Sensory Integration Therapy Swings for Autism May Cause Injury

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Two physicians, one in Israel and one in Cincinnati OH, have found a common cause for an uncommon eye injury in autistic children – a therapeutic swing which was shedding metallic particles. The “detective work” is published in the current issue of the Journal of the AAPOS, the American Association of Pediatric Ophthalmology and Strabismus.

The first patient, an 8-year-old boy, had a recurrent corneal metallic foreign body is his right eye. His parents provided a meticulous history of the child’s activities, which led his physician to link the injury to the metallic suspension on his home therapeutic swing. The second patient, a 10-year-old boy, presented with a similar metallic foreign body in his eye. He had suffered from 3 similar events in the past three years. He was using a similar swing.

According to author Dean J. Bonsall, MD from Cincinnati Children's Hospital Medical, "Raising awareness of this potential source of eye injury in children with autism is paramount. This type of injury is easily preventable by wearing protective eye wear or modifying the swing apparatus." Children with autism are not always able to communicate the presence of the foreign body or the pain associated with it.

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Editor-in-Chief, JAAPOS, David G. Hunter, MD, PhD, adds, "It is important for parents to know that some swing designs that place a metal mechanism over the child's face could result in tiny pieces of metal falling into their child's eye. These are not trivial injuries – metallic foreign bodies can lead to corneal scarring, and in one of their cases it required general anesthesia to remove the metal."

Sensory Integration Therapy for children with autism is a type of occupational therapy (OT) that places a child in a room specifically designed to stimulate and challenge all senses. The therapy is based on the assumption that the autistic child is either overstimulated or understimulated by their environment. The goal of the therapy is to improve the ability of the brain to process sensory information so that the child can better function in daily activities.

Examples of activities used in sensory integration are dancing to music, playing in boxes filled with beans, crawling through tunnels, balancing on a beam, and swinging in a hammock which simulates movement through space.

The effectiveness of sensory integration therapy is controversial and there are only a few well-designed studies in medical literature. Approximately half show some effectiveness, while the other half shows no benefits at all. Some therapies are also cost-prohibitive. While sensory integration therapy is frequently included as a component of occupational therapy, OT may not always be covered by insurance. The equipment used is low-tech, but can be very expensive. A therapeutic swing, for example, costs approximately $1400-1500.

Source: "Recurrent corneal metallic foreign bodies in children with autism spectrum disorders" by Rinat Kehat, MD, PhD and Dean J. Bonsall, MD, MS. The article appears in the Journal of AAPOS, December 2009 (Volume 13, Issue 6, Pages 621-622) published by Elsevier.

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