White qualified from London South Bank University as an
occupational therapist in 2007, and has since worked in various roles within
Forensic Mental Health services. Attending an ‘Introduction to Sensory
Integration’ course through SI Education in 2011 provided a ‘lightbulb
moment’, and she consequently embarked upon the modular pathway
to become a qualified ASI practitioner, completing her MSc in Sensory
Integration with Distinction through Ulster University and SI Education in
Dec 2018. Julia-Marie shares her findings from her research project entitled
“A mixed-methods approach to investigate the implementation of Ayres’
Sensory Integration® (ASI) by qualified ASI practitioners working with
adolescents / adults / older adults in the UK”.

Take a moment and consider effective intervention (Eccles are appealing for increased
how you have found the and Mittman, 2006). We are fast practitioner engagement in
process of implementing Ayres’ approaching 2020; for the ASI advocacy, education and practice-
Sensory Integration® (ASI) community, this marks 100 years based research activity, to better
in your workplace following on from the birth of the theory’s capture service user outcomes
qualification. Have you managed originator, Dr A. Jean Ayres and and move the field forward
to implement ASI in the way that proposes a vision for future ASI (Schaaf et al., 2015). Implementing
you envisaged, or at all? Along development. For the NHS, it is evidence-based practice can be
your journey, have you been able the target year marked to close complex though, demonstrated
to communicate your factors for the projected £30 billion funding by the growing research field
success and discuss the associated gap (NHS England, 2014). Whilst of implementation science.
challenges? It turns out that associated service redesign There is acknowledgement that
stopping to think about these may offer ASI practitioners’ interventions (such as ASI)
questions may provide a useful opportunities for newly that aim to improve quality
conduit to improve both our own commissioned health care roles, and outcomes for clients may
ASI practice and others’. the focus on cost-effective and not always be fully realized due
The ability to implement outcomes-focused service delivery to implementation challenges
evidence-base into routine requires us to demonstrate (Aarons et al., 2011). In order to
practice is key to demonstrating effective intervention. Within this address these challenges, research
climate, leading ASI researchers

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SUPPORTING RESEARCH

suggests that consideration Quantitative data sought to The quantitative data identified
of the environmental, contextual provide descriptive statistics two key, statistically significant
and cultural factors that affect to define ASI practitioner/ variables that had a positive
implementation (Marshall 2011; workplace characteristics and impact upon ASI implementation:
Shaw 2012) can support our provide a broader understanding ‘Support from service leaders’
practice development, and help of variables that might be linked and ‘Sufficient supervision to
transfer knowledge to others to successful/unsuccessful discuss clinical aspects of ASI’.
where achieving best practice ASI implementation. The data Data triangulation identified an
may remain difficult. was triangulated to provide a additional key variable; ‘MDT
The MSc research project more holistic understanding support/understanding’. Analysis
completed by Julia-Marie of the research issue. Ethical of the survey responses revealed
investigated ASI implementation approval was gained from several important findings with
in the population of qualified the Ulster University filter regards to these variables: Firstly,
ASI practitioners working committee. Recruitment and whereas MDT support seemed to
with adolescents/adults/older funding support was received impact more upon how ASI was
adults in the UK. A convergent from the Sensory Integration processed, service leader support
identical mixed methods Education (UK & Ireland), which appeared to link more to how ASI
design was used. Qualitative advertised the study online and was structured and resourced.
data sought to understand via a membership database of ‘MDT support/understanding’
practitioners’ experience and ASI-qualified practitioners who linked most directly with
explore the factors that could consented to be contacted for how ASI was perceived and
support or act as barriers research purposes. implemented within the
to ASI implementation, in workplace. Where MDT
Key Findings
addition to factors that might colleagues valued intervention,
24 eligible respondents
support future implementation. survey respondents identified
participated in the survey.

Table 1. First Cycle Coding Results: Factors affecting ASI Implementation

Facilitators Barriers Future Supports

Access to resources Limited access to resources Access to Resources
Networking Limited autonomy Mentoring
MDT Support Service user engagement Awareness / Understanding of ASI
challenges
Mentoring Limited awareness / Autonomy
Understanding of ASI
Managerial support Expert supervision limitations Evidence base
Evidence base Assessment-only service Managerial support
Awareness / Understanding of ASI Limited evidence base Practitioner experience
Identified service user need Limited practitioner expertise Networking
Autonomy ASI Practitioner isolation
Practitioner Experience Environmental challenges
Ease of access to service users Practitioner uncertainty
Personal resources & motivation ‘‘Not always the best modality’’
Care Pathways Limited managerial support
Non-clinical roles
‘‘Not practicing’

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SUPPORTING RESEARCH

to specialize and offer ASI Recommendations for Action

formulations / interventions. The following recommendations are based upon the study findings, and
In contrast, lack of MDT resource and implementation-based research used to provide context.
understanding deprioritized
ASI intervention, and had the • Seek out implementation • ‘Complexity’ (make sure ASI is
potential to reduce it to an frameworks to help guide you made easy to understand by others)
assessment-only basis. Another to plan, implement and sustain • ‘Compatibility’ (how ASI
important finding related to ASI ASI practice in your workplace can fit with existing values, past
practitioner independence: It was e.g. i-PARIHS (Harvey and experiences and client needs)
interesting to see how increased Kitson, 2016)
• ‘Trialability’ (consider proposals
autonomy enhanced practitioner • Obtain consistent, expert for how ASI could be trialled on an
flexibility, however too much supervision – where unavailable, initial basis – this makes it more
could lead to feelings of isolation. seek out peer mentoring as likely for teams to consider)
Expert supervision was identified an alternative • ‘Observability’ (ensure that
as a desired future means to
• Get involved in local ASI ASI outcomes are made visible
mitigate isolation but securing
support networks, if they don’t to others)
this on a consistent basis was
exist, try regional/ online support • Secure senior managerial
acknowledged to be problematic,
networks – or set up a local support – research has linked this
with many respondents
group yourself! to increased provision of resources
identifying peer mentoring
• If using online support and logistical support
as a current support strategy.
Table 1 displays the factors that networks for education / support • Actively enrol and work with
survey respondents identified as – research suggests that relatively stakeholders to decide how ASI
influential to current and future closed / organized groups may will operate within the workplace –
ASI implementation. work better than open forums joint decision making is a powerful
• Create a communication way to activate practice
The survey respondents
strategy to improve others’ • Engage service users as key
identified many variables
understanding of ASI – stakeholders - research indicates
that impacted upon their ASI
make sure you communicate that raising consciousness and
implementation. It is important
(Rogers, 2003) working collaboratively with
to be aware that there are
implementation frameworks • The ‘relative advantage’ of service users can effect positive
and socio-economic theories ASI (the extent to which ASI is organisational culture change
available that we can draw perceived as improving existing and help to redress inequality /
upon to better understand practice) – this is one of the accessibility issues
the factors that influence ASI strongest predictors of how • Get involved in building up the
implementation, why they may quickly an innovation is adopted ASI evidence base and share your
be difficult to access, and how we knowledge openly.
can work with others to secure
them. Sharing our factors for If you would like to find out more about the above research project, a
success and the challenges we copy can be accessed through the Royal College of Occupational Therapy
face, and making visible to others library: A mixed-methods approach to investigate the implementation of
the value, meaning and outcomes Ayres’ Sensory Integration® (ASI) by qualified ASI practitioners working
of ASI intervention may be with adolescents / adults / older adults in the UK. You can also contact
the first steps to improving the Julia-Marie at [email protected]. Many thanks to
effectiveness of our services. Dr Greg Kelly, Ulster University, who provided academic supervision
for the research study and to SI Education for providing funding and
References:
recruitment support. Huge thanks also to members of the pilot sample
https://www.sensoryintegration. and to all those who responded to / participated in the study, who took
org.uk/page-18983#Ref5 time to provide valuable, considered feedback.

