Complementary, holistic, and integrative medicine: sensory integration.

The maturation and organization of the brain is essential for the progress of human development. A. Jean Ayres first proposed a model of human development in the 1960s that she termed “sensory integration” (SI). (1)(2) According to Ayres’ theory, SI occurs under the dynamic influenceof sensory inputs: gravitational, tactile, proprioceptive, vestibular, visual, and auditory sensations. This process, which begins in the womb, allows for the development of adaptive responses that, in turn, lay the foundation for more complex skills such as language, emotional regulation, and computation. (1)(2) Inefficiencies at more basic levels lead to difficulties in higher areas. (3)According to proponents, sensory integration dysfunction (SID) can manifest as a broad range of developmental and behavioral difficulties. (4) Some estimate that 5% to 10% of the general pediatric population and 40% to 88% of children who have disabilities suffer from SID. (3)(4) Since its introduction, SI theory has attracted many supporters. SI-based therapy subsequently developed out of this theory and is practiced by trained therapists, particularly occupational therapists. (5) The SI Special Interest Section of the American Occupational Therapy Association reported 12,000 members in 2006. More than 50% of occupational therapists identifying themselves as working primarily with children rated SI as a primary or secondary practice focus. (3) This support is not universal, andmost physicians are either unfamiliar with the concept or reject SID as a diagnostic entity. Indeed, considerable debate exists among individuals and disciplines as to the existence of SID as a condition. Despite this lack of agreement, pediatricians often see treatments based on SI theory in the multidisciplinary treatment plans of children who have autism, attention-deficit/hyperactivity disorder,mooddisorders, andother conditions. Therefore, they should have an understanding of the construct. Therapy is designed to guide controlled sensory inputs from activities rich in tactile, vestibular, and proprioceptive sensations. Treatment is highly individualized but guided by key principles (Table). (5)(6) A wide variety of equipment is used, including swings, ball pits, scooter boards, bolster swings, rope ladders, pillows, and vestibulator swings. (7) According to SI theory, SID is a potentially reversible disorganization of the central nervous system rather than a disease process or brain damage. (1)(2) The goal, then, is not to teach skills, but to facilitate organization of the brain so it may learn effectively from the environment. Thus, higher-level skills naturally follow on the sound foundation gained from therapy. (5) In 2007,Miller and associates (8) published a new classification scheme for SID in hopes of enhancing diagnostic specificity and improving the quality of research on the topic. This system categorizes the consideration of SI into specific elements: sensory integration theory (discussed previously), sensory processing disorder (SPD), and sensory integration treatment. This classification separates the theoretical foundation from the disorder and the condition from the treatment. SPD is subdivided further into three specific patterns: sensory modulation disorder (SMD), sensory discrimination disorder (SDD), and sensorybased motor disability. These patterns are categorized into types. SMD is subdivided into overresponsive, underresponsive, and sensory seeking/craving subtypes. SDDhas no subtypes. Sensorybased motor disability is subdivided into postural disorder and dyspraxia. Using this framework, SPD has been included in the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood Revised, the Diagnostic