Sensory Integration: Theory and Practice

648 Pages·2020·43.106 MB·English

by  Shelly Lane, Anita C. Bundy

Sensory
Integration
Theory and Practice
THIRD EDITION

Anita C. B undy ScD, OT/L, FAOTA, FOTARA Associate Editors
Shelley M ulligan PhD, OTR/L, FAOTA
Professor and Department Head,
Occupational Therapy Associate Professor and Chairperson
College of Health & Human Services Department of Occupational Therapy
Department of Occupational Therapy University of New Hampshire
Colorado State University
Fort Collins, CO Stacey R eynolds PhD, OTR/L, FAOTA
Honorary Professor
Associate Professor
Occupational Therapy
Department of Occupational Therapy
Faculty of Health Sciences
College of Health Professions
University of Sydney
Virginia Commonwealth University
Sydney, Australia
Shelly J. L ane PhD, OTR/L, FAOTA, CSU
Professor, Occupational Therapy
College of Health & Human Services
Department of Occupational Therapy
Colorado State University
Fort Collins, CO
Professor and Discipline Lead
Discipline of Occupational Therapy
School of Health Sciences
University of Newcastle, Australia
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The third edition of this book, similar to the second, is dedicated
to A. Jean Ayres, the inspiration for this text
and the intervention and research it represents.
And to those who live with sensory integrative dysfunction,
who are the best teachers.
ACKNOWLEDGMENTS
Whenever the two of us edit a textbook, it seems and families for the photo shoot, and of course
to involve moving around the world. This one getting those all-important photo releases signed.
was no exception. This time each of us moved We can ’ t even imagine a book without these
to and/or from Australia (SJL moved both ways). “action” photos.
Those moves undoubtedly contributed to the time The reviewers of each chapter provided
it took for us to complete this edition—and also invaluable feedback. What they had to say was
makes us very grateful to a number of people, not always easy to hear—but it was always
without whom there would be no third edition. correct. We hope we have done justice to their
First, we are indebted to the therapists, comments.
researchers, academics, and occupational therapy Numerous colleagues and friends contrib-
students in many countries of the world who uted in enormously important ways by refl ecting
read—and sometimes re-read—the fi rst two edi- on content, terminology, and interpretations of
tions of this book. They tell us that those books content. Judith Abelenda, in particular, not only
informed their practice—and they insisted we do spent countless hours discussing ideas, but she
a third. This third edition is the last for us. We also made her home in Spain a writing retreat.
are very grateful to Shelley Mulligan and Stacey We made a lot of progress in that week.
Reynolds, who joined us in editing this time. We The folks at F.A. Davis stood by us through
now pass the torch to them. thick and thin. Christa Fratantoro, in particular,
It almost goes without saying that the contri- has been involved since the beginning and key
bution of each author was critical but we would to the last two editions. She is always our “go-to
never want to be silent on this. This group of person” with any questions or needs. There are
scholars is amazing—and amazingly patient. We so many others that it would be impossible to
are honored to have worked with them. We are list them without missing some. We are eternally
also thankful to the numerous therapists who grateful to all for your support.
gave their time and resources to teach us about Finally, as always, those closest to us, Rick
Jean Ayres’ life and the history of sensory inte- Thornton and Ginny Deal, literally provided
gration theory and practice. This information led years of (nearly uncomplaining) support. Shelly ’ s
to Chapter 2 . Generous fi nancial contributions children, Hannah and Lucas Thornton, provided
from F. A. Davis—and a sabbatical from the her cheering section, something that kept her
University of Sydney—allowed us to travel all going when deadlines loomed. We could not
over the United States in search of their collec- have thanked them enough—and we ’ re pretty
tive wisdom. We hope we have done a good job sure they would say we did not.
of interpreting what they said. We have undoubtedly failed to mention some
Tammie Fink, from the Sensory Gym in key players. That has more to do with failed
Hobartville, New South Wales, Australia, is memory than lack of signifi cance of their contri-
responsible for many of the photographs in this butions. We hope you will forgive us.
edition. The photos bring the content to life.
Our deep appreciation goes to Colleen Hacker Anita Bundy
for sharing Tammie ’ s time, organizing children Shelly Lane
vii
FOREWORD
Janice P. Burke
“There is no substitute for a good idea” ( Reynolds, 1971 ).
The rigor, passion, and vitality that A. Jean Ayres The authors collected together in this edited
brought to addressing the problems of sensory text have made longstanding commitments to the
integrative dysfunction in children is alive and full realization of Ayres’ initial concepts and ideas
well as proven by this third edition of Bundy and for approaching assessment and intervention.
