Occupational therapy using a sensory integrative approach for children with developmental disabilities

This article provides an introduction and overview of sensory integration theory as it is used in occupational therapy practice for children with developmental disabilities. This review of the theoretical tenets of the theory, its historical foundations, and early research provides the reader with a basis for exploring current uses and applications. The key principles of the sensory integrative approach, including concepts such as "the just right challenge" and "the adaptive response" as conceptualized by A. Jean Ayres, the theory's founder, are presented to familiarize the reader with the approach. The state of research in this area is presented, including studies underway to further delineate the subtypes of sensory integrative dysfunction, the neurobiological mechanisms of poor sensory processing, advances in theory development, and the development of a fidelity measure for use in intervention studies. Finally, this article reviews the current state of the evidence to support this approach and suggests that consensual knowledge and empirical research are needed to further elucidate the theory and its utility for a variety of children with developmental disabilities. This is especially critical given the public pressure by parents of children with autism and other developmental disabilities to obtain services and who have anecdotally noted the utility of sensory integration therapy for helping their children function more independently. Key limiting factors to research include lack of funding, paucity of doctorate trained clinicians and researchers in occupational therapy, and the inherent heterogeneity of the population of children affected by sensory integrative dysfunction. A call to action for occupational therapy researchers, funding agencies, and other professions is made to support ongoing efforts and to develop initiatives that will lead to better diagnoses and effective intervention for sensory integrative dysfunction, which will improve the lives of children and their families.     

脓毒症研究的综合思路

脓毒症是一种发病急、病情进展迅速、病死率高的危重疾病,长期以来脓毒症的本质及概念一直混淆不清。对脓毒症发病机理认识的深入、脓毒症概念的更新以及治疗方法的扩展都贯穿着综合思路,体现了当代医学发展的综合特征。脓毒症仍是危重病医学研究的热点及难点问题,未来研究的发展仍需以综合的思路来指导。     

Effect of integrative reminiscence therapy on depression,well-being,integrity, self-esteem,and life satisfaction in older adults

Reminiscence therapy is a psychological intervention for older adults to remembering and interpreting life events that were experienced at some time in the past. The purpose of the present study was to investigate the extent of integrative reminiscence intervention effects, with the aim to produce statistically significant reduction in depression symptoms, and significant improvement in psychological well-being, life satisfaction, self esteem, and integrity were examined. Thirty-four healthy elderly participated in the intervention that was implemented in eight sessions. To evaluate the effects of the program, a quasi-experimental design was applied with pretest and posttest evaluations comparing the intervention group with a control group on a waiting list. In comparison to control group, individuals in treatment sample of older adults in an integrative reminiscence group demonstrated statistically significant reduction in depression symptoms and a significant improvement in self-esteem, integrity, life satisfaction, and psychological well-being.     

Assessing Proprioception in Children: A Review

Proprioception is the subconscious and conscious awareness of the spatial and mechanical status of the musculoskeletal framework. When working with children with motor delays and sensory integrative dysfunction, occupational therapists routinely assess the client's proprioceptive system. However, currently available assessments for occupational therapists are primarily observer-based and concerns have been raised about the reliability of observer-based assessments of sensation. The author's purpose was to review measures of proprioception currently available to occupational therapists and explore direct measures of proprioception from neuroscience and rehabilitation that can be adapted for pediatric clinical use. Observer-based and direct measurements of proprioception assessments complement each other in meeting clinical needs. A better understanding of both types of evaluation will improve proprioceptive evaluation.     

Change in Symptoms and Personal Construct Structure in Anxiety Disorders: A Preliminary Study on the Effects of Constructivist Therapy

In recent years, constructivist psychotherapy has evolved as a plausible treatment for different disorders. The present study aimed to explore the effectiveness of this therapy in terms of symptom improvement and changes in the personal construct system. Forty-seven anxiety clients received brief integrative constructivist therapy. Scores on symptom and personal construct measures decreased after the treatment, but not all of them showed a statistically significant change. The percentage of clients with implicative dilemmas decreased after psychotherapy. The results provide preliminary support for the effectiveness of brief constructivist psychotherapy as a treatment for anxiety disorders in primary care services. Several limitations are acknowledged. Further controlled research is needed.     

