Tervetuloa! ~ Welcome Susanne Smith Roley OTD, OTR/L, FAOTA 2014
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Tervetuloa ~ Welcome
Susanne Smith Roley OTD OTRL FAOTA 2014
BEST PRACTICE
HEALTH amp RESILIENCE
Smith Roley 2014
INFLUENCES ON PRACTICE
Smith Roley 2014
PRENATAL FACTORS amp Epigenetics
bull Autoimmune Deficits (Amaral 2014)
Smith Roley 2013
Smith Roley 2014
Maternal Environment Prenatal Stress amp Alcohol Exposure (Schneider)
Prevalence of Autism
bull On March 27 2014 the Centers for Disease Control and Prevention (CDC) surveillance study identified
bull 1 in 68 children (1 in 42 boys and 1 in 189 girls) with Autism Spectrum Disorder in the United States
bull Atypical sensory reactivity included in DSM-5 as diagnostic feature
Smith Roley 2013
Prevalence of Mental Illness
bull Mental illness is increasing in children younger than 18 years
bull A total of 13 to 20 of children living in the United Sates experience a mental disorder in a given year
May 16 2014
CDC Morbidity and Mortality Weekly Report
Smith Roley 2014
Prevalence of Dementia
bull Expanding rapidly particularly in countries with low and middle incomes
bull It was estimated that 356 million people lived with dementia worldwide in 2010 with numbers expected to almost double every 20 years to 657 million in 2030 and 1154 million in 2050
bull In 2010 58 of all people with dementia lived in countries with low or middle incomes with this proportion anticipated to rise to 63 in 2030 and 71 in 2050
Alzheimers Dement 2013 Jan9(1)63-75e2 doi 101016jjalz201211007 The global prevalence of dementia a systematic review and metaanalysis Prince M1 Bryce R Albanese E Wimo A Ribeiro W Ferri CP Author information
Smith Roley 2013
Sensory Integration as a Vehicle for Change
Smith Roley 2014
ADAPTATION
ldquoWhen the sensory integrative capacity of the brain is sufficient to meet the demands of the environment the childrsquos response is efficient creative and satisfyingrdquo
PLAY
When the child experiences challenges to which (she) he can respond effectively (she) he ldquohas funrdquo
ldquoFun is the childrsquos word for sensory integrationrdquo Sensory Integration and the Child p8
Smith Roley 2014
Danielle Marshall spokesperson for KaBOOM a nonprofit org httpusatoday30usatodaycomnewshealthwellnessstory201108Advocates-Importance-of-play-time-for-children-neglected500718781 retrieved 82613
Changing Values re Play
bull ldquoSince the 1970s kids have lost an average nine hours of free playtime a week
bull and when given recreational activities they are likely to be adult-led and adult-supervisedrdquo
Smith Roley 2014
Neuroplasticity
bull ldquoNovel experience bull altered afferent input due to
environmental changes bull and learning new skills bull are now recognized as
modulators of brain function and underlying neuroanatomic circuitryrdquo
May A 2011 p1
Smith Roley 2013
Greenough Black amp Wallace 1987
ldquoExperience can influence
the developing and mature brainrdquo
bull Experience-independent ndash genetic unfolding
bull Experience-expectant ndash neural structuresfunctions ready during critical periods ndash Experience-dependent ndash enrichment
bull unique to the individual
bull incorporation of idiosyncratic environmental information
bull Involves active formation of new synaptic connections in response to the events
Smith Roley 2013
Animal Studies on Enriched Environments Rosenzweig Bennett amp Diamond (1972)
(summary in Reynolds Lane amp Richards 2010)
Changes to standard cage conditions provide enhanced sensory motor cognitive and potentially social opportunities
Experience dependent results from active interaction between animal amp environment Increase in dendritic branching amp
synaptogenesis Neurogenesis in hippocampus amp amygdala Gliogenesis
Smith Roley 2013
Predicting Outcomes
Neuroplasticity studies suggest outcomes of Sensory Integrative approach may be
Decreased anxiety Decreased hypersensitivity Normalization of stress response Increased social participation Reduced stereotyped behaviors Better learning amp memory
Smith Roley 2013
What are the active ingredients of change
bull Motor activity bull Sensory input bull Social interactionplay bull MOST LIKELY a
combination ndash sensory motor amp
cognitive stimulation ndash environmental novelty ndash opportunities for
engagement in challenging tasks
Smith Roley 2014
Implications for Sensory Integration in Practice
However
OTSI has an
additional active ingredient
YOU
Smith Roley 2014
bull Model of Sensory Integration bull Theory of Sensory Integration
Assessments bull Sensory Integration amp Praxis Tests bull Sensory History
Questionnaires bull Clinical Observations
bull Interpretation bull Intervention bull Outcomes Research
Scholarship ~ Mentorship
Sensory Integrative Processes
The senses Integration of their inputs End products
Auditory (hearing)
First level Second level Third level Fourth level
Vestibular
(gravity amp movement)
Proprioceptive
(muscles amp joints)
Tactile (touch)
Visual (seeing)
Speech
Language
eye movements
Posture
Balance
Muscle tone
Gravitational security
Sucking
Eating
Mother-infant bond
Tactile comfort
Body perception
Coordination of two
sides of the body
Motor planning
Activity level
Attention span
Emotional stability
Eye-hand
coordination
Visual perception
Purposeful activity
Ability to concentrate
Ability to organise
Self-esteem
Self-control
Self-confidence
Academic learning ability
Capacity for abstract
thought and reasoning
Specialization of each side
of the body and the brain
Published by WPSreg 1979 2005 (c) 2014 Smith Roley Singer amp Roley
Theory Updates
Example Symplexity Alain Berthoz (2012)
ldquoA very young baby can mimic the facial expressions of its parents even though it cannot
see its own face which would seem to suggest the existence of innate mechanism of intermodal
encoding and transfer between what is perceived and what is producedhellip
This embodiment of perception is a
fundamental mechanism of simplexityrdquo
Smith Roley 2013
Assessment Updates
Sensory Integration Patterns (Ayres 1965-1989)
bull Tactile amp motor planning deficits (1965 1966 1969 1972 1977 amp 1989)
bull Visual perceptionvisual praxis deficits (1965 1966 1969 1972 1977 amp 1989)
bull Vestibular postural amp bilateral deficits (1965 1966 1969 1972 1977 amp 1989)
bull Tactile defensiveness amp hyperactivitydistractibility (1965 1966 1969 1972)
bull Other factors (auditory language somatosensory perception) seen in some studies
(1969 1972 1977 1989)
Verification and Clarification of
Sensory Integration Patterns
Mulligan (1998)
Mailloux Mulligan Roley etal (2011)
Van Jaarsveld etal (in press)
Lane (2010)
Blanche etal (2012)
SIPT Factor Analysis
Mulligan 1998
n= 10475
Smith Roley 2014
PPR
PRVC
SV
CPR
MFP II
DC
MFP I
OPR
SWB
PRN
BMC
MAC
GRA
SPR
KIN
LTS
FG
FI
TD
ATTN
Visio amp Somatopraxis
VestibularProp
Bilateral Integration amp
Sequencing
Tactile amp
Visual Discrimination
Tactile Defensiveness
amp Attention
SIPT Factor Analysis
Mailloux etal 2011
n=278
SIPT Factor Analysis in South African Sample (Van Jaarsveld etal in press)
n=223 Convenience Sample
bull Factor 1
ndash Visuo and Somatodyspraxia
bull DC CPR SV MAc MFP KIN SPr PvVC SWB GRA
bull Factor 2
ndash Bilateral Integration and Sequencing
bull SPr BMC Opr SWB with lower loadings on PPr PrVC
bull Factor 3
ndash Tactile and Visual Discrimination
bull FI MFP LTS with moderate loadings on PrVC OPr
26 (c) 2014 Susanne Smith
Roley OTD
SIPT Factor Analysis in South African Sample (Van Jaarsveld etal in press)
27 (c) 2014 Susanne Smith
Roley OTD Figure 1 Loadings on three factors of final analysis
Lane AE etal (2010)
Sensory Profile Cluster Analysis 3 patterns of ASD sensory processing
Sensory-based inattentive seeking
under-responsive (milder)
Sensory modulation with movement sensitivity low energyweak poor endurance
Sensory modulation with tastesmell sensitivity
under and over-responsiveness with no movement issues more communication difficulties and maladaptive behaviors
Sensory subtypes predicted communication competence
and maladaptive behavior
Comprehensive Observation of Proprioception (COP) Factor Analyses
bull F1 Tone and Joint Alignment
ndash Joint hypermobility decreased tone poor joint alignment
bull F2 Behavioral Manifestations
ndash Pushing overactive crashing falling running
ndash Correlates with SPM bumping and pushing
bull F3 Postural Motor
ndash Decreased PC tendency to lean inefficient grading force inadequate weight bearing inefficient ankle strategies
ndash Correlates with SPM body awareness and SWB
bull F4 Motor Planning
ndash Decreased feedback planning decreased feedforward planning overly passive
ndash No correlation with SPM body awareness weak correlation with KIN and SWB
Blanche Bodison Chang amp Reinoso (2012)
29
(c) 2014 Susanne Smith Roley
OTD
Refining Assessment of Sensory Integrative Functions
Smith Roley 2014
Visual-Praxis
Vestibular Bilateral Integration
Proprioception Tactile
Somato- dyspraxia
Sensory Reactivity
(Modulation)
Visual motor
Postural
control
Gross
motor
skills
Praxis Arousal
Affect
Activity Level
Attention
Visual construction
Bilateral coordination
Sequencing
Fine motor skills
Auditory -Language
Organization of behavior
StateSelf Regulation
Smith Roley 2013
SENSORY INTEGRATION INTERVENTION
Intervention Planning Promoting neuroplasticity health and development
Smith Roley 2014
Implications for OTSI Intervention
Consistent with Neuroplasticity Literature
ndash Sensorimotor opportunities
ndash Control over activity
ndash Novelty
ndash Challenge
ndash Playful environment
ndash Lifelike context
Smith Roley 2014
Sensory Integration and Play
bull When the therapist is doing her job effectively and the child is organizing his nervous system it looks as if the child is merely playing rdquo ndash Ayres 1979
Smith Roley 2013
Ayres Sensory Integrationreg Intervention Fidelity Measure
Parham et al 2007 2011 2013-in press
ASIFM Structural elements ndash Part I Therapist Qualifications
ndash Part II Safe Environment
ndash Part III Record Review
ndash Part IV Space and Equipment
ndash Part V Communication with Parents amp Teachers
Smith Roley 2013
ASIFM Process Elements (Parham et al 2011)
1 Physical safety 2 Sensory opportunities
(vestibular tactile and proprioceptive)
3 Supports sensory modulation to attainmaintain a regulated state
4 Supports postural ocular oral or bilateral motor coordination
5 Challenges praxis and organization of behavior
6 Collaborative activity choice
7 Just Right Challenge
8 Ensures Success
9 Supports motivation to play
10 Establishes therapeutic alliance
Smith Roley 2013
Data-driven Intervention Process (Schaaf 2001 Schaaf amp Blanche 2012)
Participation challenges
Current behavior
Theoretical
Framework
Assessments
37
Hypotheses Interventions Outcomes
(c) 2014 Susanne Smith Roley
OTD
Grounds for Optimism
Four Common Misconceptions
in the Anti-SI Intervention Literature Clark 2012
1) Reviews critical of sensory integration
intervention research ignores issues of fidelity
and dosage
Smith Roley 2014
2) Reviewers ignore or minimize the available
positive evidence for SI intervention
bull 3 RCTrsquos with autism demonstrated positive results
following multisensory interventions (including SI
intervention) (Fazlioglu amp Baran 2008 Pfeiffer
Koenig Kinnealey Sheppard amp Henderson 2011
Smith Press Koenig amp Kinnealey 2005)
bull ldquoBased on the application of meta-analytic techniques
for cumulating probability values it is not hard to
conclude that sensory treatments have positive effects
when administered to children with ASDsrdquo Clark
2012
Smith Roley 2014
3) The lack of positive outcomes from SI Intervention may be due
to weak or poorly designed studies
bull Current studies suggest that with stronger and more
studies there will be consistent beneficial effects for
certain outcomes
bull ldquoThe challenge is to make these studies happenrdquo
Clark 2012
Smith Roley 2013
4) Critics often forget that a lack of solid evidence characterizes
nearly all interventions for children with ASDs
bull SI intervention is often held to a different standard
than other types of intervention failing to apply the
same criterion to alternate interventions
Clark 2012
Smith Roley 2014
Remaining Mysteries
Smith Roley 2013
Implications for Advocacy
People need breaks such as recess
People require sensorimotor and social play timespacevalue in the daily routine
Smith Roley 2014
Implications for Research on OT using Sensory Integration
Enhancing Neuroplasticity via Therapeutic Design
bull Dosage - Intensity of increased access in short time periods rather than small access over longer times
bull Engagement via play and not just exposure
bull Role of therapist in providing customized sensorimotor challenges
bull Access to safe dynamic and therapeutic environments vs predictable and static environments
bull The difference between practice for skill development and adaptation to challenges in changing environments
Smith Roley 2014
Implications for Sensory Integration in Practice
Most importantly the success of Sensory Integration in practice depends on
YOU
Smith Roley 2014
Thank You
bull Organizers and Participants
bull hyvaumlauml paumlivaumlnjatkoa
bull Enjoy the conference
Smith Roley 2013
bull Ayres AJ (2005) Sensory Integration and the Child Los Angeles CA Western Psychological Services bull Armstrong T (2006) The best schools How human development research should inform educational practice Alexandria
VA Association for Supervision and Curriculum Development bull Blanche E I Bodison S Chang M C amp Reinoso G (2012) Development of the comprehensive observations of
proprioception (COP) Validity reliability and factor analysis American Journal of Occupational Therapy 66 691ndash698 bull Bundy A amp Lane S (In press) Sensory integration theory and practice Third Ed Philsadelphia PA FA Davis Inc bull Casey T amp MacIntyre S (2007) Childrenrsquos need for time and space In T Casey (Ed) Environments for outdoor play A
practical guide to making space for children (pp 5 ndash 16) London Sage Publications httpwwwsagepubcomupm-data15553_CASEY_C01PDF
bull Gray P (2013) Play as preparation for learning and life American Journal of Play 5(3) 271 - 292 bull Greenough WR Black JE Wallace CS (1987) Experience and brain development Child Development 58(3)539-59 bull Lane AE Young RL Baker AEZ amp Angley MT (2010) Sensory processing subtypes in autism Association with adaptive behavior
Journal of Autism and Developmental Disorders 40 112-122
bull Lane SJ Schaaf RC (2010) Examining the neuroscience evidence for sensory-driven neuroplasticity implications for sensory-based occupational therapy for children and adolescents American Journal of Occupational Therapy 64(3)375-90
bull Mailloux Z Mulligan S Smith Roley S Cermak S Blanche E amp Bodison S Coleman G amp Lane C (2011) Verification and clarification of patterns of sensory integrative dysfunction in a retrospective clinical sample American Journal of Occupational Therapy 652 143-151
bull May A (2011) Experience-dependent structural plasticity in the adult human brain 1-8 Trends in Cognitive Sciences bull May-Benson TA Smith Roley S Mailloux Z Parham LD Koomar J Schaaf RC Van Jaarsveld AM amp Cohn E (in
press) Structural Elements of the Ayres Sensory Integrationreg Intervention Fidelity Measurecopy American Journal of Occupational Therapy
bull Milteer RM Ginsburg KR amp Council on Communications and Media Committee on Psychosocial Aspects of Child and Family Health (2011) Pediatrics e204-e213 DOI 101542peds2011-2953
bull Parham LD Cohn ES Spitzer S Koomar J Miller LJ Burke JP Brett-Green B Mailloux Z May-Benson T Smith Roley S Schaaf RC Schoen S amp Summers CA (2007) Fidelity in sensory integration intervention research American Journal of Occupational Therapy 61 2 216-227
bull Parham LD Smith Roley S May-Benson T Koomar J Brett-Green B Burke JP Cohn ES Mailloux Z Miller LJ amp Schaaf RC (2011) Development of a fidelity measure for research on effectiveness of Ayres Sensory Integrationreg intervention American Journal of Occupational Therapy 65 2 133-142
bull Reynolds S Lane SJ amp Richards L (2010) Using animal models of enriched environments to inform research on sensory integration intervention for the rehabilitation of neurodevelopmental disorders Journal of Neurodevelopmental Disorders 2( 3) 120-132 online first DOI 101007s11689-010-9053-4
bull Roley SS Mailloux Z Parham D Schaaf R Blanche E amp Lane CA Cermak S (in press) Sensory Integration and Praxis Patterns in Children with Autism American Journal of Occupational Therapy
bull Rosenzweig MR Bennet EL and Diamond MC (1972) Brain Changes in response to experience Scientific American 226(2) 22-29
bull Van Jaarsveld A Mailloux Z Smith Roley S amp Raubenheimer J (in press) Patterns of the sensory integration dysfunctions in South African children South African Journal of Occupational Therapy
bull Wills S Cabanlit M Bennett J Ashwood P Amaral DG amp Van de Water J (2009) Detection of autoantibodies to neural cells of the cerebellum in the plasma of subjects with autism spectrum disorders Brain Behavior and Immunity 23(1) 64-74
BEST PRACTICE
HEALTH amp RESILIENCE
Smith Roley 2014
INFLUENCES ON PRACTICE
Smith Roley 2014
PRENATAL FACTORS amp Epigenetics
bull Autoimmune Deficits (Amaral 2014)
Smith Roley 2013
Smith Roley 2014
Maternal Environment Prenatal Stress amp Alcohol Exposure (Schneider)
Prevalence of Autism
bull On March 27 2014 the Centers for Disease Control and Prevention (CDC) surveillance study identified
bull 1 in 68 children (1 in 42 boys and 1 in 189 girls) with Autism Spectrum Disorder in the United States
bull Atypical sensory reactivity included in DSM-5 as diagnostic feature
Smith Roley 2013
Prevalence of Mental Illness
bull Mental illness is increasing in children younger than 18 years
bull A total of 13 to 20 of children living in the United Sates experience a mental disorder in a given year
May 16 2014
CDC Morbidity and Mortality Weekly Report
Smith Roley 2014
Prevalence of Dementia
bull Expanding rapidly particularly in countries with low and middle incomes
bull It was estimated that 356 million people lived with dementia worldwide in 2010 with numbers expected to almost double every 20 years to 657 million in 2030 and 1154 million in 2050
bull In 2010 58 of all people with dementia lived in countries with low or middle incomes with this proportion anticipated to rise to 63 in 2030 and 71 in 2050
Alzheimers Dement 2013 Jan9(1)63-75e2 doi 101016jjalz201211007 The global prevalence of dementia a systematic review and metaanalysis Prince M1 Bryce R Albanese E Wimo A Ribeiro W Ferri CP Author information
Smith Roley 2013
Sensory Integration as a Vehicle for Change
Smith Roley 2014
ADAPTATION
ldquoWhen the sensory integrative capacity of the brain is sufficient to meet the demands of the environment the childrsquos response is efficient creative and satisfyingrdquo
PLAY
When the child experiences challenges to which (she) he can respond effectively (she) he ldquohas funrdquo
ldquoFun is the childrsquos word for sensory integrationrdquo Sensory Integration and the Child p8
Smith Roley 2014
Danielle Marshall spokesperson for KaBOOM a nonprofit org httpusatoday30usatodaycomnewshealthwellnessstory201108Advocates-Importance-of-play-time-for-children-neglected500718781 retrieved 82613
Changing Values re Play
bull ldquoSince the 1970s kids have lost an average nine hours of free playtime a week
bull and when given recreational activities they are likely to be adult-led and adult-supervisedrdquo
Smith Roley 2014
Neuroplasticity
bull ldquoNovel experience bull altered afferent input due to
environmental changes bull and learning new skills bull are now recognized as
modulators of brain function and underlying neuroanatomic circuitryrdquo
May A 2011 p1
Smith Roley 2013
Greenough Black amp Wallace 1987
ldquoExperience can influence
the developing and mature brainrdquo
bull Experience-independent ndash genetic unfolding
bull Experience-expectant ndash neural structuresfunctions ready during critical periods ndash Experience-dependent ndash enrichment
bull unique to the individual
bull incorporation of idiosyncratic environmental information
bull Involves active formation of new synaptic connections in response to the events
Smith Roley 2013
Animal Studies on Enriched Environments Rosenzweig Bennett amp Diamond (1972)
(summary in Reynolds Lane amp Richards 2010)
Changes to standard cage conditions provide enhanced sensory motor cognitive and potentially social opportunities
Experience dependent results from active interaction between animal amp environment Increase in dendritic branching amp
synaptogenesis Neurogenesis in hippocampus amp amygdala Gliogenesis
Smith Roley 2013
Predicting Outcomes
Neuroplasticity studies suggest outcomes of Sensory Integrative approach may be
Decreased anxiety Decreased hypersensitivity Normalization of stress response Increased social participation Reduced stereotyped behaviors Better learning amp memory
Smith Roley 2013
What are the active ingredients of change
bull Motor activity bull Sensory input bull Social interactionplay bull MOST LIKELY a
combination ndash sensory motor amp
cognitive stimulation ndash environmental novelty ndash opportunities for
engagement in challenging tasks
Smith Roley 2014
Implications for Sensory Integration in Practice
However
OTSI has an
additional active ingredient
YOU
Smith Roley 2014
bull Model of Sensory Integration bull Theory of Sensory Integration
Assessments bull Sensory Integration amp Praxis Tests bull Sensory History
Questionnaires bull Clinical Observations
bull Interpretation bull Intervention bull Outcomes Research
Scholarship ~ Mentorship
Sensory Integrative Processes
The senses Integration of their inputs End products
Auditory (hearing)
First level Second level Third level Fourth level
Vestibular
(gravity amp movement)
Proprioceptive
(muscles amp joints)
Tactile (touch)
Visual (seeing)
Speech
Language
eye movements
Posture
Balance
Muscle tone
Gravitational security
Sucking
Eating
Mother-infant bond
Tactile comfort
Body perception
Coordination of two
sides of the body
Motor planning
Activity level
Attention span
Emotional stability
Eye-hand
coordination
Visual perception
Purposeful activity
Ability to concentrate
Ability to organise
Self-esteem
Self-control
Self-confidence
Academic learning ability
Capacity for abstract
thought and reasoning
Specialization of each side
of the body and the brain
Published by WPSreg 1979 2005 (c) 2014 Smith Roley Singer amp Roley
Theory Updates
Example Symplexity Alain Berthoz (2012)
ldquoA very young baby can mimic the facial expressions of its parents even though it cannot
see its own face which would seem to suggest the existence of innate mechanism of intermodal
encoding and transfer between what is perceived and what is producedhellip
This embodiment of perception is a
fundamental mechanism of simplexityrdquo
Smith Roley 2013
Assessment Updates
Sensory Integration Patterns (Ayres 1965-1989)
bull Tactile amp motor planning deficits (1965 1966 1969 1972 1977 amp 1989)
bull Visual perceptionvisual praxis deficits (1965 1966 1969 1972 1977 amp 1989)
bull Vestibular postural amp bilateral deficits (1965 1966 1969 1972 1977 amp 1989)
bull Tactile defensiveness amp hyperactivitydistractibility (1965 1966 1969 1972)
bull Other factors (auditory language somatosensory perception) seen in some studies
(1969 1972 1977 1989)
Verification and Clarification of
Sensory Integration Patterns
Mulligan (1998)
Mailloux Mulligan Roley etal (2011)
Van Jaarsveld etal (in press)
Lane (2010)
Blanche etal (2012)
SIPT Factor Analysis
Mulligan 1998
n= 10475
Smith Roley 2014
PPR
PRVC
SV
CPR
MFP II
DC
MFP I
OPR
SWB
PRN
BMC
MAC
GRA
SPR
KIN
LTS
FG
FI
TD
ATTN
Visio amp Somatopraxis
VestibularProp
Bilateral Integration amp
Sequencing
Tactile amp
Visual Discrimination
Tactile Defensiveness
amp Attention
SIPT Factor Analysis
Mailloux etal 2011
n=278
SIPT Factor Analysis in South African Sample (Van Jaarsveld etal in press)
n=223 Convenience Sample
bull Factor 1
ndash Visuo and Somatodyspraxia
bull DC CPR SV MAc MFP KIN SPr PvVC SWB GRA
bull Factor 2
ndash Bilateral Integration and Sequencing
bull SPr BMC Opr SWB with lower loadings on PPr PrVC
bull Factor 3
ndash Tactile and Visual Discrimination
bull FI MFP LTS with moderate loadings on PrVC OPr
26 (c) 2014 Susanne Smith
Roley OTD
SIPT Factor Analysis in South African Sample (Van Jaarsveld etal in press)
27 (c) 2014 Susanne Smith
Roley OTD Figure 1 Loadings on three factors of final analysis
Lane AE etal (2010)
Sensory Profile Cluster Analysis 3 patterns of ASD sensory processing
Sensory-based inattentive seeking
under-responsive (milder)
Sensory modulation with movement sensitivity low energyweak poor endurance
Sensory modulation with tastesmell sensitivity
under and over-responsiveness with no movement issues more communication difficulties and maladaptive behaviors
Sensory subtypes predicted communication competence
and maladaptive behavior
Comprehensive Observation of Proprioception (COP) Factor Analyses
bull F1 Tone and Joint Alignment
ndash Joint hypermobility decreased tone poor joint alignment
bull F2 Behavioral Manifestations
ndash Pushing overactive crashing falling running
ndash Correlates with SPM bumping and pushing
bull F3 Postural Motor
ndash Decreased PC tendency to lean inefficient grading force inadequate weight bearing inefficient ankle strategies
ndash Correlates with SPM body awareness and SWB
bull F4 Motor Planning
ndash Decreased feedback planning decreased feedforward planning overly passive
ndash No correlation with SPM body awareness weak correlation with KIN and SWB
Blanche Bodison Chang amp Reinoso (2012)
29
(c) 2014 Susanne Smith Roley
OTD
Refining Assessment of Sensory Integrative Functions
Smith Roley 2014
Visual-Praxis
Vestibular Bilateral Integration
Proprioception Tactile
Somato- dyspraxia
Sensory Reactivity
(Modulation)
Visual motor
Postural
control
Gross
motor
skills
Praxis Arousal
Affect
Activity Level
Attention
Visual construction
Bilateral coordination
Sequencing
Fine motor skills
Auditory -Language
Organization of behavior
StateSelf Regulation
Smith Roley 2013
SENSORY INTEGRATION INTERVENTION
Intervention Planning Promoting neuroplasticity health and development
Smith Roley 2014
Implications for OTSI Intervention
Consistent with Neuroplasticity Literature
ndash Sensorimotor opportunities
ndash Control over activity
ndash Novelty
ndash Challenge
ndash Playful environment
ndash Lifelike context
Smith Roley 2014
Sensory Integration and Play
bull When the therapist is doing her job effectively and the child is organizing his nervous system it looks as if the child is merely playing rdquo ndash Ayres 1979
Smith Roley 2013
Ayres Sensory Integrationreg Intervention Fidelity Measure
Parham et al 2007 2011 2013-in press
ASIFM Structural elements ndash Part I Therapist Qualifications
ndash Part II Safe Environment
ndash Part III Record Review
ndash Part IV Space and Equipment
ndash Part V Communication with Parents amp Teachers
Smith Roley 2013
ASIFM Process Elements (Parham et al 2011)
1 Physical safety 2 Sensory opportunities
(vestibular tactile and proprioceptive)
3 Supports sensory modulation to attainmaintain a regulated state
4 Supports postural ocular oral or bilateral motor coordination
5 Challenges praxis and organization of behavior
6 Collaborative activity choice
7 Just Right Challenge
8 Ensures Success
9 Supports motivation to play
10 Establishes therapeutic alliance
Smith Roley 2013
Data-driven Intervention Process (Schaaf 2001 Schaaf amp Blanche 2012)
Participation challenges
Current behavior
Theoretical
Framework
Assessments
37
Hypotheses Interventions Outcomes
(c) 2014 Susanne Smith Roley
OTD
Grounds for Optimism
Four Common Misconceptions
in the Anti-SI Intervention Literature Clark 2012
1) Reviews critical of sensory integration
intervention research ignores issues of fidelity
and dosage
Smith Roley 2014
2) Reviewers ignore or minimize the available
positive evidence for SI intervention
bull 3 RCTrsquos with autism demonstrated positive results
following multisensory interventions (including SI
intervention) (Fazlioglu amp Baran 2008 Pfeiffer
Koenig Kinnealey Sheppard amp Henderson 2011
Smith Press Koenig amp Kinnealey 2005)
bull ldquoBased on the application of meta-analytic techniques
for cumulating probability values it is not hard to
conclude that sensory treatments have positive effects
when administered to children with ASDsrdquo Clark
2012
Smith Roley 2014
3) The lack of positive outcomes from SI Intervention may be due
to weak or poorly designed studies
bull Current studies suggest that with stronger and more
studies there will be consistent beneficial effects for
certain outcomes
bull ldquoThe challenge is to make these studies happenrdquo
Clark 2012
Smith Roley 2013
4) Critics often forget that a lack of solid evidence characterizes
nearly all interventions for children with ASDs
bull SI intervention is often held to a different standard
than other types of intervention failing to apply the
same criterion to alternate interventions
Clark 2012
Smith Roley 2014
Remaining Mysteries
Smith Roley 2013
Implications for Advocacy
People need breaks such as recess
People require sensorimotor and social play timespacevalue in the daily routine
Smith Roley 2014
Implications for Research on OT using Sensory Integration
Enhancing Neuroplasticity via Therapeutic Design
bull Dosage - Intensity of increased access in short time periods rather than small access over longer times
bull Engagement via play and not just exposure
bull Role of therapist in providing customized sensorimotor challenges
bull Access to safe dynamic and therapeutic environments vs predictable and static environments
bull The difference between practice for skill development and adaptation to challenges in changing environments
Smith Roley 2014
Implications for Sensory Integration in Practice
Most importantly the success of Sensory Integration in practice depends on
YOU
Smith Roley 2014
Thank You
bull Organizers and Participants
bull hyvaumlauml paumlivaumlnjatkoa
bull Enjoy the conference
Smith Roley 2013
bull Ayres AJ (2005) Sensory Integration and the Child Los Angeles CA Western Psychological Services bull Armstrong T (2006) The best schools How human development research should inform educational practice Alexandria
VA Association for Supervision and Curriculum Development bull Blanche E I Bodison S Chang M C amp Reinoso G (2012) Development of the comprehensive observations of
proprioception (COP) Validity reliability and factor analysis American Journal of Occupational Therapy 66 691ndash698 bull Bundy A amp Lane S (In press) Sensory integration theory and practice Third Ed Philsadelphia PA FA Davis Inc bull Casey T amp MacIntyre S (2007) Childrenrsquos need for time and space In T Casey (Ed) Environments for outdoor play A
practical guide to making space for children (pp 5 ndash 16) London Sage Publications httpwwwsagepubcomupm-data15553_CASEY_C01PDF
bull Gray P (2013) Play as preparation for learning and life American Journal of Play 5(3) 271 - 292 bull Greenough WR Black JE Wallace CS (1987) Experience and brain development Child Development 58(3)539-59 bull Lane AE Young RL Baker AEZ amp Angley MT (2010) Sensory processing subtypes in autism Association with adaptive behavior
Journal of Autism and Developmental Disorders 40 112-122
bull Lane SJ Schaaf RC (2010) Examining the neuroscience evidence for sensory-driven neuroplasticity implications for sensory-based occupational therapy for children and adolescents American Journal of Occupational Therapy 64(3)375-90
bull Mailloux Z Mulligan S Smith Roley S Cermak S Blanche E amp Bodison S Coleman G amp Lane C (2011) Verification and clarification of patterns of sensory integrative dysfunction in a retrospective clinical sample American Journal of Occupational Therapy 652 143-151
bull May A (2011) Experience-dependent structural plasticity in the adult human brain 1-8 Trends in Cognitive Sciences bull May-Benson TA Smith Roley S Mailloux Z Parham LD Koomar J Schaaf RC Van Jaarsveld AM amp Cohn E (in
press) Structural Elements of the Ayres Sensory Integrationreg Intervention Fidelity Measurecopy American Journal of Occupational Therapy
bull Milteer RM Ginsburg KR amp Council on Communications and Media Committee on Psychosocial Aspects of Child and Family Health (2011) Pediatrics e204-e213 DOI 101542peds2011-2953
bull Parham LD Cohn ES Spitzer S Koomar J Miller LJ Burke JP Brett-Green B Mailloux Z May-Benson T Smith Roley S Schaaf RC Schoen S amp Summers CA (2007) Fidelity in sensory integration intervention research American Journal of Occupational Therapy 61 2 216-227
bull Parham LD Smith Roley S May-Benson T Koomar J Brett-Green B Burke JP Cohn ES Mailloux Z Miller LJ amp Schaaf RC (2011) Development of a fidelity measure for research on effectiveness of Ayres Sensory Integrationreg intervention American Journal of Occupational Therapy 65 2 133-142
bull Reynolds S Lane SJ amp Richards L (2010) Using animal models of enriched environments to inform research on sensory integration intervention for the rehabilitation of neurodevelopmental disorders Journal of Neurodevelopmental Disorders 2( 3) 120-132 online first DOI 101007s11689-010-9053-4
bull Roley SS Mailloux Z Parham D Schaaf R Blanche E amp Lane CA Cermak S (in press) Sensory Integration and Praxis Patterns in Children with Autism American Journal of Occupational Therapy
bull Rosenzweig MR Bennet EL and Diamond MC (1972) Brain Changes in response to experience Scientific American 226(2) 22-29
bull Van Jaarsveld A Mailloux Z Smith Roley S amp Raubenheimer J (in press) Patterns of the sensory integration dysfunctions in South African children South African Journal of Occupational Therapy
bull Wills S Cabanlit M Bennett J Ashwood P Amaral DG amp Van de Water J (2009) Detection of autoantibodies to neural cells of the cerebellum in the plasma of subjects with autism spectrum disorders Brain Behavior and Immunity 23(1) 64-74
HEALTH amp RESILIENCE
Smith Roley 2014
INFLUENCES ON PRACTICE
Smith Roley 2014
PRENATAL FACTORS amp Epigenetics
bull Autoimmune Deficits (Amaral 2014)
Smith Roley 2013
Smith Roley 2014
Maternal Environment Prenatal Stress amp Alcohol Exposure (Schneider)
Prevalence of Autism
bull On March 27 2014 the Centers for Disease Control and Prevention (CDC) surveillance study identified
bull 1 in 68 children (1 in 42 boys and 1 in 189 girls) with Autism Spectrum Disorder in the United States
bull Atypical sensory reactivity included in DSM-5 as diagnostic feature
Smith Roley 2013
Prevalence of Mental Illness
bull Mental illness is increasing in children younger than 18 years
bull A total of 13 to 20 of children living in the United Sates experience a mental disorder in a given year
May 16 2014
CDC Morbidity and Mortality Weekly Report
Smith Roley 2014
Prevalence of Dementia
bull Expanding rapidly particularly in countries with low and middle incomes
bull It was estimated that 356 million people lived with dementia worldwide in 2010 with numbers expected to almost double every 20 years to 657 million in 2030 and 1154 million in 2050
bull In 2010 58 of all people with dementia lived in countries with low or middle incomes with this proportion anticipated to rise to 63 in 2030 and 71 in 2050
Alzheimers Dement 2013 Jan9(1)63-75e2 doi 101016jjalz201211007 The global prevalence of dementia a systematic review and metaanalysis Prince M1 Bryce R Albanese E Wimo A Ribeiro W Ferri CP Author information
Smith Roley 2013
Sensory Integration as a Vehicle for Change
Smith Roley 2014
ADAPTATION
ldquoWhen the sensory integrative capacity of the brain is sufficient to meet the demands of the environment the childrsquos response is efficient creative and satisfyingrdquo
PLAY
When the child experiences challenges to which (she) he can respond effectively (she) he ldquohas funrdquo
ldquoFun is the childrsquos word for sensory integrationrdquo Sensory Integration and the Child p8
Smith Roley 2014
Danielle Marshall spokesperson for KaBOOM a nonprofit org httpusatoday30usatodaycomnewshealthwellnessstory201108Advocates-Importance-of-play-time-for-children-neglected500718781 retrieved 82613
Changing Values re Play
bull ldquoSince the 1970s kids have lost an average nine hours of free playtime a week
bull and when given recreational activities they are likely to be adult-led and adult-supervisedrdquo
Smith Roley 2014
Neuroplasticity
bull ldquoNovel experience bull altered afferent input due to
environmental changes bull and learning new skills bull are now recognized as
modulators of brain function and underlying neuroanatomic circuitryrdquo
May A 2011 p1
Smith Roley 2013
Greenough Black amp Wallace 1987
ldquoExperience can influence
the developing and mature brainrdquo
bull Experience-independent ndash genetic unfolding
bull Experience-expectant ndash neural structuresfunctions ready during critical periods ndash Experience-dependent ndash enrichment
bull unique to the individual
bull incorporation of idiosyncratic environmental information
bull Involves active formation of new synaptic connections in response to the events
Smith Roley 2013
Animal Studies on Enriched Environments Rosenzweig Bennett amp Diamond (1972)
(summary in Reynolds Lane amp Richards 2010)
Changes to standard cage conditions provide enhanced sensory motor cognitive and potentially social opportunities
Experience dependent results from active interaction between animal amp environment Increase in dendritic branching amp
synaptogenesis Neurogenesis in hippocampus amp amygdala Gliogenesis
Smith Roley 2013
Predicting Outcomes
Neuroplasticity studies suggest outcomes of Sensory Integrative approach may be
Decreased anxiety Decreased hypersensitivity Normalization of stress response Increased social participation Reduced stereotyped behaviors Better learning amp memory
Smith Roley 2013
What are the active ingredients of change
bull Motor activity bull Sensory input bull Social interactionplay bull MOST LIKELY a
combination ndash sensory motor amp
cognitive stimulation ndash environmental novelty ndash opportunities for
engagement in challenging tasks
Smith Roley 2014
Implications for Sensory Integration in Practice
However
OTSI has an
additional active ingredient
YOU
Smith Roley 2014
bull Model of Sensory Integration bull Theory of Sensory Integration
Assessments bull Sensory Integration amp Praxis Tests bull Sensory History
Questionnaires bull Clinical Observations
bull Interpretation bull Intervention bull Outcomes Research
Scholarship ~ Mentorship
Sensory Integrative Processes
The senses Integration of their inputs End products
Auditory (hearing)
First level Second level Third level Fourth level
Vestibular
(gravity amp movement)
Proprioceptive
(muscles amp joints)
Tactile (touch)
Visual (seeing)
Speech
Language
eye movements
Posture
Balance
Muscle tone
Gravitational security
Sucking
Eating
Mother-infant bond
Tactile comfort
Body perception
Coordination of two
sides of the body
Motor planning
Activity level
Attention span
Emotional stability
Eye-hand
coordination
Visual perception
Purposeful activity
Ability to concentrate
Ability to organise
Self-esteem
Self-control
Self-confidence
Academic learning ability
Capacity for abstract
thought and reasoning
Specialization of each side
of the body and the brain
Published by WPSreg 1979 2005 (c) 2014 Smith Roley Singer amp Roley
Theory Updates
Example Symplexity Alain Berthoz (2012)
ldquoA very young baby can mimic the facial expressions of its parents even though it cannot
see its own face which would seem to suggest the existence of innate mechanism of intermodal
encoding and transfer between what is perceived and what is producedhellip
This embodiment of perception is a
fundamental mechanism of simplexityrdquo
Smith Roley 2013
Assessment Updates
Sensory Integration Patterns (Ayres 1965-1989)
bull Tactile amp motor planning deficits (1965 1966 1969 1972 1977 amp 1989)
bull Visual perceptionvisual praxis deficits (1965 1966 1969 1972 1977 amp 1989)
bull Vestibular postural amp bilateral deficits (1965 1966 1969 1972 1977 amp 1989)
bull Tactile defensiveness amp hyperactivitydistractibility (1965 1966 1969 1972)
bull Other factors (auditory language somatosensory perception) seen in some studies
(1969 1972 1977 1989)
Verification and Clarification of
Sensory Integration Patterns
Mulligan (1998)
Mailloux Mulligan Roley etal (2011)
Van Jaarsveld etal (in press)
Lane (2010)
Blanche etal (2012)
SIPT Factor Analysis
Mulligan 1998
n= 10475
Smith Roley 2014
PPR
PRVC
SV
CPR
MFP II
DC
MFP I
OPR
SWB
PRN
BMC
MAC
GRA
SPR
KIN
LTS
FG
FI
TD
ATTN
Visio amp Somatopraxis
VestibularProp
Bilateral Integration amp
Sequencing
Tactile amp
Visual Discrimination
Tactile Defensiveness
amp Attention
SIPT Factor Analysis
Mailloux etal 2011
n=278
SIPT Factor Analysis in South African Sample (Van Jaarsveld etal in press)
n=223 Convenience Sample
bull Factor 1
ndash Visuo and Somatodyspraxia
bull DC CPR SV MAc MFP KIN SPr PvVC SWB GRA
bull Factor 2
ndash Bilateral Integration and Sequencing
bull SPr BMC Opr SWB with lower loadings on PPr PrVC
bull Factor 3
ndash Tactile and Visual Discrimination
bull FI MFP LTS with moderate loadings on PrVC OPr
26 (c) 2014 Susanne Smith
Roley OTD
SIPT Factor Analysis in South African Sample (Van Jaarsveld etal in press)
27 (c) 2014 Susanne Smith
Roley OTD Figure 1 Loadings on three factors of final analysis
Lane AE etal (2010)
Sensory Profile Cluster Analysis 3 patterns of ASD sensory processing
Sensory-based inattentive seeking
under-responsive (milder)
Sensory modulation with movement sensitivity low energyweak poor endurance
Sensory modulation with tastesmell sensitivity
under and over-responsiveness with no movement issues more communication difficulties and maladaptive behaviors
Sensory subtypes predicted communication competence
and maladaptive behavior
Comprehensive Observation of Proprioception (COP) Factor Analyses
bull F1 Tone and Joint Alignment
ndash Joint hypermobility decreased tone poor joint alignment
bull F2 Behavioral Manifestations
ndash Pushing overactive crashing falling running
ndash Correlates with SPM bumping and pushing
bull F3 Postural Motor
ndash Decreased PC tendency to lean inefficient grading force inadequate weight bearing inefficient ankle strategies
ndash Correlates with SPM body awareness and SWB
bull F4 Motor Planning
ndash Decreased feedback planning decreased feedforward planning overly passive
ndash No correlation with SPM body awareness weak correlation with KIN and SWB
Blanche Bodison Chang amp Reinoso (2012)
29
(c) 2014 Susanne Smith Roley
OTD
Refining Assessment of Sensory Integrative Functions
Smith Roley 2014
Visual-Praxis
Vestibular Bilateral Integration
Proprioception Tactile
Somato- dyspraxia
Sensory Reactivity
(Modulation)
Visual motor
Postural
control
Gross
motor
skills
Praxis Arousal
Affect
Activity Level
Attention
Visual construction
Bilateral coordination
Sequencing
Fine motor skills
Auditory -Language
Organization of behavior
StateSelf Regulation
Smith Roley 2013
SENSORY INTEGRATION INTERVENTION
Intervention Planning Promoting neuroplasticity health and development
Smith Roley 2014
Implications for OTSI Intervention
Consistent with Neuroplasticity Literature
ndash Sensorimotor opportunities
ndash Control over activity
ndash Novelty
ndash Challenge
ndash Playful environment
ndash Lifelike context
Smith Roley 2014
Sensory Integration and Play
bull When the therapist is doing her job effectively and the child is organizing his nervous system it looks as if the child is merely playing rdquo ndash Ayres 1979
Smith Roley 2013
Ayres Sensory Integrationreg Intervention Fidelity Measure
Parham et al 2007 2011 2013-in press
ASIFM Structural elements ndash Part I Therapist Qualifications
ndash Part II Safe Environment
ndash Part III Record Review
ndash Part IV Space and Equipment
ndash Part V Communication with Parents amp Teachers
Smith Roley 2013
ASIFM Process Elements (Parham et al 2011)
1 Physical safety 2 Sensory opportunities
(vestibular tactile and proprioceptive)
3 Supports sensory modulation to attainmaintain a regulated state
4 Supports postural ocular oral or bilateral motor coordination
5 Challenges praxis and organization of behavior
6 Collaborative activity choice
7 Just Right Challenge
8 Ensures Success
9 Supports motivation to play
10 Establishes therapeutic alliance
Smith Roley 2013
Data-driven Intervention Process (Schaaf 2001 Schaaf amp Blanche 2012)
Participation challenges
Current behavior
Theoretical
Framework
Assessments
37
Hypotheses Interventions Outcomes
(c) 2014 Susanne Smith Roley
OTD
Grounds for Optimism
Four Common Misconceptions
in the Anti-SI Intervention Literature Clark 2012
1) Reviews critical of sensory integration
intervention research ignores issues of fidelity
and dosage
Smith Roley 2014
2) Reviewers ignore or minimize the available
positive evidence for SI intervention
bull 3 RCTrsquos with autism demonstrated positive results
following multisensory interventions (including SI
intervention) (Fazlioglu amp Baran 2008 Pfeiffer
Koenig Kinnealey Sheppard amp Henderson 2011
Smith Press Koenig amp Kinnealey 2005)
bull ldquoBased on the application of meta-analytic techniques
for cumulating probability values it is not hard to
conclude that sensory treatments have positive effects
when administered to children with ASDsrdquo Clark
2012
Smith Roley 2014
3) The lack of positive outcomes from SI Intervention may be due
to weak or poorly designed studies
bull Current studies suggest that with stronger and more
studies there will be consistent beneficial effects for
certain outcomes
bull ldquoThe challenge is to make these studies happenrdquo
Clark 2012
Smith Roley 2013
4) Critics often forget that a lack of solid evidence characterizes
nearly all interventions for children with ASDs
bull SI intervention is often held to a different standard
than other types of intervention failing to apply the
same criterion to alternate interventions
Clark 2012
Smith Roley 2014
Remaining Mysteries
Smith Roley 2013
Implications for Advocacy
People need breaks such as recess
People require sensorimotor and social play timespacevalue in the daily routine
Smith Roley 2014
Implications for Research on OT using Sensory Integration
Enhancing Neuroplasticity via Therapeutic Design
bull Dosage - Intensity of increased access in short time periods rather than small access over longer times
bull Engagement via play and not just exposure
bull Role of therapist in providing customized sensorimotor challenges
bull Access to safe dynamic and therapeutic environments vs predictable and static environments
bull The difference between practice for skill development and adaptation to challenges in changing environments
Smith Roley 2014
Implications for Sensory Integration in Practice
Most importantly the success of Sensory Integration in practice depends on
YOU
Smith Roley 2014
Thank You
bull Organizers and Participants
bull hyvaumlauml paumlivaumlnjatkoa
bull Enjoy the conference
Smith Roley 2013
bull Ayres AJ (2005) Sensory Integration and the Child Los Angeles CA Western Psychological Services bull Armstrong T (2006) The best schools How human development research should inform educational practice Alexandria
VA Association for Supervision and Curriculum Development bull Blanche E I Bodison S Chang M C amp Reinoso G (2012) Development of the comprehensive observations of
proprioception (COP) Validity reliability and factor analysis American Journal of Occupational Therapy 66 691ndash698 bull Bundy A amp Lane S (In press) Sensory integration theory and practice Third Ed Philsadelphia PA FA Davis Inc bull Casey T amp MacIntyre S (2007) Childrenrsquos need for time and space In T Casey (Ed) Environments for outdoor play A
practical guide to making space for children (pp 5 ndash 16) London Sage Publications httpwwwsagepubcomupm-data15553_CASEY_C01PDF
bull Gray P (2013) Play as preparation for learning and life American Journal of Play 5(3) 271 - 292 bull Greenough WR Black JE Wallace CS (1987) Experience and brain development Child Development 58(3)539-59 bull Lane AE Young RL Baker AEZ amp Angley MT (2010) Sensory processing subtypes in autism Association with adaptive behavior
Journal of Autism and Developmental Disorders 40 112-122
bull Lane SJ Schaaf RC (2010) Examining the neuroscience evidence for sensory-driven neuroplasticity implications for sensory-based occupational therapy for children and adolescents American Journal of Occupational Therapy 64(3)375-90
bull Mailloux Z Mulligan S Smith Roley S Cermak S Blanche E amp Bodison S Coleman G amp Lane C (2011) Verification and clarification of patterns of sensory integrative dysfunction in a retrospective clinical sample American Journal of Occupational Therapy 652 143-151
bull May A (2011) Experience-dependent structural plasticity in the adult human brain 1-8 Trends in Cognitive Sciences bull May-Benson TA Smith Roley S Mailloux Z Parham LD Koomar J Schaaf RC Van Jaarsveld AM amp Cohn E (in
press) Structural Elements of the Ayres Sensory Integrationreg Intervention Fidelity Measurecopy American Journal of Occupational Therapy
bull Milteer RM Ginsburg KR amp Council on Communications and Media Committee on Psychosocial Aspects of Child and Family Health (2011) Pediatrics e204-e213 DOI 101542peds2011-2953
bull Parham LD Cohn ES Spitzer S Koomar J Miller LJ Burke JP Brett-Green B Mailloux Z May-Benson T Smith Roley S Schaaf RC Schoen S amp Summers CA (2007) Fidelity in sensory integration intervention research American Journal of Occupational Therapy 61 2 216-227
bull Parham LD Smith Roley S May-Benson T Koomar J Brett-Green B Burke JP Cohn ES Mailloux Z Miller LJ amp Schaaf RC (2011) Development of a fidelity measure for research on effectiveness of Ayres Sensory Integrationreg intervention American Journal of Occupational Therapy 65 2 133-142
bull Reynolds S Lane SJ amp Richards L (2010) Using animal models of enriched environments to inform research on sensory integration intervention for the rehabilitation of neurodevelopmental disorders Journal of Neurodevelopmental Disorders 2( 3) 120-132 online first DOI 101007s11689-010-9053-4
bull Roley SS Mailloux Z Parham D Schaaf R Blanche E amp Lane CA Cermak S (in press) Sensory Integration and Praxis Patterns in Children with Autism American Journal of Occupational Therapy
bull Rosenzweig MR Bennet EL and Diamond MC (1972) Brain Changes in response to experience Scientific American 226(2) 22-29
bull Van Jaarsveld A Mailloux Z Smith Roley S amp Raubenheimer J (in press) Patterns of the sensory integration dysfunctions in South African children South African Journal of Occupational Therapy
bull Wills S Cabanlit M Bennett J Ashwood P Amaral DG amp Van de Water J (2009) Detection of autoantibodies to neural cells of the cerebellum in the plasma of subjects with autism spectrum disorders Brain Behavior and Immunity 23(1) 64-74
INFLUENCES ON PRACTICE
Smith Roley 2014
PRENATAL FACTORS amp Epigenetics
bull Autoimmune Deficits (Amaral 2014)
Smith Roley 2013
Smith Roley 2014
Maternal Environment Prenatal Stress amp Alcohol Exposure (Schneider)
Prevalence of Autism
bull On March 27 2014 the Centers for Disease Control and Prevention (CDC) surveillance study identified
bull 1 in 68 children (1 in 42 boys and 1 in 189 girls) with Autism Spectrum Disorder in the United States
bull Atypical sensory reactivity included in DSM-5 as diagnostic feature
Smith Roley 2013
Prevalence of Mental Illness
bull Mental illness is increasing in children younger than 18 years
bull A total of 13 to 20 of children living in the United Sates experience a mental disorder in a given year
May 16 2014
CDC Morbidity and Mortality Weekly Report
Smith Roley 2014
Prevalence of Dementia
bull Expanding rapidly particularly in countries with low and middle incomes
bull It was estimated that 356 million people lived with dementia worldwide in 2010 with numbers expected to almost double every 20 years to 657 million in 2030 and 1154 million in 2050
bull In 2010 58 of all people with dementia lived in countries with low or middle incomes with this proportion anticipated to rise to 63 in 2030 and 71 in 2050
Alzheimers Dement 2013 Jan9(1)63-75e2 doi 101016jjalz201211007 The global prevalence of dementia a systematic review and metaanalysis Prince M1 Bryce R Albanese E Wimo A Ribeiro W Ferri CP Author information
Smith Roley 2013
Sensory Integration as a Vehicle for Change
Smith Roley 2014
ADAPTATION
ldquoWhen the sensory integrative capacity of the brain is sufficient to meet the demands of the environment the childrsquos response is efficient creative and satisfyingrdquo
PLAY
When the child experiences challenges to which (she) he can respond effectively (she) he ldquohas funrdquo
ldquoFun is the childrsquos word for sensory integrationrdquo Sensory Integration and the Child p8
Smith Roley 2014
Danielle Marshall spokesperson for KaBOOM a nonprofit org httpusatoday30usatodaycomnewshealthwellnessstory201108Advocates-Importance-of-play-time-for-children-neglected500718781 retrieved 82613
Changing Values re Play
bull ldquoSince the 1970s kids have lost an average nine hours of free playtime a week
bull and when given recreational activities they are likely to be adult-led and adult-supervisedrdquo
Smith Roley 2014
Neuroplasticity
bull ldquoNovel experience bull altered afferent input due to
environmental changes bull and learning new skills bull are now recognized as
modulators of brain function and underlying neuroanatomic circuitryrdquo
May A 2011 p1
Smith Roley 2013
Greenough Black amp Wallace 1987
ldquoExperience can influence
the developing and mature brainrdquo
bull Experience-independent ndash genetic unfolding
bull Experience-expectant ndash neural structuresfunctions ready during critical periods ndash Experience-dependent ndash enrichment
bull unique to the individual
bull incorporation of idiosyncratic environmental information
bull Involves active formation of new synaptic connections in response to the events
Smith Roley 2013
Animal Studies on Enriched Environments Rosenzweig Bennett amp Diamond (1972)
(summary in Reynolds Lane amp Richards 2010)
Changes to standard cage conditions provide enhanced sensory motor cognitive and potentially social opportunities
Experience dependent results from active interaction between animal amp environment Increase in dendritic branching amp
synaptogenesis Neurogenesis in hippocampus amp amygdala Gliogenesis
Smith Roley 2013
Predicting Outcomes
Neuroplasticity studies suggest outcomes of Sensory Integrative approach may be
Decreased anxiety Decreased hypersensitivity Normalization of stress response Increased social participation Reduced stereotyped behaviors Better learning amp memory
Smith Roley 2013
What are the active ingredients of change
bull Motor activity bull Sensory input bull Social interactionplay bull MOST LIKELY a
combination ndash sensory motor amp
cognitive stimulation ndash environmental novelty ndash opportunities for
engagement in challenging tasks
Smith Roley 2014
Implications for Sensory Integration in Practice
However
OTSI has an
additional active ingredient
YOU
Smith Roley 2014
bull Model of Sensory Integration bull Theory of Sensory Integration
Assessments bull Sensory Integration amp Praxis Tests bull Sensory History
Questionnaires bull Clinical Observations
bull Interpretation bull Intervention bull Outcomes Research
Scholarship ~ Mentorship
Sensory Integrative Processes
The senses Integration of their inputs End products
Auditory (hearing)
First level Second level Third level Fourth level
Vestibular
(gravity amp movement)
Proprioceptive
(muscles amp joints)
Tactile (touch)
Visual (seeing)
Speech
Language
eye movements
Posture
Balance
Muscle tone
Gravitational security
Sucking
Eating
Mother-infant bond
Tactile comfort
Body perception
Coordination of two
sides of the body
Motor planning
Activity level
Attention span
Emotional stability
Eye-hand
coordination
Visual perception
Purposeful activity
Ability to concentrate
Ability to organise
Self-esteem
Self-control
Self-confidence
Academic learning ability
Capacity for abstract
thought and reasoning
Specialization of each side
of the body and the brain
Published by WPSreg 1979 2005 (c) 2014 Smith Roley Singer amp Roley
Theory Updates
Example Symplexity Alain Berthoz (2012)
ldquoA very young baby can mimic the facial expressions of its parents even though it cannot
see its own face which would seem to suggest the existence of innate mechanism of intermodal
encoding and transfer between what is perceived and what is producedhellip
This embodiment of perception is a
fundamental mechanism of simplexityrdquo
Smith Roley 2013
Assessment Updates
Sensory Integration Patterns (Ayres 1965-1989)
bull Tactile amp motor planning deficits (1965 1966 1969 1972 1977 amp 1989)
bull Visual perceptionvisual praxis deficits (1965 1966 1969 1972 1977 amp 1989)
bull Vestibular postural amp bilateral deficits (1965 1966 1969 1972 1977 amp 1989)
bull Tactile defensiveness amp hyperactivitydistractibility (1965 1966 1969 1972)
bull Other factors (auditory language somatosensory perception) seen in some studies
(1969 1972 1977 1989)
Verification and Clarification of
Sensory Integration Patterns
Mulligan (1998)
Mailloux Mulligan Roley etal (2011)
Van Jaarsveld etal (in press)
Lane (2010)
Blanche etal (2012)
SIPT Factor Analysis
Mulligan 1998
n= 10475
Smith Roley 2014
PPR
PRVC
SV
CPR
MFP II
DC
MFP I
OPR
SWB
PRN
BMC
MAC
GRA
SPR
KIN
LTS
FG
FI
TD
ATTN
Visio amp Somatopraxis
VestibularProp
Bilateral Integration amp
Sequencing
Tactile amp
Visual Discrimination
Tactile Defensiveness
amp Attention
SIPT Factor Analysis
Mailloux etal 2011
n=278
SIPT Factor Analysis in South African Sample (Van Jaarsveld etal in press)
n=223 Convenience Sample
bull Factor 1
ndash Visuo and Somatodyspraxia
bull DC CPR SV MAc MFP KIN SPr PvVC SWB GRA
bull Factor 2
ndash Bilateral Integration and Sequencing
bull SPr BMC Opr SWB with lower loadings on PPr PrVC
bull Factor 3
ndash Tactile and Visual Discrimination
bull FI MFP LTS with moderate loadings on PrVC OPr
26 (c) 2014 Susanne Smith
Roley OTD
SIPT Factor Analysis in South African Sample (Van Jaarsveld etal in press)
27 (c) 2014 Susanne Smith
Roley OTD Figure 1 Loadings on three factors of final analysis
Lane AE etal (2010)
Sensory Profile Cluster Analysis 3 patterns of ASD sensory processing
Sensory-based inattentive seeking
under-responsive (milder)
Sensory modulation with movement sensitivity low energyweak poor endurance
Sensory modulation with tastesmell sensitivity
under and over-responsiveness with no movement issues more communication difficulties and maladaptive behaviors
Sensory subtypes predicted communication competence
and maladaptive behavior
Comprehensive Observation of Proprioception (COP) Factor Analyses
bull F1 Tone and Joint Alignment
ndash Joint hypermobility decreased tone poor joint alignment
bull F2 Behavioral Manifestations
ndash Pushing overactive crashing falling running
ndash Correlates with SPM bumping and pushing
bull F3 Postural Motor
ndash Decreased PC tendency to lean inefficient grading force inadequate weight bearing inefficient ankle strategies
ndash Correlates with SPM body awareness and SWB
bull F4 Motor Planning
ndash Decreased feedback planning decreased feedforward planning overly passive
ndash No correlation with SPM body awareness weak correlation with KIN and SWB
Blanche Bodison Chang amp Reinoso (2012)
29
(c) 2014 Susanne Smith Roley
OTD
Refining Assessment of Sensory Integrative Functions
Smith Roley 2014
Visual-Praxis
Vestibular Bilateral Integration
Proprioception Tactile
Somato- dyspraxia
Sensory Reactivity
(Modulation)
Visual motor
Postural
control
Gross
motor
skills
Praxis Arousal
Affect
Activity Level
Attention
Visual construction
Bilateral coordination
Sequencing
Fine motor skills
Auditory -Language
Organization of behavior
StateSelf Regulation
Smith Roley 2013
SENSORY INTEGRATION INTERVENTION
Intervention Planning Promoting neuroplasticity health and development
Smith Roley 2014
Implications for OTSI Intervention
Consistent with Neuroplasticity Literature
ndash Sensorimotor opportunities
ndash Control over activity
ndash Novelty
ndash Challenge
ndash Playful environment
ndash Lifelike context
Smith Roley 2014
Sensory Integration and Play
bull When the therapist is doing her job effectively and the child is organizing his nervous system it looks as if the child is merely playing rdquo ndash Ayres 1979
Smith Roley 2013
Ayres Sensory Integrationreg Intervention Fidelity Measure
Parham et al 2007 2011 2013-in press
ASIFM Structural elements ndash Part I Therapist Qualifications
ndash Part II Safe Environment
ndash Part III Record Review
ndash Part IV Space and Equipment
ndash Part V Communication with Parents amp Teachers
Smith Roley 2013
ASIFM Process Elements (Parham et al 2011)
1 Physical safety 2 Sensory opportunities
(vestibular tactile and proprioceptive)
3 Supports sensory modulation to attainmaintain a regulated state
4 Supports postural ocular oral or bilateral motor coordination
5 Challenges praxis and organization of behavior
6 Collaborative activity choice
7 Just Right Challenge
8 Ensures Success
9 Supports motivation to play
10 Establishes therapeutic alliance
Smith Roley 2013
Data-driven Intervention Process (Schaaf 2001 Schaaf amp Blanche 2012)
Participation challenges
Current behavior
Theoretical
Framework
Assessments
37
Hypotheses Interventions Outcomes
(c) 2014 Susanne Smith Roley
OTD
Grounds for Optimism
Four Common Misconceptions
in the Anti-SI Intervention Literature Clark 2012
1) Reviews critical of sensory integration
intervention research ignores issues of fidelity
and dosage
Smith Roley 2014
2) Reviewers ignore or minimize the available
positive evidence for SI intervention
bull 3 RCTrsquos with autism demonstrated positive results
following multisensory interventions (including SI
intervention) (Fazlioglu amp Baran 2008 Pfeiffer
Koenig Kinnealey Sheppard amp Henderson 2011
Smith Press Koenig amp Kinnealey 2005)
bull ldquoBased on the application of meta-analytic techniques
for cumulating probability values it is not hard to
conclude that sensory treatments have positive effects
when administered to children with ASDsrdquo Clark
2012
Smith Roley 2014
3) The lack of positive outcomes from SI Intervention may be due
to weak or poorly designed studies
bull Current studies suggest that with stronger and more
studies there will be consistent beneficial effects for
certain outcomes
bull ldquoThe challenge is to make these studies happenrdquo
Clark 2012
Smith Roley 2013
4) Critics often forget that a lack of solid evidence characterizes
nearly all interventions for children with ASDs
bull SI intervention is often held to a different standard
than other types of intervention failing to apply the
same criterion to alternate interventions
Clark 2012
Smith Roley 2014
Remaining Mysteries
Smith Roley 2013
Implications for Advocacy
People need breaks such as recess
People require sensorimotor and social play timespacevalue in the daily routine
Smith Roley 2014
