Sensory processing interventions

Last update: 8 May 2017

Preliminary research suggests that some children with developmental or behavioural disorders, including cerebral palsy, may have difficulties interpreting what they see, hear, taste, smell, feel and experience1, 2, 3
These sensory processing difficulties can be distressing to the child and prevent them from participating in everyday interactions and activities
Cerebral Palsy Alliance can recommend appropriate therapies to reduce your child’s distress and increase their participation in daily life. We do not recommend sensory processing interventions that try to change rather than support the sensory system. This is due to a lack of reliable research evidence to support its effectiveness.

Who is it for?

Sensory processing interventions are not appropriate for any child with cerebral palsy.

Cerebral Palsy Alliance does not offer sensory processing interventions for children with cerebral palsy. We can, however, suggest and provide other interventions that are appropriate for your child.

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More about sensory processing interventions

Sensory processing interventions are aimed at helping children with developmental and behavioural disorders like autism respond appropriately to the information they receive through their senses.

For these children, difficulty processing sensory information can cause distress and actions like hand flapping and rocking, seeking out or avoiding certain experiences, and other behaviours of concern.

The result is that the child is unable to participate in everyday interactions and activities such as playing games with peers, mealtimes, sleeping, and concentrating on home work and in the classroom1.

Two kinds of sensory processing intervention have been developed:

Sensory integration therapy

This form of intervention is clinic-based and run by trained therapists. In a single session or several times each week, a child plays and undertakes intensive sensory activities that help them learn to process sensory information more effectively in their everyday life2.

Sensory based interventions

The second type is called sensory based intervention and involves embedding therapeutic activities into a child’s daily routine to help them acquire experiences that will enable them to participate in daily activities. Examples include exposing the child to sensory inputs like brushing, massage, swinging, bouncing on a therapy ball, or wearing a weighted vest1,2. Sometimes, when combined, these activities are described as a sensory diet.

It is important to understand that having sensory processing difficulties is different to having a sensory impairment. Some children with cerebral palsy have sensory impairment related to their brain injury. Examples include difficulties feeling light touch, pain, pressure on the skin, temperature, and knowing where their joints and muscles are positioned4.

Best available research evidence

We searched the medical, allied health and education literature to find research evaluating the effects of sensory processing interventions on children with cerebral palsy.

The search aimed to find the best available evidence to identify whether sensory processing interventions can improve behaviour, self-regulation, school performance, independence in completing daily activities and motor skills for a child with cerebral palsy.

We found three studies5-7 evaluating sensory processing interventions in children with cerebral palsy. We concluded that the results of these studies were unreliable due to significant methodological weakness5-6, and a limited description of the participants5-7 and the interventions5-6. We were also unable to identify if the children in the study had sensory processing difficulties5-7. In addition, the studies included non-validated outcome measures5 and inaccuracies in reporting results6-7. Therefore, these articles are not used as evidence to inform this topic.

As there was no usable evidence evaluating the outcomes of sensory processing interventions with children with cerebral palsy, we completed a second search, looking for systematic reviews of sensory processing interventions in other diagnoses in children, published since 2010. We located three systematic reviews, all of which included higher and lower levels of evidence1-2,8. Although, there was some overlap of the studies included in each, the reviews approached sensory processing interventions from differing perspectives. We have, therefore, appraised all three.

Review 1: Effects on children with autism with sensory processing difficulties

Case-Smith2 evaluated the effects of sensory integration therapy and sensory based interventions on children with autism who had sensory processing difficulties. The outcomes they were looking at included: individualised goal attainment, self-care ability, social function, sensory perception, attention, self-injury and stereotypical behaviours. Based on very limited low quality evidence, they concluded that sensory integration therapy may be effective for achieving individualised goals and reducing the amount of assistance children required by carers. No change was noted in other outcomes including adaptive behaviour, sensory processing and self-injurious and self-stimulating behaviours. The authors cautioned that further research was necessary before recommending sensory integration therapy and that future studies should be carried out according to formal guidelines, with trained therapists, and using objective outcome measures. The other intervention reviewed by Case-Smith and colleagues was sensory based interventions. They concluded that weighted vests, therapy balls, brushing and multisensory strategies such as sensory diets were not effective.

