Tami Bar-Shalita

Sensory modulation disorder: a risk factor for participation in daily life activities

Participation in childhood daily functional performance was examined in 78 children: 44 with sensory modulation disorder (SMD); (33 males, 11 females; mean age 7y 6mo [SD 1.20]) and 34 without SMD (18 males, 16 females; mean age 7y 8mo [SD 1.33]). Group classification was determined using two measures: the Short Sensory Profile (SSP) and the Full‐form Sensory Profile. Parents completed a battery of caregiver questionnaires. Children with SMD scored significantly lower on all three participation scales than the control group. A high correlation was observed between level of activity performance of the Participation in Childhood Occupations Questionnaire (PICO‐Q) and the SSP, and a moderate correlation was observed between the Enjoyment of Performance of the PICO‐Q and the SSP. A low correlation was observed between Frequency of Performance of the PICO‐Q and the SSP. Logistic regression indicated that all three participation scales (level of activity performance, level of enjoyment of the activity, and frequency of performance of the activity) are significantly associated with group classification, with odds ratios of 3.13, 2.05, and 1.73 respectively. These findings are the first, to our knowledge, to confirm claims of limited participation in daily activities among children with SMD. Our results have significant clinical implications and provide support for the need for practitioners and caregivers of children with SMD to facilitate participation.

Development and psychometric properties of the Sensory Responsiveness Questionnaire (SRQ)

Purpose. Individuals with Sensory Modulation Disorder (SMD) are characterized by an inability to normally grade the degree, intensity and nature of their responses to sensory input and are limited in their ability to fully participate in daily life activities, and attain optimal quality of life. Most existing diagnostic tools are intended for paediatric populations. A questionnaire that assesses the intensity of the affective-emotive responsiveness of adults to stimuli in all sensory modalities and the frequency of such responses for diagnosing adults with disorders in sensory modulation is necessary. This article describes the development and assessment of the psychometric properties of a novel instrument, the Sensory Responsiveness Questionnaire (SRQ), for this purpose (see Appendix). Method. The SRQ evolved through three developmental phases (Pilot, Version-I, and the most recent Version-II). Each phase comprised several studies conducted to further refine the instrument and to examine its psychometric properties with adults with Sensory Modulation Disorder versus SMD-free individuals (n=39 for the pilot version, n=399 for Version-I, and n=48 for Version-II). Results. The scales of Version-II indicated high test-retest reliability, moderate criterion validity and strong significant construct validity. Conclusion. There is strong indication that the SRQ can be used to diagnose adults with SMD.

Psychophysical correlates in adults with sensory modulation disorder

Purpose: Individuals with sensory modulation disorder (SMD) demonstrate abnormal responses to naturally occurring stimuli in a manner that interferes with daily life activities. This study is the first study applying quantitative sensory testing to characterize the somatosensory sensitivity of adults with SMD. Method: One hundred and fifty one adults (68 males and 83 females) were tested comparing 91 SMD to 60 SMD-free, control individuals. Group placement (SMD vs. SMD-free) was determined using the Sensory Responsiveness Questionnaire (SRQ). Sensory detection thresholds for skin warming, cooling, punctate dynamic tactile sensation, vibration and thermal pain thresholds for heat and cold stimuli were determined at several body sites. Pinprick pain and prickliness were also assessed, as well as the duration and intensity of the after-sensations of prickliness and pain evoked by the prickly stimuli. Results: Compared to control adults, individuals with SMD showed significantly higher pain intensity to prickle stimuli, marginally higher pain intensity to pinprick and hypoesthesia to punctate dynamic tactile sensation at one of two sites tested. Conclusions: These results are in line with our previous study that investigated children with SMD using the same stimuli, and found similar results. We suggest a CNS involvement as the underlying mechanisms in SMD.

The Participation in Childhood Occupations Questionnaire (PICO-Q): A Pilot Study

There is a need, among practitioners and researchers, for a feasible, user-friendly assessment tool that evaluates overall participation and guides intervention. This paper describes the process of construction and development of the Participation in Childhood Occupations Questionnaire (PICO-Q) and the establishment of its primary psychometric properties. The 22-item instrument measures the level, enjoyment, and frequency of performance for childrens participation in daily occupations in a variety of environments. The questionnaire was completed by the mothers of 41 children between the ages of 6 and 10 years (24 children with and 17 children without sensory modulation disorder). Cronbachs alpha varied from. 86 to. 89, indicating internal consistency of items. Test–retest reliability varied from. 69 to. 86, indicating that the instrument provides a stable measurement over time. The PICO-Q was found to differentiate between children with and without participation restrictions. The PICO-Q shows initial reliability and validity and has both research and clinical application potential.

Sensory modulation and daily-life participation in people with schizophrenia.

Schizophrenia is considered to be an extreme mental health disturbance that affects a persons well-being and participation in everyday activities. Participation in meaningful everyday occupations is an important component of recovery from mental illness, the ultimate goal of mental health services. The participation restrictions of people with schizophrenia have been widely investigated through different factors, such as illness symptoms and course, cognition, and demographic data; however, the resulting explanations were incomplete. The purpose of the study was to explore the contribution of sensory modulation (SM), in addition to cognition and schizophrenia symptoms, to participation in daily life activities of people with schizophrenia. Forty nine in-patients with schizophrenia (study group) and 32 adults without mental illness (control group) comprised the study. They were assessed for their participation patterns, sensory modulation processes, cognitive functioning and symptoms severity. Results indicate significant differences between the study groups in most measurements addressed: participation (diversity and satisfaction), sensory modulation scores (intensity of the response and frequency of response), and cognitive measurements. The most contributive parameters for the prediction of participation dimensions among people with schizophrenia were negative symptoms severity and general cognitive status. In conclusion, people with schizophrenia experience SM disorder with an under responsive tendency. However the complex condition of schizophrenia dominates its influence on participation dimensions.

Ecological aspects of pain in sensory modulation disorder.

BACKGROUND Sensory Modulation Disorder (SMD) interferes with the daily life participation of otherwise healthy individuals and is characterized by over-, under- or seeking responsiveness to naturally occurring sensory stimuli. Previous laboratory findings indicate pain hyper-sensitivity in SMD individuals suggesting CNS alteration in pain processing and modulation. However, laboratory studies lack ecological validity, and warrant clinical completion in order to elicit a sound understanding of the phenomenon studied. Thus, this study explored the association between sensory modulation and pain in a daily life context in a general population sample. METHODS Daily life context of pain and sensations were measured in 250 adults (aged 23-40 years; 49.6% males) using 4 self-report questionnaires: Pain Sensitivity Questionnaire (PSQ) and Pain Catastrophizing Scale (PCS) to evaluate the sensory and cognitive aspects of pain; the Sensory Responsiveness Questionnaire (SRQ) to appraise SMD; and the Short Form - 36 Health Survey, version 2 (SF36) to assess health related Quality of Life (QoL). RESULTS Thirty two individuals (12.8%) were found with over-responsiveness type of SMD, forming the SOR-SMD group. While no group differences (SOR-SMD vs. Non-SMD) were found, low-to-moderate total sample correlations were demonstrated between the SRQ-Aversive sub-scale and i) PSQ total (r=0.31, p<0.01) and sub-scales scores (r=0.27-0.28, p<0.01), as well as ii) PCS total and the sub-scales of Rumination and Helplessness scores (r=0.15, p<0.05). PSQ total and sub-scale scores were more highly correlated with SRQ-Aversive in the SOR-SMD group (r=0.57-0.68, p=0.03-<0.01) compared to Non-SMD group. The Physical Health - Total score (but not the Mental Health - Total) of the SF36 was lower for the SOR-SMD group (p=0.03), mainly due to the difference in the Body pain sub-scale (p=0.04). CONCLUSIONS Results suggest that SOR-SMD is strongly associated with the sensory aspect of pain but weakly associated with the cognitive aspect. This indicates that SMD co-occurs with daily pain sensitivity, thus reducing QoL, but less with the cognitive-catastrophizing manifestation of pain perception.

