SI Intervention Flashcards
T/F: Feedback is reactive (e.g., on ball and have to respond to movement of ball) while forward is anticipatory (e.g., leaning back to pick something up)
True Feedback is reactive. Feedforward is anticipatory–need to co-contract muscles so don’t fall over
T/F: A weighted blanket on someone who is laying down is an example of prop
False. Deep pressure. If someone was working to get out from under the blanket, this would be prop
When you are standing up with your eyes open and have one foot up, what systems are you using? With eyes closed?
Eyes open: Vestibular, prop, visual
Eyes closed, Vestibular, prop
T/F: If a child is trying to stand with one foot up with eyes closed and has a lot of trouble and needs to put his foot down, he is probably underresponsive to vestib. and prop
True
T/F: If a child has a very difficult time balancing on one foot with his eyes open, he is probably underresponsive to vestib and prop
False. Using prop and vestib, but visual field is dominant. Probably postural motor problem
The highest level of adaptive response depends on…?
The highest level of adaptive response depends on the challenge presented to the child
What is the difference between sensory strategies and individualized SI tx?
- Sensory strategies can be used in a variety of environments. They are not necessarily an SI intervention. Sometimes, though, they are included to assist in SI intervention
- Ayres SI: specialized environment to deliver 1:1 intervention in a clinical environment. Must be trained in SI
T/F: Sensory strategies, individualized SI tx, consultations, and group interventions are all possible examples of SI intervention approaches
True. Consultations may occur with parents and schools and may include the use of SI theory. Group interventions with the use of enriched environments may implement SI theory
What does research say about sensory strategies e.g., massages and weighted vests?
- Results of studies using adaptive strategies are mixed, but as research on strategies accumulates, effectiveness is clarified.
- Effects of massages don’t last very long
- Weighted vest don’t seem to have much effect (perhaps because using with some kids who don’t need it)
T/F: Weighted vests should be used with children who appear underresponsive and/or have less strength
False. If use on a child with low tone/low strength, will cause structural damange (kid will sink not in a straight way).
-Use on kids who are hyper aroused to calm them (Gives prop)
What kind of sensory input do weighted vests provide?
-Proprioceptive to help calm a hyper aroused child
Who should you provide a ball to sit on to?
- Child seeking prop or needs vestibular
- Under responsive child to increase level of arousal so he can attend more
- If low postural control, to challenge–imposed, not self-initiated
Who can you provide a slanted rubber seat to?
A child with low postural control–forces them to sit up straight. Not as supported in research than peanut ball or a ball.
Which of the following is not an example of a sensory strategy?
A. Massage
B. Weighted vests
C. Adaptive seating
E. Providing a sensory experience to receive adaptive response
F. Sensory breaks in an enriched environment e.g., recess
G. Snoezelen equipment
H. Other sensory diets
E. This is part of an individualized (Ayres) SI intervention
A sensory strategy in which a variety of sensory strategies are used?
A. Massage
B. Adaptive Seating
C. Snoezelen equipment
D. Sensory Diet
D. Sensory diet
What kind of sensory input do stretchy resistance bands provide?
Prop
What would sunglasses as a sensory strategy be used for ?
To decrease visual input–if sensitive to light
What kind of input would a weighted snake provide on a child who is sitting down?
Prop. Not deep pressure because child must activate the trunk.
T/F: Providing prop input to a child with low tone can help to increase trunk activation
False. Don’t do this! With low tone, the trunk won’t activate, so don’t put anything weighted on. Risk structural damage.
What kind of input will a stretchy vest provide?
Deep pressure (tactile)
What kind of sensory input do chewy tubes provide?
Prop
How may children who are underresponsive to tactile input appear?
- Like having a glove on all the time
- If not able to feel things correctly, takes a lot more effort to achieve tasks
- Decreases ability to pay attention–requires more cortex
Individualized SI Intervention = ___________ + __________
SI Intervention = Sensory experience + Highest level of Adaptive Responsive
In individualized SI intervention, you use sensory experience to produce an adaptive response. What elements allow you do do this?
- Context of play–intrinsically motivated, fun, active
- Therapeutic relationship: how you interact with child
- A specialized environment with enriched sensory experiences, physical environment opportunities
T/F: Sensory strategies are generalizable across multipole contexts, while direct interventions are specific to a particular context
False. Direction interventions are generalizable across multiple contexts so the child to apply what he is doing in session outside. Sensory strategies are specific to a particular context
Where do direct SI interventions take place? Sensory strategies?
- SI interventions: in specialize adaptive settings like a clinic. Environment should be constantly changing to ready child for various outside situations
- Sensory strategies: Anywhere; homes, schools, clinics
What is the time frame for outcomes of direct SI interventions vs. Sensory strategies?