Implications for Research on OT using Sensory Integration
Enhancing Neuroplasticity via Therapeutic Design
bull Dosage - Intensity of increased access in short time periods rather than small access over longer times
bull Engagement via play and not just exposure
bull Role of therapist in providing customized sensorimotor challenges
bull Access to safe dynamic and therapeutic environments vs predictable and static environments
bull The difference between practice for skill development and adaptation to challenges in changing environments
Smith Roley 2014
Implications for Sensory Integration in Practice
Most importantly the success of Sensory Integration in practice depends on
YOU
Smith Roley 2014
Thank You
bull Organizers and Participants
bull hyvaumlauml paumlivaumlnjatkoa
bull Enjoy the conference
Smith Roley 2013
bull Ayres AJ (2005) Sensory Integration and the Child Los Angeles CA Western Psychological Services bull Armstrong T (2006) The best schools How human development research should inform educational practice Alexandria
VA Association for Supervision and Curriculum Development bull Blanche E I Bodison S Chang M C amp Reinoso G (2012) Development of the comprehensive observations of
proprioception (COP) Validity reliability and factor analysis American Journal of Occupational Therapy 66 691ndash698 bull Bundy A amp Lane S (In press) Sensory integration theory and practice Third Ed Philsadelphia PA FA Davis Inc bull Casey T amp MacIntyre S (2007) Childrenrsquos need for time and space In T Casey (Ed) Environments for outdoor play A
practical guide to making space for children (pp 5 ndash 16) London Sage Publications httpwwwsagepubcomupm-data15553_CASEY_C01PDF
bull Gray P (2013) Play as preparation for learning and life American Journal of Play 5(3) 271 - 292 bull Greenough WR Black JE Wallace CS (1987) Experience and brain development Child Development 58(3)539-59 bull Lane AE Young RL Baker AEZ amp Angley MT (2010) Sensory processing subtypes in autism Association with adaptive behavior
Journal of Autism and Developmental Disorders 40 112-122
bull Lane SJ Schaaf RC (2010) Examining the neuroscience evidence for sensory-driven neuroplasticity implications for sensory-based occupational therapy for children and adolescents American Journal of Occupational Therapy 64(3)375-90
bull Mailloux Z Mulligan S Smith Roley S Cermak S Blanche E amp Bodison S Coleman G amp Lane C (2011) Verification and clarification of patterns of sensory integrative dysfunction in a retrospective clinical sample American Journal of Occupational Therapy 652 143-151
bull May A (2011) Experience-dependent structural plasticity in the adult human brain 1-8 Trends in Cognitive Sciences bull May-Benson TA Smith Roley S Mailloux Z Parham LD Koomar J Schaaf RC Van Jaarsveld AM amp Cohn E (in
press) Structural Elements of the Ayres Sensory Integrationreg Intervention Fidelity Measurecopy American Journal of Occupational Therapy
bull Milteer RM Ginsburg KR amp Council on Communications and Media Committee on Psychosocial Aspects of Child and Family Health (2011) Pediatrics e204-e213 DOI 101542peds2011-2953
bull Parham LD Cohn ES Spitzer S Koomar J Miller LJ Burke JP Brett-Green B Mailloux Z May-Benson T Smith Roley S Schaaf RC Schoen S amp Summers CA (2007) Fidelity in sensory integration intervention research American Journal of Occupational Therapy 61 2 216-227
bull Parham LD Smith Roley S May-Benson T Koomar J Brett-Green B Burke JP Cohn ES Mailloux Z Miller LJ amp Schaaf RC (2011) Development of a fidelity measure for research on effectiveness of Ayres Sensory Integrationreg intervention American Journal of Occupational Therapy 65 2 133-142
bull Reynolds S Lane SJ amp Richards L (2010) Using animal models of enriched environments to inform research on sensory integration intervention for the rehabilitation of neurodevelopmental disorders Journal of Neurodevelopmental Disorders 2( 3) 120-132 online first DOI 101007s11689-010-9053-4
bull Roley SS Mailloux Z Parham D Schaaf R Blanche E amp Lane CA Cermak S (in press) Sensory Integration and Praxis Patterns in Children with Autism American Journal of Occupational Therapy
bull Rosenzweig MR Bennet EL and Diamond MC (1972) Brain Changes in response to experience Scientific American 226(2) 22-29
bull Van Jaarsveld A Mailloux Z Smith Roley S amp Raubenheimer J (in press) Patterns of the sensory integration dysfunctions in South African children South African Journal of Occupational Therapy
bull Wills S Cabanlit M Bennett J Ashwood P Amaral DG amp Van de Water J (2009) Detection of autoantibodies to neural cells of the cerebellum in the plasma of subjects with autism spectrum disorders Brain Behavior and Immunity 23(1) 64-74
PRENATAL FACTORS amp Epigenetics
bull Autoimmune Deficits (Amaral 2014)
Smith Roley 2013
Smith Roley 2014
Maternal Environment Prenatal Stress amp Alcohol Exposure (Schneider)
Prevalence of Autism
bull On March 27 2014 the Centers for Disease Control and Prevention (CDC) surveillance study identified
bull 1 in 68 children (1 in 42 boys and 1 in 189 girls) with Autism Spectrum Disorder in the United States
bull Atypical sensory reactivity included in DSM-5 as diagnostic feature
Smith Roley 2013
Prevalence of Mental Illness
bull Mental illness is increasing in children younger than 18 years
bull A total of 13 to 20 of children living in the United Sates experience a mental disorder in a given year
May 16 2014
CDC Morbidity and Mortality Weekly Report
Smith Roley 2014
Prevalence of Dementia
bull Expanding rapidly particularly in countries with low and middle incomes
bull It was estimated that 356 million people lived with dementia worldwide in 2010 with numbers expected to almost double every 20 years to 657 million in 2030 and 1154 million in 2050
bull In 2010 58 of all people with dementia lived in countries with low or middle incomes with this proportion anticipated to rise to 63 in 2030 and 71 in 2050
Alzheimers Dement 2013 Jan9(1)63-75e2 doi 101016jjalz201211007 The global prevalence of dementia a systematic review and metaanalysis Prince M1 Bryce R Albanese E Wimo A Ribeiro W Ferri CP Author information
Smith Roley 2013
Sensory Integration as a Vehicle for Change
Smith Roley 2014
ADAPTATION
ldquoWhen the sensory integrative capacity of the brain is sufficient to meet the demands of the environment the childrsquos response is efficient creative and satisfyingrdquo
PLAY
When the child experiences challenges to which (she) he can respond effectively (she) he ldquohas funrdquo
ldquoFun is the childrsquos word for sensory integrationrdquo Sensory Integration and the Child p8
Smith Roley 2014
Danielle Marshall spokesperson for KaBOOM a nonprofit org httpusatoday30usatodaycomnewshealthwellnessstory201108Advocates-Importance-of-play-time-for-children-neglected500718781 retrieved 82613
Changing Values re Play
bull ldquoSince the 1970s kids have lost an average nine hours of free playtime a week
bull and when given recreational activities they are likely to be adult-led and adult-supervisedrdquo
Smith Roley 2014
Neuroplasticity
bull ldquoNovel experience bull altered afferent input due to
environmental changes bull and learning new skills bull are now recognized as
modulators of brain function and underlying neuroanatomic circuitryrdquo
May A 2011 p1
Smith Roley 2013
Greenough Black amp Wallace 1987
ldquoExperience can influence
the developing and mature brainrdquo
bull Experience-independent ndash genetic unfolding
bull Experience-expectant ndash neural structuresfunctions ready during critical periods ndash Experience-dependent ndash enrichment
bull unique to the individual
bull incorporation of idiosyncratic environmental information
bull Involves active formation of new synaptic connections in response to the events
Smith Roley 2013
Animal Studies on Enriched Environments Rosenzweig Bennett amp Diamond (1972)
(summary in Reynolds Lane amp Richards 2010)
Changes to standard cage conditions provide enhanced sensory motor cognitive and potentially social opportunities
Experience dependent results from active interaction between animal amp environment Increase in dendritic branching amp
synaptogenesis Neurogenesis in hippocampus amp amygdala Gliogenesis
Smith Roley 2013
Predicting Outcomes
Neuroplasticity studies suggest outcomes of Sensory Integrative approach may be
Decreased anxiety Decreased hypersensitivity Normalization of stress response Increased social participation Reduced stereotyped behaviors Better learning amp memory
Smith Roley 2013
What are the active ingredients of change
bull Motor activity bull Sensory input bull Social interactionplay bull MOST LIKELY a
combination ndash sensory motor amp
cognitive stimulation ndash environmental novelty ndash opportunities for
engagement in challenging tasks
Smith Roley 2014
Implications for Sensory Integration in Practice
However
OTSI has an
additional active ingredient
YOU
Smith Roley 2014
bull Model of Sensory Integration bull Theory of Sensory Integration
Assessments bull Sensory Integration amp Praxis Tests bull Sensory History
Questionnaires bull Clinical Observations
bull Interpretation bull Intervention bull Outcomes Research
Scholarship ~ Mentorship
Sensory Integrative Processes
The senses Integration of their inputs End products
Auditory (hearing)
First level Second level Third level Fourth level
Vestibular
(gravity amp movement)
Proprioceptive
(muscles amp joints)
Tactile (touch)
Visual (seeing)
Speech
Language
eye movements
Posture
Balance
Muscle tone
Gravitational security
Sucking
Eating
Mother-infant bond
Tactile comfort
Body perception
Coordination of two
sides of the body
Motor planning
Activity level
Attention span
Emotional stability
Eye-hand
coordination
Visual perception
Purposeful activity
Ability to concentrate
Ability to organise
Self-esteem
Self-control
Self-confidence
Academic learning ability
Capacity for abstract
thought and reasoning
Specialization of each side
of the body and the brain
Published by WPSreg 1979 2005 (c) 2014 Smith Roley Singer amp Roley
Theory Updates
Example Symplexity Alain Berthoz (2012)
ldquoA very young baby can mimic the facial expressions of its parents even though it cannot
see its own face which would seem to suggest the existence of innate mechanism of intermodal
encoding and transfer between what is perceived and what is producedhellip
This embodiment of perception is a
fundamental mechanism of simplexityrdquo
Smith Roley 2013
Assessment Updates
Sensory Integration Patterns (Ayres 1965-1989)
bull Tactile amp motor planning deficits (1965 1966 1969 1972 1977 amp 1989)
bull Visual perceptionvisual praxis deficits (1965 1966 1969 1972 1977 amp 1989)
bull Vestibular postural amp bilateral deficits (1965 1966 1969 1972 1977 amp 1989)
bull Tactile defensiveness amp hyperactivitydistractibility (1965 1966 1969 1972)
bull Other factors (auditory language somatosensory perception) seen in some studies
(1969 1972 1977 1989)
Verification and Clarification of
Sensory Integration Patterns
Mulligan (1998)
Mailloux Mulligan Roley etal (2011)
Van Jaarsveld etal (in press)
Lane (2010)
Blanche etal (2012)
SIPT Factor Analysis
Mulligan 1998
n= 10475
Smith Roley 2014
PPR
PRVC
SV
CPR
MFP II
DC
MFP I
OPR
SWB
PRN
BMC
MAC
GRA
SPR
KIN
LTS
FG
FI
TD
ATTN
Visio amp Somatopraxis
VestibularProp
Bilateral Integration amp
Sequencing
Tactile amp
Visual Discrimination
Tactile Defensiveness
amp Attention
SIPT Factor Analysis
Mailloux etal 2011
n=278
SIPT Factor Analysis in South African Sample (Van Jaarsveld etal in press)
n=223 Convenience Sample
bull Factor 1
ndash Visuo and Somatodyspraxia
bull DC CPR SV MAc MFP KIN SPr PvVC SWB GRA
bull Factor 2
ndash Bilateral Integration and Sequencing
bull SPr BMC Opr SWB with lower loadings on PPr PrVC
bull Factor 3
ndash Tactile and Visual Discrimination
bull FI MFP LTS with moderate loadings on PrVC OPr
26 (c) 2014 Susanne Smith
Roley OTD
SIPT Factor Analysis in South African Sample (Van Jaarsveld etal in press)
27 (c) 2014 Susanne Smith
Roley OTD Figure 1 Loadings on three factors of final analysis
Lane AE etal (2010)
Sensory Profile Cluster Analysis 3 patterns of ASD sensory processing
Sensory-based inattentive seeking
under-responsive (milder)
Sensory modulation with movement sensitivity low energyweak poor endurance
Sensory modulation with tastesmell sensitivity
under and over-responsiveness with no movement issues more communication difficulties and maladaptive behaviors
Sensory subtypes predicted communication competence
and maladaptive behavior
Comprehensive Observation of Proprioception (COP) Factor Analyses
bull F1 Tone and Joint Alignment
ndash Joint hypermobility decreased tone poor joint alignment
bull F2 Behavioral Manifestations
ndash Pushing overactive crashing falling running
ndash Correlates with SPM bumping and pushing
bull F3 Postural Motor
ndash Decreased PC tendency to lean inefficient grading force inadequate weight bearing inefficient ankle strategies
ndash Correlates with SPM body awareness and SWB
bull F4 Motor Planning
ndash Decreased feedback planning decreased feedforward planning overly passive
ndash No correlation with SPM body awareness weak correlation with KIN and SWB
Blanche Bodison Chang amp Reinoso (2012)
29
(c) 2014 Susanne Smith Roley
OTD
Refining Assessment of Sensory Integrative Functions
Smith Roley 2014
Visual-Praxis
Vestibular Bilateral Integration
Proprioception Tactile
Somato- dyspraxia
Sensory Reactivity
(Modulation)
Visual motor
Postural
control
Gross
motor
skills
Praxis Arousal
Affect
Activity Level
Attention
Visual construction
Bilateral coordination
Sequencing
Fine motor skills
Auditory -Language
Organization of behavior
StateSelf Regulation
Smith Roley 2013
SENSORY INTEGRATION INTERVENTION
Intervention Planning Promoting neuroplasticity health and development
Smith Roley 2014
Implications for OTSI Intervention
Consistent with Neuroplasticity Literature
ndash Sensorimotor opportunities
ndash Control over activity
ndash Novelty
ndash Challenge
ndash Playful environment
ndash Lifelike context
Smith Roley 2014
Sensory Integration and Play
bull When the therapist is doing her job effectively and the child is organizing his nervous system it looks as if the child is merely playing rdquo ndash Ayres 1979
Smith Roley 2013
Ayres Sensory Integrationreg Intervention Fidelity Measure
Parham et al 2007 2011 2013-in press
ASIFM Structural elements ndash Part I Therapist Qualifications
ndash Part II Safe Environment
ndash Part III Record Review
ndash Part IV Space and Equipment
ndash Part V Communication with Parents amp Teachers
Smith Roley 2013
ASIFM Process Elements (Parham et al 2011)
1 Physical safety 2 Sensory opportunities
(vestibular tactile and proprioceptive)
3 Supports sensory modulation to attainmaintain a regulated state
4 Supports postural ocular oral or bilateral motor coordination
5 Challenges praxis and organization of behavior
6 Collaborative activity choice
7 Just Right Challenge
8 Ensures Success
9 Supports motivation to play
10 Establishes therapeutic alliance
Smith Roley 2013
Data-driven Intervention Process (Schaaf 2001 Schaaf amp Blanche 2012)
Participation challenges
Current behavior
Theoretical
Framework
Assessments
37
Hypotheses Interventions Outcomes
(c) 2014 Susanne Smith Roley
OTD
Grounds for Optimism
Four Common Misconceptions
in the Anti-SI Intervention Literature Clark 2012
1) Reviews critical of sensory integration
intervention research ignores issues of fidelity
and dosage
Smith Roley 2014
2) Reviewers ignore or minimize the available
positive evidence for SI intervention
bull 3 RCTrsquos with autism demonstrated positive results
following multisensory interventions (including SI
intervention) (Fazlioglu amp Baran 2008 Pfeiffer
Koenig Kinnealey Sheppard amp Henderson 2011
Smith Press Koenig amp Kinnealey 2005)
bull ldquoBased on the application of meta-analytic techniques
for cumulating probability values it is not hard to
conclude that sensory treatments have positive effects
when administered to children with ASDsrdquo Clark
2012
Smith Roley 2014
3) The lack of positive outcomes from SI Intervention may be due
to weak or poorly designed studies
bull Current studies suggest that with stronger and more
studies there will be consistent beneficial effects for
certain outcomes
bull ldquoThe challenge is to make these studies happenrdquo
Clark 2012
Smith Roley 2013
4) Critics often forget that a lack of solid evidence characterizes
nearly all interventions for children with ASDs
bull SI intervention is often held to a different standard
than other types of intervention failing to apply the
same criterion to alternate interventions
Clark 2012
Smith Roley 2014
Remaining Mysteries
Smith Roley 2013
Implications for Advocacy
People need breaks such as recess
People require sensorimotor and social play timespacevalue in the daily routine
Smith Roley 2014
Implications for Research on OT using Sensory Integration
Enhancing Neuroplasticity via Therapeutic Design
bull Dosage - Intensity of increased access in short time periods rather than small access over longer times
bull Engagement via play and not just exposure
bull Role of therapist in providing customized sensorimotor challenges
bull Access to safe dynamic and therapeutic environments vs predictable and static environments
bull The difference between practice for skill development and adaptation to challenges in changing environments
Smith Roley 2014
Implications for Sensory Integration in Practice
Most importantly the success of Sensory Integration in practice depends on
YOU
Smith Roley 2014
Thank You
bull Organizers and Participants
bull hyvaumlauml paumlivaumlnjatkoa
bull Enjoy the conference
Smith Roley 2013
bull Ayres AJ (2005) Sensory Integration and the Child Los Angeles CA Western Psychological Services bull Armstrong T (2006) The best schools How human development research should inform educational practice Alexandria
VA Association for Supervision and Curriculum Development bull Blanche E I Bodison S Chang M C amp Reinoso G (2012) Development of the comprehensive observations of
proprioception (COP) Validity reliability and factor analysis American Journal of Occupational Therapy 66 691ndash698 bull Bundy A amp Lane S (In press) Sensory integration theory and practice Third Ed Philsadelphia PA FA Davis Inc bull Casey T amp MacIntyre S (2007) Childrenrsquos need for time and space In T Casey (Ed) Environments for outdoor play A
practical guide to making space for children (pp 5 ndash 16) London Sage Publications httpwwwsagepubcomupm-data15553_CASEY_C01PDF
bull Gray P (2013) Play as preparation for learning and life American Journal of Play 5(3) 271 - 292 bull Greenough WR Black JE Wallace CS (1987) Experience and brain development Child Development 58(3)539-59 bull Lane AE Young RL Baker AEZ amp Angley MT (2010) Sensory processing subtypes in autism Association with adaptive behavior
Journal of Autism and Developmental Disorders 40 112-122
bull Lane SJ Schaaf RC (2010) Examining the neuroscience evidence for sensory-driven neuroplasticity implications for sensory-based occupational therapy for children and adolescents American Journal of Occupational Therapy 64(3)375-90
bull Mailloux Z Mulligan S Smith Roley S Cermak S Blanche E amp Bodison S Coleman G amp Lane C (2011) Verification and clarification of patterns of sensory integrative dysfunction in a retrospective clinical sample American Journal of Occupational Therapy 652 143-151
bull May A (2011) Experience-dependent structural plasticity in the adult human brain 1-8 Trends in Cognitive Sciences bull May-Benson TA Smith Roley S Mailloux Z Parham LD Koomar J Schaaf RC Van Jaarsveld AM amp Cohn E (in
press) Structural Elements of the Ayres Sensory Integrationreg Intervention Fidelity Measurecopy American Journal of Occupational Therapy
bull Milteer RM Ginsburg KR amp Council on Communications and Media Committee on Psychosocial Aspects of Child and Family Health (2011) Pediatrics e204-e213 DOI 101542peds2011-2953
bull Parham LD Cohn ES Spitzer S Koomar J Miller LJ Burke JP Brett-Green B Mailloux Z May-Benson T Smith Roley S Schaaf RC Schoen S amp Summers CA (2007) Fidelity in sensory integration intervention research American Journal of Occupational Therapy 61 2 216-227
bull Parham LD Smith Roley S May-Benson T Koomar J Brett-Green B Burke JP Cohn ES Mailloux Z Miller LJ amp Schaaf RC (2011) Development of a fidelity measure for research on effectiveness of Ayres Sensory Integrationreg intervention American Journal of Occupational Therapy 65 2 133-142
bull Reynolds S Lane SJ amp Richards L (2010) Using animal models of enriched environments to inform research on sensory integration intervention for the rehabilitation of neurodevelopmental disorders Journal of Neurodevelopmental Disorders 2( 3) 120-132 online first DOI 101007s11689-010-9053-4
bull Roley SS Mailloux Z Parham D Schaaf R Blanche E amp Lane CA Cermak S (in press) Sensory Integration and Praxis Patterns in Children with Autism American Journal of Occupational Therapy
bull Rosenzweig MR Bennet EL and Diamond MC (1972) Brain Changes in response to experience Scientific American 226(2) 22-29
bull Van Jaarsveld A Mailloux Z Smith Roley S amp Raubenheimer J (in press) Patterns of the sensory integration dysfunctions in South African children South African Journal of Occupational Therapy
bull Wills S Cabanlit M Bennett J Ashwood P Amaral DG amp Van de Water J (2009) Detection of autoantibodies to neural cells of the cerebellum in the plasma of subjects with autism spectrum disorders Brain Behavior and Immunity 23(1) 64-74
Smith Roley 2014
Maternal Environment Prenatal Stress amp Alcohol Exposure (Schneider)
Prevalence of Autism
bull On March 27 2014 the Centers for Disease Control and Prevention (CDC) surveillance study identified
bull 1 in 68 children (1 in 42 boys and 1 in 189 girls) with Autism Spectrum Disorder in the United States
bull Atypical sensory reactivity included in DSM-5 as diagnostic feature
Smith Roley 2013
Prevalence of Mental Illness
bull Mental illness is increasing in children younger than 18 years
bull A total of 13 to 20 of children living in the United Sates experience a mental disorder in a given year
May 16 2014
CDC Morbidity and Mortality Weekly Report
Smith Roley 2014
Prevalence of Dementia
bull Expanding rapidly particularly in countries with low and middle incomes
bull It was estimated that 356 million people lived with dementia worldwide in 2010 with numbers expected to almost double every 20 years to 657 million in 2030 and 1154 million in 2050
bull In 2010 58 of all people with dementia lived in countries with low or middle incomes with this proportion anticipated to rise to 63 in 2030 and 71 in 2050
Alzheimers Dement 2013 Jan9(1)63-75e2 doi 101016jjalz201211007 The global prevalence of dementia a systematic review and metaanalysis Prince M1 Bryce R Albanese E Wimo A Ribeiro W Ferri CP Author information
Smith Roley 2013
Sensory Integration as a Vehicle for Change
Smith Roley 2014
ADAPTATION
ldquoWhen the sensory integrative capacity of the brain is sufficient to meet the demands of the environment the childrsquos response is efficient creative and satisfyingrdquo
PLAY
When the child experiences challenges to which (she) he can respond effectively (she) he ldquohas funrdquo
ldquoFun is the childrsquos word for sensory integrationrdquo Sensory Integration and the Child p8
Smith Roley 2014
Danielle Marshall spokesperson for KaBOOM a nonprofit org httpusatoday30usatodaycomnewshealthwellnessstory201108Advocates-Importance-of-play-time-for-children-neglected500718781 retrieved 82613
Changing Values re Play
bull ldquoSince the 1970s kids have lost an average nine hours of free playtime a week
bull and when given recreational activities they are likely to be adult-led and adult-supervisedrdquo
Smith Roley 2014
Neuroplasticity
bull ldquoNovel experience bull altered afferent input due to
environmental changes bull and learning new skills bull are now recognized as
modulators of brain function and underlying neuroanatomic circuitryrdquo
May A 2011 p1
Smith Roley 2013
Greenough Black amp Wallace 1987
ldquoExperience can influence
the developing and mature brainrdquo
bull Experience-independent ndash genetic unfolding
bull Experience-expectant ndash neural structuresfunctions ready during critical periods ndash Experience-dependent ndash enrichment
bull unique to the individual
bull incorporation of idiosyncratic environmental information
bull Involves active formation of new synaptic connections in response to the events
Smith Roley 2013
Animal Studies on Enriched Environments Rosenzweig Bennett amp Diamond (1972)
(summary in Reynolds Lane amp Richards 2010)
Changes to standard cage conditions provide enhanced sensory motor cognitive and potentially social opportunities
Experience dependent results from active interaction between animal amp environment Increase in dendritic branching amp
synaptogenesis Neurogenesis in hippocampus amp amygdala Gliogenesis
Smith Roley 2013
Predicting Outcomes
Neuroplasticity studies suggest outcomes of Sensory Integrative approach may be
Decreased anxiety Decreased hypersensitivity Normalization of stress response Increased social participation Reduced stereotyped behaviors Better learning amp memory
Smith Roley 2013
What are the active ingredients of change
bull Motor activity bull Sensory input bull Social interactionplay bull MOST LIKELY a
combination ndash sensory motor amp
cognitive stimulation ndash environmental novelty ndash opportunities for
engagement in challenging tasks
Smith Roley 2014
Implications for Sensory Integration in Practice
However
OTSI has an
additional active ingredient
YOU
Smith Roley 2014
bull Model of Sensory Integration bull Theory of Sensory Integration
Assessments bull Sensory Integration amp Praxis Tests bull Sensory History
Questionnaires bull Clinical Observations
bull Interpretation bull Intervention bull Outcomes Research
Scholarship ~ Mentorship
Sensory Integrative Processes
The senses Integration of their inputs End products
Auditory (hearing)
First level Second level Third level Fourth level
Vestibular
(gravity amp movement)
Proprioceptive
(muscles amp joints)
Tactile (touch)
Visual (seeing)
Speech
Language
eye movements
Posture
Balance
Muscle tone
Gravitational security
Sucking
Eating
Mother-infant bond
Tactile comfort
Body perception
Coordination of two
sides of the body
Motor planning
Activity level
Attention span
Emotional stability
Eye-hand
coordination
Visual perception
Purposeful activity
Ability to concentrate
Ability to organise
Self-esteem
Self-control
Self-confidence
Academic learning ability
Capacity for abstract
thought and reasoning
Specialization of each side
of the body and the brain
Published by WPSreg 1979 2005 (c) 2014 Smith Roley Singer amp Roley
Theory Updates
Example Symplexity Alain Berthoz (2012)
ldquoA very young baby can mimic the facial expressions of its parents even though it cannot
see its own face which would seem to suggest the existence of innate mechanism of intermodal
encoding and transfer between what is perceived and what is producedhellip
This embodiment of perception is a
fundamental mechanism of simplexityrdquo
Smith Roley 2013
Assessment Updates
Sensory Integration Patterns (Ayres 1965-1989)
bull Tactile amp motor planning deficits (1965 1966 1969 1972 1977 amp 1989)
bull Visual perceptionvisual praxis deficits (1965 1966 1969 1972 1977 amp 1989)
bull Vestibular postural amp bilateral deficits (1965 1966 1969 1972 1977 amp 1989)
bull Tactile defensiveness amp hyperactivitydistractibility (1965 1966 1969 1972)
bull Other factors (auditory language somatosensory perception) seen in some studies
(1969 1972 1977 1989)
Verification and Clarification of
Sensory Integration Patterns
Mulligan (1998)
Mailloux Mulligan Roley etal (2011)
Van Jaarsveld etal (in press)
Lane (2010)
Blanche etal (2012)
SIPT Factor Analysis
Mulligan 1998
n= 10475
Smith Roley 2014
PPR
PRVC
SV
CPR
MFP II
DC
MFP I
OPR
SWB
PRN
BMC
MAC
GRA
SPR
KIN
LTS
FG
FI
TD
ATTN
Visio amp Somatopraxis
VestibularProp
Bilateral Integration amp
Sequencing
Tactile amp
Visual Discrimination
Tactile Defensiveness
amp Attention
SIPT Factor Analysis
Mailloux etal 2011
n=278
SIPT Factor Analysis in South African Sample (Van Jaarsveld etal in press)
n=223 Convenience Sample
bull Factor 1
ndash Visuo and Somatodyspraxia
bull DC CPR SV MAc MFP KIN SPr PvVC SWB GRA
bull Factor 2
ndash Bilateral Integration and Sequencing
bull SPr BMC Opr SWB with lower loadings on PPr PrVC
bull Factor 3
ndash Tactile and Visual Discrimination
bull FI MFP LTS with moderate loadings on PrVC OPr
26 (c) 2014 Susanne Smith
Roley OTD
SIPT Factor Analysis in South African Sample (Van Jaarsveld etal in press)
27 (c) 2014 Susanne Smith
Roley OTD Figure 1 Loadings on three factors of final analysis
Lane AE etal (2010)
Sensory Profile Cluster Analysis 3 patterns of ASD sensory processing
Sensory-based inattentive seeking
under-responsive (milder)
Sensory modulation with movement sensitivity low energyweak poor endurance
Sensory modulation with tastesmell sensitivity
under and over-responsiveness with no movement issues more communication difficulties and maladaptive behaviors
Sensory subtypes predicted communication competence
and maladaptive behavior
Comprehensive Observation of Proprioception (COP) Factor Analyses
bull F1 Tone and Joint Alignment
ndash Joint hypermobility decreased tone poor joint alignment
bull F2 Behavioral Manifestations
ndash Pushing overactive crashing falling running
ndash Correlates with SPM bumping and pushing
bull F3 Postural Motor
ndash Decreased PC tendency to lean inefficient grading force inadequate weight bearing inefficient ankle strategies
ndash Correlates with SPM body awareness and SWB
bull F4 Motor Planning
ndash Decreased feedback planning decreased feedforward planning overly passive
ndash No correlation with SPM body awareness weak correlation with KIN and SWB
Blanche Bodison Chang amp Reinoso (2012)
29
(c) 2014 Susanne Smith Roley
OTD
Refining Assessment of Sensory Integrative Functions
Smith Roley 2014
Visual-Praxis
Vestibular Bilateral Integration
Proprioception Tactile
Somato- dyspraxia
Sensory Reactivity
(Modulation)
Visual motor
Postural
control
Gross
motor
skills
Praxis Arousal
Affect
Activity Level
Attention
Visual construction
Bilateral coordination
Sequencing
Fine motor skills
Auditory -Language
Organization of behavior
StateSelf Regulation
Smith Roley 2013
SENSORY INTEGRATION INTERVENTION
Intervention Planning Promoting neuroplasticity health and development
Smith Roley 2014
Implications for OTSI Intervention
Consistent with Neuroplasticity Literature
ndash Sensorimotor opportunities
ndash Control over activity
ndash Novelty
ndash Challenge
ndash Playful environment
ndash Lifelike context
Smith Roley 2014
Sensory Integration and Play
bull When the therapist is doing her job effectively and the child is organizing his nervous system it looks as if the child is merely playing rdquo ndash Ayres 1979
Smith Roley 2013
Ayres Sensory Integrationreg Intervention Fidelity Measure
Parham et al 2007 2011 2013-in press
ASIFM Structural elements ndash Part I Therapist Qualifications
ndash Part II Safe Environment
ndash Part III Record Review
ndash Part IV Space and Equipment
ndash Part V Communication with Parents amp Teachers
Smith Roley 2013
ASIFM Process Elements (Parham et al 2011)
1 Physical safety 2 Sensory opportunities
(vestibular tactile and proprioceptive)
3 Supports sensory modulation to attainmaintain a regulated state
4 Supports postural ocular oral or bilateral motor coordination
5 Challenges praxis and organization of behavior
6 Collaborative activity choice
7 Just Right Challenge
8 Ensures Success
9 Supports motivation to play
10 Establishes therapeutic alliance
Smith Roley 2013
Data-driven Intervention Process (Schaaf 2001 Schaaf amp Blanche 2012)
Participation challenges
Current behavior
Theoretical
Framework
Assessments
37
Hypotheses Interventions Outcomes
(c) 2014 Susanne Smith Roley
OTD
Grounds for Optimism
Four Common Misconceptions
in the Anti-SI Intervention Literature Clark 2012
1) Reviews critical of sensory integration
intervention research ignores issues of fidelity
and dosage
Smith Roley 2014
2) Reviewers ignore or minimize the available
positive evidence for SI intervention
bull 3 RCTrsquos with autism demonstrated positive results
following multisensory interventions (including SI
intervention) (Fazlioglu amp Baran 2008 Pfeiffer
Koenig Kinnealey Sheppard amp Henderson 2011
Smith Press Koenig amp Kinnealey 2005)
bull ldquoBased on the application of meta-analytic techniques
for cumulating probability values it is not hard to
conclude that sensory treatments have positive effects
when administered to children with ASDsrdquo Clark
2012
Smith Roley 2014
3) The lack of positive outcomes from SI Intervention may be due
to weak or poorly designed studies
bull Current studies suggest that with stronger and more
studies there will be consistent beneficial effects for
certain outcomes
bull ldquoThe challenge is to make these studies happenrdquo
Clark 2012
Smith Roley 2013
4) Critics often forget that a lack of solid evidence characterizes
nearly all interventions for children with ASDs
bull SI intervention is often held to a different standard
than other types of intervention failing to apply the
same criterion to alternate interventions
Clark 2012
Smith Roley 2014
Remaining Mysteries
Smith Roley 2013
Implications for Advocacy
People need breaks such as recess
People require sensorimotor and social play timespacevalue in the daily routine
Smith Roley 2014
Implications for Research on OT using Sensory Integration
Enhancing Neuroplasticity via Therapeutic Design
bull Dosage - Intensity of increased access in short time periods rather than small access over longer times
bull Engagement via play and not just exposure
bull Role of therapist in providing customized sensorimotor challenges
bull Access to safe dynamic and therapeutic environments vs predictable and static environments
bull The difference between practice for skill development and adaptation to challenges in changing environments
Smith Roley 2014
Implications for Sensory Integration in Practice
Most importantly the success of Sensory Integration in practice depends on
YOU
Smith Roley 2014
Thank You
bull Organizers and Participants
bull hyvaumlauml paumlivaumlnjatkoa
bull Enjoy the conference
Smith Roley 2013
bull Ayres AJ (2005) Sensory Integration and the Child Los Angeles CA Western Psychological Services bull Armstrong T (2006) The best schools How human development research should inform educational practice Alexandria
VA Association for Supervision and Curriculum Development bull Blanche E I Bodison S Chang M C amp Reinoso G (2012) Development of the comprehensive observations of
proprioception (COP) Validity reliability and factor analysis American Journal of Occupational Therapy 66 691ndash698 bull Bundy A amp Lane S (In press) Sensory integration theory and practice Third Ed Philsadelphia PA FA Davis Inc bull Casey T amp MacIntyre S (2007) Childrenrsquos need for time and space In T Casey (Ed) Environments for outdoor play A
practical guide to making space for children (pp 5 ndash 16) London Sage Publications httpwwwsagepubcomupm-data15553_CASEY_C01PDF
bull Gray P (2013) Play as preparation for learning and life American Journal of Play 5(3) 271 - 292 bull Greenough WR Black JE Wallace CS (1987) Experience and brain development Child Development 58(3)539-59 bull Lane AE Young RL Baker AEZ amp Angley MT (2010) Sensory processing subtypes in autism Association with adaptive behavior
Journal of Autism and Developmental Disorders 40 112-122
bull Lane SJ Schaaf RC (2010) Examining the neuroscience evidence for sensory-driven neuroplasticity implications for sensory-based occupational therapy for children and adolescents American Journal of Occupational Therapy 64(3)375-90
bull Mailloux Z Mulligan S Smith Roley S Cermak S Blanche E amp Bodison S Coleman G amp Lane C (2011) Verification and clarification of patterns of sensory integrative dysfunction in a retrospective clinical sample American Journal of Occupational Therapy 652 143-151
bull May A (2011) Experience-dependent structural plasticity in the adult human brain 1-8 Trends in Cognitive Sciences bull May-Benson TA Smith Roley S Mailloux Z Parham LD Koomar J Schaaf RC Van Jaarsveld AM amp Cohn E (in
press) Structural Elements of the Ayres Sensory Integrationreg Intervention Fidelity Measurecopy American Journal of Occupational Therapy
bull Milteer RM Ginsburg KR amp Council on Communications and Media Committee on Psychosocial Aspects of Child and Family Health (2011) Pediatrics e204-e213 DOI 101542peds2011-2953
bull Parham LD Cohn ES Spitzer S Koomar J Miller LJ Burke JP Brett-Green B Mailloux Z May-Benson T Smith Roley S Schaaf RC Schoen S amp Summers CA (2007) Fidelity in sensory integration intervention research American Journal of Occupational Therapy 61 2 216-227
bull Parham LD Smith Roley S May-Benson T Koomar J Brett-Green B Burke JP Cohn ES Mailloux Z Miller LJ amp Schaaf RC (2011) Development of a fidelity measure for research on effectiveness of Ayres Sensory Integrationreg intervention American Journal of Occupational Therapy 65 2 133-142
bull Reynolds S Lane SJ amp Richards L (2010) Using animal models of enriched environments to inform research on sensory integration intervention for the rehabilitation of neurodevelopmental disorders Journal of Neurodevelopmental Disorders 2( 3) 120-132 online first DOI 101007s11689-010-9053-4
bull Roley SS Mailloux Z Parham D Schaaf R Blanche E amp Lane CA Cermak S (in press) Sensory Integration and Praxis Patterns in Children with Autism American Journal of Occupational Therapy
bull Rosenzweig MR Bennet EL and Diamond MC (1972) Brain Changes in response to experience Scientific American 226(2) 22-29
bull Van Jaarsveld A Mailloux Z Smith Roley S amp Raubenheimer J (in press) Patterns of the sensory integration dysfunctions in South African children South African Journal of Occupational Therapy
bull Wills S Cabanlit M Bennett J Ashwood P Amaral DG amp Van de Water J (2009) Detection of autoantibodies to neural cells of the cerebellum in the plasma of subjects with autism spectrum disorders Brain Behavior and Immunity 23(1) 64-74
Prevalence of Autism
bull On March 27 2014 the Centers for Disease Control and Prevention (CDC) surveillance study identified
bull 1 in 68 children (1 in 42 boys and 1 in 189 girls) with Autism Spectrum Disorder in the United States
bull Atypical sensory reactivity included in DSM-5 as diagnostic feature
Smith Roley 2013
Prevalence of Mental Illness
bull Mental illness is increasing in children younger than 18 years
bull A total of 13 to 20 of children living in the United Sates experience a mental disorder in a given year
May 16 2014
CDC Morbidity and Mortality Weekly Report
Smith Roley 2014
Prevalence of Dementia
bull Expanding rapidly particularly in countries with low and middle incomes
bull It was estimated that 356 million people lived with dementia worldwide in 2010 with numbers expected to almost double every 20 years to 657 million in 2030 and 1154 million in 2050
bull In 2010 58 of all people with dementia lived in countries with low or middle incomes with this proportion anticipated to rise to 63 in 2030 and 71 in 2050
Alzheimers Dement 2013 Jan9(1)63-75e2 doi 101016jjalz201211007 The global prevalence of dementia a systematic review and metaanalysis Prince M1 Bryce R Albanese E Wimo A Ribeiro W Ferri CP Author information
Smith Roley 2013
Sensory Integration as a Vehicle for Change
Smith Roley 2014
ADAPTATION
ldquoWhen the sensory integrative capacity of the brain is sufficient to meet the demands of the environment the childrsquos response is efficient creative and satisfyingrdquo
PLAY
When the child experiences challenges to which (she) he can respond effectively (she) he ldquohas funrdquo
ldquoFun is the childrsquos word for sensory integrationrdquo Sensory Integration and the Child p8
Smith Roley 2014
Danielle Marshall spokesperson for KaBOOM a nonprofit org httpusatoday30usatodaycomnewshealthwellnessstory201108Advocates-Importance-of-play-time-for-children-neglected500718781 retrieved 82613
Changing Values re Play
bull ldquoSince the 1970s kids have lost an average nine hours of free playtime a week
bull and when given recreational activities they are likely to be adult-led and adult-supervisedrdquo
Smith Roley 2014
Neuroplasticity
bull ldquoNovel experience bull altered afferent input due to
environmental changes bull and learning new skills bull are now recognized as
modulators of brain function and underlying neuroanatomic circuitryrdquo
May A 2011 p1
Smith Roley 2013
Greenough Black amp Wallace 1987
ldquoExperience can influence
the developing and mature brainrdquo
bull Experience-independent ndash genetic unfolding
bull Experience-expectant ndash neural structuresfunctions ready during critical periods ndash Experience-dependent ndash enrichment
bull unique to the individual
bull incorporation of idiosyncratic environmental information
bull Involves active formation of new synaptic connections in response to the events
Smith Roley 2013
Animal Studies on Enriched Environments Rosenzweig Bennett amp Diamond (1972)
(summary in Reynolds Lane amp Richards 2010)
Changes to standard cage conditions provide enhanced sensory motor cognitive and potentially social opportunities
Experience dependent results from active interaction between animal amp environment Increase in dendritic branching amp
synaptogenesis Neurogenesis in hippocampus amp amygdala Gliogenesis
Smith Roley 2013
Predicting Outcomes
Neuroplasticity studies suggest outcomes of Sensory Integrative approach may be
Decreased anxiety Decreased hypersensitivity Normalization of stress response Increased social participation Reduced stereotyped behaviors Better learning amp memory
Smith Roley 2013
What are the active ingredients of change
bull Motor activity bull Sensory input bull Social interactionplay bull MOST LIKELY a
combination ndash sensory motor amp
cognitive stimulation ndash environmental novelty ndash opportunities for
engagement in challenging tasks
Smith Roley 2014
Implications for Sensory Integration in Practice
However
OTSI has an
additional active ingredient
YOU
Smith Roley 2014
bull Model of Sensory Integration bull Theory of Sensory Integration
Assessments bull Sensory Integration amp Praxis Tests bull Sensory History
Questionnaires bull Clinical Observations
bull Interpretation bull Intervention bull Outcomes Research
Scholarship ~ Mentorship
Sensory Integrative Processes
The senses Integration of their inputs End products
Auditory (hearing)
First level Second level Third level Fourth level
Vestibular
(gravity amp movement)
Proprioceptive
(muscles amp joints)
Tactile (touch)
Visual (seeing)
Speech
Language
eye movements
Posture
Balance
Muscle tone
Gravitational security
Sucking
Eating
Mother-infant bond
Tactile comfort
Body perception
Coordination of two
sides of the body
Motor planning
Activity level
Attention span
Emotional stability
Eye-hand
coordination
Visual perception
Purposeful activity
Ability to concentrate
Ability to organise
Self-esteem
Self-control
Self-confidence
Academic learning ability
Capacity for abstract
thought and reasoning
Specialization of each side
of the body and the brain
Published by WPSreg 1979 2005 (c) 2014 Smith Roley Singer amp Roley
Theory Updates
Example Symplexity Alain Berthoz (2012)
ldquoA very young baby can mimic the facial expressions of its parents even though it cannot
see its own face which would seem to suggest the existence of innate mechanism of intermodal
encoding and transfer between what is perceived and what is producedhellip
This embodiment of perception is a
fundamental mechanism of simplexityrdquo
Smith Roley 2013
Assessment Updates
Sensory Integration Patterns (Ayres 1965-1989)
bull Tactile amp motor planning deficits (1965 1966 1969 1972 1977 amp 1989)
bull Visual perceptionvisual praxis deficits (1965 1966 1969 1972 1977 amp 1989)
bull Vestibular postural amp bilateral deficits (1965 1966 1969 1972 1977 amp 1989)
bull Tactile defensiveness amp hyperactivitydistractibility (1965 1966 1969 1972)
bull Other factors (auditory language somatosensory perception) seen in some studies
(1969 1972 1977 1989)
Verification and Clarification of
Sensory Integration Patterns
Mulligan (1998)
Mailloux Mulligan Roley etal (2011)
Van Jaarsveld etal (in press)
Lane (2010)
Blanche etal (2012)
SIPT Factor Analysis
Mulligan 1998
n= 10475
Smith Roley 2014
PPR
PRVC
SV
CPR
MFP II
DC
MFP I
OPR
SWB
PRN
BMC
MAC
GRA
SPR
KIN
LTS
FG
FI
TD
ATTN
Visio amp Somatopraxis
VestibularProp
Bilateral Integration amp
Sequencing
Tactile amp
Visual Discrimination
Tactile Defensiveness
amp Attention
SIPT Factor Analysis
Mailloux etal 2011
n=278
SIPT Factor Analysis in South African Sample (Van Jaarsveld etal in press)
n=223 Convenience Sample
bull Factor 1
ndash Visuo and Somatodyspraxia
bull DC CPR SV MAc MFP KIN SPr PvVC SWB GRA
bull Factor 2
ndash Bilateral Integration and Sequencing
bull SPr BMC Opr SWB with lower loadings on PPr PrVC
bull Factor 3
ndash Tactile and Visual Discrimination
bull FI MFP LTS with moderate loadings on PrVC OPr
26 (c) 2014 Susanne Smith
Roley OTD
SIPT Factor Analysis in South African Sample (Van Jaarsveld etal in press)
27 (c) 2014 Susanne Smith
Roley OTD Figure 1 Loadings on three factors of final analysis
Lane AE etal (2010)
Sensory Profile Cluster Analysis 3 patterns of ASD sensory processing
Sensory-based inattentive seeking
under-responsive (milder)
Sensory modulation with movement sensitivity low energyweak poor endurance
Sensory modulation with tastesmell sensitivity
under and over-responsiveness with no movement issues more communication difficulties and maladaptive behaviors
Sensory subtypes predicted communication competence
and maladaptive behavior
Comprehensive Observation of Proprioception (COP) Factor Analyses
bull F1 Tone and Joint Alignment
ndash Joint hypermobility decreased tone poor joint alignment
bull F2 Behavioral Manifestations
ndash Pushing overactive crashing falling running
ndash Correlates with SPM bumping and pushing
bull F3 Postural Motor
ndash Decreased PC tendency to lean inefficient grading force inadequate weight bearing inefficient ankle strategies
ndash Correlates with SPM body awareness and SWB
bull F4 Motor Planning
ndash Decreased feedback planning decreased feedforward planning overly passive
ndash No correlation with SPM body awareness weak correlation with KIN and SWB
Blanche Bodison Chang amp Reinoso (2012)
29
(c) 2014 Susanne Smith Roley
OTD
Refining Assessment of Sensory Integrative Functions
Smith Roley 2014
Visual-Praxis
Vestibular Bilateral Integration
Proprioception Tactile
Somato- dyspraxia
Sensory Reactivity
(Modulation)
Visual motor
Postural
control
Gross
motor
skills
Praxis Arousal
Affect
Activity Level
Attention
Visual construction
Bilateral coordination
Sequencing
Fine motor skills
Auditory -Language
Organization of behavior
StateSelf Regulation
Smith Roley 2013
SENSORY INTEGRATION INTERVENTION
Intervention Planning Promoting neuroplasticity health and development
Smith Roley 2014
Implications for OTSI Intervention
Consistent with Neuroplasticity Literature
ndash Sensorimotor opportunities
ndash Control over activity
ndash Novelty
ndash Challenge
ndash Playful environment
ndash Lifelike context
Smith Roley 2014
Sensory Integration and Play
bull When the therapist is doing her job effectively and the child is organizing his nervous system it looks as if the child is merely playing rdquo ndash Ayres 1979
Smith Roley 2013
Ayres Sensory Integrationreg Intervention Fidelity Measure
Parham et al 2007 2011 2013-in press
ASIFM Structural elements ndash Part I Therapist Qualifications
ndash Part II Safe Environment
ndash Part III Record Review
ndash Part IV Space and Equipment
ndash Part V Communication with Parents amp Teachers
Smith Roley 2013
ASIFM Process Elements (Parham et al 2011)
1 Physical safety 2 Sensory opportunities
(vestibular tactile and proprioceptive)
3 Supports sensory modulation to attainmaintain a regulated state
4 Supports postural ocular oral or bilateral motor coordination
5 Challenges praxis and organization of behavior
6 Collaborative activity choice
7 Just Right Challenge
8 Ensures Success
9 Supports motivation to play
10 Establishes therapeutic alliance
Smith Roley 2013
Data-driven Intervention Process (Schaaf 2001 Schaaf amp Blanche 2012)
Participation challenges
Current behavior
Theoretical
Framework
Assessments
37
Hypotheses Interventions Outcomes
(c) 2014 Susanne Smith Roley
OTD
Grounds for Optimism
Four Common Misconceptions
in the Anti-SI Intervention Literature Clark 2012
1) Reviews critical of sensory integration
intervention research ignores issues of fidelity
and dosage
Smith Roley 2014
2) Reviewers ignore or minimize the available
positive evidence for SI intervention
bull 3 RCTrsquos with autism demonstrated positive results
following multisensory interventions (including SI
intervention) (Fazlioglu amp Baran 2008 Pfeiffer
Koenig Kinnealey Sheppard amp Henderson 2011
Smith Press Koenig amp Kinnealey 2005)
bull ldquoBased on the application of meta-analytic techniques
for cumulating probability values it is not hard to
conclude that sensory treatments have positive effects
when administered to children with ASDsrdquo Clark
2012
Smith Roley 2014
3) The lack of positive outcomes from SI Intervention may be due
to weak or poorly designed studies
bull Current studies suggest that with stronger and more
studies there will be consistent beneficial effects for
certain outcomes
bull ldquoThe challenge is to make these studies happenrdquo
Clark 2012
Smith Roley 2013
4) Critics often forget that a lack of solid evidence characterizes
nearly all interventions for children with ASDs
bull SI intervention is often held to a different standard
than other types of intervention failing to apply the
same criterion to alternate interventions
Clark 2012
Smith Roley 2014
Remaining Mysteries
Smith Roley 2013
Implications for Advocacy
People need breaks such as recess
People require sensorimotor and social play timespacevalue in the daily routine
Smith Roley 2014
Implications for Research on OT using Sensory Integration
Enhancing Neuroplasticity via Therapeutic Design
bull Dosage - Intensity of increased access in short time periods rather than small access over longer times
bull Engagement via play and not just exposure
bull Role of therapist in providing customized sensorimotor challenges
bull Access to safe dynamic and therapeutic environments vs predictable and static environments
bull The difference between practice for skill development and adaptation to challenges in changing environments
Smith Roley 2014
Implications for Sensory Integration in Practice
Most importantly the success of Sensory Integration in practice depends on
YOU
Smith Roley 2014
Thank You
bull Organizers and Participants
bull hyvaumlauml paumlivaumlnjatkoa
bull Enjoy the conference
Smith Roley 2013
bull Ayres AJ (2005) Sensory Integration and the Child Los Angeles CA Western Psychological Services bull Armstrong T (2006) The best schools How human development research should inform educational practice Alexandria
VA Association for Supervision and Curriculum Development bull Blanche E I Bodison S Chang M C amp Reinoso G (2012) Development of the comprehensive observations of
proprioception (COP) Validity reliability and factor analysis American Journal of Occupational Therapy 66 691ndash698 bull Bundy A amp Lane S (In press) Sensory integration theory and practice Third Ed Philsadelphia PA FA Davis Inc bull Casey T amp MacIntyre S (2007) Childrenrsquos need for time and space In T Casey (Ed) Environments for outdoor play A
practical guide to making space for children (pp 5 ndash 16) London Sage Publications httpwwwsagepubcomupm-data15553_CASEY_C01PDF
bull Gray P (2013) Play as preparation for learning and life American Journal of Play 5(3) 271 - 292 bull Greenough WR Black JE Wallace CS (1987) Experience and brain development Child Development 58(3)539-59 bull Lane AE Young RL Baker AEZ amp Angley MT (2010) Sensory processing subtypes in autism Association with adaptive behavior
Journal of Autism and Developmental Disorders 40 112-122
bull Lane SJ Schaaf RC (2010) Examining the neuroscience evidence for sensory-driven neuroplasticity implications for sensory-based occupational therapy for children and adolescents American Journal of Occupational Therapy 64(3)375-90
bull Mailloux Z Mulligan S Smith Roley S Cermak S Blanche E amp Bodison S Coleman G amp Lane C (2011) Verification and clarification of patterns of sensory integrative dysfunction in a retrospective clinical sample American Journal of Occupational Therapy 652 143-151
bull May A (2011) Experience-dependent structural plasticity in the adult human brain 1-8 Trends in Cognitive Sciences bull May-Benson TA Smith Roley S Mailloux Z Parham LD Koomar J Schaaf RC Van Jaarsveld AM amp Cohn E (in
press) Structural Elements of the Ayres Sensory Integrationreg Intervention Fidelity Measurecopy American Journal of Occupational Therapy
bull Milteer RM Ginsburg KR amp Council on Communications and Media Committee on Psychosocial Aspects of Child and Family Health (2011) Pediatrics e204-e213 DOI 101542peds2011-2953
bull Parham LD Cohn ES Spitzer S Koomar J Miller LJ Burke JP Brett-Green B Mailloux Z May-Benson T Smith Roley S Schaaf RC Schoen S amp Summers CA (2007) Fidelity in sensory integration intervention research American Journal of Occupational Therapy 61 2 216-227
bull Parham LD Smith Roley S May-Benson T Koomar J Brett-Green B Burke JP Cohn ES Mailloux Z Miller LJ amp Schaaf RC (2011) Development of a fidelity measure for research on effectiveness of Ayres Sensory Integrationreg intervention American Journal of Occupational Therapy 65 2 133-142
bull Reynolds S Lane SJ amp Richards L (2010) Using animal models of enriched environments to inform research on sensory integration intervention for the rehabilitation of neurodevelopmental disorders Journal of Neurodevelopmental Disorders 2( 3) 120-132 online first DOI 101007s11689-010-9053-4
bull Roley SS Mailloux Z Parham D Schaaf R Blanche E amp Lane CA Cermak S (in press) Sensory Integration and Praxis Patterns in Children with Autism American Journal of Occupational Therapy
bull Rosenzweig MR Bennet EL and Diamond MC (1972) Brain Changes in response to experience Scientific American 226(2) 22-29
bull Van Jaarsveld A Mailloux Z Smith Roley S amp Raubenheimer J (in press) Patterns of the sensory integration dysfunctions in South African children South African Journal of Occupational Therapy
bull Wills S Cabanlit M Bennett J Ashwood P Amaral DG amp Van de Water J (2009) Detection of autoantibodies to neural cells of the cerebellum in the plasma of subjects with autism spectrum disorders Brain Behavior and Immunity 23(1) 64-74
Prevalence of Mental Illness
bull Mental illness is increasing in children younger than 18 years
bull A total of 13 to 20 of children living in the United Sates experience a mental disorder in a given year
May 16 2014
CDC Morbidity and Mortality Weekly Report
Smith Roley 2014
Prevalence of Dementia
bull Expanding rapidly particularly in countries with low and middle incomes
bull It was estimated that 356 million people lived with dementia worldwide in 2010 with numbers expected to almost double every 20 years to 657 million in 2030 and 1154 million in 2050
bull In 2010 58 of all people with dementia lived in countries with low or middle incomes with this proportion anticipated to rise to 63 in 2030 and 71 in 2050
Alzheimers Dement 2013 Jan9(1)63-75e2 doi 101016jjalz201211007 The global prevalence of dementia a systematic review and metaanalysis Prince M1 Bryce R Albanese E Wimo A Ribeiro W Ferri CP Author information
Smith Roley 2013
Sensory Integration as a Vehicle for Change
Smith Roley 2014
ADAPTATION
ldquoWhen the sensory integrative capacity of the brain is sufficient to meet the demands of the environment the childrsquos response is efficient creative and satisfyingrdquo
PLAY
When the child experiences challenges to which (she) he can respond effectively (she) he ldquohas funrdquo
ldquoFun is the childrsquos word for sensory integrationrdquo Sensory Integration and the Child p8
Smith Roley 2014
Danielle Marshall spokesperson for KaBOOM a nonprofit org httpusatoday30usatodaycomnewshealthwellnessstory201108Advocates-Importance-of-play-time-for-children-neglected500718781 retrieved 82613
Changing Values re Play
bull ldquoSince the 1970s kids have lost an average nine hours of free playtime a week
bull and when given recreational activities they are likely to be adult-led and adult-supervisedrdquo
Smith Roley 2014
Neuroplasticity
bull ldquoNovel experience bull altered afferent input due to
environmental changes bull and learning new skills bull are now recognized as
modulators of brain function and underlying neuroanatomic circuitryrdquo
May A 2011 p1
Smith Roley 2013
Greenough Black amp Wallace 1987
ldquoExperience can influence
the developing and mature brainrdquo
bull Experience-independent ndash genetic unfolding
bull Experience-expectant ndash neural structuresfunctions ready during critical periods ndash Experience-dependent ndash enrichment
bull unique to the individual
bull incorporation of idiosyncratic environmental information
bull Involves active formation of new synaptic connections in response to the events
Smith Roley 2013
Animal Studies on Enriched Environments Rosenzweig Bennett amp Diamond (1972)
(summary in Reynolds Lane amp Richards 2010)
Changes to standard cage conditions provide enhanced sensory motor cognitive and potentially social opportunities
Experience dependent results from active interaction between animal amp environment Increase in dendritic branching amp
synaptogenesis Neurogenesis in hippocampus amp amygdala Gliogenesis
Smith Roley 2013
Predicting Outcomes
Neuroplasticity studies suggest outcomes of Sensory Integrative approach may be
Decreased anxiety Decreased hypersensitivity Normalization of stress response Increased social participation Reduced stereotyped behaviors Better learning amp memory
Smith Roley 2013
What are the active ingredients of change
bull Motor activity bull Sensory input bull Social interactionplay bull MOST LIKELY a
combination ndash sensory motor amp
cognitive stimulation ndash environmental novelty ndash opportunities for
engagement in challenging tasks
Smith Roley 2014
Implications for Sensory Integration in Practice
However
OTSI has an
additional active ingredient
YOU
Smith Roley 2014
bull Model of Sensory Integration bull Theory of Sensory Integration
Assessments bull Sensory Integration amp Praxis Tests bull Sensory History
Questionnaires bull Clinical Observations
bull Interpretation bull Intervention bull Outcomes Research
Scholarship ~ Mentorship
Sensory Integrative Processes
The senses Integration of their inputs End products
Auditory (hearing)
First level Second level Third level Fourth level
Vestibular
(gravity amp movement)
Proprioceptive
(muscles amp joints)
Tactile (touch)
Visual (seeing)
Speech
Language
eye movements
Posture
Balance
Muscle tone
Gravitational security
Sucking
Eating
Mother-infant bond
Tactile comfort
Body perception
Coordination of two
sides of the body
Motor planning
Activity level
Attention span
Emotional stability
Eye-hand
coordination
Visual perception
Purposeful activity
Ability to concentrate
Ability to organise
Self-esteem
Self-control
Self-confidence
Academic learning ability
Capacity for abstract
thought and reasoning
Specialization of each side
of the body and the brain
Published by WPSreg 1979 2005 (c) 2014 Smith Roley Singer amp Roley
Theory Updates
Example Symplexity Alain Berthoz (2012)
ldquoA very young baby can mimic the facial expressions of its parents even though it cannot
see its own face which would seem to suggest the existence of innate mechanism of intermodal
encoding and transfer between what is perceived and what is producedhellip
This embodiment of perception is a
fundamental mechanism of simplexityrdquo
Smith Roley 2013
Assessment Updates
Sensory Integration Patterns (Ayres 1965-1989)
bull Tactile amp motor planning deficits (1965 1966 1969 1972 1977 amp 1989)
bull Visual perceptionvisual praxis deficits (1965 1966 1969 1972 1977 amp 1989)
bull Vestibular postural amp bilateral deficits (1965 1966 1969 1972 1977 amp 1989)
bull Tactile defensiveness amp hyperactivitydistractibility (1965 1966 1969 1972)
bull Other factors (auditory language somatosensory perception) seen in some studies
(1969 1972 1977 1989)
Verification and Clarification of
Sensory Integration Patterns
Mulligan (1998)
Mailloux Mulligan Roley etal (2011)
Van Jaarsveld etal (in press)
Lane (2010)
Blanche etal (2012)
SIPT Factor Analysis
Mulligan 1998
n= 10475
Smith Roley 2014
PPR
PRVC
SV
CPR
MFP II
DC
MFP I
OPR
SWB
PRN
BMC
MAC
GRA
SPR
KIN
LTS
FG
FI
TD
ATTN
Visio amp Somatopraxis
VestibularProp
Bilateral Integration amp
Sequencing
Tactile amp
Visual Discrimination
Tactile Defensiveness
amp Attention
SIPT Factor Analysis
Mailloux etal 2011
n=278
SIPT Factor Analysis in South African Sample (Van Jaarsveld etal in press)
n=223 Convenience Sample
bull Factor 1
ndash Visuo and Somatodyspraxia
bull DC CPR SV MAc MFP KIN SPr PvVC SWB GRA
bull Factor 2
ndash Bilateral Integration and Sequencing
bull SPr BMC Opr SWB with lower loadings on PPr PrVC
bull Factor 3
ndash Tactile and Visual Discrimination
bull FI MFP LTS with moderate loadings on PrVC OPr
26 (c) 2014 Susanne Smith
Roley OTD
SIPT Factor Analysis in South African Sample (Van Jaarsveld etal in press)
27 (c) 2014 Susanne Smith
Roley OTD Figure 1 Loadings on three factors of final analysis
Lane AE etal (2010)
Sensory Profile Cluster Analysis 3 patterns of ASD sensory processing
Sensory-based inattentive seeking
under-responsive (milder)
Sensory modulation with movement sensitivity low energyweak poor endurance
Sensory modulation with tastesmell sensitivity
under and over-responsiveness with no movement issues more communication difficulties and maladaptive behaviors
Sensory subtypes predicted communication competence
and maladaptive behavior
Comprehensive Observation of Proprioception (COP) Factor Analyses
bull F1 Tone and Joint Alignment
ndash Joint hypermobility decreased tone poor joint alignment
bull F2 Behavioral Manifestations
ndash Pushing overactive crashing falling running
ndash Correlates with SPM bumping and pushing
bull F3 Postural Motor
ndash Decreased PC tendency to lean inefficient grading force inadequate weight bearing inefficient ankle strategies
ndash Correlates with SPM body awareness and SWB
bull F4 Motor Planning
ndash Decreased feedback planning decreased feedforward planning overly passive
ndash No correlation with SPM body awareness weak correlation with KIN and SWB
Blanche Bodison Chang amp Reinoso (2012)
29
(c) 2014 Susanne Smith Roley
OTD
Refining Assessment of Sensory Integrative Functions
Smith Roley 2014
Visual-Praxis
Vestibular Bilateral Integration
Proprioception Tactile
Somato- dyspraxia
