The Grind: EBP Systematic Review of the strength of sensory techniques and modifications

In my day to day practice, I am constantly integrating sensory-based interventions.  Many of the students with whom I directly work are preschoolers on the autism spectrum.  I am lucky enough to have an actual treatment room with a ball pit, a doorway platform swing (linear only), a trampoline, tunnels, stairs, balance beams, and a steamroller.  I even purchased light covers to soften fluorescent lighting.  And I use the heck out of this space.  I love watching my students' motor planning evolve so that they freely move and engage through the obstacle courses, vocalize, socialize, and participate in later tasks.  My practiced-based evidence, the results of my sessions and its impact on my students' functioning, supported the continued use of these sensory-based techniques.  But I wanted to know more: What does the research say?

Back to the Grind

Well, Bodison and Parham (2018) published a systematic review that reviewed over 11,000 studies from 2007 to 2015.  Only 8 (out of 11,000!!!!!!!!!) met the inclusion criteria of studies that were peer reviewed, in English, had pre and post-testing related to sensory functioning, and the outcome measures of the impact of sensory techniques and environmental modification on a child's function and participation in daily activities, not just physiological changes noted in a lab.  The included studies focused on the following intervention:

• Qigong Massage
• Weighted Vests
• Slow Linear Swinging
• Sensory Enriched Preschool
• Sensory Environment Modifications

Nitty Gritty

• Qigong Massage has been effective in infant and preschool-aged development and behavior, ***when the occupational therapist has extensive training
• There is limited evidence for use weighted vests with kiddos ADHD; using weighted vests for children with ASD was not recommended due to the lack of evidence
• Slow linear swinging may or may not improve on-task behaviors for children on the spectrum; it is dependent on arousal level
• There is insufficient evidence that embedding sensory rich activities into the preschool classroom improves development over a typical preschool setting
• Other techniques like Wilbarger Brushing Protocols, therapy ball, sensory diets, and sensory listening systems were excluded because the quality of the studies out there were low on the evidence totem pole
• Reducing lighting and sound, paired with a weighted blanket helped children participate in dental cleanings

What do the findings mean to me?

• If I were an early intervention or hospital based therapist, I would consider going for training in Qigong Massage.  But it would be at least 50 hours of training, which is a huge commitment.
• Weighted vests.  How many of us have weighted vests in our closets? Evidence is limited.  Though it is in my tool box, I would try other interventions first before implementing one of these.
• Linear swinging.  Know the reason for using the swing before using. Is it for play and language, reward, balance and strength, or regulation?
• Preschool.  Definitely need more thought and research here.  I have seen a lot, working public preschool for nearly 12 years. Each teacher sets up his or her room differently.  They use different materials, different approaches.  The children, usually between 3-5 years old, are mixed in skill and developmental level.  Collaboration levels and comfort with service providers are all cogs in the multifaceted machine of the the day.  I work with the kids in and out of the classroom to see what may work and how it could be incorporated into the daily routine with the goal that the child can learn to self regulate in his or her natural environment.  And with the push for push-in services, consultation, and modifications, more experience and studies are needed to figure out what is best practice.
• Read up on the other techniques before using them!
• Yes, more research is needed to generalize to a classroom, but it is worth educating teachers and staff to environmental modifications that can help students with ASD.

During my EBP courses I had coincidentally gone through quite a few, if not most of the studies highlighted by Bodison and Parham.  For me, I will continue to use sensory-based interventions as part of treatment for children with sensory dysfunction, but I plan on making more of an effort of keeping better data to see if my practice-based evidence is improving function and on-task behaviors.  

Bodison, S. C. & Parham, L. D. (2018). Specific sensory techniques and sensory environmental modification for children and your thaw sensory integration difficulties. A systematic review. American Journal of Occupational Therapy, 72, 7201190040. https://doi.org/10.5014/ajot.2018.029413