Occupational therapy using a sensory integration

2089 – Multidisciplinary Approach Of Children With Cerebral Palsy And Mental Retardation In Our Clinic

Faces that move contain rich information about facial form, such as facial features and their configuration, alongside the motion of those features. During social interactions, humans constantly decode and integrate these cues. To fully understand human face perception, it is important to investigate what information dynamic faces convey and how the human visual system extracts and processes information from this visual input. However, partly due to the difficulty of designing well-controlled dynamic face stimuli, many face perception studies still rely on static faces as stimuli. Here, we focus on evidence demonstrating the usefulness of dynamic faces as stimuli, and evaluate different types of dynamic face stimuli to study face perception. Studies based on dynamic face stimuli revealed a high sensitivity of the human visual system to natural facial motion and consistently reported dynamic advantages when static face information is insufficient for the task. These findings support the hypothesis that the human perceptual system integrates sensory cues for robust perception. In the present paper, we review the different types of dynamic face stimuli used in these studies, and assess their usefulness for several research questions. Natural videos of faces are ecological stimuli but provide limited control of facial form and motion. Point-light faces allow for good control of facial motion but are highly unnatural. Image-based morphing is a way to achieve control over facial motion while preserving the natural facial form. Synthetic facial animations allow separation of facial form and motion to study aspects such as identity-from-motion. While synthetic faces are less natural than videos of faces, recent advances in photo-realistic rendering may close this gap and provide naturalistic stimuli with full control over facial motion. We believe that many open questions, such as what dynamic advantages exist beyond emotion and identity recognition and which dynamic aspects drive these advantages, can be addressed adequately with different types of stimuli and will improve our understanding of face perception in more ecological settings.

Chapter 7 - Treatment of Attentional Problems

본 연구는 체계적 고찰을 통하여 뇌성마비 아동에게 적용한 작업치료의 세부적인 치료 방법과 치료 효과를 알아보고자 하였다. 연구대상논문은 2003년 1월부터 2012년 12월까지 출판된 논문이었고, 전자데이터 베이스인 PubMed를 이용하여 검색하였으며, 사용한 검색어는 'occupational therapy' OR 'exercise therapy' OR 'activities of daily living' OR 'splints' OR 'self-help devices' OR 'early intervention(education)' OR 'parents/education' OR 'parents/psychology' OR 'professional family relations' OR 'play and playthings' OR 'upper extremity' AND 'cerebral palsy'이었다. 분석대상논문은 총 18개이었다. 뇌성마비 아동에게 적용한 작업치료 방법은 보조기 26.2%, 부모교육 26.2%, 환경조정 9.6%, 감각운동기능 훈련 19.0%, 일상생활활동 19.0%로 나타났다. 뇌성마비 아동에게 적용한 작업치료의 효과는 보조기 40.0%, 부모교육 42.9%, 환경조정 40.0%에서 통계학적으로 유의하였다. 본 연구의 결과는 뇌성마비 아동의 작업치료에 있어서 근거를 마련하는데 중요한 자료가 될 것이다. The purpose of this study was to present results and methods of occupational therapy for children with cerebral palsy using systematic review. This study was searched form papers published from Jan, 2003 to Dec, 2012 using PubMed E-Data base. Key words using on the search were 'occupational therapy' OR 'exercise therapy' OR 'activities of daily living' OR 'splints' OR 'self-help devices' OR 'early intervention(education)' OR 'parents/education' OR 'parents/psychology' OR 'professional family relations' OR 'play and playthings' OR 'upper extremity' AND 'cerebral palsy'. Eighteen studies were included in this review. Methods on occupational therapy for children with cerebral palsy were splint 26.2%, parent education 26.2%, environmental modification 9.6%, training of sensorimotor function 19.0%, activities of daily living 19.0%. Results on occupational therapy for children with cerebral palsy were significant difference on splint 40.0%, parent education 42.9%, environmental modification 40.0%. Results of this study will provide evidences based on occupational therapy.