EMDR as a treatment for improving attachment status in adults and children

IntroductionThe purpose of the article is to examine the current literature regarding evidence for positive change in attachment status following Eye Movement Desensitization and Reprocessing (EMDR) therapy and to describe how an integrative EMDR and family therapy team model was implemented to improve attachment and symptoms in a child with a history of relational loss and trauma.LiteratureThe EMDR method is briefly described along with the theoretical model that guides the EMDR approach. As well, an overview of attachment theory is provided and its implication for conceptualizing symptoms related to a history of relational trauma. Finally, a literature review is provided regarding current preliminary evidence that EMDR can improve attachment status in children and adults.Clinical findingsA case study is described in which an EMDR and family therapy integrative model improved attachment status and symptoms in a child with a history attachment trauma.ConclusionThe case study and literature review provide preliminary evidence that EMDR may be a promising therapy in the treatment of disorders related to attachment trauma.     

Sensory integration and single-modality scanning.

An auditory scanning, visual scanning, and auditory-visual integration test was administered to 72 children from grades 1, 2, 3, and 5 to determine whether increases in sensory integration skills could be accounted for by increases in skills of single modalities. Using a multiple regression model, the results indicated that increases in integrative functioning occur independently of developmental changes in individual modalities. Implications for future research are presented.     

The Integrative Revolution in Couple and Family Therapy

A quiet revolution has resulted in significant movement toward integrative practice in couple and family therapy. This article examines the present status of integrative methods, highlighting the factors that have led to their broad acceptance, issues surrounding the definition of integration and the nomenclature used, the content of recent approaches, and specific conceptual developments and directions.     

Einfluss des Behandlungssettings auf den Gesundungsverlauf

Even though managed care systems research emerged as an important field in psychotherapy research in the last years, studies examining the effects of its psychotherapeutic measures on outcome are still rare, especially in Germany. Little is known about the effectiveness of psychotherapy in different treatment settings, i. e. whether and how patients in outpatient psychotherapy differ from inpatients in respect to initial impairment status and pace of improvement. Two longitudinal data sets—inpatient (N=759) and outpatient (N=521)—were used to scrutinize these questions. Results yielded no differences between treatment settings as to patients’ initial impairment. A linear model adequately represented the mean course of improvement in inpatient psychotherapy. For outpatient psychotherapy, a bipartite linear model for treatment and for the follow-up period proved more appropriate. During 1 year, patients in both settings attained a similar amount of improvement. However, pace of in-treatment improvement was 10 times faster in the inpatient setting. Initial impairment substantially predicted the course of psychological improvement in both treatment settings.     

Positive factors associated with quality of life among Chinese patients with renal carcinoma: a cross-sectional study

Quality of life and positive psychological variables has become a focus of concern in patients with renal carcinoma. However, the integrative effects of positive psychological variables on the illness have seldom been reported. The aims of this study were to evaluate the quality of life and the integrative effects of hope, resilience and optimism on the quality of life among Chinese renal carcinoma patients. A cross-sectional study was conducted at the First Hospital of China Medical University. 284 participants completed questionnaires consisting of demographic and clinical characteristics, EORTC QLQ-C30, Adult Hope Scale, Resilience Scale-14 and Life Orientation Scale-Revised from July 2013 to July 2014. Pearson’s correlation and hierarchical regression analyses were performed to explore the effects of related factors. Hope, resilience and optimism were significantly associated with quality of life. Hierarchical regression analyses indicated that hope, resilience and optimism as a whole accounted for 9.8, 24.4 and 21.9% of the variance in the global health status, functioning status and symptom status, respectively. The low level of quality of life for Chinese renal carcinoma patients should receive more attention from Chinese medical institutions. Psychological interventions to increase hope, resilience and optimism may be essential to enhancing the quality of life of Chinese cancer patients.     