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assessment feature

The Sensory Processing

Measure 2
D
iana Henry, one of the Diana’s husband Rick, has been those for infants, preschool
authors of the SPM-2 an instrumental member in age, school-age, adolescent,
and author of the SPM her team and has accompanied and adult ages. Each age range
Quick Tips, kindly shared more her on the road for 11 years includes forms for varied
information about the new whilst teaching and educating informants (including caregivers,
edition of the assessment due about sensory integration. One teachers, and self-report) which
for release at the end of 2020. of Diana’s highlights from the can be compared in varied
Diana’s occupational therapy recent AOTA Conference was settings (e.g., day care, home,
career began with the study of meeting the SIE team where school environments, and a
Sensory Integration in 1975 we had the opportunity to hear driving form).
under the mentorship of Lorna about the new SPM-2 assessment The restandardization of the
Jean King, who expanded on the at the WPS stand with a special Sensory Processing Measure,
work of Dr. Jean Ayres. One of ‘meet the author” session. It was including the expansion of
Diana’s missions throughout the wonderful to connect with Diana age ranges from birth through
years has been to bring sensory and we look forward to meeting adulthood, allows occupational
integration and processing to the again soon. therapy practitioners the ability
key stakeholders on the team: to systematically assemble
the parents, teachers, students, The SPM-2 - (Author(s): Diane information regarding specific
administrators and other health Parham, Cheryl Ecker, Heather aspects of sensory integration/
professionals. She began with Miller Kuhaneck, Diana A processing, including modulation,
Tools for Teachers, Tools for Henry, Tara J Glennon) praxis, and social participation.
Students, the Tool Chest, and Diana reported that updating
The SPM-2 is an updated,
then collaborated on Tools for assessments is normal practice
norm-referenced assessment
Infants, Tots, Parents, Teens in order to ensure that the
tool with substantial normative
and yes, even Tools for Pets. assessment is moving with the
data, allowing for evaluation
of sensory integration (SI)/ times. While the authors have
sensory processing, praxis, and still kept many of the items on
social participation. The SPM- the SPM that therapists will be
2 will have normative data on familiar with, many more items
typically developing children have been added to reflect the
and data for clinical samples. changes in children’s play and
The SPM-2 systematically occupations. Practitioners will
assembles information about appreciate the timeliness of such
sensory processing from infancy an instrument, thus contributing
through adulthood in natural to their scholarship, currency in
environments. It facilitates the field, and ability to support
intervention planning across occupational engagement for
the lifespan using a team-based individuals of all ages.
Diana Henry approach. Specific forms include Practitioners rely on carefully

20 | SensorNet 54 : July 2019 sensoryintegrationeducation.com

assessment feature

developed assessment tools and research purposes, and adults with diagnoses such as
to help them understand their supporting occupational therapy ASD/ADHD frequently obtain
client’s performance concerns to as a science-based profession. driver’s licenses, but they may
develop effective interventions. The tool is easy to administer and struggle with driving (Curry
To meet this charge, assessment score using either paper or online et al., 2017). Use of the SPM-2
of sensory processing skills administration, facilitating full enables practitioners to assess
in a variety of contexts is inclusion of all team members. SI issues related to driving and
important. The SPM-2 allows The new SPM-2 provides communicate how these issues
OT practitioners to consider practitioners with a reliable and impact driving performance.
the sensory factors that might valid way to gather information During initial SPM
be impacting the occupations, regarding sensory processing development, a primary intent
personal interests, performance across the lifespan, with new was to create a tool that could
patterns, roles, routines, and forms developed for infants facilitate team communication
patterns of engagement which (including a parent form to across and between client
were identified during the understand the impact on co- environments. The new SPM-
occupational profile portion of occupations), adolescents (with 2 forms allow even greater
the OT evaluation as described self-rating, parent, and teacher collaboration between individuals
on page 13 of the OT Practice forms), and adults, in addition involved in a client’s life and
Framework (AOTA, 2014), to the previously available care. Additionally, practitioners
McGuire, & Metzler 2016). preschool and school age forms. appreciate the significant impact
Based on theory developed by Additional new forms allow of context specific information
A. J. Ayres, the SPM-2 helps the rating of caregivers and the in order to understand the full
practitioner to discern whether driving environment. New scale scope of a client’s functional
sensory modulation or praxis development allows for varied engagement in life activities.
issues are affecting participation cross comparisons between raters The SPM-2 allows for greater
from infancy through adulthood. providing a more comprehensive understanding of a client’s
The SPM-2 is a reliable and picture of a client’s performance. performance due to concurrent
valid assessment developed The SPM-2 allows for assessment in multiple contexts
through a rigorous psychometric gathering of information about offered through the multiple SPM-
process, suitable for clinical the impact of SI on family, school 2 forms. This allows for greater
occupations and routines. SPM- understanding of the impact of
2 raters provide information sensory contextual features on the
about an individual’s responses client’s performance. The concept
and behaviors during feeding, of assessment within the natural
hygiene, play/leisure, school environment is the core of our
activities, work, caregiving, professional responsibility.
driving, and other occupations
throughout the day. For families Diana explained the
of children with SI issues and main driving force behind
comorbid autism spectrum revising and expanding the
disorder (ASD), the most common SPM assessment:
family- identified goals are ADLs The SPM was published in
and social participation (Schaaf 2007 and the SPM-Preschool in
et al., 2015), areas that the SPM- 2010, over 10 years ago. It is best
Celebrating international friendships: 2 evaluates. Driving is another practice to update assessments
Diana Henry & Lelanie Brewer important occupation for social and re-standardize to fit the
connecting at the AOTA conference participation. Adolescents and changing times and demographics.
in New Orleans