Lorna Jean King is interviewed concerning the present status of sensory integration as a treatment modality in the area of mental health. Topics covered are: use of sensory integration techniques with adults and adolescents in both chronic and acute mental health settings; goals and expected outcomes of using sensory integration techniques; cost-effectiveness of these techniques; differences between occupational therapy and other professions utilizing similar treatment modalities and useful assessments or evaluations in mental health.

The article is devoted to highlighting the features of sensory integration manifestation in childhood and its significance for the holistic development of the child. This includes uncovering the characteristics and patterns of mental development during childhood, describing the main stages of sensory integration development in ontogenesis, and examining sensory integration disorders and the application of sensory integrative therapy with children. A review of foreign and domestic literature on the research problem has shown that there is a growing interest in sensory integration in modern psychology as the foundation for a child's holistic development. Sensory integration is a process occurring in the brain that organizes information received through the senses (vision, hearing, touch, smell, taste), gives meaning to these sensations by filtering information, selecting what to focus on, and enabling us to act and react thoughtfully to the situation we are in. It also forms the basis for theoretical learning and social behavior. The harmonious development of a child depends on the coordinated functioning of all sensory systems. The article explores the features and patterns of mental development in childhood, such as heterochrony, asynchrony, staging, differentiation, and integration of mental processes and properties, as well as changes in the determinants of mental development and plasticity. The main stages of sensory integration development in ontogenesis are also examined. The importance of the sensory-perceptual sphere in a child’s development is underscored, as sensory development is the foundation of a child’s intellectual growth. Sensory development involves the development of sensations and perceptions, as well as the understanding of objects' forms, colors, sizes, and spatial locations, as well as the objects and phenomena of the surrounding world. Perception is formed based on the synthesis of various sensations: visual, auditory, tactile, kinesthetic, olfactory, and others. Perception reflects the objectivity, integrity, structure, constancy of objects, and others. Early childhood is the most favorable period for the improvement of sensory organ functions and the accumulation of representations about the surrounding world. Knowledge of the surrounding reality in children begins with the analysis of information received through touch, visual observation, sounds, smells, various tastes, and so on. It has been established that childhood plays a crucial role in sensory integration, as a child organizes not only visual and auditory sensations but also the sensations of their own body and the force of gravity, which contributes to the child’s holistic development. A significant portion of a child’s learning ability lies in their ability to integrate sensory information, as learning depends on the ability to perceive and process sensations from their movements and external influences and to use this information for planning and organizing behavior. It has been found that sensory integration facilitates the development of motor skills, movement coordination, spatial orientation, and visual and auditory perception, particularly by filtering and organizing information to help the child focus on solving specific tasks. Moreover, sensory integration contributes to the development of cognitive mental processes: attention, memory, thinking, and speech. Sensory integration also enhances a child's adaptation to the environment, social interaction, communication, and the formation of independence and curiosity in the child. Sensory integration disorders (hyposensitivity and hypersensitivity of sensory systems) have been analyzed, and the main principles of sensory-integrative therapy with children have been outlined. Children with reduced sensory processing abilities often experience difficulties in carrying out voluntary actions, which in turn can affect learning and behavior. Therefore, sensory-integrated therapy aimed at developing and integrating sensations contributes to improving the child’s learning and behavior. In conclusion, sensory integration is of great importance for child development.

