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Sensory motor integration
Therapeutic effect of intensive sensory motor integration (SMI) training in Children with ADHD:
Behavioral and fMRI studies
Shin-Siung Jung, MD and Tzu-Chen Yeh, MD, PhD
Taiwan Research Institute of Learning Disabilities, Everspring Foundation, Taiwan, Department of Radiology, Medical School, National Yang-Ming University and Department of Medical Research and Education, Taipei Veteran General Hospital, Taipei, Taiwan
Abstract
This study used behavior ratings and BOLD-based fMRI to investigate the efficacy and brain locations of children with ADHD responding to SMI training. Subjects were eight normal male students, eight male students with ADHD post-SMI training and eight male students with ADHD pre-SMI training. Mean age was10±1.5 years old, none were taking medications and all with IQ above 90. Behavior data were collected from the pre- and post-SMI training groups including parents’ SMI checklist, parents’ ADHD checklist, and behavior ratings by the chief class teachers before and after SMI training for three months. All three groups underwent BOLD-based fMRI study using the attention paradigm of go/no go task with stimulation-controlled and response- controlled sessions. MANOVA analysis of all behavior ratings showed a significant difference (P <0.05) in the post-SMI training ADHD group. Comparison of the BOLD-based fMRI results of response-controlled sessions in the three groups revealed a significant difference (P< 0.05) between the pre- and post-SMI training ADHD groups in the pre-frontal area, medial frontal area, cingulate gyrus, and caudate nucleus. The pre-SMI training ADHD group showed limited activation in fronto-striatal regions. The post-SMI training ADHD group had improvement in BOLD activation as in corresponding regions as matching the activation pattern of normal control. BOLD-based fMRI improving results of the post-SMI training ADHD group correlated with clinical improvements based on teachers’ and parents’ observations and check-list findings of long time improved full concentration, skillful fine movement and execution ability. Intensive SMI training may provide an effective therapeutic intervention for ADHD.
Keywords: Sensory-motor integration, emotional difficulty, learning disability, ADHD, ADD, sensory integration therapy.
Correspondence: Shin-Siung Jung, MD, Everspring Foundation, No.106 Chang-An West Road, Suite 5F-2, Taipei, Taiwan 103. Tel: 886-3-9586140; Fax: 886-3-9581924; E-mail:
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Sensory motor integration
Figure 1. Five methods of exercises on prone extension posture on scooter boards or cushions.
Figure 3.1. BOLD fMRI before SMI training (control) in children with ADHD.
Figure 3.2. BOLD fMRI after SMI training in children with ADHD.
Figure 3.3. BOLD fMRI of Normal Control Group.
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Correspondence: Shin-Siung Jung, MD, Everspring Foundation, No.106 Chang-An West Road, Suite 5F-2, Taipei, Taiwan 103. Tel: 886-3-9586140; Fax: 886-3-9581924; E-mail: