September 15, 2023

About Ayres Sensory Integration

September 15, 2023 by Colleen Beck OTR/L

In this post, we are going to give you the basics of Ayres Sensory Integration. If you have never heard of it, continue reading for plenty of information and resources that will help you become more familiar with this practice. Or, if you are trained in sensory approaches and looking to refresh your knowledge, we have got you covered. Learn more about the sensory system and and sensory-based activities in this resource on Sensory.

Ayres sensory integration and how this specialized sensory treatment impacts kids with sensory processing needs.

WHAT IS Ayres SENSORY INTEGRATION?

You may have heard the terms Ayres Sensory Integration, of Ayres SI. Maybe you’re familiar with the term sensory integration. But what do these terms mean?

Sensory integration has many layers, but it can be made quite simple. In fact, everyone has experienced sensory integration! Think about your senses; the way you feel things on your skin, see bright or dim light, smell a cup of coffee, or feel dizzy on a rollercoaster. Your body senses a stimulus, for example, the feeling of your shirt against your skin.

After a few moments, you don’t think about how the shirt feels on your skin. You wear it all day long without feeling it touch you.

This is an example of sensory integration. That sensation – the touch of the shirt to your skin – was processed and organized by your nervous system, and the nervous system decided that it did not need to process it any more. In other words, it was integrated!

But what happens if the sensation is not integrated?

You may have heard of someone who can feel their shirt, particularly the tag of their shirt, all day long. It may bother them so much that they cut off those tags to avoid feeling that sensation.

It may be that somewhere along the sensory nervous system pathway, the signals for processing that touch sensation are blocked, or lost. Instead of being processed and integrated as, “You don’t need to feel this any more!”, it’s stuck in a processing limbo of, “what is this that I am feeling?”.

Much like how a sudden closure on the freeway means that you will have to find another way to your destination, those sensory signals need to learn where to go when their path is not clear.

Sensory integration therapy can help find a new path to that destination and turn off the signals that cause the over-response to the stimuli (in this case, the shirt).

WHO IS Jean AYRES?

Dr. A. Jean Ayres, an occupational therapist, psychologist, and neuroscientist, developed this theory and practice in the mid 1970s. She recognized that a child’s sensory system can greatly impact how they perceive and interact with the world around them. Dr. Jean Ayres developed specific sensory integration interventions based on her research findings over the course of her career.

Since 2005, Ayres Sensory Integration (ASI) has been trademarked to differentiate this particular method from other sensory-based therapies. The term Ayres Sensory Integration, or ASI, encompasses the theory, assessments, and interventions that were developed by Dr. Ayres.

WHAT IS SPECIAL ABOUT Ayres Sensory Integration?

There are reasons why ASI is trademarked and other sensory approaches are not – so what makes Ayres Sensory Integration so unique? One reason why the trademark was necessary was to clarify to the public and the academic communities which evidence to correlate with ASI.

The evidence for sensory interventions were becoming increasingly mucky – it became difficult to discern if ASI worked because so many people were calling any sensory approaches ASI, even if they did not align with the principles (Parham et al., 2007).

To be considered true ASI, a trained practitioner must follow a specific protocol in their evaluation and treatment of their client. To start, the practitioner would evaluate their client using methods of naturalistic observation, conducting caregiver and teacher interviews, administering standardized testing, and performing clinical observations.

After the evaluation is complete, they will determine the ways in which sensory integration deficits may be interfering with the child’s functional performance.

Core Elements of Ayres Sensory Integration

After determining that ASI is an appropriate intervention method for a child, the trained practitioner will develop sensory interventions that fall within the core elements of the ASI approach:

Ensures physical safety.
Presents sensory opportunities.
Helps maintain appropriate levels of alertness.
Challenges postural, ocular, oral, or bilateral motor control.
Challenges praxis and organization of behavior.
Collaborates in activity choice.
Tailors activity to present the just-right challenge.
Ensures that activities are successful.
Supports a child’s intrinsic motivation to play.
Establishes a therapeutic alliance.
(Parham et al., 2020)

DOES Ayres Sensory Integration WORK?

Sensory integration is an on-going research topic in the field of occupational therapy. Many recent publications have suggested that ASI can be used to improve occupational performance (Koester et al., 2014; Miller, Coll, & Schoen, 2007; Pfeiffer, Koenig, Kinnealey, Sheppard, & Henderson, 2011; Roley et al., 2015; Schaaf & Nightlinger, 2007; Schaaf et al., 2013, Schaaf et al., 2015; Watling & Hauer, 2015).

