Sensory Integration Education

Amy Stephens presented at the 2018 SI Education Autumn conference in which she delved into her vast and varied role as a Speech and Language therapist. Amy is an Advanced SI Practitioner and told us how using an SI approach has enhanced her clinical practice.

Amy Stephens is a Highly Specialist Speech and Language Therapist and Advanced Practitioner in Ayres Sensory Integration. Amy is a Senior Rehabilitationist at the University of Southampton Auditory Implant Service, working across the age range to support deaf children and adults (and their parents, teachers, and carers) across the South of England. 

Amy also has an independent consultancy practice supporting schools and charities in using an SI frame of reference across the day. In this, she teaches and mentors Speech and Language Therapists and teachers in NHS and educational settings. Amy is part of the SI Education lecturing team for Sensory Integration Education, and is currently helping to develop the online training courses for SI Education.

SN: Tell us more about your current role (clinical & educational)? 

Amy: My clinical role at USAIS is quite specialist, working with deaf children and adults who have a more complex medical, communication or engagement profile. I support people right the way across the lifespan – the youngest person on my caseload at the moment is 10 months old, and the oldest is 93. It is a low incidence, high need caseload, so I cover quite an extensive area across the south of England. 

SN: How did you develop an interest in SI and where did your SI training journey begin?

Amy: In the late 1990s, when I was learning British Sign Language (BSL), I met and became friends with an inspiring OT called Nicki Walker-Williams. At that point, the impact of early cochlear implantation was beginning to have an impact on the communication and education choices for deaf children. More young deaf children were achieving speech and language skills in line with their hearing peers. It meant that the students who needed my support instead tended to be those who had more complex needs in addition to hearing. I remember having a conversation with Nicki where I talked about feeling that I was missing something really obvious for some of the students: the piece that would allow them to be ready to engage with my therapy ideas. Nicki told me “That missing piece… it’s sensory integration!”. I was intrigued, read her copy of "The Out of Sync Child", and that started me on my SI journey!

I completed SI module 1 in 2006, SI2 (as it was then) in 2007 and SI4 in 2009 and started lecturing for the Network after this. I then took Eadaoin Bhreathnach’s Sensory Attachment Intervention training, which made even more fall in to place, plus DIR Floortime certification and SOS Feeding. I then circled back to do SI2/3 in 2011 to be able me to administer the SIPT. When I started training, there weren’t really any other SLTs who had come through the formal qualification process. For all of my modules I was the only SLT in the room, and it was quite hard not to have a peer group for my journey. I wasn’t the first SLT to study SI, that was Mari Caulfield at the University of Galway. However, I was the first to formally qualify as an Advanced Practitioner. It has been my mission since then to share the “missing piece” with other SLTs, and I’m delighted to see that every module on the pathway for the last few years has had at least a couple of Speech and Language Therapists on every step of the journey.

SN: How has sensory integration training influenced your practice?

Amy: In so many different ways – it would be really hard not to see clients through a sensory lens now. I would say that the biggest influence really is that whereas in the past I typically would have had a good understanding of what to do, and when to do it, SI has challenged me always to be really clear in my thinking about why I choose a specific approach, and to relate it back to the neuroscience. It has made me more assertive in making sure that time is allocated to train parents, care staff and teachers to reframe how they interpret behaviour which might have a sensory or communicative function – I won’t give a home programme, for example, unless I’m happy the person who will be supporting it understands the reasoning behind the kinds of activities I’m suggesting.

Secondly, I’m really clear about the need to help clients achieve a calm and alert state in advance of everything else. When I look back, I can see that I used to waste a lot of therapy time trying to cajole clients to take part in activities, and that is time I would now spend helping them to recognise their levels of alertness and to self-regulate. In fact, I tell people very often that even if that’s all we do, as long as it generalises even in a small way, it’s of huge value to the client in the broader scheme of things. 

Thirdly, I would say that it has given me permission to be much more playful in therapy, particularly when I’m working with adults, and I’d say that both my clients and I have a more enjoyable time now.

SN: How do you use an SI approach as an SLT – Can you give a case example where this approach was really crucial in progressing an individuals SLT goals?

Amy: Something I work on quite often is around helping people to adjust to, and to tolerate, using their cochlear implant speech processors and other hearing aids. In order to develop auditory discrimination and useful listening for environmental sounds or speech, a person needs to have really consistent and clear access to the sounds around them. We would be encouraging people to wear their hearing aids or cochlear implants all waking hours, every day. In the past, it tended to be assumed that when people struggled to do that, it was to do with how pleasant or meaningful sound was to them, and often they would have to come back to have the sound levels on their devices reduced and reduced to try and find a level of loudness that was tolerable – and for some people, they ended up with maps which were actually too quiet to hear, and which just didn’t give them the auditory experience they needed to be able to make use of the sound.

