Date Presented 04/04/19
Participants in this session will gain an understanding of the evidence for a variety of sensory-based interventions (SBIs) that use tactile, proprioceptive, auditory, and multisensory inputs, as well as cognitive and environmental modifications on attention, behavior, and academic performance outcomes in children from preschool through high school. Critical appraisal of the literature and application to evidence-based OT practice will be discussed.
Primary Author and Speaker: Ashley Davies
Additional Authors and Speakers: Julia Shure, Leilani Jones, Katrina LaRossa
Contributing Authors: Renee Watling
PURPOSE: Although a wide variety of sensory-based interventions (SBIs) are used in school settings, there has been limited comprehensive research on the efficacy of SBIs on classroom outcomes. The purpose of the present study was to determine the impact of (SBIs), besides dynamic seating, weighted vests and Ayres’ Sensory Integration® (ASI) on attention, behavior and academic performance outcomes in children, and to use this evidence to inform recommendations for the use of SBIs in a school setting to meet the needs of classroom teachers.
DESIGN: A systematic review of the current literature on SBIs was conducted. Sixty-one key search terms were identified and a table of all possible combinations of these terms was constructed to systematically search the literature catalogued in 12 databases. Articles were retained for critical analysis if they reported the following: participants between preschool and high school age, with or without a diagnosis; outcomes including attention, behavior and academic performance; and interventions that are feasible in a school setting.
METHOD: Titles and abstracts of initial hits were screened, and remaining articles were reviewed in full. Articles were retained based on inclusion/exclusion criteria and group discussion and consensus. The outcomes and rigor of retained studies were critically analyzed through construction of a critical appraisal table and use of multiple analyses of rigor including: the PEDro scale, AOTA Hierarchy of Evidence, Research Pyramid (Tomlin & Borgetto, 2011) and a single-subject research design rigor analysis scale ( Logan, Hickman, Harris & Heriza; 2008)
RESULTS: From an initial yield of 9,064 hits, 239 articles were retained for in-depth review, 33 of these met inclusion criteria for critical analysis. Twenty of these articles were SSRD Level IV studies, and of these five were rated as strong, 13 as moderate, and two as weak. Of the other 13 studies, one was Level I, six were Level II, three were Level III, and three were Level V. Moderate evidence was found that five SBIs may improve attention, behavior or academic outcomes in specific populations. These include multi-sensory environments, sensory-cognitive interventions, fine motor hand tools, individualized sensory activities that use equipment to provide proprioceptive and vestibular input, and sound absorbing walls. There was limited evidence for the efficacy of auditory stimulation through music, tactile stimulation through static or moving touch, individualized sensory diets, and movement programs that provide proprioceptive and vestibular input.
CONCLUSION: The findings of the present study provide the field of occupational therapy with foundational knowledge regarding less commonly researched SBIs that can inform evidence-based practice and future research. The evidence that currently exists for the use of SBIs to improve academic performance, behavior and attention ranges from limited to moderate depending on the specific SBI. Those SBIs with moderate evidence may be effective tools for improving outcomes in school settings for students whose demographic profile matches those of the participants in the reviewed studies. Given the limited evidence, it is essential that occupational therapists implement these interventions with a strong rationale and outcome monitoring to inform intervention adjustments. The selection of SBIs for use in a classroom setting must take into consideration a balance between the strength of current evidence with an intervention’s feasibility in a school context and ability to meet class-wide needs. An example of how this evidence can be translated into practice can be seen in the panel session Break 5 - A Sensory-Based Movement Program for a School Setting, presented by the same authors.
References
Aronoff, E., Hillyer, R., & Leon, M. (2016). Environmental enrichment therapy for autism: Outcomes with increased access. Neural Plasticity, 2734915, 1-23. doi:10.1155/2016/2734915
Case-Smith, J., Weaver, L., & Fristad, M. (2015). A systematic review of sensory processing interventions for children with autism spectrum disorders. Autism, 19, 133-148. doi: 10.1177/1362361313517762
Marr, D., Mika, H., Miraglia, J., Roerig, M., & Sinnott, R. (2007). The effect of sensory stories on targeted behaviors in preschool children with autism. Physical & Occupational Therapy Pediatrics, 21, 63-79. doi:10.1080/J006v27n01_05
Watling, R., and Hauer, S. (2015). Effectiveness of Ayres Sensory Integration and sensory-based interventions for people with autism spectrum disorder: A systematic review. American Journal of Occupational Therapy, 69, 6905180030, 1-12. doi:10.5014/ajot.2015.018051
