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By Brian del Poso, OTR/L, CHC, RAC-CT and Tamala Sammons, MA, CCC-SLP, Therapy Resources
Sensory Integration (SI) Therapy was originally invented by OT, Jean Ayres, in the 1970s to help children with sensory processing problems. Although less prevalent, SI techniques and theory used to modulate the sensory and proprioceptive systems can also be used with the adult population.

We’ve had a few questions recently around the appropriate use of the 97533 Sensory Integration CPT code. In general, this is an allowable code and covered by our MACs. However, since we know SI is predominantly used with the pediatric population, if utilizing this code as part of therapy intervention with the adult population, it is important that we use evidence-based practice, research, and have clear supportive documentation to demonstrate that sensory processing/modulation is a cause of functional deficits and that the interventions being billed truly fall within SI intervention strategies.

Here is the Sensory Integration 97533 code descriptor:
This activity focuses on sensory integrative techniques to enhance sensory processing and to promote adaptive responses to environmental demands, with direct one-on-one contact by the qualified professional, each 15 minutes.
From AOTA:
“Occupational performance difficulties due to sensory modulation challenges or poor integration of sensation can result from difficulties in how the nervous system receives, organizes, and uses sensory information from the body and the physical environment for self-regulation, motor planning, and skill development. These problems impact self-concept, emotional regulation, attention, problem solving, behavior control, skill performance, and the capacity to develop and maintain interpersonal relationships. In adults, they may negatively impact the ability to parent, work, or engage in home management, social, and leisure activities.”
From the AOTA article: Sensory Integration Use with Elders with Advanced Dementia
“Research of current approaches in treating older adults with dementia to decrease negative symptoms and increase quality of life, revealed the trend of using a multi-sensory protocol designed for this population (Chitsey, Haight, & Jones, 2002; Knight, Adkison, & Kovach, 2010; Kverno et al., 2009; Lape, 2009; Letts et al., 2011; Padilla, 2011). Kverno et al. (2009) noted in their literature review of non-pharmacological treatment of individuals with dementia that “individuals with advanced levels of dementia benefited to a greater extent from nonverbal patterned multisensory stimulation” (p. 840). Multisensory stimulation incorporates the use of tactile, visual, auditory, olfactory, and gustatory sensory pathways, along with movement, to help the individual interpret his or her environment (Lape, 2009).”
The occupational therapy evaluation and treatment plan is designed to “structure, modify, or adapt the environment and to enhance and support performance” (American Occupational Therapy Association, 2015, p. 6913410050p1), in order to re-engage patients.

Adding sensory integration as a treatment approach starts with assessing any comfort or discomfort when a patient is participating in: ADLs (grooming, dressing, bathing, etc.); Meals; Upper extremity movement; Functional transfers; Seating and positioning.
Goals can be developed around any identified areas of discomfort by creating situations to increase episodes of comfort with those tasks.

What do the MACs say? Here is the language from the Novitas as an example:
Sensory Integration 97533
This activity focuses on sensory integrative techniques to enhance sensory processing and to promote adaptive responses to environmental demands, with direct one-on-one contact by the qualified professional, each 15 minutes.

The patient must have the capacity to learn from instructions. Utilization of sensory integrative techniques should be infrequent for Medicare patients.

For more resources, documents, and tools to help provide information to you and your staff, please see the Sensory Integration section under Therapy > Clinical Programming on the Portal.

By John Patrick Diaz, DPT, DOR, Magnolia Post Acute Care, El Cajon, CA
We all know that the mental health of our residents has been directly (through a specific medical condition) or indirectly (via communal isolation or psychological stresses) affected by this pandemic. Any type of interaction, whether it be through Facetime, window visits, regular phone calls, or even texting our loved ones, makes a huge difference in getting them through their day.

As part of Celebration and Loving One Another, Caitlin Dablow, SLP, and Jacalyn Leigh, COTA, guided a group of local community kids in creating Valentine’s Day cards for our residents at Magnolia Post Acute. The parents of the kids were so supportive in getting them together and designing simple but meaningful cards.

The cards were distributed to each resident with the assistance of our kitchen staff during their lunch meal. As each resident read their card, it was such a great sight to see that everyone had a smile on their faces while others became teary-eyed. Everyone appreciated the gesture knowing that the community cares. We may not be able to celebrate together as a group, but we for sure have felt the love and positive vibes within the facility.

Submitted by Shelby Donahoo, Therapy Resource, Tucson, AZ
When Sara Mohr, CFY at Sabino Canyon in Tucson, Arizona, was a SLP graduate student at the University of Arizona, the reality for those on modified diets became clear. Often a diagnosis of dysphagia brings confusion and worry. Getting modified diets right seems obvious, but actually can be quite hard. Options seemed few: mashed potatoes, blended meat and yogurt. She found few resources out there for patients in terms of appealing and tasty recipes with easy instructions for cooking and modifying.

She and her colleague, Louisa Williams, had an idea. What if they created a food blog to improve accessibility to quality information on modified diets?

So they established realmealsmodified.com and began creating recipes and posting foods that meet texture requirements of the International Dysphagia Diet Standardization Initiative (IDDSI) while looking appetizing and tasting flavorful!