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assessment feature

During the process, we as authors Some important information: beyond the treatment room.
discovered changes related to In addition to clinic and
• The SPM-2 will have both
the impact of new technology school models, the SPM-2
an online and paper format. For
on play, school and work, so we Quick Tips clinical reasoning
the online format, you can email
had to update our items to fit. process makes it a natural
a link to parent, caregiver or
For example the use of tablets in fit for best practice in Data-
teacher and they can complete
many of the environments. We Driven Decision Driven Making
the assessment in this manner.
also wanted to expand the age (DDDM) [7] so interventions
The link will bring you through to
groups to include individuals continue throughout the child’s
a platform and you can track the
from across the lifespan. We normal routines.
person’s progress on filling in the
have known for some time Reference: https://www.
assessment form.
now that sensory processing sensoryintegration.org.uk/page-
challenges are often evident in • There will be one 18983#Ref6
infancy. We also now know that comprehensive manual that
sensory processing challenges will cover all of the forms across
can be seen in adolescence as the lifespan. The SPM-2 Quick Tips focuses
well as in adulthood. Knowing not only on the objective of
• Therapists will have the option
that plasticity continues addressing underlying deficits
to purchase forms separately
throughout life as practitioners, through ASI® intervention or
based on their clinical needs.
we can help our adult clients sensory-based strategies but
better understand their • There will be a way to it also targets the following
sensory processing strengths compare record forms - for seven objectives:
and challenges so they can example if parents who are
1. Improve sensory- motor
have an impact in their separated complete the home
functions
neurophysiological growth forms individually, there will be
different ways to compare the 2. Educate to support
through the strategies, activities
reports meaningfully. functioning
and environmental adaptations
they develop. 3. Promote self-advocacy and
SPM-2 Quick Tips (Author: empowerment
Diana Henry)
Interested in contributing to the 4. Develop adaptations
upcoming collection of strategies Empowering stakeholders and accommodations
for the SPM-2 Quick Tips? when addressing SI within their
5. Use cognitive or behavioral
individual contexts is critical,
Would you like to share your strategies
and the SPM-2 Quick Tips™
favorite interventions/strategies process answers this need [3]. 6. Teach new skills
that you use in practice? If AOTA [4], the Individuals 7. Address the sensory
yes, they can email Diana at With Disabilities Education integration and processing
[email protected] Improvement Act of 2004 [5], patterns of others.
If your strategy is chosen, and the Affordable Healthcare
your name will be included in Act and Centers for Medicare See the table included which
the acknowledgments section as a and Medicaid Services policy expands on this in greater detail
contributor to the SPM-2 [6] all identify best practice https://www.sensoryintegration.
Quick Tips. as involving the family in goal org.uk/resources/
setting and intervention. When Documents/01J31%20SI%20
Diana strongly believes that
addressing SI the stakeholders Module%201/SPM-2QuickTips
international collaboration leads
are pivotal in supporting the ObjectivesChart Draft6-24-19%20
to a rich variety of ideas.
child for improved behavioral (1).pdf
Best of Luck! and functional outcomes
throughout the child’s life,

22 | SensorNet 54 : July 2019 sensoryintegrationeducation.com

assessment feature

This diagram provides a visual representation of the process involved in

using the new SPM-2 online assessment and SPM quick tips. (Hippa secure -
refers to data security when using the platform)

1. The therapist has the option 3. Once the assessment is it will present the relevant tips
to send an email to a parent finished, you can click on “score”, related to this.
or teacher which will include and the assessment is scored
6. Once you click on the tips, it
a link to the platform and not automatically for you.
creates an intervention report
the assessment form. When the
4. Once you receive the results, form which explains why you
parent/teacher receives the email
you can begin your clinical selected the tips you did as it
and clicks on the link, the form
reasoning and you can refer to relates back to the items on the
will then be shown. This avoids
the SPM-2 Quick Tips which assessment. This ties in with
the need to send forms back and
is another product available for explaining Data-Driven Decision
forth through email. You are
online purchase. Driven Making intervention.
instead emailing them a link and
Informing caregivers that there
people work on the platform. 5. This will integrate the results
is a reason why certain sensory
from each item of the SPM-2
2. The online platform allows systems are targeted and what
together. Each item has several
you to know if the person has drove your clinical reasoning is
tips, and there is the choice to
opened the assessment, whether captured in this way.
sort the tips by what it is you
they have started to complete it,
want e.g. you can sort all the
and when they have finished it.
tactile over responsive items and

ONLINE WORKFLOW

HELP 1. Administer 2. Score Clinical

Quick Start online HIPPA Report Form reasoning
secure
Sorting
items

5. Progress 4. Complete 3. Quick Tips

Report QT Record Intervention Filtering tips
( Initial & Form Report
Retest )

Copyright by Weston Psychological Services /

https://platform.wpspublish.com
Henry CT Services, Inc. All rights reserved.

23 | SensorNet 54 : July 2019 sensoryintegrationeducation.com

Aota conference

AOTA Conference
Round-up Lelanie Brewer

Lelanie Brewer, Head of Education Programmes for Sensory Integration

Education (SIE) provides us with her lightbulb learning moments from
attending the AOTA Conference in April 2019. Lelanie attended this
conference as a representative for SIE as well as presenting her own
research related to her PhD, which she is currently completing through
Newcastle University.