Sensory Reactivity
(Modulation)
Visual motor
Postural
control
Gross
motor
skills
Praxis Arousal
Affect
Activity Level
Attention
Visual construction
Bilateral coordination
Sequencing
Fine motor skills
Auditory -Language
Organization of behavior
StateSelf Regulation
Smith Roley 2013
SENSORY INTEGRATION INTERVENTION
Intervention Planning Promoting neuroplasticity health and development
Smith Roley 2014
Implications for OTSI Intervention
Consistent with Neuroplasticity Literature
ndash Sensorimotor opportunities
ndash Control over activity
ndash Novelty
ndash Challenge
ndash Playful environment
ndash Lifelike context
Smith Roley 2014
Sensory Integration and Play
bull When the therapist is doing her job effectively and the child is organizing his nervous system it looks as if the child is merely playing rdquo ndash Ayres 1979
Smith Roley 2013
Ayres Sensory Integrationreg Intervention Fidelity Measure
Parham et al 2007 2011 2013-in press
ASIFM Structural elements ndash Part I Therapist Qualifications
ndash Part II Safe Environment
ndash Part III Record Review
ndash Part IV Space and Equipment
ndash Part V Communication with Parents amp Teachers
Smith Roley 2013
ASIFM Process Elements (Parham et al 2011)
1 Physical safety 2 Sensory opportunities
(vestibular tactile and proprioceptive)
3 Supports sensory modulation to attainmaintain a regulated state
4 Supports postural ocular oral or bilateral motor coordination
5 Challenges praxis and organization of behavior
6 Collaborative activity choice
7 Just Right Challenge
8 Ensures Success
9 Supports motivation to play
10 Establishes therapeutic alliance
Smith Roley 2013
Data-driven Intervention Process (Schaaf 2001 Schaaf amp Blanche 2012)
Participation challenges
Current behavior
Theoretical
Framework
Assessments
37
Hypotheses Interventions Outcomes
(c) 2014 Susanne Smith Roley
OTD
Grounds for Optimism
Four Common Misconceptions
in the Anti-SI Intervention Literature Clark 2012
1) Reviews critical of sensory integration
intervention research ignores issues of fidelity
and dosage
Smith Roley 2014
2) Reviewers ignore or minimize the available
positive evidence for SI intervention
bull 3 RCTrsquos with autism demonstrated positive results
following multisensory interventions (including SI
intervention) (Fazlioglu amp Baran 2008 Pfeiffer
Koenig Kinnealey Sheppard amp Henderson 2011
Smith Press Koenig amp Kinnealey 2005)
bull ldquoBased on the application of meta-analytic techniques
for cumulating probability values it is not hard to
conclude that sensory treatments have positive effects
when administered to children with ASDsrdquo Clark
2012
Smith Roley 2014
3) The lack of positive outcomes from SI Intervention may be due
to weak or poorly designed studies
bull Current studies suggest that with stronger and more
studies there will be consistent beneficial effects for
certain outcomes
bull ldquoThe challenge is to make these studies happenrdquo
Clark 2012
Smith Roley 2013
4) Critics often forget that a lack of solid evidence characterizes
nearly all interventions for children with ASDs
bull SI intervention is often held to a different standard
than other types of intervention failing to apply the
same criterion to alternate interventions
Clark 2012
Smith Roley 2014
Remaining Mysteries
Smith Roley 2013
Implications for Advocacy
People need breaks such as recess
People require sensorimotor and social play timespacevalue in the daily routine
Smith Roley 2014
Implications for Research on OT using Sensory Integration
Enhancing Neuroplasticity via Therapeutic Design
bull Dosage - Intensity of increased access in short time periods rather than small access over longer times
bull Engagement via play and not just exposure
bull Role of therapist in providing customized sensorimotor challenges
bull Access to safe dynamic and therapeutic environments vs predictable and static environments
bull The difference between practice for skill development and adaptation to challenges in changing environments
Smith Roley 2014
Implications for Sensory Integration in Practice
Most importantly the success of Sensory Integration in practice depends on
YOU
Smith Roley 2014
Thank You
bull Organizers and Participants
bull hyvaumlauml paumlivaumlnjatkoa
bull Enjoy the conference
Smith Roley 2013
bull Ayres AJ (2005) Sensory Integration and the Child Los Angeles CA Western Psychological Services bull Armstrong T (2006) The best schools How human development research should inform educational practice Alexandria
VA Association for Supervision and Curriculum Development bull Blanche E I Bodison S Chang M C amp Reinoso G (2012) Development of the comprehensive observations of
proprioception (COP) Validity reliability and factor analysis American Journal of Occupational Therapy 66 691ndash698 bull Bundy A amp Lane S (In press) Sensory integration theory and practice Third Ed Philsadelphia PA FA Davis Inc bull Casey T amp MacIntyre S (2007) Childrenrsquos need for time and space In T Casey (Ed) Environments for outdoor play A
practical guide to making space for children (pp 5 ndash 16) London Sage Publications httpwwwsagepubcomupm-data15553_CASEY_C01PDF
bull Gray P (2013) Play as preparation for learning and life American Journal of Play 5(3) 271 - 292 bull Greenough WR Black JE Wallace CS (1987) Experience and brain development Child Development 58(3)539-59 bull Lane AE Young RL Baker AEZ amp Angley MT (2010) Sensory processing subtypes in autism Association with adaptive behavior
Journal of Autism and Developmental Disorders 40 112-122
bull Lane SJ Schaaf RC (2010) Examining the neuroscience evidence for sensory-driven neuroplasticity implications for sensory-based occupational therapy for children and adolescents American Journal of Occupational Therapy 64(3)375-90
bull Mailloux Z Mulligan S Smith Roley S Cermak S Blanche E amp Bodison S Coleman G amp Lane C (2011) Verification and clarification of patterns of sensory integrative dysfunction in a retrospective clinical sample American Journal of Occupational Therapy 652 143-151
bull May A (2011) Experience-dependent structural plasticity in the adult human brain 1-8 Trends in Cognitive Sciences bull May-Benson TA Smith Roley S Mailloux Z Parham LD Koomar J Schaaf RC Van Jaarsveld AM amp Cohn E (in
press) Structural Elements of the Ayres Sensory Integrationreg Intervention Fidelity Measurecopy American Journal of Occupational Therapy
bull Milteer RM Ginsburg KR amp Council on Communications and Media Committee on Psychosocial Aspects of Child and Family Health (2011) Pediatrics e204-e213 DOI 101542peds2011-2953
bull Parham LD Cohn ES Spitzer S Koomar J Miller LJ Burke JP Brett-Green B Mailloux Z May-Benson T Smith Roley S Schaaf RC Schoen S amp Summers CA (2007) Fidelity in sensory integration intervention research American Journal of Occupational Therapy 61 2 216-227
bull Parham LD Smith Roley S May-Benson T Koomar J Brett-Green B Burke JP Cohn ES Mailloux Z Miller LJ amp Schaaf RC (2011) Development of a fidelity measure for research on effectiveness of Ayres Sensory Integrationreg intervention American Journal of Occupational Therapy 65 2 133-142
bull Reynolds S Lane SJ amp Richards L (2010) Using animal models of enriched environments to inform research on sensory integration intervention for the rehabilitation of neurodevelopmental disorders Journal of Neurodevelopmental Disorders 2( 3) 120-132 online first DOI 101007s11689-010-9053-4
bull Roley SS Mailloux Z Parham D Schaaf R Blanche E amp Lane CA Cermak S (in press) Sensory Integration and Praxis Patterns in Children with Autism American Journal of Occupational Therapy
bull Rosenzweig MR Bennet EL and Diamond MC (1972) Brain Changes in response to experience Scientific American 226(2) 22-29
bull Van Jaarsveld A Mailloux Z Smith Roley S amp Raubenheimer J (in press) Patterns of the sensory integration dysfunctions in South African children South African Journal of Occupational Therapy
bull Wills S Cabanlit M Bennett J Ashwood P Amaral DG amp Van de Water J (2009) Detection of autoantibodies to neural cells of the cerebellum in the plasma of subjects with autism spectrum disorders Brain Behavior and Immunity 23(1) 64-74
Prevalence of Dementia
bull Expanding rapidly particularly in countries with low and middle incomes
bull It was estimated that 356 million people lived with dementia worldwide in 2010 with numbers expected to almost double every 20 years to 657 million in 2030 and 1154 million in 2050
bull In 2010 58 of all people with dementia lived in countries with low or middle incomes with this proportion anticipated to rise to 63 in 2030 and 71 in 2050
Alzheimers Dement 2013 Jan9(1)63-75e2 doi 101016jjalz201211007 The global prevalence of dementia a systematic review and metaanalysis Prince M1 Bryce R Albanese E Wimo A Ribeiro W Ferri CP Author information
Smith Roley 2013
Sensory Integration as a Vehicle for Change
Smith Roley 2014
ADAPTATION
ldquoWhen the sensory integrative capacity of the brain is sufficient to meet the demands of the environment the childrsquos response is efficient creative and satisfyingrdquo
PLAY
When the child experiences challenges to which (she) he can respond effectively (she) he ldquohas funrdquo
ldquoFun is the childrsquos word for sensory integrationrdquo Sensory Integration and the Child p8
Smith Roley 2014
Danielle Marshall spokesperson for KaBOOM a nonprofit org httpusatoday30usatodaycomnewshealthwellnessstory201108Advocates-Importance-of-play-time-for-children-neglected500718781 retrieved 82613
Changing Values re Play
bull ldquoSince the 1970s kids have lost an average nine hours of free playtime a week
bull and when given recreational activities they are likely to be adult-led and adult-supervisedrdquo
Smith Roley 2014
Neuroplasticity
bull ldquoNovel experience bull altered afferent input due to
environmental changes bull and learning new skills bull are now recognized as
modulators of brain function and underlying neuroanatomic circuitryrdquo
May A 2011 p1
Smith Roley 2013
Greenough Black amp Wallace 1987
ldquoExperience can influence
the developing and mature brainrdquo
bull Experience-independent ndash genetic unfolding
bull Experience-expectant ndash neural structuresfunctions ready during critical periods ndash Experience-dependent ndash enrichment
bull unique to the individual
bull incorporation of idiosyncratic environmental information
bull Involves active formation of new synaptic connections in response to the events
Smith Roley 2013
Animal Studies on Enriched Environments Rosenzweig Bennett amp Diamond (1972)
(summary in Reynolds Lane amp Richards 2010)
Changes to standard cage conditions provide enhanced sensory motor cognitive and potentially social opportunities
Experience dependent results from active interaction between animal amp environment Increase in dendritic branching amp
synaptogenesis Neurogenesis in hippocampus amp amygdala Gliogenesis
Smith Roley 2013
Predicting Outcomes
Neuroplasticity studies suggest outcomes of Sensory Integrative approach may be
Decreased anxiety Decreased hypersensitivity Normalization of stress response Increased social participation Reduced stereotyped behaviors Better learning amp memory
Smith Roley 2013
What are the active ingredients of change
bull Motor activity bull Sensory input bull Social interactionplay bull MOST LIKELY a
combination ndash sensory motor amp
cognitive stimulation ndash environmental novelty ndash opportunities for
engagement in challenging tasks
Smith Roley 2014
Implications for Sensory Integration in Practice
However
OTSI has an
additional active ingredient
YOU
Smith Roley 2014
bull Model of Sensory Integration bull Theory of Sensory Integration
Assessments bull Sensory Integration amp Praxis Tests bull Sensory History
Questionnaires bull Clinical Observations
bull Interpretation bull Intervention bull Outcomes Research
Scholarship ~ Mentorship
Sensory Integrative Processes
The senses Integration of their inputs End products
Auditory (hearing)
First level Second level Third level Fourth level
Vestibular
(gravity amp movement)
Proprioceptive
(muscles amp joints)
Tactile (touch)
Visual (seeing)
Speech
Language
eye movements
Posture
Balance
Muscle tone
Gravitational security
Sucking
Eating
Mother-infant bond
Tactile comfort
Body perception
Coordination of two
sides of the body
Motor planning
Activity level
Attention span
Emotional stability
Eye-hand
coordination
Visual perception
Purposeful activity
Ability to concentrate
Ability to organise
Self-esteem
Self-control
Self-confidence
Academic learning ability
Capacity for abstract
thought and reasoning
Specialization of each side
of the body and the brain
Published by WPSreg 1979 2005 (c) 2014 Smith Roley Singer amp Roley
Theory Updates
Example Symplexity Alain Berthoz (2012)
ldquoA very young baby can mimic the facial expressions of its parents even though it cannot
see its own face which would seem to suggest the existence of innate mechanism of intermodal
encoding and transfer between what is perceived and what is producedhellip
This embodiment of perception is a
fundamental mechanism of simplexityrdquo
Smith Roley 2013
Assessment Updates
Sensory Integration Patterns (Ayres 1965-1989)
bull Tactile amp motor planning deficits (1965 1966 1969 1972 1977 amp 1989)
bull Visual perceptionvisual praxis deficits (1965 1966 1969 1972 1977 amp 1989)
bull Vestibular postural amp bilateral deficits (1965 1966 1969 1972 1977 amp 1989)
bull Tactile defensiveness amp hyperactivitydistractibility (1965 1966 1969 1972)
bull Other factors (auditory language somatosensory perception) seen in some studies
(1969 1972 1977 1989)
Verification and Clarification of
Sensory Integration Patterns
Mulligan (1998)
Mailloux Mulligan Roley etal (2011)
Van Jaarsveld etal (in press)
Lane (2010)
Blanche etal (2012)
SIPT Factor Analysis
Mulligan 1998
n= 10475
Smith Roley 2014
PPR
PRVC
SV
CPR
MFP II
DC
MFP I
OPR
SWB
PRN
BMC
MAC
GRA
SPR
KIN
LTS
FG
FI
TD
ATTN
Visio amp Somatopraxis
VestibularProp
Bilateral Integration amp
Sequencing
Tactile amp
Visual Discrimination
Tactile Defensiveness
amp Attention
SIPT Factor Analysis
Mailloux etal 2011
n=278
SIPT Factor Analysis in South African Sample (Van Jaarsveld etal in press)
n=223 Convenience Sample
bull Factor 1
ndash Visuo and Somatodyspraxia
bull DC CPR SV MAc MFP KIN SPr PvVC SWB GRA
bull Factor 2
ndash Bilateral Integration and Sequencing
bull SPr BMC Opr SWB with lower loadings on PPr PrVC
bull Factor 3
ndash Tactile and Visual Discrimination
bull FI MFP LTS with moderate loadings on PrVC OPr
26 (c) 2014 Susanne Smith
Roley OTD
SIPT Factor Analysis in South African Sample (Van Jaarsveld etal in press)
27 (c) 2014 Susanne Smith
Roley OTD Figure 1 Loadings on three factors of final analysis
Lane AE etal (2010)
Sensory Profile Cluster Analysis 3 patterns of ASD sensory processing
Sensory-based inattentive seeking
under-responsive (milder)
Sensory modulation with movement sensitivity low energyweak poor endurance
Sensory modulation with tastesmell sensitivity
under and over-responsiveness with no movement issues more communication difficulties and maladaptive behaviors
Sensory subtypes predicted communication competence
and maladaptive behavior
Comprehensive Observation of Proprioception (COP) Factor Analyses
bull F1 Tone and Joint Alignment
ndash Joint hypermobility decreased tone poor joint alignment
bull F2 Behavioral Manifestations
ndash Pushing overactive crashing falling running
ndash Correlates with SPM bumping and pushing
bull F3 Postural Motor
ndash Decreased PC tendency to lean inefficient grading force inadequate weight bearing inefficient ankle strategies
ndash Correlates with SPM body awareness and SWB
bull F4 Motor Planning
ndash Decreased feedback planning decreased feedforward planning overly passive
ndash No correlation with SPM body awareness weak correlation with KIN and SWB
Blanche Bodison Chang amp Reinoso (2012)
29
(c) 2014 Susanne Smith Roley
OTD
Refining Assessment of Sensory Integrative Functions
Smith Roley 2014
Visual-Praxis
Vestibular Bilateral Integration
Proprioception Tactile
Somato- dyspraxia
Sensory Reactivity
(Modulation)
Visual motor
Postural
control
Gross
motor
skills
Praxis Arousal
Affect
Activity Level
Attention
Visual construction
Bilateral coordination
Sequencing
Fine motor skills
Auditory -Language
Organization of behavior
StateSelf Regulation
Smith Roley 2013
SENSORY INTEGRATION INTERVENTION
Intervention Planning Promoting neuroplasticity health and development
Smith Roley 2014
Implications for OTSI Intervention
Consistent with Neuroplasticity Literature
ndash Sensorimotor opportunities
ndash Control over activity
ndash Novelty
ndash Challenge
ndash Playful environment
ndash Lifelike context
Smith Roley 2014
Sensory Integration and Play
bull When the therapist is doing her job effectively and the child is organizing his nervous system it looks as if the child is merely playing rdquo ndash Ayres 1979
Smith Roley 2013
Ayres Sensory Integrationreg Intervention Fidelity Measure
Parham et al 2007 2011 2013-in press
ASIFM Structural elements ndash Part I Therapist Qualifications
ndash Part II Safe Environment
ndash Part III Record Review
ndash Part IV Space and Equipment
ndash Part V Communication with Parents amp Teachers
Smith Roley 2013
ASIFM Process Elements (Parham et al 2011)
1 Physical safety 2 Sensory opportunities
(vestibular tactile and proprioceptive)
3 Supports sensory modulation to attainmaintain a regulated state
4 Supports postural ocular oral or bilateral motor coordination
5 Challenges praxis and organization of behavior
6 Collaborative activity choice
7 Just Right Challenge
8 Ensures Success
9 Supports motivation to play
10 Establishes therapeutic alliance
Smith Roley 2013
Data-driven Intervention Process (Schaaf 2001 Schaaf amp Blanche 2012)
Participation challenges
Current behavior
Theoretical
Framework
Assessments
37
Hypotheses Interventions Outcomes
(c) 2014 Susanne Smith Roley
OTD
Grounds for Optimism
Four Common Misconceptions
in the Anti-SI Intervention Literature Clark 2012
1) Reviews critical of sensory integration
intervention research ignores issues of fidelity
and dosage
Smith Roley 2014
2) Reviewers ignore or minimize the available
positive evidence for SI intervention
bull 3 RCTrsquos with autism demonstrated positive results
following multisensory interventions (including SI
intervention) (Fazlioglu amp Baran 2008 Pfeiffer
Koenig Kinnealey Sheppard amp Henderson 2011
Smith Press Koenig amp Kinnealey 2005)
bull ldquoBased on the application of meta-analytic techniques
for cumulating probability values it is not hard to
conclude that sensory treatments have positive effects
when administered to children with ASDsrdquo Clark
2012
Smith Roley 2014
3) The lack of positive outcomes from SI Intervention may be due
to weak or poorly designed studies
bull Current studies suggest that with stronger and more
studies there will be consistent beneficial effects for
certain outcomes
bull ldquoThe challenge is to make these studies happenrdquo
Clark 2012
Smith Roley 2013
4) Critics often forget that a lack of solid evidence characterizes
nearly all interventions for children with ASDs
bull SI intervention is often held to a different standard
than other types of intervention failing to apply the
same criterion to alternate interventions
Clark 2012
Smith Roley 2014
Remaining Mysteries
Smith Roley 2013
Implications for Advocacy
People need breaks such as recess
People require sensorimotor and social play timespacevalue in the daily routine
Smith Roley 2014
Implications for Research on OT using Sensory Integration
Enhancing Neuroplasticity via Therapeutic Design
bull Dosage - Intensity of increased access in short time periods rather than small access over longer times
bull Engagement via play and not just exposure
bull Role of therapist in providing customized sensorimotor challenges
bull Access to safe dynamic and therapeutic environments vs predictable and static environments
bull The difference between practice for skill development and adaptation to challenges in changing environments
Smith Roley 2014
Implications for Sensory Integration in Practice
Most importantly the success of Sensory Integration in practice depends on
YOU
Smith Roley 2014
Thank You
bull Organizers and Participants
bull hyvaumlauml paumlivaumlnjatkoa
bull Enjoy the conference
Smith Roley 2013
bull Ayres AJ (2005) Sensory Integration and the Child Los Angeles CA Western Psychological Services bull Armstrong T (2006) The best schools How human development research should inform educational practice Alexandria
VA Association for Supervision and Curriculum Development bull Blanche E I Bodison S Chang M C amp Reinoso G (2012) Development of the comprehensive observations of
proprioception (COP) Validity reliability and factor analysis American Journal of Occupational Therapy 66 691ndash698 bull Bundy A amp Lane S (In press) Sensory integration theory and practice Third Ed Philsadelphia PA FA Davis Inc bull Casey T amp MacIntyre S (2007) Childrenrsquos need for time and space In T Casey (Ed) Environments for outdoor play A
practical guide to making space for children (pp 5 ndash 16) London Sage Publications httpwwwsagepubcomupm-data15553_CASEY_C01PDF
bull Gray P (2013) Play as preparation for learning and life American Journal of Play 5(3) 271 - 292 bull Greenough WR Black JE Wallace CS (1987) Experience and brain development Child Development 58(3)539-59 bull Lane AE Young RL Baker AEZ amp Angley MT (2010) Sensory processing subtypes in autism Association with adaptive behavior
Journal of Autism and Developmental Disorders 40 112-122
bull Lane SJ Schaaf RC (2010) Examining the neuroscience evidence for sensory-driven neuroplasticity implications for sensory-based occupational therapy for children and adolescents American Journal of Occupational Therapy 64(3)375-90
bull Mailloux Z Mulligan S Smith Roley S Cermak S Blanche E amp Bodison S Coleman G amp Lane C (2011) Verification and clarification of patterns of sensory integrative dysfunction in a retrospective clinical sample American Journal of Occupational Therapy 652 143-151
bull May A (2011) Experience-dependent structural plasticity in the adult human brain 1-8 Trends in Cognitive Sciences bull May-Benson TA Smith Roley S Mailloux Z Parham LD Koomar J Schaaf RC Van Jaarsveld AM amp Cohn E (in
press) Structural Elements of the Ayres Sensory Integrationreg Intervention Fidelity Measurecopy American Journal of Occupational Therapy
bull Milteer RM Ginsburg KR amp Council on Communications and Media Committee on Psychosocial Aspects of Child and Family Health (2011) Pediatrics e204-e213 DOI 101542peds2011-2953
bull Parham LD Cohn ES Spitzer S Koomar J Miller LJ Burke JP Brett-Green B Mailloux Z May-Benson T Smith Roley S Schaaf RC Schoen S amp Summers CA (2007) Fidelity in sensory integration intervention research American Journal of Occupational Therapy 61 2 216-227
bull Parham LD Smith Roley S May-Benson T Koomar J Brett-Green B Burke JP Cohn ES Mailloux Z Miller LJ amp Schaaf RC (2011) Development of a fidelity measure for research on effectiveness of Ayres Sensory Integrationreg intervention American Journal of Occupational Therapy 65 2 133-142
bull Reynolds S Lane SJ amp Richards L (2010) Using animal models of enriched environments to inform research on sensory integration intervention for the rehabilitation of neurodevelopmental disorders Journal of Neurodevelopmental Disorders 2( 3) 120-132 online first DOI 101007s11689-010-9053-4
bull Roley SS Mailloux Z Parham D Schaaf R Blanche E amp Lane CA Cermak S (in press) Sensory Integration and Praxis Patterns in Children with Autism American Journal of Occupational Therapy
bull Rosenzweig MR Bennet EL and Diamond MC (1972) Brain Changes in response to experience Scientific American 226(2) 22-29
bull Van Jaarsveld A Mailloux Z Smith Roley S amp Raubenheimer J (in press) Patterns of the sensory integration dysfunctions in South African children South African Journal of Occupational Therapy
bull Wills S Cabanlit M Bennett J Ashwood P Amaral DG amp Van de Water J (2009) Detection of autoantibodies to neural cells of the cerebellum in the plasma of subjects with autism spectrum disorders Brain Behavior and Immunity 23(1) 64-74
Sensory Integration as a Vehicle for Change
Smith Roley 2014
ADAPTATION
ldquoWhen the sensory integrative capacity of the brain is sufficient to meet the demands of the environment the childrsquos response is efficient creative and satisfyingrdquo
PLAY
When the child experiences challenges to which (she) he can respond effectively (she) he ldquohas funrdquo
ldquoFun is the childrsquos word for sensory integrationrdquo Sensory Integration and the Child p8
Smith Roley 2014
Danielle Marshall spokesperson for KaBOOM a nonprofit org httpusatoday30usatodaycomnewshealthwellnessstory201108Advocates-Importance-of-play-time-for-children-neglected500718781 retrieved 82613
Changing Values re Play
bull ldquoSince the 1970s kids have lost an average nine hours of free playtime a week
bull and when given recreational activities they are likely to be adult-led and adult-supervisedrdquo
Smith Roley 2014
Neuroplasticity
bull ldquoNovel experience bull altered afferent input due to
environmental changes bull and learning new skills bull are now recognized as
modulators of brain function and underlying neuroanatomic circuitryrdquo
May A 2011 p1
Smith Roley 2013
Greenough Black amp Wallace 1987
ldquoExperience can influence
the developing and mature brainrdquo
bull Experience-independent ndash genetic unfolding
bull Experience-expectant ndash neural structuresfunctions ready during critical periods ndash Experience-dependent ndash enrichment
bull unique to the individual
bull incorporation of idiosyncratic environmental information
bull Involves active formation of new synaptic connections in response to the events
Smith Roley 2013
Animal Studies on Enriched Environments Rosenzweig Bennett amp Diamond (1972)
(summary in Reynolds Lane amp Richards 2010)
Changes to standard cage conditions provide enhanced sensory motor cognitive and potentially social opportunities
Experience dependent results from active interaction between animal amp environment Increase in dendritic branching amp
synaptogenesis Neurogenesis in hippocampus amp amygdala Gliogenesis
Smith Roley 2013
Predicting Outcomes
Neuroplasticity studies suggest outcomes of Sensory Integrative approach may be
Decreased anxiety Decreased hypersensitivity Normalization of stress response Increased social participation Reduced stereotyped behaviors Better learning amp memory
Smith Roley 2013
What are the active ingredients of change
bull Motor activity bull Sensory input bull Social interactionplay bull MOST LIKELY a
combination ndash sensory motor amp
cognitive stimulation ndash environmental novelty ndash opportunities for
engagement in challenging tasks
Smith Roley 2014
Implications for Sensory Integration in Practice
However
OTSI has an
additional active ingredient
YOU
Smith Roley 2014
bull Model of Sensory Integration bull Theory of Sensory Integration
Assessments bull Sensory Integration amp Praxis Tests bull Sensory History
Questionnaires bull Clinical Observations
bull Interpretation bull Intervention bull Outcomes Research
Scholarship ~ Mentorship
Sensory Integrative Processes
The senses Integration of their inputs End products
Auditory (hearing)
First level Second level Third level Fourth level
Vestibular
(gravity amp movement)
Proprioceptive
(muscles amp joints)
Tactile (touch)
Visual (seeing)
Speech
Language
eye movements
Posture
Balance
Muscle tone
Gravitational security
Sucking
Eating
Mother-infant bond
Tactile comfort
Body perception
Coordination of two
sides of the body
Motor planning
Activity level
Attention span
Emotional stability
Eye-hand
coordination
Visual perception
Purposeful activity
Ability to concentrate
Ability to organise
Self-esteem
Self-control
Self-confidence
Academic learning ability
Capacity for abstract
thought and reasoning
Specialization of each side
of the body and the brain
Published by WPSreg 1979 2005 (c) 2014 Smith Roley Singer amp Roley
Theory Updates
Example Symplexity Alain Berthoz (2012)
ldquoA very young baby can mimic the facial expressions of its parents even though it cannot
see its own face which would seem to suggest the existence of innate mechanism of intermodal
encoding and transfer between what is perceived and what is producedhellip
This embodiment of perception is a
fundamental mechanism of simplexityrdquo
Smith Roley 2013
Assessment Updates
Sensory Integration Patterns (Ayres 1965-1989)
bull Tactile amp motor planning deficits (1965 1966 1969 1972 1977 amp 1989)
bull Visual perceptionvisual praxis deficits (1965 1966 1969 1972 1977 amp 1989)
bull Vestibular postural amp bilateral deficits (1965 1966 1969 1972 1977 amp 1989)
bull Tactile defensiveness amp hyperactivitydistractibility (1965 1966 1969 1972)
bull Other factors (auditory language somatosensory perception) seen in some studies
(1969 1972 1977 1989)
Verification and Clarification of
Sensory Integration Patterns
Mulligan (1998)
Mailloux Mulligan Roley etal (2011)
Van Jaarsveld etal (in press)
Lane (2010)
Blanche etal (2012)
SIPT Factor Analysis
Mulligan 1998
n= 10475
Smith Roley 2014
PPR
PRVC
SV
CPR
MFP II
DC
MFP I
OPR
SWB
PRN
BMC
MAC
GRA
SPR
KIN
LTS
FG
FI
TD
ATTN
Visio amp Somatopraxis
VestibularProp
Bilateral Integration amp
Sequencing
Tactile amp
Visual Discrimination
Tactile Defensiveness
amp Attention
SIPT Factor Analysis
Mailloux etal 2011
n=278
SIPT Factor Analysis in South African Sample (Van Jaarsveld etal in press)
n=223 Convenience Sample
bull Factor 1
ndash Visuo and Somatodyspraxia
bull DC CPR SV MAc MFP KIN SPr PvVC SWB GRA
bull Factor 2
ndash Bilateral Integration and Sequencing
bull SPr BMC Opr SWB with lower loadings on PPr PrVC
bull Factor 3
ndash Tactile and Visual Discrimination
bull FI MFP LTS with moderate loadings on PrVC OPr
26 (c) 2014 Susanne Smith
Roley OTD
SIPT Factor Analysis in South African Sample (Van Jaarsveld etal in press)
27 (c) 2014 Susanne Smith
Roley OTD Figure 1 Loadings on three factors of final analysis
Lane AE etal (2010)
Sensory Profile Cluster Analysis 3 patterns of ASD sensory processing
Sensory-based inattentive seeking
under-responsive (milder)
Sensory modulation with movement sensitivity low energyweak poor endurance
Sensory modulation with tastesmell sensitivity
under and over-responsiveness with no movement issues more communication difficulties and maladaptive behaviors
Sensory subtypes predicted communication competence
and maladaptive behavior
Comprehensive Observation of Proprioception (COP) Factor Analyses
bull F1 Tone and Joint Alignment
ndash Joint hypermobility decreased tone poor joint alignment
bull F2 Behavioral Manifestations
ndash Pushing overactive crashing falling running
ndash Correlates with SPM bumping and pushing
bull F3 Postural Motor
ndash Decreased PC tendency to lean inefficient grading force inadequate weight bearing inefficient ankle strategies
ndash Correlates with SPM body awareness and SWB
bull F4 Motor Planning
ndash Decreased feedback planning decreased feedforward planning overly passive
ndash No correlation with SPM body awareness weak correlation with KIN and SWB
Blanche Bodison Chang amp Reinoso (2012)
29
(c) 2014 Susanne Smith Roley
OTD
Refining Assessment of Sensory Integrative Functions
Smith Roley 2014
Visual-Praxis
Vestibular Bilateral Integration
Proprioception Tactile
Somato- dyspraxia
Sensory Reactivity
(Modulation)
Visual motor
Postural
control
Gross
motor
skills
Praxis Arousal
Affect
Activity Level
Attention
Visual construction
Bilateral coordination
Sequencing
Fine motor skills
Auditory -Language
Organization of behavior
StateSelf Regulation
Smith Roley 2013
SENSORY INTEGRATION INTERVENTION
Intervention Planning Promoting neuroplasticity health and development
Smith Roley 2014
Implications for OTSI Intervention
Consistent with Neuroplasticity Literature
ndash Sensorimotor opportunities
ndash Control over activity
ndash Novelty
ndash Challenge
ndash Playful environment
ndash Lifelike context
Smith Roley 2014
Sensory Integration and Play
bull When the therapist is doing her job effectively and the child is organizing his nervous system it looks as if the child is merely playing rdquo ndash Ayres 1979
Smith Roley 2013
Ayres Sensory Integrationreg Intervention Fidelity Measure
Parham et al 2007 2011 2013-in press
ASIFM Structural elements ndash Part I Therapist Qualifications
ndash Part II Safe Environment
ndash Part III Record Review
ndash Part IV Space and Equipment
ndash Part V Communication with Parents amp Teachers
Smith Roley 2013
ASIFM Process Elements (Parham et al 2011)
1 Physical safety 2 Sensory opportunities
(vestibular tactile and proprioceptive)
3 Supports sensory modulation to attainmaintain a regulated state
4 Supports postural ocular oral or bilateral motor coordination
5 Challenges praxis and organization of behavior
6 Collaborative activity choice
7 Just Right Challenge
8 Ensures Success
9 Supports motivation to play
10 Establishes therapeutic alliance
Smith Roley 2013
Data-driven Intervention Process (Schaaf 2001 Schaaf amp Blanche 2012)
Participation challenges
Current behavior
Theoretical
Framework
Assessments
37
Hypotheses Interventions Outcomes
(c) 2014 Susanne Smith Roley
OTD
Grounds for Optimism
Four Common Misconceptions
in the Anti-SI Intervention Literature Clark 2012
1) Reviews critical of sensory integration
intervention research ignores issues of fidelity
and dosage
Smith Roley 2014
2) Reviewers ignore or minimize the available
positive evidence for SI intervention
bull 3 RCTrsquos with autism demonstrated positive results
following multisensory interventions (including SI
intervention) (Fazlioglu amp Baran 2008 Pfeiffer
Koenig Kinnealey Sheppard amp Henderson 2011
Smith Press Koenig amp Kinnealey 2005)
bull ldquoBased on the application of meta-analytic techniques
for cumulating probability values it is not hard to
conclude that sensory treatments have positive effects
when administered to children with ASDsrdquo Clark
2012
Smith Roley 2014
3) The lack of positive outcomes from SI Intervention may be due
to weak or poorly designed studies
bull Current studies suggest that with stronger and more
studies there will be consistent beneficial effects for
certain outcomes
bull ldquoThe challenge is to make these studies happenrdquo
Clark 2012
Smith Roley 2013
4) Critics often forget that a lack of solid evidence characterizes
nearly all interventions for children with ASDs
bull SI intervention is often held to a different standard
than other types of intervention failing to apply the
same criterion to alternate interventions
Clark 2012
Smith Roley 2014
Remaining Mysteries
Smith Roley 2013
Implications for Advocacy
People need breaks such as recess
People require sensorimotor and social play timespacevalue in the daily routine
Smith Roley 2014
Implications for Research on OT using Sensory Integration
Enhancing Neuroplasticity via Therapeutic Design
bull Dosage - Intensity of increased access in short time periods rather than small access over longer times
bull Engagement via play and not just exposure
bull Role of therapist in providing customized sensorimotor challenges
bull Access to safe dynamic and therapeutic environments vs predictable and static environments
bull The difference between practice for skill development and adaptation to challenges in changing environments
Smith Roley 2014
Implications for Sensory Integration in Practice
Most importantly the success of Sensory Integration in practice depends on
YOU
Smith Roley 2014
Thank You
bull Organizers and Participants
bull hyvaumlauml paumlivaumlnjatkoa
bull Enjoy the conference
Smith Roley 2013
bull Ayres AJ (2005) Sensory Integration and the Child Los Angeles CA Western Psychological Services bull Armstrong T (2006) The best schools How human development research should inform educational practice Alexandria
VA Association for Supervision and Curriculum Development bull Blanche E I Bodison S Chang M C amp Reinoso G (2012) Development of the comprehensive observations of
proprioception (COP) Validity reliability and factor analysis American Journal of Occupational Therapy 66 691ndash698 bull Bundy A amp Lane S (In press) Sensory integration theory and practice Third Ed Philsadelphia PA FA Davis Inc bull Casey T amp MacIntyre S (2007) Childrenrsquos need for time and space In T Casey (Ed) Environments for outdoor play A
practical guide to making space for children (pp 5 ndash 16) London Sage Publications httpwwwsagepubcomupm-data15553_CASEY_C01PDF
bull Gray P (2013) Play as preparation for learning and life American Journal of Play 5(3) 271 - 292 bull Greenough WR Black JE Wallace CS (1987) Experience and brain development Child Development 58(3)539-59 bull Lane AE Young RL Baker AEZ amp Angley MT (2010) Sensory processing subtypes in autism Association with adaptive behavior
Journal of Autism and Developmental Disorders 40 112-122
bull Lane SJ Schaaf RC (2010) Examining the neuroscience evidence for sensory-driven neuroplasticity implications for sensory-based occupational therapy for children and adolescents American Journal of Occupational Therapy 64(3)375-90
bull Mailloux Z Mulligan S Smith Roley S Cermak S Blanche E amp Bodison S Coleman G amp Lane C (2011) Verification and clarification of patterns of sensory integrative dysfunction in a retrospective clinical sample American Journal of Occupational Therapy 652 143-151
bull May A (2011) Experience-dependent structural plasticity in the adult human brain 1-8 Trends in Cognitive Sciences bull May-Benson TA Smith Roley S Mailloux Z Parham LD Koomar J Schaaf RC Van Jaarsveld AM amp Cohn E (in
press) Structural Elements of the Ayres Sensory Integrationreg Intervention Fidelity Measurecopy American Journal of Occupational Therapy
bull Milteer RM Ginsburg KR amp Council on Communications and Media Committee on Psychosocial Aspects of Child and Family Health (2011) Pediatrics e204-e213 DOI 101542peds2011-2953
bull Parham LD Cohn ES Spitzer S Koomar J Miller LJ Burke JP Brett-Green B Mailloux Z May-Benson T Smith Roley S Schaaf RC Schoen S amp Summers CA (2007) Fidelity in sensory integration intervention research American Journal of Occupational Therapy 61 2 216-227
bull Parham LD Smith Roley S May-Benson T Koomar J Brett-Green B Burke JP Cohn ES Mailloux Z Miller LJ amp Schaaf RC (2011) Development of a fidelity measure for research on effectiveness of Ayres Sensory Integrationreg intervention American Journal of Occupational Therapy 65 2 133-142
bull Reynolds S Lane SJ amp Richards L (2010) Using animal models of enriched environments to inform research on sensory integration intervention for the rehabilitation of neurodevelopmental disorders Journal of Neurodevelopmental Disorders 2( 3) 120-132 online first DOI 101007s11689-010-9053-4
bull Roley SS Mailloux Z Parham D Schaaf R Blanche E amp Lane CA Cermak S (in press) Sensory Integration and Praxis Patterns in Children with Autism American Journal of Occupational Therapy
bull Rosenzweig MR Bennet EL and Diamond MC (1972) Brain Changes in response to experience Scientific American 226(2) 22-29
bull Van Jaarsveld A Mailloux Z Smith Roley S amp Raubenheimer J (in press) Patterns of the sensory integration dysfunctions in South African children South African Journal of Occupational Therapy
bull Wills S Cabanlit M Bennett J Ashwood P Amaral DG amp Van de Water J (2009) Detection of autoantibodies to neural cells of the cerebellum in the plasma of subjects with autism spectrum disorders Brain Behavior and Immunity 23(1) 64-74
ADAPTATION
ldquoWhen the sensory integrative capacity of the brain is sufficient to meet the demands of the environment the childrsquos response is efficient creative and satisfyingrdquo
PLAY
When the child experiences challenges to which (she) he can respond effectively (she) he ldquohas funrdquo
ldquoFun is the childrsquos word for sensory integrationrdquo Sensory Integration and the Child p8
Smith Roley 2014
Danielle Marshall spokesperson for KaBOOM a nonprofit org httpusatoday30usatodaycomnewshealthwellnessstory201108Advocates-Importance-of-play-time-for-children-neglected500718781 retrieved 82613
Changing Values re Play
bull ldquoSince the 1970s kids have lost an average nine hours of free playtime a week
bull and when given recreational activities they are likely to be adult-led and adult-supervisedrdquo
Smith Roley 2014
Neuroplasticity
bull ldquoNovel experience bull altered afferent input due to
environmental changes bull and learning new skills bull are now recognized as
modulators of brain function and underlying neuroanatomic circuitryrdquo
May A 2011 p1
Smith Roley 2013
Greenough Black amp Wallace 1987
ldquoExperience can influence
the developing and mature brainrdquo
bull Experience-independent ndash genetic unfolding
bull Experience-expectant ndash neural structuresfunctions ready during critical periods ndash Experience-dependent ndash enrichment
bull unique to the individual
bull incorporation of idiosyncratic environmental information
bull Involves active formation of new synaptic connections in response to the events
Smith Roley 2013
Animal Studies on Enriched Environments Rosenzweig Bennett amp Diamond (1972)
(summary in Reynolds Lane amp Richards 2010)
Changes to standard cage conditions provide enhanced sensory motor cognitive and potentially social opportunities
Experience dependent results from active interaction between animal amp environment Increase in dendritic branching amp
synaptogenesis Neurogenesis in hippocampus amp amygdala Gliogenesis
Smith Roley 2013
Predicting Outcomes
Neuroplasticity studies suggest outcomes of Sensory Integrative approach may be
Decreased anxiety Decreased hypersensitivity Normalization of stress response Increased social participation Reduced stereotyped behaviors Better learning amp memory
Smith Roley 2013
What are the active ingredients of change
bull Motor activity bull Sensory input bull Social interactionplay bull MOST LIKELY a
combination ndash sensory motor amp
cognitive stimulation ndash environmental novelty ndash opportunities for
engagement in challenging tasks
Smith Roley 2014
Implications for Sensory Integration in Practice
However
OTSI has an
additional active ingredient
YOU
Smith Roley 2014
bull Model of Sensory Integration bull Theory of Sensory Integration
Assessments bull Sensory Integration amp Praxis Tests bull Sensory History
Questionnaires bull Clinical Observations
bull Interpretation bull Intervention bull Outcomes Research
Scholarship ~ Mentorship
Sensory Integrative Processes
The senses Integration of their inputs End products
Auditory (hearing)
First level Second level Third level Fourth level
Vestibular
(gravity amp movement)
Proprioceptive
(muscles amp joints)
Tactile (touch)
Visual (seeing)
Speech
Language
eye movements
Posture
Balance
Muscle tone
Gravitational security
Sucking
Eating
Mother-infant bond
Tactile comfort
Body perception
Coordination of two
sides of the body
Motor planning
Activity level
Attention span
Emotional stability
Eye-hand
coordination
Visual perception
Purposeful activity
Ability to concentrate
Ability to organise
Self-esteem
Self-control
Self-confidence
Academic learning ability
Capacity for abstract
thought and reasoning
Specialization of each side
of the body and the brain
Published by WPSreg 1979 2005 (c) 2014 Smith Roley Singer amp Roley
Theory Updates
Example Symplexity Alain Berthoz (2012)
ldquoA very young baby can mimic the facial expressions of its parents even though it cannot
see its own face which would seem to suggest the existence of innate mechanism of intermodal
encoding and transfer between what is perceived and what is producedhellip
This embodiment of perception is a
fundamental mechanism of simplexityrdquo
Smith Roley 2013
Assessment Updates
Sensory Integration Patterns (Ayres 1965-1989)
bull Tactile amp motor planning deficits (1965 1966 1969 1972 1977 amp 1989)
bull Visual perceptionvisual praxis deficits (1965 1966 1969 1972 1977 amp 1989)
bull Vestibular postural amp bilateral deficits (1965 1966 1969 1972 1977 amp 1989)
bull Tactile defensiveness amp hyperactivitydistractibility (1965 1966 1969 1972)
bull Other factors (auditory language somatosensory perception) seen in some studies
(1969 1972 1977 1989)
Verification and Clarification of
Sensory Integration Patterns
Mulligan (1998)
Mailloux Mulligan Roley etal (2011)
Van Jaarsveld etal (in press)
Lane (2010)
Blanche etal (2012)
SIPT Factor Analysis
Mulligan 1998
n= 10475
Smith Roley 2014
PPR
PRVC
SV
CPR
MFP II
DC
MFP I
OPR
SWB
PRN
BMC
MAC
GRA
SPR
KIN
LTS
FG
FI
TD
ATTN
Visio amp Somatopraxis
VestibularProp
Bilateral Integration amp
Sequencing
Tactile amp
Visual Discrimination
Tactile Defensiveness
amp Attention
SIPT Factor Analysis
Mailloux etal 2011
n=278
SIPT Factor Analysis in South African Sample (Van Jaarsveld etal in press)
n=223 Convenience Sample
bull Factor 1
ndash Visuo and Somatodyspraxia
bull DC CPR SV MAc MFP KIN SPr PvVC SWB GRA
bull Factor 2
ndash Bilateral Integration and Sequencing
bull SPr BMC Opr SWB with lower loadings on PPr PrVC
bull Factor 3
ndash Tactile and Visual Discrimination
bull FI MFP LTS with moderate loadings on PrVC OPr
26 (c) 2014 Susanne Smith
Roley OTD
SIPT Factor Analysis in South African Sample (Van Jaarsveld etal in press)
27 (c) 2014 Susanne Smith
Roley OTD Figure 1 Loadings on three factors of final analysis
Lane AE etal (2010)
Sensory Profile Cluster Analysis 3 patterns of ASD sensory processing
Sensory-based inattentive seeking
under-responsive (milder)
Sensory modulation with movement sensitivity low energyweak poor endurance
Sensory modulation with tastesmell sensitivity
under and over-responsiveness with no movement issues more communication difficulties and maladaptive behaviors
Sensory subtypes predicted communication competence
and maladaptive behavior
Comprehensive Observation of Proprioception (COP) Factor Analyses
bull F1 Tone and Joint Alignment
ndash Joint hypermobility decreased tone poor joint alignment
bull F2 Behavioral Manifestations
ndash Pushing overactive crashing falling running
ndash Correlates with SPM bumping and pushing
bull F3 Postural Motor
ndash Decreased PC tendency to lean inefficient grading force inadequate weight bearing inefficient ankle strategies
ndash Correlates with SPM body awareness and SWB
bull F4 Motor Planning
ndash Decreased feedback planning decreased feedforward planning overly passive
ndash No correlation with SPM body awareness weak correlation with KIN and SWB
Blanche Bodison Chang amp Reinoso (2012)
29
(c) 2014 Susanne Smith Roley
OTD
Refining Assessment of Sensory Integrative Functions
Smith Roley 2014
Visual-Praxis
Vestibular Bilateral Integration
Proprioception Tactile
Somato- dyspraxia
Sensory Reactivity
(Modulation)
Visual motor
Postural
control
Gross
motor
skills
Praxis Arousal
Affect
Activity Level
Attention
Visual construction
Bilateral coordination
Sequencing
Fine motor skills
Auditory -Language
Organization of behavior
StateSelf Regulation
Smith Roley 2013
SENSORY INTEGRATION INTERVENTION
Intervention Planning Promoting neuroplasticity health and development
Smith Roley 2014
Implications for OTSI Intervention
Consistent with Neuroplasticity Literature
ndash Sensorimotor opportunities
ndash Control over activity
ndash Novelty
ndash Challenge
ndash Playful environment
ndash Lifelike context
Smith Roley 2014
Sensory Integration and Play
bull When the therapist is doing her job effectively and the child is organizing his nervous system it looks as if the child is merely playing rdquo ndash Ayres 1979
Smith Roley 2013
Ayres Sensory Integrationreg Intervention Fidelity Measure
Parham et al 2007 2011 2013-in press
ASIFM Structural elements ndash Part I Therapist Qualifications
ndash Part II Safe Environment
ndash Part III Record Review
ndash Part IV Space and Equipment
ndash Part V Communication with Parents amp Teachers
Smith Roley 2013
ASIFM Process Elements (Parham et al 2011)
1 Physical safety 2 Sensory opportunities
(vestibular tactile and proprioceptive)
3 Supports sensory modulation to attainmaintain a regulated state
4 Supports postural ocular oral or bilateral motor coordination
5 Challenges praxis and organization of behavior
6 Collaborative activity choice
7 Just Right Challenge
8 Ensures Success
9 Supports motivation to play
10 Establishes therapeutic alliance
Smith Roley 2013
Data-driven Intervention Process (Schaaf 2001 Schaaf amp Blanche 2012)
Participation challenges
Current behavior
Theoretical
Framework
Assessments
37
Hypotheses Interventions Outcomes
(c) 2014 Susanne Smith Roley
OTD
Grounds for Optimism
Four Common Misconceptions
in the Anti-SI Intervention Literature Clark 2012
1) Reviews critical of sensory integration
intervention research ignores issues of fidelity
and dosage
Smith Roley 2014
2) Reviewers ignore or minimize the available
positive evidence for SI intervention
bull 3 RCTrsquos with autism demonstrated positive results
following multisensory interventions (including SI
intervention) (Fazlioglu amp Baran 2008 Pfeiffer
Koenig Kinnealey Sheppard amp Henderson 2011
Smith Press Koenig amp Kinnealey 2005)
bull ldquoBased on the application of meta-analytic techniques
for cumulating probability values it is not hard to
conclude that sensory treatments have positive effects
when administered to children with ASDsrdquo Clark
2012
Smith Roley 2014
3) The lack of positive outcomes from SI Intervention may be due
to weak or poorly designed studies
bull Current studies suggest that with stronger and more
studies there will be consistent beneficial effects for
certain outcomes
bull ldquoThe challenge is to make these studies happenrdquo
Clark 2012
Smith Roley 2013
4) Critics often forget that a lack of solid evidence characterizes
nearly all interventions for children with ASDs
bull SI intervention is often held to a different standard
than other types of intervention failing to apply the
same criterion to alternate interventions
Clark 2012
Smith Roley 2014
Remaining Mysteries
Smith Roley 2013
Implications for Advocacy
People need breaks such as recess
People require sensorimotor and social play timespacevalue in the daily routine
Smith Roley 2014
Implications for Research on OT using Sensory Integration
Enhancing Neuroplasticity via Therapeutic Design
bull Dosage - Intensity of increased access in short time periods rather than small access over longer times
bull Engagement via play and not just exposure
bull Role of therapist in providing customized sensorimotor challenges
bull Access to safe dynamic and therapeutic environments vs predictable and static environments
bull The difference between practice for skill development and adaptation to challenges in changing environments
Smith Roley 2014
Implications for Sensory Integration in Practice
Most importantly the success of Sensory Integration in practice depends on
YOU
Smith Roley 2014
Thank You
bull Organizers and Participants
bull hyvaumlauml paumlivaumlnjatkoa
bull Enjoy the conference
Smith Roley 2013
bull Ayres AJ (2005) Sensory Integration and the Child Los Angeles CA Western Psychological Services bull Armstrong T (2006) The best schools How human development research should inform educational practice Alexandria
VA Association for Supervision and Curriculum Development bull Blanche E I Bodison S Chang M C amp Reinoso G (2012) Development of the comprehensive observations of
proprioception (COP) Validity reliability and factor analysis American Journal of Occupational Therapy 66 691ndash698 bull Bundy A amp Lane S (In press) Sensory integration theory and practice Third Ed Philsadelphia PA FA Davis Inc bull Casey T amp MacIntyre S (2007) Childrenrsquos need for time and space In T Casey (Ed) Environments for outdoor play A
practical guide to making space for children (pp 5 ndash 16) London Sage Publications httpwwwsagepubcomupm-data15553_CASEY_C01PDF
bull Gray P (2013) Play as preparation for learning and life American Journal of Play 5(3) 271 - 292 bull Greenough WR Black JE Wallace CS (1987) Experience and brain development Child Development 58(3)539-59 bull Lane AE Young RL Baker AEZ amp Angley MT (2010) Sensory processing subtypes in autism Association with adaptive behavior
Journal of Autism and Developmental Disorders 40 112-122
bull Lane SJ Schaaf RC (2010) Examining the neuroscience evidence for sensory-driven neuroplasticity implications for sensory-based occupational therapy for children and adolescents American Journal of Occupational Therapy 64(3)375-90
bull Mailloux Z Mulligan S Smith Roley S Cermak S Blanche E amp Bodison S Coleman G amp Lane C (2011) Verification and clarification of patterns of sensory integrative dysfunction in a retrospective clinical sample American Journal of Occupational Therapy 652 143-151
bull May A (2011) Experience-dependent structural plasticity in the adult human brain 1-8 Trends in Cognitive Sciences bull May-Benson TA Smith Roley S Mailloux Z Parham LD Koomar J Schaaf RC Van Jaarsveld AM amp Cohn E (in
press) Structural Elements of the Ayres Sensory Integrationreg Intervention Fidelity Measurecopy American Journal of Occupational Therapy
bull Milteer RM Ginsburg KR amp Council on Communications and Media Committee on Psychosocial Aspects of Child and Family Health (2011) Pediatrics e204-e213 DOI 101542peds2011-2953
bull Parham LD Cohn ES Spitzer S Koomar J Miller LJ Burke JP Brett-Green B Mailloux Z May-Benson T Smith Roley S Schaaf RC Schoen S amp Summers CA (2007) Fidelity in sensory integration intervention research American Journal of Occupational Therapy 61 2 216-227
bull Parham LD Smith Roley S May-Benson T Koomar J Brett-Green B Burke JP Cohn ES Mailloux Z Miller LJ amp Schaaf RC (2011) Development of a fidelity measure for research on effectiveness of Ayres Sensory Integrationreg intervention American Journal of Occupational Therapy 65 2 133-142
bull Reynolds S Lane SJ amp Richards L (2010) Using animal models of enriched environments to inform research on sensory integration intervention for the rehabilitation of neurodevelopmental disorders Journal of Neurodevelopmental Disorders 2( 3) 120-132 online first DOI 101007s11689-010-9053-4
bull Roley SS Mailloux Z Parham D Schaaf R Blanche E amp Lane CA Cermak S (in press) Sensory Integration and Praxis Patterns in Children with Autism American Journal of Occupational Therapy
bull Rosenzweig MR Bennet EL and Diamond MC (1972) Brain Changes in response to experience Scientific American 226(2) 22-29
bull Van Jaarsveld A Mailloux Z Smith Roley S amp Raubenheimer J (in press) Patterns of the sensory integration dysfunctions in South African children South African Journal of Occupational Therapy
bull Wills S Cabanlit M Bennett J Ashwood P Amaral DG amp Van de Water J (2009) Detection of autoantibodies to neural cells of the cerebellum in the plasma of subjects with autism spectrum disorders Brain Behavior and Immunity 23(1) 64-74
Danielle Marshall spokesperson for KaBOOM a nonprofit org httpusatoday30usatodaycomnewshealthwellnessstory201108Advocates-Importance-of-play-time-for-children-neglected500718781 retrieved 82613
Changing Values re Play
bull ldquoSince the 1970s kids have lost an average nine hours of free playtime a week
bull and when given recreational activities they are likely to be adult-led and adult-supervisedrdquo
Smith Roley 2014
Neuroplasticity
bull ldquoNovel experience bull altered afferent input due to
environmental changes bull and learning new skills bull are now recognized as
modulators of brain function and underlying neuroanatomic circuitryrdquo
May A 2011 p1
Smith Roley 2013
Greenough Black amp Wallace 1987
ldquoExperience can influence
the developing and mature brainrdquo
bull Experience-independent ndash genetic unfolding
bull Experience-expectant ndash neural structuresfunctions ready during critical periods ndash Experience-dependent ndash enrichment
bull unique to the individual
bull incorporation of idiosyncratic environmental information
bull Involves active formation of new synaptic connections in response to the events
Smith Roley 2013
Animal Studies on Enriched Environments Rosenzweig Bennett amp Diamond (1972)
(summary in Reynolds Lane amp Richards 2010)
Changes to standard cage conditions provide enhanced sensory motor cognitive and potentially social opportunities
Experience dependent results from active interaction between animal amp environment Increase in dendritic branching amp
synaptogenesis Neurogenesis in hippocampus amp amygdala Gliogenesis
Smith Roley 2013
Predicting Outcomes
Neuroplasticity studies suggest outcomes of Sensory Integrative approach may be
Decreased anxiety Decreased hypersensitivity Normalization of stress response Increased social participation Reduced stereotyped behaviors Better learning amp memory
Smith Roley 2013
What are the active ingredients of change
bull Motor activity bull Sensory input bull Social interactionplay bull MOST LIKELY a
combination ndash sensory motor amp
cognitive stimulation ndash environmental novelty ndash opportunities for
engagement in challenging tasks
Smith Roley 2014
Implications for Sensory Integration in Practice
However
OTSI has an
additional active ingredient
YOU
Smith Roley 2014
bull Model of Sensory Integration bull Theory of Sensory Integration
Assessments bull Sensory Integration amp Praxis Tests bull Sensory History
Questionnaires bull Clinical Observations
bull Interpretation bull Intervention bull Outcomes Research
Scholarship ~ Mentorship
Sensory Integrative Processes
The senses Integration of their inputs End products
Auditory (hearing)
First level Second level Third level Fourth level
Vestibular
(gravity amp movement)
Proprioceptive
(muscles amp joints)
Tactile (touch)
Visual (seeing)
Speech
Language
eye movements
Posture
Balance
Muscle tone
Gravitational security
Sucking
Eating
Mother-infant bond
Tactile comfort
Body perception
Coordination of two
sides of the body
Motor planning
Activity level
Attention span
Emotional stability
Eye-hand
coordination
Visual perception
Purposeful activity
Ability to concentrate
Ability to organise
Self-esteem
Self-control
Self-confidence
Academic learning ability
Capacity for abstract
thought and reasoning
Specialization of each side
of the body and the brain
Published by WPSreg 1979 2005 (c) 2014 Smith Roley Singer amp Roley
Theory Updates
Example Symplexity Alain Berthoz (2012)
ldquoA very young baby can mimic the facial expressions of its parents even though it cannot
see its own face which would seem to suggest the existence of innate mechanism of intermodal
encoding and transfer between what is perceived and what is producedhellip
This embodiment of perception is a
fundamental mechanism of simplexityrdquo
Smith Roley 2013
Assessment Updates
Sensory Integration Patterns (Ayres 1965-1989)
bull Tactile amp motor planning deficits (1965 1966 1969 1972 1977 amp 1989)
bull Visual perceptionvisual praxis deficits (1965 1966 1969 1972 1977 amp 1989)
bull Vestibular postural amp bilateral deficits (1965 1966 1969 1972 1977 amp 1989)
bull Tactile defensiveness amp hyperactivitydistractibility (1965 1966 1969 1972)
bull Other factors (auditory language somatosensory perception) seen in some studies
(1969 1972 1977 1989)
Verification and Clarification of
Sensory Integration Patterns
Mulligan (1998)
Mailloux Mulligan Roley etal (2011)
Van Jaarsveld etal (in press)
Lane (2010)
Blanche etal (2012)
SIPT Factor Analysis
Mulligan 1998
n= 10475
Smith Roley 2014
PPR
PRVC
SV
CPR
MFP II
DC
MFP I
OPR
SWB
PRN
BMC
MAC
GRA
SPR
KIN
LTS
FG
FI
TD
ATTN
Visio amp Somatopraxis
VestibularProp
Bilateral Integration amp
Sequencing
Tactile amp
Visual Discrimination
Tactile Defensiveness
amp Attention
SIPT Factor Analysis
Mailloux etal 2011
n=278
SIPT Factor Analysis in South African Sample (Van Jaarsveld etal in press)
n=223 Convenience Sample
bull Factor 1
ndash Visuo and Somatodyspraxia
bull DC CPR SV MAc MFP KIN SPr PvVC SWB GRA
bull Factor 2
ndash Bilateral Integration and Sequencing
bull SPr BMC Opr SWB with lower loadings on PPr PrVC
bull Factor 3
ndash Tactile and Visual Discrimination
bull FI MFP LTS with moderate loadings on PrVC OPr
26 (c) 2014 Susanne Smith
Roley OTD
SIPT Factor Analysis in South African Sample (Van Jaarsveld etal in press)
27 (c) 2014 Susanne Smith
Roley OTD Figure 1 Loadings on three factors of final analysis
Lane AE etal (2010)
Sensory Profile Cluster Analysis 3 patterns of ASD sensory processing
Sensory-based inattentive seeking
under-responsive (milder)
Sensory modulation with movement sensitivity low energyweak poor endurance
Sensory modulation with tastesmell sensitivity
under and over-responsiveness with no movement issues more communication difficulties and maladaptive behaviors
Sensory subtypes predicted communication competence
and maladaptive behavior
Comprehensive Observation of Proprioception (COP) Factor Analyses
bull F1 Tone and Joint Alignment
ndash Joint hypermobility decreased tone poor joint alignment
bull F2 Behavioral Manifestations
ndash Pushing overactive crashing falling running
ndash Correlates with SPM bumping and pushing
bull F3 Postural Motor
ndash Decreased PC tendency to lean inefficient grading force inadequate weight bearing inefficient ankle strategies
ndash Correlates with SPM body awareness and SWB
bull F4 Motor Planning
ndash Decreased feedback planning decreased feedforward planning overly passive
ndash No correlation with SPM body awareness weak correlation with KIN and SWB
Blanche Bodison Chang amp Reinoso (2012)
29
(c) 2014 Susanne Smith Roley
OTD
Refining Assessment of Sensory Integrative Functions
Smith Roley 2014
Visual-Praxis
Vestibular Bilateral Integration
Proprioception Tactile
Somato- dyspraxia
Sensory Reactivity
(Modulation)
Visual motor
Postural
control
Gross
motor
skills
Praxis Arousal
Affect
Activity Level
Attention
Visual construction
Bilateral coordination
Sequencing
Fine motor skills
Auditory -Language
Organization of behavior
StateSelf Regulation
Smith Roley 2013
SENSORY INTEGRATION INTERVENTION
Intervention Planning Promoting neuroplasticity health and development
Smith Roley 2014
Implications for OTSI Intervention
Consistent with Neuroplasticity Literature
ndash Sensorimotor opportunities
ndash Control over activity
ndash Novelty
ndash Challenge
ndash Playful environment
ndash Lifelike context
Smith Roley 2014
Sensory Integration and Play
bull When the therapist is doing her job effectively and the child is organizing his nervous system it looks as if the child is merely playing rdquo ndash Ayres 1979
Smith Roley 2013
Ayres Sensory Integrationreg Intervention Fidelity Measure
Parham et al 2007 2011 2013-in press
ASIFM Structural elements ndash Part I Therapist Qualifications
ndash Part II Safe Environment
ndash Part III Record Review
ndash Part IV Space and Equipment
ndash Part V Communication with Parents amp Teachers
Smith Roley 2013
ASIFM Process Elements (Parham et al 2011)
1 Physical safety 2 Sensory opportunities
(vestibular tactile and proprioceptive)
3 Supports sensory modulation to attainmaintain a regulated state
4 Supports postural ocular oral or bilateral motor coordination
5 Challenges praxis and organization of behavior
6 Collaborative activity choice
7 Just Right Challenge
8 Ensures Success
9 Supports motivation to play
10 Establishes therapeutic alliance
Smith Roley 2013
Data-driven Intervention Process (Schaaf 2001 Schaaf amp Blanche 2012)
Participation challenges
Current behavior
Theoretical
Framework
Assessments
37
Hypotheses Interventions Outcomes
(c) 2014 Susanne Smith Roley
OTD
Grounds for Optimism
Four Common Misconceptions
in the Anti-SI Intervention Literature Clark 2012
1) Reviews critical of sensory integration
intervention research ignores issues of fidelity
and dosage
Smith Roley 2014
2) Reviewers ignore or minimize the available
positive evidence for SI intervention
bull 3 RCTrsquos with autism demonstrated positive results
following multisensory interventions (including SI
intervention) (Fazlioglu amp Baran 2008 Pfeiffer
Koenig Kinnealey Sheppard amp Henderson 2011
Smith Press Koenig amp Kinnealey 2005)
bull ldquoBased on the application of meta-analytic techniques
for cumulating probability values it is not hard to
conclude that sensory treatments have positive effects
when administered to children with ASDsrdquo Clark
2012
Smith Roley 2014
3) The lack of positive outcomes from SI Intervention may be due
to weak or poorly designed studies
bull Current studies suggest that with stronger and more
studies there will be consistent beneficial effects for
certain outcomes
bull ldquoThe challenge is to make these studies happenrdquo
Clark 2012
Smith Roley 2013
4) Critics often forget that a lack of solid evidence characterizes
nearly all interventions for children with ASDs
bull SI intervention is often held to a different standard
than other types of intervention failing to apply the
same criterion to alternate interventions
Clark 2012
Smith Roley 2014
Remaining Mysteries
Smith Roley 2013
Implications for Advocacy
People need breaks such as recess
People require sensorimotor and social play timespacevalue in the daily routine
Smith Roley 2014
Implications for Research on OT using Sensory Integration
Enhancing Neuroplasticity via Therapeutic Design
bull Dosage - Intensity of increased access in short time periods rather than small access over longer times
bull Engagement via play and not just exposure
bull Role of therapist in providing customized sensorimotor challenges
bull Access to safe dynamic and therapeutic environments vs predictable and static environments
bull The difference between practice for skill development and adaptation to challenges in changing environments
Smith Roley 2014
Implications for Sensory Integration in Practice
Most importantly the success of Sensory Integration in practice depends on
YOU
Smith Roley 2014
Thank You
bull Organizers and Participants
bull hyvaumlauml paumlivaumlnjatkoa
bull Enjoy the conference
Smith Roley 2013
bull Ayres AJ (2005) Sensory Integration and the Child Los Angeles CA Western Psychological Services bull Armstrong T (2006) The best schools How human development research should inform educational practice Alexandria
VA Association for Supervision and Curriculum Development bull Blanche E I Bodison S Chang M C amp Reinoso G (2012) Development of the comprehensive observations of
proprioception (COP) Validity reliability and factor analysis American Journal of Occupational Therapy 66 691ndash698 bull Bundy A amp Lane S (In press) Sensory integration theory and practice Third Ed Philsadelphia PA FA Davis Inc bull Casey T amp MacIntyre S (2007) Childrenrsquos need for time and space In T Casey (Ed) Environments for outdoor play A
practical guide to making space for children (pp 5 ndash 16) London Sage Publications httpwwwsagepubcomupm-data15553_CASEY_C01PDF
bull Gray P (2013) Play as preparation for learning and life American Journal of Play 5(3) 271 - 292 bull Greenough WR Black JE Wallace CS (1987) Experience and brain development Child Development 58(3)539-59 bull Lane AE Young RL Baker AEZ amp Angley MT (2010) Sensory processing subtypes in autism Association with adaptive behavior
Journal of Autism and Developmental Disorders 40 112-122
bull Lane SJ Schaaf RC (2010) Examining the neuroscience evidence for sensory-driven neuroplasticity implications for sensory-based occupational therapy for children and adolescents American Journal of Occupational Therapy 64(3)375-90
bull Mailloux Z Mulligan S Smith Roley S Cermak S Blanche E amp Bodison S Coleman G amp Lane C (2011) Verification and clarification of patterns of sensory integrative dysfunction in a retrospective clinical sample American Journal of Occupational Therapy 652 143-151
bull May A (2011) Experience-dependent structural plasticity in the adult human brain 1-8 Trends in Cognitive Sciences bull May-Benson TA Smith Roley S Mailloux Z Parham LD Koomar J Schaaf RC Van Jaarsveld AM amp Cohn E (in
press) Structural Elements of the Ayres Sensory Integrationreg Intervention Fidelity Measurecopy American Journal of Occupational Therapy
bull Milteer RM Ginsburg KR amp Council on Communications and Media Committee on Psychosocial Aspects of Child and Family Health (2011) Pediatrics e204-e213 DOI 101542peds2011-2953
bull Parham LD Cohn ES Spitzer S Koomar J Miller LJ Burke JP Brett-Green B Mailloux Z May-Benson T Smith Roley S Schaaf RC Schoen S amp Summers CA (2007) Fidelity in sensory integration intervention research American Journal of Occupational Therapy 61 2 216-227
bull Parham LD Smith Roley S May-Benson T Koomar J Brett-Green B Burke JP Cohn ES Mailloux Z Miller LJ amp Schaaf RC (2011) Development of a fidelity measure for research on effectiveness of Ayres Sensory Integrationreg intervention American Journal of Occupational Therapy 65 2 133-142
bull Reynolds S Lane SJ amp Richards L (2010) Using animal models of enriched environments to inform research on sensory integration intervention for the rehabilitation of neurodevelopmental disorders Journal of Neurodevelopmental Disorders 2( 3) 120-132 online first DOI 101007s11689-010-9053-4
bull Roley SS Mailloux Z Parham D Schaaf R Blanche E amp Lane CA Cermak S (in press) Sensory Integration and Praxis Patterns in Children with Autism American Journal of Occupational Therapy
bull Rosenzweig MR Bennet EL and Diamond MC (1972) Brain Changes in response to experience Scientific American 226(2) 22-29
bull Van Jaarsveld A Mailloux Z Smith Roley S amp Raubenheimer J (in press) Patterns of the sensory integration dysfunctions in South African children South African Journal of Occupational Therapy
bull Wills S Cabanlit M Bennett J Ashwood P Amaral DG amp Van de Water J (2009) Detection of autoantibodies to neural cells of the cerebellum in the plasma of subjects with autism spectrum disorders Brain Behavior and Immunity 23(1) 64-74
Neuroplasticity
bull ldquoNovel experience bull altered afferent input due to
environmental changes bull and learning new skills bull are now recognized as
modulators of brain function and underlying neuroanatomic circuitryrdquo
May A 2011 p1
Smith Roley 2013
Greenough Black amp Wallace 1987
ldquoExperience can influence
the developing and mature brainrdquo
bull Experience-independent ndash genetic unfolding
bull Experience-expectant ndash neural structuresfunctions ready during critical periods ndash Experience-dependent ndash enrichment
bull unique to the individual
bull incorporation of idiosyncratic environmental information
bull Involves active formation of new synaptic connections in response to the events
Smith Roley 2013
Animal Studies on Enriched Environments Rosenzweig Bennett amp Diamond (1972)
(summary in Reynolds Lane amp Richards 2010)
Changes to standard cage conditions provide enhanced sensory motor cognitive and potentially social opportunities
Experience dependent results from active interaction between animal amp environment Increase in dendritic branching amp
synaptogenesis Neurogenesis in hippocampus amp amygdala Gliogenesis
Smith Roley 2013
Predicting Outcomes
Neuroplasticity studies suggest outcomes of Sensory Integrative approach may be
Decreased anxiety Decreased hypersensitivity Normalization of stress response Increased social participation Reduced stereotyped behaviors Better learning amp memory
Smith Roley 2013
What are the active ingredients of change
bull Motor activity bull Sensory input bull Social interactionplay bull MOST LIKELY a
combination ndash sensory motor amp
cognitive stimulation ndash environmental novelty ndash opportunities for
engagement in challenging tasks
Smith Roley 2014
Implications for Sensory Integration in Practice
However
OTSI has an
additional active ingredient
YOU
Smith Roley 2014
bull Model of Sensory Integration bull Theory of Sensory Integration
Assessments bull Sensory Integration amp Praxis Tests bull Sensory History
Questionnaires bull Clinical Observations
bull Interpretation bull Intervention bull Outcomes Research
Scholarship ~ Mentorship
Sensory Integrative Processes
The senses Integration of their inputs End products
Auditory (hearing)
First level Second level Third level Fourth level
Vestibular
(gravity amp movement)
Proprioceptive
(muscles amp joints)
Tactile (touch)
Visual (seeing)
Speech
Language
eye movements
Posture
Balance
Muscle tone
Gravitational security
Sucking
Eating
Mother-infant bond
Tactile comfort
Body perception
Coordination of two
sides of the body
Motor planning
Activity level
Attention span
Emotional stability
Eye-hand
coordination
Visual perception
Purposeful activity
Ability to concentrate
Ability to organise
Self-esteem
Self-control
Self-confidence
Academic learning ability
Capacity for abstract
thought and reasoning
Specialization of each side
of the body and the brain
Published by WPSreg 1979 2005 (c) 2014 Smith Roley Singer amp Roley
Theory Updates
Example Symplexity Alain Berthoz (2012)
ldquoA very young baby can mimic the facial expressions of its parents even though it cannot
see its own face which would seem to suggest the existence of innate mechanism of intermodal
encoding and transfer between what is perceived and what is producedhellip
This embodiment of perception is a
fundamental mechanism of simplexityrdquo
Smith Roley 2013
Assessment Updates
Sensory Integration Patterns (Ayres 1965-1989)
bull Tactile amp motor planning deficits (1965 1966 1969 1972 1977 amp 1989)
bull Visual perceptionvisual praxis deficits (1965 1966 1969 1972 1977 amp 1989)
bull Vestibular postural amp bilateral deficits (1965 1966 1969 1972 1977 amp 1989)
bull Tactile defensiveness amp hyperactivitydistractibility (1965 1966 1969 1972)
bull Other factors (auditory language somatosensory perception) seen in some studies
(1969 1972 1977 1989)
Verification and Clarification of
Sensory Integration Patterns
Mulligan (1998)
Mailloux Mulligan Roley etal (2011)
Van Jaarsveld etal (in press)
Lane (2010)
Blanche etal (2012)
SIPT Factor Analysis
Mulligan 1998
n= 10475
Smith Roley 2014
PPR
PRVC
SV
CPR
MFP II
DC
MFP I
OPR
SWB
PRN
BMC
MAC
GRA
SPR
KIN
LTS
FG
FI
TD
ATTN
Visio amp Somatopraxis
VestibularProp
Bilateral Integration amp
Sequencing
Tactile amp
Visual Discrimination
Tactile Defensiveness
amp Attention
SIPT Factor Analysis
Mailloux etal 2011
n=278
SIPT Factor Analysis in South African Sample (Van Jaarsveld etal in press)
n=223 Convenience Sample
bull Factor 1
ndash Visuo and Somatodyspraxia
bull DC CPR SV MAc MFP KIN SPr PvVC SWB GRA
bull Factor 2
ndash Bilateral Integration and Sequencing
bull SPr BMC Opr SWB with lower loadings on PPr PrVC
bull Factor 3
ndash Tactile and Visual Discrimination
bull FI MFP LTS with moderate loadings on PrVC OPr
26 (c) 2014 Susanne Smith
Roley OTD
SIPT Factor Analysis in South African Sample (Van Jaarsveld etal in press)
27 (c) 2014 Susanne Smith
Roley OTD Figure 1 Loadings on three factors of final analysis
Lane AE etal (2010)
Sensory Profile Cluster Analysis 3 patterns of ASD sensory processing
Sensory-based inattentive seeking
under-responsive (milder)
Sensory modulation with movement sensitivity low energyweak poor endurance
Sensory modulation with tastesmell sensitivity
under and over-responsiveness with no movement issues more communication difficulties and maladaptive behaviors
Sensory subtypes predicted communication competence
and maladaptive behavior
Comprehensive Observation of Proprioception (COP) Factor Analyses
bull F1 Tone and Joint Alignment
ndash Joint hypermobility decreased tone poor joint alignment
bull F2 Behavioral Manifestations
ndash Pushing overactive crashing falling running
ndash Correlates with SPM bumping and pushing
bull F3 Postural Motor
ndash Decreased PC tendency to lean inefficient grading force inadequate weight bearing inefficient ankle strategies
ndash Correlates with SPM body awareness and SWB
bull F4 Motor Planning
ndash Decreased feedback planning decreased feedforward planning overly passive
ndash No correlation with SPM body awareness weak correlation with KIN and SWB
Blanche Bodison Chang amp Reinoso (2012)
29
(c) 2014 Susanne Smith Roley
OTD
Refining Assessment of Sensory Integrative Functions
Smith Roley 2014
Visual-Praxis
Vestibular Bilateral Integration
Proprioception Tactile
Somato- dyspraxia
Sensory Reactivity
(Modulation)
Visual motor
Postural
control
Gross
motor
skills
Praxis Arousal
Affect
Activity Level
Attention
Visual construction
Bilateral coordination
Sequencing
Fine motor skills
Auditory -Language
Organization of behavior
StateSelf Regulation
Smith Roley 2013
SENSORY INTEGRATION INTERVENTION
Intervention Planning Promoting neuroplasticity health and development
Smith Roley 2014
Implications for OTSI Intervention
Consistent with Neuroplasticity Literature
ndash Sensorimotor opportunities
ndash Control over activity
ndash Novelty
ndash Challenge
ndash Playful environment
ndash Lifelike context
Smith Roley 2014
Sensory Integration and Play
bull When the therapist is doing her job effectively and the child is organizing his nervous system it looks as if the child is merely playing rdquo ndash Ayres 1979
Smith Roley 2013
Ayres Sensory Integrationreg Intervention Fidelity Measure
Parham et al 2007 2011 2013-in press
ASIFM Structural elements ndash Part I Therapist Qualifications
ndash Part II Safe Environment
ndash Part III Record Review
ndash Part IV Space and Equipment
ndash Part V Communication with Parents amp Teachers
Smith Roley 2013
ASIFM Process Elements (Parham et al 2011)
1 Physical safety 2 Sensory opportunities
(vestibular tactile and proprioceptive)
3 Supports sensory modulation to attainmaintain a regulated state
4 Supports postural ocular oral or bilateral motor coordination
5 Challenges praxis and organization of behavior
6 Collaborative activity choice
7 Just Right Challenge
8 Ensures Success
9 Supports motivation to play
10 Establishes therapeutic alliance
Smith Roley 2013
Data-driven Intervention Process (Schaaf 2001 Schaaf amp Blanche 2012)
Participation challenges
Current behavior
Theoretical
Framework
Assessments
37
Hypotheses Interventions Outcomes
(c) 2014 Susanne Smith Roley
OTD
Grounds for Optimism
Four Common Misconceptions
in the Anti-SI Intervention Literature Clark 2012
1) Reviews critical of sensory integration
intervention research ignores issues of fidelity
and dosage
Smith Roley 2014
2) Reviewers ignore or minimize the available
positive evidence for SI intervention
bull 3 RCTrsquos with autism demonstrated positive results
following multisensory interventions (including SI
intervention) (Fazlioglu amp Baran 2008 Pfeiffer
Koenig Kinnealey Sheppard amp Henderson 2011
Smith Press Koenig amp Kinnealey 2005)
bull ldquoBased on the application of meta-analytic techniques
for cumulating probability values it is not hard to
conclude that sensory treatments have positive effects
when administered to children with ASDsrdquo Clark
2012
Smith Roley 2014
3) The lack of positive outcomes from SI Intervention may be due
to weak or poorly designed studies
bull Current studies suggest that with stronger and more
studies there will be consistent beneficial effects for
certain outcomes
bull ldquoThe challenge is to make these studies happenrdquo
Clark 2012
Smith Roley 2013
4) Critics often forget that a lack of solid evidence characterizes
nearly all interventions for children with ASDs
bull SI intervention is often held to a different standard
than other types of intervention failing to apply the
same criterion to alternate interventions
Clark 2012
Smith Roley 2014
Remaining Mysteries
Smith Roley 2013
Implications for Advocacy
People need breaks such as recess
People require sensorimotor and social play timespacevalue in the daily routine
Smith Roley 2014
Implications for Research on OT using Sensory Integration
Enhancing Neuroplasticity via Therapeutic Design
bull Dosage - Intensity of increased access in short time periods rather than small access over longer times
bull Engagement via play and not just exposure
bull Role of therapist in providing customized sensorimotor challenges
bull Access to safe dynamic and therapeutic environments vs predictable and static environments
bull The difference between practice for skill development and adaptation to challenges in changing environments
Smith Roley 2014
Implications for Sensory Integration in Practice
Most importantly the success of Sensory Integration in practice depends on
YOU
Smith Roley 2014
Thank You
bull Organizers and Participants
bull hyvaumlauml paumlivaumlnjatkoa
bull Enjoy the conference
Smith Roley 2013
bull Ayres AJ (2005) Sensory Integration and the Child Los Angeles CA Western Psychological Services bull Armstrong T (2006) The best schools How human development research should inform educational practice Alexandria
VA Association for Supervision and Curriculum Development bull Blanche E I Bodison S Chang M C amp Reinoso G (2012) Development of the comprehensive observations of
proprioception (COP) Validity reliability and factor analysis American Journal of Occupational Therapy 66 691ndash698 bull Bundy A amp Lane S (In press) Sensory integration theory and practice Third Ed Philsadelphia PA FA Davis Inc bull Casey T amp MacIntyre S (2007) Childrenrsquos need for time and space In T Casey (Ed) Environments for outdoor play A
practical guide to making space for children (pp 5 ndash 16) London Sage Publications httpwwwsagepubcomupm-data15553_CASEY_C01PDF
bull Gray P (2013) Play as preparation for learning and life American Journal of Play 5(3) 271 - 292 bull Greenough WR Black JE Wallace CS (1987) Experience and brain development Child Development 58(3)539-59 bull Lane AE Young RL Baker AEZ amp Angley MT (2010) Sensory processing subtypes in autism Association with adaptive behavior
Journal of Autism and Developmental Disorders 40 112-122
bull Lane SJ Schaaf RC (2010) Examining the neuroscience evidence for sensory-driven neuroplasticity implications for sensory-based occupational therapy for children and adolescents American Journal of Occupational Therapy 64(3)375-90
bull Mailloux Z Mulligan S Smith Roley S Cermak S Blanche E amp Bodison S Coleman G amp Lane C (2011) Verification and clarification of patterns of sensory integrative dysfunction in a retrospective clinical sample American Journal of Occupational Therapy 652 143-151
bull May A (2011) Experience-dependent structural plasticity in the adult human brain 1-8 Trends in Cognitive Sciences bull May-Benson TA Smith Roley S Mailloux Z Parham LD Koomar J Schaaf RC Van Jaarsveld AM amp Cohn E (in
press) Structural Elements of the Ayres Sensory Integrationreg Intervention Fidelity Measurecopy American Journal of Occupational Therapy
bull Milteer RM Ginsburg KR amp Council on Communications and Media Committee on Psychosocial Aspects of Child and Family Health (2011) Pediatrics e204-e213 DOI 101542peds2011-2953
bull Parham LD Cohn ES Spitzer S Koomar J Miller LJ Burke JP Brett-Green B Mailloux Z May-Benson T Smith Roley S Schaaf RC Schoen S amp Summers CA (2007) Fidelity in sensory integration intervention research American Journal of Occupational Therapy 61 2 216-227
bull Parham LD Smith Roley S May-Benson T Koomar J Brett-Green B Burke JP Cohn ES Mailloux Z Miller LJ amp Schaaf RC (2011) Development of a fidelity measure for research on effectiveness of Ayres Sensory Integrationreg intervention American Journal of Occupational Therapy 65 2 133-142
bull Reynolds S Lane SJ amp Richards L (2010) Using animal models of enriched environments to inform research on sensory integration intervention for the rehabilitation of neurodevelopmental disorders Journal of Neurodevelopmental Disorders 2( 3) 120-132 online first DOI 101007s11689-010-9053-4
bull Roley SS Mailloux Z Parham D Schaaf R Blanche E amp Lane CA Cermak S (in press) Sensory Integration and Praxis Patterns in Children with Autism American Journal of Occupational Therapy
bull Rosenzweig MR Bennet EL and Diamond MC (1972) Brain Changes in response to experience Scientific American 226(2) 22-29
bull Van Jaarsveld A Mailloux Z Smith Roley S amp Raubenheimer J (in press) Patterns of the sensory integration dysfunctions in South African children South African Journal of Occupational Therapy
bull Wills S Cabanlit M Bennett J Ashwood P Amaral DG amp Van de Water J (2009) Detection of autoantibodies to neural cells of the cerebellum in the plasma of subjects with autism spectrum disorders Brain Behavior and Immunity 23(1) 64-74
Greenough Black amp Wallace 1987
ldquoExperience can influence
the developing and mature brainrdquo
bull Experience-independent ndash genetic unfolding
bull Experience-expectant ndash neural structuresfunctions ready during critical periods ndash Experience-dependent ndash enrichment
bull unique to the individual
bull incorporation of idiosyncratic environmental information
bull Involves active formation of new synaptic connections in response to the events
Smith Roley 2013
Animal Studies on Enriched Environments Rosenzweig Bennett amp Diamond (1972)
(summary in Reynolds Lane amp Richards 2010)
Changes to standard cage conditions provide enhanced sensory motor cognitive and potentially social opportunities
Experience dependent results from active interaction between animal amp environment Increase in dendritic branching amp
synaptogenesis Neurogenesis in hippocampus amp amygdala Gliogenesis
Smith Roley 2013
Predicting Outcomes
Neuroplasticity studies suggest outcomes of Sensory Integrative approach may be
Decreased anxiety Decreased hypersensitivity Normalization of stress response Increased social participation Reduced stereotyped behaviors Better learning amp memory
Smith Roley 2013
What are the active ingredients of change
bull Motor activity bull Sensory input bull Social interactionplay bull MOST LIKELY a
combination ndash sensory motor amp
cognitive stimulation ndash environmental novelty ndash opportunities for
engagement in challenging tasks
Smith Roley 2014
Implications for Sensory Integration in Practice
However
OTSI has an
additional active ingredient
YOU
Smith Roley 2014
bull Model of Sensory Integration bull Theory of Sensory Integration
Assessments bull Sensory Integration amp Praxis Tests bull Sensory History
Questionnaires bull Clinical Observations
bull Interpretation bull Intervention bull Outcomes Research
Scholarship ~ Mentorship
Sensory Integrative Processes
The senses Integration of their inputs End products
Auditory (hearing)
First level Second level Third level Fourth level
Vestibular
(gravity amp movement)
Proprioceptive
(muscles amp joints)
Tactile (touch)
Visual (seeing)
Speech
Language
eye movements
Posture
Balance
Muscle tone
Gravitational security
Sucking
Eating
Mother-infant bond
Tactile comfort
Body perception
Coordination of two
sides of the body
Motor planning
Activity level
Attention span
Emotional stability
Eye-hand
coordination
Visual perception
Purposeful activity
Ability to concentrate
Ability to organise
Self-esteem
Self-control
Self-confidence
Academic learning ability
Capacity for abstract
thought and reasoning
Specialization of each side
of the body and the brain
Published by WPSreg 1979 2005 (c) 2014 Smith Roley Singer amp Roley
Theory Updates
Example Symplexity Alain Berthoz (2012)
ldquoA very young baby can mimic the facial expressions of its parents even though it cannot
see its own face which would seem to suggest the existence of innate mechanism of intermodal
encoding and transfer between what is perceived and what is producedhellip
This embodiment of perception is a
fundamental mechanism of simplexityrdquo
Smith Roley 2013
Assessment Updates
Sensory Integration Patterns (Ayres 1965-1989)
bull Tactile amp motor planning deficits (1965 1966 1969 1972 1977 amp 1989)
bull Visual perceptionvisual praxis deficits (1965 1966 1969 1972 1977 amp 1989)
bull Vestibular postural amp bilateral deficits (1965 1966 1969 1972 1977 amp 1989)
bull Tactile defensiveness amp hyperactivitydistractibility (1965 1966 1969 1972)
bull Other factors (auditory language somatosensory perception) seen in some studies
(1969 1972 1977 1989)
Verification and Clarification of
Sensory Integration Patterns
Mulligan (1998)
Mailloux Mulligan Roley etal (2011)
Van Jaarsveld etal (in press)
Lane (2010)
Blanche etal (2012)
SIPT Factor Analysis
Mulligan 1998
n= 10475
Smith Roley 2014
PPR
PRVC
SV
CPR
MFP II
DC
MFP I
OPR
SWB
PRN
BMC
MAC
GRA
SPR
KIN
LTS
FG
FI
TD
ATTN
Visio amp Somatopraxis
VestibularProp
Bilateral Integration amp
Sequencing
Tactile amp
Visual Discrimination
Tactile Defensiveness
amp Attention
SIPT Factor Analysis
Mailloux etal 2011
n=278
SIPT Factor Analysis in South African Sample (Van Jaarsveld etal in press)
n=223 Convenience Sample
bull Factor 1
ndash Visuo and Somatodyspraxia
bull DC CPR SV MAc MFP KIN SPr PvVC SWB GRA
bull Factor 2
ndash Bilateral Integration and Sequencing
bull SPr BMC Opr SWB with lower loadings on PPr PrVC
bull Factor 3
ndash Tactile and Visual Discrimination
bull FI MFP LTS with moderate loadings on PrVC OPr
26 (c) 2014 Susanne Smith
Roley OTD
SIPT Factor Analysis in South African Sample (Van Jaarsveld etal in press)
27 (c) 2014 Susanne Smith
Roley OTD Figure 1 Loadings on three factors of final analysis
Lane AE etal (2010)
Sensory Profile Cluster Analysis 3 patterns of ASD sensory processing
Sensory-based inattentive seeking
under-responsive (milder)
Sensory modulation with movement sensitivity low energyweak poor endurance
Sensory modulation with tastesmell sensitivity
under and over-responsiveness with no movement issues more communication difficulties and maladaptive behaviors
Sensory subtypes predicted communication competence
and maladaptive behavior
Comprehensive Observation of Proprioception (COP) Factor Analyses
bull F1 Tone and Joint Alignment
ndash Joint hypermobility decreased tone poor joint alignment
bull F2 Behavioral Manifestations
ndash Pushing overactive crashing falling running
ndash Correlates with SPM bumping and pushing
bull F3 Postural Motor
ndash Decreased PC tendency to lean inefficient grading force inadequate weight bearing inefficient ankle strategies
ndash Correlates with SPM body awareness and SWB
bull F4 Motor Planning
ndash Decreased feedback planning decreased feedforward planning overly passive
ndash No correlation with SPM body awareness weak correlation with KIN and SWB
Blanche Bodison Chang amp Reinoso (2012)
29
(c) 2014 Susanne Smith Roley
OTD
Refining Assessment of Sensory Integrative Functions
Smith Roley 2014
Visual-Praxis
Vestibular Bilateral Integration
Proprioception Tactile
Somato- dyspraxia
Sensory Reactivity
(Modulation)
Visual motor
Postural
control
Gross
motor
skills
Praxis Arousal
Affect
Activity Level
Attention
Visual construction
Bilateral coordination
Sequencing
Fine motor skills
Auditory -Language
Organization of behavior
StateSelf Regulation
Smith Roley 2013
SENSORY INTEGRATION INTERVENTION
Intervention Planning Promoting neuroplasticity health and development
Smith Roley 2014
Implications for OTSI Intervention
Consistent with Neuroplasticity Literature
ndash Sensorimotor opportunities
ndash Control over activity
ndash Novelty
ndash Challenge
ndash Playful environment
ndash Lifelike context
Smith Roley 2014
Sensory Integration and Play
bull When the therapist is doing her job effectively and the child is organizing his nervous system it looks as if the child is merely playing rdquo ndash Ayres 1979
Smith Roley 2013
Ayres Sensory Integrationreg Intervention Fidelity Measure
Parham et al 2007 2011 2013-in press
ASIFM Structural elements ndash Part I Therapist Qualifications
ndash Part II Safe Environment
ndash Part III Record Review
ndash Part IV Space and Equipment
ndash Part V Communication with Parents amp Teachers
Smith Roley 2013
ASIFM Process Elements (Parham et al 2011)
1 Physical safety 2 Sensory opportunities
(vestibular tactile and proprioceptive)
3 Supports sensory modulation to attainmaintain a regulated state
4 Supports postural ocular oral or bilateral motor coordination
5 Challenges praxis and organization of behavior
6 Collaborative activity choice
7 Just Right Challenge
8 Ensures Success
9 Supports motivation to play
10 Establishes therapeutic alliance
Smith Roley 2013
Data-driven Intervention Process (Schaaf 2001 Schaaf amp Blanche 2012)
Participation challenges
Current behavior
Theoretical
Framework
Assessments
37
Hypotheses Interventions Outcomes
(c) 2014 Susanne Smith Roley
OTD
Grounds for Optimism
Four Common Misconceptions
in the Anti-SI Intervention Literature Clark 2012
1) Reviews critical of sensory integration
intervention research ignores issues of fidelity
and dosage
Smith Roley 2014
2) Reviewers ignore or minimize the available
positive evidence for SI intervention
bull 3 RCTrsquos with autism demonstrated positive results
following multisensory interventions (including SI
intervention) (Fazlioglu amp Baran 2008 Pfeiffer
Koenig Kinnealey Sheppard amp Henderson 2011
Smith Press Koenig amp Kinnealey 2005)
bull ldquoBased on the application of meta-analytic techniques
for cumulating probability values it is not hard to
conclude that sensory treatments have positive effects
when administered to children with ASDsrdquo Clark
2012
Smith Roley 2014
3) The lack of positive outcomes from SI Intervention may be due
to weak or poorly designed studies
bull Current studies suggest that with stronger and more
studies there will be consistent beneficial effects for
certain outcomes
bull ldquoThe challenge is to make these studies happenrdquo
Clark 2012
Smith Roley 2013
4) Critics often forget that a lack of solid evidence characterizes
nearly all interventions for children with ASDs
bull SI intervention is often held to a different standard
than other types of intervention failing to apply the
same criterion to alternate interventions
Clark 2012
Smith Roley 2014
Remaining Mysteries
Smith Roley 2013
Implications for Advocacy
People need breaks such as recess
People require sensorimotor and social play timespacevalue in the daily routine
Smith Roley 2014
Implications for Research on OT using Sensory Integration
Enhancing Neuroplasticity via Therapeutic Design
bull Dosage - Intensity of increased access in short time periods rather than small access over longer times
bull Engagement via play and not just exposure
bull Role of therapist in providing customized sensorimotor challenges
bull Access to safe dynamic and therapeutic environments vs predictable and static environments
bull The difference between practice for skill development and adaptation to challenges in changing environments
Smith Roley 2014
Implications for Sensory Integration in Practice
Most importantly the success of Sensory Integration in practice depends on
YOU
Smith Roley 2014
Thank You
bull Organizers and Participants
bull hyvaumlauml paumlivaumlnjatkoa
bull Enjoy the conference
Smith Roley 2013
bull Ayres AJ (2005) Sensory Integration and the Child Los Angeles CA Western Psychological Services bull Armstrong T (2006) The best schools How human development research should inform educational practice Alexandria
VA Association for Supervision and Curriculum Development bull Blanche E I Bodison S Chang M C amp Reinoso G (2012) Development of the comprehensive observations of
proprioception (COP) Validity reliability and factor analysis American Journal of Occupational Therapy 66 691ndash698 bull Bundy A amp Lane S (In press) Sensory integration theory and practice Third Ed Philsadelphia PA FA Davis Inc bull Casey T amp MacIntyre S (2007) Childrenrsquos need for time and space In T Casey (Ed) Environments for outdoor play A
practical guide to making space for children (pp 5 ndash 16) London Sage Publications httpwwwsagepubcomupm-data15553_CASEY_C01PDF
bull Gray P (2013) Play as preparation for learning and life American Journal of Play 5(3) 271 - 292 bull Greenough WR Black JE Wallace CS (1987) Experience and brain development Child Development 58(3)539-59 bull Lane AE Young RL Baker AEZ amp Angley MT (2010) Sensory processing subtypes in autism Association with adaptive behavior
Journal of Autism and Developmental Disorders 40 112-122
bull Lane SJ Schaaf RC (2010) Examining the neuroscience evidence for sensory-driven neuroplasticity implications for sensory-based occupational therapy for children and adolescents American Journal of Occupational Therapy 64(3)375-90
bull Mailloux Z Mulligan S Smith Roley S Cermak S Blanche E amp Bodison S Coleman G amp Lane C (2011) Verification and clarification of patterns of sensory integrative dysfunction in a retrospective clinical sample American Journal of Occupational Therapy 652 143-151
bull May A (2011) Experience-dependent structural plasticity in the adult human brain 1-8 Trends in Cognitive Sciences bull May-Benson TA Smith Roley S Mailloux Z Parham LD Koomar J Schaaf RC Van Jaarsveld AM amp Cohn E (in
press) Structural Elements of the Ayres Sensory Integrationreg Intervention Fidelity Measurecopy American Journal of Occupational Therapy
bull Milteer RM Ginsburg KR amp Council on Communications and Media Committee on Psychosocial Aspects of Child and Family Health (2011) Pediatrics e204-e213 DOI 101542peds2011-2953
bull Parham LD Cohn ES Spitzer S Koomar J Miller LJ Burke JP Brett-Green B Mailloux Z May-Benson T Smith Roley S Schaaf RC Schoen S amp Summers CA (2007) Fidelity in sensory integration intervention research American Journal of Occupational Therapy 61 2 216-227
bull Parham LD Smith Roley S May-Benson T Koomar J Brett-Green B Burke JP Cohn ES Mailloux Z Miller LJ amp Schaaf RC (2011) Development of a fidelity measure for research on effectiveness of Ayres Sensory Integrationreg intervention American Journal of Occupational Therapy 65 2 133-142
bull Reynolds S Lane SJ amp Richards L (2010) Using animal models of enriched environments to inform research on sensory integration intervention for the rehabilitation of neurodevelopmental disorders Journal of Neurodevelopmental Disorders 2( 3) 120-132 online first DOI 101007s11689-010-9053-4
bull Roley SS Mailloux Z Parham D Schaaf R Blanche E amp Lane CA Cermak S (in press) Sensory Integration and Praxis Patterns in Children with Autism American Journal of Occupational Therapy
bull Rosenzweig MR Bennet EL and Diamond MC (1972) Brain Changes in response to experience Scientific American 226(2) 22-29
bull Van Jaarsveld A Mailloux Z Smith Roley S amp Raubenheimer J (in press) Patterns of the sensory integration dysfunctions in South African children South African Journal of Occupational Therapy
bull Wills S Cabanlit M Bennett J Ashwood P Amaral DG amp Van de Water J (2009) Detection of autoantibodies to neural cells of the cerebellum in the plasma of subjects with autism spectrum disorders Brain Behavior and Immunity 23(1) 64-74
Animal Studies on Enriched Environments Rosenzweig Bennett amp Diamond (1972)
(summary in Reynolds Lane amp Richards 2010)
Changes to standard cage conditions provide enhanced sensory motor cognitive and potentially social opportunities
Experience dependent results from active interaction between animal amp environment Increase in dendritic branching amp
synaptogenesis Neurogenesis in hippocampus amp amygdala Gliogenesis
Smith Roley 2013
Predicting Outcomes
Neuroplasticity studies suggest outcomes of Sensory Integrative approach may be
Decreased anxiety Decreased hypersensitivity Normalization of stress response Increased social participation Reduced stereotyped behaviors Better learning amp memory
Smith Roley 2013
What are the active ingredients of change
bull Motor activity bull Sensory input bull Social interactionplay bull MOST LIKELY a
combination ndash sensory motor amp
cognitive stimulation ndash environmental novelty ndash opportunities for
engagement in challenging tasks
Smith Roley 2014
Implications for Sensory Integration in Practice
However
OTSI has an
additional active ingredient
YOU
Smith Roley 2014
bull Model of Sensory Integration bull Theory of Sensory Integration
Assessments bull Sensory Integration amp Praxis Tests bull Sensory History
Questionnaires bull Clinical Observations
bull Interpretation bull Intervention bull Outcomes Research
Scholarship ~ Mentorship
Sensory Integrative Processes
The senses Integration of their inputs End products
Auditory (hearing)
First level Second level Third level Fourth level
Vestibular
(gravity amp movement)
Proprioceptive
(muscles amp joints)
Tactile (touch)
Visual (seeing)
Speech
Language
eye movements
Posture
Balance
Muscle tone
Gravitational security
Sucking
Eating
Mother-infant bond
Tactile comfort
Body perception
Coordination of two
sides of the body
Motor planning
Activity level
Attention span
Emotional stability
Eye-hand
coordination
Visual perception
Purposeful activity
Ability to concentrate
Ability to organise
Self-esteem
Self-control
Self-confidence
Academic learning ability
Capacity for abstract
thought and reasoning
Specialization of each side
of the body and the brain
Published by WPSreg 1979 2005 (c) 2014 Smith Roley Singer amp Roley
Theory Updates
Example Symplexity Alain Berthoz (2012)
ldquoA very young baby can mimic the facial expressions of its parents even though it cannot
see its own face which would seem to suggest the existence of innate mechanism of intermodal
encoding and transfer between what is perceived and what is producedhellip
This embodiment of perception is a
fundamental mechanism of simplexityrdquo
Smith Roley 2013
Assessment Updates
Sensory Integration Patterns (Ayres 1965-1989)
bull Tactile amp motor planning deficits (1965 1966 1969 1972 1977 amp 1989)
bull Visual perceptionvisual praxis deficits (1965 1966 1969 1972 1977 amp 1989)
bull Vestibular postural amp bilateral deficits (1965 1966 1969 1972 1977 amp 1989)
bull Tactile defensiveness amp hyperactivitydistractibility (1965 1966 1969 1972)
bull Other factors (auditory language somatosensory perception) seen in some studies
(1969 1972 1977 1989)
Verification and Clarification of
Sensory Integration Patterns
Mulligan (1998)
Mailloux Mulligan Roley etal (2011)
Van Jaarsveld etal (in press)
Lane (2010)
Blanche etal (2012)
SIPT Factor Analysis
Mulligan 1998
n= 10475
Smith Roley 2014
PPR
PRVC
SV
CPR
MFP II
DC
MFP I
OPR
SWB
PRN
BMC
MAC
GRA
SPR
KIN
LTS
FG
FI
TD
ATTN
Visio amp Somatopraxis
VestibularProp
Bilateral Integration amp
Sequencing
Tactile amp
Visual Discrimination
Tactile Defensiveness
amp Attention
SIPT Factor Analysis
Mailloux etal 2011
n=278
SIPT Factor Analysis in South African Sample (Van Jaarsveld etal in press)
n=223 Convenience Sample
bull Factor 1
ndash Visuo and Somatodyspraxia
bull DC CPR SV MAc MFP KIN SPr PvVC SWB GRA
bull Factor 2
ndash Bilateral Integration and Sequencing
bull SPr BMC Opr SWB with lower loadings on PPr PrVC
bull Factor 3
ndash Tactile and Visual Discrimination
bull FI MFP LTS with moderate loadings on PrVC OPr
26 (c) 2014 Susanne Smith
Roley OTD
SIPT Factor Analysis in South African Sample (Van Jaarsveld etal in press)
27 (c) 2014 Susanne Smith
Roley OTD Figure 1 Loadings on three factors of final analysis
Lane AE etal (2010)
Sensory Profile Cluster Analysis 3 patterns of ASD sensory processing
Sensory-based inattentive seeking
under-responsive (milder)
Sensory modulation with movement sensitivity low energyweak poor endurance
Sensory modulation with tastesmell sensitivity
under and over-responsiveness with no movement issues more communication difficulties and maladaptive behaviors
Sensory subtypes predicted communication competence
and maladaptive behavior
Comprehensive Observation of Proprioception (COP) Factor Analyses
bull F1 Tone and Joint Alignment
ndash Joint hypermobility decreased tone poor joint alignment
bull F2 Behavioral Manifestations
ndash Pushing overactive crashing falling running
ndash Correlates with SPM bumping and pushing
bull F3 Postural Motor
ndash Decreased PC tendency to lean inefficient grading force inadequate weight bearing inefficient ankle strategies
ndash Correlates with SPM body awareness and SWB
bull F4 Motor Planning
ndash Decreased feedback planning decreased feedforward planning overly passive
ndash No correlation with SPM body awareness weak correlation with KIN and SWB
Blanche Bodison Chang amp Reinoso (2012)
29
(c) 2014 Susanne Smith Roley
OTD
Refining Assessment of Sensory Integrative Functions
Smith Roley 2014
Visual-Praxis
Vestibular Bilateral Integration
Proprioception Tactile
Somato- dyspraxia
Sensory Reactivity
(Modulation)
Visual motor
Postural
control
Gross
motor
skills
Praxis Arousal
Affect
Activity Level
Attention
Visual construction
Bilateral coordination
Sequencing
Fine motor skills
Auditory -Language
Organization of behavior
StateSelf Regulation
Smith Roley 2013
SENSORY INTEGRATION INTERVENTION
Intervention Planning Promoting neuroplasticity health and development
Smith Roley 2014
Implications for OTSI Intervention
Consistent with Neuroplasticity Literature
ndash Sensorimotor opportunities
ndash Control over activity
ndash Novelty
ndash Challenge
ndash Playful environment
ndash Lifelike context
Smith Roley 2014
Sensory Integration and Play
bull When the therapist is doing her job effectively and the child is organizing his nervous system it looks as if the child is merely playing rdquo ndash Ayres 1979
Smith Roley 2013
Ayres Sensory Integrationreg Intervention Fidelity Measure
Parham et al 2007 2011 2013-in press
ASIFM Structural elements ndash Part I Therapist Qualifications
ndash Part II Safe Environment
ndash Part III Record Review
ndash Part IV Space and Equipment
ndash Part V Communication with Parents amp Teachers
Smith Roley 2013
ASIFM Process Elements (Parham et al 2011)
1 Physical safety 2 Sensory opportunities
(vestibular tactile and proprioceptive)
3 Supports sensory modulation to attainmaintain a regulated state
4 Supports postural ocular oral or bilateral motor coordination
5 Challenges praxis and organization of behavior
6 Collaborative activity choice
7 Just Right Challenge
8 Ensures Success
9 Supports motivation to play
10 Establishes therapeutic alliance
Smith Roley 2013
Data-driven Intervention Process (Schaaf 2001 Schaaf amp Blanche 2012)
Participation challenges
Current behavior
Theoretical
Framework
Assessments
37
Hypotheses Interventions Outcomes
(c) 2014 Susanne Smith Roley
OTD
Grounds for Optimism
Four Common Misconceptions
in the Anti-SI Intervention Literature Clark 2012
1) Reviews critical of sensory integration
intervention research ignores issues of fidelity
and dosage
Smith Roley 2014
2) Reviewers ignore or minimize the available
positive evidence for SI intervention
bull 3 RCTrsquos with autism demonstrated positive results
following multisensory interventions (including SI
intervention) (Fazlioglu amp Baran 2008 Pfeiffer
Koenig Kinnealey Sheppard amp Henderson 2011
Smith Press Koenig amp Kinnealey 2005)
bull ldquoBased on the application of meta-analytic techniques
for cumulating probability values it is not hard to
conclude that sensory treatments have positive effects
when administered to children with ASDsrdquo Clark
2012
Smith Roley 2014
3) The lack of positive outcomes from SI Intervention may be due
to weak or poorly designed studies
bull Current studies suggest that with stronger and more
studies there will be consistent beneficial effects for
certain outcomes
bull ldquoThe challenge is to make these studies happenrdquo
Clark 2012
Smith Roley 2013
4) Critics often forget that a lack of solid evidence characterizes
nearly all interventions for children with ASDs
bull SI intervention is often held to a different standard
than other types of intervention failing to apply the
same criterion to alternate interventions
Clark 2012
Smith Roley 2014
Remaining Mysteries
Smith Roley 2013
Implications for Advocacy
People need breaks such as recess
People require sensorimotor and social play timespacevalue in the daily routine
Smith Roley 2014
Implications for Research on OT using Sensory Integration
Enhancing Neuroplasticity via Therapeutic Design
bull Dosage - Intensity of increased access in short time periods rather than small access over longer times
bull Engagement via play and not just exposure
bull Role of therapist in providing customized sensorimotor challenges
bull Access to safe dynamic and therapeutic environments vs predictable and static environments
bull The difference between practice for skill development and adaptation to challenges in changing environments
Smith Roley 2014
Implications for Sensory Integration in Practice
Most importantly the success of Sensory Integration in practice depends on
YOU
Smith Roley 2014
Thank You
bull Organizers and Participants
bull hyvaumlauml paumlivaumlnjatkoa
bull Enjoy the conference
Smith Roley 2013
bull Ayres AJ (2005) Sensory Integration and the Child Los Angeles CA Western Psychological Services bull Armstrong T (2006) The best schools How human development research should inform educational practice Alexandria
VA Association for Supervision and Curriculum Development bull Blanche E I Bodison S Chang M C amp Reinoso G (2012) Development of the comprehensive observations of
proprioception (COP) Validity reliability and factor analysis American Journal of Occupational Therapy 66 691ndash698 bull Bundy A amp Lane S (In press) Sensory integration theory and practice Third Ed Philsadelphia PA FA Davis Inc bull Casey T amp MacIntyre S (2007) Childrenrsquos need for time and space In T Casey (Ed) Environments for outdoor play A
practical guide to making space for children (pp 5 ndash 16) London Sage Publications httpwwwsagepubcomupm-data15553_CASEY_C01PDF
bull Gray P (2013) Play as preparation for learning and life American Journal of Play 5(3) 271 - 292 bull Greenough WR Black JE Wallace CS (1987) Experience and brain development Child Development 58(3)539-59 bull Lane AE Young RL Baker AEZ amp Angley MT (2010) Sensory processing subtypes in autism Association with adaptive behavior
Journal of Autism and Developmental Disorders 40 112-122
bull Lane SJ Schaaf RC (2010) Examining the neuroscience evidence for sensory-driven neuroplasticity implications for sensory-based occupational therapy for children and adolescents American Journal of Occupational Therapy 64(3)375-90
bull Mailloux Z Mulligan S Smith Roley S Cermak S Blanche E amp Bodison S Coleman G amp Lane C (2011) Verification and clarification of patterns of sensory integrative dysfunction in a retrospective clinical sample American Journal of Occupational Therapy 652 143-151
bull May A (2011) Experience-dependent structural plasticity in the adult human brain 1-8 Trends in Cognitive Sciences bull May-Benson TA Smith Roley S Mailloux Z Parham LD Koomar J Schaaf RC Van Jaarsveld AM amp Cohn E (in
press) Structural Elements of the Ayres Sensory Integrationreg Intervention Fidelity Measurecopy American Journal of Occupational Therapy
bull Milteer RM Ginsburg KR amp Council on Communications and Media Committee on Psychosocial Aspects of Child and Family Health (2011) Pediatrics e204-e213 DOI 101542peds2011-2953
bull Parham LD Cohn ES Spitzer S Koomar J Miller LJ Burke JP Brett-Green B Mailloux Z May-Benson T Smith Roley S Schaaf RC Schoen S amp Summers CA (2007) Fidelity in sensory integration intervention research American Journal of Occupational Therapy 61 2 216-227
bull Parham LD Smith Roley S May-Benson T Koomar J Brett-Green B Burke JP Cohn ES Mailloux Z Miller LJ amp Schaaf RC (2011) Development of a fidelity measure for research on effectiveness of Ayres Sensory Integrationreg intervention American Journal of Occupational Therapy 65 2 133-142
bull Reynolds S Lane SJ amp Richards L (2010) Using animal models of enriched environments to inform research on sensory integration intervention for the rehabilitation of neurodevelopmental disorders Journal of Neurodevelopmental Disorders 2( 3) 120-132 online first DOI 101007s11689-010-9053-4
bull Roley SS Mailloux Z Parham D Schaaf R Blanche E amp Lane CA Cermak S (in press) Sensory Integration and Praxis Patterns in Children with Autism American Journal of Occupational Therapy
bull Rosenzweig MR Bennet EL and Diamond MC (1972) Brain Changes in response to experience Scientific American 226(2) 22-29
bull Van Jaarsveld A Mailloux Z Smith Roley S amp Raubenheimer J (in press) Patterns of the sensory integration dysfunctions in South African children South African Journal of Occupational Therapy
bull Wills S Cabanlit M Bennett J Ashwood P Amaral DG amp Van de Water J (2009) Detection of autoantibodies to neural cells of the cerebellum in the plasma of subjects with autism spectrum disorders Brain Behavior and Immunity 23(1) 64-74
Predicting Outcomes
Neuroplasticity studies suggest outcomes of Sensory Integrative approach may be
Decreased anxiety Decreased hypersensitivity Normalization of stress response Increased social participation Reduced stereotyped behaviors Better learning amp memory
Smith Roley 2013
What are the active ingredients of change
bull Motor activity bull Sensory input bull Social interactionplay bull MOST LIKELY a
combination ndash sensory motor amp
cognitive stimulation ndash environmental novelty ndash opportunities for
engagement in challenging tasks
Smith Roley 2014
Implications for Sensory Integration in Practice
However
OTSI has an
additional active ingredient
YOU
Smith Roley 2014
bull Model of Sensory Integration bull Theory of Sensory Integration
Assessments bull Sensory Integration amp Praxis Tests bull Sensory History
Questionnaires bull Clinical Observations
bull Interpretation bull Intervention bull Outcomes Research
Scholarship ~ Mentorship
Sensory Integrative Processes
The senses Integration of their inputs End products
Auditory (hearing)
First level Second level Third level Fourth level
Vestibular
(gravity amp movement)
Proprioceptive
(muscles amp joints)
Tactile (touch)
Visual (seeing)
Speech
Language
eye movements
Posture
Balance
Muscle tone
Gravitational security
Sucking
Eating
Mother-infant bond
Tactile comfort
Body perception
Coordination of two
sides of the body
Motor planning
Activity level
Attention span
Emotional stability
Eye-hand
coordination
Visual perception
Purposeful activity
Ability to concentrate
Ability to organise
Self-esteem
Self-control
Self-confidence
Academic learning ability
Capacity for abstract
thought and reasoning
Specialization of each side
of the body and the brain
Published by WPSreg 1979 2005 (c) 2014 Smith Roley Singer amp Roley
Theory Updates
Example Symplexity Alain Berthoz (2012)
ldquoA very young baby can mimic the facial expressions of its parents even though it cannot
see its own face which would seem to suggest the existence of innate mechanism of intermodal
encoding and transfer between what is perceived and what is producedhellip
This embodiment of perception is a
fundamental mechanism of simplexityrdquo
Smith Roley 2013
Assessment Updates
Sensory Integration Patterns (Ayres 1965-1989)
bull Tactile amp motor planning deficits (1965 1966 1969 1972 1977 amp 1989)
bull Visual perceptionvisual praxis deficits (1965 1966 1969 1972 1977 amp 1989)
bull Vestibular postural amp bilateral deficits (1965 1966 1969 1972 1977 amp 1989)
bull Tactile defensiveness amp hyperactivitydistractibility (1965 1966 1969 1972)
bull Other factors (auditory language somatosensory perception) seen in some studies
(1969 1972 1977 1989)
Verification and Clarification of
Sensory Integration Patterns
Mulligan (1998)
Mailloux Mulligan Roley etal (2011)
Van Jaarsveld etal (in press)
Lane (2010)
Blanche etal (2012)
SIPT Factor Analysis
Mulligan 1998
n= 10475
Smith Roley 2014
PPR
PRVC
SV
CPR
MFP II
DC
MFP I
OPR
SWB
PRN
BMC
MAC
GRA
SPR
KIN
LTS
FG
FI
TD
ATTN
Visio amp Somatopraxis
VestibularProp
Bilateral Integration amp
Sequencing
Tactile amp
Visual Discrimination
Tactile Defensiveness
amp Attention
SIPT Factor Analysis
Mailloux etal 2011
n=278
SIPT Factor Analysis in South African Sample (Van Jaarsveld etal in press)
n=223 Convenience Sample
bull Factor 1
ndash Visuo and Somatodyspraxia
bull DC CPR SV MAc MFP KIN SPr PvVC SWB GRA
bull Factor 2
ndash Bilateral Integration and Sequencing
bull SPr BMC Opr SWB with lower loadings on PPr PrVC
bull Factor 3
ndash Tactile and Visual Discrimination
bull FI MFP LTS with moderate loadings on PrVC OPr
26 (c) 2014 Susanne Smith
Roley OTD
SIPT Factor Analysis in South African Sample (Van Jaarsveld etal in press)
27 (c) 2014 Susanne Smith
Roley OTD Figure 1 Loadings on three factors of final analysis
Lane AE etal (2010)
Sensory Profile Cluster Analysis 3 patterns of ASD sensory processing
Sensory-based inattentive seeking
under-responsive (milder)
Sensory modulation with movement sensitivity low energyweak poor endurance
Sensory modulation with tastesmell sensitivity
under and over-responsiveness with no movement issues more communication difficulties and maladaptive behaviors
Sensory subtypes predicted communication competence
and maladaptive behavior
Comprehensive Observation of Proprioception (COP) Factor Analyses
bull F1 Tone and Joint Alignment
ndash Joint hypermobility decreased tone poor joint alignment
bull F2 Behavioral Manifestations
ndash Pushing overactive crashing falling running
ndash Correlates with SPM bumping and pushing
bull F3 Postural Motor
ndash Decreased PC tendency to lean inefficient grading force inadequate weight bearing inefficient ankle strategies
ndash Correlates with SPM body awareness and SWB
bull F4 Motor Planning
ndash Decreased feedback planning decreased feedforward planning overly passive
ndash No correlation with SPM body awareness weak correlation with KIN and SWB
Blanche Bodison Chang amp Reinoso (2012)
29
(c) 2014 Susanne Smith Roley
OTD
Refining Assessment of Sensory Integrative Functions
Smith Roley 2014
Visual-Praxis
Vestibular Bilateral Integration
Proprioception Tactile
Somato- dyspraxia
Sensory Reactivity
(Modulation)
Visual motor
Postural
control
Gross
motor
skills
Praxis Arousal
Affect
Activity Level
Attention
Visual construction
Bilateral coordination
Sequencing
Fine motor skills
Auditory -Language
Organization of behavior
StateSelf Regulation
Smith Roley 2013
SENSORY INTEGRATION INTERVENTION
Intervention Planning Promoting neuroplasticity health and development
Smith Roley 2014
Implications for OTSI Intervention
Consistent with Neuroplasticity Literature
ndash Sensorimotor opportunities
ndash Control over activity
ndash Novelty
ndash Challenge
ndash Playful environment
ndash Lifelike context
Smith Roley 2014
Sensory Integration and Play
bull When the therapist is doing her job effectively and the child is organizing his nervous system it looks as if the child is merely playing rdquo ndash Ayres 1979
Smith Roley 2013
Ayres Sensory Integrationreg Intervention Fidelity Measure
Parham et al 2007 2011 2013-in press
ASIFM Structural elements ndash Part I Therapist Qualifications
ndash Part II Safe Environment
ndash Part III Record Review
ndash Part IV Space and Equipment
ndash Part V Communication with Parents amp Teachers
Smith Roley 2013
ASIFM Process Elements (Parham et al 2011)
1 Physical safety 2 Sensory opportunities
(vestibular tactile and proprioceptive)
3 Supports sensory modulation to attainmaintain a regulated state
4 Supports postural ocular oral or bilateral motor coordination
5 Challenges praxis and organization of behavior
6 Collaborative activity choice
7 Just Right Challenge
8 Ensures Success
9 Supports motivation to play
10 Establishes therapeutic alliance
Smith Roley 2013
Data-driven Intervention Process (Schaaf 2001 Schaaf amp Blanche 2012)
Participation challenges
Current behavior
Theoretical
Framework
Assessments
37
Hypotheses Interventions Outcomes
(c) 2014 Susanne Smith Roley
OTD
Grounds for Optimism
Four Common Misconceptions
in the Anti-SI Intervention Literature Clark 2012
1) Reviews critical of sensory integration
intervention research ignores issues of fidelity
and dosage
Smith Roley 2014
2) Reviewers ignore or minimize the available
positive evidence for SI intervention
bull 3 RCTrsquos with autism demonstrated positive results
following multisensory interventions (including SI
intervention) (Fazlioglu amp Baran 2008 Pfeiffer
Koenig Kinnealey Sheppard amp Henderson 2011
Smith Press Koenig amp Kinnealey 2005)
bull ldquoBased on the application of meta-analytic techniques
for cumulating probability values it is not hard to
conclude that sensory treatments have positive effects
when administered to children with ASDsrdquo Clark
2012
Smith Roley 2014
3) The lack of positive outcomes from SI Intervention may be due
to weak or poorly designed studies
bull Current studies suggest that with stronger and more
studies there will be consistent beneficial effects for
certain outcomes
bull ldquoThe challenge is to make these studies happenrdquo
Clark 2012
Smith Roley 2013
4) Critics often forget that a lack of solid evidence characterizes
nearly all interventions for children with ASDs
bull SI intervention is often held to a different standard
than other types of intervention failing to apply the
same criterion to alternate interventions
Clark 2012
Smith Roley 2014
Remaining Mysteries
Smith Roley 2013
Implications for Advocacy
People need breaks such as recess
People require sensorimotor and social play timespacevalue in the daily routine
Smith Roley 2014
Implications for Research on OT using Sensory Integration
Enhancing Neuroplasticity via Therapeutic Design
bull Dosage - Intensity of increased access in short time periods rather than small access over longer times
bull Engagement via play and not just exposure
bull Role of therapist in providing customized sensorimotor challenges
bull Access to safe dynamic and therapeutic environments vs predictable and static environments
bull The difference between practice for skill development and adaptation to challenges in changing environments
Smith Roley 2014
Implications for Sensory Integration in Practice
Most importantly the success of Sensory Integration in practice depends on
YOU
Smith Roley 2014
Thank You
bull Organizers and Participants
bull hyvaumlauml paumlivaumlnjatkoa
bull Enjoy the conference
Smith Roley 2013
bull Ayres AJ (2005) Sensory Integration and the Child Los Angeles CA Western Psychological Services bull Armstrong T (2006) The best schools How human development research should inform educational practice Alexandria
VA Association for Supervision and Curriculum Development bull Blanche E I Bodison S Chang M C amp Reinoso G (2012) Development of the comprehensive observations of
proprioception (COP) Validity reliability and factor analysis American Journal of Occupational Therapy 66 691ndash698 bull Bundy A amp Lane S (In press) Sensory integration theory and practice Third Ed Philsadelphia PA FA Davis Inc bull Casey T amp MacIntyre S (2007) Childrenrsquos need for time and space In T Casey (Ed) Environments for outdoor play A
practical guide to making space for children (pp 5 ndash 16) London Sage Publications httpwwwsagepubcomupm-data15553_CASEY_C01PDF
bull Gray P (2013) Play as preparation for learning and life American Journal of Play 5(3) 271 - 292 bull Greenough WR Black JE Wallace CS (1987) Experience and brain development Child Development 58(3)539-59 bull Lane AE Young RL Baker AEZ amp Angley MT (2010) Sensory processing subtypes in autism Association with adaptive behavior
Journal of Autism and Developmental Disorders 40 112-122
bull Lane SJ Schaaf RC (2010) Examining the neuroscience evidence for sensory-driven neuroplasticity implications for sensory-based occupational therapy for children and adolescents American Journal of Occupational Therapy 64(3)375-90
bull Mailloux Z Mulligan S Smith Roley S Cermak S Blanche E amp Bodison S Coleman G amp Lane C (2011) Verification and clarification of patterns of sensory integrative dysfunction in a retrospective clinical sample American Journal of Occupational Therapy 652 143-151
bull May A (2011) Experience-dependent structural plasticity in the adult human brain 1-8 Trends in Cognitive Sciences bull May-Benson TA Smith Roley S Mailloux Z Parham LD Koomar J Schaaf RC Van Jaarsveld AM amp Cohn E (in
press) Structural Elements of the Ayres Sensory Integrationreg Intervention Fidelity Measurecopy American Journal of Occupational Therapy
bull Milteer RM Ginsburg KR amp Council on Communications and Media Committee on Psychosocial Aspects of Child and Family Health (2011) Pediatrics e204-e213 DOI 101542peds2011-2953
bull Parham LD Cohn ES Spitzer S Koomar J Miller LJ Burke JP Brett-Green B Mailloux Z May-Benson T Smith Roley S Schaaf RC Schoen S amp Summers CA (2007) Fidelity in sensory integration intervention research American Journal of Occupational Therapy 61 2 216-227
bull Parham LD Smith Roley S May-Benson T Koomar J Brett-Green B Burke JP Cohn ES Mailloux Z Miller LJ amp Schaaf RC (2011) Development of a fidelity measure for research on effectiveness of Ayres Sensory Integrationreg intervention American Journal of Occupational Therapy 65 2 133-142
bull Reynolds S Lane SJ amp Richards L (2010) Using animal models of enriched environments to inform research on sensory integration intervention for the rehabilitation of neurodevelopmental disorders Journal of Neurodevelopmental Disorders 2( 3) 120-132 online first DOI 101007s11689-010-9053-4
bull Roley SS Mailloux Z Parham D Schaaf R Blanche E amp Lane CA Cermak S (in press) Sensory Integration and Praxis Patterns in Children with Autism American Journal of Occupational Therapy
bull Rosenzweig MR Bennet EL and Diamond MC (1972) Brain Changes in response to experience Scientific American 226(2) 22-29
bull Van Jaarsveld A Mailloux Z Smith Roley S amp Raubenheimer J (in press) Patterns of the sensory integration dysfunctions in South African children South African Journal of Occupational Therapy
bull Wills S Cabanlit M Bennett J Ashwood P Amaral DG amp Van de Water J (2009) Detection of autoantibodies to neural cells of the cerebellum in the plasma of subjects with autism spectrum disorders Brain Behavior and Immunity 23(1) 64-74
What are the active ingredients of change
bull Motor activity bull Sensory input bull Social interactionplay bull MOST LIKELY a
combination ndash sensory motor amp
cognitive stimulation ndash environmental novelty ndash opportunities for
engagement in challenging tasks
Smith Roley 2014
Implications for Sensory Integration in Practice
However
OTSI has an
additional active ingredient
YOU
Smith Roley 2014
bull Model of Sensory Integration bull Theory of Sensory Integration
Assessments bull Sensory Integration amp Praxis Tests bull Sensory History
Questionnaires bull Clinical Observations
