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Sensory IntegrationandChronic Schizophrenia:Past, Present an d FutureVirginia J. Hixson andArthur W. Mathews.

AbstractThis paper briefly outlines the therapy of sensory integration as developed by Dr. A. Jean Ayres, includinga breakdown of the most prevalent types of dysfunction. In an extensive literature review which includeswritings from 1811 through to the present day, the symptoms of schizophrenia which may be relatedto sensory integrative deficit are then examined. Finally, current research and treatment programs whichutilize sensory integrative treatment with schizophrenics ar e reviewed, with emphasis on a programreview conducted at Whitby Psychiatric Hospital in Ontario, 1981. Implications for future treatmentand research are explored.

Basic Sensory Integration TheoryThe theory of sensory integration was developed in the1950's by Dr. A. Jean Ayres (Ayres, 1974) and w asapplied specifically to learning disabled children. Sincethen, research by Ayres and others (Silberzahn, 1975;Rider, 1978; Endler and Eimon, 1978; Larson, 1982,Ottenbacher, 1982 etc.) has led to a continuous modifica-tion and refinement of the theory.

Essentially, sensory integration involves taking a sen-sation in , processing the information, and then connect-ing this to make sense of the environment. This abilitydevelops in a predictable, genetically determined se-quence, and if this is delayed or modified, sensoryintegrative dysfunction results. Such a dysfunctionhampers a person's ability to relate to his environment,and therefore affects his ability to adapt to the changesrequired in effective daily living.According to Dr. Ayres. "Sensory integration, or theability to organize sensory information for use, can beimproved through controlling input to active brainmechanisms." (Ayres, 1974, p. 15). In treatment, theontogenetically earlier systems (i.e. vestibular, tactile andproprioceptive), are given primary attention, as sensoryintegration aims at promoting sequential developmentand as they seem to have the most widespread effecton general function, (Ayres, 1974; Ayres, 1974b; Barr,1979).Vestibular function:The vestibular apparatus, strictly speaking, is part ofthe proprioceptive system, however its importance is soVirginia J. Hixson, 0.T.R., 0.T.(C). Sr. Occupational therapist,Occupational Therapy Department, Whitby Psychiatric Hospital,Whitby, Ontario.Arthur W. Mathews, B.Sc. (0.T.) Occupational Therapist, Occupa-tional Therapy Department. Whitby Psychiatric Hospital. Whitby.Ontario.FEBRUARY/FVRIER 1984

primary to sensory integration and its function so spe-cialized, that it is generally accorded considerationseparate from that given to muscle, joint and ligamentproprioception (Bellhorn, 1972; Ayres, 1974; Ayres,1974b; Barr, 1979). The role of this system is oftenoverlooked as its functions take place largely below thelevel of awareness. Sensations are evident only whenthe system is disturbed or when the digestive tract isaffected, giving rise to dizziness, vertigo, nausea, a feelingof faintness, or a 'lost in space' feeling that has beenreferred to as postural insecurity, or 'primal terror'.(Ayres, 1974; Weeks, 1979; Shaffer, 1979). The vestibu-lar system is constantly receiving input from the forceof gravity and allows one to detect motion (vertical,horizontal or rotary) especially acceleration and deceler-ation, as these affect the semicircular canals in the innerear. The constant reception of the earth's gravitationalpull helps in the development of a basic sense of security,a sense that the ground will always be where it isexpected to be.Proprioceptive Function and Praxis:Proprioception refers to information about the bodyarising from muscle, joint and ligament receptors as wellas those associated with bone. As with vestibular input,if the system is functioning normally, much of theinformation received by these receptors does not reachthe level of consciousness unless attention is concentrat-ed on it. Proprioception is critical to the motor actionby which reflexes, automatic responses and plannedmotion occur and is therefore basic to human survival.

Proprioception can be subdivided into a kinetic sense(sensation of active or passive movement, an awarenessof the motion of a limb or body part) and a static sense(a sense of position). The development of proprioceptionserves as a base for the development of both praxisand visual perception, (Ayres and Heskett, 1972; Ayres,

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1974; Silberzahn, 1975; Montague. 1978; Shaffer, 1979;Resman, 1981). Without good proprioceptive informa-tion about the extent and force of larger movement.the development of praxis and correct body scheme ishampered.Ayres states:The body scheme is basic to all motor action. It is

defined as the knowledge we have of the constructionand spatial relationship of the different anatomicalelements such as finger, legs, arms, that make up thebody. It involves being able to visualize these elementsin the movement and in different positional relation-ships... Active motion provides th e individual withthe knowledge of his physical self, how it is relatedand how it can deal with space (body scheme). Motionenables the body to learn the most about its relationto space for motion elicits the greatest number ofproprioceptive impulses. (Ayres. 1974b, p. 52).Poorly developed body scheme results in what Ayresterms developmental dyspraxia. In extreme cases this

may mean the inability to unconsciously plan a simplemovement such as standing up or picking up an objectfrom a table. This necessitates the employment of higherlevel cortical function for these low level tasks at theexpense of internal energy resources and efficiency.

