Occupational Therapy: Sensory Integration and Clinical Practice

Posted on Mar 22, 2026 in Psychology and Sociology

Sensory Integration (SI)

Definition

Sensory Integration is the brain’s ability to take in information from the body and environment, organize it properly, and use it to act in a coordinated, meaningful way. When this process isn’t smooth, it can affect behavior, emotions, learning, and how a child participates in everyday life.

Key Assumptions of SI Theory (Ayres)

These are the “rules” SI is built on:

  • The brain is plastic: It can change with experience.
  • Sensory integration develops over time.
  • The brain works as an integrated whole.
  • Adaptive responses help the brain grow.
  • Children naturally seek sensory experiences.

Sensory Processing: What the Brain Does

Sensory processing is the way the nervous system detects, interprets, and responds to sensory information.

Key Functions

  • Detecting input
  • Interpreting it
  • Modulating it (turning the “volume” up or down)
  • Using it for movement, emotional regulation, social engagement, and safety

Sensory Modulation: The “Volume Control” System

Sensory modulation is the ability to regulate and organize responses to sensory input so they match the situation.

Patterns of Modulation Difficulty

  • Over-responsive: Reacts too strongly.
  • Under-responsive: Barely notices input.
  • Sensory seeking: Actively looks for intense input.

Examples

  • Covers ears at loud sounds: Over-responsive
  • Doesn’t notice name: Under-responsive
  • Constantly jumping, crashing: Sensory seeking

Dunn’s Sensory Processing Model (1997/2014)

This model is based on two key ideas:

  • Neurological threshold: High (needs more input) vs. Low (notices everything).
  • Self-regulation style: Passive (lets things happen) vs. Active (tries to control input).
PatternThresholdResponse StyleWhat it looks like
Poor registrationHighPassiveAppears flat, tired, withdrawn
Sensory seekingHighActiveConstant movement, fidgety
Sensory sensitivityLowPassiveEasily overwhelmed, distractible
Sensory avoidingLowActiveCreates routines, avoids input

Sensory-Based Motor Disorders (SBMD)

Motor difficulties caused by problems with sensory discrimination, not modulation.

Two Main Types

  1. Somatodyspraxia: Difficulty planning and carrying out new motor actions (linked to tactile, vestibular, proprioceptive issues). Looks like clumsiness, difficulty imitating, and poor body awareness.
  2. Bilateral Integration & Sequencing (BIS): Difficulty coordinating two sides of the body and movement sequences. Looks like trouble with skipping, catching, or multi-step tasks.

Sensory Assessments

  • Modulation: Sensory Profile 2, Sensory Processing Measure (SPM), Sensory Experiences Questionnaire.
  • Discrimination & Praxis: SIPT (Gold standard), EASI (Modern), COMPS (Screening).
  • Environmental: Classroom Sensory Environment Assessment.

Sensory-Based Interventions (SBIs) vs. Ayres Sensory Integration (ASI)

SBIs are isolated sensory techniques (e.g., deep pressure, weighted blankets) used to temporarily change arousal. They are not the same as Ayres Sensory Integration (ASI), which is a manualized, fidelity-based intervention requiring advanced training and a just-right challenge.

Top-Down vs. Bottom-Up Approaches

  • Top-Down: Starts with participation in occupations (e.g., handwriting, dressing). Focuses on strengths and barriers.
  • Bottom-Up: Starts with underlying client factors (e.g., sensory processing, motor skills). Focuses on the “building blocks.”

Adolescent Development

Biological Development

Includes puberty, hormonal changes, and brain maturation (back to front). The prefrontal cortex (planning/impulse control) matures last, explaining risk-taking behavior.

Cognitive & Psychosocial Development

Teens develop abstract thinking but remain sensitive to emotional situations. Identity formation and peer influence become central to their daily lives.

Mental Health Conditions

Common conditions include Anxiety, Depression, OCD, ADHD, Trauma, and Eating Disorders. The OT role focuses on supporting routines, participation, and regulation strategies.

Assistive Technology (AT)

AT includes any item or system that helps a person improve their ability to participate in daily activities. Frameworks for decision-making include:

  • SETT: Student, Environment, Tasks, Tools.
  • HAAT: Human, Activity, Assistive Technology, Context.
  • MPT: Matching Person and Technology (to prevent abandonment).

Clinical Reasoning

OTs use eight styles of reasoning to make decisions:

  • Scientific: Theory and evidence-based.
  • Diagnostic: Detective work to find the cause.
  • Procedural: Choosing protocols and interventions.
  • Narrative: Understanding the child’s story.
  • Interactive: Building rapport and trust.
  • Pragmatic: Practical constraints (time, funding).
  • Ethical: Doing what is right and fair.
  • Conditional: The “big picture” for future planning.

Writing COAST Goals

A structured way to write functional goals:

  • C: Client
  • O: Occupation
  • A: Assist level
  • S: Specific conditions
  • T: Timeline

Example: “Sam will independently use the toilet during school hours with one visual schedule prompt by the end of Term 2.”