Sensory integration therapy versus usual care for sensory processing difficulties in autism spectrum disorder in children: study protocol for a pragmatic randomised controlled trial

The Effectiveness of Sensory-Motor Integration Exercises on Social Skills and Motor Performance in Children with Autism

PURPOSE

The current study aims to investigate the effectiveness of sensory-motor integration exercises on social skills and motor performance in children with autism spectrum disorder (ASD).

METHODS

This is a quasi-experimental study with a pre-test-post-test design and with a control group. The statistical population of this research included all children with ASD aged 9-11 years old in Babolsar city in 2022, among whom 30 were selected through convenient sampling from the transplant center of Babolsar, and were randomly assigned into two experimental and control groups. Then, the experimental group received the treatment program in 12 sessions. The data collection instrument included Gresham and Elliott's social skills questionnaire (Gresham FM, Elliott SN (1993) Social skills intervention guide: systematic approaches to social skills training. Spec Serv Sch 8(1):137-158) and Ulrich's motor performance test (Ulrich B, Ulrich D (1985) The role of balancing ability in performance of fundamental motor skills in 3-, 4-, and 5-year-old children. Motor Dev: Curr Select Res 1:87-97). Data analysis was conducted using covariance analysis in SPSS21.

RESULTS

The multivariate covariance analysis test showed that there is a significant difference between the experimental and control groups in the variable of social skills and motor performance, respectively (P < 0.001).

CONCLUSION

According to the research findings, it can be concluded that sensory-motor integration exercises can be used as an appropriate intervention in promoting and improving social skills and motor performance of children with autism spectrum. Results of this study can be helpful for therapists and educators who deal with autistic children.

Individual and contextual factors influencing children's effort in pediatric rehabilitation interventions

Rehabilitation clinicians strive to encourage children's sustained effort within challenging practice conditions. Effort influences intervention success, yet it is rarely defined or measured. Effort can be conflated with individual factors, such as motivation and engagement, that might influence it. Contextual factors that likely impact children's effort, such as practice conditions and therapeutic interactions, are generally under-described. Defining, describing, and measuring effort and its influencers is necessary to enhance understanding of differences in rehabilitation intervention outcomes across individuals and contexts and to support the development of personalized precision rehabilitation approaches. This narrative review describes effort conceptualization in rehabilitation, particularly in relation to intensity, engagement, and participation nomenclature. The review outlines individual and contextual factors that may influence children's effort in rehabilitation and describes potential next steps for effort description and measurement. Subsequent work should aim to identify factors that can be targeted in clinical practice to promote and sustain children's effort in the rehabilitation process, thereby individualizing interventions and potentially improving their effectiveness. WHAT THIS PAPER ADDS: Effort as it relates to rehabilitation is confusingly described and infrequently measured. Engagement, involvement, intensity, and participation are terms alluding to effort. Child-specific and therapy-specific factors, alone and in combination, may influence children's effort. Clearer conceptualization of effort and the factors that influence it will support personalization of interventions. Better measurement will enhance knowledge about relationships between effort and therapeutic outcomes.

Sensory Processing Differences in Individuals With Autism Spectrum Disorder: A Narrative Review of Underlying Mechanisms and Sensory-Based Interventions

Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by difficulties with social interaction and restricted, repetitive patterns of behavior. Altered sensory processing and perception are considered characteristics of ASD. Sensory processing differences (SPDs) are commonly observed in individuals with ASD, leading to atypical responses to sensory stimuli. SPDs refer to the way in which individuals receive, process, and respond to sensory information from the environment. People with SPDs may be hypersensitive (over-reactive) or hyposensitive (under-reactive) to sensory input, or they may experience fragmented or distorted perceptions. These differences can make it difficult for individuals with SPDs to filter out irrelevant sensory information, and to integrate sensory information from different sources. This study intends to investigate the underlying mechanisms contributing to SPDs in individuals with autism and determine the effectiveness of sensory-based therapies in addressing these challenges. The literature suggests that altered neural pathways, sensory gating dysfunction, and atypical sensory modulation contribute to SPDs in individuals with ASD. Assistive technology, environmental changes, and sensory-based interventions like sensory integration therapy (SIT) have all shown promise in improving sensory functioning and reducing associated behavioral issues. However, further research is needed to improve our understanding of sensory processing in autism and to optimize interventions for individuals with ASD.