视听整合加工及其神经机制

通常人们接收到来自不同感觉通道的信息时, 首先在大脑中各个分离的区域单独进行加工处理, 而后在多感官区进行整合。前人关于言语感知中视听整合加工的神经成像研究认为, 视觉和听觉信息能够相互影响; 两者进行整合的关键区域是人脑左后侧的颞上沟, 其整合效应受时间和空间因素的限制。未来的研究应致力于建立更加合理的实验范式和数据分析方法来探讨整合加工的脑区机制, 把多感官整合研究进一步延伸到更加复杂的领域。     

SENSORY EXTINCTION AND SENSORY REINFORCEMENT PRINCIPLES FOR PROGRAMMING MULTIPLE ADAPTIVE BEHAVIOR CHANGE

The role of sensory reinforcement was examined in programming multiple treatment gains in self-stimulation and spontaneous play for developmentally disabled children. Two phases were planned. First, we attempted to identify reinforcers maintaining self-stimulation. Sensory Extinction procedures were implemented in which auditory, proprioceptive, or visual sensory consequences of self-stimulatory behavior were systematically removed and reintroduced in a reversal design. When self-stimulation was decreased or eliminated as a result of removing one of these sensory consequences, the functional sensory consequence was designated as a child's preferred sensory reinforcer. In Phase 2, we assessed whether children would play selectively with toys producing the preferred kind of sensory stimulation. The results showed the following. (1) Self-stimulatory behavior was found to be maintained by sensory reinforcement. When the sensory reinforcer was removed, self-stimulation extinguished. (2) The sensory reinforcers identified for self-stimulatory behavior also served as reinforcers for new, appropriate toy play. (3) The multiple treatment gains observed appeared to be relatively durable in the absence of external reinforcers for play or restraints on self-stimulation. These results illustrate one instance in which multiple behavior change may be programmed in a predictable, lawful fashion by using “natural communities of sensory reinforcement.”     

Maternal sensory sensitivity, mother-infant 9-month interaction, infant attachment status: predictors of mother-toddler interaction at 24 months

At 24-months of age, toddlers (N=62) and their mothers were observed in a free-play session to determine the contribution of (a) maternal sensory sensitivity to positive and negative infant facial expressions as measured in a signal detection task at 6 months, (b) maternal behavior and affect, infant behavior and affect, and dyadic interaction at 9 months, and (c) infant attachment status at 12 months in predicting maternal, toddler, and dyadic measures at 24 months. Hierarchical regression analyses revealed that over and above early maternal behavior, which was predictive of later maternal behavior at 24 months, sensory sensitivity to the positive infant expression at 6 months predicted maternal behavior at 24 months and sensory sensitivity to both the positive and negative expression was associated with later maternal affect. Infant attachment status emerged as the variable which predicted toddler behavior and dyadic interaction at 24 months.     

不同感觉功能对抑郁的影响及其神经机制

大脑通过视觉、听觉、嗅觉、味觉和触觉等感官通道接收来自外界的信息。不同感觉功能受损涉及抑郁发生的中枢机制,而基于不同感官通道进行适当刺激以及多感官联合干预也可能发挥显著的抑郁治疗作用。笔者以症状-脑区-机制-治疗为逻辑主线,首次系统梳理了五种主要感觉障碍人群的抑郁临床症状、抑郁神经机制以及基于感觉刺激的抗抑郁治疗。结果表明,不同感觉功能障碍对抑郁相关神经机制的影响可能表征了不同的抑郁病理,涉及神经元电活动(某些神经元放电和神经环路激活等)和神经生化改变(神经可塑性和神经发生、炎症免疫和HPA轴、神经激素和神经递质等),且主要发生在边缘系统及其附近脑区,涉及岛叶、颞叶、额叶等。因此,未来研究可聚焦于机体对不同感觉信息的提取,这将为人类抑郁的病因和治疗提供新的研究视角。     

Change in dexterity with sensory awareness training: a randomised controlled trial

The role of sensory awareness in movement control is receiving increasing interest in sports and clinical literature as a feed-forward and feedback mechanism. The aim of the study was to assess the feasibility and effect of training in sensory awareness on dexterity in healthy adults. 29 healthy students were randomly allocated to a single-group, sensory awareness lesson with the dominant hand, the same lesson with the nondominant hand, or to a sham control group. Dexterity measures included the Purdue Pegboard Test, a grip-lift manipulandum, and perceived changes using a questionnaire. The sensory awareness lesson with the dominant hand produced a statistically significant improvement in mean dexterity compared to the control group, but not between the other two pairs of groups. The sensory awareness training paradigm is feasible and a single session improved dexterity in healthy adults.     

