Ayres Sensory Integration® beyond childhood
How can sensory integration be used to enhance the function and occupational performance of the adolescent, adult and elderly?
Research and evidence
- Chronic Schizophrenics (King, 1974; King, 1983; Alers, 1997) found that sensory integration is successful.
- Dunn & Brown (2002)-BD & Schizophrenia-Adult/adolescent sensory profile.
- Acute psychosis (Sabarre, 2007)-sensory integration is just as successful as other occupational therapy intervention.
- The short term effect of sensory integration on the individual with characteristics of psychosis (Annandale, Van Jaarsveld, van Heerden, Nel, 2013).
- Statistical significant improvement of communication, awareness of self, decrease in delusions and hallucinations and disorganized behaviour.
- The incidence of sensory integration problems in individuals with psychosis (Annandale, Van Jaarsveld, Nel, 2013).
- The individual with psychosis has poor processing in the vestibular, proprioceptive and tactile systems.
Neurophysiology
- Dopamine hypothesis in schizophrenia and bipolar disorder (Guyton&Hall,1996). Inhibiting function- inhibits more/less- sensory processing disorder.
- Serotonin- pain block, mood controlling and sleep- possibly sensory modulation disorder.
- Lithium- positive effect on growth of nerve endings and synapse formation- sensory processing disorder.
Neuroanatomy
- Limbic system(amygdala, hippocampus, parrahippocampus gyrus) The controlling of emotions (Saddock & Saddock, 2007). Limbic and reticular area of the brain regulates CNS to regulate own activity-sensory modulation dysfunction in individuals with schizophrenia, BD, head injuries and strokes.
- Basal ganglia and cerebellum: plays an important role in movement. Dysfunction can cause abnormal and uncoordinated movements-sensory integration discrimination disorder (Alers, 1997). Undergoes cellular changes in schizophrenia, BD and head injuries/strokes.
- Thalamus-filtrate and selection of the correct information to make appropriate response. Schizophrenics and BD find it difficult to filtrate information and react appropriately (Saddock & Saddock, 2007) –Sensory integration dysfunction. Head injuries and strokes.
- Prefrontal cortex -Motor planning and sequencing movements. Changes during Schizophrenia and BD (Saddock & Saddock,2007), head injuries/ strokes.
Pathology
Praxis dysfunction presents with:
- Postural problems
- Affected motor planning
- Affected muscle tone (hypotonia)
- Poor bilateral integration
- Poor coordination and sensory discrimination (Bundy & Murray, 2002).
Sensory modulation disorders presents with:
- Aversion response
- Gravitational insecurity
- Defensive behaviour
- Change in tactile, visual and auditory responses
- More or less distractibility
- Disorganized behaviour
- Poor motivation
- Inappropriate emotional responses (Bundy & Murray, 2002).
Research suggests that people with schizophrenia have (Alers, 1997):
- Affected perceptual ability
- Poor awareness of self
- Poor motor planning and praxis
- Poor physical endurance
- Poor postural patterns
Individuals with traumatic head injuries and strokes present with:
- Poor motor planning and praxis
- Poor sequencing of activities
- Visual-perceptual difficulties
- Changes in muscle tone (? Sensory integration)
- Poor physical endurance
- Poor posture
When to refer to Occupational Therapy
- Psychosis and chronic phase of mental illness
- ID, Autism and ADHD
- MDD and Anxiety
- Possible signs: pacing, wringing of hands, biting, self-injurious, taking clothes off or tearing clothes
- Work related stressors, IPR and marital stressors
Evaluation
- Observation during activity and ADL’s
- Adult sensory profile (Dunn & Brown, 2002)-modulation
- Schroeder, Block & Campbell Adult Psychiatric Sensory Integration Evaluation-discrimination and modulation
- EASI-current research (Annandale, van Jaarsveld)
- Sensory History questionnaire (Theresa May-Benson)
Treatment
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Limited research, UK and SA research (Kath Smith)
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Group therapy
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Individual sessions: addressing work, sleep, IPR
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Individual sessions: New Equipment, CUT (PDTS) and SAISI “Open access” ASI strategies: acute mental health settings, regulation, care takers etc.
Examples of activities
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Tactile Frisbee
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Parachute canopy
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Balloon volleyball
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Ramp and munch mat
- Obstacle course
- Inner tube bouncing
- Blanket roll
- Parachute flower
- Hammock prone and aim
The role of Occupational Therapy
- Roley, Mailloux, Miller-Kuhaneck and Glennon (2007) describes the role of the sensory integration occupational therapist in addressing the functional ability and occupational performance of the patient.
- Lombard (2007) supports the above-IPR, recreation, work and PI.
- Poor sensory integration = poor occupational performance.
- Affected areas = sleep, work, recreation, IPR and personal care.
Precautions
- Protect the patient, safe environment and equipment.
- Risk factors - falling, epilepsy etc.
- Autonomic system reactions - sweating, yawning, nausea etc.
- Always inform the doctor or MDT of possible autonomic system reactions that can be present
- Inform the team of signs of over stimulation
- Ayres Sensory Integration Fidelity Measure®