American Journal of Occupational Therapy

Systematic reviews of literature relevant to children and adolescents with difficulty processing and integrating sensory information are important to the practice of occupational therapy in this area. This article explains the five questions that were developed and served as the focus for these reviews: neuronal plasticity, subtyping, sensory integration and non–sensory integration occupational therapy interventions, and occupational performance for this population. Presented are the background for the reviews; the process followed for each question, including search terms and search strategy; the databases searched; and the methods used to summarize and critically appraise the literature. The final number of articles included in each systematic review, a summary of the results of the review, the strengths and limitations of the review, and implications for practice, education, and research are described.

When Ayres first presented the theory of sensory integration (SI), she grounded it in the neuroscience literature. Neuroplasticity was then, and is today, considered to be at the heart of this theory. This evidence-based review sought to critically examine the basic science literature to specifically identify evidence for the assumptions and tenets of Ayres’ theory of SI. We reviewed literature between 1964 and 2005, within psychological, physiological, and biomedical areas, addressing neuroplasticity. The review focused on sensorimotor-based neuroplasticity; explored the data that addressed the links among sensory input, brain function, and behavior; and evaluated its relevance in terms of supporting or refuting the theoretical premise of occupational therapy using an SI framework (OT/SI) to treatment. Although direct application from basic science to OT/SI is not feasible, we concluded that there was a basis for the assumptions of Ayes’ SI theory.

We investigated the evidence for subtypes in children with difficulty processing and integrating sensory information. Fifty-seven articles were incorporated into a systematic literature review; only 4 articles provided direct evidence for subtypes. These studies did not provide a comprehensive assessment of all sensory functions and sensory-based motor functions (i.e., praxis) and included different diagnostic groups. Therefore, generalized conclusions about subtypes could not be drawn. The other 53 studies reviewed provided meaningful information about strengths and challenges that children with difficulty processing and integrating sensory information demonstrate, but these studies were limited in scope. A principal theme was the importance of conducting comprehensive assessments of sensory-based functions, including multiple measures of sensory integrative functions such as praxis, sensory modulation, and sensory discrimination in children and adolescents with various clinical disorders. In addition, more consistency in the use of specific assessment tools will allow for synthesis of data across studies.

Twenty-seven studies were systematically reviewed to identify, evaluate, and synthesize the research literature on the effectiveness of sensory integration (SI) intervention on the ability of children with difficulty processing and integrating sensory information to engage in desired occupations and to apply these findings to occupational therapy practice. Results suggest the SI approach may result in positive outcomes in sensorimotor skills and motor planning; socialization, attention, and behavioral regulation; reading-related skills; participation in active play; and achievement of individualized goals. Gross motor skills, self-esteem, and reading gains may be sustained from 3 mo to 2 yr. Findings may be limited by Type II error because of small sample sizes, variable intervention dosage, lack of fidelity to intervention, and selection of outcomes that may not be meaningful to clients and families or may not change with amount of treatment provided. Replication of findings with methodologically and theoretically sound studies is needed to support current findings.

This literature review was completed as part of the Evidence-Based Literature Review Project of the American Occupational Therapy Association to explore the effectiveness of occupational therapy interventions with children and adolescents experiencing difficulty processing and integrating sensory information. This part of the review focused on interventions other than the sensory integration approach. Twenty articles (reporting on 21 studies) met the inclusion criteria. This systematic review found that children with difficulty processing and integrating sensory information and difficulties with the performance of daily occupations can benefit from intervention. However, the great variability that characterizes this literature in terms of populations, interventions, and study quality precludes the formation of any firm conclusions regarding specific approaches. There is an urgent need for well-controlled studies examining the effectiveness of frequently used pediatric occupational therapy interventions with well-defined, homogeneous populations on outcomes that target participation in everyday life.

A systematic review of the literature related to performance difficulties for children and adolescents with difficulty processing and integrating sensory information was completed as part of the Evidence-Based Literature Review Project of the American Occupational Therapy Association. The review focused on functional performance difficulties that these children may exhibit in areas of occupation including play and leisure, social participation, activities of daily living, instrumental activities of daily living, rest and sleep, education, and work. The results suggest that children and adolescents with difficulty processing and integrating sensory information do exhibit functional performance difficulties in key areas of occupation. However, further descriptive studies are needed to tie these difficulties to their specific sensory and motor issues. Researchers are encouraged to include functional performance measures and measures of social participation in their studies to further elucidate these relationships.

OBJECTIVE. To compare stance control between children with sensory modulation disorder (SMD) and typically developing children in various visual and somatosensory conditions.