bull Interpretation bull Intervention bull Outcomes Research
Scholarship ~ Mentorship
Sensory Integrative Processes
The senses Integration of their inputs End products
Auditory (hearing)
First level Second level Third level Fourth level
Vestibular
(gravity amp movement)
Proprioceptive
(muscles amp joints)
Tactile (touch)
Visual (seeing)
Speech
Language
eye movements
Posture
Balance
Muscle tone
Gravitational security
Sucking
Eating
Mother-infant bond
Tactile comfort
Body perception
Coordination of two
sides of the body
Motor planning
Activity level
Attention span
Emotional stability
Eye-hand
coordination
Visual perception
Purposeful activity
Ability to concentrate
Ability to organise
Self-esteem
Self-control
Self-confidence
Academic learning ability
Capacity for abstract
thought and reasoning
Specialization of each side
of the body and the brain
Published by WPSreg 1979 2005 (c) 2014 Smith Roley Singer amp Roley
Theory Updates
Example Symplexity Alain Berthoz (2012)
ldquoA very young baby can mimic the facial expressions of its parents even though it cannot
see its own face which would seem to suggest the existence of innate mechanism of intermodal
encoding and transfer between what is perceived and what is producedhellip
This embodiment of perception is a
fundamental mechanism of simplexityrdquo
Smith Roley 2013
Assessment Updates
Sensory Integration Patterns (Ayres 1965-1989)
bull Tactile amp motor planning deficits (1965 1966 1969 1972 1977 amp 1989)
bull Visual perceptionvisual praxis deficits (1965 1966 1969 1972 1977 amp 1989)
bull Vestibular postural amp bilateral deficits (1965 1966 1969 1972 1977 amp 1989)
bull Tactile defensiveness amp hyperactivitydistractibility (1965 1966 1969 1972)
bull Other factors (auditory language somatosensory perception) seen in some studies
(1969 1972 1977 1989)
Verification and Clarification of
Sensory Integration Patterns
Mulligan (1998)
Mailloux Mulligan Roley etal (2011)
Van Jaarsveld etal (in press)
Lane (2010)
Blanche etal (2012)
SIPT Factor Analysis
Mulligan 1998
n= 10475
Smith Roley 2014
PPR
PRVC
SV
CPR
MFP II
DC
MFP I
OPR
SWB
PRN
BMC
MAC
GRA
SPR
KIN
LTS
FG
FI
TD
ATTN
Visio amp Somatopraxis
VestibularProp
Bilateral Integration amp
Sequencing
Tactile amp
Visual Discrimination
Tactile Defensiveness
amp Attention
SIPT Factor Analysis
Mailloux etal 2011
n=278
SIPT Factor Analysis in South African Sample (Van Jaarsveld etal in press)
n=223 Convenience Sample
bull Factor 1
ndash Visuo and Somatodyspraxia
bull DC CPR SV MAc MFP KIN SPr PvVC SWB GRA
bull Factor 2
ndash Bilateral Integration and Sequencing
bull SPr BMC Opr SWB with lower loadings on PPr PrVC
bull Factor 3
ndash Tactile and Visual Discrimination
bull FI MFP LTS with moderate loadings on PrVC OPr
26 (c) 2014 Susanne Smith
Roley OTD
SIPT Factor Analysis in South African Sample (Van Jaarsveld etal in press)
27 (c) 2014 Susanne Smith
Roley OTD Figure 1 Loadings on three factors of final analysis
Lane AE etal (2010)
Sensory Profile Cluster Analysis 3 patterns of ASD sensory processing
Sensory-based inattentive seeking
under-responsive (milder)
Sensory modulation with movement sensitivity low energyweak poor endurance
Sensory modulation with tastesmell sensitivity
under and over-responsiveness with no movement issues more communication difficulties and maladaptive behaviors
Sensory subtypes predicted communication competence
and maladaptive behavior
Comprehensive Observation of Proprioception (COP) Factor Analyses
bull F1 Tone and Joint Alignment
ndash Joint hypermobility decreased tone poor joint alignment
bull F2 Behavioral Manifestations
ndash Pushing overactive crashing falling running
ndash Correlates with SPM bumping and pushing
bull F3 Postural Motor
ndash Decreased PC tendency to lean inefficient grading force inadequate weight bearing inefficient ankle strategies
ndash Correlates with SPM body awareness and SWB
bull F4 Motor Planning
ndash Decreased feedback planning decreased feedforward planning overly passive
ndash No correlation with SPM body awareness weak correlation with KIN and SWB
Blanche Bodison Chang amp Reinoso (2012)
29
(c) 2014 Susanne Smith Roley
OTD
Refining Assessment of Sensory Integrative Functions
Smith Roley 2014
Visual-Praxis
Vestibular Bilateral Integration
Proprioception Tactile
Somato- dyspraxia
Sensory Reactivity
(Modulation)
Visual motor
Postural
control
Gross
motor
skills
Praxis Arousal
Affect
Activity Level
Attention
Visual construction
Bilateral coordination
Sequencing
Fine motor skills
Auditory -Language
Organization of behavior
StateSelf Regulation
Smith Roley 2013
SENSORY INTEGRATION INTERVENTION
Intervention Planning Promoting neuroplasticity health and development
Smith Roley 2014
Implications for OTSI Intervention
Consistent with Neuroplasticity Literature
ndash Sensorimotor opportunities
ndash Control over activity
ndash Novelty
ndash Challenge
ndash Playful environment
ndash Lifelike context
Smith Roley 2014
Sensory Integration and Play
bull When the therapist is doing her job effectively and the child is organizing his nervous system it looks as if the child is merely playing rdquo ndash Ayres 1979
Smith Roley 2013
Ayres Sensory Integrationreg Intervention Fidelity Measure
Parham et al 2007 2011 2013-in press
ASIFM Structural elements ndash Part I Therapist Qualifications
ndash Part II Safe Environment
ndash Part III Record Review
ndash Part IV Space and Equipment
ndash Part V Communication with Parents amp Teachers
Smith Roley 2013
ASIFM Process Elements (Parham et al 2011)
1 Physical safety 2 Sensory opportunities
(vestibular tactile and proprioceptive)
3 Supports sensory modulation to attainmaintain a regulated state
4 Supports postural ocular oral or bilateral motor coordination
5 Challenges praxis and organization of behavior
6 Collaborative activity choice
7 Just Right Challenge
8 Ensures Success
9 Supports motivation to play
10 Establishes therapeutic alliance
Smith Roley 2013
Data-driven Intervention Process (Schaaf 2001 Schaaf amp Blanche 2012)
Participation challenges
Current behavior
Theoretical
Framework
Assessments
37
Hypotheses Interventions Outcomes
(c) 2014 Susanne Smith Roley
OTD
Grounds for Optimism
Four Common Misconceptions
in the Anti-SI Intervention Literature Clark 2012
1) Reviews critical of sensory integration
intervention research ignores issues of fidelity
and dosage
Smith Roley 2014
2) Reviewers ignore or minimize the available
positive evidence for SI intervention
bull 3 RCTrsquos with autism demonstrated positive results
following multisensory interventions (including SI
intervention) (Fazlioglu amp Baran 2008 Pfeiffer
Koenig Kinnealey Sheppard amp Henderson 2011
Smith Press Koenig amp Kinnealey 2005)
bull ldquoBased on the application of meta-analytic techniques
for cumulating probability values it is not hard to
conclude that sensory treatments have positive effects
when administered to children with ASDsrdquo Clark
2012
Smith Roley 2014
3) The lack of positive outcomes from SI Intervention may be due
to weak or poorly designed studies
bull Current studies suggest that with stronger and more
studies there will be consistent beneficial effects for
certain outcomes
bull ldquoThe challenge is to make these studies happenrdquo
Clark 2012
Smith Roley 2013
4) Critics often forget that a lack of solid evidence characterizes
nearly all interventions for children with ASDs
bull SI intervention is often held to a different standard
than other types of intervention failing to apply the
same criterion to alternate interventions
Clark 2012
Smith Roley 2014
Remaining Mysteries
Smith Roley 2013
Implications for Advocacy
People need breaks such as recess
People require sensorimotor and social play timespacevalue in the daily routine
Smith Roley 2014
Implications for Research on OT using Sensory Integration
Enhancing Neuroplasticity via Therapeutic Design
bull Dosage - Intensity of increased access in short time periods rather than small access over longer times
bull Engagement via play and not just exposure
bull Role of therapist in providing customized sensorimotor challenges
bull Access to safe dynamic and therapeutic environments vs predictable and static environments
bull The difference between practice for skill development and adaptation to challenges in changing environments
Smith Roley 2014
Implications for Sensory Integration in Practice
Most importantly the success of Sensory Integration in practice depends on
YOU
Smith Roley 2014
Thank You
bull Organizers and Participants
bull hyvaumlauml paumlivaumlnjatkoa
bull Enjoy the conference
Smith Roley 2013
bull Ayres AJ (2005) Sensory Integration and the Child Los Angeles CA Western Psychological Services bull Armstrong T (2006) The best schools How human development research should inform educational practice Alexandria
VA Association for Supervision and Curriculum Development bull Blanche E I Bodison S Chang M C amp Reinoso G (2012) Development of the comprehensive observations of
proprioception (COP) Validity reliability and factor analysis American Journal of Occupational Therapy 66 691ndash698 bull Bundy A amp Lane S (In press) Sensory integration theory and practice Third Ed Philsadelphia PA FA Davis Inc bull Casey T amp MacIntyre S (2007) Childrenrsquos need for time and space In T Casey (Ed) Environments for outdoor play A
practical guide to making space for children (pp 5 ndash 16) London Sage Publications httpwwwsagepubcomupm-data15553_CASEY_C01PDF
bull Gray P (2013) Play as preparation for learning and life American Journal of Play 5(3) 271 - 292 bull Greenough WR Black JE Wallace CS (1987) Experience and brain development Child Development 58(3)539-59 bull Lane AE Young RL Baker AEZ amp Angley MT (2010) Sensory processing subtypes in autism Association with adaptive behavior
Journal of Autism and Developmental Disorders 40 112-122
bull Lane SJ Schaaf RC (2010) Examining the neuroscience evidence for sensory-driven neuroplasticity implications for sensory-based occupational therapy for children and adolescents American Journal of Occupational Therapy 64(3)375-90
bull Mailloux Z Mulligan S Smith Roley S Cermak S Blanche E amp Bodison S Coleman G amp Lane C (2011) Verification and clarification of patterns of sensory integrative dysfunction in a retrospective clinical sample American Journal of Occupational Therapy 652 143-151
bull May A (2011) Experience-dependent structural plasticity in the adult human brain 1-8 Trends in Cognitive Sciences bull May-Benson TA Smith Roley S Mailloux Z Parham LD Koomar J Schaaf RC Van Jaarsveld AM amp Cohn E (in
press) Structural Elements of the Ayres Sensory Integrationreg Intervention Fidelity Measurecopy American Journal of Occupational Therapy
bull Milteer RM Ginsburg KR amp Council on Communications and Media Committee on Psychosocial Aspects of Child and Family Health (2011) Pediatrics e204-e213 DOI 101542peds2011-2953
bull Parham LD Cohn ES Spitzer S Koomar J Miller LJ Burke JP Brett-Green B Mailloux Z May-Benson T Smith Roley S Schaaf RC Schoen S amp Summers CA (2007) Fidelity in sensory integration intervention research American Journal of Occupational Therapy 61 2 216-227
bull Parham LD Smith Roley S May-Benson T Koomar J Brett-Green B Burke JP Cohn ES Mailloux Z Miller LJ amp Schaaf RC (2011) Development of a fidelity measure for research on effectiveness of Ayres Sensory Integrationreg intervention American Journal of Occupational Therapy 65 2 133-142
bull Reynolds S Lane SJ amp Richards L (2010) Using animal models of enriched environments to inform research on sensory integration intervention for the rehabilitation of neurodevelopmental disorders Journal of Neurodevelopmental Disorders 2( 3) 120-132 online first DOI 101007s11689-010-9053-4
bull Roley SS Mailloux Z Parham D Schaaf R Blanche E amp Lane CA Cermak S (in press) Sensory Integration and Praxis Patterns in Children with Autism American Journal of Occupational Therapy
bull Rosenzweig MR Bennet EL and Diamond MC (1972) Brain Changes in response to experience Scientific American 226(2) 22-29
bull Van Jaarsveld A Mailloux Z Smith Roley S amp Raubenheimer J (in press) Patterns of the sensory integration dysfunctions in South African children South African Journal of Occupational Therapy
bull Wills S Cabanlit M Bennett J Ashwood P Amaral DG amp Van de Water J (2009) Detection of autoantibodies to neural cells of the cerebellum in the plasma of subjects with autism spectrum disorders Brain Behavior and Immunity 23(1) 64-74
Implications for Sensory Integration in Practice
However
OTSI has an
additional active ingredient
YOU
Smith Roley 2014
bull Model of Sensory Integration bull Theory of Sensory Integration
Assessments bull Sensory Integration amp Praxis Tests bull Sensory History
Questionnaires bull Clinical Observations
bull Interpretation bull Intervention bull Outcomes Research
Scholarship ~ Mentorship
Sensory Integrative Processes
The senses Integration of their inputs End products
Auditory (hearing)
First level Second level Third level Fourth level
Vestibular
(gravity amp movement)
Proprioceptive
(muscles amp joints)
Tactile (touch)
Visual (seeing)
Speech
Language
eye movements
Posture
Balance
Muscle tone
Gravitational security
Sucking
Eating
Mother-infant bond
Tactile comfort
Body perception
Coordination of two
sides of the body
Motor planning
Activity level
Attention span
Emotional stability
Eye-hand
coordination
Visual perception
Purposeful activity
Ability to concentrate
Ability to organise
Self-esteem
Self-control
Self-confidence
Academic learning ability
Capacity for abstract
thought and reasoning
Specialization of each side
of the body and the brain
Published by WPSreg 1979 2005 (c) 2014 Smith Roley Singer amp Roley
Theory Updates
Example Symplexity Alain Berthoz (2012)
ldquoA very young baby can mimic the facial expressions of its parents even though it cannot
see its own face which would seem to suggest the existence of innate mechanism of intermodal
encoding and transfer between what is perceived and what is producedhellip
This embodiment of perception is a
fundamental mechanism of simplexityrdquo
Smith Roley 2013
Assessment Updates
Sensory Integration Patterns (Ayres 1965-1989)
bull Tactile amp motor planning deficits (1965 1966 1969 1972 1977 amp 1989)
bull Visual perceptionvisual praxis deficits (1965 1966 1969 1972 1977 amp 1989)
bull Vestibular postural amp bilateral deficits (1965 1966 1969 1972 1977 amp 1989)
bull Tactile defensiveness amp hyperactivitydistractibility (1965 1966 1969 1972)
bull Other factors (auditory language somatosensory perception) seen in some studies
(1969 1972 1977 1989)
Verification and Clarification of
Sensory Integration Patterns
Mulligan (1998)
Mailloux Mulligan Roley etal (2011)
Van Jaarsveld etal (in press)
Lane (2010)
Blanche etal (2012)
SIPT Factor Analysis
Mulligan 1998
n= 10475
Smith Roley 2014
PPR
PRVC
SV
CPR
MFP II
DC
MFP I
OPR
SWB
PRN
BMC
MAC
GRA
SPR
KIN
LTS
FG
FI
TD
ATTN
Visio amp Somatopraxis
VestibularProp
Bilateral Integration amp
Sequencing
Tactile amp
Visual Discrimination
Tactile Defensiveness
amp Attention
SIPT Factor Analysis
Mailloux etal 2011
n=278
SIPT Factor Analysis in South African Sample (Van Jaarsveld etal in press)
n=223 Convenience Sample
bull Factor 1
ndash Visuo and Somatodyspraxia
bull DC CPR SV MAc MFP KIN SPr PvVC SWB GRA
bull Factor 2
ndash Bilateral Integration and Sequencing
bull SPr BMC Opr SWB with lower loadings on PPr PrVC
bull Factor 3
ndash Tactile and Visual Discrimination
bull FI MFP LTS with moderate loadings on PrVC OPr
26 (c) 2014 Susanne Smith
Roley OTD
SIPT Factor Analysis in South African Sample (Van Jaarsveld etal in press)
27 (c) 2014 Susanne Smith
Roley OTD Figure 1 Loadings on three factors of final analysis
Lane AE etal (2010)
Sensory Profile Cluster Analysis 3 patterns of ASD sensory processing
Sensory-based inattentive seeking
under-responsive (milder)
Sensory modulation with movement sensitivity low energyweak poor endurance
Sensory modulation with tastesmell sensitivity
under and over-responsiveness with no movement issues more communication difficulties and maladaptive behaviors
Sensory subtypes predicted communication competence
and maladaptive behavior
Comprehensive Observation of Proprioception (COP) Factor Analyses
bull F1 Tone and Joint Alignment
ndash Joint hypermobility decreased tone poor joint alignment
bull F2 Behavioral Manifestations
ndash Pushing overactive crashing falling running
ndash Correlates with SPM bumping and pushing
bull F3 Postural Motor
ndash Decreased PC tendency to lean inefficient grading force inadequate weight bearing inefficient ankle strategies
ndash Correlates with SPM body awareness and SWB
bull F4 Motor Planning
ndash Decreased feedback planning decreased feedforward planning overly passive
ndash No correlation with SPM body awareness weak correlation with KIN and SWB
Blanche Bodison Chang amp Reinoso (2012)
29
(c) 2014 Susanne Smith Roley
OTD
Refining Assessment of Sensory Integrative Functions
Smith Roley 2014
Visual-Praxis
Vestibular Bilateral Integration
Proprioception Tactile
Somato- dyspraxia
Sensory Reactivity
(Modulation)
Visual motor
Postural
control
Gross
motor
skills
Praxis Arousal
Affect
Activity Level
Attention
Visual construction
Bilateral coordination
Sequencing
Fine motor skills
Auditory -Language
Organization of behavior
StateSelf Regulation
Smith Roley 2013
SENSORY INTEGRATION INTERVENTION
Intervention Planning Promoting neuroplasticity health and development
Smith Roley 2014
Implications for OTSI Intervention
Consistent with Neuroplasticity Literature
ndash Sensorimotor opportunities
ndash Control over activity
ndash Novelty
ndash Challenge
ndash Playful environment
ndash Lifelike context
Smith Roley 2014
Sensory Integration and Play
bull When the therapist is doing her job effectively and the child is organizing his nervous system it looks as if the child is merely playing rdquo ndash Ayres 1979
Smith Roley 2013
Ayres Sensory Integrationreg Intervention Fidelity Measure
Parham et al 2007 2011 2013-in press
ASIFM Structural elements ndash Part I Therapist Qualifications
ndash Part II Safe Environment
ndash Part III Record Review
ndash Part IV Space and Equipment
ndash Part V Communication with Parents amp Teachers
Smith Roley 2013
ASIFM Process Elements (Parham et al 2011)
1 Physical safety 2 Sensory opportunities
(vestibular tactile and proprioceptive)
3 Supports sensory modulation to attainmaintain a regulated state
4 Supports postural ocular oral or bilateral motor coordination
5 Challenges praxis and organization of behavior
6 Collaborative activity choice
7 Just Right Challenge
8 Ensures Success
9 Supports motivation to play
10 Establishes therapeutic alliance
Smith Roley 2013
Data-driven Intervention Process (Schaaf 2001 Schaaf amp Blanche 2012)
Participation challenges
Current behavior
Theoretical
Framework
Assessments
37
Hypotheses Interventions Outcomes
(c) 2014 Susanne Smith Roley
OTD
Grounds for Optimism
Four Common Misconceptions
in the Anti-SI Intervention Literature Clark 2012
1) Reviews critical of sensory integration
intervention research ignores issues of fidelity
and dosage
Smith Roley 2014
2) Reviewers ignore or minimize the available
positive evidence for SI intervention
bull 3 RCTrsquos with autism demonstrated positive results
following multisensory interventions (including SI
intervention) (Fazlioglu amp Baran 2008 Pfeiffer
Koenig Kinnealey Sheppard amp Henderson 2011
Smith Press Koenig amp Kinnealey 2005)
bull ldquoBased on the application of meta-analytic techniques
for cumulating probability values it is not hard to
conclude that sensory treatments have positive effects
when administered to children with ASDsrdquo Clark
2012
Smith Roley 2014
3) The lack of positive outcomes from SI Intervention may be due
to weak or poorly designed studies
bull Current studies suggest that with stronger and more
studies there will be consistent beneficial effects for
certain outcomes
bull ldquoThe challenge is to make these studies happenrdquo
Clark 2012
Smith Roley 2013
4) Critics often forget that a lack of solid evidence characterizes
nearly all interventions for children with ASDs
bull SI intervention is often held to a different standard
than other types of intervention failing to apply the
same criterion to alternate interventions
Clark 2012
Smith Roley 2014
Remaining Mysteries
Smith Roley 2013
Implications for Advocacy
People need breaks such as recess
People require sensorimotor and social play timespacevalue in the daily routine
Smith Roley 2014
Implications for Research on OT using Sensory Integration
Enhancing Neuroplasticity via Therapeutic Design
bull Dosage - Intensity of increased access in short time periods rather than small access over longer times
bull Engagement via play and not just exposure
bull Role of therapist in providing customized sensorimotor challenges
bull Access to safe dynamic and therapeutic environments vs predictable and static environments
bull The difference between practice for skill development and adaptation to challenges in changing environments
Smith Roley 2014
Implications for Sensory Integration in Practice
Most importantly the success of Sensory Integration in practice depends on
YOU
Smith Roley 2014
Thank You
bull Organizers and Participants
bull hyvaumlauml paumlivaumlnjatkoa
bull Enjoy the conference
Smith Roley 2013
bull Ayres AJ (2005) Sensory Integration and the Child Los Angeles CA Western Psychological Services bull Armstrong T (2006) The best schools How human development research should inform educational practice Alexandria
VA Association for Supervision and Curriculum Development bull Blanche E I Bodison S Chang M C amp Reinoso G (2012) Development of the comprehensive observations of
proprioception (COP) Validity reliability and factor analysis American Journal of Occupational Therapy 66 691ndash698 bull Bundy A amp Lane S (In press) Sensory integration theory and practice Third Ed Philsadelphia PA FA Davis Inc bull Casey T amp MacIntyre S (2007) Childrenrsquos need for time and space In T Casey (Ed) Environments for outdoor play A
practical guide to making space for children (pp 5 ndash 16) London Sage Publications httpwwwsagepubcomupm-data15553_CASEY_C01PDF
bull Gray P (2013) Play as preparation for learning and life American Journal of Play 5(3) 271 - 292 bull Greenough WR Black JE Wallace CS (1987) Experience and brain development Child Development 58(3)539-59 bull Lane AE Young RL Baker AEZ amp Angley MT (2010) Sensory processing subtypes in autism Association with adaptive behavior
Journal of Autism and Developmental Disorders 40 112-122
bull Lane SJ Schaaf RC (2010) Examining the neuroscience evidence for sensory-driven neuroplasticity implications for sensory-based occupational therapy for children and adolescents American Journal of Occupational Therapy 64(3)375-90
bull Mailloux Z Mulligan S Smith Roley S Cermak S Blanche E amp Bodison S Coleman G amp Lane C (2011) Verification and clarification of patterns of sensory integrative dysfunction in a retrospective clinical sample American Journal of Occupational Therapy 652 143-151
bull May A (2011) Experience-dependent structural plasticity in the adult human brain 1-8 Trends in Cognitive Sciences bull May-Benson TA Smith Roley S Mailloux Z Parham LD Koomar J Schaaf RC Van Jaarsveld AM amp Cohn E (in
press) Structural Elements of the Ayres Sensory Integrationreg Intervention Fidelity Measurecopy American Journal of Occupational Therapy
bull Milteer RM Ginsburg KR amp Council on Communications and Media Committee on Psychosocial Aspects of Child and Family Health (2011) Pediatrics e204-e213 DOI 101542peds2011-2953
bull Parham LD Cohn ES Spitzer S Koomar J Miller LJ Burke JP Brett-Green B Mailloux Z May-Benson T Smith Roley S Schaaf RC Schoen S amp Summers CA (2007) Fidelity in sensory integration intervention research American Journal of Occupational Therapy 61 2 216-227
bull Parham LD Smith Roley S May-Benson T Koomar J Brett-Green B Burke JP Cohn ES Mailloux Z Miller LJ amp Schaaf RC (2011) Development of a fidelity measure for research on effectiveness of Ayres Sensory Integrationreg intervention American Journal of Occupational Therapy 65 2 133-142
bull Reynolds S Lane SJ amp Richards L (2010) Using animal models of enriched environments to inform research on sensory integration intervention for the rehabilitation of neurodevelopmental disorders Journal of Neurodevelopmental Disorders 2( 3) 120-132 online first DOI 101007s11689-010-9053-4
bull Roley SS Mailloux Z Parham D Schaaf R Blanche E amp Lane CA Cermak S (in press) Sensory Integration and Praxis Patterns in Children with Autism American Journal of Occupational Therapy
bull Rosenzweig MR Bennet EL and Diamond MC (1972) Brain Changes in response to experience Scientific American 226(2) 22-29
bull Van Jaarsveld A Mailloux Z Smith Roley S amp Raubenheimer J (in press) Patterns of the sensory integration dysfunctions in South African children South African Journal of Occupational Therapy
bull Wills S Cabanlit M Bennett J Ashwood P Amaral DG amp Van de Water J (2009) Detection of autoantibodies to neural cells of the cerebellum in the plasma of subjects with autism spectrum disorders Brain Behavior and Immunity 23(1) 64-74
bull Model of Sensory Integration bull Theory of Sensory Integration
Assessments bull Sensory Integration amp Praxis Tests bull Sensory History
Questionnaires bull Clinical Observations
bull Interpretation bull Intervention bull Outcomes Research
Scholarship ~ Mentorship
Sensory Integrative Processes
The senses Integration of their inputs End products
Auditory (hearing)
First level Second level Third level Fourth level
Vestibular
(gravity amp movement)
Proprioceptive
(muscles amp joints)
Tactile (touch)
Visual (seeing)
Speech
Language
eye movements
Posture
Balance
Muscle tone
Gravitational security
Sucking
Eating
Mother-infant bond
Tactile comfort
Body perception
Coordination of two
sides of the body
Motor planning
Activity level
Attention span
Emotional stability
Eye-hand
coordination
Visual perception
Purposeful activity
Ability to concentrate
Ability to organise
Self-esteem
Self-control
Self-confidence
Academic learning ability
Capacity for abstract
thought and reasoning
Specialization of each side
of the body and the brain
Published by WPSreg 1979 2005 (c) 2014 Smith Roley Singer amp Roley
Theory Updates
Example Symplexity Alain Berthoz (2012)
ldquoA very young baby can mimic the facial expressions of its parents even though it cannot
see its own face which would seem to suggest the existence of innate mechanism of intermodal
encoding and transfer between what is perceived and what is producedhellip
This embodiment of perception is a
fundamental mechanism of simplexityrdquo
Smith Roley 2013
Assessment Updates
Sensory Integration Patterns (Ayres 1965-1989)
bull Tactile amp motor planning deficits (1965 1966 1969 1972 1977 amp 1989)
bull Visual perceptionvisual praxis deficits (1965 1966 1969 1972 1977 amp 1989)
bull Vestibular postural amp bilateral deficits (1965 1966 1969 1972 1977 amp 1989)
bull Tactile defensiveness amp hyperactivitydistractibility (1965 1966 1969 1972)
bull Other factors (auditory language somatosensory perception) seen in some studies
(1969 1972 1977 1989)
Verification and Clarification of
Sensory Integration Patterns
Mulligan (1998)
Mailloux Mulligan Roley etal (2011)
Van Jaarsveld etal (in press)
Lane (2010)
Blanche etal (2012)
SIPT Factor Analysis
Mulligan 1998
n= 10475
Smith Roley 2014
PPR
PRVC
SV
CPR
MFP II
DC
MFP I
OPR
SWB
PRN
BMC
MAC
GRA
SPR
KIN
LTS
FG
FI
TD
ATTN
Visio amp Somatopraxis
VestibularProp
Bilateral Integration amp
Sequencing
Tactile amp
Visual Discrimination
Tactile Defensiveness
amp Attention
SIPT Factor Analysis
Mailloux etal 2011
n=278
SIPT Factor Analysis in South African Sample (Van Jaarsveld etal in press)
n=223 Convenience Sample
bull Factor 1
ndash Visuo and Somatodyspraxia
bull DC CPR SV MAc MFP KIN SPr PvVC SWB GRA
bull Factor 2
ndash Bilateral Integration and Sequencing
bull SPr BMC Opr SWB with lower loadings on PPr PrVC
bull Factor 3
ndash Tactile and Visual Discrimination
bull FI MFP LTS with moderate loadings on PrVC OPr
26 (c) 2014 Susanne Smith
Roley OTD
SIPT Factor Analysis in South African Sample (Van Jaarsveld etal in press)
27 (c) 2014 Susanne Smith
Roley OTD Figure 1 Loadings on three factors of final analysis
Lane AE etal (2010)
Sensory Profile Cluster Analysis 3 patterns of ASD sensory processing
Sensory-based inattentive seeking
under-responsive (milder)
Sensory modulation with movement sensitivity low energyweak poor endurance
Sensory modulation with tastesmell sensitivity
under and over-responsiveness with no movement issues more communication difficulties and maladaptive behaviors
Sensory subtypes predicted communication competence
and maladaptive behavior
Comprehensive Observation of Proprioception (COP) Factor Analyses
bull F1 Tone and Joint Alignment
ndash Joint hypermobility decreased tone poor joint alignment
bull F2 Behavioral Manifestations
ndash Pushing overactive crashing falling running
ndash Correlates with SPM bumping and pushing
bull F3 Postural Motor
ndash Decreased PC tendency to lean inefficient grading force inadequate weight bearing inefficient ankle strategies
ndash Correlates with SPM body awareness and SWB
bull F4 Motor Planning
ndash Decreased feedback planning decreased feedforward planning overly passive
ndash No correlation with SPM body awareness weak correlation with KIN and SWB
Blanche Bodison Chang amp Reinoso (2012)
29
(c) 2014 Susanne Smith Roley
OTD
Refining Assessment of Sensory Integrative Functions
Smith Roley 2014
Visual-Praxis
Vestibular Bilateral Integration
Proprioception Tactile
Somato- dyspraxia
Sensory Reactivity
(Modulation)
Visual motor
Postural
control
Gross
motor
skills
Praxis Arousal
Affect
Activity Level
Attention
Visual construction
Bilateral coordination
Sequencing
Fine motor skills
Auditory -Language
Organization of behavior
StateSelf Regulation
Smith Roley 2013
SENSORY INTEGRATION INTERVENTION
Intervention Planning Promoting neuroplasticity health and development
Smith Roley 2014
Implications for OTSI Intervention
Consistent with Neuroplasticity Literature
ndash Sensorimotor opportunities
ndash Control over activity
ndash Novelty
ndash Challenge
ndash Playful environment
ndash Lifelike context
Smith Roley 2014
Sensory Integration and Play
bull When the therapist is doing her job effectively and the child is organizing his nervous system it looks as if the child is merely playing rdquo ndash Ayres 1979
Smith Roley 2013
Ayres Sensory Integrationreg Intervention Fidelity Measure
Parham et al 2007 2011 2013-in press
ASIFM Structural elements ndash Part I Therapist Qualifications
ndash Part II Safe Environment
ndash Part III Record Review
ndash Part IV Space and Equipment
ndash Part V Communication with Parents amp Teachers
Smith Roley 2013
ASIFM Process Elements (Parham et al 2011)
1 Physical safety 2 Sensory opportunities
(vestibular tactile and proprioceptive)
3 Supports sensory modulation to attainmaintain a regulated state
4 Supports postural ocular oral or bilateral motor coordination
5 Challenges praxis and organization of behavior
6 Collaborative activity choice
7 Just Right Challenge
8 Ensures Success
9 Supports motivation to play
10 Establishes therapeutic alliance
Smith Roley 2013
Data-driven Intervention Process (Schaaf 2001 Schaaf amp Blanche 2012)
Participation challenges
Current behavior
Theoretical
Framework
Assessments
37
Hypotheses Interventions Outcomes
(c) 2014 Susanne Smith Roley
OTD
Grounds for Optimism
Four Common Misconceptions
in the Anti-SI Intervention Literature Clark 2012
1) Reviews critical of sensory integration
intervention research ignores issues of fidelity
and dosage
Smith Roley 2014
2) Reviewers ignore or minimize the available
positive evidence for SI intervention
bull 3 RCTrsquos with autism demonstrated positive results
following multisensory interventions (including SI
intervention) (Fazlioglu amp Baran 2008 Pfeiffer
Koenig Kinnealey Sheppard amp Henderson 2011
Smith Press Koenig amp Kinnealey 2005)
bull ldquoBased on the application of meta-analytic techniques
for cumulating probability values it is not hard to
conclude that sensory treatments have positive effects
when administered to children with ASDsrdquo Clark
2012
Smith Roley 2014
3) The lack of positive outcomes from SI Intervention may be due
to weak or poorly designed studies
bull Current studies suggest that with stronger and more
studies there will be consistent beneficial effects for
certain outcomes
bull ldquoThe challenge is to make these studies happenrdquo
Clark 2012
Smith Roley 2013
4) Critics often forget that a lack of solid evidence characterizes
nearly all interventions for children with ASDs
bull SI intervention is often held to a different standard
than other types of intervention failing to apply the
same criterion to alternate interventions
Clark 2012
Smith Roley 2014
Remaining Mysteries
Smith Roley 2013
Implications for Advocacy
People need breaks such as recess
People require sensorimotor and social play timespacevalue in the daily routine
Smith Roley 2014
Implications for Research on OT using Sensory Integration
Enhancing Neuroplasticity via Therapeutic Design
bull Dosage - Intensity of increased access in short time periods rather than small access over longer times
bull Engagement via play and not just exposure
bull Role of therapist in providing customized sensorimotor challenges
bull Access to safe dynamic and therapeutic environments vs predictable and static environments
bull The difference between practice for skill development and adaptation to challenges in changing environments
Smith Roley 2014
Implications for Sensory Integration in Practice
Most importantly the success of Sensory Integration in practice depends on
YOU
Smith Roley 2014
Thank You
bull Organizers and Participants
bull hyvaumlauml paumlivaumlnjatkoa
bull Enjoy the conference
Smith Roley 2013
bull Ayres AJ (2005) Sensory Integration and the Child Los Angeles CA Western Psychological Services bull Armstrong T (2006) The best schools How human development research should inform educational practice Alexandria
VA Association for Supervision and Curriculum Development bull Blanche E I Bodison S Chang M C amp Reinoso G (2012) Development of the comprehensive observations of
proprioception (COP) Validity reliability and factor analysis American Journal of Occupational Therapy 66 691ndash698 bull Bundy A amp Lane S (In press) Sensory integration theory and practice Third Ed Philsadelphia PA FA Davis Inc bull Casey T amp MacIntyre S (2007) Childrenrsquos need for time and space In T Casey (Ed) Environments for outdoor play A
practical guide to making space for children (pp 5 ndash 16) London Sage Publications httpwwwsagepubcomupm-data15553_CASEY_C01PDF
bull Gray P (2013) Play as preparation for learning and life American Journal of Play 5(3) 271 - 292 bull Greenough WR Black JE Wallace CS (1987) Experience and brain development Child Development 58(3)539-59 bull Lane AE Young RL Baker AEZ amp Angley MT (2010) Sensory processing subtypes in autism Association with adaptive behavior
Journal of Autism and Developmental Disorders 40 112-122
bull Lane SJ Schaaf RC (2010) Examining the neuroscience evidence for sensory-driven neuroplasticity implications for sensory-based occupational therapy for children and adolescents American Journal of Occupational Therapy 64(3)375-90
bull Mailloux Z Mulligan S Smith Roley S Cermak S Blanche E amp Bodison S Coleman G amp Lane C (2011) Verification and clarification of patterns of sensory integrative dysfunction in a retrospective clinical sample American Journal of Occupational Therapy 652 143-151
bull May A (2011) Experience-dependent structural plasticity in the adult human brain 1-8 Trends in Cognitive Sciences bull May-Benson TA Smith Roley S Mailloux Z Parham LD Koomar J Schaaf RC Van Jaarsveld AM amp Cohn E (in
press) Structural Elements of the Ayres Sensory Integrationreg Intervention Fidelity Measurecopy American Journal of Occupational Therapy
bull Milteer RM Ginsburg KR amp Council on Communications and Media Committee on Psychosocial Aspects of Child and Family Health (2011) Pediatrics e204-e213 DOI 101542peds2011-2953
bull Parham LD Cohn ES Spitzer S Koomar J Miller LJ Burke JP Brett-Green B Mailloux Z May-Benson T Smith Roley S Schaaf RC Schoen S amp Summers CA (2007) Fidelity in sensory integration intervention research American Journal of Occupational Therapy 61 2 216-227
bull Parham LD Smith Roley S May-Benson T Koomar J Brett-Green B Burke JP Cohn ES Mailloux Z Miller LJ amp Schaaf RC (2011) Development of a fidelity measure for research on effectiveness of Ayres Sensory Integrationreg intervention American Journal of Occupational Therapy 65 2 133-142
bull Reynolds S Lane SJ amp Richards L (2010) Using animal models of enriched environments to inform research on sensory integration intervention for the rehabilitation of neurodevelopmental disorders Journal of Neurodevelopmental Disorders 2( 3) 120-132 online first DOI 101007s11689-010-9053-4
bull Roley SS Mailloux Z Parham D Schaaf R Blanche E amp Lane CA Cermak S (in press) Sensory Integration and Praxis Patterns in Children with Autism American Journal of Occupational Therapy
bull Rosenzweig MR Bennet EL and Diamond MC (1972) Brain Changes in response to experience Scientific American 226(2) 22-29
bull Van Jaarsveld A Mailloux Z Smith Roley S amp Raubenheimer J (in press) Patterns of the sensory integration dysfunctions in South African children South African Journal of Occupational Therapy
bull Wills S Cabanlit M Bennett J Ashwood P Amaral DG amp Van de Water J (2009) Detection of autoantibodies to neural cells of the cerebellum in the plasma of subjects with autism spectrum disorders Brain Behavior and Immunity 23(1) 64-74
Sensory Integrative Processes
The senses Integration of their inputs End products
Auditory (hearing)
First level Second level Third level Fourth level
Vestibular
(gravity amp movement)
Proprioceptive
(muscles amp joints)
Tactile (touch)
Visual (seeing)
Speech
Language
eye movements
Posture
Balance
Muscle tone
Gravitational security
Sucking
Eating
Mother-infant bond
Tactile comfort
Body perception
Coordination of two
sides of the body
Motor planning
Activity level
Attention span
Emotional stability
Eye-hand
coordination
Visual perception
Purposeful activity
Ability to concentrate
Ability to organise
Self-esteem
Self-control
Self-confidence
Academic learning ability
Capacity for abstract
thought and reasoning
Specialization of each side
of the body and the brain
Published by WPSreg 1979 2005 (c) 2014 Smith Roley Singer amp Roley
Theory Updates
Example Symplexity Alain Berthoz (2012)
ldquoA very young baby can mimic the facial expressions of its parents even though it cannot
see its own face which would seem to suggest the existence of innate mechanism of intermodal
encoding and transfer between what is perceived and what is producedhellip
This embodiment of perception is a
fundamental mechanism of simplexityrdquo
Smith Roley 2013
Assessment Updates
Sensory Integration Patterns (Ayres 1965-1989)
bull Tactile amp motor planning deficits (1965 1966 1969 1972 1977 amp 1989)
bull Visual perceptionvisual praxis deficits (1965 1966 1969 1972 1977 amp 1989)
bull Vestibular postural amp bilateral deficits (1965 1966 1969 1972 1977 amp 1989)
bull Tactile defensiveness amp hyperactivitydistractibility (1965 1966 1969 1972)
bull Other factors (auditory language somatosensory perception) seen in some studies
(1969 1972 1977 1989)
Verification and Clarification of
Sensory Integration Patterns
Mulligan (1998)
Mailloux Mulligan Roley etal (2011)
Van Jaarsveld etal (in press)
Lane (2010)
Blanche etal (2012)
SIPT Factor Analysis
Mulligan 1998
n= 10475
Smith Roley 2014
PPR
PRVC
SV
CPR
MFP II
DC
MFP I
OPR
SWB
PRN
BMC
MAC
GRA
SPR
KIN
LTS
FG
FI
TD
ATTN
Visio amp Somatopraxis
VestibularProp
Bilateral Integration amp
Sequencing
Tactile amp
Visual Discrimination
Tactile Defensiveness
amp Attention
SIPT Factor Analysis
Mailloux etal 2011
n=278
SIPT Factor Analysis in South African Sample (Van Jaarsveld etal in press)
n=223 Convenience Sample
bull Factor 1
ndash Visuo and Somatodyspraxia
bull DC CPR SV MAc MFP KIN SPr PvVC SWB GRA
bull Factor 2
ndash Bilateral Integration and Sequencing
bull SPr BMC Opr SWB with lower loadings on PPr PrVC
bull Factor 3
ndash Tactile and Visual Discrimination
bull FI MFP LTS with moderate loadings on PrVC OPr
26 (c) 2014 Susanne Smith
Roley OTD
SIPT Factor Analysis in South African Sample (Van Jaarsveld etal in press)
27 (c) 2014 Susanne Smith
Roley OTD Figure 1 Loadings on three factors of final analysis
Lane AE etal (2010)
Sensory Profile Cluster Analysis 3 patterns of ASD sensory processing
Sensory-based inattentive seeking
under-responsive (milder)
Sensory modulation with movement sensitivity low energyweak poor endurance
Sensory modulation with tastesmell sensitivity
under and over-responsiveness with no movement issues more communication difficulties and maladaptive behaviors
Sensory subtypes predicted communication competence
and maladaptive behavior
Comprehensive Observation of Proprioception (COP) Factor Analyses
bull F1 Tone and Joint Alignment
ndash Joint hypermobility decreased tone poor joint alignment
bull F2 Behavioral Manifestations
ndash Pushing overactive crashing falling running
ndash Correlates with SPM bumping and pushing
bull F3 Postural Motor
ndash Decreased PC tendency to lean inefficient grading force inadequate weight bearing inefficient ankle strategies
ndash Correlates with SPM body awareness and SWB
bull F4 Motor Planning
ndash Decreased feedback planning decreased feedforward planning overly passive
ndash No correlation with SPM body awareness weak correlation with KIN and SWB
Blanche Bodison Chang amp Reinoso (2012)
29
(c) 2014 Susanne Smith Roley
OTD
Refining Assessment of Sensory Integrative Functions
Smith Roley 2014
Visual-Praxis
Vestibular Bilateral Integration
Proprioception Tactile
Somato- dyspraxia
Sensory Reactivity
(Modulation)
Visual motor
Postural
control
Gross
motor
skills
Praxis Arousal
Affect
Activity Level
Attention
Visual construction
Bilateral coordination
Sequencing
Fine motor skills
Auditory -Language
Organization of behavior
StateSelf Regulation
Smith Roley 2013
SENSORY INTEGRATION INTERVENTION
Intervention Planning Promoting neuroplasticity health and development
Smith Roley 2014
Implications for OTSI Intervention
Consistent with Neuroplasticity Literature
ndash Sensorimotor opportunities
ndash Control over activity
ndash Novelty
ndash Challenge
ndash Playful environment
ndash Lifelike context
Smith Roley 2014
Sensory Integration and Play
bull When the therapist is doing her job effectively and the child is organizing his nervous system it looks as if the child is merely playing rdquo ndash Ayres 1979
Smith Roley 2013
Ayres Sensory Integrationreg Intervention Fidelity Measure
Parham et al 2007 2011 2013-in press
ASIFM Structural elements ndash Part I Therapist Qualifications
ndash Part II Safe Environment
ndash Part III Record Review
ndash Part IV Space and Equipment
ndash Part V Communication with Parents amp Teachers
Smith Roley 2013
ASIFM Process Elements (Parham et al 2011)
1 Physical safety 2 Sensory opportunities
(vestibular tactile and proprioceptive)
3 Supports sensory modulation to attainmaintain a regulated state
4 Supports postural ocular oral or bilateral motor coordination
5 Challenges praxis and organization of behavior
6 Collaborative activity choice
7 Just Right Challenge
8 Ensures Success
9 Supports motivation to play
10 Establishes therapeutic alliance
Smith Roley 2013
Data-driven Intervention Process (Schaaf 2001 Schaaf amp Blanche 2012)
Participation challenges
Current behavior
Theoretical
Framework
Assessments
37
Hypotheses Interventions Outcomes
(c) 2014 Susanne Smith Roley
OTD
Grounds for Optimism
Four Common Misconceptions
in the Anti-SI Intervention Literature Clark 2012
1) Reviews critical of sensory integration
intervention research ignores issues of fidelity
and dosage
Smith Roley 2014
2) Reviewers ignore or minimize the available
positive evidence for SI intervention
bull 3 RCTrsquos with autism demonstrated positive results
following multisensory interventions (including SI
intervention) (Fazlioglu amp Baran 2008 Pfeiffer
Koenig Kinnealey Sheppard amp Henderson 2011
Smith Press Koenig amp Kinnealey 2005)
bull ldquoBased on the application of meta-analytic techniques
for cumulating probability values it is not hard to
conclude that sensory treatments have positive effects
when administered to children with ASDsrdquo Clark
2012
Smith Roley 2014
3) The lack of positive outcomes from SI Intervention may be due
to weak or poorly designed studies
bull Current studies suggest that with stronger and more
studies there will be consistent beneficial effects for
certain outcomes
bull ldquoThe challenge is to make these studies happenrdquo
Clark 2012
Smith Roley 2013
4) Critics often forget that a lack of solid evidence characterizes
nearly all interventions for children with ASDs
bull SI intervention is often held to a different standard
than other types of intervention failing to apply the
same criterion to alternate interventions
Clark 2012
Smith Roley 2014
Remaining Mysteries
Smith Roley 2013
Implications for Advocacy
People need breaks such as recess
People require sensorimotor and social play timespacevalue in the daily routine
Smith Roley 2014
Implications for Research on OT using Sensory Integration
Enhancing Neuroplasticity via Therapeutic Design
bull Dosage - Intensity of increased access in short time periods rather than small access over longer times
bull Engagement via play and not just exposure
bull Role of therapist in providing customized sensorimotor challenges
bull Access to safe dynamic and therapeutic environments vs predictable and static environments
bull The difference between practice for skill development and adaptation to challenges in changing environments
Smith Roley 2014
Implications for Sensory Integration in Practice
Most importantly the success of Sensory Integration in practice depends on
YOU
Smith Roley 2014
Thank You
bull Organizers and Participants
bull hyvaumlauml paumlivaumlnjatkoa
bull Enjoy the conference
Smith Roley 2013
bull Ayres AJ (2005) Sensory Integration and the Child Los Angeles CA Western Psychological Services bull Armstrong T (2006) The best schools How human development research should inform educational practice Alexandria
VA Association for Supervision and Curriculum Development bull Blanche E I Bodison S Chang M C amp Reinoso G (2012) Development of the comprehensive observations of
proprioception (COP) Validity reliability and factor analysis American Journal of Occupational Therapy 66 691ndash698 bull Bundy A amp Lane S (In press) Sensory integration theory and practice Third Ed Philsadelphia PA FA Davis Inc bull Casey T amp MacIntyre S (2007) Childrenrsquos need for time and space In T Casey (Ed) Environments for outdoor play A
practical guide to making space for children (pp 5 ndash 16) London Sage Publications httpwwwsagepubcomupm-data15553_CASEY_C01PDF
bull Gray P (2013) Play as preparation for learning and life American Journal of Play 5(3) 271 - 292 bull Greenough WR Black JE Wallace CS (1987) Experience and brain development Child Development 58(3)539-59 bull Lane AE Young RL Baker AEZ amp Angley MT (2010) Sensory processing subtypes in autism Association with adaptive behavior
Journal of Autism and Developmental Disorders 40 112-122
bull Lane SJ Schaaf RC (2010) Examining the neuroscience evidence for sensory-driven neuroplasticity implications for sensory-based occupational therapy for children and adolescents American Journal of Occupational Therapy 64(3)375-90
bull Mailloux Z Mulligan S Smith Roley S Cermak S Blanche E amp Bodison S Coleman G amp Lane C (2011) Verification and clarification of patterns of sensory integrative dysfunction in a retrospective clinical sample American Journal of Occupational Therapy 652 143-151
bull May A (2011) Experience-dependent structural plasticity in the adult human brain 1-8 Trends in Cognitive Sciences bull May-Benson TA Smith Roley S Mailloux Z Parham LD Koomar J Schaaf RC Van Jaarsveld AM amp Cohn E (in
press) Structural Elements of the Ayres Sensory Integrationreg Intervention Fidelity Measurecopy American Journal of Occupational Therapy
bull Milteer RM Ginsburg KR amp Council on Communications and Media Committee on Psychosocial Aspects of Child and Family Health (2011) Pediatrics e204-e213 DOI 101542peds2011-2953
bull Parham LD Cohn ES Spitzer S Koomar J Miller LJ Burke JP Brett-Green B Mailloux Z May-Benson T Smith Roley S Schaaf RC Schoen S amp Summers CA (2007) Fidelity in sensory integration intervention research American Journal of Occupational Therapy 61 2 216-227
bull Parham LD Smith Roley S May-Benson T Koomar J Brett-Green B Burke JP Cohn ES Mailloux Z Miller LJ amp Schaaf RC (2011) Development of a fidelity measure for research on effectiveness of Ayres Sensory Integrationreg intervention American Journal of Occupational Therapy 65 2 133-142
bull Reynolds S Lane SJ amp Richards L (2010) Using animal models of enriched environments to inform research on sensory integration intervention for the rehabilitation of neurodevelopmental disorders Journal of Neurodevelopmental Disorders 2( 3) 120-132 online first DOI 101007s11689-010-9053-4
bull Roley SS Mailloux Z Parham D Schaaf R Blanche E amp Lane CA Cermak S (in press) Sensory Integration and Praxis Patterns in Children with Autism American Journal of Occupational Therapy
bull Rosenzweig MR Bennet EL and Diamond MC (1972) Brain Changes in response to experience Scientific American 226(2) 22-29
bull Van Jaarsveld A Mailloux Z Smith Roley S amp Raubenheimer J (in press) Patterns of the sensory integration dysfunctions in South African children South African Journal of Occupational Therapy
bull Wills S Cabanlit M Bennett J Ashwood P Amaral DG amp Van de Water J (2009) Detection of autoantibodies to neural cells of the cerebellum in the plasma of subjects with autism spectrum disorders Brain Behavior and Immunity 23(1) 64-74
Theory Updates
Example Symplexity Alain Berthoz (2012)
ldquoA very young baby can mimic the facial expressions of its parents even though it cannot
see its own face which would seem to suggest the existence of innate mechanism of intermodal
encoding and transfer between what is perceived and what is producedhellip
This embodiment of perception is a
fundamental mechanism of simplexityrdquo
Smith Roley 2013
Assessment Updates
Sensory Integration Patterns (Ayres 1965-1989)
bull Tactile amp motor planning deficits (1965 1966 1969 1972 1977 amp 1989)
bull Visual perceptionvisual praxis deficits (1965 1966 1969 1972 1977 amp 1989)
bull Vestibular postural amp bilateral deficits (1965 1966 1969 1972 1977 amp 1989)
bull Tactile defensiveness amp hyperactivitydistractibility (1965 1966 1969 1972)
bull Other factors (auditory language somatosensory perception) seen in some studies
(1969 1972 1977 1989)
Verification and Clarification of
Sensory Integration Patterns
Mulligan (1998)
Mailloux Mulligan Roley etal (2011)
Van Jaarsveld etal (in press)
Lane (2010)
Blanche etal (2012)
SIPT Factor Analysis
Mulligan 1998
n= 10475
Smith Roley 2014
PPR
PRVC
SV
CPR
MFP II
DC
MFP I
OPR
SWB
PRN
BMC
MAC
GRA
SPR
KIN
LTS
FG
FI
TD
ATTN
Visio amp Somatopraxis
VestibularProp
Bilateral Integration amp
Sequencing
Tactile amp
Visual Discrimination
Tactile Defensiveness
amp Attention
SIPT Factor Analysis
Mailloux etal 2011
n=278
SIPT Factor Analysis in South African Sample (Van Jaarsveld etal in press)
n=223 Convenience Sample
bull Factor 1
ndash Visuo and Somatodyspraxia
bull DC CPR SV MAc MFP KIN SPr PvVC SWB GRA
bull Factor 2
ndash Bilateral Integration and Sequencing
bull SPr BMC Opr SWB with lower loadings on PPr PrVC
bull Factor 3
ndash Tactile and Visual Discrimination
bull FI MFP LTS with moderate loadings on PrVC OPr
26 (c) 2014 Susanne Smith
Roley OTD
SIPT Factor Analysis in South African Sample (Van Jaarsveld etal in press)
27 (c) 2014 Susanne Smith
Roley OTD Figure 1 Loadings on three factors of final analysis
Lane AE etal (2010)
Sensory Profile Cluster Analysis 3 patterns of ASD sensory processing
Sensory-based inattentive seeking
under-responsive (milder)
Sensory modulation with movement sensitivity low energyweak poor endurance
Sensory modulation with tastesmell sensitivity
under and over-responsiveness with no movement issues more communication difficulties and maladaptive behaviors
Sensory subtypes predicted communication competence
and maladaptive behavior
Comprehensive Observation of Proprioception (COP) Factor Analyses
bull F1 Tone and Joint Alignment
ndash Joint hypermobility decreased tone poor joint alignment
bull F2 Behavioral Manifestations
ndash Pushing overactive crashing falling running
ndash Correlates with SPM bumping and pushing
bull F3 Postural Motor
ndash Decreased PC tendency to lean inefficient grading force inadequate weight bearing inefficient ankle strategies
ndash Correlates with SPM body awareness and SWB
bull F4 Motor Planning
ndash Decreased feedback planning decreased feedforward planning overly passive
ndash No correlation with SPM body awareness weak correlation with KIN and SWB
Blanche Bodison Chang amp Reinoso (2012)
29
(c) 2014 Susanne Smith Roley
OTD
Refining Assessment of Sensory Integrative Functions
Smith Roley 2014
Visual-Praxis
Vestibular Bilateral Integration
Proprioception Tactile
Somato- dyspraxia
Sensory Reactivity
(Modulation)
Visual motor
Postural
control
Gross
motor
skills
Praxis Arousal
Affect
Activity Level
Attention
Visual construction
Bilateral coordination
Sequencing
Fine motor skills
Auditory -Language
Organization of behavior
StateSelf Regulation
Smith Roley 2013
SENSORY INTEGRATION INTERVENTION
Intervention Planning Promoting neuroplasticity health and development
Smith Roley 2014
Implications for OTSI Intervention
Consistent with Neuroplasticity Literature
ndash Sensorimotor opportunities
ndash Control over activity
ndash Novelty
ndash Challenge
ndash Playful environment
ndash Lifelike context
Smith Roley 2014
Sensory Integration and Play
bull When the therapist is doing her job effectively and the child is organizing his nervous system it looks as if the child is merely playing rdquo ndash Ayres 1979
Smith Roley 2013
Ayres Sensory Integrationreg Intervention Fidelity Measure
Parham et al 2007 2011 2013-in press
ASIFM Structural elements ndash Part I Therapist Qualifications
ndash Part II Safe Environment
ndash Part III Record Review
ndash Part IV Space and Equipment
ndash Part V Communication with Parents amp Teachers
Smith Roley 2013
ASIFM Process Elements (Parham et al 2011)
1 Physical safety 2 Sensory opportunities
(vestibular tactile and proprioceptive)
3 Supports sensory modulation to attainmaintain a regulated state
4 Supports postural ocular oral or bilateral motor coordination
5 Challenges praxis and organization of behavior
6 Collaborative activity choice
7 Just Right Challenge
8 Ensures Success
9 Supports motivation to play
10 Establishes therapeutic alliance
Smith Roley 2013
Data-driven Intervention Process (Schaaf 2001 Schaaf amp Blanche 2012)
Participation challenges
Current behavior
Theoretical
Framework
Assessments
37
Hypotheses Interventions Outcomes
(c) 2014 Susanne Smith Roley
OTD
Grounds for Optimism
Four Common Misconceptions
in the Anti-SI Intervention Literature Clark 2012
1) Reviews critical of sensory integration
intervention research ignores issues of fidelity
and dosage
Smith Roley 2014
2) Reviewers ignore or minimize the available
positive evidence for SI intervention
bull 3 RCTrsquos with autism demonstrated positive results
following multisensory interventions (including SI
intervention) (Fazlioglu amp Baran 2008 Pfeiffer
Koenig Kinnealey Sheppard amp Henderson 2011
Smith Press Koenig amp Kinnealey 2005)
bull ldquoBased on the application of meta-analytic techniques
for cumulating probability values it is not hard to
conclude that sensory treatments have positive effects
when administered to children with ASDsrdquo Clark
2012
Smith Roley 2014
3) The lack of positive outcomes from SI Intervention may be due
to weak or poorly designed studies
bull Current studies suggest that with stronger and more
studies there will be consistent beneficial effects for
certain outcomes
bull ldquoThe challenge is to make these studies happenrdquo
Clark 2012
Smith Roley 2013
4) Critics often forget that a lack of solid evidence characterizes
nearly all interventions for children with ASDs
bull SI intervention is often held to a different standard
than other types of intervention failing to apply the
same criterion to alternate interventions
Clark 2012
Smith Roley 2014
Remaining Mysteries
Smith Roley 2013
Implications for Advocacy
People need breaks such as recess
People require sensorimotor and social play timespacevalue in the daily routine
Smith Roley 2014
Implications for Research on OT using Sensory Integration
Enhancing Neuroplasticity via Therapeutic Design
bull Dosage - Intensity of increased access in short time periods rather than small access over longer times
bull Engagement via play and not just exposure
bull Role of therapist in providing customized sensorimotor challenges
bull Access to safe dynamic and therapeutic environments vs predictable and static environments
bull The difference between practice for skill development and adaptation to challenges in changing environments
Smith Roley 2014
Implications for Sensory Integration in Practice
Most importantly the success of Sensory Integration in practice depends on
YOU
Smith Roley 2014
Thank You
bull Organizers and Participants
bull hyvaumlauml paumlivaumlnjatkoa
bull Enjoy the conference
Smith Roley 2013
bull Ayres AJ (2005) Sensory Integration and the Child Los Angeles CA Western Psychological Services bull Armstrong T (2006) The best schools How human development research should inform educational practice Alexandria
VA Association for Supervision and Curriculum Development bull Blanche E I Bodison S Chang M C amp Reinoso G (2012) Development of the comprehensive observations of
proprioception (COP) Validity reliability and factor analysis American Journal of Occupational Therapy 66 691ndash698 bull Bundy A amp Lane S (In press) Sensory integration theory and practice Third Ed Philsadelphia PA FA Davis Inc bull Casey T amp MacIntyre S (2007) Childrenrsquos need for time and space In T Casey (Ed) Environments for outdoor play A
practical guide to making space for children (pp 5 ndash 16) London Sage Publications httpwwwsagepubcomupm-data15553_CASEY_C01PDF
bull Gray P (2013) Play as preparation for learning and life American Journal of Play 5(3) 271 - 292 bull Greenough WR Black JE Wallace CS (1987) Experience and brain development Child Development 58(3)539-59 bull Lane AE Young RL Baker AEZ amp Angley MT (2010) Sensory processing subtypes in autism Association with adaptive behavior
Journal of Autism and Developmental Disorders 40 112-122
bull Lane SJ Schaaf RC (2010) Examining the neuroscience evidence for sensory-driven neuroplasticity implications for sensory-based occupational therapy for children and adolescents American Journal of Occupational Therapy 64(3)375-90
bull Mailloux Z Mulligan S Smith Roley S Cermak S Blanche E amp Bodison S Coleman G amp Lane C (2011) Verification and clarification of patterns of sensory integrative dysfunction in a retrospective clinical sample American Journal of Occupational Therapy 652 143-151
bull May A (2011) Experience-dependent structural plasticity in the adult human brain 1-8 Trends in Cognitive Sciences bull May-Benson TA Smith Roley S Mailloux Z Parham LD Koomar J Schaaf RC Van Jaarsveld AM amp Cohn E (in
press) Structural Elements of the Ayres Sensory Integrationreg Intervention Fidelity Measurecopy American Journal of Occupational Therapy
bull Milteer RM Ginsburg KR amp Council on Communications and Media Committee on Psychosocial Aspects of Child and Family Health (2011) Pediatrics e204-e213 DOI 101542peds2011-2953
bull Parham LD Cohn ES Spitzer S Koomar J Miller LJ Burke JP Brett-Green B Mailloux Z May-Benson T Smith Roley S Schaaf RC Schoen S amp Summers CA (2007) Fidelity in sensory integration intervention research American Journal of Occupational Therapy 61 2 216-227
bull Parham LD Smith Roley S May-Benson T Koomar J Brett-Green B Burke JP Cohn ES Mailloux Z Miller LJ amp Schaaf RC (2011) Development of a fidelity measure for research on effectiveness of Ayres Sensory Integrationreg intervention American Journal of Occupational Therapy 65 2 133-142
bull Reynolds S Lane SJ amp Richards L (2010) Using animal models of enriched environments to inform research on sensory integration intervention for the rehabilitation of neurodevelopmental disorders Journal of Neurodevelopmental Disorders 2( 3) 120-132 online first DOI 101007s11689-010-9053-4
bull Roley SS Mailloux Z Parham D Schaaf R Blanche E amp Lane CA Cermak S (in press) Sensory Integration and Praxis Patterns in Children with Autism American Journal of Occupational Therapy
bull Rosenzweig MR Bennet EL and Diamond MC (1972) Brain Changes in response to experience Scientific American 226(2) 22-29
bull Van Jaarsveld A Mailloux Z Smith Roley S amp Raubenheimer J (in press) Patterns of the sensory integration dysfunctions in South African children South African Journal of Occupational Therapy
bull Wills S Cabanlit M Bennett J Ashwood P Amaral DG amp Van de Water J (2009) Detection of autoantibodies to neural cells of the cerebellum in the plasma of subjects with autism spectrum disorders Brain Behavior and Immunity 23(1) 64-74
Assessment Updates
Sensory Integration Patterns (Ayres 1965-1989)
bull Tactile amp motor planning deficits (1965 1966 1969 1972 1977 amp 1989)
bull Visual perceptionvisual praxis deficits (1965 1966 1969 1972 1977 amp 1989)
bull Vestibular postural amp bilateral deficits (1965 1966 1969 1972 1977 amp 1989)
bull Tactile defensiveness amp hyperactivitydistractibility (1965 1966 1969 1972)
bull Other factors (auditory language somatosensory perception) seen in some studies
(1969 1972 1977 1989)
Verification and Clarification of
Sensory Integration Patterns
Mulligan (1998)
Mailloux Mulligan Roley etal (2011)
Van Jaarsveld etal (in press)
Lane (2010)
Blanche etal (2012)
SIPT Factor Analysis
Mulligan 1998
n= 10475
Smith Roley 2014
PPR
PRVC
SV
CPR
MFP II
DC
MFP I
OPR
SWB
PRN
BMC
MAC
GRA
SPR
KIN
LTS
FG
FI
TD
ATTN
Visio amp Somatopraxis
VestibularProp
Bilateral Integration amp
Sequencing
Tactile amp
Visual Discrimination
Tactile Defensiveness
amp Attention
SIPT Factor Analysis
Mailloux etal 2011
n=278
SIPT Factor Analysis in South African Sample (Van Jaarsveld etal in press)
n=223 Convenience Sample
bull Factor 1
ndash Visuo and Somatodyspraxia
bull DC CPR SV MAc MFP KIN SPr PvVC SWB GRA
bull Factor 2
ndash Bilateral Integration and Sequencing
bull SPr BMC Opr SWB with lower loadings on PPr PrVC
bull Factor 3
ndash Tactile and Visual Discrimination
bull FI MFP LTS with moderate loadings on PrVC OPr
