Detailed theoretical background of Sensory integration with clear distinction of Ayre's sensory integration and Sensory stimulation protocol.

1. SENSORYINTEGRATION
Discussion Outlines:
1. What is sensory integration
2. Sensory system
3. Theory behind sensory integration
4. Assumptions of sensory integration
5. Sensory integration / Sensory processing disorder
6. Assessment tools
7. Sensory integration therapy
8. Intervention
9. Evidence Based Practice
10. Intervention Outcome
11. Ref.
WHAT IS SENSORYINTEGRATION?
The process that organize sensational (feeling) information from one’s own body and the
environment which help the body system to function effectively within the environment.
- Our senses give us information about the physical conditions of our body and the
environment around us.
SENSORY SYSTEM:
Sensory system consists of sensory receptors, sensory pathways into the brain and how
the brain welcomes the incoming sensory information (sensory perception).
- There are several senses in our body system. The senses can be classify into two :
1 Proximal senses (Tactile –skin & touch, Vestibular –balance, equilibrium & gravity,
Proprioceptive -joint)
2 Distal senses (vision, auditory, olfactory & gustatory awareness.
- The proximal senses are interoceptive (bodily senses)
- The distal senses are exteroceptive (environmental senses)

2. Senses
Exteroceptive Interoceptive
1 Auditory 1 Proprioception
2 Visual 2 Vestibular
3 Olfactory
4 Gustatory
Tactile
THEORY BEHIND SENSORYINTEGRATION:
SI is a theory of brain and behavior relationship which is used to:
1. Explain (why individual behave in particular way)
2. Plan (intervention to ameliorate particular difficulties)
3. Predict (how behavior will change as a result of intervention)
ASSUMPTIONS OF SENSORY INTEGRATION:
There are five assumptions of SI theory. This includes,
1. Neuroplasticity of the brain (flexibility of the brain to changes)
-3-7 years critical to Neuroplasticity
- Younger benefited more than older
2. SI develops in stages
3. The brain works as an integrated whole
- Higher order (Depends on lower order and responsible for abstraction, perception,
reasoning and language)
- Lower order (SI occur at lower order or subcritical center)

3. 4. Adaptive responses: (Optimal arousal to sensory interaction - fading to start
following adaptive response).
5. Inner or self-drive to develop SI through participation in sensorimotor activities.
- Child skill acquisition has been linked to the concept of self-actualization.
- Inner drive and motivation has been linked to self-direction and self-actualization.
Child with SI dysfunction showed little motivation to be active participation and it
disturbed on a noisy playground, he/she will seek out a quieter environment to
avoid sensory overload.
SENSORY INTEGRATIVE DISORDER
Sensory integrative disorder (SID) or Sensory processing disorder (SPD) is a neurological
disorder that results from the brains inability to integrate certain information received from the
body’s sensory systems.
Causes,
- Disconnection in the neuron cells causing improper message to the brain.
- Failure of sensory messages to connect properly
- Sensory messages being received inconsistently.
Sensory Processing Disorder (SPD)
Sensory modulation Sensory Based Motor Disorder (SBMD) Sensory Discrimination Disorder (SDD)
Disorder (SMD) - Dyspraxia -Visual (Eye)
-SO responsivity - Postural disorder -Auditory (Ear)
-SU responsivity * Gravitational insecurity -Tactile
-S secking kraving * Postural insecurity -Vestibular
-Proprioception (Joint)
- Gustatory (Taste)
- Olfactory (smell)

4. ASSESSMENT TOOLS USED BY O.T
An occupational therapist will assess a child’s sensory profile using observation, interview, play
and standardized assessments.
Standardized scales: 3 scales will be discussed.
1. Sensory Integration and Praxis Test
The SIPT is a specialized group of 17 standardized subtests appropriate for children who
have deficits with sensory processing. The SIPT is regarded as the ‘GOLD
STANDARD’ for determining SP Deficits.
- Major areas: Motor free visual perception, motor planning (praxis), sensory motor
processing and somato sensory processing.
- Age limit: 4-8 years old
- Time required: 2-3 hours.
2. Sensory Processing Measure (SPM)
SPM provides a complete picture of children’s sensory functioning at home, at school,
and in the community.
- It also assesses sensory processing, praxis, and social participation.
- It consists of three forms:
*Home form *Main classroom form *School environment form.
- Age limit: 5-12 years.
3. Short Sensory Profile (SSP)
The SSP was designed as screening tools for children who exhibit difficulties in any of
the areas of daily life performance. The scale has to be completed by parent and interpret
by an occupational therapist.
Main areas of assessment:
- Sensory processing
In home and school setting.
- Sensory modulation
Age limit: 3 to 10 years

5. SENSORY INTEGRATION
By definition: Sensory integration is the process of organizing sensory in puts so that the brain
produces a useful body response and also useful perceptions, emotions, and thoughts.
(Nervous system is involved in processing or organization of sensory Input)
SENSORY INTEGRATIVE THERAPY: Usually emphasized that when the brains are whole
and balanced, body movements are highly adaptive learning is easy and good behavior is a
natural outcome.
Sensory integrating therapy can be broadly classified into 2:
1. Gold standard SI ( by jean Ayre’s (sensory integrating approach)
2. Sensory integration (others) Sensory stimulation techniques
Sensory stimulation protocol
Sensory Integrative Therapy
Gold standard SI (by jean Ayre’s) Sensory integration (others)
Sensory stimulation technique Sensory stimulation protocol
 My analysis will focus more on sensory stimulation techniques and protection.
Jean Ayre’s SI (ASI)
The neurological problem in the child with a sensory integrative disorder prevents him from
processing the sensations of his out play, so he cannot develop the adaptive responses that
organize the brain.
- Note, the child may play, but he does not play in a manner that is integrating. He
needs an environment specially designed to meet his needs. Such an environment
is usually not available at home or in school (Ayre’s).