In a review of neurophysiological experiments relatedto cortical and subcortical integration of sensory stimuli,Foulks (1960) found considerable evidence indicatingthat if one concentrates on a motion, this has a detri-mental effect on the quality and accuracy of that motion.Additionally, muscles controlled by attention fatiguerapidly. It was found that more afferent impulses werereceived in the cortex when attention was not beingdirected toward a movement in execution. Thus, theneurophysiological result of dyspraxia compounds theproblem.

Visual skills and perception are also affected by poorproprioceptive function as inadequate information fromthe muscle spindles in fine occular muscles results inpoor occular control. The development of visual percep-tion is thus inaccurate and unreliable, interfering furtherwith higher level learning.Tactile Function:Closely connected with praxis through factorial studiesis the tactile system, (Ayres, 1966; Ayres, 1971; Geddes,1972; Ayres, 1974b). Ayres (1974; 1974b) postulates dualfunctional cutaneous afferent systems (1) a protectivesystem which responds to stimuli with movement. al-tertness and a high degree of affect (often negative),and (2) a discriminative system which is used in theinterpretation of stimuli in a temporal and spatial sensefo r cognition. This duality was earlier identified by Head(1920). who named these the "protopathic" (protect) andthe "epicritic" (discriminate) systems.The major purpose of the protective tactile systemis to warn of potential harm and to assist in preparingthe body for defense. It tends to interpret cutaneousstimuli as signs of danger and responds by eliciting theemotions and physiological changes appropriate to fightor flight and by evoking motor activity. This phylogene-

tically early system, when balanced by the more ad-vanced discriminative system, continues to serve a valu-able function in alerting the individual to close stimuliand in preparing him (physically and emotionally) indangerous situations.Adaptive behaviour and modern life however, requiremore than a general alerting and a diffuse response to

danger. One must have more specific information aboutthe environment. If the body is constantly dealing withtouch as a warning of danger. giving necessary attentionto the finer aspects of tactile stimuli becomes impossible.For effective function, the discriminative system mustbe able to inhibit the excitation of the protective system.Additionally however, when danger does threaten, theperson must be alerted to it and be able to respondquickly. Ayres (1974; 1974b), postulates that the balanceof two well functioning systems fluctuates to meet therequirements of the specific circumstances an individualfinds himself in. If the person is threatened or if thesystem is malfunctioning, the protective system domi-nates. Otherwise, the discriminative system is predomi-nant.

Disorders in tactile perception may occur in eithersystem or may be noticed as an imbalance in the two.If an imbalance exists, its most common manifestationis tactile defensiveness which is connected with fear oftouch, increased motor activity, anxiety and withdrawal,(Ayres, 1972; Ayres, 1974; Ayres, 1974b; Montague,1978).

The second functional cutaneous afferent system pos-tulated, that of discriminative touch, serves as a sourceof specific tactile information about the environment.Through the manipulation of objects and the tactileinput involved in moving objects, the individual de-velops form and space perception and develops relianceupon the tactile messages his system receives. Dysfunc-tion in the discriminative tactile system results not onlyin poor tactile accuracy, but also hampers the develop-ment of body scheme, motor coordination and form andspace perception. Tasks which others find easy, e.g.dressing, become monumental without reliable tactileinformation. Self confidence and self esteem suffer.Bilateral Integration:Another problem related to sensory integration whichAyres adresses is that of poor bilateral integration,(Ayres, 1971; Ayres, 1974; Ayres, 1974b). Often linkedwith vestibular disorders, the most significant charac-teristic of this dysfunction is a tendency to us e eachhand independently of the other and on its own sideof the body. Since the symptoms of this problem area tendency rather than an inability, this disorder is easilyoverlooked. Adequate bilateral motor function requiresfirst of all, two acceptably coordinated extremities.Kephart (1960) suggesied that laterality (an internalawareness of the difference between the two sides ofthe body) must be learned by experimenting throughmovement with the two sides of the body and with theirinter-relationship. A person with poor bilateral integra-tion will tend to do tasks one-handedly. thereby missingthis movement experience. A true hand dominance for

