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Sensory Integration therapy for better brain function — Fact or Fad?

A form of treatment that's taken hold with many occupational therapists revolves around the concept of "sensory integration." The approach also has some opponents.

Sensory integration, or SI, therapy, began as part of OT in the 1970s. Started by OT and brain researcher Jean Ayres, it now has its own foundation, Sensory Integration International, in Torrance, Calif. ([310] 320-2335; http://home.earthlink.net/~sensoryint/), which offers certification courses, membership services to parents, and treatment and evaluation for children.

SI theory says that impairment in a child's ability to integrate and process physical sensations can lead to a range of present and future difficulties. SI advocates say a child needs to perceive where his muscles are in space; where his head is (part of the sensation of balance); and what things feel like (tactile, or touch, sensation) for the brain to develop normally and process more complex information later.

Children with motor disorders may be especially prone to sensory integration problems, some SI therapists say, because they don't have as much access to usual childhood sensations, such as swinging on swings, spinning on merry-go-rounds or playing in sand.

Practice in experiencing the needed sensations improves their integration and processing in a child's brain, advocates of the theory say, so that the child is more graceful, comfortable and confident. Some also say — and this point has been the most debated and even refuted in some studies — that such practice can prevent and treat learning disabilities, such as reading disorders.

"I believe some of it," neuropsychologist Jane Healey says, expressing concern that parts of the theory reflect an old idea that children who aren't walking have to first be taught to crawl. That theory had its day, too, she says, and has since been discredited.

Noah's therapist, Jennifer Schwartz, agrees on this point. "Some children with cerebral palsy or muscular dystrophy may not be able to go through all the things that developmental psychologists say the child needs to do," she says. "But you take that awfully far in saying his cognitive development is not going to be normal or he's not going to be able to learn to read." She says she's not "rigid" enough to believe that.

Schwartz and many other OTs who use SI exercises look at them more as short-term aids to smoother social and motor functioning than as prerequisites for later gains in reading and arithmetic.

Children who are overly sensitive to touch — "tactilely defensive" — can probably be helped by SI therapy, Schwartz says. "A lot of kids don't want to stand next to each other if they have these types of problems, because the simple brush of another person's skin or clothing is too much for them." Getting "tactile stimulation" by touching shaving cream, rice and beans can help with this kind of problem, she says.

Children with tactile defensiveness and children with a poor sense of their bodies in space may, says Schwartz, have trouble touching things and people in general. They may steer away from close relationships and may not be able to tolerate loud environments such as the school cafeteria.

Even those whose muscles allow playing may avoid activities such as climbing on playground equipment or "not even have the desire to do that," Schwartz says. She believes SI-focused OT could help remedy those problems.

You'll likely hear about SI therapy if you get involved with OT, particularly if the program is school-system-based. SI therapy is generally pleasant and unlikely to do harm, but parents may want to consider costs and time factors in deciding how aggressively to pursue SI.