A Clinician`s Guide to Implementing Ayres Sensory Integration

A Clinician's Guide to Implementing Ayres Sensory
Integration®: Promoting Participation for Children
with Autism
American Occupational Therapy Association Annual
Conference, Nashville, TN
April 19, 2015
Roseann Schaaf, PhD., OTR/L, FAOTA and Zoe Mailloux,
OTD, OTR/L, FAOTA
Thomas Jefferson University, Philadelphia PA 19107
®
Ayres Sensory Integration (ASI) targets the sensory-motor factors that are hypothesized to be
impacting participation daily life activities
Rich in tactile, vestibular and proprioception
Active, individually-tailored sensory motor activities
Adaptive response is catalyst for change
Designed to improve the ability to process and integrate sensation as a basis for enhancing
successful participation in daily occupations.
Data Driven Decision Making
Identifying the
Child’s
Conducting a
Comprehensive
Generating
Developing and
Identifying
Setting the Stage
Con
ductin
Measuring
Outcomes
Identifying
the Child’s
Strengths and
Participation
Challenges
Raul is a bright
boy who has limited receptivelanguage and
poor motor
skills. He is very
good at puzzles
and building
and likes to take
things apart and
put them back
together. Participation challenges
include difficulty
holding and
using utensils
at school, such
as crayons and
scissors, and
managing his
lunch containers.
Raul’s play skills
are limited, and
he does not sustain interaction
with peers at
school. In addition, his parents
and teacher have
concerns about
Raul’s safety.
Conducting the
Comprehensive
Assessment
Generating
Hypotheses
Developing and
Scaling Goals
Raul has relative
strengths in visual perception
as evidenced by
Sensory Integration and Praxis
Tests (SIPT)
scores of visual
perception and
visual praxis
and in motor
planning based
on receptivelanguage scores.
His strength
and execution
of familiar
motor skills are
adequate.
Raul’s difficulties at
school, including his
poor ability to hold
and use utensils, such
as crayons and scissors;
his problems managing
lunch containers; and
safety concerns, noted
in his walking into
unsafe situations and
bumping into objects
and people, are likely
because of poor sensory perception in the
areas of touch (tactile)
and position (proprioception) sense and
poor motor planning,
or somatodyspraxia.
Raul will independently and
appropriately grasp
utensils at school,
such as crayons
and scissors, and
maintain the grasp
for at least 10 min
during a classroom
task.
Raul has
difficulties in somatodyspraxia,
characterized
by poor tactile
perception, proprioception, and
praxis, which are
shown by SIPT
and Sensory
Processing
Measure (SPM)
scores and
observations.
Poor somatosensory
perception in the tactile and proprioceptive
systems and difficulties
in praxis are factors
underlying Raul’s
problems in initiating
and sustaining play
with peers.
Raul will be able
to navigate the
playground during
recess without
walking into
unsafe situations
and bumping into
objects and people,
with no more than
2 physical cues to
reposition him or
change his course.
Raul will be able
to manage the containers by sequencing the actions
needed to open
lunch-related items
Raul’s relative strengths (e.g., milk carton,
a zipper-locked bag
in visual perception
holding crackers
and visual praxis supor sandwich,
port his ability to read
and excel at building
packages of cookies
Raul has diffitasks, and his adequate or dried fruit) with
no more than 2
strength and ability to
culties in social
execute familiar motor physical or verbal
participation,
prompts, 4 of 5
actions allow him to
which is shown
by SPM scores
participate in very basic times observed.
and observations. play activities at school.
Identifying
Outcome
Measures
Proximal measures
are as follows:
• SIPT tactile
perception tests
• SIPT
proprioceptive
tests
• SIPT praxis,
balance,
and bilateral
integration
tests.
Setting the Stage for
Intervention
Raul’s therapist has 7 years
of experience, including
advanced training in the
SIPT. She plans Raul’s
intervention around his
identified sensory–motor
factors, including his relative
strengths in visual perception
and visual–motor skills and
typical sensory reactivity,
as well as his difficulties in
tactile and proprioceptive
perception and praxis.
Distal measures
Before initiating his schoolare as follows:
based occupational therapy
• Goal attainment program, an individual education plan (IEP) meeting
scaling
was held to determine Raul’s
• Data sheets
eligibility and service recomrecording the
mendations for 60 min/week
frequency and
of occupational therapy in
duration of
a setting with specialized
the targeted
therapy equipment (referred
behaviors.
to as clinic in the IEP) and
These may
30 min/week of one-on-one
be taken by
classroom-based occupathe teacher,
tional therapy until his next
a one-to-one
behavioral aide, annual IEP meeting. Activities, equipment, and supplies
a parent (if
that incorporate Raul’s
observation is
made at home), strengths and address his aror the therapist. eas of difficulty are obtained,
planned, and arranged. A
formal communication plan
was developed to ensure
that collaboration with key
stakeholders (i.e., teacher,
behavioral aide, parents,
speech–language pathologist)
continues through the
school year.
Conducting
the
Intervention
For Raul, individually tailored activities
that support
development
of tactile
perception,
proprioceptive
awareness, and
praxis are emphasized, along
with activities
aimed at using
his strength
in visual
perception.
Careful considerations of how
Raul’s strengths
and challenges
affect his
performance at
school are also
emphasized in
his intervention program.
Measuring
Outcomes
and
Monitoring
Progress
School
aides chart
Raul’s grasp,
safety on the
playground,
and ability
to manage
lunch containers.
The therapist
compares
Raul’s SIPT
scores at preintervention
and at end
of the fall
semester.
Th teacher
or an independent
evaluator
reports Raul’s
goal attainment scaling
scores.