Lane ’ s Sensory Integration Theory and Practice. Their chapters provide evidence of their ability
Throughout the book, the authors exhibit current to think scientifi cally and synthesize knowledge
work that fully understands and implements and understanding that readers will fi nd useful
contemporary education, research, and practice as they defi ne and implement the next wave of
agendas related to sensory integration (SI). Each research. These authors exhibit the commitment
of the 23 chapters focuses on the importance of and courage refl ective of A. Jean Ayres. They con-
discoveries that advance the initial theory and tinue the evolution of Ayres’ work, particularly
application of SI fi rst presented by A. Jean Ayres as evidenced in their consideration of broader
nearly 60 years ago. applications of the theory ( Chapter 16 ), inclu-
The legacy of A. Jean Ayres is steeped in a sion of complementary approaches ( Chapter 17 ),
tradition of inquiry and research. It is humbling and application of SI principles beyond tradi-
to realize the profound effect that Ayres’ founda- tional diagnostic groups ( Chapter 18 ).
tional work still holds on the current day prac- The 1960s as a decade witnessed an explosion
tice of occupational therapy. In the early 1960s, of conceptual and theoretical work across a wide
she had a remarkable sense of how a deep and swath of occupational therapy. Occupational
detailed inquiry into neuroscience could provide therapy thinkers sought to import relevant ideas
a bridge to the fi eld of occupational therapy when from neurobiology, kinesiology, psychoanalytic
applied to individuals with SI problems. Her theory, and the social sciences. Ayres’ contem-
initial vision of what the marriage of these fi elds poraries, including theoreticians such as Mary
could yield has resulted in a sustained effort of Reilly, Gail Fidler, Anne Mosey, Margret Rood,
thought and action that continues to propel us and Josephine Moore, to name a few, were eager
toward a research agenda for the 21st century to develop models that would guide clinicians to
( Chapters 15 and 16 ) and describe both assess- better assess and treat specifi c occupation-based
ment and intervention methodologies ( Chapters 8 problems.
to 13 ). These scholars recognized that occupational
Similar to Ayres herself, the authors in this therapy was maturing as a profession, shift-
book are intrigued and driven by the compli- ing away from a dependency on medicine and
cated questions posed by SI dysfunction. Their rehabilitation. Occupational therapy was ready
curiosity and good science expand her tradi- to stand on its own two feet. Focused attention
tion of inquiry by asking diffi cult and probing was needed to articulate theories with specifi c
questions. Both the questions and the resultant concepts and principles that would sharpen the
answers further inform the underlying theory understanding of the therapeutic value of an
(Part I), explicate SI disorders and their neuro- occupation-based approach. This was to dis-
science basis (Part II), explore the current status tinguish the focus of occupational therapy as
of assessment and intervention (Parts III and IV), unique, and, as it turns out, lay the ground-
extend theory application (Part V), and provide work for what would become a research-based,
case exemplars (Part VI). evidence-generating, highly valued and widely
ix
x ■ Foreword
recognized approach to remediating the problems They surrounded themselves with students and
of occupation. Using strategies from the social scholars in graduate level education and worked
and hard sciences, they set out to understand and to engage them in a path to become great think-
solve problems of occupation and the diffi culties ers. In this way, A. Jean Ayres and Mary Reilly
of fully participating in society. planned to seed their ideas and create the next
Ayres, along with her contemporaries in neu- generation of leaders. All the students in their
robiology and education, were deeply involved classrooms were able to benefi t from the natural
in identifying, defi ning, and understanding chil- productivity that is inherent when one is curious,
dren with visual and perceptual motor problems a student, and learning at the table of wonderful
and learning diffi culties. During the 1960s, they thinkers, mentors, and educators.
worked to develop ways for remediating occu- Paul Reynolds in A Primer in Theory Con-
pational issues in both educational and clinical struction, his book on theory, wrote: “[T]he ulti-
settings. mate test of any idea is its utility in achieving the
Ayres’ perspective was authentic to its occu- goals of science” ( Reynolds, 1971 ).
pational therapy roots. It had a sharp focus on I sat in graduate classes with both of them,
the needs of a special population of children and on mats in Jean ’ s clinic and at seminar tables
was designed as a bridge on the road to full par- in Mary ’ s classroom. All present listened to the
ticipation. It provided the fi eld with legitimate, exquisite ideas they were developing. There I
science-based explanations for the use of specifi c came to realize what was needed to reach the
occupational therapy approaches. Ayres drew the infi nite possibilities and potentials that occupa-
attention of occupational therapists concerned tional therapy has to understand, articulate, and
with children with neurologically based issues remediate problems of individuals as they move
to the possibilities of a theory rooted in scien- into a world of meaning and purpose.
