Sensory Integration Theory
The theory of sensory integration was the life work of A. Jean Ayres, Ph.D, OTR, and continues to evolve and be modified by researchers and clinicians worldwide. Sensory integration is a neurobiological process that organizes sensation from one’s body and the environment, making it possible to use the body effectively within the environment. The spatial and temporal aspects of inputs from different sensory modalities are interpreted, associated, and unified.The theory proposes the provision of enhanced sensory inputs in the context of a meaningful activity that elicits an adaptive response will result in changes in brain function as well as behavior.1
Enhancing sensory integration will improve functioning in many areas, in addition to school activities.
Intervention Principles Based on Sensory Integration Theory:
This theoretical information forms the foundation for the sensory integration frame of reference used by occupational and some physical and speech therapists in practice. This frame of reference is explicated and well cited.2 This specific intervention approach of occupational therapy using a sensory integration approach has been trademarked as Ayres Sensory Integration™ (ASI) and is referred to as OT-SI. This occupational therapy approach to intervention involves specific parameters, which differentiate it from other sensory-based interventions that may be incorrectly referred to as sensory integration interventions. Many sensory-based or sensori-motor interventions referred to in the literature are not sensory integration interventions and should not be confused with or grouped with OT-SI and the sensory integration approach referred to as Ayres Sensory Integration™.
The foundational components of occupational therapy using Ayres Sensory Integration™ have been defined3 and a fidelity to intervention measure has been developed which specifies the components of Ayres Sensory Integration™ that are in accordance with this scope of practice and practice guidelines.
The clinical practice of OT-SI intervention consists of:
- Adequate specialized advanced education of the OT practitioner;
- Comprehensive assessment of occupational, sensory, motor, and skill-based functions;
- Availability of specialized intervention equipment; a specific process of therapist-child interaction during the intervention itself; and
- Consultation with the caregivers and family of the client.
The process of the sensory integration intervention session itself involves ten major components:
- Assurance of the physical and emotional safety of the client
- Presentation of opportunities for the client to engage in a variety of activities which provide enhanced sensation, usually of a multi-sensory nature and usually emphasizing tactile, vestibular and proprioceptive inputs
- Facilitation of the client’s self-regulation of arousal level, attention and emotion through provision of organizing sensory inputs and activities
- Provision of activity challenges which promote enhancement of postural, ocular, and bilateral skill development
- Provision of activity challenges which support and guide the client’s ability to motor plan, organize, and execute motor tasks
- Activities that are presented at the level of the “just-right challenge” for the individual child to promote success and engagement
- The therapist ensures that the client’s responses are successful in order to promote the development of adaptive responses
- The client and therapist collaborate on activity choices and a routine pre-determined set of activities is not used
- The context of the activities are meaningful to the client and for children this usually means that activities are in the context of play
- The therapist fosters a therapeutic alliance with the client which engenders a climate of trust and emotional safety
1 May-Benson TA, Barraza MA, Flannagan J. (2011) Review of medical policy of UnitedHealthcare: Sensory integration therapy. Unpublished document submitted to the American Academy of Pediatrics.
2 Schaaf RC, Schoen SA, Smith Roley S, Lane SJ, Koomar JA, May-Benson TA. (2009) A frame of reference for sensory integration. In Kramer & Hinojosa (Eds), Frames of reference for pediatric occupational therapy (3rd ed, pp 99-186). Philadelphia: Lippincott Williams & Wilkins.
3 Parham LD, Roley SS, May-Benson TA, Koomar JA, et al. (2011, in press) Development of a fidelity measure for research on effectiveness of Ayres Sensory Integration™ intervention. American Journal of Occupational Therapy.