I was very excited in October I was impressed by how useful An area that I was particularly
2018 once I found that two of my the app was to plan and manage interested in was to see the
abstracts for poster presentations my time at the conference. With application of Ayres Sensory
were accepted for the AOTA 2019 more than 1600 educational and Integration and other sensory
Annual Conference and Expo in poster sessions, it was important interventions in relation to
New Orleans. From the moment to plan ahead to make the most improving participation in
that my abstracts were accepted, of the experience. Therefore, everyday life. I attended a
I was extremely impressed my first take-away from this session by Dr. Alexa Grief and
by the organisation and the conference is that I can not Dr. Ashley Stoffel titled: “Using
professionalism of the conference. recommend it highly enough for Participation and Occupation
All abstracts were peer reviewed anyone (clinicians or academics) to Guide the Paediatric
and scored by two reviewers. The who want to present their work Occupational Therapy Process”
feedback that I received from related to occupational therapy, which was useful to see how
the peer review process was not or for occupational therapy a sensory integration frame
only useful in relation to the practitioners who want to keep of reference could be used
preparation for the conference up with the latest research. as a complementary model
but also relevant to further Not only was the quality of alongside occupation-focussed
developing my research ideas. the content outstanding but models when applying the
Once sessions were confirmed the sense of a community of International Classification of
by presenters, the AOTA practice was well throughout Functioning-Children and Youth
conference organisers shared the the conference. Further, I was (ICF-CY) in clinical practice. I
full schedule in an app that could also impressed by the breadth was particularly struck by how
be downloaded by all delegates. and depth of presentations challenges in sensory processing
Although all delegates were and posters related to Sensory and sensory integration were
presented with a paper copy of Integration and by how welcome recognised and integrated
the full conference schedule upon we were made to feel by other in many forms of practice as
registration at the conference, delegates and the organisers. opposed to Sensory Integration

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Aota conference

as a frame of reference being with computers, tablets or Most delegates made a point to
seen in isolation and not relevant smartphones could join in with go and see the posters and as a
to “occupation focused” practice. any interactive activities or result many conversations and
Practical application of sensory quizzes throughout conference new contacts were made within
integration included topics from presentations. Quizzes were the poster hall. I certainly didn’t
sensory-based programmes used by presenters for a number expect to be talking about my
to improve self-regulation for of reasons including to get research on self-care in children
veterans to sensory adapted more information about the for four hours (which was more
dental environments to enhance audience and their clinical than I would have in an oral
oral care for children with experience, and to get feedback presentation) but was delighted to
Autistic Spectrum Disorders about specific aspects of a talk to interested parties and have
(Cermak). Sharon Cermak’s presentation. Feedback from one conversations about my work. It
presentation also made reference delegate regarding this included certainly made me reconsider the
to the first Sensory Friendly that in a room where several value of poster sessions. I would
airport in the world which hundred delegates were present, highly recommend applying for
happened to be Shannon Airport participation in the online quiz the poster session at the AOTA
in Ireland. It was also pleasing made her feel more connected conference and Expo if you
to see the scope of SI practice and part of the audience. This wanted to have more in depth
in different clinical populations has inspired me to include this conversations with a number of
from infants to older people. type of technology or similar people about your work instead
Another lightbulb moment for conference presentations in of a standard oral presentation
for me was the technology used the future, and particularly for where you don’t always get
throughout the conference very large audiences where it feedback or questions.
by presenters. As Head of can be more difficult to facilitate
References:
Education Programmes, I audience participation.
https://www.sensoryintegration.
am always interested in new I was also surprised to
org.uk/page-18983#Ref7
ways that encourage learning see how seriously poster
and engagement in courses presentations were taken. There
and presentations. Free WiFi were dedicated time slots for
was available throughout the posters and presenters were
conference venue for delegates expected to stay with their
which ensured that delegates posters for the full two hour slot.

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Aota conference

Amy Stephens shares her highlights from the

AOTA conference which she attended as a
representative for Sensory Integration Education
in April 2019. Amy Stephens

I was overwhelmed by the One of the topics which multiple times a week, while
sheer scale of the event: more wove through a number of the bigger and most robust
than 10,000 delegates attending, sessions, and which I think studies in ASI effectiveness are
dozens of parallel sessions, an is particularly relevant to us all modelled on high-intensity
exhibition hall bigger than a as ASI Practitioners, was the dosage (including Miller, Coll,
football pitch, so many posters work of critically evaluating and Schoen (2007), Pfeiffer,
that there was only space the evidence base and then Clark, and Arbesman (2018) and
for each to be displayed for translating and adapting that Schaaf et al. (2014).)
2 hours – all in a conference for practice. There was a strong My second take-away learning
centre spread over 4 floors emphasis on the risks (and point is the emphasis on making
and stretching for more than ineffectiveness) of cherrypicking support and training for families
¼ of a mile. This required the a few strategies here and there and caregivers a priority,
delegates to think and plan from different approaches, shifting to more of an indirect
about what they wanted to get and then combining them all therapeutic relationship with
out of the conference for their together. Instead, the call was the clients, and instead working
own practice, and to tailor their to think clearly and critically in a coaching and teaching
schedules, being quite strategic about making adaptations to role. This ranged from Bobbi
in planning which sessions they existing programmes in the face Pineda’s SENSE programme
wanted to attend. Unlike smaller of new evidence, and to have a coaching parents of babies in
European conferences, there process for such adaptations. NICU to manage their sensory
weren’t really plenary or “whole In Kari Burch’s sessions on needs, to Evan Dean and Winnie
delegation” sessions. Instead adapting published dementia Dunn’s work coaching young
they ran parallel workshops and support programmes, she adults with learning disabilities
short courses - ranging from 1-3 referenced the work of Gitlin, and those who support them.
hours in length. This meant that Marx, Stanley, and Hodgson This approach is used in other
the speakers didn’t tend to run (2015) and Rolleri et al. (2014) areas of practice, such as in
over by trying to cover a complex as a good place for clinicians to Hanen/Parent-Child Interaction
topic in a 20 minute time start to create a protocol for their programmes in SLT, and is
slot, allowing plenty time for own settings. Stacey Reynolds very much the model which
questions at the end. I think from and Hope Caracci talked about Eadaoin Breathnach’s Sensory
a learning perspective, there is a the issues and critical thinking Attachment Intervention uses to
lot to recommend this approach. in translating the evidence for work with traumatised children
ASI dosage into outpatient and families. It brought home to
settings where there would be me that as the evidence builds
no possibility of seeing a client for the benefits of working with