Purpose The Cerebral Palsy quality of life instrument is a well-known health-related quality of life measure for children with Cerebral Palsy. Due to its length it is not suitable as the basis of a preference-based instrument. The aim of this study is to develop a short version of the Cerebral Palsy quality of life instrument that can subsequently be scored as a multi-attribute utility instrument through assigning preference-based values. Methods A sample of 473 participants who have a child with Cerebral Palsy completed the Cerebral Palsy quality of life instrument(proxy-version) instrument. After deleting questions related only to the proxy, the dimensional structure was obtained using exploratory factor analysis. Extended Rasch analysis was then undertaken to test the psychometric performance of items and select the best item to represent each dimension. Expert opinion was sought to confirm the dimensions and items. Results A six-dimension classification system was identified, in which four domains were extracted from the factor analysis. Following expert opinion, two other domains were also added, as these were considered to have significant impact on health-related quality of life in children with Cerebral Palsy. Conclusions The combination of Factor and Rasch analysis along with consultation with patients, clinicians and experts in health-related quality-of-life instrument development, has resulted in a short version of the Cerebral Palsy quality of life instrument. IMPLICATION FOR REHABILITATION This study provides the first classification system for children with Cerebral Palsy. The Cerebral Palsy-six dimension (CP-6D) survey, which is a short version of Cerebral Palsy Quality Of Life instrument, can be timesaving when measuring quality of life in children with Cerebral Palsy. The short version (CP-6D) can be used in preference based measurement and generate quality adjusted life years for children with Cerebral Palsy.

BackgroundCerebral palsy (CP) can cause motor, sensory, perceptual, cognitive, communication and behavioural disorders. The complexity of this condition justifies measuring the quality of life (QOL) of children with CP. This measurement depends on personal and socio-economic factors, hence the relevance of performing it in our cultural context of Tunisia.ObjectivesThe objectives of this study were to assess the QOL of Tunisian children with CP and to identify predictive factors for QOL.MethodA cross-sectional study using a self-administered questionnaire (the CP QOL-Child) was employed. It included 68 children with CP and their parents who consulted the outpatient clinics of Physical Medicine and Rehabilitation of the University Hospital of Sahloul Sousse.ResultsThe QOL of children with CP was altered, and the mean total score for the CP QOL-Child was 59.3 (± 14). All domains were affected by this alteration. Six predictive factors for lowered QOL in children with CP were identified, namely age older than 6 years, swallowing disorders, more intense chronic pain, greater level of motor impairment, the use of botulinum toxin injection and the absence of verbal communication.ConclusionIntervention with children with CP must be mindful of their altered QOL. Five out of the six predictive factors of QOL are modifiable through a multidisciplinary approach within the framework of the International Classification of Functioning, Disability and Health (ICF).ContributionThe multiplicity of the factors associated with QOL revealed by this study incites clinicians to adopt the ICF approach by displaying its practical implications on the efficiency of the medical intervention.

Background: Cerebral palsy (CP) is a neurological motor disability, and children with CP should receive rehabilitation services to achieve their full potential. Objectives: The purpose of this study was to explore the quality of life (QOL) of children with CP across various domains and to assess the role of access to rehabilitation services on their QOL. Methods: We conducted a cross-sectional study involving all 126 children aged 4 - 12 with CP and their parents in Saqqez county, Kurdistan province, Iran. The "Physical Rehabilitation Accessibility Assessment Questionnaire" and the "Parental Proxy CP QOL-Child questionnaire" were used to measure the main variables. The analysis performed separately for two subpopulations: 27 children aged 4 - 6 years and 99 children older than six, using SPSS version 23. After prforming Kolmogorov-Smirnov test, the Spearman correlation coefficient was employed to identify correlations. Results: The average age of the participants was 8 ± 2.36 years, with 51 (40.5%) being girls. Of the 126 children with CP, 45 (35.7%) had independent mobility function (GMFCS levels I and II). The mean CP QOL-Child domain scores ranged from 35.3 ± 25.1 in the 'access to services' domain to 74.5 ± 16.1 in the 'Emotional well-being and self-esteem' domain. The average accessibility score was 53.8 ± 22.1. Among children older than 6 years, access to rehabilitation services showed a significant correlation with all CP QOL-Child domain scores (P < 0.05), except for 'social well-being and acceptance.' In children aged 4 - 6 years, only the Family Health domain score was significantly correlated with access to rehabilitation services (r = 0.44, P = 0.021). Conclusions: Access to rehabilitation services is a significant predictor of QOL in children older than 6 years. Further experimental research is needed to examine changes in various aspects of QOL in children with CP following improved access to rehabilitation services.

