Sensory Integration Therapy

Ayres Sensory Integration® Therapy is a form of sensory evaluation and treatment guided by the works and research of A. Jean Ayres, a pioneer in the field. Although Ms. Ayres passed away in the 1980s, work and research has continued by a group of highly skilled and devoted occupational therapists. These OTs along with distinguished educators and researchers have created the Sensory Integration Research Collaborative (SIRC). SIRC resulted from a research project funded by the National Institutes of Health, with a focus on ensuring that Ayres Sensory Integration® (ASI®) is provided only by appropriately trained therapists and in its evidence-based form. To ensure fidelity in ASI®, the Ayres Sensory Integration Fidelity Measure was developed. The information below regarding necessary therapist qualifications, treatment space requirements, and components of a therapy session is taken directly from the ASI® Fidelity Measure.

Therapist Qualifications
Any occupational therapist providing sensory integration therapy is expected to have completed post-professional training in sensory integration theory, assessment, and intervention, or be receiving regular mentoring from an occupational therapist with this training. Post-professional training consists of a minimum of 50 hours of continuing education focused on SI theory and practice.

The following US SI certification programs are considered to meet these requirements. There are other certification programs, however, they are currently available only overseas.

• University of Southern California: Sensory Integration Certification Program
• CLASI: Certificate in Ayres Sensory Integration®
• STAR Institute: ProCert Level 2 Certification
• SIPT Certification: discontinued and replaced with USC SI Certification Program

In addition to certification, any occupational therapist trained in sensory integration therapy should be able to easily answer question from families and explain the purpose and course of treatment. In the case of OTs who are being mentored by a SI Certified OT, they should be able to collaborate with their mentor to answer questions from families. While there are many sensory-based certifications (i.e., Therapeutic Listening, Astronaut Training, Wilbarger Brushing, etc.), these are recognized as sensory-based treatments and treatment strategies, not sensory integration therapy.

Physical Treatment Environment
When entering a treatment space for ASI® therapists, a number of environmental features will be easily identifiable. These include:

• Adequate space to allow for vigorous movement and activity
• Flexible arrangement to allow for quick change-out of equipment and materials
• Suspension hang-points that allow for full orbital movement on equipment
• At least one rotational device to be used on suspended equipment, allowing for 360 degrees of rotation
• Suspended equipment and/or equipment accessories that allow for a bungee effect
• A devoted calming, quiet space
• Mats, cushions, pillows, etc. for use under suspended and climbing equipment
• Equipment adjustable to a child’s size
• Therapist monitoring of accessible equipment for safe use
• Unused equipment safely placed or stored where a child cannot fall or trip
• Regular monitoring of equipment for safety and wear
• Availability of a large variety of equipment, toys, and materials

Occupational therapists providing sensory integration therapy will have all of these environmental features available within the treatment space. Additionally, unless there is a safety concern, children should have access to explore and find any equipment or materials that are interesting and motivating.

Therapeutic Strategies
So what do sensory integration therapy sessions look like? Play! With a highly skilled ASI® therapist, a parent might even wonder if any work is being done at all. However, while observing OT sessions with ASI® therapists, a variety of therapeutic strategies will be employed. If you watch carefully, you should see all of the following ASI® therapeutic strategies being used.

• Ensures physical safety: The therapist anticipates any safety concerns that may be present for the child, specific to the child and activity. This may include close physical proximity, the use of adaptations to support safety, and modifications in the activity expectations.
• Presents sensory opportunities: The therapist presents at least two types of sensory input from the foundational sensory systems – tactile, proprioceptive, and vestibular – to support self-regulation, sensory awareness, and/or movement in space development.
• Assists the child to attain and maintain appropriate levels of alertness: The therapist helps the child become attentive and engaged in activities presented, as well as assisting the child in maintaining this level of arousal and regulation throughout engagement.
• Challenges postural, ocular, oral, or bilateral motor control: The therapist supports and offers challenges to children in these areas, at least one of which is offered intentionally rather than incidentally.
• Challenges praxis and organization of behavior: The therapist presents challenges that require the child to create ideas and plan and organize sequences related to unfamiliar motor tasks, or completing familiar motor tasks in an unfamiliar way.
• Collaborates in activity choice: The therapist and child decide together what the session will consist of. Activity choices and sequences may be offered as ideas, but are never chosen solely by the therapist.
• Tailors activity to present just-right challenge: The therapist increases the challenge of activities until a child has reached their highest level of skill and performance. If a child struggles, the therapist grades expectations back down to reach the just-right challenge.
• Ensures that activities are successful: The therapist presents a variety of sensory modulation or discrimination challenges to promote adaptive responses, making careful modifications to ensure the child’s success.
• Supports child’s intrinsic motivation to play: The therapist incorporates play-based activities or presents activities in a playful manner, ensuring the child is fully engaged and intrinsically motivated during intervention.
• Establishes a therapeutic alliance: The therapist develops and maintains rapport and connection with the child to ensure that activities are playful, meaningful, and enjoyable. This connection goes beyond pleasantries and positive reinforcement.

During sensory integration therapy, these therapeutic strategies should be evident in all therapy sessions once a therapeutic alliance has been established.

In addition to these aspects of ASI® therapy, caregiver communication and engagement are necessary. This includes goal setting with the input of children and families, including parent report of educational challenges. Additionally, input from and collaboration with teachers and other important adults should be initiated and ongoing.

Have questions about ASI® and sensory integration therapy? Feel free to contact us!

Referenced information adapted from:
Parham, L. D., et al. (2011). Development of a fidelity measure for research on the effectiveness of the Ayres Sensory Integration® intervention. The American Journal of Occupational Therapy, 65(2), 133–142.