Effectiveness of Sensory Integration Therapy on Functional Mobility in Children With Spastic Diplegic Cerebral Palsy

Background  A set of non-progressive brain abnormalities and nervous system dysfunctions are referred to as cerebral palsy (CP). Due to this, the child's mobility, eyesight, learning, and thought processes are affected. It can evolve before, through birth, or the first year of a child's life. The activity through which the brain organizes and analyses external sensations like touch, motion, body awareness, vision, hearing, and gravity is indicated as sensory integration. The use of sensory integration therapy (SIT) necessitates that the sensorimotor exercises target the specific parts of difficulties that the child experiences daily. This study aims to study the effectiveness of SIT on functional mobility in children with spastic diplegic CP. Methods In this study, 40 children of CP with spastic diplegic who met the inclusion and exclusion criterion were enlisted and were separated into two groups, with Group A (n=20) receiving SIT for 25 minutes along with conventional physiotherapy for 20 minutes, and Group B (n=20) were given conventional physiotherapy for 45 minutes. A four-week therapy plan was followed. Short sensory profile (SSP) and Gross Motor Function Classification System (GMFCS), Pediatric mini-mental state examination (MMSE), and Modified Ashworth Scale were taken as outcome measures. Results SIT along with traditional treatment is described in the study protocol which aids CP children to improve themselves. Following a four-week protocol, combined therapy of SIT and conventional physiotherapy show an effect on the motor function of the children. After therapy, scores in GMFCS and SSP improved. By using Student's paired t-test, a statistically significant difference was found in GMFCS score at pre and post-test treatment in group A (7.28, p=0.0001) and group B (4.48, p=0.0001), in SSP score at pre and post-test treatment in group A (27.91, p=0.0001) and group B (11.31, p=0.0001), in MMSE score at pre- and post-test treatment in group A (6.89, p=0.0001) and group B (6.32, p=0.0001). The significance threshold was p<0.0001. Conclusion Under the study's experimental conditions, both groups showed substantial improvements in the functional mobility of children. When the efficacy of SIT along with conventional physiotherapy was examined, the impact resulted in a significantly greater improvement in the functional mobility of spastic diplegic CP children.

Assessment of Balance Parameters in Children with Weakened Axial Muscle Tone Undergoing Sensory Integration Therapy

Children with weakened axial muscle tone face various problems every day. One is maintaining a stable body posture, which limits their participation in activities and games with peers. The study aimed to assess balance parameters in children with weakened axial muscle tone who underwent sensory integration therapy (SI). The study group consisted of 21 children (divided into three age groups) referred by a doctor for therapy.

METHODS

The ZEBRIS platform was used to measure the balance parameters (MCoCx, MCoCy, SPL, WoE, HoE, and AoE). The study was conducted twice: before and after two months of sensory integration therapy. The results were compiled using the TIBICO^® Statistica software version 13.3.0.

RESULTS

After the SI program, statistically significant changes were observed in the values of MCoCy_oe, WoE_oe, AoE_oe in the group of four-year-olds, MCoCX_ce in the group of five-year-olds, and in SPL_ce and AoE_ce in six-year-olds. A statistically significant, highly positive correlation was observed between body height and changes in SPL_oe, HoE_oe, and AoE_oe in the group of six-year-olds, as well as in the case of changes in SPL_oe in the group of five-year-olds. In the group of four-year-olds, a statistically significant correlation occurred only between body height and the change in the MCoCx_oe value.

CONCLUSIONS

the sensory integration therapy used in the study group of 4-6-year-old children with reduced muscle tone gave positive results in the form of improved static balance and balance.