This article provides an introduction and overview of sensory integration theory as it is used in occupational therapy practice for children with developmental disabilities. This review of the theoretical tenets of the theory, its historical foundations, and early research provides the reader with a basis for exploring current uses and applications. The key principles of the sensory integrative approach, including concepts such as "the just right challenge" and "the adaptive response" as conceptualized by A. Jean Ayres, the theory's founder, are presented to familiarize the reader with the approach. The state of research in this area is presented, including studies underway to further delineate the subtypes of sensory integrative dysfunction, the neurobiological mechanisms of poor sensory processing, advances in theory development, and the development of a fidelity measure for use in intervention studies. Finally, this article reviews the current state of the evidence to support this approach and suggests that consensual knowledge and empirical research are needed to further elucidate the theory and its utility for a variety of children with developmental disabilities. This is especially critical given the public pressure by parents of children with autism and other developmental disabilities to obtain services and who have anecdotally noted the utility of sensory integration therapy for helping their children function more independently. Key limiting factors to research include lack of funding, paucity of doctorate trained clinicians and researchers in occupational therapy, and the inherent heterogeneity of the population of children affected by sensory integrative dysfunction. A call to action for occupational therapy researchers, funding agencies, and other professions is made to support ongoing efforts and to develop initiatives that will lead to better diagnoses and effective intervention for sensory integrative dysfunction, which will improve the lives of children and their families.

To determine the health-related quality of life in children with cerebral palsy and their families. One hundred children (3-10 years of age) receiving regular rehabilitation therapy for cerebral palsy for last 1 year at a Child Development Centrer were enrolled and the Lifestyle assessment questionnaire - cerebral palsy was administered to the parents. 9% had good, 24% had mildly-affected, 37% had moderately-affected and 30% had severely-affected health-related quality of life. The physical independence, mobility and social integration dimensions were much more severely affected than the clinical burden, economic burden and schooling dimensions. Health-related quality of child is affected in most children with cerebral palsy.

This study aims to evaluate the sensitivity of the speech intelligibility index (SII) to the assumed speech dynamic range (DR) in different languages and with different types of stimuli. Intelligibility prediction uses the absolute transfer function (ATF) to map the SII value to the predicted intelligibility for a given stimuli. To evaluate the sensitivity of the predicted intelligibility to the assumed DR, ATF-transformed SII scores for English (words), Korean (sentences), and Mandarin (sentences) were derived for DRs ranging from 10 dB to 60 dB. Increasing the assumed DR caused steeper ATFs for all languages. However, high correlation coefficients between predicted and measured intelligibility scores were observed for DRs from 20 dB to 60 dB for ATFs in English, Korean, and Mandarin. Results of the present study indicate that the intelligibility computed from the SII is not sensitive to the assumed DR. The 30-dB DR commonly used in computing the SII is thus a reasonable assumption that produces accurate predictions for different languages and different types of stimuli.

Cell-Assembly Coding in Several Memory Processes

BACKGROUNDSensory integration intervention is highly related to the child's effective interaction with the environment and the child's development. Currently, various sensory integration interventions are being applied, but research methodological problems are arising due to unsystematic protocols. This study aims to present the optimal intervention protocol by presenting scientific standards for sensory integration intervention through meta-analysis.AIMTo prove the effectiveness of sensory integration therapy, examine the latest trend of sensory integration studies in Korea, and provide clinical evidence for sensory integration therapies.METHODSThe database of Korean search engines, including RISS, KISS, and DBpia, was used to search for related literature published from 2001 to October 2020. The keywords, “Children”, “Sensory integration”, “Integrated sensory”, “Sensory-motor”, and “Sensory stimulation” were used in this search. Then, a meta-analysis was conducted on 24 selected studiesRISS, KISS, and DBpia, was used to search for related literature published from 2001 to October 2020. The keywords, “Children”, “Sensory integration”, “Integrated sensory”, “Sensory-motor”, and “Sensory stimulation” were used in this search. Then, a meta-analysis was conducted on 24 selected studies.RESULTSSensory integration intervention has been proven effective in children with cerebral palsy, autism spectrum disorder, attention deficit/hyperactivity disorder, developmental disorder, and intellectual disability in relation to the diagnosis of children. Regarding sensory integration therapies, 1:1 individual treatment with a therapist or a therapy session lasting for 40 min was most effective. In terms of dependent variables, sensory integration therapy effectively promoted social skills, adaptive behavior, sensory processing, and gross motor and fine motor skills.CONCLUSIONThe results of this study may be used as therapeutic evidence for sensory integration intervention in the clinical field of occupational therapy for children, and can help to present standards for sensory integration intervention protocols.