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Aota conference

and through key stakeholders particularly struck me was how Other things which struck
as a priority for therapy, not as integrated the understanding me at the AOTA conference was
an “add on”, it challenges some of sensory processing was the warm welcome, support and
of the classical conceptions of across so many clinical areas friendliness which we received
ASI in set ups where a parent or – clinicians made reference as the representatives of Sensory
teacher or care-worker might to clients’ sensory processing Integration Education, with
observe but does not participate. and integration, even if that genuine curiosity and interest
And my third big learning wasn’t their intervention focus, from so many international
point, which came up time and rather than seeing SI in its own ASI experts about what’s
time again in different forms, little silo. It made me realise happening in other countries,
was the encouragement for what a great job our American in other professions, and in
OTs (and by extension other counterparts have done in other settings. It made me
AHPs) to see themselves as advocating for SI throughout feel how connected we are, as
changemakers and influencers, professional bodies and ASI therapists, to the global
actively advocating for their networks, and how the challenge community of practitioners.
clients and for their profession. continues for us in Europe
The incoming president of to explain the sensory piece
AOTA, Wendy Hildenbrand, running through so many areas
used her inaugural address to of practice.
emphasise this as an integral
part of our professional
roles as AHPs. We become
agents of change by creating
and nurturing strategic
relationships; by building our
personal and professional
resilience; and by committing
to innovation to assure our
relevance in a changing field
of health and human sciences.
One of the things which

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European Sensory Integration Congress (ESIC 2019)

ESIC 2019
Round-up

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European Sensory Integration Congress (ESIC 2019)

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ESIC 2019

The 6th European

Sensory Integration
Congress 2019 Annie Sampsonidis

Annie Sampsonidis, tells us about her role in hosting ESIC in

Thessaloniki, Greece and how she is determined to keep the
tradition of the ESIC alive.
Ms. Anna Sampsonidis MA, University of Southern California, SN: Can you explain what
OTR, is an occupational Department of Occupational this year’s congress theme
therapist who graduated from Science & Occupational Therapy “Translating Sensory Processing
New York University with a in hosting the continuing into Quality of Life in Various
professional graduate degree in education training and Environments” means?
occupational therapy. Prior to certification program in Sensory
moving to Greece she worked as Integration in Greece. She is a
AS: Well, in looking at the
an occupational therapist in the founding member of the Hellenic
trend in effectiveness studies
USA, predominantly in pediatrics Scientific Society for Sensory
we noticed that there is a
and neonatal care. She was an Integration (EELEAO) which
tendency to focus more on
instructor for the University of represents Greece in international
the improvement of skills at
Southern California & Western collaborations of similar
the body level rather than at
Psychological Services training organizations for the promotion
the participation level. This in
program in Sensory Integration and research of Sensory
combination with the narratives
and was also a presenter in several Integration. Ms. Sampsonidou
from parents about the effects
EBTA basic NDT courses on is the programme leader of
of sensory processing & sensory
occupational therapy subject the Occupational Therapy
integration intervention in
areas. She has been an invited Department at Metropolitan
their everyday life, made it clear
speaker for the post graduate College, Thessaloniki campus
that this is a relationship that
programs for the Department since 2014. She has co-authored
needs to be emphasized and
of Educational and Social Policy several articles on occupational
investigated. Also, there are now
of the University of Macedonia therapy and pediatric practice.
a variety of ways to apply sensory
in Thessaloniki, Greece and for Having approximately 30 years of
integration principles outside a
Nova Southeastern University experience in clinical practice she
clinical setting and we decided
in USA. She has presented in is also co-owner and coordinator
to add that to the theme as well,
various professional conferences of the professional & scientific
and invite innovators to show us
and educational seminars development of the 2 pediatric
their work.
on different issues regarding therapeutic clinics, “Syn-Ergasia,
pediatric rehabilitation and is Therapeutic Intervention”,
associated as an advisor with located in Northern Greece.
different centers in Greece
and Cyprus. She maintains
continuing collaboration with the

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ESIC 2019

SN: Tell us about your role in An individual may avoid SN: What is the state of SI
bringing this congress together exposure to certain activities currently in Greece?
from vision to reality? or environments in order to
avoid either a motor challenge AS: Although Sensory
AS: The congress was initiated or a sensory overload which Integration is popular in Greece,
by Elisabeth Soechting in Austria can affect the quality of life of as in every other country it
in 2003 and has evolved into those around the individual with can be overused to explain
a tradition for Europe. When sensory processing issues. certain behaviour, especially
we were asked to organize the in the ASD population. There
next ESIC we gave a positive is the common practice of
SN: Tell our readers more about
response and vowed to make it over-simplifying the theory in
the Hellenic Scientific Society
an exceptional one. We worked order to make it available to
for Sensory Integration? What
hard to make it happen and everyone which puts emphasis
does this organisation stand for
we felt maximally rewarded on protocols/strategies that
(values, beliefs, work completed?)
when we received such positive relieve symptoms for a period
feedback. of time. Although this practice
AS: The Hellenic Scientific
increases the popularity of SI,
Society for Sensory Integration
it creates the notion that this is
SN: You had quite the line-up (ELEEO) evolved from our
all it is, and incorrectly equates
of presenters this year – tell us attempt to create a reference
sensory integration with sensory
about this selection and what point for anyone seeking for
strategies. Our goal is to promote
they are offered. more knowledge and education
education on the different ways
about sensory integration. It
that the appropriate sensory
AS: Our goal was to make is named a ‘Scientific Society’
experiences can enhance our
this ESIC an example of good because we wanted to give
lives and differentiate these from
collaboration and a gold emphasis to the nature of the
the individualized treatment.
standard of including all the organization. The mission of
We also have a mission to
major players who are advancing ELEEO is to promote quality and
provide high level education
Sensory Integration (SI) up to date education in Sensory
to professionals.
theory including application Integration as well as promoting
of SI principles and producing common knowledge of SI in the
evidence through research. general population. We aim to SN: What do you hope to achieve
We invited representatives collaborate with leaders in SI from this congress?
from the different groups and education in different countries
institutions and were very lucky as well as other educational AS: Well initially to show
to have them accept and be part programs. We have goals that that the European Sensory
of this congress. include research & replication Integration Congress is an
studies that will be more in our important event for all the
scope in the upcoming future. European countries and that it
SN: How do you think SI affects
We have done some pilot studies shouldn’t cease to exist. Also, it
quality of life?
that are pending publication. was important to showcase all
We also have plans to promote the different perspectives and
AS: I believe that the issues
publications (translated or new). the work that is being carried out
related with modulation as well
It has been a slow process but throughout Europe and the SI
as those associated with motor
we are finally blooming and world. This and every congress
performance can affect the
reaching our goals as well as should be about sharing new
individual and the family on an
forming new ones. ideas and achievements and
activity and participation level.
respecting all the relevant work
These restrictions can occur
that is done by our colleagues in
in everyday life participation.
all the different working

