Examining the neuroscience evidence for sensory-driven neuroplasticity: implications for sensory-based occupational therapy for children and adolescents.

When Ayres first presented the theory of sensory integration (SI), she grounded it in the neuroscience literature. Neuroplasticity was then, and is today, considered to be at the heart of this theory. This evidence-based review sought to critically examine the basic science literature to specifically identify evidence for the assumptions and tenets of Ayres\u27 theory of SI. We reviewed literature between 1964 and 2005, within psychological, physiological, and biomedical areas, addressing neuroplasticity. The review focused on sensorimotor-based neuroplasticity; explored the data that addressed the links among sensory input, brain function, and behavior; and evaluated its relevance in terms of supporting or refuting the theoretical premise of occupational therapy using an SI framework (OT/SI) to treatment. Although direct application from basic science to OT/SI is not feasible, we concluded that there was a basis for the assumptions of Ayes\u27 SI theory

Sensory Over-Responsivity and ADHD: Differentiating Using Electrodermal Responses, Cortisol, and Anxiety

Deficits in sensory modulation have been linked clinically with impaired attention, arousal, and impulsivity for years, but a clear understanding of the relationship between sensory modulation disorders and attention deficit hyperactivity disorder (ADHD) has proven elusive. Our preliminary work suggested that patterns of salivary cortisol and electrodermal responsivity to sensation may be linked to different groups of children with ADHD; those with and without sensory over-responsivity (SOR). Additionally, SOR has been linked to anxiety, and anxiety has been linked to ADHD. A clearer understanding of the relationship between anxiety, SOR, and ADHD may support a better understanding of ADHD diagnostic subtypes. We examined neuroendocrine, electrodermal and behavioral characteristics and sought to predict group membership among 6- to 12-year-old children with ADHD and SOR (ADHDs), ADHD and no SOR (ADHDt), and typicals (TYP). Behavioral questionnaires were completed to document SOR and anxiety. Lab testing used a Sensory Challenge Protocol (SCP) with concurrent electrodermal measurement and the collection of cortisol prior to and following the SCP. Results substantiated links between SOR and anxiety, in both TYP and ADHD children. Results suggests that ADHD should be considered in conjunction with anxiety and sensory responsivity; both may be related to bottom-up processing differences, and deficits in prefrontal cortex/hippocampal synaptic gating

If Reasoning, Reflection, and Evidence-Based Practice are Essential to Practice, We Must Define Them

Reasoning, reflection, and evidence-based practice are considered essential to the delivery of high-quality occupational therapy services. These skills are highlighted in occupational therapy practice acts and educational standards. Unfortunately, although clearly integral to practice, reasoning, reflection, and evidence-based practice are rarely and inconsistently defined in the profession of occupational therapy. Because the terms reasoning, reflection, and evidence-based practice are used so frequently, and so often their definitions are assumed, occupational therapy students may be unclear on how they will be evaluated and, ultimately, what they will be expected to do in practice in relation to these skills. Through a review of literature, this paper identifies the need for clear conceptualizations of professional skills in occupational therapy and synthesizes the significance of reasoning, reflection, and evidence-based practice to both the education of occupational therapy students and the practice of occupational therapy. This Opinions in the Profession paper seeks to begin a discussion around actions required to advance occupational therapy as a profession through the process of clarifying how these skills are conceptualized, taught, and implemented to promote clear language in literature, education, and practice with the hope of positively impacting therapy services

Test of Ideational Praxis (TIP): Preliminary Findings and Interrater and Test–Retest Reliability With Preschoolers