Advancing cluster randomised trials in children’s therapy: a survey of the acceptability of trial behaviours to therapists and parents

Background

Randomised controlled trials of non-pharmacological interventions in children’s therapy are rare. This is, in part, due to the challenges of the acceptability of common trial designs to therapists and service users. This study investigated the acceptability of participation in cluster randomised controlled trials to therapists and service users.

Methods

A national electronic survey of UK occupational therapists, physiotherapists, speech and language therapists, service managers, and parents of children who use their services. Participants were recruited by NHS Trusts sharing a link to an online questionnaire with children’s therapists in their Trust and with parents via Trust social media channels. National professional and parent networks also recruited to the survey. We aimed for a sample size of 325 therapists, 30 service managers, and 60 parents. Trial participation was operationalised as three behaviours undertaken by both therapists and parents: agreeing to take part in a trial, discussing a trial, and sharing information with a research team. Acceptability of the behaviours was measured using an online questionnaire based on the Theoretical Framework of Acceptability constructs: affective attitude, self-efficacy, and burden. The general acceptability of trials was measured using the acceptability constructs of intervention coherence and perceived effectiveness. Data were collected from June to September 2020. Numerical data were analysed using descriptive statistics and textual data by descriptive summary.

Results

A total of 345 survey responses were recorded. Following exclusions, 249 therapists and 40 parents provided data which was 69.6% (289/415) of the target sample size. It was not possible to track the number of people invited to take the survey nor those who viewed, but did not complete, the online questionnaire for calculation of response rates. A completion rate (participants who completed the last page of the survey divided by the participants who completed the first, mandatory, page of the survey) of 42.9% was achieved. Of the three specified trial behaviours, 140/249 (56.2%) therapists were least confident about agreeing to take part in a trial. Therapists (135/249, 52.6%) reported some confidence they could discuss a trial with a parent and child at an appointment. One hundred twenty of 249 (48.2%) therapists reported confidence in sharing information with a research team through questionnaires and interviews or sharing routine health data. Therapists (140/249, 56.2%) felt that taking part in the trial would take a lot of effort and resources. Support and resources, confidence with intervention allocation, and sense of control and professional autonomy over clinical practice were factors that positively affected the acceptability of trials. Of the 40 parents, twelve provided complete data. Most parents (18/40, 45%) agreed that it was clear how trials improve children’s therapies and outcomes and that a cluster randomised trial made sense to them in their therapy situation (12/29, 30%).

Conclusions

Using trials to evaluate therapy interventions is, in principle, acceptable to therapists, but their willingness to participate in trials is variable. The willingness to participate may be particularly influenced by their views related to the burden associated with trials, intervention allocation, and professional autonomy.

Review of Sensory Integration Therapy for Children With Cerebral Palsy

Cerebral palsy (CP) refers to a group of non-progressive brain disorders. Several different approaches are used to treat cerebral palsy children like neurodevelopmental therapy (NDT), sensory integration therapy (SIT), and hippotherapy. Sensory integration therapy is a clinically based approach that places an emphasis on the relationship between the therapist and the child and uses play-based sensory and motor activities to encourage analysis and integration. SIT seems to offer a lot of therapeutic prospects. It uses various interventions. According to sensory integration therapists, some impacts of SIT include an improved ability to concentrate in academic, therapeutic, and social settings. Sensory integration treatment is successful in enhancing gait, balance, and gross motor function.

The sensory experiences of autistic people: A metasynthesis

LAY ABSTRACT

Sensory atypicalities are very common among autistic people and are integrated in several theories and explanatory models of autism. Qualitative studies have explored these singular sensory experiences from the perspectives of autistic people themselves. This article gathers all these qualitative studies and provides original findings regarding the everyday sensory experience of autistic people, that is, around four dimensions - physical, emotional, relational and social - experienced holistically, as inseparable, and not hierarchically or in terms of cause and effect. Adopting this holistic view could improve the adaptation of the sensory environment in health care facilities and the training of professionals around this specific issue.