31 | SensorNet 54 : July 2019 sensoryintegrationeducation.com

ESIC 2019

groups in the world. For us therapy and therefore those session of the congress. The
there is no better and worse, that do go on to post graduate work of teams in taking the
there is only variety of work studies, do so in a different principles of sensory integration
that can complement SI theory, field. This limits their subjects into nature and everyday
evaluation, and intervention. of research to more generic life through participation
areas rather than focused and the arts, I believe is
on occupational therapy or quite inspirational. These
SN: Tell us the importance
sensory integration. Once most presentations (M. Protopapadaki
and significance of the pre-
therapists finish their training & Kivotos Center) serve as
congress workshop on
in sensory integration we are examples to all of us to utilize
“Blending Sensory Integration
not sure how they proceed SI principles in everyday life in
with other Approaches.”
with applying the intervention order to promote the quality
principles in their daily practice. of life.
AS: The reality is that most of the
time in our clinical intervention
we are blending approaches. SN: What were your ESIC
This is done automatically and highlights?
without reflection towards our
clinical reasoning. There are AS: The highlights seem to
many diagnostic categories (of have been the workshops from
course ASD being a major one) the various teams and some of
that require more than just one the keynote speakers. Namely,
approach. Many individuals Virginia Spielman and the entire
have expressed the need to talk team from the Star Center, Lucy
about the blending process and Miller, Shelley Mulligan, Sara
the issues that we need to pay Schoen. The USC presence was
attention to. Erna Imperatore very powerful. It was also very
Blanche, Clare Giuffrida and interesting to hear about the
Mary Hallway have been editing EASI project updates from Dr.
a book that will be coming out Zoe Mailloux. However, besides
possibly by the end of 2019 on all these great names and work,
this subject. I therefore asked I think the most impressive
them to do this workshop for us presentations were in the last
because it was a good match for
this congress and a relevant issue
for practice.

SN: What is your greatest

challenge in terms of SI practice,
accessibility and research in
Greece currently?

AS: Our greatest challenge

is that we don’t have a great
amount of therapists with post
graduate degrees that can initiate
and carry out research. We don’t
have post graduate educational
programs in occupational

32 | SensorNet 54 : July 2019 sensoryintegrationeducation.com

sie ESIC BURSARY AWARDS

ESIC 2019 Bursary

Awards Rebecca Matson

We hear from the three Sensory Integration Education members

who presented their research at this year’s ESIC.

Rebecca Matson is a Head Occupational Therapist for a site called Cygnet

Delfryn in Mold, North Wales which has both male and female adult mental
health rehabilitation units. She completed her SI module 4 in June 2018. As
part of her MSc in Sensory Integration through Ulster University and SIE,
she is currently conducting her research project exploring the use of sensory
strategies in female mental health. Rebecca is also interested in completing
training in trauma related approaches. Rebecca received a travel bursary
award from SI Education to attend ESIC and present an oral presentation on a
case example of trauma and Ayres Sensory Integration.

I began working with Jo*, a the noises that to everyone else places or move away from people
53-year-old patient on a mental went unnoticed, but to her caused could be connected to auditory
health rehabilitation unit, distress. and tactile hyper-responsivity,
while completing my Sensory The more I worked with Jo that her discomfort in hugging
Integration module 4: Advanced the more it became apparent her daughters could be connected
Treatment. Jo presented with that the trauma she experienced to poor tactile discrimination, and
poor self-regulation, including in childhood was a big part of that her tripping and bumping
a history of fire setting, self- the picture. During her early could be connected to her
harm and sleep difficulties, but childhood years Jo suffered gravitational insecurity and poor
also with prominent motor neglect, sexual and physical abuse body scheme, not a need to “be
difficulties. Jo experienced high all of which trauma literature more careful” as she reported
levels of frustration at feeling suggests are likely to have often being told in childhood.
misunderstood, describing how impacted significantly on her Goal Attainment Scaling (GAS)
people would see her trip and sensory processing and motor was used to focus priorities and
bump in the community and development. connect these to functional areas
assume she was drunk, or think of concern for Jo. From there the
The assessment process in
she was being awkward when she ASI sessions were planned.
itself provided some validation for
needed to leave a place due to ASI® therapy is so different to
Jo to know that her need to flee

33 | SensorNet 54
53 : February
July 20192019 sensoryintegrationeducation.com
sie ESIC BURSARY AWARDS

approaches normally used within in incidents of self-harm and Learning points

the setting of an adult mental improved sleep pattern. While
health rehabilitation unit but Jo’s overall somatosensory • “Play” needs to be given
that is perhaps what supported processing showed improvement, more focus when working with
Jo’s motivation to engage with tests of tactile discrimination adults, particularly trauma
the twice weekly sessions. The and modulation did not correlate survivors whose “energy now
playfulness of the approach with the final GAS goal which becomes focused on suppressing
allowed Jo to experience play showed no improvement of inner chaos, at the expense of
for herself; her main recall of feeling comfortable when spontaneous involvement in
play being with her children hugging her daughters. This their life” (Van der Kolk 2014).
not from her own childhood, suggested that Jo’s perception of • The importance of humility
while attaching more positive tactile input had improved but as a therapist is significant. We
experiences to difficult sensations her ability to regulate this input never stop learning and our
and engaging Jo’s competitive was still a work in progress. patients have so much to teach
spirit. Sessions became a The connection between touch us. We can become so focused
partnership where I was with experiences and memories of on “doing” therapy that we can
her in the challenges of sessions specific traumatic experiences forget to be in the process with
while asking her to tackle the may have made strategies our patients and to let them
difficulties that had led to further usually utilised to treat tactile guide us.
trauma as a child being “told off” hyperreactivity less effective.
for her clumsiness. • Don’t be tempted to skip the
education – one of the main
By the end of the course of 12
Recommendations catalysts in progress for Jo was
sessions, Jo had made progress
the assessment process that gave
in three of her four GAS goals.
• There needs to be more focus her answers for many of the
Sensory assessments including
on bodily-based and bottom up problems she had experienced
the Adult Adolescent Sensory
approaches for trauma. for years.
History and Clinical Observations
reflected improved postural • ASI® has potential as an References:
control, gravitational security intervention for trauma to https://www.sensoryintegration.
and body scheme. Jo showed improve sensory processing, org.uk/page-18983#Ref8
improvements in self-regulation self-regulation, functioning
with decreased use of PRN (as and participation.
required) medication, a decrease • There is a need for formal
studies into the use of ASI
with trauma.

