Sensory Integration Education

This article on adopting a sensory integration approach to the treatment of eating disorders was originally published in SensorNet Issue 40, July 2014:

By Julie Martell, Clinical Specialist and Occupational Therapist, and a clinical lead and registered manager of a 7-bed residential care home for adolescents aged 15-23 with severe and complex eating disorders. The home is part of 4 Specialist Services based in the Cotswolds and North London that form part of the Mental Health Division of Care UK – a national independent health care services provider.

What on earth am I doing considering using Sensory Integration (SI) theory, approaches and treatment methods with teenagers with severe anorexia nervosa (AN)? I don’t mind admitting it’s a question I’ve been asking myself since I convinced my manager to pay for me to go on the SI training in Belfast in 2012. I have worked in the clinical field of eating disorders for over 14 years, engaging in ‘traditional’ and ‘accepted’ treatment approaches including psycho-education, self-reflection and skills development on a 1:1 and group basis. I became aware of Sensory Integration within our services as we have used SI informed approaches with young people, who use deliberate self-harming, by using personal sensory boxes and a ‘snoozelen’ styled room to promote emotional regulation.

Ayres Sensory Integration (ASI) is a reliable and evidence based approach used by Paediatric Occupational Therapists (OTs) internationally in a variety of clinical settings. I can understand that purists might struggle with the concept of application of ASI in mental health – isn’t it shoehorning an interesting concept or jumping on a band wagon that is evidence based and scientific? There is however, growing research for the use of ASI informed assessment, principles and intervention in adults with a variety of mental health issues and diagnoses.

The validity of using ASI informed approaches with AN sufferers seems to be evidenced by recent research that identifies several sensory based neurological processes that may contribute to occupational function and emotional regulation. Specifically, research supports a link between AN and associated mental health co-morbidity to difficulties (Weltzin, Weisensel et al. 2005; Greenberg & Schoen 2008;) with sensory processing and modulation providing some justification for using ASI informed approaches with this client group. Relevant research explores areas of the brain involved in receiving sensory information and how they work with other neurological systems concerned with memory, emotion and interpretation.

In our service we have used a full range of assessments as part of our own exploration into following protocols for the use of sensory integration informed practice. This includes the Sensory Integration and Praxis Test (SIPT), as we found that clinical data obtained provided useful information about sensory functioning in adolescents and adults when added to observations and reported difficulties. We also were able to identify praxis issues that had previously been associated with dyslexic function to explain the behaviour and learning ability of one client. SIPT data is combined with both unstructured and structured neurological observations. This added contextual evidence to SIPT results and supported identification of sensory processing difficulties or helped make sense of behaviour and functioning observed.

The Adolescent/Adult Sensory Profile was completed as part of the assessment process. This version is demonstrated to have high validity and reliability for the four subscales of sensory processing. There is growing evidence regarding the relationship between sensory processing patterns or how a person experiences and perceives their world through their senses and their mood, behaviour and relationship with others or affect (Engel-Yeger and Dunn, 2011). Certainly we concur with the notion that knowledge about a person’s neurological thresholds, mood manifestation and self regulation strategies can enable individuals to recognise and manage arousal levels through adaptive means. The profile was used in conjunction with a sensory history and again this helped provide contextual relevance to developmental change and adaptation from birth to current presentation. We also use the Model of Human Occupation Screening Tool (MOHOST) and eating disorder specific assessments as part of our clinical formulation and care planning processes.

Sensory modulation intervention strategies initiated with our service users has involved several components – activities aimed at improving self-awareness, including use of the sensory room (the only equipment missing are suspended items as we can’t have fixed ligature points due to the location of the room); development of a personal sensory resource box; exposure to vestibular-proprioceptive experiences, including ‘heavy muscle work’ and ‘play’ activities at the local park and leisure centre; activities aimed to increase somatosensory input, including deep-pressure and brushing. There are a few pieces of research available that promotes and identifies the benefits of using these sensory integration focused techniques (Champagne and Koomar, 2011), it is an area however, where more research is required.

As we develop our service and become more proficient at assessment, interpretation and treatment our goal is to have an initial period of intensive intervention as research indicates this is most effective to elicit positive effects from sensory integration strategies. Additional strategies can then be used in their residential setting to both control the environment and used strategically by a young person to maintain and manage their emotional regulation.

However, in a mental health setting the best laid plans can be ineffective if the service user is not ready for change or the therapist is not prepared for being flexible and patient. The caution for therapists working in mental health settings is to ensure that a sensory informed approach is relevant to functional needs, supports multiple intervention techniques and involves good communication between often several professional disciplines.

References

CHAMPAGNE, T. & KOOMAR, J., 2011. Expanding the Focus: Addressing Sensory Discrimination Concerns in Mental Health. Special Interest Section Quarterly Mental Health March Vol. 34 (2) pp.1-4

ENGEL-YEGER, B. & DUNN, W. 2011. Exploring relationship between affect and sensory processing patterns in adults British Journal of Occupational Therapy Oct 74 (10) pp.456-464

GREENBERG, S. & SCHOEN, E. 2008. Males And Eating Disorders: Gender-Based Therapy For Eating Disorder Recovery. Professional Psychology: Research and Practice. 39 (4) pp.464-471

WELTZIN, T., WEISENSEL, N., FRANCZYK, D., BURNETT, K., KLITZ, C., & BEAN, P. 2005. Eating disorders in men: Journal of Men’s Health & Gender. 2 (2) pp.186-191

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