Recent evidence suggests that speech substantially changes in ageing. As a complex neurophysiological process, it can accurately reflect changes in the motor and cognitive systems underpinning human speech. Since healthy ageing is not always easily discriminable from early stages of dementia based on cognitive and behavioural hallmarks, speech is explored as a preclinical biomarker of pathological itineraries in old age. A greater and more specific impairment of neuromuscular activation, as well as a specific cognitive and linguistic impairment in dementia, unchain discriminating changes in speech. Yet, there is no consensus on such discriminatory speech parameters, neither on how they should be elicited and assessed. To provide a state-of-the-art on speech parameters that allow for early discrimination between healthy and pathological ageing; the aetiology of these parameters; the effect of the type of experimental stimuli on speech elicitation and the predictive power of different speech parameters; and the most promising methods for speech analysis and their clinical implications. A scoping review methodology is used in accordance with the PRISMA model. Following a systematic search of PubMed, PsycINFO and CINAHL, 24 studies are included and analysed in the review. The results of this review yieldthree key questions for the clinical assessment of speech in ageing. First, acoustic and temporal parameters are more sensitive to changes in pathological ageing and, of these two, temporal variables are more affected bycognitive impairment. Second, different types of stimuli can trigger speech parameters with different degree of accuracy for the discrimination of clinical groups. Tasks with higher cognitive load are more precise in eliciting higher levels of accuracy. Finally, automatic speech analysis for the discrimination of healthy and pathological ageing should be improved for both research and clinical practice. Speech analysis is a promising non-invasive tool for the preclinical screening of healthy and pathological ageing. The main current challenges of speech analysis in ageing are the automatization of its clinical assessment and the consideration of the speaker's cognitive background during evaluation. What is already known on the subject Societal aging goes hand in hand with the rising incidence of ageing-related neurodegenerations, mainly Alzheimer's disease (AD). This is particularly noteworthy in countries with longer life expectancies. Healthy ageing and early stages of AD share a set of cognitive and behavioural characteristics. Since there is no cure for dementias, developing methods for accurate discrimination ofhealthy ageing and early AD is currently a priority. Speech has been described as one of the most significantly impaired features in AD. Neuropathological alterations in motor and cognitive systems would underlie specific speech impairment in dementia. Since speech can be evaluated quickly, non-invasively and inexpensively, its value for the clinical assessment of ageing itineraries may be particularly high. What this paper adds to existing knowledge Theoretical and experimental advances in the assessment of speech as a marker of AD have developed rapidly over the last decade. Yet, they are not always known to clinicians. Furthermore, there is a need to provide an updated state-of-the-art on which speech features are discriminatory to AD, how they can be assessed, what kind of results they can yield, and how such results should be interpreted. This article provides an updated overview of speech profiling, methods of speech measurement and analysis, and the clinical power of speech assessment for early discrimination of AD as the most common cause of dementia. What are the potential or actual clinical implications of this work? This article provides an overview of the predictive potential of different speech parameters in relation to AD cognitive impairment. In addition, it discusses the effect that the cognitive state, the type of elicitation task and the type of assessment method may have on the results of the speech-based analysis in ageing.