With SI intervention, want long term change so they are able to function without you. With sensory strategies, short term or immediate changes.
Who provides tx for SI direct intervention vs. sensory strategies?
-OT or other trained professional (speech, PT) provides direct intervention. Parents, teachers provide sensory strategies.
T/F: SI interventions require individualization for the child while sensory strategies do not.
False. Sensory strategies should be somewhat individualized e.g., don’t use weighted vest on all kids. Need to be with consult with follow ups
If using SI as a frame of reference, you need to know about what is happening at each of which three systems?
Need to know what’s happening to vestibular, prop, and tactile. Need to know if each system is hyper (over), hypo (under), or a discrimination problem. Don’t need to know exactly about responses to each, but need to be able to say you measured each to see how it is responding. (Tactile discrimination is especially hard to assess)
Which of the following is not important to ensure fidelity of SI interventions?
A. Professional qualifications and expertise
B. Appropriate Evaluation
C. Communication with family and other related professionals
D. Environmental affordances
E. Home assessment
F. Scaffolding by the therapist or adapting the activity to meet the goals
E. Home assessment
What sensory input is the most difficult to provide a child during an SI intervention in school?
- Vestibular input
- Must be creative in school setting
- Need suspended equipment, at least in 1:1 intervention (may not use with every kid)
What population of children did Ayres first studies of SI interventions look at? Which children were shown to be better candidates for the interventions?
- First studies with Ayres taught children with LD with increase and under postrotary nystagmus. Those with under postrotary were better candidates.
- Also looked at children with ASD
How do art and science combine to form Ayres SI tx?
Art: Therapeutic use of self, therapist’s style of interaction, therapist’s background
Science: Descriptive studies and factor analysis, effectiveness studies
What are the three main ways in which information is gathered during the evaluation process of SI intervention?
- Parent questionnaires
- Skilled observations (Informal and clinical)
- Standardized assessments
Which of the following would you NOT use to gain information from parents on their children’s sensory processing?
A. Sensory Profile
B. SIPT
C. Sensory Processing Measure
D. Touch Inventory for Elementary School-Aged Children
E. Touch Inventory for Preschoolers
B. SIPT. This is a comprehensive standardized assessment.
Which of the following would you NOT use to gain information from parents on their children’s sensory processing?
A. Sensory Profile
B. SIPT
C. Sensory Processing Measure
D. Touch Inventory for Elementary School-Aged Children
E. Touch Inventory for Preschoolers
B. SIPT. This is a comprehensive standardized assessment that assesses sensory discrimination and praxis.
Standardized forms completed by caregivers and teachers to assess children’s sensory processing patterns
Sensory Profile
-Also infant/toddler, adolescent/adult, school companion
Provides a complete picture of children’s sensory processing difficulties at school, at home and in the community. Completed by parent/caregiver.
Sensory Processing Measure
- K-6(5-12)
- Yields eight norm-referenced standard scores (typical, some problems, definite dysfunction)
26-item screening tool that measures tactile defensiveness
Touch Inventory for Elementary School-Aged Children (also for preschoolers)
Provide information about sensory processing, choices in play, motor performance, and the relationship of sensory processing to behavior and functional performance
Skilled observation for SI Tx
Two types of skilled observations for SI tx
- Ecological: information in natural environment
2. Clinical: structured and unstructured in clinical environment
Comprehensive standardized assessment for 4-8 yo, includes 17 subtests, and takes 2 hours to give (30-45 mins to score)
SIPT
All of the following tests yield info about sensory processing except…
A. Miller Assessment for Preschoolers (MAP) and MFUN
B. Bayley III
C. HELP
D. Bruininks-Oserestsky Test of Motor Proficiency (BOTMP)
E. Peabody Developmental Motor Scales (PDMS)
E. Peabody (PDMS) looks at fine and gross motor skills of birth-5 years
The uniqueness of intervention is based on…
SI Intervention (Sensory experience + highest level of AR)
Providing and controlling sensory input, especially…from the vestibular system, muscles and joints, and the skin (Ayres). This is the central idea of SI according to Ayres, and is referred to as…
Sensory experience
T/F: The sensory experience varies depending on the type of dysfunction
True
What kind of sensory experience can you provide a child who is hypo responsive to a system?
-Need to increase sensory experience. E.g., if child is underresponsive to vestib, provide intense vestib. If underresponsive to touch, provide tactile
T/F: If a child is hyper responsive to vestibular, you should provide intense vestibular input
False. If hyper responsive, take away the input first to provide inhibitory sensory experiences, then slowly bring it back in. For vestib, provide pressure first, then slowly provide slow and rhythmic vestib.
All of the following except which are inhibitory sensory experiences? A. Light touch B. Deep pressure C. Resistance D. Brushing E. Neutral warmth F. Rhythmic vestibular F. Slow vestibular
A. Light touch is excitatory while firm touch is inhibitory
The brushing technique is recommended for who?