Praxis is the ability of the brain to develop an idea for action and plan, organize, and execute unfamiliar motor actions. It enables purposeful interaction with people and things in the environment. Ideation is central to praxis but has been little researched. This study investigated the reliability of the Test of Ideational Praxis (TIP) and examined ideational praxis in typical preschoolers. TIP performance for 78 preschoolers ages 3, 4, and 5 yr was videotaped and scored by two trained raters. The TIP has strong interrater reliability, supporting earlier findings. Further, we documented test–retest stability over 2 wk. As a group, preschoolers identified 10.6 affordances (ideas) for action on the TIP; no age differences were found. Training is required for accurate scoring of the TIP; following training, clinicians and researchers may find the TIP a useful tool to screen motor ideational abilities in young children

Relationships Between Reasoning, Reflective Practice, and Evidence-Based Practice: Educators’ Perspectives

Many models of professional thinking exist within occupational therapy, but the relationships among reasoning, reflective practice, and evidence-based practice as essential skills for practice are not clear. Because occupational therapy educators impart these skills to students, understanding how educators conceptualize relationships among skills is necessary. We used Delphi methodology to explore educator conceptualizations of the relationships among clinical reasoning, professional reasoning, reflective practice, and evidence-based practice. Inclusion criteria were: an educator in an occupational therapy program for at least three years at the master’s level or higher, currently an occupational therapy educator based in the United States, and available across multiple survey rounds. Nine participants completed all three survey rounds. Participants agreed that the four skills are reciprocally related to one another, with some discrepancies surrounding differing conceptualizations of clinical and professional reasoning. Additionally, relationships were understood to be non-linear and complex. Continued exploration of how these essential skills are related to one another is needed to support future exploration of how they are integrated in occupational therapy education and how this influences practice

Defining Reasoning, Reflective Practice, and Evidence-Based Practice in Occupational Therapy Education: A Delphi Study

Reasoning, reflective practice, and evidence-based practice are essential skills for occupational therapy practitioners, but it is unclear how these skills are defined in occupational therapy education. We used Delphi methodology to explore educator conceptualizations of clinical reasoning, professional reasoning, reflective practice, and evidence-based practice. Eligible participants on the Delphi expert panel were required to have been an educator in an occupational therapy program for at least three years at the master’s level or higher, to be a current occupational therapy educator, based in the United States, and available across multiple survey rounds. Nine participants completed all three survey rounds. Among members of the expert panel there was continued moderate disagreement about terminology related to reasoning and there were some discrepancies between expert perspectives and the occupational therapy literature. However, these educators largely agreed on key features of the complex constructs. Consistency about the use of these terms will support both education and research related to essential professional skills

Mothers’ perspectives: daily life when your child has sensory differences

A child’s sensory processing and sensory integration (SP-SI) differences can be a barrier to participation in daily life for both child and mother. Supporting mothers is advocated for, but little is known about the everyday experiences of these mothers. To gain an understanding of daily life for mothers and their children with SP-SI differences. Qualitative semi-structured interviews with six mothers were analyzed through thematic analysis. Theme 1 described the impact of child SP-SI on daily life, including challenges in occupations across environments, adaptations required, and the lack of knowledge and understanding from social and professional networks. Theme 2 identified what helps: empowering mothers through relationships based on listening, gaining knowledge, and understanding, and adapting the activity and the environment. Mothers report that their child’s SP-SI differences impact daily occupations and social relationships. In addition, supportive relationships, adapting activities, and adapting the environment, support participation

Coaching Parents of Children with Sensory Integration Difficulties: A Scoping Review

Aim. To review current evidence regarding the effectiveness of occupational therapy coaching interventions for parents of children with sensory integration difficulties, delivered to individuals or groups of parents. Method. A historical scoping review was completed of empirical research records to summarize what is known and how this information can guide future research. The process was guided by PRISMA guidelines. Inclusion criteria were English language and peer-reviewed empirical studies of parent coaching intervention for children with sensory processing or sensory integration difficulties. Five databases were searched. Papers were critically reviewed using McMaster’s guidelines. Results. Four studies met the search criteria. Three studies took a direct coaching approach with individual parents or families. The fourth study took a mixed educational/coaching approach with groups of parents and teachers. Conclusion. There is some evidence to conclude that occupational therapists can deliver individual parent-focused coaching interventions which impact positively on individual child goals, parental stress, and sense of competence. Group intervention can lead to caregivers’ improved perceived and actual knowledge of sensory integration, as well as a sense of self-efficacy in dealing with sensory-related child behaviors. Current evidence is limited. Suggestions for future research are offered

Parasympathetic functions in children with sensory processing disorder.