Atypical Sensory Modulation and Psychological Distress in the General Population

OBJECTIVE Atypical sensory modulation (ASM) is characterized by over- or underresponsiveness to sensory stimuli in one or more sensory systems. Faulty sensory information processing could result in anxiety. Because the relation between ASM and psychological distress has not been examined, we explored psychological distress and ASM in the general population. METHOD A community-based sample of 204 adults (105 men; mean age = 27.4 yr, standard deviation = 3.71) completed the Sensory Responsiveness Questionnaire--Intensity Scale (SRQ-IS; Bar-Shalita, Seltzer, Vatine, Yochman, & Parush, 2009); the Brief Symptom Inventory (BSI; Derogatis & Coons, 1993); and the Short Form--36 Health Survey, Version 2 (SF-36; Ware, Kosinski, & Gandek, 2005). RESULTS The ASM group displayed considerably more distress symptoms than the comparison group. Multivariate linear regression showed SRQ-IS and SF-36 scores as significant predictors of BSI score (r = .64). CONCLUSION ASM may be a risk factor for developing other mental health concerns.

Sensory over-responsiveness among healthy subjects is associated with a pro-nociceptive state

Chronic pain patients show hypersensitivity to sensory nonpainful stimuli. Sensory over‐responsiveness (SOR) to innocuous daily stimuli, experienced as painful, is prevalent in 10% of the healthy population. This altered sensory processing may be an expression of overfacilitation, or a less efficient pain‐inhibitory process in the pain pathways. We therefore aimed to investigate specifically the pain‐inhibitory system of subjects with SOR who are otherwise healthy, not studied as of yet.

Relationships among Sensory Responsiveness, Anxiety, and Ritual Behaviors in Children with and without Atypical Sensory Responsiveness

ABSTRACT Aim: To explore relationships between sensory responsiveness, anxiety, and ritual behaviors in boys with typical and atypical sensory responsiveness. Method: Forty-eight boys, ages 5–9 participated in the study (28 boys with atypical sensory responsiveness and 20 controls). Atypical sensory responsiveness was defined as a score of ≤154 on the Short Sensory Profile. Parents completed the Sensory Profile, the Screen for Child Anxiety Related Emotional Disorders, and the Childhood Routines Inventory. Results: Children with atypical sensory responsiveness had significantly higher levels of anxiety and a higher frequency of ritual behaviors than controls. Atypical sensory responsiveness was significantly related to both anxiety and ritual behaviors, with anxiety mediating the relationship between sensory modulation and ritual behaviors. Conclusions: The findings elucidate the potential consequences of atypical sensory responsiveness and could support the notion that ritual behaviors develop as a coping mechanism in response to anxiety stemming from primary difficulty in modulating sensory input.

Assessment of Responsiveness to Everyday Non-Noxious Stimuli in Pain-Free Migraineurs With Versus Without Aura

Migraineurs with aura (MWA) express higher interictal response to non-noxious and noxious experimental sensory stimuli compared with migraineurs without aura (MWoA), but whether these differences also prevail in response to everyday non-noxious stimuli is not yet explored. This is a cross-sectional study testing 53 female migraineurs (30 MWA; 23 MWoA) who underwent a wide battery of noxious psychophysical testing at a pain-free phase, and completed a Sensory Responsiveness Questionnaire and pain-related psychological questionnaires. The MWA group showed higher questionnaire-based sensory over-responsiveness (P = .030), higher magnitude of pain temporal summation (P = .031) as well as higher monthly attack frequency (P = .027) compared with the MWoA group. Overall, 45% of migraineurs described abnormal sensory (hyper- or hypo-) responsiveness; its incidence was higher among MWA (19 of 30, 63%) versus MWoA (6 of 23, 27%, P = .012), with an odds ratio of 3.58 for MWA. Sensory responsiveness scores were positively correlated with attack frequency (r = .361, P = .008) and temporal summation magnitude (r = .390, P = .004), both regardless of migraine type. MWA express higher everyday sensory responsiveness than MWoA, in line with higher response to experimental noxious stimuli. Abnormal scores of sensory responsiveness characterize people with sensory modulation dysfunction, suggesting possible underlying mechanisms overlap, and possibly high incidence of both clinical entities. PERSPECTIVE This article presents findings distinguishing MWA, showing enhanced pain amplification, monthly attack frequency, and over-responsiveness to everyday sensations, compared with MWoA. Further, migraine is characterized by a high incidence of abnormal responsiveness to everyday sensation, specifically sensory over-responsiveness, that was also found related to pain.