METHOD. Thirty-one children participated in this study, including 17 children with SMD and 14 matched typically developing children. The Sensory Profile was used to screen for sensory modulation problems, which were further confirmed by measures of electrodermal response and the Evaluation of Sensory Processing. Stance parameters for an assessment of postural stability were obtained with a dual-axis accelerometer on the lumbar area.

RESULTS. The children with SMD presented atypical sensory responses in terms of both electrophysiological and behavioral measures. The results for stance showed a greater body sway in the SMD group than in the control group (p < .05). However, the group difference was not always significant under the conditions of reliable somatosensory input and sway-referenced vision.

CONCLUSION. Our findings first confirmed impaired stance control in children with SMD.

OBJECTIVE. Stereotyped movements (SM) are a defining characteristic of autism but are also present in children with a range of sensory and developmental disorders. We examined whether the severity of sensory processing disorders (SPD) was associated with the severity of SM and whether SPD accounted for between-group differences in SM.

METHOD. The Short Sensory Profile and the Stereotyped and Self-Injurious Movements Interview were administered to children with autism, intellectual disability, visual impairment, and hearing impairment and to typically developing children.

RESULTS. SPD predicted the severity of SM in all samples and accounted for differences in SM between the groups. Other differences in the severity of SM were the result of diagnosis and the interaction between diagnosis and an intellectual disability.

CONCLUSION. SPD may be a source of SM, but functional connections between these phenomena will need to be tested in future research. Implications for occupational performance are addressed.

Participation in social aspects of daily life is crucial to children’s development. Although disability status is recognized to affect children’s ability to participate in social activities, little is understood about the impact of sensory processing disorders (SPD) on children’s social participation. We examined the social participation patterns of 2 groups of children (ages 6–9): (1) children with SPD and (2) their typically developing peers. All children participated in a structured interview to report their social participation patterns, including activity patterns and social networks. We used parent and teacher questionnaires to triangulate the data gathered from the children. Results revealed that the 2 groups of children demonstrated generally similar patterns of activity preferences and use of free time but had significant differences in areas related to intensity and enjoyment of involvement and in their social networks. Implications for future research and interventions are discussed.

OBJECTIVE. The purpose of the study was to determine the relationship between sensory processing and context for children with autism. We examined home and school contexts using the Sensory Profile (Dunn, 1999) and the Sensory Profile School Companion (Dunn, 2006a) questionnaires.

METHOD. Teachers of 49 students with autism completed the Sensory Profile School Companion, and parents completed the Sensory Profile. We conducted correlational analyses using the avoiding and seeking quadrant scores from the School Companion and corresponding avoiding and seeking quadrant scores from the Sensory Profile.

RESULTS. The avoiding quadrant score coefficient (.59) and the seeking quadrant score coefficient (.45) were statistically significant (p = .01) with good and fair correlations, respectively, suggesting that sensory processing patterns have both universal qualities and context-specific qualities in children with autism.

CONCLUSION. Findings from this study provide initial evidence that sensory processing and context for children with autism are related.

OBJECTIVE. Parkinson’s disease affects the ability to express motivation through face, body, and voice; contextual factors may facilitate or inhibit expressive behavior. The purpose of this study was to determine whether qualities of the interview context are associated with client motivational behavior in Parkinson’s disease.

METHOD. Men and women with Parkinson’s disease (N = 106) discussed 2 topics (enjoyable activity vs. frustrating activity) during an assessment with a female or male interviewer. From videotaped clips, displays of 4 categories of motivation and 12 verbal and 18 nonverbal behavioral patterns were rated.

RESULTS. During the discussion of enjoyable activities, participants used more positive words, smiled more, and were more facially expressive. Participants were less talkative about their negative feelings and appeared to be more apathetic with the same-gender interviewer.

CONCLUSION. Occupational therapy practitioners should vary the emotional tone of their questions to improve the validity of motivation assessments.

OBJECTIVE. We investigated quality of life (QOL) in American Indian women with different chronic diseases.

METHOD. Sixty American Indian women with diabetes mellitus (DM), rheumatoid arthritis (RA), or both DM and RA (DM + RA), and healthy control women received evaluations of joint motion, hand strength dexterity, pain, activity and participation limitations and QOL.

RESULTS. The DM + RA and RA groups had significantly more pain, less joint motion, decreased hand strength, and more activity limitations. Participation was similar for all groups except the DM + RA group. Past and present QOL were similar; however, the DM + RA group reported significantly decreased future QOL.

CONCLUSION. Results suggest that the presence of more than one chronic disease affects activity and participation. Factors that related to QOL were different for each disease group, with the exception of pain. Identification of factors related to QOL can help occupational therapists identify areas for intervention.