In other words, ASI is supported by research in it’s main goal: to increase a child’s participation in their daily activities.

ASI was originally developed as a measure to address the functional abilities of children with learning and behavioral concerns. The positive outcomes of ASI have since been well-documented for children with Autism Spectrum Disorder, as well as for children with learning disabilities, ADHD, developmental delay, regulatory disorder, and developmental coordination disorder.

The theory and practice has also been modified for use with other populations and age groups, too!

Who Uses Ayres Sensory Integration?

Most recent research estimates that up to 95% of children with developmental delays or disabilities have deficits in sensory functioning (AOTA, 2017).

Additionally, it is estimated that sensory processing difficulties occur in 5% to 14% kindergartners, 16% of elementary students, and 10% to 12% of people of all ages with no related diagnosis (AOTA, 2017).

In short, the relevance for sensory integration is huge, due the prevalence of sensory deficits in individuals of various populations.

To find out if an individual can benefit from ASI therapy, the Sensory Integration and Praxis Test (SIPT) would be administered, per the ASI guidelines. The SIPT was developed by Dr. Ayres specifically to test whether or not ASI is appropriate for an individual, and to highlight specific deficits in sensory processing.

RESOURCES on Sensory Integration

There are many great resources available for practitioners and families alike. See the options below to discover more about the sensory system, ASI theory, and sensory-based interventions.

Frequently Asked Questions about ASI
How to Build Competency in ASI for Practitioners
Sensory Integration Global Network
Want to become certified in ASI? The Collaborative for Leadership in Ayres Sensory Integration (CLASI) or ASI Wise are great places to start.
If you are looking for even more ASI information, look no further than this video! Occupational therapist Ivan describes the sensory system and methods of intervention in a way that I believe any one can understand.
For a more advanced understanding of the neurological basis of ASI, check out this video.

Ayers Sensory Integration and Therapy

While Sensory integration (SI) refers to a theory developed by Dr. Jean Ayers in the 1960’s much has changed in the world since the conception of sensory integration therapy.

We have screens, online worlds, technology, fast paced lifestyles, full schedules, various educational models and programming types, changed environments, different home lifestyles, adapted parenting styles, and many other overall lifestyle differences since the 1960s.

The theory that our Central Nervous System (CNS) takes information from the outside world that has VASTLY changed, while our internal systems has not is an interesting one to chew on.

We’ve had to accommodate for these different and updated needs that our world has moved into.

What hasn’t changed is the nervous system’s ability t take information from the outside world, organize it, and use that information to produce purposeful and useful responses toward specific goals we have, physically, cognitively, emotionally, and behaviorally.

We are able to use that purposeful information in order to perceive incoming sensory information (the sensory systems of touch, movement, pressure, sounds, tastes, joint sense, sights, and internal information) in order to determine the quality of the responses of each sensory system as they work together as a whole.

It’s amazing when you think about it, right?!

Then, there is the vast amount of knowledge that we have as individuals. Today, we can access information, the use of AI, and we can share that information in seconds. Today, the awareness of tools and underlying reasons why we behave the way we do is available to every individual.

This might mean that sensory interventions can be used in not just the clinical setting anymore. Jean Ayres layed the framework for this knowledge and theories.

References on Jean Ayers Sensory Integration

The following are sources of information regarding Jean Ayers Sensory Integration.

For more in-depth information on Jean Ayres’ sensory integration theory and a comprehensive exploration of occupational therapy interventions based on her principles, I recommend referring to authoritative textbooks, academic papers, and professional resources in the field of sensory integration therapy. These references can provide valuable insights and guidance for those seeking a deeper understanding and effective application of Ayres’ groundbreaking concepts in occupational therapy practice.

American Occupational Therapy Association [AOTA]. (2017). Frequently asked questions (FAQ) about: Ayres Sensory Integration®. https://www.aota.org/-
/media/Corporate/Files/Secure/Practice/Children/FAQAyres.pdf

Koester, A. C., Mailloux, Z., Coleman, G. G., Mori, A. B., Paul, S. M., Blanche, E., … Cermak, S. A. (2014). Sensory integration functions of children with cochlear implants. American Journal of Occupational Therapy, 68, 562–569.
http://dx.doi.org/10.5014/ajot.2014.012187

Miller, L. J., Coll, J. R., & Schoen, S. A. (2007). A randomized controlled pilot study of the effectiveness of occupational therapy for children with sensory modulation disorder. American Journal of Occupational Therapy, 61, 228–238.

Parham, L. D.., Smith Roley, S., May-Benson, T. A., Koomar J., Brett-Green, B., Burke, J. P., Cohn, E. S., Mailloux, Z., Miller, L. C. & Schaaf, R. C. (2020). Development of a fidelity measure for research on the effectiveness of the Ayres Sensory Integration® intervention. American Journal of Occupational Therapy, 65, 133-142. https://doi.org/10.5014/ajot.2011.000745

Parham, L. D., Cohn, E. S., Spitzer, S., Koomar, J. A., Miller, L. J., Burke, J. P. … Summers, C. A. (2007). Fidelity in sensory integration intervention research. American Journal of Occupational Therapy, 61, 216–227.

Pfeiffer, B. A., Koenig, K., Kinnealey, M., Sheppard, M., & Henderson, L. (2011). Effectiveness of sensory integration interventions in children with autism spectrum disorders: A pilot study. American Journal of Occupational Therapy, 65, 76–85. http://dx.doi.org/10.5014/ajot.2011.09205

Roley, S. S., Mailloux, Z., Parham, L. D., Schaaf, R. C., Lane, C. J., & Cermak, S. (2015). Sensory integration and praxis patterns in children with autism. American Journal of Occupational Therapy, 69, 6901220010. http://dx.doi.org/ 10.5014/ajot.2015.012476

Schaaf, R. C., Benevides, T., Mailloux, Z., Faller, P., Hunt, J., van Hooydonk, E.,… Kelly, D. (2013). An intervention for sensory difficulties in children with autism: A randomized trial. Journal of Autism and Developmental Disorders, 44, 1493–1506.
http://dx.doi.org/10.1007/ s10803-013-1983-8

Schaaf, R. C., Cohn, E. S., Burke, J., Dumont, R., Miller, A., & Mailloux, Z. (2015). Linking sensory factors to participation: Establishing intervention goals with parents for children with autism spectrum disorder. American Journal of Occupational Therapy, 69, http:// dx.doi.org/10.5014/ajot.2015.018036

Watling, R., & Hauer, S. (2015). Effectiveness of Ayres Sensory Integration® and sensory-based interventions for people with autism spectrum disorder: A systematic review. American Journal of Occupational Therapy, 69, 6905180030.
http://dx.doi.org/10.5014/ajot.2015.018051

Sydney Thorson, OTR/L, is a new occupational therapist working in school-based therapy. Her
background is in Human Development and Family Studies, and she is passionate about
providing individualized and meaningful treatment for each child and their family. Sydney is also
a children’s author and illustrator and is always working on new and exciting projects.

Under the Desk Foot Rest

October 16, 2023September 15, 2023 by Victoria Wood OTR/L

If you are a tall person, you might not give much thought to an under the desk foot rest. Your feet might naturally sit on the floor. You might be thinking “what is the big deal?” The big deal is about posture, core strength, and improving function. Here, we’re covering how a desk foot support can improve sitting posture when writing. While it feels cool to swing your legs under your desk, it is not beneficial in the long term. Let’s explain…

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Under the desk foot rest

An under the floor desk foot rest may be an essential tool to support upper body positioning that offers the stability needed for distal mobility when writing, reading, and completing fine motor or visual motor tasks.

These positioning devices can be a great flexible seating option as well.

What is an under the desk foot rest?

An under the desk foot rest is just as you might imagine it to be…a supportive place to rest the feet to promote optimal alignment of the body in a chair. We cover specific reasons to use an under the desk positioner below.

Let’s break this down…

Enter the (Amazon affiliate link) Squatty Potty as Exhibit A. The people who invented the squatty potty did research to show that having your feet on the floor (or elevated on their stool), helps you go #2 by improving body position. Positioning is one of the first areas an occupational therapy practitioners addresses when it comes to potty training interventions.

There is a long list of other benefits to having your feet on the floor while using the toilet. I think the best one is comfort. If a stool is beneficial for one of the body’s basic functions, imagine what it can do when supporting the feet under a desk!

The positioning needs of sitting at a desk are not much different. An optimal position is needed for working at a desk with refined motor skills.

The layout of workstations has not changed much over the years. Even though the workforce is more inclusive today, workstations are still set up for people 5”10” or taller.

School desks and chairs are set up much the same way. Adults of shorter stature (5’6” for males and 5’2” for females) can benefit from an under the desk foot rest. Children of smaller size can also benefit.

The benefits of having an under the desk foot rest

Let’s break down the benefits of using an under the desk foot positioner.

Comfort – I already mentioned comfort in regards to toileting. If you are of shorter stature, think about sitting on a stool at a bar. Your feet are dangling, and it feels like you are about to slip off the chair. You keep scooting backward trying to get some traction.

While you keep scooting and squirming in your chair, you are conscious of your body and not on the conversation you are supposed to be having.

This is the same for people in any kind of chair.

Health benefits – Footrests align posture, reduce fatigue, and ease pain or discomfort in the feet, ankles, knees, and thighs.

A rocking footrest improves the circulation in your legs by maintaining consistent movement throughout the day. This lowers the chances of leg pain, stiffness, and developing varicose veins or blood clots.

A chair that is too high may lead users to sit cross legged instead of feet on the floor.

Positioning – there are several components to positioning. Some of it was mentioned under comfort. If a person is small and trying to sit in a large chair, they need to scoot forward to reach the edge of the chair, which results in slumping, or tired muscles from sitting without support.

If they scoot all the way to the back of the chair, these students can not effectively reach the desk in front of them. The front of the chair often hits their legs at inconvenient places other than the back of the knees.

Proper positioning which sitting includes the hips, knees, and ankles at ninety degrees. Studies show that sitting cross legged for more than three hours per day may cause shoulder inclination, lateral pelvic tilt, and forward head posture.

Fine motor precision – people are often given taller chairs to make them the correct height to reach the table. This is wise, as the elbows should be at ninety degrees for optimal fine motor output.

A person who is falling out of their chair is less likely to produce efficient or effective output. While this taller chair gives the student a better tabletop position, it leaves the legs dangling.

While the ultimate solution is a small chair and a small desk, this is not always feasible.

Posture – posture goes hand in hand with positioning, or can be an effect of positioning.

People of short stature who can not reach the ground often slump in their chair to touch the ground, lean forward on their desks to try and gain stability, or tip laterally due to weakened core muscles. Check out this post on Writing Posture. Also, read about: Why do Kids Slouch in their seats?

Sensory – while having your legs dangling due to an incorrect sized chair can be great sensory input, in can also cause disorganization and dysregulation. Sensory input, at its’ best is self-regulated.

This means that you have control over your body and what is happening to it. If you can not reach the floor to stop the movement and get grounded, this often leads to dysregulation.

Dysregulation can add to inattention, lack of focus, emotional instability, and seeking or avoiding behaviors as your body and brain expends so much effort trying to stay in your chair.

TYPES OF UNDER THE DESK FOOT RESTS

An under the desk foot rest can range from home made boxes to deluxe apparatus. This will depend on environment, budget, and needs.

Homemade foot positioner options – if you are on a tight budget, or feel this accommodation might be temporary, making a simple home-made under the desk foot rest may be right for you.

This can be made from a stack of books, carboard box, pieces of wood, a plastic tub, shoebox, etc. You can also make an under the desk foot rest out of scrap wood or pallets if you are handy. In the “old days” the Yellow Pages were great for making foot rests and booster seats!

Basic foot rests – A basic foot rest (affiliate link) is a simple design that are basically no more than a box. Use these for someone who needs nothing more than a place to put their feet.

Slanted foot rests – A slanted foot rest (affiliate link) helps you sit back further in your chair and lean into the support of your chair. A good one to look for has grippy surface to keep the feet from sliding on the slanted rest. It keeps you sitting upright in a more neutral posture.

Rocking foot rest – A rocking foot rest (affiliate link) encourages leg and foot movement at a time of day where most people are inactive. It can increase metabolic rate and keep you healthy. This is a great option for individuals who need a quiet fidget tool at school in order to self-regulate through movement.

Foam foot rest – A foam foot rest (affiliate link) has a soft cushion that feels good to use. The soft surface is comfortable on the feet. You can flip this over for a rocking surface, and get one with a base to raise the height. Most come with a washable cover to keep it clean.