The overall goal of this study was to determine if parasympathetic nervous system (PsNS) activity is a significant biomarker of sensory processing difficulties in children. Several studies have demonstrated that PsNS activity is an important regulator of reactivity in children, and thus, it is of interest to study whether PsNS activity is related to sensory reactivity in children who have a type of condition associated with sensory processing disorders termed sensory modulation dysfunction (SMD). If so, this will have important implications for understanding the mechanisms underlying sensory processing problems of children and for developing intervention strategies to address them. The primary aims of this project were: (1) to evaluate PsNS activity in children with SMD compared to typically developing (TYP) children, and (2) to determine if PsNS activity is a significant predictor of sensory behaviors and adaptive functions among children with SMD. We examine PsNS activity during the Sensory Challenge Protocol; which includes baseline, the administration of eight sequential stimuli in five sensory domains, recovery, and also evaluate response to a prolonged auditory stimulus. As a secondary aim we examined whether subgroups of children with specific physiological and behavioral sensory reactivity profiles can be identified. Results indicate that as a total group the children with severe SMD demonstrated a trend for low baseline PsNS activity, compared to TYP children, suggesting this may be a biomarker for SMD. In addition, children with SMD as a total group demonstrated significantly poorer adaptive behavior in the communication and daily living subdomains and in the overall Adaptive Behavior Composite of the Vineland than TYP children. Using latent class analysis, the subjects were grouped by severity and the severe SMD group had significantly lower PsNS activity at baseline, tones and prolonged auditory. These results provide preliminary evidence that children who demonstrate severe SMD may have physiological activity that is different from children without SMD, and that these physiological and behavioral manifestations of SMD may affect a child\u27s ability to engage in everyday social, communication, and daily living skills

An Algebraic Pairing Model with Sp(4) Symmetry and its Deformation

A fermion realization of the compact symplectic sp(4) algebra provides a natural framework for studying isovector pairing correlations in nuclei. While these correlations manifest themselves most clearly in the binding energies of 0^+ ground states, they also have a large effect on the energies of excited states, including especially excited 0^+ states. In this article we consider non-deformed as well as deformed algebraic descriptions of pairing through the reductions of sp_{(q)}(4) to different realizations of u_{(q)}(2) for single-j and multi-j orbitals. The model yields a classification scheme for completely paired 0^{+} states of even-even and odd-odd nuclei in the 1d_{3/2}, 1f_{7/2}, and 1f_{5/2}2p_{1/2}2p_{3/2}1g_{9/2} shells. Phenomenological non-deformed and deformed isospin-breaking Hamiltonians are expressed in terms of the generators of the dynamical symmetry groups Sp(4) and Sp_{q}(4). These Hamiltonians are related to the most general microscopic pairing problem, including isovector pairing and isoscalar proton-neutron interaction along with non-linear interaction in the deformed extension. In both the non-deformed and deformed cases the eigenvalues of the Hamiltonian are fit to the relevant Coulomb corrected experimental 0^{+} energies and this, in turn, allows us to estimate the interaction strength parameters, to investigate isovector-pairing properties and symmetries breaking, and to predict the corresponding energies. While the non-deformed theory yields results that are comparable to other theories for light nuclei, the deformed extension, which takes into account higher-order interactions between the particles, gives a better fit to the data. The multi-shell applications of the model provide for reasonable predictions of energies of exotic nuclei.Comment: 19 pages, 5 figures minor changes; improvements to achieve a better and clearer presentation of our messages and idea