Understanding the support experiences of families of children with autism and sensory processing difficulties: A qualitative study

Background

Support, such as information, advice and therapies, can play a vital role in the lives of families of autistic children. However, little is known about the support experiences of UK parents and carers.

Aim

To explore experiences of and access to support for families of children with autism and sensory processing difficulties, from the perspective of parents and carers.

Methods

Semi‐structured, timeline‐assisted interviews were conducted with parents/carers of 30 children aged 5–11, exploring experiences of support. Framework analysis was used to identify themes in the interview data.

Results

Support varied widely and was not accessed equitably. Specialist autism support, together with support from other parents and voluntary organizations, was perceived as more useful than statutory and nonspecialist provision. Unmet support needs included an ongoing point of contact for information and advice for parents, and access to direct therapy and specialist mental health provision for children.

Conclusions

Findings emphasize the need for a clear pathway of support following autism diagnosis, autism‐specific training for professional service providers and specialist provision tailored to the needs of autistic children.

Patient or Public Contribution

An advisory group of four parents of children with autism provided feedback on study procedures and materials, including participant information sheets and timeline completion instructions.

Hybrid artificial neural network and structural equation modelling techniques: a survey

Topical treatments with structural equation modelling (SEM) and an artificial neural network (ANN), including a wide range of concepts, benefits, challenges and anxieties, have emerged in various fields and are becoming increasingly important. Although SEM can determine relationships amongst unobserved constructs (i.e. independent, mediator, moderator, control and dependent variables), it is insufficient for providing non-compensatory relationships amongst constructs. In contrast with previous studies, a newly proposed methodology that involves a dual-stage analysis of SEM and ANN was performed to provide linear and non-compensatory relationships amongst constructs. Consequently, numerous distinct types of studies in diverse sectors have conducted hybrid SEM-ANN analysis. Accordingly, the current work supplements the academic literature with a systematic review that includes all major SEM-ANN techniques used in 11 industries published in the past 6 years. This study presents a state-of-the-art SEM-ANN classification taxonomy based on industries and compares the effort in various domains to that classification. To achieve this objective, we examined the Web of Science, ScienceDirect, Scopus and IEEE Xplore ^® databases to retrieve 239 articles from 2016 to 2021. The obtained articles were filtered on the basis of inclusion criteria, and 60 studies were selected and classified under 11 categories. This multi-field systematic study uncovered new research possibilities, motivations, challenges, limitations and recommendations that must be addressed for the synergistic integration of multidisciplinary studies. It contributed two points of potential future work resulting from the developed taxonomy. First, the importance of the determinants of play, musical and art therapy adoption amongst autistic children within the healthcare sector is the most important consideration for future investigations. In this context, the second potential future work can use SEM-ANN to determine the barriers to adopting sensing-enhanced therapy amongst autistic children to satisfy the recommendations provided by the healthcare sector. The analysis indicates that the manufacturing and technology sectors have conducted the most number of investigations, whereas the construction and small- and medium-sized enterprise sectors have conducted the least. This study will provide a helpful reference to academics and practitioners by providing guidance and insightful knowledge for future studies.

Autistic Self-Advocacy and the Neurodiversity Movement: Implications for Autism Early Intervention Research and Practice

The growth of autistic self-advocacy and the neurodiversity movement has brought about new ethical, theoretical and ideological debates within autism theory, research and practice. These debates have had genuine impact within some areas of autism research but their influence is less evident within early intervention research. In this paper, we argue that all autism intervention stakeholders need to understand and actively engage with the views of autistic people and with neurodiversity as a concept and movement. In so doing, intervention researchers and practitioners are required to move away from a normative agenda and pay diligence to environmental goodness-of-fit, autistic developmental trajectories, internal drivers and experiences, and autistic prioritized intervention targets. Autism intervention researchers must respond to these debates by reframing effectiveness, developing tools to measure autistic prioritized outcomes, and forming partnerships with autistic people. There is a pressing need for increased reflection and articulation around how intervention practices align with a neurodiversity framework and greater emphasis within intervention programmes on natural developmental processes, coping strategies, autonomy, and well-being.