Clinical Reasoning Model for Intervention for Praxis
This model simplifies the complex information on praxis and aims to guide clinical reasoning of practitioners who adapt sensory integrative approach. It lists three levels of theoretical considerations and specifies the neural processes, systems, and outcome functions associated. The three levels and the components are: foundation components (sensory modulation skills, sensory discrimination skills, sequencing/rhythmicity), praxis components (ideation, motor planning, execution/motor coordination, feedback) and end product components (problem solving, sequencing/organization). Intervention considerations are also presented for each of the component, with the types of adaptive responses expected and the recommended types of intervention approaches for each component. This model adapts a sensory integration frame of reference, involving understanding of the theoretical foundations of praxis, underlying sensory systems supporting each component of praxis, and available intervention approaches and their expected outcomes.
Sensory processing disorder
Domain of occupation
It emphasizes that the fundament of intervention for praxis is the ability to elicit adaptive responses to environmental demands.
May-Benson, T.A. (2004). Praxis is more than just motor planning: Clinical reasoning for understanding intervention for praxis. OT Practice, 9(18), CE1-CE7.
The Sensory Integration (SI) frame of reference focuses on how the interaction between the sensory systems including auditory, vestibular, proprioceptive, tactile, and visual systems, provides integrated information that contributes to a child’s learning and adaptive behaviors. The key consideration is that children have the abilities to make adaptive responses to constantly changing sensory environments. The sensory integrative abilities include sensory modulation, sensory discrimination, postural-ocular control, praxis, bilateral integration, and sequencing.
The Biomechanical frame of reference for positioning children for function is applied to individuals who are unable to maintain posture from appropriate automatic muscle activity caused by neuromuscular or musculoskeletal dysfunction. The goals of this frame of reference are (1) to enhance development of postural reactions, which can be done by reducing the demands of gravity and aligning the body, and (2) to improve functional performance by providing external support for proximal stability to improve distal function.
The clinical reasoning framework aims to guide practitioners in selecting strategies in approaching sensory challenges in order to optimize participation of children with autism spectrum disorder. Several clinical reasoning considerations are based on this framework, and these include research evidence, client- and family-centeredness, practice contexts, occupation-centeredness, and risks. This framework emphasizes on the use of mutual information-sharing and coaching to empower families or teachers and develop their own solutions to supporting children’s participation.
Sensory Integration Theory aims to explain behaviors, plan intervention, and predict behavioral change through intervention, and provide specific intervention strategies to remediate the underlying sensory issues that affect functional performance. It purposes therapeutic interventions that incorporate sensation to affect multi-sensory perception to influence learning and behavior, as the central nervous system does not process sensory information in isolation.