26 (c) 2014 Susanne Smith
Roley OTD
SIPT Factor Analysis in South African Sample (Van Jaarsveld etal in press)
27 (c) 2014 Susanne Smith
Roley OTD Figure 1 Loadings on three factors of final analysis
Lane AE etal (2010)
Sensory Profile Cluster Analysis 3 patterns of ASD sensory processing
Sensory-based inattentive seeking
under-responsive (milder)
Sensory modulation with movement sensitivity low energyweak poor endurance
Sensory modulation with tastesmell sensitivity
under and over-responsiveness with no movement issues more communication difficulties and maladaptive behaviors
Sensory subtypes predicted communication competence
and maladaptive behavior
Comprehensive Observation of Proprioception (COP) Factor Analyses
bull F1 Tone and Joint Alignment
ndash Joint hypermobility decreased tone poor joint alignment
bull F2 Behavioral Manifestations
ndash Pushing overactive crashing falling running
ndash Correlates with SPM bumping and pushing
bull F3 Postural Motor
ndash Decreased PC tendency to lean inefficient grading force inadequate weight bearing inefficient ankle strategies
ndash Correlates with SPM body awareness and SWB
bull F4 Motor Planning
ndash Decreased feedback planning decreased feedforward planning overly passive
ndash No correlation with SPM body awareness weak correlation with KIN and SWB
Blanche Bodison Chang amp Reinoso (2012)
29
(c) 2014 Susanne Smith Roley
OTD
Refining Assessment of Sensory Integrative Functions
Smith Roley 2014
Visual-Praxis
Vestibular Bilateral Integration
Proprioception Tactile
Somato- dyspraxia
Sensory Reactivity
(Modulation)
Visual motor
Postural
control
Gross
motor
skills
Praxis Arousal
Affect
Activity Level
Attention
Visual construction
Bilateral coordination
Sequencing
Fine motor skills
Auditory -Language
Organization of behavior
StateSelf Regulation
Smith Roley 2013
SENSORY INTEGRATION INTERVENTION
Intervention Planning Promoting neuroplasticity health and development
Smith Roley 2014
Implications for OTSI Intervention
Consistent with Neuroplasticity Literature
ndash Sensorimotor opportunities
ndash Control over activity
ndash Novelty
ndash Challenge
ndash Playful environment
ndash Lifelike context
Smith Roley 2014
Sensory Integration and Play
bull When the therapist is doing her job effectively and the child is organizing his nervous system it looks as if the child is merely playing rdquo ndash Ayres 1979
Smith Roley 2013
Ayres Sensory Integrationreg Intervention Fidelity Measure
Parham et al 2007 2011 2013-in press
ASIFM Structural elements ndash Part I Therapist Qualifications
ndash Part II Safe Environment
ndash Part III Record Review
ndash Part IV Space and Equipment
ndash Part V Communication with Parents amp Teachers
Smith Roley 2013
ASIFM Process Elements (Parham et al 2011)
1 Physical safety 2 Sensory opportunities
(vestibular tactile and proprioceptive)
3 Supports sensory modulation to attainmaintain a regulated state
4 Supports postural ocular oral or bilateral motor coordination
5 Challenges praxis and organization of behavior
6 Collaborative activity choice
7 Just Right Challenge
8 Ensures Success
9 Supports motivation to play
10 Establishes therapeutic alliance
Smith Roley 2013
Data-driven Intervention Process (Schaaf 2001 Schaaf amp Blanche 2012)
Participation challenges
Current behavior
Theoretical
Framework
Assessments
37
Hypotheses Interventions Outcomes
(c) 2014 Susanne Smith Roley
OTD
Grounds for Optimism
Four Common Misconceptions
in the Anti-SI Intervention Literature Clark 2012
1) Reviews critical of sensory integration
intervention research ignores issues of fidelity
and dosage
Smith Roley 2014
2) Reviewers ignore or minimize the available
positive evidence for SI intervention
bull 3 RCTrsquos with autism demonstrated positive results
following multisensory interventions (including SI
intervention) (Fazlioglu amp Baran 2008 Pfeiffer
Koenig Kinnealey Sheppard amp Henderson 2011
Smith Press Koenig amp Kinnealey 2005)
bull ldquoBased on the application of meta-analytic techniques
for cumulating probability values it is not hard to
conclude that sensory treatments have positive effects
when administered to children with ASDsrdquo Clark
2012
Smith Roley 2014
3) The lack of positive outcomes from SI Intervention may be due
to weak or poorly designed studies
bull Current studies suggest that with stronger and more
studies there will be consistent beneficial effects for
certain outcomes
bull ldquoThe challenge is to make these studies happenrdquo
Clark 2012
Smith Roley 2013
4) Critics often forget that a lack of solid evidence characterizes
nearly all interventions for children with ASDs
bull SI intervention is often held to a different standard
than other types of intervention failing to apply the
same criterion to alternate interventions
Clark 2012
Smith Roley 2014
Remaining Mysteries
Smith Roley 2013
Implications for Advocacy
People need breaks such as recess
People require sensorimotor and social play timespacevalue in the daily routine
Smith Roley 2014
Implications for Research on OT using Sensory Integration
Enhancing Neuroplasticity via Therapeutic Design
bull Dosage - Intensity of increased access in short time periods rather than small access over longer times
bull Engagement via play and not just exposure
bull Role of therapist in providing customized sensorimotor challenges
bull Access to safe dynamic and therapeutic environments vs predictable and static environments
bull The difference between practice for skill development and adaptation to challenges in changing environments
Smith Roley 2014
Implications for Sensory Integration in Practice
Most importantly the success of Sensory Integration in practice depends on
YOU
Smith Roley 2014
Thank You
bull Organizers and Participants
bull hyvaumlauml paumlivaumlnjatkoa
bull Enjoy the conference
Smith Roley 2013
bull Ayres AJ (2005) Sensory Integration and the Child Los Angeles CA Western Psychological Services bull Armstrong T (2006) The best schools How human development research should inform educational practice Alexandria
VA Association for Supervision and Curriculum Development bull Blanche E I Bodison S Chang M C amp Reinoso G (2012) Development of the comprehensive observations of
proprioception (COP) Validity reliability and factor analysis American Journal of Occupational Therapy 66 691ndash698 bull Bundy A amp Lane S (In press) Sensory integration theory and practice Third Ed Philsadelphia PA FA Davis Inc bull Casey T amp MacIntyre S (2007) Childrenrsquos need for time and space In T Casey (Ed) Environments for outdoor play A
practical guide to making space for children (pp 5 ndash 16) London Sage Publications httpwwwsagepubcomupm-data15553_CASEY_C01PDF
bull Gray P (2013) Play as preparation for learning and life American Journal of Play 5(3) 271 - 292 bull Greenough WR Black JE Wallace CS (1987) Experience and brain development Child Development 58(3)539-59 bull Lane AE Young RL Baker AEZ amp Angley MT (2010) Sensory processing subtypes in autism Association with adaptive behavior
Journal of Autism and Developmental Disorders 40 112-122
bull Lane SJ Schaaf RC (2010) Examining the neuroscience evidence for sensory-driven neuroplasticity implications for sensory-based occupational therapy for children and adolescents American Journal of Occupational Therapy 64(3)375-90
bull Mailloux Z Mulligan S Smith Roley S Cermak S Blanche E amp Bodison S Coleman G amp Lane C (2011) Verification and clarification of patterns of sensory integrative dysfunction in a retrospective clinical sample American Journal of Occupational Therapy 652 143-151
bull May A (2011) Experience-dependent structural plasticity in the adult human brain 1-8 Trends in Cognitive Sciences bull May-Benson TA Smith Roley S Mailloux Z Parham LD Koomar J Schaaf RC Van Jaarsveld AM amp Cohn E (in
press) Structural Elements of the Ayres Sensory Integrationreg Intervention Fidelity Measurecopy American Journal of Occupational Therapy
bull Milteer RM Ginsburg KR amp Council on Communications and Media Committee on Psychosocial Aspects of Child and Family Health (2011) Pediatrics e204-e213 DOI 101542peds2011-2953
bull Parham LD Cohn ES Spitzer S Koomar J Miller LJ Burke JP Brett-Green B Mailloux Z May-Benson T Smith Roley S Schaaf RC Schoen S amp Summers CA (2007) Fidelity in sensory integration intervention research American Journal of Occupational Therapy 61 2 216-227
bull Parham LD Smith Roley S May-Benson T Koomar J Brett-Green B Burke JP Cohn ES Mailloux Z Miller LJ amp Schaaf RC (2011) Development of a fidelity measure for research on effectiveness of Ayres Sensory Integrationreg intervention American Journal of Occupational Therapy 65 2 133-142
bull Reynolds S Lane SJ amp Richards L (2010) Using animal models of enriched environments to inform research on sensory integration intervention for the rehabilitation of neurodevelopmental disorders Journal of Neurodevelopmental Disorders 2( 3) 120-132 online first DOI 101007s11689-010-9053-4
bull Roley SS Mailloux Z Parham D Schaaf R Blanche E amp Lane CA Cermak S (in press) Sensory Integration and Praxis Patterns in Children with Autism American Journal of Occupational Therapy
bull Rosenzweig MR Bennet EL and Diamond MC (1972) Brain Changes in response to experience Scientific American 226(2) 22-29
bull Van Jaarsveld A Mailloux Z Smith Roley S amp Raubenheimer J (in press) Patterns of the sensory integration dysfunctions in South African children South African Journal of Occupational Therapy
bull Wills S Cabanlit M Bennett J Ashwood P Amaral DG amp Van de Water J (2009) Detection of autoantibodies to neural cells of the cerebellum in the plasma of subjects with autism spectrum disorders Brain Behavior and Immunity 23(1) 64-74
Verification and Clarification of
Sensory Integration Patterns
Mulligan (1998)
Mailloux Mulligan Roley etal (2011)
Van Jaarsveld etal (in press)
Lane (2010)
Blanche etal (2012)
SIPT Factor Analysis
Mulligan 1998
n= 10475
Smith Roley 2014
PPR
PRVC
SV
CPR
MFP II
DC
MFP I
OPR
SWB
PRN
BMC
MAC
GRA
SPR
KIN
LTS
FG
FI
TD
ATTN
Visio amp Somatopraxis
VestibularProp
Bilateral Integration amp
Sequencing
Tactile amp
Visual Discrimination
Tactile Defensiveness
amp Attention
SIPT Factor Analysis
Mailloux etal 2011
n=278
SIPT Factor Analysis in South African Sample (Van Jaarsveld etal in press)
n=223 Convenience Sample
bull Factor 1
ndash Visuo and Somatodyspraxia
bull DC CPR SV MAc MFP KIN SPr PvVC SWB GRA
bull Factor 2
ndash Bilateral Integration and Sequencing
bull SPr BMC Opr SWB with lower loadings on PPr PrVC
bull Factor 3
ndash Tactile and Visual Discrimination
bull FI MFP LTS with moderate loadings on PrVC OPr
26 (c) 2014 Susanne Smith
Roley OTD
SIPT Factor Analysis in South African Sample (Van Jaarsveld etal in press)
27 (c) 2014 Susanne Smith
Roley OTD Figure 1 Loadings on three factors of final analysis
Lane AE etal (2010)
Sensory Profile Cluster Analysis 3 patterns of ASD sensory processing
Sensory-based inattentive seeking
under-responsive (milder)
Sensory modulation with movement sensitivity low energyweak poor endurance
Sensory modulation with tastesmell sensitivity
under and over-responsiveness with no movement issues more communication difficulties and maladaptive behaviors
Sensory subtypes predicted communication competence
and maladaptive behavior
Comprehensive Observation of Proprioception (COP) Factor Analyses
bull F1 Tone and Joint Alignment
ndash Joint hypermobility decreased tone poor joint alignment
bull F2 Behavioral Manifestations
ndash Pushing overactive crashing falling running
ndash Correlates with SPM bumping and pushing
bull F3 Postural Motor
ndash Decreased PC tendency to lean inefficient grading force inadequate weight bearing inefficient ankle strategies
ndash Correlates with SPM body awareness and SWB
bull F4 Motor Planning
ndash Decreased feedback planning decreased feedforward planning overly passive
ndash No correlation with SPM body awareness weak correlation with KIN and SWB
Blanche Bodison Chang amp Reinoso (2012)
29
(c) 2014 Susanne Smith Roley
OTD
Refining Assessment of Sensory Integrative Functions
Smith Roley 2014
Visual-Praxis
Vestibular Bilateral Integration
Proprioception Tactile
Somato- dyspraxia
Sensory Reactivity
(Modulation)
Visual motor
Postural
control
Gross
motor
skills
Praxis Arousal
Affect
Activity Level
Attention
Visual construction
Bilateral coordination
Sequencing
Fine motor skills
Auditory -Language
Organization of behavior
StateSelf Regulation
Smith Roley 2013
SENSORY INTEGRATION INTERVENTION
Intervention Planning Promoting neuroplasticity health and development
Smith Roley 2014
Implications for OTSI Intervention
Consistent with Neuroplasticity Literature
ndash Sensorimotor opportunities
ndash Control over activity
ndash Novelty
ndash Challenge
ndash Playful environment
ndash Lifelike context
Smith Roley 2014
Sensory Integration and Play
bull When the therapist is doing her job effectively and the child is organizing his nervous system it looks as if the child is merely playing rdquo ndash Ayres 1979
Smith Roley 2013
Ayres Sensory Integrationreg Intervention Fidelity Measure
Parham et al 2007 2011 2013-in press
ASIFM Structural elements ndash Part I Therapist Qualifications
ndash Part II Safe Environment
ndash Part III Record Review
ndash Part IV Space and Equipment
ndash Part V Communication with Parents amp Teachers
Smith Roley 2013
ASIFM Process Elements (Parham et al 2011)
1 Physical safety 2 Sensory opportunities
(vestibular tactile and proprioceptive)
3 Supports sensory modulation to attainmaintain a regulated state
4 Supports postural ocular oral or bilateral motor coordination
5 Challenges praxis and organization of behavior
6 Collaborative activity choice
7 Just Right Challenge
8 Ensures Success
9 Supports motivation to play
10 Establishes therapeutic alliance
Smith Roley 2013
Data-driven Intervention Process (Schaaf 2001 Schaaf amp Blanche 2012)
Participation challenges
Current behavior
Theoretical
Framework
Assessments
37
Hypotheses Interventions Outcomes
(c) 2014 Susanne Smith Roley
OTD
Grounds for Optimism
Four Common Misconceptions
in the Anti-SI Intervention Literature Clark 2012
1) Reviews critical of sensory integration
intervention research ignores issues of fidelity
and dosage
Smith Roley 2014
2) Reviewers ignore or minimize the available
positive evidence for SI intervention
bull 3 RCTrsquos with autism demonstrated positive results
following multisensory interventions (including SI
intervention) (Fazlioglu amp Baran 2008 Pfeiffer
Koenig Kinnealey Sheppard amp Henderson 2011
Smith Press Koenig amp Kinnealey 2005)
bull ldquoBased on the application of meta-analytic techniques
for cumulating probability values it is not hard to
conclude that sensory treatments have positive effects
when administered to children with ASDsrdquo Clark
2012
Smith Roley 2014
3) The lack of positive outcomes from SI Intervention may be due
to weak or poorly designed studies
bull Current studies suggest that with stronger and more
studies there will be consistent beneficial effects for
certain outcomes
bull ldquoThe challenge is to make these studies happenrdquo
Clark 2012
Smith Roley 2013
4) Critics often forget that a lack of solid evidence characterizes
nearly all interventions for children with ASDs
bull SI intervention is often held to a different standard
than other types of intervention failing to apply the
same criterion to alternate interventions
Clark 2012
Smith Roley 2014
Remaining Mysteries
Smith Roley 2013
Implications for Advocacy
People need breaks such as recess
People require sensorimotor and social play timespacevalue in the daily routine
Smith Roley 2014
Implications for Research on OT using Sensory Integration
Enhancing Neuroplasticity via Therapeutic Design
bull Dosage - Intensity of increased access in short time periods rather than small access over longer times
bull Engagement via play and not just exposure
bull Role of therapist in providing customized sensorimotor challenges
bull Access to safe dynamic and therapeutic environments vs predictable and static environments
bull The difference between practice for skill development and adaptation to challenges in changing environments
Smith Roley 2014
Implications for Sensory Integration in Practice
Most importantly the success of Sensory Integration in practice depends on
YOU
Smith Roley 2014
Thank You
bull Organizers and Participants
bull hyvaumlauml paumlivaumlnjatkoa
bull Enjoy the conference
Smith Roley 2013
bull Ayres AJ (2005) Sensory Integration and the Child Los Angeles CA Western Psychological Services bull Armstrong T (2006) The best schools How human development research should inform educational practice Alexandria
VA Association for Supervision and Curriculum Development bull Blanche E I Bodison S Chang M C amp Reinoso G (2012) Development of the comprehensive observations of
proprioception (COP) Validity reliability and factor analysis American Journal of Occupational Therapy 66 691ndash698 bull Bundy A amp Lane S (In press) Sensory integration theory and practice Third Ed Philsadelphia PA FA Davis Inc bull Casey T amp MacIntyre S (2007) Childrenrsquos need for time and space In T Casey (Ed) Environments for outdoor play A
practical guide to making space for children (pp 5 ndash 16) London Sage Publications httpwwwsagepubcomupm-data15553_CASEY_C01PDF
bull Gray P (2013) Play as preparation for learning and life American Journal of Play 5(3) 271 - 292 bull Greenough WR Black JE Wallace CS (1987) Experience and brain development Child Development 58(3)539-59 bull Lane AE Young RL Baker AEZ amp Angley MT (2010) Sensory processing subtypes in autism Association with adaptive behavior
Journal of Autism and Developmental Disorders 40 112-122
bull Lane SJ Schaaf RC (2010) Examining the neuroscience evidence for sensory-driven neuroplasticity implications for sensory-based occupational therapy for children and adolescents American Journal of Occupational Therapy 64(3)375-90
bull Mailloux Z Mulligan S Smith Roley S Cermak S Blanche E amp Bodison S Coleman G amp Lane C (2011) Verification and clarification of patterns of sensory integrative dysfunction in a retrospective clinical sample American Journal of Occupational Therapy 652 143-151
bull May A (2011) Experience-dependent structural plasticity in the adult human brain 1-8 Trends in Cognitive Sciences bull May-Benson TA Smith Roley S Mailloux Z Parham LD Koomar J Schaaf RC Van Jaarsveld AM amp Cohn E (in
press) Structural Elements of the Ayres Sensory Integrationreg Intervention Fidelity Measurecopy American Journal of Occupational Therapy
bull Milteer RM Ginsburg KR amp Council on Communications and Media Committee on Psychosocial Aspects of Child and Family Health (2011) Pediatrics e204-e213 DOI 101542peds2011-2953
bull Parham LD Cohn ES Spitzer S Koomar J Miller LJ Burke JP Brett-Green B Mailloux Z May-Benson T Smith Roley S Schaaf RC Schoen S amp Summers CA (2007) Fidelity in sensory integration intervention research American Journal of Occupational Therapy 61 2 216-227
bull Parham LD Smith Roley S May-Benson T Koomar J Brett-Green B Burke JP Cohn ES Mailloux Z Miller LJ amp Schaaf RC (2011) Development of a fidelity measure for research on effectiveness of Ayres Sensory Integrationreg intervention American Journal of Occupational Therapy 65 2 133-142
bull Reynolds S Lane SJ amp Richards L (2010) Using animal models of enriched environments to inform research on sensory integration intervention for the rehabilitation of neurodevelopmental disorders Journal of Neurodevelopmental Disorders 2( 3) 120-132 online first DOI 101007s11689-010-9053-4
bull Roley SS Mailloux Z Parham D Schaaf R Blanche E amp Lane CA Cermak S (in press) Sensory Integration and Praxis Patterns in Children with Autism American Journal of Occupational Therapy
bull Rosenzweig MR Bennet EL and Diamond MC (1972) Brain Changes in response to experience Scientific American 226(2) 22-29
bull Van Jaarsveld A Mailloux Z Smith Roley S amp Raubenheimer J (in press) Patterns of the sensory integration dysfunctions in South African children South African Journal of Occupational Therapy
bull Wills S Cabanlit M Bennett J Ashwood P Amaral DG amp Van de Water J (2009) Detection of autoantibodies to neural cells of the cerebellum in the plasma of subjects with autism spectrum disorders Brain Behavior and Immunity 23(1) 64-74
SIPT Factor Analysis
Mulligan 1998
n= 10475
Smith Roley 2014
PPR
PRVC
SV
CPR
MFP II
DC
MFP I
OPR
SWB
PRN
BMC
MAC
GRA
SPR
KIN
LTS
FG
FI
TD
ATTN
Visio amp Somatopraxis
VestibularProp
Bilateral Integration amp
Sequencing
Tactile amp
Visual Discrimination
Tactile Defensiveness
amp Attention
SIPT Factor Analysis
Mailloux etal 2011
n=278
SIPT Factor Analysis in South African Sample (Van Jaarsveld etal in press)
n=223 Convenience Sample
bull Factor 1
ndash Visuo and Somatodyspraxia
bull DC CPR SV MAc MFP KIN SPr PvVC SWB GRA
bull Factor 2
ndash Bilateral Integration and Sequencing
bull SPr BMC Opr SWB with lower loadings on PPr PrVC
bull Factor 3
ndash Tactile and Visual Discrimination
bull FI MFP LTS with moderate loadings on PrVC OPr
26 (c) 2014 Susanne Smith
Roley OTD
SIPT Factor Analysis in South African Sample (Van Jaarsveld etal in press)
27 (c) 2014 Susanne Smith
Roley OTD Figure 1 Loadings on three factors of final analysis
Lane AE etal (2010)
Sensory Profile Cluster Analysis 3 patterns of ASD sensory processing
Sensory-based inattentive seeking
under-responsive (milder)
Sensory modulation with movement sensitivity low energyweak poor endurance
Sensory modulation with tastesmell sensitivity
under and over-responsiveness with no movement issues more communication difficulties and maladaptive behaviors
Sensory subtypes predicted communication competence
and maladaptive behavior
Comprehensive Observation of Proprioception (COP) Factor Analyses
bull F1 Tone and Joint Alignment
ndash Joint hypermobility decreased tone poor joint alignment
bull F2 Behavioral Manifestations
ndash Pushing overactive crashing falling running
ndash Correlates with SPM bumping and pushing
bull F3 Postural Motor
ndash Decreased PC tendency to lean inefficient grading force inadequate weight bearing inefficient ankle strategies
ndash Correlates with SPM body awareness and SWB
bull F4 Motor Planning
ndash Decreased feedback planning decreased feedforward planning overly passive
ndash No correlation with SPM body awareness weak correlation with KIN and SWB
Blanche Bodison Chang amp Reinoso (2012)
29
(c) 2014 Susanne Smith Roley
OTD
Refining Assessment of Sensory Integrative Functions
Smith Roley 2014
Visual-Praxis
Vestibular Bilateral Integration
Proprioception Tactile
Somato- dyspraxia
Sensory Reactivity
(Modulation)
Visual motor
Postural
control
Gross
motor
skills
Praxis Arousal
Affect
Activity Level
Attention
Visual construction
Bilateral coordination
Sequencing
Fine motor skills
Auditory -Language
Organization of behavior
StateSelf Regulation
Smith Roley 2013
SENSORY INTEGRATION INTERVENTION
Intervention Planning Promoting neuroplasticity health and development
Smith Roley 2014
Implications for OTSI Intervention
Consistent with Neuroplasticity Literature
ndash Sensorimotor opportunities
ndash Control over activity
ndash Novelty
ndash Challenge
ndash Playful environment
ndash Lifelike context
Smith Roley 2014
Sensory Integration and Play
bull When the therapist is doing her job effectively and the child is organizing his nervous system it looks as if the child is merely playing rdquo ndash Ayres 1979
Smith Roley 2013
Ayres Sensory Integrationreg Intervention Fidelity Measure
Parham et al 2007 2011 2013-in press
ASIFM Structural elements ndash Part I Therapist Qualifications
ndash Part II Safe Environment
ndash Part III Record Review
ndash Part IV Space and Equipment
ndash Part V Communication with Parents amp Teachers
Smith Roley 2013
ASIFM Process Elements (Parham et al 2011)
1 Physical safety 2 Sensory opportunities
(vestibular tactile and proprioceptive)
3 Supports sensory modulation to attainmaintain a regulated state
4 Supports postural ocular oral or bilateral motor coordination
5 Challenges praxis and organization of behavior
6 Collaborative activity choice
7 Just Right Challenge
8 Ensures Success
9 Supports motivation to play
10 Establishes therapeutic alliance
Smith Roley 2013
Data-driven Intervention Process (Schaaf 2001 Schaaf amp Blanche 2012)
Participation challenges
Current behavior
Theoretical
Framework
Assessments
37
Hypotheses Interventions Outcomes
(c) 2014 Susanne Smith Roley
OTD
Grounds for Optimism
Four Common Misconceptions
in the Anti-SI Intervention Literature Clark 2012
1) Reviews critical of sensory integration
intervention research ignores issues of fidelity
and dosage
Smith Roley 2014
2) Reviewers ignore or minimize the available
positive evidence for SI intervention
bull 3 RCTrsquos with autism demonstrated positive results
following multisensory interventions (including SI
intervention) (Fazlioglu amp Baran 2008 Pfeiffer
Koenig Kinnealey Sheppard amp Henderson 2011
Smith Press Koenig amp Kinnealey 2005)
bull ldquoBased on the application of meta-analytic techniques
for cumulating probability values it is not hard to
conclude that sensory treatments have positive effects
when administered to children with ASDsrdquo Clark
2012
Smith Roley 2014
3) The lack of positive outcomes from SI Intervention may be due
to weak or poorly designed studies
bull Current studies suggest that with stronger and more
studies there will be consistent beneficial effects for
certain outcomes
bull ldquoThe challenge is to make these studies happenrdquo
Clark 2012
Smith Roley 2013
4) Critics often forget that a lack of solid evidence characterizes
nearly all interventions for children with ASDs
bull SI intervention is often held to a different standard
than other types of intervention failing to apply the
same criterion to alternate interventions
Clark 2012
Smith Roley 2014
Remaining Mysteries
Smith Roley 2013
Implications for Advocacy
People need breaks such as recess
People require sensorimotor and social play timespacevalue in the daily routine
Smith Roley 2014
Implications for Research on OT using Sensory Integration
Enhancing Neuroplasticity via Therapeutic Design
bull Dosage - Intensity of increased access in short time periods rather than small access over longer times
bull Engagement via play and not just exposure
bull Role of therapist in providing customized sensorimotor challenges
bull Access to safe dynamic and therapeutic environments vs predictable and static environments
bull The difference between practice for skill development and adaptation to challenges in changing environments
Smith Roley 2014
Implications for Sensory Integration in Practice
Most importantly the success of Sensory Integration in practice depends on
YOU
Smith Roley 2014
Thank You
bull Organizers and Participants
bull hyvaumlauml paumlivaumlnjatkoa
bull Enjoy the conference
Smith Roley 2013
bull Ayres AJ (2005) Sensory Integration and the Child Los Angeles CA Western Psychological Services bull Armstrong T (2006) The best schools How human development research should inform educational practice Alexandria
VA Association for Supervision and Curriculum Development bull Blanche E I Bodison S Chang M C amp Reinoso G (2012) Development of the comprehensive observations of
proprioception (COP) Validity reliability and factor analysis American Journal of Occupational Therapy 66 691ndash698 bull Bundy A amp Lane S (In press) Sensory integration theory and practice Third Ed Philsadelphia PA FA Davis Inc bull Casey T amp MacIntyre S (2007) Childrenrsquos need for time and space In T Casey (Ed) Environments for outdoor play A
practical guide to making space for children (pp 5 ndash 16) London Sage Publications httpwwwsagepubcomupm-data15553_CASEY_C01PDF
bull Gray P (2013) Play as preparation for learning and life American Journal of Play 5(3) 271 - 292 bull Greenough WR Black JE Wallace CS (1987) Experience and brain development Child Development 58(3)539-59 bull Lane AE Young RL Baker AEZ amp Angley MT (2010) Sensory processing subtypes in autism Association with adaptive behavior
Journal of Autism and Developmental Disorders 40 112-122
bull Lane SJ Schaaf RC (2010) Examining the neuroscience evidence for sensory-driven neuroplasticity implications for sensory-based occupational therapy for children and adolescents American Journal of Occupational Therapy 64(3)375-90
bull Mailloux Z Mulligan S Smith Roley S Cermak S Blanche E amp Bodison S Coleman G amp Lane C (2011) Verification and clarification of patterns of sensory integrative dysfunction in a retrospective clinical sample American Journal of Occupational Therapy 652 143-151
bull May A (2011) Experience-dependent structural plasticity in the adult human brain 1-8 Trends in Cognitive Sciences bull May-Benson TA Smith Roley S Mailloux Z Parham LD Koomar J Schaaf RC Van Jaarsveld AM amp Cohn E (in
press) Structural Elements of the Ayres Sensory Integrationreg Intervention Fidelity Measurecopy American Journal of Occupational Therapy
bull Milteer RM Ginsburg KR amp Council on Communications and Media Committee on Psychosocial Aspects of Child and Family Health (2011) Pediatrics e204-e213 DOI 101542peds2011-2953
bull Parham LD Cohn ES Spitzer S Koomar J Miller LJ Burke JP Brett-Green B Mailloux Z May-Benson T Smith Roley S Schaaf RC Schoen S amp Summers CA (2007) Fidelity in sensory integration intervention research American Journal of Occupational Therapy 61 2 216-227
bull Parham LD Smith Roley S May-Benson T Koomar J Brett-Green B Burke JP Cohn ES Mailloux Z Miller LJ amp Schaaf RC (2011) Development of a fidelity measure for research on effectiveness of Ayres Sensory Integrationreg intervention American Journal of Occupational Therapy 65 2 133-142
bull Reynolds S Lane SJ amp Richards L (2010) Using animal models of enriched environments to inform research on sensory integration intervention for the rehabilitation of neurodevelopmental disorders Journal of Neurodevelopmental Disorders 2( 3) 120-132 online first DOI 101007s11689-010-9053-4
bull Roley SS Mailloux Z Parham D Schaaf R Blanche E amp Lane CA Cermak S (in press) Sensory Integration and Praxis Patterns in Children with Autism American Journal of Occupational Therapy
bull Rosenzweig MR Bennet EL and Diamond MC (1972) Brain Changes in response to experience Scientific American 226(2) 22-29
bull Van Jaarsveld A Mailloux Z Smith Roley S amp Raubenheimer J (in press) Patterns of the sensory integration dysfunctions in South African children South African Journal of Occupational Therapy
bull Wills S Cabanlit M Bennett J Ashwood P Amaral DG amp Van de Water J (2009) Detection of autoantibodies to neural cells of the cerebellum in the plasma of subjects with autism spectrum disorders Brain Behavior and Immunity 23(1) 64-74
PPR
PRVC
SV
CPR
MFP II
DC
MFP I
OPR
SWB
PRN
BMC
MAC
GRA
SPR
KIN
LTS
FG
FI
TD
ATTN
Visio amp Somatopraxis
VestibularProp
Bilateral Integration amp
Sequencing
Tactile amp
Visual Discrimination
Tactile Defensiveness
amp Attention
SIPT Factor Analysis
Mailloux etal 2011
n=278
SIPT Factor Analysis in South African Sample (Van Jaarsveld etal in press)
n=223 Convenience Sample
bull Factor 1
ndash Visuo and Somatodyspraxia
bull DC CPR SV MAc MFP KIN SPr PvVC SWB GRA
bull Factor 2
ndash Bilateral Integration and Sequencing
bull SPr BMC Opr SWB with lower loadings on PPr PrVC
bull Factor 3
ndash Tactile and Visual Discrimination
bull FI MFP LTS with moderate loadings on PrVC OPr
26 (c) 2014 Susanne Smith
Roley OTD
SIPT Factor Analysis in South African Sample (Van Jaarsveld etal in press)
27 (c) 2014 Susanne Smith
Roley OTD Figure 1 Loadings on three factors of final analysis
Lane AE etal (2010)
Sensory Profile Cluster Analysis 3 patterns of ASD sensory processing
Sensory-based inattentive seeking
under-responsive (milder)
Sensory modulation with movement sensitivity low energyweak poor endurance
Sensory modulation with tastesmell sensitivity
under and over-responsiveness with no movement issues more communication difficulties and maladaptive behaviors
Sensory subtypes predicted communication competence
and maladaptive behavior
Comprehensive Observation of Proprioception (COP) Factor Analyses
bull F1 Tone and Joint Alignment
ndash Joint hypermobility decreased tone poor joint alignment
bull F2 Behavioral Manifestations
ndash Pushing overactive crashing falling running
ndash Correlates with SPM bumping and pushing
bull F3 Postural Motor
ndash Decreased PC tendency to lean inefficient grading force inadequate weight bearing inefficient ankle strategies
ndash Correlates with SPM body awareness and SWB
bull F4 Motor Planning
ndash Decreased feedback planning decreased feedforward planning overly passive
ndash No correlation with SPM body awareness weak correlation with KIN and SWB
Blanche Bodison Chang amp Reinoso (2012)
29
(c) 2014 Susanne Smith Roley
OTD
Refining Assessment of Sensory Integrative Functions
Smith Roley 2014
Visual-Praxis
Vestibular Bilateral Integration
Proprioception Tactile
Somato- dyspraxia
Sensory Reactivity
(Modulation)
Visual motor
Postural
control
Gross
motor
skills
Praxis Arousal
Affect
Activity Level
Attention
Visual construction
Bilateral coordination
Sequencing
Fine motor skills
Auditory -Language
Organization of behavior
StateSelf Regulation
Smith Roley 2013
SENSORY INTEGRATION INTERVENTION
Intervention Planning Promoting neuroplasticity health and development
Smith Roley 2014
Implications for OTSI Intervention
Consistent with Neuroplasticity Literature
ndash Sensorimotor opportunities
ndash Control over activity
ndash Novelty
ndash Challenge
ndash Playful environment
ndash Lifelike context
Smith Roley 2014
Sensory Integration and Play
bull When the therapist is doing her job effectively and the child is organizing his nervous system it looks as if the child is merely playing rdquo ndash Ayres 1979
Smith Roley 2013
Ayres Sensory Integrationreg Intervention Fidelity Measure
Parham et al 2007 2011 2013-in press
ASIFM Structural elements ndash Part I Therapist Qualifications
ndash Part II Safe Environment
ndash Part III Record Review
ndash Part IV Space and Equipment
ndash Part V Communication with Parents amp Teachers
Smith Roley 2013
ASIFM Process Elements (Parham et al 2011)
1 Physical safety 2 Sensory opportunities
(vestibular tactile and proprioceptive)
3 Supports sensory modulation to attainmaintain a regulated state
4 Supports postural ocular oral or bilateral motor coordination
5 Challenges praxis and organization of behavior
6 Collaborative activity choice
7 Just Right Challenge
8 Ensures Success
9 Supports motivation to play
10 Establishes therapeutic alliance
Smith Roley 2013
Data-driven Intervention Process (Schaaf 2001 Schaaf amp Blanche 2012)
Participation challenges
Current behavior
Theoretical
Framework
Assessments
37
Hypotheses Interventions Outcomes
(c) 2014 Susanne Smith Roley
OTD
Grounds for Optimism
Four Common Misconceptions
in the Anti-SI Intervention Literature Clark 2012
1) Reviews critical of sensory integration
intervention research ignores issues of fidelity
and dosage
Smith Roley 2014
2) Reviewers ignore or minimize the available
positive evidence for SI intervention
bull 3 RCTrsquos with autism demonstrated positive results
following multisensory interventions (including SI
intervention) (Fazlioglu amp Baran 2008 Pfeiffer
Koenig Kinnealey Sheppard amp Henderson 2011
Smith Press Koenig amp Kinnealey 2005)
bull ldquoBased on the application of meta-analytic techniques
for cumulating probability values it is not hard to
conclude that sensory treatments have positive effects
when administered to children with ASDsrdquo Clark
2012
Smith Roley 2014
3) The lack of positive outcomes from SI Intervention may be due
to weak or poorly designed studies
bull Current studies suggest that with stronger and more
studies there will be consistent beneficial effects for
certain outcomes
bull ldquoThe challenge is to make these studies happenrdquo
Clark 2012
Smith Roley 2013
4) Critics often forget that a lack of solid evidence characterizes
nearly all interventions for children with ASDs
bull SI intervention is often held to a different standard
than other types of intervention failing to apply the
same criterion to alternate interventions
Clark 2012
Smith Roley 2014
Remaining Mysteries
Smith Roley 2013
Implications for Advocacy
People need breaks such as recess
People require sensorimotor and social play timespacevalue in the daily routine
Smith Roley 2014
Implications for Research on OT using Sensory Integration
Enhancing Neuroplasticity via Therapeutic Design
bull Dosage - Intensity of increased access in short time periods rather than small access over longer times
bull Engagement via play and not just exposure
bull Role of therapist in providing customized sensorimotor challenges
bull Access to safe dynamic and therapeutic environments vs predictable and static environments
bull The difference between practice for skill development and adaptation to challenges in changing environments
Smith Roley 2014
Implications for Sensory Integration in Practice
Most importantly the success of Sensory Integration in practice depends on
YOU
Smith Roley 2014
Thank You
bull Organizers and Participants
bull hyvaumlauml paumlivaumlnjatkoa
bull Enjoy the conference
Smith Roley 2013
bull Ayres AJ (2005) Sensory Integration and the Child Los Angeles CA Western Psychological Services bull Armstrong T (2006) The best schools How human development research should inform educational practice Alexandria
VA Association for Supervision and Curriculum Development bull Blanche E I Bodison S Chang M C amp Reinoso G (2012) Development of the comprehensive observations of
proprioception (COP) Validity reliability and factor analysis American Journal of Occupational Therapy 66 691ndash698 bull Bundy A amp Lane S (In press) Sensory integration theory and practice Third Ed Philsadelphia PA FA Davis Inc bull Casey T amp MacIntyre S (2007) Childrenrsquos need for time and space In T Casey (Ed) Environments for outdoor play A
practical guide to making space for children (pp 5 ndash 16) London Sage Publications httpwwwsagepubcomupm-data15553_CASEY_C01PDF
bull Gray P (2013) Play as preparation for learning and life American Journal of Play 5(3) 271 - 292 bull Greenough WR Black JE Wallace CS (1987) Experience and brain development Child Development 58(3)539-59 bull Lane AE Young RL Baker AEZ amp Angley MT (2010) Sensory processing subtypes in autism Association with adaptive behavior
Journal of Autism and Developmental Disorders 40 112-122
bull Lane SJ Schaaf RC (2010) Examining the neuroscience evidence for sensory-driven neuroplasticity implications for sensory-based occupational therapy for children and adolescents American Journal of Occupational Therapy 64(3)375-90
bull Mailloux Z Mulligan S Smith Roley S Cermak S Blanche E amp Bodison S Coleman G amp Lane C (2011) Verification and clarification of patterns of sensory integrative dysfunction in a retrospective clinical sample American Journal of Occupational Therapy 652 143-151
bull May A (2011) Experience-dependent structural plasticity in the adult human brain 1-8 Trends in Cognitive Sciences bull May-Benson TA Smith Roley S Mailloux Z Parham LD Koomar J Schaaf RC Van Jaarsveld AM amp Cohn E (in
press) Structural Elements of the Ayres Sensory Integrationreg Intervention Fidelity Measurecopy American Journal of Occupational Therapy
bull Milteer RM Ginsburg KR amp Council on Communications and Media Committee on Psychosocial Aspects of Child and Family Health (2011) Pediatrics e204-e213 DOI 101542peds2011-2953
bull Parham LD Cohn ES Spitzer S Koomar J Miller LJ Burke JP Brett-Green B Mailloux Z May-Benson T Smith Roley S Schaaf RC Schoen S amp Summers CA (2007) Fidelity in sensory integration intervention research American Journal of Occupational Therapy 61 2 216-227
bull Parham LD Smith Roley S May-Benson T Koomar J Brett-Green B Burke JP Cohn ES Mailloux Z Miller LJ amp Schaaf RC (2011) Development of a fidelity measure for research on effectiveness of Ayres Sensory Integrationreg intervention American Journal of Occupational Therapy 65 2 133-142
bull Reynolds S Lane SJ amp Richards L (2010) Using animal models of enriched environments to inform research on sensory integration intervention for the rehabilitation of neurodevelopmental disorders Journal of Neurodevelopmental Disorders 2( 3) 120-132 online first DOI 101007s11689-010-9053-4
bull Roley SS Mailloux Z Parham D Schaaf R Blanche E amp Lane CA Cermak S (in press) Sensory Integration and Praxis Patterns in Children with Autism American Journal of Occupational Therapy
bull Rosenzweig MR Bennet EL and Diamond MC (1972) Brain Changes in response to experience Scientific American 226(2) 22-29
bull Van Jaarsveld A Mailloux Z Smith Roley S amp Raubenheimer J (in press) Patterns of the sensory integration dysfunctions in South African children South African Journal of Occupational Therapy
bull Wills S Cabanlit M Bennett J Ashwood P Amaral DG amp Van de Water J (2009) Detection of autoantibodies to neural cells of the cerebellum in the plasma of subjects with autism spectrum disorders Brain Behavior and Immunity 23(1) 64-74
SIPT Factor Analysis in South African Sample (Van Jaarsveld etal in press)
n=223 Convenience Sample
bull Factor 1
ndash Visuo and Somatodyspraxia
bull DC CPR SV MAc MFP KIN SPr PvVC SWB GRA
bull Factor 2
ndash Bilateral Integration and Sequencing
bull SPr BMC Opr SWB with lower loadings on PPr PrVC
bull Factor 3
ndash Tactile and Visual Discrimination
bull FI MFP LTS with moderate loadings on PrVC OPr
26 (c) 2014 Susanne Smith
Roley OTD
SIPT Factor Analysis in South African Sample (Van Jaarsveld etal in press)
27 (c) 2014 Susanne Smith
Roley OTD Figure 1 Loadings on three factors of final analysis
Lane AE etal (2010)
Sensory Profile Cluster Analysis 3 patterns of ASD sensory processing
Sensory-based inattentive seeking
under-responsive (milder)
Sensory modulation with movement sensitivity low energyweak poor endurance
Sensory modulation with tastesmell sensitivity
under and over-responsiveness with no movement issues more communication difficulties and maladaptive behaviors
Sensory subtypes predicted communication competence
and maladaptive behavior
Comprehensive Observation of Proprioception (COP) Factor Analyses
bull F1 Tone and Joint Alignment
ndash Joint hypermobility decreased tone poor joint alignment
bull F2 Behavioral Manifestations
ndash Pushing overactive crashing falling running
ndash Correlates with SPM bumping and pushing
bull F3 Postural Motor
ndash Decreased PC tendency to lean inefficient grading force inadequate weight bearing inefficient ankle strategies
ndash Correlates with SPM body awareness and SWB
bull F4 Motor Planning
ndash Decreased feedback planning decreased feedforward planning overly passive
ndash No correlation with SPM body awareness weak correlation with KIN and SWB
Blanche Bodison Chang amp Reinoso (2012)
29
(c) 2014 Susanne Smith Roley
OTD
Refining Assessment of Sensory Integrative Functions
Smith Roley 2014
Visual-Praxis
Vestibular Bilateral Integration
Proprioception Tactile
Somato- dyspraxia
Sensory Reactivity
(Modulation)
Visual motor
Postural
control
Gross
motor
skills
Praxis Arousal
Affect
Activity Level
Attention
Visual construction
Bilateral coordination
Sequencing
Fine motor skills
Auditory -Language
Organization of behavior
StateSelf Regulation
Smith Roley 2013
SENSORY INTEGRATION INTERVENTION
Intervention Planning Promoting neuroplasticity health and development
Smith Roley 2014
Implications for OTSI Intervention
Consistent with Neuroplasticity Literature
ndash Sensorimotor opportunities
ndash Control over activity
ndash Novelty
ndash Challenge
ndash Playful environment
ndash Lifelike context
Smith Roley 2014
Sensory Integration and Play
bull When the therapist is doing her job effectively and the child is organizing his nervous system it looks as if the child is merely playing rdquo ndash Ayres 1979
Smith Roley 2013
Ayres Sensory Integrationreg Intervention Fidelity Measure
Parham et al 2007 2011 2013-in press
ASIFM Structural elements ndash Part I Therapist Qualifications
ndash Part II Safe Environment
ndash Part III Record Review
ndash Part IV Space and Equipment
ndash Part V Communication with Parents amp Teachers
Smith Roley 2013
ASIFM Process Elements (Parham et al 2011)
1 Physical safety 2 Sensory opportunities
(vestibular tactile and proprioceptive)
3 Supports sensory modulation to attainmaintain a regulated state
4 Supports postural ocular oral or bilateral motor coordination
5 Challenges praxis and organization of behavior
6 Collaborative activity choice
7 Just Right Challenge
8 Ensures Success
9 Supports motivation to play
10 Establishes therapeutic alliance
Smith Roley 2013
Data-driven Intervention Process (Schaaf 2001 Schaaf amp Blanche 2012)
Participation challenges
Current behavior
Theoretical
Framework
Assessments
37
Hypotheses Interventions Outcomes
(c) 2014 Susanne Smith Roley
OTD
Grounds for Optimism
Four Common Misconceptions
in the Anti-SI Intervention Literature Clark 2012
1) Reviews critical of sensory integration
intervention research ignores issues of fidelity
and dosage
Smith Roley 2014
2) Reviewers ignore or minimize the available
positive evidence for SI intervention
bull 3 RCTrsquos with autism demonstrated positive results
following multisensory interventions (including SI
intervention) (Fazlioglu amp Baran 2008 Pfeiffer
Koenig Kinnealey Sheppard amp Henderson 2011
Smith Press Koenig amp Kinnealey 2005)
bull ldquoBased on the application of meta-analytic techniques
for cumulating probability values it is not hard to
conclude that sensory treatments have positive effects
when administered to children with ASDsrdquo Clark
2012
Smith Roley 2014
3) The lack of positive outcomes from SI Intervention may be due
to weak or poorly designed studies
bull Current studies suggest that with stronger and more
studies there will be consistent beneficial effects for
certain outcomes
bull ldquoThe challenge is to make these studies happenrdquo
Clark 2012
Smith Roley 2013
4) Critics often forget that a lack of solid evidence characterizes
nearly all interventions for children with ASDs
bull SI intervention is often held to a different standard
than other types of intervention failing to apply the
same criterion to alternate interventions
Clark 2012
Smith Roley 2014
Remaining Mysteries
Smith Roley 2013
Implications for Advocacy
People need breaks such as recess
People require sensorimotor and social play timespacevalue in the daily routine
Smith Roley 2014
Implications for Research on OT using Sensory Integration
Enhancing Neuroplasticity via Therapeutic Design
bull Dosage - Intensity of increased access in short time periods rather than small access over longer times
bull Engagement via play and not just exposure
bull Role of therapist in providing customized sensorimotor challenges
bull Access to safe dynamic and therapeutic environments vs predictable and static environments
bull The difference between practice for skill development and adaptation to challenges in changing environments
Smith Roley 2014
Implications for Sensory Integration in Practice
Most importantly the success of Sensory Integration in practice depends on
YOU
Smith Roley 2014
Thank You
bull Organizers and Participants
bull hyvaumlauml paumlivaumlnjatkoa
bull Enjoy the conference
Smith Roley 2013
bull Ayres AJ (2005) Sensory Integration and the Child Los Angeles CA Western Psychological Services bull Armstrong T (2006) The best schools How human development research should inform educational practice Alexandria
VA Association for Supervision and Curriculum Development bull Blanche E I Bodison S Chang M C amp Reinoso G (2012) Development of the comprehensive observations of
proprioception (COP) Validity reliability and factor analysis American Journal of Occupational Therapy 66 691ndash698 bull Bundy A amp Lane S (In press) Sensory integration theory and practice Third Ed Philsadelphia PA FA Davis Inc bull Casey T amp MacIntyre S (2007) Childrenrsquos need for time and space In T Casey (Ed) Environments for outdoor play A
practical guide to making space for children (pp 5 ndash 16) London Sage Publications httpwwwsagepubcomupm-data15553_CASEY_C01PDF
bull Gray P (2013) Play as preparation for learning and life American Journal of Play 5(3) 271 - 292 bull Greenough WR Black JE Wallace CS (1987) Experience and brain development Child Development 58(3)539-59 bull Lane AE Young RL Baker AEZ amp Angley MT (2010) Sensory processing subtypes in autism Association with adaptive behavior
Journal of Autism and Developmental Disorders 40 112-122
bull Lane SJ Schaaf RC (2010) Examining the neuroscience evidence for sensory-driven neuroplasticity implications for sensory-based occupational therapy for children and adolescents American Journal of Occupational Therapy 64(3)375-90
bull Mailloux Z Mulligan S Smith Roley S Cermak S Blanche E amp Bodison S Coleman G amp Lane C (2011) Verification and clarification of patterns of sensory integrative dysfunction in a retrospective clinical sample American Journal of Occupational Therapy 652 143-151
bull May A (2011) Experience-dependent structural plasticity in the adult human brain 1-8 Trends in Cognitive Sciences bull May-Benson TA Smith Roley S Mailloux Z Parham LD Koomar J Schaaf RC Van Jaarsveld AM amp Cohn E (in
press) Structural Elements of the Ayres Sensory Integrationreg Intervention Fidelity Measurecopy American Journal of Occupational Therapy
bull Milteer RM Ginsburg KR amp Council on Communications and Media Committee on Psychosocial Aspects of Child and Family Health (2011) Pediatrics e204-e213 DOI 101542peds2011-2953
bull Parham LD Cohn ES Spitzer S Koomar J Miller LJ Burke JP Brett-Green B Mailloux Z May-Benson T Smith Roley S Schaaf RC Schoen S amp Summers CA (2007) Fidelity in sensory integration intervention research American Journal of Occupational Therapy 61 2 216-227
bull Parham LD Smith Roley S May-Benson T Koomar J Brett-Green B Burke JP Cohn ES Mailloux Z Miller LJ amp Schaaf RC (2011) Development of a fidelity measure for research on effectiveness of Ayres Sensory Integrationreg intervention American Journal of Occupational Therapy 65 2 133-142
bull Reynolds S Lane SJ amp Richards L (2010) Using animal models of enriched environments to inform research on sensory integration intervention for the rehabilitation of neurodevelopmental disorders Journal of Neurodevelopmental Disorders 2( 3) 120-132 online first DOI 101007s11689-010-9053-4
bull Roley SS Mailloux Z Parham D Schaaf R Blanche E amp Lane CA Cermak S (in press) Sensory Integration and Praxis Patterns in Children with Autism American Journal of Occupational Therapy
bull Rosenzweig MR Bennet EL and Diamond MC (1972) Brain Changes in response to experience Scientific American 226(2) 22-29
bull Van Jaarsveld A Mailloux Z Smith Roley S amp Raubenheimer J (in press) Patterns of the sensory integration dysfunctions in South African children South African Journal of Occupational Therapy
bull Wills S Cabanlit M Bennett J Ashwood P Amaral DG amp Van de Water J (2009) Detection of autoantibodies to neural cells of the cerebellum in the plasma of subjects with autism spectrum disorders Brain Behavior and Immunity 23(1) 64-74
SIPT Factor Analysis in South African Sample (Van Jaarsveld etal in press)
27 (c) 2014 Susanne Smith
Roley OTD Figure 1 Loadings on three factors of final analysis
Lane AE etal (2010)
Sensory Profile Cluster Analysis 3 patterns of ASD sensory processing
Sensory-based inattentive seeking
under-responsive (milder)
Sensory modulation with movement sensitivity low energyweak poor endurance
Sensory modulation with tastesmell sensitivity
under and over-responsiveness with no movement issues more communication difficulties and maladaptive behaviors
Sensory subtypes predicted communication competence
and maladaptive behavior
Comprehensive Observation of Proprioception (COP) Factor Analyses
bull F1 Tone and Joint Alignment
ndash Joint hypermobility decreased tone poor joint alignment
bull F2 Behavioral Manifestations
ndash Pushing overactive crashing falling running
ndash Correlates with SPM bumping and pushing
bull F3 Postural Motor
ndash Decreased PC tendency to lean inefficient grading force inadequate weight bearing inefficient ankle strategies
ndash Correlates with SPM body awareness and SWB
bull F4 Motor Planning
ndash Decreased feedback planning decreased feedforward planning overly passive
ndash No correlation with SPM body awareness weak correlation with KIN and SWB
Blanche Bodison Chang amp Reinoso (2012)
29
(c) 2014 Susanne Smith Roley
OTD
Refining Assessment of Sensory Integrative Functions
Smith Roley 2014
Visual-Praxis
Vestibular Bilateral Integration
Proprioception Tactile
Somato- dyspraxia
Sensory Reactivity
(Modulation)
Visual motor
Postural
control
Gross
motor
skills
Praxis Arousal
Affect
Activity Level
Attention
Visual construction
Bilateral coordination
Sequencing
Fine motor skills
Auditory -Language
Organization of behavior
StateSelf Regulation
Smith Roley 2013
SENSORY INTEGRATION INTERVENTION
Intervention Planning Promoting neuroplasticity health and development
Smith Roley 2014
Implications for OTSI Intervention
Consistent with Neuroplasticity Literature
ndash Sensorimotor opportunities
ndash Control over activity
ndash Novelty
ndash Challenge
ndash Playful environment
ndash Lifelike context
Smith Roley 2014
Sensory Integration and Play
bull When the therapist is doing her job effectively and the child is organizing his nervous system it looks as if the child is merely playing rdquo ndash Ayres 1979
Smith Roley 2013
Ayres Sensory Integrationreg Intervention Fidelity Measure
Parham et al 2007 2011 2013-in press
ASIFM Structural elements ndash Part I Therapist Qualifications
ndash Part II Safe Environment
ndash Part III Record Review
ndash Part IV Space and Equipment
ndash Part V Communication with Parents amp Teachers
Smith Roley 2013
ASIFM Process Elements (Parham et al 2011)
1 Physical safety 2 Sensory opportunities
(vestibular tactile and proprioceptive)
3 Supports sensory modulation to attainmaintain a regulated state
4 Supports postural ocular oral or bilateral motor coordination
5 Challenges praxis and organization of behavior
6 Collaborative activity choice
7 Just Right Challenge
8 Ensures Success
9 Supports motivation to play
10 Establishes therapeutic alliance
Smith Roley 2013
Data-driven Intervention Process (Schaaf 2001 Schaaf amp Blanche 2012)
Participation challenges
Current behavior
Theoretical
Framework
Assessments
37
Hypotheses Interventions Outcomes
(c) 2014 Susanne Smith Roley
OTD
Grounds for Optimism
Four Common Misconceptions
in the Anti-SI Intervention Literature Clark 2012
1) Reviews critical of sensory integration
intervention research ignores issues of fidelity
and dosage
Smith Roley 2014
2) Reviewers ignore or minimize the available
positive evidence for SI intervention
bull 3 RCTrsquos with autism demonstrated positive results
following multisensory interventions (including SI
intervention) (Fazlioglu amp Baran 2008 Pfeiffer
Koenig Kinnealey Sheppard amp Henderson 2011
Smith Press Koenig amp Kinnealey 2005)
bull ldquoBased on the application of meta-analytic techniques
for cumulating probability values it is not hard to
conclude that sensory treatments have positive effects
when administered to children with ASDsrdquo Clark
2012
Smith Roley 2014
3) The lack of positive outcomes from SI Intervention may be due
to weak or poorly designed studies
bull Current studies suggest that with stronger and more
studies there will be consistent beneficial effects for
certain outcomes
bull ldquoThe challenge is to make these studies happenrdquo
Clark 2012
Smith Roley 2013
4) Critics often forget that a lack of solid evidence characterizes
nearly all interventions for children with ASDs
bull SI intervention is often held to a different standard
than other types of intervention failing to apply the
same criterion to alternate interventions
Clark 2012
Smith Roley 2014
Remaining Mysteries
Smith Roley 2013
Implications for Advocacy
People need breaks such as recess
People require sensorimotor and social play timespacevalue in the daily routine
Smith Roley 2014
Implications for Research on OT using Sensory Integration
Enhancing Neuroplasticity via Therapeutic Design
bull Dosage - Intensity of increased access in short time periods rather than small access over longer times
bull Engagement via play and not just exposure
bull Role of therapist in providing customized sensorimotor challenges
bull Access to safe dynamic and therapeutic environments vs predictable and static environments
bull The difference between practice for skill development and adaptation to challenges in changing environments
Smith Roley 2014
Implications for Sensory Integration in Practice
Most importantly the success of Sensory Integration in practice depends on
YOU
Smith Roley 2014
Thank You
bull Organizers and Participants
bull hyvaumlauml paumlivaumlnjatkoa
bull Enjoy the conference
Smith Roley 2013
bull Ayres AJ (2005) Sensory Integration and the Child Los Angeles CA Western Psychological Services bull Armstrong T (2006) The best schools How human development research should inform educational practice Alexandria
VA Association for Supervision and Curriculum Development bull Blanche E I Bodison S Chang M C amp Reinoso G (2012) Development of the comprehensive observations of
proprioception (COP) Validity reliability and factor analysis American Journal of Occupational Therapy 66 691ndash698 bull Bundy A amp Lane S (In press) Sensory integration theory and practice Third Ed Philsadelphia PA FA Davis Inc bull Casey T amp MacIntyre S (2007) Childrenrsquos need for time and space In T Casey (Ed) Environments for outdoor play A
practical guide to making space for children (pp 5 ndash 16) London Sage Publications httpwwwsagepubcomupm-data15553_CASEY_C01PDF
bull Gray P (2013) Play as preparation for learning and life American Journal of Play 5(3) 271 - 292 bull Greenough WR Black JE Wallace CS (1987) Experience and brain development Child Development 58(3)539-59 bull Lane AE Young RL Baker AEZ amp Angley MT (2010) Sensory processing subtypes in autism Association with adaptive behavior
Journal of Autism and Developmental Disorders 40 112-122
bull Lane SJ Schaaf RC (2010) Examining the neuroscience evidence for sensory-driven neuroplasticity implications for sensory-based occupational therapy for children and adolescents American Journal of Occupational Therapy 64(3)375-90
bull Mailloux Z Mulligan S Smith Roley S Cermak S Blanche E amp Bodison S Coleman G amp Lane C (2011) Verification and clarification of patterns of sensory integrative dysfunction in a retrospective clinical sample American Journal of Occupational Therapy 652 143-151
bull May A (2011) Experience-dependent structural plasticity in the adult human brain 1-8 Trends in Cognitive Sciences bull May-Benson TA Smith Roley S Mailloux Z Parham LD Koomar J Schaaf RC Van Jaarsveld AM amp Cohn E (in
press) Structural Elements of the Ayres Sensory Integrationreg Intervention Fidelity Measurecopy American Journal of Occupational Therapy
bull Milteer RM Ginsburg KR amp Council on Communications and Media Committee on Psychosocial Aspects of Child and Family Health (2011) Pediatrics e204-e213 DOI 101542peds2011-2953
bull Parham LD Cohn ES Spitzer S Koomar J Miller LJ Burke JP Brett-Green B Mailloux Z May-Benson T Smith Roley S Schaaf RC Schoen S amp Summers CA (2007) Fidelity in sensory integration intervention research American Journal of Occupational Therapy 61 2 216-227
bull Parham LD Smith Roley S May-Benson T Koomar J Brett-Green B Burke JP Cohn ES Mailloux Z Miller LJ amp Schaaf RC (2011) Development of a fidelity measure for research on effectiveness of Ayres Sensory Integrationreg intervention American Journal of Occupational Therapy 65 2 133-142
bull Reynolds S Lane SJ amp Richards L (2010) Using animal models of enriched environments to inform research on sensory integration intervention for the rehabilitation of neurodevelopmental disorders Journal of Neurodevelopmental Disorders 2( 3) 120-132 online first DOI 101007s11689-010-9053-4
bull Roley SS Mailloux Z Parham D Schaaf R Blanche E amp Lane CA Cermak S (in press) Sensory Integration and Praxis Patterns in Children with Autism American Journal of Occupational Therapy
bull Rosenzweig MR Bennet EL and Diamond MC (1972) Brain Changes in response to experience Scientific American 226(2) 22-29
bull Van Jaarsveld A Mailloux Z Smith Roley S amp Raubenheimer J (in press) Patterns of the sensory integration dysfunctions in South African children South African Journal of Occupational Therapy
bull Wills S Cabanlit M Bennett J Ashwood P Amaral DG amp Van de Water J (2009) Detection of autoantibodies to neural cells of the cerebellum in the plasma of subjects with autism spectrum disorders Brain Behavior and Immunity 23(1) 64-74
Lane AE etal (2010)
Sensory Profile Cluster Analysis 3 patterns of ASD sensory processing
Sensory-based inattentive seeking
under-responsive (milder)
Sensory modulation with movement sensitivity low energyweak poor endurance
Sensory modulation with tastesmell sensitivity
under and over-responsiveness with no movement issues more communication difficulties and maladaptive behaviors
Sensory subtypes predicted communication competence
and maladaptive behavior
Comprehensive Observation of Proprioception (COP) Factor Analyses
bull F1 Tone and Joint Alignment
ndash Joint hypermobility decreased tone poor joint alignment
bull F2 Behavioral Manifestations
ndash Pushing overactive crashing falling running
ndash Correlates with SPM bumping and pushing
bull F3 Postural Motor
ndash Decreased PC tendency to lean inefficient grading force inadequate weight bearing inefficient ankle strategies
ndash Correlates with SPM body awareness and SWB
bull F4 Motor Planning
ndash Decreased feedback planning decreased feedforward planning overly passive
ndash No correlation with SPM body awareness weak correlation with KIN and SWB
Blanche Bodison Chang amp Reinoso (2012)
29
(c) 2014 Susanne Smith Roley
OTD
Refining Assessment of Sensory Integrative Functions
Smith Roley 2014
Visual-Praxis
Vestibular Bilateral Integration
Proprioception Tactile
Somato- dyspraxia
Sensory Reactivity
(Modulation)
Visual motor
Postural
control
Gross
motor
skills
Praxis Arousal
Affect
Activity Level
Attention
Visual construction
Bilateral coordination
Sequencing
Fine motor skills
Auditory -Language
Organization of behavior
StateSelf Regulation
Smith Roley 2013
SENSORY INTEGRATION INTERVENTION
Intervention Planning Promoting neuroplasticity health and development
Smith Roley 2014
Implications for OTSI Intervention
Consistent with Neuroplasticity Literature
ndash Sensorimotor opportunities
ndash Control over activity
ndash Novelty
ndash Challenge
ndash Playful environment
ndash Lifelike context
Smith Roley 2014
Sensory Integration and Play
bull When the therapist is doing her job effectively and the child is organizing his nervous system it looks as if the child is merely playing rdquo ndash Ayres 1979
Smith Roley 2013