Sara says her goal with modified diet recipes is that “it should be good enough to bring to a potluck, share with the group, and not be embarrassed.” They do the cooking, test the recipes in various consistencies, and essentially take the guesswork out of modified diets.
If a recipe doesn’t work well modified, they don’t post it. Last year, Sara was working on a potato salad recipe using cauliflower (potatoes would just end up mashed) but reported it was “too soupy, too vinegary.” She’s recently perfected it and it will post the recipe soon.
Recipes include items such as Chicken Pot Pie Puree, Sopa Azteca, Chocolate Chip Banana Bread, Minced Pancakes and Salmon! Portions can be made for individuals or the whole family.

Sara and Louisa are planning a “puree road trip” this summer, with the goal of finding options for those on modified diets to eat when traveling.

What a great resource for our SLPs to share with clients and families!

By Razan Malkawi, M.S., CF-SLP, Rose Villa Healthcare Center, Bellflower, CA
Research indicates a clear link between oral hygiene and the overall health of patients. Poor oral hygiene can contribute to new arising medical conditions, and it may worsen the existing disease and interfere with the outcomes of treatment. Continuous education and awareness in oral hygiene are essential in our facility. We hold weekly, if not daily, in-services to discuss preventative measures collaboratively. Members of the interdisciplinary team, including but not limited to the speech therapist, occupational and physical therapists, CNAs, nurses, and the administrators, are all involved in providing evidence-based resources to assure a high quality of life for our patients here at Rose Villa Healthcare Center.

Causes of poor oral hygiene may be related to genetic, developmental and environmental factors. Most of our patients receive medications that may have side effects. For example, Xerostomia (i.e., extremely dry mouth) is a common problem that contributes to poor oral hygiene; causes include drugs, smoking, radiation therapy, diabetes Mellitus, etc. (Kapoor et al., 2014). Our role is to assist with and provide instructions and education regarding the different mouth care approaches for our patients. Mouth cleaning and care, including brushing teeth, mouth wash, and the use of sponge sticks, are all vital behaviors to prevent the existing disease’s escalation and the emergence of new ones. A speech therapist often works with patients who suffer from swallowing problems (i.e., dysphagia), as swallowing dysfunction may cause the entry of food or drink particles into the airways, and bacteria from the mouth may reach the patient’s lungs and cause aspiration pneumonia (Shun-Te HUANG, 2020). Safe swallowing strategies like posture adjustment, proper oral care, and motor-exercises contribute to treating dysphagia and reduce the prevalence of aspiration pneumonia (Shun-Te HUANG, 2020).

In a recent in-service, we discussed the necessity of providing oral care to NPO patients as a preventative measure. Education in this area is essential; one may think that if patients do not eat or drink, mouth cleaning is not a priority! Well, this is not true; NPO patients are at risk for infections, aspiration pneumonia, Xerostomia, and dehydration if oral care is neglected (Liddle, 2014). The state of NPO, along with the presence of dysphagia, may cause aspiration or pulmonary pneumonia if appropriate oral hygiene regimens are not in place. The patient may still aspirate on his/her own saliva; commonly, such incidences occur at nighttime when HOB (i.e., head of bed) is minimally elevated. As healthcare providers, let us all take the initiative to provide our patients with the highest quality of life by spreading awareness.

Refer to our SLP Dehydration Risk Free Water Protocol, for additional information including an Oral Health Assessment Tool (OHAT) for non-dental professionals.

By Cory Robertson, Therapy Resource, Idaho

Temple View Transitional Care Center in Rexburg, Idaho, Therapy led by Susie Swetter, DPT, DOR, joined the organization in the fall of 2019 during the transition from PPS to PDPM. One area in particular they have been focused on is improving their Self-Care GG scores. The challenge to improve was brought to the team, and their new OT, Neil Marion, stepped up to own it.

The team met to review their GG scores and their coding process. Neil looked at the metrics and said, “I want Temple View to lead the market in the self-care increase score.” At the time, Temple View was behind several other buildings in the Market in self-care. However, within several weeks of continued improvement in self-care scores, Temple View grabbed the top spot in percentage improvement in self-care scores for the ID/NV market.

When asked how Neil did it, his response to getting the top spot was amazing:

“Thanks for all the congratulations! I appreciate that, and when Susie asked me to respond about what I did to increase self-care scores, I simply said, ‘I’m just doing my job as an OT. Don’t hide your skills as an OT or COTA; we can offer so much to the people we care for, from the core self-care tasks with adaptations or full restoration of their skills, positioning in bed or w/c, home assessments, splinting/orthotics, neuro-rehab, cognitive rehab as it relates to ADLs, IADLs, fine/gross motor training, power w/c assessment, and strengthening of the specific muscles to increase independence and so much more! Don’t lose who you are as an OT; that identity is important … what makes us different than PT or ST? My answer: so, so much, and it’s our job to proudly proclaim who we are and show our facilities what we can do.”

Thank you, Team Temple View and Neil, for your ownership of this important measure and ensuring your patients get the very best care!