Effectiveness of sensory integration therapy in children,focusing on Korean children:A systematic review and meta-analysis

BACKGROUND Sensory 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.AIM To 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.METHODS The 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”,“Sensorymotor”,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”,“Sensorymotor”,and“Sensory stimulation”were used in this search.Then,a meta-analysis was conducted on 24 selected studies.RESULTS Sensory 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.CONCLUSION The 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.

Play therapy in children with autism:Its role,implications,and limitations

Play is a pleasurable physical or mental activity that enhances the child’s skills involving negotiation abilities,problem-solving,manual dexterity,sharing,decision-making,and working in a group.Play affects all the brain's areas,structures,and functions.Children with autism have adaptive behavior,adaptive response,and social interaction limitations.This review explores the different applications of play therapy in helping children with autism disorder.Play is usually significantly impaired in children with autism.Play therapy is mainly intended to help children to honor their unique mental abilities and developmental levels.The main aim of play therapy is to prevent or solve psychosocial difficulties and achieve optimal child-healthy growth and development.Play therapy helps children with autism to engage in play activities of their interest and choice to express themselves in the most comfortable ways.It changes their way of self-expression from unwanted behaviors to more non-injurious expressive behavior using toys or activities of their choice as their words.Play therapy also helps those children to experience feeling out various interaction styles.Every child with autism is unique and responds differently.Therefore,different types of intervention,like play therapy,could fit the differences in children with autism.Proper evaluation of the child is mandatory to evaluate which type fits the child more than the others.This narrative review revised the different types of play therapy that could fit children with autism in an evidence-based way.Despite weak evidence,play therapy still has potential benefits for patients and their families.

Multimodal integrated intervention for children with attentiondeficit/hyperactivity disorder

BACKGROUND Attention-deficit/hyperactivity disorder(ADHD)is one of the most common disorders in child and adolescent psychiatry,with a prevalence of more than 5%.Despite extensive research on ADHD in the last 10 to 20 years,effective treatments are still lacking.Instead,the concept of ADHD seems to have become broader and more heterogeneous.Therefore,the diagnosis and treatment of ADHD remains challenging for clinicians.AIM To investigate the effects of a multimodal integrated intervention for children with ADHD.METHODS Between March 2019 and September 2020,a total of 100 children with ADHD who were diagnosed and treated at our hospital were assessed for eligibility,two of whom revoked their consent.A case-control study was conducted in which the children were equally assigned,using a randomized number table,to either a medication group(methylphenidate hydrochloride extended-release tablets and atomoxetine hydrochloride tablets)or a multimodal integrated intervention group(medication+parent training+behavior modification+sensory integration therapy+sand tray therapy),with 49 patients in each group.The clinical endpoint was the efficacy of the different intervention modalities.RESULTS The two groups of children with ADHD had comparable patient characteristics(P>0.05).Multimodal integrated intervention resulted in a significantly higher treatment efficacy(91.84%)than medication alone(75.51%)(P<0.05).Children who received the multimodal integrated intervention showed lower scores in the Conners Parent Symptom Questionnaire and the Weiss Functional Impairment Rating Scale than those treated with medication alone(P<0.05).The Sensory Integration Scale scores of children in the multimodal integrated intervention group were higher than those of children in the medication group(P<0.05).Children who received the multimodal integrated intervention had higher compliance and family satisfaction and a lower incidence of adverse events than those treated with medication alone(P<0.05).CONCLUSION Multimodal integrated intervention effectively alleviated symptoms associated with ADHD in children.It enhanced their memory and attention with high safety and parental satisfaction,demonstrating good potential for clinical promotion.

Multisensory Conflict Impairs Cortico-Muscular Network Connectivity and Postural Stability: Insights from Partial Directed Coherence Analysis

Sensory conflict impacts postural control,yet its effect on cortico-muscular interaction remains underexplored.We aimed to investigate sensory conflict's influence on the cortico-muscular network and postural stability.We used a rotating platform and virtual reality to present subjects with congruent and incongruent sensory input,recorded EEG(electroencephalogram)and EMG(electromyogram)data,and constructed a directed connectivity network.The results suggest that,compared to sensory congruence,during sensory conflict:(1)connectivity among the sensorimotor,visual,and posterior parietal cortex generally decreases,(2)cortical control over the muscles is weakened,(3)feedback from muscles to the cortex is strengthened,and(4)the range of body sway increases and its complexity decreases.These results underline the intricate effects of sensory conflict on cortico-muscular networks.During the sensory conflict,the brain adaptively decreases the integration of conflicting information.Without this integrated information,cortical control over muscles may be lessened,whereas the muscle feedback may be enhanced in compensation.

Modulation of the assay system for the sensory integration of 2 sensory stimuli that inhibit each other in nematode Caenorhabditis elegans

