Sensory-Based Strategies Are Not the Same as Ayres Sensory Integration

Incorrect Use?

Sensory strategies are often incorrectly used with sensory integration interventions. One way to distinguish sensory integration methods involve active client participation, whereas sensory strategies involve passive sensations.

Sensory integration treatment is based on sensory integration theory which was proposed by Dr. Jean Ayres. The core theory was built on what Ayres new at the time and her understanding of neurobiology. She proposed that learning takes place as a function of reward (or punishment), one learns what they do, and learning takes place because it is purposeful. Therefore, the client must perceive the goal in order to benefit from it. Ayres proposed that sensory systems do not develop in isolation, but rather these systems such as visual and auditory depend on body-centered senses.^[1]Ayres, A. J. (1969). Deficits in sensory integration in educationally handicapped children. Journal of Learning Disabilities, 2(3), 44–52.^[2]Ayres, A. J. (1971). Characteristics of types of sensory integrative dysfunction.
American Journal of Occupational Therapy, 25, 329–334. In other words, the brain processes sensory information in order to produce a specific response.

Ayres sensory integration (ASI) is provided by trained therapists who have completed additional training in addition to their occupational therapy training. In order for therapy to be considered ASI, it should follow specific guidelines to meet fidelity criteria and not other things, similar to following a protocol.

The core principles of ASI include:

1. The child leads therapy such as in play. This means the child chooses the equipment and the activity to meet their specific needs. The therapist participates as well but does not decide and lead the session. The session is driven by the child’s intrinsic motivation.
2. There is specific equipment that is used in order to meet fidelity requirements. Typically, ASI equipment involves large movements that challenge the vestibular and proprioceptive systems such as large swings, large climbing frames, ramps, and scooter boards. This equipment serves to provide vestibular, proprioceptive, and tactile sensations and opportunities for praxis.
3. The child experiences an adaptive response that is supported by the therapist. This helps the child to overcome barriers that limit their function as they are challenged to participate in these child-led activities. It is similar to grading up the activity while providing the just-right challenge for the child.
4. Activities combine sensory experiences and opportunities to integrate this incoming information with other sensations such as visual and auditory. Activities also have a degree of motor control, such as postural, oral-motor, ocular-motor, or bilateral motor with respect to gravity. These activities promote praxis.
5. Activities are negotiated but not preplanned by the therapist.
6. The activities themselves are rewarding, not a means to an end.^[3]Parham, L. D., Cohn, E. S., Spitzer, S., Koomar, J. A., Miller, L. J., Burke, J. P., et al. (2007). Fidelity in sensory integration intervention research. American Journal of Occupational Therapy, … Reference List

What ASI is Not

ASI involves active participation using the specified equipment in a sensory activity. Therefore, passive sensory strategies (which may be beneficial), are not ASI. Examples include:

• Weighted blankets – child just sits there
• Sitting on a therapy ball – no active large movements
• Brushing techniques – child just gets brushed
• Therapeutic listening – child just listens without moving
• Environmental adaptations – passively benefits the child

About Sensory Strategies

This does not mean that sensory strategies are not effective. However, one thing to be aware of is that if you consider sensory strategies to be used in research, it is incorrect to classify it as ASI. For example, some researchers note that many studies published with keywords sensory integration do not report fidelity and minimal adhere to the fidelity principles that actually define ASI. This means that in the real world, occupational therapy practitioners are likely not practicing ASI but report that they are or believe they are.

Sensory strategies should not be used interchangeably as a term as ASI. ASI and sensory strategies can be combined, but they are technically different. The use of sensory strategies does not require additional training, but ASI does.