Ayres Sensory Integrationreg Intervention Fidelity Measure
Parham et al 2007 2011 2013-in press
ASIFM Structural elements ndash Part I Therapist Qualifications
ndash Part II Safe Environment
ndash Part III Record Review
ndash Part IV Space and Equipment
ndash Part V Communication with Parents amp Teachers
Smith Roley 2013
ASIFM Process Elements (Parham et al 2011)
1 Physical safety 2 Sensory opportunities
(vestibular tactile and proprioceptive)
3 Supports sensory modulation to attainmaintain a regulated state
4 Supports postural ocular oral or bilateral motor coordination
5 Challenges praxis and organization of behavior
6 Collaborative activity choice
7 Just Right Challenge
8 Ensures Success
9 Supports motivation to play
10 Establishes therapeutic alliance
Smith Roley 2013
Data-driven Intervention Process (Schaaf 2001 Schaaf amp Blanche 2012)
Participation challenges
Current behavior
Theoretical
Framework
Assessments
37
Hypotheses Interventions Outcomes
(c) 2014 Susanne Smith Roley
OTD
Grounds for Optimism
Four Common Misconceptions
in the Anti-SI Intervention Literature Clark 2012
1) Reviews critical of sensory integration
intervention research ignores issues of fidelity
and dosage
Smith Roley 2014
2) Reviewers ignore or minimize the available
positive evidence for SI intervention
bull 3 RCTrsquos with autism demonstrated positive results
following multisensory interventions (including SI
intervention) (Fazlioglu amp Baran 2008 Pfeiffer
Koenig Kinnealey Sheppard amp Henderson 2011
Smith Press Koenig amp Kinnealey 2005)
bull ldquoBased on the application of meta-analytic techniques
for cumulating probability values it is not hard to
conclude that sensory treatments have positive effects
when administered to children with ASDsrdquo Clark
2012
Smith Roley 2014
3) The lack of positive outcomes from SI Intervention may be due
to weak or poorly designed studies
bull Current studies suggest that with stronger and more
studies there will be consistent beneficial effects for
certain outcomes
bull ldquoThe challenge is to make these studies happenrdquo
Clark 2012
Smith Roley 2013
4) Critics often forget that a lack of solid evidence characterizes
nearly all interventions for children with ASDs
bull SI intervention is often held to a different standard
than other types of intervention failing to apply the
same criterion to alternate interventions
Clark 2012
Smith Roley 2014
Remaining Mysteries
Smith Roley 2013
Implications for Advocacy
People need breaks such as recess
People require sensorimotor and social play timespacevalue in the daily routine
Smith Roley 2014
Implications for Research on OT using Sensory Integration
Enhancing Neuroplasticity via Therapeutic Design
bull Dosage - Intensity of increased access in short time periods rather than small access over longer times
bull Engagement via play and not just exposure
bull Role of therapist in providing customized sensorimotor challenges
bull Access to safe dynamic and therapeutic environments vs predictable and static environments
bull The difference between practice for skill development and adaptation to challenges in changing environments
Smith Roley 2014
Implications for Sensory Integration in Practice
Most importantly the success of Sensory Integration in practice depends on
YOU
Smith Roley 2014
Thank You
bull Organizers and Participants
bull hyvaumlauml paumlivaumlnjatkoa
bull Enjoy the conference
Smith Roley 2013
bull Ayres AJ (2005) Sensory Integration and the Child Los Angeles CA Western Psychological Services bull Armstrong T (2006) The best schools How human development research should inform educational practice Alexandria
VA Association for Supervision and Curriculum Development bull Blanche E I Bodison S Chang M C amp Reinoso G (2012) Development of the comprehensive observations of
proprioception (COP) Validity reliability and factor analysis American Journal of Occupational Therapy 66 691ndash698 bull Bundy A amp Lane S (In press) Sensory integration theory and practice Third Ed Philsadelphia PA FA Davis Inc bull Casey T amp MacIntyre S (2007) Childrenrsquos need for time and space In T Casey (Ed) Environments for outdoor play A
practical guide to making space for children (pp 5 ndash 16) London Sage Publications httpwwwsagepubcomupm-data15553_CASEY_C01PDF
bull Gray P (2013) Play as preparation for learning and life American Journal of Play 5(3) 271 - 292 bull Greenough WR Black JE Wallace CS (1987) Experience and brain development Child Development 58(3)539-59 bull Lane AE Young RL Baker AEZ amp Angley MT (2010) Sensory processing subtypes in autism Association with adaptive behavior
Journal of Autism and Developmental Disorders 40 112-122
bull Lane SJ Schaaf RC (2010) Examining the neuroscience evidence for sensory-driven neuroplasticity implications for sensory-based occupational therapy for children and adolescents American Journal of Occupational Therapy 64(3)375-90
bull Mailloux Z Mulligan S Smith Roley S Cermak S Blanche E amp Bodison S Coleman G amp Lane C (2011) Verification and clarification of patterns of sensory integrative dysfunction in a retrospective clinical sample American Journal of Occupational Therapy 652 143-151
bull May A (2011) Experience-dependent structural plasticity in the adult human brain 1-8 Trends in Cognitive Sciences bull May-Benson TA Smith Roley S Mailloux Z Parham LD Koomar J Schaaf RC Van Jaarsveld AM amp Cohn E (in
press) Structural Elements of the Ayres Sensory Integrationreg Intervention Fidelity Measurecopy American Journal of Occupational Therapy
bull Milteer RM Ginsburg KR amp Council on Communications and Media Committee on Psychosocial Aspects of Child and Family Health (2011) Pediatrics e204-e213 DOI 101542peds2011-2953
bull Parham LD Cohn ES Spitzer S Koomar J Miller LJ Burke JP Brett-Green B Mailloux Z May-Benson T Smith Roley S Schaaf RC Schoen S amp Summers CA (2007) Fidelity in sensory integration intervention research American Journal of Occupational Therapy 61 2 216-227
bull Parham LD Smith Roley S May-Benson T Koomar J Brett-Green B Burke JP Cohn ES Mailloux Z Miller LJ amp Schaaf RC (2011) Development of a fidelity measure for research on effectiveness of Ayres Sensory Integrationreg intervention American Journal of Occupational Therapy 65 2 133-142
bull Reynolds S Lane SJ amp Richards L (2010) Using animal models of enriched environments to inform research on sensory integration intervention for the rehabilitation of neurodevelopmental disorders Journal of Neurodevelopmental Disorders 2( 3) 120-132 online first DOI 101007s11689-010-9053-4
bull Roley SS Mailloux Z Parham D Schaaf R Blanche E amp Lane CA Cermak S (in press) Sensory Integration and Praxis Patterns in Children with Autism American Journal of Occupational Therapy
bull Rosenzweig MR Bennet EL and Diamond MC (1972) Brain Changes in response to experience Scientific American 226(2) 22-29
bull Van Jaarsveld A Mailloux Z Smith Roley S amp Raubenheimer J (in press) Patterns of the sensory integration dysfunctions in South African children South African Journal of Occupational Therapy
bull Wills S Cabanlit M Bennett J Ashwood P Amaral DG amp Van de Water J (2009) Detection of autoantibodies to neural cells of the cerebellum in the plasma of subjects with autism spectrum disorders Brain Behavior and Immunity 23(1) 64-74
Comprehensive Observation of Proprioception (COP) Factor Analyses
bull F1 Tone and Joint Alignment
ndash Joint hypermobility decreased tone poor joint alignment
bull F2 Behavioral Manifestations
ndash Pushing overactive crashing falling running
ndash Correlates with SPM bumping and pushing
bull F3 Postural Motor
ndash Decreased PC tendency to lean inefficient grading force inadequate weight bearing inefficient ankle strategies
ndash Correlates with SPM body awareness and SWB
bull F4 Motor Planning
ndash Decreased feedback planning decreased feedforward planning overly passive
ndash No correlation with SPM body awareness weak correlation with KIN and SWB
Blanche Bodison Chang amp Reinoso (2012)
29
(c) 2014 Susanne Smith Roley
OTD
Refining Assessment of Sensory Integrative Functions
Smith Roley 2014
Visual-Praxis
Vestibular Bilateral Integration
Proprioception Tactile
Somato- dyspraxia
Sensory Reactivity
(Modulation)
Visual motor
Postural
control
Gross
motor
skills
Praxis Arousal
Affect
Activity Level
Attention
Visual construction
Bilateral coordination
Sequencing
Fine motor skills
Auditory -Language
Organization of behavior
StateSelf Regulation
Smith Roley 2013
SENSORY INTEGRATION INTERVENTION
Intervention Planning Promoting neuroplasticity health and development
Smith Roley 2014
Implications for OTSI Intervention
Consistent with Neuroplasticity Literature
ndash Sensorimotor opportunities
ndash Control over activity
ndash Novelty
ndash Challenge
ndash Playful environment
ndash Lifelike context
Smith Roley 2014
Sensory Integration and Play
bull When the therapist is doing her job effectively and the child is organizing his nervous system it looks as if the child is merely playing rdquo ndash Ayres 1979
Smith Roley 2013
Ayres Sensory Integrationreg Intervention Fidelity Measure
Parham et al 2007 2011 2013-in press
ASIFM Structural elements ndash Part I Therapist Qualifications
ndash Part II Safe Environment
ndash Part III Record Review
ndash Part IV Space and Equipment
ndash Part V Communication with Parents amp Teachers
Smith Roley 2013
ASIFM Process Elements (Parham et al 2011)
1 Physical safety 2 Sensory opportunities
(vestibular tactile and proprioceptive)
3 Supports sensory modulation to attainmaintain a regulated state
4 Supports postural ocular oral or bilateral motor coordination
5 Challenges praxis and organization of behavior
6 Collaborative activity choice
7 Just Right Challenge
8 Ensures Success
9 Supports motivation to play
10 Establishes therapeutic alliance
Smith Roley 2013
Data-driven Intervention Process (Schaaf 2001 Schaaf amp Blanche 2012)
Participation challenges
Current behavior
Theoretical
Framework
Assessments
37
Hypotheses Interventions Outcomes
(c) 2014 Susanne Smith Roley
OTD
Grounds for Optimism
Four Common Misconceptions
in the Anti-SI Intervention Literature Clark 2012
1) Reviews critical of sensory integration
intervention research ignores issues of fidelity
and dosage
Smith Roley 2014
2) Reviewers ignore or minimize the available
positive evidence for SI intervention
bull 3 RCTrsquos with autism demonstrated positive results
following multisensory interventions (including SI
intervention) (Fazlioglu amp Baran 2008 Pfeiffer
Koenig Kinnealey Sheppard amp Henderson 2011
Smith Press Koenig amp Kinnealey 2005)
bull ldquoBased on the application of meta-analytic techniques
for cumulating probability values it is not hard to
conclude that sensory treatments have positive effects
when administered to children with ASDsrdquo Clark
2012
Smith Roley 2014
3) The lack of positive outcomes from SI Intervention may be due
to weak or poorly designed studies
bull Current studies suggest that with stronger and more
studies there will be consistent beneficial effects for
certain outcomes
bull ldquoThe challenge is to make these studies happenrdquo
Clark 2012
Smith Roley 2013
4) Critics often forget that a lack of solid evidence characterizes
nearly all interventions for children with ASDs
bull SI intervention is often held to a different standard
than other types of intervention failing to apply the
same criterion to alternate interventions
Clark 2012
Smith Roley 2014
Remaining Mysteries
Smith Roley 2013
Implications for Advocacy
People need breaks such as recess
People require sensorimotor and social play timespacevalue in the daily routine
Smith Roley 2014
Implications for Research on OT using Sensory Integration
Enhancing Neuroplasticity via Therapeutic Design
bull Dosage - Intensity of increased access in short time periods rather than small access over longer times
bull Engagement via play and not just exposure
bull Role of therapist in providing customized sensorimotor challenges
bull Access to safe dynamic and therapeutic environments vs predictable and static environments
bull The difference between practice for skill development and adaptation to challenges in changing environments
Smith Roley 2014
Implications for Sensory Integration in Practice
Most importantly the success of Sensory Integration in practice depends on
YOU
Smith Roley 2014
Thank You
bull Organizers and Participants
bull hyvaumlauml paumlivaumlnjatkoa
bull Enjoy the conference
Smith Roley 2013
bull Ayres AJ (2005) Sensory Integration and the Child Los Angeles CA Western Psychological Services bull Armstrong T (2006) The best schools How human development research should inform educational practice Alexandria
VA Association for Supervision and Curriculum Development bull Blanche E I Bodison S Chang M C amp Reinoso G (2012) Development of the comprehensive observations of
proprioception (COP) Validity reliability and factor analysis American Journal of Occupational Therapy 66 691ndash698 bull Bundy A amp Lane S (In press) Sensory integration theory and practice Third Ed Philsadelphia PA FA Davis Inc bull Casey T amp MacIntyre S (2007) Childrenrsquos need for time and space In T Casey (Ed) Environments for outdoor play A
practical guide to making space for children (pp 5 ndash 16) London Sage Publications httpwwwsagepubcomupm-data15553_CASEY_C01PDF
bull Gray P (2013) Play as preparation for learning and life American Journal of Play 5(3) 271 - 292 bull Greenough WR Black JE Wallace CS (1987) Experience and brain development Child Development 58(3)539-59 bull Lane AE Young RL Baker AEZ amp Angley MT (2010) Sensory processing subtypes in autism Association with adaptive behavior
Journal of Autism and Developmental Disorders 40 112-122
bull Lane SJ Schaaf RC (2010) Examining the neuroscience evidence for sensory-driven neuroplasticity implications for sensory-based occupational therapy for children and adolescents American Journal of Occupational Therapy 64(3)375-90
bull Mailloux Z Mulligan S Smith Roley S Cermak S Blanche E amp Bodison S Coleman G amp Lane C (2011) Verification and clarification of patterns of sensory integrative dysfunction in a retrospective clinical sample American Journal of Occupational Therapy 652 143-151
bull May A (2011) Experience-dependent structural plasticity in the adult human brain 1-8 Trends in Cognitive Sciences bull May-Benson TA Smith Roley S Mailloux Z Parham LD Koomar J Schaaf RC Van Jaarsveld AM amp Cohn E (in
press) Structural Elements of the Ayres Sensory Integrationreg Intervention Fidelity Measurecopy American Journal of Occupational Therapy
bull Milteer RM Ginsburg KR amp Council on Communications and Media Committee on Psychosocial Aspects of Child and Family Health (2011) Pediatrics e204-e213 DOI 101542peds2011-2953
bull Parham LD Cohn ES Spitzer S Koomar J Miller LJ Burke JP Brett-Green B Mailloux Z May-Benson T Smith Roley S Schaaf RC Schoen S amp Summers CA (2007) Fidelity in sensory integration intervention research American Journal of Occupational Therapy 61 2 216-227
bull Parham LD Smith Roley S May-Benson T Koomar J Brett-Green B Burke JP Cohn ES Mailloux Z Miller LJ amp Schaaf RC (2011) Development of a fidelity measure for research on effectiveness of Ayres Sensory Integrationreg intervention American Journal of Occupational Therapy 65 2 133-142
bull Reynolds S Lane SJ amp Richards L (2010) Using animal models of enriched environments to inform research on sensory integration intervention for the rehabilitation of neurodevelopmental disorders Journal of Neurodevelopmental Disorders 2( 3) 120-132 online first DOI 101007s11689-010-9053-4
bull Roley SS Mailloux Z Parham D Schaaf R Blanche E amp Lane CA Cermak S (in press) Sensory Integration and Praxis Patterns in Children with Autism American Journal of Occupational Therapy
bull Rosenzweig MR Bennet EL and Diamond MC (1972) Brain Changes in response to experience Scientific American 226(2) 22-29
bull Van Jaarsveld A Mailloux Z Smith Roley S amp Raubenheimer J (in press) Patterns of the sensory integration dysfunctions in South African children South African Journal of Occupational Therapy
bull Wills S Cabanlit M Bennett J Ashwood P Amaral DG amp Van de Water J (2009) Detection of autoantibodies to neural cells of the cerebellum in the plasma of subjects with autism spectrum disorders Brain Behavior and Immunity 23(1) 64-74
Refining Assessment of Sensory Integrative Functions
Smith Roley 2014
Visual-Praxis
Vestibular Bilateral Integration
Proprioception Tactile
Somato- dyspraxia
Sensory Reactivity
(Modulation)
Visual motor
Postural
control
Gross
motor
skills
Praxis Arousal
Affect
Activity Level
Attention
Visual construction
Bilateral coordination
Sequencing
Fine motor skills
Auditory -Language
Organization of behavior
StateSelf Regulation
Smith Roley 2013
SENSORY INTEGRATION INTERVENTION
Intervention Planning Promoting neuroplasticity health and development
Smith Roley 2014
Implications for OTSI Intervention
Consistent with Neuroplasticity Literature
ndash Sensorimotor opportunities
ndash Control over activity
ndash Novelty
ndash Challenge
ndash Playful environment
ndash Lifelike context
Smith Roley 2014
Sensory Integration and Play
bull When the therapist is doing her job effectively and the child is organizing his nervous system it looks as if the child is merely playing rdquo ndash Ayres 1979
Smith Roley 2013
Ayres Sensory Integrationreg Intervention Fidelity Measure
Parham et al 2007 2011 2013-in press
ASIFM Structural elements ndash Part I Therapist Qualifications
ndash Part II Safe Environment
ndash Part III Record Review
ndash Part IV Space and Equipment
ndash Part V Communication with Parents amp Teachers
Smith Roley 2013
ASIFM Process Elements (Parham et al 2011)
1 Physical safety 2 Sensory opportunities
(vestibular tactile and proprioceptive)
3 Supports sensory modulation to attainmaintain a regulated state
4 Supports postural ocular oral or bilateral motor coordination
5 Challenges praxis and organization of behavior
6 Collaborative activity choice
7 Just Right Challenge
8 Ensures Success
9 Supports motivation to play
10 Establishes therapeutic alliance
Smith Roley 2013
Data-driven Intervention Process (Schaaf 2001 Schaaf amp Blanche 2012)
Participation challenges
Current behavior
Theoretical
Framework
Assessments
37
Hypotheses Interventions Outcomes
(c) 2014 Susanne Smith Roley
OTD
Grounds for Optimism
Four Common Misconceptions
in the Anti-SI Intervention Literature Clark 2012
1) Reviews critical of sensory integration
intervention research ignores issues of fidelity
and dosage
Smith Roley 2014
2) Reviewers ignore or minimize the available
positive evidence for SI intervention
bull 3 RCTrsquos with autism demonstrated positive results
following multisensory interventions (including SI
intervention) (Fazlioglu amp Baran 2008 Pfeiffer
Koenig Kinnealey Sheppard amp Henderson 2011
Smith Press Koenig amp Kinnealey 2005)
bull ldquoBased on the application of meta-analytic techniques
for cumulating probability values it is not hard to
conclude that sensory treatments have positive effects
when administered to children with ASDsrdquo Clark
2012
Smith Roley 2014
3) The lack of positive outcomes from SI Intervention may be due
to weak or poorly designed studies
bull Current studies suggest that with stronger and more
studies there will be consistent beneficial effects for
certain outcomes
bull ldquoThe challenge is to make these studies happenrdquo
Clark 2012
Smith Roley 2013
4) Critics often forget that a lack of solid evidence characterizes
nearly all interventions for children with ASDs
bull SI intervention is often held to a different standard
than other types of intervention failing to apply the
same criterion to alternate interventions
Clark 2012
Smith Roley 2014
Remaining Mysteries
Smith Roley 2013
Implications for Advocacy
People need breaks such as recess
People require sensorimotor and social play timespacevalue in the daily routine
Smith Roley 2014
Implications for Research on OT using Sensory Integration
Enhancing Neuroplasticity via Therapeutic Design
bull Dosage - Intensity of increased access in short time periods rather than small access over longer times
bull Engagement via play and not just exposure
bull Role of therapist in providing customized sensorimotor challenges
bull Access to safe dynamic and therapeutic environments vs predictable and static environments
bull The difference between practice for skill development and adaptation to challenges in changing environments
Smith Roley 2014
Implications for Sensory Integration in Practice
Most importantly the success of Sensory Integration in practice depends on
YOU
Smith Roley 2014
Thank You
bull Organizers and Participants
bull hyvaumlauml paumlivaumlnjatkoa
bull Enjoy the conference
Smith Roley 2013
bull Ayres AJ (2005) Sensory Integration and the Child Los Angeles CA Western Psychological Services bull Armstrong T (2006) The best schools How human development research should inform educational practice Alexandria
VA Association for Supervision and Curriculum Development bull Blanche E I Bodison S Chang M C amp Reinoso G (2012) Development of the comprehensive observations of
proprioception (COP) Validity reliability and factor analysis American Journal of Occupational Therapy 66 691ndash698 bull Bundy A amp Lane S (In press) Sensory integration theory and practice Third Ed Philsadelphia PA FA Davis Inc bull Casey T amp MacIntyre S (2007) Childrenrsquos need for time and space In T Casey (Ed) Environments for outdoor play A
practical guide to making space for children (pp 5 ndash 16) London Sage Publications httpwwwsagepubcomupm-data15553_CASEY_C01PDF
bull Gray P (2013) Play as preparation for learning and life American Journal of Play 5(3) 271 - 292 bull Greenough WR Black JE Wallace CS (1987) Experience and brain development Child Development 58(3)539-59 bull Lane AE Young RL Baker AEZ amp Angley MT (2010) Sensory processing subtypes in autism Association with adaptive behavior
Journal of Autism and Developmental Disorders 40 112-122
bull Lane SJ Schaaf RC (2010) Examining the neuroscience evidence for sensory-driven neuroplasticity implications for sensory-based occupational therapy for children and adolescents American Journal of Occupational Therapy 64(3)375-90
bull Mailloux Z Mulligan S Smith Roley S Cermak S Blanche E amp Bodison S Coleman G amp Lane C (2011) Verification and clarification of patterns of sensory integrative dysfunction in a retrospective clinical sample American Journal of Occupational Therapy 652 143-151
bull May A (2011) Experience-dependent structural plasticity in the adult human brain 1-8 Trends in Cognitive Sciences bull May-Benson TA Smith Roley S Mailloux Z Parham LD Koomar J Schaaf RC Van Jaarsveld AM amp Cohn E (in
press) Structural Elements of the Ayres Sensory Integrationreg Intervention Fidelity Measurecopy American Journal of Occupational Therapy
bull Milteer RM Ginsburg KR amp Council on Communications and Media Committee on Psychosocial Aspects of Child and Family Health (2011) Pediatrics e204-e213 DOI 101542peds2011-2953
bull Parham LD Cohn ES Spitzer S Koomar J Miller LJ Burke JP Brett-Green B Mailloux Z May-Benson T Smith Roley S Schaaf RC Schoen S amp Summers CA (2007) Fidelity in sensory integration intervention research American Journal of Occupational Therapy 61 2 216-227
bull Parham LD Smith Roley S May-Benson T Koomar J Brett-Green B Burke JP Cohn ES Mailloux Z Miller LJ amp Schaaf RC (2011) Development of a fidelity measure for research on effectiveness of Ayres Sensory Integrationreg intervention American Journal of Occupational Therapy 65 2 133-142
bull Reynolds S Lane SJ amp Richards L (2010) Using animal models of enriched environments to inform research on sensory integration intervention for the rehabilitation of neurodevelopmental disorders Journal of Neurodevelopmental Disorders 2( 3) 120-132 online first DOI 101007s11689-010-9053-4
bull Roley SS Mailloux Z Parham D Schaaf R Blanche E amp Lane CA Cermak S (in press) Sensory Integration and Praxis Patterns in Children with Autism American Journal of Occupational Therapy
bull Rosenzweig MR Bennet EL and Diamond MC (1972) Brain Changes in response to experience Scientific American 226(2) 22-29
bull Van Jaarsveld A Mailloux Z Smith Roley S amp Raubenheimer J (in press) Patterns of the sensory integration dysfunctions in South African children South African Journal of Occupational Therapy
bull Wills S Cabanlit M Bennett J Ashwood P Amaral DG amp Van de Water J (2009) Detection of autoantibodies to neural cells of the cerebellum in the plasma of subjects with autism spectrum disorders Brain Behavior and Immunity 23(1) 64-74
Smith Roley 2013
SENSORY INTEGRATION INTERVENTION
Intervention Planning Promoting neuroplasticity health and development
Smith Roley 2014
Implications for OTSI Intervention
Consistent with Neuroplasticity Literature
ndash Sensorimotor opportunities
ndash Control over activity
ndash Novelty
ndash Challenge
ndash Playful environment
ndash Lifelike context
Smith Roley 2014
Sensory Integration and Play
bull When the therapist is doing her job effectively and the child is organizing his nervous system it looks as if the child is merely playing rdquo ndash Ayres 1979
Smith Roley 2013
Ayres Sensory Integrationreg Intervention Fidelity Measure
Parham et al 2007 2011 2013-in press
ASIFM Structural elements ndash Part I Therapist Qualifications
ndash Part II Safe Environment
ndash Part III Record Review
ndash Part IV Space and Equipment
ndash Part V Communication with Parents amp Teachers
Smith Roley 2013
ASIFM Process Elements (Parham et al 2011)
1 Physical safety 2 Sensory opportunities
(vestibular tactile and proprioceptive)
3 Supports sensory modulation to attainmaintain a regulated state
4 Supports postural ocular oral or bilateral motor coordination
5 Challenges praxis and organization of behavior
6 Collaborative activity choice
7 Just Right Challenge
8 Ensures Success
9 Supports motivation to play
10 Establishes therapeutic alliance
Smith Roley 2013
Data-driven Intervention Process (Schaaf 2001 Schaaf amp Blanche 2012)
Participation challenges
Current behavior
Theoretical
Framework
Assessments
37
Hypotheses Interventions Outcomes
(c) 2014 Susanne Smith Roley
OTD
Grounds for Optimism
Four Common Misconceptions
in the Anti-SI Intervention Literature Clark 2012
1) Reviews critical of sensory integration
intervention research ignores issues of fidelity
and dosage
Smith Roley 2014
2) Reviewers ignore or minimize the available
positive evidence for SI intervention
bull 3 RCTrsquos with autism demonstrated positive results
following multisensory interventions (including SI
intervention) (Fazlioglu amp Baran 2008 Pfeiffer
Koenig Kinnealey Sheppard amp Henderson 2011
Smith Press Koenig amp Kinnealey 2005)
bull ldquoBased on the application of meta-analytic techniques
for cumulating probability values it is not hard to
conclude that sensory treatments have positive effects
when administered to children with ASDsrdquo Clark
2012
Smith Roley 2014
3) The lack of positive outcomes from SI Intervention may be due
to weak or poorly designed studies
bull Current studies suggest that with stronger and more
studies there will be consistent beneficial effects for
certain outcomes
bull ldquoThe challenge is to make these studies happenrdquo
Clark 2012
Smith Roley 2013
4) Critics often forget that a lack of solid evidence characterizes
nearly all interventions for children with ASDs
bull SI intervention is often held to a different standard
than other types of intervention failing to apply the
same criterion to alternate interventions
Clark 2012
Smith Roley 2014
Remaining Mysteries
Smith Roley 2013
Implications for Advocacy
People need breaks such as recess
People require sensorimotor and social play timespacevalue in the daily routine
Smith Roley 2014
Implications for Research on OT using Sensory Integration
Enhancing Neuroplasticity via Therapeutic Design
bull Dosage - Intensity of increased access in short time periods rather than small access over longer times
bull Engagement via play and not just exposure
bull Role of therapist in providing customized sensorimotor challenges
bull Access to safe dynamic and therapeutic environments vs predictable and static environments
bull The difference between practice for skill development and adaptation to challenges in changing environments
Smith Roley 2014
Implications for Sensory Integration in Practice
Most importantly the success of Sensory Integration in practice depends on
YOU
Smith Roley 2014
Thank You
bull Organizers and Participants
bull hyvaumlauml paumlivaumlnjatkoa
bull Enjoy the conference
Smith Roley 2013
bull Ayres AJ (2005) Sensory Integration and the Child Los Angeles CA Western Psychological Services bull Armstrong T (2006) The best schools How human development research should inform educational practice Alexandria
VA Association for Supervision and Curriculum Development bull Blanche E I Bodison S Chang M C amp Reinoso G (2012) Development of the comprehensive observations of
proprioception (COP) Validity reliability and factor analysis American Journal of Occupational Therapy 66 691ndash698 bull Bundy A amp Lane S (In press) Sensory integration theory and practice Third Ed Philsadelphia PA FA Davis Inc bull Casey T amp MacIntyre S (2007) Childrenrsquos need for time and space In T Casey (Ed) Environments for outdoor play A
practical guide to making space for children (pp 5 ndash 16) London Sage Publications httpwwwsagepubcomupm-data15553_CASEY_C01PDF
bull Gray P (2013) Play as preparation for learning and life American Journal of Play 5(3) 271 - 292 bull Greenough WR Black JE Wallace CS (1987) Experience and brain development Child Development 58(3)539-59 bull Lane AE Young RL Baker AEZ amp Angley MT (2010) Sensory processing subtypes in autism Association with adaptive behavior
Journal of Autism and Developmental Disorders 40 112-122
bull Lane SJ Schaaf RC (2010) Examining the neuroscience evidence for sensory-driven neuroplasticity implications for sensory-based occupational therapy for children and adolescents American Journal of Occupational Therapy 64(3)375-90
bull Mailloux Z Mulligan S Smith Roley S Cermak S Blanche E amp Bodison S Coleman G amp Lane C (2011) Verification and clarification of patterns of sensory integrative dysfunction in a retrospective clinical sample American Journal of Occupational Therapy 652 143-151
bull May A (2011) Experience-dependent structural plasticity in the adult human brain 1-8 Trends in Cognitive Sciences bull May-Benson TA Smith Roley S Mailloux Z Parham LD Koomar J Schaaf RC Van Jaarsveld AM amp Cohn E (in
press) Structural Elements of the Ayres Sensory Integrationreg Intervention Fidelity Measurecopy American Journal of Occupational Therapy
bull Milteer RM Ginsburg KR amp Council on Communications and Media Committee on Psychosocial Aspects of Child and Family Health (2011) Pediatrics e204-e213 DOI 101542peds2011-2953
bull Parham LD Cohn ES Spitzer S Koomar J Miller LJ Burke JP Brett-Green B Mailloux Z May-Benson T Smith Roley S Schaaf RC Schoen S amp Summers CA (2007) Fidelity in sensory integration intervention research American Journal of Occupational Therapy 61 2 216-227
bull Parham LD Smith Roley S May-Benson T Koomar J Brett-Green B Burke JP Cohn ES Mailloux Z Miller LJ amp Schaaf RC (2011) Development of a fidelity measure for research on effectiveness of Ayres Sensory Integrationreg intervention American Journal of Occupational Therapy 65 2 133-142
bull Reynolds S Lane SJ amp Richards L (2010) Using animal models of enriched environments to inform research on sensory integration intervention for the rehabilitation of neurodevelopmental disorders Journal of Neurodevelopmental Disorders 2( 3) 120-132 online first DOI 101007s11689-010-9053-4
bull Roley SS Mailloux Z Parham D Schaaf R Blanche E amp Lane CA Cermak S (in press) Sensory Integration and Praxis Patterns in Children with Autism American Journal of Occupational Therapy
bull Rosenzweig MR Bennet EL and Diamond MC (1972) Brain Changes in response to experience Scientific American 226(2) 22-29
bull Van Jaarsveld A Mailloux Z Smith Roley S amp Raubenheimer J (in press) Patterns of the sensory integration dysfunctions in South African children South African Journal of Occupational Therapy
bull Wills S Cabanlit M Bennett J Ashwood P Amaral DG amp Van de Water J (2009) Detection of autoantibodies to neural cells of the cerebellum in the plasma of subjects with autism spectrum disorders Brain Behavior and Immunity 23(1) 64-74
SENSORY INTEGRATION INTERVENTION
Intervention Planning Promoting neuroplasticity health and development
Smith Roley 2014
Implications for OTSI Intervention
Consistent with Neuroplasticity Literature
ndash Sensorimotor opportunities
ndash Control over activity
ndash Novelty
ndash Challenge
ndash Playful environment
ndash Lifelike context
Smith Roley 2014
Sensory Integration and Play
bull When the therapist is doing her job effectively and the child is organizing his nervous system it looks as if the child is merely playing rdquo ndash Ayres 1979
Smith Roley 2013
Ayres Sensory Integrationreg Intervention Fidelity Measure
Parham et al 2007 2011 2013-in press
ASIFM Structural elements ndash Part I Therapist Qualifications
ndash Part II Safe Environment
ndash Part III Record Review
ndash Part IV Space and Equipment
ndash Part V Communication with Parents amp Teachers
Smith Roley 2013
ASIFM Process Elements (Parham et al 2011)
1 Physical safety 2 Sensory opportunities
(vestibular tactile and proprioceptive)
3 Supports sensory modulation to attainmaintain a regulated state
4 Supports postural ocular oral or bilateral motor coordination
5 Challenges praxis and organization of behavior
6 Collaborative activity choice
7 Just Right Challenge
8 Ensures Success
9 Supports motivation to play
10 Establishes therapeutic alliance
Smith Roley 2013
Data-driven Intervention Process (Schaaf 2001 Schaaf amp Blanche 2012)
Participation challenges
Current behavior
Theoretical
Framework
Assessments
37
Hypotheses Interventions Outcomes
(c) 2014 Susanne Smith Roley
OTD
Grounds for Optimism
Four Common Misconceptions
in the Anti-SI Intervention Literature Clark 2012
1) Reviews critical of sensory integration
intervention research ignores issues of fidelity
and dosage
Smith Roley 2014
2) Reviewers ignore or minimize the available
positive evidence for SI intervention
bull 3 RCTrsquos with autism demonstrated positive results
following multisensory interventions (including SI
intervention) (Fazlioglu amp Baran 2008 Pfeiffer
Koenig Kinnealey Sheppard amp Henderson 2011
Smith Press Koenig amp Kinnealey 2005)
bull ldquoBased on the application of meta-analytic techniques
for cumulating probability values it is not hard to
conclude that sensory treatments have positive effects
when administered to children with ASDsrdquo Clark
2012
Smith Roley 2014
3) The lack of positive outcomes from SI Intervention may be due
to weak or poorly designed studies
bull Current studies suggest that with stronger and more
studies there will be consistent beneficial effects for
certain outcomes
bull ldquoThe challenge is to make these studies happenrdquo
Clark 2012
Smith Roley 2013
4) Critics often forget that a lack of solid evidence characterizes
nearly all interventions for children with ASDs
bull SI intervention is often held to a different standard
than other types of intervention failing to apply the
same criterion to alternate interventions
Clark 2012
Smith Roley 2014
Remaining Mysteries
Smith Roley 2013
Implications for Advocacy
People need breaks such as recess
People require sensorimotor and social play timespacevalue in the daily routine
Smith Roley 2014
Implications for Research on OT using Sensory Integration
Enhancing Neuroplasticity via Therapeutic Design
bull Dosage - Intensity of increased access in short time periods rather than small access over longer times
bull Engagement via play and not just exposure
bull Role of therapist in providing customized sensorimotor challenges
bull Access to safe dynamic and therapeutic environments vs predictable and static environments
bull The difference between practice for skill development and adaptation to challenges in changing environments
Smith Roley 2014
Implications for Sensory Integration in Practice
Most importantly the success of Sensory Integration in practice depends on
YOU
Smith Roley 2014
Thank You
bull Organizers and Participants
bull hyvaumlauml paumlivaumlnjatkoa
bull Enjoy the conference
Smith Roley 2013
bull Ayres AJ (2005) Sensory Integration and the Child Los Angeles CA Western Psychological Services bull Armstrong T (2006) The best schools How human development research should inform educational practice Alexandria
VA Association for Supervision and Curriculum Development bull Blanche E I Bodison S Chang M C amp Reinoso G (2012) Development of the comprehensive observations of
proprioception (COP) Validity reliability and factor analysis American Journal of Occupational Therapy 66 691ndash698 bull Bundy A amp Lane S (In press) Sensory integration theory and practice Third Ed Philsadelphia PA FA Davis Inc bull Casey T amp MacIntyre S (2007) Childrenrsquos need for time and space In T Casey (Ed) Environments for outdoor play A
practical guide to making space for children (pp 5 ndash 16) London Sage Publications httpwwwsagepubcomupm-data15553_CASEY_C01PDF
bull Gray P (2013) Play as preparation for learning and life American Journal of Play 5(3) 271 - 292 bull Greenough WR Black JE Wallace CS (1987) Experience and brain development Child Development 58(3)539-59 bull Lane AE Young RL Baker AEZ amp Angley MT (2010) Sensory processing subtypes in autism Association with adaptive behavior
Journal of Autism and Developmental Disorders 40 112-122
bull Lane SJ Schaaf RC (2010) Examining the neuroscience evidence for sensory-driven neuroplasticity implications for sensory-based occupational therapy for children and adolescents American Journal of Occupational Therapy 64(3)375-90
bull Mailloux Z Mulligan S Smith Roley S Cermak S Blanche E amp Bodison S Coleman G amp Lane C (2011) Verification and clarification of patterns of sensory integrative dysfunction in a retrospective clinical sample American Journal of Occupational Therapy 652 143-151
bull May A (2011) Experience-dependent structural plasticity in the adult human brain 1-8 Trends in Cognitive Sciences bull May-Benson TA Smith Roley S Mailloux Z Parham LD Koomar J Schaaf RC Van Jaarsveld AM amp Cohn E (in
press) Structural Elements of the Ayres Sensory Integrationreg Intervention Fidelity Measurecopy American Journal of Occupational Therapy
bull Milteer RM Ginsburg KR amp Council on Communications and Media Committee on Psychosocial Aspects of Child and Family Health (2011) Pediatrics e204-e213 DOI 101542peds2011-2953
bull Parham LD Cohn ES Spitzer S Koomar J Miller LJ Burke JP Brett-Green B Mailloux Z May-Benson T Smith Roley S Schaaf RC Schoen S amp Summers CA (2007) Fidelity in sensory integration intervention research American Journal of Occupational Therapy 61 2 216-227
bull Parham LD Smith Roley S May-Benson T Koomar J Brett-Green B Burke JP Cohn ES Mailloux Z Miller LJ amp Schaaf RC (2011) Development of a fidelity measure for research on effectiveness of Ayres Sensory Integrationreg intervention American Journal of Occupational Therapy 65 2 133-142
bull Reynolds S Lane SJ amp Richards L (2010) Using animal models of enriched environments to inform research on sensory integration intervention for the rehabilitation of neurodevelopmental disorders Journal of Neurodevelopmental Disorders 2( 3) 120-132 online first DOI 101007s11689-010-9053-4
bull Roley SS Mailloux Z Parham D Schaaf R Blanche E amp Lane CA Cermak S (in press) Sensory Integration and Praxis Patterns in Children with Autism American Journal of Occupational Therapy
bull Rosenzweig MR Bennet EL and Diamond MC (1972) Brain Changes in response to experience Scientific American 226(2) 22-29
bull Van Jaarsveld A Mailloux Z Smith Roley S amp Raubenheimer J (in press) Patterns of the sensory integration dysfunctions in South African children South African Journal of Occupational Therapy
bull Wills S Cabanlit M Bennett J Ashwood P Amaral DG amp Van de Water J (2009) Detection of autoantibodies to neural cells of the cerebellum in the plasma of subjects with autism spectrum disorders Brain Behavior and Immunity 23(1) 64-74
Implications for OTSI Intervention
Consistent with Neuroplasticity Literature
ndash Sensorimotor opportunities
ndash Control over activity
ndash Novelty
ndash Challenge
ndash Playful environment
ndash Lifelike context
Smith Roley 2014
Sensory Integration and Play
bull When the therapist is doing her job effectively and the child is organizing his nervous system it looks as if the child is merely playing rdquo ndash Ayres 1979
Smith Roley 2013
Ayres Sensory Integrationreg Intervention Fidelity Measure
Parham et al 2007 2011 2013-in press
ASIFM Structural elements ndash Part I Therapist Qualifications
ndash Part II Safe Environment
ndash Part III Record Review
ndash Part IV Space and Equipment
ndash Part V Communication with Parents amp Teachers
Smith Roley 2013
ASIFM Process Elements (Parham et al 2011)
1 Physical safety 2 Sensory opportunities
(vestibular tactile and proprioceptive)
3 Supports sensory modulation to attainmaintain a regulated state
4 Supports postural ocular oral or bilateral motor coordination
5 Challenges praxis and organization of behavior
6 Collaborative activity choice
7 Just Right Challenge
8 Ensures Success
9 Supports motivation to play
10 Establishes therapeutic alliance
Smith Roley 2013
Data-driven Intervention Process (Schaaf 2001 Schaaf amp Blanche 2012)
Participation challenges
Current behavior
Theoretical
Framework
Assessments
37
Hypotheses Interventions Outcomes
(c) 2014 Susanne Smith Roley
OTD
Grounds for Optimism
Four Common Misconceptions
in the Anti-SI Intervention Literature Clark 2012
1) Reviews critical of sensory integration
intervention research ignores issues of fidelity
and dosage
Smith Roley 2014
2) Reviewers ignore or minimize the available
positive evidence for SI intervention
bull 3 RCTrsquos with autism demonstrated positive results
following multisensory interventions (including SI
intervention) (Fazlioglu amp Baran 2008 Pfeiffer
Koenig Kinnealey Sheppard amp Henderson 2011
Smith Press Koenig amp Kinnealey 2005)
bull ldquoBased on the application of meta-analytic techniques
for cumulating probability values it is not hard to
conclude that sensory treatments have positive effects
when administered to children with ASDsrdquo Clark
2012
Smith Roley 2014
3) The lack of positive outcomes from SI Intervention may be due
to weak or poorly designed studies
bull Current studies suggest that with stronger and more
studies there will be consistent beneficial effects for
certain outcomes
bull ldquoThe challenge is to make these studies happenrdquo
Clark 2012
Smith Roley 2013
4) Critics often forget that a lack of solid evidence characterizes
nearly all interventions for children with ASDs
bull SI intervention is often held to a different standard
than other types of intervention failing to apply the
same criterion to alternate interventions
Clark 2012
Smith Roley 2014
Remaining Mysteries
Smith Roley 2013
Implications for Advocacy
People need breaks such as recess
People require sensorimotor and social play timespacevalue in the daily routine
Smith Roley 2014
Implications for Research on OT using Sensory Integration
Enhancing Neuroplasticity via Therapeutic Design
bull Dosage - Intensity of increased access in short time periods rather than small access over longer times
bull Engagement via play and not just exposure
bull Role of therapist in providing customized sensorimotor challenges
bull Access to safe dynamic and therapeutic environments vs predictable and static environments
bull The difference between practice for skill development and adaptation to challenges in changing environments
Smith Roley 2014
Implications for Sensory Integration in Practice
Most importantly the success of Sensory Integration in practice depends on
YOU
Smith Roley 2014
Thank You
bull Organizers and Participants
bull hyvaumlauml paumlivaumlnjatkoa
bull Enjoy the conference
Smith Roley 2013
bull Ayres AJ (2005) Sensory Integration and the Child Los Angeles CA Western Psychological Services bull Armstrong T (2006) The best schools How human development research should inform educational practice Alexandria
VA Association for Supervision and Curriculum Development bull Blanche E I Bodison S Chang M C amp Reinoso G (2012) Development of the comprehensive observations of
proprioception (COP) Validity reliability and factor analysis American Journal of Occupational Therapy 66 691ndash698 bull Bundy A amp Lane S (In press) Sensory integration theory and practice Third Ed Philsadelphia PA FA Davis Inc bull Casey T amp MacIntyre S (2007) Childrenrsquos need for time and space In T Casey (Ed) Environments for outdoor play A
practical guide to making space for children (pp 5 ndash 16) London Sage Publications httpwwwsagepubcomupm-data15553_CASEY_C01PDF
bull Gray P (2013) Play as preparation for learning and life American Journal of Play 5(3) 271 - 292 bull Greenough WR Black JE Wallace CS (1987) Experience and brain development Child Development 58(3)539-59 bull Lane AE Young RL Baker AEZ amp Angley MT (2010) Sensory processing subtypes in autism Association with adaptive behavior
Journal of Autism and Developmental Disorders 40 112-122
bull Lane SJ Schaaf RC (2010) Examining the neuroscience evidence for sensory-driven neuroplasticity implications for sensory-based occupational therapy for children and adolescents American Journal of Occupational Therapy 64(3)375-90
bull Mailloux Z Mulligan S Smith Roley S Cermak S Blanche E amp Bodison S Coleman G amp Lane C (2011) Verification and clarification of patterns of sensory integrative dysfunction in a retrospective clinical sample American Journal of Occupational Therapy 652 143-151
bull May A (2011) Experience-dependent structural plasticity in the adult human brain 1-8 Trends in Cognitive Sciences bull May-Benson TA Smith Roley S Mailloux Z Parham LD Koomar J Schaaf RC Van Jaarsveld AM amp Cohn E (in
press) Structural Elements of the Ayres Sensory Integrationreg Intervention Fidelity Measurecopy American Journal of Occupational Therapy
bull Milteer RM Ginsburg KR amp Council on Communications and Media Committee on Psychosocial Aspects of Child and Family Health (2011) Pediatrics e204-e213 DOI 101542peds2011-2953
bull Parham LD Cohn ES Spitzer S Koomar J Miller LJ Burke JP Brett-Green B Mailloux Z May-Benson T Smith Roley S Schaaf RC Schoen S amp Summers CA (2007) Fidelity in sensory integration intervention research American Journal of Occupational Therapy 61 2 216-227
bull Parham LD Smith Roley S May-Benson T Koomar J Brett-Green B Burke JP Cohn ES Mailloux Z Miller LJ amp Schaaf RC (2011) Development of a fidelity measure for research on effectiveness of Ayres Sensory Integrationreg intervention American Journal of Occupational Therapy 65 2 133-142
bull Reynolds S Lane SJ amp Richards L (2010) Using animal models of enriched environments to inform research on sensory integration intervention for the rehabilitation of neurodevelopmental disorders Journal of Neurodevelopmental Disorders 2( 3) 120-132 online first DOI 101007s11689-010-9053-4
bull Roley SS Mailloux Z Parham D Schaaf R Blanche E amp Lane CA Cermak S (in press) Sensory Integration and Praxis Patterns in Children with Autism American Journal of Occupational Therapy
bull Rosenzweig MR Bennet EL and Diamond MC (1972) Brain Changes in response to experience Scientific American 226(2) 22-29
bull Van Jaarsveld A Mailloux Z Smith Roley S amp Raubenheimer J (in press) Patterns of the sensory integration dysfunctions in South African children South African Journal of Occupational Therapy
bull Wills S Cabanlit M Bennett J Ashwood P Amaral DG amp Van de Water J (2009) Detection of autoantibodies to neural cells of the cerebellum in the plasma of subjects with autism spectrum disorders Brain Behavior and Immunity 23(1) 64-74
Sensory Integration and Play
bull When the therapist is doing her job effectively and the child is organizing his nervous system it looks as if the child is merely playing rdquo ndash Ayres 1979
Smith Roley 2013
Ayres Sensory Integrationreg Intervention Fidelity Measure
Parham et al 2007 2011 2013-in press
ASIFM Structural elements ndash Part I Therapist Qualifications
ndash Part II Safe Environment
ndash Part III Record Review
ndash Part IV Space and Equipment
ndash Part V Communication with Parents amp Teachers
Smith Roley 2013
ASIFM Process Elements (Parham et al 2011)
1 Physical safety 2 Sensory opportunities
(vestibular tactile and proprioceptive)
3 Supports sensory modulation to attainmaintain a regulated state
4 Supports postural ocular oral or bilateral motor coordination
5 Challenges praxis and organization of behavior
6 Collaborative activity choice
7 Just Right Challenge
8 Ensures Success
9 Supports motivation to play
10 Establishes therapeutic alliance
Smith Roley 2013
Data-driven Intervention Process (Schaaf 2001 Schaaf amp Blanche 2012)
Participation challenges
Current behavior
Theoretical
Framework
Assessments
37
Hypotheses Interventions Outcomes
(c) 2014 Susanne Smith Roley
OTD
Grounds for Optimism
Four Common Misconceptions
in the Anti-SI Intervention Literature Clark 2012
1) Reviews critical of sensory integration
intervention research ignores issues of fidelity
and dosage
Smith Roley 2014
2) Reviewers ignore or minimize the available
positive evidence for SI intervention
bull 3 RCTrsquos with autism demonstrated positive results
following multisensory interventions (including SI
intervention) (Fazlioglu amp Baran 2008 Pfeiffer
Koenig Kinnealey Sheppard amp Henderson 2011
Smith Press Koenig amp Kinnealey 2005)
bull ldquoBased on the application of meta-analytic techniques
for cumulating probability values it is not hard to
conclude that sensory treatments have positive effects
when administered to children with ASDsrdquo Clark
2012
Smith Roley 2014
3) The lack of positive outcomes from SI Intervention may be due
to weak or poorly designed studies
bull Current studies suggest that with stronger and more
studies there will be consistent beneficial effects for
certain outcomes
bull ldquoThe challenge is to make these studies happenrdquo
Clark 2012
Smith Roley 2013
4) Critics often forget that a lack of solid evidence characterizes
nearly all interventions for children with ASDs
bull SI intervention is often held to a different standard
than other types of intervention failing to apply the
same criterion to alternate interventions
Clark 2012
Smith Roley 2014
Remaining Mysteries
Smith Roley 2013
Implications for Advocacy
People need breaks such as recess
People require sensorimotor and social play timespacevalue in the daily routine
Smith Roley 2014
Implications for Research on OT using Sensory Integration
Enhancing Neuroplasticity via Therapeutic Design
bull Dosage - Intensity of increased access in short time periods rather than small access over longer times
bull Engagement via play and not just exposure
bull Role of therapist in providing customized sensorimotor challenges
bull Access to safe dynamic and therapeutic environments vs predictable and static environments
bull The difference between practice for skill development and adaptation to challenges in changing environments
Smith Roley 2014
Implications for Sensory Integration in Practice
Most importantly the success of Sensory Integration in practice depends on
YOU
Smith Roley 2014
Thank You
bull Organizers and Participants
bull hyvaumlauml paumlivaumlnjatkoa
bull Enjoy the conference
Smith Roley 2013
bull Ayres AJ (2005) Sensory Integration and the Child Los Angeles CA Western Psychological Services bull Armstrong T (2006) The best schools How human development research should inform educational practice Alexandria
VA Association for Supervision and Curriculum Development bull Blanche E I Bodison S Chang M C amp Reinoso G (2012) Development of the comprehensive observations of
proprioception (COP) Validity reliability and factor analysis American Journal of Occupational Therapy 66 691ndash698 bull Bundy A amp Lane S (In press) Sensory integration theory and practice Third Ed Philsadelphia PA FA Davis Inc bull Casey T amp MacIntyre S (2007) Childrenrsquos need for time and space In T Casey (Ed) Environments for outdoor play A
practical guide to making space for children (pp 5 ndash 16) London Sage Publications httpwwwsagepubcomupm-data15553_CASEY_C01PDF
bull Gray P (2013) Play as preparation for learning and life American Journal of Play 5(3) 271 - 292 bull Greenough WR Black JE Wallace CS (1987) Experience and brain development Child Development 58(3)539-59 bull Lane AE Young RL Baker AEZ amp Angley MT (2010) Sensory processing subtypes in autism Association with adaptive behavior
Journal of Autism and Developmental Disorders 40 112-122
bull Lane SJ Schaaf RC (2010) Examining the neuroscience evidence for sensory-driven neuroplasticity implications for sensory-based occupational therapy for children and adolescents American Journal of Occupational Therapy 64(3)375-90
bull Mailloux Z Mulligan S Smith Roley S Cermak S Blanche E amp Bodison S Coleman G amp Lane C (2011) Verification and clarification of patterns of sensory integrative dysfunction in a retrospective clinical sample American Journal of Occupational Therapy 652 143-151
bull May A (2011) Experience-dependent structural plasticity in the adult human brain 1-8 Trends in Cognitive Sciences bull May-Benson TA Smith Roley S Mailloux Z Parham LD Koomar J Schaaf RC Van Jaarsveld AM amp Cohn E (in
press) Structural Elements of the Ayres Sensory Integrationreg Intervention Fidelity Measurecopy American Journal of Occupational Therapy
bull Milteer RM Ginsburg KR amp Council on Communications and Media Committee on Psychosocial Aspects of Child and Family Health (2011) Pediatrics e204-e213 DOI 101542peds2011-2953
bull Parham LD Cohn ES Spitzer S Koomar J Miller LJ Burke JP Brett-Green B Mailloux Z May-Benson T Smith Roley S Schaaf RC Schoen S amp Summers CA (2007) Fidelity in sensory integration intervention research American Journal of Occupational Therapy 61 2 216-227
bull Parham LD Smith Roley S May-Benson T Koomar J Brett-Green B Burke JP Cohn ES Mailloux Z Miller LJ amp Schaaf RC (2011) Development of a fidelity measure for research on effectiveness of Ayres Sensory Integrationreg intervention American Journal of Occupational Therapy 65 2 133-142
bull Reynolds S Lane SJ amp Richards L (2010) Using animal models of enriched environments to inform research on sensory integration intervention for the rehabilitation of neurodevelopmental disorders Journal of Neurodevelopmental Disorders 2( 3) 120-132 online first DOI 101007s11689-010-9053-4
bull Roley SS Mailloux Z Parham D Schaaf R Blanche E amp Lane CA Cermak S (in press) Sensory Integration and Praxis Patterns in Children with Autism American Journal of Occupational Therapy
bull Rosenzweig MR Bennet EL and Diamond MC (1972) Brain Changes in response to experience Scientific American 226(2) 22-29
bull Van Jaarsveld A Mailloux Z Smith Roley S amp Raubenheimer J (in press) Patterns of the sensory integration dysfunctions in South African children South African Journal of Occupational Therapy
bull Wills S Cabanlit M Bennett J Ashwood P Amaral DG amp Van de Water J (2009) Detection of autoantibodies to neural cells of the cerebellum in the plasma of subjects with autism spectrum disorders Brain Behavior and Immunity 23(1) 64-74
Ayres Sensory Integrationreg Intervention Fidelity Measure
Parham et al 2007 2011 2013-in press
ASIFM Structural elements ndash Part I Therapist Qualifications
ndash Part II Safe Environment
ndash Part III Record Review
ndash Part IV Space and Equipment
ndash Part V Communication with Parents amp Teachers
Smith Roley 2013
ASIFM Process Elements (Parham et al 2011)
1 Physical safety 2 Sensory opportunities
(vestibular tactile and proprioceptive)
3 Supports sensory modulation to attainmaintain a regulated state
4 Supports postural ocular oral or bilateral motor coordination
5 Challenges praxis and organization of behavior
6 Collaborative activity choice
7 Just Right Challenge
8 Ensures Success
9 Supports motivation to play
10 Establishes therapeutic alliance
Smith Roley 2013
Data-driven Intervention Process (Schaaf 2001 Schaaf amp Blanche 2012)
Participation challenges
Current behavior
Theoretical
Framework
Assessments
37
Hypotheses Interventions Outcomes
(c) 2014 Susanne Smith Roley
OTD
Grounds for Optimism
Four Common Misconceptions
in the Anti-SI Intervention Literature Clark 2012
1) Reviews critical of sensory integration
intervention research ignores issues of fidelity
and dosage
Smith Roley 2014
2) Reviewers ignore or minimize the available
positive evidence for SI intervention
bull 3 RCTrsquos with autism demonstrated positive results
following multisensory interventions (including SI
intervention) (Fazlioglu amp Baran 2008 Pfeiffer
Koenig Kinnealey Sheppard amp Henderson 2011
Smith Press Koenig amp Kinnealey 2005)
bull ldquoBased on the application of meta-analytic techniques
for cumulating probability values it is not hard to
conclude that sensory treatments have positive effects
when administered to children with ASDsrdquo Clark
2012
Smith Roley 2014
3) The lack of positive outcomes from SI Intervention may be due
to weak or poorly designed studies
bull Current studies suggest that with stronger and more
studies there will be consistent beneficial effects for
certain outcomes
bull ldquoThe challenge is to make these studies happenrdquo
Clark 2012
Smith Roley 2013
4) Critics often forget that a lack of solid evidence characterizes
nearly all interventions for children with ASDs
bull SI intervention is often held to a different standard
than other types of intervention failing to apply the
same criterion to alternate interventions
Clark 2012
Smith Roley 2014
Remaining Mysteries
Smith Roley 2013
Implications for Advocacy
People need breaks such as recess
People require sensorimotor and social play timespacevalue in the daily routine
Smith Roley 2014
Implications for Research on OT using Sensory Integration
Enhancing Neuroplasticity via Therapeutic Design
bull Dosage - Intensity of increased access in short time periods rather than small access over longer times
bull Engagement via play and not just exposure
bull Role of therapist in providing customized sensorimotor challenges
bull Access to safe dynamic and therapeutic environments vs predictable and static environments
bull The difference between practice for skill development and adaptation to challenges in changing environments
Smith Roley 2014
Implications for Sensory Integration in Practice
Most importantly the success of Sensory Integration in practice depends on
YOU
Smith Roley 2014
Thank You
bull Organizers and Participants
bull hyvaumlauml paumlivaumlnjatkoa
bull Enjoy the conference
Smith Roley 2013
bull Ayres AJ (2005) Sensory Integration and the Child Los Angeles CA Western Psychological Services bull Armstrong T (2006) The best schools How human development research should inform educational practice Alexandria
VA Association for Supervision and Curriculum Development bull Blanche E I Bodison S Chang M C amp Reinoso G (2012) Development of the comprehensive observations of
proprioception (COP) Validity reliability and factor analysis American Journal of Occupational Therapy 66 691ndash698 bull Bundy A amp Lane S (In press) Sensory integration theory and practice Third Ed Philsadelphia PA FA Davis Inc bull Casey T amp MacIntyre S (2007) Childrenrsquos need for time and space In T Casey (Ed) Environments for outdoor play A
practical guide to making space for children (pp 5 ndash 16) London Sage Publications httpwwwsagepubcomupm-data15553_CASEY_C01PDF
bull Gray P (2013) Play as preparation for learning and life American Journal of Play 5(3) 271 - 292 bull Greenough WR Black JE Wallace CS (1987) Experience and brain development Child Development 58(3)539-59 bull Lane AE Young RL Baker AEZ amp Angley MT (2010) Sensory processing subtypes in autism Association with adaptive behavior
Journal of Autism and Developmental Disorders 40 112-122
bull Lane SJ Schaaf RC (2010) Examining the neuroscience evidence for sensory-driven neuroplasticity implications for sensory-based occupational therapy for children and adolescents American Journal of Occupational Therapy 64(3)375-90
bull Mailloux Z Mulligan S Smith Roley S Cermak S Blanche E amp Bodison S Coleman G amp Lane C (2011) Verification and clarification of patterns of sensory integrative dysfunction in a retrospective clinical sample American Journal of Occupational Therapy 652 143-151
bull May A (2011) Experience-dependent structural plasticity in the adult human brain 1-8 Trends in Cognitive Sciences bull May-Benson TA Smith Roley S Mailloux Z Parham LD Koomar J Schaaf RC Van Jaarsveld AM amp Cohn E (in
press) Structural Elements of the Ayres Sensory Integrationreg Intervention Fidelity Measurecopy American Journal of Occupational Therapy
bull Milteer RM Ginsburg KR amp Council on Communications and Media Committee on Psychosocial Aspects of Child and Family Health (2011) Pediatrics e204-e213 DOI 101542peds2011-2953
bull Parham LD Cohn ES Spitzer S Koomar J Miller LJ Burke JP Brett-Green B Mailloux Z May-Benson T Smith Roley S Schaaf RC Schoen S amp Summers CA (2007) Fidelity in sensory integration intervention research American Journal of Occupational Therapy 61 2 216-227
bull Parham LD Smith Roley S May-Benson T Koomar J Brett-Green B Burke JP Cohn ES Mailloux Z Miller LJ amp Schaaf RC (2011) Development of a fidelity measure for research on effectiveness of Ayres Sensory Integrationreg intervention American Journal of Occupational Therapy 65 2 133-142
bull Reynolds S Lane SJ amp Richards L (2010) Using animal models of enriched environments to inform research on sensory integration intervention for the rehabilitation of neurodevelopmental disorders Journal of Neurodevelopmental Disorders 2( 3) 120-132 online first DOI 101007s11689-010-9053-4
bull Roley SS Mailloux Z Parham D Schaaf R Blanche E amp Lane CA Cermak S (in press) Sensory Integration and Praxis Patterns in Children with Autism American Journal of Occupational Therapy
bull Rosenzweig MR Bennet EL and Diamond MC (1972) Brain Changes in response to experience Scientific American 226(2) 22-29
bull Van Jaarsveld A Mailloux Z Smith Roley S amp Raubenheimer J (in press) Patterns of the sensory integration dysfunctions in South African children South African Journal of Occupational Therapy
bull Wills S Cabanlit M Bennett J Ashwood P Amaral DG amp Van de Water J (2009) Detection of autoantibodies to neural cells of the cerebellum in the plasma of subjects with autism spectrum disorders Brain Behavior and Immunity 23(1) 64-74
ASIFM Process Elements (Parham et al 2011)
1 Physical safety 2 Sensory opportunities
(vestibular tactile and proprioceptive)