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tasks is not established. Ayres hypothesized that "thefailure to integrate function of the two sides of the bodyreduces the tendency to establish one hand as thedominant hand because the non-dominant hand per-forms most of the motor duties on its side of the body."(Ayres, 1974b, p. 140). The ability to use the handstogether becomes more important with increased age,as more complex tasks ar e required in daily life experi-ences. Again, the more affected a person is by thisdysfunction, the more difficulty he will have in attempt-ing complex motor tasks and self confidence will suffer.Sensory Integration as Related toSchizophreniaIn his book, SCHIZOPHRENIA: SCIENCE ANDPRACTICE, Shershow (1978) includes writings of manymodern 'experts' on schizophrenia, e.g. Borus, Hollister,Kety, Klerman, Lidz, Snyder, etc. Regarding a definitionof schizophrenia, he states: "The point, of course, is thatthe definition of 'schizophrenia' has varied tremendouslythroughout modern psychiatric history, not to mentionthe period prior to the modern era." (p. 4). The greatestconsensus identified was that process schizophrenia, or"poor prognosis schizophrenia" was a true schizophren-ia .

Process schizophrenia is "characterized by a gradualdecline of activity, dullness, autism, ideas of reference,thought disturbances, prolonged history of malad-justment, poor physical health, difficulties at home andin school, abnormal family relationships and somaticdelusions." (Wolman, 1973, p. 339). Another definitionof this category reads: "those forms of severe schi-zophrenic disorders in which chronic and progressiveorganic brain changes are considered to be the primarycause and in which prognosis is poor, as contrasted withreactive schizophrenia.'; (Stedman, 1976, p. 1259). It isthe chronic or process schizophrenic with which thispaper is primarily concerned.Past:Vestibular Function:In 1811, (reprinted in 1977) Cox published case studiesdescribing the effect of his use of a special swing (vesti-bular sensory input) on the treatment of the mentallyill. Although many of his patients resisted its applicationand it was sometimes seen by the patient as a punish-ment, Dr. Cox states:

...after a very few circumvolutions a degree of changewas observed, both as to the appearance of the fea-tures and the mind: the former expressed apprehen-sion, while the ideas, though confused, did not seemto crowd so rapidly... surrounding objects though theymust have appeared indistinct and confused from thegyration, attracted the attention, and became the sub-ject of conversation... on suspending the motion, bothmind and body in a fe w seconds resumed their formermorbid peculiarities ...I could detail other cases whereconsiderable relief was procured by swinging..." (Cox,1977, p. 3, 4).

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For decades the involvement of the vestibular systemin schizophrenia has been under examination. Studiescomparing nystagmus responses, (vestibular-occular re-flex, an indirect measure of vestibular function) of schi-zophrenics with those of the normal population wereundertaken as early as 1940 (Angyal and Blackman,1940), and have shown this population as having amarked deviation from the normal reaction e.g., de-creased duration, decreased number of beats, greaterdysrhythmia (Schilder, 1933; Angyal, 1940; Freemanand Rodnick, 1942; Leach, 1960).With th e advent of electronystagmography a smallnumber of studies, (Rosenblum and Friedhoff. 1961;Levy, Holzman and Proctor, 1965) have shownno significant difference of nystagmus response betweenschizophrenic and normal populations. This may be dueto the type of schizophrenia included in the studies ormedication effects, neither of which were clearly report--ed. Other studies using electronystagmographycontinue to show differences, notably Colbert who,when studying nystagmus responses in schizophrenicchildren, found an average duration of zero. Most ofthese subjects found the experience pleasurable andnone showed any sign of dizzines or nausea. Similarresults were found with caloric stimulation (Douglas,1982). Numerous reports suggest that there is some con-nection between nystagmus and schizophrenia.Scientific methodology has consistently linked psy-chosis in both children and adults with disorders in thevestibular system (Angyal, 1940; Freeman, 1942; Ayres,1972; Montague, 1978; Weeks, 1979; Rider, 1979). Pos-tural reflex development and muscle tone, largely vesti-bular traits, have been identified as irregular in manyschizophrenic people. Silver and Gabriel (1964) foundresidual primitive postural responses and decreasedmuscle tone in 30 out of 39 boys diagnosed as schi-zophrenic. Endler and Eimon (1978), found comparableresults in a study with adult schizophrenic patients.