6. Intervention:
- Must be specifically designed to suit the need of the child, directed and lead by the
child during therapy.
- The therapist must cajole, encourage, entice and motivate the child into choosing
the activities that will help his brain to develop.
- 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.
- The drive ‘’to do’’ must come from within the child, even though he has been
unable ‘’to do’’ successfully before.
- Therapy using a sensory integration approach must be holistic; it should involve
the whole body, all of the senses and the entire brain.
SI Approach is rigid and required a special training before can be practice correctly. Also, it has
to be individualized which makes it difficult for most therapist to practice and being child
directed makes it to take more time to practice than sensory stimulating techniques.
Sensory Integration Others
Sensory Stimulation Protocols Sensory Stimulation Techniques
Sensory stimulation protocol: refers to the intervention that involves application of specific
types of sensory stimuli that are controlled by the therapist and delivered in a predetermined
manner, usually according to a prescribed schedule or sequence.
- It is applied in a non- contingent manner.
Differences betweensensorystimulation techniques and protocol
1. Sensory Stimulation protocols
- Stand-alone intervention
- Performed in a prescribed manner and sequence.

7. - Expected outcomes include improved (sensory modulation, self-regulation and general
improvements in attention, learning and behavior).
- Evidence is inconsistent
Example includes:
* Wilbargar body brushing protocol
*Astronaut program
* Brain gym activities
* Miller method
* Reciprocal imitation training.
2. Sensory Stimulation Techniques
- Embedded within ongoing activities
- Modified based on child’s response
- Purpose is to support the child’s sensory arousal modulation
- Has a short term calming effect
Examples: Sensory Diet
* Swinging to increase or decrease arousal level by adjusting sensory quality (velocity, direction)
* Floor time
* Snoezelen rooms intervention
*Animal assisted therapy
* Sensory garden
* Play skills.
* Sensory based intervention Single sensory (Sensory intervention for specific sense)
Multi-sensory (Sensory intervention design to address multiple senses)

8. SENSORY STIMULATION TECHNIQUES INCLUDES:
1. Calming techniques (help child who is anxious)
- Deep pressure
- Joint compression
- Slow rocking/rocking chair
- Neutral warmth
- Reduce noise and light level
- Weighted vest
- Predictable routine
- Brain gym
- Work out on excess energy.
2. Organizing techniques: (Helps child who is under or over active)
- Vibration
- Proprioceptive activities
- Chewing and blowing activities
- Swimming
- Therapy chair
3. Alerting techniques: (Not to be used for child with sensory defensiveness.)
-Helps child who is under reactive to SI.
- Sensory mat
- Bright light
- Fast swing
- Quiet unpredictable movement
- Cold water play
- Loud or fast music and sudden noise
- Strong order
- Sensory garden
4. Postural instability:
- Stand with one foot
- Work in uneven surface
- Heel- toe walking
- Stepping stone (sensory mat)
- Hopping games
- Climbing object
- Obstacle crossing (course)

9. 5. Bilateral integration
- Jumping with feet together
- Skipping
- Cycling
- Sand and water play
- Art and craft
- Construction activities
- Play musical instruments.
6. Spatial and body awareness
- Name and touch body parts with eyes open and close
- Body wrestling/tug of war with tire.
- Shine a torch on body parts
- Body / face puzzles
- Rolling on diff- surface
- Bean bag target activities.
EVIDENCE BASED PRACTICE AND OUTCOME OF SI:
OT’s have expertise in Ayre’s Sensory Integration and sensory stimulation techniques or sensory
based intervention (SBI’s). However, studies of the effects of ASI approaches with children who
have sensory processing disorder (SPD) are few (Baranek, 2002). Although several studies can
be found on sensory stimulation techniques (SST) and sensory stimulation protocol (SSP) with
little significant evidence of improvement.
- Intensive individualized clinic based ASI intervention has provide moderate
evidence of clinical improvement in many patient. (Pfeifer, 2011).
IN CONCLUSION
Drawing conclusions about effectiveness of Ayre’s sensory integration in most cases is
premature due to lack of rigorous studies.

10. Prepared by:
Odeyoyin Yusuph Abiodun
Asst. Lecturer, University of Rwanda,
College of Medicine and Health Sciences (Kigali),
Occupational Therapist (Dip OT, BOT, MOT –Neurological Rehab),
Sensory Integration Intermediary Course, NIPMR (India).
Compiled on 06th
July, 2019.