tifi cally grounded principles. This theory was What is especially intriguing about this period
testable and subject to validation and proof. The of theory development is to ask the question of
path Ayres forged was rigorous and would have why some theories, such as that of A. Jean Ayres,
scholarly, and demanding, vistas. continued to evolve, prove their durability and
I had the great fortune of studying at the Uni- applicability to current problems, and ask why
versity of Southern California with two incredible some, even to this day, 60 years later, demon-
pioneers during this time of theoretical explosion strate their inherently sound foundation.
in occupational therapy: A. Jean Ayres and Mary A. Jean Ayres had a good idea. This book is
Reilly. Though their theoretical orientations were a testament to the durability of Ayres’ initial idea
different, Ayres in the neurosciences and Reilly and the science that followed and is an important
in social science, they both had a single-minded milestone for the editors and authors who have
perspective of their subject matter that led to an made contributions to her legacy.
unwavering commitment that set the stage for a
theory-driven approach to assessment and inter-
vention. Both had a foundational belief in the
power of occupation. They employed similar
Reynolds , P. D. ( 1971 ). A primer in theory
strategies, based in evidence and observation, to construction . Indianapolis, IN : Bobbs Merrill
test their ideas. Educational Publishing .
PREFACE
More than a decade has passed since we pub- sensory modulation. However, she did not live
lished the second edition of S ensory Integration: long enough to fully develop her explanations.
Theory and Practice. A lot has happened in that In the ensuing decades, while the theory did not
time, and, as much as possible, we have tried change fundamentally, the terminology associated
to capture the evolution. We have made several with it morphed. At the same time, many occupa-
notable changes from the second edition. tional therapy educators relegated SI theory and
Ayres developed sensory integration (SI) therapy to continuing professional education,
theory in the 1960s at a time when the occu- perhaps believing it was beyond that required for
pational therapy profession, struggling to gain basic preparation of entry-level practitioners. All
credibility, embraced a medical model. Her these factors seemed to conspire to make occupa-
driving force was to explain links between brain tional therapists (and ultimately other profession-
processing and observable behavior. Nonethe- als) increasingly unclear about the terminology
less, although participation in everyday activ- associated with SI theory and what actually con-
ity was traditionally the core of occupational stituted sensory integrative therapy. Throughout
therapy, Ayres began her work in an era when this third edition of Sensory Integration: Theory
many occupational therapists believed that and Practice, we have attempted to clarify the
changing body structure and function would terminology and the principles of intervention.
translate automatically into improved function. We also offer a new chapter ( Chapter 3 ) tracing
Some therapists who employed SI therapy fell the history of the development of SI theory–with
into that trap. What could be more seductive all its triumphs and dramas—from Ayres through
than changing the brain? But over-emphasis on to the present. We think that chapter makes a par-
changing the brain sometimes resulted in rel- ticularly good read.
egating occupation to the back seat. We now Research evidence for both the theory and the
know that changing the brain matters, but only intervention has risen to a higher level. Studies
if those changes contribute to making everyday of SI now include government-funded random-
life easier and more meaningful—and that does ized controlled trials (RCTs) as well as quasi-
not occur automatically. Publication of the I nter- experimental, correlational, and descriptive
national Classifi cation of Functioning Disability studies that set the stage for additional RCTs
and Health (ICF) has shifted the attention and needed to test the effectiveness of this complex
beliefs of all health-care professionals toward intervention. In this third edition, we devote
activities and participation. In this third edition two chapters to that evidence. One chapter
of S ensory Integration: Theory and Practice, we ( Chapter 15 ) describes the clinically based
give greater prominence to SI in everyday life. research applicable in everyday practice. The
Among other more subtle changes throughout second ( Chapter 16 ) describes a growing body of
the book, we expanded the chapter on SI and basic research underpinning SI theory. We also
occupation from the second edition and placed it have expanded the chapters on praxis and sensory
where it should be—near the front. modulation. Refl ecting the explosion of research
Ayres died in 1989 and she still is sorely in the area, we also expanded the chapter on
missed. For many years, colleagues who had structure and function of the sensory systems
worked with her carried the torch that Ayres ( Chapter 4 ), augmenting it with some information
lighted. Through time, as might be expected, on interoception, and added a separate chapter on
some of those colleagues shifted their focus sensory discrimination (Chapter 7).