34 | SensorNet 54 : July 2019 sensoryintegrationeducation.com

sie ESIC BURSARY AWARDS

Angeliki Drougka has 21 years of experience in clinical

practice as an occupational therapist. She obtained
her Science in Occupational Therapy (BA) at Athens
Technological Educational Institution, School of Health
Science. In 2009, eager to delve deeper into Sensory
Integration theory and practice, Angeliki joined the
Sensory Integration Education UK & Ireland and sought
to combine extensive training with clinical supervision. Angeliki Drougka

She is an Advanced Sensory Integration Practitioner

and has successfully completed her masters of Science
in Sensory Integration through Ulster University. Her
MSc Research Project focused on the exploration and
evaluation of the evidence associating sensory processing
disorders with anxiety in diverse populations.

Angeliki runs ‘Exelixi Center”, Purpose of the presentation: 37 studies were included in the
a private practice in Argos City final stage of analysis. 46% (17) of
in Peloponnese, Greece. It is a • To show how Sensory them were classified as Level II and
multidisciplinary service providing Processing Disorders (SPDs) and 54% (20) were classified as Level III
comprehensive evaluation and anxiety/anxiety disorders affect evidence. The retained papers were
intervention for children and quality of life, which was the main rated using the Standard Quality
adolescents with developmental, focus of the ESIC 2019. Assessment Criteria for Evaluating
learning and mental problems. Primary Research Papers from a
• To offer insight into the
She is particularly interested in Variety of Fields - Checklist for
patient’s and parent’s experience
combining different approaches assessing the quality of quantitative
of sensory abnormalities with
for children with ASD, including studies (Kmet et al., 2004). In
comorbid anxiety.
Ayres Sensory Integration, sensory- addition to the quality assessment
based interventions, Floortime, • To present the systematic scores, evidence synthesis was
Applied Behavioral Techniques and review of the literature that conducted by consideration of
Cognitive Behavioral Therapy. focused on exploring and population categories, study design,
evaluating the evidence of the sample size and accuracy of the
She has recently joined the SI
association between SPDs and reported results.
Module 3 Clinical Mentor Register
anxiety/anxiety disorders.
providing clinical mentoring
sessions and supporting Sensory
Findings
Integration postgraduate students Methods
gaining SI intervention experience.
Summary for the body of studies:
Angeliki was funded by SIE to attend A systematic search of four
ESIC and present her literature • All studies reported a consistent,
electronic databases (MEDLINE,
review as an oral presentation at the statistically significant association
Embase, PsycINFO, ERIC) was
congress in Greece. between SPD and anxiety
undertaken in April 2018. In total,
1674 references were identified • Most correlations referred
and screened against a set of to low threshold patterns of
pre-specified eligibility criteria. sensory processing

35 | SensorNet 54 : July 2019 sensoryintegrationeducation.com

sie ESIC BURSARY AWARDS

• Significant correlations were relatively stable over time / may In the present context, occupational
reported between anxiety and predict increases in anxiety. therapists working with children
high threshold sensory patterns with difficulty processing sensory
in six studies information should be aware that
Limitations
• Limited evidence in regard to their clients may be at increased risk
the association of SPD and specific of developing anxiety. They should,
One significant limitation was that therefore, become more vigilant
anxiety disorder subtypes. the electronic literature search was with regard to not dismissing
• Further, main findings were not supplemented by a hand-search symptoms of anxiety and be able to
presented by diagnostic groups. to ensure that all relevant articles build up a network of contacts that
The evidence was moderate for on the topic were identified. communicate and manage potential
participants with ASD, insufficient Secondly, the lack of parallel outbreaks of anxiety.
for participants with ADHD, limited independent data assessment in
Subsequently, health care
for subjects with Affective Disorders each stage, from screening through
providers working with patients
and limited for healthy/non-clinical data extraction, reduces the overall
with affective disorders should
individuals (Grade Definitions - US reliability of the project.
become more open to consdering
Preventive Services Task Force) High heterogeneity between the value of requesting for
studies was found, in terms of prescribing an SPD evaluation
different diagnostic and age groups, for their clients.
Discussion
different behavioral constructs
The review warrants
assessed, great variability in the
• Findings do not establish outcome measures, dissimilar
more precise estimates of the
causality association between SPD and
methods defining exposures
anxiety. Informed decisions in
• Individuals with developmental and outcomes. In addition,
public health and clinical practice
conditions or chronic mental health consistent methodological issues
require methodologically sound
problems are more likely to exhibit were noticed: the majority of
epidemiological studies with
sensory symptoms and anxiety. the designs were underpowered,
appropriate allocation and blinding
• Subjects with ASD compared with systematic differences in the
procedures that also consider
to those diagnosed with other baseline characteristics of groups,
exposure and outcome assessment
developmental conditions exhibit recruitment or selection bias and
from measured data. Researchers
indications of sensory over systematic differences in outcome
should also consider viewing
responsiveness (SOR) and anxiety assessment (blind or objective
anxiety as the independent variable
more frequently. assessment) measurement or
in future studies, as this kind of
detection bias.
• The association exists beyond research is limited. Further to this,
clinical categories more high-quality prospective
Implications for practice and studies are recommended in order
• SPDs appear to be strong
future research to enlighten the temporal relation
predictors of several functional of SPD and anxiety. Finally, where
outcomes: repetitive behaviors, feasible, future randomized control
A deeper understanding of
sleep problems, eating problems, interventional studies using a
the mechanisms explaining
gastrointestinal problems. replicable intervention protocol
the associations between SPD
• Anxiety explained a series and anxiety would be of great with adherence to Ayres Sensory
of psychological and emotional public health significance. Integration principles could include
variables: intolerance of uncertainty, Advancing the evidence of measures of anxiety in order to
self-esteem and social acceptance, this co-occurrence could lead clarify potential causal links.
perceived social supports and to improvements in treatment
parenting stress. strategies, in that, addressing References:
• Limited evidence from one more integrative approaches for https://www.sensoryintegration.
prospective study (Green et al. both areas of defect would enhance org.uk/page-18983#Ref9
2012) involving infants with ASD: the therapeutic response of patients
SOR emerges earlier and remains with anxiety disorders.