In more recent times, a cross-cultural study of tetra-ataxiametric (four point weight bearing) patterns of stat-ic balance in adults, by Kohen-Raz and Hiriartborde(1979), found that the sub-group of subjects who wereemotionally disturbed but neurologically normal wascharacterized by a significantly more pronounced poste-rior weight displacement relative to that of the remain-ing subjects in France, suggesting differences in postureand balance in that group. All other groups studiedacross four nations showed no appreciable difference.Schilder (1933) considered the vestibular system tobe the primary organizer of sensory information andsaw it as having a direct link with emotions throughthe limbic system. Anatomically this is supported (Barr,1979; Dimond, 1980; Douglas, 1982). Ornitz (1933) hy -pothesized that the schizophrenic person limits his mo-tion to avoid perceptual distortions which can beinduced in a disordered system by motion and suggeststhat vestibular disturbances and disturbances of the per-ception of one's own body are related.Hubbard, in his study of skyjackers who exhibitedschizoprenia post-skyjack concludes:

Essentially, the skyjacker appeared to be driven tocommit his extraordinary crime by a combination of

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an intense sense of unreality and clear suicidal intent.Substantial evidence has been accumulated to the ef-fect that the skyjacker developed an inordinateawareness of his personal inability to maintain a sta-ble physical equilibrium. vertically as well as bothon a literal and on an angular axis. His psychic dise-quilibrium appears to have clear associative patternswith his physical disequilibrium... equilibratory de-fects create great difficulties in achieving psychic ho-meostasis intrapersonally and interpersonally'. (Hub-bard, 1971, p. 230).

Proprioceptive Function and PraxisIn 1972, Gellhorn related proprioception with emotionin a cause/effect relationship, stating that propriocep-tive discharges contribute to the physiological processesunderlying the emotions in two ways: (1) By setting thehypothalamic balance determined by the posture ofthe body the total quantity of impulses from the pro-prio-impulses arriving in the posterior hypothalamusper unit of time serve as a regulator. (2) By facial expres-sion input from contraction patterns leads to afferentimpulses via the hypothalamic-cortical system which in-teract with the tactile impulses of the expression in thecortex.

In 1940, Angyal related many of the hallucinationscommon in certain types of schizophrenia to a proprio-ceptive and tactile base. These are often included inclinical descriptions of the schizophrenic. "The generalbehaviour appears odd in many ways: mannerisms, gri-maces, purposeless acts, stereotyped motions, impulsivegestures are observed." (Angyal, 1940, p. 616). At timesmotion is reported to be exaggerated, at times to beseverely limited. Both can be explained through applica-tion of sensory integrative theory. Excessive, exagger-ated or stereotyped motion may increase both vestibularand proprioceptive input. Severely limiting motion canbe indicative of postural insecurity or tactile defensi-veness in an adult.Tactile Function:A second neurological system central to sensory integra-tion is the tactile system. Referring to this, Montaguewrote: "Although touch is not itself emotion, its sensoryelements induce those neural, glandular, muscular andmental changes which, in combination, we call emo-tion..." He further states that contact (touch) seekingis the foundation upon which all subsequent behaviourdevelops (Montague, 1978, p. 103). Lacombe refers tothe ego as being the perception of the bodily self "...andw-hat one feels and knows of the body is the skin." (inMontague, 1978. p. 88). In describing schizophrenia,Weiner (1958) related tactile failure to estrangement,uninvolvement, lack of identity, detachment, emotionalshallowness and indifference.

"Another basic characteristic of schizophrenic pa-tients." states Lidz. "is their tenuous self boundaries(sometimes termed 'ego boundaries'). which lead to con-fusions between what arises within the self and whatis outside it and to deficiencies in maintaining the integ-

rity and differentiation of the self." (1978, p. 71). Hecontinues.The failure to differentiate clearly between self andnon-self which is so characteristic of schizophrenic pa-tients, is. as Piaget has described, a normal charac-teristic of the young child. It represents the egocentri-city of the `sensori-motof period and to some degreethe 'preoperational' state of cognitive development...Overcoming this initial egocentricity' is vital to humandevelopment fo r many reasons but especially' for cog-nitive development because no true category forma-tion can occur unless the self can be excluded froma grouping or category. nor can object constancy beachieved. (Lidz, 1978, p. 81).The tactile system forms the literal boundary betweenthe self and non-self, and as such appears vital to theestablishment of individual identity and ego strength.

