Dynamic Seating : Improving Engagement
Susan O. Rivelli, MBA, OTD, OTR/L
An Evidence-Based Occupational Therapy Intervention
Chatham University, Pittsburgh, PA
Contact: [email protected]
SETTING & BACKGROUND
Living Life to Its Fullest!
LITERATURE REVIEW
OUTCOMES
The Critically Appraised Topic Portfolio
Average Time Engaged
Middle School Participants
Search Terms Used:
ASD and
 Dynamic Seating
 Alternate Seating
 Sensory Modulation
 Stability Balls in Education
(Webster Public Schools, 2013)
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Located in south central Massachusetts
Approximately 1,800 student
Elementary School: Preschool through Grade 2
Middle School: Grades 3-6
2 Classrooms for students with Autism
2 Special Education Teachers, 4 Behavioral Technicians
PIO QUESTION
Does the use of dynamic seating improve
engagement in school-aged children diagnosed
with autism?
 Comorbidity of sensory modulation disorder with ASD, and the high prevalence of
sensory modulation disorder within this population (Ben-Sasson et al., 2008;
Tomchek & Dunn, 2007)
 Individuals with ASD have a 40-80% chance of having a co-morbid Sensory
Processing Disorder (Baranek, 2002, p. 398)
DESIGN & IMPLEMENTATION
 Engagement was defined as “…when the student is orientated towards the appropriate
classroom activity such as instructional materials, activity, or teacher and either
interacting with the materials, responding to the speaker, or looking at the speaker”
(Schilling & Schwartz, 2004, p.427)
Average Time Engaged
Post-Intervention Teacher
Questionnaire
Question
Strongly
Disagree
Uncertain
Agree
90%
89%
81%
65%
61%
59%
57%
55%
44%
43%
Strongly
38%
Disagree
37%
Agree
29%
Therapy balls are a safe
60%
40%
accommodation to use in
(3)
(2)
The goals of the
40%
60%
intervention were clear
(2)
(3)
25%
my classroom.
Baseline
Intervention
Withdrawal
and easily understood.
Using dynamic seating as
60%
20%
20%
an accommodation
(3)
(1)
(1)
Average Time Engaged
Elementary School
Participants
presents a distraction to
other students.
I would recommend the
20%
80%
use of this
(1)
(4)
I plan to continue to use
80%
20%
dynamic seating as an
(4)
(1)
accommodation to other
teachers.
accommodation in my
classroom
Average Time Engaged
“Every Classroom, Every Student, Every Day”
25 articles dated from 2002 – 2013
 1 randomized control trial
 2 meta-analysis
 5 systematic reviews
 16 single case studies
 1 qualitative study
91%
90%
83%
85%
81%
73%
66%
48%
40%
35%
SIGNIFICANCE TO OT
 All participants diagnosed with Autism Spectrum Disorder
BRIAN
Baseline
 Addresses the underlying sensory needs of a child
diagnosed with ASD
 Assists the school-based occupational therapist in
providing classroom strategies to enhance alertness for
learning in all children
 Supports child in their role as student within the context
of the classroom
 Adds to evidenced-based interventions used within the
classroom for children diagnosed with ASD
 Completed the Sensory Processing Measure: Main Classroom Form on all participants
with the assistance of classroom teachers and behavioral technicians
(Kuhaneck et al., 2007)
 First two weeks- participants used standard classroom
chairs, second two weeks- participants used therapy balls
for seating
 Elementary School Participants: 10 minutes during 1:1 direct teaching
Intervention
JARED
Withdrawal
SUMMARY

Evidence is mixed regarding the use of therapy balls to improve engagement in
children diagnosed with ASD

Results highlight the need for standardized assessments and protocols needed in the
treatment of individuals with ASD

Qualitative results demonstrated agreement with classroom personnel that therapy
balls are a safe, easy to use accommodation within the classroom setting
 Two classrooms, eight participants six data collectors
 Middle School Participants: 10 minutes during morning calendar group
DAMIEN
Use of Dynamic Seating to Improve Engagement in
School-Aged Children Diagnosed with Autism
Susan O. Rivelli, OTD, MBA, OTR/L
Contact: [email protected]
Session: PO1059
The purpose of this Evidenced-Based Occupational Therapy Project was to determine the effectiveness of
using therapy balls as chairs on engagement in eight school-aged children diagnosed with autism spectrum disorder
(ASD). Each participant was also assessed using the Sensory Processing Measure to determine if patterns of sensory
processing had an effect on outcomes. Baseline data were collected on engagement while sitting on a standard
classroom chair. During the intervention phase, participants sat on therapy balls. Although results were mixed, use
of the therapy ball appeared to have a positive effect on engagement for many participants. For others, poor postural
stability seemed to impede engagement while seated on the ball. The participants’ specific pattern of sensory
processing did not appear to effect engagement. The results highlight the multi-faceted diagnosis of ASD. These
children have both unique and extreme reactions to sensory input, as compared to their typically developing peers.
It also emphasizes the importance of using clinical judgment when recommending sensory motor accommodations
for use with this population.
References
Bagatell, N., Mirigliani, G., Patterson, C., Reyes, Y., & Test, L. (2010). Effectiveness of therapy ball chairs on classroom
participation in children diagnosed with autism spectrum disorders. American Journal of Occupational
Therapy, 64(6), 895-903. doi:10.5014/ajot.2010.09149
Baranek, G. (2002). Efficacy of sensory and motor interventions for children with autism. Journal of Autism and
Developmental Disorders, 32(5), 397-422.
National Autism Center. (2009). National standards project-addressing the need for evidence-based practice
guidelines for autism spectrum disorders. Randolph: National Autism Center.
Pfeiffer, B. A., Koenig, K., Kinnealey, M., Sheppard, M., & Henderson, L. (2011). Reasearch Scholars Initiative Effectiveness of sensory integration interventions in children with autism spectrum disorders: A pilot study.
American Journal of Occupational Therapy, 65(1), 76-85. doi:10.5014/ajot2011.09205
Schilling, D., & Schwartz, I. (2004). Alternative seating for young children with autism spectrum disorder: Effects on
classroom behavior. Journal of Autism and Developmental Disorders, 34(4), 423-432.