An Evidence-Based Guide to Combining Interventions with Sensory Integration in Pediatric Practice

Erna Imperatore Blanche, Clare Giuffrida, Mary Hallway, Bryant Edwards, Lisa A. Test, Erna Imperatore Blanche, Clare Giuffrida, Mary Hallway, Bryant Edwards, Lisa A. Test

• Publisher: Routledge
• Year: 2021
• ISBN:
  9781000481679
• Edition: 1
• Topic: Medizin
• Subtopic: Beschäftigungstherapie

This book offers practical ideas on the combination of sensory integration theory principles with other evidence-based approaches in the evaluation and treatment of multifaceted issues in children with disabilities.

Using the ICF Model, a Clinical Reasoning Model, and featuring numerous case studies, the opening chapters focus on the evidence forcombining intervention approaches with diagnoses most often encountered in clinical practice. The latter half of the book covers the delivery of services using blended intervention approaches in different settings, such as the school, the hospital, and in nature. Featured are existing community programs illustrating the combination of approaches in practice. Appendices include reproducible resources, a guide to assessments, and approaches.

The text will guide occupational therapists and other health professionals working with children and adolescents across a variety of settings in using clinical reasoning skills in a systematic manner that will lead to better interventions.

Part 1

Foundations for Clinical Reasoning

1 The Pieces of the Whole

Erna Imperatore Blanche and Clare Giuffrida

DOI: 10.4324/9781003050810-2

Sarah, a newly hired occupational therapist working in a community setting, receives a referral for Luke, a 2-year-old boy who is developmentally delayed and shows signs of autism. Luke lives with his mother and 14-year-old sister in subsidized housing. His mother works the early shift at a local grocery store and leaves the house before the children are up so that in the early afternoon she can come home, prepare a meal for her children, and go to a second part time job at a local restaurant. The mother relies on her daughter to put Luke to bed, and to get him up in the morning to take him to his daycare before she goes to school. The daycare staff referred Luke to a state agency because he is delayed in his motor skills, is clumsy, and does not interact well with the other children. Sarah does not quite know where to start. She questions whether Luke has signs of autism spectrum disorder (ASD) and/or a coordination problem or is just tired and hungry. She wonders whether, because the family is stressed, Luke does not receive sufficient care and support at home.

Facing multifaceted cases, such as the foregoing example, is a common dilemma encountered by health care workers in the present health care environment. With increasing complexity of service delivery, several aspects need to be considered: the needs of the child and family, the socioeconomic status affecting available funding for intervention, and the research evidence available to support the use of the specific interventions chosen to ameliorate the child’s problems. Furthermore, when assessing the child and the family needs, the practitioner must consider the relationships among the diagnosis, the functional limitations, and the child’s participation in home, school, and community.

This book is written for pediatric clinicians with intermediate levels of experience treating clients where there are multiple factors to consider. The primary focus is on the application of the Reasoning in Action Model (RAM, Chapter 2) to a variety of diagnoses. The model incorporates the challenges of service delivery, family and child goals, and participation issues. The book also focuses on the sensory integration approach, one of the most fundamental interventions in pediatrics, and its combination with other approaches using evidence-based clinical practice and applicable research findings. Informing each chapter is terminology associated with the International Classification of Function, Disability and Health: Children and Youth version (ICF-CY), an inclusive international framework useful in characterizing pediatric health conditions across many dimensions and in various contexts. The ICF-CY is used to classify the function and health of the developing child, and to describe the impact of context on some of the most common pediatric health conditions (World Health Organization, 2007) as presented herein and as seen by therapists.

The choices of relevant intervention models depend upon how and to what degree the child’s health condition has impacted functioning at home, in school, and in the community. For example, a practitioner cannot choose to utilize sensory integration as traditionally described when addressing the needs of a child with cerebral palsy. Alternatively, a practitioner cannot focus solely on sensory processing when intervening with a child with ASD. In the case of a child with cerebral palsy, the child’s fine and gross motor difficulties require the inclusion of neuromotor approaches. Possible intervention strategies could include sensory strategies developed within a sensory integration approach and positioning strategies developed within a biomechanical approach. In the case of a child with ASD, it is likely the clinician will also need to include behavioral strategies thus incorporating a behavioral approach within the intervention plan. These strategies need to optimize participation of the child in the family’s daily living context; therefore, the positioning devices, and behavioral and sensory strategies, respectively, need to be practical for parent/guardian implementation. Furthermore, practitioners’ intervention schedule will be dictated by the health care delivery or educational system in which they practice. For example, to promote self-determination, the school practitioner would collaborate with the student and the educational team to ensure that appropriate supports are embedded throughout the school routine, including recess and lunch time. A practitioner in an outpatient facility might provide direct intervention to a child once or twice a week, while supplementing it with a therapeutic program for the family to incorporate at home. In summary, the complexity of current practice requires threading together multiple pieces to provide the most comprehensive interventions using the most relevant and available options (See Figure 1.1).

Figure 1.1Multiple Influences on Daily Clinical Practice

The Pieces of the Whole

Sensory integration treatment (SIT) is one of the most utilized evidence-based approaches in pediatric practice (Monez et al., 2019) and the most commonly researched individualized (and singular) intervention. However, current literature supports the use of multiple frames of reference in daily treatment planning, either theoretically (Reynolds et al., 2017), through research that combines sensory integration with other approaches (Blanche et al., 2016; Schoen et al., 2018), or through the combination of multiple approaches in the conceptualization of randomized intervention studies with a variety of populations (Prizant et al., 2003; Rogers et al., 2012). Combining different approaches with sensory integration principles also requires consideration of the socioeconomic environment dictating practice, the family’s needs, and the best available evidence.

Socioeconomic Environment and Funding

We navigate a range of different political systems and an ever-changing global environment, as highlighted by the occurrence of the unprecedented, international pandemic, COVID-19 in 2020. The pandemic drastically impacted health care and the global economy. Such pivotal events influence everyday life, which dictate and dominate not only health care delivery models, but the ability of people in various socioeconomic brackets to readily access them. In the case of COVID-19, many settings transitioned from traditional health care, where therapists provided direct face-to-face services, to telehealth when it was possible and appropriate.

Other and more traditional shifts prompting changes in health care have included ongoing changes in funding priorities and an ongoing need for research evidence to guide clinical practice. However, the overarching issue has been specific to several international initiatives highlighted by the World Health Organization’s (WHO) introduction of the ICF (2001) and the ICF-CY (2007), two international frameworks designed to guide health care practice and research for adults and children while accounting for all aspects of function across various contexts.

International Trends

In the last 30 years of health care, two major models of disablement emerged to guide clinical practice: the medical model and the social model. For many years the medical model, the primary model for health care, focused on pathology and examining the causes of impairments leading to disability. The medical model of disablement reflects a treatment approach focused on the body (i.e., muscle shortening) impairment level, and clinical intervention (muscle elongation and stretching) focused on improving dysfunction. However, a competing model, the social model of disablement, views disability as a composite of factors and conditions, many of which are caused by society and act as barriers to the individual’s participation in society.

Clinically, the medical model impacts the selection of interventions that are focused on the impairment level, along with the lessening of impairments and concomitant functional limitations. On the other hand, the social model prioritizes the need for social interventions to enable all persons to participate in society regardless of their disabilities. While the medical and social models both highlight different aspects of the ability-disability continuum, neither fully captures a person’s capabilities and, their health and participation in society. However, the ICF and the ICF-CY (WHO’s approach for measuring health and disability), does capture both for adults and children. Endorsed by WHO in 2001, the I...