Present :As mentioned in the review of basic sensory integrativetheory included earlier, factorial studies have linkedvisual-motor problems with dysfunction in the morebasic tactile and vestibular sensory modalities, (Ayres,1964; Ayres, 1966; Geddes, 1972; Ayres, 1974; Monta-gue, 1978). Kenny and Rohn, (1979) found that adoles-cents who attempted suicide showed a significantlyhigher incidence of visual-motor problems during psy-chological testing than did a comparable group ofnormal adolescents. Their findings suggested thatunrecognized learning disabilities might be an addi-tional stress in life which could increase susceptibilityto suicide.The importance of early sensory stimulation to devel-opment was shown by Melzack. (1962) who demon-strated that even mild deprivation of patterned visualstimuli during early maturation of dogs resulted ingreater difficulty in perceptual discrimination and in theability to utilize the discrimination in a new learningsituation. In adult humans sensory deprivation hasresulted in emotional, perceptual, and other behaviouraldeterioration. There is repeated reference to lack oforganizing, structuring and relating of the self to objectsand objects to objects, (Solomon, 1961; Silver andGabriel, 1964; Gellhorn, 1972; Montague, 1979; Hub-bard, 1971; Resman. 1981). In a study of mice withvestibular defects, Douglas (1982) found that there wasa marked increase in vestibular self stimulation, anti-social behaviour, agressive behaviour, and a decrease innuturing and parenting skills. Such studies show resultswhich appear similar to the clinical picture of the personwith sensory integrative dysfunction and to that ofschizophrenia.

Ornitz (1973) suggested that faulty modulation orinadequate homeostatic regulation of sensory input, (i.e.sensory integrative dysfunction), may result in severeemotional stress and may be the mechanism that pro-duces hallucinations in schizophrenia. Lerner (1968)generated and confirmed a hypothesis that in a sampleof schizophrenic patients there is a correspondence indevelopmental level between cognitive-perceptual func-tioning and social effectiveness and that the level of

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cognitive-perceptual functioning is predictable from thelevel of social effectiveness.The preceeding authors have connected dysfunctionin the sensory systems primarily targeted in sensoryintegrative treatment, or their integration as being highlyinvolved with emotions, emotional disturbance andmore directly with schizophrenia.

ApplicationKing, (1974) began reporting on the symptoms of senso-ry integrative dysfunction which she noted in chronicschizophrenic patients and since then attention has beenfocused on the implications this holds fo r occupationaltherapy treatment with this difficult population. Theunderlying theoretical concepts for her use of a sensoryintegrative approach with this population are based onthe premises that:

1. Schizophrenics often show poor ability to moveautomatically (motor plan). This is shown in psychomo-tor retardation, perseverative behaviours, and disruptionof speech patterns. Motor planning is related to all ofthe primary sensory systems considered by Ayres.(Ayres, 1974, 1974b, 1971).

2. Schizophrenia has often been associated with pos-tural-vestibular difficulties such as excessive primitivepostural reflex patterns, unstable posture, and posturalinsecurity (Ornitz, 1970; Montague, 1978; Douglas,1982).

3. The vestibular system is in continuous contact withthe limbic system, thus having a potentially strong effecton the emotions (Schilder, 1933; Barr, 1979; Dimond,1980; Douglas, 1982).

4. Vestibular and tactile input have a strong effecton basic arousal levels, even affecting physiological signssuch as blood pressure, heart rate, and respiration(Ayres, 1974; Barr, 1979; Montague, 1978).

Recent studies with adult schizophrenics have shownsensory integration treatment as effective in promotingverbalization, gait and posture, body scheme and ona short term, decreasing overt psychotic behaviour. Mostof these studies were short, with treatment being givenfor an average of six weeks. None of these studies weredesigned with a control group to control for the possiblebiasing of the Hawthorne effect, and all were done withless than ten subjects participating, (King, 1976; Levine,1977; Rider, 1978; Leville, 1981).

