Additional occupational therapy considerations for functional neurological disorders: a potential role for sensory processing.
Additional occupational therapy considerations for functional neurological disorders: a potential role for sensory processing.
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功能性神经系统疾病的其他职业治疗注意事项：感觉处理的潜在作用。
DOI：
10.1017/s1092852918000950
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发表时间：
2018
期刊：
影响因子：
3.3
通讯作者：
MacLean,Julie
中科院分区：
文献类型：
--
作者：
Ranford,Jessica;Perez,DavidL;MacLean,Julie
我们饶有兴趣地阅读了加德纳及其同事在《中枢神经系统光谱》上发表的题为“功能性神经障碍的职业疗法：范围审查和研究议程”的文章。1我们祝贺作者开始了至关重要的对话，以扩大对职能治疗（OT）社区内功能性神经障碍（FND）的理解，并提出了FND患者OT的评估，管理和研究议程。我们同意，职业治疗师，作为身心临床医生，有很好的定位是跨学科治疗团队的重要成员FND。在他们的综述中，作者提出了一个生物心理社会框架来概念化FND患者。虽然我们同意并使用这种非常有价值的方法，但我们也想强调，感觉处理障碍可能是重要的共病持续因素，在FND患者的个性化治疗计划中，这些因素对评估和治疗非常有用。感觉统合理论是由Jean Ayers在20世纪70年代发展起来的，是OT干预的支柱，特别是在儿科。2感觉统合理论的基础是，个体处理来自自身身体和外部世界的感觉信息的能力使他们能够有效地适应环境并与环境互动。感觉调节是感觉加工的一个重要组成部分，它被定义为对感觉刺激的特定行为反应的调节。当行为不符合情境要求时，可能会发生感觉调节障碍，感觉调节的缺陷会导致一系列适应不良的情绪和注意力反应。值得注意的是，我们的小组以前提出，在整合的感觉运动，认知和情感过程的干扰可能在FND. In过去几十年的病理生理学中发挥作用，有越来越多的研究联系感觉调制障碍（特别是感觉防御和感觉过度反应）与抑郁，焦虑，创伤后应激障碍，和解离。感觉调节困难，更具体地说是感觉防御，会导致学习不良和认知能力下降。在我们护理FND患者的集体临床经验中，我们遇到了支持感觉调制障碍的人。例如，在最初的OT评估中，我们观察到一些FND患者抱怨认知困难和感觉敏感性，如超敏反应和对声音、光线、移动目标和拥挤环境的过度反应。这些人中的许多人为他们的感官敏感性提供了有限的自我生成的应对策略，我们为患者提供了感官偏好检查表，以识别警觉，接地，刺激和平静的感官刺激。[3]成人/青少年感觉特征在我们的经验中也被证明是一种有用的自我评价工具，用于评估对日常感觉体验的行为反应，帮助患者和临床医生了解个体的感觉处理模式。4收集这些信息可以制定基于感觉的个性化治疗策略
We have read with interest the article entitled “Occupational Therapy for Functional Neurological Disorders: A Scoping Review and Agenda for Research” by Gardiner and colleagues published in CNS Spectrums. 1 We congratulate the authors on starting the critically important conversation to broaden understanding of functional neurological disorders (FND) within the occupational therapy (OT) community and proposing an assessment, management, and research agenda for OT in patients with FND. We agree that occupational therapists, as mind-body clinicians, are well positioned to be vital members of interdisciplinary treatment teams for FND. In their review, the authors suggest a biopsychosocial framework to conceptualize patients with FND. While we agree with and use this highly valuable approach, we would also like to highlight that sensory-processing impairments can be important comorbid perpetuating factors that are useful to assess and treat in the context of an individualized treatment plan for patients with FND. Sensory integration theory was developed by Jean Ayers in the 1970s and is a pillar of OT interventions, especially in pediatrics. 2 The basis of sensory integration theory is that individuals’ ability to process sensory information from their own bodies and the outside world allows them to adapt and interact effectively with the environment. An important component of sensory processing is sensory modulation, which is defined as the regulation of specific behavioral responses to sensory stimuli. Disorders of sensory modulation can occur when behaviors are not graded to the situational demands, with deficits in sensory modulation leading to a range of maladaptive emotional and attentional responses. Notably, our group has previously proposed that disturbances in the integration of sensory-motor, cognitive, and affective processes may play a role in the pathophysiology of FND.Over the last few decades, there has been growing research linking sensory-modulation disorders (specifically sensory defensiveness and sensory overresponsiveness) with depression, anxiety, posttraumatic stress disorder, and dissociation. Sensory-modulation difficulties, and sensory defensiveness more specifically, can result in poor learning and decreased cognitive performance. In our collective clinical experience caring for patients with FND, we have encountered individuals who endorse sensory-modulation impairments. For example, during initial OT assessments, we have observed that some patients with FND complain of cognitive difficulties and sensory sensitivities such as hypersensitivity and overresponsiveness to sounds, light, moving targets, and crowded environments. Many of these same individuals offer limited self-generated coping strategies for their sensory sensitivities, and we provide patients with the Sensory Preference Checklist to identify alerting, grounding, irritating, and calming sensory stimuli across the senses. 3 The Adult/Adolescent Sensory Profile has also proven in our experience to be a useful selfevaluation tool of behavioral responses to everyday sensory experiences, helping both patients and clinicians gain awareness of individuals’ sensory-processing patterns. 4 Gathering this information allows the development of individualized sensory-based treatment strategies