Recommended for kids who need deep pressure. Brushing provides deep pressure, then do joint compressions (triggers joints, but not prop)
-Evidence doesn’t support it much
All of the following except which sensory experience is excitatory? A. Light touch B. Light placement of the hands C. Soft textures D. Rotary E. Resistance F. Vertical Linear G. Dysrhythmic H. Fast vestibular input
E. Resistance is inhibitory
The following provide what type of sensory experience?
- Proprioceptive
- Active interaction
- Resistance (push, pull, proximal joint stability, weight-bearing, antigravity positions, climbing)
- Oral motor (chewing, blowing)
Organizing
deep pressure is more calming than organizing
Level at which clients perform most consistently, highest level they can achieve and lowest level at which they become over-stimulated or excessively challenged
Adaptive response
How does the challenge presented in SI differ from that in other tx?
In SI, the child spontaneously has an adaptive response that integrates the sensations
A challenge that can be met successfully– child is in zone of optimal development
Just-right challenge
What are the requirements for having an adaptive response?
- Sensory stimuli in the environment
- Interpretation of sensory stimuli by brain
- Interpretation of sensation from our own body
- Ability to produce an AR
T/F: Acceptive sensory input can be an example of an adaptive response
True. Sometimes, just accepting input may be an AR
How does level of arousal relate to AR?
An AR will only occur if the level of arousal is optimal. If over or under, need to bring to optimal level first
Active participation; an increase in frequency, duration, and complexity; and generalizability outside of the sessions are all goals of forming ________
Adaptable responses
All of the following are types of adaptive responses except which?
A. Somatomotor
B. Social interactive
C. Discrimination
D. Behavior/emotion regulation, attention
E. Language/communication
C. Discrimination
Type of adaptive response that relates to motor planning
somatomotor AR
T/F: With SI tx, we should be always looking for ways to decrease the level of adaptive response.
False. We should always be looking for ways to increase the level of AR
With SI intervention, ____ is the context
Play!
-Therapeutic relationship also important
T/F: An example of working on postural control is a child holding onto and standing on a swing
False. The child has to co-contract to stay on, but he’s not working on postural control.
-If kid is underresponsive to vestib, put him in a swing and have him grab him. Stop the swing once in a while
T/F: Within SI tx, play should be therapist driven and planned ahead of time
False. While the therapist chooses which play options the child has a choice of (not whatever the child wants), the child should be intrinsically motivated and therapy is child driven. You transform what the child chooses into the therapeutic activity. Often spontaneous–best ideas come from kids
What does the “as it” world refer to within the context of play?
The “as if” world allows for novel things and for kids to play. It offers a safe space different from the outside world.
All of the following are characteristics of play within SI tx except which?
A. Intrinsically motivated and processes oriented (child driven)
B. Spontaneous
C. Enjoyable
D. May decrease the level of arousal
E. Bracketed in the “as if” world
F. Flexible and many forms (creative, humorous, serious, risky, intense, calming)
D. Kid’s level of arousal may increase when playing e.g., laughing screaming. This is normal
T/F: There are two forms of play within SI tx
False. There are many forms e.g., serious, risky, intense, calming, creative, humorous. Depends on who you are as a therapist and who the kid is
Why is building a relationship, artful vigilance, and having an individual style important?
The therapeutic relationship/therapeutic use of self is part of the SI intervention
Requires a skilled therapist and large room with lots of simple but essential equipment
Specialized Environment
All of the following are requirements for a specialized physical environment for SI intervention except which?
A. Safe space that permits movement, novelty, and exploration
B. Occurs in the clinical setting
C. Flexible arrangement of essential equipment
D. Allows for various activities and sensory opportunities
B. Can occur in a clinic, school, or home setting, however more difficult to treat outside the clinic
What is the reward offered for children engaging in SI intervention?
Play! AR is its own reward. Don’t need stickers!
Number two of the fidelity measure, "presents sensory opportunities," relates to what part of the SI intervention? A. Sensory experience B. Safety C. Context of Play D. Adaptive Response E. Therapeutic relationship
A. Sensory experience
Number nine of the fidelity measure, "supports child's intrinsic motivation to play," relates to what part of the SI intervention? A. Sensory experience B. Safety C. Context of Play D. Adaptive Response E. Therapeutic relationship
C. Context of play
Number four of the fidelity measure, "challenges postural, ocular, oral, or bilateral motor control," and number five, "challenges praxis and organization of behavior," refers to what part of the SI intervention? A. Sensory experience B. Safety C. Context of Play D. Adaptive Response E. Therapeutic relationship
D. Adaptive response
Functional goals of SI may be related to adaptive responses and/or _________
Daily activities
How does the perceptual motor approach/psychomotor approach compare to SI intervention?