At the present time, several facilities in Ontario areconsidering establishing a sensory integration programfo r their chronic schizophrenic population. One suchprogram is found at Whitby Psychiatric Hospital (WPH).WPH is a large facility, serving urban and rural areasand both an acute and chronic psychiatric population.The sensory integration program is an outgrowth of theoccupational therapy assessment unit, organized in 1977.By 1978 it was operating as a separate speciality area.Currently the program is comprised of three treatmentgroups, indiv idual treatment sessions and assessment,which utilize the Bruininks-Oseretsky Test of MotorProficiency, the Purdue Perceptual Motor Survey, theSouthern California Sensory Integration Test, theFEBRUARY/FVRIER 1984

Southern California Postrotary Nystagmus Test, andclinical observations as suggested by Dr. Ayres. (1974).

In the fall of 1981 a review of the sensory integrationprogram participants was undertaken in which resultsfrom pre and post treatment assessments (Bruininks-Oseretsky and Purdue), were analyzed and comparedwith similar testing of non-treated patients with aneleven month interval between pre- and post- testings.The results of this analysis highlighted a number ofsignificant trends. In particular, the treatment groupconsistently improved on the two measures utilized whilethe non-treated group had instances of decreased orstagnated function. This improvement in the treatmentgroup approached statistical significance in the finemotor function composite and the battery composite ofthe Bruininks-Oseretsky test and in all three sectionsof the Purdue battery.

In comparing the two groups after the eleven monthtime span, (between initial and post-test), the treatmentgroup had improved more than the non-treatmentgroup to a degree which approached statistical signifi-cance on four measures; the Bruininks- Oseretsky grossmotor composite, upper limb co-ordination measure andbattery composite, and the Purdue perceptual-motormatch task. It is felt that with a larger group size, andthe resultant smaller standard deviation, statistical sig-nificance would be achieved on these measures.Future:Many indicators point to the possibility of a sensoryintegrative basis fo r chronic schizophrenia, ranging fromliterature published in 1811 to more recent works. Dueto the subjective nature and multitude of confoundsassociated with many of these indicators, the immediatefuture holds primarily the promise of increased struc-tured research aimed at developing a more definitivestatement regarding the nature of chronic schizophreniaand its relationship to sensory integration.

The application of sensory integrative theory tochronic schizophrenia offers a possible explanation fo rvariabilities observed in this confusing diagnostic cate-gory. Differing symptomatology may be related to dys-function in different sensory systems or in the way theyinteract. It is possible that the difference between reac-tive and chronic schizophrenia is related to the strengthwith which the basis of sensory integrative function hasbeen formed. With stress, a stronger system may collapseand then re-integrate, whereas a weaker system maybe unable to do so, and deteriorate further.

In the longterm, if the connection postulated is sup-ported through research, tw o major benefits will beaccrued. Firstly, this will serve as the foundation fo rthe development of a non-invasive treatment modalityfor a most difficult clientele, and secondly, this may aidin the development of preventative strategies. With theearly recognition of sensory integrative difficulties anda greater knowledge of the implications this holds fo rthe individual it may be possible, through early inter-vention, to decrease the incidence of process schi-zophrenia in future generations.

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Wilkins Company, 1976.Weeks, Z. EffectS of the vestibular system on human development,part 2: effects of vestibular stimulation on mentally retarded,emotionally disturbed and learning-disabled children. AmericanJournal of Occupational Therapy. 1979. 33 . 450-457.

Weiner, H. Diagnosis and symptomatology, in L. Bellak, ed. Schi-zophrenia, New York; Logos Press, 1958.

Wolman, B.B. (ed.). Dictionary of behavioural science. Toronto: VanNostrand Reinhold Company, 1973.

A ck nowledgemen tsWe would like to offer sincere thanks to all of the staff at Whitbywho were of assistance to us in the preparation of this paper. inparticular to the research advisory committee, Joyce Pierdon, Chiefof Occupational Therapy Service, and to Marcel Vandyke, R.N. forher services in translation.

RsumCet article a pour but de dfinir brivement ce qu'est l'intgration des sens telle qu'explique par leDr. A. Jean Ayres. mettant en N , aleur les cas type les plus communs de malfonction. Par une recherchetendue de la littrature comprenant des crits de 1811 jusqu' nos jours, les symptmes de schyzophrniequi paraissent associs la dficience de l'intgration des sens sont l'tude.

En conclusion. les recherches et traitements actuels employant la mthode d'intgration des sens pourles cas de schizophrnie sont examins et mettent en valeur une revue du programme dveloppl'Hpital Psychiatrique de Whitby en 1981.Les possibilits de traitements et recherches venir sont galement tudies.

24 JOT - VOL. 51 - NO. 1

si with chronic schizophrenics past, present anf future

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