peds interventions quiz 2

ASI

individualized OT approach developed by A. Jean Ayres to remediate sensory integrative problems in children

NOT simply "give sensory input"

Sensory input → adaptive response → improved sensory integration → improved participation/occupation

ASI is:

Child-led

Play-based

Active

Individualized

Sensory-rich

Just-right challenge

Adaptive responses

Intrinsic motivation

Therapist-guided, but child-directed

Focuses on underlying sensory integration processes

sensory reactivity/modulation

How strongly/appropriately a person responds to sensory input.

Think: OVER or UNDER responsive.

sensory discrimination & perception

Ability to distinguish/interpret sensory information.

Think: "What am I sensing?"

praxis

motor planning

Think:Ideation → motor planning → execution

major areas of function/dysfunction

sensory reactivity/modulation

sensory discrimination and perception

praxis

sensory integration theory

organization of sensation for use

core assumptions of ASI

1. sensory experiences shape development

2. brain can change = neuroplasticity

3. Adaptive responses promote development

4. Children are intrinsically motivated

5. Just-right challenges support growth

adaptive response

appropriate action in which the individual responds successfully to an environmental demand

example:

Child is learning to ride a bike.

Vestibular + proprioceptive information comes in

Child begins to fall

Brain rapidly integrates sensory information

Child shifts weight appropriately

Maintains balance

➡️ That successful response = adaptive response

T/F: ASI is trying to create opportunities for adaptive responses.

true

just-right challenge

Activity is:

Not too easy + Not too difficult

but challenging enough that the child must exert effort and can still experience success.

**changing activity difficulty based on child's response

T/F: ASI is child-directed within therapist-guided experiences.

true

inner drive

Motivation to physically engage in challenging and therapeutic activities that facilitate an adaptive response

ASI works best when

child is:

Interested

Motivated

Actively participating

Given some choice

T/F: Balance between therapist structure and child's freedom of choice.

true

Brain learns differently when the child is ________ __________ rather than passively receiving stimulation.

actively involved

neuroplasticity

Nervous system's ability to change in response to environmental input and demands

ASI theory proposes:

Active sensory-motor experiences

→ adaptive responses

→ repeated successful experiences

→ neural changes / improved sensory integration

→ improved occupational participation

ASI environment

Large activity areas

Specialized equipment

Suspended equipment

Sensory-rich

Novel

Opportunities for movement

Challenging cognitive/sensory/motor tasks

T/F: Suspended equipment is hallmark of ASI.

true

10 process elements of ASI

Safety

Sensory opportunities

Modulation

Motor control

Praxis

Collaborate

Just-right challenge

Success

Intrinsic motivation/play

Therapeutic alliance

physical safety

safe environment

Sensory Opportunities

tactile/vestibular/prop

sensory modulation

optimal arousal

motor control

postural/ocular/oral/bilateral

praxis

motor planning/ideation

collaborates in activity choice

shared control

just-right challenge

not too easy/hard

activities are successful

experience success

intrinsic motivation

child wants to play

therapeutic alliance

positive OT-child relationship

sensory-based intervention

Modify sensory input/environment/task

⬇️

Improve regulation/attention/arousal/function

⬇️

Participation

ASI

Underlying sensory integration

⬇️

Adaptive response

⬇️

Neuroplastic change

⬇️

Occupation/participation

sensory based interventions

Therapist-directed strategy

Environmental modification

sensory support

Regulation

Attention

Arousal

participation

Predictable routines

Noise reduction

Movement breaks

Visual schedules

Sensory diet

specific sensory techniques

involve specific sensory stimuli that are controlled and delivered in a predetermined manner, often according to a protocol/schedule

Astronaut Program

Hug Machine

Therapeutic Listening

Weighted vests

Wilbarger Protocol

sensory diet

Individualized sensory experiences/activities provided throughout the day to support optimal functioning

scheduled/individualized

sensory environmental modifications

Modify the environment to help the child manage sensory input.

Examples:

Reduce noise

Change lighting

Reduce visual distractions

Modify physical contact

Change seating

Quiet space

Noise-reducing headphones

Classroom sensory supports

modulation

Sensory processing concept

➡️ How the nervous system responds to sensory input.