36 | SensorNet 54 : July 2019 sensoryintegrationeducation.com

sie ESIC BURSARY AWARDS

Alison Double is a senior lecturer at the University

of Worcester, teaching on the undergraduate
occupational therapy programme. She is also a
clinician working in special schools, using the
theory of Sensory Integration to frame her practice.
The presentation she gave at ESIC 2019, which she
received a bursary from SIE for, bridged her roles as an
academic and a specialist clinician. Her presentation
Alison Double
entitled “How can Football Stadiums be more Autism
Friendly” discussed one of her greatest passions as an
occupational therapist, which is sensory processing.
It explored how the occupation of going to see your
favourite team play football can be impossible with a
diagnosis of autism, due to the sensory challenges that
the environment of a stadium creates. Alison shares
her presentation with you, the readers.

The focus of the conference About the research ‘autism friendly’, supporting
was ‘Using Sensory Integration the important role that football
to enhance quality of life’. Families with children who have clubs can play in providing “a
When I saw this advertised autism frequently miss out on perfect opportunity for children
last November, I felt that this social and leisure activities, due who often feel like outsiders
theme encapsulated my research the child’s condition. Autism to become part of a group,
topic well. The majority of can effect children’s social and strengthen bonds with family and
children and adults with autism emotional development and even form new bonds with fellow
have difficulties processing the ability to process sensory fans”. Autism Wessex (2018)
information from their senses in information in unfamiliar and published suggestions for autism
everyday life, and the nature of a unpredictable environments, friendly football clubs, including
football match and entering the often resulting in behavioural training for stewards, quiet rooms
environment of a stadium makes difficulties. These make attending for people who feel overwhelmed,
this hugely challenging. The social and public events and videos showing routines,
scoping exercise and research that problematic and inaccessible to acknowledging that every stadium
I presented at ESIC was carried families of children with autism. and club will have its individual
out by myself and a special needs There is increasing interest challenges that need to be
teacher, Jodie Fotheringham, at in developing autism friendly assessed and addressed.
Hamilton School (Birmingham), football stadiums to support these West Bromwich Albion have
along with two Occupational families to participate in football established a quiet, sensory
Therapy Students (Lois Connelly events. In 2017, Redknapp space to provide a retreat for
and Frances Rodgers), from the highlighted the need for football people with autism and similar
University of Worcester. stadiums and clubs to become conditions, however, this room

37 | SensorNet 54 : July 2019 sensoryintegrationeducation.com

 sie ESIC BURSARY AWARDS

does overlook the stadium What next? Having the opportunity to

and is therefore not often used travel to the conference was
during matches. This summer we will seek to fantastic, and I would like to
This research project set out publish our results so far. We thank Sensory Integration
to gather evidence to support will also continue to work with Education for the bursary which
autism friendly football and to West Bromwich Albion using helped to make this possible. I
evaluate the sensory barriers of ‘Action research’ to identify ways would also welcome contact from
the stadium environment. It also that families can be introduced anyone interested in knowing
identified effective individualised to football with strategies in more about the research we have
strategies to enable children and place. The ‘icing on the cake’ carried out so far (a.double@
their families to attend matches, will be if we can get to work worc.ac.uk).
and made recommendations of with the Football Association
how to make the best possible regarding a set of ‘standards’
sensory spaces within a stadium. that clubs should adhere to be
West Bromwich Albion ‘Autism Friendly’. This is our
ground have since made some dream, so that we can ensure
changes to their stadium based that all stadiums consider the
on the recommendations. small things that can make a
big difference to a person with
autism who is trying to use
sensory regulation strategies in an
overwhelming environment.

Here at Southpaw, we work closely with therapeutic professionals SWINGING

to research, develop and manufacture sensory integration and
neurodevelopmental products for the classroom, clinic and home.

With our extensive range of unique products designed specifically

to support the implementation of successful sensory therapies, SCOOTING
we can assist you achieve the Ayres Sensory Integration® Fidelity
Measure for your clinic or setting.

‘The purpose of this measure is to ensure for research and clinical

purposes that occupational therapy using sensory integration adheres VIBRATING
to the theory and principles originally developed by Dr. A. Jean Ayres.’
(SCHAFF, R & MAILLOUX, Z. Clinicians Guide for Implementing Ayres Sensory
Integration)

ROLLING
facebook.com/southpawsensoryUK BOUNCING
twitter.com/S0uthpawUK
instagram.com/southpawuk

www.southpaw.co.uk
38 | SensorNet 53 : February 2019 sensoryintegrationeducation.com
CRASHING
EMBRACING THE WORLD OF SENSORY THERAPIES
 SIE Research Awards
Robust evidence in support of Ayres' sensory integration is
critical. Sensory Integration Education is committed to
supporting the development of research in SI.
You can make an essential
contribution to this evidence base:

Has Ayres' SI changed the lives

of those you work with?
Has Ayres' SI impacted on your life?

Has Ayres' SI changed how you provide services?

Research in Ayres' SI Integration and related approaches

is being done, but we need more.

Contact us for Researcher Support Contact us for Research Study Support:

from our Researcher Support SIE can provide support for UK/Ireland
Committee: Research Studies related to Ayres' Sensory
We can support the development of Integration
researcher capability in Ayres' SI knowledge
and practise for Novice Researchers, Early • SIE Research Award Information
Career Researchers and Advanced • MSc Projects - £5,000
Researchers. • PhD Projects - £5,000
• Small Projects Award - £7,000
• Dissemination Award - £3,000
• Opportunities to access potential study
recruits

39 | SensorNet 53 : February 2019 sensoryintegrationeducation.com

www.sensoryintegrationeducation.com/research
research updates

Research updates
Bringing the most recent SI research to you. Click on the hyperlinks
below to read about new research relating to sensory integration across Gemma Cartwright
a number of sectors. Share with your colleagues, friends and clients.

Mental health Impact on occupation Assessment

Link to Mental Health research Link to Impact on Occupation Link to Assessment research
resources on our website: research resources on resources on our website:
https://www.sensoryintegration. our website: https://www. https://www.sensoryintegration.
org.uk/(Resources)-Mental- sensoryintegration.org.uk/ org.uk/page-18436
Health-Research page-18978

Neuroscience Autism Diverse populations

Link to Neurosicence research Link to Autism research Link to Diverse Populations

resources on our website: https:// resources on our website: research resources on our
www.sensoryintegration.org.uk/ https://www.sensoryintegration. website: https://www.
page-18260 org.uk/page-18437 sensoryintegration.org.uk/
(Resources)-Diverse-Populations-
Articles-&-Research

Intervention Aetiology

Link to Intervention research Link to Aetiology research

resources on our website: resources on our website:
https://www.sensoryintegration. https://www.sensoryintegration.
org.uk/page-18313 org.uk/page-18980

40 | SensorNet 54 : July 2019 sensoryintegrationeducation.com