This information pertains solely to our practice at Pediatric Building Blocks. 

Sensory Integration Evaluations and Treatment in the academic setting

This information pertains solely to the opinion and understanding of Pediatric Building Blocks and it's scope of practice within the state of California.  Many therapists have different beliefs, and opinions regarding the scope of this modality. States having varying policies and positions regarding Sensory Integration. There are varying interpretations of educational law.  Persons seeking a definitive answer to a specific educational application or question are advised to contact legal counsel with expertise in special education laws of their state.  Persons seeking information regarding Sensory Integration are encouraged to research this theory using a variety of resources to reach conclusions.

There are many treatment modalities used during occupational therapy assessment and treatment.  One of them is sensory integration.  A comprehensive Occupational Therapy assessment includes the identification of sensory processing issues. If Sensory Integration is a “suspected area of deficit”; the district or LEA must provide an occupational therapy assessment, that specifically addresses that issue upon request.

We would like to offer these statements to clarify our position on this matter:

1.      “Sensory integration” is only one modality of Occupational Therapy.

2.      Parents are not entitled to dictate to a public school system a method or modality in either assessment or therapy services.

3.      Public School systems are not required to provide a specific method or modality of therapy if the students’ academic needs are being met with “normal” school based therapy. 

4.       Sensory Integration should not be written on formal IEP documentation UNLESS, the district intends to provide SI therapy on site or allow the parent to have their child attend an SI Clinic.  General understanding of SI therapy is that provided by a “SI certified” therapist, in an environment equipped for SI treatment.  This “environment” normally a “clinic space”, with a variety of activities available, including suspended equipment and climbing apparatus (swings, platforms, ramps, slides) as well as the use of other sensory activities for sensory input enrichment. This environment in not currently available at any school sites we serve in the Bay Area and this is not appropriate for academic school based therapy.

5.        School based sensory integration treatment involves observation of the student’s behavior and providing the activities that encourage a child to go beyond their current ability as it relates to educational function.  This would include ability to focus, transition, learn, and apply new information without in appropriate behavior.  The treatment environment (i.e. suspended equipment) is not as important as providing a choice of activities that support the child in learning and integrating new skills.  The child’s choices are an important piece of the puzzle based on the theory that the brain understands what it needs and will seek activities that provide the stimulus.

 Dr. A. Jean Ayres developed Sensory Integration Theory, which refers to both a neurological process and a theory of relationship between the neurological process and behavior.   The doctors own definition of Sensory Integration (1989) is as follows:

Sensory integration is the neurological process that organizes sensation from one’s own body and from the environment and makes it possible to use the body effectively within the environment.  The spatial and temporal aspects of inputs from different sensory modalities are interpreted, associated, and unified.  Sensory integration is information processing.  The brain must select, enhance, inhibit, compare, and associate the sensory information in a flexible, constantly changing patterns: in other words, the brain must integrate it.

There are several components to Sensory Integration.  A therapist must be able to:

1.      Understand normal human development.

2.      Understand normal sensory integrative function.

3.      Understand sensory integrative dysfunction. 

4.      Know how to develop interventions that use sensory integration techniques. 

Central nervous system processing, sensory integration or motor planning is observed via a child’s behavior.  The hypothesis is that deficits are a result of poor sensory integration and with intervention, and it is possible to effect a change in behavior.

This is only one of many modalities that an OTR/L has at hand to provide services to children. Sensory integration (SI) is core curriculum for Occupational Therapy Programs.  A trained therapist has skills to provide sensory integration activities within the treatment session.  Certification is not required to use the SI modality in treatment.

Certification is in regards to a specific test, the Sensory Integration Praxis Test (SIPT).  "SI Certified" simply means that this therapist has taken several courses to learn Administration, interpretation theory and practice in regard to the SIPT.

The following paraphrased information is taken from the introduction chapter to the SIPT manual:

“The SIPT was designed for use with children from four years of age to eight years, eleven months of age. It is inappropriate for children falling outside that age range.  Most testable children with mild learning, behavioral or developmental irregularities are suitable candidates for most of the test. The test is complex requiring two to two and half-hours.”

“A mild neuromotor problem will not appreciably affect test performance on most of the tests, but a severe neuromotor problem will interfere with performance on more than half of the tests.   SIPT scores alone should not be used to determine whether or not a child with sensory integrative dysfunction or dyspraxia will profit from therapy.”

“The test norms are based upon the performance of children with no known language disorders, whose native language is English, and who receive precise test instructions in English. Therefore if the SIPT is used to assess children whose native language is not English, or children with language comprehension disorders, the user must use extreme caution when interpreting the results.

“The SIPT scores are only one source of data in the evaluative process and normally should be supplemented by other data and by clinical observations before any final diagnostic or treatment decisions are made.  SIPT scores alone do not indicate the cause of learning or behavior problems, but may help to identify the sensory integrative part of those problems.”

The Sensory Integration Praxis Test (SIPT) requires a Certified SI Therapist. The test takes approximately two hours to administer.  The test can only be interpreted by a therapist who has the technology to do so. A CD must be purchased from Western Psychological Services (WPS) for use on computer or the exam is sent to WPS, with the interpretation and scores returned in one to two weeks.

There are several other appropriate tests to evaluate sensory function, to name but a few: the Winnie Dunn Sensory Profile, the Sensory Profile Assessment (SPA) and the Analysis of Sensory Behavior Inventory-R: (ASBI-R).

Additionally Clinical Observations and observation of performance during other assessments can also be used to determine sensory function.  Current testing material covers the areas listed below; this is not an inclusive simply an example:

1.                  Somatosensory processing, Clinical Observation

2.                  Bilateral integration and sequencing, Beery Test of Visual Motor Integration (VMI).

3.                  Somatopraxis, Clinical Observation

4.                  Visual praxis, visual perception/motor coordination, Test of Visual Motor Skills (TVMS)

5.                  Visual perception skills, Gardener's Test of Visual‑Perceptual Skill (TVPS)

6.                  Gross and Fine Motor Development, Bruininks-Oseretsky Test of Motor Proficiency (B&O)

7.                  Motor Planning, Clinical Observation

When a child learns new skills, they will integrate the new ‘sensory’ processing (information needed for performance) creating a foundation for supporting higher skills.  This theory (sensory integration) is inherent all of the OT’s treatment skills.

Reference:

Fisher, Murray, Bundy.  Sensory Integration Theory and Practice, F.A Davis, Philadelphia, 1991.  

Kramer, Hinojosa. Pediatric Occupational Therapy, Williams & Wilkins, Philadelphia, 1993, chapter 6 Sensory Integrative Frame of Reference.

Lecture Notes: Sensory Integration International Theory Lecture Notes, Sensory Integration International/Ayres Clinic.