Think:

OVER-responsive / UNDER-responsive

regulation

Functional state/ability to manage arousal and behavior

Think:

Can the child stay in an appropriate state for the activity?

astronaut program

Rotatory vestibular + sound + proprioceptive input

hug machine

deep pressure

therapeutic listening

Sound/music + sensory-integrative activities

weighted vest

Tactile + proprioceptive input

willbarger protocol

Brushing + joint compression

EASI

evaluation in ASI

SIPT

sensory integration and praxis test

➡️ Most closely aligned with ASI➡️ Specialized training required

SPM-2

Sensory Processing Measure-2

Provides broader information including:

sensory reactivity

praxis

planning/ideas

participation

Sensory profile 2

Provides valuable information about:

sensory reactivity

modulation patterns

But does NOT comprehensively assess all SI constructs.

participation/performance measures

PDMS

BOT

M-FUN

T/F: ASI targets underlying sensory integration processes.

true

ASI outcomes

Occupational participation

Goal attainment

Adaptive responses

Praxis/motor planning

Sensory integration/processing

Functional performance

Confidence

Competence in everyday activities

ASI dosing

18-30 sessions

2-3× per week

45-60 minutes/session

6-10 weeks

fidelity

Extent to which intervention is implemented as intended

Appropriate practitioner/training

Appropriate evaluation

Clinical reasoning grounded in SI

Individualized intervention

Adaptive responses

Participation-focused outcomes

Appropriate environment

Appropriate process

fidelity: structural

ROOM + DOCUMENTATION + SAFETY

Variety of SI equipment

Safe equipment procedures

Adequate space

Documentation

Goals connected to intervention

fidelity: process

WHAT THE THERAPIST DOES DURING THE SESSION

T/F: ASI has highest evidence for children with autism ages 4-12.

true

continue/supported interventions

Environmental modifications/supports

Parent/teacher education & coaching

Consultation embedded in routines

Occupation-based interventions with strong sensory input

Qigong massage — strongest support among specific sensory techniques

Alert Program for self-regulation

Individualized sensory supports tied to participation goals

Sensory diets

Therapy balls/active seating

Weighted vests for select children with ADHD

Therapeutic Listening

Classroom sensory supports

Strategic vestibular activities

use clinical judgement interventions

Wilbarger Protocol

Astronaut Program

Swinging as a stand-alone intervention

reconsider interventions

Weighted vests as a routine intervention for autism

Reflex integration programs with limited supporting evidence

Sensory techniques used without monitoring outcomes

overactivity

Response is too intense or lasts too long

May be defensive/aversive

Touch, movement, sound, visual input, etc. may interfere with participation

underreactivity

Response is less than expected

May not notice sensory information others detect

Can affect engagement/participation

discrimination

accurately interpreting sensory information so it can be USED

tactile

localization + discrimination of touch

proprioceptive

body position/movement; force, timing, direction

vestibular

movement, gravity, head position; balance/postural control

visual

form, space, figure-ground, visual-motor

auditory

discrimination + interpretation of sound

praxis

IDEATION → PLANNING → EXECUTION → MODIFICATION

praxis: ideation

generating ideas

what could i do?

praxis: planning

organize + sequence actions

how will i do it?

praxis: execution

carry out motor plan

try it

praxis: modification

adapt plan based on results

did it work? what should change?

T/F: Repetition equals praxis.

false

low praxis demand

OT telling child exactly how to complete a task

high praxis demand

OT setting up obstacle course and asking the child to tell them how to get through it

praxis demand

"Don't plan all the movement for a child whose goal is to learn to plan movement."

sensory-specific techniques

controlled, predetermined sensory stimuli

delivered according to:

schedule

protocol

sequence

Expected outcomes:

adaptive behavior

attention

arousal

regulation

FUNCTIONAL STATE

Vestibular/tactile input can cause

Strong autonomic responses

Changes in arousal

Hyperactive/distractible states

Lethargic/drowsy states

tactile defensiveness

Forcing tactile stimulation ≠ automatically improving tolerance.

It may actually:

➡️ increase sensitization

➡️ increase defensiveness

sensory intervention categories

1. specific sensory techniques

2. sensory environmental modifications

3. education & coaching

4. cognitive interventions

5. occupation-based interventions with strong sensory input

cognitive interventions

best used with older clients

alert program

CO-OP

alert program

cognitive intervention

Uses sensory integration concepts to teach children to:

Self-manage their arousal levels

goal: better participation

occupation-based interventions with strong sensory input

use meaningful occupations/activities that naturally provide sensory input

sensory goals

connect the sensory problem to FUNCTION

dosage: scientific clinical reasoning

research dosage

dosage: pragmatic clinical reasoning

time, space, finances, availability

dosage: narrative/interactive clinical reasoning

family priorities

dosage: conditional clinical reasoning

monitor progress + adapt