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STARLights: Ayres Influence with Treatment Strategies
BY Lynn Witzen
Director of Clinical Services at the STAR Center
I remember the "funny kids" in my school when I was growing up. These were the kids who couldn‘t sit still, didn‘t seem to listen or even be interested in school. They weren‘t "bad" kids, but they were frequently seated on a chair in the hallway because the teacher couldn‘t deal with them in the classroom. I remember feeling very sad for these kids because school seemed so fun to me. Looking back, I can only imagine how frustrating it was for each of these children as they struggled through every day in school.
The work of Dr. A. Jean Ayres (Read more about Jean Ayres in Ask Dr. Lucy; appearing in this issue) began before I enrolled in my occupational therapy academic program. Until then, when an occupational therapist worked with a child, it was usually because of an obvious physical challenge such as cerebral palsy, spina bifida, coordination problems, or a developmental disability such as Down syndrome. There were specific treatments that could be done, and progress was documented through improvement in range of motion, strength, or coordination. However, the improvement in these measurements did not always translate to a child‘s ability to function in his life.
Dr. Ayres looked for the "why" behind what parents, teachers, and therapists saw in children everyday. She realized that the base of problems often involved a child‘s inability to accurately take in, make sense of, and appropriately respond to sensory information. She based her "why" on careful observations of the children, and it guided her treatment as well.
This new way of looking at some of the children‘s challenges required a new vocabulary as well. It was critical to have common terminology so everyone could understand exactly what was being described. For instance, it is easy to understand the concept of visual input or what can be seen. However, there are more complex terms such as "proprioceptive input." This reference to the feeling of muscles and their positions was a new concept with a complicated name! Even now, it is not a commonly understood concept.
As Dr. Ayres explored these concepts in more depth, she realized that children would over-respond, under-respond, or appropriately respond to sensory input. This occurred as the child took in the information. When the response was not appropriate, it was because the information could not accurately be processed or - in her terminology - "integrated" in the brain. We see these responses in, say, a child who cannot tolerate eating certain textures of food or certain fabrics in clothing or noisy environments. The under-responsivity is obvious if children don‘t perceive when they fall and injure themselves, can‘t hear their names being called if there is other background noise, and can‘t find items in visually cluttered backgrounds.
Dr. Ayres was the first person to understand and name many of these concepts. She used her clinical reasoning skills, which means her professional problem solving ability rather than a formula she had learned, as she understood, named what she observed, and then decided with a great deal of trial and error the best treatment for the children. Part of her mission was to help other occupational therapists understand these concepts and to help them develop good clinical reasoning skills for treatment. I remember her "blue book," (Sensory Integration and Learning Disorders, 1972) which was a small but dense textbook outlining her concepts and treatment recommendations. She developed a test to measure the underlying abilities that supported sensory "integration." This test was packed into a large suitcase-sized container, which the evaluating therapists had to lug from place to place as they administered the test. The therapists had to be trained extensively prior to administering the test. In addition, the testing itself took hours, and the scoring often took longer than administering the test!
Unfortunately, this brilliant woman died at a young age. It was impressive that she completed so much in a short life span, but her death was also a great loss because she had such great potential to increase understanding of and improve treatment of Sensory Processing Disorder (SPD). Many therapists understood some of these concepts, but there was concern about her work and research continuing. This is where Dr. Lucy Jane Miller stepped forward, committing herself to promoting understanding and treatment of SPD and founding Sensory Processing Disorder Foundation in the process.
Dr. Ayres was a pioneer in the field of sensory processing. After being mentored by her, Dr. Miller continues the search for greater understanding and determining optimal treatment of sensory challenges. Part of Dr. Miller‘s search has included assembling a team of researchers and establishing a systematic research program to document what occurs inside the body when a processing disorder is present and to study the changes that occur with treatment. I know that many therapists out in the field do not view research as related to their practice. But, as a clinician at STAR (Sensory Research AND Therapies) Center, I know that the research of the team at the SPD Foundation is critical to what I do with children every day. With greater understanding of what the activities we perform with the child actually do to the arousal of the brain, and the specific outcome of the child‘s responses to specific sensations (things that are currently being measured by the SPD Foundation researchers), we therapists at STAR are able to more accurately assess and treat our clients.
Occupational therapists worldwide acknowledge the wisdom and historic advances made by individuals like Dr. A. Jean Ayres. We value the present work of Dr. Miller and her research team as they continue to learn more about the specifics of Sensory Processing Disorder, and we are grateful to have their guidance which is based on empirical data, for our treatment at STAR Center every day. We look forward to the Sensory Processing Disorder Foundation completing more groundbreaking research and with it equipping the therapists at STAR and throughout the world to provide the best assessment and treatment possible for clients and their families.
This creates the hope that, in the future, there won‘t be "funny kids" who end up sitting in school hallways separated from their peers but instead more kids who experience greater quality of life as they succeed academically and socially. We see it happening for many of the children we treat now and we want to see it happening for all children with Sensory Processing Disorders. We celebrate the progress the last 30 years have brought us toward this goal and anticipate with excitement the future research that will make this happen.
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