Objective To perform the modulation of an assay system for the sensory integration of 2 sensory stimuli that inhibit each other.Methods The assay system for assessing the integrative response to 2 reciprocally-inhibitory sensory stimuli was modulated by changing the metal ion barrier.Moreover,the hen-1,ttx-3 and casy-1 mutants having known defects in integrative response were used to evaluate the modulated assay systems.Based on the examined assay systems,new genes possibly involved in the sensory integration control were identified.Results In the presence of different metal ion barriers and diacetyl,locomotion behaviors,basic movements,pan-neuronal,cholinergic and GABAergic neuronal GFP expressions,neuronal development,structures of sensory neurons and interneurons,and stress response of nematodes in different regions of examined assay systems were normal,and chemotaxis toward different concentrations of diacetyl and avoidance of different concentrations of metal ions were inhibited.In the first group,most of the nematodes moved to diacetyl by crossing the barrier of Fe2＋,Zn2＋,or Mn2＋.In the second group,almost half of the nematodes moved to diacetyl by crossing the barrier of Ag＋,Cu2＋,Cr2＋,or Cd2＋.In the third group,only a small number of nematodes moved to diacetyl by crossing the barrier of Pb2＋ or Hg2＋.Moreover,when nematodes encountered different metal ion barriers during migration toward diacetyl,the percentage of nematodes moving back and then turning and that of nematodes moving straight to diacetyl were very different.With the aid of examined assay systems,it was found that mutations of fsn-1 that encodes a F-box protein,and its target scd-2 that encodes a receptor tyrosine kinase,caused severe defects in integrative response,and the sensory integration defects of fsn-1 mutants were obviously inhibited by scd-2 mutation.Conclusion Based on the nematode behaviors in examined assay systems,3 groups of assay systems were obtained.The first group may be helpful in evaluating or identifying the very subtle deficits in sensory integration,and the third group may be useful for the final confirmation of sensory integration defects of mutants identified in the first or the second group of assay systems.Furthermore,the important association of sensory integration regulation with stabilization or destabilization of synaptic differentiation may exist in C.elegans.

Postural control and sensory information integration abilities of boys with two subtypes of attention deficit hyperactivity disorder： a case-control study

Background Attention deficit hyperactivity disorder （ADHD） is one of the most commonly diagnosed psychiatric disorder in childhood. ADHD children with overlapping symptoms and signs of motor problems have more serious prognosis than that of children with ADHD only. However, the motor and sensory processing problems in children with ADHD have not been studied well. Few people adopt the technique of computerized dynamic posturography （CDP） in the study of ADHD, which is applied widely in clinical and laboratory research to objectively evaluate human＇s balance performance. This study aimed to assess the characteristics of postural control and sensory information processing of boys with two subtypes of ADHD by using CDP, so as to provide the proof for non-drug therapy of ADHD. Method From June 2003 to September 2004, a total of 73 boys （7-15 years of age） with ADHD and 73 normal developing boys matched by age and intelligence quotient from Peking University Institute of Mental Health were recruited in the study. The Sensory Organization Test was adopted to test the static balance performance under six sensory input conditions by SMART EquiTest 8.0 （NeuroCom） instrument. The sensory information from three sensory systems were available under condition 1, the visual inputs were removed or distorted under condition 2 or 3, the somatosensory inputs were in conflict with or without the visual inputs removed under condition 4 or 5, and both the visual and somatosensory inputs were in conflict under condition 6. The indexes of equilibrium score, somatosensory, vestibular, and visual ratios, and strategy scores were analyzed to indicate the subjects＇ postural control ability. Results ADHD boys had significantly lower composite equilibrium score （CES） than the normal group （P 〈0.05）. Under condition 1 and conditions 3-6, the equilibrium scores （ES） of the ADHD group were significantly lower （all P 〈0.05） than those of the control. Significantly lower visual and vestibular ratios and strategy scores under conditions 4-6 were found in boys with ADHD compared with the control group （P 〈0.05）. Boys of ADHD-predominantly inattentive （ADHD-I） type had a significantly lower CES and ES under conditions 4-6 than the controls （all P 〈0.05） while the ESs of ADHD-combined type （ADHD-C） boys under each condition were similar with that of boys with ADHD-I and no significant difference was found between boys with ADHD-C and the control group （all P 〉0.05）. Compared with the control group, the ADHD-I boys showed significantly lower visual and vestibular ratios and strategy scores under conditions 4-6 whereas the ADHD-C boys showed a trend of lower visual ratio （all P 〈0.05）. Conclusions ADHD boys had a poorer static postural control ability and impaired function of processing visual and vestibular information compared with the normal control. Boys with ADHD-I showed particularly severe defect of static postural control and vestibular function integrating conflict information than normal boys. These deficits may be an important contributor to the clinical presentation of ADHD children and their cognitive deficits. Assessment and training of postural control function would be suggested during the diagnosis and treatment of ADHD children.

Insulin-like signaling pathway functions in integrative response to an olfactory and a gustatory stimuli in Caenorhabditis elegans

Animals integrate various environmental stimuli within the nervous system to generate proper behavioral responses.However,the underlying neural circuits and molecular mechanisms are largely unknown.The insulinlike signaling pathway is known to regulate dauer formation,fat metabolism,and longevity in Caenorhabditis elegans(C.elegans).Here,we show that this highly conserved signaling pathway also functions in the integrative response to an olfactory diacetyl and a gustatory Cu^(2+) stimuli.Worms of wild-type N2 Bristol displayed a strong avoidance to the Cu^(2+) barrier in the migration pathway to the attractive diacetyl.Mutants of daf-2(insulin receptor),daf-18(PTEN lipid phosphatase),pdk-1(phosphoinositide-dependent kinase),akt-1/-2(Akt/PKB kinase)and sgk-1(serum-and glucocorticoidinducible kinase)show severe defects in the elusion from the Cu^(2+) .Mutations in DAF-16,a forkhead-type transcriptional factor,suppress the integrative defects of daf-2 and akt-1/-2 mutants.We further report that neither cGMP nor TGFβpathways,two other dauer formation regulators,likely plays a role in the integrative learning.These results suggest that the insulin-like signaling pathway constitutes an essential component for sensory integration and decision-making behavior plasticity.