Now, of course, I do a lot of work for Cochlear Implant and Audiology programmes across the UK, to help professionals understand that it’s not necessarily about loudness – and that if the barrier to using the equipment is tactile hyperreactivity to the feeling of the ear mould, nothing about changing the sound levels is going to fix that issue! I have a number of teenagers who have come through my caseload who were previously non-users of their hearing equipment, but now not only tolerate the equipment, but actually enjoy sound. They think it’s hilarious that they can hear body sounds like burping and breaking wind!

SN: Can you explain and share with our readers about your presentation in Birmingham – “Using Sensory Integration in Practice: A Speech and Language Therapist's Perspective” (perhaps provide a brief synopsis of the key take home learning points)

Amy: At the Birmingham conference, I talked through some of the different cases I encountered in a typical week, and thought briefly about how SI knowledge influences my treatment decisions and priorities. My main point was that sensory integration is so foundational to engagement, the ability to form relationships, developing joint attention and participating in a shared joyful experience, that it is absolutely central to almost everything we want to do as Speech and Language Therapists. 

SN: How do you feel the profession of SLT is progressing in terms of training and using SI within their practice? 

Amy: It’s small, but growing. I’m doing my best to get the message out there, as are the other SLTs who have trained in SI. Our professional body, the Royal College of Speech and Language Therapists, is interested in and supportive of the work we are doing. I think the two biggest barriers to more SLTs coming forward are firstly the continued misconception that SI is “an OT thing” rather than a framework for practice in which many different professions can work. 

Secondly, there’s something around the tendency of service commissioners to perhaps parcel “sensory work” off as an optional extra, rather than it being a tool, or an approach, which can be a really effective part of the tool kit for every Occupational Therapist, Speech and Language Therapist and Physiotherapist. 

SN: What advice have you for other SLT colleagues looking to find out more or learn more about SI – are there any local regional SI Network groups/SLT groups to recommend?

Amy: I’m always happy to talk to other SLTs about SI, and I speak at CEN meetings for SLTs working with different clinical populations all around the country. I’m part of my local SI Network group in Dorset, which includes OTs, teachers and psychologists; it’s a great resource. My advice would be to reach out and make connections with other people working in the field, and every chance you get, read, read, read, read, read! It’s always tempting to think of yourself as being too busy or too tired to set time aside for reading, but it’s amazing how your perspective shifts about what you are doing once you start to connect to that much wider community of research around clinical practice. One of the best pieces of career advice I ever had was from Gretchen Dahl-Reeves, who challenged me to make a commitment to myself to set aside one Sunday morning a month to read at least one new research paper or journal article in an area related to my work. It came as a real surprise to me to discover that lots of clinicians working for the NHS in the UK don’t realise that most clinicians can sign up for an OpenAthens account to be able to read journal articles for free.

I’m planning to organise a study day for SLTs in SI next year to gauge the appetite for a Clinical Excellence Network (CEN) group in SI – RCSLT are supportive, it’s just a question of whether enough SLTs who work inside the SI framework would find it useful to be part of a specific SLT group as well as being part of the local and regional multi-professional network groups.

SN: What research interests are drawing your attention currently? Is there any recommended literature or text books that marry the use of SI in SLT practice to share? 

Amy: I have a bit of a magpie mind – there are always about a hundred things that I’m interested in learning more about at any one time. At the moment, I’m doing a lot of reading around the in utero experiences of listening and movement, thinking about the impact of deafness on early sensory development, and particularly around that shared initial pathway of the vestibulocochlear nerve for sound and vestibular input. If people are interested, a couple of papers in this area would be: (Kral, Kronenberger, Pisoni, & O'Donoghue, 2016) and (Torkildsen, Arciuli, Haukedal, & Wie, 2018).

In terms of SLT and SI – most of the queries I get from SLTs out in the field are about how to manage and intervene for auditory processing disorders, as I am part of the specialist APD team at the University of Southampton. 

SN: What do you enjoy most about attending the SI Autumn Conference?

Amy: It’s a wonderful opportunity to catch up with other people who are on the education team, but who I don’t necessarily cross paths with very often. The community of SI practitioners is growing in the UK and Ireland, and so it’s lovely to bump in to people who I trained with at various points along the way, or people who have been to workshops and training days I have run. I love hearing how people are moving forward with SI in so many different areas of practice. It’s an opportunity to be inspired all over again – there’s always more to learn, and new ideas to try out.

Amy pictured with some of her SLT colleagues who were in attendance at the SI Education Autumn Conference 

References: 

Kral, A., Kronenberger, W. G., Pisoni, D. B., & O'Donoghue, G. M. (2016). Neurocognitive factors in sensory restoration of early deafness: a connectome model. Lancet Neurology, 15(6), 610-621. doi:10.1016/s1474- 4422(16)00034-x

Torkildsen, J. V., Arciuli, J., Haukedal, C. L., & Wie, O. B. (2018). Does a lack of auditory experience affect sequential learning? Cognition, 170, 123-129. doi:10.1016/j.cognition.2017.09.017