An Overview of Directions in Psychotherapy Integration Research

In general, empirical research in psychotherapy integration has lagged behind the growing theoretical and clinical interest in the field. Even though many of the theoretically integrative treatment models currently available are based on empirical findings and clinical observations, the models themselves remain, for the most part, untested. Rigorous examination of integrative psychological theories and therapeutic programs is a necessary and useful way to increase our understanding of the process of psychotherapy and establish the efficacy and effectiveness of integrative therapies. The present article explores five different research areas in the field of psychotherapy integration, discussing several published studies in each area. The utility of this research for practicing clinicians is also discussed. Additional investigations in these areas and others are encouraged, with the goals of greater understanding of psychotherapy, as well as the further development and acceptance of integrative approaches.     

Interpretive sensory-access theory and conscious intentions

It is typically assumed that while we know other people's mental states by observing and interpreting their behavior, we know our own mental states by introspection, i.e., without interpreting ourselves. In his latest book, The opacity of mind: An integrative theory of self-knowledge, Peter Carruthers [2011. The opacity of mind: An integrative theory of self-knowledge. Oxford: Oxford University Press] argues against this assumption. He holds that findings from across the cognitive sciences strongly suggest that self-knowledge of conscious propositional attitudes such as intentions, judgments, and decisions involves a swift and unconscious process of self-interpretation that utilizes the same sensory channels that we employ when working out other people's mental states. I provide an overview of Carruthers’ book before discussing a pathological case that challenges his account of self-knowledge and mentioning empirical evidence that undermines his use of a particular kind of data in his case against introspection of conscious attitudes.     

Practice effects in backward masking

In two experiments we demonstrate that much larger practice effects occur in a backward masking paradigm where patterned masks are used than in similar visual processing paradigms, such as lateral masking and whole report. In additional experiments we examine four possible explanations for the large practice effects: increased familiarity with the paradigm in general, learning about the targets, learning about the masks, and enhanced sensory processing. Because of failure to observe similar practice effects in related paradigms not involving backward masking and because of the sustained nature of the improvement, we reject the first explanation as a source of practice effect. Experiment 3 allowed us to reject target learning as a source of improvement as well; target sets were switched at the end of training, but no decrement in performance was observed. In Experiment 4, mask sets were switched at the end of training, revealing a significant decrement in performance. Learning about the specific masks, then, does contribute to the observed improvement. However, it is responsible for only about one third of the overall improvement in performance. The final experiment provides evidence that the residual improvement is due to enhanced sensory processing. In that experiment, training on backward masking led to a lowered threshold in a two-flash paradigm but not to a significant change in whole-report performance.     

Motor fluency deficits in the sequencing of actions in schizophrenia

Many everyday activities depend on the capacity to organize and smoothly execute motor sequences. The authors tested the hypothesis that a sequencing deficit is associated with schizophrenia. They used a new method to distinguish between lower and higher order mechanisms for the impairment. The 1st task involved triggered sequences in which sensory information from 1 movement was the cue for initiation of the following movement. Results showed that the motor sequences were performed as fluently in patients as in controls. The 2nd and 3rd tasks involved sequences in which the entire movement sequence could be preplanned. Patients executed the sequences less fluently than controls but only under the condition where action sequences were required. Furthermore, the patients' fluency deficit increased with sequence complexity. The high discrimination power of Task 3 gave the authors a means to control for a potential psychometric confound involving differential discriminating power and to argue in favor of a specific higher order motor fluency deficit in patients with schizophrenia. It is suggested that basic lower order mechanisms that integrate sensory information with outgoing motor commands are preserved in schizophrenia, whereas higher order integrative mechanisms that are required for the smooth coordination of motor sequences are impaired.     

Depressed youth: treatment outcome and changes in family functioning in individual and family therapy

This study explores the role of family functioning in therapeutic change in focused individual psychodynamic psychotherapy (FIPP) and time‐limited systems integrative family therapy (SIFT) for depressed children and adolescents. After a screening process, 72 participants aged 8 to 15 were randomized to either FIPP or time‐limited SIFT. Assessments took place prior to, at the end of, and 6 months after treatment. Families in both SIFT and FIPP showed a small but significant and sustained improvement in family functioning by the end of treatment in both mothers' self‐reports and family therapists' assessments. Better family functioning at baseline in mothers' self‐reports and improved family functioning during SIFT, as assessed by family therapists, predicted a sustained decrease in self‐reported depressive symptoms. Results indicated that time‐limited SIFT may be more effective with younger children and in patients without a diagnosis of double depression than adolescents.