Ayres' Sensory Integration Therapy
Helping children and adults with SI difficulties
What is sensory integration?
Sensory integration is about how our brain receives and processes sensory information so that we can do the things we need to do in our everyday life. There is a theory of sensory integration and a therapeutic approach based on the theory.
Sensory integration theory
Our understanding of sensory integration was initially developed in the late 60s and 70s by Jean Ayres, an occupation therapist and psychologist with an understanding of neuroscience, working in the United States of America. Jean Ayres was interested in explaining how difficulties with receiving and processing sensory information from one’s body and environment could relate to difficulties at school or using one’s body to engage in everyday life. Jean Ayres defined sensory integration as:
“The neurological process that organises sensation from one’s own body and from the environment and makes it possible to use the body effectively with the environment” (1972)
Photo credit: By family member (personal photo) GFDL, via Wikimedia Commons.
The different parts of our body that receive sensory information from our environment (such as our skin, eyes and ears) send this information up to our brain. Our brain interprets the information it receives, compares it to other information coming in as well as to information stored in our memory and then the brain uses all of this information to help us respond to our environment. Therefore sensory integration is important in all the things that we need to do (such as getting dressed, eating, socialising, learning and working).
For most of us the development of sensory integration occurs when we are young as part of our normal development and in the things we do such as rolling, crawling, walking and in play; for others sensory integration is less well developed – see problems with sensory integration.
Jean Ayres developed a theory about what happens when sensory integration does not develop well, she developed a way of assessing these difficulties and a way of treating them. She carried out research to further develop and understand sensory integration and she treated many children with sensory integration difficulties. Since then a number of occupational therapists have continued her work. With new brain imaging techniques, much of what Ayres postulated has been supported.
The 8 senses
In sensory integration we are interested in all 8 senses. You can probably immediately think of 5 – seeing, hearing, tasting, smelling and the sense of touch.
The other 3 are proprioception, vestibular and interoception, these are defined below.
Our muscles and joints have tiny sensory receptors that tell our brain where our body parts are. When you put a spoon to your mouth, you don’t need to look at the spoon to see where it is or feel for your mouth to know where to place the spoon; you know where your hand is in relation to your mouth. It is largely your proprioceptive receptors giving you this information.
Your brain then uses this information to plan movements so that you can coordinate your body.
In our inner ear we have small, fluid filled canals, the fluid in these canals moves every time we move our head. Receptors in these canals pick up the direction of movement and send this information on to our brain. So we know if we are moving forwards, backwards, side to side, tilting our head, turning round or moving up and down.
Once again, our brain uses this information to plan for movements and help us maintain our balance.
Interoception: this is a fairly new area for discussion in sensory integration; interoception is how our body tells our brain what is going on inside our body, when we are hungry or feel full, when our heart is beating fast or when we have that sensation of butterflies in the stomach.
Jean Ayres was particularly interested in the interaction between and development of the vestibular, proprioception, touch, vision, and hearing. She saw these as important in supporting our ability to use our body, concentrate, develop self-esteem and confidence as well as having self-control and academic skills.
Sensory integration problems
Recently Parham and Mailloux (2015) identified four categories of sensory integration problems
1. Problems with sensory modulation
Problems with sensory modulation occur when our brain either over responds to, or under responds to sensory information. For example, if someone over responds to touch they may be very aware of the label in the back of their clothes. If someone is under responsive to touch they may not notice someone tapping them on the shoulder.
We could all say we have similar experiences, but for some people the degree to which their brain under or over responds impacts on their ability to do the things they need to do in everyday life. As a result, they could become distressed or miss out on things that could keep them safe. Problems with modulation can cause the person to become anxious, fearful, angry and frustrated.
People often compensate for problems with modulation. The types of strategies they may use could be to remove their clothes, not wash, flap their hands, rock or to withdraw from social contact. That is not to say that these behaviours mean that the person has a problem with sensory modulation, these behaviours could be a result of a number of other things, but sensory modulation is one thing to think about and a trained sensory integration therapist would be able to help with this thinking.
It has been found that people can be over responsive or under responsive in all the different senses, they can be over responsive in one sense and under responsive in another. For some people they can be over responsive and under responsive within the same sense. Responsiveness can be dependent on a situation, for example a stressful situation can make us more and sometimes less aware of sensation.
2. Sensory discrimination and perceptual problems
This is when the brain has difficulties with making sense of the sensory information it receives. The person then struggles to interpret subtle differences in the sense. For example, being able to feel two different points of touch that are close together – this is useful when we are doing things like doing up buttons. The brain also has difficulty with giving meaning to the information it is receiving. If these problems are with proprioception or touch a person can seem clumsy, or use too much or too little force when doing things. People with visual perceptual problems may have difficulties with finding objects in cluttered environments, or finding a word on a page.
3. Vestibular-bilateral functional problems
These problems are a result of problems with our vestibular sense and can result in poor balance and difficulties with coordinating two sides of the body. Balance and coordination problems could be a result of a range of different problems and a SI practitioner will be able to identify whether the difficulties are a result of problems with the vestibular system.
4. Praxis problems
Praxis is how our brain plans for and carries out movements we have not done before. For children this could be learning to jump, for adults it may be learning to drive or use chopsticks. You may have heard terms such as dyspraxia or motor planning problems; this is what we mean when we say praxis problems. Not all problems with praxis are a result of sensory integration. Jean Ayres identified two types of praxis difficulties associated with underlying sensory issues. She called one somatodyspraxia and the other visuodyspraxia. Somatodyspraxia is when a person has problems with praxis as well as problems with processing touch and proprioceptive senses, while visuodyspraxia is a problem with praxis and visual processing. Some people have been found to have both of these problems, while others have one or the other. People with dyspraxia often look clumsy or awkward in their movements.
How to manage sensory integration problems
For many people small adjustments to their environment or to the way they are allowed to move at school or at work can make a huge difference to how they manage their day to day life. We offer a range of courses for parents, teachers and other professionals to help you understand more about sensory integration difficulties and think about changes you can make to your environment or the way you manage work, play or school that will make these activities more accessible to people with sensory integration difficulties.
Ayres’ Sensory Integration intervention (or ASI) is a term used to describe intervention developed by Ayres to improve or develop sensory integration for children and adults with sensory integration difficulties. Therapists need specific training to understand the complex reasoning underpinning this therapy.
Sensory integration therapists
A sensory integration therapist will have gained additional in-depth postgraduate training following their initial qualification to become a therapist. This training involves developing a detailed understanding of the neuroscience and evidence base underpinning sensory integration as well as developing expertise in assessing and providing intervention for people with sensory integration problems.
If you are an occupational therapist, physiotherapist or speech and language therapist and are interested in furthering your career in sensory integration take a look at our modular pathway to becoming an SI practitioner.