to specifi c aspects of the theory. Ayres empha- Through time, we became increasingly aware
sized praxis and dyspraxia. She labeled “tactile of the need to illustrate the multiple complex
defensiveness” and saw it as a refl ection of poor aspects of assessment related to SI theory. In this
xi
xii ■ Preface
third edition of Sensory Integration: Theory and including the Wilbarger Approach; the Alert
Practice, we reintroduced a chapter describing Program; Interactive Metronome®; Astronaut
the Sensory Integration and Praxis Tests (SIPT; Training; Infi nity Walk Training; Therapeutic
Chapter 8) ; introduced an entire chapter on clin- Listening®; Suck, Swallow, Breathe; and Aquatic
ical observations ( Chapter 9) ; and expanded the Therapy. In an attempt to be clear about the
information on assessing without the SIPT into a relationship of each of these programs to SI, we
chapter on its own ( Chapter 10 ). We retained an analyzed each in terms of three factors: whether
updated and expanded version of the chapter on (1)the sensation provided is uni-modal or multi-
interpreting test results related to sensory inte- modal; (2) the approach is responsive or pre-
grative dysfunction, illustrating that process with scribed; and (3) the setting in which it is delivered
multiple case examples ( Chapter 11 ). is traditional, nontraditional, or both. The authors
Since the second edition of Sensory Integra- of each program described the background, ratio-
tion: Theory and Practice, Parham and colleagues nale, and relationship of the program to SI and
developed and published a Fidelity Measure that occupation; benefi ts; and populations for which
operationally defi nes sensory integrative therapy. it is appropriate.
In providing clarifi cation of what actually con- We have peppered all the chapters in this
stitutes sensory integrative therapy, the Fidelity third edition with case examples. In addition, we
Measure has, arguably, had the greatest single have included several chapters entirely devoted
effect on the intervention chapters. In this third to applying theory, assessment, or intervention
edition, we label sensory integrative therapy as a principles in a case context. We retained and
direct intervention with particular characteristics. expanded a second edition chapter in which we
We offer a new chapter ( Chapter 14 ) illustrating illustrate the process of planning and implement-
use of the Fidelity Measure as well as Miller and ing intervention for the child with sensory inte-
colleagues’ STEP-SI and A SECRET models grative dysfunction ( Chapter 20 ) who was a case
as a means for distilling theory in practice and example in the interpretation chapter described
making it more readily accessible. We retained earlier ( Chapter 11 ). We complement that chapter
the chapters describing the art and science of with one comprising a case example of planning
sensory integrative therapy ( Chapters 12 and 13 , and implementing intervention for a child with
respectively), but those chapters are so updated autism spectrum disorder ( Chapter 21 ).
that they barely resemble their second edition The question of whether or not sensory inte-
predecessors. grative therapy is effective theory has always gen-
In this third edition of Sensory Integration: erated conversation and controversy both within
Theory and Practice, w e clearly separate sensory and outside occupational therapy. In Chapters 15
integrative therapy from indirect approaches and 16, we summarize the evidence from basic
that often employ SI or related theories (i.e., science and from clinical studies. We close this
coaching). We offer a new chapter on coach- third edition with a chapter ( Chapter 23 ) address-
ing (C hapter 17 ) that draws on, but is much ing the complex question of effectiveness explic-
expanded over, the second edition chapter that itly. We remind readers that sensory integrative
described use of SI theory as the basis for con- therapy comprises both art and science—and that
sultation in schools. to try to divorce one from the other is to destroy
Recognizing the growth in thinking and options the essence of the intervention. Thus, researchers
regarding occupational therapy intervention for who have failed to consider both art and science
children with motor coordination or sensory have failed to test the effectiveness of sensory
regulation issues, we offer a new case-based integrative therapy. Therefore, they cannot know
chapter ( Chapter 22 ) in which we view interven- whether or not it works.
tion for a child with poor motor coordination, We closed the Preface of the second edition
fi rst through a sensory integrative lens and then with a comment that seems as apt for this edition
through a Cognitive Orientation to daily Occu- as it was more than a decade ago:
pational Performance (CO-OP) lens. We retained
Sensory integration theory, as much as any
and updated a chapter on sensory-based interven- theory in occupational therapy, depends on a
tions often used as a complement to or instead partnership of art and science. Science gives
of sensory integrative therapy ( Chapter 18 ), sensory integration credibility; art gives it
Preface ■ xiii
meaning. Toward a partnership of art and of Practice Wisdom, brief summaries of relevant
science, we offer these [new] works from a studies we have labeled “Here ’ s the Evidence,”
number of outstanding theorists, researchers, and “enrichment” reading we have called “Where
clinicians, and artists. Jean Ayres touched us all.
Can I Find More?” We hope these, and all the
We carry the torch that she passed to us at her
added features, will make learning and teaching
death, fueling it with new perspectives and new
this content easier and more enjoyable. Above
knowledge.
all, we sought to create a text that students and
At the request of several reviewers and to make practitioners want to read. We hope we have met
this third edition more usable than previous edi- our objective.
tions for teaching, we added several pedagogical
features. Among these: chapter objectives, peri- Anita C. Bundy
odic “Here ’ s the Point” summaries, refl ections Shelly J. Lane