Sensory Integration Education

Mary Read, Occupational Therapist and Advanced Practitioner in Sensory Integration from “TakePart Occupational Therapy” shares her thoughts and experiences of moving forward and adapting her practice in a time of crisis and uncertainty.

While considering how to deliver SI informed OT practice during the Covid-19 pandemic something came to mind. The familiar undulating graph illustrating how we adapt to change. The change curve is taken from the original Kübler-Ross model (1) describing the five stages of grief where a sudden and unexpected change generates feeling loss and shock, followed by (hopefully) an acceptance and then rediscovery of energy going forward. It is both an emotional and organisational process. 

I am an occupational therapist who completed SI Module 4 of the SIE postgraduate pathway to become an advanced practitioner in Ayres Sensory Integration (ASI) in 2018. I am an independent paediatric OT working regularly in a special school, offering private practice with children at home and in mainstream schools and am also employed by an independent school for autistic students.

Stage 1: Information and Stage 2: Support

As schools and small businesses entered confusion and restrictions as the impacts of the COVID-19 pandemic were realised, I quickly needed to rethink what my key role could be to support students, parents and staff. I searched for and shared information as best as I could. I rapidly consumed YouTube tutorials to improve my online communication and googled classroom skills.

Stage 3: Direction

The SI training has transformed my practice in understanding how the sensory systems impact function in the development of both modulation and praxis. With no direct hands on intervention, how can the ASI fidelity measures (2) be met? Clearly, some of the structural elements (space and equipment) would be different, but the process elements (supporting intrinsic motivation, playfulness, therapeutic alliance) can still hold.

How much more do the key principles of OT need to be paramount in our practice now? I considered meaningful occupation, personal motivation and environmental adaptation. It was essential to somehow bridge the gap through the remote working using a video conference or developing online resources while keeping playful yet recognising how the personal and emotional elements of COVID-19 are impacting everyone.

I wanted to develop a tool that could combine SI modulation and praxis interventions, yet also be informed by trauma responses and the Sympathetic and Parasympathetic Nervous Systems regulation. The concept of activities being sensory based and flexible made sense for parents and children at home. A “meal deal” concept supports having a choice of activities from different levels of sensory and SNS regulating activity. The pressure of parents becoming “teachers at home” could be alleviated and reframed. The table below (fig 1: Sensory Meal Deal for a Balanced Day) could be adapted to use images from a child’s own interests and graded depending on the child’s level of development. Students could self-fill it via google classroom. It was shared as part of a weekly newsletter to parents. One week the newsletter was geared for the parents to think about their own regulation using the same “meal deal” concept.

Figure 1: Sensory Meal Deal for Balanced Day

Google Classroom has been a useful tool to adapt previously delivered material, such as “Zones of Regulation'' (3) from a real classroom situation to target individual children at home. An example is using Pokémon characters for the different zones. Widget symbols are transferable onto this format too and can be used as prompts for regulation strategies and activities. Blank text boxes enable the student to choose their own strategies. They can also send pictures or videos of themselves performing these activities.

Stage 4 Encouragement

Live video conferencing for home sessions has been interesting. The success (or not) is highly dependent on the parent managing their device while supporting from home as the child is showing me their trampoline, swing, sofa jumps etc. The engagement via the live video is more difficult than face to face. I have prepared using symbols and game ideas that we can do interactivity – but this is not as “child led” as true SI would encourage. I felt more encouraged once I decided to stop myself “leading the therapy” online but rather to support the parents regularly in their ideas of sensory rich activity and regulation within their own home settings. I have seen several parent’s own confidence and sense of agency increase greatly as they are facilitating and seeing the progress their own child is making.

Where now? 

At the time of writing, I see one of the key roles of OT as supporting regulation and anxiety during the uncertainties of returning to school after a long and unpredictable break as a key factor. We, as adults, will need to be effective co-regulators to provide a sense of safety and emotional security for children who may be dysregulated as their own “safe” adults are also expressing anxiety and uncertainty. The future of delivering interventions in enclosed SI rooms will perhaps be limited. Using outdoor spaces capturing the calming and enriching benefits of nature seams one natural progression for the delivery of SI informed practice. Together with the children, young people and their carers I would see us developing these enriching nature-filled and more “socially distance friendly” environments to the full.