Review 2: Effects on children with autism (sensory processing difficulties were unspecified)

The second review we appraised8 also examined the effects of sensory integration therapy and sensory based interventions in children with autism, but did not specify if the children had sensory processing difficulties. Like Case-Smith2, this review concluded that there may be some evidence that sensory integration therapy improves individual goal attainment and decreases autism mannerisms and the burden on the care-giver. This review also concluded that the evidence did not support the effectiveness of sensory based interventions which use a single sensory modality such as sound therapy, weighted vests and dynamic seating. The authors suggested that the small effects noted when using two or more sensory modalities should be considered with caution due to issues such as methodological weakness and heterogeneity of the study participants. Therefore recommendations could not be made for the use of two or more sensory modalities.

Review 3: Effects on children with behavioural problems

Wan Yunus et al’s1 systematic review took a different perspective, by examining the evidence for sensory based interventions for children with behavioural problems (60% of whom had autism). Their outcomes of interest included participation in school, social and daily activities in addition to reduction of difficult behaviours. The evidence reviewed did not support the use of sensory based interventions for children with behaviour difficulties. One exception may be massage therapy, for which there was some preliminary evidence for its effectiveness. This finding, however, was based on low quality studies, and there were varied intervention descriptions. The result is that there are no clear recommendations about how massage therapy should be implemented.

Overall recommendations

Sensory integration therapy is not recommended for children with cerebral palsy. Some studies reported positive outcomes for children with sensory processing difficulties or autism2,8. However further research is necessary before the use of sensory integration therapy is recommended.
The best available evidence concluded that sensory based interventions (those which attempt to alter how an individual processes sensory information) are not effective for children with sensory processing difficulties, autism, or behaviour difficulties1-2,8. These types of sensory based interventions are not recommended for children with cerebral palsy.

Date of literature searches: July 2016

  1. Wan Yunus, F., Liu, K. P., Bissett, M., & Penkala, S. (2015). Sensory-based intervention for children with behavioral problems: A systematic review. Journal of Autism & Developmental Disorders, 45(11), 3565-3579. See abstract
  2. Case-Smith, J., Weaver, L. L., & Fristad, M. A. (2015). A systematic review of sensory processing interventions for children with autism spectrum disorders. Autism, 19(2), 133-148. See abstract
  3. Pavao, S., L., & Rocha, N., A. C., F. (2016). Sensory processing disorders in children with cerebral palsy. Infant Behaviour & Development, 46(February 2017), 1-6. See abstract
  4. Auld, M. L., Boyd, R. N., Moseley, G. L., Ware, R. S., & Johnston, L. M. (2012). Impact of tactile dysfunction on upper-limb motor performance in children with unilateral cerebral palsy. Archives of Physical Medicine and Rehabilitation, 93(4), 696-702.
  5. Bumin, G., & Kayihan, H. (2001). Effectiveness of two different sensory-integration programmes for children with spastic diplegic cerebral palsy. Disability and Rehabilitation: An International, Multidisciplinary Journal, 23(9), 394-399.
  6. Shamsoddini, A. (2010). Comparison between the effect of neurodevelopmental treatment and sensory integration therapy on gross motor function in children with cerebral palsy. Iranian Journal of Child Neurology, 4(1), 31-38. See abtract
  7. Shamsoddini, A. R., & Hollisaz, M. T. (2009). Effect of sensory integration therapy on gross motor function in children with cerebral palsy. Iranian Journal of Child Neurology, 3(1), 43-48.
  8. Watling, R., & Hauer, S. (2015). Effectiveness of Ayres sensory integration and sensory-based interventions for people with autism spectrum disorder: A systematic review. American Journal of Occupational Therapy, 69(5), 1-12. See abstract