It is lightweight and portable, although big and bulky. This might not be the greatest if you are in a dirty space, or come in from the outside with shoes on and step on it.

Sensory foot rest – some sensory cushions can double as an under the desk sensory footrest. (affiliate link) The wiggle cushion and square blue foot cushion not only provide great sensory input, they can bridge the height gap.

One inexpensive sensory foot rest is to use a partially deflated beach ball. We love the sensory tool as a seating tool and under the desk positioning offers sensory input as well.

ALTERNATIVE TYPES OF UNDER DESK FOOT REST

Above are the more traditional types of foot rests. There are times when a traditional method is not feasible or the best for the user. Some of these offer heavy work through the feet and legs. Others on the list below offer a form of proprioceptive input. Others provide a base of support for better alignment.

These are affiliate links to Amazon.

Bouncy band (affiliate link) – check out my post on Foot Fidgets to get an idea of under the desk fidgets. The bouncy band can provide a moveable surface to give input to the feet and legs. It can provide some support, but is not going to be as stable as a traditional foot rest. These however are more subtle, cost effective, and easier to move.
Exercise equipment (affiliate link) – an under the desk bike or elliptical can provide movement, but not as much stability. If you need a foot rest because of sensory or health issues requiring movement, an under the desk exercise bike might be a good alternative.
Exercising foot rest (affiliate link) – this footrest has an exercising motion that improves circulation. It has a unique surface that helps stimulate and promote blood flow to your feet. This design is going to be more cumbersome if you switch desks a lot. It is super expensive, but very cool!
Foot massager(affiliate link) – if you need some extra comfort while you work, a massager might we what you need.
Foot bar (affiliate link) – this simple bar gives you a place to rest the feet and move with a swinging motion. This is great for people who are required to stand in one place for long periods of time. Resting one foot at a time on the bar reduces pressure on the lower back and allows more dynamic posture throughout the day. There is also a foot hammock as another alternative…
Foot rest hammock (affiliate link)– this is a cool new idea to elevate the feet. Not sure how effective it is for positioning in the long run, but innovative.

One of the the best solutions for an under the desk footrest is to change the workplace set up. Creating a workplace that is ergonomically designed for your specific body is ultimately best for you.

While you still might benefit from a moving foot rest, you will not be dependent on one for height requirements. Check out this post on Alternative Seating Options.

TIPS FOR SELECTING an UNDER The DESK FOOT REST

As with everything in life, nothing is one size fits all. Trial and error may be required to find the right solution, but there are general guidelines to consider:

Measure the distance between the feet and the floor to get the best fit. Knees can be slightly elevated, and feet should be able to firmly sit on the foot rest.
Check the type of seat provided. Is it too large, too small, too soft/firm, not supportive, or uncomfortable? Some people need arm rests and lateral supports. Other people need high back rests for optimum comfort.
Make sure the foot rest is acceptable for the user and other people in their workspace. Something distracting or noisy might not be the best in a busy classroom. A student who moves to several different classrooms might need a stool in each room, or something small and portable.
Safety first. Check for slipping of the feet on the foot rest, movement of the footrest on the floor, and ease of getting in/out of the desk with the foot rest there.
Watch for other seating needs. Users might need a cushion, head rest, lateral supports, foot cups, and other adaptations to insure the best posture and comfort
Check for compliance. Be sure that your user is using the footrest provided. If not, find out why. Maybe it is too distracting, embarrassing, ugly, improper fit, uncomfortable, or not allowed by the staff.

Power of an Under the Desk FootRest

What seems so simple, like sitting in a chair (or on the toilet!) can be full of complications that have a larger effect than first imagined. Go back to the foundation when diagnosing and treating problems.

Maybe visual motor difficulties stem from poor seating. Perhaps that neck and back pain have to do with sitting posture. Sometimes a simple fix such as an under the desk foot rest can ripple into a big change.

Victoria Wood, OTR/L is a contributor to The OT Toolbox and has been providing Occupational Therapy treatment in pediatrics for more than 25 years. She has practiced in hospital settings (inpatient, outpatient, NICU, PICU), school systems, and outpatient clinics in several states. She has treated hundreds of children with various sensory processing dysfunction in the areas of behavior, gross/fine motor skills, social skills and self-care. Ms. Wood has also been a featured speaker at seminars, webinars, and school staff development training. She is the author of Seeing your Home and Community with Sensory Eyes.

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