Wednesday, October 31, 2007

Sensory issues are not really that confusing, if we would only stop confusing them ourselves

People are easily confused whenever someone talks about sensory integration or sensory processing, mostly because of confusing messages that are sent by occupational therapists regarding these issues.

Confusion is evident in the public but it is also interesting evident among occupational therapists and researchers as well. There have been some recent efforts to address this confusion by initiating conversation about 'fidelity' in sensory integration research. This means that when someone claims that a study is about sensory integration that it REALLY is about sensory integration. I encourage people to look at the Sensory Integration Global Network website; it has a lot of good information that helps to clearly define the concept of sensory integration.

However, it is also important to understand that sensory integration research is not equivalent to occupational therapy research. Evidence supporting or refuting a sensory integration approach is NOT the same as evidence supporting or refuting occupational therapy intervention. Children improve function through a variety of therapeutic methods: direct trial practice and training, training in motor control, training in visual perceptual and visual motor skills, and by providing adaptations to the task or the environment. Sensory integration is only one small intervention method. Perhaps this concept is sometimes forgotten.

Occupational therapists need to stay 'on message' when it comes to representing sensory integration methods or other methods of intervention. An example of recent confusion is in the Advance for Occupational Therapy Practitioners magazine in the article Math and Science. Compare this article and the accompanying tables to the SIGN websites fidelity check-off. If we as professionals can't listen to ourselves regarding the fidelity issue, how can we ever hope to elucidate the nature of these difficulties for others?

Wednesday, October 10, 2007

Is Brain Gym Effective?

I frequently get email from people asking me about Brain Gym, so I thought I would post one of the emails here. Identifying details have been changed but the letter is essentially intact as written:


Dear Chris,

My son is 11 years old and in the 6th grade. He has Neurofibromatosis Type 1 which is a neurological disorder that affects his entire nervous system. He has Apraxia of Speech, ADHD, auditory processing issues and learning disabilities. We took him for a speech eval and they suggested sensory integration therapy. This summer, based on recommendations from our speech therapist who is GREAT and one of the few people who have actually been trained to treat Apraxia, we began OT with couple of therapists who do sensory integration therapy and are very much into Brain Gym.

I’m really starting to question whether Brain Gym is effective for us. We’ve only gone a couple of months, but I really don’t see any improvements. My child is social, independent and making progress…he is in a mainstream classroom at school and the special education teachers come into the class to work with him. His handwriting is horrible, he still doesn’t hold a spoon correctly, he can’t button on his own - he has a difficult time with coordination. I’m just trying to get some guidance on the type of therapy he really needs.

We do different exercises every week, but it seems like we should be “practicing” skills more. When I google “Brain Gym” all of the articles rave about it. However, it appears that most of them are written by therapists who use it in their therapies or by people doing training. Any advice? Thanks!

++++++++++++++++++++++++++++++++++++++++++++++++

Dear Parent,

Thanks for writing.

I have mentioned Brain Gym in my blog in the past and my basic opinion is that Brain Gym is pseudoscientific, unresearched, and experimental.

I am concerned about the claims made on their website. They state that their programs will help you "Learn ANYTHING faster and more easily" and other grandiose claims. According to the website, Brain Gym supposedly helps with outrigger canoe paddling, knitting, public speaking, transcribing tapes in criminal investigations, and overcoming learning challenges. (see http://www.braingym.org/users)

They have what they call a 'research packet' but the vast majority of the articles there are "published" in the 'Brain Gym Journal' which hardly qualifies as a respected, unbiased, peer-reviewed journal. There are a few other articles in there that are published in foreign languages so it is not possible to really evaluate their quality.

I would recommend that you focus your therapy efforts on functional skills training. If your child has difficulty holding a spoon correctly or writing neatly there are some very specific methods that can be used to help. Direct trial practice, correction, and positive reinforcement can go a long way to developing functional living skills. Adaptive methods may also be used if needed.

In addition to the functional skills training the occupational therapist can work on the underlying problems with motor coordination, but I would suggest methods that have what we call "FACE VALIDITY." This means that the intervention "looks like" it is going to address what it is supposed to address. For example, activities to address motor coordination should "look like" ball and target games, fine motor exercises, obstacle courses, etc. This is a good way for parents to assess therapy and I would encourage parents to ASK the therapist the purpose and intent of interventions that don't LOOK LIKE they address the problem.

Parents then need to appraise what the therapist tells them - do some internet research, talk to others, and see if there is evidence to support the intervention. Most importantly, if you are not getting results, talk to the therapist about changing their methods.

Best of luck,

Chris

EDIT 6/29/09 - fixed broken link! http://www.braingym.org/users