- Often uses the same approach, often focusing on visual and perception
- Uses lot of games/groups
- SI uses more individual attention to child and inserts pieces of equipment that the child can benefit from
How does Floor Time/DIR compare to SI intervention?
- Focus is not on sensory
- Works on regulation of behavior and interaction
- context is on social interaction and intrinsic motivation
How does sensory stimulation approaches compare to SI intervention?
- There is a sensory experience, but it is not controlled by the child
- The person is not expecting an adaptive response
- Uses brushing as ex
How does Nueromotor/NDT compare to SI intervention?
- There is a sensory experience that is recognized
- AR is postural and movement
- Originally, not following the child’s lead
How does the Behavior Management approach compare to SI interventions?
- Uses sensory as reinforcer
- Expecting a behavior change
- Not intrinsically motivated
All of the following except which are outcomes of the SI intervention?
A. Decreased stereotypical behavior
B. Increased attention to tasks
C. Increased independence
D. Increased eye contact and verbalizations
E. Increased participation
F. Improved motor performance
C. Increased independence
What did the American Academa of Pediatrics recommend regarding SI therapies in their policy statement (2012)
- Recommended that sensory processing disorder should be used as a diagnoses
- That Pediatricians should recognize and communicate with families regarding limited data for sensory based therapies
- That pediatricians should help families monitor the success of an intervention
- That tx should be prioritized based on the effect that sensory problems on functional performance e.g., able to focus, tolerate foods, be in room with loud noises
T/F: According to the American Academy of Pediatrics (policy statement on SI therapies 2012), strong research supports the use of SI therapies for children with developmental and behavioral disorders.
False. States there is limited research and that sensory processing disorder should not be used as a diagnosis
T/F: As stated by the American Academy of Pediatrics (Policy Statement on SI Therapies 20012), Devlin’s research comparing behavioral interventions and SI revealed that SI interventions were more effective in reducing challenging behavior and self-injurious behavior than behavioral intervention
False. Devlin found that the behavioral intervention was more effective than the SI interventions
What are some problems with the Policy Statement issued b the American Academy of Pediatrics regarding SI therapies in 2012?
- Devlin’s research that showed that behavioral interventions were more effective than SI tx did not actually use true SI, although they said they did
- There have been recent changes in research e.g., the fidelity measure, which Devlin did not use
In Miller, Coll, and Schoen’s study, which found that OT-SI may be effective in ameliorating difficulties of children with Sensory Modulation Disorders, found which to be the most meaningful and sensitive outcome measure?
The Goal Attainment Scale (GAS) was found to be the most meaningful and sensitive outcome measure in this study. The Electrodermal reactivity (EDR), which measures activity of the SNS, also showed change.
Also used:
-The Leiter International Performance Scale-Revised: Parent Rating Scale
-Short Sensory Profile (SSP)
-Vineland Adaptive Behavior Scales
-Child Behavior Checklist (CBCL)
Miller, Coll, and Schoen (2007) found that 20 sessions of occupational therapy SI interventions for children with Sensory Modulation Disorders had what effect?
Associated with a reduction in electrodermal responses, indicating a decrease in a stress response to repeated sensory stimuli known to produce sensory defensiveness
Where were the most significant improvements found in Miller, Coll, and Schoen’s (2007) research regarding SI interventions for children with Sensory Modulation Disorders?
Significant improvement on individualized goals developed by the family, including those measured by Goal Attainment Scaling (GAS) for functional abilities
Studies with children with ASD have shown improvements in all of which?
A. Play and social interaction
B. Functional, behavioral, attentional individualized goals
C. Self care and socialization
D. Perceptual motor skills
E. Increase in grades at school
F. Decreased mannerisms
E. Increase in grades
Schoen and Miller investigated the impact of an intensive, short-term program that incorporates the principles of SI and relationship-based therapies with extensive parent collaboration. Used SI and DIR/Floortime. They measured adaptive behavior, emotional functioning, sensory-related behaviors, and motor functioning and made connections between sensory modulation and behavior. Which of the following assessments did they see change in?
A. BOT, second edition (FM, GM)
B. Miller Function and Participation Scale (motor abilities)
C. Adaptive Behavior Assessment scale, second edition (ABAS-II) (emotions and behaviors)
D. Sensory Processing 3 Dimensions (SP3D)-modulation, motor, discrimination
E. Sensory Processing 3 Dimensions (SP3D) Parent Inventory
F. Short Sensory Profile (SSP)
Improvements were noted on all standardized scales, suggesting their usefulness in future investigations of tx effectiveness. Intensive, short-term intervention was effective in improving adaptive behavior, emotional functioning, and sensory processing as reported by parents and examiner-assessed motor performance.
