Date Presented 04/04/19
A nonconcurrent multiple baseline design was implemented to test the effectiveness of OT-SI for improving motor coordination in children who have difficulty processing and interpreting sensory input. The Ayres Sensory Integration Fidelity Measure was used to ensure fidelity. Initial findings suggest high patient goal achievement using an intensive three times per week model of therapy. Future studies using this research design are feasible and can help bolster the evidence base for OT-SI.
Primary Author and Speaker: Lauren Andelin
Additional Authors and Speakers: Stacey Reynolds, Allison Wolf
PURPOSE: For children with sensory processing difficulties, a sensory integrative approach to intervention (OT-SI) may be used to achieve functional goals; however, the variety of intervention outcomes and heterogenous nature of treatment makes it difficult to implement effectiveness research (Mailloux et al., 2007). While randomized controlled trials (RCTs) are the gold standard for effectiveness research, they may be prohibitive to clinicians with limited research experience and/or constraints based on limited funding and inaccessibility to large samples. The purpose of this study was to use a rigorous research design that was feasible for use in a clinical setting to evaluate the effectiveness of occupational therapy using a sensory integrative approach (OT-SI) to improve motor coordination and functional behaviors in children with sensory processing differences.
DESIGN: This study used a non-concurrent, multiple baseline design (MBD) to evaluate research outcomes in three children with sensory processing differences. Intervention was provided 3x per week (intensity) over a 10-week period (duration). The Ayres Sensory Integration Fidelity Measure (ASIFM) was used to ensure fidelity to the intervention and enhance the overall rigor of the research.
METHOD: Subjects were children, ages 4.11-8.11, recruited from a waiting list at a large urban Children’s Hospital. Interested subjects were screened for eligibility using the Sensory Processing Measure (SPM), and subjects were enrolled on a rolling basis once consent/assent forms were signed. Three motor probes (jumping jacks, 1 foot balance, finger-to-nose touching) were administered every other day for up to seven days until baseline stability was achieved. Motor probes continued to be measured 1 time per week for the duration of the intervention to assess intervention effects. In addition, pre-post outcomes were assessed by an independent examiner using the Bruinincks-Oseretsky Test of Motor Proficiency (BOT-2) Short-Form and Goal Attainment Scaling (GAS). During the intervention phase, subjects received 3x per week OT-SI over 10 weeks with an OT with advanced training in the approach. All sessions were video recorded and random 15 minute intervals scored using the ASIFM (Parham et al., 2011); this procedure was completed by a researcher with ASFIM training and advanced OT-SI certification.
RESULTS: Initial findings (n=1) from this study suggest high patient satisfaction and goal achievement using a 3x per week model of therapy with OT-SI. The treatment frequency has proven to be feasible for patient attendance (100% attendance thus far) and therapist availability for scheduling. Motor probes have significantly increased from baseline levels and gains have been achieved in all GAS areas.
CONCLUSION: OT-SI using an intensive model appears to be effective for increasing motor coordination in children with sensory processing differences. Future studies using this research design are feasible in the clinic setting for clinicians with limited research background and can help bolster the evidence base for OT-SI.
References
Schaaf, R.C., Burke, J.P., Cohn, E., May-Benson, T.A., Schoen, S.A. Roley, S.S. Lane, S.J., Parham, D.J., Mailloux, Z. (2014). The Issue Is-State of measurement in occupational therapy using sensory integration. American Journal of Occupational Therapy, 68, 149-153. http://dx.doi.org/10.5014/ajot.2014.012526.
Parham, L.D., Roley, S.S., May-Benson, T.A., Koomar, J., Brett-Green, B., Burke, J.P., et al. (2011). Development of a fidelity measure for research on the effectiveness of the Ayres Sensory integration® intervention. American Journal of Occupational Therapy, 65, 133-142. doi:10.5014/ajot.2011.000745.
Mailloux, Z., May-Benson, T.A., Summers, C.A., Miller, L.J., Brett-Green, B., Burke, J.P., …Schoen, S.A. (2007). The Issue is—Goal attainment scaling as a measure of meaningful outcomes for children with sensory integration disorders. American Journal of Occupational Therapy, 61, 254-259.