3 Supports sensory modulation to attainmaintain a regulated state
4 Supports postural ocular oral or bilateral motor coordination
5 Challenges praxis and organization of behavior
6 Collaborative activity choice
7 Just Right Challenge
8 Ensures Success
9 Supports motivation to play
10 Establishes therapeutic alliance
Smith Roley 2013
Data-driven Intervention Process (Schaaf 2001 Schaaf amp Blanche 2012)
Participation challenges
Current behavior
Theoretical
Framework
Assessments
37
Hypotheses Interventions Outcomes
(c) 2014 Susanne Smith Roley
OTD
Grounds for Optimism
Four Common Misconceptions
in the Anti-SI Intervention Literature Clark 2012
1) Reviews critical of sensory integration
intervention research ignores issues of fidelity
and dosage
Smith Roley 2014
2) Reviewers ignore or minimize the available
positive evidence for SI intervention
bull 3 RCTrsquos with autism demonstrated positive results
following multisensory interventions (including SI
intervention) (Fazlioglu amp Baran 2008 Pfeiffer
Koenig Kinnealey Sheppard amp Henderson 2011
Smith Press Koenig amp Kinnealey 2005)
bull ldquoBased on the application of meta-analytic techniques
for cumulating probability values it is not hard to
conclude that sensory treatments have positive effects
when administered to children with ASDsrdquo Clark
2012
Smith Roley 2014
3) The lack of positive outcomes from SI Intervention may be due
to weak or poorly designed studies
bull Current studies suggest that with stronger and more
studies there will be consistent beneficial effects for
certain outcomes
bull ldquoThe challenge is to make these studies happenrdquo
Clark 2012
Smith Roley 2013
4) Critics often forget that a lack of solid evidence characterizes
nearly all interventions for children with ASDs
bull SI intervention is often held to a different standard
than other types of intervention failing to apply the
same criterion to alternate interventions
Clark 2012
Smith Roley 2014
Remaining Mysteries
Smith Roley 2013
Implications for Advocacy
People need breaks such as recess
People require sensorimotor and social play timespacevalue in the daily routine
Smith Roley 2014
Implications for Research on OT using Sensory Integration
Enhancing Neuroplasticity via Therapeutic Design
bull Dosage - Intensity of increased access in short time periods rather than small access over longer times
bull Engagement via play and not just exposure
bull Role of therapist in providing customized sensorimotor challenges
bull Access to safe dynamic and therapeutic environments vs predictable and static environments
bull The difference between practice for skill development and adaptation to challenges in changing environments
Smith Roley 2014
Implications for Sensory Integration in Practice
Most importantly the success of Sensory Integration in practice depends on
YOU
Smith Roley 2014
Thank You
bull Organizers and Participants
bull hyvaumlauml paumlivaumlnjatkoa
bull Enjoy the conference
Smith Roley 2013
bull Ayres AJ (2005) Sensory Integration and the Child Los Angeles CA Western Psychological Services bull Armstrong T (2006) The best schools How human development research should inform educational practice Alexandria
VA Association for Supervision and Curriculum Development bull Blanche E I Bodison S Chang M C amp Reinoso G (2012) Development of the comprehensive observations of
proprioception (COP) Validity reliability and factor analysis American Journal of Occupational Therapy 66 691ndash698 bull Bundy A amp Lane S (In press) Sensory integration theory and practice Third Ed Philsadelphia PA FA Davis Inc bull Casey T amp MacIntyre S (2007) Childrenrsquos need for time and space In T Casey (Ed) Environments for outdoor play A
practical guide to making space for children (pp 5 ndash 16) London Sage Publications httpwwwsagepubcomupm-data15553_CASEY_C01PDF
bull Gray P (2013) Play as preparation for learning and life American Journal of Play 5(3) 271 - 292 bull Greenough WR Black JE Wallace CS (1987) Experience and brain development Child Development 58(3)539-59 bull Lane AE Young RL Baker AEZ amp Angley MT (2010) Sensory processing subtypes in autism Association with adaptive behavior
Journal of Autism and Developmental Disorders 40 112-122
bull Lane SJ Schaaf RC (2010) Examining the neuroscience evidence for sensory-driven neuroplasticity implications for sensory-based occupational therapy for children and adolescents American Journal of Occupational Therapy 64(3)375-90
bull Mailloux Z Mulligan S Smith Roley S Cermak S Blanche E amp Bodison S Coleman G amp Lane C (2011) Verification and clarification of patterns of sensory integrative dysfunction in a retrospective clinical sample American Journal of Occupational Therapy 652 143-151
bull May A (2011) Experience-dependent structural plasticity in the adult human brain 1-8 Trends in Cognitive Sciences bull May-Benson TA Smith Roley S Mailloux Z Parham LD Koomar J Schaaf RC Van Jaarsveld AM amp Cohn E (in
press) Structural Elements of the Ayres Sensory Integrationreg Intervention Fidelity Measurecopy American Journal of Occupational Therapy
bull Milteer RM Ginsburg KR amp Council on Communications and Media Committee on Psychosocial Aspects of Child and Family Health (2011) Pediatrics e204-e213 DOI 101542peds2011-2953
bull Parham LD Cohn ES Spitzer S Koomar J Miller LJ Burke JP Brett-Green B Mailloux Z May-Benson T Smith Roley S Schaaf RC Schoen S amp Summers CA (2007) Fidelity in sensory integration intervention research American Journal of Occupational Therapy 61 2 216-227
bull Parham LD Smith Roley S May-Benson T Koomar J Brett-Green B Burke JP Cohn ES Mailloux Z Miller LJ amp Schaaf RC (2011) Development of a fidelity measure for research on effectiveness of Ayres Sensory Integrationreg intervention American Journal of Occupational Therapy 65 2 133-142
bull Reynolds S Lane SJ amp Richards L (2010) Using animal models of enriched environments to inform research on sensory integration intervention for the rehabilitation of neurodevelopmental disorders Journal of Neurodevelopmental Disorders 2( 3) 120-132 online first DOI 101007s11689-010-9053-4
bull Roley SS Mailloux Z Parham D Schaaf R Blanche E amp Lane CA Cermak S (in press) Sensory Integration and Praxis Patterns in Children with Autism American Journal of Occupational Therapy
bull Rosenzweig MR Bennet EL and Diamond MC (1972) Brain Changes in response to experience Scientific American 226(2) 22-29
bull Van Jaarsveld A Mailloux Z Smith Roley S amp Raubenheimer J (in press) Patterns of the sensory integration dysfunctions in South African children South African Journal of Occupational Therapy
bull Wills S Cabanlit M Bennett J Ashwood P Amaral DG amp Van de Water J (2009) Detection of autoantibodies to neural cells of the cerebellum in the plasma of subjects with autism spectrum disorders Brain Behavior and Immunity 23(1) 64-74
Data-driven Intervention Process (Schaaf 2001 Schaaf amp Blanche 2012)
Participation challenges
Current behavior
Theoretical
Framework
Assessments
37
Hypotheses Interventions Outcomes
(c) 2014 Susanne Smith Roley
OTD
Grounds for Optimism
Four Common Misconceptions
in the Anti-SI Intervention Literature Clark 2012
1) Reviews critical of sensory integration
intervention research ignores issues of fidelity
and dosage
Smith Roley 2014
2) Reviewers ignore or minimize the available
positive evidence for SI intervention
bull 3 RCTrsquos with autism demonstrated positive results
following multisensory interventions (including SI
intervention) (Fazlioglu amp Baran 2008 Pfeiffer
Koenig Kinnealey Sheppard amp Henderson 2011
Smith Press Koenig amp Kinnealey 2005)
bull ldquoBased on the application of meta-analytic techniques
for cumulating probability values it is not hard to
conclude that sensory treatments have positive effects
when administered to children with ASDsrdquo Clark
2012
Smith Roley 2014
3) The lack of positive outcomes from SI Intervention may be due
to weak or poorly designed studies
bull Current studies suggest that with stronger and more
studies there will be consistent beneficial effects for
certain outcomes
bull ldquoThe challenge is to make these studies happenrdquo
Clark 2012
Smith Roley 2013
4) Critics often forget that a lack of solid evidence characterizes
nearly all interventions for children with ASDs
bull SI intervention is often held to a different standard
than other types of intervention failing to apply the
same criterion to alternate interventions
Clark 2012
Smith Roley 2014
Remaining Mysteries
Smith Roley 2013
Implications for Advocacy
People need breaks such as recess
People require sensorimotor and social play timespacevalue in the daily routine
Smith Roley 2014
Implications for Research on OT using Sensory Integration
Enhancing Neuroplasticity via Therapeutic Design
bull Dosage - Intensity of increased access in short time periods rather than small access over longer times
bull Engagement via play and not just exposure
bull Role of therapist in providing customized sensorimotor challenges
bull Access to safe dynamic and therapeutic environments vs predictable and static environments
bull The difference between practice for skill development and adaptation to challenges in changing environments
Smith Roley 2014
Implications for Sensory Integration in Practice
Most importantly the success of Sensory Integration in practice depends on
YOU
Smith Roley 2014
Thank You
bull Organizers and Participants
bull hyvaumlauml paumlivaumlnjatkoa
bull Enjoy the conference
Smith Roley 2013
bull Ayres AJ (2005) Sensory Integration and the Child Los Angeles CA Western Psychological Services bull Armstrong T (2006) The best schools How human development research should inform educational practice Alexandria
VA Association for Supervision and Curriculum Development bull Blanche E I Bodison S Chang M C amp Reinoso G (2012) Development of the comprehensive observations of
proprioception (COP) Validity reliability and factor analysis American Journal of Occupational Therapy 66 691ndash698 bull Bundy A amp Lane S (In press) Sensory integration theory and practice Third Ed Philsadelphia PA FA Davis Inc bull Casey T amp MacIntyre S (2007) Childrenrsquos need for time and space In T Casey (Ed) Environments for outdoor play A
practical guide to making space for children (pp 5 ndash 16) London Sage Publications httpwwwsagepubcomupm-data15553_CASEY_C01PDF
bull Gray P (2013) Play as preparation for learning and life American Journal of Play 5(3) 271 - 292 bull Greenough WR Black JE Wallace CS (1987) Experience and brain development Child Development 58(3)539-59 bull Lane AE Young RL Baker AEZ amp Angley MT (2010) Sensory processing subtypes in autism Association with adaptive behavior
Journal of Autism and Developmental Disorders 40 112-122
bull Lane SJ Schaaf RC (2010) Examining the neuroscience evidence for sensory-driven neuroplasticity implications for sensory-based occupational therapy for children and adolescents American Journal of Occupational Therapy 64(3)375-90
bull Mailloux Z Mulligan S Smith Roley S Cermak S Blanche E amp Bodison S Coleman G amp Lane C (2011) Verification and clarification of patterns of sensory integrative dysfunction in a retrospective clinical sample American Journal of Occupational Therapy 652 143-151
bull May A (2011) Experience-dependent structural plasticity in the adult human brain 1-8 Trends in Cognitive Sciences bull May-Benson TA Smith Roley S Mailloux Z Parham LD Koomar J Schaaf RC Van Jaarsveld AM amp Cohn E (in
press) Structural Elements of the Ayres Sensory Integrationreg Intervention Fidelity Measurecopy American Journal of Occupational Therapy
bull Milteer RM Ginsburg KR amp Council on Communications and Media Committee on Psychosocial Aspects of Child and Family Health (2011) Pediatrics e204-e213 DOI 101542peds2011-2953
bull Parham LD Cohn ES Spitzer S Koomar J Miller LJ Burke JP Brett-Green B Mailloux Z May-Benson T Smith Roley S Schaaf RC Schoen S amp Summers CA (2007) Fidelity in sensory integration intervention research American Journal of Occupational Therapy 61 2 216-227
bull Parham LD Smith Roley S May-Benson T Koomar J Brett-Green B Burke JP Cohn ES Mailloux Z Miller LJ amp Schaaf RC (2011) Development of a fidelity measure for research on effectiveness of Ayres Sensory Integrationreg intervention American Journal of Occupational Therapy 65 2 133-142
bull Reynolds S Lane SJ amp Richards L (2010) Using animal models of enriched environments to inform research on sensory integration intervention for the rehabilitation of neurodevelopmental disorders Journal of Neurodevelopmental Disorders 2( 3) 120-132 online first DOI 101007s11689-010-9053-4
bull Roley SS Mailloux Z Parham D Schaaf R Blanche E amp Lane CA Cermak S (in press) Sensory Integration and Praxis Patterns in Children with Autism American Journal of Occupational Therapy
bull Rosenzweig MR Bennet EL and Diamond MC (1972) Brain Changes in response to experience Scientific American 226(2) 22-29
bull Van Jaarsveld A Mailloux Z Smith Roley S amp Raubenheimer J (in press) Patterns of the sensory integration dysfunctions in South African children South African Journal of Occupational Therapy
bull Wills S Cabanlit M Bennett J Ashwood P Amaral DG amp Van de Water J (2009) Detection of autoantibodies to neural cells of the cerebellum in the plasma of subjects with autism spectrum disorders Brain Behavior and Immunity 23(1) 64-74
Grounds for Optimism
Four Common Misconceptions
in the Anti-SI Intervention Literature Clark 2012
1) Reviews critical of sensory integration
intervention research ignores issues of fidelity
and dosage
Smith Roley 2014
2) Reviewers ignore or minimize the available
positive evidence for SI intervention
bull 3 RCTrsquos with autism demonstrated positive results
following multisensory interventions (including SI
intervention) (Fazlioglu amp Baran 2008 Pfeiffer
Koenig Kinnealey Sheppard amp Henderson 2011
Smith Press Koenig amp Kinnealey 2005)
bull ldquoBased on the application of meta-analytic techniques
for cumulating probability values it is not hard to
conclude that sensory treatments have positive effects
when administered to children with ASDsrdquo Clark
2012
Smith Roley 2014
3) The lack of positive outcomes from SI Intervention may be due
to weak or poorly designed studies
bull Current studies suggest that with stronger and more
studies there will be consistent beneficial effects for
certain outcomes
bull ldquoThe challenge is to make these studies happenrdquo
Clark 2012
Smith Roley 2013
4) Critics often forget that a lack of solid evidence characterizes
nearly all interventions for children with ASDs
bull SI intervention is often held to a different standard
than other types of intervention failing to apply the
same criterion to alternate interventions
Clark 2012
Smith Roley 2014
Remaining Mysteries
Smith Roley 2013
Implications for Advocacy
People need breaks such as recess
People require sensorimotor and social play timespacevalue in the daily routine
Smith Roley 2014
Implications for Research on OT using Sensory Integration
Enhancing Neuroplasticity via Therapeutic Design
bull Dosage - Intensity of increased access in short time periods rather than small access over longer times
bull Engagement via play and not just exposure
bull Role of therapist in providing customized sensorimotor challenges
bull Access to safe dynamic and therapeutic environments vs predictable and static environments
bull The difference between practice for skill development and adaptation to challenges in changing environments
Smith Roley 2014
Implications for Sensory Integration in Practice
Most importantly the success of Sensory Integration in practice depends on
YOU
Smith Roley 2014
Thank You
bull Organizers and Participants
bull hyvaumlauml paumlivaumlnjatkoa
bull Enjoy the conference
Smith Roley 2013
bull Ayres AJ (2005) Sensory Integration and the Child Los Angeles CA Western Psychological Services bull Armstrong T (2006) The best schools How human development research should inform educational practice Alexandria
VA Association for Supervision and Curriculum Development bull Blanche E I Bodison S Chang M C amp Reinoso G (2012) Development of the comprehensive observations of
proprioception (COP) Validity reliability and factor analysis American Journal of Occupational Therapy 66 691ndash698 bull Bundy A amp Lane S (In press) Sensory integration theory and practice Third Ed Philsadelphia PA FA Davis Inc bull Casey T amp MacIntyre S (2007) Childrenrsquos need for time and space In T Casey (Ed) Environments for outdoor play A
practical guide to making space for children (pp 5 ndash 16) London Sage Publications httpwwwsagepubcomupm-data15553_CASEY_C01PDF
bull Gray P (2013) Play as preparation for learning and life American Journal of Play 5(3) 271 - 292 bull Greenough WR Black JE Wallace CS (1987) Experience and brain development Child Development 58(3)539-59 bull Lane AE Young RL Baker AEZ amp Angley MT (2010) Sensory processing subtypes in autism Association with adaptive behavior
Journal of Autism and Developmental Disorders 40 112-122
bull Lane SJ Schaaf RC (2010) Examining the neuroscience evidence for sensory-driven neuroplasticity implications for sensory-based occupational therapy for children and adolescents American Journal of Occupational Therapy 64(3)375-90
bull Mailloux Z Mulligan S Smith Roley S Cermak S Blanche E amp Bodison S Coleman G amp Lane C (2011) Verification and clarification of patterns of sensory integrative dysfunction in a retrospective clinical sample American Journal of Occupational Therapy 652 143-151
bull May A (2011) Experience-dependent structural plasticity in the adult human brain 1-8 Trends in Cognitive Sciences bull May-Benson TA Smith Roley S Mailloux Z Parham LD Koomar J Schaaf RC Van Jaarsveld AM amp Cohn E (in
press) Structural Elements of the Ayres Sensory Integrationreg Intervention Fidelity Measurecopy American Journal of Occupational Therapy
bull Milteer RM Ginsburg KR amp Council on Communications and Media Committee on Psychosocial Aspects of Child and Family Health (2011) Pediatrics e204-e213 DOI 101542peds2011-2953
bull Parham LD Cohn ES Spitzer S Koomar J Miller LJ Burke JP Brett-Green B Mailloux Z May-Benson T Smith Roley S Schaaf RC Schoen S amp Summers CA (2007) Fidelity in sensory integration intervention research American Journal of Occupational Therapy 61 2 216-227
bull Parham LD Smith Roley S May-Benson T Koomar J Brett-Green B Burke JP Cohn ES Mailloux Z Miller LJ amp Schaaf RC (2011) Development of a fidelity measure for research on effectiveness of Ayres Sensory Integrationreg intervention American Journal of Occupational Therapy 65 2 133-142
bull Reynolds S Lane SJ amp Richards L (2010) Using animal models of enriched environments to inform research on sensory integration intervention for the rehabilitation of neurodevelopmental disorders Journal of Neurodevelopmental Disorders 2( 3) 120-132 online first DOI 101007s11689-010-9053-4
bull Roley SS Mailloux Z Parham D Schaaf R Blanche E amp Lane CA Cermak S (in press) Sensory Integration and Praxis Patterns in Children with Autism American Journal of Occupational Therapy
bull Rosenzweig MR Bennet EL and Diamond MC (1972) Brain Changes in response to experience Scientific American 226(2) 22-29
bull Van Jaarsveld A Mailloux Z Smith Roley S amp Raubenheimer J (in press) Patterns of the sensory integration dysfunctions in South African children South African Journal of Occupational Therapy
bull Wills S Cabanlit M Bennett J Ashwood P Amaral DG amp Van de Water J (2009) Detection of autoantibodies to neural cells of the cerebellum in the plasma of subjects with autism spectrum disorders Brain Behavior and Immunity 23(1) 64-74
2) Reviewers ignore or minimize the available
positive evidence for SI intervention
bull 3 RCTrsquos with autism demonstrated positive results
following multisensory interventions (including SI
intervention) (Fazlioglu amp Baran 2008 Pfeiffer
Koenig Kinnealey Sheppard amp Henderson 2011
Smith Press Koenig amp Kinnealey 2005)
bull ldquoBased on the application of meta-analytic techniques
for cumulating probability values it is not hard to
conclude that sensory treatments have positive effects
when administered to children with ASDsrdquo Clark
2012
Smith Roley 2014
3) The lack of positive outcomes from SI Intervention may be due
to weak or poorly designed studies
bull Current studies suggest that with stronger and more
studies there will be consistent beneficial effects for
certain outcomes
bull ldquoThe challenge is to make these studies happenrdquo
Clark 2012
Smith Roley 2013
4) Critics often forget that a lack of solid evidence characterizes
nearly all interventions for children with ASDs
bull SI intervention is often held to a different standard
than other types of intervention failing to apply the
same criterion to alternate interventions
Clark 2012
Smith Roley 2014
Remaining Mysteries
Smith Roley 2013
Implications for Advocacy
People need breaks such as recess
People require sensorimotor and social play timespacevalue in the daily routine
Smith Roley 2014
Implications for Research on OT using Sensory Integration
Enhancing Neuroplasticity via Therapeutic Design
bull Dosage - Intensity of increased access in short time periods rather than small access over longer times
bull Engagement via play and not just exposure
bull Role of therapist in providing customized sensorimotor challenges
bull Access to safe dynamic and therapeutic environments vs predictable and static environments
bull The difference between practice for skill development and adaptation to challenges in changing environments
Smith Roley 2014
Implications for Sensory Integration in Practice
Most importantly the success of Sensory Integration in practice depends on
YOU
Smith Roley 2014
Thank You
bull Organizers and Participants
bull hyvaumlauml paumlivaumlnjatkoa
bull Enjoy the conference
Smith Roley 2013
bull Ayres AJ (2005) Sensory Integration and the Child Los Angeles CA Western Psychological Services bull Armstrong T (2006) The best schools How human development research should inform educational practice Alexandria
VA Association for Supervision and Curriculum Development bull Blanche E I Bodison S Chang M C amp Reinoso G (2012) Development of the comprehensive observations of
proprioception (COP) Validity reliability and factor analysis American Journal of Occupational Therapy 66 691ndash698 bull Bundy A amp Lane S (In press) Sensory integration theory and practice Third Ed Philsadelphia PA FA Davis Inc bull Casey T amp MacIntyre S (2007) Childrenrsquos need for time and space In T Casey (Ed) Environments for outdoor play A
practical guide to making space for children (pp 5 ndash 16) London Sage Publications httpwwwsagepubcomupm-data15553_CASEY_C01PDF
bull Gray P (2013) Play as preparation for learning and life American Journal of Play 5(3) 271 - 292 bull Greenough WR Black JE Wallace CS (1987) Experience and brain development Child Development 58(3)539-59 bull Lane AE Young RL Baker AEZ amp Angley MT (2010) Sensory processing subtypes in autism Association with adaptive behavior
Journal of Autism and Developmental Disorders 40 112-122
bull Lane SJ Schaaf RC (2010) Examining the neuroscience evidence for sensory-driven neuroplasticity implications for sensory-based occupational therapy for children and adolescents American Journal of Occupational Therapy 64(3)375-90
bull Mailloux Z Mulligan S Smith Roley S Cermak S Blanche E amp Bodison S Coleman G amp Lane C (2011) Verification and clarification of patterns of sensory integrative dysfunction in a retrospective clinical sample American Journal of Occupational Therapy 652 143-151
bull May A (2011) Experience-dependent structural plasticity in the adult human brain 1-8 Trends in Cognitive Sciences bull May-Benson TA Smith Roley S Mailloux Z Parham LD Koomar J Schaaf RC Van Jaarsveld AM amp Cohn E (in
press) Structural Elements of the Ayres Sensory Integrationreg Intervention Fidelity Measurecopy American Journal of Occupational Therapy
bull Milteer RM Ginsburg KR amp Council on Communications and Media Committee on Psychosocial Aspects of Child and Family Health (2011) Pediatrics e204-e213 DOI 101542peds2011-2953
bull Parham LD Cohn ES Spitzer S Koomar J Miller LJ Burke JP Brett-Green B Mailloux Z May-Benson T Smith Roley S Schaaf RC Schoen S amp Summers CA (2007) Fidelity in sensory integration intervention research American Journal of Occupational Therapy 61 2 216-227
bull Parham LD Smith Roley S May-Benson T Koomar J Brett-Green B Burke JP Cohn ES Mailloux Z Miller LJ amp Schaaf RC (2011) Development of a fidelity measure for research on effectiveness of Ayres Sensory Integrationreg intervention American Journal of Occupational Therapy 65 2 133-142
bull Reynolds S Lane SJ amp Richards L (2010) Using animal models of enriched environments to inform research on sensory integration intervention for the rehabilitation of neurodevelopmental disorders Journal of Neurodevelopmental Disorders 2( 3) 120-132 online first DOI 101007s11689-010-9053-4
bull Roley SS Mailloux Z Parham D Schaaf R Blanche E amp Lane CA Cermak S (in press) Sensory Integration and Praxis Patterns in Children with Autism American Journal of Occupational Therapy
bull Rosenzweig MR Bennet EL and Diamond MC (1972) Brain Changes in response to experience Scientific American 226(2) 22-29
bull Van Jaarsveld A Mailloux Z Smith Roley S amp Raubenheimer J (in press) Patterns of the sensory integration dysfunctions in South African children South African Journal of Occupational Therapy
bull Wills S Cabanlit M Bennett J Ashwood P Amaral DG amp Van de Water J (2009) Detection of autoantibodies to neural cells of the cerebellum in the plasma of subjects with autism spectrum disorders Brain Behavior and Immunity 23(1) 64-74
3) The lack of positive outcomes from SI Intervention may be due
to weak or poorly designed studies
bull Current studies suggest that with stronger and more
studies there will be consistent beneficial effects for
certain outcomes
bull ldquoThe challenge is to make these studies happenrdquo
Clark 2012
Smith Roley 2013
4) Critics often forget that a lack of solid evidence characterizes
nearly all interventions for children with ASDs
bull SI intervention is often held to a different standard
than other types of intervention failing to apply the
same criterion to alternate interventions
Clark 2012
Smith Roley 2014
Remaining Mysteries
Smith Roley 2013
Implications for Advocacy
People need breaks such as recess
People require sensorimotor and social play timespacevalue in the daily routine
Smith Roley 2014
Implications for Research on OT using Sensory Integration
Enhancing Neuroplasticity via Therapeutic Design
bull Dosage - Intensity of increased access in short time periods rather than small access over longer times
bull Engagement via play and not just exposure
bull Role of therapist in providing customized sensorimotor challenges
bull Access to safe dynamic and therapeutic environments vs predictable and static environments
bull The difference between practice for skill development and adaptation to challenges in changing environments
Smith Roley 2014
Implications for Sensory Integration in Practice
Most importantly the success of Sensory Integration in practice depends on
YOU
Smith Roley 2014
Thank You
bull Organizers and Participants
bull hyvaumlauml paumlivaumlnjatkoa
bull Enjoy the conference
Smith Roley 2013
bull Ayres AJ (2005) Sensory Integration and the Child Los Angeles CA Western Psychological Services bull Armstrong T (2006) The best schools How human development research should inform educational practice Alexandria
VA Association for Supervision and Curriculum Development bull Blanche E I Bodison S Chang M C amp Reinoso G (2012) Development of the comprehensive observations of
proprioception (COP) Validity reliability and factor analysis American Journal of Occupational Therapy 66 691ndash698 bull Bundy A amp Lane S (In press) Sensory integration theory and practice Third Ed Philsadelphia PA FA Davis Inc bull Casey T amp MacIntyre S (2007) Childrenrsquos need for time and space In T Casey (Ed) Environments for outdoor play A
practical guide to making space for children (pp 5 ndash 16) London Sage Publications httpwwwsagepubcomupm-data15553_CASEY_C01PDF
bull Gray P (2013) Play as preparation for learning and life American Journal of Play 5(3) 271 - 292 bull Greenough WR Black JE Wallace CS (1987) Experience and brain development Child Development 58(3)539-59 bull Lane AE Young RL Baker AEZ amp Angley MT (2010) Sensory processing subtypes in autism Association with adaptive behavior
Journal of Autism and Developmental Disorders 40 112-122
bull Lane SJ Schaaf RC (2010) Examining the neuroscience evidence for sensory-driven neuroplasticity implications for sensory-based occupational therapy for children and adolescents American Journal of Occupational Therapy 64(3)375-90
bull Mailloux Z Mulligan S Smith Roley S Cermak S Blanche E amp Bodison S Coleman G amp Lane C (2011) Verification and clarification of patterns of sensory integrative dysfunction in a retrospective clinical sample American Journal of Occupational Therapy 652 143-151
bull May A (2011) Experience-dependent structural plasticity in the adult human brain 1-8 Trends in Cognitive Sciences bull May-Benson TA Smith Roley S Mailloux Z Parham LD Koomar J Schaaf RC Van Jaarsveld AM amp Cohn E (in
press) Structural Elements of the Ayres Sensory Integrationreg Intervention Fidelity Measurecopy American Journal of Occupational Therapy
bull Milteer RM Ginsburg KR amp Council on Communications and Media Committee on Psychosocial Aspects of Child and Family Health (2011) Pediatrics e204-e213 DOI 101542peds2011-2953
bull Parham LD Cohn ES Spitzer S Koomar J Miller LJ Burke JP Brett-Green B Mailloux Z May-Benson T Smith Roley S Schaaf RC Schoen S amp Summers CA (2007) Fidelity in sensory integration intervention research American Journal of Occupational Therapy 61 2 216-227
bull Parham LD Smith Roley S May-Benson T Koomar J Brett-Green B Burke JP Cohn ES Mailloux Z Miller LJ amp Schaaf RC (2011) Development of a fidelity measure for research on effectiveness of Ayres Sensory Integrationreg intervention American Journal of Occupational Therapy 65 2 133-142
bull Reynolds S Lane SJ amp Richards L (2010) Using animal models of enriched environments to inform research on sensory integration intervention for the rehabilitation of neurodevelopmental disorders Journal of Neurodevelopmental Disorders 2( 3) 120-132 online first DOI 101007s11689-010-9053-4
bull Roley SS Mailloux Z Parham D Schaaf R Blanche E amp Lane CA Cermak S (in press) Sensory Integration and Praxis Patterns in Children with Autism American Journal of Occupational Therapy
bull Rosenzweig MR Bennet EL and Diamond MC (1972) Brain Changes in response to experience Scientific American 226(2) 22-29
bull Van Jaarsveld A Mailloux Z Smith Roley S amp Raubenheimer J (in press) Patterns of the sensory integration dysfunctions in South African children South African Journal of Occupational Therapy
bull Wills S Cabanlit M Bennett J Ashwood P Amaral DG amp Van de Water J (2009) Detection of autoantibodies to neural cells of the cerebellum in the plasma of subjects with autism spectrum disorders Brain Behavior and Immunity 23(1) 64-74
4) Critics often forget that a lack of solid evidence characterizes
nearly all interventions for children with ASDs
bull SI intervention is often held to a different standard
than other types of intervention failing to apply the
same criterion to alternate interventions
Clark 2012
Smith Roley 2014
Remaining Mysteries
Smith Roley 2013
Implications for Advocacy
People need breaks such as recess
People require sensorimotor and social play timespacevalue in the daily routine
Smith Roley 2014
Implications for Research on OT using Sensory Integration
Enhancing Neuroplasticity via Therapeutic Design
bull Dosage - Intensity of increased access in short time periods rather than small access over longer times
bull Engagement via play and not just exposure
bull Role of therapist in providing customized sensorimotor challenges
bull Access to safe dynamic and therapeutic environments vs predictable and static environments
bull The difference between practice for skill development and adaptation to challenges in changing environments
Smith Roley 2014
Implications for Sensory Integration in Practice
Most importantly the success of Sensory Integration in practice depends on
YOU
Smith Roley 2014
Thank You
bull Organizers and Participants
bull hyvaumlauml paumlivaumlnjatkoa
bull Enjoy the conference
Smith Roley 2013
bull Ayres AJ (2005) Sensory Integration and the Child Los Angeles CA Western Psychological Services bull Armstrong T (2006) The best schools How human development research should inform educational practice Alexandria
VA Association for Supervision and Curriculum Development bull Blanche E I Bodison S Chang M C amp Reinoso G (2012) Development of the comprehensive observations of
proprioception (COP) Validity reliability and factor analysis American Journal of Occupational Therapy 66 691ndash698 bull Bundy A amp Lane S (In press) Sensory integration theory and practice Third Ed Philsadelphia PA FA Davis Inc bull Casey T amp MacIntyre S (2007) Childrenrsquos need for time and space In T Casey (Ed) Environments for outdoor play A
practical guide to making space for children (pp 5 ndash 16) London Sage Publications httpwwwsagepubcomupm-data15553_CASEY_C01PDF
bull Gray P (2013) Play as preparation for learning and life American Journal of Play 5(3) 271 - 292 bull Greenough WR Black JE Wallace CS (1987) Experience and brain development Child Development 58(3)539-59 bull Lane AE Young RL Baker AEZ amp Angley MT (2010) Sensory processing subtypes in autism Association with adaptive behavior
Journal of Autism and Developmental Disorders 40 112-122
bull Lane SJ Schaaf RC (2010) Examining the neuroscience evidence for sensory-driven neuroplasticity implications for sensory-based occupational therapy for children and adolescents American Journal of Occupational Therapy 64(3)375-90
bull Mailloux Z Mulligan S Smith Roley S Cermak S Blanche E amp Bodison S Coleman G amp Lane C (2011) Verification and clarification of patterns of sensory integrative dysfunction in a retrospective clinical sample American Journal of Occupational Therapy 652 143-151
bull May A (2011) Experience-dependent structural plasticity in the adult human brain 1-8 Trends in Cognitive Sciences bull May-Benson TA Smith Roley S Mailloux Z Parham LD Koomar J Schaaf RC Van Jaarsveld AM amp Cohn E (in
press) Structural Elements of the Ayres Sensory Integrationreg Intervention Fidelity Measurecopy American Journal of Occupational Therapy
bull Milteer RM Ginsburg KR amp Council on Communications and Media Committee on Psychosocial Aspects of Child and Family Health (2011) Pediatrics e204-e213 DOI 101542peds2011-2953
bull Parham LD Cohn ES Spitzer S Koomar J Miller LJ Burke JP Brett-Green B Mailloux Z May-Benson T Smith Roley S Schaaf RC Schoen S amp Summers CA (2007) Fidelity in sensory integration intervention research American Journal of Occupational Therapy 61 2 216-227
bull Parham LD Smith Roley S May-Benson T Koomar J Brett-Green B Burke JP Cohn ES Mailloux Z Miller LJ amp Schaaf RC (2011) Development of a fidelity measure for research on effectiveness of Ayres Sensory Integrationreg intervention American Journal of Occupational Therapy 65 2 133-142
bull Reynolds S Lane SJ amp Richards L (2010) Using animal models of enriched environments to inform research on sensory integration intervention for the rehabilitation of neurodevelopmental disorders Journal of Neurodevelopmental Disorders 2( 3) 120-132 online first DOI 101007s11689-010-9053-4
bull Roley SS Mailloux Z Parham D Schaaf R Blanche E amp Lane CA Cermak S (in press) Sensory Integration and Praxis Patterns in Children with Autism American Journal of Occupational Therapy
bull Rosenzweig MR Bennet EL and Diamond MC (1972) Brain Changes in response to experience Scientific American 226(2) 22-29
bull Van Jaarsveld A Mailloux Z Smith Roley S amp Raubenheimer J (in press) Patterns of the sensory integration dysfunctions in South African children South African Journal of Occupational Therapy
bull Wills S Cabanlit M Bennett J Ashwood P Amaral DG amp Van de Water J (2009) Detection of autoantibodies to neural cells of the cerebellum in the plasma of subjects with autism spectrum disorders Brain Behavior and Immunity 23(1) 64-74
Remaining Mysteries
Smith Roley 2013
Implications for Advocacy
People need breaks such as recess
People require sensorimotor and social play timespacevalue in the daily routine
Smith Roley 2014
Implications for Research on OT using Sensory Integration
Enhancing Neuroplasticity via Therapeutic Design
bull Dosage - Intensity of increased access in short time periods rather than small access over longer times
bull Engagement via play and not just exposure
bull Role of therapist in providing customized sensorimotor challenges
bull Access to safe dynamic and therapeutic environments vs predictable and static environments
bull The difference between practice for skill development and adaptation to challenges in changing environments
Smith Roley 2014
Implications for Sensory Integration in Practice
Most importantly the success of Sensory Integration in practice depends on
YOU
Smith Roley 2014
Thank You
bull Organizers and Participants
bull hyvaumlauml paumlivaumlnjatkoa
bull Enjoy the conference
Smith Roley 2013
bull Ayres AJ (2005) Sensory Integration and the Child Los Angeles CA Western Psychological Services bull Armstrong T (2006) The best schools How human development research should inform educational practice Alexandria
VA Association for Supervision and Curriculum Development bull Blanche E I Bodison S Chang M C amp Reinoso G (2012) Development of the comprehensive observations of
proprioception (COP) Validity reliability and factor analysis American Journal of Occupational Therapy 66 691ndash698 bull Bundy A amp Lane S (In press) Sensory integration theory and practice Third Ed Philsadelphia PA FA Davis Inc bull Casey T amp MacIntyre S (2007) Childrenrsquos need for time and space In T Casey (Ed) Environments for outdoor play A
practical guide to making space for children (pp 5 ndash 16) London Sage Publications httpwwwsagepubcomupm-data15553_CASEY_C01PDF
bull Gray P (2013) Play as preparation for learning and life American Journal of Play 5(3) 271 - 292 bull Greenough WR Black JE Wallace CS (1987) Experience and brain development Child Development 58(3)539-59 bull Lane AE Young RL Baker AEZ amp Angley MT (2010) Sensory processing subtypes in autism Association with adaptive behavior
Journal of Autism and Developmental Disorders 40 112-122
bull Lane SJ Schaaf RC (2010) Examining the neuroscience evidence for sensory-driven neuroplasticity implications for sensory-based occupational therapy for children and adolescents American Journal of Occupational Therapy 64(3)375-90
bull Mailloux Z Mulligan S Smith Roley S Cermak S Blanche E amp Bodison S Coleman G amp Lane C (2011) Verification and clarification of patterns of sensory integrative dysfunction in a retrospective clinical sample American Journal of Occupational Therapy 652 143-151
bull May A (2011) Experience-dependent structural plasticity in the adult human brain 1-8 Trends in Cognitive Sciences bull May-Benson TA Smith Roley S Mailloux Z Parham LD Koomar J Schaaf RC Van Jaarsveld AM amp Cohn E (in
press) Structural Elements of the Ayres Sensory Integrationreg Intervention Fidelity Measurecopy American Journal of Occupational Therapy
bull Milteer RM Ginsburg KR amp Council on Communications and Media Committee on Psychosocial Aspects of Child and Family Health (2011) Pediatrics e204-e213 DOI 101542peds2011-2953
bull Parham LD Cohn ES Spitzer S Koomar J Miller LJ Burke JP Brett-Green B Mailloux Z May-Benson T Smith Roley S Schaaf RC Schoen S amp Summers CA (2007) Fidelity in sensory integration intervention research American Journal of Occupational Therapy 61 2 216-227
bull Parham LD Smith Roley S May-Benson T Koomar J Brett-Green B Burke JP Cohn ES Mailloux Z Miller LJ amp Schaaf RC (2011) Development of a fidelity measure for research on effectiveness of Ayres Sensory Integrationreg intervention American Journal of Occupational Therapy 65 2 133-142
bull Reynolds S Lane SJ amp Richards L (2010) Using animal models of enriched environments to inform research on sensory integration intervention for the rehabilitation of neurodevelopmental disorders Journal of Neurodevelopmental Disorders 2( 3) 120-132 online first DOI 101007s11689-010-9053-4
bull Roley SS Mailloux Z Parham D Schaaf R Blanche E amp Lane CA Cermak S (in press) Sensory Integration and Praxis Patterns in Children with Autism American Journal of Occupational Therapy
bull Rosenzweig MR Bennet EL and Diamond MC (1972) Brain Changes in response to experience Scientific American 226(2) 22-29
bull Van Jaarsveld A Mailloux Z Smith Roley S amp Raubenheimer J (in press) Patterns of the sensory integration dysfunctions in South African children South African Journal of Occupational Therapy
bull Wills S Cabanlit M Bennett J Ashwood P Amaral DG amp Van de Water J (2009) Detection of autoantibodies to neural cells of the cerebellum in the plasma of subjects with autism spectrum disorders Brain Behavior and Immunity 23(1) 64-74
Implications for Advocacy
People need breaks such as recess
People require sensorimotor and social play timespacevalue in the daily routine
Smith Roley 2014
Implications for Research on OT using Sensory Integration
Enhancing Neuroplasticity via Therapeutic Design
bull Dosage - Intensity of increased access in short time periods rather than small access over longer times
bull Engagement via play and not just exposure
bull Role of therapist in providing customized sensorimotor challenges
bull Access to safe dynamic and therapeutic environments vs predictable and static environments
bull The difference between practice for skill development and adaptation to challenges in changing environments
Smith Roley 2014
Implications for Sensory Integration in Practice
Most importantly the success of Sensory Integration in practice depends on
YOU
Smith Roley 2014
Thank You
bull Organizers and Participants
bull hyvaumlauml paumlivaumlnjatkoa
bull Enjoy the conference
Smith Roley 2013
bull Ayres AJ (2005) Sensory Integration and the Child Los Angeles CA Western Psychological Services bull Armstrong T (2006) The best schools How human development research should inform educational practice Alexandria
VA Association for Supervision and Curriculum Development bull Blanche E I Bodison S Chang M C amp Reinoso G (2012) Development of the comprehensive observations of
proprioception (COP) Validity reliability and factor analysis American Journal of Occupational Therapy 66 691ndash698 bull Bundy A amp Lane S (In press) Sensory integration theory and practice Third Ed Philsadelphia PA FA Davis Inc bull Casey T amp MacIntyre S (2007) Childrenrsquos need for time and space In T Casey (Ed) Environments for outdoor play A
practical guide to making space for children (pp 5 ndash 16) London Sage Publications httpwwwsagepubcomupm-data15553_CASEY_C01PDF
bull Gray P (2013) Play as preparation for learning and life American Journal of Play 5(3) 271 - 292 bull Greenough WR Black JE Wallace CS (1987) Experience and brain development Child Development 58(3)539-59 bull Lane AE Young RL Baker AEZ amp Angley MT (2010) Sensory processing subtypes in autism Association with adaptive behavior
Journal of Autism and Developmental Disorders 40 112-122
bull Lane SJ Schaaf RC (2010) Examining the neuroscience evidence for sensory-driven neuroplasticity implications for sensory-based occupational therapy for children and adolescents American Journal of Occupational Therapy 64(3)375-90
bull Mailloux Z Mulligan S Smith Roley S Cermak S Blanche E amp Bodison S Coleman G amp Lane C (2011) Verification and clarification of patterns of sensory integrative dysfunction in a retrospective clinical sample American Journal of Occupational Therapy 652 143-151
bull May A (2011) Experience-dependent structural plasticity in the adult human brain 1-8 Trends in Cognitive Sciences bull May-Benson TA Smith Roley S Mailloux Z Parham LD Koomar J Schaaf RC Van Jaarsveld AM amp Cohn E (in
press) Structural Elements of the Ayres Sensory Integrationreg Intervention Fidelity Measurecopy American Journal of Occupational Therapy
bull Milteer RM Ginsburg KR amp Council on Communications and Media Committee on Psychosocial Aspects of Child and Family Health (2011) Pediatrics e204-e213 DOI 101542peds2011-2953
bull Parham LD Cohn ES Spitzer S Koomar J Miller LJ Burke JP Brett-Green B Mailloux Z May-Benson T Smith Roley S Schaaf RC Schoen S amp Summers CA (2007) Fidelity in sensory integration intervention research American Journal of Occupational Therapy 61 2 216-227
bull Parham LD Smith Roley S May-Benson T Koomar J Brett-Green B Burke JP Cohn ES Mailloux Z Miller LJ amp Schaaf RC (2011) Development of a fidelity measure for research on effectiveness of Ayres Sensory Integrationreg intervention American Journal of Occupational Therapy 65 2 133-142
bull Reynolds S Lane SJ amp Richards L (2010) Using animal models of enriched environments to inform research on sensory integration intervention for the rehabilitation of neurodevelopmental disorders Journal of Neurodevelopmental Disorders 2( 3) 120-132 online first DOI 101007s11689-010-9053-4
bull Roley SS Mailloux Z Parham D Schaaf R Blanche E amp Lane CA Cermak S (in press) Sensory Integration and Praxis Patterns in Children with Autism American Journal of Occupational Therapy
bull Rosenzweig MR Bennet EL and Diamond MC (1972) Brain Changes in response to experience Scientific American 226(2) 22-29
bull Van Jaarsveld A Mailloux Z Smith Roley S amp Raubenheimer J (in press) Patterns of the sensory integration dysfunctions in South African children South African Journal of Occupational Therapy
bull Wills S Cabanlit M Bennett J Ashwood P Amaral DG amp Van de Water J (2009) Detection of autoantibodies to neural cells of the cerebellum in the plasma of subjects with autism spectrum disorders Brain Behavior and Immunity 23(1) 64-74
Implications for Research on OT using Sensory Integration
Enhancing Neuroplasticity via Therapeutic Design
bull Dosage - Intensity of increased access in short time periods rather than small access over longer times
bull Engagement via play and not just exposure
bull Role of therapist in providing customized sensorimotor challenges
bull Access to safe dynamic and therapeutic environments vs predictable and static environments
bull The difference between practice for skill development and adaptation to challenges in changing environments
Smith Roley 2014
Implications for Sensory Integration in Practice
Most importantly the success of Sensory Integration in practice depends on
YOU
Smith Roley 2014
Thank You
bull Organizers and Participants
bull hyvaumlauml paumlivaumlnjatkoa
bull Enjoy the conference
Smith Roley 2013
bull Ayres AJ (2005) Sensory Integration and the Child Los Angeles CA Western Psychological Services bull Armstrong T (2006) The best schools How human development research should inform educational practice Alexandria
VA Association for Supervision and Curriculum Development bull Blanche E I Bodison S Chang M C amp Reinoso G (2012) Development of the comprehensive observations of
proprioception (COP) Validity reliability and factor analysis American Journal of Occupational Therapy 66 691ndash698 bull Bundy A amp Lane S (In press) Sensory integration theory and practice Third Ed Philsadelphia PA FA Davis Inc bull Casey T amp MacIntyre S (2007) Childrenrsquos need for time and space In T Casey (Ed) Environments for outdoor play A
practical guide to making space for children (pp 5 ndash 16) London Sage Publications httpwwwsagepubcomupm-data15553_CASEY_C01PDF
bull Gray P (2013) Play as preparation for learning and life American Journal of Play 5(3) 271 - 292 bull Greenough WR Black JE Wallace CS (1987) Experience and brain development Child Development 58(3)539-59 bull Lane AE Young RL Baker AEZ amp Angley MT (2010) Sensory processing subtypes in autism Association with adaptive behavior
Journal of Autism and Developmental Disorders 40 112-122
bull Lane SJ Schaaf RC (2010) Examining the neuroscience evidence for sensory-driven neuroplasticity implications for sensory-based occupational therapy for children and adolescents American Journal of Occupational Therapy 64(3)375-90
bull Mailloux Z Mulligan S Smith Roley S Cermak S Blanche E amp Bodison S Coleman G amp Lane C (2011) Verification and clarification of patterns of sensory integrative dysfunction in a retrospective clinical sample American Journal of Occupational Therapy 652 143-151
bull May A (2011) Experience-dependent structural plasticity in the adult human brain 1-8 Trends in Cognitive Sciences bull May-Benson TA Smith Roley S Mailloux Z Parham LD Koomar J Schaaf RC Van Jaarsveld AM amp Cohn E (in
press) Structural Elements of the Ayres Sensory Integrationreg Intervention Fidelity Measurecopy American Journal of Occupational Therapy
bull Milteer RM Ginsburg KR amp Council on Communications and Media Committee on Psychosocial Aspects of Child and Family Health (2011) Pediatrics e204-e213 DOI 101542peds2011-2953
bull Parham LD Cohn ES Spitzer S Koomar J Miller LJ Burke JP Brett-Green B Mailloux Z May-Benson T Smith Roley S Schaaf RC Schoen S amp Summers CA (2007) Fidelity in sensory integration intervention research American Journal of Occupational Therapy 61 2 216-227
bull Parham LD Smith Roley S May-Benson T Koomar J Brett-Green B Burke JP Cohn ES Mailloux Z Miller LJ amp Schaaf RC (2011) Development of a fidelity measure for research on effectiveness of Ayres Sensory Integrationreg intervention American Journal of Occupational Therapy 65 2 133-142
bull Reynolds S Lane SJ amp Richards L (2010) Using animal models of enriched environments to inform research on sensory integration intervention for the rehabilitation of neurodevelopmental disorders Journal of Neurodevelopmental Disorders 2( 3) 120-132 online first DOI 101007s11689-010-9053-4
bull Roley SS Mailloux Z Parham D Schaaf R Blanche E amp Lane CA Cermak S (in press) Sensory Integration and Praxis Patterns in Children with Autism American Journal of Occupational Therapy
bull Rosenzweig MR Bennet EL and Diamond MC (1972) Brain Changes in response to experience Scientific American 226(2) 22-29
bull Van Jaarsveld A Mailloux Z Smith Roley S amp Raubenheimer J (in press) Patterns of the sensory integration dysfunctions in South African children South African Journal of Occupational Therapy
bull Wills S Cabanlit M Bennett J Ashwood P Amaral DG amp Van de Water J (2009) Detection of autoantibodies to neural cells of the cerebellum in the plasma of subjects with autism spectrum disorders Brain Behavior and Immunity 23(1) 64-74
Implications for Sensory Integration in Practice
Most importantly the success of Sensory Integration in practice depends on
YOU
Smith Roley 2014
Thank You
bull Organizers and Participants
bull hyvaumlauml paumlivaumlnjatkoa
bull Enjoy the conference
Smith Roley 2013
bull Ayres AJ (2005) Sensory Integration and the Child Los Angeles CA Western Psychological Services bull Armstrong T (2006) The best schools How human development research should inform educational practice Alexandria
VA Association for Supervision and Curriculum Development bull Blanche E I Bodison S Chang M C amp Reinoso G (2012) Development of the comprehensive observations of
proprioception (COP) Validity reliability and factor analysis American Journal of Occupational Therapy 66 691ndash698 bull Bundy A amp Lane S (In press) Sensory integration theory and practice Third Ed Philsadelphia PA FA Davis Inc bull Casey T amp MacIntyre S (2007) Childrenrsquos need for time and space In T Casey (Ed) Environments for outdoor play A
practical guide to making space for children (pp 5 ndash 16) London Sage Publications httpwwwsagepubcomupm-data15553_CASEY_C01PDF
bull Gray P (2013) Play as preparation for learning and life American Journal of Play 5(3) 271 - 292 bull Greenough WR Black JE Wallace CS (1987) Experience and brain development Child Development 58(3)539-59 bull Lane AE Young RL Baker AEZ amp Angley MT (2010) Sensory processing subtypes in autism Association with adaptive behavior
Journal of Autism and Developmental Disorders 40 112-122
bull Lane SJ Schaaf RC (2010) Examining the neuroscience evidence for sensory-driven neuroplasticity implications for sensory-based occupational therapy for children and adolescents American Journal of Occupational Therapy 64(3)375-90
bull Mailloux Z Mulligan S Smith Roley S Cermak S Blanche E amp Bodison S Coleman G amp Lane C (2011) Verification and clarification of patterns of sensory integrative dysfunction in a retrospective clinical sample American Journal of Occupational Therapy 652 143-151
bull May A (2011) Experience-dependent structural plasticity in the adult human brain 1-8 Trends in Cognitive Sciences bull May-Benson TA Smith Roley S Mailloux Z Parham LD Koomar J Schaaf RC Van Jaarsveld AM amp Cohn E (in
press) Structural Elements of the Ayres Sensory Integrationreg Intervention Fidelity Measurecopy American Journal of Occupational Therapy
bull Milteer RM Ginsburg KR amp Council on Communications and Media Committee on Psychosocial Aspects of Child and Family Health (2011) Pediatrics e204-e213 DOI 101542peds2011-2953
bull Parham LD Cohn ES Spitzer S Koomar J Miller LJ Burke JP Brett-Green B Mailloux Z May-Benson T Smith Roley S Schaaf RC Schoen S amp Summers CA (2007) Fidelity in sensory integration intervention research American Journal of Occupational Therapy 61 2 216-227
bull Parham LD Smith Roley S May-Benson T Koomar J Brett-Green B Burke JP Cohn ES Mailloux Z Miller LJ amp Schaaf RC (2011) Development of a fidelity measure for research on effectiveness of Ayres Sensory Integrationreg intervention American Journal of Occupational Therapy 65 2 133-142
bull Reynolds S Lane SJ amp Richards L (2010) Using animal models of enriched environments to inform research on sensory integration intervention for the rehabilitation of neurodevelopmental disorders Journal of Neurodevelopmental Disorders 2( 3) 120-132 online first DOI 101007s11689-010-9053-4
bull Roley SS Mailloux Z Parham D Schaaf R Blanche E amp Lane CA Cermak S (in press) Sensory Integration and Praxis Patterns in Children with Autism American Journal of Occupational Therapy
bull Rosenzweig MR Bennet EL and Diamond MC (1972) Brain Changes in response to experience Scientific American 226(2) 22-29
bull Van Jaarsveld A Mailloux Z Smith Roley S amp Raubenheimer J (in press) Patterns of the sensory integration dysfunctions in South African children South African Journal of Occupational Therapy
bull Wills S Cabanlit M Bennett J Ashwood P Amaral DG amp Van de Water J (2009) Detection of autoantibodies to neural cells of the cerebellum in the plasma of subjects with autism spectrum disorders Brain Behavior and Immunity 23(1) 64-74
Thank You
bull Organizers and Participants
bull hyvaumlauml paumlivaumlnjatkoa
bull Enjoy the conference
Smith Roley 2013
bull Ayres AJ (2005) Sensory Integration and the Child Los Angeles CA Western Psychological Services bull Armstrong T (2006) The best schools How human development research should inform educational practice Alexandria
VA Association for Supervision and Curriculum Development bull Blanche E I Bodison S Chang M C amp Reinoso G (2012) Development of the comprehensive observations of
proprioception (COP) Validity reliability and factor analysis American Journal of Occupational Therapy 66 691ndash698 bull Bundy A amp Lane S (In press) Sensory integration theory and practice Third Ed Philsadelphia PA FA Davis Inc bull Casey T amp MacIntyre S (2007) Childrenrsquos need for time and space In T Casey (Ed) Environments for outdoor play A
practical guide to making space for children (pp 5 ndash 16) London Sage Publications httpwwwsagepubcomupm-data15553_CASEY_C01PDF
bull Gray P (2013) Play as preparation for learning and life American Journal of Play 5(3) 271 - 292 bull Greenough WR Black JE Wallace CS (1987) Experience and brain development Child Development 58(3)539-59 bull Lane AE Young RL Baker AEZ amp Angley MT (2010) Sensory processing subtypes in autism Association with adaptive behavior
Journal of Autism and Developmental Disorders 40 112-122
bull Lane SJ Schaaf RC (2010) Examining the neuroscience evidence for sensory-driven neuroplasticity implications for sensory-based occupational therapy for children and adolescents American Journal of Occupational Therapy 64(3)375-90
bull Mailloux Z Mulligan S Smith Roley S Cermak S Blanche E amp Bodison S Coleman G amp Lane C (2011) Verification and clarification of patterns of sensory integrative dysfunction in a retrospective clinical sample American Journal of Occupational Therapy 652 143-151
bull May A (2011) Experience-dependent structural plasticity in the adult human brain 1-8 Trends in Cognitive Sciences bull May-Benson TA Smith Roley S Mailloux Z Parham LD Koomar J Schaaf RC Van Jaarsveld AM amp Cohn E (in
press) Structural Elements of the Ayres Sensory Integrationreg Intervention Fidelity Measurecopy American Journal of Occupational Therapy
bull Milteer RM Ginsburg KR amp Council on Communications and Media Committee on Psychosocial Aspects of Child and Family Health (2011) Pediatrics e204-e213 DOI 101542peds2011-2953
bull Parham LD Cohn ES Spitzer S Koomar J Miller LJ Burke JP Brett-Green B Mailloux Z May-Benson T Smith Roley S Schaaf RC Schoen S amp Summers CA (2007) Fidelity in sensory integration intervention research American Journal of Occupational Therapy 61 2 216-227
bull Parham LD Smith Roley S May-Benson T Koomar J Brett-Green B Burke JP Cohn ES Mailloux Z Miller LJ amp Schaaf RC (2011) Development of a fidelity measure for research on effectiveness of Ayres Sensory Integrationreg intervention American Journal of Occupational Therapy 65 2 133-142
bull Reynolds S Lane SJ amp Richards L (2010) Using animal models of enriched environments to inform research on sensory integration intervention for the rehabilitation of neurodevelopmental disorders Journal of Neurodevelopmental Disorders 2( 3) 120-132 online first DOI 101007s11689-010-9053-4
bull Roley SS Mailloux Z Parham D Schaaf R Blanche E amp Lane CA Cermak S (in press) Sensory Integration and Praxis Patterns in Children with Autism American Journal of Occupational Therapy
bull Rosenzweig MR Bennet EL and Diamond MC (1972) Brain Changes in response to experience Scientific American 226(2) 22-29
bull Van Jaarsveld A Mailloux Z Smith Roley S amp Raubenheimer J (in press) Patterns of the sensory integration dysfunctions in South African children South African Journal of Occupational Therapy
bull Wills S Cabanlit M Bennett J Ashwood P Amaral DG amp Van de Water J (2009) Detection of autoantibodies to neural cells of the cerebellum in the plasma of subjects with autism spectrum disorders Brain Behavior and Immunity 23(1) 64-74
bull Ayres AJ (2005) Sensory Integration and the Child Los Angeles CA Western Psychological Services bull Armstrong T (2006) The best schools How human development research should inform educational practice Alexandria
VA Association for Supervision and Curriculum Development bull Blanche E I Bodison S Chang M C amp Reinoso G (2012) Development of the comprehensive observations of
proprioception (COP) Validity reliability and factor analysis American Journal of Occupational Therapy 66 691ndash698 bull Bundy A amp Lane S (In press) Sensory integration theory and practice Third Ed Philsadelphia PA FA Davis Inc bull Casey T amp MacIntyre S (2007) Childrenrsquos need for time and space In T Casey (Ed) Environments for outdoor play A
practical guide to making space for children (pp 5 ndash 16) London Sage Publications httpwwwsagepubcomupm-data15553_CASEY_C01PDF
bull Gray P (2013) Play as preparation for learning and life American Journal of Play 5(3) 271 - 292 bull Greenough WR Black JE Wallace CS (1987) Experience and brain development Child Development 58(3)539-59 bull Lane AE Young RL Baker AEZ amp Angley MT (2010) Sensory processing subtypes in autism Association with adaptive behavior
Journal of Autism and Developmental Disorders 40 112-122
bull Lane SJ Schaaf RC (2010) Examining the neuroscience evidence for sensory-driven neuroplasticity implications for sensory-based occupational therapy for children and adolescents American Journal of Occupational Therapy 64(3)375-90
bull Mailloux Z Mulligan S Smith Roley S Cermak S Blanche E amp Bodison S Coleman G amp Lane C (2011) Verification and clarification of patterns of sensory integrative dysfunction in a retrospective clinical sample American Journal of Occupational Therapy 652 143-151
bull May A (2011) Experience-dependent structural plasticity in the adult human brain 1-8 Trends in Cognitive Sciences bull May-Benson TA Smith Roley S Mailloux Z Parham LD Koomar J Schaaf RC Van Jaarsveld AM amp Cohn E (in
press) Structural Elements of the Ayres Sensory Integrationreg Intervention Fidelity Measurecopy American Journal of Occupational Therapy
bull Milteer RM Ginsburg KR amp Council on Communications and Media Committee on Psychosocial Aspects of Child and Family Health (2011) Pediatrics e204-e213 DOI 101542peds2011-2953
bull Parham LD Cohn ES Spitzer S Koomar J Miller LJ Burke JP Brett-Green B Mailloux Z May-Benson T Smith Roley S Schaaf RC Schoen S amp Summers CA (2007) Fidelity in sensory integration intervention research American Journal of Occupational Therapy 61 2 216-227
bull Parham LD Smith Roley S May-Benson T Koomar J Brett-Green B Burke JP Cohn ES Mailloux Z Miller LJ amp Schaaf RC (2011) Development of a fidelity measure for research on effectiveness of Ayres Sensory Integrationreg intervention American Journal of Occupational Therapy 65 2 133-142
bull Reynolds S Lane SJ amp Richards L (2010) Using animal models of enriched environments to inform research on sensory integration intervention for the rehabilitation of neurodevelopmental disorders Journal of Neurodevelopmental Disorders 2( 3) 120-132 online first DOI 101007s11689-010-9053-4
bull Roley SS Mailloux Z Parham D Schaaf R Blanche E amp Lane CA Cermak S (in press) Sensory Integration and Praxis Patterns in Children with Autism American Journal of Occupational Therapy
bull Rosenzweig MR Bennet EL and Diamond MC (1972) Brain Changes in response to experience Scientific American 226(2) 22-29
bull Van Jaarsveld A Mailloux Z Smith Roley S amp Raubenheimer J (in press) Patterns of the sensory integration dysfunctions in South African children South African Journal of Occupational Therapy
bull Wills S Cabanlit M Bennett J Ashwood P Amaral DG amp Van de Water J (2009) Detection of autoantibodies to neural cells of the cerebellum in the plasma of subjects with autism spectrum disorders Brain Behavior and Immunity 23(1) 64-74
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